JEFFERSON CITY, MISSOURI — Missouri legislators are reviewing proposed legislation that would impose stricter criminal penalties for elder abuse in long-term care facilities and establish new transparency requirements for facilities with histories of substantiated abuse or neglect findings.
State Senator Adam Schnelting, a Republican from St. Charles, has introduced the measure after two previous attempts in 2024 and 2025. According to the senator, the legislation responds to widespread concerns about accountability gaps when nursing home residents suffer harm. The bill received debate in a Senate committee last week, as reported by The Missouri Independent.
The proposed law would reclassify abuse or neglect by caregivers in long-term care settings from a class A misdemeanor to a class E felony. Additionally, facilities would face a mandate to carry liability insurance policies valued at no less than $1 million. According to testimony provided to lawmakers, the insurance requirement aims to ensure families can obtain financial compensation when their relatives experience abuse or neglect in care facilities.
Senator Schnelting cited personal experience as motivation for the legislation. He described his mother receiving rehabilitative care following a stroke at a facility where she sustained head injuries. According to the senator's account, she subsequently suffered a second stroke and entered a vegetative state before her death. He told lawmakers he found the process of seeking answers and resolution deeply frustrating.
Another family member who testified, Miranda Malone of St. Charles County, recounted her mother's deterioration while receiving care for Parkinson's disease during 2020. According to Malone's testimony to The Missouri Independent, pandemic visitor restrictions prevented her from seeing her mother for months. When concerns about weight loss prompted discussions with nursing staff about increased protein, the situation continued to decline. A nurse not regularly assigned to her mother's care eventually contacted Malone about severe pain and an extreme pressure injury. By the time a specialist examined her mother, the infection had advanced to the point where bone was visible, and medical imaging revealed bone involvement. Malone's mother chose hospice over tube feeding and died in December 2020. Facility explanations citing pandemic-era staffing shortages did not satisfy Malone's questions about the care failures.
Transparency and Public Reporting
The legislation would establish a new public notification system through the Missouri Department of Health and Human Services website. According to the bill's provisions, the department would display a symbol on facility listings whenever abuse or neglect findings have been substantiated by the state agency, the Centers for Medicare and Medicaid Services, or law enforcement agencies. The symbol would remain visible for three years following the most recent confirmed finding, accompanied by an incident summary.
Federal authorities already mark nursing homes with recent abuse citations using an icon on the national Care Compare website, as reported by The Missouri Independent. The Missouri proposal would create a parallel state-level system.
Dr. Jana Opperman-Bendt, who operates a small long-term care facility, testified in support of the transparency provision. According to her statement, the system would assist families navigating an already overwhelming and emotional process of selecting appropriate care settings.
Jay Hardenbrook, advocacy director for AARP Missouri, told lawmakers that transparency measures enable families to make informed decisions during difficult transitions. He emphasized the importance of accessible, reliable information when caregivers can no longer provide care themselves.
Missouri's National Rankings
Recent federal data highlights significant challenges in Missouri's long-term care sector. According to figures released by the U.S. Centers for Medicare and Medicaid Services in February, nursing home residents in Missouri receive only 1.14 hours of daily care from licensed nurses, marking the lowest level nationally. Total nursing care hours, including certified nursing assistants, averaged 3.37 hours daily as of March 2025, according to federal statistics.
AARP's 2023 evaluation ranked Missouri's long-term care facilities 47th nationally for safety and quality metrics and 38th in overall performance. U.S. News and World Report places Missouri 50th among states for nursing home quality.
Industry Opposition
Opponents of the legislation raised concerns about the financial impact of mandatory liability insurance on facility operations. Nikki Strong, representing the Missouri Health Care Association, a nonprofit industry group for long-term care providers, warned lawmakers that insurance mandates would cause premium costs to increase substantially, according to testimony reported by The Missouri Independent.
Industry representatives argued that smaller and rural facilities could face particular financial strain from the insurance requirement, potentially forcing closures in areas with limited care options.
Federal regulations under the Nursing Home Reform Act establish baseline requirements for care quality, including adequate staffing levels and protection from abuse and neglect. State laws vary in their additional protections and enforcement mechanisms.
Resources for Families
Families with concerns about care quality or potential abuse in Missouri nursing homes can contact the State Long-Term Care Ombudsman program, which investigates complaints and advocates for residents. The National Long-Term Care Ombudsman Resource Center operates a hotline at 1-800-677-1116, and additional information is available at ltcombudsman.org.
Suspected abuse should also be reported to local law enforcement and the Missouri Department of Health and Human Services. Federal regulations require facilities to report suspected crimes to appropriate authorities within specified timeframes and to notify family members or representatives when incidents affect residents.
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