The New Old Age Blog: New Efforts to Close Hospitals' Revolving Doors

In the past, the only thing a patient was sure to get after a hospital stay was a bill. But as Medicare cracks down on high readmission rates, hospitals are dispatching nurses, transportation, culturally specific diet tips, free medications and even bathroom scales to patients deemed at risk of relapsing.

Robert Wood Johnson University Hospital in New Brunswick, N.J., has nurses visit high-risk patients at their home within two days of leaving the hosital. Teresa De Peralta, a nurse practitioner who runs the program, said they frequently find that patients don’t realize a drug they were prescribed in the hospital does the same thing as one they have already been taking.

“When medications are changed, they don’t want to throw things out, they think it’s a waste,” Ms. De Peralta said. “We actually go through the cupboards and painstakingly write out in big letters what they should be taking during the day.”

Many hospital officials say their efforts to keep patients healthy after discharge have been spurred by new financial penalties Medicare started imposing in October on places with too many readmissions. Increasingly, hospitals are no longer leaving to patients the responsibility for setting up follow-up appointments or filling new prescriptions.

And hospitals are not assuming that personnel in nursing homes and other facilities know how to properly care for their patients and follow the hospital discharge instructions.

Patients taking the wrong dose or mixing medicines that react badly often end up back in the hospital. A survey of 377 elderly patients at Yale-New Haven Hospital, published this year in The Journal of General Internal Medicine, discovered that 81 percent of the patients either didn’t understand what all their prescriptions were for; were prescribed the wrong drug or the wrong dose; were taken off a drug they needed, or never picked up a new prescription.

Dr. Leora Horwitz, the study’s leader, said patients who were called a week after their discharge and were asked what changes to their medication they were supposed to make “overwhelmingly” couldn’t tell them.

A big part of reducing readmissions is making sure that patients understand early warning signs that their health is deteriorating. Sun Health Care Transitions, a foundation-supported program in Sun City, Ariz., gives scales to some patients with congestive heart failure because small weight gains indicate they are retaining water, a sign that their heart isn’t pumping adequately.

“We have them keep a log,” said Jennifer Drago, a Sun Health vice president. “We want them to be looking for a two-pound daily weight gain, or five pounds over the week.”

Patients whose weight creeps up are quickly sent back to their doctor. Debra Richards, director of case management at Banner Del E. Webb Medical Center, one of the hospitals Sun Health is assisting, said, “That program has helped us quite a bit.”

Shady Grove Adventist Hospital in Rockville, Md., has started taking patients’ cultural backgrounds into consideration when doling out advice about maintaining their health. For example, the hospital encourages Salvadoran patients to substitute olive oils for the palm oils their cuisine traditionally calls for, to roast or bake meat instead of frying it and to use sugar substitutes when making horchata, a popular Central American drink.

When Hackensack University Medical Center sent staff members to teach caregivers how to take care of their patients, one place “didn’t even know what a low-salt diet was,” even though that’s a critical part of keeping heart failure patients from retaining fluids, said Dr. Charles Riccobono, chief quality and safety officer at the New Jersey hospital.

Aurora Health Care, a Milwaukee-based health system, now places its own nurse practitioners in several nursing homes to watch over Aurora’s discharged patients. Aurora says readmission rates of those patients have decreased, in some months by as much as half.

Dr. Eric Coleman, a Denver geriatrician whose ideas on reducing readmissions have been adopted by a number of hospitals and Medicare, said that while some hospital changes are “exciting and new,” others are “relabeling old wine in new bottles.”

“Yesterday we had ‘discharge planning’ and today we have a ‘rapid response transition team,’ and content-wise they’re doing the same thing,” Dr. Coleman said. “But it’s a nice thing to report out to the board of trustees.”

Jordan Rau is a reporter for Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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Military's dogs of war also suffer post-traumatic stress disorder

LACKLAND AIR FORCE BASE, Texas — Not long after a Belgian Malinois named Cora went off to war, she earned a reputation for sniffing out the buried bombs that were the enemy's weapon of choice to kill or maim U.S. troops.

