their origin story and their record as rulers.

“The lines are blurred on China’s part between who constitutes a terrorist and who constitutes someone who has simply been politically active,” Mr. Small said. “Individuals who are politically and economically connected with any activities they find problematic” are likely to be targeted, he said.

The uncertain future of Uyghurs in Afghanistan has caught the attention of Abdul Aziz Naseri, a Uyghur activist who was born in Afghanistan and now lives in Turkey. Mr. Abdul Aziz said he had compiled a list of roughly 500 Afghan Uyghurs who want to leave the country.

“They say to me: ‘Please save our future, please save our children,’” he said.

He shared the names and photographs of these people with The New York Times, but asked that their information be kept private. At least 73 people on the list appeared to be under the age of 5.

Shabnam, a 32-year-old Uyghur, her mother and two sisters managed to get out of Afghanistan last month. The women rushed to the airport in Kabul during the frenzied United States evacuation. Her sisters boarded one flight, her mother another. Shabnam said she was the last to leave.

In an interview, she described being separated from her husband while getting through the chaotic security lines at the airport. She was holding his passport and begged the security guards to deliver it to him. No one helped, she said.

Shabnam waited for her husband for four days, while the people around her at the airport encouraged her to leave.

She finally did — boarding a U.S. military plane with hundreds of other Afghans late last month. Her trip took her to Qatar, Germany and finally the United States, where she landed on Aug. 26. She is now in New Jersey and still trying to get her husband out of Afghanistan.

“I was happy that I got out of there, thank God,” Shabnam said. “I like it here. It’s safe and secure.”

Nilo Tabrizy contributed reporting.

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Haiti Protests Mass U.S. Deportation of Migrants to Country in Crisis

PORT-AU-PRINCE, Haiti — The first Haitians deported from a makeshift camp in Texas landed in their home country Sunday amid sweltering heat, anger and confusion, as Haitian officials beseeched the United States to stop the flights because the country is in crisis and cannot handle thousands of homeless deportees.

“We are here to say welcome, they can come back and stay in Haiti — but they are very agitated,” said the head of Haiti’s national migration office, Jean Negot Bonheur Delva. “They don’t accept the forced return.”

Mr. Bonheur Delva said the authorities expected that about 14,000 Haitians will be expelled from the United States over the coming three weeks.

An encampment of about that size has formed in the Texas border town of Del Rio in recent days as Haitian and other migrants crossed over the Rio Grande from Mexico. The Biden administration has said it is moving swiftly to deport them under a Trump-era pandemic order.

On Sunday alone, officials in Haiti were preparing for three flights of migrants to arrive in Port-au-Prince, the capital. After that, they expect six flights a day for three weeks, split between Port-au-Prince and the coastal city of Cap Haitien.

Beyond that, little was certain.

“The Haitian state is not really able to receive these deportees,” Mr. Bonheur Delva said.

The Haitian appeal for a suspension of deportations appeared likely to increase the pressure on the Biden administration, which is grappling with the highest level of border crossings in decades.

President Biden, who pledged a more humanitarian approach to immigration than his predecessor, has been taking tough measures to stop the influx, and the administration said this weekend that the Haitian deportations are consistent with that enforcement policy.

But the migrants are being sent back to a country still reeling from a series of overlapping crises, including the assassination of its president in July and an earthquake in August. Only once since 2014 has the United States deported more than 1,000 people to the country.

As the sun beat down Sunday in Port-au-Prince, more than 300 of the newly returned migrants milled close together around a white tent, looking dazed and exhausted as they waited to be processed — and despondent at finding themselves back at Square 1. Some held babies as toddlers ran around playing. Some of the children were crying.

Many said their only hope was to once again follow the long, arduous road of migration.

“I’m not going to stay in Haiti,” said Elène Jean-Baptiste, 28, who traveled with her 3-year-old son, Steshanley Sylvain, who was born in Chile and has a Chilean passport, and her husband, Stevenson Sylvain.

Like Ms. Jean-Baptiste, many had fled Haiti years ago, in the years after the country was devastated by an earlier earthquake, in 2010. Most had headed to South America, hoping to find jobs and rebuild a life in countries like Chile and Brazil.

Recently, facing economic turmoil and discrimination in South America and hearing that it might be easier to cross into the United States under the Biden administration, they decided to make the trek north.

From Mexico, they crossed the Rio Grande into the United States — only to find themselves detained and returned to a country that is mired in a deep political and humanitarian crisis.

In July, the Haitian president, Jovenel Moïse, was assassinated, setting off a battle for power. A month later, the impoverished southern peninsula was devastated by a 7.2 magnitude earthquake, and the Caribbean nation’s shaky government was ill-equipped to handle the aftermath.

