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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While most of the provider aid has been distributed, the Biden administration is expected to begin doling out the remaining funds, estimated at $25 billion of the original $178 billion, said Kristen O’Brien, a vice president for McDermott+Consulting in Washington, D.C. Hospitals are asking for more time to spend the money.

How the aid was spent has not been fully documented. While the larger hospital networks aggressively sought the funds from the start, smaller organizations, children’s hospitals and those in rural areas or serving large numbers of low-income patients had more difficulty securing the aid because of the way the funding formula was structured.

In a later round of funding decisions, officials with the Department of Health and Human Services reviewed applications more closely, and in some cases, reduced or denied requests, Ms. O’Brien said.

Grants given after the initial rush were more targeted, to those hospitals in Covid hot spots or rural areas. A few large chains, including HCA Healthcare and the Mayo Clinic, returned at least some of the money, in the wake of disclosures that wealthier hospitals had received far more aid while reporting healthy profits.

Overall, the aid program did prevent hospital closings, said Ken Marlow, a lawyer with K&L Gates in Nashville, who advises hospitals. “We haven’t seen a real avalanche of these distressed hospitals coming on the market.”

But some may no longer be able to resist takeovers or mergers. “Those providers are potentially more distressed as a result of the stress of the pandemic and will have to be thinking hard about the future, their survival,” said Torrey McClary, a lawyer with Ropes & Gray who also counsels hospitals.

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A confused federal effort to retrieve Americans overseas in the initial outbreak led to safety risks, a new report says.

The government’s confused effort to retrieve Americans overseas during the early weeks of the coronavirus outbreak compromised the safety of the evacuees, federal employees and communities near where Americans returned to, according to a new report published on Monday by Congress’s nonpartisan watchdog.

The effort was so dysfunctional that federal health agencies could not even agree on the purpose and terms of the mission, contradicting one another about whether it was classified as an evacuation or repatriation.

The more-than-yearlong investigation by the Government Accountability Office concluded that the evacuation of Americans from China bogged down badly as different divisions within the Department of Health and Human Services argued over which was responsible. That fighting undermined the earliest attempts to protect those Americans after they returned from China, where the coronavirus was believed to have originated.

The G.A.O. said three agencies within the department — the Centers for Disease Control and Prevention, the Office of the Assistant Secretary for Preparedness and Response, and the Administration for Children and Families — “did not follow plans or guidance delineating their roles and responsibilities for repatriating individuals during a pandemic — an event these agencies had never experienced.”

whistle-blower complaint filed early last year. Last April, the department’s top lawyer concluded that federal health employees without adequate protective gear or training interacted with Americans quarantined at the base, validating the whistle-blower’s central complaint.

According to the G.A.O. report issued Monday, as the Administration for Children and Families, or A.C.F., began its role overseeing the repatriation of the evacuees, lawyers at H.H.S. determined that the flights from Wuhan, China, constituted an evacuation, not a repatriation, and therefore were the C.D.C.’s responsibility.

For that reason, A.C.F. officials said resources from the federal government’s repatriation program were not used. But the decision from H.H.S. lawyers was not communicated to the C.D.C., the report said, and G.A.O. investigators were not given an explanation of the distinction between a repatriation and evacuation.

A focus of the report is the federal government’s response at March Air Reserve Base, near Los Angeles, where the health agencies functioned independently and without coordination, the G.A.O. said. As the A.C.F. prepared for the evacuees in late January, the Office of the Assistant Secretary for Preparedness and Response was abruptly put in charge on the day they arrived.

A.S.P.R.’s Incident Management Team “was not mobilized until after the flight landed and did not deploy to the site until January 31,” the report said. That led to broad confusion about who was in charge, with A.S.P.R. officials believing they were only supporting other agencies there.

The report describes other significant missteps, some of which had already been made public. It cites last year’s report from H.H.S. lawyers describing a scene at the base in which an A.C.F. official told health department employees to remove personal protective gear at a meeting with evacuees, lest there be “bad optics.”

