Most states don’t require background checks
Checks find abuses, but can be time-consuming
In a two-part series in November, USA Today accused the home health industry of being poorly regulated and a "buyer-beware" business. Although the newspaper was criticized for sensationalizing isolated instances of abuse, a government report shows that formal safeguards differ from state to state.
"Assessing the extent of problems with abuse, neglect, or misappropriation in the home care industry is a difficult task," says a September 1996 report from the U.S. General Accounting Office (GAO).1 The report adds that "Formal safeguards for home care consumers vary widely across political jurisdictions, public programs, and types of providers; and in some instances, few safeguards exist."
The report acknowledges that a criminal history does not always predict criminal behavior. However, advocates of criminal background screening argue that the use of this process may deter any individuals with criminal intent from entering the field.
Even so, private duty home health agencies have found that checking for criminal backgrounds of job applicants can be costly and time-consuming.
How agencies check
The Home Care Aide Association in Washington, DC, has been gathering information about laws regarding criminal background checks. It reports that from the laws collected so far, costs for the background checks range from about $15 to $30 and take several weeks to process.
One provider in Missouri hired an independent contractor to speed up the process. The provider faxes the information about the applicant to the contractor. The contractor then physically takes the information to the Highway Patrol office. The arrangement shortens the time it takes to make the check to several days, but it carries a price about $30 per applicant.
Not everyone, though, can afford to do that. At a cost of about $7 each, Sunshine Home Health Care in Ft. Wayne, IN, sends its background checks off to the state and gets the results back in three to four weeks, says Linda Brady, administrator.
"There is a great lag time," she says.
Brady says she never hired an employee to later discover he or she had a criminal background. To cover herself, Brady hires employees from a local company that trains, certifies, and does background and reference checks on its CNAs. For workers not hired from this company, Brady thoroughly checks references and makes background checks at the city and county level, while waiting on results from the state level. These local checks costs about $3 each and take just a few days.
"We might be taking a risk, but we have done everything possible," she says.
Even with the inconvenience of background checks, it is important that agencies have a quality work force in a time that the home health industry has been under attack and under heavy scrutiny, says Deborah McNeal Arrindell, executive director of the Home Care Aide Association. "We need to ensure the safety of our consumers," she says.
Background checks, though, are just one part of providing a quality work force, she says. "Agencies should do all the reference checking and screening that they would to hire good quality workers, as well as providing adequate supervision and training."
The GAO report found that 15 states require criminal background checks for at least some of the individuals who may be employed as home care workers. (See chart, p. 19.) In these states, checks usually were a condition of agency licensure or certification; although in a few states, they were also a condition of individual licensure or registration.
In Utah, applicants for registration as a health care assistant are asked to provide a sworn statement regarding their criminal background. In Minnesota, a statute allows but does not require a criminal background check. State officials in California told the GAO that although the state has a law requiring a type of criminal background check that is not based on fingerprints, the law has not been enforced.
Three states rely on FBI data
At least three states Idaho, Nevada, and Ohio reported using national FBI data, but officials of other states cited the expense of FBI data as a reason for not using it. Almost all states that reported requiring such checks indicated that a criminal background could be grounds for denying employment or refusing licensure or for some other type of adverse action.
According to the GAO report, criminal background checks are generally limited to a state’s own criminal records. States with a statute requiring such checks may access FBI data for this purpose, but few states have made use of this capacity with respect to home care workers. Although there is no charge for checking these data for criminal justice purposes, fees are charged for checks for employment screening, and some state officials have cited these fees as a factor in reluctance to make greater use of the FBI data.
Although checks using state and local data are implemented more readily, they are not as comprehensive as those employing national records because they miss convictions that have occurred even in neighboring states or communities. Also, if they are based primarily on the name, birthday, and social security number provided by the job applicant, they can result in false positives or false negatives.
Since this report was published, the governor of Massachusetts signed into law a bill requiring health care employers to conduct criminal background checks on prospective employees. The legislation mandates that anyone who employs individuals involved in the direct or indirect care, treatment, education, transportation, instruction, counseling, or supervision of the elderly and disabled in a community-based setting, including volunteers, conduct a criminal background check on prospective employees or volunteers. This requirement is extended to entities receiving federal, state, and local funding as well as to privately funded entities.
Bill proposed for tracking abuse
The Home & Health Care Association of Massachusetts also filed a bill for the 1997 legislative session that would establish a central abuse registry for home health aides. The bill would provide for a clearinghouse of home health aides who were found to have violated certain categories of abuse, to be set up within the Department of Public Health. The proposal also contains an employer immunity measure that allows agencies to offer a subjective assessment on a prospective employee’s ability to provide services to a patient, without the fear of litigation.
Reference
1. General Accounting Office. Long-term care: Some states apply criminal background checks to home care workers. GAO/PEMD-96-5. Washington, DC; September 1996.
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