According to a United Nations report released last week, 800,000 people have been affected by the quake. A month after it struck, 650,000 still need emergency humanitarian assistance.

Many of the migrants who stepped off the plane Sunday have little to return to.

Claire Bazille left home in 2015, and had a job cleaning office buildings in Chile’s capital, Santiago. It wasn’t the dream life she had left Haiti to find, but she got by, even sending money home to her mother each month.

When Ms. Bazille heard that it was possible to enter the United States under the Biden administration, she left everything behind and headed north, joining other Haitians along the way.

On Sunday, she was put on a plane and returned to where it had all begun for her.

Only now, Ms. Bazille’s family’s home in Les Cayes had been destroyed in the earthquake. Her mother and six siblings are living in the streets, she said, and she is alone with a small child, a backpack with all their belongings, and no prospect of a job.

“I don’t know how I will survive,” said Ms. Bazille, 35. “It was the worst decision I could have taken. This is where I ended up. This is not where I was going.”

At least a dozen of the migrants said they felt tricked by the United States. They said they had been told by uniformed officials that the flight they were getting on was bound for Florida. When they learned otherwise, some protested but were placed on board in handcuffs, they said.

“I didn’t want to come back,” said Kendy Louis, 34, who had been living in Chile but decided to head to the United States when construction work dried up. He was traveling with his wife and 2-year-old son, and was among those who were handcuffed during the flight, he said.

The director of migration and integration at the Haitian office of migration, Amelie Dormévil, said several of the returnees told her they had been cuffed by the wrists, ankles and waist during the flight.

After the first plane carrying the deportees landed, the first to climb out were parents with babies in their arms and toddlers by the hand. Other men and women followed with little luggage, save perhaps for a little food or some personal belongings.

Amid confusion and shouting, the Haitians were led for processing at the makeshift tent, which had been set up by the International Organization for Migration.

Some expressed dismay at finding themselves back in a place they had worked so hard to escape — and with so few resources to receive them.

“Do we have a country?” asked one woman. “They’ve killed the president. We don’t have a country. Look at the state of this country!”

Haitian officials gave them little cause to think otherwise.

Mr. Bonheur Delva said “ongoing security issues” made the prospect of resettling thousands of new arrivals hard to imagine. Haiti, he said, cannot provide adequate security or food for the returnees.

And then there is the Covid-19 pandemic.

“I am asking for a humanitarian moratorium,” Mr. Bonheur Delva said. “The situation is very difficult.”

After the earthquake in August, which killed more than 2,000 people, the Biden administration paused its deportations to Haiti. But it changed course last week when the rush of Haitian migrants crossed into Texas from the border state of Coahuila, Mexico, huddling under a bridge in Del Rio and further straining the United States’ overwhelmed migration system.

The deportations have left Haiti’s new government scrambling.

“Will we have all those logistics?” Mr. Bonheur Delva said. “Will we have enough to feed these people?”

On Sunday, after being processed, the migrants were given Styrofoam containers with a meal of rice and beans. The government planned to give them the equivalent of $100.

After that, said Mr. Bonheur Delva, it will be up to them to find their own way.

Natalie Kitroeff contributed reporting from Mexico City.

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In Panjshir, Few Signs of an Active Resistance, or Any Fight at All

PANJSHIR, Afghanistan — In this lush strip of land — walled off from potential invaders by high mountain peaks and narrow, ambush-prone passes — former mujahedeen fighters and Afghan commandos regrouped in the days after the Taliban toppled the Afghan government, vowing to fight to the last man. With its history of resistance and its reputation for impenetrability, the Panjshir Valley seemed an ideal place for a determined force of renegades to base an insurgency.

By Sept. 6, however, the Taliban claimed to have captured the entire province of Panjshir, a momentous victory in a region that repelled numerous Soviet offensives in the 1980s, and had remained beyond the Taliban’s control during its rule from 1996 to 2001.

their origin story and their record as rulers.

He said that Qari Qudratullah, the new provincial governor, was meeting with elders to discuss a peaceful handover.

A Taliban military commission official, Mullah Hafiz Osman, later confirmed this was true, while Mr. Nazary, the resistance spokesman, denied the claim.

Behind the Panjshiri fighters flew the green, white and black flag of the Northern Alliance, repurposed to signify the National Resistance Front, which is led by Ahmad Massoud, son of Ahmad Shad Massoud, the leader assassinated in 2001. But villagers said that the Taliban had long been active in the valley, and that their takeover had been negotiated by some of the residents.

Outside the tomb of the elder Massoud, a young Talib, far from his home in Helmand Province in the south, performed his evening prayers.

