Background Checks
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Caregiver Background Check Best Practices

An elderly woman and her caregiver sitting on a couch together

A thorough caregiver background check is essential for individuals or home healthcare employers looking to hire an in-home caregiver.

This article explains the benefits of using home health agencies to find caregivers; federal, state and industry requirements for caregiver background checks; and how to conduct home health care aide and home care aide background checks.

For home healthcare employers looking to hire a caregiver as part of your staff, conducting a thorough caregiver background check first is essential. Moreover, it’s important for individuals considering hiring caregivers for family members to understand how the caregiver background check process works and what it entails. 

In-home caregivers fall into two major categories. Home care aides or personal care aides primarily assist with non-medical activities of daily living such as housekeeping, bathing and personal care, transportation, and grocery shopping. Home health aides provide some of the same services, but also provide basic health care under the supervision of a nurse or other medical professional. This might include monitoring vital signs, administering medication, caring for wounds, accompanying patients to the doctor, or assisting with medical equipment. 

Whether they provide medical or non-medical care, trust is paramount whenever caregivers enter the homes of vulnerable individuals. According to the National Institute on Aging, as many as one in 10 Americans over age 60 are abused physically, emotionally, financially, or otherwise. Caregiver background checks can help mitigate that risk for companies that hire caregivers and home health aides. 

In this article, we’ll cover the benefits of using home health agencies to find caregivers; federal, state and industry requirements for caregiver background checks; and how to conduct home health care aide and home care aide background checks. 

How To Hire A Nurse For Home Care: Benefits Of Using Home Health Agencies 

A Home Health Agency’s (HHA) primary purpose is providing skilled nursing services and other therapeutic services, such as physical or occupational therapy, and is a great place to start for individuals looking to hire a home nurse. Their employees typically include home health aides, certified nursing assistants (CNAs) and licensed vocational nurses (LVNs), each providing increasingly skilled levels of care. 

A home care aide organization, on the other hand, employs personal caregivers who handle non-medical activities of daily living, such as light housekeeping, cooking, bathing, and dressing.

How to hire a nurse for home care: When seeking an in-home nurse or other home health aide, many individuals prefer to use an HHA to find caregivers for their family members, which offers several benefits. 

  • High Standards of Care: In order to serve Medicare or Medicaid patients, HHAs must follow Centers for Medicare/Medicaid Services (CMS) regulations; this helps to ensure a certain standard of care. They may also have to follow state and local laws regarding HHA operation; this varies from state to state.
  • Personal & Consistent Care: HHAs have multiple caregivers on staff and can match each patient with those who are best suited to him or her. If a regular caregiver is absent or ill, they can send a substitute. 
  • Ease of Use: Using an HHA streamlines the process of finding a caregiver. Seeking care for a family member can be stressful and must often be done quickly. Contacting one HHA to handle the process is faster and easier than researching, contacting, interviewing, and evaluating dozens of individuals. 
  • Reduced Burden: The HHA acts as the caregiver’s employer. They take care of issues such as contracts, wages, employment taxes, employee benefits and insurance, relieving the patient’s family of this burden.
  • Peace of Mind: The caregiver background check process is time-consuming and complicated; state and federal criminal records may not be accessible to individuals, limiting how much an individual can uncover. Using an HHA gives clients peace of mind that a detailed background check was conducted before hiring the caregiver. 

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State & Federal Requirements For Conducting Caregiver Background Checks

While there is no federal law requiring HHAs to conduct caregiver background checks, HHAs that want to receive Medicare or Medicaid funding must comply with their state laws regarding home care background checks. 

In 2010, the Affordable Care Act established the National Background Check Program (NBCP). The NBCP gives states grants to create a standardized system for conducting comprehensive, fingerprint-based background checks of caregivers who will have direct contact with patients. Although the CMS encourages states to participate, not all have chosen to do so. 

Each state has its own requirements for HHA caregiver background checks. In most cases, HHAs must be licensed by the state, which requires meeting the standards set by the state department of health. More information about home care background check and licensure requirements in each state can be obtained by visiting the website of that state’s department of health.

States that participate in the NBCP must require HHAs to conduct the following background checks. HHAs that want to receive federal funding must conduct these checks even if it’s not required by their state. 