Federal health agencies also struggled to stop those on the base from leaving in the absence of a federal quarantine order, which lasted several days, the report said. One person with the “potential to spread” Covid-19 attempted to leave the base.

The G.A.O. also wrote that federal health officials disagreed on which agency was responsible for infection control on the base, while the use of personal protective gear was uneven among poorly-trained federal employees there. The dispute led to an almost comical bureaucratic tangle.

At first, A.C.F. and A.S.P.R. officials viewed the C.D.C. as the body with more expertise and authority, including under a section of the federal government’s guidance on repatriation procedures related to Ebola. But C.D.C. officials told their colleagues that section was not applicable to other diseases, and that the agency was not responsible for managing the employees of other agencies. Still, the C.D.C. offered training after it was requested.

“According to H.H.S., C.D.C. personnel on the ground provided inconsistent and informal infection prevention and control guidance for the first 3 days of the mission because of a lack of clear roles,” the report said.

The G.A.O. noted that H.H.S. did not feature repatriation in its planning exercises for a pandemic, and therefore was not equipped to coordinate such an effort. “Until H.H.S. conducts such exercises, it will be unable to test its repatriation plans during a pandemic and identify areas for improvement,” the office wrote.

H.H.S. agreed with its recommendations, the G.A.O. said.

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The Covid-19 Plasma Boom Is Over. What Did We Learn From It?

Scott Cohen was on a ventilator struggling for his life with Covid-19 last April when his brothers pleaded with Plainview Hospital on Long Island to infuse him with the blood plasma of a recovered patient.

The experimental treatment was hard to get but was gaining attention at a time when doctors had little else. After an online petition drew 18,000 signatures, the hospital gave Mr. Cohen, a retired Nassau County medic, an infusion of the pale yellow stuff that some called “liquid gold.”

In those terrifying early months of the pandemic, the idea that antibody-rich plasma could save lives took on a life of its own before there was evidence that it worked. The Trump administration, buoyed by proponents at elite medical institutions, seized on plasma as a good-news story at a time when there weren’t many others. It awarded more than $800 million to entities involved in its collection and administration, and put Dr. Anthony S. Fauci’s face on billboards promoting the treatment.

A coalition of companies and nonprofit groups, including the Mayo Clinic, Red Cross and Microsoft, mobilized to urge donations from people who had recovered from Covid-19, enlisting celebrities like Samuel L. Jackson and Dwayne Johnson, the actor known as the Rock. Volunteers, some dressed in superhero capes, showed up to blood banks in droves.

took a long time to measure its effectiveness. Eventually, studies did emerge to suggest that under the right conditions, plasma might help. But enough evidence has now accumulated to show that the country’s broad, costly plasma campaign had little effect, especially in people whose disease was advanced enough to land them in the hospital.

N.I.H. recently halted an outpatient trial of plasma because of a lack of benefit.

Doctors have used the antibodies of recovered patients as treatments for more than a century, for diseases including diphtheria, the 1918 flu and Ebola.

So when patients began falling ill with the new coronavirus last year, doctors around the world turned to the old standby.

In the United States, two hospitals — Mount Sinai in New York City and Houston Methodist in Texas — administered the first plasma units to Covid-19 patients within hours of each other on March 28.

Dr. Nicole M. Bouvier, an infectious-disease doctor who helped set up Mount Sinai’s plasma program, said the hospital had tried the experimental treatment because blood transfusions carry a relatively low risk of harm. With a new virus spreading quickly, and no approved treatments, “nature is a much better manufacturer than we are,” she said.

As Mount Sinai prepared to infuse patients with plasma, Diana Berrent, a photographer, was recovering from Covid-19 at her home in Port Washington, N.Y. Friends began sending her Mount Sinai’s call for donors.

thousands of Orthodox Jewish people were getting tested for coronavirus antibodies and showing up to donate. Coordinating it all was exhausting.

