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Families struggle with nursing home visitation restrictions

It has been more than four months since Gloria Hulett has been able to hug her husband.

Hulett’s husband, Donald, an 88-year-old resident at the Country Terrace memory care unit in Altoona, is in the late stages of Alzheimer’s disease.

Though Hulett understands the visitation restrictions in place at Wisconsin nursing homes to protect residents from possible coronavirus infection, that doesn’t make it any easier to abide by them.

“I can see him, but we can’t touch,” said Hulett, of Altoona. “I’m going crazy about it. Thankfully, he’s not because he really doesn’t recognize us anymore. If he was, I might try to break down the door.”

Hulett’s pain is being felt by families across the country as they struggle to balance their desire to maintain close personal contact with loved ones in nursing homes and the need to protect vulnerable residents from falling victim to the COVID-19 pandemic that Kaiser Family Foundation says has killed 63,000 U.S. nursing home residents and resulted in positive tests for more than 336,000.

Families have been forced to rely on phone calls, video chats and window visits since nursing homes started banning almost all visitors in mid-March. At that time, the state Department of Health Services and U.S. Centers for Disease Control and Prevention informed nursing homes and assisted living facilities to allow entrance only to essential employees, those deemed medically necessary and relatives visiting a resident at end-of-life.

Window and video visits happen almost every day at Dove Healthcare’s three nursing homes in the Chippewa Valley.

“While we empathize with the very difficult circumstance of not being able to sit right by each other or give a hug, our residents and their families are overwhelmingly appreciative for this form of communication, and the other options available, for the time being,” said Jeremy Kiley, Dove’s regional director of operations.

Outdoor visits

DHS offered some relief for contact-starved families by issuing new guidance on July 17 permitting in-person outdoor visitation, although the state agency cautioned that the safest approach is still to prohibit indoor and outdoor visitation. Outdoor visits, which are being phased in by Chippewa Valley nursing homes and are believed to present a lower risk of virus transmission, still require masks, extra cleaning and social distancing of 6 feet between residents and guests.

Dove has started offering outdoor visits by appointment at four of its assisted living facilities and is developing procedures to allow safe outdoor visits soon at its six regional nursing homes, Kiley said.

“It has been such a wonderful experience seeing loved ones together again,” Kiley said of the outdoor visits at assisted living facilities.

At Country Terrace, Hulett has appreciated the chance to see her husband without looking through glass — and complete her daily milk shake deliveries to Donald in person — during recent outdoor visits on the facility’s patio.

Donald’s sister, Donna Gran of Northfield, also said the visitation restrictions have been tough to live with.

“We want him to be safe and healthy, but it’s just a challenge, like it is for everybody,” Gran said.

Mandy Heard of Eau Claire worries about the impact of visitation limits on residents.

Heard’s 94-year-old mother, Betty Crews, is a resident at Chippewa Manor in Chippewa Falls who Heard fears has struggled with the lack of visitors during the COVID-19 lockdown.

“It’s very important that people have interaction, and now my mother says she is depressed,” Heard said. “That’s hard because there’s nothing I can do about it.”

While she understands the reasons for the restrictions — and even acknowledges COVID-19 could be fatal for Crews because of her fragile physical health — Heard said the mental health of isolated residents, who also are enduring greatly reduced social activities in the facilities, should be taken into account.

“It is a real problem for the nursing homes, the families and the residents,” she said. “It’s a big deal.”

After months of unsatisfactory window visits in which hearing was consistently a hurdle, Heard said she enjoyed her first outdoor visit last week and was particularly appreciative that Chippewa Manor provided a microphone with an amplifier to improve communication through masks.

Nursing home administrators also understand the additional challenges visitation limits present for residents and families, and they have worked with state officials to develop temporary solutions such as the protocol for outdoor visits, said Jim Stoa, government relations director for the Wisconsin Health Care Association and the Wisconsin Center for Assisted Living.

Stoa acknowledged that visits by friends and family play a major role in maintaining the mental and emotional well-being of nursing home residents.

