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Live Updates: Covid Wave Dampens New Year Observances Worldwide

Life was supposed to return to normal this year. Instead, 2021 turned into a kind of purgatory. But there is good reason to hope 2022 will be better.

As this year comes to a close, we want to look back on the arc of the pandemic — and look ahead to the new year that starts Saturday.

This past year began with the ramping up of a mass vaccination campaign, which many people celebrated by taking post-shot selfies of their bandaged arms. By February, new Covid-19 cases were plummeting, and by spring, the virus seemed as if it might be in permanent retreat. On June 2, President Biden gave a speech looking ahead to “a summer of freedom, a summer of joy.”

But then came a turning point of 2021: the emergence of the Delta variant.

It began spreading in the U.S. in the late spring and caused many more infections among the vaccinated than earlier versions of the virus. The overwhelming majority of these breakthrough infections were mild, but they did have the potential to cause serious illness in the older and other vulnerable people.

Delta also sparked new outbreaks among the unvaccinated, and tens of thousands of them died. Ultimately, the U.S. death toll from Covid in 2021 — more than 475,000 — exceeded the 2020 toll. The increase is especially tragic, epidemiologists say, because the availability of vaccines had made most of those deaths avoidable.

Altogether, the year ending tonight has often felt disappointing and grim.

In addition to the direct damage from Covid, the disruptions to daily life — intended to slow the spread of the virus — have brought their own costs. Children have fallen behind in school, and for many, isolation has worsened their mental health. Adults are struggling, too; Americans’ blood pressure has risen, and drug overdoses have soared.

Even people who have avoided the worst of the pandemic’s damage often feel fed up. And the latest variant, Omicron, has sent cases soaring again, to their highest levels yet, and raised the prospect that 2022 will be another year of pandemic purgatory.

At this point, it should be clear that there are no Covid guarantees. Perhaps future variants will emerge, even more dangerous than Omicron or Delta. But the most likely scenario is more hopeful, many experts believe. As the New Year arrives, there are reasons to hope that 2022 will become what people expected 2021 to be — the year that Covid switched from being a pandemic to an endemic virus, not so different from the flu.

Emerging evidence suggests that Omicron really is milder than earlier versions of this coronavirus (either because of intrinsic biological reasons or because of higher levels of population immunity). In South Africa and England, as well as New York, San Francisco and other parts of the U.S., hospitalization numbers are lower than doctors feared.

Omicron will still do terrible damage, especially among the millions of middle-aged and older Americans who remain unvaccinated as well as the hundreds of millions of adults worldwide who remain unvaccinated, because of either vaccine skepticism or unavailability. Many hospitals face the risk of being overwhelmed in the coming weeks.

But when the current surge begins receding, it will likely have left a couple of silver linings. Omicron is so contagious that it will have infected a meaningful share of the population, increasing the amount of Covid immunity and helping defang the virus.

As important, the world has more powerful weapons to fight Covid than it did only a few weeks ago: two new post-infection treatments, one from Merck and a more powerful one from Pfizer, that lower the risk of hospitalization and death. With Pfizer’s treatment, the reduction is almost 90 percent, according to early research trials.

All of which suggests that the U.S. could emerge from the Omicron wave significantly closer to the most realistic Covid future — one in which it becomes an endemic disease that is a more normal part of daily life. It will still cause illness and death; a typical flu season kills about 35,000 Americans, most of them older. For the foreseeable future, battling Covid — through vaccination, treatment and research — will remain important.

But endemic disease does not need to dominate life the way a pandemic does. It does not need to cause the sort of social isolation and public health problems that Covid has over the past two years.

If the U.S. reaches that point in 2022 — as looks likely — the next New Year’s Eve will feel a lot more satisfying than this one.

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First Fires, Then Floods: Climate Extremes Batter Australia

WEE WAA, Australia — Two years ago, the fields outside Christina Southwell’s family home near the cotton capital of Australia looked like a dusty, brown desert as drought-fueled wildfires burned to the north and south.

Last week, after record-breaking rains, muddy floodwaters surrounded her, along with the stench of rotting crops. She had been trapped for days with just her cat, and still didn’t know when the sludge would recede.

