Excerpted from a McKnight’s Blog by Jessica Towhey
A federal watchdog has issued its third 2025 report analyzing state oversight of background checks for nursing home employees, finding mixed results so far on compliance and enforcement.
The latest audit from the US Department of Health and Human Services Office of Inspector General on Alabama’s practices found lax enforcement, resulting in nearly one-third of sampled employees having been improperly hired. Findings in Florida and Louisiana — the other two states investigated so far — ranged from appropriate oversight to requiring improvements.
Alabama’s Department of Public Health did not have a process for verifying that nursing homes completed background checks or registry queries before hiring staff, stated a report on that state’s practices posted Thursday.
“In addition, the State agency lacked sufficient oversight of the nursing homes to ensure staff properly applied Federal and State requirements for prospective employees,” the audit found. “These failures increased the risk that residents at these nursing homes were vulnerable to employees who had a history of disqualifying offenses.”
The Inspector General’s office conducted announced visits to 20 of the state’s 216 Medicaid certified nursing homes on Nov. 27, 2023. They also selected 20 employees per facility, reviewing all incident reports alleging abuse and exploitation toward residents during the audit timeframe of Jan. 1, 2022, through April 8, 2024. Following a review of those reports, the inspectors further selected 39 additional employees identified from incident reports that categorized the workers for being a higher risk for abuse and neglect.
Per the OIG findings, 139 nursing homes failed to complete background checks before allowing individuals to begin working, resulting in persons with disqualifying backgrounds being hired. Furthermore, the state does not require surveyors to review background check completions as part of standard surveys unless a facility is being surveyed specifically for abuse and neglect allegations.
The OIG found four key errors related to employee background checks, including not having a process at the state level to verify background checks were conducted prior to hiring and that the state did not educate nursing homes on the importance of conducting timely checks.
“These errors increased the risk that residents at these nursing homes were vulnerable to employees who had a disqualifying record,” the report stated.
Alabama’s missteps contrasted with the findings of similar investigations in Florida and Louisiana.
In Florida, the OIG’s April 2024 report found that the state was in compliance with federal requirements. There, the inspector general looked at 1,019 nursing home employees, discovering that all had completed background checks before beginning work.
The investigation in Louisiana covered Oct. 1, 2019, through June 30, 2021, and included nine nursing homes, reviewing background checks for 209 non-licensed employees plus verifying the license status of another 77 workers. The audit found that the licensed employees were all in good standing, but it did uncover “potential limitations” in the background checks and adjudication methods for 49 of the licensed workers.
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