ENI Announces Major Gas Find Off Mozambique

LONDON — The Italian oil company ENI said Wednesday that it had made new natural gas discoveries in the waters off Mozambique, a find that will help consolidate ENI’s position as one of the leaders in the hot new East Africa region.

Offshore Mozambique, where ENI’s discovery is located, ranked third in the world in terms of oil and gas discovered last year, after the Santos Basin in Brazil and Iraqi Kurdistan, according to Mansur Mohammed, an analyst at Wood Mackenzie in Edinburgh.

The finds — from the sixth and seventh wells that ENI has drilled — add an additional 6 trillion cubic feet of gas to what ENI has already found. That is a large amount of gas but is dwarfed by the 68 trillion cubic feet that ENI now says it has found in its exploration concession called Block 4, where ENI has a 70 percent shareholding.

Three other shareholders — Galp Energia of Portugal, Kogas of South Korea and ENH, the Mozambican national oil company — each hold 10 percent.

The total amount discovered is equivalent to about 12 billion barrels of oil. A high proportion is likely to be recoverable, ENI said.

According to industry estimates, ENI’s share of the Mozambique discoveries could be worth around $15 billion.

The ENI finds coincide with an effort by the company’s chief executive, Paolo Scaroni, to focus more on exploration and production. In an interview, Mr. Scaroni said that ENI’s exploration activities in Mozambique would come to about $700 million. When you make a business of exploration and are “successful you make a huge amount of money,” he said.

ENI first found gas in Mozambique last year, closely following a discovery by Anadarko Petroleum of the United States.

The two companies are now negotiating with the government on a development plan. The biggest money earner is likely to be exporting gas to Asia as liquefied natural gas. The Web site of the Mozambique Instituto Nacional de Petroleo, the energy ministry, has a presentation that indicates that as many as 10 LNG plants or trains could be built, which would make Mozambique a very large player in the world gas market.

Mr. Scaroni said there could also be a role for a floating LNG facility, a technology that Royal Dutch Shell is now developing for use off western Australia. Shell recently tried to buy Cove Energy, which had a small position in the Mozambique discoveries, but was outbid by Thailand’s PTT Exploration and Production.

ENI is not a major player in LNG and may need help with the huge capital costs for developing the gas, which Mr. Scaroni put in the “tens of billions” of dollars.

Anadarko is also not an LNG specialist. It is widely thought in the industry that the companies will bring in partners.

Mr. Scaroni said he had been talking to potential partners “but we are fairly reluctant to strike a deal with anybody until we finish our exploration.”

A recent report by Bernstein Research says that Mozambique will be “ENI’s most significant project, although we do not expect production until 2019 at the earliest.” Bernstein estimates that the internal rate of return for Mozambique LNG will be a substantial 27 percent.

The gas discoveries off Mozambique are contained in sandstone deposits in what were ancient river beds, similar to those off West Africa and elsewhere.

What makes the Mozambique discoveries particularly rich is that the sandstone layers containing the gas are particularly thick. One of the wells ENI drilled, called Coral 2 found gas-bearing rock 140 meters, or almost 460 feet, thick — an exceptional amount.

“Mozambique is a very positive exploration story,” Mr. Mohammed of Wood Mackenzie said. “We are talking about an unprecedented high exploration success rate that transformed the outlook for the region.”

This article has been revised to reflect the following correction:

Correction: December 5, 2012

An earlier version of this article misspelled the first name of ENI’s chief executive. He is Paolo Scaroni, not Paulo.

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High-Speed Trades Hurt Investors, a Study Says

A top government economist has concluded that the high-speed trading firms that have come to dominate the nation’s financial markets are taking significant profits from traditional investors.

Mendoza College of Business

The economist Andrei Kirilenko’s findings are still being reviewed by peers and have encountered opposition.

Hiroko Masuike/The New York Times

Bart Chilton of the C.F.T.C. says high-speed traders are taking “some of the cream off the top.”

The chief economist at the Commodity Futures Trading Commission, Andrei Kirilenko, reports in a coming study that high-frequency traders make an average profit of as much as $5.05 each time they go up against small traders buying and selling one of the most widely used financial contracts.

