DealBook: Delta Takes 49% Stake in Virgin Atlantic for $360 Million

There are few more lucrative airline routes than the one between the financial powerhouses of New York and London. On Tuesday, Delta Air Lines signaled that it was going after that business-heavy market, agreeing to buy a 49 percent stake in Virgin Atlantic from Singapore Airlines for $360 million.

The deal will provide Delta with more access to Heathrow Airport, one of the world’s busiest hubs, where takeoff and landing rights are limited because of high demand and tight capacity. New York, where all major airlines are battling to attract high-paying passengers, is the top international destination from Heathrow.

Singapore bought its stake in 2000 for £600.3 million ($966 million), but it has been dissatisfied with the returns, analysts said. While Delta had considered buying Singapore’s stake two years, the carriers could not agree on a price.

On Tuesday, Delta and Virgin Atlantic said they would apply for antitrust immunity from American and European competition authorities in order to coordinate fares and flight schedules, as well as offer seats on each other’s planes. Virgin Group, headed by the British billionaire Richard Branson, has said it does not plan to sell its 51 percent controlling majority in Virgin Atlantic.

Delta has a strong partnership with Air France-KLM that serves many European destinations, but it is not a strong contender in the London market. Delta has nine daily flights to Heathrow from New York, Boston and Atlanta. But it has no direct flights from other top markets like San Francisco, Chicago, Washington, D.C., Miami or Los Angeles, requiring passengers to connect through its other hubs.

Heathrow is operating at full capacity, and the British government has rejected expansion plans to build a third runway. As a result, landing and takeoff rights, known as slots, are limited, making them rare and prized commodities for the airlines.

Getting more slots, however, is no simple matter even for an airline like Delta, which has global ambitions. Delta has just 0.3 percent of the Heathrow slots, according to the Airport Coordination Limited, which is responsible for slot allocations at airports in Britain.

British Airways dominates Heathrow, with 53 percent of the slots, followed by Lufthansa of Germany, with 5.6 percent, and Virgin with 3.3 percent. American and United each have 2.3 percent.

British Airways’ hold on the airport actually increased in the last year after it completed the acquisition of British Midland International from Lufthansa. The acquisition was challenged by Virgin Atlantic, which claimed it would distort competition and simply reinforce the dominance of British Airways. The deal, however, was cleared by the European Commission in March under certain conditions, including that 14 of the 56 daily slot pairs British Airways received from British Midland be released to other carriers.

Still, Delta’s move is a challenge to American Airlines and British Airways, which are partners in the Oneworld global alliance. The two carriers dominate the New York to London market with 15 daily flights and a shuttlelike schedule of departures every 20 or 30 minutes in the peak evening hours. British Airways and American received antitrust immunity two years ago allowing them to coordinate their schedules and fares.

Delta’s challenge in New York comes at a weak time for American Airlines, which has been in bankruptcy for over a year and which counts New York as one of its five major hubs. Delta is spending $1.2 billion in New York to build a new
terminal at Kennedy Airport to replace its outdated facilities there. It has also expanded its presence at La Guardia Airport, which serves mostly domestic locations, with a deal to exchange landing right with US Airways.

United Airlines, for its part, holds a dominant position at Newark Liberty International Airport since merging with Continental Airlines in 2010.

Virgin was founded by Mr. Branson in 1984 with flights to New York. From the start, it embraced an image of fun travel and cheaper fares. It now has 38 airplanes in its fleet and flies to more than two dozen destinations. But the airline, which is not aligned with any of the three global groups – ­Star Alliance, Sky Team and Oneworld Alliance – has struggled in recent years because of high fuel prices.

The announcement in New York came a day after Virgin disclosed its plans to start domestic flights within the United Kingdom in the spring, with service to Edinburgh and Aberdeen in Scotland. Thanks to slots at Heathrow that British Airways gave up, Virgin will add 24 domestic flights a day.

The Virgin Group also own 25 percent of Virgin America, a low-cost domestic carrier that is independent of its international namesake. American law forbids foreigners from owning more than 25 percent of a domestic
airline. The European Union has a similar requirement barring non-European carriers from holding a majority stake in a European Union airline.

