As Germany heads into an election that will see Angela Merkel step down after 16 years as chancellor, she leaves behind a country profoundly changed — and anxious about changing more.
By Katrin Bennhold
Photographs by Lena Mucha
STUTTGART, Germany — The small silver star at the tip of Aleksandar Djordjevic’s Mercedes shines bright. He polishes it every week.
Mr. Djordjevic makes combustion engines for Daimler, one of Germany’s flagship carmakers. He has a salary of around 60,000 euros (about $70,000), eight weeks of vacationand a guarantee negotiated by the union that he cannot be fired until 2030. He owns a two-story house and that E-class 250 model Mercedes in his driveway.
All of that is why Mr. Djordjevic polishes the star on his car.
“The star is something stable and something strong: It stands for Made in Germany,” he said.
But by 2030 there will be no more combustion engines at Daimler — or people making combustion engines.
parental leave in Catholic Bavaria. The married gay couple raising two children outside Berlin. The woman in a hijab teaching math in a high school near Frankfurt, where most students have German passports but few have German parents.
successive crises and left others unattended, there was change that she led and change that she allowed.
phase out nuclear power in Germany. She ended compulsory military service. She was the first chancellor to assert that Islam “belongs” to Germany. When it came to breaking down her country’s and party’s conservative family values, she was more timid but ultimately did not stand in the way.
Konrad Adenauer anchored Germany in the West. Willy Brandt reached across the Iron Curtain. Helmut Kohl, her onetime mentor, became synonymous with German unity. Gerhard Schröder paved the way for the country’s economic success.
Ms. Merkel’s legacy is less tangible but equally transformative. She changed Germany into a modern society — and a country less defined by its history.
She may be remembered most for her decision to welcome over a million refugees in 2015-16 when most other Western nations rejected them. It was a brief redemptive moment for the country that had committed the Holocaust and turned her into an icon of liberal democracy.
“It was a sort of healing,” said Karin Marré-Harrak, the headmaster of a high school in the multicultural city of Offenbach. “In a way we’ve become a more normal country.”
lingering inequality between East and West three decades after reunification is still evident, even though taxpayers’ money has flowed east and things have gradually improved. With the government planning to phase out coal production by 2038, billions more in funding are promised to help compensate for the job losses.
But as Mike Balzke, a worker at the nearby coal plant in Jänschwalde, put it: “We don’t want money — we want a future.”
Mr. Balzke recalled his optimism when Ms. Merkel first became chancellor. Because she was an easterner and a scientist, he expected her to be an ambassador for the East — and for coal.
Instead, his village lost a quarter of its population during her chancellorship. A promised train line from Forst to Berlin was never built. The post office shut down.
Mr. Balzke, 41, worries that the region will turn into a wasteland.
That anxiety runs deep. And it deepened again with the arrival of refugees in 2015.
Two Fathers and Two Sons
was up in arms, but only a decade later, it has become the new normal.
Ms. Merkel never backed same-sex marriage outright, but she allowed lawmakers to vote for it, knowing that it would go through.
Mr. Winkler left the party again in 2019 after Ms. Merkel’s successor as conservative leader, Annegret Kramp-Karrenbauer, disparaged same-sex marriage. But he acknowledged his debt to the chancellor.
On June 30, 2017, the day of the vote, he wrote her a letter.
“It is a pity that you could not support opening marriage to same-sex couples,” he wrote. “Still, thank you that you ultimately made today’s decision possible.”
Then he invited her to visit his family, “to see for yourself.”
She never replied. But he and his family used to live just around the corner from Ms. Merkel, who never gave up her apartment in central Berlin. They would see her occasionally in the supermarket checkout line.
“There she was with toilet paper in her basket, going shopping like everyone else,” Mr. Winkler’s partner, Roland Mittermayer, recalled. Even after 16 years, they are still trying to figure the chancellor out.
“She is an enigma,” Mr. Winkler said. “She’s a bit like the queen — someone who has been around for a long time, but you never feel you really know her.”