The agency has not endorsed Mr. Kirilenko’s findings, which are still being reviewed by peers, and they are already encountering some resistance from academics. But Bart Chilton, one of five C.F.T.C. commissioners, said on Monday that “what the study shows is that high-frequency traders are really the new middleman in exchange trading, and they’re taking some of the cream off the top.”

Mr. Kirilenko’s work stands in contrast to several statements from government officials who have expressed uncertainty about whether high-speed traders are earning profits at the expense of ordinary investors.

The study comes as a council of the nation’s top financial regulators is showing increasing concern that the accelerating automation and speed of the financial markets may represent a threat both to other investors and to the stability of the financial system.

The Financial Stability Oversight Council, an organization formed after the recent financial crisis to deal with systemic risks, took up the issue at a meeting in November that was closed to the public, according to minutes that were released Monday.

The gathering of top regulators, including Treasury Secretary Timothy F. Geithner and Ben S. Bernanke, the Federal Reserve chairman, said in its annual report this summer that recent developments “could lead to unintended errors cascading through the financial system.” The C.F.T.C. is a member of the oversight council.

The issue of high-frequency trading has generated anxiety among investors in the stock market, where computerized trading first took hold. But the minutes from the oversight council, and the council’s annual report released this year, indicate that top regulators are viewing the automation of trading as a broader concern as high-speed traders move into an array of financial markets, including bond and foreign currency trading.

Mr. Kirilenko’s study focused on one corner of the financial markets that the C.F.T.C. oversees, contracts that are settled based on the future value of the Standard & Poor’s 500-stock index. He and his co-authors, professors at Princeton and the University of Washington, chose the contract because it is one of the most heavily traded financial assets in any market and is popular with a broad array of investors.

Using previously private data, Mr. Kirilenko’s team found that from August 2010 to August 2012, high-frequency trading firms were able to reliably capture profits by buying and selling futures contracts from several types of traditional investors.

The study notes that there are different types of high-frequency traders, some of which are more aggressive in initiating trades and some of which are passive, simply taking the other side of existing offers in the market.

The researchers found that more aggressive traders accounted for the largest share of trading volume and made the biggest profits. The most aggressive scored an average profit of $1.92 for every futures contract they traded with big institutional investors, and made an average $3.49 with a smaller, retail investor. Passive traders, on the other hand, saw a small loss on each contract traded with institutional investors, but they made a bigger profit against retail investors, of $5.05 a contract.

Large investors can trade thousands of contracts at once to bet on future shifts in the S.& P. 500 index. The average aggressive high-speed trader made a daily profit of $45,267 in a month in 2010 analyzed by the study.

Industry profits have been falling, however, as overall stock trading volume has dropped and the race for the latest technological advances has increased costs.

Ben Protess contributed reporting.

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US reacts with joy to royal baby news

WESTPORT, Connecticut (AP) — An heir to the British throne is on the way — and Americans may be as enthralled as the Brits.

This former colony has been riveted by the royal news that the former Kate Middleton is pregnant — perhaps as much as Britain, where such regal developments are taken in stride.

"We don't really have a princess here," said Kathy Gitlin, an elementary school teacher in Connecticut who was thrilled to hear that Kate is with child. "I'm an Anglophile, I love England, and I think it's wonderful that two people in love wanted to get married and start a family. It's great."

There are several reasons for the American public's pleasure in Kate's news, manifested not only by the good wishes sent by President Obama but also by the breathless news coverage and the general good will toward the actually not-so-young young couple, who have both now reached 30.

First, and least complicated, is the fact that Kate seems a likeable and sensible young woman who married one of the world's most eligible bachelors without letting the power, prestige and A-plus jewelry go to her head.

Then there are the long ties between the two countries, so alike and so maddeningly different.

When Americans proudly declared their independence, they swore off sovereign kings and queens forever, yet several centuries later they find themselves drawn to the royals' pomp and pageantry, embracing the more colorful aspects of a system whose substance they had eagerly overthrown.

Finally, hardest to quantify, is the fading, almost ghostly, image of Princess Diana, who died so young. Americans want Diana's sons to flourish, and Kate seems to have made William very, very happy.

"I remember when Diana died, it was such a shock," said Gitlin, 52. "No one can ever take her place, but it's nice to have another person, someone this generation can look up to, and someone who William can love."

