Last week we discussed some of the challenges and concerns facing nursing homes and skilled nursing facilities regarding quality of care and patient safety. According to a USA Today article from December 2013, several states are considering bills aimed at increasing oversight and requirements for the home healthcare workforce. This article discusses why legislators are calling for extensive employment background screening at home healthcare organizations, reviews some of the recent proposed legislation, and covers some healthcare background check tips and best practices.

The Safety and Quality Care Issue in Home Healthcare

One of the states where the quality issue in home healthcare is most severe is Kentucky. According to an article published in The Courier-Journal from August 2013, Kentucky’s problems include staffing issues, a high volume of registered ombudsman complaints and a severe deficiency at one in five nursing homes. Nursing Home Report Card analyzes, compares, and ranks states’ nursing home quality. Their website features an infographic that gives an overview of how states are performing, and there’s an overabundance of red, unfortunately. According to their report, 1 in 5 nursing homes abused, neglected, or mistreated residents in almost half of all states. In addition, nearly 90% of all nursing homes were cited a deficiency.

Another state with a low quality rating is Michigan, who ranks 43rd nationwide according to the scorecard. In November 2013, the Lansing State Journal reported that most mid-Michigan nursing homes have been cited for severe deficiencies and have collectively paid more than $400,000 fines since 2010. But the issue of care quality and patient abuse in home healthcare has been ongoing for years. Beginning in 1997, the Government Accountability Office has issued more than 20 reports documenting serious quality of care problems in nursing homes and inadequate enforcement of federal regulations to protect residents’ health and safety. That’s why lawmakers are turning to background checks as a means of protecting the safety of these patients.

Home Healthcare Background Check Legislation on the Rise

Given the troubled nature of the home healthcare sector, states have taken action to instate extensive background check processes. For example, Oklahoma has established the Oklahoma Long Term Care National Background Check Program, a fingerprint based national background check program after being awarded a grant from the Centers for Medicare & Medicaid Services (CMS) in 2011. A similar Ohio regulation also went into effect on January 1, 2013 to make criminal-background checks more frequent, detailed and uniform among home- and community-based care workers. What’s interesting about the Ohio regulation is that it requires organizations to conduct background checks on employees every five years, recognizing that a background check only represents a snapshot in time.

These are just a few examples of states that have taken action to address these issues. Other states with home healthcare worker background check regulation being considered or soon to go into effect include California, Iowa, and Kentucky.

Healthcare Background Check Tips and Best Practices

It’s commendable that states are passing legislation to protect the care and safety of patients treated by home healthcare workers, but the national FBI fingerprint-based background checks may not be sufficient. Last year, I wrote an article about the deficiencies of the FBI background check and why employers should not use it as the sole component of their background check program. The background check that is required by the government offers a subpar level of protection, and it’s highly recommended that healthcare organizations use other forms of criminal searches that are more accurate and up-to-date, such as county and state criminal records.

The following advice is not unique to home healthcare organizations, but any organization should use caution when using any database search—they are only as good as the information they contain, and it can often be out of date. The FBI databases, for example, are estimated to be missing final disposition information for at least half of the records in the system. That’s a lot of missing information that can impact the safety of patients. If you’re in a state that requires an FBI fingerprint background, you should certainly comply with the law; but it’s also highly recommended that you conduct a primary source criminal background check, such as county criminal record searches. This ensures that you are checking the latest publicly available information.

In addition to conducting more thorough background checks, it’s also important to ensure that you are conducting background checks on your staff on an ongoing basis. At PreCheck, we’ve been an advocate of this practice for years, but it looks like legislators are now enacting legislation to enforce the frequency of screenings. Background checks represent a moment in time, and the information they contain may change as time goes on. For healthcare organizations, the DHHS Office of Inspector General recommends that they check the OIG List of Excluded Individual’s and Entities (LEIE) on a monthly basis. While this may not be the appropriate frequency rate for a criminal background check, it does emphasize the importance of ongoing screening.

Are you evaluating background screening vendors? Contact us today to learn how PreCheck’s healthcare-focused screening services can help you protect your patients and staff.