Call That Kept Nursing Home Patients in Sandy’s Path

Chang W. Lee/The New York Times

Workers were shocked that nursing and adult homes in areas like Rockaway Park, Queens, weren’t evacuated.

Hurricane Sandy was swirling northward, four days before landfall, and at the Sea Crest Health Care Center, a nursing home overlooking the Coney Island Boardwalk in Brooklyn, workers were gathering medicines and other supplies as they prepared to evacuate.

Then the call came from health officials: Mayor Michael R. Bloomberg, acting on the advice of his aides and those of Gov. Andrew M. Cuomo, recommended that nursing homes and adult homes stay put. The 305 residents would ride out the storm.

The same advisory also took administrators by surprise at the Ocean Promenade nursing home, which faces the Atlantic Ocean in Queens. They canceled plans to move 105 residents to safety.

“No one gets why we weren’t evacuated,” said a worker there, Yisroel Tabi. “We wouldn’t have exposed ourselves to dealing with that situation.”

The recommendation that thousands of elderly, disabled and mentally ill residents remain in more than 40 nursing homes and adult homes in flood-prone areas of New York City had calamitous consequences.

At least 29 facilities in Queens and Brooklyn were severely flooded. Generators failed or were absent. Buildings were plunged into a cold, wet darkness, with no access to power, water, heat and food.

While no immediate deaths were reported, it took at least three days for the Fire Department, the National Guard and ambulance crews from around the country to rescue over 4,000 nursing home and 1,500 adult home residents. Without working elevators, many had to be carried down slippery stairwells.

“I was shocked,” said Greg Levow, who works for an ambulance service and helped rescue residents at Queens. “I couldn’t understand why they were there in the first place.”

Many sat for hours in ambulances and buses before being transported to safety through sand drifts and debris-filled floodwaters. They went to crowded shelters and nursing homes as far away as Albany, where for days, they often lacked medical charts and medications. Families struggled to locate relatives.

The decision not to empty the nursing homes and adult homes in the mandatory evacuation area was one of the most questionable by the authorities during Hurricane Sandy. And an investigation by The New York Times found that the impact was worsened by missteps that officials made in not ensuring that these facilities could protect residents.

They did not require that nursing homes maintain backup generators that could withstand flooding. They did not ensure that health care administrators could adequately communicate with government agencies during and after a storm. And they discounted the more severe of the early predictions about Hurricane Sandy’s surge.

The Times’s investigation was based on interviews with officials, health care administrators, doctors, nurses, ambulance medics, residents, family members and disaster experts. It included a review of internal State Health Department status reports. The findings revealed the striking vulnerability of the city’s nursing and adult homes.

On Sunday, Oct. 28, the day before Hurricane Sandy arrived, Mr. Bloomberg ordered a mandatory evacuation in Zone A, the low-lying neighborhoods of the city. But by that point, Mr. Bloomberg, relying on the advice of the city and state health commissioners, had already determined that people in nursing homes and adult homes should not leave, officials said.

The mayor’s recommendations that health care facilities not evacuate startled residents of Surf Manor adult home in Coney Island, said one of them, Norman Bloomfield. He recalled that another resident exclaimed, “What about us! Why’s he telling us to stay?”

The commissioners made the recommendation to Mr. Bloomberg and Mr. Cuomo because they said they believed that the inherent risks of transporting the residents outweighed the potential dangers from the storm.

In interviews, senior Bloomberg and Cuomo aides did not express regret for keeping the residents in place.

“I would defend all the decisions and the actions” by the health authorities involving the storm, said Linda I. Gibbs, a deputy mayor. “I feel like I’m describing something that was a remarkable, lifesaving event.”

Dr. Nirav R. Shah, the state health commissioner, who regulates nursing homes, said: “I’m not even thinking of second-guessing the decisions.”

Still, officials in New Jersey and in Nassau County adopted a different policy, evacuating nursing homes in coastal areas well before the storm.

Contradictory Forecasts

The city’s experience with Tropical Storm Irene last year weighed heavily on state and city health officials and contributed to their underestimating the impact of Hurricane Sandy, according to records and interviews.

Before Tropical Storm Irene, the officials ordered nursing homes and adult homes to evacuate. The storm caused relatively minor damage, but the evacuation led to millions of dollars in health care, transportation, housing and other costs, and took a toll on residents.

