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Big hurdles to moving town out of flood plain
State law and lack of money are among challenges faced by those who want to relocateWinslow to higher ground

Half the households in flood-battered Winslow are willing to pack up and move to higher ground to avoid the risk and heartache of future flooding.

The leaders of the tiny village in Dodge County — population 100 — think relocating the entire town after it was heavily damaged by Elkhorn River flooding in March is the only way to ensure Winslow's survival.

But a group of state and federal officials who met in Winslow Thursday night said plenty of hurdles stand in the village's way.

Those obstacles include state law, the likely millions of dollars needed to put in new streets and utilities in Winslow 2.0 and its dwindling population.

"We all want what's best for Winslow, I want to make that abundantly clear," said Molly Bargmann, a recovery supervisor for the Nebraska Emergency Management Agency. "We want to get to yes, but there's a lot of no's right now."

Even in the best-case scenario, she said, it's unlikely that any houses would be able to move to a new site this year, another delay for flood-weary residents who just want life to return to normal.

Ed Nelson, who's lived in Winslow for more than a decade, is skeptical that relocation will ever happen. "We ain't going nowhere," he said after the meeting, shaking his head.

Only about 10 families are currently living in Winslow, according to Nelson. The rest have moved — permanently or temporarily — to nearby towns like Hooper, Scribner and Fremont, while they fix up their houses or wait to see if relocation pans out.

Winslow, a roughly four block-by-four block gravel-road town of modest homes surrounded by far fields, is 12 miles north of Fremont and about an hour's drive from downtown Omaha.

Nearly every structure in town — all 48 buildings — took on water when the Elkhorn, which flows about a half-mile from town, spilled over a levee meant to protect Winslow.

Many of the houses were damaged badly enough that if residents were to rebuild, building regulations would require them to raise homes by a foot or more to reduce the risk of future flooding.

Elevating homes and buildings is expensive and unpopular, so Village Board member Zachary Klein proposed uprooting and moving the town — including any houses that are structurally sound — to a new location out of the flood plain. Other towns have done it, including Niobrara, Nebraska and Valmeyer, Illinois.

Not everyone is on board. About five families want to stay put in Winslow. Others have already moved on and prefer a federal buyout of their flood-prone property. But 27 households have indicated their willingness to relocate.

One site on a hill nearby fell through, but the village is currently eyeing a 72-acre farmland plot three miles away, across from Logan View Junior-Senior High School. It sits 80 to 90 feet higher than Winslow, and local donors have offered to pick up roughly $630,000 of the $900,000 price tag.

"If we fail, we fail. If we have to go buy a house in another town, we go buy a house in another town," Klein said Thursday night. "I'm not done fighting."

But a new town would require new infrastructure — roads, water pipes, sewer lines and other utilities.

Klein is researching state, federal and local recovery funds and grants to help build that — including what could amount to about $560,000 in aid from the Federal Emergency Management Agency — but Winslow is not flush with cash.

The village is already carrying a big tax and debt burden, including bonds on the levee that failed in March and $200,000 in disaster expenses it hopes will be reimbursed by FEMA.

The tax base is small. Preflood, the assessed value of all the property in the town was about $2.7 million, and the village had an annual operating budget of just $17,000 or so.

Last year, Winslow had the highest property tax rate in Dodge County, at about $3.82 per $100 assessed value. For comparison, the rate in the much-larger city of Fremont was $2.08.

"I don't know how you get past the financial side," said Lynn Rex, executive director of the League of Nebraska Municipalities. "That's the dilemma ... what you really need is finances."

And then there's the legal question — can Winslow even start over and relocate under current state law?

Rex and Pat Sullivan, a real estate and municipal lawyer, said Nebraska law wouldn't allow Winslow to just pick up and move. State law requires new municipalities to have a population of at least 100, which would be a stretch for new Winslow.

Residents could vote to dissolve the village—not unheard of in Nebraska — and try to create a new sanitary and improvement district. But sanitary and improvement districts (SIDs) are usually led by developers who use the governmental entity to issue debt and levy taxes to pay off the costs of installing roads and utilities.

While Winslow 2.0 would ideally include extra lots for sale - there's a housing shortage in Dodge County- several officials Thursday said it would be difficult to find a developer or bond underwriter willing to take on that risk given the relatively small number of people who want to relocate. And as an SID, not an official village, Winslow might become ineligible for state and federal disaster recovery funds.