“It seems to take for bloody ever to go away,” she said, watching a boat carry food into the town of Wee Waa. “All it leaves behind is this stink, and it’s just going to get worse.”

Life on the land has always been hard in Australia, but the past few years have delivered one extreme after another, demanding new levels of resilience and pointing to the rising costs of a warming planet. For many Australians, moderate weather — a pleasant summer, a year without a state of emergency — increasingly feels like a luxury.

Black Summer bush fires of 2019 and 2020 were the worst in Australia’s recorded history. This year, many of the same areas that suffered through those epic blazes endured the wettest, coldest November since at least 1900. Hundreds of people, across several states, have been forced to evacuate. Many more, like Ms. Southwell, are stranded on floodplain islands with no way to leave except by boat or helicopter, possibly until after Christmas.

La Niña in full swing, meteorologists are predicting even more flooding for Australia’s east coast, adding to the stress from the pandemic, not to mention from a recent rural mouse plague of biblical proportions.

pregnancies on pause, shows that the El Niño-La Niña cycle has been around long enough for flora and fauna to adapt.

more than doubled since the 1970s.

Ron Campbell, the mayor of Narrabri Shire, which includes Wee Waa, said his area was still waiting for government payments to offset damage from past catastrophes. He wondered when governments would stop paying for infrastructure repairs after every emergency.

“The costs are just enormous, not just here but at all the other places in similar circumstances,” he said.

60 percent of the trees in some places. Cattle farmers culled so much of their herds during the drought that beef prices have risen more than 50 percent as they rush to restock paddocks nourished (nearly to death) by heavy rain.

Bryce Guest, a helicopter pilot in Narrabri, once watched the dust bowls grow from above. Then came “just a monstrous amount of rain,” he said, and new kind of job: flights to mechanical pumps pushing water from fields to irrigation dams in a last-ditch effort to preserve crops that had been heading for a record harvest.

On one recent flight, he pointed to mountains of stored grain — worth six figures, at least — that were ruined by the rains, with heavy equipment trapped and rusting next to it. Further inland, a home surrounded by levees had become a small island accessible only by boat or copter.

“Australia is all about water — everything revolves around it,” he said. “Where you put your home, your stock. Everything.”

The flood plains in what is known as the Murray-Darling basin stretch out for hundreds of miles, not unlike the land at the mouth of the Mississippi River. The territory is so flat that towns can be cut off with roads flooded by less than an inch of additional rain.

That happened a few weeks ago in Bedgerabong, a few hundred miles south of Narrabri. On a recent afternoon, a couple of teachers were being driven out of town in a hulking fire truck — equipment for one disaster often serves another. Across a flooded road behind them, three other teachers had decided to camp out so they could provide some consistency for children who had already been kept out of school for months by pandemic lockdowns.

Paul Faulkner, 55, the principal of the school (total enrollment: 42), said that many parents craved social connection for their children. The Red Cross has sent in booklets for those struggling with stress and anxiety.

“Covid has kept everyone from their families,” he said. “This just isolates them even more.”

He admitted that there were a few things they did not discuss; Santa, for one. The town is expected to be cut off until after the holidays as the waters that rose with surging rains over a few days take weeks to drain and fade.

In Wee Waa, where the water has started to recede, supplies and people flowed in and out last week by helicopter and in a small boat piloted by volunteers.

Still, there were shortages everywhere — mostly of people. In a community of around 2,000 people, half of the teachers at the local public school couldn’t make it to work.

At the town’s only pharmacy, Tien On, the owner, struggled with a short-handed staff to keep up with requests. He was especially concerned about delayed drug deliveries by helicopter for patients with mental health medications.

Ms. Southwell, 69, was better prepared than most. She spent 25 years volunteering with emergency services and has been teaching first aid for decades. After a quick trip into Wee Waa by boat, she returned to her home with groceries and patience, checking a shed for the stray cats she feeds and discovering that only one of her chickens appeared to have drowned.

She said she wasn’t sure how much climate change could be blamed for the floods; her father had put their house on higher stilts because they knew the waters would rise on occasion.

