low staff levels routinely mask is … · accounts is causing real-life headaches for even the...

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Growing up in Minnesota, Hel- en Hoang suffered from crippling social anxiety and struggled to make friends. She found refuge in romance novels, frothy stories that allowed her to experience in- tense feelings that were clearly spelled out on the page, always with the promise of a happy end- ing. “It was like I found a pure, un- diluted drug,” she said. Many years later, as a mother of two in her 30s, Ms. Hoang began researching autism and realized that she’s on the spectrum, a con- dition that makes it difficult for her to hold casual conversations, read emotional cues, have an of- fice job and meet new people. She once again turned to romance. But this time, she wrote the story her- self. So far, romance fans have swooned over Ms. Hoang’s debut novel, “The Kiss Quotient,” a mul- ticultural love story centered on an autistic woman who has trou- ble navigating the nuances of dat- ing and courtship. Readers have flooded the website Goodreads with nearly 8,000 positive ratings, and the book, which was pub- lished in June, is already in its fourth printing. The novel’s unexpected success is all the more astonishing given the striking lack of diversity within the romance genre. Ro- mance novels released by big pub- lishing houses tend to center on white characters, and rarely fea- ture gay, lesbian, bisexual or transgender people in leading roles, or heroines with disabilities. Even as the genre has evolved to reflect readers’ varied tastes and fetishes — popular subcategories include vampire and werewolf ro- Going Beyond Boy-Meets-Girl, Romances Ignite Fans’ Passions By ALEXANDRA ALTER Continued on Page 4 Helen Hoang’s “The Kiss Quo- tient,” about an autistic wom- an, has won over romance fans. ADAM AMENGUAL FOR THE NEW YORK TIMES WASHINGTON — In Germany and France, the authorities thwarted terrorists’ plots to attack with the deadly poison ricin. In eastern Syria, the Islamic State continued its retreat under stepped-up assaults by Kurdish militia and Iraqi pilots. And extre- mists in Yemen, Somalia and Lib- ya were targeted by American airstrikes. That spate of action, over the past few weeks alone, illustrates the shifting and enduring threat from Islamic extremism around the world that will last long after the Islamic State, also known as ISIS, is defeated on the battlefield. From the scheming of lone ex- tremists with no apparent connec- tions to terrorist groups, like the ricin plots, to fighters aligned with the Islamic State or Al Qaeda in more than two dozen countries, terrorist threats are as complex and diverse as ever, American and other Western intelligence offi- cials said in interviews. The Islamic State, in particular, is adapting to setbacks and in- creasingly using the tools of glob- As ISIS Wanes, Threat of Terror Rises and Shifts By ERIC SCHMITT Continued on Page 11 MACERATA, Italy — At the end of his shooting rampage as the po- lice closed in, Luca Traini climbed the steps of a Fascist-era monu- ment, wrapped himself in an Ital- ian flag and straightened his arm in a Fascist salute. He had shot and wounded six African migrants — from Ghana, Mali and Nigeria — in this medi- eval city near the Adriatic Sea to avenge the dismemberment of a young Italian woman, allegedly by a Nigerian drug dealer. In his mind, he was a patriot. But to Italian leaders, liberals and anti-fascist groups, Mr. Traini was a terrifying omen. National elections were weeks away and the Feb. 3 shootings came during a hate-laced cam- paign marred by anti-migrant lan- guage, rising intolerance and hints of a Fascist revival. At the height of the migrant cri- sis, Italy had been a progressive bastion and a staunch supporter of European unity. But now, the national mood had hardened. Mr. Traini’s rage crystallized, in gro- tesque form, the growing back- lash against migrants and the rise of right-wing politics. The March 4 elections swept in a new populist government which is deeply skeptical of the Euro- pean Union and has already slammed the door to new mi- grants while threatening to expel the ones already in the country. To some in Brussels, Italy is now Eu- rope’s greatest existential threat. “Within one year, we will see if united Europe still exists,” Matteo Salvini, the country’s new interior minister, said recently. Mr. Salvini is now Italy’s most turbulent and powerful force. More than anyone, he understood and harnessed the rage unleashed in Macerata. Often scoffed at for its wobbly governments and disregarded as a mere pleasuredome, Italy has long been Europe’s laboratory for political change. The birthplace of Fascism, Italy gave the world Mussolini, flirted seriously with communism, and, in electing Sil- vio Berlusconi, provided a play- Migrants Were Welcome. Then Came a Murder. By JASON HOROWITZ Bullet holes at a pub in Macerata, Italy, where a woman’s death fueled a vengeful rampage and became a national election issue. DMITRY KOSTYUKOV FOR THE NEW YORK TIMES Continued on Page 10 ITHACA, N.Y. — Most nursing homes had fewer nurses and care- taking staff than they had re- ported to the government for years, according to new federal data, bolstering the long-held sus- picions of many families that staffing levels were often inade- quate. The records for the first time re- veal frequent and significant fluc- tuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest. The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only re- cently began gathering and pub- lishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medi- care previously had been rating each facility’s staffing levels based on the homes’ own unveri- fied reports, making it