"The statute has not caught up in this respect," Klein said. "It needs to. This isn't the only community that's smack-dab in the middle of a flood plain. If we cannot come up with a plan that's going to help move Winslow, what are you going to do for the next town?"

The office of State Sen. LynneWalz of Fremont, who represents Dodge County and Winslow, is working on a bill that would amend current law to allow a smaller city or village to relocate after a catastrophic flood.

Settling the legality of relocation would put the village in a much better position to secure funding, Klein said. But it will still take precious time for the bill to wind its way through the Nebraska Legislature.

"I can't keep people waiting forever on the possibility of relocation," he said.

Meanwhile, some people in Winslow are still displaced, and the spring flood season is just months away.

"By the time you get a bill introduced and passed, this whole year's just going to be shot," Nelson said. "The only thing I hope is it doesn't flood this year like it did last year." eduffy@owh.com, 402-444-1210 twitter.com/eduff88


Livewellnebraska
'If you don't use it, you lose it': Methodist Hospital unit focuses on keeping older patients active

Teaira Homan settled three patients in chairs in a Methodist Hospital family room and began leading them through a series of gentle exercises, from simple shoulder rolls to the toughest — chair pushups.

The workout was not the kind intended to forge the next Crossfit champion.

But for the patients, all 65 or older, the goal was arguably more important: helping them head off the loss of strength and mobility that can occur during a hospital stay.

“If you don’t use it, you lose it,” said Harry Esch of Omaha, who’d been hospitalized with an infection, as he did a set of arm curls with light weights.

The exercise sessions, which Homan leads twice a week, are one of the special features of the hospital’s Acute Care for Elders unit, a 32-bed ward that follows a national model aimed at preventing complications in seniors and helping them maintain independence.

For hospitals, balancing the need to keep patients safe from injurious falls while still preserving their mobility can be challenging.

If patients don’t keep moving, they can get weaker. That’s a particular problem with older patients, who may be weaker to start with. For every day an older adult is in a hospital bed, it can take them three to four days to get back to their previous condition.

CHRIS MACHIAN/THE WORLD-HERALD  

At Methodist Hospital, Jane Sparks, left, and Nancy Colwell do leg lifts during an exercise class conducted by Teaira Homan, in the foreground.

Yet hospitals, in addition to caring for patients, are tasked with keeping them safe. They can face financial penalties if patients fall and injure themselves. Some reports nationally indicate that efforts to prevent falls may be costing patients mobility.

“It’s, ‘how do you keep people safe while maximizing mobility?’ ” said Becky Jizba, the service leader for Methodist’s ACE unit.

Indeed, area health systems all have systems and equipment in place to help strike that balance, including making physical therapy available to patients who need it and encouraging those who are able to get up and walk. They also use safety devices, including lowered beds and wrapping less steady patients in gait belts so staff can support them while walking if necessary.

The ACE unit puts a particular focus on mobility and has some extra resources — like Homan — to make it happen, Jizba said.

The ACE unit and two Methodist clinics also are the first in the state to pilot another national program aimed at improving care for older patients. It, too, addresses patients’ physical and mental health and focuses on keeping patients moving.

The Age-Friendly Health Initiative is a program of the John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States. The goal behind the initiative is to spread a framework for caring for older adults among hospitals and medical practices. The framework is based on four inter-related elements known as the 4 M’s: what matters to patients; medications; mentation, or mental state; and mobility.

Deborah Conley, Methodist Hospital’s geriatrics service leader, said Methodist eventually plans to spread the age-friendly initiative it launched nearly a year ago throughout the health system. A handful of other hospitals nationwide pioneered the program, which launched in 2017.

Meantime, the Nebraska Hospital Association is launching the initiative in 10 other Nebraska hospitals, most smaller rural facilities stretched from Alliance to Tecumseh. Margaret Woeppel, the association’s vice president for quality initiatives, said plans call for eventually extending it to all of the state’s hospitals.

“We recognize that most of our population is 55 and older,” Woeppel said, “and that we need to do a better job of addressing these specialized needs of that aging population and their wants.”

The University of Nebraska Medical Center will be providing training to primary care physicians that will also will focus on the four elements. The university received a five-year, $3.7 million federal grant last summer as part of an effort to help cover a looming shortage of geriatricians, doctors who specialize in caring for older adults.

