The first warning sign that all was not well with Miranda Malone’s mom was that she had lost a lot of weight.
It was June 2020, and Malone, of St. Charles County, hadn’t been able to visit the nursing home where her mom was receiving care for Parkinson’s disease since the beginning of the COVID-19 pandemic. Malone told The Independent she discussed upping her mom’s protein intake with the nurses, but her mom only got thinner and developed a bedsore.
Three months later Malone got a worried call from a nurse who wasn’t part of her mom’s usual care team. Her mom had been screaming in pain, and her bedsore, the nurse said, was “the most extreme she’d ever seen.”
By the time Malone got her mom to an appointment with a specialist, her infection had gotten so bad that “you could see her spine.” When she was checked into an ER that November, she was severely malnourished. An MRI showed the infection had spread to her bones.
Given the choice between a feeding tube and hospice care, Malone’s mom chose hospice care. She died on Dec. 4, 2020.
“The only answer that I have gotten…is, ‘During COVID, we were short-staffed,” Malone said. “That’s not good enough for me. I’m sorry. That’s just not good enough.
Missouri lawmakers are considering legislation aiming to increase accountability and transparency around elder abuse and neglect in long-term care facilities. A Senate committee debated the bill last week.
Sponsored by Republican state Sen. Adam Schnelting of St. Charles, the
legislation would increase penalties for abuse or neglect of an elderly person and require long-term care facilities to maintain liability insurance policies worth at least $1 million.
Schnelting, who sponsored similar proposals in
2024 and
2025, said the bill would help families get closure and compensation for abuse and neglect of loved ones.
“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,” Schnelting said.
Schnelting recalled being “enraged” as he struggled “trying to get answers [and] trying to find resolution” after his mother died in a facility.
She was getting rehabilitative care after a stroke, Schnelting said, and suffered head injuries in the facility. She had a second stroke and died after going into a vegetative state.
“It looked like someone had punched her multiple times in the face,” Schnelting said.
Nursing home residents in Missouri receive the fewest daily hours of care by licensed nurses in the U.S. — only
1.14 hours per day — according to data released by the U.S. Centers for Medicare and Medicaid last month. They
received an average of 3.37 hours of nursing care daily in March 2025. In 2023, AARP ranked Missouri’s long-term care facilities
47th for safety and quality and 38th overall. U.S. News and World Report ranks Missouri
50th in nursing home quality.
Schnelting’s bill would also require the Missouri Department of Health and Human Services to display a symbol on its website identifying facilities with abuse or neglect findings substantiated by the department, the Centers for Medicare and Medicaid or law enforcement. In addition to displaying the symbol, the department would have to provide a summary of the incident for three years after the most recent confirmed finding.
The Centers for Medicare and Medicaid already marks nursing homes with recent
abuse citations with an icon.
Dr. Jana Opperman-Bendt, who switched careers to establish a small long-term care facility, said this provision would help families searching for a safe place for their loved ones, “when they are already overwhelmed and vulnerable themselves.”
Jay Hardenbrook, advocacy director for AARP Missouri, said the bill would enable families to find reliable information about facilities when they are no longer able to care for loved ones themselves.
“Being able to have transparency to look directly at what has happened in facilities and make an informed decision is so vitally important to the caregivers of our state,” Hardenbrook said.
The bill would also make abuse or neglect by a caregiver in a long-term care facility a class E felony. Elder abuse or neglect is currently a class A misdemeanor for anyone.
Opponents of the bill argued that the liability insurance requirement could drive small and rural facilities out of business.
Nikki Strong, representing the Missouri Health Care Association, a nonprofit that represents long-term care facilities, said mandating liability insurance would cause premiums to “skyrocket.”
Tim Blattel, legislative chair for the Missouri Assisted Living Association and CEO of Twin Oaks Senior Living in Wentzville, said the insurance requirement would hurt family-owned operators and asked to work with Schnelting to compromise on the bill.
Blattel said his annual insurance premium increased from $73,000 to $230,000 in one year because St. Louis has been deemed a “litigious area.”
Brandon Koch, executive director of the Missouri Insurance Coalition, said that if the bill set the minimum threshold for liability insurance too high, “it could impact affordability and availability.”
But Opperman-Bendt said she was “appalled” when she learned that long-term care facilities are not 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, and I want to be held accountable for what has taken place,” she said.
Malone underlined the importance for families of getting closure and answers about what happened to their loved ones.
“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.”
