Inspector General Report on Convicted Nursing Home Employees: More Yawn Than Alarm

Published on
March 16, 2011

Sen. Herb Kohl, a Wisconsin Democrat and the chairman of the Senate Aging Committee, recently told the New York Times,

The current system of background checks is haphazard, inconsistent and full of gaping holes in many states. Predators can easily evade detection during the hiring process, securing jobs that allow them to assault, abuse and steal from defenseless elders.

He was talking about the hiring process for nursing homes. And his assessment was pretty shocking for anyone who might have a family member living in one.

Kohl was responding to a report by the Office of the Inspector General for the Department of Health and Human Services last week. The report comes in the wake of the incredible ProPublica/Los Angeles Times investigation, When Caregivers Harm, which documented a pattern of nurses who hurt patients in one hospital or nursing home but are allowed to work in others all around the country. The reporting by Tracy Weber, Charles Ornstein and Maloy Moore was exhaustive, definitive and compelling evidence that health facilities need to do more to check the backgrounds of their nurses before putting them in positions where they might hurt or take advantage of vulnerable patients.

The OIG report, however, is much weaker sauce.

It does not make a strong case that background checks are the main culprit compromising patient safety. Instead, it confuses the issue by making any criminal conviction appear to be reason alone to bar someone from working in a health facility. This is an unfortunate overstatement that Antidote will examine over a few posts.

First, let's look at what the report actually said.

Are predators evading easy detection in the nation's nursing homes, as Sen. Kohl said?

A casual reader might say "yes." The report showed that very few nursing homes had zero employees with clean criminal records. But take a closer look. The majority (51.8%) had 5% or fewer employees with criminal convictions. Another 26% had between 5% and 10% of their employees with criminal convictions. That means that 77.8% of all the nursing homes investigated had a ratio of fewer than 1 in 10 employees with criminal convictions. Is that really alarming?I'm not sure that a handful of employees who may have committed a crime – any crime – sometime in their past make a health facility, or any organization for that matter, dangerous.

Now let's look at the crimes themselves. Are these crimes evidence of potential threats against patient safety?

* 43.6% of the employees with convictions were convicted of crimes against property. This could be as minor as a shoplifting conviction or writing bad checks to as serious as a break-in.

* 32.2% of them were convicted of driving related crimes, including DUIs

* 16.2% had drug-related offenses.

* There were 26.4% listed in the "other" category.

And then the crucial figure: of all the employees with criminal convictions, just 13.1% had committed crimes against another person, meaning an assault, rape or other violent act.

All these percentages add up to 131.5%, which is one of the many limitations of the report. The report tries to gloss over this with this footnote, "Percentages do not sum to 100 percent because some employees had criminal convictions in more than one category."

We have to ask, what good is a list of percentages if they don't represent some fraction of the total? How are we to make any sense of these numbers?

In the back of the report, in Table D-1. We are given one clue. The sample size for these crime numbers is 1,722. This means that the OIG was able to find 232 employees in 256 nursing facilities nationwide who had committed a crime against a person at some point in their history.

Is this cause for alarm?

Next: Why criminal background checks are only as good as the data

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