The report was issued by Daniel R. Levinson, inspector general of the Department of Health and Human Services, who obtained the names of more than 35,000 nursing home employees and then checked with the Federal Bureau of Investigation to see if they had criminal records.
“Our analysis of F.B.I. criminal history records revealed that 92 percent of nursing facilities employed at least one individual with at least one criminal conviction,” Mr. Levinson said. “Nearly half of nursing facilities employed five or more individuals with at least one conviction. For example, a nursing facility with a total of 164 employees had 34 employees with at least one conviction each.”
Charlene A. Harrington, a professor at the School of Nursing of the University of California, San Francisco, said: “This sounds like a very important study. It cries out for additional regulation. Residents in these homes are so vulnerable.”
The inspector general said that no federal law or regulation specifically required nursing homes to check federal or state criminal history records for prospective employees. Ten states require a check of F.B.I. and state records, Mr. Levinson said, while 33 require a check of state records, and the remainder do not have explicit requirements.
Given the patchwork of requirements, people convicted of crimes in one state have been able to obtain jobs at nursing homes in other states. Moreover, Mr. Levinson said, “Some states allow individual nursing facilities to make decisions regarding the employability of individuals with criminal convictions, while others rely on a state agency.”
Senator Herb Kohl, Democrat of Wisconsin, who has investigated nursing homes as chairman of the Aging Committee, said: “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.”
The most common types of conviction were for crimes against property, like burglary, and drug-related offenses. But some nursing home employees had been convicted of crimes against persons, like assault.
Federal rules say that nursing homes must not employ people who have been found guilty of abusing, neglecting or mistreating patients. But F.B.I. records do not always indicate if the victim was a nursing home resident.
Most of the convictions occurred before the offenders began working in nursing homes. But for 16 percent of employees with convictions, the most recent offense occurred after they had started work in a nursing home.
Joshua M. Wiener, an expert on long-term care at RTI International, a nonprofit research institute, said nursing homes had historically had difficulty recruiting and retaining employees, especially nurse’s aides, who he said were paid an average starting wage of $10 an hour.
Dr. Harrington said that many nursing homes did background checks in a perfunctory way, and that some did not check people who applied for housekeeping, food service or laundry jobs.
“Even some of the better nursing homes have problems with theft, rampant theft of residents’ clothing and personal possessions, including jewelry,” Dr. Harrington said. “People convicted of crimes are often left alone with nursing home residents because the supervision of care is, in many homes, very inadequate.”
The new health care law offers $160 million to states to improve criminal background checks on prospective employees at nursing homes and other providers of long-term care.