There's no doubt that many Britons are thrilled as well, and the country's embattled tabloid press certainly views a royal pregnancy (at Christmastime no less!) as a surefire circulation booster and a welcome diversion from a series of press scandals.

But some on Monday expressed a rather blasé attitude to the prospect of a new generation of Windsors seemingly bound for the throne. In the chill of early evening in north London's Camden market, young couples strolling among the stalls received the news of Kate's pregnancy with a shrug.

"I'm happy for them, but I don't really care," said Enya Lonergan, 19, who was visiting from Canterbury, south of London, with her friend Will Nichols, 20.

They could muster little enthusiasm for the news, noting that they had little in common with the royals, particularly in these bleak economic times.

"I don't think about them," Nichols said, adding that — naturally — he'd send them a gift. Or not.

Others said they were not interested and questioned the need for a royal family in the 21st century.

"I don't think it's a good thing," said Stephen Jowitt, 63, as he ambled down Camden High Street. "It reinforces a class system."

The news did provide a boost to one of Britain's national pastimes — finding new ways to wager money. Bookmakers are now taking bets on the gender of Kate's child, what the infant will be named and the color of his/her hair.

Joe Crilly, a spokesman for the William Hill bookmaker, said a high level of betting interest is expected, with favored names including Diana, Philip, Elizabeth and Sarah.

In America, ABC News even offered a poll, asking people to rate likely baby names.

Baby thoughts have been found in some less-than-fully-credible supermarket tabloids for months. They've been trumpeting "stories" about Kate's pregnancies for months, without any apparent basis in fact.

But that didn't keep the public from gobbling them up — the British royals, with their haughty glamour and slightly tragic air, have long captivated Americans.

"I'm always looking for any news of William and Kate," said 19-year-old Stacy McFacken, a clerk at a grocery store in Mentor, Ohio, in August when a number of tabloids offered screaming headlines about Kate's purported pregnancy.

"There's nothing like this in the States," she said. "It's just like all the fairy tales we read about as kids. We all want to be Kate."

Word of Kate's condition, including her hospitalization for complications, was top news on websites throughout the world. Her condition requires specialist treatment but if diagnosed early, it is unlikely to have long-term consequences for the mother or baby, and does not raise the risk of a miscarriage.

But while the parents might be anxious, world leaders stepped in to wish her well. The news was featured prominently on front pages in Argentina, India, France, South Africa and other countries. It sent Twitter into a tizzy, with the hashtag "royalbaby" trending worldwide and used more than 28,000 times in the first few hours following the official announcement. U.S. media websites such as People, Vanity Fair and the Daily Beast provided extensive coverage, with the Huffington Post launching a live blog to track developments.

"The whole wide world is excited," said Shao Hua Huang, a surgical nurse who practices in New York and Connecticut. "We're really happy for her. It's because of England and all the tradition. We Americans followed in their footsteps."

___

Associated Press writers Paisley Dodds, Danica Kirka and Cassandra Vinograd in London contributed to this report.

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Generic Drug Makers Facing Squeeze on Revenue

They call it the patent cliff.

Brand-name drug makers have feared it for years. And now the makers of generic drugs fear it, too.

This year, more than 40 brand-name drugs — valued at $35 billion in annual sales — lost their patent protection, meaning that generic companies were permitted to make their own lower-priced versions of well-known drugs like Plavix, Lexapro and Seroquel — and share in the profits that had exclusively belonged to the brands.

Next year, the value of drugs scheduled to lose their patents and be sold as generics is expected to decline by more than half, to about $17 billion, according to an analysis by Crédit Agricole Securities.“The patent cliff is over,” said Kim Vukhac, an analyst for Crédit Agricole. “That’s great for large pharma, but that also means the opportunities theoretically have dried up for generics.”

In response, many generic drug makers are scrambling to redefine themselves, whether by specializing in hard-to-make drugs, selling branded products or making large acquisitions. The large generics company Watson acquired a European competitor, Actavis, in October, vaulting it from the fifth- to the third-largest generic drug maker worldwide.

“They are certainly saying either I need to get bigger, or I need to get ‘specialer,’ ” said Michael Kleinrock, director of research development at the IMS Institute for Healthcare Informatics, a health industry research group. “They all want to be special.”