Cora could roam a hundred yards or more off her leash, detect an explosive and then lie down gently to signal danger. All she asked in return was a kind word or a biscuit, maybe a play session with a chew toy once the squad made it back to base.

"Cora always thought everything was a big game," said Air Force Tech. Sgt. Garry Laub, who trained Cora before she deployed. "She knew her job. She was a very squared-away dog."

PHOTOS: Military dogs

But after months in Iraq and dozens of combat patrols, Cora changed. The transformation was not the result of one traumatic moment, but possibly the accumulation of stress and uncertainty brought on by the sharp sounds, high emotion and ever-present death in a war zone.

Cora — deemed a "push-button" dog, one without much need for supervision — became reluctant to leave her handler's side. Loud noises startled her. The once amiable Cora growled frequently and picked fights with other military working dogs.

When Cora returned to the U.S. two years ago, there was not a term for the condition that had undercut her combat effectiveness and shattered her nerves. Now there is: canine post-traumatic stress disorder.

"Dogs experience combat just like humans," said Marine Staff Sgt. Thomas Gehring, a dog handler assigned to the canine training facility at Lackland Air Force Base, who works with Cora daily.

Veterinarians and senior dog handlers at Lackland have concluded that dogs, like humans, can require treatment for PTSD, including conditioning, retraining and possibly medication such as the anti-anxiety drug Xanax. Some dogs, like 5-year-old Cora, just need to be treated as honored combat veterans and allowed to lead less-stressful lives.

Walter Burghardt Jr., chief of behavioral medicine and military working-dog studies at Lackland, estimates that at least 10% of the hundreds of dogs sent to Iraq and Afghanistan to protect U.S. troops have developed canine PTSD.

Cora appears to have a mild case. Other dogs come home traumatized.

"They're essentially broken and can't work," Burghardt said.

There are no official statistics, but Burghardt estimates that half of the dogs that return with PTSD or other behavioral hitches can be retrained for "useful employment" with the military or law enforcement, such as police departments, the Border Patrol or the Homeland Security Department.

The others dogs are retired and made eligible for adoption as family pets.

The decision to officially label the dogs' condition as PTSD was made by a working group of dog trainers and other specialists at Lackland. In most cases, such labeling of animal behavior would be subjected to peer review and scrutiny in veterinary medical journals.

But Burghardt and others in the group decided that they could not wait for that kind of lengthy professional vetting — that a delay could endanger those who depend on the dogs.

Since the terrorist attacks of 2001, the military has added hundreds of canines and now has about 2,500 — Dutch and German shepherds, Belgian Malinois and Labrador retrievers — trained in bomb detection, guard duty or "controlled aggression" for patrolling.

Lackland trains dogs and dog handlers for all branches of the military. The huge base, located in San Antonio, has a $15-million veterinary hospital devoted to treating dogs working for the military or law enforcement, like a Border Patrol dog who lost a leg during a firefight between agents and a suspected drug smuggler.

"He's doing fine, much better," the handler yelled out when asked about the dog's condition.

Cora received her initial training here and then additional training with Laub at Moody Air Force Base in Georgia. Before they could deploy, however, Laub was transferred to Arkansas, and Cora shipped off to Iraq with a different handler, much to Laub's regret.

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Betfair pulls out of Greece over permits row

LONDON (Reuters) – Online gambling exchange Betfair said it would withdraw from the Greek market until there was greater clarity on gaming regulation in the country.

Betfair, which has not yet applied for a permit to operate in Greece, questioned the cost and conditions attached to permits required by gaming firms to trade in the country.

“According to legal advice received, the value of these permits is unclear and we consider the gambling legislation in the country to be inconsistent with European law,” Betfair said on Monday.

“The associated fiscal conditions attached to these permits, which may include payment of taxes on historical revenues, make the market economically unattractive.”

