States pressed to guarantee Medicaid expansion

WASHINGTON — The Obama administration stepped up pressure on states Monday to guarantee insurance for all their low-income residents in 2014 under the new healthcare law, warning governors that the federal government would not pick up the total cost of partially expanding coverage.

"We continue to encourage all states to fully expand their Medicaid programs and take advantage of the generous federal matching funds to cover more of their residents," Health and Human Services Secretary Kathleen Sebelius wrote in a letter to governors.

But Sebelius indicated that governors who do not open their Medicaid programs to all eligible low-income residents would forfeit some of the federal aid promised by the Affordable Care Act.

"The law does not provide for a phased-in or partial expansion," the Department of Health and Human Services said in guidance accompanying Sebelius' letter.

Medicaid has become a major issue in the implementation of the law since the U.S. Supreme Court ruled in June that states can decide whether to expand their Medicaid programs in 2014.

The law originally required the states to open Medicaid to all Americans who earn less than 138% of the federal poverty level, a major change for a program that now largely covers poor children and mothers.

To ease the expansion, the law initially provides full federal funding to cover the new population. Currently, Medicaid costs are split between state and federal governments.

Nonetheless, several Republican governors have said they won't expand Medicaid, citing cost concerns. That prompted speculation that some states might partially expand Medicaid programs. But Obama administration officials said Monday the law did not authorize full federal funding for a more limited expansion.

A state that opens Medicaid to only some new low-income residents would qualify for reduced federal aid, requiring the state to come up with the remainder of the funding.

How the guidance will affect state decisions remains unclear.

Alan Weil, president of the National Academy for State Health Policy, said state leaders probably would not make final decisions until they worked out 2014 budgets next year. "A lot of what we have seen so far is posturing," he said.

But the administration's announcement drew quick criticism from the Republican Governors Assn.

"The Obama administration's refusal to grant states more flexibility on Medicaid is as disheartening as it is short-sighted," said Louisiana Gov. Bobby Jindal, the group's chairman. Jindal has said he will not expand Medicaid in his state.

In contrast, the administration's move was applauded by the National Assn. of Public Hospitals and Health Systems, whose members care for millions of the nation's uninsured, often without compensation. Dr. Bruce Siegel, the association president, said it "takes an important step toward significantly reducing the ranks of the uninsured."

The Obama administration is facing additional resistance from several Republican governors who have said they won't set up insurance exchanges — a cornerstone of the law that will allow Americans who don't get health benefits at work to shop for insurance plans that meet new minimum standards. The federal government can set up exchanges for states that refuse to do so.

Also Monday, Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington got conditional federal approval to operate their own exchanges. The six were the first to apply, and administration officials said approval for other states, including California, would probably follow.

noam.levey@latimes.com

Read More..

BlackBerry Messenger 7 adds free Wi-Fi voice calling, split-screen multitasking and more

Research in Motion (RIMM) updated its BlackBerry Messenger to version 7 on Monday, adding a new key feature called “BBM Voice” that “will allow customers to make free voice calls to their BBM contacts around the world over a Wi-Fi connection.” BBM 7 also introduces multitasking with split-screen, which allows users to BBM, check email, or use other apps while on a BBM Voice call; new compatibility with Bluetooth headsets and accessories, 16 new emoticons; direct BBM Update Notification that provides in-app alerts when new versions of an app are available and an easier way to synchronize BBM profiles; Groups; and Contacts with BBIDs for simpler backup and restores. BBM 7 is available as a free update for all BlackBerry smartphones running BlackBerry 6 OS or higher. Users on BlackBerry OS 5 will get BBM Voice “early next year.”

“BBM began as a convenient and effective business messaging tool, and today it is an essential part of daily communications for customers around the world,” said T.A. McCann, RIM’s Vice President of BBM and Social Communities. ”Now, with BBM version 7, customers have a new option: they can text and talk with their BBM contacts near and far, for free.”

Get more from BGR.com: Follow us on Twitter, Facebook

Gadgets News Headlines – Yahoo! News

Read More..

