Monica McAfee stands in her yard in Ravenswood, holding a photo from her wedding day. Shortly after her husband died, McAfee moved from Ravenswood to Georgia to spread her husband's ashes. Lauren Peace photo

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This is the first of two stories about the COVID-19 deaths of West Virginia nursing home residents. Read part two here.

Monica McAfee and her husband, Lawrence “Mac” McAfee, had plans. They were going to head back south to Georgia, where they met 25 years ago. 

Then, in early April, Mac got sick. The coronavirus had made its way into the Ripley nursing home where he lived.

By April 10, four days after the nursing home reported its first case, the Jackson County Health Department rejected Gov. Jim Justice’s decision to classify the county as a “hotspot” for the virus. At the end of the month, 71 of the 86 residents at Eldercare Health and Rehabilitation were positive for COVID-19. 

By early May, Mac McAfee and 14 other residents were dead.

Monica McAfee moved back to Georgia by herself — to spread her husband’s ashes. He was 58.

“People think it’s all old people in these homes that are going to die,” she said. “It’s not. My husband was 58 years old. He was living. He was alive.”

Since the beginning of the pandemic, nursing home residents were known to be particularly vulnerable to the virus. As of Sept. 21, at least 130 of West Virginia’s 312 reported COVID-19 deaths have been nursing home residents. But families of residents and former employees at Eldercare said the administration’s inaction and secrecy put residents in harm’s way.  

Six former and current employees, along with five families who had relatives who died after contracting the virus at Eldercare, allege the nursing home’s communication failures prevented them from making informed decisions about their loved ones’ care. 

One former employee filed a lawsuit against the nursing home in July, saying he was fired after administrators suspected he went to the local health department to advocate for patients. That lawsuit follows five others filed by former employees against the nursing home since 2017. 

Eldercare did not reply to multiple requests for comment. In responses filed to the most recent lawsuit against the facility, Eldercare and its administrator acknowledged that employees had been called in to discuss an anonymous tip left with the county health department. Eldercare denied most other claims.

Dr. John Snyder, head of Jackson County Health Department, said in an interview with Mountain State Spotlight that his team rejected the governor’s decision to classify the county as a “hotspot” because the surge of new cases at the time had been linked to closed facilities, like Eldercare. Snyder said the department had been tracking cases and there was no sign of broader community spread, but said that the county reported all cases to the relevant state agencies upon identification.

Monica and Mac

It was Monica McAfee’s birthday the night she met Mac. He was a mechanic. She was a waitress. The two had a drink at a bar next to the restaurant where she worked.

“I was out with my friends,” said Monica. “We met that night and were together ever since.”

Both were in their late 20s and had previous marriages. She had three kids and he had one, but they decided to merge their families a year after they met, and drove up to Chattanooga, Tennessee, where they married in a court.

Monica McAfee shows a photo of her and her husband ‘Mac’ on their ten-year anniversary, when they renewed their vows at a church in Georgia. Mac McAfee was one of 15 residents to die from COVID-19 after contracting it at Eldercare. Lauren Peace photo

Mac liked to joke that he took his new wife on a cruise for their wedding. He’d say, “we cruised on up to Chattanooga and cruised right back,” but the couple promised each other if they made it 10 years they’d marry again in a church.

On their 10-year anniversary, they did. She wore a white dress with half-sleeves and a pearl necklace. He wore a tux with a red satin vest and bowtie to match.

“We invited all our family and friends. People were worried about what they were going to wear,” said Monica. “Wear whatever you want. We just wanted everyone there.”

By the time the two moved to Monica McAfee’s native West Virginia, her husband’s health had begun to decline.

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Monica McAfee laughs while recalling the night she and her husband moved to her hometown in West Virginia from Georgia where the couple met, and her husband’s first-impressions of his new home.

Mac had overcome addiction when he was younger, but the drugs and alcohol had taken a toll on his heart and liver. He had a heart attack, followed by a stroke.

“It almost killed him. I thought we were going to lose him,” Monica said. “But he survived.”

The aftermath left Mac blind and in a wheelchair, but his personality was still there. For a while, the McAfees hired aides to come and help care for him at their house near Ravenswood. But soon it became clear that Mac needed more specialized attention.

In 2015, he moved to Eldercare, about 13 miles southeast of the McAfees’ home. It was close enough for daily visits, and that made Monica feel safe.

But as she spent more time visiting her husband at the 120-bed facility, Monica said she started to feel bothered by the quality of care. Mac would frequently complain that staff members were ignoring him. He relied on assistance for basic needs like using the restroom. He would ring a bell to call an aide for help, but there would be long delays before anybody came.

“I would go sometimes and you couldn’t find a nurse, then they wondered why he had wet or soiled briefs,” said Monica. “They were always understaffed, on the night shift, especially.”

One time, Monica said her husband called to tell her that when he asked an aide for help using the restroom, he was told that he “better get to the bathroom the best damn way he knew how.”

Mac McAfee stands with a catfish he caught shortly after moving to Ripley, West Virginia. Photo courtesy Monica McAfee

She began to voice her frustrations with the nursing home. She said she filed written complaints with Eldercare, but she doesn’t know what became of them. She considered moving her husband to a different care facility, but didn’t feel like she had local options. That’s one of the reasons the couple were planning to move back to Georgia this year.

But in West Virginia, Monica said Eldercare was the best option for her and her husband. So he stayed at the facility, and she began spending more time there to advocate for his care.

“I made it known that I was there to protect my husband,” she said. 

In mid-March, Monica McAfee received a letter in the mail. To protect residents from the potential spread of coronavirus, visitors would no longer be allowed. 

