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Covid-19 made America’s long-term care crisis impossible to ignore

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The vast majority of Americans want to age in their home and community, spending their twilight years in a familiar and comfortable setting. But the choice is not always their own.
The US long-term care system — such as it is — is broken. Hundreds of thousands of Americans are <a href="https://www.kff.org/medicaid/issue-brief/key-state-policy-choices-about-medicaid-home-and-community-based-services/">on waiting lists</a> for home-based care. More than 40 million people <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">report</a> that they have cared for a loved one over 50 without any pay in the last year. The United States <a href="https://www.nature.com/articles/s43587-020-00018-y.pdf">ranks</a> near the bottom of developed economies in the number of older adults who receive long-term care at home. Meanwhile, America’s nursing homes are staffed by overwhelmed and underpaid workers, and for-profit takeovers of those facilities have led to <a href="https://www.vox.com/policy-and-politics/22295461/nursing-home-deaths-private-equity-firms">worse care for patients</a>.
Covid-19 has made this long-term care crisis impossible to ignore. More than 130,000 nursing home residents <a href="https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/">have died</a> in the pandemic, accounting for nearly one in four US deaths. Residents of large institutions died at higher rates than those who live in the community.
In America, aging people who need care — in a nursing facility or at home — either must be wealthy enough to pay for it themselves or must deplete their income and assets enough that they qualify for Medicaid. Almost by accident, the health insurance program for low-income Americans has become the main payer for nursing home and home-based care. Experts describe long-term care in the US with a sense of disbelief.
“If you were starting from scratch, you would never design a system this way,” David Grabowski, a Harvard professor who studies the economics of long-term care, told me.
Tricia Neuman, who studies long-term care at the Kaiser Family Foundation, put it even more baldly: “We do not have a system of long-term care in our country.”
America has been struggling for decades to figure out a balance between having people age in long-term care facilities and age at home. President Joe Biden has proposed a massive infusion of federal spending on home-based care. Experts say it should start to address these structural problems — but it’s only a start.
The story of America’s long-term care failure begins in earnest in the 1950s.
Before then, and really for all of human history, if you were lucky enough to age into your elder years, you probably aged at home. Nursing homes didn’t exist. But that also meant you needed somebody to take care of you — and that responsibility would often fall on a spouse or children or another family member. Women in particular often shouldered these duties.
Things started to change in the middle of the 20th century. More women entered the workforce during and after World War II. Americans became less likely to live as adults in the place where they grew up, with more people moving to other parts of the country to seek employment and settle down. Fewer family members were around to provide unpaid care, and so proto-nursing homes — alms houses, board-and-care homes — first appeared.
Then President Lyndon B. Johnson signed Medicaid into law in 1965. One of the benefits covered by the new program for America’s poor was nursing home care — but at first, there was no coverage for home and community care.
In the following years, and accelerating in the 1980s, more older people and people with disabilities were moved into institutional settings. The nursing home industry was born, and it boomed. Today, about <a href="https://www.kff.org/other/state-indicator/number-of-nursing-facility-residents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">1.2 million Americans</a> live in a nursing home.
Ideally, people would live in those facilities by choice. The most important principle for long-term care policy is personal agency: The patient and their family should have a right to determine what kind of care they receive.