“April,” Mr. Lebovits recalled with a laugh, “was like 20 decades.”

Two developments that month further accelerated plasma’s use. With the help of $66 million in federal funding, the F.D.A. tapped the Mayo Clinic to run an expanded access program for hospitals across the country. And the government agreed to cover the administrative costs of collecting plasma, signing deals with the American Red Cross and America’s Blood Centers.

news releases announcing those deals got none of the flashy media attention that the billion-dollar contracts for Covid-19 vaccines did when they arrived later in the summer. And the government did not disclose how much it would be investing.

American Red Cross and America’s Blood Centers since last April.

“The convalescent plasma program was intended to meet an urgent need for a potential therapy early in the pandemic,” a health department spokeswoman said in a statement. “When these contracts began, treatments weren’t available for hospitalized Covid-19 patients.”

As spring turned to summer, the Trump administration seized on plasma — as it had with the unproven drug hydroxychloroquine — as a promising solution. In July, the administration announced an $8 million advertising campaign “imploring Americans to donate their plasma and help save lives.” The blitz included promotional radio spots and billboards featuring Dr. Fauci and Dr. Hahn, the F.D.A. commissioner.

provided access to its advertising agency, which created the look and feel for the Fight Is In Us campaign, which included video testimonials from celebrities.

although he later corrected his remarks following criticism from the scientific community.

the Infectious Diseases Society of America recommended that plasma not be used in hospitalized patients outside of a clinical trial. (On Wednesday, the society restricted its advice further, saying plasma should not be used at all in hospitalized patients.) In January, a highly anticipated trial in Britain was halted early because there was not strong evidence of a benefit in hospitalized patients.

narrowed the authorization for plasma so that it applied only to people who were early in the course of their disease or who couldn’t make their own antibodies.

Dr. Marks, the F.D.A. regulator, said that in retrospect, scientists had been too slow to adapt to those recommendations. They had known from previous disease outbreaks that plasma treatment is likely to work best when given early, and when it contained high levels of antibodies, he said.

“Somehow we didn’t really take that as seriously as perhaps we should have,” he said. “If there was a lesson in this, it’s that history actually can teach you something.”

pandemic exceptionalism” — had drained valuable time and attention from discovering other treatments.

“Pandemic exceptionalism is something we learned from prior emergencies that leads to serious unintended consequences,” she said, referring to the ways countries leaned on inadequate studies during the Ebola outbreak. With plasma, she said, “the agency forgot lessons from past emergencies.”

While scant evidence shows that plasma will help curb the pandemic, a dedicated clutch of researchers at prominent medical institutions continue to focus on the narrow circumstances in which it might work.

Dr. Arturo Casadevall, an immunologist at Johns Hopkins University, said many of the trials had not succeeded because they tested plasma on very sick patients. “If they’re treated early, the results of the trials are all consistent,” he said.

found that giving plasma early to older people reduced the progression of Covid-19. And an analysis of the Mayo Clinic program found that patients who were given plasma with a high concentration of antibodies fared better than those who did not receive the treatment. Still, in March, the N.I.H. halted a trial of plasma in people who were not yet severely ill with Covid-19 because the agency said it was unlikely to help.

With most of the medical community acknowledging plasma’s limited benefit, even the Fight Is In Us has begun to shift its focus. For months, a “clinical research” page about convalescent plasma was dominated by favorable studies and news releases, omitting major articles concluding that plasma showed little benefit.

the website has been redesigned to more broadly promote not only plasma, but also testing, vaccines and other treatments like monoclonal antibodies, which are synthesized in a lab and thought to be a more potent version of plasma. Its clinical research page also includes more negative studies about plasma.

Nevertheless, the Fight Is In Us is still running Facebook ads, paid for by the federal government, telling Covid-19 survivors that “There’s a hero inside you” and “Keep up the fight.” The ads urge them to donate their plasma, even though most blood banks have stopped collecting it.