Days earlier, photos of the partially destroyed tomb, in a dramatic hilltop mausoleum overlooking the valley, appeared on social media alongside accusations that the Taliban had ransacked the place. “This wasn’t our work,” one of the Taliban guards said. “Civilians broke in and smashed the glass.”

The site had since been repaired by the Taliban and was now in its original state. A group of guards stood around the tomb, and as evening fell, they stretched a green shroud over it and closed the doors for the night.

Outside the valley, those who had fled wondered if they would ever be able to return.

When the Taliban first entered Panjshir, Sahar, 17, and her family barricaded themselves at home, thinking the resistance would eventually chase the Talibs away. But the fighting steadily drew closer.

Neighbors started to flee, said Sahar, whose last name is being withheld to protect her identity. Her uncle and cousin were stopped at a Taliban checkpoint near the village, she said, where they were beaten and ordered to turn over their weapons and the names of resistance fighters.

Last week, the family escaped through the mountains. They walked for five days, through remote valleys and over mountain ridges. Sahar fainted three times from dehydration, she said, and her mother had blisters and swollen feet. Her father, who is diabetic, nearly collapsed.

Eventually, they hitched a ride to Kabul, the country’s capital, where they had relatives with whom they are now living.

“We don’t know what will happen,” Sahar said by phone from Kabul. “We may never be able to get back.”

Farnaz Fassihi contributed reporting from New York, N.Y. Wali Arian contributed from Istanbul, Turkey.

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In Submarine Deal With Australia, U.S. Counters China but Enrages France

PARIS — President Biden’s announcement of a deal to help Australia deploy nuclear-powered submarines has strained the Western alliance, infuriating France and foreshadowing how the conflicting American and European responses to confrontation with China may redraw the global strategic map.

In announcing the deal on Wednesday, Mr. Biden said it was meant to reinforce alliances and update them as strategic priorities shift. But in drawing a Pacific ally closer to meet the China challenge, he appears to have alienated an important European one and aggravated already tense relations with Beijing.

France on Thursday reacted with outrage to the announcements that the United States and Britain would help Australia develop submarines, and that Australia was withdrawing from a $66 billion deal to buy French-built submarines. At its heart, the diplomatic storm is also a business matter — a loss of revenue for France’s military industry, and a gain for American companies.

Jean-Yves Le Drian, France’s foreign minister, told Franceinfo radio that the submarine deal was a “unilateral, brutal, unpredictable decision” by the United States, and he compared the American move to the rash and sudden policy shifts common during the Trump administration.

“America-is-back” foreign-policy message, had promised to revive the country’s alliances, which were particularly undermined by Mr. Trump’s dismissiveness of NATO and the European Union. Hopes ran high from Madrid to Berlin. But a brief honeymoon quickly gave way to renewed tensions.

The French were disappointed that Secretary of State Antony J. Blinken did not make Paris, where he lived for many years, one of his first destinations in Europe. And they were angered when Mr. Biden made his decision on the American withdrawal from Afghanistan with scant if any consultation of European allies who had contributed to the war effort.

“Not even a phone call,” Ms. Bacharan said of the Afghan decision.

In his comments on Wednesday, Mr. Biden called France a key ally with an important presence in the Indo-Pacific. But the president’s decision, at least in French eyes, appeared to make a mockery of that observation.

The French statement on Thursday said that France was “the only European nation present in the Indo-Pacific region, with nearly two million citizens and more than 7,000 military personnel” in overseas territories like French Polynesia and New Caledonia in the Pacific and Reunion in the Indian Ocean.

Next week, Mr. Biden will meet at the White House with leaders of “the Quad” — an informal partnership of Australia, India, Japan and the United States — in what amounts to a statement of shared resolve in relations with Beijing. He will also meet with Mr. Johnson, apparently before the Quad gathering.

Given the Australian deal, these meetings will again suggest to France that in the China-focused 21st century, old allies in continental Europe matter less.

For Britain, joining the security alliance was further evidence of Mr. Johnson’s determination to align his country closely with the United States in the post-Brexit era. Mr. Johnson has sought to portray himself as loyal partner to Mr. Biden on issues like China and climate change.

London’s relations with Washington were ruffled by the Biden administration’s lack of consultation on Afghanistan. But the partnership on the nuclear submarine deal suggests that in sensitive areas of security, intelligence sharing and military technology, Britain remains a preferred partner over France.

Reporting was contributed by Helene Cooper and Eric Schmitt in Washington; Aurelien Breeden in Paris; Mark Landler in London; and Elian Peltier in Brussels.

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Poverty in U.S. Declined Thanks to Government Aid, Census Report Shows

The share of people living in poverty in the United States fell to a record low last year as an enormous government relief effort helped offset the worst economic contraction since the Great Depression.