Luke Bryan cleans up at ACAs with 9 awards

Luke Bryan didn't want the American Country Awards to end.

He cleaned up during the fan-voted show, earning nine awards, including artist and album of the year. His smash hit "I Don't Want This Night To End" was named single and music video of the year.

Miranda Lambert took home the second most guitar trophies with three. Jason Aldean was named touring artist of the year. Carrie Underwood won female artist of the year, and a tearful Lauren Alaina won new artist of the year.

Bryan, Aldean, Keith Urban, Lady Antebellum and Trace Adkins with Lynyrd Skynrd were among the high-energy performances.

The third annual ACAs were held at Mandalay Bay in Las Vegas Monday night.

___

Online: http://www.theACAs.com

___

Follow http://www.twitter.com/AP_Country for the latest country music news from The Associated Press.

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..

Stocks open higher ahead of Fed meeting

Stocks opened higher Tuesday ahead of a meeting of the Federal Reserve and possible additional steps to bolster the U.S. economy.

The Dow Jones industrial average was up 67.5 points at 13,236 as of 9:42 a.m. EST. The Standard & poor's 500 was up eight points at 1426. The Nasdaq composite was up 22 points at 3,008.

Delta Air Lines rose 27 cents to $10.61 after the company said it will buy almost half of Richard Branson's Virgin Atlantic for $360 million as it seeks a bigger share of the lucrative New York-to-London travel market.

AIG gained 78 cents to $34.14 after the U.S. Treasury Department said that it has sold all of its remaining shares in the insurer. AIG was bailed out by the government after nearly collapsing during the financial crisis.

Stocks have edged up since the start of the month, eking out small advances, as investors watch for developments in the “fiscal cliff” talks, the tax increases and federal spending cuts scheduled to start Jan. 1 unless a deal is reached to reduce the U.S. budget deficit. Economists say the measures, if implemented, could eventually push the economy back into recession.

Stocks are holding on to their gains for the year. The Dow Jones is up 8.3 percent since the start of the year, while the S&P 500 has gained 13.3 percent.

The yield on the 10-year Treasury note rose 3 basis points to 1.65 percent.

Other stocks making big moves:

—Urban Outfitters shares rose $2.07 to $39.14 after the company said that sales at stores are increasing in the high single digit range. The retailer, which operates Anthropologie, Free People and its namesake stores, reported its third-quarter results in November, which fell just short of market expectations.

—Dollar General fell $1.01 to $45.61 after the company said that while its sales over the Thanksgiving weekend and the start of the holiday shopping season were encouraging, it remains cautious about the rest of the year, noting that consumer spending remains tight.

Read More..

Latin music star Jenni Rivera believed dead in plane crash

Fans of Mexican-American singing star Jenni Rivera held a vigil Sunday night in Lynwood

MEXICO CITY — Mexican American singer Jenni Rivera, the "diva de la banda" whose commanding voice burst through the limits of regional Latin music and made her a cross-border sensation and the queen of a business empire, was believed to have died Sunday when the small jet carrying her and members of her entourage crashed in mountainous terrain.

Rivera, a native of Long Beach, was 43. Mexico's ministry of transportation did not confirm her death outright, but it said that she had been aboard the plane and that no one had survived the crash. Six others, including two pilots, also were on board.

"Everything suggests, with the evidence that's been found, that it was the airplane that the singer Jenni Rivera was traveling in," said Gerardo Ruiz Esparza, Mexico's secretary of communications and transportation. Of the crash site, Ruiz said: "Everything is destroyed. Nothing is recognizable."

Word of the accident ricocheted around the entertainment industry, with performer after performer expressing shock and grief. Fans gathered outside Rivera's four-acre estate in Encino.

"She was the Diana Ross of Mexican music," said Gustavo Lopez, an executive vice president at Universal Music Latin Entertainment, an umbrella group that includes Rivera's label. Lopez called Rivera "larger than life" and said that based on ticket sales, she was by far the top-grossing female artist in Mexico.

