Employee background-check policies in long-term care facilities in the United States

Abstract

Background and Objectives: Employee background checks can help protect older adults in long-term care facilities. The National Background Check Program (NBCP) offers federal support to strengthen employee background-check systems. Yet, regulations on provider requirements, disqualifying offenses, and administrative processes differ across states. We examine differences between NBCP (N = 27) and non-NBCP (N = 23) states across three domains: (1) types of LTC providers required to conduct background checks, (2) disqualifying offenses considered by each state, and (3) processes used to administer background checks. We also assess regulatory changes across these domains from 2005 to 2024 across all 50 states. Research Design and Methods: We conducted policy surveillance of state regulations on employee background-check programs applicable to individuals seeking work at long-term care facilities. Our sample includes all 50 states, with 27 receiving an NBCP grant. We assess current regulations across three policy domains and review how these regulations have evolved since 2005, when the NBCP pilot program was initiated. Results: NBCP states have expanded background-check regulations to include a broader range of long-term care providers and disqualifying offenses following the grant. However, minimal differences were observed between the two groups in background check processes such as fingerprinting and registry reviews. Discussion and Implications: While many NBCP states have adopted measures like disqualifying offenses and RAP back systems, their overall impact on hiring practices, F-tags, and quality of care remains uncertain.