The 30-Minute Interview: The 30-Minute Interview With Nick J. Romito

Mr. Romito, 30, is the founder and chief executive of View the Space, a new real estate technology business that creates online video tours, primarily of office space, and provides data-tracking services to commercial real estate companies, among them SL Green Realty, Vornado Realty Trust and Silverstein Properties.

Before starting the business last year, Mr. Romito worked as a commercial broker and tenant and landlord representative.

Q. How has business been so far?

A. Business is good. We launched the beta version of the Web site about a year ago, and this April was when we took the beta logo off and decided that we were at a point where we could start charging for the product. We’ve grown extraordinarily fast, but that’s a good thing.

Q. Are you profitable yet?

A. We had profitability in May, then like most start-up companies we scaled up. We hit profitability again in October.

I put in all my life savings, which was roughly $50,000 to $100,000, with my wife’s help. As we were going into the market and trying to get people to believe in our dream it gets rough. But we actually got really lucky and found some great partners — a syndicate of hedge fund professionals who knew commercial real estate and invest in start-ups — who liked our idea. We raised about $650,000.

Q. Let’s talk about the services you provide.

A. As you probably know, commercial real estate is an antiquated business, more or less reluctant to embrace technology. We thought we were a crazy enough bunch to change that. We decided we could improve the process by taking it online from start to finish. So for us that means video. We’ve created a style of shooting video for office space that’s really never existed. Ours is the closest thing to actually being there, where you fly through the space and you actually feel like you’re in it. You just can’t touch the walls.

On the landlord side, we allow you to track how a person is interacting with the tour. So you get to see 1) the prospect who’s looking at it; 2) how many times they’ve watched it; and 3) how engaged are they with it. You’ll actually be able to tell whether a specific firm has taken the tour 10 times — that’s a very, very high level of engagement — and they’re a serious prospect so I’m going to follow up with them.

Q. What kind of analytics software accomplishes this?

A. We had to build a pretty serious back end of data that’s taken us awhile. You’ve got I.P. addresses all over the place, so we had to build a library of those, which we can identify for the most part which companies are viewing your space.

Q. And how do the clients see this information?

A. They can see it in real time whenever they want — from their dashboard. And if they’re not online we’ll e-mail it to them.

Q. Has this service helped to sell property faster?

A. Yeah. We’re at about 1.5 million square feet leased on View the Space since December 2011.

Q. How many clients do you have right now?

A. Over 50. We’ve got most of the larger commercial real estate institutions both on the public and private side.

It’s funny, when we first started, our thesis was that we would get all of the smaller landlords on board first because we have more access to them. But because we worked so tightly with the brokerage community to build this, SL Green caught wind of what we were doing very quickly and they ended up being our first big client.

So it’s kind of like a domino effect where you get the SL Greens of the world soon enough the Silversteins and all the other players want to find out what you’re doing.

Q. Where do you hope to see your business in, say, the next five to 10 years?

A. We think that technology is here to stay in commercial real estate. And we see us growing, hopefully, in every major market. We’re actively in 10 markets right now.

New York right now is probably 60 percent of the activity that we have.

Q. You don’t have a technology background, do you?

A. I don’t. During the first year of development I was still a broker. I tried to outsource the first part of this to India, which was a very painful process. You’ve got to start your day at 4 a.m., because of the time difference, and the language barrier was very difficult. Not only was I trying to learn Hindi, but also the language of technology.

Q. So when you’re not learning new languages, what do you do for fun?

A. I surf. That was more or less my life growing up on the Jersey Shore. In Toms River.

Q. Were you or your family affected by Hurricane Sandy?

A. My mom lost her house. She got a couple of feet of water, and now they’ll have to demo the house.

But as long as everyone is O.K., it’s just stuff. I think everybody down there is so resilient, and this is like when everybody really comes together.

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Op-Ed Contributor: Our Failed Approach to Schizophrenia

TOO many pendulums have swung in the wrong directions in the United States. I am not referring only to the bizarre all-or-nothing rhetoric around gun control, but to the swing in mental health care over the past 50 years: too little institutionalizing of teenagers and young adults (particularly men, generally more prone to violence) who have had a recent onset of schizophrenia; too little education about the public health impact of untreated mental illness; too few psychiatrists to talk about and treat severe mental disorders — even though the medications available in the past 15 to 20 years can be remarkably effective.

Instead we have too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking. In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot — at home and at schools, in movie theaters, houses of worship and shopping malls.

“Psychosis” — a loss of touch with reality — is an umbrella term, not unlike “fever.” As with fevers, there are many causes, from drugs and alcohol to head injuries and dementias. The most common source of severe psychosis in young adults is schizophrenia, a badly named disorder that, in the original Greek, means “split mind.” In fact, schizophrenia has nothing to do with multiple personality, a disorder that is usually caused by major repeated traumas in childhood. Schizophrenia is a physiological disorder caused by changes in the prefrontal cortex, an area of the brain that is essential for language, abstract thinking and appropriate social behavior. This highly evolved brain area is weakened by stress, as often occurs in adolescence.

Psychiatrists and neurobiologists have observed biochemical changes and alterations in brain connections in patients with schizophrenia. For example, miscommunications between the prefrontal cortex and the language area in the temporal cortex may result in auditory hallucinations, as well as disorganized thoughts. When the voices become commands, all bets are off. The commands might insist, for example, that a person jump out of a window, even if he has no intention of dying, or grab a set of guns and kill people, without any sense that he is wreaking havoc. Additional symptoms include other distorted thinking, like the notion that something — even a spaceship, or a comic book character — is controlling one’s thoughts and actions.

Schizophrenia generally rears its head between the ages of 15 and 24, with a slightly later age for females. Early signs may include being a quirky loner — often mistaken for Asperger’s syndrome — but acute signs and symptoms do not appear until adolescence or young adulthood.

People with schizophrenia are unaware of how strange their thinking is and do not seek out treatment. At Virginia Tech, where Seung-Hui Cho killed 32 people in a rampage shooting in 2007, professors knew something was terribly wrong, but he was not hospitalized for long enough to get well. The parents and community-college classmates of Jared L. Loughner, who killed 6 people and shot and injured 13 others (including a member of Congress) in 2011, did not know where to turn. We may never know with certainty what demons tormented Adam Lanza, who slaughtered 26 people at an elementary school in Newtown, Conn., on Dec. 14, though his acts strongly suggest undiagnosed schizophrenia.