In the month that followed, according to Monica, staff at the facility assured her of her husband’s safety, but phone calls with her husband contradicted those assurances.

‘I’ll never understand’

On April 3, 2020, Todd Kimble, the administrator of Eldercare Nursing and Rehabilitation said in an interview with Jackson Newspapers that stringent health protocols were being put in place at the home.

“We were proactive,” Kimble told Jackson Newspapers. “Our top priority is to keep our patients and residents safe. They deserve the highest level of care at all times, but now more than ever.”

Three days later, the virus had entered the facility. 

Eldercare Health and Rehabilitation in Ripley became site of one of the deadliest single-site COVID-19 outbreaks in West Virginia when 15 residents died after contracting the virus at the home. Lauren Peace photo

According to Eldercare, officials notified the local health department as soon as a positive case was identified. But a lawsuit filed by Matthew Williams, a former cook at the nursing home, alleges the report was delayed.

Williams said he was brought into Kimble’s office on April 5. There, Williams said, he was falsely accused of anonymously reporting positive COVID-19 cases at Eldercare to the county health department. 

Williams was fired the next day.

Snyder, the head of Jackson County Health Department confirmed that a voicemail had been left with the department regarding potential cases at Eldercare, but said that it was unclear how that specific information got back to Kimble.

In response, lawyers representing Eldercare confirmed that the questioning took place, but they said Williams was fired because of poor performance. He was issued two write-ups following the conversation about the anonymous tip. 

Williams later said that one was for storing his beverage in a facility cooler. The other was for not cooking meat the day before it was going to be served to residents. 

“I just don’t see how you can be fired for that,” said Williams in an interview with Mountain State Spotlight.

Williams said losing his job during the pandemic has been hard. He lost his house and has since moved into an RV. What’s weighed on him most is not being able to see the residents.

Matthew Williams in front of the RV where he lives in Ripley, WV on Tuesday Sept. 1, 2020. F. Brian Ferguson photo

“I loved my job because of them,” said Williams. “We were family. I just want the residents to be safe.”

Six families of residents at Eldercare said in interviews they weren’t called and notified that the virus was in the nursing home until April 9. That’s three days after Eldercare said it had notified the health department that COVID-19 had entered the facility.

At Sundale Nursing Home in Morgantown, the site of the first COVID-19 outbreak in the state nearly a month earlier, families were notified within 24 hours of the first resident testing positive. Soon after, press briefings and Zoom video calls were scheduled by the home to keep families of residents informed. Residents and staff at Sundale were all tested within a week of the first positive, regardless of symptoms. 

When Eldercare reported its first positive case of COVID-19 to the local health department, CDC guidelines did not recommend seeking testing for asymptomatic patients. Eldercare officials said that they were adhering to those recommendations and did not conduct facility-wide testing. But in West Virginia, the precedent for widespread testing had already been set.

Families of Eldercare residents said they were kept in the dark.

Teresa McCroskey Starcher, whose mother died after contracting COVID-19 at Eldercare, said she received little information from the facility, despite calling daily to ask for updates.

“The week leading up to [Mom’s death] was nothing but lies,” said Starcher. “From how many residents were positive to how many staff had it… they wouldn’t give an honest answer.”

Starcher said after the governor mandated testing, she called the facility to ask for the numbers after listening to a daily briefing during which the positives were announced.

“I played stupid and I called right after that press conference and asked for the numbers,” said Starcher.

Starcher said the person who she spoke with told her she didn’t think the nursing home had any employees who tested positive. 

Families of Eldercare residents said even when their family members were ill, the facility didn’t act. 

Like Starcher, Brenda Barefield’s mother was a long-time resident at Eldercare. She got sick and died of COVID-19 on April 18, just one day after she was tested because of the governor’s mandate. 

Barefield said her mom had been showing symptoms for weeks. 

“The last time I FaceTimed my mom was March 22. That was her birthday,” said Barefield. “Her face was so swollen. She didn’t have a real full face, but her face was big [that day].”

Barefield said she called and asked the facility to test her mother for COVID-19 that week. They tested her for the flu instead, and that result came back negative.

“That was on the 29th [of March],” Barefield said. “She was running a fever and tested negative for the flu. They should have tested her right then. Then maybe she would have had a chance.”

The story for Monica McAfee’s husband, Mac, was similar.

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Monica McAfee reads from her calendar and remembers the conversations she had with an Eldercare employee and her husband the week before he was tested for COVID-19.

McAfee said for more than two weeks after the first case was reported by Eldercare, her husband told her over the phone that he was experiencing symptoms.

“I begged them to get him tested,” said McAfee. “They kept telling me he was fine.”

Monica McAfee stands in her home in Ravenswood three weeks after her husband died of COVID-19. He was 58-years-old. Lauren Peace photo

McAfee has always kept detailed calendars.

On April 14, she wrote, “Mac called and said he was having headaches and asking for medicine but that nobody was coming to his room to check on him.”

The next day, she penned in pink ink, “Mac called. He was hoarse and couldn’t breathe.”

A day later, McAfee said that her husband called and said he was still having trouble breathing. McAfee said she spoke to a nurse.

“She told me he couldn’t breathe because he was wearing a mask,” said McAfee.

That same day, Justice was notified of the outbreak at Eldercare, and the governor soon mandated testing at nursing homes across the state.

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Monica McAfee recalls the days leading up to her husband’s death. “He was the best,” McAfee said.

Mac’s test came back positive. He died at Charleston Area Medical Center less than two weeks later. McAfee and her family watched from an iPad as the nurses took him off life support.

Next from Mountain State Spotlight: Nursing homes in West Virginia were easy marks for the coronavirus pandemic. Find out why.

Lauren Peace is a Report for America Corps Member who covers public health.