Sustained Outrage

Convicts and nursing homes

As ProPublica.org pointed out, the Office of Inspector General just released a study that found that 92 percent of nursing homes employ a person with a criminal conviction, and almost half employ five or more people with convictions.

Now, not all of these convictions were of the sort that preclude a person from working at a nursing home, such as having abused, neglected or mistreated a nursing home resident. (These can vary from state to state.) The study broke the convictions down by broad category: 43.6 percent were crimes against property; 26.4 percent were “other”; 20.3 percent were DUIs; 16.2 percent were drug-related; 13.1 percent were crimes against persons; 11.9 percent were driving crimes besides DUIs. (Those numbers don’t add up to 100 percent because some people qualified in more than one category.)

The study noted:

Our estimate of the number of nursing facility employees with criminal convictions relies entirely upon the accuracy of the information contained in FBI’s Interstate Identification Index. Because the Interstate Identification Index relies on local, State, and Federal law enforcement agencies to report criminal records, it is possible that not all criminal history record information was accurate and up-to-date.

The criminal history record information we received from FBI suggested that the records did not contain all of the convictions for particular employees. For example, criminal history record information contained notations of probation violations (suggesting that a conviction occurred), but the record did not contain the convictions leading to the imposition of probation periods. In addition, many charges had no corresponding disposition information (e.g., conviction, dismissal), so we could not determine whether a conviction occurred. Finally, it is possible that some individuals’ records did not contain convictions because they were removed following a judicial diversion program (e.g., completion of an alcohol and substance abuse education course).

Our estimates are conservative because we did not include criminal convictions if we could not conclusively identify the individual (e.g., if identifiers were similar but did not exactly match). Also, we could not confirm that the information that nursing facilities provided us was accurate or that the information the employees provided to the nursing facilities was accurate.

FBI-maintained criminal history records do not contain detailed information (i.e., whether the victim of a crime was a nursing facility resident) to determine whether a conviction disqualifies an individual from nursing facility employment under Federal regulation.

West Virginia is one of 33 states that requires a statewide criminal background check, but not one of the 10 that requires both a federal and statewide check.

The study recommended that the Centers for Medicare & Medicaid Services (CMS) develop background check procedures:

To ensure that States conduct background checks consistently, CMS should (1) clearly define the employee classifications that are direct patient access employees and (2) work with participating States to develop a list of State and local convictions that disqualify an individual from nursing facility employment under the Federal regulation and periods for which each conviction bars the individual from employment.