In the latest and most conclusive evidence that poverty fell because of the aid, the Census Bureau reported on Tuesday that 9.1 percent of Americans were living below the poverty line last year, down from 11.8 percent in 2019. That figure — the lowest since records began in 1967, according to calculations from researchers at Columbia University — is based on a measure that accounts for the impact of government programs. The official measure of poverty, which leaves out some major aid programs, rose to 11.4 percent of the population.

The new data will almost surely feed into a debate in Washington about efforts by President Biden and congressional leaders to enact a more lasting expansion of the safety net that would extend well beyond the pandemic. Democrats’ $3.5 trillion plan, which is still taking shape, could include paid family and medical leave, government-supported child care and a permanent expansion of the Child Tax Credit.

Liberals cited the success of relief programs, which were also highlighted in an Agriculture Department report last week that showed that hunger did not rise in 2020, to argue that such policies ought to be expanded. But conservatives argue that higher federal spending is not needed and would increase the federal debt while discouraging people from working.

difficult to assess changes in health coverage last year. Census estimates conflicted with other government counts, and officials acknowledged problems with data collection during the pandemic.

federal supplement to state unemployment benefits lapsed. She fell behind on bills, setting in motion events that ultimately left her family homeless for two months this year.

New aid programs adopted this year, including the expanded Child Tax Credit, helped Ms. Long, who moved into a new home last month. She said she had noticed improvements in her children, particularly her 5-year-old son.

“It was bad, but it could have been so much worse, and we have come out the other side once again unbroken,” Ms. Long said.

By the government’s official definition, the number of people living in poverty jumped by 3.3 million in 2020, to 37.2 million, among the biggest annual increases on record. But economists have long criticized that definition, which dates to the 1960s, and said it did a particularly poor job of reflecting reality last year.

7.5 million people lost unemployment benefits this month after Congress allowed expansions of the program to lapse.

Jen Dessinger, a photographer who lives in New York City and Los Angeles, said work dried up abruptly at the start of the pandemic. A freelancer, she didn’t qualify for traditional unemployment benefits but eventually received help under a federal program created last year to help people who fell outside the regular system.

Now that program has ended in the middle of another surge in coronavirus cases. Ms. Dessinger said a single positive coronavirus case could shut down a photo shoot. “It’s made it a more desperate situation,” she said.

Democrats on Tuesday said experiences like Ms. Dessinger’s showed both the potential for government aid to protect people from financial ruin, and the need for a more expansive, permanent safety net that can support people in bad and good times.

A White House economist, Jared Bernstein, said on Tuesday that the new poverty data should encourage lawmakers to enact the $3.5 trillion Democratic measure that includes much of Mr. Biden’s economic agenda, which the administration argues will create more and better-paying jobs.

“It’s one thing to temporarily lift people out of poverty — hugely important — but you can’t stop there,” said Mr. Bernstein, a member of Mr. Biden’s Council of Economic Advisers. “We have to make sure that people don’t fall back into poverty after these temporary measures abate.”

“reckless taxing and spending spree.”

Conservative policy experts said that although some expansion of government aid was appropriate during the pandemic, those programs should be wound down, not expanded, as the economy healed.

“Policymakers did a remarkable job last March enacting CARES and other legislation, lending to businesses, providing loan forbearance, expanding the safety net,” Scott Winship, a senior fellow and the director of poverty studies at the American Enterprise Institute, a conservative group, wrote in reaction to the data, referring to an early pandemic aid bill, which included around $2 trillion in spending. “But we should have pivoted to other priorities thereafter.”

Jason DeParle and Margot Sanger-Katz contributed reporting.

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A Million Afghan Children Could Die in ‘Most Perilous Hour,’ U.N. Warns

Millions of Afghans could run out of food before the arrival of winter and one million children are at risk of starvation and death if their immediate needs are not met, top United Nations officials warned on Monday, putting the country’s plight into stark relief.

Secretary General António Guterres, speaking at a high-level U.N. conference in Geneva convened to address the crisis, said that since the Taliban takeover in Afghanistan last month, the nation’s poverty rate has soared and basic public services have neared collapse and, in the past year, hundreds of thousands of people have been made homeless after being forced to flee fighting.

“After decades of war, suffering and insecurity, they face perhaps their most perilous hour,” Mr. Guterres said, adding that one in three Afghans do not know where they will get their next meal.

The deepening humanitarian crisis tops a dizzying array of challenges confronting the new Taliban regime as it navigates governing a country propped up for decades by aid from international donors.

face potential collapse. At a local hospital in Chak-e Wardak, administrators have been unable to pay salaries or purchase new medicines with banks still closed, according to Faridullah, the facility’s resident doctor.

as drought enveloped the nation.