As one consequence of the approaching cliff, executives for generic drug companies say, they will no longer be able to rely as much on the lucrative six-month exclusivity periods that follow the patent expirations of many drugs. During those periods, companies that are the first to file an application with the Food and Drug Administration, successfully challenge a patent and show they can make the drug win the right to sell their version exclusively or with limited competition.

The exclusivity windows can give a quick jolt to companies. During the first nine months of 2012, sales of generic drugs increased by 19 percent over the same period in 2011, to $39.1 billion from $32.8 billion, according to Michael Faerm, an analyst for Credit Suisse. Sales of branded drugs, by contrast, fell 4 percent during the same period, to $174.2 billion from $181.3 billion.

But those exclusive periods also make generic drug makers vulnerable to the fickle cycle of patent expiration. “The only issue is it’s a bubble, too,” said Mr. Kleinrock. He said next year, the generic industry would enter a drought that was expected to last about two years.  Of the drugs that are becoming generic, fewer have exclusivity periods dedicated to a single drug maker.

In 2013, for example, the antidepressant Cymbalta, sold by Eli Lilly, is scheduled to be available in generic form. But more than five companies are expected to share in sales during the first six months, according to a report by Ms. Vukhac.

Heather Bresch, the chief executive of Mylan, the second-largest generics company in the United States, said Wall Street analysts were obsessed with the issue. “I can’t go anywhere without being asked about the patent cliff, the patent cliff, the patent cliff,” she said. “The patent cliff is one aspect of a complex, multilayered landscape, and I think each company is going to face it differently.”

Jeremy M. Levin, the chief executive of Teva Pharmaceuticals, the largest global maker of generic drugs, agreed. “The concept of exclusivity — where only one generic player could actually make money out of the unique moment — has diminished,” he said. “In the absence of that, many companies have had to really ask the question, ‘How do I really play in the generics world?’ ”

For Teva, Mr. Levin said, he believes the answer will be both its reach  — it sells 1,400 products, and one in six generic prescriptions in the United States is filled with a Teva product  — and what he says is a reputation for making quality products. That focus will be increasingly important, he said, given recent statements by the F.D.A. that it intends to take a closer look at the quality of generic drugs. Mr. Levin also said he planned to cut costs, announcing last week that he intended to trim from $1.5 to $2 billion in expenses over the next five years.

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Generic Drug Makers Facing Squeeze on Revenue

They call it the patent cliff.

Brand-name drug makers have feared it for years. And now the makers of generic drugs fear it, too.

This year, more than 40 brand-name drugs — valued at $35 billion in annual sales — lost their patent protection, meaning that generic companies were permitted to make their own lower-priced versions of well-known drugs like Plavix, Lexapro and Seroquel — and share in the profits that had exclusively belonged to the brands.

Next year, the value of drugs scheduled to lose their patents and be sold as generics is expected to decline by more than half, to about $17 billion, according to an analysis by Crédit Agricole Securities.“The patent cliff is over,” said Kim Vukhac, an analyst for Crédit Agricole. “That’s great for large pharma, but that also means the opportunities theoretically have dried up for generics.”

In response, many generic drug makers are scrambling to redefine themselves, whether by specializing in hard-to-make drugs, selling branded products or making large acquisitions. The large generics company Watson acquired a European competitor, Actavis, in October, vaulting it from the fifth- to the third-largest generic drug maker worldwide.

“They are certainly saying either I need to get bigger, or I need to get ‘specialer,’ ” said Michael Kleinrock, director of research development at the IMS Institute for Healthcare Informatics, a health industry research group. “They all want to be special.”

As one consequence of the approaching cliff, executives for generic drug companies say, they will no longer be able to rely as much on the lucrative six-month exclusivity periods that follow the patent expirations of many drugs. During those periods, companies that are the first to file an application with the Food and Drug Administration, successfully challenge a patent and show they can make the drug win the right to sell their version exclusively or with limited competition.

The exclusivity windows can give a quick jolt to companies. During the first nine months of 2012, sales of generic drugs increased by 19 percent over the same period in 2011, to $39.1 billion from $32.8 billion, according to Michael Faerm, an analyst for Credit Suisse. Sales of branded drugs, by contrast, fell 4 percent during the same period, to $174.2 billion from $181.3 billion.