  • A fingerprint-based search of state and federal (FBI) criminal history. The FBI search will uncover federal crimes as well as crimes committed in any state that have been reported to the FBI. This can uncover felony convictions for healthcare-related fraud, theft, or other financial misconduct; Medicare or Medicaid fraud; or the unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
  • A search of abuse and neglect registries including:
  • State abuse and neglect registries in the caregiver’s current state and any other states where the person has worked as a home health aide. 

Depending on state requirements, an HHA caregiver background check may also need to search state-level board disciplinary actions against the candidate and verify the current status of any professional licenses. 

How To Conduct Caregiver Background Checks

While HHAs can take a “DIY” approach to conducting caregiver background checks, using a professional consumer reporting agency (CRA) will simplify the process and help the HHA comply with all relevant regulations. When using a CRA, HHAs should follow these steps:

  1. Find a CRA that is accredited by the Professional Background Screeners Association (PBSA), the only organization accrediting CRAs.
  2. Gather information from the caregiver-candidate. This includes the job candidate’s full name, birthdate, address, and Social Security number, all of which the CRA will need to conduct a background check. Depending on the position, the person’s driver’s license number and any degrees or professional licenses they hold may also be required.  
  3. Using a CRA can help to ensure the background check process complies with federal Fair Credit Reporting Act (FCRA) requirements. This includes informing candidates that the background check will be run using a formal disclosure document, getting the candidate’s written authorization to run the background check, and following the adverse action process when deciding not to hire based on the results of the background check. Some states also have their own fair hiring laws with additional requirements.
  4. The HHA will need to order the background checks that are required by the state and by any accrediting organizations whose standards the HHA needs to meet. Be sure to also consider any additional checks outlined in the HHA’s employment screening policy or contractual requirements. 
  5. Review the background check results. Depending on applicable regulations and the HHA’s policy, results that may exclude an employer from hiring a home care provider could include OIG sanctions, being a registered sex offender, certain felonies, license suspension, or drug use. It’s important to follow all applicable laws and requirements regarding which offenses can exclude a candidate from hire; states have different laws in this regard. If a hiring decision is made based on information revealed in a background check, the employer must be sure to follow the adverse action process.

Home Care Background Check Best Practices 

For home care aide organizations that do not provide skilled nursing services, caregiver background checks can still be valuable. Conducting a background check can help you hire qualified candidates and mitigate risk to your company and the vulnerable populations you serve. 

When hiring home care aides, employers may wish to follow these best practices for caregiver background checks:

  • Conduct criminal background checks for caregivers to uncover federal, state and county felony and misdemeanor convictions that may indicate the candidate could be a threat to vulnerable patients. 
  • Conduct employment history verifications and education verifications to confirm the candidate is truthful and has the necessary experience, education, and qualifications for the job. 
  • Conduct drug screening for the presence of drugs that could make the candidate a danger to patients. The Equal Employment Opportunity Commission (EEOC) recommends conducting pre-employment drug screening only after making a job offer that’s contingent on passing the test. 
  • Check driving records. If the position involves transporting patients or running errands for them, check state motor vehicle records (MVRs) to confirm the driver’s license is valid and uncover DUIs, moving violations, license suspensions, and other risky driving behavior.
  • Conduct ongoing background checks after hiring employees. Post-hire background checks, such as continual checks of criminal records or regular drug testing, can help protect your business from risk. 

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Home health aides and home care aides help vulnerable clients in their homes, making thorough vetting of these caregivers essential. Both HHAs and caregiver organizations can benefit from conducting caregiver background checks to weed out unqualified employees and to help keep clients safe.

While it’s beneficial, the background check process is also complex and time-consuming. Having a CRA such as GoodHire conduct caregiver background checks for you simplifies the process, helps you maintain compliance with all applicable laws, and gives you confidence that you are making an informed decision based on accurate results.

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The resources provided here are for educational purposes only and do not constitute legal advice. We advise you to consult your own counsel if you have legal questions related to your specific practices and compliance with applicable laws.

About the Author

author karen axelton

Karen Axelton is a Southern California-based freelance writer specializing in business topics.