Starting Jan. 1, those living in Missouri's seven Veterans Homes will pay $100 more each month for their contribution rate.
The current rate, $2,050 a month, has been in effect since April 2015.
The change will add about $1.1 million to the homes' revenues, Veterans Commission Director Larry Kay told commissioners Monday, "given that 74 percent of the people in our homes pay the maximum amount."
But even with the increase, Kay said, "We will still be behind the consumer price index for the last three years."
Commissioners approved the increase on a voice vote.
Commissioners spent about 45 minutes Monday morning discussing operations of the veterans homes, especially the St. Louis home in north St. Louis County. The discussion centered on complaints from some families the home's operations are well-below acceptable levels.
"Any and all allegations involving veteran care were looked into and thoroughly reviewed," Kay said. "We took the opportunity to address, specifically, two things - communication and customer service. Those were two areas that we found were lacking, and we could improve on.
"In general, the feedback we got from families was positive."
Kay and Deputy Director Bryan Hunt said the internal probe followed complaints to Gov. Eric Greitens from veterans' family members.
Some of those family members, as well as some of the St. Louis home's staff members, scheduled a Monday evening media event in Kirkwood to publicize numerous problems they said have occurred at the St. Louis Veterans Home.
Those complaints were listed in an email sent to reporters, and included:
- A significant number of falls due to lack of properly trained staff.
- Instances of burns and scalding due to negligence.
- Bed sores due to lack of proper care.
- Veterans not bathed properly "and records are falsified."
- Occurrences of prescription medication errors and fraudulent reporting of usage.
- Blood and urine pooled under wheelchairs due to lack of staff action.
- Premature deaths due to neglect.
Hunt told commissioners the St. Louis home has "an independent pharmacy that does an independent review" each month of the home's handling of residents' prescriptions - and it hasn't shown any major problems.
He said the families' complaints were investigated by the state's Public Safety department and by the federal Veterans Administration, in addition to the internal probe.
The federal investigation was "very thorough," Hunt reported, since the VA's contractor brings specialists from all over the country to make the inspections.
"They were made aware of the family allegations, and spent quite a bit of time talking with several of those family members," Hunt said, noting the St. Louis home was found to be in full compliance with all 158 VA standards.
That finding concerned Brant Logan of Blue Springs, chief executive officer of TechWay Health, a consulting company.
He attended Monday's meeting but didn't speak to the commission.
However, Logan said afterward: "They talk about 158 quality checks, but CMS (the federal Center for Medicare Standards) has over 500. There's 24 quality assurance measures, and I didn't hear anything about that."
Commission Chairman Scott Englund, of Jefferson City, told colleagues, "One of the things that concerns me, when this first came up, is that some of these things were not reported to us for months."
Family members have said their complaints to the home's administrators were ignored and that home residents and their families were labeled as "troublemakers" if they raised issues.
Commissioner William A. Wallace, St. Louis - who once served as a nursing home clinical director - agreed "we want to know about complaints right away - and the complaints (about the St. Louis home) were not forthcoming right away."
He said the commission staff conducted a thorough professional internal investigation.
Commissioner J. Michael Mowrer, Kennett, said when he first heard of the complaints in mid-July, he "broke out into a cold sweat, because there were allegations that veterans, under our care, who had been abused and neglected."
After hearing investigations found no major problems, he said, "I now sleep better. I'm at ease - but I'm still vigilant."
Commissioners agreed on the need to address morale problems caused by low staffing and requiring workers to stay if another employee doesn't report for the next shift.
Commissioners took no votes or action about the homes' operations.
But Englund said the discussion was important.
"One of the things the commission has to do is take these things seriously," he said. "An allegation of murderous conditions is about as serious an allegation that there is."
Commissioner Nancy M. Nelson, of Imperial, said: "After being a long-time commissioner here, I can honestly that, if I should ever need nursing home skills, I hope to God I'm lucky enough to land in one of these state-run homes. Because the other states don't have this, and we are very blessed to have what we have."