But those exclusive periods also make generic drug makers vulnerable to the fickle cycle of patent expiration. “The only issue is it’s a bubble, too,” said Mr. Kleinrock. He said next year, the generic industry would enter a drought that was expected to last about two years.  Of the drugs that are becoming generic, fewer have exclusivity periods dedicated to a single drug maker.

In 2013, for example, the antidepressant Cymbalta, sold by Eli Lilly, is scheduled to be available in generic form. But more than five companies are expected to share in sales during the first six months, according to a report by Ms. Vukhac.

Heather Bresch, the chief executive of Mylan, the second-largest generics company in the United States, said Wall Street analysts were obsessed with the issue. “I can’t go anywhere without being asked about the patent cliff, the patent cliff, the patent cliff,” she said. “The patent cliff is one aspect of a complex, multilayered landscape, and I think each company is going to face it differently.”

Jeremy M. Levin, the chief executive of Teva Pharmaceuticals, the largest global maker of generic drugs, agreed. “The concept of exclusivity — where only one generic player could actually make money out of the unique moment — has diminished,” he said. “In the absence of that, many companies have had to really ask the question, ‘How do I really play in the generics world?’ ”

For Teva, Mr. Levin said, he believes the answer will be both its reach  — it sells 1,400 products, and one in six generic prescriptions in the United States is filled with a Teva product  — and what he says is a reputation for making quality products. That focus will be increasingly important, he said, given recent statements by the F.D.A. that it intends to take a closer look at the quality of generic drugs. Mr. Levin also said he planned to cut costs, announcing last week that he intended to trim from $1.5 to $2 billion in expenses over the next five years.

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News Analysis: Criticized as Weak in Past Talks, Obama Takes Harder Line

WASHINGTON — Amid demands from Republicans that President Obama propose detailed new spending cuts to avert the year-end fiscal crisis, his answer boils down to this: you first.

Pool photo by Roger L. Wollenberg

Peter R. Orszag, left, a former White House budget director, with Ben S. Bernanke, second from right, the Federal Reserve chairman, and President Obama.

Pablo Martinez Monsivais/Associated Press

Disciplined and unyielding, Mr. Obama argues for raising taxes on the wealthy while offering nothing new to rein in spending and overhaul entitlement programs beyond what was on the table last year.

Mr. Obama, scarred by failed negotiations in his first term and emboldened by a clear if close election to a second, has emerged as a different kind of negotiator in the past week or two, sticking to the liberal line and frustrating Republicans on the other side of the bargaining table.

Disciplined and unyielding, he argues for raising taxes on the wealthy while offering nothing new to rein in spending and overhaul entitlement programs beyond what was on the table last year. Until Republicans offer their own new plan, Mr. Obama will not alter his. In effect, he is trying to leverage what he claims as an election mandate to force Republicans to take ownership of the difficult choices ahead.

His approach is born of painful experience. In his first four years in office, Mr. Obama has repeatedly offered what he considered compromises on stimulus spending, health care and deficit reduction to Republicans, who either rejected them as inadequate or pocketed them and insisted on more. Republicans argued that Mr. Obama never made serious efforts at compromise and instead lectured them about what they ought to want rather than listening to what they did want.

Either way, the two sides were left at loggerheads over the weekend with less than a month until a series of painful tax increases and spending cuts automatically take effect, risking what economists say would be a new recession.

Mr. Obama refuses to propose more spending cuts until Republicans accept higher tax rates on the wealthy, and Republicans refuse to accept higher tax rates on the wealthy while asking for more spending cuts.

“I’m puzzled why Republicans are locking into a principle that’s not sustainable and why Democrats aren’t taking the moment to put forward their own vision of entitlement reform,” said Peter R. Orszag, a former White House budget director for Mr. Obama.

Mr. Orszag’s former White House colleagues said they had grown tired of making unilateral concessions only to see Republicans moving the goal posts, as they see it. “The president is not going to negotiate with himself,” said Dan Pfeiffer, the White House communications director. “He’s laid out his position, and Republicans have to come to the table.”

