Making Grey Gold: A Book Review

Making Gray Gold: A Book Review

Making Gray Gold: Narratives of Nursing Home Care. Timothy Diamond. Chicago and London: The University of Chicago Press. 1992. 280 pp.

The plight of the elderly in America is wrought with failures and a lack of concern and focus on their wants and needs. In Making Gray Gold, Diamond paints a tragic picture of the lives of those who live and work in a nursing home based on his personal experiences as a nursing assistant and his educational background as a sociologist. In a project that took over ten years time Diamond worked as a nursing assistant while carefully documenting his experiences through his ties to Northwestern University’s Program on Women. The University, the Midwest Council for Social Research in Aging, The Retirement Research Foundation, California State University, and many colleagues, coworkers, and fellow ethnographers also supported him over this ten-year journey.

Diamond’s book is based on many years worth of experience as a sociologist and nursing assistant in multiple types of nursing home settings; from those who cater to the wealthy to those dependent on Medicaid because they were or have become destitute. It is important to note that while Making Gray Gold is a narrative; it is far more than Diamond’s story. Making Gray Gold is a compilation of the complex and interwoven story of the nursing home industry and the colorful tapestry of those under its rule.

Diamond collected data and wrote about his findings through unconventional methods. As he worked as a nursing assistant he wrote notes on scraps of paper that he later assembled. The assembled writings were studied for patterns and written about in a narrative format. While he utilized multiple outside resources in the formation of his theories, he cites them as endnotes rather than including them directly in the book. Diamond believes this helps with the continuity of his story. I must say this was on of my favorite features of this text. Many times when reading research based information it is easy to get distracted and lost in all of the citations. The format Diamond used allows readers to get immersed in the story without getting bogged down outside citation information that can easily be found in the back.

Through sharing personal narratives Diamond defines the problems currently plaguing the nursing home industry. The nursing home industry turns people into patients and the “complex act of caretaking into quantifiable tasks”  (p.170). While the nursing home industry works to turn people into patients and caretaking tasks into something quantifiable, Diamond’s storytelling draws the personhood back out of a quagmire of bed numbers and bottom lines.

Concerns from the staff were met with severe admonishment that their job was to care for patients, not criticize. There were very strict boundaries between management and those who provided direct care. This often left Diamond, his colleagues, and patients filling in the gaps left by a system where money is the bottom line. While bureaucracy reigned over the nursing home facilities, it failed to keep the staff and patients from maintaining small pieces of their independence and humanity. From clients helping one another get up to staff accepting tips to help residents feel a sense of autonomy, they all worked together in a give and take fashion. This undercurrent of caring and fights for autonomy bleed through the lines of Diamond’s narrative and left me feeling compassion for those involved. There were moments throughout the story when I felt myself cheering Diamond or other clients on as they fought against the bureaucratic system.

Nursing home patients come in from various levels of social standing, cultures, and backgrounds, yet they end up enmeshed under social policies that “abstract two common characteristics of their lives, disability and impoverishment, and corralled them into the same living space” (p.67).  While some who started their time in a nursing home may have had assets and wealth, the structure of the system quickly drained those resources and left the person dependent on Medicaid. Medicare and Medicaid are described as the “twin pillars of long term health care policy” (p.56). A person entering nursing home care is first covered by their private insurance, private pay, or for short-term stays, Medicare. The high cost of care quickly depletes those resources. Patients are eligible for Medicaid only when they have reached the poverty level. Patients are required to “spend down” their assets before they can have any assistance (p.59). By the time patients reach this level; they have become dependent on the care. Many have had to sell their homes and have no other resources to rely on. They come in because they need assistance with their daily living and stay because they have no other place to go.

While Quadango (2014) reports that people who have resources earlier in life continue to have opportunities to accumulate more, the Cumulative Disadvantage Theory is contrary to the experiences reported by Diamond. While some residents in nursing homes may start in private homes where they receive greater care, he reports that many quickly deplete those resources and are moved into homes where resources are few and care is strained. What is important it note is that the quality of care is not at all related to those providing the care, but to the bureaucratic nightmare that governs the home. Overworked staff given too many patients and not enough time simply cannot provide the same level of care as those with lesser patients and more resources.

