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Health_care
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State has issued 13 federal citations to Evansville Manor in 2020

EVANSVILLE

Surveyors with the state Department of Health Services have been sent to Evansville Manor six times this year, resulting in 13 federal citations and four instances of surveyors believing residents were in immediate jeopardy.

No citations were issued in three investigations, including one launched after a case of COVID-19 was identified at the nursing home, according to documents from the state Department of Health Services.

The other three investigations, conducted March 9, March 19 and June 29, resulted in citations. The nursing home had to submit plans of correction for each.

Evansville Manor Administrator Regina Teska said the nursing home is in full compliance with state standards since the investigations were conducted.

Teska, who started her job at Evansville Manor about two months ago, said state surveyors have returned to the nursing home several times during her tenure and found no issues.

Teska and the facility’s director of nursing are new to their positions and bring a wealth of knowledge, Teska said.

State documents indicate the director of nursing and administrator who were on duty when the nursing home was cited no longer work at Evansville Manor.

“Getting new leaders in the facility has already moved us in the right direction,” Teska said.

The following details were reported in documents from the state Department of Health Services.

Immediate jeopardy

The state defines immediate jeopardy as a situation in which “a deficient practice has caused or is likely to cause serious injury, serious harm, impairment or death to a resident receiving care in the facility.”

Corrective action must be taken after immediate jeopardy is identified, and that status remains as long as facility practices show potential of a similar situation happening again, according to the state’s survey guide for long-term care facilities.

Immediate jeopardy was identified at Evansville Manor twice March 3 and twice June 18. It was removed in each circumstance the day it was identified.

On Feb. 26, a resident was given 50 milligrams of morphine, 10 times the prescribed dose of 5 milligrams. Nursing staff later administered Narcan to the resident to prevent an overdose.

The morphine was given by a certified medical assistant, a worker who does not have the state credentials needed to administer medications.

In an interview with surveyors, the medical assistant said he or she asked the director of nursing about the dosage before giving the medication.

The investigation found the pharmacy sent two different morphine orders with different concentration amounts, leading to confusion.

The facility’s failure to ensure staff had proper credentials to perform tasks led to the finding of immediate jeopardy as of July 31, 2019, when the certified medical assistant began administering medication.

The same incident caused a second finding of immediate jeopardy because of the facility’s failure to ensure a resident was free from a significant medication error.

Evansville Manor made several changes to lift the immediate jeopardy orders, including removing the medical assistant from medication duties, reviewing policies, educating staff and auditing medication carts.

On March 17, a hospice nurse found a resident not breathing and presumably dead during a routine visit to the resident’s room. The resident’s daughter told the nurse not to do CPR because it was unclear when the resident had stopped breathing.

The resident was identified as being “full code” in a care plan, meaning that resuscitation efforts should be performed if the resident had no heartbeat or pulse.

The facility’s failure to begin CPR or call 911 after finding the resident and failure to communicate the resident’s full-code status between medical and hospice staff both led to findings of immediate jeopardy.

Since then, Evansville Manor has conducted training and enhanced education to lift the immediate jeopardy status.

Other findings

Federal citations were issued for these concerns:

  • Failure to make prompt efforts to resolve a resident’s grievance. Staff knew a resident was missing his or her hearing aid for months and did not document or investigate the concern.
  • Failure to carry out activities of daily living to maintain good nutrition, grooming and hygiene. A resident did not receive weekly showers as scheduled and received two showers in a one-month span instead of four.
  • Failure to take action to prevent pressure ulcers or injuries and failure to promote healing of existing injuries. Four residents were found to not have received proper wound care or prevention.
  • Failure to ensure the environment remains free of accident hazards. Interventions were not put in place after one resident fell on two different occasions.
  • Failure to ensure certified nursing assistants complete 12 hours of in-service training. Three nursing assistants did not complete training.
  • Failure to complete performance reviews every 12 months for certified nursing assistants.
  • Failure to report alleged misappropriation, neglect or abuse to the nursing administrator and failure to make sure allegations are fully investigated after two incidents of abuse between residents.

Plans of correction were submitted for each citation. The state’s Division of Quality Assurance is tasked with ensuring changes are made.

The nursing home continues to audit practices weekly and monthly to maintain compliance, Teska said.

Staff also meets monthly to discuss quality assurance and to look over various metrics, she said.

The state deems investigations closed when corrective plans are submitted.

No other penalties were given as a result of the findings.

“We have a staff that is dedicated to making improvements,” Teska said.


Dave Godek


Josey and Dean Suiter load up their vehicle with the plants they purchased Saturday at Rotary Botanical Gardens’ annual fall plant sale.


Washington
AP
A million mail-in ballots could go uncounted this fall. The USPS might not be to blame

WASHINGTON

The controversial new chief of the U.S. Postal Service had not even started his job when a disturbing thing happened to hundreds of thousands of Americans who cast ballots by mail in primary elections this spring.

Their votes were never counted.

