Missouri in the last year has significantly reduced its backlog of overdue nursing home inspections, recent federal data shows, though it still stands out for how low nursing staff is at many facilities.

Around this time last year, a quarter of nursing homes hadn’t been inspected in at least two years. 

Now the number is closer to 3%, according to Centers for Medicare and Medicaid Services data.

The state’s surveyors “have investigated complaints at night, early morning, weekends and holidays,” said Lisa Cox, spokesperson for the Department of Health and Senior Services. “The decline in overdue complaints can be attributed to the hard work and dedication of our surveyors and inspectors.”

The department also hired certified part-time staff to help with the backlog, received additional money in this year’s budget to increase the nurse surveyor salaries and has contracted with private agencies to get additional staff, Cox said.

The backlog had mounted in part due to state staffing issues, plus an increase in complaints.

When the state resumed its standard inspections in January of 2021, after a COVID pause, there were over 4,000 pending complaint investigations and now there are 265.

Still, advocates are worried about oversight in Missouri’s nursing homes. 

The main issue that has come up for years is Missouri’s low level of nursing home staffing.

The most recent data, updated last month, shows residents receive 3.3 hours of daily care, on average. That’s below the federal standard of 3.48 daily hours that is going into effect over the next few years — and even that was a level advocates fought for being too low.

Missouri has consistently ranked among the worst states for nursing home staffing levels.

Staffing varies widely by facility in the state. Two dozen facilities offer less than 2 hours of daily nursing care per resident.

The for-profit Reliant Care owns several of the largest facilities in Missouri. Sixteen of the entities associated with Reliant Care offer less than 2 hours of daily individual nursing care, according to the latest data.

One, North Village Park, offers just 37 minutes per day of care, the federal data shows.

Marjorie Moore, executive director of VOYCE St. Louis, an advocacy group for long-term care residents, said Missouri’s nursing home staffing is one of the biggest challenges facing residents.

“A lot of people are going to be laying in bed all day uncared for because there’s short staffing in the facilities,” she said. 

She said they’ve recently been hearing about a lot of residents who don’t have nurses to come get them out of bed to attend activities.

Moore said the state’s ombudsman program, which is an oversight arm composed of staff and volunteers who advocate for long-term care residents, can help but needs more resources.

Moore’s organization operates the ombudsman program for St. Louis and Northeast Missouri regions.

“Those residents really rely on ombudsmen, both staff and volunteers, to speak up for them and to make sure that they’re getting the care that they need and that they deserve,” she said.

Ombudsmen make sure residents can go to the bathroom, take their medications and be fed on time, as well as enjoy activities.

Without the oversight that ombudsmen offer, she said, “it’s very easy for people to just kind of say, ‘Oh well, the call light was on for a long time, I just didn’t get to it.’”

For the second year in a row, Gov. Mike Parson vetoed the $2.5 million increase the legislature approved for the program, which would have added around 25 staff statewide, Moore said.

Parson wrote that “while this supports the important goal of helping seniors throughout the state, there is insufficient funding from the appropriated source to support this item.” 

Moore said she was aware of some issues with the source lawmakers assigned to draw funding from but was hopeful they’d be resolved by the end of session.

“We have a lot of challenges here in Missouri for nursing homes,” she said. “…It’s definitely a disappointment.”