Air France-KLM is also considering buying part of Mr. Branson’s stake in Virgin Atlantic, according to reports in the British media. Such a deal, if it happened, would further strengthen Delta, which is a partner with Air France within the Sky Team alliance.

With the deal, Delta is wading into an old and often feisty rivalry opposing Virgin and British Airways.

Willie Walsh, who runs the parent company of British Airways, the International Airlines Group, said recently that Delta was really more interested in Virgin’s slots at Heathrow than in preserving the airline or its brand.

“I can’t see Delta wanting to operate the Virgin brand because if they do, what does that say about the Delta brand?” Mr. Walsh told Britain’s Telegraph newspaper in an interview. “Delta believes they are the No. 1 airline in the world, so what they would want to do is acquire the slots at Heathrow to enable them to have a strong presence at Heathrow.”

The comments drew a quick response from Mr. Branson, doubled with a characteristic challenge.

“Rumors have been spread in the press that I am planning to give up control of Virgin Atlantic and, according to Willie Walsh (who runs BA) that our brand will soon disappear,” Mr. Branson said on Monday in a statement titled “Sorry BA ­we’re not going anywhere.” “This is wishful thinking and totally misguided. Will BA never learn?”

Mr. Branson then offered to give employees of British Airways £1 million if Virgin Atlantic disappeared within the next five years. If it was still in business then, he challenged Mr. Walsh to pay the same amount to Virgin’s employees.

“Let’s see how much they believe this,” he said. “Let them put their money where their mouth is.”

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Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

Read More..

Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

Read More..

Huawei to Open Research Center in Finland

PARIS — Huawei Technologies, a Chinese maker of telecommunications equipment, said on Monday that it planned to open a research and development center in Helsinki next year, accelerating its investments in Europe, where its business is expanding rapidly.

The move illustrates a trans-Atlantic difference in attitudes toward Huawei. The company has been largely shut out of the United States market for network gear because of Congressional concerns about possible security threats — fears the company insists are unfounded.

While Huawei has faced difficulties in some European markets, like France, it has done better elsewhere. Huawei employs more than 7,000 people in the region, and it says that total could double in the next three to five years. Huawei already has a research center in Italy and is studying the possibility of opening one in Spain. It also recently announced a $2 billion investment in Britain.

The planned center in Helsinki, involving an investment of 70 million euros, or about $90 million, will work on smartphone development, including features like user interfaces and power management, the company said. When the center opens next year, it will employ 30 people, but this could grow to 100 over the next five years, the company said.

The announcement is a plus for the Finnish technology industry, which has been suffering from the woes at Nokia. The company was once the world’s biggest cellphone maker, but its market share has fallen sharply in recent years.

“The open and innovative environment in Finland,” Huawei said, “is an ideal place for Huawei to strengthen our global R.& D. capabilities for devices, creating opportunities for both Huawei and the Finnish telecommunications industry.”

Huawei has been known mostly for its network equipment, but the company is pushing to make a name for itself with its handsets.

Mobile devices accounted for 22 percent of its revenue last year, an increase of 37 percent. That compares with growth of 12 percent for the overall business.

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Libyan Reluctance Hobbles Benghazi Assault Investigation

WASHINGTON — An unarmed American military surveillance drone now flies virtually every day over Benghazi, gathering information and poised to respond at a moment’s notice if any of the suspects believed to be behind the attacks last Sept. 11 on the American Mission in the Libyan city are located.

But three months after the assault that killed Ambassador J. Christopher Stevens and three other Americans, the investigation into the attacks has been hobbled by the reluctance of the Libyan authorities to move against Islamist extremist suspects who belong to powerful militias, officials briefed on the investigation said. While the F.B.I. has identified several suspects, none have been arrested and some have fled Benghazi.

In an effort to generate as many leads as possible, the F.B.I. issued a global appeal last month asking anyone with information about the assailants to send tips in an e-mail, a text message or a post on a bureau Facebook page.

