Federal law requires that registered sex offenders be tracked on a national  and state level; however, parolees are generally monitored and supervised  by each state. It also does  not include all registered sex offenders, as states have had varying degrees  of difficulty submitting their records to the NSOR because of technical  problems, lack of resources, or inability to provide the required FBI  number for certain offenders. Because there is no national data source on  parolees that includes address information, we also obtained parolee  databases from the eight states we reviewed and identified 204 offenders  on parole for non-sex offenses living in long-term care facilities. The risk  of abuse within nursing homes or ICFs-MR by residents with prior  convictions is unclear because states we reviewed do not report the prior  convictions of residents who commit abuse; however, facility  administrators we interviewed more frequently expressed concern about  the potential for abuse by residents with cognitive impairments or mental  illness than by residents with prior convictions. Most Sex Offenders Identified Were Male, Were under Age 65, and Resided in a Small Number of Nursing Homes and ICFs- MR

Using the NSOR, we identified 683 registered sex offenders living in long- term care facilities during 2005, representing about 0.05 percent of the  total 1.5 million residents of nursing homes and ICFs-MR. (See app. Of  the approximately 16,000 nursing homes and 6,600 ICFs-MR that  participate in Medicare or Medicaid, we identified 3 percent of nursing  homes (470) and 0.7 percent of ICFs-MR (46) as housing at least 1  registered sex offender during 2005. The NSOR  included about 57 percent of sex offenders registered in these states, with  submission rates ranging from 1 to 83 percent. For example, Utah had  submitted about 1 percent of its registry to the NSOR. States Required to Notify Community about Registered Sex Offenders, but Extent of Notification Varies

Federal law requires state law enforcement agencies to release relevant  information about registered sex offenders when necessary to protect the  public, but we did not identify a similar federal requirement pertaining to  the parolee population. Consequently, the extent to  which states’ community notification laws apply to all registered sex  offenders or explicitly include nursing homes and ICFs-MR varies. For example, New  Jersey classifies its registered sex offenders into three categories based on  their assessed risk of re-offending. Four  states we reviewed—California, Illinois, Minnesota, and Oklahoma— passed laws in summer and fall 2005 that specified long-term care facilities  as entities to be notified for at least some registered sex offenders who  entered them.28, 29 Notification in these states is conducted by individual  facility officials, state or law enforcement officials, or registered sex  offenders themselves. Even if long-term care facility officials wanted to impose different  supervision and separation requirements on offenders, numerous factors  could affect their ability to do so. GAO staff who made major contributions to this report are  listed in appendix V.

Appendix I: Scope and Methodology

To determine the prevalence of registered sex offenders residing in long- term care facilities nationwide, we matched the addresses of registered  sex offenders listed in the Federal Bureau of Investigation’s (FBI) National  Sex Offender Registry (NSOR) as of January 3, 2005, with the addresses of  nursing homes and intermediate care facilities for people with mental  retardation (ICF-MR) listed in the Centers for Medicare & Medicaid  Services’ (CMS) Online Survey, Certification and Reporting system  (OSCAR) database. We also  interviewed Department of Health and Human Services Office for Civil  Rights officials about the applicability of the Health Insurance Portability  and Accountability Act of 1996 Privacy Rule to the notification of facilities  about residents who are sex offenders or parolees. To determine whether states we reviewed have laws or long-term care  facilities have practices that provide for notification of these individuals  and to determine the extent to which these individuals are subject to  supervision and separation requirements that differ from those for other  residents, we reviewed laws and interviewed state officials responsible for  long-term care facility licensing, industry officials, long-term care  ombudsmen, and the administrators at 29 long-term care facilities, which  were chosen based on the criteria discussed above.
Why GAO Did This Study

Approximately 23,000 nursing homes and intermediate care facilities for people with mental retardation (ICF-MR) receive federal Medicare and Medicaid funding. Media reports have cited examples of convicted sex offenders residing in long-term care facilities and, in some cases, allegedly abusing other residents. Given concerns about resident safety, GAO was asked to assess (1) the prevalence of sex offenders and others on parole for non-sex offenses living in long-term care facilities and the extent of any abuse they may have caused, (2) the legal requirements for notifying facilities and others when offenders are residents, and (3) the extent to which facilities have different supervision and separation requirements for offenders. GAO analyzed a national database for sex offenders and analyzed state databases in a sample of eight states for sex offenders and parolees.

What GAO Found

By analyzing the FBI's National Sex Offender Registry (NSOR), which is a compilation of sex offender registries submitted by all states, GAO identified about 700 registered sex offenders living in nursing homes or ICFs-MR during 2005. Most identified sex offenders were male, under age 65, and living in nursing homes, and represented 0.05 percent of the 1.5 million residents of nursing homes and ICFs-MR. About 3 percent of nursing homes and 0.7 percent of ICFs-MR housed at least 1 identified sex offender during 2005. However, these estimates are understated due to data limitations. For example, because of a lack of resources or an inability to comply with certain FBI reporting requirements, states have had varying degrees of difficulty submitting their full state registries to the NSOR. While the FBI does not track NSOR submission rates, GAO compared sex offender registry data from seven of the eight states reviewed to NSOR data and found that the NSOR data included about 57 percent of sex offenders registered in these states, with submission rates ranging from 1 percent to 83 percent. Because a national data source on parolees that included address information was not available, GAO also obtained parolee databases from the eight reviewed states and identified 204 offenders on parole for non-sex offenses living in long-term care facilities. GAO could not determine the overall risk that registered sex offenders and parolees pose to other residents in long-term care facilities because offender status is not tracked with abuse reporting. Facility administrators expressed greater concern over the risk posed by cognitively impaired or mentally ill residents. Federal law requires state law enforcement agencies to release relevant information about registered sex offenders when necessary to protect the public, but GAO did not identify a similar federal law for the parolee population. States have broad discretion in how to implement the requirement for registered sex offender notification. Therefore, the extent to which states' community notification laws apply to all registered sex offenders or explicitly include long-term care facilities varies. For example, four of the eight states GAO reviewed--California, Illinois, Minnesota, and Oklahoma--had laws that specified long-term care facilities as entities to be notified for at least some registered sex offenders who entered them. However, some facility administrators GAO contacted were uncertain as to whether they could share information with staff and others about residents who were known offenders in light of the Privacy Rule issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Long-term care facilities GAO contacted do not routinely impose different supervision or separation requirements on residents who are offenders based solely on their prior convictions. Instead, these facilities base such decisions on the demonstrated behaviors of residents. Even if long-term care facilities wanted to impose different supervision and separation requirements on offenders, their ability to do so is limited because they are not always aware of residents' prior convictions.