Jizba said getting surgical patients up and moving has become common practice, particularly when it comes to those who’ve had orthopedic procedures. Not only can surgical patients get weaker if they stay in bed, they also risk blood clots.

But medical patients, particularly older ones, tend to be sicker now when they’re hospitalized. Keeping them active can take an extra push.

“They don’t feel good, and they’re tired, and the hospital is not a place typically where you get a lot of rest,” she said. “So we have to push the mobility and the movement much more purposefully than we used to back in the day.”

In addition to leading exercises, Homan walks with patients, clocking up to 983 laps around the unit a month, which works out to 61 miles. Known as a restorative aide, she’s a nursing assistant with training in occupational, physical and respiratory therapy.

Esch could walk only about 15 feet when he started walking with Homan. Later in his stay, he was up to 200 feet. “We sit and take a few breaks,” Homan said, “but we can do it.”

CHRIS MACHIAN/THE WORLD-HERALD  

Harry Esch in the ACE unit’s exercise class at Methodist Hospital. The hospital puts a particular focus on mobility for seniors and devotes extra resources toward that goal.

Said Esch, “She got me motivated.”

For those who truly are bedbound, Homan may help them exercise there. Patients also have access to physical and occupational therapy services.

Teresa Hawlik, vice president of patient care services at Lakeside Hospital, said health care providers within the CHI Health system encourage movement. But they also teach patients that they need to call for help when they want to get up — and explain why.

While they’re used to getting up to walk to the bathroom at home, the lighting and the footing are different in the hospital. Patients may be connected to intravenous lines or monitors, and they may not be used to walking in a floppy hospital gown.

To get ahead of the kind of needs that might cause them to make trips alone, the system has implemented what it calls purposeful hourly rounding. Staff members check to make sure patients’ pain is managed, that personal items like cellphones are at hand and bathroom needs are met, among other things.

Jizba said older adults also are at risk of delirium, a type of confusion that can come with things like altered sleep, infection and anesthesia. Delirium can have long-lasting effects even after patients recover, such as making them more forgetful.

Making sure patients don’t feel isolated while hospitalized is important in preventing delirium. The unit has its own therapeutic recreationist trained to make sure patients engage in activities such as games or puzzles, either in their rooms or in groups. Homan mixed her exercises with small talk about music and the weather.

“This class is not just about exercise but about having a little social conversation,” she said.

Unit staff and others also conduct what are known as 4M rounds that focus on the elements of the age-friendly initiative. That includes having a pharmacist review medications daily, looking specifically at those that can be problematic for older patients.

Since implementing the 4M model in early 2018 and launching those rounds, the unit has cut injurious falls in half, from 12 to 6, between 2017 and 2018, Jizba said.

The hospital also has a number of other programs focused on older patients, including having a geriatric nurse in its emergency room. A Hospital Elder Life Program brings volunteer health professions and gerontology students to the ACE unit to spend time with patients. That one is aimed at preventing delirium.

Woeppel, the hospital association official, said hospitals across the state have been using many of the M’s, such as checking patients’ medications on admission. But they may not have been focusing on how the four elements can affect one another. Certain medications, for instance, may make older patients too sleepy to be mobile and lead to delirium.

Asking patients what matters to them also is important. A patient may not want to live another 10 years. But it might be important to attend a granddaughter’s graduation.

“It’s really important we’re asking patients what they want out of health care,” she said.

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Articles
Iranians protest over country's downing of plane, days of denials

DUBAI, United Arab Emirates (AP) — Iranian demonstrators defied a heavy police presence Sunday night to protest their country's days of denials that it shot down a Ukrainian passenger plane carrying 176 people, the latest unrest to roil the capital amid soaring tensions with the United States.

Videos posted online showed protesters shouting anti-government slogans and moving through subway stations and sidewalks, many around Azadi (Freedom) Square after a call for people to demonstrate there. Other videos suggested that similar protests were taking place in other Iranian cities.

Protesters often wore hoods and covered their faces, probably to avoid being recognized by surveillance cameras. Some online videos purported to show police firing tear gas sporadically, though there was no immediate wholesale crackdown on demonstrators.

Meanwhile, in an emotional speech before Parliament, the head of the Revolutionary Guard apologized for the shootdown and insisted that it was a tragic mistake.