Even as frustration builds over the inquiry’s sputtering progress, American officials insist that at least for now they intend to fulfill President Obama’s vow to bring the killers to justice by working with the Libyan authorities, though that means sorting through delicate issues like sovereignty and the weakness of the Libyan government. For now, a decision whether to try suspected assailants in Libyan or American courts has not been made, officials said.

“This case is surrounded and intertwined with sensitivities — it is a process of doing business there and respecting their sovereignty,” said one American official who has been briefed on the investigation and who spoke on the condition of anonymity because the inquiry is continuing.

Under increasing pressure from the Obama administration, there have been some halting steps forward in recent weeks.

Since first visiting Benghazi in early October, F.B.I. agents have returned to the city at least twice, accompanied by small United States military and Libyan security teams, to interview witnesses and collect other information related to the attack. Libyan witnesses have identified suspects caught on surveillance cameras at the mission and in photos taken during the attacks, American officials said.

Gen. Carter F. Ham, the head of the military’s Africa Command, said in an interview that investigators now believed that they had identified some but not all of the major actors in the attack on the diplomatic mission and the nearby C.I.A. annex, but “we don’t yet have sufficient information to indict anyone. They’re still collecting and building information.”

“The Libyans clearly accept responsibility” for investigating the attack, General Ham said, but “I have expressed to the Libyans that it hasn’t proceeded as quickly as any of us would have liked.”

A senior F.B.I. official is leading a team of what the American official described as “handpicked counterterrorism agents experienced in working overseas.” Many agents are from the F.B.I.’s New York office, the official said. The F.B.I.’s legal attaché from the United States Embassy in Cairo has also been involved with the investigation.

The official said that in contrast to a typical investigation in the United States, which is focused on making a case in a courtroom, the F.B.I. agents in Libya are primarily focused on establishing what occurred before and during the attacks.

“This is an intelligence-driven investigation, the goal is to establish the facts,” the official said. “Like this and other cases abroad, we have to be very sensitive. Every country is different when there is investigating on their turf.”

Among the obstacles the F.B.I. has encountered in Libya has been a reluctance by some police and government officials there to target members of Ansar al-Shariah, a local Islamist group whose fighters joined the attack, according to witnesses.

Government officials in Benghazi have said it would be impossible for their weak, lightly armed forces to arrest militia members. Leaders of Benghazi’s most powerful militias, some of whom fought with Ansar al-Shariah members during the Libyan uprising against Col. Muammar el-Qaddafi, say they would be hesitant to act against suspects unless they were presented with conclusive proof of their involvement.

One witness in Libya said in an interview that the F.B.I. tried to question him in front of other Libyans, making the witness nervous that the Libyans could reveal his identity. Other witnesses have said they fear that the F.B.I. will not protect them if they cooperate with the investigation.

Kareem Fahim and David D. Kirkpatrick contributed reporting from Benghazi, Libya.

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Euro Watch: Italian Political Turmoil Weighs on Markets

ROME — Italian bond yields were sharply higher Monday, and Italian stocks led major European indexes lower, after a weekend of political turmoil in Italy gave rise to fears that the country was headed for renewed instability.

Former Prime Minister Silvio Berlusconi said he would again seek Italy’s highest office after pulling his party’s support from Mario Monti, the unelected official who currently holds the office. Mr. Monti decided over the weekend to step down.

Mr. Monti has restored Italy’s credibility with investors, giving the country a break on its borrowing costs. But those gains have come at the cost of painful austerity measures that have worsened the country’s economic situation, and given Mr. Berlusconi an opening to attack.

Mr. Monti will leave after Parliament passes a budget this month and may contest national elections against Mr. Berlusconi, with the vote — previously scheduled for April — now possible as early as February or March.

Mr. Berlusconi, a four time prime minister, left office a year ago as markets pushed Italy to the brink of financial collapse.

The Milan benchmark MIB index was down 3.6 percent in the early European afternoon, with trading halted in the shares of two banks, Monte Paschi and Banca Popolare di Milano, after they fell by their maximum daily limit.

