These include the increasing size and obvious vulnerability of the population in need of home care services, the challenges the home care setting poses for worker supervision, rapid expansion of the home care industry, unrelenting demand for home care services in the face of worker shortages, the low wages typically available to paraprofessional workers serving a largely low- or fixed-income population, diffuse responsibility for worker selection, and anecdotal reports of abuses by home care workers with criminal history. This registry is important for two reasons: (1) there is some overlap between the nursing home and home care work force; and (2) it is a model for worker screening that has already been incorporated in the Medicare and Medicaid programs that some states have extended to cover other types of workers, including home care workers. With respect to criminal background checks, several variations are possible. We report results on the extent to which states have taken advantage of this law in connection with home care workers, who primarily serve the elderly. We also asked about states’ experience in operating the federally mandated registry for nursing home aides that records documented findings of abuse, neglect, or misappropriation of a resident’s property and the states’ use of this or similar registries for home care workers. Although most states require that at least certain professionals who provide paid home care obtain a state license, they are not likely to require licensure or registration of some common types of home care workers. Do States Compile a Registry of Home Care Workers? Twelve of these states indicated that state statutes or regulations specified the jurisdictions that these checks must cover, but the breadth of the check was generally limited to a state’s own criminal records, which may be problematic where many workers come from neighboring states. Conclusions

While it is difficult to assess the extent of problems with abuse, neglect, or misappropriation of property in the home care industry, we found that federal regulations do not require criminal background checks of home care workers. While some states and localities have instituted criminal background checks or other safeguards, states’ approaches to regulating home care are quite varied, and in some instances, there may be few formal safeguards to protect potentially vulnerable elderly persons from unscrupulous operators. While some states have instituted criminal background checks for some home care providers, few have used the FBI’s national data, citing cost concerns. ), or a hospital nursing diplomate.
Why GAO Did This Study

Pursuant to a congressional request, GAO examined federal and state provisions for protecting vulnerable elderly and disabled persons from home care wokers with histories of crime and patient abuse, focusing on: (1) federal or state requirements for licensure, registration, or certification of home care workers and organizations; (2) the extent to which states have used the federally mandated registry for nursing home aides, or a similar mechanism, to identify home care workers with past involvement in abuse, neglect, or misappropriation of property; and (3) the extent to which states have required criminal background checks of home care workers.

What GAO Found

GAO found that: (1) assessing the extent of problems with abuse, neglect, or misappropriation in the home care industry is a difficult task; (2) formal safeguards for home care consumers vary widely across political jurisdictions, public programs, and types of providers; and in some instances, few safeguards exist; (3) GAO has three key results of its evaluation to report; (4) few states have licensure requirements for types of workers that are among the most common providers of home care services; (5) however, the vast majority of states license or otherwise regulate some types of home care organizations or professionals, and some states indicate that all types of home care organizations are subject to a state licensure requirement; (6) while all states must maintain a registry for nursing home aides in accordance with federal law, only about a quarter have incorporated home care workers into it or have developed a separate registry for home care workers; (7) finally, GAO found that slightly over a quarter of the states require criminal background checks on some types of home care workers, though these checks are generally limited to a state's own criminal records; (8) states with a statute requiring such checks may access Federal Bureau of Investigation (FBI) data for this purpose, but few states have made use of this capacity with respect to home care workers; and (9) 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.