Earlier this month the Greek Gaming Commission said gambling firms operating in Greece without a permit would face financial penalties and criminal sanctions.

Betfair said it believes there are “significant issues with the legality of this decision” by the Greek Gaming Commission.

It added that it was disappointed the European Commission had not moved to prevent what Betfair calls “protectionist behavior.”

Earlier this month Betfair, which launched 12 years ago and operates an exchange system that allows gamblers to bet against each other rather than the bookmaker, withdrew its online sports betting exchange in Germany because of a tax levied on stakes on sports events from July 2012.

The European Commission last month said it was not proposing EU-wide legislation to regulate online gambling.

Prior to Betfair’s decision to withdraw from the market, it had been expected to generate 13 million pounds ($ 20.81 million) of revenue from the Greek market in the current financial year.

($ 1 = 0.6246 British pounds)

(Reporting by Rhys Jones; editing by James Davey)

Internet News Headlines – Yahoo! News

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Rolling Stones mark 50th year with London show

LONDON (AP) — The Rolling Stones made a triumphant return to the London stage on Sunday night in the first of five concerts to mark the 50th anniversary of their debut as an American-oriented blues band.

They showed no signs of wear and tear — except on their aging, heavily lined faces — as frontman Mick Jagger swaggered and strutted through a stellar two-and-a-half hour show. He looked remarkably trim and fit and was in top vocal form.

The Stones passed the half-century mark in style at the sometimes emotional gig that saw former bassist Bill Wyman and guitar master Mick Taylor join their old mates in front of a packed crowd at London's 02 Arena.

It was the first of five mega-shows to mark the passage of 50 years since the band first appeared in a small London pub determined to pay homage to the masters of American blues.

Jagger, in skin-tight black pants, a black shirt and a sparkly tie, took time out from singing to thank the crowd for its loyalty.

"It's amazing that we're still doing this, and it's amazing that you're still buying our records and coming to our shows," he said. "Thank you, thank you, thank you."

Lead guitarist Keith Richards, whose survival has surprised many who thought he would succumb to drugs and drink, was blunter: "We made it," he said. "I'm happy to see you. I'm happy to see anybody."

But the band's fiery music was no joke, fuelled by an incandescent guest appearance by Taylor, who played lead guitar on a stunning extended version of the ominous "Midnight Rambler," and Mary J. Blige, who shook the house in a duet with Jagger on "Gimme Shelter."

The 50th anniversary show, which will be followed by one more in London, then three in the greater New York area, lacked some of the band's customary bravado — the "world's greatest rock 'n' roll band" intro was shelved — and there were some rare nostalgic touches.

Even the famously taciturn Wyman briefly cracked a smile when trading quips with Richards and Ronnie Wood.

The concert started with a brief video tribute from luminaries like Elton John, Iggy Pop and Johnny Depp, who praised the Stones for their audacity and staying power. The Stones' show contained an extended video homage to the American trailblazers who shaped their music: Muddy Waters, John Lee Hooker, Otis Redding, Bob Dylan, Johnny Cash and others. The montage included rare footage of the young Elvis Presley.

The Stones began their professional career imitating the Americans whose music they cherished, but they quickly developed their own style, spawning hundreds — make that thousands — of imitators who have tried in vain to match their swagger and style.

The concert began with some early Stones' numbers that are rarely heard in concert, including the band's cover of the Lennon-McCartney rocker "I Wanna Be Your Man" and the Stones original "It's All Over Now."

They didn't shy away from their darker numbers, including "Paint It Black" and "Sympathy for the Devil" — Jagger started that one wearing a black, purple-lined faux fur cape that conjured up his late '60s satanic image.

He even cracked a joke about one of the band's low points, telling the audience it was in for a treat: "We're going to play the entire "Satanic Majesty's Request" album now," he said, referring to one of the band's least-loved efforts, a psychedelic travesty that has been largely, mercifully, forgotten.

He didn't make good on his threat.

He also made fun of the sky-high ticket prices, which had exposed the band to some criticism in the London press.

