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Employee Background Checks

Nursing homes use background checks in order to avoid hiring individuals who have histories of committing crimes and abuse. Many of the elderly in nursing homes are dependent on staff and vulnerable to abuse, so it is the responsibility of the nursing home to make sure their staff does not take advantage of the residents.

Although 98% of nursing homes indicate that they perform background checks before hiring, there are still many problems with the current system. Studies show that more than 90% of nursing homes have at least one employee who has been convicted of a crime. In addition, almost half of nursing homes have five or more people who have been convicted of at least one crime. Though federal and state authorities suggest that nursing homes complete stringent background checks, many are not doing as much as they can.

Federal and State Law Regarding Background Checks

According to federal law, elder care facilities must not hire people who have committed violence against a patient or been neglectful of a patient for direct access positions. Direct access employees are employees who have direct access to the residents and whose jobs involve interacting with residents. Though the law prohibits nursing homes from hiring these types of people, it does not require nursing homes to use any specified types of background checks. The type of background checks they use are under the discretion of the nursing home.

Some states require background checks, but not all of them. Currently ten states require nursing homes to do FBI background checks and state background checks. In addition, there are 33 states that require that nursing homes perform state background checks, but don’t require FBI background checks.

Criminals Slipping Through the Cracks

The current state and federal regulations are not keeping criminals out of nursing homes. Though nursing homes can apply more stringent background checks than required by law, most only perform the bare minimum. In the seven states that have no requirements, nursing homes just check an online databases for potential employees, but many of those databases have incomplete knowledge.

Nursing homes in the 33 states that only require state background checks are also unable to screen out criminals. If an applicant has been convicted of a crime in another state, even a violent crime, it will not show up on the state background check. This allows convicted criminals to move to nearby states and secure positions at nursing homes.

Another problem is the breadth of the background check. With few regulations, it is up to the discretion of the nursing homes. Some nursing homes only check for violent crimes or crimes involving fraud or theft. Because of this, people who have been convicted of other crimes, such as sex offenses, domestic violence, or drug crimes, may be able to slip through the cracks and gain employment.

Better Background Checks for Safer Nursing Homes

Nursing home residents are extremely vulnerable, especially those who have serious illnesses, are immobile, or suffer from dementia and other cognitive diseases. Violence, assault, and theft are high among this population, so it is important that nursing homes employ staff members who will not commit physical or financial abuse. Though some states are considering requiring their nursing homes to perform both state and FBI background checks, they have still not made it an official law. Some state governments are concerned about the extra costs this would impose on nursing homes.

A high quality background check would check both state and national databases for crimes involving:

  • Homicide and assault
  • Sex offenses
  • Theft and fraud
  • Domestic violence
  • Conspiracy and weapons
  • Drugs
  • Adulteration of food


“CMS National Background Check Program .” CMS.gov. Department of Health and Human Services, n.d. Web. 28 Feb 2014. <http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/BackgroundCheck.html>.

Levinson, Daniel. “Federal Requirement.” Nursing Facility’s Employment of Individuals with Criminal Convictions. Department of Health and Human Services, n.d. Web. 28 Feb 2014. <http://oig.hhs.gov/oei/reports/oei-07-09-00110.pdf>.


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