Before the COVID-19 lockdown, care for untold thousands of nursing home residents across the country came as much from family members as from the aides on the floor. From Maine to Hawaii, relatives would drop in to feed residents of chronically short-staffed nursing homes, brush their teeth, check for bedsores, get them moving, keep them company.
Barred since March, many have worried that no one has sufficiently taken up the slack.
Now, after tens of thousands of residents died as COVID-19 swept through one nursing home after another, more than a dozen states are cautiously setting rules for the return of a limited number of family visitors. They range from New Jersey, where officials believe the peak of the pandemic has passed, to New Hampshire, which has seen very few cases all spring, to Oklahoma, where even as cases are spiking, criteria have been drawn up to allow family access. But the distancing rules in effect will prevent visitors from carrying out much of their earlier hygiene care.
Limited access raises difficult questions about equity and bias. Not every resident, or every family, will qualify for a visit. Nursing homes vary considerably in their capacity to control infection. The pandemic is still raging and some states — including New York, Pennsylvania, Ohio and Florida — have not budged.
June Cox had gone to see her mother, Dorothy Cox, three times a day at her nursing home in San Diego. “I tried to take care of her physically, emotionally, musically, spiritually, every way I could think of,” she said.
After March 13 she called as often as she could on FaceTime. “’I’ll be there as soon as I can be, as soon as I’m allowed, Mama,’” she told her mother. “She’s not a prisoner. She hasn’t committed a crime. She’s not supposed to be living in solitary confinement.”
Dorothy began declining shortly after the lockdown began and died alone on April 7, after a seizure. “My mother would still be alive, I’m pretty sure,” said June, if she had been able to keep looking after her.
On March 11, Leonard Beatty, of Ashland, Missouri, seemed as robust as he had been in months. His appetite was back. His wife Myrna, and daughter, Cindy Harper, had made plans to bring him home from The Bluffs nursing home in nearby Columbia by early April. The staff “worked their butts off,” Harper said, but they felt they could care for her father, who had dementia, better at home. He was unnerved, she said, by the “hollering” and crying of other residents.
“Then COVID-19 hit. The door slammed. What do you do?”
They visited with him through a window on March 31, his 84th birthday. He still seemed strong, but when they sang “Happy Birthday” he started sobbing.
The next time they saw him was a week later. “We were shocked,” Harper said. “He was just a shell of himself. We didn’t know what was going on.”
No one from the nursing home had told them he was failing.
Two days after that, a staff member called them and said he should be put in hospice care. He had bronchitis, they were told. He was not tested for COVID-19. Instead, with considerable difficulty, they arranged to bring him home, where he died 29 hours later.
Myrna Beatty believes that by being there she had enabled him to survive a bout of pneumonia last October. She and Harper think their absence this spring was fatal to him, that he’d still be alive if they’d been able to bring him home on April 1 as they had planned.
“I have to accept,” Harper said. “This is the way it went down. We have to tell ourselves we did our best. It was out of our hands, that we weren’t there to help him. And that hurts. COVID-19? It did us in. We’ll feel forever guilty.
“He may not have died from COVID-19. But he definitely died because of it.”
The tension with renewed visits is between safety and compassion, said Susan Frampton, president of an advocacy group called Planetree International. Staff and residents alike shouldn’t be needlessly exposed to the virus. But neither should someone be cut off from all family contact. Frampton points out that family members can spot troubling signs in residents more quickly than staff members who may be rotating through shifts and not well acquainted with certain residents.
“Isolation has serious impacts on the health and well-being of the residents of these facilities,” said Daniel Rusyniak, the chief medical officer of Indiana’s Family and Social Services Administration. As with most of the other states relaxing visitation rules, Indiana now permits families to meet outdoors only, socially distanced, masked, tested for COVID-19 and under supervision.
New Jersey’s rules are similar, with special attention given to infection control measures as residents move through the nursing home to meet their relatives outdoors. Visits are allowed only at nursing homes that have “attested” to the state their ability to meet the requirements. As of this week, more than 300 had done so, according to Dawn Thomas, a spokeswoman for the Department of Health.
