The Brief

Even with extensive caregiving experience, Patti LaFleur was unprepared for the crisis that hit in April 2021, when her mother, Linda LaTurner, fell out of a chair and broke her hip.

LaTurner, 71, had been diagnosed with early-onset dementia seven years before. For two years, she’d been living with LaFleur, who managed insulin injections for her mother’s Type 1 diabetes, helped her shower and dress, dealt with her incontinence, and made sure she was eating well.

In the hospital after her mother’s hip replacement, LaFleur was told her mother would never walk again. When LaTurner came home, two emergency medical technicians brought her on a stretcher into the living room, put her on the bed LaFleur had set up, and wished LaFleur well.

That was the extent of help LaFleur received upon her mother’s discharge.

She didn’t know how to change her mother’s diapers or dress her since at that point LaTurner could barely move. She didn’t know how to turn her mother, who was spending all day in bed, to avoid bedsores. Even after an occupational therapist visited several days later, LaFleur continued to face caretaking tasks she wasn’t sure how to handle.

“It’s already extremely challenging to be a caregiver for someone living with dementia. The lack of training in how to care for my mother just made an impossible job even more impossible,” said LaFleur, who lives in Auburn, Washington, a Seattle suburb. Her mother passed away in March 2022.

A new proposal from the Centers for Medicare & Medicaid Services addresses this often-lamented failure to support family, friends, and neighbors who care for frail, ill, and disabled older adults. For the first time, it would authorize Medicare payments to healthcare professionals to train informal caregivers who manage medications, assist loved ones with activities such as toileting and dressing, and oversee the use of medical equipment.

The proposal, which covers both individual and group training, is a long-overdue recognition of the role informal caregivers — also known as family caregivers — play in protecting the health and well-being of older adults. About 42 million Americans provided unpaid care to people 50 and older in 2020, according to a much-cited report.

“We know from our research that nearly 6 in 10 family caregivers assist with medical and nursing tasks such as injections, tube feedings, and changing catheters,” said Jason Resendez, president and CEO of the National Alliance for Caregiving. But fewer than 30% of caregivers have conversations with health professionals about how to help loved ones, he said.

Even fewer caregivers for older adults — only 7% — report receiving training related to tasks they perform, according to a June 2019 report in JAMA Internal Medicine.

Cheryl Brown’s husband, Hardy, was diagnosed with amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, in 2002. He can’t walk but he can use his arms and hands. Brown says she “never gets a break” from caregiving responsibilities.

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Van Howard

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Image Arts

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Nancy LeaMond, chief advocacy and engagement officer for AARP, experienced this gap firsthand when she spent six years at home caring for her husband, who had amyotrophic lateral sclerosis, a neurological condition also known as Lou Gehrig’s disease. Although she hired health aides, they weren’t certified to operate the feeding tube her husband needed at the end of his life and couldn’t show LeaMond how to use it. Instead, she and her sons turned to the internet and trained themselves by watching videos.

“Until very recently, there’s been very little attention to the role of family caregivers and the need to support caregivers so they can be an effective part of the health delivery system,” she told me.

Several details of CMS’ proposal have yet to be finalized. Notably, CMS has asked for public comments on who should be considered a family caregiver for the purposes of training and how often training should be delivered.

(If you’d like to let CMS know what you think about its caregiving training proposal, you can comment on the CMS site until 5 p.m. ET on Sept. 11. The expectation is that Medicare will start paying for caregiver training next year, and caregivers should start asking for it then.)

Advocates said they favor a broad definition of caregiver. Since often several people perform these tasks, training should be available to more than one person, Resendez suggested. And since people are sometimes reimbursed by family members for their assistance, being unpaid shouldn’t be a requirement, suggested Anne Tumlinson, founder and chief executive officer of ATI Advisory, a consulting firm in aging and disability policy.

As for the frequency of training, a one-size-fits-all approach isn’t appropriate given the varied needs of older adults and the varied skills of people who assist them, said Sharmila Sandhu, vice president of regulatory affairs at the American Occupational Therapy Association. Some caregivers may need a single session when a loved one is discharged from a hospital or a rehabilitation facility. Others may need ongoing training as conditions such as heart failure or dementia progress and new complications occur, said Kim Karr, who manages payment policy for AOTA.

When possible, training should be delivered in a person’s home rather than at a health care institution, suggested Donna Benton, director of the University of Southern California’s Family Caregiver Support Center and the Los Angeles Caregiver Resource Center. All too often, recommendations that caregivers get from health professionals aren’t easy to implement at home and need to be adjusted, she noted.

