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Inadequate Employee Screening Puts Nursing Home Patients At Risk

By: Jeff Powless August 17, 2023 no comments

Inadequate Employee Screening Puts Nursing Home Patients At Risk

Federal regulations specifically prohibit any form of patient abuse or neglect. Yet tragically, some form of nursing home abuse, including sexual assault, is inflicted upon patients by nursing home employees each and every day in U.S. nursing homes. In addition, too many nursing home patients dependent upon the nursing home staff for assistance with activities of daily living are neglected, leading to dehydration, malnutrition, and/or pressure sores (often “to the bone”) due to the failure by the staff to ensure adequate hydration, nutrition, and adequate turning and repositioning.
One reason that vulnerable patients are neglected and abused is that many nursing homes hire convicted criminals — yes, you read that right: known criminals. In some cases, nursing homes fail to closely examine who they’re putting in charge of vulnerable patients; in others, they’re hiring people whom they knew, or should have known, were criminals.

The Vast Majority of Nursing Homes Have Hired Convicted Criminals

You may be shocked to learn that the vast majority of U.S. nursing homes have hired convicted criminals. Take for instance the 2011 U.S. Inspector General report which revealed that 92% of U.S. nursing homes employ one or more people who have been convicted of at least one crime (Levinson, OIG, 2011). Nearly half of these nursing homes employed five or more individuals with at least one criminal conviction. These convictions ranged from personal crimes such as assault and sexual assault to crimes against property, such as theft of personal possessions, medications, or finances.

What About Background Checks?

Perhaps what’s most startling is that 84% of these employees’ most recent conviction occurred prior to beginning employment with these nursing homes! So why didn’t background checks reveal their criminal histories?
Because there’s currently no national requirement mandating exactly how a nursing home should go about conducting background checks on prospective employees. Currently, only a few states even require nursing homes to search both the FBI criminal background database, along with state databases. This lack of consistency is compounded by the fact that state requirements vary in terms of whose backgrounds must be checked (e.g., direct-care workers only, such as nurses and nurses aides, versus all staff, which would include service personnel). The 2014 OIG report found that relying only on state databases leaves crucial gaps in background checks, which enables individuals convicted of crimes in one state to slip through the net and obtain nursing home jobs in other states (Levinson, OIG, 2014).
Congress is aware of this problem. In a New York Times report, former Senator Herb Kohl, D-Wisconsin, chairman of the Aging Committee, issued this remark:

“The current system of background checks is haphazard, inconsistent and full of gaping holes in many states. Predators can easily evade detection during the hiring process, securing jobs that allow them to assault, abuse, and steal from defenseless elders.”

Although most of the convictions were for crimes committed prior to an individual’s employment, this study found that, for nearly 16% of employees with criminal backgrounds, the most recent had offenses that occurred after the start of their employment. Thus, nursing facilities would have needed to perform ongoing, periodical criminal background checks to discover these convictions. But given the high rate of turnover among nursing home staff, that seems unlikely to happen.

What About Laws Against Hiring Convicted Criminals To Work In Nursing Homes?

You may be asking, aren’t there explicit laws prohibiting nursing homes from hiring criminals? Yes, there certainly are. Federal regulations prohibit Medicare & Medicaid nursing facilities from employing people who have been found guilty of neglecting or mistreating residents by a court of law, or who have a finding of abuse, neglect, or misappropriation of property entered into the State Nurse Registry. Federal regulations also prohibit health care providers (including nursing homes) from billing federal healthcare programs for services performed by these individuals.
Yet, some nursing home corporations continue to flout the rules and employ criminals and, to add insult to injury, bill government-funded programs for the services they provide. In Indiana alone, a more than $988,117.96 in combined state and federal recoveries was obtained through settlements with 36 excluded nursing home providers since early 2008 through the efforts of the Indiana Attorney General’s Medicaid Fraud Control Unit. In one of the largest settlements to date, one nursing home company was forced to pay the State of Indiana and federal government $376,432 to settle allegations that it submitted ineligible bills to Medicaid for work performed by seven employees whom the company knew, or should have known, were ineligible to participate in Medicaid and other federal health care programs.

What Can You Do?

Ask Questions

First, when selecting a nursing home, inquire about the nursing home’s employee screening procedures. Ask specifically whether criminal background checks are conducted for all employees, including caregivers. Ask if the facility employs any convicted criminals. If the facility cannot provide satisfactory information, consider it a red flag.

Visit Regularly and Be Observant

Once you have chosen a facility based upon the information available, there are other things you can do to stay vigilant. First, make regular visits and be observant. Regular visits to the nursing home offer a firsthand opportunity to assess the overall atmosphere, observe caregiver behavior, and interact with staff members. By actively engaging in these visits, families can gain deeper insights into the care provided to their loved ones and detect any signs of potential problems. Learn more about how to recognize physical signs of neglect or abuse in a nursing home.
During your visits, pay close attention to how caregivers interact with residents. Notice whether they are attentive, compassionate, and respectful. Caregivers should treat residents with dignity and take the time to listen to their needs. Regular visits not only allow you to monitor the quality of care but also give you the opportunity to establish relationships with the caregivers. Engaging in friendly conversations with them can provide insights into their personalities, professionalism, and dedication. Developing a rapport with caregivers can lead to better communication and a sense of accountability.

