Bill would establish national abuse registry
Affects agencies receiving any federal funds
Private duty home health agencies often do everything they can to investigate the backgrounds of their applicants. But it’s not always easy. Background checks are often time-consuming, expensive, and not thorough due to a lack of available information.
Now a senator has taken the initiative and introduced the Patient Abuse Prevention Act to Congress. With the help of the Home Care Aide Association of America in Washington, DC, nursing home associations, and attorneys general, Sen. Herb Kohl (D-WI) has developed a bill that would establish a national registry of abusive and criminal patient-care workers and would require criminal background checks of "vulnerable care workers."
According to the Association and the Senate Committee on Aging, the bill would cover health care facilities receiving federal funds, including Medicare, Medicaid, or Medicaid waiver reimbursement. Agencies providing personal care services under the Medicaid program or through a waiver, for example, would have to comply with the bill.
Health care facilities defined by the bill include nursing homes, skilled nursing facilities, board and care facilities, adult day care centers, adult family homes, assisted living facilities, hospices, and hospitals. Federal health care facilities also would be subject to the requirements.
Refinements are expected as the bill goes through the approval process. "There’s a lot of interest in this on the Senate Aging Committee," says Deborah McNeal Arrindell, executive director of the Home Care Aide Association in Washington, DC.
States need to share information
In introducing the bill, Sen. Kohl lamented the lack of information-sharing between states about known criminal and abusive workers. "There are no federal requirements or guidelines on information-sharing about abusive workers even those who have been convicted in a court of law," he says.
"Because no national registry of abusive health care workers exists, people with histories of abuse or serious crimes in one state can simply travel to another state to find work. These workers can also move from nursing home to home health agencies or to hospitals without ever undergoing a complete background check.
"Problems also exist with reporting abuse," he continues. "Rather than going through the trouble of making a report and drawing possible unwanted attention, a facility often will dismiss a worker without ever filing a report."
The association is pleased to see efforts being made to protect patients through the development of national criminal background standards, says Arrindell. "We’ve been working closely with Sen. Kohl’s office to ensure the development of a bill that protects the rights of workers and patients and protects agencies from liability."
The bill also pleases providers. "A registry that crosses state lines would be wonderful," says Nancy J. Woods, RN, specialty services director for Contin-U-Care Home Health in Chattanooga, TN. "Any service or anything that can monitor behavior patterns of caregivers that would cause a danger to our patients is well worth doing whatever it takes.
"If there is a caregiver with the potential to injure someone, anyone in the health care field would surely want to know this before they send the person unsupervised to a patient’s home."
How it works
The bill would require the Department of Health and Human Services’ (HHS) Office of the Inspector General to establish and maintain a national registry. The national registry would include all health care workers who have been convicted of a federal or state crime or those found by the state to have committed patient. abuse.
The bill requires providers to report to the state any incidence of a "covered health care worker" who has been accused of committing patient abuse. Patient abuse is defined as "any incidence of abuse, neglect, mistreatment, or misappropriation of property of a patient of a covered health care facility." A covered health care worker is defined as an individual who has direct contact with a patient of a health care facility, under an employment or other contract, or under a volunteer agreement.
The state investigates abuse reports to determine their validity. Any information disclosed by the state to the registry would include the findings of the investigation along with a statement from the employee about the charges.
For new health care employees, the bill requires Federal Bureau of Investigation (FBI) criminal background checks for those direct patient-care workers who have not been subject to a criminal background check under state licensing requirements. This would include licensed practitioners who have not undergone a background check, nurse aides, home care aides, and other workers.
When an agency prepares to hire such an employee, it contacts the state to begin a background check. States will search their own registries, where applicable, and also would submit background check requests to the FBI national criminal background check system, according to the association.
Because of the current FBI backlog, the provision would be effective January 1999, when the FBI Integrated Automated Fingerprint Identification System should be fully operational. The system is expected to have a two-day turnaround and operate at a lower cost than current manual systems.
As great as a registry sounds, providers shouldn’t let it give them a false sense of security if it becomes operational, Woods says.
For every person on the registry, she explains, there may be 10 or 20 who don’t ever get that far.
"Health care providers always need to be conscientious and to look for signs of [abuse] before they have to find the arrest record on someone. You can’t think that everyone not on the registry is fine."
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