Missouri bill targets abuse in nursing homes with tougher penalties, more transparency

Supporters of the bill said it could help families get compensation and closure — and hold facilities accountable — for abuse or neglect of older Missourians. Opponents said insurance requirements could push small providers out of business

By: Steph Quinn

Republican Sen. Adam Schnelting of St. Charles describes his bill targeting nursing home abuse and neglect as a "way to foster a culture of life in our state." He sponsored similar bills in 2024 and 2025, but this is the first year the legislation has gotten a hearing (Annelise Hanshaw/Missouri Independent).

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.” 

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Missouri bill targets abuse in nursing homes with tougher penalties, more transparency 

Ohio pushes for more nursing home accountability, transparency

Ohio is looking to increase nursing home oversight in the state while stiffening the penalties for ones who treat patients poorly.

By Josh Croup

COLUMBUS, Ohio (WTVG) - Ohio is looking to increase nursing home oversight in the state while stiffening the penalties for ones who treat patients poorly.

The state’s new two-year budget dedicates an additional $1.4 billion to increase the quality of care in nursing homes, the governor’s office says.

The budget includes money to “dramatically” increase the number of inspectors in the state to “make sure people are living with dignity in high quality and safe environments,” Gov. Mike DeWine said.

The budget also stiffens penalties for nursing homes that consistently fail to provide quality care.

“Expectations are a two-way street,” DeWine said. “If a nursing home takes care of its residents exceptionally well and is well-staffed, they will be rewarded with more funding.”

The governor says the budget also provides nursing homes with more resources to hire qualified and compassionate staff members, along with technical assistance to improve their quality of care.

The state is also developing an “easy-to-navigate” website with details about every nursing home in the state.

For people who want to age in their homes, the budget dedicates $40 million to establishing a new Healthy Aging Grants program.

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Ohio pushes for more nursing home accountability, transparency

Florida clerks working to implement guardianship database

Pinellas County Clerk of
Court Ken Burke

The Florida Clerks of Court Operations Corporation is hard at work creating a statewide database of guardian and guardianship case information as prescribed by the Florida Legislature last year.

The database came at the recommendation of the Guardianship Improvement Task Force to create greater transparency in the guardianship process. The legislation, HB 1349, was signed into law by Gov. DeSantis on June 28, 2022.

From its first meeting on July 21, 2021, to its last meeting on November 15, 2021, the task force studied problems in Florida’s guardianship system and made recommendations for improvement.

Pinellas County Clerk Ken Burke, chair of the task force, says media interest in guardianship drove the Legislature to put the database into action.

“There was a constant barrage of news stories about problems in the guardianship arena,” Burke said. “It was evident that there were flaws in the system and we wanted to get everyone who had a stake in the process involved in the task force to find common areas we can all agree on.”

Members of the task force included legislators, court clerks, court system employees who work with guardianships, lawyers from the Elder Law and Real Property, Probate and Trust Law sections, consumer advocates, a former ward, and others. Their goal was to make recommendations for improving the system.

Burke said the high national media interest in guardianship, specifically with the Britney Spears case, led to the Florida Legislature acting quickly on the task force’s recommendations.

“For something this complex, you definitely need a champion, and thankfully Rep. [Linda] Chaney and Sen. [Jennifer] Bradley stepped up very quickly,” Burke said.

Rep. Chaney, R-St. Petersburg, and Sen. Bradley, R-Fleming Island, helped guide the bill through four House and three Senate committees during the final month of the 2022 session.

Burke said the task force used “every tool in our toolbox,” to get this legislation through.

Florida courts define a guardian as a surrogate decisionmaker appointed by the court to make either personal and/or financial decisions for a minor or for an adult with mental or physical disabilities. After adjudication, the subject of the guardianship is a “ward.”

Currently, there is no way to track guardianship cases in the state and no reliable data to show how many guardians there are, how many wards they have, and how much money they control.

“We needed a way to get better data in guardianship,” Burke said. “A judge cannot answer how you can reform the guardianship system without data, and that is what the database intends to do.”

Once completed — the database can only be accessible to judges, magistrates, court clerks, and certain court personnel — the searchable database would include such things as the registration status and “substantiated” disciplinary history of professional guardians.

The bill called for the Florida Clerks of Court Operations Corporation to build the database. The CCOC put out a request for proposals and finally decided to use Cloud Navigator as its vendor in late December.

Burke says the initial meetings with Cloud Navigator have been good and they are currently working to build the stakeholder data dictionary as well as working with the Department of Elder Affairs to get that department’s data fed into the new database.

The legislation passed last year also requires the Office of Public and Professional Guardians, by July 1, to post searchable profiles of registered professional guardians on a website.

