Mark Shaver hadn't seen his 96-year-old mother, Betty, in months when he hit a breaking point and decided he had to see her.
Shaver lived in South Carolina and Betty was in a nursing home in Morgantown, W.Va., when COVID-19 outbreaks began sweeping across the nation. By early March, West Virginia Gov. Jim Justice requested that nursing homes in the state restrict visitors, blocking any real chance Shaver would have to see his mom in person.
For three months, Shaver and his wife, Janet, were only able to talk to Betty virtually. Then last week, they decided they would make the roughly 500-mile drive to visit her. They didn't know if they'd be able to see her face-to-face, or if the meeting would have to be through glass.
"We said we're going North," Shaver said. "Didn't matter if we had to look in the window."
Then something unexpected happened. Gov. Justice announced that the state would begin allowing nursing homes to reopen.
West Virginia has one of the lowest numbers of COVID-19 cases in the nation, according to the Centers for Disease Control and Prevention. Under the governor's plan, homes can reopen only if they have had no cases of the coronavirus for 14 consecutive days. And while the state provides guidance for reopening, individual facilities have broad leeway to set their own restrictions on everything from how many visitors to allow, to how long they can spend on-site.
"We know the people in our nursing homes are the most vulnerable of all," Justice said. "So we've got to have a plan that phases in visitation, while doing so as fast as safely possible."
In a state that's home to the third highest percentage of the population over the age of 65, the caution around reopening stems from the cruel reality that the elderly have been among the groups most vulnerable to the coronavirus. An analysis this month by USA Today found that residents and staff at long-term care facilities have accounted for more than 40% of all COVID-19 deaths in the United States. So while the reopening of nursing homes has been welcomed by many residents and their families in West Virginia, there remains concern over whether it is still too soon — particularly at a time when the number of cases in the state has been trending up.
Families are learning that the experience of reopening won't be the same for everyone.
For Shaver, his hope of seeing his mom, who lives in a home with about 100 other full-time residents, became a reality soon after the governor's announcement. But visiting wasn't like it was before the pandemic. He and his wife had to go through new safety protocols, like wearing masks and watching videos about hand-washing.
The new protocols are familiar for members of the center's staff, who have had to wear masks since early April. The staff follows guidance from the CDC, says Jeff Grewell, the administrator of the home, but guidance can change daily. That has meant a lot of conversations with residents.
"I think it's imperative we let them know what we are doing and being 100% transparent because we don't have the answers, we are all working together to try to figure it out as best we can," Grewell said.
Given the uncertainty that surrounds COVID-19, Grewell said he has some anxieties about opening back up.
"We can control staff; we've all been tested and trained," he said. "But then when you start introducing unknowns, you don't know where that family member's been."
Despite his trepidations, Grewell acknowledged the challenges his residents have had to face. Three months is a long time in a nursing home, and loneliness and feelings of isolation can increase health risks.
"It's been tough" for the residents," Grewell said.
Among those residents is Margalit Persing, who has lived at the Mapleshire Nursing and Rehabilitation Center for five years.
"I know everything is for the best for us, but this is really getting to me," she said. Persing said she had recently been visited by a friend, who brought along her two little dogs. It was the first time they had seen each other in three months, she said.
"She came up to the window and we high-fived," Persing said. "And then when she left, I was so sad."
"I cried the whole way home"
It's been hard for families too.
Every Sunday, Shaver's daughter, Dara Mayle, visits Betty. Mayle, who is a nurse in Morgantown, is one of Betty's 13 grandchildren.
Coronavirus restrictions have meant that when Mayle visits, she has only been able to speak with Betty through a window. But they've managed to develop tricks for communicating through the glass, she said.
"If you talk into the middle of the pane you can hear completely," Mayle said. "The first time I cried the whole way home. It was just the weirdest feeling of not being able to be with her, you know. She's tough. She would never tear up over anything. She still thinks it's crazy. She'd be like, 'Why are you coming to stare at me?' I'm like, 'I'm not doing it for you. I'm doing it for me.'"