All she knew was that more extreme weather and severe challenges to the community would be coming their way.

“The worst part of it is the waiting,” she said. “And the cleanup.”

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Refinery Mission Breaks Ground on Transitional Housing Complex

OPELOUSAS, La.–(BUSINESS WIRE)–Yesterday, the Refinery Mission and its staff joined representatives from St. Landry Homestead Federal Savings Bank (St. Landry Homestead FSB) and the Federal Home Loan Bank of Dallas (FHLB Dallas) to break ground on a new transitional housing facility that will serve adult men.

Refinery Mission is a faith-based emergency and transitional housing facility for men who are homeless or transitioning from jail, rehab, mental health facilities or hospitals. The organization’s goal is to provide the support its residents need to move toward self-sufficiency and stability.

The banks awarded Refinery Mission a $750,000 Affordable Housing Program (AHP) subsidy to help fund the $1.5 million construction project creating 44 additional units for its residents.

Johnny Carriere Jr., executive director at the Refinery Mission, said the funds will help tremendously.

“The funds are very critical to this project,” said Mr. Carriere. “The Affordable Housing Program is a game changer and a great tool that allows us to serve people who need our help. The subsidy will allow us to increase our intake and open the door for emergency beds for guys who are in more vulnerable situations. It’s hard for me to describe how appreciative we are for St. Landry Homestead FSB and FHLB Dallas’ commitment to the community.”

St. Landry Homestead FSB President and CEO Joe Zanco commended Refinery Mission’s involvement in the community.

“The Refinery Mission has a strong commitment to serving those in need across our community,” Mr. Zanco said. “We are honored to be involved with the Affordable Housing Program and to partner with FHLB Dallas to help improve programs and housing for those who are just getting the opportunity for a fresh start.”

AHP funds are intended to assist FHLB Dallas members in financing the purchase, construction and/or rehabilitation of owner-occupied, rental or transitional housing and housing for the homeless. AHP funds must be used to benefit households with incomes at or below 80 percent of the median income for the area.

For 2021, FHLB Dallas awarded $18.5 million in subsidies to 26 affordable housing projects. The funds will help create 2,113 new or rehabilitated housing units. Included in that total, are $3 million in subsidies for 323 units of housing in the state of Louisiana.

Between 1990 and 2020, FHLB Dallas awarded more than $323 million in AHP and Homeownership Set-Aside Programs and has assisted more than 57,000 households.

“Partnering with our members to support community housing efforts is part of FHLB Dallas’ mission,” said Greg Hettrick, first vice president and director of Community Investment at FHLB Dallas. “St. Landry Homestead FSB is a valued partner in this commitment, and we appreciate its involvement in the Affordable Housing Program to help improve the community it serves.”

For more information about the AHP, visit fhlb.com/ahp.

About St. Landry Homestead Federal Savings Bank

St. Landry Homestead Federal Savings Bank, founded in 1922, is a federally-chartered savings bank that serves the banking needs of customers in our market area in the Acadiana region of south central Louisiana. We operate from our headquarters and main banking office in Opelousas, Louisiana, as well as three additional full-service branch offices located in St. Landry Parish and two branch offices located in Lafayette Parish, Louisiana.

About the Federal Home Loan Bank of Dallas

The Federal Home Loan Bank of Dallas is one of 11 district banks in the FHLBank System created by Congress in 1932. FHLB Dallas, with total assets of $60.2 billion as of September 30, 2021, is a member-owned cooperative that supports housing and community development by providing competitively priced loans and other credit products to approximately 800 members and associated institutions in Arkansas, Louisiana, Mississippi, New Mexico and Texas. For more information, visit our website at fhlb.com.

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The Economic Rebound Is Still Waiting for Workers

Some businesses seem determined to wait them out. Wages have risen, but many employers appear reluctant to make other changes to attract workers, like flexible schedules and better benefits. That may be partly because, for all their complaints about a labor shortage, many companies are finding that they can get by with fewer workers, in some instances by asking customers to accept long waits or reduced service.