The yield gap, or spread, between Italian 10-year sovereign bonds and equivalent German securities, the European benchmark for safety, grew to 3.61 percentage points Monday from 3.25 points late Friday, suggesting that investors were growing more wary of holding Italian debt.

A barometer of euro zone blue-chip stocks, the Euro Stoxx 50 index, fell 1.1 percent. The euro was little changed from its levels in New York Friday, at $1.2907.

“It’s as if a tank moved through” the market, said Mario Sechi, editor in chief of the Rome daily Il Tempo, speaking on Radio 24 on Monday morning. Like many Italian commentators, Mr. Sechi expressed reservations about Mr. Berlusconi’s decision to return to politics.

A dismal economic report Monday served as a reminder that despite Mr. Monti’s success with investors, the real economy continues to suffer. Italian industrial production fell a seasonally adjusted 1.1 percent in October from September, and by 6.2 percent from a year earlier, the national Istat statistics agency reported from Rome.

The coming Italian election “remains high on our list of tail risks for 2013,” Holger Schmieding, an economist in London with Berenberg Bank, wrote in a research note. “A Berlusconi campaign against ‘German austerity’ could potentially unsettle markets,” he noted, and possibly push Spain or Italy into a bailout and additional bond purchases by the European Central Bank to hold down borrowing costs.

Spanish bonds also came under renewed pressure following Mr. Monti’s announcement, with the risk premium demanded by investors for holding Spanish 10-year bonds rather than equivalent German bonds rising to 4.38 percentage points on Monday morning, from 4.16 points on Friday.

Luís de Guindos, the economy minister, warned that Italy’s political turmoil would have an impact on Spain. “When doubts emerge over the stability of a neighboring country like Italy, which is also seen as vulnerable, there’s an immediate contagion for us,” he said Monday morning on Spanish national radio.

Asked whether Spain would itself seek further European rescue funding, the minister instead said that “the help that Spain needs is that the doubts over the future of the euro be removed.”

Speaking ahead of the Nobel prize awards on Monday, the European Commission president, José Manuel Barroso, said that Italy had to “continue on the road of structural reforms.” The elections, Mr. Barroso said on Sky News, “must not be used to postpone reforms.”

David Jolly reported from Paris. Raphael Minder contributed reporting from Madrid.

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The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Read More..

The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

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IHT Rendezvous: Philosophy, or Plumbing: How Well Is Academia Preparing Students for the Real World?

A report being released Monday by the McKinsey Center for Government shows a big disconnect between new grads looking for work and the employers looking to hire them. Both sides have acknowledged that something is amiss: Only 42 percent of employers felt that new hires were adequately prepared by their education or formal training. Similarly, only 45 percent of graduates felt they were adequately prepared for even entry-level positions in their field.

But when asked the same question, 72 percent of education providers felt that they adequately prepared students for the workplace. Given that many graduates and recruiters disagree, one could say that academia is either overly optimistic or simply out of touch about its own usefulness.

This mismatch has turned into a global problem. McKinsey estimates that 75 million young people are unemployed worldwide.

McKinsey has invited panelists from all over the world to debate this divide on a live Web chat starting at 9 a.m. E.S.T. on Monday. You can register to watch it here.

The McKinsey report offers a range of practical solutions, like curriculums designed by companies, on-site job training and better career advice.

But there is a larger question: What is the point of a university education?

Some would say that it is the only time that a young person can luxuriate in learning for the sake of learning, for the sheer joy of it. When else can you fill your head with everything from foreign languages to science, and be on both the debate team and the cheerleading squad? The ability to be creative, inquisitive, critical and open-minded is invaluable. Most educators will tell you that it’s not the piece of paper you get at the end that matters, but what you learned on the way.

The counter-argument is that there are an awful lot of well-rounded, brilliant philosophy majors leaving school with student debt, no job prospects and no marketable skills. A cynic would say that many of them would be more gainfully employed had they spent three or four years learning a practical trade. There are plenty of plumbers, chefs and mechanics out-earning new university graduates right now.

