Covid Pandemic Forces Families to Rethink Nursing Home Care

Even before the pandemic began 14 months ago, nursing homes had become the source for rampant, antibiotic-resistant infections. The facilities also faced systemic problems like high turnover among nursing home staff and the gaming of the federal government’s rating system, which made it hard for families to judge the quality of homes.

For years, federal health officials and some insurers have tried to encourage more stay-at-home care, and the pandemic has created a sense of urgency.

“It’s really changed the paradigm on how older adults want to live,” said Dr. Sarita Mohanty, the chief executive of the SCAN Foundation, a nonprofit group focused on issues facing older adults. The vast majority of those adults would prefer to stay at home as they age, she said.

“What’s happened is a welcome sort of market correction for nursing homes,” said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform in San Francisco. Some families, he said, “ended up agreeing to a nursing home without giving it a lot of deliberation.” But after trying home care during the pandemic, many families found keeping an older relative at home was a viable alternative, he said.

Nursing homes rose from the almshouses in England and America that cared for the poor. In the United States, passage of the Social Security Act in 1935 provided money for states to care for the elderly. Thirty years later, the Medicaid program expanded funding, making long-term care homes central to elder care, said Terry Fulmer, the president of the John A. Hartford Foundation, an advocacy group for older adults. “If you pay the nursing homes, that’s where you go,” Dr. Fulmer said.

It wasn’t until the 1970s that some programs began to pay for home care, and the number of nursing home residents nationwide started to slowly decline, with occupancy levels in recent years flattened to about 80 percent, according to data from the Kaiser Family Foundation.

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They Were Promised a Socialist Paradise, and Ended Up in ‘Hell’

SEOUL — On a bright August morning in 1960, after two days of sailing from Japan, hundreds of passengers rushed on deck as someone shouted, “I see the fatherland!”

The ship pulled into Chongjin, a port city in North Korea, where a crowd of people waved paper flowers and sang welcome songs. But Lee Tae-kyung felt something dreadfully amiss in the “paradise” he had been promised.

“The people gathered were expressionless,” Mr. Lee recalled. “I was only a child of 8, but I knew we were in the wrong place.”

Mr. Lee’s and his family were among 93,000 people who migrated from Japan to North Korea from 1959 to 1984 under a repatriation program sponsored by both governments and their Red Cross societies. When they arrived, they saw destitute villages and people living in poverty, but were forced to stay. Some ended up in prison camps.

renewed interest in North Korean human rights violations, and when leaders in Japan and South Korea remain particularly sensitive about opening old wounds between the two countries.

“It was my mother who urged my father to take our family to the North,” Mr. Lee said. “And it was her endless source of regret until she died at age 74.”

The Lees were among two million Koreans who moved to Japan during Japanese colonial rule from 1910 to 1945. Some went there looking for work, others were taken for forced labor in Japan’s World War II effort. Lacking citizenship and financial opportunities, most returned to Korea after the Japanese surrender.

Citizens’ Alliance for North Korean Human Rights.

Japan approved of the migration despite the fact that most Koreans in the country were from the South, which was mired in political unrest. While Japanese authorities said ethnic Koreans chose to relocate to North Korea, human rights groups have accused the country of aiding and abetting the deception by ignoring the circumstances the migrants would face in the communist country.

Japanese women married to Korean men and thousands of biracial children. Among them was a young woman named Ko Yong-hee, who would later become a dancer and give birth to Kim Jong-un, the leader of North Korea, and grandson of its founder.

When Mr. Lee’s family boarded the ship in 1960, his parents thought Korea would soon be reunited. Mr. Lee’s mother gave him and his four siblings cash and told them to enjoy their last days in Japan. Mr. Lee bought a mini pinball-game machine. His younger sister brought home a baby doll that closed its eyes when it lay on the bed.

“It was the last freedom we would taste,” he said.

He realized his family had been duped, he said, when he saw the people at Chongjin, who “all looked poor and ashen.” In the rural North Korean county where his family was ordered to resettle, they were shocked to see people go without shoes or umbrellas in the rain.

In 1960 alone, 49,000 people migrated from Japan to North Korea, but the number sharply declined as word spread of the true conditions in the country. Despite the watchful eye of censors, families devised ways to warn their relatives. One man wrote a message on the back of a postage stamp:

“We are not able to leave the village,” he wrote in the tiny space, urging his brother in Japan not to come.

Mr. Lee’s aunt ​sent her mother​ a letter​ telling her to consider immigrating to North Korea when her nephew was old enough to marry. The message was clear: The nephew was only 3.