Republican strategists argue that in resorting to campaign-style events to take his fiscal message to voters, Mr. Obama is overplaying his hand, much as President George W. Bush did after his re-election when he barnstormed the country in favor of a Social Security restructuring plan that he never successfully sold to leaders on Capitol Hill.

“He is overreading his mandate,” said John Feehery, a former adviser to top House Republicans. “By doing the campaign thing, he is making the same mistake Bush made in 2005.” Eventually, he said, Democratic and Republican leaders “are going to cut the deal, and Obama is going to be on the outside looking in.”

The difference might be that Mr. Obama ran more explicitly on the idea of letting Mr. Bush’s tax cuts expire for incomes over $250,000, while Mr. Bush’s re-election was fought more on grounds of national security than Social Security. But both presidents emerged from relatively narrow popular-vote victories determined to impose their will on a balky Congress resisting their leadership.

Mr. Obama seemed to defy the Republican House last week when Treasury Secretary Timothy F. Geithner delivered a plan calling for $1.6 trillion in additional taxes from the wealthy over 10 years, as well as $50 billion in short-term stimulus spending and $612 billion in recycled cuts first put on the table during last year’s failed debt talks.

Republicans erupted in outrage, though they produced no specific alternative. Instead, they noted they had expressed newfound willingness since the election to increase tax revenue by limiting deductions for the wealthy, though not by raising rates.

The administration laid out its latest plan in less formal ways a couple of weeks earlier, according to a senior official who declined to be identified discussing private deliberations. But the message was that Speaker John A. Boehner could not move yet. After waiting with no further response, the administration decided to have Mr. Geithner deliver the proposal on paper knowing it would be provocative but thinking it was needed to move the process along.

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Study shows growth in second screen users

NEW YORK (AP) — Television viewers were once called couch potatoes. Many are becoming more active while watching now, judging by the findings in a new report that illustrates the explosive growth in people who watch TV while connected to social media on smartphones and tablets.

The Nielsen company said that one in three people using Twitter in June sent messages at some point about the content of television shows, an increase of 27 percent from only five months earlier. And that was before the Olympics, which was probably the first big event to illustrate the extent of second screen usage.

"Twitter has become the second screen experience for television," said Deirdre Bannon, vice president of social media at Nielsen.

Social networking is becoming so pervasive that the study found nearly a third of people aged 18-to-24 reported using the sites while in the bathroom.

An estimated 41 percent of tablet owners and 38 percent of smartphone owners used their device while also watching television at least once a day, Nielsen said.

That percentage hasn't changed much; in fact, 40 percent of smartphone owners reported daily dual screen usage a year earlier, Nielsen said. The difference is that far more people own these devices and they are using them for a longer period of time. The company estimated that Americans spent a total of 157.5 billion minutes on mobile devices in July 2012, nearly doubling the 81.8 billion the same month a year earlier.

"There are big and interesting implications," Bannon said. "I think both television networks and advertisers are onto it."

The social media can provide networks with real-time feedback on what they are doing. The performance of moderators at presidential debates this fall was watched more closely than perhaps ever before, because people were instantly taking on Twitter to provide their own critiques.

It also makes for some conflicting information: Twitter buzzed with complaints last summer about NBC's policy of airing many Olympics events from London on tape delay, yet ratings for the prime-time Olympics telecast soared past expectations.

The increase in people watching television and commenting about it online would seem to run counter to another big trend this fall: more people recording programs and watching them at a later hour. Those contrary trends both increase the value of live event programming like awards shows or sporting events.

The Nielsen study also found that 35 percent of people who used tablets while watching TV looked up information online about the program they were watching. A quarter of tablet owners said they researched coupons or deals for products they saw advertised on television

As rapid as the use of social media while on television is growing in the United States, it already lags behind other countries. Nielsen said that 63 percent of people in the Middle East or Africa report using social media while on TV, and 52 percent of people in Latin America.

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The New Old Age Blog: Forced to Choose: Nursing Home vs. Hospice

An older person, someone who will die within six months, leaves a hospital. Where does she go?

Almost a third of the time, according to a recent study from the University of California, San Francisco, records show she takes advantage of Medicare’s skilled-nursing facility benefit and enters a nursing home. But is that the best place for end-of-life care?

