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 Carol 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?

Editor’s Note:

Correction: An earlier version of this post contained an incorrect spelling of the first name of the director of the Families and Health Care Project of the United Hospital Fund. She is Carol Levine, not Carole Levine.

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DealBook: Standard Chartered Agrees to Settle Iran Money Transfer Claims

The British bank Standard Chartered reached a deal with federal and state prosecutors on Monday over accusations that it had illegally funneled money for Iranian banks and corporations.

The 150-year-old bank will pay $327 million to settle claims by the Justice Department, the Manhattan district attorney’s office, the Federal Reserve Bank of New York and the Treasury Department.

“Investigations of financial institutions, businesses and individuals who violate U.S. sanctions by misusing banks in New York are vitally important to national security and the integrity of our banking system,” Cyrus R. Vance Jr., the Manhattan district attorney, said in a statement.

The agreement allows the bank to move beyond a turbulent period.

In August, the New York State Department of Financial Services, headed by Benjamin M. Lawsky, broke from regulators and moved to accuse Standard Chartered of scheming for nearly a decade to hide 60,000 transactions worth $250 billion. Standard Chartered agreed to pay $340 million over the matter a month later.

United States authorities have been cracking down on banks that flouted federal law to transfer money on behalf of sanctioned nations. Investigations into Standard Chartered began in 2009, according to several law enforcement officials.

Executives at Standard Chartered have spent months trying to work out a settlement and resolve the investigation. Lawyers for the bank, in numerous conversations with federal and state prosecutors, maintained vociferously that a large majority of the transactions with Iran were permitted under a federal law that previously allowed foreign banks to transfer money for Iranian clients to another foreign institution through their American subsidiaries.

The settlement will also help to quell tensions between the law enforcement agencies, which were riven by divisions after Mr. Lawsky moved independently against the bank.

Since January 2009, the Justice Department, Treasury and the Manhattan prosecutor have charged five foreign banks in an effort to crack down on the illegal movement of tainted money across the globe. In June, ING Bank reached a $619 million settlement to resolve claims that it had transferred billions of dollars in the United States for Cuba and Iran.

As part of the agreement announced on Monday, Standard Chartered admitted to processing more than $200 million for Iranian and Sudanese clients through its American subsidiaries. To avoid having those transactions detected by Treasury Department computer filters, Standard Chartered deliberately removed identifying information, according to the authorities.

Until 2008, foreign banks like Standard Chartered were permitted to transfer money for Iranian clients through their American branches to separate offshore institutions. These so-called U-turn transactions required banks to provide scant information about the original client to their American operations as long as they had checked for questionable activities. The Iranian loophole was closed in 2008 after American authorities suspected that Iranian banks were funneling money to support nuclear weapons development.

While the overwhelming majority of payments processed by Standard Chartered for Iran and Sudan were technically legal, they should have been disclosed, the Manhattan district attorney said on Monday.

Mr. Lawsky of the New York financial services department had based his case against Standard Chartered, in large part, on similar claims that the bank had thwarted efforts to spot sanctions violations by cloaking the identities of Iranian clients and lying to regulators.

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Changes to Agriculture Highlight Cuba’s Problems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Rolling Stones rock Brooklyn at anniversary gig

NEW YORK (AP) — It sure didn't feel like a farewell.

The Rolling Stones — average age 68-plus, if you're counting — were in rollicking form as they rocked the Barclays Center in Brooklyn for 2½ hours Saturday night, their first U.S. show on a mini-tour marking a mind-boggling 50 years as a rock band.

And although every time the Stones tour, the inevitable questions arise, — whether it's "The Last Time," to quote one of their songs — there was no sign that anything is ending anytime soon.

"People say, why do you keep doing this?" mused 69-year-old Mick Jagger, the band's impossibly energetic frontman, before launching into "Brown Sugar." ''Why do you keep touring, coming back? The answer is, you're the reason we're doing this. Thank you for buying our records and coming to our shows for the last 50 years."

Jagger was in fine form, with strong vocals and his usual swagger — strutting, jogging, skipping and pumping his arms like a man half his age. And though he briefly donned a flamboyant feathered black cape for "Sympathy for the Devil" and later, some red-sequined tails, he was mostly content to prowl the stage in a tight black T-shirt and trousers.