In Oklahoma the rules are not so strict. “We encourage families as they reunite with their loved ones to consider getting tested in advance and to wear masks for visitations and closely follow heightened protocols at the facilities,” Commissioner of Health Lance Frye said in a press release.
On June 18 Gov. Greg Abbott of Texas said guidance for visits would be forthcoming within a week, but since then, cases have spiked and he has announced a pause on further re-opening in the state.
Elaine Ryan, vice president of state advocacy and government affairs for AARP, said she is concerned that the states are moving too fast and too haphazardly.
“No state has the infection and death count under control in nursing homes and assisted living,” she said. “Nursing homes are struggling with just the basics. We have a long way to go to have the assurances that these kinds of visits can be done safely.”
But COVID-19 already has a foothold in many if not most nursing homes, brought in through the “back door” by staff, said Mike Dark, an attorney with California Advocates for Nursing Home reform.
And since March, those nursing homes have been operating without the vigilant oversight that visitors provide.
“Facilities have spiraled into apocalyptic conditions without that outside eye,” he said. “And we’re looking for this crisis to play out over years, not months.” There’s no way that residents can be kept isolated from their families that long, he said.
A California woman who asked not to be identified out of fear of reprisals said of her 38-year-old son, paralyzed four years ago when he was hit by a truck, “I don’t want him to feel like he’s been put in a closet and forgotten.” He can’t speak because of a tracheostomy, which she fears has contributed to less-than-attentive care.
“It’s very easy to ignore people who don’t have voices themselves,” she said. That’s why she wants to get back in to be his constant advocate.
Marcia Reimer’s 93-year-old mother, Joyce, was in a nursing home in Orchard Lake, Michigan. Marcia visited at least four days a week. “I had made up my mind to be a presence there so they knew I was watching,” she said. She believes it paid off; she has no qualms about the care her mother received.
Joyce had always been strong and independent, Marcia said, but went into the nursing home after falling and breaking her hip. One day, after the lockdown began, a trusted aide told Marcia over the phone, “You know, I’ve never seen her mad. But today she was as mad as could be. She was mad at that virus.”
She died May 30. The doctor said it was congestive heart failure.
“She slipped away,” Marcia said. “That was her wish and my wish. She would have hated the drama, that bedside vigil thing.”
She knew the lockdown was out of her control, that there was nothing she could do about it. She had been praying that Michigan would change course and allow visits. “I would have gowned up and masked up and done whatever I would have had to. That’s the one thing that haunts me, that I wasn’t able to see her.”
Seventy years ago this week, members of the West Virginia Air National Guard’s 167th Fighter Squadron were returning to their home base at Kanawha Airport from a two-week summer training camp at Lockbourne Air Force Base, near Columbus, Ohio, when they heard the news.
“We were riding in Army trucks on the way back to Charleston when we learned that North Korea had invaded South Korea,” said Jack Tamplin of Boomer, who had joined the Air Guard unit three months previously. “The first question everyone asked was, ‘Where the hell is Korea?’ The second question was, ‘What does this mean mean for us?’”
On June 25, 1950, 75,000 troops from the Soviet-backed North Korean Peoples Army swarmed into United States-supported South Korea along a 125-mile front, taking U.S. military leaders and the administration of President Harry S. Truman by surprise.
Korea, occupied and managed as a colony by the Japanese during World War II, was divided after the war along an arbitrary latitude line — the 38th Parallel. The Soviet Union, an Ally during the just-ended war, took charge of the northern portion of the Korean peninsula, while the U.S. oversaw the southern half.
The idea was to reunify the nation after it stabilized from the devastation suffered during the world war. But in 1947, when it came time for an agreed-upon vote to establish a government for a unified Korea, the Soviet Union balked, and Korea remained divided.
On the day of the invasion, Truman called for the United Nations to convene an emergency session of its Security Council, which the Soviet Union was boycotting at the time. In short order, the Security Council passed a resolution calling for an immediate end to hostilities and a withdrawal of North Korean troops from South Korea.