Two of plasma’s early boosters, Mr. Lebovits and Ms. Berrent, have also turned their attention to monoclonal antibodies. As he had done with plasma last spring, Mr. Lebovits helped increase acceptance of monoclonals in the Orthodox Jewish community, setting up an informational hotline, running ads in Orthodox newspapers, and creating rapid testing sites that doubled as infusion centers. Coordinating with federal officials, Mr. Lebovits has since shared his strategies with leaders in the Hispanic community in El Paso and San Diego.

And Ms. Berrent has been working with a division of the insurer UnitedHealth to match the right patients — people with underlying health conditions or who are over 65 — to that treatment.

“I’m a believer in plasma for a lot of substantive reasons, but if word came back tomorrow that jelly beans worked better, we’d be promoting jelly beans,” she said. “We are here to save lives.”’

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Surge in Migrants Defies Easy or Quick Solutions for Biden

WASHINGTON — The Biden administration warned on Tuesday that the United States expected to make more apprehensions along the southwestern border this year than at any time in the past two decades, underscoring the urgency for the White House to develop solutions for the chronic problems with immigration from Central America.

The grim prediction by Alejandro N. Mayorkas, the secretary of homeland security, came as President Biden was being assailed for his handling of a surge at the border involving thousands of unaccompanied children and teenagers from the region — with attacks coming from the right for not being tough enough and from the left for not being humane enough.

The president has pleaded for time and patience, blaming his predecessor for dismantling the immigration system in his zeal to keep foreigners out. But even Mr. Biden’s top advisers acknowledge that after unwinding the harsh policies of President Donald J. Trump’s, there is no easy or quick fix for a problem that has been a recurring crisis.

“We have no illusions about how hard it is, and we know it will take time,” Mr. Mayorkas said in a statement on Tuesday as the House prepared to vote this week on several immigration measures and the administration rushed to provide more housing for the young migrants arriving at the border. But, he added, “We will get it done.”

restart the Obama-era Central American Minors program, which was intended to allow some children to apply in their home region for permission to live in the United States with a parent or other relative. When Mr. Trump ended the program, about 3,000 Central American children had been approved for travel to the United States.

It will take time to ramp up the program, which has strict vetting requirements, in order to verify the relationships of the children and their relatives.

Now, the administration is eager to examine even broader efforts to consider asylum applications remotely.

The administration is already testing a system where migrants, who were told by the Trump administration to wait along the border in squalid camps in Mexico, can use an app on their cellphones to apply for asylum and track their cases. That kind of system might be expanded more broadly, officials said.

“This is the road map going forward for a system that is safe, orderly and fair,” Mr. Mayorkas said.

Many of the changes Mr. Biden wants are included in comprehensive immigration legislation he sent to Congress on his first day in office. But that bill is a long way from becoming law, especially with Mr. Trump and other Republicans again using immigration to stoke their partisan base.

Mr. Biden’s most ambitious — and difficult — goal is to use the United States’ wealth and diplomatic power to reshape the region in the hopes of diminishing the root causes of migration from Central America, starting with poverty and violence.

It is an effort that has been tried before, Mr. Obama and members of Congress from both parties agreed to invest several hundred million dollars into Central America with the hope of improving the courts, diminishing the cartels and improving economic conditions.

Mr. Trump cut that spending, arguing that it was a waste of money, before restoring some of it. But Mr. Biden’s team is betting that even more investment will produce results. In Honduras, for example, the country’s coffee production has been hurt by hurricanes and slumping prices for coffee beans, driving many people into poverty.

But helping to reverse those kinds of economic trends could take years.

“When the president talks about ‘root causes,’ some of this is immediate humanitarian aid, but a lot of it is policy and aid together, making sure that you tackle the root causes of migration,” Ms. Jacobson said. “Otherwise, what you see is continued cycles.”

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How U.S. Ratings of Nursing Homes Mislead the Public

The pandemic laid bare the flaws in the government rating system.