"I swear to almighty God that I wished I was on that plane and had crashed with them and burned but had not witnessed this tragic incident," Gen. Hossein Salami said. "I have never been this embarrassed in my entire life. Never."

Iran's state-run media, as well as semiofficial news agencies and publications, did not immediately report on the demonstrations.

However, international rights groups already have called on Iran to allow people to protest peacefully as allowed by the country's constitution.

"After successive national traumas in a short time period, people should be allowed to safely grieve and demand accountability," said Hadi Ghaemi, executive director of the New York-based Center for Human Rights in Iran. "Iranians shouldn't have to risk their lives to exercise their constitutional right to peaceful assembly."

Riot police earlier massed in Vali-e Asr Square, at Tehran University and other landmarks. Revolutionary Guard members patrolled the city on motorbikes, and plainclothes security men were also out in force.

The plane crash early Wednesday killed all on board, mostly Iranians and Iranian-Canadians. After initially pointing to a technical failure and insisting that the armed forces were not to blame, authorities early Saturday admitted accidentally shooting the plane down amid mounting evidence and accusations by Western leaders.

Iran downed the flight as it braced for possible American retaliation after firing ballistic missiles at two bases in Iraq housing U.S. forces. The missile attack, which caused no casualties, was a response to the killing of Gen. Qassem Soleimani, Iran's top general, in a U.S. airstrike in Baghdad.

Iranians have expressed anger over the downing of the plane and the misleading explanations from senior officials in the wake of the tragedy. They are also mourning the dead, which included many young people who were studying abroad.

"Even talking about it makes my heart beat faster and makes me sad," said Zahra Razeghi, a Tehran resident. "I feel ashamed when I think about their families."

"The denial and covering up the truth over the past three days greatly added to the suffering and pain of the families, and me," she said.

Another individual, who identified himself only as Saeed, said Iran's largely state-run media had concealed the cause of the crash for "political reasons."

"Later developments changed the game, and they had to tell the truth," he said.

Bahareh Arvin, a reformist member of the Tehran City Council, took to social media to say she was resigning in protest of the government's lies and corruption.

"With the current mechanism, there is no hope of reform," she said.

Some Iranian artists, including director Masoud Kimiai, withdrew from a coming international film festival. Two state TV hosts resigned in protest over the false reporting about the cause of the plane crash.

President Donald Trump, who has expressed support for past waves of anti-government demonstrations in Iran, addressed the country's leaders in a tweet, saying "DO NOT KILL YOUR PROTESTERS." His account later tweeted the same message in Farsi.

"The World is watching. More importantly, the USA is watching," he tweeted.

Iranians demonstrated across the nation in November after the government raised gas prices. The government shut down Internet access for days, making it difficult to gauge the scale of the protests and the subsequent crackdown. Amnesty International later said more than 300 people were killed.

A candlelight ceremony late Saturday in Tehran turned into a protest, with hundreds of people chanting against the country's leaders, including Supreme Leader Ayatollah Ali Khamenei, and police dispersing them with tear gas. Protests were also held in the city of Isfahan and elsewhere. Police briefly detained the British ambassador to Iran, Rob Macaire, who said he went to the vigil without knowing it would turn into a protest.


Articles
Biden is winning 'endorsements primary,' but does it matter?

WASHINGTON — When Joe Biden's campaign announced an Alabama Democrat's endorsement last month, it seemed ho-hum: Yet another elected official throwing his weight behind the 2020 presidential candidate most closely associated with the party establishment.

Yet this one was different: Mayor Randall Woodfin of Birmingham is no old-school party regular, but a young, black progressive elected as an insurgent in 2017 with support from Sen. Bernie Sanders of Vermont — now Biden's 2020 rival — and his organization, Our Revolution.

Woodfin's endorsement of Biden not only turned heads but also reinforced Biden's argument that he is the candidate best equipped to beat President Donald Trump.

"For me this is not left against moderate. I have no desire for that fight," Woodfin said. "I'm more concerned about who has the best path to victory, who can be strongest to support down-ballot candidates."

In the race for Democrats' presidential nomination, Biden is dominating the endorsement primary. FiveThirtyEight, a nonpartisan website keeping track of endorsements by "party elites," finds Biden running away with it.