Nancy Gross had to perform “nursing tasks I wasn’t prepared to do” when her husband, Jim Kotcho, came home after a stem cell transplant for leukemia. “Until you’re really into caregiving, you don’t know what your issues will be,” she says.

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Courtesy of Jim Kotcho

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Nancy Gross, 72, of Mendham, New Jersey, experienced this when her husband, Jim Kotcho, 77, received a stem cell transplant for leukemia in May 2015. Once Kotcho came home, Gross was responsible for flushing the port that had been implanted in his chest, administering medications through that site, and making sure all the equipment she was using was sterile.

Although a visiting nurse came out and offered education, it wasn’t adequate for the challenges Gross confronted. “I’m not prone to crying, but when you think your loved one’s life is in your hands and you don’t know what to do, that’s unbelievably stressful,” she told me.

For her part, Cheryl Brown, 79, of San Bernardino, California — a caregiver for her husband, Hardy Brown Sr., 80, since he was diagnosed with ALS in 2002 — is skeptical about paying professionals for training. At the time of his diagnosis, doctors gave Hardy five years, at most, to live. But he didn’t accept that prognosis and ended up defying expectations.

Today, Hardy’s mind is fully intact, and he can move his hands and his arms but not the rest of his body. Looking after him is a full-time job for Cheryl, who is also chair of the executive committee of California’s Commission on Aging and a former member of the California State Assembly. She said hiring paid help isn’t an option, given the expense.

And that’s what irritates Cheryl about Medicare’s training proposal.

“What I need is someone who can come into my home and help me,” she told me. “I don’t see how someone like me, who’s been doing this a very long time, would benefit from this. We caregivers do all the work, and the professionals get the money? That makes no sense to me.”

Big Bear’s famous bald eagle nest has taken a turn — both of Jackie and Shadow’s eggs have been attacked by ravens.

In the nest overlooking Big Bear Lake, a raven could be seen poking a large hole into, and potentially eating, one of the eagle eggs. The intrusion was noticed on a popular YouTube livestream run by the nonprofit Friends of Big Bear Valley.

Jenny Voisard, the organization’s media and website manager, confirmed the crack in Friends of Big Bear Valley’s official Facebook group, which has nearly 400,000 members, after Jackie and Shadow were away from the nest, and eggs, for several hours Friday.

Voisard told LAist one of the eggs may still be partly intact, but both eggs are believed to be breached. Jackie returned to their nest shortly after the raven left to lay on the remaining egg, according to organization records.

“Our hearts are with Jackie and Shadow always and we wrap our arms around them,” Voisard wrote. “Our hearts are also with you eagle fam, we know how you are feeling now."

“Step away from the screen when needed,” she continued in the post. “Try and rest tonight.”

How we got here

Jackie laid the first egg of the season around 4:30 p.m. last Friday and the second egg around 5:10 p.m. Monday as thousands of eager fans watched online.

It was almost exactly a year after the feathered duo welcomed the first egg of the 2025 season.

Bald eagles generally have one clutch per season, according to Friends of Big Bear Valley. A second clutch is possible if the eggs don’t make it through the early incubation process.

For example, Jackie laid a second clutch in February 2021 after the first round of eggs was broken or destroyed by ravens the month before.

Jackie and Shadow may have the left the nest unattended Friday because they knew on some level "that not everything was right," Voisard wrote.

"We are hopeful however, because bald eagles can lay replacement clutches if something happens early enough in the season," she continued. "The fact that the raven came to do its job so quickly may be just what Jackie and Shadow needed."

A raven is believed to have breached both eggs in Big Bear's famous nest.

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Friends of Big Bear Valley

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Watch the nest

This is a developing story and will be updated.

The Meta researcher’s tone was alarmed.

“oh my gosh yall IG is a drug,” the user experience specialist allegedly wrote to a colleague, referring to the social media platform Instagram. “We’re basically pushers... We are causing Reward Deficit Disorder bc people are binging on IG so much they can’t feel reward anymore.”

The researcher concluded that users’ addiction was “biological and psychological” and that company management was keen to exploit the dynamic. “The top down directives drive it all towards making sure people keep coming back for more,” the researcher added.

The conversation was included recently as part of a long-simmering lawsuit in a California-based federal court. Condensing complaints from hundreds of school districts and state attorneys general, including California’s, the suit alleges that social media companies knew about risks to children and teens but pushed ahead with marketing their products to them, putting profits above kids’ mental health. The suit seeks monetary damages and changes to companies’ business practices.