"How are you doing up in the cheap seats," he said, motioning to fans in the upper rows of the cavernous 02 Arena. "Except they're not cheap seats, that's the problem."

But Jagger seemed more mellow than usual, chatting a bit about the good old days and asking if there was anyone in the crowd who had seen them in 1962, when they first took to the stage.

He said 2012 had been a terrific year for Britain and that the Stones nearly missed the boat, playing no role in the celebration of the Queen's Diamond Jubilee, the London Olympics, or the new James Bond film.

"We just got in under the wire," he said. "We feel pretty good."

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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Playa Vista's parent company is being sold

The parent company of Playa Vista is set to be sold to a Canadian developer that intends to finish building the housing approved for the planned community near Marina del Rey, according to people close to the deal.

Brookfield Homes is buying Playa Capital Co. and gaining command of more than 50 acres of land near the coast. The transaction, valued at more than $250 million, is set to close at the end of the month, according to the individuals, who wished to remain anonymous because the deal isn't wrapped up.

Playa Vista has been under development for more than a decade. The 1,000-acre community already has more than 3,200 residences and 2 million square feet of offices. The land Brookfield is taking over is zoned for an additional 2,000 housing units.

As the new master developer of Playa Vista, Brookfield is expected to sell rights to develop 1,500 apartments to Irvine Apartment Communities, a division of Irvine Co. It is also expected to sell some of the remaining 500 residential sites to Los Angeles developer KB Home.

Developers at work at Playa Vista include Ratkovich Co. and Lincoln Property Co. Ratkovich is turning buildings once occupied by mogul Howard Hughes' aviation company into creative office space for rent, and Lincoln is working on the Runway, a $260-million shopping and apartment complex intended to be the commercial and social heart of Playa Vista.

Representatives of Playa Capital, Brookfield and the Irvine Co. declined to comment. Earlier this month Brookfield Residential Properties raised $222 million through a stock sale, which it used to pay down debt.

Lincoln Property executive David S. Binswanger acknowledged that Playa Capital is on the market.

"Obviously a sales transaction to new, well-qualified and capitalized developers would be nothing but good for the area," he said.

Pierpont Inn & Spa in Ventura is sold

The Pierpont Inn & Spa, a century-old Ventura hotel that once served as a getaway for L.A.'s upper crust, has been sold for $6.5 million.

The 77-room Arts and Crafts-style hotel was built in 1910 by Josephine Pierpont and is the oldest hostelry in Ventura County.

A 1916 story in The Times called it "an inn of the highest class" and praised its views of the Channel Islands.

The hotel at 550 Sanjon Road was purchased from a private investor, said real estate broker Kent R. Williams of Marcus & Millichap. Public records identify the seller as the Ahn Family Trust and the buyer as a limited partnership.

Famous guests of the hotel include Hollywood legends Cecil B. DeMille, Bette Davis, Edward G. Robinson and Charlie Chaplin. Former President George H.W. Bush stayed there with his family when he was in the oil business in the years after World War II.

U.S. architects report growth in October

The nation's architects reported improved business in October, with billings accelerating to their strongest pace of growth since December 2010.

Architectural contracts are a leading indicator of construction activity, with a lag time of about nine months to a year between the awarding of contracts and construction spending.

The American Institute of Architects, the leading trade group for the profession, said its index of "work on the boards" reported by architects was 52.8, up from 51.6 in September. Any score above 50 indicates an increase in billings.

"With three straight monthly gains — and the past two being quite strong — it's beginning to look like demand for design services has turned the corner," chief economist Kermit Baker said.

roger.vincent@latimes.com

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Solar power plants burden the counties that host them

When it comes to attracting business to California's eastern deserts, Inyo County is none too choosy.

Since the 19th century the sparsely populated county has worked to attract industries shunned by others, including gold, tungsten and salt mining. The message: Your business may be messy, but if you plan to hire our residents, the welcome mat is out.