The Post-Merkel Generation
Six hours northwest of Berlin, past endless green fields dotted with wind farms and a 40-minute ferry ride off the North Sea coast, lies Pellworm, a sleepy island where the Backsen family has been farming since 1703.
Two years ago, they took Ms. Merkel’s government to court for abandoning its carbon-dioxide emission targets under the Paris climate accord. They lost, but then tried again, filing a complaint at the constitutional court.
This time they won.
“It’s about freedom,” said Sophie Backsen, 23, who would like to take over her father’s farm one day.
Sophie’s younger brothers, Hannes, 19, and Paul, 21, will vote for the first time on Sunday. Like 42 percent of first-time voters, they will vote for the Greens.
“If you look at how our generation votes, it’s the opposite of what you see in the polls,” Paul said. “The Greens would be running the country.”
Pellworm is flush with the sea level and in parts even below it. Without a dike ringing the coastline, it would flood regularly.
“When you have permanent rain for three weeks, the island fills up like a bath tub inside the dikes,” Hannes said.
The prospect of rising sea levels is an existential threat here. “This is one of the most important elections,” Hannes said. “It’s the last chance really to get it right.”
“If not even a country like Germany can manage this,” he added, “what chance do we stand?”
Christopher F. Schuetze contributed reporting from Berlin.
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.
Living on the South Carolina coast means living under the threat of dangerous weather during storm season. But the added peril of the pandemic made Ann Freeman nervous.
“What do I do if there’s an evacuation or there’s a storm and you have all this coronavirus and problems with hotels?” Ms. Freeman said. “So I said, ‘Maybe now is the time.’”
That’s why Ms. Freeman spent $12,400 last year to install a Generac backup generator at her home on Johns Island, a sea island near the Charleston peninsula. The wait — about three months — seemed long.
But she was lucky: The wait is twice as long now.
Demand for backup generators has soared over the last year, as housebound Americans focused on preparing their homes for the worst, just as a surge of extreme weather ensured many experienced it.
10 deaths in New Orleans are believed to have been tied to the heat. Over the summer, officials in California warned that wildfires might once again force rolling blackouts amid record heat and the threat of wildfire. In February, a deep freeze turned deadly after widespread outages in Texas. Even lower-profile outages — last month, storms in Michigan left almost a million homes and businesses in the dark for up to several days — have many American homeowners buying mini power plants of their own.
The vast majority are made by a single company: Generac, a 62-year-old Waukesha, Wis., manufacturer that accounts for roughly 75 percent of standby home generator sales in the United States. Its dominance of the market and the growing threat posed by increasingly erratic weather have turned it into a Wall Street darling.
climate crises is shifting the priorities of American consumers.
“Instead of a nice-to-have, backup power is increasingly a need-to-have, when you’re working at home,” said Mark Strouse, a J.P. Morgan analyst who covers Generac and other alternative energy stocks.
and Etsy — have shone as a result of Covid-era shocks and economic disruptions. And the vaccine-maker Moderna is the best-performing stock in the S&P 500. But Generac and a few other alternative energy companies have ballooned in value at the same time.
struck in June during a heat wave, and a prediction in the Farmers’ Almanac of another round of storms early next year made the decision easy: It was time to buy a generator.
The 15,000-watt Generac generator was hooked up last week, big enough to keep the house snug if the power goes out this winter. “I’m not going through that again,” Ms. Collins said.
Generac’s sales are up roughly 70 percent over the past year and orders are vastly outpacing production. The new factory in South Carolina — the two others that produce residential generators are in Wisconsin — is up and running and the company plans to employ about 800 people there by the end of the year. Company officials have floated the prospect of adding further manufacturing operations closer to fast-growing markets like California and Texas, J.P. Morgan analysts reported in a recent client note.
Generac seems to need them. Average delivery times for its generators have lengthened during the pandemic.