But now, with restrictions beginning to ease, Mayle can see Betty in person again after three months of FaceTime calls and conversations through windows. So can Mark and Janet Shaver.
"I haven't put my arms around her and see how she's doing," Shaver said before seeing his mother again last week. The state's guidelines encourage social distancing, but his wife said she planned on embracing her mother-in-law. "I'm hugging her. I don't care."
And she did. The Shavers and Mayle all got to see Betty in person.
An uneven reopening
But because visitation depends on facilities meeting certain requirements, not everyone has been as fortunate.
Lisa Giuliani, 41, has a father who has been in a nursing home since late last year. He has end-stage pancreatic cancer and dementia, and Giuliani hasn't been able to see him in more than three months.
She thought the governor's announcement meant she would be able to see her dad. But as the home was working through the details, a few kids in town returned from a beach in South Carolina. They tested positive for the coronavirus. The home was placed back in lockdown, explaining that some of its employees had come into close contact with the kids.
"It's weird because you feel this obligation to call," Giuliani said. "But it's also hard because when I see him, is he going to know who I am? Makes it tough ... It's a weird space in time that is strange and precious and hard."
While the Shavers make plans for their next visit, Giuliani has more waiting to do.
"When this first started and he was so sick, I thought, 'Huh, I wonder if this is the last time I'm going to see him,'" Giuliani said. "But my dad has so much grit. He'll be around for a while I think. I feel like I will see him again."
DAVID GREENE, HOST:
The elderly in this country have been among the most vulnerable populations during this pandemic. In fact, in most states, more than a third of fatalities have been nursing home residents and staff. As soon as it became clear how devastating the virus could be, long-term care facilities around the country went on lockdown.
Now, after more than three months, some states are saying these facilities can open up again if the homes themselves determine that it is safe. One of the first states to do this is West Virginia. And Rachel, I know you spent time last week in Morgantown, W.Va., speaking to families about just how complex these decisions can be. What did they tell you?
RACHEL MARTIN, HOST:
Right. They're really anxious, David. I mean, the staff, the residents in these nursing homes, their families, they all feel a ton of anxiety right now. I mean, on the one hand, they so desperately want this to happen because the isolation for residents has been so hard. But it's about safety, right? It's all been so touch-and-go. Situations can change so quickly with COVID-19.
Case in point - we thought that this was going to be a story about two families each getting to reunite with their loved ones who've been sequestered in nursing homes. But as you are about to hear, things changed. Before we get to that, though, some introductions.
Hi, nice to meet you.
LISA GIULIANI: Hi, nice to meet you.
MARTIN: This is Lisa Giuliani. Her dad is in a nursing home just outside of Morgantown. He's been there since late last year dealing with Stage 4 pancreatic cancer.
GIULIANI: It's a blessing and a curse, really. I'm sure it is very hard for a lot of residents up there not being able to see. But they're doing and FaceTime, you know? And they have so many nurses up there that just love them, are invested in them.
MARTIN: Across town, we meet Mark Shaver, who just arrived from South Carolina.
How was your drive?
MARK SHAVER: Oh, it was uneventful.
M SHAVER: That's what we love...
M SHAVER: ...About 7 1/2 hours. And we're used to it.
MARTIN: He grew up in Morgantown. And his 96-year-old mother is in a nursing home here. He and his wife, Janet, decided that they had just gone too long without seeing her in person. So they made plans to drive up even if it just meant getting a glimpse of her from a distance.
M SHAVER: We said, we're going north. And it doesn't matter if I looked in the window. That's - we were coming.
MARTIN: But then something unexpected happened. The governor of West Virginia, Jim Justice, announced that the state would allow nursing homes to open up. Here's the context. West Virginia was the last state to report a confirmed COVID case on March 17. The governor had actually declared a state of emergency the day before, shutting down schools and then, soon after, non-essential businesses.
And it paid off because West Virginia has one of the lowest numbers of infections. So the nursing homes can now open. And both Mark Shaver and Lisa Giuliani got their hopes up, so much so that they agreed to let us come see their reunions. We went to check out one of the nursing homes ahead of time.
