Missouri Governor Again Vetoes Funding Increase for Understaffed Nursing Home Advocates

For the second time in two years, Gov. Mike Parson has vetoed a multimillion-dollar funding increase that would support a program that advocates say protects nursing home residents.

Missouri’s Long-Term Care Ombudsman Program organizes staff and volunteers to advocate for and educate residents of the hundreds of nursing homes and skilled nursing facility management facilities in the state.

According to administrators, the program has less than half the recommended number of staff members.

That puts a huge strain on the workers and volunteers who serve people in Missouri’s approximately 1,100 long-term care facilities, said Jenny Hollandsworth, the state’s long-term care ombudsman.

“We go into residential care facilities, assisted living facilities, intermediate care facilities, nursing facilities, veterans homes, all across the state,” she said. “When you look at that many facilities … it’s an incredible amount of work. And it’s just way too much work for people.”

Ombudsman visits allow residents to solve problems in an accessible way.

The state’s ombudsman program has 19 full-time employees for its hundreds of homes in Missouri. That’s less than half the staff that health experts recommended even 30 years ago, Hollandsworth said. The program also has about 90 volunteers.

People who work or volunteer for the program can help residents resolve complaints with staff and advocate for residents who are not getting enough bathing and toilet assistance, Hollandsworth said.

Often, an ombudsman helps residents when they are transferred from a nursing home to other facilities. He lets the residents know that they have the right to choose where they are transferred and that a facility must have a legitimate reason for transferring a resident.

Even with a largely volunteer workforce, the roughly $300,000 the program receives annually from the state isn’t enough, advocates say. The program also receives funding from federal sources, including through the Older Americans Act and the American Rescue Plan Act.

In 2023, the Legislature requested a $2.2 million increase in state funding for the program, which the governor vetoed. In 2024, lawmakers asked again, this time for $2.5 million.

Parson again denied the request, writing in a letter that the program plays an important role but that there was not enough money in the budget to fund the increase.

According to Hollandsworth, the $2.5 million can be used for salaries, benefits, rent and travel expenses to the various facilities. He added that paid staff is needed to coordinate and recruit volunteers.

The budget bill indicated that the money for the increase could come from a federal funding source under the state budget, Hollandsworth said. But there was no money in that federal source.

The funding increase “was put in the wrong category,” said Marjorie Moore, executive director of VOYCE, a St. Louis-based organization that advocates for nursing home residents and their families. Other funding could be used for the program, she said.

The program will become more important as the state’s population ages, she said. According to the Missouri Department of Health and Senior Services, there are more than 1 million Missourians over the age of 60. Census estimates indicate that in just over five years, the number of older Americans could surpass the number of minors.

“We need to look at our elder care system,” Moore said. “That system needs to grow.”

VOYCE is contracted to perform the ombudsman duties, but it has one part-time employee who covers 16 counties in northeastern Missouri.

According to Debbie Blessing, director of the Northeast Missouri Area Agency on Aging, the ombudsman program is particularly difficult to implement in rural parts of the state because of the large number of facilities and the distances between them.

According to Blessing, residents are sometimes afraid to discuss problems with nursing home managers.

“I find that older adults don’t always advocate for themselves,” she said. “So having someone in between them who can act as a mediator can be really helpful.”