Criminal history often not considered in nursing home hires

Posted on behalf of Stewart Bell, PLLC on Mar 08, 2011 in Nursing Home Injury or Death

A recent study confirms the worst fears of nursing home residents and their loved ones: Across the nation, 92 percent of nursing homes have at least one person on staff with a criminal record. Industry experts and lawmakers responded to the findings with calls for tougher hiring standards for people who will be taking care of the most vulnerable among us.

The study also found that almost 50 percent of nursing homes had five or more staff members with at least one criminal conviction. In more concrete terms, that means that 34 out of 164 employees in a single facility have at least one conviction.

The unsettling statistics are based on analysis by the Department of Health and Human Services. Researchers checked the names of 35,000 nursing home employees against Federal Bureau of Investigation criminal databases. The FBI is the primary source for information about crimes committed in the 50 states. A state database has information only regarding crimes committed in that state.

Though federal rules bar nursing homes from employing anyone who has been convicted of abusing, neglecting or mistreating patients, the absence of federal regulations mandating criminal background checks leaves it up to the individual states. But the laws are inconsistent from state to state. Only 10 states require facilities to check both federal and state records for an applicant's criminal history. Another 32 states and the District of Columbia require state records to be checked. Seven states have no requirements at all.

The result is, as one U.S. Senator said, a haphazard and inconsistent system that works to the advantage of a person with a record in state A who is applying for a job in state B. This uncoordinated approach allows predators to assault, abuse and steal from defenseless nursing home residents.

Among the crimes committed by the employees, the most common were property crimes (e.g., burglary) and drug-related crimes. The study did uncover employees whose records included assault and other crimes against persons.

Researchers were able to determine if criminal convictions occurred before or after the employees began working in nursing homes. More than 15 percent of employees with a record had started working in a nursing home before they committed their most recent offense. And, while the federal rule barring facilities from employing anyone convicted of a crime against a nursing home patient is nice in theory, the FBI doesn't always note if a victim was in a home.

According to a long-term care expert, employment practices at nursing homes are often driven by a shortage of manpower. A nurse's aide, for example, earns about $10 an hour for decidedly unglamorous work. Facilities have a hard time hiring, much less retaining employees.

In the end, when they find people for the jobs, the hiring managers likely perform just the minimum background check. And, though theft from patients is rampant, many facilities only run checks for jobs with patient contact, so laundry, housekeeping and food service applicants aren't checked at all.

The new health care law addresses the issue by trying to eliminate at least one barrier to conducting thorough background checks on nursing home and long-term care facility applicants. The law gives states $160 million to improve their background check systems and, as a result, their patient care.


New York Times, "Study finds criminal pasts of nursing home workers," Robert Pear, 03/blog/11

Department of Health and Human Services, Office of Inspector General, "Nursing Facilities' Employment of Individuals With Criminal Convictions," March 2011

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