The torrent of disenfranchisement provided a worrying prelude to a general election where, for the first time in history, most Americans will probably vote in advance of Election Day. Amid President Donald Trump’s efforts to undermine mail voting and the tumultuous tenure of Louis DeJoy, the Trump loyalist now running the mail, many people see the Postal Service as an obvious culprit.

But election experts say recent controversies surrounding the post office and Trump’s campaign of disinformation about mail-in voting are mostly sideshows. The bigger dangers for voters predate this administration and involve election officials in the states.

When ballots get tossed, one of the most common reasons is that states mislead voters into thinking they can safely wait until a day or two before Election Day to drop them in the mail. Even when the post office is running on all cylinders, that isn’t enough time to guarantee votes will be counted in many states.

“It is unrealistic and wishful thinking by these states,” said Charles Stewart III, a political science professor at MIT who focuses on voting.

“They set the deadline as close as they can to Election Day, taking the position (that) we are giving people as much opportunity as possible to vote by mail. It has done the opposite. It has set up voters to fail.”

Missing the deadline for ballots to be delivered to election officials was the main reason that about 1% of all mail ballots were tossed in 2016. Amid this year’s rapid shift toward mail voting, the percentage has surged higher in some states. More than 5% of mail votes were thrown out during this year’s primary in Virginia, for example, according to figures reported by National Public Radio.

In Wisconsin, about 2% of ballots—around 23,000 votes—were rejected in the primary. That was a larger share of votes than Trump’s winning margin in the last presidential election.

Nationwide, the number of mail-in voters disenfranchised this year already has exceeded the total for the entire previous presidential election cycle by more than 200,000. With polling suggesting that roughly one-third of voters—perhaps as many as 50 million people—plan to vote by mail, the uptick in discarded ballots is worrisome in an already chaotic election.

Even if all voters sent ballots in by mail in this year’s general election, delivering them would be no problem for a Postal Service that handles 3 billion cards and letters a week during a typical holiday season, said Mark Dimondstein, president of the American Postal Workers Union. The key is that voters have to allow enough time for their ballots to arrive, and states need to provide accurate information about the deadlines.

That clearly did not happen during the primaries.

Between early June and mid-August, more than 1 million ballots were mailed out to voters so late—within a week of the primary election in their state—that they put voters at “high risk” of having their completed ballots arrive too late at election offices to be counted, according to a new report from the post office inspector general.

In 34 states, officials ignore postal service guidance to set a deadline for distributing absentee ballots to voters more than seven days before the election.

Deadlines vary from state to state. California has among the most voter-friendly rules, allowing ballots to be counted for days after an election as long as they are postmarked by Election Day.

Most states, however, require ballots to arrive by Election Day, according to a compilation by the National Conference of State Legislatures. States also vary in how easily voters can resolve problems with mail-in ballots, such as a signature that doesn’t precisely match the one on file—another leading cause of ballots being disqualified.

About 30 states have websites that allow voters to track whether their ballot has been received and whether it has been accepted for counting. In August, California Secretary of State Alex Padilla announced the launch of a ballot-tracking tool for state voters.

Elections experts worry that voters aren’t hearing enough about those deadlines and sources of information. They are instead getting dire warnings from lawmakers about post office management issues that have caused serious problems with delivery of medicines, perishable items and even live animals, but which even major postal unions say are not going to disrupt their ability to deliver ballots, especially now that DeJoy—facing a public outcry—has vowed to put some of his plans on hold until after the election.

“I understand the Democrats’ inclination to sound the five-alarm fire here, but you want to make sure that people are confident in their mail ballots,” said Nathaniel Persily, a Stanford professor who co-directs the Stanford-MIT Healthy Elections Project with Stewart.

The message that should be directed at voters, Persily said, is that mail voting will work fine if ballots are mailed back at least a week before Election Day.

“One of the things I hope the Postal Service (controversy) has done is convince everyone that if they want to vote by mail, they should do it as early as possible,” he said.

That message is especially important in states that don’t have much experience with widespread mail-in voting. In New York City, for example, more than 1 in 5 ballots were rejected in this June’s primary. Until this year, voting by mail had accounted for just a small share of ballots cast in the state, and election officials were overwhelmed by a ten-fold increase.

In California, more than 100,000 ballots went uncounted during this year’s primary, about 1.5% of the nearly 7 million cast. More than two-thirds of those were discarded because they arrived too late. Most of the rest had a missing or defective signatures.

For November, the state has extended the deadline for receipt of ballots by two weeks, as long as they are postmarked by Election Day.

In other states, proposals to extend ballot deadlines or take other steps to avoid disenfranchising voters have stalled amid a coordinated push by the Trump campaign and the Republican National Committee against expanded use of mail-in ballots.

Further complicating matters is the president’s persistent spread of disinformation about mail voting, falsely branding it as being at a high fraud risk and a conspiracy against him. The installation of DeJoy in June fueled fears by Democrats that the administration was seeking to rig the system against absentee voters. Polls have repeatedly shown that more Democrats than Republicans say they plan to vote by mail this year.

