'Identity Thief' grabs $34.6M to debut at No. 1

LOS ANGELES (AP) — Jason Bateman and Melissa McCarthy's "Identity Thief" has made off with the weekend box-office title with a $34.6 million debut.

The top 20 movies at U.S. and Canadian theaters Friday through Sunday, followed by distribution studio, gross, number of theater locations, average receipts per location, total gross and number of weeks in release, as compiled Monday by Hollywood.com are:

1. "Identity Thief," Universal, $34,551,025, 3,141 locations, $11,000 average, $34,551,025, one week.

2. "Warm Bodies," Lionsgate, $11,356,090, 3,009 locations, $3,774 average, $36,481,172, two weeks.

3. "Side Effects," Open Road Films, $9,303,145, 2,605 locations, $3,571 average, $9,303,145, one week.

4. "Silver Linings Playbook," Weinstein Co., $6,425,271, 2,809 locations, $2,287 average, $89,519,510, 13 weeks.

5. "Hansel and Gretel: Witch Hunters," Paramount, $5,753,165, 3,285 locations, $1,751 average, $43,836,018, three weeks.

6. "Mama," Universal, $4,229,665, 2,677 locations, $1,580 average, $63,951,810, four weeks.

7. "Zero Dark Thirty," Sony, $4,006,860, 2,562 locations, $1,564 average, $83,567,450, eight weeks.

8. "Argo," Warner Bros., $2,375,344, 1,405 locations, $1,691 average, $123,608,957, 18 weeks.

9. "Django Unchained," Weinstein Co., $2,303,495, 1,502 locations, $1,534 average, $154,516,627, seven weeks.

10. "Bullet to the Head," Warner Bros., $2,078,192, 2,404 locations, $864 average, $8,269,214, two weeks.

11. "Top Gun" in 3-D, Paramount, $1,965,737, 300 locations, $6,552 average, $1,965,737, one week.

12. "Lincoln," Disney, $1,873,537, 1,517 locations, $1,235 average, $173,621,006, 14 weeks.

13. "Parker," FilmDistrict, $1,867,411, 2,004 locations, $932 average, $15,848,064, three weeks.

14. "Life of Pi," Fox, $1,745,744, 924 locations, $1,889 average, $108,530,249, 12 weeks.

15. "Les Miserables," Universal, $1,555,550, 1,447 locations, $1,075 average, $143,983,705, seven weeks.

16. "The Hobbit: An Unexpected Journey," Warner Bros., $1,468,374, 1,001 locations, $1,467 average, $298,333,426, nine weeks.

17. "Parental Guidance," Fox, $1,071,766, 1,219 locations, $879 average, $74,344,256, seven weeks.

18. "Wreck-It Ralph," Disney, $1,065,817, 757 locations, $1,408 average, $184,414,532, 15 weeks.

19. "The Impossible," Summit, $957,594, 739 locations, $1,296 average, $16,668,338, eight weeks.

20. "Quartet," Weinstein Co., $940,930, 244 locations, $3,856 average, $5,000,417, five weeks.

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Online:

http://www.hollywood.com

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Universal and Focus are owned by NBC Universal, a unit of Comcast Corp.; Sony, Columbia, Sony Screen Gems and Sony Pictures Classics are units of Sony Corp.; Paramount is owned by Viacom Inc.; Disney, Pixar and Marvel are owned by The Walt Disney Co.; Miramax is owned by Filmyard Holdings LLC; 20th Century Fox and Fox Searchlight are owned by News Corp.; Warner Bros. and New Line are units of Time Warner Inc.; MGM is owned by a group of former creditors including Highland Capital, Anchorage Advisors and Carl Icahn; Lionsgate is owned by Lions Gate Entertainment Corp.; IFC is owned by AMC Networks Inc.; Rogue is owned by Relativity Media LLC.

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Personal Health: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent. (Hazelden also published his book.)

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found at “Effective Addiction Treatment.”

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Tax help comes with health insurance advice

Derrick Bean filed his income taxes at an H&R Block office in Los Angeles this month, and the 26-year-old left with something unexpected: a price quote on federally subsidized health insurance.

Using the information from his 2012 return, a tax advisor told the actor and waiter that he would qualify for significant government help and pay only about $65 a month in premiums under the federal healthcare law. If he skips coverage, H&R Block warned him, he faces a $95 tax penalty next year and $356 the following year.