But America has failed to live up to that ideal. More than three in four people over the age of 50 <a href="https://www.aarp.org/retirement/planning-for-retirement/info-2018/retirees-age-in-place-aarp-study.html">said</a> in a 2018 AARP survey they want to stay in their community as long they can. But fewer than half thought that would be possible — and many of them may end up being right, as the long waiting lists for home- and community-based services attest. As of February 2020, more than 820,000 Americans were stuck on their state Medicaid program’s waiting list for home- and community-based services, according to <a href="https://www.kff.org/medicaid/issue-brief/key-state-policy-choices-about-medicaid-home-and-community-based-services/">the Kaiser Family Foundation</a>, and their average wait time is longer than three years.
Even for those lucky enough to be able to afford in-home care, the US long-term care system hasn’t done them any favors. Virginia Veliz, a 70-year-old in Santa Clarita, California, has been coordinating care for her 90-year-old mother, who has Lewy body dementia and Parkison’s disease, for the past five years.
“You really have to treat it like a job,” she said.
Veliz lives with very specific fears about what would happen if her mom moved into a nursing home. Her mother is prone to urinary tract infections; they’ve put her in the hospital multiple times in the past decade. During a recent hospital stay, Veliz came to the room to find her mom, who has hallucinations because of her dementia, hanging over the side of her bed and “traumatized” by the isolation, she said.
With those experiences in her mind, Veliz cannot bear the idea of sending her mom to a nursing home, where she might be alone for hours at a time. Instead, she and her siblings are paying for home health aides five days a week, with physical therapists and physicians stopping by regularly. She knows they are lucky they can afford it, but, in the same breath, she jokes that they need a family therapist to navigate the stress of organizing their mom’s care.
“She just will not get the attention in a convalescent setting, because they don’t have the manpower,” Veliz told me. “What am I afraid of? I’m afraid of them not taking care of her. She’s very fragile.”
There are some people for whom institutional care makes sense — those with severe cognitive decline, for example. Others might simply prefer to live in a nursing home with other people instead of living alone at home.
But the idea is that it should be the patient’s choice. The US still has not found a way to put that decision entirely in the patient’s hands.
“There is a huge unmet need,” Neuman said.
The crisis has been decades in the making, but the Covid-19 pandemic has made it impossible to ignore.
“The pandemic was an accelerant and gave momentum about how to move people out of facilities,” Neuman said. “You had families going to nursing homes urgently to get their parent or grandparent out, even at a great cost personally or financially.”
Gene Dorio, a California doctor who cares for Virginia Veliz’s mother, says he lost three patients to the coronavirus in the past year. As somebody who makes house calls to seniors and cares for patients in nursing homes, he did not seem surprised about the loss of life experienced in the latter.
“They ended up being at the wrong place at the wrong time,” he said. “The long-term care setting … some of these places are abominations.”
Finding a better equilibrium between community-based care and nursing homes will require money. Biden, as part of his American Jobs Plan, has proposed a $400 billion investment over 10 years into home- and community-based services. Many of the details would need to be determined when legislation is drafted in Congress, but the size of the investment alone has caught the attention of experts who work on long-term care issues.
Experts agree that resources — read: money — are the biggest challenge for long-term care. The challenges are so great that they aren’t sure $400 billion is “enough.”
“If the question is, ‘Is that enough?’, I don’t know,” Grabowski said. “Hopefully that will buy you a lot of community-based care.”
Neuman said more or less the same thing.
“It’s remarkable and unusual to see such a huge proposed investment,” she said. “How far this would go, I don’t know. But it is a significant investment.”
The money would presumably be spent, in large part, on home health workers. But there is a tension created by putting a hard number on that investment.
Experts say long-term care workers are underpaid for their difficult work (the average pay can be as little as $10 a day), so better compensation could lead to more people entering the field and staying in the work once they’ve started. Recent <a href="https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00957">research</a> showing some nursing homes see roughly 100 percent turnover in a given year suggests that retention is a serious problem in long-term care.
“You’re not going to get very far in fixing this without money. You need good caregivers. You need to pay them,” Grabowski said. “How do we ensure going forward that this is basically a better job, that starts with better pay and benefits?”