The state health inspections do little to penalize homes with poor records of preventing and controlling infections. From 2017 to 2019, The Times found, inspectors cited nearly 60 percent — more than 2,000 — of the country’s five-star facilities at least once for not following basic safety precautions, like regular hand washing. Yet they earned top ratings.

In San Bernardino, Calif., inspectors wrote up Del Rosa Villa for four different infection-control violations. It kept its five stars. Ninety residents at the 104-bed facility have contracted the coronavirus, and 13 have died.

Del Rosa Villa officials didn’t respond to requests for comment.

Life Care Centers of Kirkland, Wash., the first nursing home in the United States to have documented coronavirus cases, was found in 2019 to have weak infection controls, despite its five stars. State inspectors wrote it up for failing to “consistently implement an effective infection control program.”

Thirty-nine of the facility’s residents have died from Covid-19. The home has 190 beds.

Leigh Atherton, a Life Care spokeswoman, said that citation was the only lapse in infection control that inspectors had identified over 32 previous visits. She said the home quickly fixed the problem.

If the rating system worked as intended, it would have offered clues as to which homes were most likely to have out-of-control outbreaks and which homes would probably muddle through.

That is not what happened.

The Times found that there was little if any correlation between star ratings and how homes fared during the pandemic. At five-star facilities, the death rate from Covid-19 was only half a percentage point lower than at facilities that received lower ratings. And the death rate was slightly lower at two-star facilities than at four-star homes.

A facility’s location, the infection rate of the surrounding community and the race of nursing home residents all were predictors of whether a nursing home would suffer an outbreak. The star ratings didn’t matter.

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Facing Pressure, Biden Administration Scrambles to Shelter Migrant Children

Republicans are framing the situation as a crisis of Mr. Biden’s making, signaling an aim to use his immigration agenda as a political weapon against him in 2022. Representative Kevin McCarthy of California, the minority leader, is planning to lead other Republicans on a trip to the border to highlight the issue. Representative James R. Comer, Republican of Kentucky, on Wednesday called the increase in migration a signal “to the world that our immigration laws can be violated with little, if any, consequence.”

Mr. Biden, however, has continued to use a Trump-era rule to rapidly turn away most migrants at the border, with the exception of unaccompanied minors. The administration last week directed the shelters designed to hold the children to return to their normal capacity, despite the coronavirus pandemic.

In the scramble to find additional space for the children, the Biden administration is considering housing them at unused school buildings, military bases and even a NASA site, Moffett Federal Airfield in Mountain View, Calif., according to a memo obtained by The Times. The NASA site would “remain unoccupied but available for use if H.H.S. has an urgent need for additional shelter space,” the memo said.

Darryl Waller, a spokesman for NASA, confirmed in a statement that the administration was considering sheltering migrant children at “currently vacant property” at the site. “This effort will have no impact on NASA’s ability to conduct its primary missions,” he said.

The Health and Human Services Department did not respond to requests for comment.

Mr. Biden campaigned on a more humane approach to immigration at the border, one that would prioritize investing in Central America to deter illegal immigration. But it has had the effect of drawing more people who see a better chance to enter the United States than they had under the Trump administration.

“One of the things I think is important is we’ve seen surges before,” Ms. Jacobson said. “Surges tend to respond to hope. And there was a significant hope for a more humane policy.”

One part of the Obama administration’s response was creating the program that allowed Central American children to apply for protection from their home countries.

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President Biden Faces Challenge From Surge of Migrants at the Border

WASHINGTON — Thousands of migrant children are backed up in United States detention facilities along the border with Mexico, part of a surge of immigration from Central Americans fleeing poverty and violence that could overwhelm President Biden’s attempt to create a more humane approach to those seeking entry into the country.

The number of migrant children in custody along the border has tripled in the past two weeks to more than 3,250, according to federal immigration agency documents obtained by The New York Times, and many of them are being held in jail-like facilities for longer than the three days allowed by law.