I write this despite the so-called Goldwater Rule, an ethical standard the American Psychiatric Association adopted in the 1970s that directs psychiatrists not to comment on someone’s mental state if they have not examined him and gotten permission to discuss his case. It has had a chilling effect. After mass murders, our airwaves are filled with unfounded speculations about video games, our culture of hedonism and our loss of religious faith, while psychiatrists, the ones who know the most about severe mental illness, are largely marginalized.

Severely ill people like Mr. Lanza fall through the cracks, in part because school counselors are more familiar with anxiety and depression than with psychosis. Hospitalizations for acute onset of schizophrenia have been shortened to the point of absurdity. Insurance companies and families try to get patients out of hospitals as quickly as possible because of the prohibitively high cost of care.

As documented by writers like the law professor Elyn R. Saks, author of the memoir “The Center Cannot Hold: My Journey Through Madness,” medication and treatment work. The vast majority of people with schizophrenia, treated or untreated, are not violent, though they are more likely than others to commit violent crimes. When treated with medication after a rampage, many perpetrators who have shown signs of schizophrenia — including John Lennon’s killer and Ronald Reagan’s would-be assassin — have recognized the heinousness of their actions and expressed deep remorse.

It takes a village to stop a rampage. We need reasonable controls on semiautomatic weapons; criminal penalties for those who sell weapons to people with clear signs of psychosis; greater insurance coverage and capacity at private and public hospitals for lengthier care for patients with schizophrenia; intense public education about how to deal with schizophrenia; greater willingness to seek involuntary commitment of those who pose a threat to themselves or others; and greater incentives for psychiatrists (and other mental health professionals) to treat the disorder, rather than less dangerous conditions.

Too many people with acute schizophrenia have gone untreated. There have been too many Glocks, too many kids and adults cut down in their prime. Enough already.

Paul Steinberg is a psychiatrist in private practice.

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Op-Ed Contributor: Our Failed Approach to Schizophrenia

TOO many pendulums have swung in the wrong directions in the United States. I am not referring only to the bizarre all-or-nothing rhetoric around gun control, but to the swing in mental health care over the past 50 years: too little institutionalizing of teenagers and young adults (particularly men, generally more prone to violence) who have had a recent onset of schizophrenia; too little education about the public health impact of untreated mental illness; too few psychiatrists to talk about and treat severe mental disorders — even though the medications available in the past 15 to 20 years can be remarkably effective.

Instead we have too much concern about privacy, labeling and stereotyping, about the civil liberties of people who have horrifically distorted thinking. In our concern for the rights of people with mental illness, we have come to neglect the rights of ordinary Americans to be safe from the fear of being shot — at home and at schools, in movie theaters, houses of worship and shopping malls.

“Psychosis” — a loss of touch with reality — is an umbrella term, not unlike “fever.” As with fevers, there are many causes, from drugs and alcohol to head injuries and dementias. The most common source of severe psychosis in young adults is schizophrenia, a badly named disorder that, in the original Greek, means “split mind.” In fact, schizophrenia has nothing to do with multiple personality, a disorder that is usually caused by major repeated traumas in childhood. Schizophrenia is a physiological disorder caused by changes in the prefrontal cortex, an area of the brain that is essential for language, abstract thinking and appropriate social behavior. This highly evolved brain area is weakened by stress, as often occurs in adolescence.

Psychiatrists and neurobiologists have observed biochemical changes and alterations in brain connections in patients with schizophrenia. For example, miscommunications between the prefrontal cortex and the language area in the temporal cortex may result in auditory hallucinations, as well as disorganized thoughts. When the voices become commands, all bets are off. The commands might insist, for example, that a person jump out of a window, even if he has no intention of dying, or grab a set of guns and kill people, without any sense that he is wreaking havoc. Additional symptoms include other distorted thinking, like the notion that something — even a spaceship, or a comic book character — is controlling one’s thoughts and actions.

Schizophrenia generally rears its head between the ages of 15 and 24, with a slightly later age for females. Early signs may include being a quirky loner — often mistaken for Asperger’s syndrome — but acute signs and symptoms do not appear until adolescence or young adulthood.

People with schizophrenia are unaware of how strange their thinking is and do not seek out treatment. At Virginia Tech, where Seung-Hui Cho killed 32 people in a rampage shooting in 2007, professors knew something was terribly wrong, but he was not hospitalized for long enough to get well. The parents and community-college classmates of Jared L. Loughner, who killed 6 people and shot and injured 13 others (including a member of Congress) in 2011, did not know where to turn. We may never know with certainty what demons tormented Adam Lanza, who slaughtered 26 people at an elementary school in Newtown, Conn., on Dec. 14, though his acts strongly suggest undiagnosed schizophrenia.

I write this despite the so-called Goldwater Rule, an ethical standard the American Psychiatric Association adopted in the 1970s that directs psychiatrists not to comment on someone’s mental state if they have not examined him and gotten permission to discuss his case. It has had a chilling effect. After mass murders, our airwaves are filled with unfounded speculations about video games, our culture of hedonism and our loss of religious faith, while psychiatrists, the ones who know the most about severe mental illness, are largely marginalized.

Severely ill people like Mr. Lanza fall through the cracks, in part because school counselors are more familiar with anxiety and depression than with psychosis. Hospitalizations for acute onset of schizophrenia have been shortened to the point of absurdity. Insurance companies and families try to get patients out of hospitals as quickly as possible because of the prohibitively high cost of care.

As documented by writers like the law professor Elyn R. Saks, author of the memoir “The Center Cannot Hold: My Journey Through Madness,” medication and treatment work. The vast majority of people with schizophrenia, treated or untreated, are not violent, though they are more likely than others to commit violent crimes. When treated with medication after a rampage, many perpetrators who have shown signs of schizophrenia — including John Lennon’s killer and Ronald Reagan’s would-be assassin — have recognized the heinousness of their actions and expressed deep remorse.

It takes a village to stop a rampage. We need reasonable controls on semiautomatic weapons; criminal penalties for those who sell weapons to people with clear signs of psychosis; greater insurance coverage and capacity at private and public hospitals for lengthier care for patients with schizophrenia; intense public education about how to deal with schizophrenia; greater willingness to seek involuntary commitment of those who pose a threat to themselves or others; and greater incentives for psychiatrists (and other mental health professionals) to treat the disorder, rather than less dangerous conditions.

Too many people with acute schizophrenia have gone untreated. There have been too many Glocks, too many kids and adults cut down in their prime. Enough already.