His campaign says more than a thousand public officials and community leaders have declared their support. Many are older-generation party figures, like former senator and 2004 presidential nominee John Kerry, but the campaign is also trying to showcase younger backers, including Iowa Rep. Abby Finkenauer, who has endorsed Biden and campaigned with him.

It is not clear, however, how much endorsements matter in modern politics driven by social media. They once were far more important, back in the days of machine politics when a party boss' blessing was essential to a candidate. The Democratic Party passed power to rank-and-file voters in the 1960s and 1970s, when caucuses and primaries took over the presidential nominating process.

Still, all the major candidates are seeking and publicizing endorsements, each in ways that reflect broader campaign strategy.

The differences between Biden and Sanders provide the starkest contrast. Biden's endorsements are mostly from current and former elected officials, including at least nine who are or have been governors and 15 who are or were U.S. senators. The lineup reinforces his message that he is well connected, experienced and seen by seasoned pols as someone who can beat Trump.

Sanders' endorsements include no governors and just one senator, but also include stars of the progressive movement such as NewYork Rep. Alexandria Ocasio-Cortez, grassroots activists and left-leaning celebrities including Cardi B, Ariana Grande and Danny DeVito.

Sanders is dominating the California endorsement primary: His campaign compiled a list of 127 endorsers, mostly local officials. Biden's campaign lists just 47 Californians but includes more members of Congress and state legislators.

The senator from Vermont also has compiled an anti-endorsement list of powerful critics, among them banking tycoon Jamie Dimon and the centrist think tank Third Way. His website quotes President Franklin D. Roosevelt: "I ask you to judge me by the enemies I have made."

Some endorsements are eagerly sought because of their potential organizational impact. All of the major Democratic candidates are courting Nevada's Culinary Workers Union because it is a large, well-organized force of mostly Democratic voters who can drive turnout.

Other endorsements carry symbolic significance.

When Sen. Edward Kennedy of Massachusetts endorsed Barack Obama over Hillary Clinton in early 2008, it was a huge momentum booster for the young first-term senator over the establishment front-runner.

Ocasio-Cortez's endorsement of Sanders in October has been one of the most consequential of the 2020 primary. While not surprising since she backed Sanders in 2016, her timing — as the 78-year old candidate recovered from a heart attack — had a huge effect. Her subsequent appearance with him at a "Bernie's back" rally helped allay supporters' fears that his campaign would be derailed by health problems.

Sen. Elizabeth Warren of Massachusetts was endorsed Monday by former Obama housing chief Julián Castro, who dropped his presidential bid last week. Warren has placed less emphasis on establishment endorsements than on outreach to grassroots supporters. In Iowa, she did score the backing of State Treasurer Michael Fitzgerald, one of just three Democrats holding statewide office. And she got splashy celebrity endorsements from U.S. women's soccer icon Megan Rapinoe and "Queer Eye" star Jonathan Van Ness.

Pete Buttigieg, former mayor of South Bend, Indiana, is backed by a roster of 58 mayors — including from Warren's childhood hometown of Norman, Oklahoma, an answer of sorts to critics of his experience. Kevin Costner, star of "Field of Dreams," the Iowa-based baseball fantasy film, appeared at a Buttigieg rally that drew more than 1,000 in Indianola. Perhaps more helpful: the nod of Deb Berry, a black former Iowa legislator who is a good get for a candidate struggling to garner African American support.

Sen. Amy Klobuchar of Minnesota dismisses celebrity endorsements to boast of the value of her list of endorsements from local officials in Iowa. "I don't need celebrities in Iowa — I have won the mayor of Fertile," she said at an event Jan. 3, referring to a town of 370 people in the state's north.

Iowa Democrats, however, may be particularly resistant to third-party persuasion because voters have so much direct contact with candidates. One cautionary tale: In 2004, three prominent Iowa Democrats — Sen. TomHarkin and former Reps. Berkley Bedell and David Nagle — endorsed Vermont Gov. Howard Dean for president. He ended up coming in third in the Iowa caucuses and dropped out a few weeks later.

The endorsement of the Des Moines Register is sought as a prize. But in every year since 1988 that it endorsed a Democratic candidate for the nomination, just one placed first in the caucuses — Clinton in 2016.

Among Biden's Iowabackers is Tom Vilsack, a former governor and Obama's agriculture secretary.

This report includes material from the Associated Press.