North Korea ignored the resolution, and on June 27, Truman ordered elements of the U.S. Army, Air Force and Navy to Korea to assist South Korean defenders. A declaration of war was never sought, but Congress quickly voted to fund the “police action,” as Truman called the war in its early days, to check Soviet-sponsored aggression. Fourteen other UN member nations joined the U.S. in sending combat units to South Korea.
The first U.S. Army elements to arrive in Korea had been serving as part of an occupation force stationed on Kyushu, the southernmost of Japan’s main islands, when the invasion took place.
Among them was Pfc. Kenneth Shadrick of Skin Fork, in Wyoming County, one of 10 children born to the coal mining family of Theodore and Lucy Shadrick. After attending Pineville High School, Shadrick enlisted in the Army in November 1948 at age 17. After completing basic training, Shadrick spent a year on Kyushu before his unit was ordered to Korea, arriving there on July 1, 1950.
On the morning of July 5, the first U.S. Army engagement with North Korean troops took place near the town of Osan, about 25 miles south of the South Korean capital of Seoul, recently overrun by the North Korean invasion force.
Early that afternoon, Shadrick’s bazooka squad and the small infantry force that accompanied it was ordered to watch for North Korean tanks at a village about 5 miles south of Osan.
Not long after Shadrick’s squad set up an observation post in a hilltop cemetery, North Korean tanks loomed into view. After one bazooka operator fired at an approaching tank, to little effect, Shadrick stepped into position to take his turn. Seconds after firing the anti-tank weapon, the West Virginia soldier stood on an embankment to see if he had struck his target and was himself fatally wounded by machine gun fire from the unharmed tank.
As darkness approached and it became apparent that the outdated bazookas assigned to Shadrick’s squad lacked the firepower needed to penetrate the armor of the North Koreans’ Soviet-built tanks, the group returned to regimental headquarters, carrying the West Virginia man’s body. Their arrival caught the attention of New York Herald Tribune correspondent Marguerite Higgins, who had been discussing the day’s action with the officers in charge. She filed a story on Shadrick’s death, describing him as the first American to be killed in action in Korea.
For many months, virtually all publications referred to the Wyoming County soldier as America’s first Korean War combat fatality, but it was eventually determined that at least one other GI was killed earlier that day a few miles to the north.
Meanwhile, back in Charleston later that month, Tamplin and other members of the 167th Fighter Squadron received word that their unit would soon be summoned to active duty with the U.S. Air Force.
“In August, we began transferring to Godman Air Force Base in Kentucky, and by the end of September, we were all there,” Tamplin said.
On Oct. 10, 1950, members of the Air National Guard unit were called to active duty for 21 months. Most members remained at the Kentucky Air Force base until July 1951, when the unit, which flew P-51 Mustang fighter planes, became part of an Air Force fighter-bomber group stationed in England. But before setting up shop in England, tragedy struck.
On April 5, 1951, a member of the 167th, Maj. Woodford “Jock” Sutherland of St. Albans died in a training accident when his stationary P-51 was struck by a taxiing aircraft at Eglin Air Force Base, in Florida.
Two days later, a C-47 transport plane carrying 21 members of the 167th back to Charleston from Godman to attend Sutherland’s funeral was within four minutes of landing at Kanawha Airport when it clipped a hilltop, crashed, and burst into flames, killing all aboard.
Four companies of a West Virginia Army National Guard unit, the 1092nd Engineer Combat Battalion, stationed in Parkersburg and Salem, were ordered into federal service on September 1, 1950, and sent immediately to Korea, where they took part in almost nonstop military campaigns for the next two years.
Twelve pilots from the 167th Fighter Squadron with World War II combat experience were sent to Korea in early 1951. Three, all from Charleston, never returned.
First Lieutenant Roma Carl Foglesong Jr., of Charleston, was killed when the Mustang he was flying on a reconnaissance mission over South Korea was struck by anti-aircraft fire and burst into flames on April 14. Since his remains have never been recovered, he is officially listed as missing in action and presumed dead.
A graduate of Stonewall Jackson High School, Foglesong attended Vanderbilt University and worked for Union Carbide after serving as a pilot during World War II.