The suit, and a similar one filed in Los Angeles Superior Court, targets Facebook, Instagram, YouTube, TikTok, and Snap. The cases are exposing embarrassing internal conversations and findings at the companies, particularly Facebook and Instagram owner Meta, further tarnishing their brands in the public eye. They are also testing a particular vector of attack against the platforms, one that targets not so much alarming content as design and marketing decisions that accelerated harms. The upshot, some believe, could be new forms of regulation, including at the federal level.

One document discussed during a hearing this week included a 2016 email from Mark Zuckerberg about Facebook’s live videos feature. In the email, the Meta chief wrote, “we’ll need to be very good about not notifying parents / teachers” about teens’ videos.

“If we tell teens’ parents about their live videos, that will probably ruin the product from the start,” he wrote, according to the email.

In slides summarizing internal tech company documents, released this week as part of the litigation, an internal YouTube discussion suggested that accounts from minors in violation of YouTube policies were actively on the platform for years, producing content an average of “938 days before detection – giving them plenty of time to create content and continue putting themselves and the platform at risk.”

A spokesperson for Meta didn’t immediately respond to requests for comment.

A YouTube spokesperson, José Castañeda, described the slide released this week as “a cherry-picked view of a much larger safety framework” and said the company uses more than one tool to detect underage accounts, while taking action every time it finds an underage account.

In court, the companies have argued that they are making editorial decisions permitted by the First Amendment,. That trial is set for June.

The state court litigation moved into jury selection this week, increasing the pressure on social media companies.

While the state and federal cases differ slightly, the core argument is the same: that social media companies deliberately designed their products to hook young people, leading to disastrous but foreseeable consequences.

“It's led to mental health issues, serious anxiety, depression, for many. For some, eating disorders, suicidality,” said Previn Warren, co-lead counsel on the case in federal court. “For the schools, it’s been lost control over the educational environment, inability of teachers to really control their classrooms and teach.”

A federal suit

Meta and other companies have faced backlash for years over their treatment of kids on their platforms, including Facebook and Instagram. Parents, lawmakers and privacy advocates have argued that social media contributed to a mental health crisis among young people and that tech companies failed to act when that fact became clear.

Those allegations gained new scrutiny last month when a brief citing still-sealed documents in the federal suit became public.

While the suit also names TikTok, Snap, and Google as defendants, the filing includes allegations against Meta that are especially detailed.

In the more than 200-page filing, for example, the plaintiffs argue that Meta deliberately misled the public about how damaging their platforms were.

Warren pointed to claims in the brief that Meta researchers found that 55% of Facebook users had “mild” problematic use of the platform, while 3.1 percent had “severe” problems. Zuckerberg, according to the brief, pointed out that 3% of billions would still be millions of people.

But the brief claims the company published research noting only that "we estimate (as an upper bound) that 3.1% of Facebook users in the US experience problematic use.”

“That’s a lie,” Warren said.

In response to recent interest in the suits, Meta published a blog post this month arguing that the litigation “oversimplifies” the issue of youth mental health, and pointed to past instances where it has worked with parents and families with features to protect kids.

The federal case faced a key hearing this week, as the defendants argued that a judge should summarily dismiss the case. A decision on that motion is likely coming in the next few weeks, Warren said.

Social media companies, like other web-based services, receive protection from some legal claims under a part of federal law. Section 230 of the Communications Decency Act gives legal immunity to website operators for potentially illegal content on their platforms.

Mary Anne Franks, a legal scholar in First Amendment issues at George Washington University who has long studied Section 230, said rather than online content in and of itself, the recent social media cases are focusing on the design of the platforms and their marketing.

“The litigation strategy is saying it's the way that you're providing that space and you're pushing this toward individuals that are vulnerable that is really an issue here,” she said. “It's your own conduct, not somebody else's.”

The companies are making key decisions behind the scenes, she said, and could be held responsible for them.

“You were manipulating things,” she said the plaintiffs are arguing. “You were deliberately making choices about what comes to the top or what is directly accessible or may be tempting to vulnerable users.”

A California state trial begins

Meanwhile, the related state lawsuit went to jury selection this week.

The case, which makes similar claims about personal injury caused by the social media companies, has also drawn nationwide attention, and major industry figures like Zuckerberg are expected to appear on the stand.

The personal injury case focuses on an unnamed plaintiff who claims to have had her mental health damaged by an addiction to social media.

In a last-minute development this week, TikTok and Snap reportedly reached undisclosed settlements in the case. Meta and Google are continuing as defendants.

Franks said these trials could be a tipping point in regulating how tech companies design and market their products. While the companies have faced scrutiny in the past, she said, the glare of examination at trial could be especially bright.