"I was surprised to hear all that," Bean said. "It's good to finally see some concrete evidence that this is happening."

As tax season kicks into high gear across the country, millions of Americans are getting their first taste of the biggest change to health insurance in nearly half a century. Many of the changes in President Obama's Affordable Care Act take effect in January, when most Americans will be required to buy coverage or incur a penalty.

The individual effects and consequences of the nation's healthcare overhaul in 2014 are far from certain, but insurance companies, tax consultants and other financial planners are starting to offer cost estimates for next year and describe the penalties for inaction.

For many consumers, their 2012 tax returns will offer some of the first clues on what financial aid may be available and what coverage may cost.

"Your 2012 tax return is key to determining if you're eligible for any financial assistance on health insurance," said Meg Sutton, senior advisor for tax and healthcare services at H&R Block. "This law represents sweeping changes for how the middle class will get insurance."

The Internal Revenue Service and state insurance exchanges will rely primarily on 2012 federal tax returns, officials say, to verify people's income and household size and to help determine what premium subsidies are available. By October, exchanges in California and other states are slated to open for enrollment and allow comparison shopping of health plans.

In California, individuals earning up to about $15,000 will qualify for an expansion of Medi-Cal, the state's Medicaid program for the poor and disabled.

Beyond that, people and households earning up to 400% of the federal poverty level are eligible for subsidies. For instance, a family of four earning about $93,000 in modified adjusted gross income may be eligible for a monthly credit of $445 and pay $742 a month for health coverage. In 2014, the penalty for not having coverage is $95 per adult or 1% of household income, whichever is greater. The penalties grow in subsequent years.

An estimated 2.6 million Californians would qualify for premium subsidies, and nearly 800,000 of them are in the Los Angeles area, according to state data.

At an H&R Block Inc. office on Wilshire Boulevard in Los Angeles, Cindy Salcedo Bravo, 35, flipped through a stack of drugstore receipts on a recent Friday morning as her 8-month-old son, Fernando, bounced on her knee.

She rattled off dollar amounts to her tax advisor, who tallied them for a potential deduction on medical expenses. Then they sorted through W-2 forms, investment statements and other paperwork.

As they wrapped up, tax advisor Blanca Chavez began the company's free health insurance review by asking the Northridge mother whether her family of six had health coverage.

Bravo responded that they have insurance through her husband's engineering job. Chavez reminded Bravo that her family could face a steep penalty if they lost employer-based insurance and didn't find new coverage.

"On my tax return? Regardless of my age?" asked Bravo, her reddish-black hair pulled back in a ponytail. "I didn't have any idea about that. I need to talk to my parents, because they don't have health insurance."

Nationwide, H&R Block officials are urging customers such as Bravo who have existing health coverage to examine the estimated cost of subsidized insurance through the new exchange since they may be paying more for their employer plan.

"A lot of people think, 'I have insurance with my job and I don't need to worry,'" said Frank Gomez, an H&R Block manager in Beverly Hills. "We're telling them to make sure you're aware of your options."

For customers who want more healthcare details, H&R Block refers them to insurers affiliated with the Blue Cross and Blue Shield Assn., an industry group that represents both Anthem Blue Cross and Blue Shield of California in the state. That partnership stands to give those insurers valuable leads on potential customers.

Although the Blue Cross and Blue Shield logo is present, there is no mention inside H&R Block's offices of Covered California. That is the state's new insurance marketplace, and it is planning to spend about $250 million on marketing statewide to establish its brand name and make it a prime destination for consumer information.

Some healthcare experts consider it a missed opportunity for Covered California with so many customers streaming into tax offices now. About 15 million Americans visited an H&R Block office last year, and it typically handles nearly 1 in 7 U.S. tax returns, according to the company.

Lucien Wulsin, executive director of the Insure the Uninsured Project, a nonprofit research group in Santa Monica, said "this is exactly when people are needing to hear about all this."

Peter Lee, executive director of Covered California, said he welcomes the information H&R Block is providing before the state's marketing ramps up this summer closer to when enrollment begins. A Covered California website is set to launch this month.

"We will be exploring relationships with tax preparers because they offer a great way to provide one-on-one assistance," Lee said. "But we don't want to be too far ahead of when people can enroll."

Bean, the actor and waiter, is among the "young invincibles" that Covered California and health insurers are eager to reach. Those young, healthy consumers can help offset the risk of too many older, sicker individuals enrolling early on and potentially driving up premiums in the exchange.

