When Governor Parson signed the Missouri State Budget on June 30, 2023, he line-item vetoed an increase to nursing home oversight funding that would have transformed the lives of nursing home residents throughout the state.

The Legislature budgeted a $2.2 million increase for the Long-Term Care Ombudsman Program, which would have translated to 24 new Regional Ombudsman Coordinators (ROC) throughout the state to visit nursing home residents and help resolve problems they are having with the facility, their families, and others. Ten new ROCs would have joined the VOYCE team in the St. Louis and Northeast Missouri regions. This increase would have brought the program to federal standards of having one ROC per 2000 residents. There is about one ROC for every 5000 residents in the area that VOYCE oversees.

Nursing homes in Missouri have been in crisis for many years, going without crucial staff members, allowing buildings to crumble, and witnessing an influx of new owners with an eye only on profits. Residents frequently go without bathing for over a week, are not turned often or brought out of bed unsafely, are left in their rooms for days on end, and even miss or receive reduced meals.

Missouri has the 7th highest percentage of problem facilities in the country, with 30.4% of our skilled nursing facilities earning a one-star rating from the Centers for Medicare and Medicaid (CMS) or being on CMS’s Special Focus Facility list or candidate list.

For the past several years, Missouri has claimed the spot of 50th in the nation for hours of care per resident per day, with 3.14 hours in the third quarter of 2022. The national standard is at least 4.1 hours per care per day to avoid adverse outcomes. Of 491 skilled nursing facilities, only 71 meet this standard.

Missouri rates second in the nation for providing antipsychotic drugs to long-term care residents. These drugs are prescribed to people with schizophrenia, Huntington’s Disease, or Tourette’s Syndrome, which affect 2% of our nation’s population. In Missouri, 28% of nursing home residents receive these dangerous drugs carrying black box warnings against their use in older adults. Instead, they’re used to sedate residents who cause too much trouble for the staff.

Ombudsmen visit long-term care residents regularly, get to know them, and help them when they encounter some of the problems listed above and more.

With additional nursing home oversight funding:

  • Ombudsmen could have visited at-risk long-term care facilities weekly and other facilities every other month, tripling their visits, resolving more complaints and making residents safer.
  • Ombudsmen could have created more resident and family councils to harness the power of group advocacy among those living in long-term care to obtain better conditions.
  • Ombudsmen could have been able to recruit more volunteers who would monitor their assigned facilities weekly and form strong bonds with residents.
  • Ombudsmen could have been able to provide more crucial training for new long-term care facility staff about the rights of residents in long-term care, the dangers of antipsychotic drugging, proper procedures, and more.

As a society, we must ensure that vulnerable populations receive the dignity of having independence, say in care, choices, and respect.

To Governor Parson- In your 2024 budget proposal, you said you would ensure quality services to Missouri’s most vulnerable citizens, but now those most vulnerable will go on to receive some of the worst nursing home care in the nation.


  1. 1
    Laraine Lamb on July 7, 2023

    MS. Moore.
    Thank you for your response to Missouri’s governor’s lack of caring for individuals residing in long term care facilities. He overlooks them because he thinks they will not vote and are not activity members of society. His empathy towards them reinforces what I’ve thought of him as a progressive leader for the duration of his governorship.

    Thank you for speaking up! I’m a former Regional Ombudsman for five years in the state of Arkansas. I have seen everything! I have returned to Missouri, my home state, and have resided here for the past three years.

    How we treat Elderly in America is a disgrace! Please continue your advocacy for our seniors who do not have a voice. I’m forwarding your message to Martha Deaver, advocate in the state of Arkansas who continues her march for seniors’ rights in long term care.

    I live in Mexico, Mo but am from st. Louis originally. If I can be of help, my number is 501.701.3979.
    Laraine Lamb

    1. 2
      Marjorie Moore on July 7, 2023

      Thank you Laraine!
      We can always use advocates to speak up for long-term care residents state-wide! We have something really exciting coming soon, so we will be in touch!

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