Kiley said Dove caregivers also are aware that visitation changes are difficult and monitor residents’ mental health and seek ways to support them.

“Nothing can fully compare to or replace being able to embrace your loved one in a hug, hold their hand or sit next to each other while enjoying a good meal, so this is hard,” Kiley said, adding, “We have extremely creative employees dedicated to improvising and adapting. There is still hope, joy, laughs and smiles taking place every day at Dove Healthcare.”

Balancing act

In the early days of the pandemic, nursing homes relied heavily on facilitating virtual communication with residents. While that can be helpful, Stoa said, it doesn’t work for all residents and can’t replace the human connection of in-person visits.

Outdoor visits offer a reasonable band-aid fix for now, he said, adding, “Everybody realizes we’re going to need to adapt as the weather changes and if the disease surges.”

In the meantime, Stoa said state officials and long-term care administrators will continue the balancing act of trying to meet residents’ needs for both physical protection from a highly contagious virus and the mental health boost that comes from interacting with relatives.

“Facilities have been and are continuing to take every precaution to prevent COVID-19 from entering facilities and to prevent its spread,” he said. “While we are doing our best to find ways to meet residents’ psycho-social needs, it is with the understanding that the top priority right now has to be infection control.”

The high-risk nature of many nursing home residents is evident in Kaiser Family Foundation statistics. The 1,432 cases reported in Wisconsin long-term care facilities through Thursday make up just 3% of the state’s total caseload. However, the 365 deaths of people living in those facilities account for 42% of the state’s coronavirus-related deaths.

DHS reported last week that it has two active and four closed COVID-19 investigations in Eau Claire County nursing homes. Public health investigations are initiated when at least one person tests positive for the virus.

Though they understand the risk, family members said it’s difficult to remain apart from loved ones in long-term care.

Heather Betsinger of La Crosse, for instance, said it’s frustrating that she hasn’t been able to hug her 87-year-old grandmother, Gert Rutherford, for more than four months at Pine View Terrace in Black River Falls even though the facility hasn’t had a single COVID-19 case.

“I was able to see her through a window for about two minutes a few weeks ago, and to not touch her or sit down and look her in the eye and spend time with her was heartbreaking,” Betsinger said.

She would like to see the residents get more of their quality of life back in the time they have left.

Outlook unclear

Before the pandemic struck, Ginger Harings of Chippewa Falls said she used to go for walks three or four times a week with her sister Kathy Cliff, a resident at River Pines in Altoona. That hasn’t happened since March, and they both miss interacting without panes of glass between them.

“It’s a bit daunting, but you just have to accept it and understand that it’s not about one of us; it’s about all of us and hopefully getting through it,” Harings said. “Unfortunately, it has lasted much longer than I anticipated.”

Nursing home officials pledged to continue following the guidance of regulatory agencies to keep residents safe, but they stopped short of making promises about the duration of restrictions.

“COVID-19 has proven to be anything but predictable,” Kiley said, asserting that no one can forecast with any certainty what the next week, month or even year will bring with the pandemic.

“In an ideal world,” Stoa said, “we would be able to return to safe and regular visitation sometime soon in a less restrictive way than is now required because of COVID. But given the situation, it’s not realistic to expect a quick return to the way things used to be.”

Wisconsin absentee ballots may pose issues for 2020 election

MADISON — For months, President Donald Trump has alleged without evidence that any expansion of mail-in voting in the 2020 election will lead to “tremendous” fraud and a “rigged” election.

But an APM Reports analysis of voter data from Wisconsin’s April primary shows a far more measurable and consequential effect of mail-in voting — rejected ballots. Slightly more than 23,000 ballots were thrown out, mostly because those voters or their witnesses missed at least one line on a form.

The figure is nearly equivalent to Trump’s 2016 margin of victory in Wisconsin of 22,748 votes. And with voter turnout expected to double from April to more than 3 million in November, a proportionate volume of absentee ballot rejections could be the difference in who wins the swing state — and possibly the presidency.