Paul Steinberg is a psychiatrist in private practice.

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Gaza City Journal: Gaza Cease-Fire Expands Fishing Area, but Risks Remain

Relaxed Rules Restore Old Opportunities:
As a part of last month's cease-fire agreement between Hamas and Israel, Gazans can now fish 6 miles off the coast, doubling the previous limit.

GAZA CITY — Khader Bakr, a 19-year-old fisherman, was thrilled to hear that he could now fish up to six nautical miles from the coast, up from the three-mile limit Israel had had in place since 2009. The change was part of the cease-fire deal that halted last month’s fighting in Gaza between Israel and Hamas.

But testing the waters late last month, Mr. Bakr apparently sailed out too far. An Israeli gunboat patrolling against arms smuggling ordered him to stop and strip to his underwear. As the Israelis sank his boat, he jumped into the sea and was hauled aboard the Israeli vessel for questioning.

“I spent four hours trembling,” he said, before the Israelis ordered another Palestinian fishing boat to ferry Mr. Bakr back to shore.

Run-ins with Israeli patrols are still the bane of Gaza fishermen. But in most respects, the new arrangement has been a boon.

The fishermen have raced to take advantage of broader fishing grounds, farther from the shore where sewage is pumped into the water untreated.

Catches have improved in quantity, quality and freshness, and thus price. The fish are bigger and include desirable species like grouper, red mullet and Mediterranean sea bass that were no longer present closer to land.

But the fishermen risk rapidly overfishing. “In the first few days, I caught fish worth $1,580 to $1,850,” said Yasser Abu al-Sadeq. “Today, I made around $1,050.” But the situation is still better, he said. “Before the cease-fire, I would barely catch $790.”

“It’s like when you come to a house that’s been abandoned for years and start cleaning it,” he said. “When you start cleaning, you get out a lot of trash, but when you clean daily, you get out only a little.”

He and his crew go out for 24 hours at a time, he said, cooking the small crabs and squid they catch in the nets.

He described an early trip out past the six-mile limit, when an Israeli gunboat circled his boat, shaking it in the wake, and ordered him back toward shore.

He remembers a golden time, before the second Palestinian intifada in 2000, when he could go out as far as 12 nautical miles, where he could find sardines and what he called guitarfish, a small ray. “There, it’s a reserve protected by God,” he said.

The fishermen say they estimate their distance, since most of them lack precise navigational systems, but there is usually one indicator.

“When we were allowed within 3 miles, the gunboats would attack us at 2.5 miles,” said Monzer Abu Amira, as he repaired his green nylon nets. “Today, they hit us when we are at 5.5 miles.”

The Israelis generally use loudspeakers and water cannons, but sometimes they shoot live ammunition at fishing gear, the motor or the boat itself. Gazans in principle can apply for compensation if boats are damaged or destroyed, but in practice few do.

A senior Israeli official said that there had never been an official announcement that the fishing limit had been extended to six miles from three, but he confirmed that six was the new reality. Israel is continuing to negotiate indirectly with Hamas, the Islamist movement that rules Gaza, with Egypt as an intermediary, to turn the cease-fire agreement into something more permanent, the official said.

“We have an interest in prolonging the longevity of the quiet,” the official said. “We understand that relaxation of some of the restrictions is conducive to that goal. Quiet is in our interest. So we have an interest in showing flexibility where we can, and to show the Egyptians that we’re serious.”

There were problems immediately after the cease-fire, the Israeli official said, because “some in Gaza were interested in testing the limits and pushing the envelope,” and because the expansion of the fishing zone meant deploying more Israeli resources to cover more sea.

“But if people don’t exceed the six-mile limit, it’s O.K.,” he said.

The Israelis are not interested in the smuggling of “Kalashnikovs and bullets,” he added, but in preventing Iran from resupplying longer-range missiles and preventing Hamas from smuggling in foreign experts to aid them in missile development and technology. “The important thing for us is to prevent Hamas from rearming,” he said.

Ed Ou contributed reporting.

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Books: From Bang to Whimper: A Heart Drug’s Story

On June 23, 2005, American medicine managed to take a small step forward and a giant step backward at precisely the same time, with government approval of the first medication to be earmarked for a specific racial group. It was BiDil, a drug designed to treat heart failure in blacks.

Enthusiasts hailed BiDil’s approval by the Food and Drug Administration as a landmark event in the nascent field of pharmacogenomics, which aims to create drugs tailored to fit an individual’s genetic makeup as precisely as a bespoke suit drapes its owner’s shoulders. Critics just winced and clocked one more misstep in medicine’s long history of race-related disasters.

You would think that the elucidation of the human genome would have cleared up most of the hoary untruths surrounding race and health. But as Jonathan Kahn makes clear in his worthy if convoluted review of the events surrounding the birth of BiDil, the genome has in many respects only made things worse.

It has been clear for decades that race has minimal relevance to the body’s inner workings. Research has repeatedly shown that the biologic variations among individuals of the same race are reliably great enough for race to retain little utility as a biologic predictor. You might as well sort people by height. Or, in the words of an editorial writer for Nature Biotechnology in 2005, “Pooling people in race silos is akin to zoologists grouping raccoons, tigers and okapis on the basis that they are all stripy.”

But old misconceptions die hard, particularly for entrepreneurs eagerly awaiting cash bonanzas from the genomic revolution.

Race may be irrelevant; it may be, as Dr. Francis Collins, the director of the National Institutes of Health, put it, “a weak and imperfect proxy” for genetic differences. But it is also a familiar concept — and asking people what race they are is substantially cheaper than genotyping them.

So in a peculiar paradox, race has come to serve in some circles as a crude surrogate for genetic analysis until actual genomic medicine comes along — a temporary bridge from now to later, known to be flawed but still a quasi-legitimate stand-in for the real thing.

Against this background unfolds the story of BiDil, a drama of greed and good intentions.

Several observations prompted the drug’s development. Among them was the common assertion from the last century that blacks with heart failure were more likely to die than whites. (Mr. Kahn does an impressive job of researching and debunking this statistic.) Then there was the belief that blacks often reacted badly to some of the newer drugs used for treating heart failure, and the results of a study dating from the 1980s suggesting that many black patients did well with two old standby drugs.

Those two drugs were (and are) on sale as generics, costing pennies a pill. But just suppose they were combined into a single pill that could be then specifically marketed to patients who just happened to be thought in particular need of effective medication? Now there was a pharmacologic and marketing plan that would extend a lucrative new patent for decades.