On Monday, in his first public remarks to Congress, Secretary of State Antony J. Blinken defended the Biden administration’s withdrawal from Afghanistan, saying there was no reason to believe the country would have stabilized had the United States remained.

“There’s no evidence that staying longer would have made the Afghan security forces or the Afghan government any more resilient or self-sustaining,” Mr. Blinken told the House Foreign Affairs Committee, in a live teleconference call. “If 20 years and hundreds of billions of dollars in support, equipment, and training did not suffice, why would another year, or five, or 10, make a difference?”

international aid workers having fled the country out of safety concerns. Those who remain are unsure if they will be able to continue their work.

During the conference on Monday, the U.N. said it needed $606 million in emergency funding to address the immediate crisis, while acknowledging that money alone will not be enough. The organization has pressed the Taliban to provide assurances that aid workers can go about their business safely. By the end of the gathering, international pledges had surpassed the amount requested.

But even as the Taliban sought to make that pledge, the U.N.’s human rights chief, Michelle Bachelet, also speaking in Geneva, said Afghanistan was in a “new and perilous phase” since the militant Islamist group seized power.

“In contradiction to assurances that the Taliban would uphold women’s rights, over the past three weeks, women have instead been progressively excluded from the public sphere,” she said, a warning that the Taliban would need to use more than words to demonstrate their commitment to aid workers’ safety.

Monday’s conference was also intended to drive home the enormousness of the crisis and offer some reassurance to Western governments hesitant to provide assistance that could legitimize the authority of a Taliban government that includes leaders identified by the U.N. as international terrorists with links to Al Qaeda.

their origin story and their record as rulers.

On Sunday, Taliban authorities sent assurances that they would facilitate humanitarian aid deliveries by road, he said.

some $12 billion in assistance to Afghanistan over four years.

While the Taliban did not have a representative in Geneva for the meeting, Zabihullah Mujahid, the Taliban’s deputy information and culture minister, said the government welcomed all humanitarian efforts by any nation, including the United States.

He also acknowledged that not even the Taliban expected to be in control of the country so quickly.

“It was a surprise for us how the former administration abandoned the government,” he said. “We were not fully prepared for that and are still trying to figure things out to manage the crisis and try to help people in any way possible.”

More than half a million Afghans were driven from their homes by fighting and insecurity this year, bringing the total number of people displaced within the country to 3.5 million, Filippo Grandi, the U.N. refugee chief said.

The danger of economic collapse raised the possibility of stoking an outflow of refugees to neighboring countries.

Said, 33, lived in Kunduz before fleeing to Kabul, where he now lives in a tent in a park. He has been there with his wife and three children for a month.

“It’s cold here, we have no food, no shelter, and we can’t find a job in this city,” he said, adding that he had not received any aid. “We all have children and they need food and shelter, and it’s not easy to live here.”

Jim Huylebroek contributed reporting from Chak-e Wardak, Afghanistan. Sami Sahak also contributed reporting.

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Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.

David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.

“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”

But there was no evidence that Mr. Blakeney actually had schizophrenia.

Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.

one in 150 people.

Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.

“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”

refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.

But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.

hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.

One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.

According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.

To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.

The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.

The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.

“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”

significant drop since 2012 in the share of residents on the drugs.

But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.

For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.

In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.

But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.

11 percent from less than 7 percent, records show.

The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.

Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.

Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)

more than 200,000 since early last year and is at its lowest level since 1994.

As staffing dropped, the use of antipsychotics rose.

Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.

Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.

“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”

Homes that violate the rules face few consequences.

In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.

In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”

a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.

There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”

Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”

“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”

Representatives of Hialeah Shores declined to comment.

Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.

make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.

But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.

Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.

in a “sprinkle” form that makes it easy to slip into food undetected.

“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.

In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.

According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.

Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.

Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.

“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”

published a brochure titled “Nursing Homes: Times have changed.”

“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.

Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.

“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.

The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)

Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)

During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.

In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.

“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”

Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.

In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.

“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”

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In US Drone Strike, Evidence Suggests No ISIS Bomb