Making Gray Gold was consistent with other resources reporting about the differences in the gender ratio in nursing homes Both Diamond and Quandrango (2014) report that there are far more female residents in nursing homes than males. Quandrango (2014) reports that this difference is due to the fact that women live longer than men and typically are the caregivers so when they need someone to care for them, there is no one.

Diamond has many lofty suggestions for reformation. He believes that nursing assistants should form unions so that they have the ability to fight against their working conditions. According to Diamond the residents should be involved in planning how the home operates it’s daily schedule. He points to many occasions where the current system fails to meets residents needs such as residents being forced to wake up at 7 am, take showers whether or not warm water was available, and meal times that left them hungry for hours at a time.

Making Gray Gold is a sympathetic portrayal of the lives of those involved in the nursing home care system. From patients to direct care staff, stories encapsulate the struggle between the needs of patients to the resources available, both of which at the mercy of a money driven bureaucracy. This is the most informational and easily read book that I have ever read concerning the care of the elderly. The resources cited allowed me to research any additional information when a question arose. I would highly recommend anyone working with the elderly or their families be required to read this text, especially those in management.

References

Diamond, T. (1992). Making gray gold: Narratives of nursing home care. Chicago and London, IL: The University of Chicago Press.

Quadango, J. (2014). Aging and the life course: An introduction to social gerontology (6th ed.). New York, New York: McGraw-Hill Companies, Inc.

The Abuse of Persons with Disabilities

Abuse of Persons with Disabilities

The abuse of persons with disabilities is defined as the physical, sexual, emotional abuse or exploitation of any person with developmental, physical or intellectual disabilities (Baladerian, Coleman, and Stream, 2013). Abuse of persons with disabilities is often underreported and unrecognized despite the fact that they are more than three times likely to be abused than a person without disabilities (Baladerian et al., 2013). Being disabled makes people vulnerable to abuse regardless of what category of disability they fit in; though there are some disabilities that appear more likely to experience abuse and also fail to report it.

Prevalence of Abuse

Baladerian et al., (2013) surveyed over 7000 persons with disabilities, family members, service providers, professionals, response personnel, and advocates in an effort to determine the types and frequency of abuse suffered by people with disabilities. While others were included, most of the people who took the survey were directly connected to disability issues either as a person with a disability or having an immediate family member with a disability (Baladerian et al., 013).

Of those surveyed with disabilities, over 70% reported being a victim of abuse at some point in their lives, with more than 63% of parents or family members reporting their relative had experienced abuse (Baladerian et al., 2013).

The survey conducted by Baladerian et al. (2013) found that the type of disability was related to the number of abuse incidents: Mental health conditions (74.8%), speech disability (67.1), autism (66.5%), intellectual or developmental disability (62.5%) and a mobility disability (55.2%).

Types and Frequency of Abuse

Baladerian et al. (2013) found that the prevalence of abuse varied with the type of abuse experienced. Dixon, Biggs, Stephens, and Tinker (2013) found that abuse could occur in singlular or multiple acts and could be:

Physical, verbal or psychological, it may be an act of neglect or omission to act, or it may be when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented or cannot consent.

The most common form of abuse experienced was verbal or emotional abuse at 87.2% (Baladerian et al., 2013). Physical and sexual abuse accounted for 50.6% and 41.6% of abuse reports respectively (Baladerian et al., 2013). Neglect accounts for 37.7% of abuse incidents (Baladerian et al., 2013). Of those surveyed, 31.5% reported experiencing some type of financial abuse (Baladerian et al., 2013). It is also important to note that the statistics related to the abuse of disabled persons is considered to be very unreliable due to a failure to report (Sin, Sheikh, & Hohini, 2012).

Baladerian et al. (2013) report that sexual abuse showed the most varied responses according to the type of disability the victim had: mental health conditions (47.4%), intellectual or developmental disabilities (34.2%), mobility disabilities (31.6%), and autism (24.9%). More research needs to be conducted to determine if it is the type of disability or the sensitive nature of sexual abuse that has resulted in such vast differences in reporting prevalence. It is curious that minor abuse is the most often reported.