And so it came to pass that a collection of eager investors and some of the nation’s foremost cardiologists smiled on the results of an industry-sponsored trial performed on self-identified black subjects with heart failure: The two cheap drugs combined into the not-so-cheap BiDil reduced mortality by 40 percent compared with placebo. This figure was impressive enough to end the trial early and speed BiDil to market.

How did whites do on BiDil? Nobody bothered to check.

Mr. Kahn deserves credit for teasing out all the daunting complexities behind these events, including the details of genetic analysis, the perils of racial determinations and the minutiae of patent law. Unfortunately, though, he suffocates his powerful subject in a dry, repetitive, ponderous read.

A law professor with a doctorate in history and longstanding interest in race issues, Mr. Kahn trudges a partisan path through the drama in which he himself was a player. (He testified before an F.D.A. advisory committee that BiDil should be approved without racial qualifications.)

He heads bravely into many statistical thickets, but omits relevant clinical data; he repeatedly refers to the trial that led to BiDil’s approval, for instance, but I could find its numerical findings nowhere in the book and had to look them up. In a story that fairly drips with potential human interest, he offers the reader not one sip.

The issues raised on every page are so important and so thought-provoking that it would be irresponsible to warn interested readers away. Still, it would be almost as irresponsible to misrepresent the difficulty of the journey.

As it happens, BiDil itself has had a remarkably inglorious career. Despite its much-trumpeted release, patients did not request the medication, and practicing doctors did not prescribe it.

NitroMed, the company that developed it, sponsored no further studies and failed in 2009.

The drug still lingers on the market; Mr. Kahn writes that BiDil may be resurrected in sustained-release form — that other time-honored technique for wringing a few more years from a drug’s patent.

For a parable of early 21st-century medicine, as it treads water between past and future and never hesitates to reach for a buck, it doesn’t get much better than BiDil.

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News Analysis: Getting Polio Campaigns Back on Track

How in the world did something as innocuous as the sugary pink polio vaccine turn into a flash point between Islamic militants and Western “crusaders,” flaring into a confrontation so ugly that teenage girls — whose only “offense” is that they are protecting children — are gunned down in the streets?

Nine vaccine workers were killed in Pakistan last week in a terrorist campaign that brought the work of 225,000 vaccinators to a standstill. Suspicion fell immediately on factions of the Pakistani Taliban that have threatened vaccinators in the past, accusing them of being American spies.

Polio eradication officials have promised to regroup and try again. But first they must persuade the killers to stop shooting workers and even guarantee safe passage.

That has been done before, notably in Afghanistan in 2007, when Mullah Muhammad Omar, spiritual head of the Afghan Taliban, signed a letter of protection for vaccination teams. But in Pakistan, the killers may be breakaway groups following no one’s rules.

Vaccination efforts are also under threat in other Muslim regions, although not this violently yet.

In Nigeria, another polio-endemic country, the new Islamic militant group Boko Haram has publicly opposed it, although the only killings that the news media have linked to polio were those of two police officers escorting vaccine workers. Boko Haram has killed police officers on other missions, unrelated to polio vaccinations.

In Mali, extremists took over half of the country in May, declaring an Islamic state. Vaccination is not an issue yet, but Mali had polio cases as recently as mid-2011, and the virus sometimes circulates undetected.

Resistance to polio vaccine springs from a combination of fear, often in marginalized ethnic groups, and brutal historical facts that make that fear seem justified. Unless it is countered, and quickly, the backlash threatens the effort to eradicate polio in the three countries where it remains endemic: Pakistan, Afghanistan and Nigeria.

In 1988, long before donors began delivering mosquito nets, measles shots, AIDS pills, condoms, deworming drugs and other Western medical goods to the world’s most remote villages, Rotary International dedicated itself to wiping out polio, and trained teams to deliver the vaccine.

But remote villages are often ruled by chiefs or warlords who are suspicious not only of Western modernity, but of their own governments.

The Nigerian government is currently dominated by Christian Yorubas. More than a decade ago, when word came from the capital that all children must swallow pink drops to protect them against paralysis, Muslim Hausas in the far-off north could be forgiven for reacting the way the fundamentalist Americans of the John Birch Society did in the 1960s when the government in far-off Washington decreed that, for the sake of children’s teeth, all drinking water should have fluoride.

The northerners already had grievances. In 1996, the drug company Pfizer tested its new antibiotic, Trovan, during a meningitis outbreak there. Eleven children died. Although Pfizer still says it was not to blame, the trial had irregularities, and last year the company began making payments to victims.

Other rumors also spring from real events.

In Pakistan, resistance to vaccination, low over all, is concentrated in Pashtun territory along the Afghan border and in Pashtun slums in large cities. Pashtuns are the dominant tribe in Afghanistan but a minority in Pakistan among Punjabis, Sindhis, Baluchis and other ethnic groups. Many are Afghan refugees and are often poor and dismissed as medieval and lawless.

Pakistan’s government is friendly with the United States while the Pashtuns’ territory in border areas has been heavily hit by American Taliban-hunting drones, which sometimes kill whole families.

So, when the Central Intelligence Agency admitted sponsoring a hepatitis vaccination campaign as a ruse to get into a compound in Pakistan to confirm that Osama bin Laden was there, and the White House said it had contemplated wiping out the residence with a drone missile, it was not far-fetched for Taliban leaders to assume that other vaccinators worked for the drone pilots.

Even in friendly areas, the vaccine teams have protocols that look plenty suspicious. If a stranger knocked on a door in Brooklyn, asked how many children under age 5 were at home, offered to medicate them, and then scribbled in chalk on the door how many had accepted and how many refused — well, a parent might worry.

In modern medical surveys — though not necessarily on polio campaigns — teams carry GPS devices so they can find houses again. Drones use GPS coordinates.

The warlords of Waziristan made the connection specific, barring all vaccination there until Predator drones disappeared from the skies.

Dr. Bruce Aylward, a Canadian who is chief of polio eradication for the World Health Organization, expressed his frustration at the time, saying, “They know we don’t have any control over drone strikes.”

The campaign went on elsewhere in Pakistan — until last week.

The fight against polio has been hampered by rumors that the vaccine contains pork or the virus that causes AIDS, or is a plot to sterilize Muslim girls. Even the craziest-sounding rumors have roots in reality.

The AIDS rumor is a direct descendant of Edward Hooper’s 1999 book, “The River,” which posited the theory — since discredited — that H.I.V. emerged when an early polio vaccine supposedly grown in chimpanzee kidney cells contaminated with the simian immunodeficiency virus was tested in the Belgian Congo.

