by Marian Wang ProPublica, March 3, 2011

Though most states require nursing homes to conduct criminal background checks for prospective hires, 92 percent employ at least one worker with a criminal conviction, according to a report released today [1] by the inspector general for the Department of Health and Human Services.

(Hawaii currently has no background checks in place.  A note from page 3 of Inspector General Report explains: “A statute requiring FBI checks exists in Hawaii; however, no implementing rules have been published.  A Hawaii State official confirmed that nursing facilities are not yet required to conduct such checks.”—HFP)

About 5 percent of nursing home workers—or one out of every 20—had at least one conviction, according to the report, which took a random sample of 260 nursing homes certified by Medicare and ran FBI background checks on their workers.

State rules differ regarding background checks: 43 states require nursing homes to perform background checks against state records, ten of those require an additional FBI background check, and eight states don’t require background checks at all.

The rules also differ on what types of crimes disqualify workers. The report noted that of the workers with convictions, 44 percent had committed property crimes such as theft, vandalism or writing bad checks. Some 16 percent had drug-related crimes, and 13 percent had committed crimes against people, including sexual offenses.

Federal regulations prohibit nursing homes from employing workers convicted of “abusing, neglecting, or mistreating residents,” but because FBI data do not show whether the victims of the crimes were nursing home residents, it’s unclear whether these rules were violated.

The New York Times noted [2] that the current system for background checks—which Wisconsin Democrat Sen. Herb Kohl criticized as “haphazard, inconsistent, and full of gaping holes [3]—has allowed people convicted of crimes in one state simply find jobs at nursing homes in another state.

We’ve noted a similar lack of oversight in the nursing field, which allowed problem nurses to cross state lines in order to keep working and avoid consequences [4]. A national database was created decades ago to prevent this from happening, but reporting failures at both the state [5] and federal level [6] have left the database riddled with gaps.

The inspector general recommended that the federal government’s Centers for Medicare and Medicaid Services, or CMS, work with the states to develop background check procedures, including lists of convictions that would disqualify a potential hire.

CMS oversees nursing homes eligible for funding under Medicare and Medicaid. In a written response to the report, the agency agreed with the recommendation. CMS also runs Nursing Home Compare [7], a searchable database with ratings on nursing homes.

For more, read the full report [1].

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Government Report Finds 92 Percent of Nursing Homes Employ Convicts (by Marian Wang, ProPublica)

Nursing Facilities' Employment of Individuals with Criminal Convictions (Department of Health and Human Services Office of Inspector General)

From the Report: Almost all nursing facilities employed one or more individuals with at least one criminal conviction. 

Our analysis of FBI-maintained criminal history records revealed that 92 percent of nursing facilities employed at least one individual with at least one criminal conviction. The number of individuals with at least 1 conviction employed by these nursing facilities ranged from 1 to 66.

Nearly half of nursing facilities employed five or more individuals with at least one conviction. For example, a nursing facility with a total of 164 employees had 34 employees with at least 1 conviction each. These 34 individuals had 102 total convictions categorized as follows:

• 29 convictions for crimes categorized as other,
• 25 convictions for crimes against property,
• 18 drug-related convictions,
• 16 convictions for crimes against persons,
• 8 convictions for DUI, and
• 6 driving-related convictions.