"Remember her with your heart the way she was," her father, Don Pedro Rivera, told reporters in Spanish on Sunday evening. "She never looked back. She was a beautiful person with the whole world."

Rivera had performed a concert in Monterrey, Mexico, on Saturday night — her standard fare of knee-buckling power ballads, pop-infused interpretations of traditional banda music and dizzying rhinestone costume changes.

At a news conference after the show, Rivera appeared happy and tranquil, pausing at one point to take a call on her cellphone that turned out to be a wrong number. She fielded questions about struggles in her personal life, including her recent separation from husband Esteban Loaiza, a professional baseball player.

"I can't focus on the negative," she said in Spanish. "Because that will defeat you. That will destroy you.... The number of times I have fallen down is the number of times I have gotten up."

Hours later, shortly after 3 a.m., Rivera is believed to have boarded a Learjet 25, which took off under clear skies. The jet headed south, toward Toluca, west of Mexico City; there, Rivera had been scheduled to tape the television show "La Voz" — Mexico's version of "The Voice" — on which she was a judge.

The plane, built in 1969 and registered to a Las Vegas talent management firm, reached 11,000 feet. But 10 minutes and 62 miles into the flight, air traffic controllers lost contact with its pilots, according to Mexican authorities. The jet crashed outside Iturbide, a remote city that straddles one of the few roads bisecting Mexico's Sierra de Arteaga national park.

Wreckage was scattered across several football fields' worth of terrain. An investigation into the cause of the crash was underway, and attempts to identify the remains of the victims had begun.

Rivera, a mother of five and grandmother of two, was believed to have been traveling with her publicist Arturo Rivera, who was not related to her, as well as with her lawyer, hairstylist and makeup artist; reports of their names were not consistent. Their identities were not confirmed by authorities. The pilots were identified as Miguel Perez and Alejandro Torres.

In the world of regional Latin music — norteño, cumbia and ranchera are among the popular niches — Rivera was practically royalty.

Her father was a noted singer of the Mexican storytelling ballads known as corridos. In the 1980s he launched the record label Cintas Acuario. It began as a swap-meet booth and grew into an influential and taste-making independent outfit, fueling the careers of artists such as the late Chalino Sanchez. Jenni Rivera's four brothers were associated with the music industry; her brother Lupillo, in particular, is a huge star in his own right.

Born on July 2, 1969, Rivera initially showed little inclination to join the family business. She worked for a time in real estate. But after a pregnancy and a divorce, she went to work for her father's record label and found her voice, literally and figuratively.

She released her first studio album in 2003, when she was 34.

Her path had not been easy, but rather than running from it, she wrote it into her music — domestic violence; struggles with weight; raising her children alone, or "sin capitan," without a captain. She was known for marathon live shows that left audiences exhilarated and exhausted; by the fifth hour of one recent performance, she was drinking straight from a tequila bottle and launching into a cover of "I Will Survive."

In a witty and sometimes baffling stew of Spanish and English, she sang about her three husbands, about drug traffickers, in tribute to her father, in tribute to her gynecologist.

She became, in a most unlikely way, a feminist hero among Latin women in Mexico and the United States and a powerful player in a genre of music dominated by men and machismo. Regional Mexican music styles had long been seen as limiting to artists, but Rivera shrugged off the labels and brought traditional-laced music — some of which sounded perilously close to polka — to a massive pop audience.

Read More..

Singer feared dead in Mexican plane crash

MONTERREY, Mexico (AP) — Mexico's music world mourned Jenni Rivera, the U.S.-born singer presumed killed in a plane crash whose soulful voice and openness about her personal troubles had made her a Mexican-American superstar.

Authorities have not confirmed her death, but Rivera's relatives in the U.S. say they have few doubts that she was on the Learjet 25 that disintegrated on impact Sunday in rugged territory in Nuevo Leon state in northern Mexico.

"My son Lupillo told me that effectively it was Jenni's plane that crashed and that everyone on board died," her father, Pedro Rivera, told dozens of reporters gathered in front of his Los Angeles-area home. "I believe my daughter's body is unrecognizable."