First Lieutenant Lee A. Harper flew a Mustang night fighter with the 39th Fighter-Interceptor Squadron while in Korea. During a combat mission on June 19, 1951, Harper’s aircraft was struck by anti-aircraft fire and he was unable to bail out, according to the American Battle Monuments Commission.
A pilot during the North Africa and Italian campaigns in World War II, Harper worked as an agent for the Soil Conservation Service in Charleston before being called to active duty in Korea.
Capt. Harold Ora Keister was flying a B-26B Invader bomber, with two crew members on board, on a night intruder mission over North Korea targeting rail activity and truck convoys on the night of Aug. 30, 1951, when his bomber crashed after being struck by anti-aircraft fire. Three parachutes were sighted in the crash area, but no remains were seen or recovered. He is officially listed as missing in action and presumed dead.
A native of Romney, Keister was a graduate of Morris Harvey College (now the University of Charleston) and worked in a chemical laboratory in Charleston prior to being called to duty in Korea.
By the time hostilities ended with a cease-fire agreement on July 27, 1953, a total of 112,000 West Virginians had served in military roles during the Korean War. Of those, 814 lost their lives and 2,088 were wounded.
The war also produced four West Virginia Medal of Honor recipients. Among them was Raleigh County native Cornelius Charlton, one of 17 children born to a Sophia-area coal mining family. In his mid-teens, Charlton moved to New York City and enlisted in the Army in 1946 immediately after graduating high school.
He served his first term of enlistment as a member of the U.S. occupation force in postwar Germany. After re-enlisting, he joined an engineering unit stationed on the island of Okinawa, wrested from Japan by U.S. Marines and Army troops in the last major battle of World War II.
When war broke out in Korea, he sought a transfer to a combat unit. In early 1951, he was assigned to the all-black 24th Infantry Regiment — the Army’s last de facto segregated combat unit, following Truman’s 1948 executive order designed to officially desegregate the military.
Charlton, by then a sergeant, was soon named a squad leader and a short time later, nominated for a battlefield commission as his leadership skills were noticed. But before that could be processed, the 24th was given the task of clearing a force of Chinese and North Korean soldiers entrenched on the slopes of Hill 543 near the village of Chipo-ri.
On the first attempt to charge up the hill, Charlton’s platoon leader was wounded and evacuated, leaving him to launch the next attack. Charlton led from the front, personally wiping out two enemy firing positions and six soldiers. But the enemy troops rallied and sent a wave of withering return fire at the Americans, pinning them down until Charlton could mount another charge, during which he suffered a massive chest wound caused by an enemy hand grenade.
On a third attack, Charlton led the way again, holding his chest with one hand and his rifle in the other, and reached the top of the hill only to encounter a wave of mortar rounds descending on them from the hill’s opposite slope.
The sergeant made a fourth and final charge alone, and was struck by shrapnel from an enemy grenade, but kept moving forward, destroying the fortified enemy mortar site and clearing away resistance before succumbing to his wounds.
Charlton was posthumously awarded the Medal of Honor for his actions in 1952, but it took another 57 years before he was able to occupy the final resting place to which his act of heroism entitled him — a grave in a place of honor at Arlington National Cemetery.
All Medal of Honor recipients are entitled to burial in those hallowed grounds, but a self-described “clerical error” by the cemetery postponed interment in Arlington until 2008.
Prior to that date, a park in the Bronx, where Charlton spent his last years as a civilian, a bridge on the West Virginia Turnpike, a barracks in South Korea and a U.S. Navy transport ship have all been named in his honor.
West Virginia’s response rate to the 2020 census continues to trail a majority of the country, despite the efforts of multiple groups working across the state to get people counted.
Only 53.3% of West Virginians have completed the census, according to data from the U.S. Census Bureau. Only Alaska, Maine, New Mexico and Puerto Rico have a lower participation rate.
If the response rate doesn’t increase, West Virginians have a lot to lose, said Carey Jo Grace, an organizer with Our Future West Virginia who is leading the group’s census campaign.
“West Virginia is one of the states that is most heavily dependent on federal funding, and a lot of that funding — roughly $7 billion or so — is, right off the top, based only on our census data and our population and demographics recorded by the census count,” Grace said. “If we don’t count every person, we lose out on real dollars. There’s a real effect.”