But the more you pay for one worker, the fewer workers you can hire. It’s simple economics.
That doesn’t mean the Biden plan couldn’t still do a lot of good. A single staffer could potentially help a lot of people.
But still: Virginia’s family has hired caregivers who stay with their mother eight hours per day, every weekday. That’s one salaried position for a single patient — and, eventually, with enough of those, even $400 billion could eventually run out.
So the Biden plan isn’t a cure to the ills that afflict America’s long-term care, even if it is “a step in the right direction,” as Grabowski told me.
The pressure on the US’s broken long-term care system will keep growing. The number of Americans over 65 is <a href="https://www.prb.org/aging-unitedstates-fact-sheet/">projected</a> to nearly double by 2060. Though Americans are working later in their lives, the number of people living in nursing homes could still reach 2 million, from the current 1.2 million, as soon as 2030.
That structural problem may eventually require structural reforms. Right now, the US doesn’t provide any government assistance to middle-income people who need long-term care. You are either wealthy enough to pay for your own care or you have to spend enough of your own money on long-term services that you become poor enough to qualify for Medicaid, and then that program takes responsibility for your bills.
“There still could be holes here for middle-income families,” Grabowski said, which he called “the forgotten middle.”
“There’s not a menu of services for this group,” he said. “That still isn’t here in this plan.”
There have been previous proposals to address that problem. The Affordable Care Act initially included what was called the CLASS Act, which would have created a voluntary public insurance program to cover long-term care. But the Obama administration quickly <a href="https://www.cnn.com/2011/10/14/politics/health-care-program/">decided</a> it would be too expensive and scrapped the program in 2011 before it ever got off the ground.
Prioritizing home-based care appears to be the preferred solution for both patients and policymakers. But it will cost money. The Netherlands, Norway, and Sweden are considered global leaders in providing community-based services, but they also spend a substantially higher share of their GDPs on long-term care (around 3 percent) than the US (0.5 percent).
On the other hand, the United States spends far more on other kinds of medical care than any other country. As Grabowski wrote in <a href="https://www.nature.com/articles/s43587-020-00018-y.pdf">a recent Nature column</a>, just 5 percent of that money is currently being spent on long-term care.
“Dollars could be taken from general health care spending and reallocated to [home and community-based services],” he argued. “This increased spending on HCBS would not only benefit the care recipients but also their family members, who often must take time away from their jobs and risk their own health to provide this care.”
And the choice is not binary between home-based care and nursing homes. The Netherlands in particular has experimented with small group homes, with much success. There is a similar model in the US, called Green House, a loose collective of homes with 10 to 12 beds that house seniors and are served by a small team of nurses.
Researchers have <a href="https://www.sciencedirect.com/science/article/pii/S1525861021001201">found</a> that the residents of these small-group nursing homes were significantly less likely to contract Covid-19 or die of it compared to people who lived in larger institutions. The authors, from the University of North Carolina, concluded that small homes were “a promising model of care” as nursing homes are “reinvented” post Covid-19.
It’s hard to measure specific outcomes between aging in the community and aging in a nursing home. Tamara Konetzka, a University of Chicago professor, pointed out in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231570/">a 2014 article</a> that nobody was really sure which was “better” for patients from a health perspective, or which was more cost-effective.
But patient satisfaction and preference appears solidly on the side of aging at home. Rob Waters also covered Green House extensively <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2021.00081">in a recent issue of Health Affairs</a> and clearly saw promise in the model. But he also highlighted how far it has to go: Right now, less than 1 percent of US nursing home residents live in a Green House.
“We just have a lot of ground to make up,” Grabowski said. “People want them. That’s where we should be directing services.”
 