He said that his son would fly to Monterrey Monday.

Messages of condolence poured in from fellow musicians and celebrities.

Mexican songstress and actress Lucero wrote on her Twitter account: "What terrible news! Rest in peace ... My deepest condolences for her family and friends." Rivera's colleague on the Mexican show "The Voice of Mexico," pop star Paulina Rubio, said on her Twitter account: "My friend! Why? There is no consolation. God, please help me!"

Born in Long Beach, California, Rivera was at the peak of her career as perhaps the most successful female singer in grupero, a male-dominated regional style influenced by the norteno, cumbia and ranchero styles.

A 43-year-old mother of five children and grandmother of two, the woman known as the "Diva de la Banda" was known for her frank talk about her struggles to give a good life to her children despite a series of setbacks.

She was recently divorced from her third husband, was once detained at a Mexico City airport with tens of thousands of dollars in cash, and she publicly apologized after her brother assaulted a drunken fan who verbally attacked her in 2011.

Her openness about her personal troubles endeared her to millions in the U.S. and Mexico.

"I am the same as the public, as my fans," she told The Associated Press in an interview last March.

Rivera sold 15 million records, and recently won two Billboard Mexican Music Awards: Female Artist of the Year and Banda Album of the Year for "Joyas prestadas: Banda." She was nominated for Latin Grammys in 2002, 2008 and 2011.

Transportation and Communications Minister Gerardo Ruiz Esparza said "everything points toward" the wreckage belonging to the plane carrying Rivera and six other people to Toluca, outside Mexico City, from Monterrey, where the singer had just given a concert.

"There is nothing recognizable, neither material nor human" in the wreckage found in the state of Nuevo Leon, Ruiz Esparza said. The impact was so powerful that the remains of the plane "are scattered over an area of 250 to 300 meters. It is almost unrecognizable."

A mangled California driver's license with Rivera's name and picture was found in the crash site debris.

No cause was given for the plane's crash, but its wreckage was found near the town of Iturbide in Mexico's Sierra Madre Oriental, where the terrain is very rough.

The Learjet 25, number N345MC, took off from Monterrey at 3:30 a.m. local time and was reported missing about 10 minutes later. It was registered to Starwood Management of Las Vegas, Nevada, according to FAA records. It was built in 1969 and had a current registration through 2015.

Also believed aboard the plane were her publicist, Arturo Rivera, her lawyer, makeup artist and the flight crew.

Though drug trafficking was the theme of some of her songs, she was not considered a singer of "narco corridos," or ballads glorifying drug lords like other groups, such as Los Tigres del Norte. She was better known for singing about her troubles in love and disdain for men.

Her parents were Mexicans who had migrated to the United States. Two of her five brothers, Lupillo and Juan Rivera, are also well-known singers of grupero music.

She studied business administration and formally debuted on the music scene in 1995 with the release of her album "Chacalosa". Due to its success, she recorded two more independent albums, "We Are Rivera" and "Farewell to Selena," a tribute album to slain singer Selena that helped expand her following.

At the end of the 1990s, Rivera was signed by Sony Music and released two more albums. But widespread success came for her when she joined Fonovisa and released her 2005 album titled "Partier, Rebellious and Daring."

Besides being a singer, she is also a businesswoman and actress, appearing in the indie film Filly Brown, which was shown at the Sundance Film Festival, as the incarcerated mother of Filly Brown.

She was filming the third season of "I love Jenni," which followed her as she shared special moments with her children and as she toured through Mexico and the United States. She also has the reality shows: "Jenni Rivera Presents: Chiquis and Raq-C" and her daughter's "Chiquis 'n Control."

In 2009, she was detained at the Mexico City airport when she declared $20,000 in cash but was really carrying $52,167. She was taken into custody. She said it was an innocent mistake and authorities gave her the benefit of the doubt and released her.