“There's always been talk of it and the members of Congress have kind of said, ‘maybe we'll regulate you,’” she said. “I think now the platforms are really getting nervous about what this is going to mean if they look really bad on the stand.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

On Saturday, Burbank is officially launching a new hiking trail accessibility program for people with disabilities. Two new all-terrain wheelchairs will be available to rent at Stough Canyon Nature Center for use on the fire trail.

The program is the first of its kind in Southern California. Several jurisdictions in the region have beach accessibility programs, but this is the first for mountain trails.

The background

In recent years, Burbank has become a leader in the movement to make sports and the outdoors more accessible to people with disabilities.

Since 2021, the city has launched several adaptive sports programs, including offering wheelchair rugby and fencing, Piper’s Pals youth baseball and basketball, powerchair soccer, boccia and the Burbank Adaptive Sports Expo, which is coming up for its third year running on Feb. 21.

The new equipment

The new all-terrain wheelchairs are the latest in that effort, said Diego Cevallos,  assistant director of the city’s parks and recreation department.

“We are building an ecosystem here in Burbank of robust programming and activities that cater to folks with disabilities,” he said. “Really what we want to do is inspire the community and also our other civic leaders to engage in this movement of making outdoor equity more accessible through programs just like this.”

Burbank is launching its accessibility program with two new all-terrain wheelchairs.

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Courtesy Burbank Parks and Recreation

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The city purchased the all-terrain Action Trackchair AXIS 40 wheelchairs — each about $20,000 — exclusively with funds raised by Leadership Burbank. The community-based organization raised about $90,000 for the trail accessibility program. The remaining funds went to the city’s parafencing program and all staff time associated with maintaining these programs comes out of the city’s general fund, Cevallos said.

How the program works

The program is open to anyone with mobility issues in the region, not only Burbank residents.

You can reserve one of the two wheelchairs by going to BurbankParks.com. The process is a bit clunky, but city staff are working to simplify it.

Once reserved, the user will have to bring a non-disabled companion to assist them and a staff member or volunteer with the Nature Center will accompany them on the trail. That docent will provide nature education during the hike and make sure everything is going smoothly and safely.

Right now, the chairs can only be reserved for up to two hours, said recreation services manager Noah Altman, but he said staff welcomes feedback from the public and will consider updating the requirements for the program as needed.

And an important note: Residents with all types of disabilities can use the chairs — it’s not necessary to have mobility in one’s hands. The family member or friend accompanying the user can remotely control the wheelchairs if needed.

Why all-terrain wheelchairs matter

Mobility challenges are the most common type of disability in L.A. County — around half a million Angelenos have some type of ambulatory disability, according to the county’s Aging and Disabilities Department.

But all-terrain wheelchairs cost around $20,000 and weigh around 400 pounds, making them out of reach and impractical for most individuals to own themselves, said Austin Nicassio, a San Dimas resident and founder of Accessible Off-Road, a nonprofit that advocates and is raising funds for more off-road mobility devices.

Nicassio provided consultation early on in the Burbank accessible trail project effort, and is currently working with L.A. County and California State Parks to bring all-terrain wheelchairs to more areas. The nonprofit is raising money to purchase all-terrain wheelchairs for use in those jurisdictions.

“ It's a huge milestone,” Nicassio said of the Burbank program. “It's going to be absolutely life changing for everyone in Southern California.”

For Nicassio, these efforts are deeply personal. Growing up in the eastern San Gabriel Valley, he used to be an avid hiker and mountain biker.

“Five years ago I was completely able-bodied working as an aerospace engineer, mountain biking, hiking, surfing,” Nicassio said. “My body did whatever I wanted it to do, and I always took it for granted.”

Austin Nicassio uses his all-terrain wheelchair at Frank G. Bonelli Regional Park near his home in San Dimas.

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But in 2022, after a mild case of COVID-19, he started experiencing strange symptoms — muscle weakness, severe brain fog. He was later diagnosed with a condition that affects his blood flow and makes it difficult to stand for long periods of time and impossible to do anything too strenuous. He was also diagnosed with chronic fatigue syndrome.

“I went from being very active to being a wheelchair user,” Nicassio said.

His mental health plummeted — he realized he used to cope with strong emotions by getting out on the trails or in the ocean. When he finally saved up enough to purchase his own off-road wheelchair, it was “life changing.”

“And not just for me, but for my father, for my wife, for my friends, my whole community,” Nicassio said.

He says he wants to see a world where access to such offroad wheelchairs is the norm.

“ No one has told me that their favorite hike or trail's been paved unless you're disabled, and it has to be,” said Nicassio. “Being out on these trails, a couple miles from the noise, from the trash, from the people, it's life changing.”