 
source <a href="https://www.vox.com/policy-and-politics/22375360/nursing-home-care-in-home-covid-19">https://www.vox.com/policy-and-politics/22375360/nursing-home-care-in-home-covid-19</a>

vox Covid-19 made America’s long-term care crisis impossible to ignore

The vast majority of Americans want to age in their home and community, spending their twilight years in a familiar and comfortable setting...

Dhaka Faces Migrant Exodus As Bangladesh Tightens Covid Lockdown

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<div class="ins_instory_dv_cont"><img alt="Dhaka Faces Migrant Exodus As Bangladesh Tightens Covid Lockdown" src="https://c.ndtvimg.com/2021-06/efccsoq4_bangladeshlockdownafp650_625x300_27_June_21.jpg" title="Dhaka Faces Migrant Exodus As Bangladesh Tightens Covid Lockdown" /></div>
Lockdown: Bangladesh reported over 5,000 new COVID-19 cases and a pandemic-high of 119 deaths on Sunday.
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Sreenagar (Bangladesh):
Tens of thousands of migrant workers fled Bangladesh's capital Sunday on the eve of a tightened lockdown that will curtail most economic activity and confine people to their homes as coronavirus infections soar.
Restrictions on activities and movement have been in place since mid-April as cases and deaths jumped.
Infections declined in May but started to rise again this month, with over 5,000 new cases and a pandemic-high of 119 deaths on Sunday, according to the health ministry.
The resurgence has prompted the government to toughen restrictions in stages from Monday, with economic activity -- including shops, markets, transportation and offices -- to shut down by Thursday.
People will be ordered to stay at homes while only emergency services and export-oriented factories continue operations.
The coming closure has sparked an exodus from Dhaka, the capital.
With public inter-city transportation already suspended since June 22, people have squeezed into rickshaws, hopped onto motorbikes and even hired ambulances to make their way to their villages.
Ferries have been operating on overdrive, with some running services 24 hours a day and cramming more than 1,000 passengers onto each trip.
"We don't want them to overcrowd the ferry. But they don't listen," said police sub-inspector Mohammad Reza. "There is a mad rush of people."
A senior official at the state-run Bangladesh Inland Water Transport Corporation told AFP that at least 50,000 people had crossed the river by ferries on Sunday alone.
At a river station in the rural town of Sreenagar about 70 kilometres (43 miles) south of Dhaka, thousands queued from early Sunday to cross the Padma, a tributary of the Ganges.
"We did not have any choice but to leave the city," Fatema Begum, 60, told AFP while waiting for a ferry.
"During lockdown, there is no work. And if we don't work, how do we pay rent? So, we packed up everything and are going back to our village."
Mohammad Masum, 30, a street vendor in Dhaka, said it was better to return home and "spend the time with family" than be confined in the capital.
Bangladesh has reported more than 880,000 infections and just over 14,000 virus deaths, but experts say the actual count could be much higher due to possible underreporting.
 
 
source <a href="https://www.ndtv.com/world-news/dhaka-faces-migrant-exodus-as-bangladesh-tightens-covid-lockdown-2473702">https://www.ndtv.com/world-news/dhaka-faces-migrant-exodus-as-bangladesh-tightens-covid-lockdown-2473702</a>

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Lockdown: Bangladesh reported over 5,000 new COVID-19 cases and a pandemic-high of 119 deaths on Sunday. Sreenagar (Bangladesh): Tens o...

Saudi Arabia Releases Two Jailed Women Activists: Rights Group

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<div class="ins_instory_dv_cont"><img alt="Saudi Arabia Releases Two Jailed Women Activists: Rights Group" src="https://c.ndtvimg.com/2021-06/gjnoehls_samarbadawireuters650_625x300_27_June_21.jpg" title="Saudi Arabia Releases Two Jailed Women Activists: Rights Group" /></div>
Saudi Arabia: Activist Samar Badawi had received US' International Women of Courage Award in 2012 (File).
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London:
Saudi Arabia has released two women's rights activists detained nearly three years ago after they had served their time, London-based Saudi rights group ALQST said on Sunday.
Samar Badawi and Nassima al-Sadah were detained in July 2018, along with more than a dozen other activists, on suspicion of harming Saudi interests, a move that drew international condemnation.
The Saudi government's media office did not immediately respond to a Reuters request for comment. Few details have been provided by authorities on the charges against the women or on sporadic trials that have been closed to the public.
Their release follows that of prominent activist Loujain al-Hathloul in February who had served half of her custodial sentence on broad cybercrime and counterterrorism charges. She still faces a five-year travel ban.
Human Rights Watch welcomed the report by ALQST on Twitter of the release of Badawi and Sadah: "These brave women should have never been detained in the first place. They should have been appreciated for leading change in Saudi Arabia."
<blockquote class="twitter-tweet">
BREAKING: prominent <a href="https://twitter.com/hashtag/Saudi?src=hash&ref_src=twsrc%5Etfw">#Saudi</a> women human rights defenders Samar Badawi and Nassima al-Sadah have been released following the expiry of the sentences against them. <a href="https://t.co/m1qEPLvpuH">pic.twitter.com/m1qEPLvpuH</a>
— ALQST for Human Rights (@ALQST_En) <a href="https://twitter.com/ALQST_En/status/1409042809261277187?ref_src=twsrc%5Etfw">June 27, 2021</a></blockquote>
Badawi received the United States' International Women of Courage Award in 2012 for challenging the Saudi male guardianship system, and was among the first women who signed a petition calling on the government to allow women to drive and to vote and run in local elections.
Sadah, from the restive Shi'ite-majority Qatif province, has also campaigned to abolish the guardianship system.
Crackdown
The women's rights activists were detained before and after the kingdom in 2018 lifted a ban on women driving as part of social reforms that have been accompanied by a crackdown on dissent that has also netted clerics and intellectuals.
Badawi's former husband is serving a 15-year jail sentence for human rights activism. Her brother Raif Badawi, a prominent blogger, is serving a 10-year sentence on charges of insulting Islam and for cybercrime.
US President Joe Biden's administration has taken a tough stance over Saudi Arabia's human rights record, which came under the spotlight after the October 2018 murder of prominent Saudi journalist Jamal Khashoggi in the kingdom's Istanbul consulate.
Washington in February released an intelligence report implicating de facto ruler Crown Prince Mohammed bin Salman in Khashoggi's killing. The prince denies any involvement.
In April, the State Department voiced concern about the sentencing of a Saudi aid worker by a counterterrorism court to 20 years in prison followed by a 20-year travel ban.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/saudi-arabia-releases-two-women-activists-samar-badawi-and-nassima-al-sadah-says-rights-group-2473688">https://www.ndtv.com/world-news/saudi-arabia-releases-two-women-activists-samar-badawi-and-nassima-al-sadah-says-rights-group-2473688</a>