The frequency of abuse experienced by persons with disabilities is stunning. Over 90% report being abused multiple times with 57% of them stating they had been abused more than 20 times, and 46% reporting it had occurred on countless occasions (Baladerian et al., 2013). The abuse can occur in any setting and in any type of relationship (Dixon et al., 2013)

Perpetrators of Abuse

Abuse can occur in many settings, from a home or school environment to community and residential settings. Dixon, Biggs, Stephens, and Tinker (2013) report that current definitions of both abuse and perpetrators vary widely and include content that is both imprecise and subjective. The lack of concise and comprehensive definitions leads to random and subjective awareness, prevention, and interventions of abuse situations (Brammer & Biggs, 1998).

Dixon, Biggs, Stephens, and Tinker (2013) highlight the many ways in which current definitions of a perpetrator fail to recognize the complexities of abuse and neglect and the relationships involved therein. There is often is a lack of balance between concerns about the experience of the victim and what the perpetrator intended (Brandl et al., 2007). There is also a problem with the generally accepted idea that perpetrators of abuse must be in a position of trust. Dixon et al., (2013) point out that there are many instances in which abuse occurs that a trust relationship does not exist because they have not “assumed a duty of care.”

One consistent characteristic of an abuser is the desire or need for power and control (Brandl et al., 2007). For them, a person who is in some way disabled is the perfect target (Brandl et al., 2007). A physically disabled person may not be able to defend himself or herself from physical or sexual assault or remove themselves from neglectful situations (Brammer & Biggs, 1998). A person who is mentally disabled may not know or understand that abuse is happening to them or have the capacity to report their abuse (Brandl et al., 2007). Having a disability can also change the power dynamics in such a way that the victim is dependent on their abuser, which also makes getting out of the situation difficult (Brandl et al., 2007).

There are many cases in which social and economic pressures along with a caregiver’s inability to cope can lead to a person becoming a perpetrator (Brinig, 2012). Many relationships are based on reciprocity in some form or fashion but when caring for a person who is disabled, especially if those disabilities are severe, there is little compensation for the effort they put forth and the person who is disabled becomes a scapegoat (Brinig, 2012). This is also known as caregiver fatigue or stress (Brandl et al., 2007).

Systemic Responses to Abuse

A lack of information, fear, and the belief that nothing would happen are the primary reasons that persons with disabilities and their loved ones fail to report abuse (Baladerian et al., 2013). These numbers fail to improve regardless of the seriousness of the abuse and only slightly improve with family member involvement (Baladerian et al., 2013).

            Many of those tasked with reporting, investigating, and prosecuting those who have perpetrated abuse against a person who is disabled are ill prepared for that task. Sin, Sheikh, and Hohini (2012) report that there is poor accountability and a lack of training and support for professionals. There are limited policies and procedures that are specifically designed to meet the needs of those in the community who are disabled (Sin, Sheikh, & Hohini, 2012). For the most part the agencies who are tasked with handling the abuse do not have the experience or training necessary to create effective intervention and

Those within the disabled community see how the authorities treat other victims and come to believe that their attempts to hold the abuser accountable are futile.  Statistics related to prosecution and conviction of abuse strongly support those fears.  In 52.9% of cases where someone with a disability reported abuse, nothing happened and only 9.8% of the perpetrators were ever arrested (Baladerian et al., 2013). Numbers diminished when family members made the reports with nothing happening in 42.8% of cases and only 7.8% of alleged perpetrators being arrested (Baladerian et al., 2013).

A lack of information and understanding about what abuse is and the importance of reporting is the primary hindrance for the arrest and prosecution of those responsible for abusing person with disabilities (Baladerian et al., 2013). Family members, community members, and services providers should also be educated about indicators of abuse and proper reporting and intervention methods to ensure they are able to protect those who are unable to protect themselves (Baladerian et al., 2013).

Even when a disabled person reports their abuse and either the perpetrator is punished or they are removed from the situation, the extreme lack of services and placements make it so that the victim doesn’t have a place to go (Baladerian et al., 2013).

With only 37.3% of abuse victims reporting abuse to authorities, it is no wonder that so few perpetrators ever face arrest or prosecution (Baladerian et al., 2013). Family member involvement improves these numbers only slightly to 51.7% (Baladerian et al., 2013).

Many states offer victim compensation programs, yet less than 5% of disabled persons benefit from these type of programs (Baladerian et al., 2013). Victim compensation programs often include therapy and other support services that could be highly beneficial to the person who has been abused. Despite this, over 65.4% of abuse victims who have a form of disability never receive any type of counseling or therapy (Baladerian et al., 2013). This is tragic because when those who have received therapy have found that it was helpful.