To survive, the migrants often relied on cash and packages sent by relatives still in Japan. In school, Mr. Lee said, children called him “ban-jjokbari,” an insulting term for Koreans from Japan. Everyone lived under constant fear of being called disloyal and banished to prison camps.

refugees, spending two and a half years in prison in Myanmar when he and his smuggler were detained for human trafficking. After arriving in Seoul in 2009, Mr. Lee helped smuggle his wife and daughter out of North Korea. But he still has ​relatives, including a son, stuck in the country, he said.

His wife died in 2013, and now Mr. Lee lives alone in a small rented apartment in Seoul. “But I have freedom,” he said. “I would have sacrificed everything else for it.”

Mr. Lee has formed an association with 50 ethnic Koreans from Japan who migrated to North Korea and escaped to the South. Every December, the group meets to mark the anniversary of the beginning of the mass migration in 1959. His memoir is nearly complete. His generation is the last to have firsthand experience of what happened to those 93,000 migrants, he said.

“It’s sad that our stories will be buried when we die,” Mr. Lee said.

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‘Every Time I’m Calling, Someone Has Died’: The Anguish of India’s Diaspora

LONDON — First, there was the scramble to find her father a bed in intensive care. Then came the price gouging for an all but impossible to find therapeutic injection. And, through it all, countless hours on the phone with doctors, family and friends dealing with logistical problems.

From nearly 5,000 miles and five time zones away, Anuja Vakil, 40, has been struggling for the last 12 days to help manage care for her father, Jatin Bhagat, who lies in critical condition in a hospital in Ahmedabad, in India’s western Gujarat State. She knows he has been lucky to get care at all.

“When I pray to God now, it is for my dad,” Ms. Vakil said. “He has to come back.”

Cases of the coronavirus have exploded in India in recent weeks, up to nearly 400,000 a day, surpassing all records and still rising. As they have, so, too, has the collective grief and anxiety among the huge Indian diaspora, over loved ones lost or fighting for their lives amid a health-care system pushed past the brink. In WhatsApp chats, video calls, Facebook groups and forums, a global community has worried, mourned and organized.

Some 17 million people from India were living outside their homeland in 2020, according to figures from the United Nations, and millions more have Indian heritage, making the diaspora the largest in the world. In the United States, some 4.8 million people were either born in India or reported Indian ancestry on the last census.

pooling money to buy oxygen concentrators, connecting those in need of care with doctors and using community networks to share resources.

Deliveries of aid collected by the diaspora are beginning to arrive in India, alongside government relief fromBritain, the United States, Germany and Australia among others.

Ms. Vakil has tried to focus on these positives. While it has been hard to be away from family, she says her local Indian community in London has proved to be a lifeline, and she speaks with a friend in New York whose own father is unwell. She tries to lift her father’s spirits with daily video calls, and his doctors are hopeful he can pull through.

added to Britain’s travel “red list” last week, halting nearly all direct flights and imposing an expensive and mandatory 10-day hotel quarantine for the few citizens and residents who are allowed in. And on Friday, the United States said it would start restricting travel from India beginning next week.

The restrictions, steep costs, job commitments and a fear of contracting the virus have left many unable to travel. As cases of the coronavirus continue to rise, many described painful conversations with friends and relatives at home, and a feeling of helplessness as they watched the horrors unfold half a world away.

as the government allowed cricket matches in packed stadiums, mass election rallies and a major religious festival called Kumbh Mela, where millions gathered in one city. Meanwhile, case levels began to rise exponentially.

In Britain, home to a vibrant and diverse community of people with roots in India, the pain is palpable. In a neighborhood shop in Harrow, a community in London’s northwest with a large Indian population, two staffers recounted losing a brother in the last week.

The cultural ties between the two countries run deep, with Britain’s large Indian diaspora estimated to number over 1.5 million people — the single largest ethnic minority population in the country. For many, the loss, anxiety or grief they are experiencing as family members became ill in recent weeks are compounding what was already a difficult year, and just as Britain is emerging from lockdown and hopeful about crushing the virus.

Harmeet Gill, 31, was born and raised in London, but his parents are from Indian’s northern Punjab State, and they remain extremely close with extended family there.

disproportionately hit by the pandemic. “We went through it here and we thought, ‘Well, at least India was protected.’ They were doing reasonably well.”

But it didn’t last, and on Monday his uncle died from the coronavirus. His aunt was hospitalized on Thursday. In pre-pandemic times, his family would all have traveled to India to mourn his uncle, a patriarch of a tight-knit Sikh family.

“It’s just the sheer, sort of, helplessness of it,” he said, adding that along with the shock and sorrow is a growing anger about government mismanagement. “They know it didn’t need to happen the way it has happened.”

Mr. Gill, who volunteers at a Sikh temple in the London neighborhood of Southall, has seen the impact of the outbreak in India ripple through his community, noting “the sheer scale of it means we all have become a bit numb to it now.”