news world Saudi Arabia Releases Two Jailed Women Activists: Rights Group

Saudi Arabia: Activist Samar Badawi had received US' International Women of Courage Award in 2012 (File). London: Saudi Arabia has ...

North Koreans Worry Over Kim Jong Un's Apparent Weight Loss: Report

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<div class="ins_instory_dv_cont"><img alt="North Koreans Worry Over Kim Jong Un's Apparent Weight Loss: Report" src="https://c.ndtvimg.com/2020-08/8clamljo_kim-jong-un-afp_625x300_19_August_20.jpg" title="North Koreans Worry Over Kim Jong Un's Apparent Weight Loss: Report" /></div>
North Korea: Foreign analysts noted in early June that Kim Jong Un appeared to have lost weight (File).
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Seoul:
Everyone in North Korea is heartbroken over leader Kim Jong Un's apparent weight loss, said an unidentified resident of Pyongyang quoted on the country's tightly controlled state media, after watching recent video footage of Kim.
The rare public comment on Kim's health come after foreign analysts noted in early June that the autocratic leader, who is believed to be 37, appeared to have lost a noticeable amount of weight.
"Seeing respected general secretary (Kim Jong Un) looking emaciated breaks our people's heart so much," the man said in an interview aired by state broadcaster KRT on Friday.
"Everyone is saying that their tears welled up," he said.
In the clip, which Reuters could not independently verify, Pyongyang residents were seen watching a big screen on the street showing a concert attended by Kim and party officials after a plenary meeting of their Workers' Party of Korea (WPK).
The broadcast did not provide any details on what had led to the weight loss.
When Kim reappeared in state media in June after not being seen in public for almost a month, analysts at NK News, a Seoul-based website that monitors North Korea, noted that his watch appeared to be fastened more tightly than before around an apparently slimmer wrist.
Given Kim's tight grip on power in North Korea - and the uncertainty over any plans for a successor - international media, spy agencies, and specialists closely watch his health.
Early last year, speculation about Kim's health exploded after he missed the birth anniversary celebrations of state founder Kim Il Sung on April 15, only to reappear in public in early May.
In 2014, state media reported that Kim was suffering from "discomfort", after a prolonged period out of the public eye.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/north-koreans-worry-over-kim-jong-uns-apparent-weight-loss-report-2473671">https://www.ndtv.com/world-news/north-koreans-worry-over-kim-jong-uns-apparent-weight-loss-report-2473671</a>

news world North Koreans Worry Over Kim Jong Un's Apparent Weight Loss: Report

North Korea: Foreign analysts noted in early June that Kim Jong Un appeared to have lost weight (File). Seoul: Everyone in North Korea ...