Address Concerns Promptly with Administration

If, during your visits, you notice any concerning behavior or inconsistencies that raise doubts about the caregivers’ credentials or intentions, do not hesitate to address the issue. Approach the nursing home administration with your observations and seek clarification. Ask for a thorough explanation and plan for addressing the concerns. Keep a record of your observations during each visit. Note dates, times, and any incidents you find troubling. This documentation can serve as tangible evidence should you need to escalate your concerns to regulatory authorities or higher-ups within the nursing home.

Join the Nursing Home Family Council

Joining a nursing home’s family council can provide a platform for family members to collaborate, share experiences, voice concerns, and collectively advocate for improved resident care and safety measures. By participating in these councils, families can pool their insights and efforts to effect positive change within the nursing home environment.
Family councils serve as a unified voice for concerns and suggestions related to nursing home care. When families come together, their collective advocacy carries more weight and can influence facility policies and practices. Families can identify common issues, including concerns about caregiver background checks, and work together to push for stricter regulations and enhanced screening processes.

Engage with a Nursing Home Ombudsman

Engaging with a nursing home ombudsman can be a crucial step in addressing concerns about a nursing home failing to conduct proper background checks. Ombudsmen are trained advocates who specialize in addressing issues related to long-term care facilities. They possess the expertise to investigate and resolve complaints from residents and their families, ensuring that the residents’ rights and well-being are upheld. By reaching out to a nursing home ombudsman, families can leverage their knowledge and influence to thoroughly investigate the facility’s hiring practices, demand transparency, and push for stringent background check procedures. Ombudsmen play a pivotal role in holding nursing homes accountable for maintaining safe and secure environments, thereby fostering a culture of accountability and improvement within the facility. Learn more on how to engage a nursing home ombudsman.

File A Complaint

In every state, there is a government agency that is responsible for conducting investigations into complaints against nursing homes for providing substandard care. But many patients and families often struggle with the question of whether they should indeed file a complaint to address the concerns they have encountered. Anyone with knowledge or concerns about the care of a nursing home patient has the right to file a complaint with their state’s regulatory agency, including the patient herself/himself, family members, guardians or other patient representatives, persons who are simply visiting the nursing home, and even the nursing home facility staff. Complaints can be filed anonymously and the complainant’s name and any specific medical information is confidential. Learn more about how to report nursing home abuse or neglect.

Consult A Nursing Home Neglect Attorney

Finally, if your concerns are not adequately addressed, you can consult an attorney with experience in handling nursing home abuse and neglect cases for guidance. Learn more on how to select an Indiana nursing home abuse lawyer.


The issue of inadequate employee screening in nursing homes remains a pressing concern, putting residents at risk of abuse and neglect. Hiring convicted criminals as caregivers further exacerbates this problem, emphasizing the urgent need for systematic change. Families, advocates, and regulatory bodies must collaborate to demand stringent background checks, consistent regulations, and transparent hiring practices. By staying vigilant, joining family councils, engaging with ombudsmen, and taking legal action when necessary, we can collectively work towards ensuring the safety and dignity of nursing home residents.



Levinson, Daniel R., Office of the Inspector General, DHHS. (2011) Nursing Facilities’ Employment of Individuals with Criminal Convictions. March 2011.

Frequently Asked Questions (FAQs):

1. How prevalent is the hiring of convicted criminals in nursing homes?

Answer: Surprisingly, studies have shown that the majority of U.S. nursing homes have hired employees with criminal backgrounds. An alarming U.S. Inspector General report from 2011 revealed that 92% of nursing homes employ individuals with at least one criminal conviction.

2. Why are background checks failing to prevent the hiring of criminals in nursing homes?

Answer: Background check processes vary significantly across states, and there is no standardized national requirement. Even when checks are conducted, they may not always include comprehensive searches through both state and federal criminal databases. This inconsistency leaves gaps that can be exploited by individuals with criminal backgrounds.

3. What steps can families take to address the concern about criminals working in nursing homes?

Answer: Families can take several proactive measures. They can ask detailed questions about the nursing home’s employee screening procedures, make regular visits to observe caregiver behavior, join family councils to advocate for improved safety measures, engage with nursing home ombudsmen to address concerns, and, if necessary, consult attorneys experienced in nursing home neglect cases.

Jeff Powless is an attorney and the author of the 2017 book, Abuses and Excuses: How To Hold Bad Nursing Homes Accountable.  Abuses and Excuses breaks new ground in helping patients and families hold bad nursing homes accountable, sharing a wealth of insider strategies and insights. It’s an eye-opening account of corporate greed, acts of neglect and abuse, an insidious industry culture of cover-up, and the actual harm that inevitably befalls vulnerable nursing home patients all across the country with shocking frequency.


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