As a result, when Hurricane Sandy loomed, the officials were acutely aware that they could come under criticism if they ordered another evacuation that proved unnecessary.

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DealBook: Delta Air Lines Ponders Stake in Virgin Atlantic Airways

Delta Air Lines is in talks to buy Singapore Airlines’ 49 percent stake in Virgin Atlantic Airways, in an effort to bolster its international operations, particularly flights between New York and London, a person briefed on the matter said on Sunday.

Talks are continuing but a deal will not be announced soon, this person said. Singapore Airlines confirmed that it was in discussions about a potential sale of its Virgin stake, but provided no further details.

A transaction would be the latest in a round of mergers that has reshaped the airline industry, as companies in the United States and Europe have looked to consolidation to restore profitability.

With oil prices remaining stubbornly high and the economic outlook uncertain, many airlines have continued to struggle. That may precipitate even more takeovers, analysts say.

A deal would also be Delta’s most significant strategic move since its 2008 merger with Northwest Airlines, which made it the biggest American carrier until the union of United Airlines and Continental Airlines last year.

It would provide more access to London’s Heathrow Airport, one of the world’s busiest, and expand Delta’s North Atlantic business.

It would also bolster its partnership with Air France KLM, Europe’s biggest airline. Both companies are part of the Sky Team global alliance, and also run a joint business in the North Atlantic market, sharing flights, revenues and costs.

“Delta has shown time and time again that it is extremely opportunistic,” said Brett Snyder, an airline expert. “If it sees a good opportunity, nothing is off the table.”

If it proceeded, a transaction would directly challenge the Oneworld global alliance, whose biggest members are American Airlines and British Airways. The two airlines have an international joint venture. Virgin does not belong to any of the three major airline alliances — Star, Oneworld and Sky Team — depriving it of the ability to coordinate flights and cut costs, which has helped many of its competitors. Star’s major carriers are United, US Airways and Lufthansa. The deal would also give Virgin a strong partner as it struggles to compete against rivals with deeper pockets. Founded by Richard Branson in 1984, the company has long embraced an image of fun travel and cheaper fares.

But that has not helped the airline’s financial condition of late. Virgin lost £80 million, or $128 million, in the year that ended in February, compared with a profit of £18.5 million in the previous year.

The company has been under pressure from the likes of British Airways, whose corporate parent, IAG, bought BMI British Midlands earlier this year. Virgin fought against that deal, arguing that it would give British Airways too much of a presence at Heathrow. But the takeover was completed, after IAG complied with a European Commission order to give back 14 slots at the airport.

The deal may also pave the way for an eventual change of control of Virgin. The company’s chief executive, Steve Ridgway, told The Financial Times in an interview in January that Mr. Branson was prepared to sell some of his 51 percent controlling stake in the airline.

“For Virgin, it’s an exit strategy in an environment where they are being marginalized by alliances on the Atlantic,” said Robert W. Mann, an airline analyst based in Port Washington, N.Y.

A Delta spokeswoman declined to comment. A representative for Virgin was not immediately available for comment.

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This post has been revised to reflect the following correction:

Correction: December 3, 2012

An earlier version of this article misstated the date of Delta's merger with Northwest Airlines. It was 2008, not 2010.

A version of this article appeared in print on 12/03/2012, on page B2 of the NewYork edition with the headline: Delta, Seeking London Access, Ponders Stake in Virgin.

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Tunnel Collapse Outside Tokyo Traps Motorists

TOKYO — At least seven people were feared dead after part of a highway tunnel collapsed Sunday in eastern Japan, trapping them in their vehicles and starting a fire that filled the tunnel with thick, black smoke. Government officials said fear of an additional collapse had prevented rescuers from reaching the two trapped vehicles.

The vehicles were crushed under concrete that fell from the ceiling of the three-mile Sasago Tunnel near the city of Otsuki in Yamanashi Prefecture, about 50 miles west of Tokyo, the national government’s disaster management agency said. The agency said it remained unclear why the 150-200-foot section of 8-inch-thick concrete suddenly fell.

A burning vehicle emitted heavy smoke that initially prevented firefighters from entering the tunnel. But even after putting out the blaze, rescuers suspended efforts to reach the trapped vehicles because of the danger of further collapse, the agency said.

The agency said a woman in her 20s managed to flee one of the crushed vehicles. She told firefighters that six other people remained trapped in her vehicle. It was unknown how many people were in the other vehicle besides the driver, who was apparently also still trapped inside.