possible to game the system. The payroll records provide the strongest evidence that over the last decade, the government’s five-star rating system for nurs- ing homes often exaggerated staffing levels and rarely identi- fied the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the re- vamped star ratings still mask the erratic levels of people working from day to day. At the Beechtree Center for Re- habilitation & Nursing here, Jay Vandemark, 47, who had a stroke NURSING HOMES ROUTINELY MASK LOW STAFF LEVELS VOLATILE FLUCTUATIONS ‘It’s Almost Like a Ghost Town’ on Weekends, One Resident Said By JORDAN RAU Continued on Page 17 WASHINGTON — Democratic senators running for re-election in red states where President Trump remains popular face an agoniz- ing choice over his coming Su- preme Court nominee: Vote to confirm the pick and risk demoral- izing Democratic voters ahead of the midterm elections, or stick with the party and possibly sacri- fice their own seats — and any chance at a Democratic majority in 2019. The actions of a handful of Sen- ate Democrats struggling to hold their seats in those states — nota- bly Heidi Heitkamp of North Da- kota, Joe Donnelly of Indiana and Joe Manchin III of West Virginia — will have broad implications for the party at a critical political juncture. A decision by one or all of them to try to bolster their standing with Republican-leaning voters in their states by backing the presi- dent’s nominee would undermine Democratic leaders as they try to sustain party unity. And if their votes put the president’s choice on the court, it could hasten the move to the left by the party’s ag- gressive activist core, while inten- sifying the clamor for new, more confrontational leadership. But if they hold together on a “no” vote, those senators could not only surrender their own seats, but by expanding the Re- publican majority, they could also narrow the path of Democrats to a Senate majority for years to come by ceding those states to Republi- cans. “It is a terrible vote,” Jennifer Duffy, a longtime nonpartisan an- alyst of Senate races for the Cook Political Report, said about the showdown, which will escalate on Monday with the scheduled offi- cial announcement of the nomi- nee. It could not come at a worse time. A final confirmation vote will probably be called just weeks be- fore an election in which Demo- crats are defending a sprawling battleground, including 10 states carried by Mr. Trump, with Demo- cratic pickup opportunities in only a handful of states. A failure to hang on to nearly all of the 10 would make a Senate takeover very difficult. Risk Unity or Seats? Red-State Democrats Agonize Over Court Pick By CARL HULSE With Battle Escalating, Vulnerable Senators Face ‘Terrible Vote’ Continued on Page 16 The sheer volume of fake social media accounts is causing real-life headaches for even the best-known celebrities — including Oprah Winfrey. PAGE 1 SUNDAY BUSINESS Oprah, Is That You? Not Likely Tayari Jones PAGE 1 SUNDAY REVIEW PYONGYANG, North Korea — North Korea accused the Trump administration on Saturday of pushing a “unilateral and gang- ster-like demand for denuclear- ization” and called it “deeply re- grettable,” hours after Secretary of State Mike Pompeo said his two days of talks in the North Korean capital were “productive.” Despite the criticism, North Ko- rea’s Foreign Ministry said the country’s leader, Kim Jong-un, still wanted to build on the “friendly relationship and trust” forged with President Trump dur- ing their summit meeting in Sin- gapore on June 12. The ministry said Mr. Kim had written a person- al letter to Mr. Trump, reiterating that trust. The harsh North Korean reac- tion may have been a time-tested negotiating tactic. Two months ago, a brief blowup between the two countries led President Trump to briefly cancel, then re- schedule, his summit meeting with Mr. Kim. But North Korea’s remarks also played to a larger fear: that the summit meeting’s vaguely worded commitment to “the denuclearization of the Kore- an Peninsula” meant something very different in Pyongyang and Washington. Distrust on both sides has led the Americans to insist on rapid, deep dismantlement and highly intrusive verification; the North Koreans want an early lifting of sanctions and a formal end to the Korean War, among other steps. On Saturday, Mr. Pompeo and his entourage offered no immedi- ate evidence that they had come NORTH KOREANS SAY U.S. POSITION IS ‘GANGSTER-LIKE’ SHIFT IN NUCLEAR TALKS Pompeo Sees Progress, but Cites No Evidence of Any Gains By GARDINER HARRIS and CHOE SANG-HUN Continued on Page 9 KYODO/REUTERS More than 60 people have died and millions have been urged to evacuate. Above, rescue workers in Kurashiki. Page 12. Torrential Rains Overwhelm Japan England defeated Sweden, 2-0, and advanced to the World Cup’s final four for the first time since 1990, and Croatia beat Russia in a shootout. PAGE 1 SPORTSSUNDAY England and Croatia Advance U(D5E71D)x+?!/!/!#!{ The upsets continued at Wimbledon, as Simona Halep, the top-ranked woman, lost in the third round, as did the fourth- seeded Alexander Zverev. PAGE 6 SPORTSSUNDAY More Upsets at Wimbledon A NUDGE Senator Mitch McCon- nell has tried to steer President Trump toward two Supreme Court options. PAGE 16 Late Edition VOL. CLXVII . . No. 58,017 © 2018 The New York Times Company NEW YORK, SUNDAY, JULY 8, 2018 Divers began an effort to rescue 12 boys and their soccer coach on Sunday from the cave in Thailand where they have been trapped for two weeks. PAGE 12 INTERNATIONAL 6-12 Rescue of Thai Boys Begins Today, plenty of sunshine, low hu- midity, high 82. Tonight, clear, low 68. Tomorrow, abundant sunshine, much warmer, low humidity, high 87. Details in SportsSunday on Page 10. $6.00

