Inspector General, FBI can't show that "convict" nursing home workers threaten patients
The biggest finding in a new report about the criminal histories of nursing home workers is that the Office of Inspector General can't say whether seniors and people with disabilities truly are in danger.
And, as I noted in my earlier post, the Department of Health and Human Services' OIG office found that very few of these workers' crimes were committed against people at all.
But, let's assume that any crime against a person is reason alone for the convicted person to be barred from working at a nursing facility. For patient safety advocates and health writers, the only question that needed to be answered then was this: Are there people working in nursing facilities around the country who have been convicted of crimes against the facilities' residents?
The answer? The OIG doesn't know. This is what the report says:
Federal regulation prohibits Medicare and Medicaid nursing facilities from employing individuals found guilty of abusing, neglecting, or mistreating residents by a court of law, or who have had a finding entered into the State nurse aide registry concerning abuse, neglect, or mistreatment of residents or misappropriation of their property. FBI-maintained criminal history records do not contain detailed information (i.e., they do not indicate whether the victim of a crime was a nursing facility resident) to determine whether a conviction disqualifies an individual from nursing facility employment under Federal regulation. Therefore, we did not determine whether these individuals were employed in violation of Federal regulation as that question is outside the scope of this evaluation.
Outside the scope of the evaluation? What exactly was the point of the evaluation if it was not to find out whether patients were in jeopardy?
This is supremely frustrating, to say the least, for patient advocates and for health writers.
Let's ask a different question then. Assuming all criminal convictions are bad–because this report lumps bad check writers in with child molesters – are these "convicts" in positions where they can abuse patients?
No. The report looked at different categories of nursing home staff to find out which areas had employees with the highest percentage of criminal convictions. The single biggest fraction – if you can all 6.5% big – was the housekeeping staff. Here's another crucial sentence in the report that has been overlooked by many health writers. "Five percent of staff identified by the nursing facilities as direct-care employees had criminal convictions, which mirrors the conviction rate for nursing facility staff in general."
Even if that percentage sounds alarming to you, you would want to know whether these crimes were committed against nursing home residents. Neither the FBI nor the OIG can say.
What the OIG can say, which goes toward answering that question, is that the vast majority of these employees with criminal records had never been convicted of a crime while working at the nursing facility. The report says, "Eighty-four percent of employees with criminal convictions had their most recent conviction prior to their beginning date of employment. Of the employees with criminal convictions prior to the beginning date of employment, 38 percent had their most recent conviction 10 or more years prior to employment."
Then the report uses an example that would certainly make the lead anecdote for any number of newspapers. It found that one nursing home employee had 13 convictions. Can't you read it?
"Sam Bridges" had been and out of jail for nearly his entire adult life. With 13 felony convictions to his name, he had a hard time landing a good-paying job. Then he walked into the employment office at the Sharing Smiles Wellness Home in Maple Valley, Washington.
But this employee's crimes were all property crimes and, for the past 22 years, the employee had kept out of trouble. He hasn't had a conviction since 1988.
That last point was often missed in the coverage of this report. So you end up with comments like this one found in The New York Times: Charlene A. Harrington, a professor at the School of Nursing of the University of California, San Francisco, said: "This sounds like a very important study. It cries out for additional regulation. Residents in these homes are so vulnerable."
And this one from CBS News: "On its face, it's shocking," said Janet Wells, director of public policy for the National Consumer Voice for Quality Long-Term Care. She added, "People move from state to state and they may have an abuse record at another health care facility, that's why we would prefer to see a national mandatory program."
There may be good reason for a mandatory background check program. This report doesn't provide the reason, and, as health writers, we should be on the lookout for any unwarranted overreaction that could add yet another layer of complication to any already complicated health care industry.
Next: Health care workers deserve better than a felony litmus test
Photo credit: Sima Dimitric via Flickr