So the county grew giddy last year as it began to consider hosting a huge, clean industry. BrightSource Energy, developer of the proposed $2.7-billion Hidden Hills solar power plant 230 miles northeast of Los Angeles, promised a bounty of jobs and a windfall in tax receipts. In a county that issued just six building permits in 2011, Inyo officials first estimated that property taxes from the facility would boost the general fund 17%.

But upon closer inspection, the picture didn't seem so rosy.

An economic consultant hired by the county found that property tax revenue would be a fraction of the customary amount because portions of the plant qualifiy for a solar tax exclusion. Fewer than 10 local workers would land permanent positions — and just 5% of the construction jobs would be filled by county residents. And construction workers are likely to spend their money across the nearby state line, in Nevada.

Worse, the project would cost the county $11 million to $12 million during the 30-month construction phase, with much of the money going to upgrade a historic two-lane road to the plant. Once the plant begins operation, the county estimates taxpayers will foot the bill for nearly $2 million a year in additional public safety and other services.

Two of California's other Mojave Desert counties, Riverside and San Bernardino, have made similar discoveries. Like Inyo, they are now pushing back against solar developers, asking them to cover the costs of servicing the new industry.

"Southern California is going to become the home to the state's ability to meet its solar goals," said Gerry Newcombe, public works director for San Bernardino County. "That's great, but where are the benefits to the county?"

Desert counties also are anticipating costly shifts in land use, including the conversion of taxable private property into habitat for endangered species. Solar developers are required to buy land to offset the loss of habitat caused by their projects. Once the property is acquired, it cannot be developed, which reduces its potential for tax revenue.

Two of the largest solar plants in the world are under construction in San Bernardino County. But county officials are not sure if revenue from the projects will offset the cost of additional fire and safety services, which analysts say will amount to millions of dollars a year.

For example, the $2.2-billion Ivanpah solar project at the county's eastern border has agreed to pay $377,000 annually, but that may not be enough to cover the county's new costs related to the plant. The county doesn't know how much solar plants will drain from its budget because the projects are being planned and approved too quickly for adequate analysis, officials say.

"We really support private development and generating jobs," Newcombe said. "On the other hand, I am concerned that it's going too fast. I don't know that we've had a chance to appreciate the long-term impacts."

The county is also worried because most of the land inside its borders is owned by the federal government, and up to 1 million acres of that — nearly 8% of the county — could be set aside for solar development, removing it from public access and recreational opportunities, Newcombe said.

Counties that object to the pace of development, however, have been scolded for standing in the way of progress. Not only is renewable energy a priority of the Obama administration, it is also the darling of California's chief executive.

Gov. Jerry Brown has vowed to "crush" opponents of solar projects. At the launch of a solar farm near Sacramento, the governor pledged: "It's not easy. There are gonna be screw-ups. There are gonna be bankruptcies. There'll be indictments and there'll be deaths. But we're gonna keep going — and nothing's gonna stop me."

Counties have little say because the state controls planning and licensing of large-scale projects. The California Energy Commission issues the permits for utility-scale solar farms, and counties depend on the commission's staff to look out for their interests.

To the extent that California counties are pushing back against industrial solar, the rebellion began in Riverside County more than a year ago.

Some 20 utility-scale solar farms are proposed in the eastern stretch of the county on 118,000 acres of federal land along the Interstate 10 corridor between Desert Center and Blythe.

The Riverside County Board of Supervisors considered charging companies a franchise fee to offset the effects on roads and public services and to compensate for the loss of recreation and tourism access to the 185 square miles of federal land. Local officials saw it as a matter of fairness. Public utilities pay 2% of gross receipts to the county, for example.

"The solar companies are the beneficiaries of huge government loans, tax credits and, most critically for me, property tax exemptions, at the expense of taxpayers," said county Supervisor John Benoit, referring to a variety of taxpayer-supported loans and grants available to large solar projects as part of the Obama administration's renewable energy initiative. "I came to the conclusion that my taxpayers need to get something back."