The band's guitarists, the brilliant Keith Richards and Ronnie Wood, alternated searing solos and occasionally ventured onto a stage extension that brought them closer to the crowd. The now-gray Richards, wearing a red bandana, exuded the easy familiarity of a favorite uncle: "While we wait for Ronnie," he said at one point, "I'll wish you happy holidays." Watts, the dapper drummer in a simple black T-shirt, smiled frequently at his band mates.

The grizzled quartet was joined on "Gimme Shelter" by Mary J. Blige, who traded vocals with Jagger and earned a huge cheer at the end. Also visiting: the Texas blues guitarist Gary Clark Jr.

The sense of nostalgia was heightened by projections on a huge screen of footage of the early days, when the Stones looked like teenagers. At one point, Jagger reminisced about the first time the band played New York — in 1964.

A carton of milk cost only a quarter then, he said. And a ticket to the Rolling Stones? "I don't want to go there," he quipped. It was a reference to the sky-high prices at the current "50 and Counting" shows, where even the "cheap" seats cost a few hundred dollars and a prime seat cost in the $700 range or higher.

From the opening number, "Get Off Of My Cloud," the band played a generous 23 songs, including two new ones — "Doom and Gloom" and "One More Shot" — but mostly old favorites. The rousing encore included "Jumping Jack Flash," of course, but the final song was "Satisfaction." And though the song speaks of not getting any, the consensus of the packed 18,000-seat arena was that it was a satisfying evening indeed.

"If you like the Stones, this was as good a show as you could have had," said one fan, Robert Nehring, 58, of Westfield, N.J., who'd paid $500 for his seat. "It was worth it," he said simply.

The Brooklyn show was a coup for the new Barclays Center — there are no Manhattan shows. It followed two rapturously received Stones shows in London late last month. The band also will play two shows in Newark, N.J., on Dec. 13 and 15.

And just before that, the Stones will join a veritable who's who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Superstorm Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, "Doom and Gloom" and "One More Shot," and HBO premiered a new documentary on their formative years, "Crossfire Hurricane."

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who'd met on a train platform a year earlier. Bassist Bill Wyman and Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 and replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, "A Bigger Bang," which earned more than $550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really "One Last Shot?"

The Stones won't say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

"I thought it would be kind of churlish not to do something," Jagger told The Associated Press. "Otherwise, the BBC would have done a rather dull film about the Rolling Stones."

There certainly was nothing dull about the band's performance on Saturday, a show that brought together many middle-aged fans, to be sure, but also some of their children, who seemed to be enjoying the classic Stones brand of blues-tinged rock as much as their parents.

Yes, a Stone's average age might be a bit higher than that of the average Supreme Court justice. (To be fair, the newest justices bring the average down). But to watch these musicians play with vitality and vigor a half-century on is to believe that maybe they were right when they sang, "Time Is On My Side." At least for a few more years.

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Associated Press writer David Bauder contributed to this report.

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New Taxes to Take Effect to Fund Health Care Law

WASHINGTON — For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.

The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.

Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.

To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.

The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.

Ruth M. Wimer, a tax lawyer at McDermott Will & Emery, said the taxes came with “a shockingly inequitable marriage penalty.” If a single man and a single woman each earn $200,000, she said, neither would owe any additional Medicare payroll tax. But, she said, if they are married, they would owe $1,350. The extra tax is 0.9 percent of their earnings over the $250,000 threshold.

Since the creation of Social Security in the 1930s, payroll taxes have been levied on the wages of each worker as an individual. The new Medicare payroll is different. It will be imposed on the combined earnings of a married couple.

Employers are required to withhold Social Security and Medicare payroll taxes from wages paid to employees. But employers do not necessarily know how much a worker’s spouse earns and may not withhold enough to cover a couple’s Medicare tax liability. Indeed, the new rules say employers may disregard a spouse’s earnings in calculating how much to withhold.

Workers may thus owe more than the amounts withheld by their employers and may have to make up the difference when they file tax returns in April 2014. If they expect to owe additional tax, the government says, they should make estimated tax payments, starting in April 2013, or ask their employers to increase the amount withheld from each paycheck.

In the Affordable Care Act, the new tax on investment income is called an “unearned income Medicare contribution.” However, the law does not provide for the money to be deposited in a specific trust fund. It is added to the government’s general tax revenues and can be used for education, law enforcement, farm subsidies or other purposes.