MARTIN: Hi. How's it going?
JEFFREY GREWELL: Hi. Welcome.
MARTIN: I'm Rachel.
This is where Mark's mom lives, a nursing home called Mapleshire. It's got about 106 full-time residents. The lawn is decorated with American flags and Fourth of July pinwheels. There's a tent set up outside the front door where we get checked in.
(SOUNDBITE OF BEEP)
GREWELL: Ninety-eight-point-nine. Very good. We're good to go.
UNIDENTIFIED PERSON #1: Sounds like we're ready to go? Yep? All right.
MARTIN: The center's administrator is Jeffrey Grewell. Jeffrey is wearing a mask, like all the staff here. But that's only been the case since April. He says the guidance he has gotten from his bosses and the CDC has changed from week to week - sometimes day to day, hour to hour - which means a lot of conversations with residents.
GREWELL: I think it's imperative we let them know what we are doing and being 100% transparent with that.
MARTIN: Have you had concerns or anxieties around opening up again?
GREWELL: Yes. Yes. We can control some of the risk factors here with staff and our residents because we've all been tested. We're all negative. But then when you start introducing some of the unknowns, you don't know where that family member has been.
MARTIN: Family visits are limited right now to 30 minutes once a day, two guests at a time, tops. Jeffrey is telling families that they have to be prepared that this could be temporary. If there's an outbreak, visits could be called off again. He says, during the lockdown, four residents died of non-coronavirus causes. And their families were allowed to be at their bedside in their final days. But those were the only exceptions.
Have you seen loneliness set in for some residents?
GREWELL: Yes. We've tried to do as much as we can. You know, if we see somebody that's maybe disengaged a little bit, to try and do a little bit of extra things for them to perk them up whether it's, you know, having a 20-minute conversation with them, playing a game of bingo with them. It's been tough, it really has been.
MARTIN: Has it been hard not to be able to see people in person?
BETTY SHAVER: Yes. It's hard. I can talk to them. But I do like to see them.
MARTIN: Remember Mark Shaver, the man who drove up from South Carolina to see his mom through the window of the nursing home? This is his mom.
B SHAVER: This is a wonderful place. I have no complaints, except pork chops. They don't quite fry them right (laughter).
MARTIN: Her name is Betty Shaver. And next month, she turns 97 years old.
B SHAVER: I think it's my son that's going to be here tomorrow. I have a wonderful family - 10 grandsons, three granddaughters.
MARTIN: Since March, her granddaughter, Dara Mayle, has been visiting her outside her window every Sunday after church. Dara is Mark's daughter. And she lives in Morgantown with her husband and two kids. I talked with Dara and her parents on Dara's back porch. She told me she's developed some tricks for window visits.
DARA MAYLE: If you talk into the middle of the pane, you can hear her completely. The first time, I cried the whole way home. She still thinks it's crazy that I came to her. Like, every time, she would be like, why are you coming to stare at me, you know (laughter)? I'm like, I'm not doing it for you. I'm doing it for me.
MARTIN: Because every day matters.
MAYLE: Whenever someone is going to be 97, like, you think about the fact that - I was just worried that a lot of our time was gone. It was just - it's sad that we lost three months with her.
MARTIN: I turned to Mark, her dad, who's been doing a lot of listening from the corner of the deck.
How are you feeling?
M SHAVER: Anxious, I think, is the word I would use. I'm anxious. It's difficult. And it's just being anxious about it. And again, you know, I'm the baby of the family. But I've always taken care mom. But I got great hands here. You know what I'm saying? But it's just I haven't put my arms around her and see what she's doing. So...
MARTIN: Can you put your arms around her today?
UNIDENTIFIED PERSON #2: (Laughter).
M SHAVER: Janet says she's going to whether she wants to or not.
JANET SHAVER: I don't care.
MARTIN: About an hour later, the Shavers arrive at Mapleshire.
GREWELL: Mark and Janet Shaver.
M SHAVER: All righty.
(SOUNDBITE OF BEEP)
GREWELL: Well, you all are clear to go inside.
