OIG Report Assesses National LTC Background Check Program

A November 7 report from the Office of Inspector General (OIG) evaluated the effectiveness of the National Background Check Program, created under the Affordable Care Act, to enhance safety in long-term care settings. This initiative, which concluded in 2024, enabled states to create systems for conducting background checks on prospective employees, helping to screen out individuals who might pose a risk of abuse or neglect.

The report assesses activities of the 29 states involved in the program between 2010 and 2024. Participants used over $100 million in federal and state funding to establish more robust systems for screening potential employees and disqualifying those with concerning criminal records, according to the report. Of the 29 initial participants, two states, Maryland and Wisconsin, withdrew from the program early.

The National Background Check Program supported 27 states in establishing programs to develop efficient and cost-effective background check procedures for prospective long-term care employees. Through the program, states successfully built systems to disqualify individuals with concerning criminal convictions from working in long-term care settings.

The most effective measures, according to the report, were automated background check systems and ongoing post-check monitoring. These significantly contributed to resident safety in long-term care. Notably, states rarely reported any unintended consequences such as workforce reductions as a result of conducting background checks.

Among the most common challenges faced by state participants were insufficient legislative authority at the state level and difficulties in coordinating efforts among various state departments.

The OIG provided recommendations throughout the program that contributed to the positive outcomes in this final assessment. At this time, the OIG has no further recommendations for the Centers for Medicare and Medicaid Services (CMS). Read the OIG fact sheet here.

Following the program's conclusion, states continue to advance the initiatives established in the program by participating in the National Background Check Program Forum. With an increased focus on preventing abuse and neglect in nursing homes, CMS has updated survey guidance within the requirements of participation.

LeadingAge has continuously advocated for programs that prevent abuse, neglect and misappropriation of resident funds.