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Nearly all nursing homes employ convicted criminals

California Watch
Christina Jewett
March 7, 2011

More than 90 percent of nursing homes employ at least one person with at least one criminal conviction, and nearly half of facilities have five people on staff with a criminal conviction, according to a report by the federal Health and Human Services Inspector General.

Among those convicted, about 44 percent of employees were found guilty of property crimes such as burglary, shoplifting or writing bad checks. The workers most likely to have convictions were housekeeping, nursing assistant and dietary workers, according to the report [PDF], which was released last week.

The report also found:
  • Among convicted workers, 20 percent had driven under the influence, 16 percent were convicted of drug-related crimes and 13 percent committed crimes against people.
  • Eighty-four percent of convicted employees had their most recent conviction before the start of their current employment.
  • In 15 percent of nursing homes, 10 percent or more of the staff had a criminal conviction.

Report authors say the federal health reform law aims to address the problem of unfit caregivers by creating a national criminal background check database.

Still, the fitness of care workers in homes, nursing homes and small residential facilities has been a hot topic in California.

Last year, the state Senate Office of Oversight and Outcomes issued a report [PDF] showing that about 20 workers barred from caring for seniors in nursing homes turned up caring for seniors at other types of elder care facilities in California.

Report author John Hill found that one care worker pleaded guilty to a crime related to concealing the fact that she caused an elderly woman to fall and break her hip. That worker was barred from working in nursing homes, but soon ended up in a residential care facility for the elderly, or RCFE.

Hill's report found that a 2006 law required the Department of Social Services, which oversees RCFE facilities, to create a database of workers who were sanctioned for lapses in care. However:

Four years later, the database does not exist. The Department of Social Services decided in the 2007-08 fiscal year that it would not seek money to comply with the new law, which was contingent on a budget allocation. In later years, as the state's budget deteriorated, Social Services did not consider seeking money for the centralized database, estimated to cost "in excess of $500,000." Nor did it inform the Legislature that the database would not be built, deciding on its own that the state's cash crunch would mean shelving the project while it pursued less costly steps.

The report also found that one person was allowed to operate an RCFE even after "a criminal conviction for battery and other misconduct that led Public Health to conclude that he 'may pose a potential risk to the health, safety and welfare of residents.'"

Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, said it's problematic that there is very little public reporting of criminal history or discipline actions against nursing assistants, workers who perform the bulk of nursing home work.

While the Medical Board of California lists disciplinary actions against doctors and arrest records on a public website, no such resource exists for nursing assistants, whose licenses are granted by the Department of Public Health.

"It's always been a problem in that you just don't know," McGinnis said. "There's a lot of abuse in nursing homes, but we never know if these people have criminal backgrounds."

Following the issuance of the report, Sen. Elaine Alquist, D-San Jose, carried a bill that would have prevented anyone convicted of murder, kidnapping or several other crimes from operating a residential care facility for the elderly. The bill, while seemingly uncontroversial, carried a price tag for the stepped-up checks and died in committee.

California law lists the specific convictions that disqualify people from working in or operating a nursing home, and health professional licensing boards have their own requirements.

The topic of unfit caregivers has also been controversial in the In-Home Support Services program. The Los Angeles Times reported last year that people convicted of murder, rape and elder abuse served as caregivers under that program.

Former Gov. Arnold Schwarzenegger moved to ban felons from working in the program. However, a group of care workers and patients sued to block the move. Ultimately an Alameda County Superior Court judge sided with the plaintiffs, some of whom were care workers with decades-old convictions, including one for marijuana possession in the 1970s.