[explosion] In one of the final acts of its 20-year war in Afghanistan, the United States fired a missile from a drone at a car in Kabul. It was parked in the courtyard of a home, and the explosion killed 10 people, including 43-year-old Zemari Ahmadi and seven children, according to his family. The Pentagon claimed that Ahmadi was a facilitator for the Islamic State, and that his car was packed with explosives, posing an imminent threat to U.S. troops guarding the evacuation at the Kabul airport. “The procedures were correctly followed, and it was a righteous strike.” What the military apparently didn’t know was that Ahmadi was a longtime aid worker, who colleagues and family members said spent the hours before he died running office errands, and ended his day by pulling up to his house. Soon after, his Toyota was hit with a 20-pound Hellfire missile. What was interpreted as the suspicious moves of a terrorist may have just been an average day in his life. And it’s possible that what the military saw Ahmadi loading into his car were water canisters he was bringing home to his family — not explosives. Using never-before seen security camera footage of Ahmadi, interviews with his family, co-workers and witnesses, we will piece together for the first time his movements in the hours before he was killed. Zemari Ahmadi was an electrical engineer by training. For 14 years, he had worked for the Kabul office of Nutrition and Education International. “NEI established a total of 11 soybean processing plants in Afghanistan.” It’s a California based NGO that fights malnutrition. On most days, he drove one of the company’s white Toyota corollas, taking his colleagues to and from work and distributing the NGO’s food to Afghans displaced by the war. Only three days before Ahmadi was killed, 13 U.S. troops and more than 170 Afghan civilians died in an Islamic State suicide attack at the airport. The military had given lower-level commanders the authority to order airstrikes earlier in the evacuation, and they were bracing for what they feared was another imminent attack. To reconstruct Ahmadi’s movements on Aug. 29, in the hours before he was killed, The Times pieced together the security camera footage from his office, with interviews with more than a dozen of Ahmadi’s colleagues and family members. Ahmadi appears to have left his home around 9 a.m. He then picked up a colleague and his boss’s laptop near his house. It’s around this time that the U.S. military claimed it observed a white sedan leaving an alleged Islamic State safehouse, around five kilometers northwest of the airport. That’s why the U.S. military said they tracked Ahmadi’s Corolla that day. They also said they intercepted communications from the safehouse, instructing the car to make several stops. But every colleague who rode with Ahmadi that day said what the military interpreted as a series of suspicious moves was just a typical day in his life. After Ahmadi picked up another colleague, the three stopped to get breakfast, and at 9:35 a.m., they arrived at the N.G.O.’s office. Later that morning, Ahmadi drove some of his co-workers to a Taliban-occupied police station to get permission for future food distribution at a new displacement camp. At around 2 p.m., Ahmadi and his colleagues returned to the office. The security camera footage we obtained from the office is crucial to understanding what happens next. The camera’s timestamp is off, but we went to the office and verified the time. We also matched an exact scene from the footage with a timestamp satellite image to confirm it was accurate. A 2:35 p.m., Ahmadi pulls out a hose, and then he and a co-worker fill empty containers with water. Earlier that morning, we saw Ahmadi bring these same empty plastic containers to the office. There was a water shortage in his neighborhood, his family said, so he regularly brought water home from the office. At around 3:38 p.m., a colleague moves Ahmadi’s car further into the driveway. A senior U.S. official told us that at roughly the same time, the military saw Ahmadi’s car pull into an unknown compound 8 to 12 kilometers southwest of the airport. That overlaps with the location of the NGO’s office, which we believe is what the military called an unknown compound. With the workday ending, an employee switched off the office generator and the feed from the camera ends. We don’t have footage of the moments that followed. But it’s at this time, the military said that its drone feed showed four men gingerly loading wrapped packages into the car. Officials said they couldn’t tell what was inside them. This footage from earlier in the day shows what the men said they were carrying — their laptops one in a plastic shopping bag. And the only things in the trunk, Ahmadi’s co-workers said, were the water containers. Ahmadi dropped each one of them off, then drove to his home in a dense neighborhood near the airport. He backed into the home’s small courtyard. Children surrounded the car, according to his brother. A U.S. official said the military feared the car would leave again, and go into an even more crowded street or to the airport itself. The drone operators, who hadn’t been watching Ahmadi’s home at all that day, quickly scanned the courtyard and said they saw only one adult male talking to the driver and no children. They decided this was the moment to strike. A U.S. official told us that the strike on Ahmadi’s car was conducted by an MQ-9 Reaper drone that fired a single Hellfire missile with a 20-pound warhead. We found remnants of the missile, which experts said matched a Hellfire at the scene of the attack. In the days after the attack, the Pentagon repeatedly claimed that the missile strike set off other explosions, and that these likely killed the civilians in the courtyard. “Significant secondary explosions from the targeted vehicle indicated the presence of a substantial amount of explosive material.” “Because there were secondary explosions, there’s a reasonable conclusion to be made that there was explosives in that vehicle.” But a senior military official later told us that it was only possible to probable that explosives in the car caused another blast. We gathered photos and videos of the scene taken by journalists and visited the courtyard multiple times. We shared the evidence with three weapons experts who said the damage was consistent with the impact of a Hellfire missile. They pointed to the small crater beneath Ahmadi’s car and the damage from the metal fragments of the warhead. This plastic melted as a result of a car fire triggered by the missile strike. All three experts also pointed out what was missing: any evidence of the large secondary explosions described by the Pentagon. No collapsed or blown-out walls, including next to the trunk with the alleged explosives. No sign that a second car parked in the courtyard was overturned by a large blast. No destroyed vegetation. All of this matches what eyewitnesses told us, that a single missile exploded and triggered a large fire. There is one final detail visible in the wreckage: containers identical to the ones that Ahmadi and his colleague filled with water and loaded into his trunk before heading home. Even though the military said the drone team watched the car for eight hours that day, a senior official also said they weren’t aware of any water containers. The Pentagon has not provided The Times with evidence of explosives in Ahmadi’s vehicle or shared what they say is the intelligence that linked him to the Islamic State. But the morning after the U.S. killed Ahmadi, the Islamic State did launch rockets at the airport from a residential area Ahmadi had driven through the previous day. And the vehicle they used … … was a white Toyota. The U.S. military has so far acknowledged only three civilian deaths from its strike, and says there is an investigation underway. They have also admitted to knowing nothing about Ahmadi before killing him, leading them to interpret the work of an engineer at a U.S. NGO as that of an Islamic State terrorist. Four days before Ahmadi was killed, his employer had applied for his family to receive refugee resettlement in the United States. At the time of the strike, they were still awaiting approval. Looking to the U.S. for protection, they instead became some of the last victims in America’s longest war. “Hi, I’m Evan, one of the producers on this story. Our latest visual investigation began with word on social media of an explosion near Kabul airport. It turned out that this was a U.S. drone strike, one of the final acts in the 20-year war in Afghanistan. Our goal was to fill in the gaps in the Pentagon’s version of events. We analyzed exclusive security camera footage, and combined it with eyewitness accounts and expert analysis of the strike aftermath. You can see more of our investigations by signing up for our newsletter.”