The accident closed a section of the Chuo Expressway, a vital transportation artery connecting Tokyo to western Japan. Such long tunnels — usually lined with smooth, white concrete — are a common sight on highways in this mountainous island nation.

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John McAfee Plays Hide-and-Seek in Belize

Photo Illustration by The New York Times

John McAfee, right, a pioneer in computer security who lives in Belize, is a “person of interest” in the murder of his neighbor. More Photos »

DANIEL GUERRERO promised during his campaign for mayor here to clean up San Pedro, the only town on this island, a 20-minute puddle jump from the mainland. But if he ever runs for re-election, don’t expect him to mention that vow.

“I meant clean up the trash, the traffic, that sort of thing,” he says. “I didn’t mean this.”

“This” is a full-blown international media frenzy and the kind of mess that no politician could have seen coming. It started on Nov. 11, the morning that Gregory Faull, a 52-year-old American, was found dead, lying face up in a pool of blood in his home. He had been shot in the head. His laptop and iPhone were missing. A 9-millimeter shell was found nearby.

What happened next turned this from a local crime story to worldwide news: The police announced that a “person of interest” in the investigation was a neighbor, John McAfee, a Silicon Valley legend who years ago earned millions from the computer virus-fighting software company that still bears his name.

A priapic 67-year-old, with an improbable mop of blond-highlighted hair and a rotating group of young girlfriends, Mr. McAfee quickly melted into the island’s lush green forest. Then, for Belizean authorities, the real embarrassment began.

Asserting his innocence, Mr. McAfee became a multiplatform cyberdissident, with a Twitter account, and a blog at whoismcafee.com with audio links, a comments section, photographs and a stream of invective against the government and the police of Belize. He has done interviews on podcasts, like the “Joe Rogan Experience,” and offered a $25,000 reward for information leading to the arrest of “the person or persons” who killed Mr. Faull. He has turned lamming it into a kind of high-tech performance art.

“I am asking all people of conscience to read this blog, especially the links in the ‘Background’ section,’ and see the ugly truth unfolding here,” he posted on Nov. 18. “Speak out. Write your congressmen. Write the prime minister. Do what you can.”

Before he went underground, Mr. McAfee led a noisy, opulent and increasingly stressful life here. He was known for the retinue of prostitutes who he says moved in and out of his house, and for employing armed guards, some of whom stood watch on the beach abutting his house. He also kept a pack of untethered dogs on his property who barked at and sometimes bit passers-by.

Two days before the murder, someone had poisoned a handful of those dogs. As it happens, Mr. Faull had complained about the animals, as well as the guards and the constant late-night inflow and outflow of taxis on the dirt path that runs behind his and Mr. McAfee’s homes — a path so tiny that it’s supposed to be off-limits to cars.

Mr. Faull had shown up at the town council office a few weeks ago with a letter decrying the din and the dogs, as well as Mr. McAfee’s guns and behavior. Nothing came of it.

“We were planning to meet with John McAfee and hand him the letter,” Mr. Guerrero said. “But it never happened. We were busy doing other work.”

In hindsight, that looks like a blunder. Mr. McAfee has since said on his blog that he had no choice but to flee because police and politicians in Belize are corrupt and eager to kill him. As proof, he has written at length about a late April raid that the country’s Gang Suppression Unit conducted at a property of his on the mainland, in a district called Orange Walk.

Some McAfee watchers have a different theory — namely, that he grew paranoid and perhaps psychotic after months of experimenting with and consuming MDPV, a psychoactive drug. These experiments were described in detail by Mr. McAfee himself, under the pseudonym “Stuffmonger” in a forum on Bluelight, a Web site popular with drug hobbyists.

So, here’s one hypothesis: Rich man doses himself to madness while seeking sexual bliss through pharmacology. Then shoots neighbor in a rage. Case closed, right? Ah, but those Bluelight posts were a ruse, Mr. McAfee would later blog, just one of the many pranks he has perpetrated over the years — part of a bet with a friend to see if he could create Bluelight’s largest-ever thread.

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Opinion: A Health Insurance Detective Story

I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?

After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?

The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.

Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.

But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?

A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.

Here’s a snapshot of my surreal experience:

NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.

Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”

I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.

NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.

NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.

My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.

NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.

Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.

But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.

NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.

CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.

NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.

Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.

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Opinion: A Health Insurance Detective Story

I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?