Donald B. Marron Jr., the director of the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, said the burden of this tax would be borne by the most affluent taxpayers, with about 85 percent of the revenue coming from 1 percent of taxpayers. By contrast, the biggest potential beneficiaries of the law include people with modest incomes who will receive Medicaid coverage or federal subsidies to buy private insurance.

Wealthy people and their tax advisers are already looking for ways to minimize the impact of the investment tax — for example, by selling stocks and bonds this year to avoid the higher tax rates in 2013.

The new 3.8 percent tax applies to the net investment income of certain high-income taxpayers, those with modified adjusted gross incomes above $200,000 for single taxpayers and $250,000 for couples filing jointly.

David J. Kautter, the director of the Kogod Tax Center at American University, offered this example. In 2013, John earns $160,000, and his wife, Jane, earns $200,000. They have some investments, earn $5,000 in dividends and sell some long-held stock for a gain of $40,000, so their investment income is $45,000. They owe 3.8 percent of that amount, or $1,710, in the new investment tax. And they owe $990 in additional payroll tax.

The new tax on unearned income would come on top of other tax increases that might occur automatically next year if President Obama and Congress cannot reach an agreement in talks on the federal deficit and debt. If Congress does nothing, the tax rate on long-term capital gains, now 15 percent, will rise to 20 percent in January. Dividends will be treated as ordinary income and taxed at a maximum rate of 39.6 percent, up from the current 15 percent rate for most dividends.

Under another provision of the health care law, consumers may find it more difficult to obtain a tax break for medical expenses.

Taxpayers now can take an itemized deduction for unreimbursed medical expenses, to the extent that they exceed 7.5 percent of adjusted gross income. The health care law will increase the threshold for most taxpayers to 10 percent next year. The increase is delayed to 2017 for people 65 and older.

In addition, workers face a new $2,500 limit on the amount they can contribute to flexible spending accounts used to pay medical expenses. Such accounts can benefit workers by allowing them to pay out-of-pocket expenses with pretax money.

Taken together, this provision and the change in the medical expense deduction are expected to raise more than $40 billion of revenue over 10 years.

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Changes to Agriculture Highlight Cuba’s Problems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Read More..

Art and Commerce Meet in Miami Beach

Katie Orlinsky for The New York Times

Visitors at the V.I.P. opening of Art Basel Miami Beach.

MIAMI — Mera Rubell was taking time out from greeting the hundreds of visitors at her family’s sprawling contemporary art center here to vent.

“It’s the height of arrogance to dismiss — — ,” she began.

Jason, her son, interrupted: “It’s arrogance. It’s a completely uninteresting story.”

For the moment her husband, Don, had given up on trying to get a word in.

The Rubells, deans of Miami’s bustling art scene, were pushing back against a chorus of complaints that has been growing louder in the weeks leading up to Art Basel Miami Beach, the annual art pilgrimage that began Wednesday and ends Sunday.

Prominent art writers and critics, including Sarah Thornton, Felix Salmon, Will Gompertz and Dave Hickey, have been attacking the art world, arguing that the staggering sums of money being spent on works are distorting judgments about art and undermining its long-term cultural significance.

“Money talks loudly and easily drowns out other meanings,” Ms. Thornton wrote in TAR magazine in a recent article, “Top 10 Reasons NOT to Write About the Art Market.”

In its special edition for the opening day of the fair, The Art Newspaper asked whether “the art world is facing a crisis of values” because of the “pernicious influence of the market on art.”

And in the eyes of many critics, Art Basel Miami Beach — or what Simon Doonan, writing in Slate last week, labeled a “promo-party cheese-fest” — has become a symbol of everything that’s wrong with the art market. The fair’s extraordinary success in just over a decade, and its celebration of wretched excess, have triggered a backlash.

But the Rubells, along with a growing number of other prominent collectors, art dealers and curators, are having none of it. The backlash against the backlash has begun.

“The market supports artists,” Jason Rubell said. Given the limited amount of government support for the arts, he added, “it’s an industry that without commerce doesn’t exist. What do people want — to go back to the recession?”

Ms. Rubell was annoyed that critics seemed to ignore the social, economic and cultural transformation of Miami that the fair and collectors like her have helped bring about. She noted that the Rubells’ 45,000-square-foot art center — where one huge gallery is now filled with works by Oscar Murillo, a 26-year-old Colombian immigrant who lived with and was supported by the Rubells while he created dozens of mural-sized canvases — used to be a Drug Enforcement Administration storage center.