Despite dominating the home market, Generac could be vulnerable if competitors are able to serve customers faster. Major manufacturers such as the engine-maker Cummins and the heavy equipment company Caterpillar have a relatively small share of the home generator market, but have the expertise to lift production if they see an opportunity. Generac, aware of the potential competition from other players as well as home solar panels and other solutions, has made a series of acquisitions in the battery and energy storage industry, which is emerging as a small but fast-growing source of revenue for the company.
But there’s no doubt about the demand for its core product right now.
After her generator was installed last week, Ms. Collins took a run around the neighborhood and noticed a neighbor unboxing one in the driveway.
NAMPA, Idaho & BOSTON–(BUSINESS WIRE)–Thomas H. Lee Partners, L.P. (“THL”), a premier private equity firm investing in growth companies, announced today that it has acquired a majority interest in House of Design LLC (the “Company”), a leading provider of robotic automation systems and software for the residential construction market. THL’s investment will strengthen House of Design’s existing capabilities and provide capital and resources for future growth investments. House of Design’s co-founders will hold minority positions in the Company. Terms of the transaction were not disclosed.
Founded in 2012 and based in Nampa, Idaho, House of Design is a leading provider of automated solutions for the building components and residential offsite construction industries. The Company designs and engineers robotic systems that increase component manufacturers’ production output and capacity while reducing the challenges of labor shortages. Proprietary software makes House of Design’s system the only fully automated system that can produce complex variable trusses and wall panels without robot retraining or resetting.
THL’s investment in House of Design will accelerate the Company’s ability to build upon its leading robotic technology and software platform and accelerate new product innovation for its customers.
“Our partnership with THL is a monumental milestone for the Company,” said Shane Dittrich and Ryan Okelberry, Co-Founders of House of Design. “THL brings the expertise and sophistication needed to reach the next stage in our Company’s growth, and we have a shared vision for how to get there. We are excited to partner with THL and leverage their deep automation expertise and financial and operational resources to fuel House of Design’s growth strategy.”
“We are thrilled to partner with the House of Design team,” said Mike Kaczmarek, Managing Director at THL. “Persistent labor scarcity in the construction industry is driving greater need for automated solutions, and House of Design’s offerings help address labor shortage and worker safety challenges while providing an attractive ROI to the customer. THL is excited to support House of Design in continuously growing and innovating its product offerings to help customers increase production throughput and revenue.”
Stifel acted as financial advisor, Kirkland & Ellis LLP acted as legal advisor and PwC acted as accounting and tax advisor to THL. PEAK Technology Partners, a San Francisco based investment bank, acted as the exclusive financial advisor and Stoel Rives acted as legal advisor to House of Design.
About House of Design
House of Design has established itself as a thought leader and premier provider of robotic solutions, dynamic software applications, and system integration services. Through a multitude of successful automation projects across varied industries, House of Design is recognized as an innovative, collaborative partner committed to the success of the clients it serves.
Founded in 2012 by two engineers, House of Design has grown to 100+ employees and one of the largest robotic integrators in the West. Over the last ten years House of Design has been recognized nationally for its innovation in the robotics industry and as a small business leader in Idaho. The company’s vision is to ensure that execution matches strategy, emerging opportunities are captured, and team members grow, prosper and their work changes the world.
For more information, please visit www.thehouseofdesign.com.
About Thomas H. Lee Partners
Thomas H. Lee Partners, L.P. (“THL”) is a premier private equity firm investing in middle market growth companies exclusively in three sectors: Financial Services, Healthcare and Technology & Business Solutions. THL couples deep sector expertise with dedicated internal operating resources to transform and build great companies of lasting value in partnership with management. The Firm’s domain expertise and resources help to build great companies with an aim to accelerate growth, improve operations and drive long-term sustainable value. Since 1974, THL has raised more than $30 billion of equity capital, invested in over 160 companies and completed more than 500 add-on acquisitions representing an aggregate enterprise value at acquisition of over $210 billion. THL invests in automation companies through its flagship private equity fund and a dedicated automation fund. For more information, please visit www.thl.com.
