Every day, LaRanda Schoolcraft drives five minutes down the hill from her Terra Alta home to visit the family member she calls her "person."

"My grandpa has dementia now and doesn't always make sense," she said. "But I see the care he receives every day, and I ride the emotional rollercoaster beside him."

Carl Schoolcraft, originally from Clendenin, has a white beard that nursing home workers keep well trimmed. He used to dress as Santa Claus each year.

His granddaughter says the nurses and aides at Hopemont Hospital see him as their adopted grandfather.

Last month, Gov. Patrick Morrisey announced the sale of this state-owned nursing home and the three others to a private company.

And while the company says it has no plans to cut staff, public records show it employs fewer nursing staff on average at its facilities in other states than are employed at the state's hospitals.

For people like Schoolcraft, living at home until the end of life isn't an option.

With few family members left, Schoolcraft lived alone, but his granddaughter checked on him every day. Earlier this year, she arrived to find the man who built her a treehouse beyond her ability to care for him, and she moved him to the state-owned nursing home.

He was diagnosed with a fatal brain disease that causes dementia and other problems like confusion and trouble with mobility.

During a recent visit, she found him making his way down a well-traveled linoleum hall and told him she would wheel him to his room for their daily talk.

She told him about a trip she's planning and asked him how he likes the workers.

"I ask them about their lives," he said. "I ask them about their loves. I ask them about their happies."

Other nursing home options were more than an hour away from her, so she wouldn't have been able to visit as often.

And when he was first diagnosed about six months ago, he was combative, and a private nursing home in nearby Kingwood wouldn't accept him.

"Deciding to put him there was the hardest decision I've ever had to make," she said. "And it was awful to come to that decision. But if there's anything that was of consolation or that did make it better, it is the staff that's there."

She said she knows the facility could use upgrades and more workers. She sees single employees feeding two people at a time on a daily basis.

But she knows he would have wanted to be close to her.

"I'll be able to sleep at night," she said. "I'll know that I was there, and I did everything he would have wanted."

The nursing homes being sold are Hopemont Hospital, Jackie Withrow Hospital in Beckley, Lakin Hospital in West Columbia in Mason County and John Manchin Sr. Health Care Center in Fairmont.

West Virginia opened the historic buildings to meet the urgent health needs of their times.

State lawmakers passed an act in 1911 to build Hopemont Hospital for the isolation of tuberculosis patients.

Jackie Withrow Hospital in Beckley originally served people with that infectious disease as well.

In 1899, lawmakers passed a law requiring hospitals to be built for people who worked in dangerous industries. The Fairmont site where the John Manchin Sr. Health Care Center is located was once the location of Miners Hospital Three, where victims of mining accidents were treated.

And Black delegates in the West Virginia Legislature proposed the creation of Lakin Hospital during the era of segregation to serve as the state's Black mental hospital.

All four became state-run nursing homes, often serving people who couldn't pay for care or whom private companies wouldn't accept.

Morrisey announced the $60 million sale of the health care facilities on Aug. 12. He said they were operating at a $6 million yearly loss to the state.

The nursing home company Majestic Care will run the nursing homes.

Company officials have said they are in the early stages of evaluating the construction of three to five new facilities, although they haven't said where or when.

But residents in Majestic Care's nursing homes in Michigan, Ohio and Indiana receive around an hour less nursing care per day on average than residents at the state's four hospitals, Hopemont, Jackie Withrow, Lakin and John Manchin, according to federal health agency reports.

Lower staffing levels increase the risk of falls, bedsores, missed medications, infections, behavioral health crises and emergency room visits.

Majestic officials said the company meets all state and federal staffing requirements and that it offers competitive pay and benefits.

"Staffing levels are only one measure," they added. "Equally important is how we invest in training, recruitment, and resources, so staff can deliver safe, compassionate care."

Despite Majestic Care's staffing level track record, Morrisey said he expects to see patient care improve.

"I think you're going to get the benefit of having a company that does this for a living, as opposed to having a government that really shouldn't have been in the business in the first place," he said.

Gailyn Markham, spokesperson for the Department of Health Facilities, said health officials also believe the company is well-equipped to provide patients with better care amid a nationwide nursing shortage.

Mary Stein-Johnson feels like she grew up at Lakin Hospital, where she works as a nurse. Her mother worked there before her, so she knew the employees and residents well.

Patients live their lives there too. She said that many patients have serious mental illnesses or disabilities, and some are deemed too difficult to care for by private companies.

She used to work in the private sector and remembers severe understaffing and companies picking and choosing patients with fewer needs.

"My mother's words to me when I was considering it were, 'go back to Lakin, Mary, the state's always taken care of me,'" she said. "Well, the state's not taking care of us now."

Many of Lakin's patients have been accused of crimes but were too ill to understand the charges, or they show aggressive behaviors associated with their illnesses.

She predicts a private provider will release patients, and they'll end up in jails or homeless shelters.

Pastor Leah Starkey said she shows up to minister and finds patients have drawn her pictures. One woman who used to never speak now gives her regular hugs and prays for her. One man is training to teach his own Bible study courses.

She's also called to minister when patients are on their deathbeds, and she'll ask if she can expect family to be there.

"A lot of times that's when they'll tell me there is no family," she said. "That is their family. That is one of my concerns. Are they going to keep them all together?"

Stein-Johnson said the health and retirement benefits she has been offered are so inferior in comparison to state benefits, they're essentially equivalent to a pay cut.

Majestic officials said the company is offering jobs with no pay cuts to all employees, as well as health insurance, retirement, paid time off and other perks like a relief fund, leadership development, sign-on bonuses and tuition reimbursement.

"Our goal isn't just to keep staff," the company said in a statement. "It's to help them grow and thrive with us."

They've also said they will keep current patients.

In Rivesville in Marion County, flags line the streets with the names and faces of "Hometown Heroes."

Across from City Hall, one waves for Andrew Dorsey, a coal miner and Purple Heart veteran who served in World War II and lived out the last of his 92 years of life at the John Manchin Sr. Health Care Center.

Like the miners who stayed there a century before him, he died in the care of the state after developing black lung through years of inhaling coal dust.

He also had hearing loss and was starting to fall often.

His son, Mark Dorsey, lives a few minutes away from City Hall, and about ten minutes away from the center.

Dorsey, a retired coal miner himself, said his dad liked to hunt, fish and bowl.

He didn't talk much about the war.

He wasn't a big talker at all really. But he wouldn't have kept quiet about any mistreatment.

And because the center was so close, Dorsey was there every day, so he was able to spend time with his father at the end of his life and also monitor staff.

"It wasn't just a job for them," he said. "They actually care about the people there."

He noted that private companies are different from state programs because they are motivated by profit.

"They're not buying it to lose money," he said. "Is that what their game is? And if it is, you know, they're going to cut staff, and the health care is not going to be as good."

Dorsey said the rest home has a strong reputation among families in the area.

Even so, residents have regularly had to come out and protest the potential sale of the center when state officials have considered it in years past.

This story was originally published by Mountain State Spotlight and distributed through a partnership with The Associated Press.

West Virginia residents concerned after state nursing homes sold to private company