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Page 1: LOW STAFF LEVELS ROUTINELY MASK IS … · accounts is causing real-life headaches for even the best-known celebrities

C M Y K Nxxx,2018-07-08,A,001,Bs-4C,E3

Growing up in Minnesota, Hel-en Hoang suffered from cripplingsocial anxiety and struggled tomake friends. She found refuge inromance novels, frothy storiesthat allowed her to experience in-tense feelings that were clearlyspelled out on the page, alwayswith the promise of a happy end-ing. “It was like I found a pure, un-diluted drug,” she said.

Many years later, as a mother oftwo in her 30s, Ms. Hoang beganresearching autism and realizedthat she’s on the spectrum, a con-dition that makes it difficult forher to hold casual conversations,read emotional cues, have an of-fice job and meet new people. Sheonce again turned to romance. Butthis time, she wrote the story her-self.

So far, romance fans haveswooned over Ms. Hoang’s debutnovel, “The Kiss Quotient,” a mul-ticultural love story centered onan autistic woman who has trou-ble navigating the nuances of dat-ing and courtship. Readers haveflooded the website Goodreadswith nearly 8,000 positive ratings,and the book, which was pub-lished in June, is already in itsfourth printing.

The novel’s unexpected successis all the more astonishing giventhe striking lack of diversitywithin the romance genre. Ro-mance novels released by big pub-lishing houses tend to center onwhite characters, and rarely fea-ture gay, lesbian, bisexual ortransgender people in leadingroles, or heroines with disabilities.Even as the genre has evolved toreflect readers’ varied tastes andfetishes — popular subcategoriesinclude vampire and werewolf ro-

Going Beyond Boy-Meets-Girl,Romances Ignite Fans’ Passions

By ALEXANDRA ALTER

Continued on Page 4

Helen Hoang’s “The Kiss Quo-tient,” about an autistic wom-an, has won over romance fans.

ADAM AMENGUAL FOR THE NEW YORK TIMES

WASHINGTON — In Germanyand France, the authoritiesthwarted terrorists’ plots to attackwith the deadly poison ricin. Ineastern Syria, the Islamic Statecontinued its retreat understepped-up assaults by Kurdishmilitia and Iraqi pilots. And extre-mists in Yemen, Somalia and Lib-ya were targeted by Americanairstrikes.

That spate of action, over thepast few weeks alone, illustratesthe shifting and enduring threatfrom Islamic extremism aroundthe world that will last long afterthe Islamic State, also known asISIS, is defeated on the battlefield.

From the scheming of lone ex-tremists with no apparent connec-tions to terrorist groups, like thericin plots, to fighters aligned withthe Islamic State or Al Qaeda inmore than two dozen countries,terrorist threats are as complexand diverse as ever, American andother Western intelligence offi-cials said in interviews.