The temple has been a hub of aid throughout Britain’s outbreak, delivering thousands of meals weekly, and members are now looking for ways to help back home.

Indian doctors living abroad have also been providing medical expertise and advice to dozens of friends and family members. Many wake early to go through dozens of messages asking for help, and some even provide video consultations.

Rajesh Hembrom, 43, originally from Bhagalpur in India’s Bihar State, has lived and worked as a doctor in Britain since 2003. His wife is also a frontline health care worker, and when cases surged in England early last year, his elderly father and older sisters were anxious.

“They were quite worried, and there was quite a degree of calm back home,” he said, “until it all erupted.”

But then the dynamic shifted, and as the numbers surged family and close friends began messaging, frantically seeking help. At the moment, he is advising around 30 people by phone, he said, helping to manage their care or offering any insights that he can. Some of the people he was trying to help have died.

“There are no proper help lines where they can call so they end up clutching at straws, and they know me, so obviously they contact me,” he said.

A childhood friend is being treated in a hospital in Mumbai, and family members are in touch with Dr. Hembrom daily. He fears his friend won’t make it.

“We see a lot of death in our medical work,” he said. “But never have I seen so many people so close to me that are already dead or are possibly going to die. It’s almost like a war zone in some ways, without a visible enemy.”

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Online Schools Are Here to Stay, Even After the Pandemic

In a study by the RAND Corporation, “Remote Learning Is Here to Stay,” 58 out of 288 district administrators — roughly 20 percent — said their school system had already started an online school, was planning to start one or was considering doing so as a postpandemic offering.

“This is hardly a panacea or a silver bullet for public schooling,” said Heather Schwartz, a senior policy researcher at RAND who directed the study. But, she added, “there is a minority of parents, a minority of students and even a minority of teachers for whom virtual schooling is the preferred mode.

Yet a surge of online schools comes with risks. It could normalize remote learning approaches that have had poor results for many students, education researchers said. It could also further divide a fragile national education system, especially when many Asian, Black and Latino families have been wary of sending their children back to school this year.

“My fear is that it will lead to further fracturing and fragmentation,” said Jack Schneider, an assistant professor of education at the University of Massachusetts, Lowell.

Districts said they were simply responding to demand from parents and children who want to stick with remote learning — some because of student health issues, some because of concerns about bullying or discrimination in their school, and some who just prefer the convenience of learning at home.

Districts that fail to start online schools could lose students — along with government education funding — to virtual academies run by neighboring districts, companies or nonprofits, administrators said. To pay for the new online offerings, some districts said, they are using federal coronavirus relief funds or shifting resources from other programs.

Online schools began opening in the 1990s, some run by states or districts and others by private companies or nonprofit charter management organizations. But until recently, they played a niche role in many states.

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My Family’s Global Vaccine Journey

On Feb. 22, Mom texted that she and Dad had booked a March 11 appointment to get their first shots, followed by second doses in April. A day later, she reported that Dad hadn’t pressed the button to confirm the appointment on the online booking system and had lost the slots.

The next week, they texted again: They had walked to a private clinic that was dispensing Sinovac shots. After a short wait, they received the vaccine. On April 2, they told us that they had gotten their second dose of Sinovac and were feeling fine. Mom groused that even though they had an appointment, they “still need to wait for half an hour.”

Our responses were more enthusiastic.

“Great news,” I wrote.

“Yay!” Pui-Ying texted, followed by celebratory emojis.

“Congrats!” Pui Ling said.

Pui-Ying had moved with her family to Malawi in 2016 to work as a doctor and conduct clinical research on children’s health. Resources at the Queen Elizabeth Central Hospital, where she works, were limited. When Madonna’s charity helped finance the construction of a new children’s wing at the hospital, which opened in 2017, it was big news.

Staffing was tight even before the coronavirus, Pui-Ying said. When the pandemic came, the hospital decided on a one-week-on, one-week-off routine to reduce staff exposure to Covid-19 while ensuring that enough medical professionals would be working at all times. Masks, gloves and other protective equipment were scarce.

In pediatrics, Pui-Ying and her colleagues set up a “respiratory zone” for children with Covid-19. It was essentially a two-room ward, with about a dozen beds in the main room. The second room, which was an isolation unit, had space for four children.

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Family Travel Gets Complicated Without a Covid Vaccine for Kids

“Unvaccinated children would still need to quarantine for five days, and the parents, of course, must stay with the child,” said Eric Newman, who owns the travel blog Iceland With Kids. “Iceland’s brand-new travel regulations are not friendly to families hoping to visit with children.”

After a year of virtual schooling and working from home, parents have no desire to quarantine with their kids, said Anthony Berklich, the founder of the travel platform Inspired Citizen. “What these destinations are basically saying is you can come but your children can’t,” he said.

Instead, families are opting for warm-weather destinations closer to home.