The problem for the administration is both the number of children crossing the border and what to do with them once they are in custody. Under the law, the children are supposed to be moved to shelters run by the Health and Human Services Department, but because of the pandemic the shelters until last week were limiting how many children they could accommodate.

The growing number of unaccompanied children is just one element of an escalating problem at the border. Border agents encountered a migrant at the border about 78,000 times in January — more than double the rate at the same time a year ago and higher than in any January in a decade.

refused to call a “crisis” but could nevertheless become a potent political weapon for his Republican adversaries and upend his efforts to legalize millions of undocumented immigrants.

The president has proposed overhauling the nation’s decades-old immigration system by making it easier for asylum seekers and refugees, expanding legal pathways for foreign workers, increasing opportunities for family-based immigration and vastly reducing threats of mass deportations. His State Department announced on Monday that foreigners rejected after Jan. 20, 2020, under Mr. Trump’s travel ban could try to obtain visas without paying additional fees.

Hundreds of migrant families are also being released into the United States after being apprehended at the border, prompting predictable attacks by conservatives.

Liberal politicians are denouncing the expansion of detention facilities and railing against the continued imposition of Trump-era rules intended to prevent the spread of the coronavirus from immigrants. And advocates for families separated at the border during Mr. Trump’s administration are pressuring the president to move faster to reunite them.

Together, it has put Mr. Biden on the defensive in the early days of his presidency as he attempts to demonstrate a tone very different from his predecessor’s.

The immigration system Mr. Biden envisions will take months, if not years, to be fully implemented, forcing the administration to scramble to find space for children and rely, for now, on a rule that swiftly returns adults and most families to their home countries.

For now, Mr. Biden has broken from his predecessor in not applying the pandemic emergency rule to children, meaning the United States is still responsible for caring for them until they are placed with a sponsor.

long-term detention facilities within 72 hours.

But for now, using the same pandemic rule the Trump administration did, the Biden administration has continued to turn away most migrants other than unaccompanied children.

And almost as soon as Mr. Biden came into office, top administration officials publicly sought to discourage migrants from traveling north, saying it would take time to unravel Mr. Trump’s policies. Previous public messaging campaigns, including standing up billboards in Central America to encourage migrants to stay home, have failed.

“Realistically, one is addressing a population of people that are desperate,” Mr. Mayorkas said in an interview. “It is not going to work 100 percent, but if it is effective at all, that is of momentous importance not only to what we are trying to do but for the well being of the people.”

Some families are being released into the United States. Border agents have not been able to turn away migrant families in South Texas because of a change in Mexican law that bans the detention of small children.

Administration officials point to a flurry of actions underway aimed at fixing what they say is a broken immigration system: improving communications between the Border Patrol and the health department, including whether the children being transported to the long-term centers are boys or girls; streamlining background checks for shelter employees; and vaccinating border workers against the coronavirus.

They are also accelerating efforts to get new facilities to care for children during the weeks and months that it takes to find relatives or foster parents. They are considering unused school buildings, military bases and federal facilities that could be rapidly converted into places acceptable for children.

And they are restarting a program in Central America that will allow children to apply for asylum without making the dangerous trek to the border. Mr. Trump ended the program, which Biden administration officials said would eventually reduce the flow of migrant children to the United States.

But all of that will take time. Meanwhile, officials say, they recognize that the pressure on Mr. Biden will only increase.

“At every step of the way we’re looking at where are the bottlenecks and then trying to eliminate those bottlenecks and yes it won’t be solved by tomorrow,” said Esther Olavarria, the deputy director for immigration at the White House’s Domestic Policy Council. “But if you don’t start to do each of these things, you are never going to solve the problem.”

Annie Karni and Maggie Haberman contributed reporting.

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Biden Faces Challenge From Surge of Migrants at the Border

WASHINGTON — Thousands of migrant children are backed up in United States detention facilities along the border with Mexico, part of a surge of immigration from Central Americans fleeing poverty and violence that could overwhelm President Biden’s attempt to create a more humane approach to those seeking entry into the country.

