Preheat oven to 375 degrees F. In a medium bowl stir together 1-1/3 cups flour and 1/2 teaspoon of the salt. Cut in shortening until the size of small peas. Add water, 1 tablespoon at a time, tossing with a fork until all is moistened. Gently work dough into a ball with your hands. On a lightly floured surface, roll dough to a 13-inch circle. Transfer to a 9-inch pie plate. Trim and flute crust as desired. Set aside.
In a very large bowl stir together 1/2 cup sugar, tapioca, cinnamon, remaining 1/4 teaspoon salt, and nutmeg. Add pears and lemon juice; toss to combine. Let stand 15 minutes.
Meanwhile, in a medium bowl combine the oats, 3 tablespoons sugar, and 1 tablespoon flour. Cut in butter until crumbly. Transfer pear mixture to crust-line pie plate. Top with crumb mixture, spreading evenly to cover pears as much as possible.
Bake for 50 minutes. Meanwhile, in a small saucepan heat caramels and milk until melted and smooth. Stir in almonds. Remove pie from oven. Spoon caramel mixture carefully over pie. Bake for 10 minutes more or until bubbly and fruit is tender. Remove and cool on a wire rack. Makes 8 servings.