The sterilization claim was allegedly first made on a Nigerian radio station by a Muslim doctor upset that he had been passed over for a government job. The “proof” was supposed to be lab tests showing it contained estrogen, a birth control hormone.

The vaccine virus is grown in a broth of live cells; fetal calf cells are typical. They may be treated with a minute amount of a digestive enzyme, trypsin — one source of which is pig pancreas, which could account for the pork rumor.

In theory, a polio eradicator explained, if a good enough lab tested the vaccine used at the time the rumor started, it might have detected estrogen from the calf’s mother, but it would have been far less estrogen than is in mother’s milk, which is not accused of sterilizing anyone. The trypsin is supposed to be washed out.

In any case, polio vaccine is now bought only from Muslim countries like Indonesia, and Muslim scholars have ruled it halal — the Islamic equivalent of kosher.

Reviving the campaign will mean quelling many rumors. It may also require adding other medical “inducements,” like deworming medicine, mosquito nets or vitamin A, whose immediate benefits are usually more obvious.

But changing mind-sets will be a crucial step, said Dr. Aylward, who likened the shootings of the girls to those of the schoolchildren in Newtown, Conn.

More police involvement — what he called a “bunkerized approach” — would not solve either America’s problem or Pakistan’s, he argued. Instead, average citizens in both countries needed to rise up, reject the twisted thinking of the killers and “generate an understanding in the community that this kind of behavior is not acceptable.”

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IHT Rendezvous: China Assails U.S. Over Alliance With Japan and Possible F-16 Sales to Taiwan

HONG KONG — The nomination of Senator John Kerry as the new U.S. secretary of state has been warmly received by China, but the state-run news media on the mainland has sharply attacked the passage of a new military spending bill that is awaiting President Obama’s signature.

Two amendments to the $633 billion bill have drawn particular scorn from Beijing, which has unleashed a series of scathing articles and editorials in the state-run news media.

One provision in the bill says “the United States takes no position on the ultimate sovereignty of the Senkaku islands,” but endorses Japan’s administration of the fiercely disputed islands.

A commentary by Xinhua, the official Chinese news agency, called the amendment “a gross violation of China’s sovereign rights.”

The uninhabited islets, located in the East China Sea, are known in China as the Diaoyu islands. They are claimed by China, Japan and Taiwan, all of whom have conducted provocative naval patrols around the islands.

When a Chinese military surveillance plane overflew the islands two weeks ago, Japan scrambled fighter jets in response. The next day, an editorial in Global Times, a mainland newspaper tied to the Chinese Communist Party, said the overflight “marks the beginning of China’s air surveillance” of the islands.

“The situation could easily veer into a serious military clash,” the paper said, warning that “if Tokyo keeps on intercepting Chinese patrol planes, such a confrontation is bound to happen sooner or later.”

Shinzo Abe, expected to be sworn in this week as the new Japanese prime minister, has suggested he might send government workers or Coast Guard personnel to occupy the islands, a move that would complete a worrisome air-land-sea trifecta.

The new military spending bill, known as the 2013 National Defense Authorization Act, was passed in both houses of Congress by wide margins.

Its amendment on the islands reaffirms Washington’s commitment to a bilateral security alliance with Tokyo, and says in part, “The unilateral actions of a third party will not affect the United States acknowledgement” of Tokyo’s de facto control of the islands.

“In an apparent move to bolster Japan’s unwarranted claims, the document goes even further to say that the U.S.-Japan security treaty applies to the dispute, should the islands come under attack,” said an editorial in Monday’s editions of the state-run newspaper China Daily. “This is a blatant violation of China’s sovereign rights.

“The U.S. meddling in the dispute over the Diaoyu islands is detrimental to regional peace and stability,” the paper said, “as it will only embolden the increasingly rightist Japan.”

The other provision of the bill that has angered China expresses congressional support for the sale of dozens of new F-16 C/D fighter jets to Taiwan. The amendment, offered by Rep. Kay Granger, a Texas Republican, refers to Taiwan as “our key strategic ally in the Pacific.”

“Our support for a democratic Taiwan is consistent with our national security priorities in the region,” Ms. Granger said in a statement on her official Web site. “It also demonstrates that we stand by our friends and allies no matter where the threats are from.”

China opposes all arms sales to Taiwan, which it considers to be a breakaway province.

“The U.S. arms sales to Taiwan, an inalienable part of China, are the most sensitive issue standing in the way of bilateral ties,” China Daily said. “Any mishandling of the issue could derail what is widely seen as the most important bilateral relationship in the world.”

The Obama administration declined last year to sell 66 new F-16s to Taiwan but did approve $5.3 billion in upgrades to the island’s 20-year-old fleet of American-made combat aircraft.

Senator John Cornyn of Texas assailed that refusal, saying at the time that the “capitulation to Communist China by the Obama administration marks a sad day in American foreign policy, and it represents a slap in the face to a strong ally and longtime friend.”

For China, the upgrades were insult enough, and Beijing summoned the American ambassador and military attaché to register a “strong protest” over what Xinhua called a “despicable breach of faith in international relations.”

Another similar response — official outrage, an ambassadorial summons and the like — is certainly possible again if Mr. Obama signs the 2013 bill, which could be this week.

“This is a kind of ritual, and all the players know their roles,” Yawei Liu, director of the China Program at the Carter Center in Atlanta, told my colleague Andrew Jacobs. “There is a script they follow and then hope things cool down so they can return to business as usual.”

Xinhua said in a signed commentary by Zhi Linfei that the two new amendments, which are not binding on Mr. Obama, are “set to cause harm to China-U.S. relations at a sensitive time of political transition in both countries.”

The Xinhua commentary concluded this way:

The history of the past four decades has clearly demonstrated that China and the U.S. can break the curse of zero-sum game between a sitting power and an emerging power, through building a cooperative partnership based on mutual respect and benefit.

So, it’s advisable for the Obama administration to reject the two amendments and continue to honor its commitment to building a new type of inter-power relationship with China, by respecting China’s vital interests, enhancing strategic mutual trust and handling differences properly.

Meanwhile, the reception for Senator Kerry’s nomination has been far less contentious across Greater China.

Greg Torode, the veteran foreign affairs columnist for The South China Morning Post in Hong Kong, wrote that Mr. Kerry has “forged a reputation as an intelligent pro-engagement pragmatist.”