The number of migrant children in custody along the border has tripled in the past two weeks to more than 3,250, according to federal immigration agency documents obtained by The New York Times, and many of them are being held in jail-like facilities for longer than the three days allowed by law.

The problem for the administration is both the number of children crossing the border and what to do with them once they are in custody. Under the law, the children are supposed to be moved to shelters run by the Health and Human Service Department, but because of the pandemic the shelters until last week were limiting how many children they could accommodate.

The growing number of unaccompanied children is just one element of an escalating problem at the border. Border agents encountered a migrant at the border about 78,000 times in January — more than double the rate at the same time a year ago and higher than in any January in a decade.

refused to call a “crisis” but could nevertheless become a potent political weapon for his Republican adversaries and upend his efforts to legalize millions of undocumented immigrants.

The president has proposed overhauling the nation’s decades-old immigration system by making it easier for asylum seekers and refugees, expanding legal pathways for foreign workers, increasing opportunities for family-based immigration and vastly reducing threats of mass deportations. His State Department announced on Monday that foreigners rejected after Jan. 20, 2020, under Mr. Trump’s travel ban could try to obtain visas without paying additional fees.

Hundreds of migrant families are also being released into the United States after being apprehended at the border, prompting predictable attacks by conservatives.

Liberal politicians are denouncing the expansion of detention facilities and railing against the continued imposition of Trump-era rules intended to prevent the spread of the coronavirus from immigrants. And advocates for families separated at the border during Mr. Trump’s administration are pressuring the president to move faster to reunite them.

Together, it has put Mr. Biden on the defensive in the early days of his presidency as he attempts to demonstrate a tone very different from his predecessor’s.

The immigration system Mr. Biden envisions will take months, if not years, to be fully implemented, forcing the administration to scramble to find space for children and rely, for now, on a rule that swiftly returns adults and most families to their home countries.

For now, Mr. Biden has broken from his predecessor in not applying the pandemic emergency rule to children, meaning the United States is still responsible for caring for them until they are placed with a sponsor.

long-term detention facilities within 72 hours.

But for now, using the same pandemic rule the Trump administration did, the Biden administration has continued to turn away most migrants other than unaccompanied children.

And almost as soon as Mr. Biden came into office, top administration officials publicly sought to discourage migrants from traveling north, saying it would take time to unravel Mr. Trump’s policies. Previous public messaging campaigns, including standing up billboards in Central America to encourage migrants to stay home, have failed.

“Realistically, one is addressing a population of people that are desperate,” Mr. Mayorkas said in an interview. “It is not going to work 100 percent, but if it is effective at all, that is of momentous importance not only to what we are trying to do but for the well being of the people.”

Some families are being released into the United States. Border agents have not been able to turn away migrant families in South Texas because of a change in Mexican law that bans the detention of small children.

Administration officials point to a flurry of actions underway aimed at fixing what they say is a broken immigration system: improving communications between the Border Patrol and the health department, including whether the children being transported to the long-term centers are boys or girls; streamlining background checks for shelter employees; and vaccinating border workers against the coronavirus.

They are also accelerating efforts to get new facilities to care for children during the weeks and months that it takes to find relatives or foster parents. They are considering unused school buildings, military bases and federal facilities that could be rapidly converted into places acceptable for children.

And they are restarting a program in Central America that will allow children to apply for asylum without making the dangerous trek to the border. Mr. Trump ended the program, which Biden administration officials said would eventually reduce the flow of migrant children to the United States.

But all of that will take time. Meanwhile, officials say, they recognize that the pressure on Mr. Biden will only increase.

“At every step of the way we’re looking at where are the bottlenecks and then trying to eliminate those bottlenecks and yes it won’t be solved by tomorrow,” said Esther Olavarria, the deputy director for immigration at the White House’s Domestic Policy Council. “But if you don’t start to do each of these things, you are never going to solve the problem.”

Annie Karni and Maggie Haberman contributed reporting.

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