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Pushing for More Long-term Care Oversight Funds in Missouri

woman sitting and talking to another woman
Lisa Smith, the lead ombudsman for the city of St. Louis, works on behalf of residents at nursing homes or assisted living facilities to help resolve complaints and ensure quality of care.
Photo by Theo Welling

Residents going for weeks without a shower. Cockroaches, mice and other pests in bedrooms and common areas. Unexpected and inaccurate bills.

Those are some of the complaints long-term care ombudsman Lisa Smith investigates at nursing homes and assisted living facilities in the St. Louis area. She travels about 100 miles and visits eight to 10 facilities each month.

But Smith is only able to do that much thanks to outside grant funding. Many long-term care ombudsmen in the state lack such financial resources.

The Missouri Long-Term Care Ombudsman Program has been chronically understaffed, and advocates are urging the state to increase funding. The General Assembly in May approved $2.2 million in additional spending for the program as part of the fiscal 2024 state budget. But the funding boost was among $555.3 million in proposed state spending that Gov. Mike Parson (R) vetoed at the end of June. The final approved budget totaled approximately $51.8 billion.

In announcing the finalized budget, Parson said in a statement: "With this budget, our administration has done the right thing – the conservative thing – to make strategic investments and maintain responsible spending."

Long-term care ombudsmen investigate complaints, educate residents and families about their rights and help them assert those rights, among other duties.

AARP strongly advocated for the extra ombudsman funding and was disappointed the governor vetoed it, says Jay Hardenbrook, associate state director of advocacy for AARP Missouri.

“We will continue to push for funding for this vital program in next year’s state budget,” Hardenbrook says.

The state’s program has long been unable to meet the recommended industry standard of one ombudsman for every 2,000 long-term care beds. Missouri has less than half of the paid staff needed to meet that standard, and has struggled to adequately cover the state’s 84,000 long-term care beds — despite increases in federal funding over the years, says Jenny Hollandsworth, the state’s top ombudsman.

The state allocates about $300,000 in general revenue funds annually to the ombudsman program, Hollandsworth says.

But staffing shortages have remained persistent — forcing difficult choices such as prioritizing visits to nursing homes over assisted living facilities, she says. More funding would allow the program to hire additional staff and reach a lot more people, Hollandsworth notes.

Training more volunteers

Advocates say additional money is also needed to train volunteer ombudsmen, who visit care facilities weekly or biweekly and play an important role in extending the program’s reach across the state.

“Missouri’s ombudsmen volunteers have been carrying the weight in identifying problems in long-term care throughout the pandemic,” says AARP Missouri’s Hardenbrook.

Smith, the St. Louis ombudsman, has seen firsthand the difference more funding can make. The St. Louis City ombudsman program is able to meet the goal of one ombudsman per 2,000 beds with the help of grants from foundations. She’s been able to train more workers, make more visits to facilities and get to know residents better.

“They’re happy to see me, and they know I’ll be back,” she says. “When the staff knows I’m around more, it builds credibility. It really is a more thorough way to do my job.”

Other ombudsmen around the state don’t have the same advantage. In nearby St. Louis County, for example, three full-time and one part-time ombudsmen oversee facilities with a capacity of more than 18,000 beds.

Many residents at long-term care facilities have no one else to speak for them, says Marjorie Moore, executive director of Voyce, a nonprofit that the state contracts with to oversee ombudsmen in several regions in the state, including the St. Louis area.

“They’re people who’ve outlived their families, live far away or may not talk to their kids,” Moore says.

Tim Poor is a writer living in Clayton, Missouri.

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