Jefferson City, Missouri — When Miranda Malone realized something was wrong at her mother’s nursing home, it was already too late to prevent the worst.
Her mother, who had Parkinson’s disease, had been losing weight throughout the COVID-19 pandemic — a period when family visits were banned. By the time Malone got her mom to a specialist, the infection from an untreated bedsore had spread to her bones. Her mother chose hospice care and died in December 2020. The only explanation Malone ever received was that the facility had been short-staffed during COVID.
“That’s not good enough for me,” Malone said at a recent Senate committee hearing. “I’m sorry. That’s just not good enough.”
Her testimony came as Missouri lawmakers are pushing legislation that would sharply increase penalties for elder abuse and neglect in long-term care facilities — and require nursing homes to carry liability insurance for the first time.
What the Bill Would Do
Sponsored by Republican state Sen. Adam Schnelting of St. Charles, the proposal would:
- Elevate caregiver abuse or neglect in a long-term care facility to a class E felony — currently it’s only a class A misdemeanor for any person
- Require facilities to carry liability insurance of at least $1 million
- Force the Missouri Department of Health and Senior Services to publicly flag facilities with confirmed abuse or neglect findings — displaying a symbol on its website along with a summary of each incident for three years after the most recent confirmed finding
Schnelting has pushed similar proposals in 2024 and 2025, without success. He said the bill would help families get compensation and closure when their loved ones are harmed — and stop facilities from hiding behind a lack of assets.
“When someone gets hurt or their loved one gets hurt, facilities shouldn’t be able to say, ‘Well, you’re out of luck. I don’t have any insurance,’” he said.
Schnelting’s own motivation isn’t abstract. His mother died in a rehabilitation facility after a stroke, and he says she suffered unexplained head injuries there. “It looked like someone had punched her multiple times in the face,” he said.
The Stakes Are High in Missouri
Missouri’s track record on nursing home care gives the bill added urgency. According to federal data from CMS, Missouri nursing home residents receive just 1.14 hours of licensed nursing care per day — the lowest in the country. That’s a staggering drop from 3.37 hours recorded just a year earlier. AARP ranked Missouri’s long-term care facilities 47th for safety and quality in 2023. U.S. News ranks the state dead last — 50th — in nursing home quality.
It’s a pattern that researchers have consistently tied to worse resident outcomes. Understaffed facilities report significantly higher rates of serious fall injuries, and experts have long argued that inadequate nurse staffing is one of the clearest predictors of poor care quality.
Industry Pushback
Not everyone is on board. Industry representatives warned that a mandatory liability insurance requirement could push smaller and rural facilities toward closure. One operator told the committee his annual premium jumped from $73,000 to $230,000 in a single year because of his location in what insurers consider a litigious market.
Nikki Strong, speaking on behalf of a nonprofit representing long-term care facilities in the state, said mandating liability coverage would cause premiums to “skyrocket.”
But supporters pushed back. Dr. Jana Opperman-Bendt, who owns a small long-term care facility herself, said she was “appalled” that facilities aren’t already required to carry liability insurance. “Should something go wrong with any of these individuals that I care for, I want my families to have protection,” she said.
What Comes Next
The bill remains in committee. Schnelting has invited industry stakeholders to work with him on a compromise, particularly around the insurance threshold. Whether that leads to changes — or a third consecutive year without a law — remains to be seen.
For families like Malone’s, the wait feels long overdue. “This bill will help families,” she said, “because when you try to go and fight to get accountability and get transparency, there are walls there.”