In terms of monitoring her vital signs and handling IVs — the round-the-clock nursing care that the skilled-nursing facility benefit is designed to provide — maybe so. But for treating end-of-life symptoms like pain and shortness of breath, for providing spiritual support for her and her family, for palliative care that helps her through the ultimate transition – hospice is the acknowledged expert.

She could receive hospice care, also covered by Medicare, while in the nursing home. But since Medicare only rarely reimburses for both hospice and the skilled-nursing facility benefit at the same time, this hypothetical patient and her family face a financial bind. If she opts for the hospice benefit, which does not include room and board at the nursing home, then she will be on the hook for hundreds of dollars a day to remain in the facility.

She could use the hospice benefit at home, of course. But, “we know these patients are medically complex,” said Katherine Aragon, lead author of the study in The Archives of Internal Medicine, and now a palliative care specialist at Lawrence General Hospital in Massachusetts. “And we know that taking care of someone near the end of life can be very demanding, hard for families to manage at home.” And that assumes the patient has a family or a home.

For some patients, a nursing home, though possibly dreaded, is the only place that can provide 24/7 care.

But if she uses the skilled-nursing facility benefit to pay for room and board in a facility, she probably has to forgo hospice. (The exception: if she was hospitalized for something unrelated to her hospice diagnosis. If she has cancer, then trips and breaks a hip, she can have both nursing home coverage and hospice. If cancer itself caused the bone to fracture, no dice.)

Let’s acknowledge that these are lousy choices.

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).

The choice to use S.N.F. had ongoing repercussions. Almost 43 percent of those who used it died in a nursing home and almost 40 percent in a hospital. Just 11 percent died at home, though that is where most people prefer to die, studies repeatedly show.

Among those who didn’t use the S.N.F. benefit, more than 40 percent died at home.

In effect, nursing homes were providing end-of-life care, expensively and probably not so well, for almost a third of the elderly population.

The skilled-nursing facility benefit, Dr. Aragon pointed out in an interview, is meant to provide rehabilitation. “The hope is that someone will get stronger and go home,” she said.

Sometimes, of course, that is what happens.

“What we may be missing is that this patient is on an end-of-life trajectory,” she continued. “Maybe they can’t get stronger.”

Moreover, Dr. Aragon pointed out, nursing homes often have financial incentives to keep re-hospitalizing patients. After three days in a hospital, the skilled-nursing facility benefit starts anew, and it reimburses at a higher level than Medicaid, which pays for most nursing home care.

Because this unhappy choice between hospice care and nursing home reimbursement reflects federal policy, there may be little that individual families can do. If physicians are willing to honestly discuss their patients’ prognosis, to assess whether a nursing home stay will lead to rehabilitation or whether it is where a patient will likely die, sooner rather than later, families may have some personal options.

If they knew that death was likely within a few months, they might try to provide care at home with hospice help for that limited time, difficult as that is. Or they might be able to muster enough money to pay for a few months in a nursing home, so that their parent can be a resident and still receive hospice care.

But these are still lousy choices. “Palliative care should be part of nursing home care,” said Alexander K. Smith, the study’s senior author and a palliative care specialist at the University of California, San Francisco. “And that regulation that prevents concurrent use of the S.N.F. benefit and hospice isn’t in the interest of patients and families.”

Coming up in a future post: Experimenting with a concurrent-coverage option.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Egyptian Court Postpones Ruling on Charter

CAIRO — Egypt’s highest court on Sunday postponed its much-awaited ruling on the legitimacy of the legislative assembly that drafted a new charter last week, accusing a crowd of Islamists of blocking judges from entering their building on what it called “a dark black day in the history of the Egyptian judiciary.”

Although hundreds of security officers were on hand to ensure that judges of the Supreme Constitutional Court could get into the court, and civilians came and went without any problems, the accusations intensified a standoff between the Mubarak-appointed judges and Egypt’s new Islamist leaders that has thrown the political transition into a new crisis 22 months after the ouster of Hosni Mubarak.

Upon approaching the court on Sunday morning, the judges said in a statement that they saw crowds “closing the entrances of the roads to the gates, climbing the fences, chanting slogans denouncing its judges and inciting the people against them.”