While DeJoy has backed down to a large extent on his aggressive cost-cutting measures, the confusion he helped create has rattled voters. A new Wisconsin poll by the Marquette University Law School, for example, shows the numbers of voters in that key swing state who say they plan to vote by mail has dropped considerably since May, from 43% to 32%.

“He played a role, wittingly or unwittingly, in undermining people’s confidence in voting by mail, which fed into the suppression tactic of ‘there is something wrong with voting this way,’” Dimondstein said.

Some groups are scrambling now to get word out about the importance of mailing ballots early. They are testing new mobile apps, distributing ballot-tracking tools and deluging social media in an effort to push voters to request and return their ballots early.

On the Republican side, state parties that have long relied on mail-in voting, especially by older people, are scrambling to find ways to encourage their side to vote despite the president’s attacks on mail balloting.

On the left, organizers are emphasizing that ballots not returned by the week before election should be brought to drop boxes set up at polling places, election offices and elsewhere.

“We are encouraging every single voter to know the rules and make a plan,” said Wendy Fields, executive director of the Democracy Initiative, a coalition of progressive groups working to expand voting rights.

“This is a high-information moment. We are making sure folks are checking their registration, getting the ballot, getting it done and getting it in the mail,” Fields said. “We need to keep our foot on the gas.”

Fields said activists are also guiding voters to alternatives to mail if they don’t get their ballot to the Postal Service in time.

Educating voters is a steep challenge this cycle. The COVID-19 pandemic and legal fights over how voting should be carried out are causing frequent changes in state rules. Misinformation abounds.

And progressive groups continue to highlight the fights over the post office in fundraising campaigns, which often suggest that mail voting could be imperiled, further confusing voters.

“Providing clear and accurate information to voters in a timely manner is the biggest challenge we face,” said Tom Lopach, chief executive of the Voter Participation Center, a nonprofit that has registered more than 1 million voters for the 2020 election.


Obituaries and death notices for Sept. 14, 2020

Lawrence Brooks Jr.

Scott James Devine

Cicely “Diana” Eager

Lucille “Luci” Faytle

Hazel L. Johnson

Dolores M. Jones

Dennis J. Kramer

Marlene Ann Larsen

Michael Haven Meton

Patricia L. Schlaefer

Larry Allen Stefanik

Donna Kay Wagner


FILE—In this Tuesday, Sept. 1, 2020, file photo, Vice President Mike Pence speaks at a campaign event on the grounds of Kuharchik Construction, Inc., in Exeter, Pa. Labor Day kicks off the unofficial start to fall election campaign. (AP Photo/John Minchillo, File)


Local
top story
Census workers fan out as response deadline approaches

JANESVILLE

City Clerk-Treasurer Dave Godek said he is happy with Janesville’s self-response rate for the 2020 Census.

Janesville has a 79% self-response rate, which is 13.5 percentage points higher than the national rate of 65.5%. It’s also 7.5 points higher than the state response rate of 71.5% and 2.5 points higher than Rock County’s 76.5% rate.

Milton and Edgerton’s response rates are 82.2% and 81.8%, respectively, Godek said.

The U.S. Constitution mandates a nationwide headcount every 10 years. Data from the census determines congressional representation and federal funding for state and local programs, and it influences where businesses choose to build or relocate.

Census enumerators, otherwise known as census workers, in the last week or so have started circulating in the city to gather responses from those who have not yet filled out their census forms.

The coronavirus pandemic has pushed everything back, Godek said. Census workers typically would have made their rounds earlier in summer, but they started later because of the pandemic.

Workers will be out and about through Sept. 30, the last day for people to self-respond online, according to the U.S. Census Bureau’s website.

This is the first year online forms have been available. Those looking to fill out their forms online will need their mailed forms because those forms include a code needed to complete the online document.

Enumerators carry identification with them, Godek said, and residents should not be afraid to ask to see identification if a census worker shows up at their door.

He advises residents and workers to wear masks, speak outside and maintain 6 feet of distance between them to prevent spreading the virus.

Census workers will never ask for personal information about finances or health and will never ask for a Social Security number, Godek said.

Anyone who believes they have been approached by someone pretending to be a census worker should call the Janesville Police Department’s nonemergency phone line to report it, Godek said.

Census data is aggregated, meaning it is added to a large pool and cannot be traced back to a particular respondent, Godek said. It is illegal for Census Bureau workers to share the data with anyone, including government agencies such as U.S. Immigration and Customs Enforcement, he said.

Enumerators will visit only homes where people have not responded, but they might approach neighbors to ask about households they are trying to reach, Godek said.

After the response deadline passes, the bureau will aggregate the data and eventually report population counts to municipalities.

The counts will be delivered to states for legislative redistricting July 31, according to the bureau’s website.

Census counts are used to create legislative districts and to help allocate $600 billion in federal funds annually, Godek said.