Long-Term Care

Persons needing assistance with daily activities generally prefer home- and community-based services to nursing homes, and increasing numbers of elderly and disabled persons are turning to paid home care workers for such services. Home care workers have frequent, unsupervised access to potentially vulnerable people and their property. This report examines the federal and state provisions that protect vulnerable elderly and disabled persons from home care workers with histories of crime and patient abuse. GAO describes (1) federal or state requirements for licensure, registration, or certification that apply to 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.

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.