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First Flight From Kabul Is Hailed as Positive Step Amid Troubling Signs

KABUL, Afghanistan — Ten days after the chaotic evacuation of Afghanistan came to an end, a lone jetliner lifted off from Kabul’s airport on Thursday, the first international passenger flight since American forces ended their 20-year presence in the country.

The departure of the chartered Qatar Airways Boeing 777, with scores of Americans, Canadians and Britons on board, was hailed by some as a sign that Taliban-ruled Afghanistan might be poised to re-engage with the world, even as reports emerged that the group was intensifying its crackdown on dissent.

“Kabul Airport is now operational,” Mutlaq bin Majed Al-Qahtani, a special envoy from Qatar’s Ministry of Foreign Affairs, said at a news conference on the tarmac.

In recent days, Qatari and Turkish personnel worked with the Taliban to repair damage and make the airport basically functional again. But just more than a week ago, the facility was a scene of frantic desperation as people jockeyed to find seats on the last commercial and military planes out.

a suicide bombing attack at the gates of the airport killed scores of Afghans and 13 U.S. service members.

Zabihullah Mujahid, a spokesman for the Taliban who joined the Qatari envoy at the news conference, said that the resumption of international flights would be critical to ensuring that much-needed aid continued to flow into the country.

China, making cautious overtures to its unstable neighbor, has pledged to give $30 million in food and other aid to the new government. But China’s foreign minister, Wang Yi, also urged the Taliban to work to contain terrorist groups.

The United Nations warned on Thursday that the freezing of billions of dollars in Afghan assets to keep it out of Taliban hands would inevitably have devastating economic consequences.

Deborah Lyons, the U.N. special envoy on Afghanistan, told the U.N. Security Council that the international community needed to find way to make these funds available to the country, with safeguards to prevent misuse by the Taliban, “to prevent a total breakdown of the economy and social order.”

a statement. “Afghans who have taken to the streets, understandably fearful about the future, are being met with intimidation, harassment and violence — particularly directed at women.”

U.S. officials said that the Americans on board the flight from Kabul on Thursday were considered the “most interested” in getting out, but said other Americans in Afghanistan would have other opportunities to leave.

Senator Angus King of Maine, an independent who sits on the Senate Intelligence and Armed Services Committees, was cautiously optimistic on Thursday morning about Americans elsewhere in Afghanistan being able to depart from the Kabul airport, although he noted the journey could be “treacherous and difficult.” But he said it was still unclear how many who wanted to leave remained in Afghanistan, or how they would get to the capital.

“I don’t want to sound like I have a great deal of confidence in the Taliban,” Mr. King said, adding, “All I can say is that it appears that, thus far, the Taliban has honored their commitment to allow Americans to leave.”