In 2011, her brother Juan assaulted a drunken fan at a popular fair in Guanajuato. In the face of heavy criticism among her fans and on social networks, Rivera publicly apologized for the incident during a concert in Mexico City, telling her fans: "Thank you for accepting me as I am, with my virtues and defects."

On Saturday night, Rivera had given a concert before thousands of fans in Monterrey. After the concert she gave a press conference during which she spoke of her emotional state following her recent divorce from former Major League Baseball pitcher Esteban Loaiza, who played for teams including the New York Yankees and Los Angeles Dodgers.

"I can't get caught up in the negative because that destroys you. Perhaps trying to move away from my problems and focus on the positive is the best I can do. I am a woman like any other and ugly things happen to me like any other woman," she said Saturday night. "The number of times I have fallen down is the number of times I have gotten up."

Rivera had announced in October that she was divorcing Loaiza after two years of marriage.

There have been several high-profile crashes involving Learjets, known as swift, longer-distance passenger aircraft popular with corporate executives, entertainers and government officials.

A Learjet carrying pro-golfer Payne Stewart and five others crashed in northeastern South Dakota in 1999. Investigators said the plane lost cabin pressure and all on board died after losing consciousness for lack of oxygen. The aircraft flew for several hours on autopilot before running out of fuel and crashing in a corn field.

Former Blink 182 drummer Travis Barker was severely injured in a 2008 Learjet crash in South Carolina that killed four people.

That same year, a Learjet slammed into rush-hour traffic in a posh Mexico City neighborhood, killing Mexico's No. 2 government official, Interior Secretary Juan Camilo Mourino, and eight others on the plane, plus five people on the ground.

___

Associated Press Writer Galia Garcia-Palafox and Olga R. Rodriguez contributed to this report from Mexico City.

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?

Read More..

Long-treasured mortgage interest deduction may face changes

WASHINGTON — At 70, Frank White isn't a typical first-time home buyer. But a key reason he ditched his Altadena apartment and bought a three-bedroom house in nearby Pasadena has been common for decades: He wanted the tax break.

"I pay very high taxes, and I have no deductions," said White, who owns an apartment rental business with his two brothers. Now, after purchasing the $500,000 home in November, he's looking forward to writing off the interest on his 30-year mortgage.

But the longtime tax break could face major changes as Washington policymakers search for ways to reduce the deficit as part of the debate on the so-called fiscal cliff. And that's sending shivers through home buyers such as White and much of the housing industry.

"My deductions are important to me, what few I have," White said. "We need to go after the corporations that don't pay a … cent. Let's go after those guys first. But leave me alone."

The home mortgage interest deduction is one of the most cherished in the U.S. tax code. It's also one of the most expensive, estimated to cost the federal government $100 billion this fiscal year.

Primer: Understanding the fiscal cliff

For that reason, the deduction taken on income tax returns is expected to be on the table in Washington's search for more money to reduce the budget deficit and resolve the fiscal cliff.

But the specter of scaling back the tax break, particularly with the housing market still trying to recover from the collapse of the subprime mortgage bubble, is raising alarms among homeowners, Realtors and home builders.

It's also sparking a debate about the true effect of the deduction, which critics argue benefits the wealthy much more than the middle class. They contend that the break hurts first-time home buyers by driving up house prices and that other countries that have no such deduction still have high homeownership rates.

"If we really care about homeownership, then the deduction is just the absolute wrong way to go," said Dennis Ventry, a UC Davis law professor who has studied its effect.

There is agreement that reducing the interest deduction — no one is talking about eliminating it — would cause prices to drop as buyers scale back the amount they could afford to spend.

The concerns are even greater in Southern California and other high-priced regions where homeowners benefit more from the deduction because their mortgages are larger.

"A lot of people buy rather than rent simply because, after the mortgage deduction, it's more affordable," said Syd Leibovitch, president of Rodeo Realty in Beverly Hills. "To limit it or take it away, I think you're going to be surprised at the shocking effect it has on the real estate market."

QUIZ: How much do you know about the fiscal cliff?