AstraZeneca Tests Booster Vaccine Against Beta Variant Of Covid

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<div class="ins_instory_dv_cont"><img alt="AstraZeneca Tests Booster Vaccine Against Beta Variant Of Covid" src="https://c.ndtvimg.com/2021-06/bcct08hc_astrazenecavaccinereuters650_625x300_23_June_21.jpg" title="AstraZeneca Tests Booster Vaccine Against Beta Variant Of Covid" /></div>
COVID-19: AstraZeneca's 'booster' vaccine's trial will involve around 2,250 participants (File).
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London:
AstraZeneca and the University of Oxford on Sunday began new trials to test a modified vaccine against the Beta variant, which first emerged in South Africa.
The 'booster' vaccine's trial will involve around 2,250 participants from Britain, South Africa, Brazil and Poland.
They include people who have been fully vaccinated with two doses of the original Oxford-AstraZeneca vaccine or an mRNA vaccine such as Pfizer as well as those who have not got the jab at all.
The new vaccine, known as AZD2816, has been designed using the same base as the main AstraZeneca shot but with minor genetic alterations to the spike protein based on the Beta variant.
"Testing booster doses of existing vaccines and new variant vaccines is important to ensure we are best prepared to stay ahead of the pandemic coronavirus, should their use be needed," said Andrew Pollard, chief investigator and director of the Oxford Vaccine Group at the University of Oxford.
Britain has had a successful vaccine roll-out programme, but experts do not know how long protection lasts.
"This study will provide vital evidence on whether further doses including 'tweaks' against new virus variants may be needed in the future," said Maheshi Ramasamy, Principal Investigator at the Oxford Vaccine Group.
Initial data from the trial is expected later this year.
Current vaccines are believed to be less effective against the Beta variant, although it is the Delta variant, which emerged in India, that is currently causing most concern.
Although the main vaccines are believed to be highly effective at preventing serious illness, the Delta variant's transmissible nature is leading to a spike in cases in some countries, including Britain.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/coronavirus-astrazeneca-tests-booster-vaccine-against-beta-variant-of-covid-2473665">https://www.ndtv.com/world-news/coronavirus-astrazeneca-tests-booster-vaccine-against-beta-variant-of-covid-2473665</a>

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COVID-19: AstraZeneca's 'booster' vaccine's trial will involve around 2,250 participants (File). London: AstraZeneca an...

Pet Lion Of Chinese Owner Confiscated In Cambodia

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<div class="ins_instory_dv_cont"><img alt="Pet Lion Of Chinese Owner Confiscated In Cambodia" src="https://c.ndtvimg.com/2021-06/4qc5mqns_petlionafp650_625x300_27_June_21.jpg" title="Pet Lion Of Chinese Owner Confiscated In Cambodia" /></div>
Cambodia: The lion was imported by the owner to be raised in his home, an official told AFP.
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Phnom Penh:
Cambodian authorities on Sunday confiscated a pet lion from a Chinese national after it was seen in TikTok videos being cuddled and bathed in a Phnom Penh villa.
The 18-month-old male, weighing 70 kilograms, had been imported from overseas by the owner to be raised in his home, environment ministry spokesman Neth Pheaktra told AFP.
"Cambodian authorities started investigating this lion since we saw it on TikTok in late April," Pheaktra said.
The owner had shared a photo on the app of the lion sitting in a driveway as a dog played nearby.
There was also a video of it as a young cub being sprayed down with a hose.
"People have no right to raise rare wildlife as pets," Pheaktra said.
The big cat was shown in photos released Sunday by the environment ministry lounging with a small dog as authorities prepped a crate to move it to the Phnom Tamao Wildlife Rescue Centre in the capital.
The confiscation comes a day after a Twitter user posted an aerial shot of the creature roaming around a garden in the upscale Boeung Keng Kang district of Phnom Penh.
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)
 
 
source <a href="https://www.ndtv.com/world-news/cambodia-pet-lion-of-chinese-owner-confiscated-2473662">https://www.ndtv.com/world-news/cambodia-pet-lion-of-chinese-owner-confiscated-2473662</a>

news world Pet Lion Of Chinese Owner Confiscated In Cambodia

Cambodia: The lion was imported by the owner to be raised in his home, an official told AFP. Phnom Penh: Cambodian authorities on Sunda...