After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?

The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.

Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.

But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?

A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.

Here’s a snapshot of my surreal experience:

NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.

Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”

I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.

NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.

NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.

My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.

NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.

Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.

But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.

NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.

CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.

NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.

Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.

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Muslims Face Expulsion From Western Myanmar

Kuni Takahashi for The New York Times

A Muslim girl at a camp for displaced people in Sittwe, where Muslims face what some groups are calling ethnic cleansing. More Photos »

SITTWE, Myanmar — The Buddhist monastery on the edge of this seaside town is a picture of tranquillity, with novice monks in saffron robes finding shade under a towering tree and their teacher, U Nyarna, greeting a visitor in a sunlit prayer room.

But in these placid surroundings Mr. Nyarna’s message is discordant, and a far cry from the Buddhist precept of avoiding harm to living creatures. Unprompted, Mr. Nyarna launches into a rant against Muslims, calling them invaders, unwanted guests and “vipers in our laps.”

“According to Buddhist teachings we should not kill,” Mr. Nyarna said. “But when we feel threatened we cannot be saints.”

Violence here in Rakhine State — where clashes have left at least 167 people dead and 100,000 people homeless, most of them Muslims — has set off an exodus that some human rights groups condemn as ethnic cleansing. It is a measure of the deep intolerance that pervades the state, a strip of land along the Bay of Bengal in western Myanmar, that Buddhist religious leaders like Mr. Nyarna, who is the head of an association of young monks, are participating in the campaign to oust Muslims from the country, which only recently began a transition to democracy from authoritarian rule.

After a series of deadly rampages and arson attacks over the past five months, Buddhists are calling for Muslims who cannot prove three generations of legal residence — a large part of the nearly one million Muslims from the state — to be put into camps and sent to any country willing to take them. Hatred between Muslims and Buddhists that was kept in check during five decades of military rule has been virtually unrestrained in recent months.

Even the country’s leading liberal voice and defender of the downtrodden, Daw Aung San Suu Kyi, has been circumspect in her comments about the violence. President Obama made the issue a priority during his visit to the country this month — the first by a sitting American president — and Muslim nations as diverse as Indonesia and Saudi Arabia have expressed alarm.

Buddhists and Muslims in western Myanmar have had an uneasy coexistence for decades, and in some areas for centuries, but the thin threads that held together the social fabric of Rakhine State have torn apart this year.

Muslims who fled their homes now live in slumlike encampments that are short on food and medical care, surrounded by a Buddhist population that does not want them as neighbors.

“This issue must be solved urgently,” said U Shwe Maung, a Muslim member of Parliament. “When there is no food or shelter, people will die.”

Conditions have become so treacherous for Muslims across the state that Mr. Shwe Maung travels with a security force provided by the government. “They give me a full truck of police,” he said. “Two, three or four policemen is not enough.”

Leaders of the Buddhist majority in the state say they feel threatened by what they say is the swelling Muslim population from high birthrates and by Islamic rituals they find offensive, like the slaughter of animals.

“We are very fearful of Islamicization,” said U Oo Hla Saw, general secretary of the Rakhine Nationalities Development Party, the largest party in the state. “This is our native land; it’s the land of our ancestors.”

During outbreaks of sectarian violence in June and again in October, villagers armed themselves with swords, clubs and sharpened bicycle spokes that they launched from homemade catapults. In Muslim-majority areas, monasteries were burned. In Buddhist-majority areas, mosques were destroyed. The mayhem was set off by the rape and murder of a Buddhist girl for which Muslims were blamed.

The center of Sittwe, a former British colonial outpost, is now empty of the Muslims who once worked in large numbers as stevedores and at other manual jobs.

“I’m scared to go back,” said Aye Tun Sein, who was a teacher at a government school before the upheaval. In his village, Teh Chaung East, a 20 minute drive from Sittwe, he said that no one has a job because no one can leave the village, a collection of shacks and tents.

Political leaders describe the near total segregation of Muslims as temporary, but it appears to be more and more permanent.

“I don’t miss them,” said U Win Maung, a bicycle rickshaw driver whose house was burned down in June by his Muslim neighbors. “The hatred we have for each other is growing day by day.”

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Gadgetwise Blog: Q&A: Avoiding the Unwanted Beach Ball Party

Why does my Mac’s cursor often turn into rotating color pinwheel that freezes up my screen until I restart the computer?

