Lillie Montgomery raised eight children in Poplar Bluff, Mo., while her husband worked construction and helped build the community their family chose in 1950.
For the past 15 months, Montgomery has been a resident of Westwood Hills Health and Rehabilitation Center. A broken collarbone made her 24-hour care more than son, Doug, could handle at home.
Montgomery is just one of the many people nursing home operators and advocates say could be adversely affected by the governor's decision to reduce Medicaid funding by 3.5 percent, taking away $60 million budgeted for mid-year cost increases.
Cuts went into effect July 1, after state officials were unable to find a solution the governor would accept. Gov. Eric Greitens vetoed a bill in June that would have taken $35 million from other departments, in what he said was an unconstitutional, one-time fix that put other programs at risk.
Families and other opponents of the cuts are now asking legislators to convene a special session and try again.
One out of every 12 seniors in Missouri is covered by Medicaid, according to the Missouri Foundation for Health. It pays for more than 60 percent of all nursing home care in the state.
"It just makes me sick that they want to do this," said Doug Montgomery, 61.
He says he cared for his mother until she was unable to get out of bed on her own. The middle child of the woman nurses call Miss Lillie, he has chronic lymphocytic leukemia and congestive heart failure. His youngest sibling died in April, after a battle with cancer.
"There was just no way I could do that and be here 24-7," said Doug Montgomery.
Westwood Hills believes the current cuts will mean about $10,000 a month to the facility.
Like many rural facilities, it sees a higher percentage of Medicaid patients, explained administrator Joetta Martin. About 70 percent of their current residents receive Medicaid to pay for around the clock skilled nursing, lodging, meals, therapy and other needs.
The cuts will first be felt in the areas of maintenance and social activities, Martin said. Westwood Hills is reducing both areas from two full-time staff to one full-time and one part-time person.
Staff is the facility's greatest expense, she said. The next area to see cuts could likely be the buffet-style dining, where the center would limit the options residents have at meal time.
"Those are the immediate things that we've been thinking about, depending on how long this lasts and the impact," Martin said.
The state is actually turning away additional federal dollars by making these cuts, because most of Medicaid costs are covered by matching money, Martin added.
Missouri nursing homes will now receive an average of $153.81 per patient, per day from Medicaid, down from an average of about $157.
The state will pay only 10 percent of that cost, or $15.26.
The remainder comes from federal money and patient contributions, said Nikki Strong, the executive vice president of the Missouri Health Care Association. The association represents about 330 of the approximately 500 facilities in Missouri.
"Nursing homes are going to have to go in and figure out how they're going to absorb these cuts," said Strong, who believes it could even force some smaller, rural facilities to close. "Residents are going to lose care because the current funding level can't sustain the highly regulated care that's mandated and necessary to properly take care of these residents."
The new rate is $25 less than what it actually costs facilities to care for patients, based on audited costs presented to the state, Strong added. Rates were about $17 below costs prior to the cuts, she said.
Martin is asking her families to contact their state representatives and senators and share how important the Medicaid funding is for their loved ones.
Victor Murray has learned that lesson in the last decade, after his 46-year-old wife had to be admitted for the kind of around the clock care her family was unable to provide at home. Husband and wife worked for Walmart prior to her admission.
Tammy Murray, now 56, went to bed one night with what she thought was a cold. When Victor tried to wake his wife the next morning, she could no longer speak or move on her own.
He believes she had a stroke in the middle of the night.
Victor and other members of Murray's family are at Westwood every day.
"I don't worry about my wife being out here, because she's taken very good care of," said Victor, who hasn't missed a day in the past 10 years.
It isn't the life the couple had planned, said Victor, but he treasures every moment they have together.
"We've had a great marriage," he said, talking of their shared love of '50s and '60s music, drag races and outdoor sports. "She's my best friend. ... If I do anything else (now), it always seems like there's an empty seat beside me.
"If I've got my feet on the floor, I'm coming here."
He hopes legislators can find a way to ensure his wife and others continue to receive the care they need, Victor said.
MHCA estimates anywhere from 2,000 to 2,500 nursing home jobs are at risk, said Strong.
The changes set by the governor also raise the criteria patients must meet before being admitted to a nursing home or in home care, which means they must be sicker to qualify for the same care, she said. This change could impact about 8,000 potential nursing home and in home care patients, the state has said.
Martin said the change would not force out anyone already in a nursing home, but it could be difficult to readmit someone that does not meet the new targets.
Martin said nursing homes also recently received 700 pages in new regulations that will require, for instance, hiring an infection control nurse at every facility, as well as increased reporting and paperwork.