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Hobbits, superheroes put magic in NZ film industry

WELLINGTON, New Zealand (AP) — A crate full of sushi arrives. Workers wearing wetsuit shirts or in bare feet bustle past with slim laptops. With days to go, a buzzing intensity fills the once-dilapidated warehouses where Peter Jackson's visual-effects studio is rushing to finish the opening film in "The Hobbit" trilogy.

The fevered pace at the Weta Digital studio near Wellington will last nearly until the actors walk the red carpet Nov. 28 for the world premiere. But after "The Hobbit: An Unexpected Journey" hits theaters, there's more work to be done.

Weta Digital is the centerpiece of a filmmaking empire that Jackson and close collaborators have built in his New Zealand hometown, realizing his dream of bringing a slice of Hollywood to Wellington. It's a one-stop shop for making major movies — not only his own, but other blockbusters like "Avatar" and "The Avengers" and hoped-for blockbusters like next year's "Man of Steel."

Along the way, Jackson has become revered here, even receiving a knighthood. His humble demeanor and crumpled appearance appeal to distinctly New Zealand values, yet his modesty belies his influence. He's also attracted criticism along the way.

The special-effects workforce of 150 on "The Lord of the Rings" trilogy a decade ago now numbers 1,100. Only five of Weta Digital's workers are actual employees, however, while the rest are contractors. Many accept the situation because movie work often comes irregularly but pays well. Union leaders, though, say the workers lack labor protections existing in almost any other industry.

Like many colleagues, Weta Digital's director, Joe Letteri, came to New Zealand in 2001 to work on the "Rings" trilogy for two years. The work kept coming, so he bought a house in Wellington and stayed.

"People come here because they know it's their chance to do something really great and to get it up on the screen," he said in a recent interview. "And you want to do it in these next two weeks, because the two weeks after the movie's finished are useless."

Jackson, who declined to be interviewed for this story, launched Weta in 1993 with fellow filmmakers Jamie Selkirk and Richard Taylor. Named after an oversized New Zealand insect, the company later was split into its digital arm and Weta Workshop, which makes props and costumes.

Loving homages to the craft are present in Weta Digital's seven buildings around the green-hilled suburb of Miramar. There are old-time movie posters, prop skulls of dinosaurs and apes, and a wall of latex face impressions of actors from Chris O'Donnell to Tom Cruise.

Its huge data center, with the computing power of 30,000 laptops, resembles a milk-processing plant because only the dairy industry in New Zealand knew how to build cooling systems on such a grand scale.

Little of Weta's current work was visible. Visitors must sign confidentiality agreements, and the working areas of the facilities are off-limits. The company is secretive about any unannounced projects, beyond saying Weta will be working solidly for the next two years, when the two later "Hobbit" films are scheduled to be released.

The workforce has changed from majority American to about 60 percent New Zealanders. The only skill that's needed, Letteri says, is the ability to use a computer as a tool.

Beyond having creativity as a filmmaker, Jackson has proved a savvy businessman, Letteri says.

"The film business in general is volatile, and visual effects has to be sitting right on the crest of that wave," Letteri says. "We don't get asked to do something that somebody has seen before."

The government calculates that feature films contribute $560 million each year to New Zealand's economy. Like many countries, New Zealand offers incentives and rebates to film companies and will contribute about $100 million toward the $500 million production costs of "The Hobbit" trilogy. Almost every big budget film goes through Jackson's companies.

"New Zealand has a good reputation for delivering films on time and under budget, and Jackson has been superb at that," says John Yeabsley, a senior fellow at New Zealand's Institute of Economic Research. "Nobody has the same record or the magic ability to bring home the bacon as Sir Peter."

"You cannot overestimate the fact that Peter is a brand," says Graeme Mason, chief executive of the New Zealand Film Commission. "He's built this incredible reputational position, which has a snowball effect."