While the flight Thursday appeared to be a step toward resolving a diplomatic impasse that has left scores of Americans and other international workers stranded in Afghanistan, it was not clear if the Taliban would allow the tens of thousands of Afghans who once helped the U.S. government and now qualify for emergency U.S. visas to leave.

Taliban and foreign officials have said that Afghans with dual citizenship would be allowed to leave, but it was unclear whether any were on the first flight.

It also remained unclear whether charter flights from the airport in the northern city of Mazar-i-Sharif, where dozens of Americans and hundreds of Afghans were waiting to leave the country, would be allowed to fly.

In recent days, Secretary of State Antony J. Blinken has said that the Taliban are to blame for the grounded flights, and that they claim some passengers on the manifesto do not have the proper documentation.

Mr. Price, the State Department spokesman, said the United States had “pulled every lever” to persuade the Taliban to allow flights to depart from Mazar-i-Sharif carrying not only American citizens and legal residents but also Afghans considered to be at high risk.

“It continues to be our contention that these individuals should be allowed to depart,” he said. “At the first possible opportunity.”

Paul Mozur and Marc Santora contributed reporting.

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Taliban Appoint Stalwarts to Top Government Posts

KABUL, Afghanistan — The Taliban announced a caretaker government on Tuesday, taking a major step in re-establishing their Islamic Emirate of Afghanistan, and empowering many of the movement’s stalwarts from their regime in the 1990s.

After weeks of assurances from Taliban leaders that the movement would offer a more moderate and inclusive style of governing, most of the acting appointments on Tuesday were of senior figures who served in similar roles decades ago — a sign that the group’s conservative and theocratic core remain largely unchanged. All were men, and several are listed by the United States and United Nations as global terrorists.

“I assure all our countrymen that these officials will work hard to uphold Islamic rules and Shariah law,” Sheikh Haibatullah Akhundzada, the movement’s supreme leader, said in a written statement handed out at a news conference in Kabul. “The Islamic Emirate needs the continued support of its people to rebuild the ruined country together.”

The Taliban made clear that more appointments would be coming, extending a process that has already stretched for weeks since the group suddenly seized national control last month.

“Guantánamo Five.” They were held at the American detainment camp at Guantánamo Bay for 13 years before being exchanged in 2014 for Sgt. Bowe Bergdahl, an American soldier captured by the Taliban.

In order to govern, the Taliban will need to secure aid, which has been frozen by the United States and other nations. Yet U.S. sanctions against some cabinet members, including Mr. Haqqani and his uncle, Khalil Haqqani, appointed acting minister of refugees and repatriation — both listed as leaders of the terrorist-designated Haqqani network — will make that a difficult proposition.

Another factor will be foreign governments, lenders and aid organizations who are waiting to see the fate of the opposition and whether the Taliban will respect rights for women and ethnic and religious minorities. Just hours before the Taliban announced their new government posts, in fact, their fighters were on Kabul’s streets violently breaking up a peaceful demonstration for the second time in less than a week.

their origin story and their record as rulers.

As they marched on Tuesday morning, they carried a banner with a single word: “Freedom.”

The protests are happening as the Taliban cement their military grip on the country as well, announcing on Monday that they had seized the capital of restive Panjshir Province.

Afghanistan also faces a worsening humanitarian crisis. Basic services like electricity are under threat, while the country has been buffeted by food and cash shortages.

Thousands of Afghans are still desperately trying to flee the country, even as the United States works to evacuate dozens of its citizens. At a news conference in Doha, Qatar, on Tuesday, Secretary of State Antony J. Blinken said U.S. officials were “working around the clock” to ensure that charter flights carrying Americans can depart Afghanistan safely.

One senior Western diplomat, speaking on condition of anonymity, said the fact that the Taliban took more than three weeks to announce even a transitional government, despite pressing need to reestablish services and economic functions, could be taken as a sign that “they weren’t really ready, and they didn’t have a plan.”

The appointed officials, who were all men, were also notable for including only a few non-Pashtuns, despite the country’s ethnic diversity and the Taliban’s promises of inclusive government.

At the news conference naming the new cabinet, the chief Taliban spokesman, Zabihullah Mujahid, who was named deputy information and culture minister, stressed the transitional nature of the government.

“This is an acting cabinet appointed to handle current affairs, and we are preparing the foundations of government and state-building,” he said. “In the near future, the role of the people’s participation and the shuras will be developed.”

Taliban officials said that a nationwide gathering of religious scholars and elders is still being planned in order to confirm Sheikh Haibatullah, a native of Kandahar Province and a widely respected religious scholar within the movement, as Afghanistan’s supreme leader.

Reporting was contributed by Wali Arian, Sami Sahak, Mujib Mashal, Adam Nossiter, Michael Crowleyand Farnaz Fassihi.

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