“He backed the congressional push behind China’s landmark entry into the World Trade Organization and was a key early driver in Washington’s normalization of ties with its old enemy, Vietnam.

“And how he juggles Obama’s priorities of boosting ties with both Beijing and a wary region at the same time will be a key early test of his skills.”

Read More..

E-Book Price War Has Yet to Arrive

Thor Swift for The New York Times

A Google e-reader is displayed at a bookstore. Sales of e-books for the devices have slowed this year.

Right about now, just as millions of e-readers and tablets are being slipped under Christmas trees, there was supposed to be a ferocious price war over e-books.

Last spring, the Justice Department sued five major publishers and Apple on e-book price-fixing charges. The case was a major victory for Amazon, and afterward there were widespread expectations — fueled by Amazon — that the price of e-books would plunge.

The most extreme outcome went like this: Digital versions of big books selling for $9.99 or less would give Amazon complete domination over the e-book market. As sales zoomed upward, even greater numbers of consumers would abandon physical books. The major publishers and traditional bookstores were contemplating a future that would pass them by.

But doomsday has not arrived, at least not yet. As four of the publishers have entered into settlements with regulators and revised the way they sell e-books, prices have selectively fallen but not as broadly or drastically as anticipated.

The $10 floor that publishers fought so hard to maintain for popular new novels is largely intact. Amazon, for instance, is selling Michael Connelly’s new mystery, “The Black Box,” for $12.74. New best sellers by David Baldacci and James Patterson cost just over $11.

One big reason for the lack of fireworks is that the triumph of e-books over their physical brethren is not happening quite as fast as forecast.

“The e-book market isn’t growing at the caffeinated level it was,” said Michael Norris, a Simba Information analyst who follows the publishing industry. “Even retailers like Amazon have to be wondering, how far can we go — or should we go — to make our prices lower than the other guys if it’s not helping us with market share?”

Adult e-book sales through August were up 34 percent from 2011, an impressive rate of growth if you forget that sales have doubled every year for the last four years. And there have been more recent signs of a market pausing for breath.

Macmillan, the only publisher that has not settled with the Justice Department, said last week as part of a statement from John Sargent, its chief executive, that “our e-book business has been softer of late, particularly for the last few weeks, even as the number of reading devices continues to grow.” His laconic conclusion: “Interesting.”

Mr. Norris said Simba, which regularly surveys e-book buyers, has been noticing what it calls “commitment to content” issues.

“A lot of these e-book consumers aren’t behaving like lab rats at a feeder bar,” the analyst said. “We have found that at any given time about a third of e-book users haven’t bought a single title in the last 12 months. I have a feeling it is the digital equivalent of the ‘overloaded night stand’ effect; someone isn’t going to buy any more books until they make a dent in reading the ones they have already acquired.”

Another, more counterintuitive possibility is that the 2011 demise of Borders, the second-biggest chain, dealt a surprising blow to the e-book industry. Readers could no longer see what they wanted to go home and order. “The print industry has been aiding and assisting the e-book industry since the beginning,” Mr. Norris said.

It is possible that Amazon, which controls about 60 percent of the e-book market, is merely holding back with price cuts for the right moment.

The next few weeks are when e-book sales traditionally take a big jump, as all those newly received devices are loaded up with content.

Amazon declined to comment beyond saying, “We have lowered prices for customers from the prices publishers set on a broad assortment of Kindle books.” Barnes & Noble declined to comment on its pricing strategy.

The question of the proper price for e-books has shadowed the industry ever since Amazon introduced the Kindle in late 2007 and created the first truly popular portable reading device. Amazon had a natural impulse to build a market and was an aggressive retailer in any case, so it took best sellers that cost $25 in independent bookstores and sold them for $9.99 as e-books. Consumers liked that. E-book adoption soared.

Read More..

Well: With Help Here and There, Preserving Independence in Old Age

My 92-year-old aunt, who is cognitively impaired and requires a walker or wheelchair to get around, still lives in her own apartment, where round-the-clock home health aides help her get to and from the bathroom, bathe, dress and undress, and go outside each day for some fresh air. The aides shop, prepare and serve meals, do light housekeeping and make sure she takes her medications on time.

But last month, my aunt’s long-term care insurance ran out, and her meager savings will soon do the same. Then what?

Her daughters, both of whom work to support their families, cannot afford the $150 a day for 24-hour care by a certified home health aide, and my aunt has nothing to sell that could bring in the needed cash. Nor does she yet qualify for Medicaid or have a terminal illness that would justify hospice care, which would be covered by Medicare.

Complicating matters, her daughters long ago promised that they would not put her in a nursing home.

Such dilemmas are increasingly common as people live longer. The number of Americans 65 and older is expected to double to 80 million in the next three decades. People 85 and older are the fastest-growing age group; by 2020, there will be 6.6 million people in that age bracket, when rates of debilitating ailments soar.

Most Americans over 65 will eventually need help with the so-called tasks of daily living — eating, dressing, bathing, shopping and the like. But with family members spread all over the map or unable to be full-time caregivers for other reasons, the need for new and better options will only increase.

When asked, 80 to 90 percent of older people say they want to remain in their own homes as long as possible. Yet remaining in one’s home indefinitely is not always the best choice, even if it is financially feasible. As life draws near a close, many older adults need more care than can be provided safely at home. Simply finding reputable home health aides can be a nightmare, and family members often are forced to fill gaps in even the best caregiving plans.

The challenge is all the more difficult when no one has thought through the options before a serious illness or injury makes it impossible for elders to return home without full-time help.

Many elders living independently need outside help long before they require round-the-clock care. A range of assistance and housing alternatives has rapidly sprung up to meet this demand. Many focus on improving accessibility in the home and access to neighborhood conveniences.

An older person living in the suburbs who can no longer drive may become isolated, lonely and at risk of malnutrition if there is no person or community service to shop for her and take her places. Even stairs are a major obstacle.

Elinor Ginzler, director of the Cahnmann Center for Supportive Services at the Jewish Council for the Aging in Rockville, Md., writes that “the ability to age in place is greatly determined by the physical design and accessibility of a home, as well as community features like the availability of nearby services and amenities, affordable housing and transportation options.”

Organizations like Staying in Place, a nonprofit group of volunteers, helps people age 50 and older in Woodstock, N.Y., and surrounding communities “maintain active, independent, fulfilling lives in their own homes.” For $125 a year (plus $50 for each additional household member over 50), the organization assists with paperwork and technology; free or low-cost transportation; referrals to discounted service workers; information about, and transport to, local classes and cultural and social activities; and recommendations for home health care agencies and personnel.