Back in 2010, however, a labor dispute erupted before filming began on "The Hobbit." Unions said they would boycott the movie if the actors didn't get to collectively negotiate. Jackson and others warned that New Zealand could lose the films to Europe. Warner Bros. executives flew to New Zealand and held a high-stakes meeting with Prime Minister John Key, whose government changed labor laws overnight to clarify that movie workers were exempt from being treated as regular employees.

Helen Kelly, president of the New Zealand Council of Trade Unions, says a compromise could easily have been reached. She says the law changes amounted to unnecessary union-busting and a "gross breach" of employment laws.

"I was very disappointed at Peter Jackson for lobbying for that," she says, "and I was furious at the government for doing it."

Weta Digital's general manager Tom Greally compared it to the construction industry, where multiple contractors and mobile workers do specific projects and then move on.

Animal rights activists said last week they plan to picket the premiere of "The Hobbit" after wranglers alleged that three horses and up to two dozen other animals died in unsafe conditions at a farm where animals were boarded for the movies. Jackson's spokesman Matt Dravitzki acknowledged two horses died preventable deaths at the farm but said the production company worked quickly to improve animal housing and safety. He rejected claims any animals were mistreated or abused.

Jackson's team pointed out that 55 percent of animal images in "The Hobbit" were computer generated at Weta. The People for the Ethical Treatment of Animals (PETA) have asked Jackson in the future to create all his animals in the studio.

Controversies aside, the rise of Weta and the expat American community in and around Miramar is visible in everything from a Mexican restaurant to yoga classes. On Halloween, which in the past was not much celebrated in New Zealand, hundreds of costumed children roamed about collecting candy. Americans gave the tradition a boost here, but the locals have embraced it.

The National Business Review newspaper estimates Jackson's personal fortune to be about $400 million, which could rise considerably if "The Hobbit" franchise succeeds. Public records show Jackson has partial ownership stakes in 21 private companies, most connected with his film empire. He's spent some of his money on philanthropy, helping save a historic church and a performance theater.

For all his influence, Jackson maintains a hobbit-like existence himself, preferring a quiet home life outside of work. In the end, many say, he seems to be driven by what has interested him from the start: telling great stories on the big screen.

___

Follow Nick Perry on Twitter at http://twitter.com/nickgbperry

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Indian Prostitutes’ New Autonomy Imperils AIDS Fight

Kuni Takahashi for The New York Times

Sex workers in Mumbai’s long-established red-light district, where brothels are dwindling.

MUMBAI, India — Millions once bought sex in the narrow alleys of Kamathipura, a vast red-light district here. But prostitutes with inexpensive mobile phones are luring customers elsewhere, and that is endangering the astonishing progress India has made against AIDS.

Indeed, the recent closings of hundreds of ancient brothels, while something of an economic victory for prostitutes, may one day cost them, and many others, their lives.

“The place where sex happens turns out to be an important H.I.V. prevention point,” said Saggurti Niranjan, program associate of the Population Council. “And when we don’t know where that is, we can’t help stop the transmission.”

Cellphones, those tiny gateways to modernity, have recently allowed prostitutes to shed the shackles of brothel madams and strike out on their own. But that independence has made prostitutes far harder for government and safe-sex counselors to trace. And without the advice and free condoms those counselors provide, prostitutes and their customers are returning to dangerous ways.

Studies show that prostitutes who rely on cellphones are more susceptible to H.I.V. because they are far less likely than their brothel-based peers to require their clients to wear condoms.

In interviews, prostitutes said they had surrendered some control in the bedroom in exchange for far more control over their incomes.

“Now, I get the full cash in my hand before we start,” said Neelan, a prostitute with four children whose side business in sex work is unknown to her husband and neighbors. (Neelan is a professional name, not her real one.)

“Earlier, if the customer got scared and didn’t go all the way, the madam might not charge the full amount,” she explained. “But if they back out now, I say that I have removed all my clothes and am going to keep the money.”

India has been the world’s most surprising AIDS success story. Though infections did not appear in India until 1986, many predicted the nation would soon become the epidemic’s focal point. In 2002, the C.I.A.’s National Intelligence Council predicted that India would have as many as 25 million AIDS cases by 2010. Instead, India now has about 1.5 million.