The analysis shows the difficulty some voters had casting a ballot through the mail, often for the first time.

• • •

For an absentee ballot to count in Wisconsin, a voter and a witness must sign the ballot envelope and include the address of the witness. Those safeguards — put in place to eliminate mail-in ballot fraud — contributed to the rejection of 13,834 ballots, according to APM Reports’ analysis.

Election experts say people in states like Wisconsin that traditionally have low by-mail voting rates are more prone to make errors.

“You’re asking folks to do something new,” said Michael McDonald, a political science professor and voter data expert at the University of Florida. “And whenever you try to do something new in the midst of unprecedented demand, you’re going to have problems.”

Nationally more than 300,000 absentee ballots were rejected in the 2016 presidential election, according to the U.S. Election Assistance Commission. But that number is likely to grow in November as election officials and public health experts encourage by-mail voting to reduce the spread of the coronavirus. The anticipated surge will come in an election already expected to have heavy turnout nationwide.

“We could easily see a million or more ballots being rejected because of some deficiency of the ballot,” McDonald predicted.

Wisconsin is among 29 “no excuse” states, plus the District of Columbia, that allow residents to vote absentee for any reason. Another five states send ballots to all registered voters without requiring a request for one.

• • •

APM Reports, the investigative and documentary journalism team at American Public Media, and Wisconsin Watch analyzed Wisconsin’s experience because the state is vital to Trump’s reelection efforts and was one of the first to hold an in-person primary as the nation shut down. The state also has traditionally low vote-by-mail participation.

The analysis serves as a case study of what may lie ahead for presidential battleground states overwhelmed by applications and without the experience or systems to cope. Other such states, including Georgia and Pennsylvania, saw problems managing increased absentee balloting in their primaries.

In the 2016 and 2018 Wisconsin general elections, absentee ballots made up no more than 6% of the ballots. In April, the portion jumped to more than 60% after the state instituted its stay-at-home order.

State officials stress that the percentage of rejected ballots in the April primary is consistent with rejection rates in past elections. While the rate may be similar, raw numbers will make the difference when it comes to winning or losing an election.

• • •

APM Reports and Wisconsin Watch requested the names of voters whose ballots were rejected in the April primary, the 2018 general election and the 2016 primary and general elections. Rejections are important to understand because voters may make a mistake, receive no notification and not be given an opportunity to fix the problem.

James Moses of Salem Lakes says he was never notified that absentee ballots he cast in multiple elections were rejected.

Moses says he voted absentee in April because he had shoulder surgery and could not drive. APM Reports filed an open records request to view his April ballot envelope. It was rejected because his wife, who witnessed Moses fill out the ballot and put it in the envelope, did not list their address on the certificate envelope. Wisconsin requires the voter and a witness to sign the ballot envelope. It also requires the witness to fill out an address.

Moses says the rejections make him distrustful of voting by mail. Next time he plans to vote in person “no matter what it takes.”

Salem Lakes clerk Shannon Hahn says she tried to contact voters who did not properly fill out the form.

“We acted like detectives trying to find and get a hold of these people,” she said. “We would have much more rejections if it wasn’t for us contacting people.”

Hahn went above and beyond. Wisconsin law does not require election officials to contact voters if they find a problem with an absentee ballot, which is similar to roughly 35 states.

• • •

Wisconsin’s April 7 election was chaotic. There were political and legal fights over whether the election should be delayed. The U.S. Postal Service failed to deliver hundreds of ballots. And competing legal rulings created uncertainty over which guidelines voters and clerks had to follow when it came to absentee balloting.

State election officials have taken steps to ensure a better process for the August primary and the November general election. They have changed the computer system to help municipal clerks process absentee ballot applications. They are putting barcodes on mailings to help voters and officials track their ballots. And they are hoping the courts make early decisions on which rules to follow.

“I certainly hope that we can get the rules down straight so everybody knows what they are, so they’re not changing very close to the deadline,” said Reid Magney, spokesman for the Wisconsin Elections Commission.