Other services that are free or low-cost include Meals on Wheels; friendly visiting; shopping services accessed by phone or computer; activities at senior centers; and adult day care centers.

There are also more costly commercial organizations like Home Instead Senior Care, an international network of more than 900 independently owned franchises that provide in-home nonmedical care for elders and support for their caregivers.

The organization sponsored a yearlong online study of 1,631 caregivers, 697 of whom were assisted by paid in-home nonmedical care. The study found that people receiving the additional paid care required 25 percent fewer doctor visits and were more likely to participate in adult day care.

Sadly, many aides are seriously underpaid. Home Instead, for instance, has lobbied to keep home health care aides exempt from minimum wage standards.

Henry Cisneros, former secretary of the United States Department of Housing and Urban Development and editor of the book “Independent for Life: Homes and Neighborhoods for an Aging America,” points out that “Americans are aging in traditional homes, neighborhoods and communities that were designed for yesterday’s demographic realities, not those of today or the future.”

Mr. Cisneros advocates changing our communities so that the elderly can remain in them. “Homes can be retrofitted, new age-appropriate homes built, existing neighborhoods reconnected, and new communities planned,” he wrote. For example, to accommodate declining eyesight, homes can be fitted with brighter bulbs, better lighting locations, easily accessed controls and nighttime guide lights.

Mr. Cisneros sees a pressing need for affordable packages of home modifications and maintenance to make residences more suitable for older people.

“A certified renovation package for aging in place could include roll-under kitchen and bathroom sinks, grab bars, curbless showers, lever faucets and door handles, a zero-step entrance, and wider doors and hallways,” he wrote.

While such changes have a price tag, they may cost a lot less than current care alternatives for the elderly.

Needed changes at the community level include affordable small-scale housing and cluster housing situated in walkable communities with nearby amenities, businesses, health facilities and public transportation.

Borrowing from the design of assisted living facilities, individual dwelling units might be located around a common space that includes dining areas and social rooms.

For elders who want to be near family members yet maintain their independence, so-called accessory dwelling units with their own kitchens and bathrooms are being built near or attached to family homes.

---

How to Know When Home Alone Is No Longer a Good Idea

Paula Spencer Scott, senior editor at Caring.com, recently compiled a guide to help families determine when the time has come to move older relatives from their homes and into a more supportive environment or, alternatively, to bring in a home health aide who can provide assistance. These signs to look for and questions to ask are adapted from Ms. Scott’s recommendations.

¶ Recent accidents or close calls, like a fall, medical scare or minor car accident.

¶ A slow recovery. How well was a recent illness weathered? Did it develop into something serious? Was medical help sought when needed?

¶ Worsening of a chronic health condition. As problems like chronic obstructive pulmonary disease, dementia or congestive heart failure progress, more help will be needed.

¶ Greater difficulty managing the so-called activities of daily living, like dressing, bathing and cooking.

¶ Bodily changes, like obvious weight loss or gain, increased frailty or unpleasant body odor.

¶ A loss of active friendships, including outings with friends, visits with neighbors or participation in religious or other group activities.

¶ Days spent without leaving the house, perhaps because of difficulty driving or a fear of using public transportation.

¶ Is someone checking in regularly? If not, is there a home-safety alarm system, a personal alarm system or a daily calling service in place?

¶ Is someone nearby to assist if there’s a fire, earthquake, flood or other disaster, and does the older resident understand plans for a catastrophe?

¶ Mail in a chaotic state, scattered about and unopened. Are there unpaid overdue bills, surprising thank-you notes from charities, piles of unread magazines?

¶ If an older relative is still driving, go along for a ride and look for failure to fasten the seat belt or heed dashboard warning lights; signs of tension, preoccupation or distraction while driving; damage to the vehicle that may indicate carelessness.

¶ In the kitchen, signs of excess or forgetfulness, like perishables well past their expiration dates.

¶ Favorite appliances are broken but not scheduled for repair.

¶ Signs of fires. Look for charred stove knobs or pot bottoms, potholders with burned edges, a discharged fire extinguisher. Do smoke and carbon monoxide detectors have live batteries?

¶ A once-neat home now cluttered, spills that were not cleaned up, grime coating bathroom and kitchen appliances or an overflowing laundry basket.

¶ Neglected plants or pets.

¶ Signs of neglect outside the home, like broken windows, debris-filled gutters and drains, uncollected rubbish and an overstuffed mailbox.

¶ Ask friends and neighbors whether your family member’s behavior has changed lately.

¶ Ask the person’s doctor whether you should be concerned about the person’s health or safety and whether a home assessment by a social worker or geriatric care manager may be advisable. If you expect resistance from the person, ask the doctor to “prescribe” a professional evaluation.

¶ If you are the primary caregiver, how are you doing? Are you increasingly exhausted, depressed or becoming resentful of the sacrifices you have to make to care for the person?

¶ Consider your older relative’s emotional state. If she is riddled with anxieties or increasingly lonely, then it may be time to make a move for reasons other than health and safety.

Read More..

Well: With Help Here and There, Preserving Independence in Old Age

My 92-year-old aunt, who is cognitively impaired and requires a walker or wheelchair to get around, still lives in her own apartment, where round-the-clock home health aides help her get to and from the bathroom, bathe, dress and undress, and go outside each day for some fresh air. The aides shop, prepare and serve meals, do light housekeeping and make sure she takes her medications on time.

But last month, my aunt’s long-term care insurance ran out, and her meager savings will soon do the same. Then what?

Her daughters, both of whom work to support their families, cannot afford the $150 a day for 24-hour care by a certified home health aide, and my aunt has nothing to sell that could bring in the needed cash. Nor does she yet qualify for Medicaid or have a terminal illness that would justify hospice care, which would be covered by Medicare.

Complicating matters, her daughters long ago promised that they would not put her in a nursing home.

Such dilemmas are increasingly common as people live longer. The number of Americans 65 and older is expected to double to 80 million in the next three decades. People 85 and older are the fastest-growing age group; by 2020, there will be 6.6 million people in that age bracket, when rates of debilitating ailments soar.

Most Americans over 65 will eventually need help with the so-called tasks of daily living — eating, dressing, bathing, shopping and the like. But with family members spread all over the map or unable to be full-time caregivers for other reasons, the need for new and better options will only increase.