Bean said he earns less than $20,000 annually and welcomes any subsidy to make coverage more affordable. He said he has health coverage for another year on his parents' policy and saw firsthand the value of insurance when he broke his leg last summer.

"The medical bills started coming in," he said, "and they were pretty hefty."

chad.terhune@latimes.com

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Ambitious makeover planned for old housing project

Denise Penegar puts a little extra effort into the teenage girls, the ones who've dropped out of high school to care for their firstborns.

Don't be afraid, the outreach worker tells them. Come down to the housing project's community center, get your GED and some job skills. Change your life.

"I was one of those girls," said Penegar, now 51 and still living in Jordan Downs, the Watts housing project where she was born.

Sometimes, she imagines how different her life might have been if someone had knocked on her door when she was 17, caring for her first baby. What would it have meant just to have "someone who is here who can help pick me up"?

Penegar is on the front lines of a bold social experiment underway at Jordan Downs, a project notorious to outsiders for its poverty, blight and violence but seen by many longtime residents, for all its problems, as a close-knit community worth preserving.

In the last year, the Housing Authority of the City of Los Angeles has begun an effort to transform Jordan that could cost more than $600 million. The plan is to turn the complex of 700 aging units into a mixed-income community of up to 1,400 apartments and condominiums, with shops and restaurants and fancy touches such as native plant gardens. The city hopes to draw in hundreds of more-affluent residents willing to pay market rate to live side by side with the city's poorest.

Spurred by changes in federal funding and policy, such "mixed use" developments have sprung up in place of infamous housing projects all over the country. But experts say Jordan is taking an approach that has not been tried on this scale.

Typically, public housing residents are moved out ahead of the bulldozers, scattered to search for new shelter. In Los Angeles, the housing authority has promised that any of the 2,300 Jordan residents "in good standing" can stay in their old units until the day they move into new ones. The project is to be built in phases, beginning with units on 21 acres of adjacent land purchased by the authority in 2008 for $31 million.

To ease the transition, the city has dispatched "community coaches" like Penegar, along with teachers, social workers, therapists — even police officers whose charge is not to make arrests but to coach youth football and triathlon teams.

In essence, officials intend to raze the buildings, not the community — and radically change its character.

It will be an enormous challenge, with success likely to be measured in tiny increments.

Only 47% of adults at Jordan reported any wages to the housing authority last year. As in many urban projects, poverty and social ills have multiplied through the generations, leaving some residents unfamiliar with opportunities and expectations beyond the neighborhood. Some rarely leave the area.

Before inviting in new neighbors with expectations of safety and comfort, the housing authority has begun flooding Jordan Downs with social services. Many of the programs are focused on women, because more than 60% of Jordan Downs' tenants live in households headed by single mothers. But men are targeted too — for job training and lessons in parenting, for instance.

By December, 10 months into the effort, more than 450 families had been surveyed by intake workers and 280 signed up for intensive services.

"Most people would say it's ambitious, but I think it's essential," said Kathryn Icenhower, executive director of Shields for Families, the South Los Angeles nonprofit that is running many of the new programs under a more than $1-million annual contract with the housing authority.

It is unknown, however, how effective the social services will be, how easy it will be to draw in wealthier residents and how many millions of dollars the federal government — a major source of funding — will provide.

Already, the housing authority has picked a development team — the for-profit Michaels Organization and the nonprofit Bridge Housing, both with respectable track records in other cities. But with financing still uncertain, it is unclear exactly how many units will be built or how much various occupants would pay.

Ultimately, a working family could pay hundreds of dollars more in rent than unemployed tenants next door for a nearly identical unit. Officials say they do not expect Watts to draw the same kind of high-income residents as the former Cabrini Green project in Chicago, which sat on prime real estate near downtown. But Jordan is in a convenient location, near the intersection of the 105 and 110 Freeways; and in a high-rent city like Los Angeles, even the steepest rates at Jordan are likely to seem a bargain.

Despite the onslaught of social services and some palpable changes — including a 53% plunge in the violent crime rate at Jordan last year — financial risks abound.

Later this spring, the authority plans to put in an application for $30 million from the federal government's Choice Neighborhoods Program as seed money. Without it, the project could be delayed.

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The Black Keys, Skrillex share early Grammys lead

LOS ANGELES (AP) — Dan Auerbach of The Black Keys is not such a lonely boy after all.