The judges were prevented from entering “because of the threat of harm and danger to their safety,” the statement said, calling it “an abhorrent scene of shame and disgrace.”

As a result, the judges announced that they were “suspending the court’s sessions” until they can resume their work without “psychological and physical pressures.”

Anticipation of the court’s decision on the new constitution had set off the latest political crisis. Fear that the court would dissolve the assembly and undo months of work led President Mohamed Morsi, of the Muslim Brotherhood’s political party, to announce 10 days ago that his edicts were not be subject to judicial review until the completion of the constitution.

Despite Mr. Morsi’s attempt, the same anticipation of dissolution drove the Islamist-dominated assembly to rush out a hurried constitution before the court could act and against the objections of Egypt’s secular parties and the Coptic Christian church. Mubarak-appointed judges have previous dissolved the elected parliament and the first constitutional assembly.

The sudden push by the president and his Islamist allies to push through a constitution over any objections from their secular factions or the courts has unified the opposition, brought hundreds of thousands of protesters to the streets, and set off a wave of attacks on a dozen offices of the Brotherhood’s Freedom and Justice Party. A judicial trade association has urged judges across the country to go on strike, and some of the highest courts have joined it.

Over the weekend, Mr. Morsi continued to push his plans for the new constitution, setting a national referendum on it for Dec. 15.

“I pray to God and hope that it will be a new day of democracy in Egypt,” he said in a nationally televised speech, calling for a “national dialogue.”

But his recent tone and actions reminded critics of the autocratic ways of his predecessor, and have aroused a new debate here about his commitment to democracy and pluralism at a time when he and his Islamist allies dominate political life.

Mr. Morsi’s advisers call the tactics a regrettable but necessary response to genuine threats to the political transition from what they call the deep state — the vestiges of the autocracy of former President Mubarak, especially in the news media and the judiciary.

But his critics say they hear a familiar paranoia in Mr. Morsi’s new tone that reminds them of talk of the “hidden hands” and foreign plots that Mr. Mubarak once used to justify his authoritarianism.

“I have sent warnings to many people who know who they are, who may be committing crimes against the homeland,” Mr. Morsi declared in an interview with state television on Thursday night, referring repeatedly to secret information about a “conspiracy” and “real and imminent threats” that he would not disclose. “If anybody tries to derail the transition, I will not allow them.”

In a speech to supporters that unveiled his new push to seize control of the transition’s end, Mr. Morsi was even more zealous. “To the corrupters who hide under respectable cover, I say, ‘Never imagine that I can’t see you,”‘ he declared. “I’m on the lookout for them and will never let them go.”

The Muslim Brotherhood has mobilized hundreds of thousands of supporters to rally on Mr. Morsi’s behalf.

On Saturday, crowds gathered at Cairo University to rally in support of the president and against the court. Demonstrators held up banners picturing the court’s judges, and chants derided a deputy chief of the court known for their outspoken political activism and opposition to the Islamists. By the end of the night, some speakers had urged the crowd to gather outside the court the next day.

By about 10 a.m. Sunday, hundreds of Islamists had done just that. Like many demonstrations called by the Muslim Brotherhood, the mainstream Islamist group, it was a mostly middle-aged and middle-class crowd of men in sweaters and a few neckties. Many carried placards with Mr. Morsi’s picture or banners with logo of his party.

“We immunize the constituent assembly, and dissolve the constitutional court,” they chanted. “Freedom is coming, coming.”

Several armored personnel carriers and hundreds of riot police formed a barrier holding back the demonstration to ensure that the judges could enter the court.

Magdy Hamed, 47, a businessman and member of the Brotherhood’s party attending the rally, said the demonstrators had done nothing to stop the judges from entering. “We didn’t stop them. We are asking them to come down and do their job,” he said, faulting the judges for failing to show up.

Mahmoud Akhas, 51, another businessman and party member, interrupted. “We are here to exert pressure on the Supreme Constitutional Court to comply with the will of the people,” he added, repeating the fears of many Islamists that the court might dissolve the constitutional assembly or even seek to annul the presidential decree granted Mr. Morsi power over the generals.

“The Egyptian people like stability,” Mr. Hamed said. “We don’t want chaos, and we don’t want to start this transition all over again.”

Mayy El Sheikh contributed reporting.

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