National Background Check Program for Long-Term Care Providers: A Final Assessment

Report Materials

• Full Report (PDF, 1.4 MB)
• Report Highlights (PDF, 361.6 KB)

Why OIG Did This Review

• As many as 70 percent of seniors may need care in long-term care setting at some point in their lives. In 2023, nearly 16 percent of residents living in long-term care settings reported experiencing abuse.
• In 2010, the Patient Protection and Affordable Care Act (the Act) established a National Background Check Program, which provided Federal financial assistance for States to develop or enhance systems for long-term care settings to conduct background checks on prospective employees.
• Twenty-nine States participated in the program at various times from 2010 to 2024. The last two States ended participation on May 31, 2024.
• The Act included a mandate for OIG to produce an evaluation of this program.

What OIG Found

The National Background Check Program successfully established a program to help States identify efficient, effective, and economical procedures for conducting background checks on prospective long-term care employees.

The National Background Check Program helped States successfully build systems to disqualify employees with concerning criminal convictions from working in long-term care settings.

States reported two procedures that were appropriate, efficient, and effective for conducting background checks: having an automated system for conducting background checks and having the ability to monitor status changes to a person's background check after the initial background check has been completed.

States rarely reported that conducting background checks resulted in any unintended consequences, such as a reduction in workforce.

The most common challenges that States encountered while in the program were a lack of State legislative authority and difficulty coordinating between State-level departments.

States spent more than $100 million in combined Federal and State funds to develop or enhance systems to conduct background checks of potential employees of long-term care providers.

What OIG Recommends

OIG issued recommendations during the program that aided the outcomes in this final assessment. OIG does not have further recommendations for CMS.