Magney said the commission also will mail absentee ballot applications to every registered voter in September to help local elections officials.

Attorneys representing Democrats have pushed to loosen the restrictions on mail-in voting in at least 13 states including Wisconsin.

Although studies show that younger voters and minority voters tend to have their ballots rejected at a higher rate than older, white voters, McDonald says he is not certain that will continue — especially if mail delivery slows in rural communities that traditionally back Republican candidates.

“These rejected absentee ballots tend to break toward the Democrats,” McDonald said. “I don’t think anyone knows how these ballots will break for November, because there’s so many different moving parts.”

• • •

A typically high voter participation rate, combined with small city staff in an area that is not used to voting by mail, are ingredients for a spike in ballot rejection.

Consider the city of Cedarburg.

Residents of this community of 11,500 people north of Milwaukee take voting seriously — more than 80% of the voting age population cast ballots in the past two presidential elections. That is more than 13 points higher than the state average. But nearly all those voters voted in person.

That changed with the pandemic. More than 60% of Cedarburg voters cast absentee ballots, compared to 7% in 2018.

“We were just inundated,” said Tracie Sette, Cedarburg’s city clerk. “It was all we could do to just keep up with the requests.”

The increase also brought a surge in ballot rejections.

In April, Cedarburg had both a relatively high number of rejected ballots (209) and rate of rejected ballots (7%), according to Wisconsin Elections Commission data. Comparatively, just three ballots were rejected in the 2016 presidential primary and the 2016 and 2018 general elections.

Bob and Jan Capen voted absentee for the first time in the April election. The couple signed their names as witnesses to each other’s ballots and mailed them in. Neither of their votes counted.

Their ballots were marked as “certification insufficient,” the most common reason cited for the 23,196 absentee ballots rejected in April. Copies of the Capens’ ballot envelopes show they both missed the yellow-highlighted line that required their addresses as witnesses.

“It’s my fault,” Bob Capen said. “But based on what I’ve learned so far, it’s not an easy process for a lot of people, so I can see how it could get all clustered up.”

• • •

Diane Coenen, president of the Wisconsin Municipal Clerks Association, says first-time absentee voters can be confused by the ballot envelope, which displays a lot of information and requires attention to detail. Most people do not read it from top to bottom, Coenen said, “And if they miss something, the ballot will be rejected.”

Rykki Casey of Cedarburg is a health care worker who voted absentee because she takes care of elderly and hospice patients. “I didn’t want to spread (illness) to them,” she said.

Casey was confused about why her vote did not count. Her husband witnessed her ballot, but a copy of the ballot envelope showed that he, too, missed the line for his address. “I feel very sad. I want my voice heard,” she said.

Sette says she tried to contact voters to tell them about the problems with the ballot envelopes in April but stopped when she and her two colleagues became overwhelmed. She aims to contact voters if she finds problems with their ballots before the August and November elections.

“We’re getting probably about 15 to 20 ballots back every day now,” Sette said. “And every single day, there is a little stack that is missing some information.”

• • •

The Wisconsin Elections Commission is preparing a public relations campaign in the next few weeks to remind voters how to cast a mail-in ballot.

The commission reported in late July that more than 700,000 absentee ballots have been sent to voters for the August primary — 10 times the number of ballots sent in the 2016 August primary. That should free up time for clerks to contact voters.

“Our hope is that we will have enough time to be able to communicate with voters,” said Magney of the state’s election commission, “and for them to be able to communicate back and handle this process.”

The nonprofit news outlet Wisconsin Watch provided this article to The Associated Press through a collaboration with Institute for Nonprofit News.

Negotiators report progress in coronavirus relief talks

WASHINGTON — Lawmakers reported progress on a huge coronavirus relief bill Saturday, as political pressure mounts to restore an expired $600-per-week supplemental unemployment benefit and send funding to help schools reopen.