The singer-guitarist took the early lead at the Grammy Awards, picking up three trophies and assisting with a fourth during the pre-telecast show. Auerbach won producer of the year alone and best rock song for "Lonely Boy" and rock album for "El Camino" with his bandmate Patrick Carney, joining electronic dance music innovator Skrillex atop the early leaderboard. He was also producer for another winner, Dr. John.

A slew of artists sit one back going into the main awards show Sunday night at the Staples Center, including Kanye West and Jay-Z, Gotye, former best new artist winner Esperanza Spalding, jazz man Chick Corea and Christian singer-songwriter Matt Redman.

Most of the attention has been on Frank Ocean going into the awards, but his fellow lead nominees got an early lead on the R&B singer during the pre-telecast show.

West and Jay-Z won best rap song and best rap performance for the song "... in Paris" from their "Watch the Throne" collaboration and lost a third for short form video for "No Church in The Wild," which featured Ocean. Ocean will be up for five awards later in the evening.

Other early winners included Rihanna, Beyonce, Taylor Swift and Mumford & Sons, one of six top nominees with six nods apiece. Ocean is up for the major awards best new artist, album of the year and record of the year when the show airs live on CBS at 8 p.m. EST from the Staples Center.

The Grammy pre-telecast awards show at the Nokia Theatre had 70 trophies up for grabs, including rock, pop, rap and country categories.

Skrillex won best dance recording for "Bangarang," featuring Sirah, best dance/electronica album for "Bangarang" and best remixed recording.

"Let's keep making music," he said. "... We're a big family. We're a big community. We support music and forward-thinking ideas here."

Gotye won best alternative album for "Making Mirrors" and best pop/duo performance for "Somebody That I Used To Know," featuring Kimbra.

Spalding had one of the most touching moments of the pre-telecast awards show, taking the stage with her longtime jazz teacher Thara Memory for their win in the best instrumental arrangement accompanying vocalist category. She also won for best jazz vocal album for her "Radio Music Society."

Corea, who competed against himself in two categories, won best improvised jazz solo for "Hot House" with Gary Burton and best instrumental composition for "Mozart Goes Dancing."

And Redman won best gospel/contemporary Christian music performance and best contemporary Christian music song (in a tie) for "10,000 Reasons (Bless The Lord)."

Other early winners included Rihanna, who won short form music video for "We Found Love" featuring Calvin Harris, and Swift won the Grammy for best song written for visual media for "Safe & Sound," her collaboration with The Civil Wars on "The Hunger Games" soundtrack. It was Swift's seventh Grammy and the third for Joy Williams and John Paul White of The Civil Wars.

"I think it's appropriate that Taylor thanks us because we've been carrying her for a while and it's getting really tiring," White joked.

Beyonce won for best traditional R&B performance, Mumford & Sons took their first Grammy, winning along with Old Crow Medicine Show and Edward Sharpe and the Magnetic Zeros for their long form video documentary "Big Easy Express."

Celebrities began rolling down the red carpet in the early afternoon, but it remained to be seen if any would try to skirt CBS's mandate that stars dress appropriately with butts, breasts and other sensitive areas covered adequately.

"I think it's just, you know, we should always stay classy and dress according to the event that's being held," Ashanti said on the red carpet. "So I don't think people should be limited so much and told what you can and cannot do. But, you know, you do have to have a certain class and prestige about yourself."

Celebrities also felt an increased Los Angeles Police Department presence in light of a manhunt involving an alleged cop killer. Police were everywhere, including atop the hotel across from the Staples Center.

Ocean might be riding a wave toward some of the night's biggest honors. He is still up for five awards going into the night along with fellow top nominee fun.

"It feels cool," Ocean said on the red carpet. "It's really bright, a lot of beautiful ladies walking around being fancy. I have to perform tonight so the wheels are constantly spinning. You can't really just sit in your seat and take it all in."

All the night's major awards are still to come. Jack White's "Blunderbuss" competes with fun.'s "Some Nights," Ocean's "channel ORANGE," Mumford's "Babel" and The Keys' "El Camino" for the night's top award, album of the year.

Gotye's "Somebody That I Used To Know," featuring Kimbra, Taylor Swift's "We Are Never Ever Getting Back Together" and Kelly Clarkson's "Stronger (What Doesn't Kill You)" join the fun., Ocean and Black Keys entries in record of the year.

Fun. and Clarkson also are nominated for song of the year along with Ed Sheeran's "The A Team," Carly Rae Jepsen's "Call Me Maybe" and Miguel's "Adorn."