Outside, in the center’s courtyard, visitors like Martha Stewart admired the French artist Bernar Venet’s collaboration with Bugatti, the superluxury sports car brand, on a one-of-a-kind Veyron Grand Sport Venet car (a price hasn’t been set, a Bugatti spokeswoman said, but will undoubtedly be in “the higher end of the millions”).

“I’m grateful to Bugatti, Perrier, Bank of America and other companies,” Ms. Rubell declared. “Their support helps facilitate quality programs and opens exhibits like this” — the Murillo show — “to the public.”

In Miami Beach, at the main fair, the consumer-oriented glitter abounds this week: coffee carts with $20-a-glass Ruinart Champagne; Davidoff cigar rollers; BMW’s artist-designed cars; and Takashi Murakami’s $70,000-and-up commissioned portraits. One could almost imagine that the Barbara Kruger work on display at L&M gallery — a super-sized sign reading “Greedy” on one line and an unprintable expletive on the next — had an invisible subtitle telling the wealthy V.I.P.’s who had come to shop, “I’m Talking to You — Yeah, You!”

Of course, rich patrons have always supported artists, Don Rubell pointed out, from the pharaohs to the Medicis. Today, multimillion-dollar sales represent only a silk-thin layer of a deeply varied and thriving art market. The art world, Mr. Rubell asserted, is “actually becoming more democratic.”

“There’s 20 ancillary fairs” in addition to the high-end main event of Art Basel, he said. “Whatever amount of money you have in your pocket, you can enter this magical world of art.”

The notion that the art market contains multitudes is one with which Marc Glimcher, part of the family dynasty that runs the Pace Gallery, said he agreed.

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Lupus forces singer Toni Braxton into LA hospital

LOS ANGELES (AP) — Singer Toni Braxton has been hospitalized in Los Angeles.

The R&B performer says in a Tweet on Friday that she's been hospitalized because of "minor health issues" related to Lupus. A spokeswoman confirmed the hospitalization but had no other details. "But no worries!," Braxton wrote to fans. "I will be out any day now."

The 45-year-old singer of "Un-break My Heart" revealed two years ago she has Lupus, a potentially deadly autoimmune disease that killed Braxton's uncle. She also suffers from a narrowing of the blood vessels in her heart.

Braxton said in a recent "20/20" interview that doctors told her the Lupus diagnosis meant her performing career would likely be diminished and the disease helped push her into a recent bankruptcy.

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Online:

http://tonibraxton.com

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Developers of New Housing Aim for Renters, Not Buyers

Michael Stravato for The New York Times

Apartment buildings under construction in Camden City Centre II in Houston.

Houston is better known for urban sprawl than dense apartment living. But as part of a national rush to capitalize on rising rents, developers there are building thousands of apartments like those south of downtown at Camden City Centre, where 268 units will open early next year in a complex that also has two swimming pools, billiards tables, a coffee bar and a fitness center.

As residential building recovers from a near standstill after the housing crisis, much of the momentum is coming not from subdivisions with green lawns and two-car garages but from rental apartments. Multifamily construction nationwide is two-thirds of the way back to its prerecession peak, while single-family home construction is still only about a third of the way back to its peak, said David Crowe, the chief economist of the National Association of Home Builders.

The multifamily construction recovery, fueled by young people who are striking out on their own, is strongest in the South and West, particularly in markets where job growth is picking up. Last month, the Commerce Department released data on new construction that showed new apartment complexes were going up at the fastest rate since July 2008.

That has led to a fear of overbuilding. While rents are still rising, analysts say the steep increases between 2011 and 2012 are unlikely to be repeated as a surge of units are completed in the latter part of this year and will continue to come on the market early next year. Nationally, residential rents rose 4.2 percent in 2011, but only 3.6 percent so far this year, according to Axiometrics, a Dallas-based apartment market research firm.

Much depends on the fortunes of the job market, which industry analysts said would determine whether higher rents were sustainable.

“The real test is going to be what happens between now and April or May as we see all these new units introduced to the market,” said Jay Denton, the vice president for research at Axiometrics.