Fewer people counted could mean less money in the state’s school system and for health initiatives. There also could be less money for nonprofits, which also rely on census data for grants to support feeding programs, after-school programs, homeless shelters and more.
“Less counted is less for us, and that is a real risk if we don’t step up,” Grace said. “Also, wouldn’t it be great to show that there are more people here than others think? Because there certainly are.”
As of Friday, Jefferson County had the state’s highest percentage of census participation, with 68.1% of residents there responding. McDowell County, with 22.5% responding, was last in the state.
In McDowell and other rural counties, areas not easily accessible make door-to-door visits difficult, Grace said. Those areas also tend to have limited internet access, which further complicates the effort since this is the first time the census is being conducted mostly online.
Donald Reed, director at the McDowell County Commission on Aging, said organizers in the area are using social media to try to connect to people and educate them on the census.
“A lot of people, even if they don’t have access to regular broadband, they can usually get on social media one way or another, on their phones or something,” Reed said. “We’ve seen some feedback there, but there are probably quite a few people here who haven’t even heard or been contacted for the census.”
Part of that is likely due to COVID-19, which eliminated the opportunity for organizations to conduct door-knocking campaigns, Grace said.
In McDowell County, hundreds of census mailers never made it to residents, as the federal agency used physical addresses — which in many rural communities aren’t used for mail — instead of P.O. boxes.
The Appalachian District of the United States Postal Service responded to concerns about the failed mailings in a letter to Sen. Joe Manchin, D-W.Va., writing there had been no wrongdoings.
“If the Census sends something incorrectly addressed [using a physical address instead of a P.O. box], the office has no way of knowing who the customer is,” the letter reads. “Census mailings do not contain the citizen’s name, just an address.”
Grace said this issue exists in many of West Virginia’s rural communities. Combined with limited online access and the challenges of the coronavirus, that could mean those areas are drastically undercounted in 2020.
“And absolutely, these are the places we need to count most — our rural communities, our Black and minority communities. Not counting them robs the people there of chances for more opportunity, more investment in their communities,” Grace said.
The census coalition at Our Future — dubbed CountMeInWV — started working before the COVID-19 pandemic to get volunteers settled around the state and educating their respective communities.
Currently, there are 20 fellows doing this, and all had to rework their approaches in March when the pandemic led to statewide shutdowns.
Now, instead of in-person sessions and meetings, Grace said the fellows are working with schools to get information to those registering students. They’re hosting raffles, where people are entered for prizes if they show proof of filling out the census. Some are working at food pantries and food banks, setting up computers if needed so people can fill out the census there. They’re at recovery sessions and health clinics, connecting people to more resources.
“They really are doing a bang-up job,” Grace said. “We couldn’t ask for better given these circumstances, but there’s still a lot to do.”
On top of potential losses in federal funding, West Virginia could lose a seat in the U.S. House of Representatives if population counts in the 3rd District — which includes the southern coalfields — remain low.
Representation at the state legislative level could also be affected.
“People don’t want that, they want direct representation from people in their area,” Grace said. “In other places, they won’t know the need as well. That, for us, has been a big motivator for some people participating.”
In McDowell, Reed worries what will happen if more people aren’t counted. In 2010, a year where West Virginia had a 59% response rate, McDowell County had the second-lowest participation rate in the state after Pocahontas County, which is also mostly rural and home to many hard-to-count areas.
Reed said he doesn’t know what would have been different in the past 10 years if those rates had been higher, but he suspects things could only have been better for struggling counties like McDowell. Now, he wants to ensure the next 10 years aren’t the same.
“The local economy would have had more money to go around, and I hate to say this, but it does all tie back to money. We could have seen better roads, better services for our people, maybe even a better reputation,” Reed said. “I am concerned what the census count will do to our funding for the next 10 years. This is not an issue that next year we can do better at or fix. This is our one opportunity for a decade. The magnitude of getting that correct count — I can’t put it into words.”
To fill out the census, visit https://2020census.gov/ or call 844-330-2020 to respond by phone. The deadline to respond is Oct. 31, 2020.