“They’re making a lot of profits in part because they’re saving on labor costs, and the question is how long can that go on,” said Julia Pollak, chief economist for the employment site ZipRecruiter. Eventually, she said, customers may get tired of busing their own tables or sitting on hold for hours, and employers may be forced to give into workers’ demands.

Some businesses are already changing how they operate. When Karter Louis opened his latest restaurant this year, he abandoned the industry-standard approach to staffing, with kitchen workers earning low wages and waiters relying on tips. At Soul Slice, his soul-food pizza restaurant in Oakland, Calif., everyone works full time, earns a salary rather than an hourly wage, and receives health insurance, retirement benefits and paid vacation. Hiring still hasn’t been easy, he said, but he isn’t having the staffing problems that other restaurants report.

Restaurant owners wondering why they can’t find workers, Mr. Louis said, need to look at the way they treated workers before the pandemic, and also during it, when the industry laid off millions.

“The restaurant industry didn’t really have the back of its people,” he said.

Still, better pay and benefits alone won’t bring back everyone who has left the job market. The steepest drop in labor force participation came among older workers, who faced the greatest risks from the virus. Some may return to work as the health situation improves, but others have simply retired.

And even some nowhere near retirement have made ends meet outside a traditional job.

When Danielle Miess, 30, lost her job at a Philadelphia-area travel agency at the start of the pandemic, it was in some ways a blessing. Some time away helped her realize how bad the job had been for her mental health, and for her finances — her bank balance was negative on the day she was laid off. With federally supplemented unemployment benefits providing more than she made on the job, she said, she gained a measure of financial stability.

Ms. Miess’s unemployment benefits ran out in September, but she isn’t looking for another office job. Instead, she is cobbling together a living from a variety of gigs. She is trying to build a business as an independent travel agent, while also doing house sitting, dog sitting and selling clothes online. She estimates she is earning somewhat more than the roughly $36,000 a year she made before the pandemic, and although she is working as many hours as ever, she enjoys the flexibility.

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Singapore Struggles to Reopen After Vaccinations

The country’s experience has become a sobering case study for other nations pursuing reopening strategies without first having had to deal with large outbreaks in the pandemic. For the Singapore residents who believed the city-state would reopen once the vaccination rate reached a certain level, there was a feeling of whiplash and nagging questions about what it would take to reopen if vaccines were not enough.

“In a way, we are a victim of our own success, because we’ve achieved as close to zero Covid as we can get and a very, very low death rate,” said Dr. Paul Tambyah, an infectious diseases specialist at National University Hospital. “So we want to keep the position at the top of the class, and it’s very hard to do.”

vaccinated people are already gathering at concerts, festivals and other large events. But unlike Singapore, both of those places had to manage substantial outbreaks early in the pandemic.

Lawrence Wong, Singapore’s finance minister and a chair of the country’s Covid-19 task force, said the lesson for “Covid-naive societies” like Singapore, New Zealand and Australia is to be ready for large waves of infections, “regardless of the vaccine coverage.”

up against the Delta variant, Mr. Wong said.

“In Singapore, we think that you cannot just rely on vaccines alone during this intermediate phase,” he said. “And that’s why we do not plan an approach where we reopen in a big bang manner, and just declare freedom.”

highest since 2012, a trend that some mental health experts have attributed to the pandemic. People have called on the government to consider the mental health concerns caused by the restrictions.

“It’s just economically, sociologically, emotionally and mentally unsustainable,” said Devadas Krishnadas, chief executive at Future-Moves Group, a consultancy in Singapore. Mr. Krishnadas said the decision to reintroduce restrictions after reaching such a high vaccination rate made the country a global outlier.

granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for mandates in both the public and private sectors. Such mandates are legally allowed and have been upheld in court challenges.

  • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
  • Schools. California became the first state to issue a vaccine mandate for all educators and to announce plans to add the Covid-19 vaccine as a requirement to attend school, which could start as early as next fall. Los Angeles already has a vaccine mandate for public school students 12 and older that begins Nov. 21. New York City’s mandate for teachers and staff, which went into effect Oct. 4 after delays due to legal challenges, appears to have prompted thousands of last-minute shots.
  • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get vaccinated. Mandates for health care workers in California and New York State appear to have compelled thousands of holdouts to receive shots.
  • Indoor activities. New York City requires workers and customers to show proof of at least one dose of the Covid-19 for indoor dining, gyms, entertainment and performances. Starting Nov. 4, Los Angeles will require most people to provide proof of full vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.
  • At the federal level. On Sept. 9, President Biden announced a vaccine mandate for the vast majority of federal workers. This mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services.
  • In the private sector. Mr. Biden has mandated that all companies with more than 100 workers require vaccination or weekly testing, helping propel new corporate vaccination policies. Some companies, like United Airlines and Tyson Foods, had mandates in place before Mr. Biden’s announcement.
  • “I think a lot of times we are so focused on wanting to get good results that we just have tunnel vision,” she said.

    Ms. Ng lives across from a testing center. Almost daily, she watched a constant stream of people go in for tests, a strategy that many public health experts say is a waste of resources in such a highly vaccinated country.

    “Freedom Day — as our ministers have said — is not the Singapore style,” said Jeremy Lim, an associate professor at the National University of Singapore and an expert on health policy, referring to England’s reopening in the summer. But moving too cautiously over the potential disadvantages of restrictions is a “bad public health” strategy, he said.

    The government should not wait for perfect conditions to reopen, “because the world will never be perfect. It’s so frustrating that the politicians are almost like waiting for better circumstances,” Dr. Lim said.

    Sarah Chan, a deputy director at Singapore’s Agency for Science, Technology and Research, said she had a fleeting taste of what normal life was like when she arrived in Italy last month to visit her husband’s family.

    No masks were required outdoors, vaccinated people could gather in groups, and Dr. Chan and her son could bop their heads to music in restaurants. In Singapore, music inside restaurants has been banned based on the notion that it could encourage the spread of the virus.

    Dr. Chan said she was so moved by her time in Italy that she cried.

    “It’s almost normal. You forget what that’s like,” she said. “I really miss that.”

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    Facebook, Instagram, WhatsApp Were Down: Here’s What to Know

    “With Facebook being down we’re losing thousands in sales,” said Mark Donnelly, a start-up founder in Ireland who runs HUH Clothing, a fashion brand focused on mental health that uses Facebook and Instagram to reach customers. “It may not sound like a lot to others, but missing out on four or five hours of sales could be the difference between paying the electricity bill or rent for the month.”

    Samir Munir, who owns a food-delivery service in Delhi, said he was unable to reach clients or fulfill orders because he runs the business through his Facebook page and takes orders via WhatsApp.

    “Everything is down, my whole business is down,” he said.

    Douglas Veney, a gamer in Cleveland who goes by GoodGameBro and who is paid by viewers and subscribers on Facebook Gaming, said, “It’s hard when your primary platform for income for a lot of people goes down.” He called the situation “scary.”

    Inside Facebook, workers also scrambled because their internal systems stopped functioning. The company’s global security team “was notified of a system outage affecting all Facebook internal systems and tools,” according to an internal memo sent to employees and shared with The New York Times. Those tools included security systems, an internal calendar and scheduling tools, the memo said.

    Employees said they had trouble making calls from work-issued cellphones and receiving emails from people outside the company. Facebook’s internal communications platform, Workplace, was also taken out, leaving many unable to do their jobs. Some turned to other platforms to communicate, including LinkedIn and Zoom as well as Discord chat rooms.

    Some Facebook employees who had returned to working in the office were also unable to enter buildings and conference rooms because their digital badges stopped working. Security engineers said they were hampered from assessing the outage because they could not get to server areas.

    Facebook’s global security operations center determined the outage was “a HIGH risk to the People, MODERATE risk to Assets and a HIGH risk to the Reputation of Facebook,” the company memo said.

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    Whistle-Blower Says Facebook ‘Chooses Profits Over Safety’

    John Tye, the founder of Whistleblower Aid, a legal nonprofit that represents people seeking to expose potential lawbreaking, was contacted this spring through a mutual connection by a woman who claimed to have worked at Facebook.