Conclusion

The population of disabled persons is in great need of change to the way abuse is determined, reported, and handled. Even with disabled persons being three times more likely to be abused, there is yet to be a single federal employee who is tasked with handling abuse (Brandl et al., 2007). A lack of organization and information oftentimes lead to a failure of victims and their families to report as well as anything to be done when they do. Our most vulnerable members of society have little to no protection; remaining at the mercy of the negligent, overwhelmed, or cruel.

References

Baladerian, N. J., Coleman, T. F., & Stream, J. (2013). Abuse of people with disabilities: Victims and their families speak out. A Report on the 2012 National Survey on Abuse of People with Disabilities, , 1-39. Retrieved from http://disability-abuse.com/survey/survey-report.pdf

Brammer, A., & Biggs, S. (1998). Defining elder abuse. Journal of Social Welfare and Family Law, 20(3), 285-305. doi:10.1080/09649069808410253

Brandl, B., Dyer, C. B., Heisler, C. J., Otto, J. M., Stiegal, L. A., & Thomas, R. W. (2007). Elder Abuse Detection and Intervention. New York, New York: Springer Publishing Company, LLC.

Brinig, M. F. (2012). Explaining abuse of the disabled child. Family Law Quarterly, 46(2), 269-296. Retrieved from https://ezproxy.shsu.edu/login?url=http://search.proquest.com/docview/1272443428?accountid=7065

Dixon, J., Biggs, S., Stephens, M., & Tinker, A. (2013). Defining the "perpetrator": Abuse, neglect and dignity in care. The Journal of Adult Protection, 15(1), 5-14. doi:http://dx.doi.org/10.1108/14668201311299872

Sin, C. H., Sheikh, S., & Hohini, K. (2012). Police readiness for tacklling hate crime against people with learning disabilities-areas for improvement and examples of good practice. Safer Communities, 11(3), 145-153. doi:http://dx.doi.org/10.1108/17578041211244058

Child Abuse Information

          The pathogenic care of children causes lifelong consequences for the child, their family and friends, and the community at large. Research shows a strong correlation between childhood abuse and a multitude of personal and social problems such as mental illness, being a victim or perpetrator of abuse, and a host of self destructive and deviant behaviors (Prevent Child Abuse NC, 2015). Through the utilization of a multisystemic approach children can be removed from pathogenic care, either through actual removal or family intervention strategies, and helped to heal. While the trauma of the abuse is never erased, studies have shown that with patience, sensitivity, and empathetic understanding from healthy caregivers, engaged professionals, and community members he damage can be made less (Cole, 2005).

History

While children throughout the ages have experienced what we now term “child abuse” actually labeling the issue is fairly new (Pfohl, 1977). Throughout history children have been subjected to whatever their caregivers chose with no hope for relief or intervention from those outside of the home. Parents, guardians, and other adults had no limitations on the way they chose to discipline or parent those in their care with the general belief that as their caregiver they knew best. There were three reform movements that were primarily responsible for the change in the way child abuse was viewed: House of Refuge Movement, Society for the Prevention of Cruelty to Children crusades, and the juvenile court system (Pfohl, 1977).

The House of Refuge Movement

The House of Refuge Movement was highly criticized for it’s constitutionality because they took children from situations that they deemed bad or improper and placed them in an institutional setting, essentially locking up the innocent without due process (Pfohl, 1977). Still yet, it did help to intervene in abuse and neglect situations that had previously gone unnoticed. The House of Refuge Movement lacked in that acted more on prevention with no responses to actual incidents of child abuse. While the House of Refuge Movement had good intentions, our understanding of attachment and trauma today highlights the utter devastation these types of placements left in their wake. Overpopulated institutions were simply unable to meet the needs of the children in their care, especially with the additional needs experienced by children who had been victims of abuse.

The Society for the Prevention of Cruelty to Children

When a nine-year-old girl became the victim of extreme child abuse at the hands of her foster parents, the Society for the Prevention of Cruelty to Animals came into the public scene as a champion for the abused (Pfohl, 1977). They argued that because children were animals they deserved the same protections (Stark, 2014). The Society for the Prevention of Cruelty to Children arose from this movement years later but was not successful due to a lack of funding, poor public interest, and being identified as part of the House of Refuge Movement and other similar public agencies (Pfohl, 1977).