When asked, 80 to 90 percent of older people say they want to remain in their own homes as long as possible. Yet remaining in one’s home indefinitely is not always the best choice, even if it is financially feasible. As life draws near a close, many older adults need more care than can be provided safely at home. Simply finding reputable home health aides can be a nightmare, and family members often are forced to fill gaps in even the best caregiving plans.

The challenge is all the more difficult when no one has thought through the options before a serious illness or injury makes it impossible for elders to return home without full-time help.

Many elders living independently need outside help long before they require round-the-clock care. A range of assistance and housing alternatives has rapidly sprung up to meet this demand. Many focus on improving accessibility in the home and access to neighborhood conveniences.

An older person living in the suburbs who can no longer drive may become isolated, lonely and at risk of malnutrition if there is no person or community service to shop for her and take her places. Even stairs are a major obstacle.

Elinor Ginzler, director of the Cahnmann Center for Supportive Services at the Jewish Council for the Aging in Rockville, Md., writes that “the ability to age in place is greatly determined by the physical design and accessibility of a home, as well as community features like the availability of nearby services and amenities, affordable housing and transportation options.”

Organizations like Staying in Place, a nonprofit group of volunteers, helps people age 50 and older in Woodstock, N.Y., and surrounding communities “maintain active, independent, fulfilling lives in their own homes.” For $125 a year (plus $50 for each additional household member over 50), the organization assists with paperwork and technology; free or low-cost transportation; referrals to discounted service workers; information about, and transport to, local classes and cultural and social activities; and recommendations for home health care agencies and personnel.

Other services that are free or low-cost include Meals on Wheels; friendly visiting; shopping services accessed by phone or computer; activities at senior centers; and adult day care centers.

There are also more costly commercial organizations like Home Instead Senior Care, an international network of more than 900 independently owned franchises that provide in-home nonmedical care for elders and support for their caregivers.

The organization sponsored a yearlong online study of 1,631 caregivers, 697 of whom were assisted by paid in-home nonmedical care. The study found that people receiving the additional paid care required 25 percent fewer doctor visits and were more likely to participate in adult day care.

Sadly, many aides are seriously underpaid. Home Instead, for instance, has lobbied to keep home health care aides exempt from minimum wage standards.

Henry Cisneros, former secretary of the United States Department of Housing and Urban Development and editor of the book “Independent for Life: Homes and Neighborhoods for an Aging America,” points out that “Americans are aging in traditional homes, neighborhoods and communities that were designed for yesterday’s demographic realities, not those of today or the future.”

Mr. Cisneros advocates changing our communities so that the elderly can remain in them. “Homes can be retrofitted, new age-appropriate homes built, existing neighborhoods reconnected, and new communities planned,” he wrote. For example, to accommodate declining eyesight, homes can be fitted with brighter bulbs, better lighting locations, easily accessed controls and nighttime guide lights.

Mr. Cisneros sees a pressing need for affordable packages of home modifications and maintenance to make residences more suitable for older people.

“A certified renovation package for aging in place could include roll-under kitchen and bathroom sinks, grab bars, curbless showers, lever faucets and door handles, a zero-step entrance, and wider doors and hallways,” he wrote.

While such changes have a price tag, they may cost a lot less than current care alternatives for the elderly.

Needed changes at the community level include affordable small-scale housing and cluster housing situated in walkable communities with nearby amenities, businesses, health facilities and public transportation.

Borrowing from the design of assisted living facilities, individual dwelling units might be located around a common space that includes dining areas and social rooms.

For elders who want to be near family members yet maintain their independence, so-called accessory dwelling units with their own kitchens and bathrooms are being built near or attached to family homes.

---

How to Know When Home Alone Is No Longer a Good Idea

Paula Spencer Scott, senior editor at Caring.com, recently compiled a guide to help families determine when the time has come to move older relatives from their homes and into a more supportive environment or, alternatively, to bring in a home health aide who can provide assistance. These signs to look for and questions to ask are adapted from Ms. Scott’s recommendations.

¶ Recent accidents or close calls, like a fall, medical scare or minor car accident.

¶ A slow recovery. How well was a recent illness weathered? Did it develop into something serious? Was medical help sought when needed?

¶ Worsening of a chronic health condition. As problems like chronic obstructive pulmonary disease, dementia or congestive heart failure progress, more help will be needed.

¶ Greater difficulty managing the so-called activities of daily living, like dressing, bathing and cooking.

¶ Bodily changes, like obvious weight loss or gain, increased frailty or unpleasant body odor.

¶ A loss of active friendships, including outings with friends, visits with neighbors or participation in religious or other group activities.

¶ Days spent without leaving the house, perhaps because of difficulty driving or a fear of using public transportation.

¶ Is someone checking in regularly? If not, is there a home-safety alarm system, a personal alarm system or a daily calling service in place?

¶ Is someone nearby to assist if there’s a fire, earthquake, flood or other disaster, and does the older resident understand plans for a catastrophe?

¶ Mail in a chaotic state, scattered about and unopened. Are there unpaid overdue bills, surprising thank-you notes from charities, piles of unread magazines?

¶ If an older relative is still driving, go along for a ride and look for failure to fasten the seat belt or heed dashboard warning lights; signs of tension, preoccupation or distraction while driving; damage to the vehicle that may indicate carelessness.

¶ In the kitchen, signs of excess or forgetfulness, like perishables well past their expiration dates.

¶ Favorite appliances are broken but not scheduled for repair.

¶ Signs of fires. Look for charred stove knobs or pot bottoms, potholders with burned edges, a discharged fire extinguisher. Do smoke and carbon monoxide detectors have live batteries?

¶ A once-neat home now cluttered, spills that were not cleaned up, grime coating bathroom and kitchen appliances or an overflowing laundry basket.

¶ Neglected plants or pets.

¶ Signs of neglect outside the home, like broken windows, debris-filled gutters and drains, uncollected rubbish and an overstuffed mailbox.

¶ Ask friends and neighbors whether your family member’s behavior has changed lately.

¶ Ask the person’s doctor whether you should be concerned about the person’s health or safety and whether a home assessment by a social worker or geriatric care manager may be advisable. If you expect resistance from the person, ask the doctor to “prescribe” a professional evaluation.

¶ If you are the primary caregiver, how are you doing? Are you increasingly exhausted, depressed or becoming resentful of the sacrifices you have to make to care for the person?

¶ Consider your older relative’s emotional state. If she is riddled with anxieties or increasingly lonely, then it may be time to make a move for reasons other than health and safety.

Read More..