And rounding out the major categories, fun., Ocean, Alabama Shakes, Hunter Hayes and The Lumineers are up for best new artist.

Swift will kick things off with a show-opening performance. Fun. and Ocean will take the stage. Others scheduled to perform include Justin Timberlake, Carrie Underwood, Clarkson, White and Juanes.

There will be no shortage of mashups the Grammys have become famous for, either. Elton John, Mavis Staples, Mumford, Brittany Howard, T Bone Burnett and Zac Brown are saluting the late Levon Helm, who won the Americana Grammy last year a few months before his death. The Keys will join Dr. John and the Preservation Hall Jazz Band on stage. Sting, Rihanna and Bruno Mars will perform together. Other team-ups include Miranda Lambert and Dierks Bentley, and Alicia Keys and Maroon 5.

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AP writers Nekesa Mumbi Moody and Beth Harris in Los Angeles contributed to this report.

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Follow AP Music Writer Chris Talbott: http://twitter.com/Chris_Talbott.

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Apple developing wristwatch device that runs on iOS, reports say

The cycle of speculation that Apple plans to build some kind of wristwatch or other wearable computing device kicked into high gear this weekend after a pair of reports claimed to confirm that such a device was under development. 

First, the New York Times reported that it had confirmed with multiple sources that Apple "is experimenting with wristwatch-like devices made of curved glass."

That story was followed by another report from the Wall Street Journal saying it had also confirmed that Apple "is experimenting with designs for a watch-like device that would perform some functions of a smartphone."

QUIZ: Test your Apple knowledge

There were no additional confirmed details about what such a gadget might do, what features it would specifically offer, how much it would cost, or even when it might hit the market. 

Speculation about a possible iWatch has been ebbing and flowing for several years now. In December, a Chinese blog claimed it had confirmation that such a device was under development. And this week, former Apple designer Bruce Tognazzini wrote an expansive blog post suggesting what such a device might do. 

He believed Apple was the perfect company to address the numerous design flaws, such as bulkiness and short battery life, that have made adoption of other such devices slow. 

"The first thing Apple has to do is address traditional drawbacks in smartwatch design, something they are qualified to do," he wrote. 

One other notable nugget from the New York Times story: Steve Jobs had told another reporter that he had very much wanted Apple to build a car:

"In a meeting in his office before he died, Steven P. Jobs, Apple’s co-founder and former chief executive, told John Markoff of The New York Times that if he had more energy, he would have liked to take on Detroit with an Apple car."

The idea of dueling Apple and Google cars battling it out for the future of our roadways may be the stuff nerd dreams are made of. 

ALSO: 

Unusual, quirky and just plain weird iPhone cases

German buys one song, wins $13,525 iTunes gift card 

It's Apple and CalPERS vs. Greenlight in stock proposal showdown

Follow me on Twitter @obrien.

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A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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Snoop Dogg blazes one during BMI songwriting panel

LOS ANGELES (AP) — Music fans who turned out to BMI's annual pre-Grammy Awards "How I Wrote That Song" discussion got a little more than they expected thanks to Snoop Dogg — a contact high.

The rapper smoked marijuana during Saturday's panel discussion, lighting up a large, Kush-filled blunt on stage at The Roxy. He briefly passed it off to B.o.B before methodically reducing it to ash over a 15-minute period. The panel also included Busta Rhymes and songwriters Luke Laird and Evan Bogart, all of whom abstained — at least on stage.

Fittingly, the conversation eventually turned to Snoop's groundbreaking work on "The Chronic."

Laird recalled growing up at the end of a dirt road 10 miles outside Conneaut Lake, a small town of 700 in rural Pennsylvania. Yet Snoop's work with Dr. Dre still infiltrated his world and that of all the other country kids around him.

"Let me just say, the album everyone was listening to was 'The Chronic,'" Laird said, noting how surreal it was to be sitting on stage with Snoop.

With acoustic guitar in hand, he played a bit of his Blake Shelton hit "Hillbilly Bone" in its original form: a rap song. The Nashville-based songwriter had everyone bobbing their heads to the beat.

"Now I feel like more than ever you see these influences crossing genres," Laird said.

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Follow AP Music Writer Chris Talbott at http://twitter.com/Chris_Talbott .