The “rotating color pinwheel” goes by many names, both official and colloquial (Spinning Wait Cursor, Spinning Disc Pointer, Beach Ball of Doom, Rolling Rainbow of Death and so on). It usually appears temporarily when the Mac is busy with a task, like saving a large file. In most cases, the wait cursor should disappear after a few seconds. If it sticks around until you have to restart the Mac, it sounds like time to do some troubleshooting.

If you regularly get the wait cursor when working on the Mac, it could be because of a number of things, including lack of memory (the RAM kind) to efficiently complete the task on screen, not enough available hard-drive space or an overworked processor. If the cursor appears only when using a certain program, the issue may be with that piece of software. If this turns out to be the case, check the program’s online forums to see if this is a known issue, hopefully one with a workaround or solution.

Instead of restarting the entire computer, you may want forcibly close the program you have open when the wait cursor appears, to see if the problem is just with that one particular application. To force-quit an unresponsive program, press the Mac’s Option, Command and Escape keys at the same time. In the box that appears, select the stalled program in the list and click the Force Quit button.

If more than one program keeps stalling out and the Mac is underpowered, adding more memory to the computer and deleting unneeded files from an overstuffed hard drive might help, as can downloading system and program updates. But before you dive into hardware upgrades, check out The X Lab’s frequently asked questions page for a collection of suggested solutions to various problems regarding the Spinning Beach Ball of Death.

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The New Old Age Blog: Forced to Choose: Nursing Home vs. Hospice

An older person, someone who will die within six months, leaves a hospital. Where does she go?

Almost a third of the time, according to a recent study from the University of California, San Francisco, records show she takes advantage of Medicare’s skilled-nursing facility benefit and enters a nursing home. But is that the best place for end-of-life care?

In terms of monitoring her vital signs and handling IVs — the round-the-clock nursing care the skilled-nursing facility benefit is designed to provide — maybe so. But for treating end-of-life symptoms like pain and shortness of breath, for providing spiritual support for her and her family, for palliative care that helps her through the ultimate transition – hospice is the acknowledged expert.

She could receive hospice care, also covered by Medicare, while in the nursing home. But since Medicare only rarely reimburses for both hospice and the skilled-nursing facility benefit at the same time, this hypothetical patient and her family face a financial bind. If she opts for the hospice benefit, which does not include room and board at the nursing home, then she will be on the hook for hundreds of dollars a day to remain in the facility.

She could use the hospice benefit at home, of course. But, “we know these patients are medically complex,” said Katherine Aragon, lead author of the study in The Archives of Internal Medicine, and now a palliative care specialist at Lawrence General Hospital in Massachusetts. “And we know that taking care of someone near the end of life can be very demanding, hard for families to manage at home.” And that assumes the patient has a family or a home.

For some patients, a nursing home, though possibly dreaded, is the only place that can provide 24/7 care.

But if she uses the skilled-nursing facility benefit to pay for room and board in a facility, she probably has to forgo hospice. (The exception: if she was hospitalized for something unrelated to her hospice diagnosis. If she has cancer, then trips and breaks a hip, she can have both nursing home coverage and hospice. If cancer itself caused the bone to fracture, no dice.)

Let’s acknowledge that these are lousy choices.

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).

The choice to use S.N.F. had ongoing repercussions. Almost 43 percent of those who used it died in a nursing home and almost 40 percent in a hospital. Just 11 percent died at home, though that is where most people prefer to die, studies repeatedly show.

Among those who didn’t use the S.N.F. benefit, more than 40 percent died at home.

In effect, nursing homes were providing end-of-life care, expensively and probably not so well, for almost a third of the elderly population.

The skilled-nursing facility benefit, Dr. Aragon pointed out in an interview, is meant to provide rehabilitation. “The hope is that someone will get stronger and go home,” she said.

Sometimes, of course, that is what happens.

“What we may be missing is that this patient is on an end-of-life trajectory,” she continued. “Maybe they can’t get stronger.”

Moreover, Dr. Aragon pointed out, nursing homes often have financial incentives to keep re-hospitalizing patients. After three days in a hospital, the skilled-nursing facility benefit starts anew, and it reimburses at a higher level than Medicaid, which pays for most nursing home care.

Because this unhappy choice between hospice care and nursing home reimbursement reflects federal policy, there may be little that individual families can do. If physicians are willing to honestly discuss their patients’ prognosis, to assess whether a nursing home stay will lead to rehabilitation or whether it is where a patient will likely die, sooner rather than later, families may have some personal options.