The consortium did not disclose how it had obtained the list, and it was unclear whether the list was aspirational or whether the people had actually been targeted with NSO spyware.
Let Us Help You Protect Your Digital Life
Among those listed were Azam Ahmed, who had been the Mexico City bureau chief for The Times and who has reported widely on corruption, violence and surveillance in Latin America, including on NSO itself; and Ben Hubbard, The Times’s bureau chief in Beirut, Lebanon, who has investigated rights abuses and corruption in Saudi Arabia and wrote a recent biography of the Saudi crown prince, Mohammed bin Salman.
It also included 14 heads of state, including President Emmanuel Macron of France, President Cyril Ramaphosa of South Africa, Prime Minister Mostafa Madbouly of Egypt, Prime Minister Imran Khan of Pakistan, Saad-Eddine El Othmani, who until recently was the prime minister of Morocco, and Charles Michel, the head of the European Council.
Shalev Hulio, a co-founder of NSO Group, vehemently denied the list’s accuracy, telling The Times, “This is like opening up the white pages, choosing 50,000 numbers and drawing some conclusion from it.”
This year marks a record for the discovery of so-called zero days, secret software flaws like the one that NSO used to install its spyware. This year, Chinese hackers were caught using zero days in Microsoft Exchange to steal emails and plant ransomware. In July, ransomware criminals used a zero day in software sold by the tech company Kaseya to bring down the networks of some 1,000 companies.
For years, the spyware industry has been a black box. Sales of spyware are locked up in nondisclosure agreements and are frequently rolled into classified programs, with limited, if any, oversight.
NSO’s clients previously infected their targets using text messages that cajoled victims into clicking on links. Those links made it possible for journalists and researchers at organizations like Citizen Lab to investigate the possible presence of spyware. But NSO’s new zero-click method makes the discovery of spyware by journalists and cybersecurity researchers much harder.
Beloved shows removed from the airwaves. A television station cutting from a news report a story about a pregnant police officer who was reportedly fatally shot by the Taliban. A radio editor telling his colleagues to edit out anti-Taliban cheers from coverage of demonstrations in the capital.
Afghanistan’s vibrant free press and media industry, once celebrated as a success story and labeled one of the country’s most important achievements of the past two decades, has abruptly been transformed after the Taliban takeover of the country. Now, its survival is threatened by physical assaults, self-censorship and a dwindling journalist population less than a month after the Taliban seized control of Kabul, the capital, and began enforcing their hard-line Islamist policies.
The Taliban’s crackdown on the free press was even more evident on Wednesday after two Afghan journalists were detained and violently assaulted for covering a protest in Kabul. Photos showed the backsides of both reporters covered with bruises and gashes from being whipped repeatedly with cables, sparking an international outcry.
“The situation of free media is very critical,” said Neda, an anchor for a local television station in Kabul, identified by her nickname to protect her identity. “No one dares to ask the Taliban about their past wrongdoings and the atrocities they have committed.”
the Taliban rounded up scores of demonstrators around Kabul and journalists covering the protests, subjecting them to abuse in overcrowded jails, according to journalists who were present. The crackdown on the demonstrations and the ensuing coverage followed a Taliban announcement Tuesday that protests would not be allowed without government approval. At least 19 journalists were detained on Tuesday and Wednesday, the United Nations said.
“You’re lucky you have not been beheaded,” Taliban guards told one detained journalist as they kicked him in the head, Ravina Shamdasdani, a spokeswoman for the United Nations human rights office in Geneva, told reporters.
Understand the Taliban Takeover in Afghanistan
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Who are the Taliban? The Taliban arose in 1994 amid the turmoil that came after the withdrawal of Soviet forces from Afghanistan in 1989. They used brutal public punishments, including floggings, amputations and mass executions, to enforce their rules. Here’s more on their origin story and their record as rulers.
Who are the Taliban leaders? These are the top leaders of the Taliban, men who have spent years on the run, in hiding, in jail and dodging American drones. Little is known about them or how they plan to govern, including whether they will be as tolerant as they claim to be. One spokesman told The Times that the group wanted to forget its past, but that there would be some restrictions.
