For the second time in two years, Gov. Mike Parson has vetoed multimillion-dollar funding increases that would support a program advocates say safeguards nursing home residents.
Missouri’s long-term care ombudsman program organizes workers and volunteers to advocate for and educate residents at the state’s hundreds of nursing homes and skilled nursing facilities.
The program has fewer than half the recommended staff members, administrators said.
That puts strain on the workers and volunteers who serve the people who live at 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, intermediate care, skilled nursing facilities, and then veterans homes as well, across the state,” she said. “When you're looking at that many facilities for you ... that's an incredible amount of work. And it's just really stretching people way too thin.”
Through ombudsman’s visits, residents have an accessible way to solve issues.
The state’s ombudsman program has 19 full-time employees for Missouri’s hundreds of homes. That’s fewer than half the staff health experts recommended even 30 years ago, Hollandsworth said. The program also has about 90 volunteer workers.
People who work or volunteer for the program can help residents resolve complaints with staff, can advocate for residents who aren’t being bathed and helped to the bathroom enough, Hollandsworth said.
Often an ombudsman helps residents when nursing homes transfer them to other facilities, letting people in homes know that they have a right to choose where they are moved and that a center should have a legitimate reason for transferring a resident.
Even with a mostly volunteer workforce, the approximately $300,000 annually the program receives from the state isn’t enough, advocates said. The program also receives funding from federal sources, including through the Older Americans Act and the American Rescue Plan Act.
In 2023, the legislature asked for an increase in state funding of $2.2 million for the program, which the governor vetoed. In 2024, the lawmakers asked again, this time for $2.5 million.
Parson again nixed the request, writing in a letter explaining the cuts that the program has an important role but that there wasn’t enough money in the budget to fund the increase.
The $2.5 million could cover salaries, benefits, rent and mileage for driving to different facilities, Hollandsworth said, adding paid workers are necessary to coordinate and recruit volunteers.
The appropriations bill indicated the money for the increase could come out of a federal funding source under the state’s budget, Hollandsworth said. But there wasn’t money in that federal source.
The funding increase “got put in the wrong bucket,” 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 grow more important as the state's population ages, she said. There are more than 1 million Missourians over 60, according to the Missouri Department of Health and Senior Services. Census estimates indicate that in a little more than five years, older Americans could outnumber minors.
“We need to look at our elder care system,” Moore said. “That system needs to grow.”
VOYCE has a contract to handle the ombudsman duties. But it has one half-time employee covering 16 counties in northeast Missouri.
The ombudsman program is particularly difficult to run in rural parts of the state because of the number of facilities and the distance between them, said Debbie Blessing, head of the Northeast Missouri Area Agency on Aging.
Residents can be afraid to bring up problems with nursing home operators, Blessing said.
“I find that older adults don't tend to always speak up for themselves,” she said. “And so having someone in between who can be that intermediary person can be very helpful.”