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Entrepreneur Brian Lee is business partner to the stars

The gig: Lawyer-turned-serial-entrepreneur Brian Lee, 41, is pulling double duty as the chief executive of two celebrity-backed e-commerce websites: ShoeDazzle, co-founded with Kim Kardashian, and Honest Co., co-founded with Jessica Alba. The companies are headquartered in Santa Monica and offer customers monthly subscription plans in addition to typical a la carte shopping for shoes and baby products, respectively.

ShoeDazzle has more than 15 million registered users and last year posted $100 million in revenue, up 80% from 2011; it has raised $66 million from investors including venture capital firm Andreessen Horowitz. Honest Co., launched a year ago, has yet to release membership or financial numbers but has raised $27 million.

From Seoul to L.A.: Lee was born in Seoul. When he was 1, his family immigrated to Huntington Beach, where he grew up.

As an 8-year-old, Lee mapped out his trick-or-treating route on Halloween so he could collect as much candy as possible. When he got home, he separated his loot into Ziploc bags, which he sold at school for 25 cents each.

"Cost of goods: zero. Profit margins: 100%, outside of my own little labor," he said. "I probably did that for five years."

He now lives in Marina del Rey with his wife, Mira; their 4-year-old son, Davis; and their 1-year-old daughter, Madison.

Education: Bachelor's degree in business economics from UCLA in 1993, J.D. from UCLA School of Law in 1996.

Bold cold call: After practicing law for a few years, Lee came up with the idea for LegalZoom, which offers self-help legal documents such as divorce and bankruptcy forms, prenuptial agreements and wills. He wanted a high-profile name to represent the start-up, and decided to approach O.J. Simpson defense attorney Robert Shapiro.

Lee got Shapiro's number from 411 and called him at 10 p.m. "He picked up the phone and said, 'Hi, this is Robert Shapiro, how can I help you?' and I said, 'Well, my name is Brian Lee and I have a business opportunity I'd like to run by you.'... I think he heard the desperation in my voice and he said, 'You've got two minutes.'"

LegalZoom, based in Glendale, launched in 2001.

Online shoe shopping: ShoeDazzle was inspired by Lee's wife, who one day returned from a shopping spree on Robertson Boulevard with a pair of pricey designer shoes. When Lee asked her why she didn't just go to Loehmann's or DSW, she said discount chains didn't provide the type of personalized, one-on-one service that small boutiques did. Lee set out to replicate that experience online and met Kardashian through Shapiro, who is a family friend.

ShoeDazzle launched four years ago as an online subscription business, with members viewing a customized showroom of shoes based on a personal fashion quiz and choosing one new pair to receive every month for $39.95 including shipping.

Taking back the reins: In November, Lee became CEO of ShoeDazzle for a second time. He returned after the departure of Bill Strauss, who scrapped the company's subscription-based business model last year, leading to speculation that the company wasn't doing well.

In his first 100 days on the job, Lee laid off about two dozen employees and hired celebrity fashion stylist Rachel Zoe as the company's chief stylist; ShoeDazzle also began introducing one new shoe style every day. This month the company will roll out an optional $9.95-a-month VIP membership program that includes free shipping, early access to sales, discounts and an extended return policy.

Since a site relaunch in January, orders have increased 30% and repeat visits are up 12%, Lee said. The company sells as many as 250,000 pairs of shoes per month.

From shoes to babies: Lee was approached by Alba when the actress wanted to start an eco-friendly baby products line. Honest Co. sells diapers, shampoo, sunscreen and household items online that are nontoxic and made with organic ingredients.

Caffeine junkie: As the CEO of two companies, Lee arrives at Honest Co. offices by 7 a.m. every day and is there until 9:30 a.m. He then heads over to nearby ShoeDazzle, where he stays until 5 p.m. or so. Then it's back to Honest Co. until about 8 or 9 p.m.

"I drink seven Coca-Colas a day," he said. "Regular Coke, which is really bad for me."

Advice to entrepreneurs: "Believe in the idea with 100% certainty," Lee said. "But also don't be scared to change that idea and pivot very quickly. Because as an entrepreneur, nothing ever goes to plan."

For instance, Lee said that in the early days of LegalZoom, the company created do-it-yourself software programs such as Estate Planning in a Box that it hoped to sell at Staples and OfficeMax. When LegalZoom realized that Internet-based downloading was the future, it dropped those plans.

"We spent a lot of resources on it," he said, "but we weren't afraid at all to just cut it."

andrea.chang@latimes.com

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