Reporters with Etilaat e Roz described being detained at the protests, then brought to a nearby police station where they were tied up and beaten with cables.
Taqi Daryabi, one of the reporters, said about a half-dozen Taliban members handcuffed him behind his back when he was on the ground on his stomach, then began kicking and hitting him until he lost consciousness.
“They beat so much that I couldn’t resist or move,” he said. “They forced me to the ground on my stomach, flogging me on my buttocks and back, and the ones who were in the front were kicking me in the face.”
Reporters working for Tolo News, Ariana News, Pajhwok News Agency and several freelance journalists have also been detained and beaten by the Taliban in the past three weeks, according to local media reports.
“The Taliban is quickly proving that earlier promises to allow Afghanistan’s independent media to continue operating freely and safely are worthless,” Steven Butler, Asia program coordinator for the Committee to Protect Journalists, said in a statement Wednesday. “We urge the Taliban to live up to those earlier promises, to stop beating and detaining reporters doing their job.”
On top of the dangerous environment, the flow of information from the government has slowed and become very limited. There used to be dozens of government spokesmen; now there are only a handful speaking for the new Taliban government, and they are less responsive than during the group’s insurgency.
In the late 1990s, the Taliban imposed strict restrictions on the media, banning television and using the state-owned radio and newspapers as propaganda platforms. But the group promised greater openness toward freedom of expression once it seized power last month.
“We will respect freedom of the press, because media reporting will be useful to society and will be able to help correct the leaders’ errors,” Zabihullah Mujahid, the acting deputy information and culture minister, told Reporters Without Borders last week. “We declare to the world that we recognize the importance of the role of the media.”
Many Afghan journalists said those promises are just “words” by Taliban’s leaders, citing recent assaults on reporters in Kabul and elsewhere.
“Press freedom is dead in Afghanistan,” said Mr. Quraishi, the media advocate. “And the society without a free press dies.”
Jim Huylebroek contributed reporting from Kabul, Afghanistan. Nick Bruce contributed from Geneva.
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.
A Doubled Risk of Death
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.
A Substitute for Staff
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.)
‘Hold His Haldol’
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.”
Building and installing enough solar panels to generate up to 45 percent of the country’s power needs will strain manufacturers and the energy industry, increasing demand for materials like aluminum, silicon, steel and glass. The industry will also need to find and train tens of thousands of workers and quickly. Some labor groups have said that in the rush to quickly build solar farms, developers often hire lower-paid nonunion workers rather than the union members Mr. Biden frequently champions.
Challenges like trade disputes could also complicate the push for solar power. China dominates the supply chain for solar panels, and the administration recently began blocking imports connected with the Xinjiang region of China over concerns about the use of forced labor. While many solar companies say they are working to shift away from materials made in Xinjiang, energy experts say the import ban could slow the construction of solar projects throughout the United States in the short term.
Yet, energy analysts said it would be impossible for Mr. Biden to achieve his climate goals without a big increase in the use of solar energy. “No matter how you slice it, you need solar deployments to double or quadruple in the near term,” said Michelle Davis, a principal analyst at Wood Mackenzie, an energy research and consulting firm. “Supply chain constraints are certainly on everyone’s mind.”
Administration officials pointed to changes being made by state and local officials as an example of how the country could begin to move faster toward renewable energy. Regulators in California, for example, are changing the state’s building code to require solar and batteries in new buildings.
Another big area of focus for the administration is greater use of batteries to store energy generated by solar panels and wind turbines for use at night or when the wind is not blowing. The cost of batteries has been falling but remains too high for a rapid shift to renewables and electric cars, according to many analysts.
To some solar industry officials, the Energy Department report ought to help to focus people’s minds on what is possible even if lawmakers haven’t worked out the details.
“In essence the D.O.E. is saying America needs a ton more solar, not less, and we need it today, not tomorrow,” said Bernadette Del Chiaro, executive director of the California Solar and Storage Association, which represents solar developers in the state with by far the largest number of solar installations. “That simple call to action should guide every policymaking decision from city councils to legislatures and regulatory agencies across the country.”