The Islamic State, in particular,is adapting to setbacks and in-creasingly using the tools of glob-

As ISIS Wanes, Threat of TerrorRises and Shifts

By ERIC SCHMITT

Continued on Page 11

MACERATA, Italy — At the endof his shooting rampage as the po-lice closed in, Luca Traini climbedthe steps of a Fascist-era monu-ment, wrapped himself in an Ital-ian flag and straightened his armin a Fascist salute.

He had shot and wounded sixAfrican migrants — from Ghana,Mali and Nigeria — in this medi-eval city near the Adriatic Sea toavenge the dismemberment of ayoung Italian woman, allegedlyby a Nigerian drug dealer. In hismind, he was a patriot.

But to Italian leaders, liberalsand anti-fascist groups, Mr. Trainiwas a terrifying omen.

National elections were weeksaway and the Feb. 3 shootingscame during a hate-laced cam-paign marred by anti-migrant lan-guage, rising intolerance andhints of a Fascist revival.

At the height of the migrant cri-sis, Italy had been a progressivebastion and a staunch supporterof European unity. But now, thenational mood had hardened. Mr.Traini’s rage crystallized, in gro-tesque form, the growing back-lash against migrants and the riseof right-wing politics.

The March 4 elections swept ina new populist government whichis deeply skeptical of the Euro-pean Union and has already

slammed the door to new mi-grants while threatening to expelthe ones already in the country. Tosome in Brussels, Italy is now Eu-rope’s greatest existential threat.

“Within one year, we will see ifunited Europe still exists,” MatteoSalvini, the country’s new interiorminister, said recently.

Mr. Salvini is now Italy’s mostturbulent and powerful force.More than anyone, he understood

and harnessed the rage unleashedin Macerata.

Often scoffed at for its wobblygovernments and disregarded asa mere pleasuredome, Italy haslong been Europe’s laboratory forpolitical change. The birthplace ofFascism, Italy gave the worldMussolini, flirted seriously withcommunism, and, in electing Sil-vio Berlusconi, provided a play-

Migrants Were Welcome. Then Came a Murder.By JASON HOROWITZ

Bullet holes at a pub in Macerata, Italy, where a woman’s deathfueled a vengeful rampage and became a national election issue.

DMITRY KOSTYUKOV FOR THE NEW YORK TIMES

Continued on Page 10

ITHACA, N.Y. — Most nursinghomes had fewer nurses and care-taking staff than they had re-ported to the government foryears, according to new federaldata, bolstering the long-held sus-picions of many families thatstaffing levels were often inade-quate.

The records for the first time re-veal frequent and significant fluc-tuations in day-to-day staffing,with particularly large shortfallson weekends. On the worst staffeddays at an average facility, thenew data show, on-duty personnelcared for nearly twice as manyresidents as they did when thestaffing roster was fullest.

The data, analyzed by KaiserHealth News, come from dailypayroll records Medicare only re-cently began gathering and pub-lishing from more than 14,000nursing homes, as required by theAffordable Care Act of 2010. Medi-care previously had been ratingeach facility’s staffing levelsbased on the homes’ own unveri-fied reports, making it possible togame the system.

The payroll records provide thestrongest evidence that over thelast decade, the government’sfive-star rating system for nurs-ing homes often exaggeratedstaffing levels and rarely identi-fied the periods of thin staffingthat were common. Medicare isnow relying on the new data toevaluate staffing, but the re-vamped star ratings still mask theerratic levels of people workingfrom day to day.

At the Beechtree Center for Re-habilitation & Nursing here, JayVandemark, 47, who had a stroke

NURSING HOMESROUTINELY MASKLOW STAFF LEVELS

VOLATILE FLUCTUATIONS

‘It’s Almost Like a GhostTown’ on Weekends,

One Resident Said

By JORDAN RAU

Continued on Page 17

WASHINGTON — Democraticsenators running for re-election inred states where President Trumpremains popular face an agoniz-ing choice over his coming Su-preme Court nominee: Vote toconfirm the pick and risk demoral-izing Democratic voters ahead ofthe midterm elections, or stickwith the party and possibly sacri-fice their own seats — and anychance at a Democratic majorityin 2019.

The actions of a handful of Sen-ate Democrats struggling to holdtheir seats in those states — nota-bly Heidi Heitkamp of North Da-kota, Joe Donnelly of Indiana and

Joe Manchin III of West Virginia— will have broad implications forthe party at a critical politicaljuncture.

