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, 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 actually 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."

But 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 only reopen 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.

What families are learning, is that the experience of reopening won't be the same for everyone.

"Introducing unknowns"

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 still 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's 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 isolationcan 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. A nurse in Morgantown, Mayle is one of Betty's 13 grandchildren.

Coronavirus restrictions have meant that when Mayle visits, she's 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, too. 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 COVID-19. 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."

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