If they knew that death was likely within a few months, they might try to provide care at home with hospice help for that limited time, difficult as that is. Or they might be able to muster enough money to pay for a few months in a nursing home, so that their parent can be a resident and still receive hospice care.

But these are still lousy choices. “Palliative care should be part of nursing home care,” said Alexander K. Smith, the study’s senior author and a palliative care specialist at the University of California, San Francisco. “And that regulation that prevents concurrent use of the S.N.F. benefit and hospice isn’t in the interest of patients and families.”

Coming up in a future post: Experimenting with a concurrent-coverage option.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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The New Old Age Blog: Forced to Choose: Nursing Home vs. Hospice

An older person, someone who will die within six months, leaves a hospital. Where does she go?

Almost a third of the time, according to a recent study from the University of California, San Francisco, records show she takes advantage of Medicare’s skilled-nursing facility benefit and enters a nursing home. But is that the best place for end-of-life care?

In terms of monitoring her vital signs and handling IVs — the round-the-clock nursing care the skilled-nursing facility benefit is designed to provide — maybe so. But for treating end-of-life symptoms like pain and shortness of breath, for providing spiritual support for her and her family, for palliative care that helps her through the ultimate transition – hospice is the acknowledged expert.

She could receive hospice care, also covered by Medicare, while in the nursing home. But since Medicare only rarely reimburses for both hospice and the skilled-nursing facility benefit at the same time, this hypothetical patient and her family face a financial bind. If she opts for the hospice benefit, which does not include room and board at the nursing home, then she will be on the hook for hundreds of dollars a day to remain in the facility.

She could use the hospice benefit at home, of course. But, “we know these patients are medically complex,” said Katherine Aragon, lead author of the study in The Archives of Internal Medicine, and now a palliative care specialist at Lawrence General Hospital in Massachusetts. “And we know that taking care of someone near the end of life can be very demanding, hard for families to manage at home.” And that assumes the patient has a family or a home.

For some patients, a nursing home, though possibly dreaded, is the only place that can provide 24/7 care.

But if she uses the skilled-nursing facility benefit to pay for room and board in a facility, she probably has to forgo hospice. (The exception: if she was hospitalized for something unrelated to her hospice diagnosis. If she has cancer, then trips and breaks a hip, she can have both nursing home coverage and hospice. If cancer itself caused the bone to fracture, no dice.)

Let’s acknowledge that these are lousy choices.

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).

The choice to use S.N.F. had ongoing repercussions. Almost 43 percent of those who used it died in a nursing home and almost 40 percent in a hospital. Just 11 percent died at home, though that is where most people prefer to die, studies repeatedly show.

Among those who didn’t use the S.N.F. benefit, more than 40 percent died at home.

In effect, nursing homes were providing end-of-life care, expensively and probably not so well, for almost a third of the elderly population.

The skilled-nursing facility benefit, Dr. Aragon pointed out in an interview, is meant to provide rehabilitation. “The hope is that someone will get stronger and go home,” she said.

Sometimes, of course, that is what happens.

“What we may be missing is that this patient is on an end-of-life trajectory,” she continued. “Maybe they can’t get stronger.”

Moreover, Dr. Aragon pointed out, nursing homes often have financial incentives to keep re-hospitalizing patients. After three days in a hospital, the skilled-nursing facility benefit starts anew, and it reimburses at a higher level than Medicaid, which pays for most nursing home care.

Because this unhappy choice between hospice care and nursing home reimbursement reflects federal policy, there may be little that individual families can do. If physicians are willing to honestly discuss their patients’ prognosis, to assess whether a nursing home stay will lead to rehabilitation or whether it is where a patient will likely die, sooner rather than later, families may have some personal options.

If they knew that death was likely within a few months, they might try to provide care at home with hospice help for that limited time, difficult as that is. Or they might be able to muster enough money to pay for a few months in a nursing home, so that their parent can be a resident and still receive hospice care.

But these are still lousy choices. “Palliative care should be part of nursing home care,” said Alexander K. Smith, the study’s senior author and a palliative care specialist at the University of California, San Francisco. “And that regulation that prevents concurrent use of the S.N.F. benefit and hospice isn’t in the interest of patients and families.”

Coming up in a future post: Experimenting with a concurrent-coverage option.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..