President Obama's deficit commission proposed lowering the limit on mortgage principal eligible for a deduction to $500,000 from the current $1 million, removing any break for interest on a second home and turning the deduction into a tax credit capped at 12% of interest paid.

A tax credit would allow homeowners who don't itemize deductions to subtract the interest from the taxes they owe. But while more taxpayers could take advantage of the benefit, a cap would mean those with large mortgages on expensive homes couldn't get a credit for all the interest they pay.

Other proposals have called for similar changes.

Supporters of the tax break worry that proposed changes would not only push down prices but also spook potential buyers.

Lawrence Tang, 38, and his wife own a house in West Covina. But they are renting in San Gabriel and looking for a house there, near where he works as a school technology director. They don't want to sell the West Covina house because the drop in home values wiped out most of their equity.

So the proposed changes would limit how much interest they could deduct on their first house and prevent them from deducting any interest on what would be their second home, Tang said.

Read More..

Chavez to have more cancer surgery in Cuba

CARACAS, Venezuela—

Venezuelan President Hugo Chavez is heading back to Cuba on Sunday for more surgery for cancer, announcing on television that the illness has returned after two previous operations, chemotherapy and radiation treatment.

Chavez acknowledged the seriousness of his situation in an address Saturday night, saying for the first time that if he suffers complications Vice President Nicolas Maduro should take his place as Venezuela's leader and continue his socialist movement.

"There are risks. Who can deny it?" Chavez said, seated at the presidential palace beside Maduro and other aides.

"In any circumstance, we should guarantee the advance of the Bolivarian Revolution," Chavez said.

Outside medical experts said that based on Chavez's account of his condition, he is facing a very difficult fight against an aggressive type of cancer.

The president, who just returned from Cuba early Friday, said tests had found a return of "some malignant cells" in the same area where tumors were previously removed.

Chavez, who has yet to be sworn in for his new term after winning re-election on Oct. 7, said he would return to Havana on Sunday and would undergo the operation in the coming days.

Chavez's quick trip home appeared aimed at sending a clear directive to his inner circle that Maduro is his chosen successor. He called for his allies to pull together, saying: "Unity, unity, unity."

Chavez said his doctors had recommended he have the surgery right away, but that he had told them he wanted to return to Venezuela first.

"I want to go there. I need to go to Venezuela," Chavez recalled telling his doctors. "And what I came for was this," he said, seated below a portrait of independence hero Simon Bolivar, the inspiration of his Bolivarian Revolution movement.

Chavez named Maduro, his longtime foreign minister, as his choice for vice president three days after winning re-election. Maduro, a burly former bus driver, has shown unflagging loyalty and become a leading spokesman for Venezuela's socialist leader in recent years.

The vice president's expression was solemn as Chavez said that Maduro should become president if any complication were to prevent him from finishing his current term, which concludes in early January. Chavez said that if new elections are held, his movement's candidate should be Maduro.

"In that scenario, which under the constitution would require presidential elections to be held again, you all elect Nicolas Maduro as president," Chavez said. "I ask that of you from my heart."

Chavez held a small blue copy of the constitution in his hands and waved it. The Venezuelan constitution says that if a president-elect dies before taking office, a new election should be held within 30 days and that in the meantime the president of the National Assembly is to be in charge of the government.

While he spoke, Chavez was flanked by both Maduro and National Assembly President Diosdado Cabello.

Chavez is scheduled to be sworn in for a new six-year term Jan. 10, and he called his relapse a "new battle."

This will be his third operation to remove cancerous tissue in about a year and a half.

The 58-year-old president first underwent surgery for an unspecified type of pelvic cancer in Cuba in June 2011, after an operation for a pelvic abscess earlier in the month found the cancer. He had another cancer surgery last February after a tumor appeared in the same area. He has also undergone chemotherapy and radiation treatments.

Chavez said tests immediately after his re-election win had shown no sign of cancer. But he said he had swelling and pain, which he thought was due to "the effort of the campaign and the radiation therapy treatment."

"It's a very sensitive area, so we started to pay a lot of attention to that," he said, adding that he had reduced his public appearances.

Read More..