Still, vacancies remain extremely low and the pace of building in recent years has not been quick enough to replace obsolete, decrepit or demolished units, said Mr. Crowe of the homebuilders group. He projected that it would be several years before supply was back to normal.

In Houston, from January to September, construction permits for multifamily housing increased by more than 70 percent over the same period a year earlier, according to data compiled by the homebuilders group. Permits for single-family homes, by contrast, increased by 25 percent. Shares of Camden Property, the real estate investment trust that is building Camden City Centre, were up about 20 percent over a year ago.

“The demand for building is all over the country, really,” said Ric Campo, Camden’s chairman and chief executive. “We’re seeing higher rents, faster lease-ups, lower construction costs — everything you want to see. Part of it is there’s just a pent-up demand for new product because we didn’t build anything during the downturn.”

In Houston, where low housing prices have traditionally kept the cost of living down, Camden can rent a one-bedroom apartment for $1,450.

Houston is far from the only market where demand for rentals is at a fever pitch. Denver, Oakland, Seattle, Miami and Charlotte, N.C., where many of the condo projects that went bust have been converted to rentals, also appear at the top of lists by data collectors like Trulia, Zillow and Axiometrics.

The bulk of the apartments are not going to families who lost their homes to foreclosure, many of whom are renting single-family houses. Instead, the apartments are being rented by young people who had moved in with their parents during the recession, or simply had not yet moved out.

People in their early 30s, the age when many might look to buy a first home, are renting for longer periods of time, partly because mortgages are difficult to come by and partly because they have been unnerved by the turmoil in the housing market.

“That portion of the population is starting to grow again, but I think a lot of them, seeing what has happened, are not particularly enthralled with the idea of going out and buying a house,” said Steve Blitz, the chief economist at ITG Investment Research.

Michael Hoffman, a 26-year-old electrical engineer, said he moved into a two-bedroom apartment in Camden City Centre a few months ago after living with his parents to save money.

“It was easier,” he said of the rent-free arrangement with his parents. “But I felt like I was missing out on my 20s.”

Daniel Cadis contributed reporting from Houston.

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Alicia Keys raises $2.9M at gala, honors Winfrey

NEW YORK (AP) — During the auction portion of Alicia Keys' Black Ball Redux, one man was ready to jump his bid from $100,000 to $250,000 for a trip to South Africa — if Keys would join him and his friends.

"I'll go for a little more," Keys said Thursday night at the Apollo Theater, where her charity's annual gala was held.

The man — pharmaceutical billionaire Stewart Rahr — didn't raise his bid, but he later pledged $1 million to Keep a Child Alive, helping the R&B singer raise more than $2.9 million.

Keys' charity assists those affected by HIV/AIDS in Africa and India. Thursday's event was originally planned for Nov. 1, but was canceled due to Superstorm Sandy.

"There are places in the world where Keep a Child Alive serves where they have a Hurricane Sandy every day," Keys said in an interview on the red carpet. "They don't have electricity, they don't have heat ... and that made me more invigorated to make sure this Black Ball happened."

Keys honored Oprah Winfrey at the event for the entrepreneur's philanthropic efforts, including her school, The Oprah Winfrey Leadership Academy for Girls in South Africa, which launched in 2007.

"It's a universal truth, Oprah makes change happen," Keys said.

Winfrey said she was honored to receive an award from Keys, and that it confirms she's "moving in the right direction."

"You try to keep a child alive and I try to educate them as best as I can," Winfrey said onstage.

Before that, a video played onscreen detailing the launch of Winfrey's school and how the mogul struggled in her early years, riding on a bus with maids from the inner city to the suburbs to attend a better high school.

"When I look at Africans girls I see myself," 58-year-old Winfrey said. "I continue to work for them to have the same opportunities that I have. "

Beninese singer Angélique Kidjo was also honored and she joined Keys onstage for some upbeat, drum-filled numbers.

Bonnie Raitt also performed, as she and Keys sang a duet version of her slow groove "I Just Can't Make You Love Me." Keys said it was "one of my dreams to sing" with Raitt.

Jennifer Hudson and Brittany Howard of Alabama Shakes also hit the stage, where Whoopi Goldberg worked as the night's emcee.

"I read '50 Shades of Grey' so I stay away from paddles," Goldberg said when the auction began.

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Online:

http://keepachildalive.org/

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Follow Mesfin Fekadu on Twitter at twitter.com/MusicMesfin

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