For years, start-ups, automakers and other companies have been slowly building chargers, mainly in California and other coastal states where most electric cars are sold. These businesses use different strategies to make money, and auto experts say it is not clear which will succeed. The company with the most stations, ChargePoint, sells chargers to individuals, workplaces, stores, condo and apartment buildings, and businesses with fleets of electric vehicles. It collects subscription fees for software that manages the chargers. Tesla offers charging mainly to get people to buy its cars. And others make money by selling electricity to drivers.
The Transition to Electric Cars
Once the poor cousin to the hip business of making sleek electric cars, the charging industry has been swept up in its own gold rush. Venture capital firms poured nearly $1 billion into charging companies last year, more than the five previous years combined, according to PitchBook. So far in 2021, venture capital investments are up to more than $550 million.
On Wall Street, publicly traded special purpose acquisition companies, or SPACs, have struck deals to buy eight charging companies out of 26 deals involving electric vehicle and related businesses, according to Dealogic, a research firm. The deals typically include an infusion of hundreds of millions of dollars from big investors like BlackRock.
“It’s early, and folks are trying to wrap their heads around what does the potential look like,” said Gabe Daoud Jr., a managing director and analyst at Cowen, an investment bank.
These businesses could benefit from the infrastructure bill, but it is not clear how the Biden administration would distribute money for charging stations.
Another unanswered question is who will be the Exxon Mobil of the electric car age. It might well be automakers.
Tesla, which makes about two-thirds of the electric cars sold in the United States, has built thousands of chargers, which it made free for early customers. The company could open its network to vehicles made by other automakers by the end of the year, its chief executive, Elon Musk, said in July.
“The Suicide Squad” should have been a big hit for Warner Bros. last month. It had superheroes, a marquee director (James Gunn), a huge production budget ($185 million) and received terrific reviews. But instead of delivering a box office ka-pow, it went ker-thud: Ticket sales total $156 million (split roughly 50-50 with theaters), compared with $747 million for the first “Suicide Squad” in 2016.
Of course, the latest one had to battle a pandemic. And it was also made available free on HBO Max in lock step with its theatrical debut. On that platform, it was a relative success — at least according to HBO Max, which heralded “The Suicide Squad” as the service’s second-most-viewed movie debut of the year.
But it offered no numbers.
“Paw Patrol: The Movie” (Paramount) was released simultaneously in theaters and on Paramount+ late last month. It took in $13 million over its first weekend, enough for second place behind “Free Guy,” a holdover. But the actual demand for “Paw Patrol” was shrouded. Regal Cinemas, the second-largest multiplex chain in the United States behind AMC Entertainment, refused to play the animated adventure because of its streaming availability. Paramount+ said on Aug. 25 that the movie “ranked as one of the service’s most-watched originals.”
But it offered no numbers.
In contrast, Disney-Marvel released “Shang-Chi and the Legend of the Ten Rings” exclusively in theaters on Friday. Disney’s chief executive had called the old-fashioned release an “experiment.” Would the coronavirus keep people at home?
In surveys in late August of American moviegoers by the National Research Group, a film industry consultant, about 67 percent of respondents said they felt comfortable (“very or somewhat”) sitting in a theater. Disney has cited coronavirus concerns for making films like “Jungle Cruise,” “Cruella” and “Black Widow” available in homes on Disney+ at the same time as in theaters (even though Hollywood has suspected that the real reason — or at least an equally important one — has been helping Disney+).
The crystal-clear result: Audiences flocked to “Shang-Chi,” which was on pace to collect $83.5 million from 4,300 theaters in the United States and Canada from Friday through Monday, according to Comscore, which compiles box office data. Overseas, the well-reviewed movie, notable for being Marvel’s first Asian-led superhero spectacle, generated an additional $56.2 million. “Shang-Chi” cost roughly $200 million to make.