A decision by one or all of themto try to bolster their standingwith Republican-leaning voters intheir states by backing the presi-dent’s nominee would undermineDemocratic leaders as they try tosustain party unity. And if theirvotes put the president’s choice onthe court, it could hasten the moveto the left by the party’s ag-gressive activist core, while inten-sifying the clamor for new, moreconfrontational leadership.

But if they hold together on a“no” vote, those senators couldnot only surrender their ownseats, but by expanding the Re-

publican majority, they could alsonarrow the path of Democrats to aSenate majority for years to comeby ceding those states to Republi-cans.

“It is a terrible vote,” JenniferDuffy, a longtime nonpartisan an-alyst of Senate races for the CookPolitical Report, said about theshowdown, which will escalate onMonday with the scheduled offi-cial announcement of the nomi-

nee.It could not come at a worse

time. A final confirmation vote willprobably be called just weeks be-fore an election in which Demo-crats are defending a sprawlingbattleground, including 10 statescarried by Mr. Trump, with Demo-cratic pickup opportunities in onlya handful of states. A failure tohang on to nearly all of the 10would make a Senate takeoververy difficult.

Risk Unity or Seats? Red-State Democrats Agonize Over Court PickBy CARL HULSE With Battle Escalating,

Vulnerable Senators Face ‘Terrible Vote’

Continued on Page 16

The sheer volume of fake social mediaaccounts is causing real-life headachesfor even the best-known celebrities —including Oprah Winfrey. PAGE 1

SUNDAY BUSINESS

Oprah, Is That You? Not Likely Tayari Jones PAGE 1

SUNDAY REVIEW

PYONGYANG, North Korea —North Korea accused the Trumpadministration on Saturday ofpushing a “unilateral and gang-ster-like demand for denuclear-ization” and called it “deeply re-grettable,” hours after Secretaryof State Mike Pompeo said his twodays of talks in the North Koreancapital were “productive.”

Despite the criticism, North Ko-rea’s Foreign Ministry said thecountry’s leader, Kim Jong-un,still wanted to build on the“friendly relationship and trust”forged with President Trump dur-ing their summit meeting in Sin-gapore on June 12. The ministrysaid Mr. Kim had written a person-al letter to Mr. Trump, reiteratingthat trust.

The harsh North Korean reac-tion may have been a time-testednegotiating tactic. Two monthsago, a brief blowup between thetwo countries led PresidentTrump to briefly cancel, then re-schedule, his summit meetingwith Mr. Kim. But North Korea’sremarks also played to a largerfear: that the summit meeting’svaguely worded commitment to“the denuclearization of the Kore-an Peninsula” meant somethingvery different in Pyongyang andWashington.

Distrust on both sides has ledthe Americans to insist on rapid,deep dismantlement and highlyintrusive verification; the NorthKoreans want an early lifting ofsanctions and a formal end to theKorean War, among other steps.

On Saturday, Mr. Pompeo andhis entourage offered no immedi-ate evidence that they had come

NORTH KOREANSSAY U.S. POSITION IS ‘GANGSTER-LIKE’

SHIFT IN NUCLEAR TALKS

Pompeo Sees Progress,but Cites No Evidence

of Any Gains

By GARDINER HARRISand CHOE SANG-HUN

Continued on Page 9

KYODO/REUTERS

More than 60 people have died and millions have been urged to evacuate. Above, rescue workers in Kurashiki. Page 12.Torrential Rains Overwhelm Japan

England defeated Sweden, 2-0, andadvanced to the World Cup’s final fourfor the first time since 1990, and Croatiabeat Russia in a shootout. PAGE 1

SPORTSSUNDAY

England and Croatia Advance

U(D5E71D)x+?!/!/!#!{

The upsets continued at Wimbledon, asSimona Halep, the top-ranked woman,lost in the third round, as did the fourth-seeded Alexander Zverev. PAGE 6

SPORTSSUNDAY

More Upsets at Wimbledon

A NUDGE Senator Mitch McCon-nell has tried to steer PresidentTrump toward two SupremeCourt options. PAGE 16

Late Edition

VOL. CLXVII . . No. 58,017 © 2018 The New York Times Company NEW YORK, SUNDAY, JULY 8, 2018

Divers began an effort to rescue 12 boysand their soccer coach on Sunday fromthe cave in Thailand where they havebeen trapped for two weeks. PAGE 12

INTERNATIONAL 6-12

Rescue of Thai Boys Begins

Today, plenty of sunshine, low hu-midity, high 82. Tonight, clear, low68. Tomorrow, abundant sunshine,much warmer, low humidity, high 87.Details in SportsSunday on Page 10.

$6.00