An important reason the disease never took extensive hold in India is that most women here have fewer sexual partners than in many other developing countries. Just as important was an intensive effort underwritten by the World Bank and the Bill and Melinda Gates Foundation to target high-risk groups like prostitutes, gay men and intravenous drug users.

But the Gates Foundation is now largely ending its oversight and support for AIDS prevention in India, just as efforts directed at prostitutes are becoming much more difficult. Experts say it is too early to identify how much H.I.V. infections might rise.

“Nowadays, the mobility of sex workers is huge, and contacting them is very difficult,” said Ashok Alexander, the former director in India of the Gates Foundation. “It’s a totally different challenge, and the strategies will also have to change.”

An example of the strategies that had been working can be found in Delhi’s red-light district on Garstin Bastion Road near the old Delhi railway station, where brothels have thrived since the 16th century. A walk through dark alleys, past blind beggars and up narrow, steep and deeply worn stone staircases brings customers into brightly lighted rooms teeming with scores of women brushing each other’s hair, trying on new dresses, eating snacks, performing the latest Bollywood dances, tending small children and disappearing into tiny bedrooms with nervous men who come out moments later buttoning their trousers.

A 2009 government survey found 2,000 prostitutes at Garstin Bastion (also known as G. B.) Road who served about 8,000 men a day. The government estimated that if it could deliver as many as 320,000 free condoms each month and train dozens of prostitutes to counsel safe-sex practices to their peers, AIDS infections could be significantly reduced. Instead of broadcasting safe-sex messages across the country — an expensive and inefficient strategy commonly employed in much of the world — it encircled Garstin Bastion with a firebreak of posters with messages like “Don’t take a risk, use a condom” and “When a condom is in, risk is out.”

Surprising many international AIDS experts, these and related tactics worked. Studies showed that condom use among clients of prostitutes soared.

“To the credit of the Indian strategists, their focus on these high-risk groups paid off,” said Dr. Peter Piot, the former executive director of U.N.AIDS and now director of the London School of Hygiene and Tropical Medicine. A number of other countries, following India’s example, have achieved impressive results over the past decade as well, according to the latest United Nations report, which was released last week.

Sruthi Gottipati contributed reporting in Mumbai and New Delhi.

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Social Security benefits: Five tips

Deciding when to start collecting Social Security retirement benefits is one of the most important financial decisions Americans face. Beginning too soon — or too late — can end up costing you tens of thousands of dollars, depending on how long you live. Some key things to consider:

• You can start receiving Social Security payments at age 62, but the amount will be reduced 25% to 30% from what it would be at your "full" retirement age. If you were born in 1960 or later, your full retirement age is 67. For those born from 1943 to 1959, it's somewhere from age 66 to 66 years and 10 months. See http://www.ssa.gov/retire2/agereduction.htm.

•You may want to put off Social Security beyond your full retirement age. "You can get 32% more than your full benefit by waiting until you're 70 to begin collecting," author Jonathan Peterson wrote in "Social Security for Dummies." There's no reason, though, to wait beyond age 70 — your payments won't increase.

•Estimate your benefits. You can get a personalized estimate of your Social Security benefits, based on your lifetime earnings, by setting up an online account at http://www.ssa.gov/mystatement. A simpler but less accurate option is to use the Social Security quick calculator at http://www.ssa.gov/OACT/quickcalc/.

•Get a ballpark idea of how long you'll live by checking an online life expectancy calculator. "Also consider how old your parents lived to be and your personal health, including chronic conditions that may shorten your life span," Peterson said. Generally, the longer you expect to live, the more delaying the start of retirement benefits makes sense.

•Remember other factors. Your Social Security benefit is only one part of your financial equation. Consider your pension, 401(k), savings and medical needs, and how long you plan to keep working. Also consider your spouse's finances and the age when he or she will start receiving Social Security benefits.

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