The profiles would include such things as whether the professional guardian meets educational and bonding requirements, the number and types of substantiated complaints filed against the guardian, and any disciplinary actions imposed by Elder Affairs.

It also requires the Legislature’s Office of Program Policy Analysis and Government Accountability (OPPAGA), to use the database information to generate annual reports suggesting reforms.

The task force also called for barring hospitals and nursing homes from recommending a specific guardian when they file for a guardianship, including consideration of powers of attorney and advanced directives previously signed by a ward when a guardianship is set up, and improving training and education for everyone involved in the guardianship process.

Burke says while all the task force’s recommendations are important, the database is paramount.

“We provided the Legislature with 10 recommendations, but the database is the most important one,” Burke said. “How can you make a compelling argument for change unless you have real data?”

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Florida clerks working to implement guardianship database

Colorado lawmaker wants more accountability, transparency in state’s guardianship system

Denver7 Investigates exposed how guardians can bleed estates 

 

A Colorado lawmaker wants more accountability and transparency in the state’s guardianship system after Denver7 Investigates exposed how guardians can bleed estates of the most vulnerable with little oversight. 

By: Jennifer Kovaleski

DENVER -- A Colorado lawmaker wants more accountability and transparency in the state’s guardianship system after Denver7 Investigates exposed how guardians can bleed estates of the most vulnerable with little oversight.

“There has to be a better way,” said State Rep. Kim Ransom, R-Douglas County. “They need to have some type of oversight and there really needs to be some accountability for these guardians.”

Denver7 Investigates first told the story of twin brothers Greg and David Wells.

The probate court placed their mother, Sharon Wells, 80, under guardianship, and court records show how quickly the money started disappearing.

“Her golden years have been turned into a nightmare,” Greg Wells said.

During an 18-month period, records show the conservator charged nearly $150,000 to Sharon Wells, making up to $325 an hour for taking care of her estate. Items included tasks like answering emails, phone calls and managing her properties.

“The fees absolutely need to be transparent,” Ransom said.

When a probate court finds an adult mentally unfit, a judge can place them under guardianship. The guardian is then responsible for making all their medical, financial and legal decisions. It also often means isolating the elderly from their family.

Lawmakers previously tried to act

Former Colorado State Sen. Laura Woods tried to help fix the guardianship system five years ago.

“If the state legislature can’t shut them down. I don’t know who can, and that’s what we were trying to do,” Woods previously told Denver7.

Ransom was also co-sponsor on the 2016 bill. It would have given basic rights to those under guardianships, access to a phone, mail, and visits from family. However, the bill died in the State House of Representatives.

“I was very grateful when I saw your report because it actually pointed out that there really was a problem that existed at the time and continues to exist now,” Ransom said.

The Wells brothers estimate the conservators and guardians who were responsible for their mother have drained more than a million dollars from her estate.

“It’s a money-making machine,” one of the Wells brothers said.

Colorado attorney says system needs to change

Chris Forsyth is the director of the Judicial Integrity Project, a nonprofit watchdog group.

He said judges aren’t reviewing the fees submitted to the court and thinks more needs to be done to protect the most vulnerable.

“Having their lives ruined emotionally and financially by the probate system because it has insufficient checks and balances. To hear it over and over again, consistently shows that there is a problem,” he said. “The state auditor has twice criticized the probate system in Colorado for a lack of transparency, a lack of accountability,” he said.

The most recent state audit from 2017 found conservators aren’t giving the courts enough information regarding the fees they charge. At the same time, it found the courts aren’t adequately tracking data to properly oversee public administrators.

Forsyth blames lobbying efforts for why lawmakers have not stepped in to act to address many of the aspects identified in the audits.

“Because of the powerful lobby within the Colorado Bar Association, the probate lawyers that are serving as these public administrators... it’s not a fair fight at the Capitol,” he said.

The Colorado Bar Association (CBA) told Denver7 Investigates that it has done a lot of work to prevent elderly abuse and a spokesman said it wants to ensure legislation is not one-sided.

The CBA did oppose Woods bill in 2016 but said it has supported other legislation that better protects those under guardianship.

Forsyth said none of those bills have gone far enough.

“Capping fees would definitely help,” he said.

Ransom agrees.

“The fees are definitely a problem. Clearly, people have their entire estate wiped out by a court appointed guardian who has no oversight or very little oversight,” she said. “If there's a solution, I would absolutely be willing to be part of it.”

Denver7 Investigates also reached out to the state Attorney General’s Office. A spokesman said the AG doesn’t have jurisdiction over guardianships because these are court appointed roles and are overseen by the state judicial system.

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Colorado lawmaker wants more accountability, transparency in state’s guardianship system