Between the years of 1962-1964 child abuse became illegal in all fifty states after the legislatures passed statues defining and prohibiting the abuse of children (Pfohl, 1977). Prior to this, child beating was considered a necessary part of life to obtain “disciplinary, educational, and religious obedience” (Pfohl, 1977, p.310). What was tragic is that despite it becoming illegal, child abuse still remained fairly invisible with the problem being considered a social issue rather than trauma to an individual child.

The Juvenile Court System

The juvenile court system has changed dramatically since its inception. Originally juvenile courts were utilized to prevent the development of  “lower class,” focusing on the victims of abuse rather than holding those who perpetrated the abuse accountable (Pfohl, 1977). The preventative phenology of the early juvenile justice system eventually failed pushed primarily by the Great Depression (Pfohl, 1977). It became evident that children needed a more individualized approach rather than one that merely worked to prevent society from being negatively affected by them.  Child abuse was still difficult to recognize due to four factors: a failure of doctors to recognize abuse as a diagnosis because they did not fit with the original X-ray indicators of abuse, a lack of doctors ability to believe that parents were capable of abusing their children, a fear of liability for violating confidentiality norms, and a doctors desire to avoid becoming involved in the criminal justice system (Pfohl, 1977).

While advances continued, the publication of the article “The Battered Child Syndrome” in 1962 by the Journal of the American Medical Association stands as a “symbolic focal point” for the identification of child abuse (Pfohl, 1977, p. 319). By labeling abuse as a diagnosable illness caused by “psychopathic” perpetrators with “defects in character structure” eliminated many of the previously mentioned issues that kept child abuse from being recognized and perpetrators from being identified (Pfohl, 1977, p. 319). Recognition by the medical community lead to a general push for the investigation, prevention, and treatment of childhood abuse; known as the child abuse reporting movement (Pfohl, 1977).

Prevalence of Abuse

According to Childhelp.org (2013) and the Rape Abuse & Incest National Network (2009): a report of child abuse is made every ten seconds, four children die everyday from child abuse, or an American is sexually assaulted every two minutes. The National Child Abuse and Neglect Data System (NCANDS) recognize and report four types of abuse: physical abuse, psychological abuse, neglect, and sexual abuse (Child Welfare Information Center). When physical force is used to cause pain, injury, or other bodily harm it is called physical abuse (Goldman et al., 2003). A caregiver commits psychological abuse or maltreatment when they behave in a way that conveys feelings of worthlessness to the child (Goldman et al., 2003). Neglect occurs when a caregiver fails to meet the needs of the child through a lack of action (Goldman, Salus, Wolcott, & Kennedy, 2003). Fondling, intercourse, rape, incest, sodomy, exhibitionism, sexual exploitation, and exposure to pornography are all forms of sexual abuse recognized by the NCANDS (Child Welfare Information Center, 2010).

Utilizing the above-mentioned definitions of abuse, it is estimated that approximately 695 thousand new reports came through the NCANDS in 2010. Neglect accounted for78.3% of reports, 17.6% experienced physical abuse, and 9.2% experienced sexual abuse. The reports of psychological abuse are harder to prove and are less likely to be reported as a separate incident (Child Welfare Information Center, 2010).

Consequences of Child Abuse

Child abuse has far reaching consequences. Prevent Child Abuse NC (2015) reports that abuse and neglect issues extend beyond the immediate physical, emotional, social service, and intervention costs of the criminal justice system. As the children grow up they experience problems with physical and mental health, lost productivity, and the cost of their interactions with the adult criminal justice system as a victim or perpetrator (Prevent Child Abuse NC, 2015).

Abuse victims lack the coping skills necessary to handle oth the trauma they have experienced and life in general. As children grow into young adults those who experience abuse are more likely to consider suicide as a coping mechanism because they see and feel on a regular basis a deep sense of hopelessness about their lives (Clinton & Clark, 2010). These children are always on guard and waiting on the next blow to come. Sometimes the waiting becomes too much, the pain too intense, the burden too heavy and so they try to escape the only way they know how, to die.