    The woman told Mr. Tye and his team something intriguing: She had access to tens of thousands of pages of internal documents from the world’s largest social network. In a series of calls, she asked for legal protection and a path to releasing the confidential information. Mr. Tye, who said he understood the gravity of what the woman brought “within a few minutes,” agreed to represent her and call her by the alias “Sean.”

    She “is a very courageous person and is taking a personal risk to hold a trillion-dollar company accountable,” he said.

    On Sunday, Frances Haugen revealed herself to be “Sean,” the whistle-blower against Facebook. A product manager who worked for nearly two years on the civic misinformation team at the social network before leaving in May, Ms. Haugen has used the documents she amassed to expose how much Facebook knew about the harms that it was causing and provided the evidence to lawmakers, regulators and the news media.

    knew Instagram was worsening body image issues among teenagers and that it had a two-tier justice system — have spurred criticism from lawmakers, regulators and the public.

    Ms. Haugen has also filed a whistle-blower complaint with the Securities and Exchange Commission, accusing Facebook of misleading investors with public statements that did not match its internal actions. And she has talked with lawmakers such as Senator Richard Blumenthal, a Democrat of Connecticut, and Senator Marsha Blackburn, a Republican of Tennessee, and shared subsets of the documents with them.

    The spotlight on Ms. Haugen is set to grow brighter. On Tuesday, she is scheduled to testify in Congress about Facebook’s impact on young users.

    misinformation and hate speech.

    In 2018, Christopher Wylie, a disgruntled former employee of the consulting firm Cambridge Analytica, set the stage for those leaks. Mr. Wylie spoke with The New York Times, The Observer of London and The Guardian to reveal that Cambridge Analytica had improperly harvested Facebook data to build voter profiles without users’ consent.

    In the aftermath, more of Facebook’s own employees started speaking up. Later that same year, Facebook workers provided executive memos and planning documents to news outlets including The Times and BuzzFeed News. In mid-2020, employees who disagreed with Facebook’s decision to leave up a controversial post from President Donald J. Trump staged a virtual walkout and sent more internal information to news outlets.

    “I think over the last year, there’ve been more leaks than I think all of us would have wanted,” Mark Zuckerberg, Facebook’s chief executive, said in a meeting with employees in June 2020.

    Facebook tried to preemptively push back against Ms. Haugen. On Friday, Nick Clegg, Facebook’s vice president for policy and global affairs, sent employees a 1,500-word memo laying out what the whistle-blower was likely to say on “60 Minutes” and calling the accusations “misleading.” On Sunday, Mr. Clegg appeared on CNN to defend the company, saying the platform reflected “the good, the bad and ugly of humanity” and that it was trying to “mitigate the bad, reduce it and amplify the good.”

    personal website. On the website, Ms. Haugen was described as “an advocate for public oversight of social media.”

    A native of Iowa City, Iowa, Ms. Haugen studied electrical and computer engineering at Olin College and got an M.B.A. from Harvard, the website said. She then worked on algorithms at Google, Pinterest and Yelp. In June 2019, she joined Facebook. There, she handled democracy and misinformation issues, as well as working on counterespionage, according to the website.

    filed an antitrust suit against Facebook. In a video posted by Whistleblower Aid on Sunday, Ms. Haugen said she did not believe breaking up Facebook would solve the problems inherent at the company.

    “The path forward is about transparency and governance,” she said in the video. “It’s not about breaking up Facebook.”

    Ms. Haugen has also spoken to lawmakers in France and Britain, as well as a member of European Parliament. This month, she is scheduled to appear before a British parliamentary committee. That will be followed by stops at Web Summit, a technology conference in Lisbon, and in Brussels to meet with European policymakers in November, Mr. Tye said.

    On Sunday, a GoFundMe page that Whistleblower Aid created for Ms. Haugen also went live. Noting that Facebook had “limitless resources and an army of lawyers,” the group set a goal of raising $10,000. Within 30 minutes, 18 donors had given $1,195. Shortly afterward, the fund-raising goal was increased to $50,000.

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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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