MARTIN: They each wear a mask - blue for him, pink for her. When they walk in, they see a lot of familiar faces.
UNIDENTIFIED PERSON #3: Hi. How are you?
MARTIN: Staff members pass by and open their arms up like they're giving an air hug. Mark and Janet have to watch a video about the importance of handwashing and how to interact with residents.
M SHAVER: Says no hugs, Janet.
J SHAVER: I know.
MARTIN: They're escorted into a small, glass-enclosed dining room. And then Betty appears, moving slowly with her walker, all dressed up in a blue-flowered dress with matching sweater. She smiles at her daughter-in-law and then she fixes her gaze on her son.
J SHAVER: There's Mark.
B SHAVER: Well, there you are. I've never seen anybody that looks so good (laughter).
J SHAVER: Aw. Bless your heart.
M SHAVER: You OK?
B SHAVER: Don't make me cry.
MARTIN: And, yes, there are hugs.
B SHAVER: Oh, Mark.
J SHAVER: Aw. You look so good. Your hair looks great.
B SHAVER: Oh, she just kind of touched it up.
M SHAVER: Oh, did she?
J SHAVER: Did she? Oh, yeah.
MARTIN: Lisa Giuliani, remember, her dad is sick with cancer and dementia. She did not get a reunion. When the governor made an announcement that nursing homes could open up, she called Windy Hill Village, where her dad lives, and asked a staff member when she could come.
GIULIANI: She said, why don't you call back tomorrow, and then we'll have a better idea. I said, OK. And then that night, there was a Facebook post. We're back in lockdown.
MARTIN: A couple of kids in town had been on vacation to the beach in South Carolina. And they tested positive for COVID-19.
So where is...
GIULIANI: So anywhere - where do you want to sit?
MARTIN: We situate ourselves in her backyard right next to a massive fire pit overlooking the river. I asked her when she started to worry about the pandemic.
GIULIANI: You knew it was coming, you know? You saw, like, OK, it's in China. Well, oops, it's in Italy. It's in Seattle. It's in the nursing homes. And you're like, you know, you don't have to be a genius to see that it's going to spread.
MARTIN: She says the staff at Windy Hill have been great during these past few months.
GIULIANI: So they kind of, like, walk you through that. And they, you know - oh, he's done great. He's had a good day. He's had a bad day, you know? He's eating. He's doing this.
MARTIN: Talking on the phone with him, though, has been hard.
GIULIANI: He'd be like, when are you coming to see me? I'm like, well, Dad, we've got this stuff. And he's like, oh, OK. And then, the next time, when are you coming to see me? And so I kind of pivoted at one point and was like, I'll be there tomorrow.
MARTIN: But, of course, she didn't come because her dad's mind is deteriorating, along with his body. And she knew he'd forget by the time they talked again.
What's it like to not be able to see him for these months?
GIULIANI: It's weird because you feel this obligation to call. But, you know - but then it's also hard because you know that, like, man, when I see him, is he going to know who I am? So it makes it tough. So when I talked to him this morning, I was like, man, Dad, I wish you were here. We got weeds. And you were the best about picking the weeds.
He's like, oh, I'm coming. I'm going to come down there. And we're going to do that. I was like, (laughter) you need to get down here. It's a mixed bag. So there's, like, obligation and fear. Yeah. That's what it is. So it's a weird space and time. It's, like, precious and important and hard.
MARTIN: Two families who have endured a lot.
B SHAVER: OK.
M SHAVER: All right, Mom.
B SHAVER: Have a good day.
M SHAVER: See you tomorrow.
J SHAVER: See you.
B SHAVER: OK.
J SHAVER: Good seeing you.
MARTIN: Mark Shaver and his mom are already making plans for the next visit. Lisa Giuliani has more waiting to do.
GIULIANI: When this first started and he was so sick, I thought, huh, I wonder if that was the last time I'm going to see him, because you have that kind of stuff sneak in. But my dad has so much grit, he'll be around for a while, I think. I feel like I will see him again.
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