In economically trying times — in the face of alarming rates of youth unemployment — are philosophy degrees a luxury that some students simply cannot afford?

Should everyone go to university? Should schools focus on creating well-rounded graduates, or on teaching specific, technical skills needed by the marketplace?

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Changes to Agriculture Highlight Cuba’s Problems

HAVANA — Cuba’s liveliest experiment with capitalism unfolds every night in a dirt lot on the edge of the capital, where Truman-era trucks lugging fresh produce meet up with hundreds of buyers on creaking bicycle carts clutching wads of cash.

“This place, it feeds all of Havana,” said Misael Toledo, 37, who owns three small food stores in the city. “Before, you could only buy or sell in the markets of Fidel.”

The agriculture exchange, which sprang up last year after the Cuban government legalized a broader range of small businesses, is a vivid sign of both how much the country has changed, and of all the political and practical limitations that continue to hold it back.

President Raúl Castro has made agriculture priority No. 1 in his attempt to remake the country. He used his first major presidential address in 2007 to zero in on farming, describing weeds conquering fallow fields and the need to ensure that “anyone who wants can drink a glass of milk.”

No other industry has seen as much liberalization, with a steady rollout of incentives for farmers. And Mr. Castro has been explicit about his reasoning: increasing efficiency and food production to replace imports that cost Cuba hundreds of millions of dollars a year is a matter “of national security.”

Yet at this point, by most measures, the project has failed. Because of waste, poor management, policy constraints, transportation limits, theft and other problems, overall efficiency has dropped: many Cubans are actually seeing less food at private markets. That is the case despite an increase in the number of farmers and production gains for certain items. A recent study from the University of Havana showed that market prices jumped by nearly 20 percent in 2011 alone. And food imports increased to an estimated $1.7 billion last year, up from $1.4 billion in 2006.

“It’s the first instance of Cuba’s leader not being able to get done what he said he would,” said Jorge I. Domínguez, vice provost for international affairs at Harvard, who left Cuba as a boy. “The published statistical results are really very discouraging.”

A major cause: poor transportation, as trucks are in short supply, and the aging ones that exist often break down.

In 2009, hundreds of tons of tomatoes, part of a bumper crop that year, rotted because of a lack of transportation by the government agency charged with bringing food to processing centers.

“It’s worse when it rains,” said Javier González, 27, a farmer in Artemisa Province who described often seeing crops wilt and rot because they were not picked up.

Behind him were the 33 fertile, rent-free acres he had been granted as part of a program Mr. Castro introduced in 2008 to encourage rural residents to work the land. After clearing it himself and planting a variety of crops, Mr. Gonzalez said, he was doing relatively well and earned more last year than his father, who is a doctor, did.

But Cuba’s inefficiencies gnawed at him. Smart, strong, and ambitious, he had expansion plans in mind, even as in his hand he held a wrench. He was repairing a tractor part meant to be grading land. It was broken. Again.

The 1980s Soviet model tractor he bought from another farmer was as about good as it gets in Cuba. The Cuban government maintains a monopoly on selling anything new, and there simply is not enough of anything — fertilizer, or sometimes even machetes — to go around.

Government economists are aware of the problem. “If you give people land and no resources, it doesn’t matter what happens on the land,” said Joaquin Infante of the Havana-based Cuban National Association of Economists.

But Mr. Castro has refused to allow what many farmers and experts see as an obvious solution to the shortages of transportation and equipment: Let people import supplies on their own. “It’s about control,” said Philip Peters, a Cuba analyst with the Lexington Institute, a Virginia-based research group.

Other analysts agree, noting that though the agricultural reforms have gone farther than other changes — like those that allow for self-employment — they remain constrained by politics.

“The government is not ready to let go,” said Ted Henken, a Latin American studies professor at Baruch College. “They are sending the message that they want to let go, or are trying to let go, but what they have is still a mechanism of control.”

For many farmers, that explains why land leases last for 10 years with a chance to renew, not indefinitely or the 99 years offered to foreign developers. It is also why many farmers say they will not build homes on the land they lease, despite a concession this year to allow doing so.

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