When the Centers for Disease Control and Prevention announced in January that proof of a negative PCR test would be required of all air passengers arriving in the United States, many tropical resorts — including more than a dozen Hyatt properties — began offering not just free on-site testing, but a deeply discounted room in which to quarantine in case that test comes back positive. That move, said Rebecca Alesia, a travel consultant with SmartFlyer, has been a boon for family travel business.

“What happens if the morning you’re supposed to come home, you get up and Junior has a surprise positive test?” she said. “A lot of my clients have booked this summer because of this policy.”

For parents struggling to decide how and when to return to travel, there is good news on the horizon, said Dr. Shruti Gohil, the medical director of infection prevention at the University of California, Irvine.

“The chances of a good pediatric vaccine coming soon are high,” she said, noting that both Pfizer and Moderna are already running pediatric trials on their vaccines. “There is no reason to think that the vaccine will have any untoward effects on children that we haven’t already noted in adults.”

In the meantime, she said, parents with children need to continue to be cautious. That doesn’t mean families shouldn’t travel at all, but she recommends choosing to drive rather than fly; to not allow unvaccinated children to play unmasked with children from other households; and to remain vigilant about wearing masks and regularly washing hands while on the road.

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A Break for Working Families

The “lookback” also applies to the child tax credit, which is partly refundable. The credit is worth up to $2,000 for each child under 17.

The problem is that some people may not know about the option, Mr. Flacke said. He urged people to have their 2019 tax return handy when they do their taxes or meet with their preparer and to double check which year’s income would result in a bigger refund.

So how do you qualify for the earned-income tax credit? For 2020, the credit is available for families earning up to about $57,000. Individual filers earning up to about $16,000, with no children, can get a credit of up to $538. (There are also limits on investment income.)

You can see if you qualify by using the I.R.S.’s online assistant.

Because many people lost income last year, families who don’t usually claim the credit might qualify for it this year, the I.R.S. said.

Even in a normal year, millions of eligible people fail to claim the credit, according to the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution. Some people have income so low that they aren’t required to file a federal tax return and may not realize they can claim the credit by filing one.

Roxy Caines, director of the earned-income tax credit campaign at the Center on Budget and Policy Priorities, a research group, encouraged filers to check if they qualify since changes in family situations, as well as income, may affect eligibility. Plus, if you didn’t claim the credit in a previous year but think you would have qualified, you can file and claim it for up to three previous years, she said.

The I.R.S. began accepting tax year 2020 returns on Feb. 12. People expecting refunds usually file early. But because of fraud prevention steps, the I.R.S. must wait until after mid-February to issue refunds to most people claiming the earned-income credit. Early filers should start receiving their refunds this month. They can check the status of their refund using the I.R.S.’s refund tool.

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Child Tax Credit, Proposed in Stimulus, Advances an Effort Years in the Making

Welfare critics warn the country is retreating from success. Child poverty reached a new low before the pandemic, and opponents say a child allowance could reverse that trend by reducing incentives to work. About 10 million children are poor by a government definition that varies with family size and local cost of living. (A typical family of four with income below about $28,000 is considered poor.)

“Why are Republicans asleep at the switch?” wrote Mickey Kaus, whose antiwelfare writings influenced the 1990s debate. He has urged Republicans to run ads in conservative states with Democratic senators, attacking them for supporting “a new welfare dole.”

Under Mr. Biden’s plan, a nonworking mother with three young children could receive $10,800 a year, plus food stamps and Medicaid — too little to prosper but enough, critics fear, to erode a commitment to work and marriage. Scott Winship of the conservative American Enterprise Institute wrote that the new benefit creates “a very real risk of encouraging more single parenthood and more no-worker families.”

But a child allowance differs from traditional aid in ways that appeal to some on the right. Libertarians like that it frees parents to use the money as they choose, unlike targeted aid such as food stamps. Proponents of higher birthrates say a child allowance could help arrest a decline in fertility. Social conservatives note that it benefits stay-at-home parents, who are bypassed by work-oriented programs like child care.

And supporters argue that it has fewer work disincentives than traditional aid, which quickly falls as earnings climb. Under the Democrats’ plan, full benefits extend to single parents with incomes of $112,500 and couples with $150,000.

Backlash could grow as the program’s sweep becomes clear. But Samuel Hammond, a proponent of child allowances at the center-right Niskanen Center, said the politics of aid had changed in ways that softened conservative resistance.

A quarter-century ago, debate focused on an urban underclass whose problems seemed to set them apart from a generally prospering society. They were disproportionately Black and Latino and mostly represented by Democrats. Now, insecurity has traveled up the economic ladder to a broader working class with similar problems, like underemployment, marital dissolution and drugs. Often white and rural, many are voters whom Republicans hope to court.

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