“This was the longest meeting we’ve had and it was more productive than the other meetings,” said Senate Minority Leader Chuck Schumer, D-N.Y., who was part of the rare weekend session. “We’re not close yet, but it was a productive discussion — now each side knows where they’re at.”

Schumer spoke alongside House Speaker Nancy Pelosi, D-Calif., after meeting for three hours with Treasury Secretary Steven Mnuchin and White House chief of staff Mark Meadows.

The Democratic leaders are eager for an expansive agreement, as are President Donald Trump and top Republicans like Senate Majority Leader Mitch McConnell of Kentucky. But perhaps one half of Senate Republicans, mostly conservatives and those not facing difficult races this fall, are likely to oppose any deal.

Prior talks had yielded little progress and Saturday’s cautious optimism was a break from gloomy private assessments among GOP negotiators. The administration is willing to extend the newly expired $600 jobless benefit, at least in the short term, but is balking at other Democratic demands like aid for state and local governments, food stamp increases, and assistance to renters and homeowners.

Pelosi mentioned food aid and funding for voting by mail after the negotiating session was over. She and Schumer appeared more upbeat than they have after earlier meetings.

“We have to get rid of this virus so that we can open our economy, safely open our schools, and to do so in a way that does not give a cut in benefits to American workers,” Pelosi said.

Mnuchin said restoring the $600 supplemental jobless benefit is critically important to Trump.

“We’re still a long ways apart and I don’t want to suggest that a deal is imminent because it is not,” Meadows said afterward. “There are still substantial differences, but we did make good progress.”

The additional jobless benefit officially lapsed on Friday, and Democrats have made clear that they will not extend it without securing other relief priorities. Whatever unemployment aid negotiators agree on will be made retroactive — but antiquated state systems are likely to take weeks to restore the benefits.

Republicans in the Senate had been fighting to trim back the $600 benefit, saying it must be slashed so that people don’t make more in unemployment than they would if they returned to work. But their resolve weakened as the benefit expired, and Trump abruptly undercut their position by signaling he wants to keep the full $600 for now.

On Friday, Trump used Twitter to explicitly endorse extending the $600 payment and to criticize Schumer.

Washington’s top power players agree that Congress must pass further relief in the coming days and weeks. At stake beyond the $600 per week jobless benefit is a fresh $1,200 direct payment to most Americans, and hundreds of billions of dollars in other aid to states, businesses and the poor, among other elements.

Democrats hold a strong negotiating hand — exploiting GOP divisions — and they are expected to deliver a necessary trove of votes.

The COVID package will be the fifth legislative response to the pandemic and could well be the last one before the November election. The only other must-pass legislation on the agenda is a stopgap spending measure that should advance in September.

Since May, Republicans controlling the Senate had kept the relief negotiations on “pause” in a strategy aimed at reducing its price tag. But as the pandemic surged back over the summer — and as fractures inside the GOP have eroded the party’s negotiating position — Republicans displayed some greater flexibility.

Even with signs of progress in the talks, the list of items to negotiate remains daunting.

McConnell’s must-have item is a liability shield from lawsuits for businesses, schools, and charities that reopen as the pandemic goes on. The GOP’s business allies are strong backers but the nation’s trial lawyers retain considerable clout in opposition. A compromise is probably a challenging but necessary part of a final deal.

Among the priorities for Democrats is a boost in food stamp benefits. Republicans added $20 billion for agribusinesses but no increase for food stamp benefits in their $1 trillion proposal. Meadows played a role in killing an increase in food aid during talks on the $2 trillion relief bill in March, but Pelosi appears determined. The food stamp increases, many economists say, provide an immediate injection of demand into the economy in addition to combating growing poverty.

Food aid was the first item Pelosi mentioned in a letter to fellow Democrats apprising them of the progress.

“This is a very different kind of negotiation, because of what is at stake. Millions of children are food insecure, millions of families are at risk of eviction, and for the nineteenth straight week, over 1 million Americans applied for unemployment insurance,” Pelosi said.