Guide to Caregiver Background Checks

In the following sections, we’ll take a closer look at caregiver background checks: what they are, why they matter (legally and otherwise), and how to conduct a caregiver background screening that is compliant and thorough.

A caregiver background check helps home health agencies (HHAs), community care organizations such as nursing homes, home care aide organizations, and private employers including families hiring caregivers for their family members screen prospective caregivers before hiring them to provide direct care to clients in a home or facility. Caregivers who provide personal care and health services may include:

In most states, home health agency employers must meet state requirements for caregiver background checks, which typically include criminal background checks and searches of abuse and neglect registries. Employers may also conduct additional screening, for example to verify past employment and education, or check a candidate’s motor vehicle record (MVR) if driving will be part of the job.

Employers can choose from a range of pre-employment background screenings when conducting caregiver background checks. In addition to meeting state requirements regarding background checks for caregivers, employers may choose to conduct additional searches, such as employment or education verification or driving records for employees, contractors, and volunteers who have direct contact with clients.

Pre-employment background screening for caregivers is typically extensive because of the nature of this type of work. In-home caregivers may enter their clients’ homes where they can work independently and unsupervised. Elderly and disabled clients can be vulnerable to abuse and neglect. The National Institute on Aging estimates that hundreds of thousands of adults over 60 are abused, neglected, or financially exploited every year.

What is a caregiver background check? Depending on employer needs, a caregiver background check may include the following searches and screenings:

There is no federal law that requires caregiver background checks. However, home health agencies that want to receive Medicare or Medicaid funding must comply with state laws regarding home care background checks.

The Centers for Medicare & Medicaid Services (CMS) has awarded more than $65 million to 28 states to develop comprehensive national background check programs for direct patient access employees. States that participate in the National Background Check Program (NBCP) require HHAs to conduct the following background checks. HHAs in states that do not participate in the NBCP must also comply if they want to receive federal funding.

Each state has its own licensing requirements for HHAs and other caregiver organizations, including specific guidelines for caregiver background checks. Your state may require you to verify the current status of a candidate’s professional licenses, or to search state board disciplinary actions against the candidate. Some states require data sharing between present and future employer(s) to confirm the candidate has not received any negative reports, related to information found in a background check, during their time with the present employer. To learn more about laws and regulations in your state, check the website of your state’s department of health or department of social services.

As an example of state-specific laws, California employers must contend with various state and local regulations regarding caregivers. Under Cal. Health & Safety Code § 1520, caregiver applicants are required to undergo a fingerprint-based criminal background check. If a misdemeanor or felony conviction is found, the applicant is disqualified unless they obtain an exemption from the California Department of Social Services. For caregivers who wish to receive funding from a county in-home support services (IHSS) program in California, IHSS background check requirements also call for fingerprint-based criminal background checks by the California Department of Justice.

Although specific requirements can vary from state to state, criminal background checks are the baseline. In Michigan, employees and independent contractors who provide direct services to patients or residents must undergo a state and FBI criminal background check as part of their application for employment. 
In Virginia, employees of home care organizations must submit a sworn statement disclosing criminal convictions and pending criminal charges prior to employment, and complete a criminal history check within 30 days of employment. While waiting for results of a criminal background check, the employee may not have direct contact with patients unless under the supervision of an employee with clearance.

The best background check for caregivers meets your needs as an employer. This means complying with legal requirements and providing the information you need to evaluate a candidate’s experience, qualifications, and readiness to do the job. Although a caregiver background check may include different elements depending on your jurisdiction–and your situation–here are a few basic screening options to consider:

Your state may require fingerprint-based criminal records checks conducted through the FBI. You may want to run additional criminal background checks, including a state criminal records search to uncover any criminal convictions in your state that were not reported to the FBI. Searching the sex offender registry and domestic terrorist watch list are additional options, whether required by regulation or not.

Employers can verify the candidate’s education and employment history, as well as the current status of their professional licenses to better understand their experience and qualifications.

You may want to check the central neglect and abuse registry in your state and in other states where a candidate has lived or worked.  State neglect and abuse registries are centralized databases of child abuse and neglect investigation records that may also include records of abuse of vulnerable adults. If applicable, employers may also check federal and state healthcare sanctions registries, such as the OIG exclusion list, which shows individuals who are not eligible to receive funding from healthcare programs like Medicare. These screenings may or may not be included in a state-required background check.

Employers may elect to check a caregiver candidate’s driving record to confirm license type and status, accidents, and moving violations for positions that require driving on the job.

Illegal drug use can compromise a caregiver’s ability to do their work. The Equal Employment Opportunity Commission recommends conducting pre-employment drug screening only after a provisional offer of employment is made.

Once candidates are hired, ongoing checks of criminal records and driving records, or periodic drug testing can help keep you up to date.

You might start by learning about state requirements where you live. In addition to regulations on caregiver background checks, your state may have resources to help. For example, the California Department of Social Services (CDSS) maintains Guardian, a system for conducting self-service background checks for caregivers through its Care Provider Management Bureau. The CDSS also maintains the Home Care Aide Registry, a listing of individuals who have completed a criminal background check administered by the CDSS and TrustLine, a registry of child care providers who have passed a criminal background screening. In Georgia, family employers looking to hire personal caregivers for family members may access the Georgia Caregiver Portal to verify the employment eligibility of prospective caregivers.

While it’s possible to conduct a caregiver background check yourself, many organizations and employers choose to work with a professional consumer reporting agency (CRA), like Checkr. A third-party provider can help you conduct thorough pre-employment background checks that are compliant with federal, state, and local regulations–as well as fair-hiring laws at every level.

Follow these steps to get a caregiver background check with help from a CRA:

Working with a professional background check provider, like Checkr, to conduct caregiver background checks can save you time while helping you comply with legal and industry regulations, as well as fair-hiring laws. Checkr offers multiple background check options, including criminal background checks, professional license verification, and healthcare sanctions searches.

About the author

Gayle writes about business topics, specializing in background checks and screening best practices.