A teen that experiences the trauma of family violence is likely to create cognitive distortions (Clinton & Clark, 2010). Cognitive distortions are inaccurate thoughts that are used to reinforce negative thinking or emotions. Adolescents with cognitive distortions overestimate the “magnitude and insolubility of problems” (Clinton & Clark, 2010, p. 266).  Cognitive distortions that play a role in adolescent suicide are “hopelessness, problem solving deficits, cognitive rigidity, dichotomous thinking, perfectionism, personalizing, catastrophising, and time perspective” (Oncu & Sakarya, 2013). The cognitive distortions most often include false beliefs about what has happened, why it happened, as well as blaming themselves, the victim, or anyone or agency who attempts to intervene (Oncu & Sakarya, 2013). There are multiple interventions which have been shown to help teens struggling with suicidal thoughts such as “crisis hotlines, school based educational and screening procedures, effective treatment of suicide attempters, minimizing opportunities for suicide imitation, and controlling access to items commonly used to commit suicide” (Shaffer, Garland, Gould, Fisher & Trautman, 1988).

Conclusion

Child abuse is a social problem that has multisystemic consequences for those involved as well as the community at large. While child abuse has existed throughout history, until recently it was thought to be a necessary act to keep children in line. Parents who abused children were seen as exercising their rights instead of causing harm to those in their care. The community generally ignored the abuse and took far too many years to ever intervene. The lack of intervention lead to perpetual cycles of abuse repeated one generation after another. It will not be easy to change things, but with awareness and commitment by various community members there is hope for improvement in the life of the abused child. 

References

Child Help. (2013). National child abuse statisics: Child abuse in America. Retrieved from http://www.childhelp.org/pages/statistics

Child Welfare Information Center. (2010). Foster Care Statistics. http://www.childwelfare.gov/pubs/factsheets/foster.cfm. Retrieved October 26, 2015.

Clinton, T. E., Clark, C., & Straub, J. (2010). The quick-reference guide to counseling teenagers. Grand Rapids, Mich.: Baker Books.

Goldman, J., Salus, M. K., Wolcott, D., Kennedy, K. Y. (2003). Office on Child Abuse and Neglect. A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice. Retrived October 10, 2015 from https://www.childwelfare.gov/pubs/usermanuals/foundation/foundationm.cfm#psychologicalmaltreatment

McWhirter, Jeffries J., McWhirter, Benedict T., McWhirter, Ellen Hawley, and McWhirter, Robert J. (2013). At Risk Youth (5th ed.). Belmont, CA, United States: Brooks/Cole.

Oncu, B. & Sakarya, A. (2013). Role of cognitive factors and distortions in adolescent suicides. Current Approaches in Psychiatry, 5 (2), 232-245.

Phol, S. J. (1977). The discovery of child abuse. Social Problems, 24(3), 310-323. Retrieved from https://ezproxy.shsu.edu/login?url=http://www.jstor.org/stable/800083

Prevent Child Abuse North Carolina. (2015). Impact of child abuse and neglect. Retrieved from http://www.preventchildabusenc.org/about-child-abuse/impact-of-child-abuse-and-neglect

Rape, Abuse & Incest National Network. (2009). Statistics. Retrieved from https://www.rainn.org/statistics

 Rodriguez, C. M. (2010). Parent-child aggression: Association with child abuse potential and parenting styles. Violence And Victims, 25(6), 728-741. Retrieved from https://ezproxy.shsu.edu/login?url=http://dx.doi.org/doi:10.1891/0886-6708.25.6.728

Stark, E. (2007). Coervice control: How men entrap women in personal life. New York, New York: Oxford University Press.

Shaffer, D., Garland, A., Gould, M., Fisher, P., & Trautman, P. (1988). Preventing teenage suicide: a critical review. Journal of the American Academy of Child & Adolescent Psychiatry, 27(6), 675-687.

The Wiz

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Single Black Female Seeking Long Term Commitment

Gorgeous long-haired female cat with white highlights is seeking a forever family.

Unwilling to share your attention with dogs! Other pets are negotiable as long as you remember I am the Princess. 

Treats must be shown to me and then placed carefully on the ground. I will not eat out of my subjects hands.

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Jessica was kind enough to offer me a room at the inn to have my babies this winter, but Her daughter stupidly owns my arch enemy, the DOG!

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