Report: Nurse Assistants Rehired After Misconduct

March 22, 2010

A California state Senate report said nurse assistants who lost their certification over abuse, negligence or theft in nursing homes were able to go to work as caregivers in assisted living facilities because of a computer tracking loophole.

A Senate subcommittee plans to hold a hearing this week on the findings by an oversight office that show nurse assistants who lost their certification with one state department over misconduct were later approved by another.

The report “Dangerous Caregivers” by the California Senate Office of Oversight and Outcomes revealed a loophole within the state Health and Human Services Agency.

In one case cited in the report, a nurse assistant lost her certification for hitting a blind, developmentally disabled client with a puzzle tray and throwing a softball into another client’s stomach. Three weeks later, the Department of Social Services cleared her to work as a caregiver in a small assisted living facility.

In another case, a nurse assistant was decertified for stealing from nursing home residents. Nine months later, Social Services approved her to work as a housekeeper in another home.

“There is no excuse for allowing people with known histories of abuse to work in residential care facilities for the elderly or as caregivers in any other setting,” said Michael Connors, long-term care advocate for California Advocates for Nursing Home Reform.

In a narrow sampling using uncommon names, the state report found 20 cases involving nurse assistants whose certifications were revoked by the Department of Public Health then cleared by the Department of Social Services to work as caregivers.

Both departments fall under the purview of the Health and Human Services Agency.

Lizelda Lopez, spokeswoman for the Department of Social Services, said Friday that the department began investigating caregivers last November, when the Senate office started its inquiry.

The department checked all 140,000 caregivers and only found a handful of cases of decertified nursing assistants beyond the 20 mentioned in the report, she said.

The loophole results from the lack of a centralized database of workers that the state departments can check in pre-employment screenings, said John Hill, the consultant who prepared the 32-page report.

“A criminal background check is routine, but what they haven’t done is check each other’s administrative actions,” he said.

Lopez said Social Services and Public Health are now exchanging information every month on disciplinary actions and caregiver applicants.

The state’s 197,000 nurse assistants are trained to perform medical-related and caretaking tasks mostly in nursing homes, while some 140,000 caregivers help with the daily living of senior citizens who are generally not ill but need assistance.

Hill noted the loophole is putting some of the state’s most vulnerable residents at risk.

The loophole has come to state legislators’ attention in the past. In 2006, a Senate bill required Social Services to set up a database of administrative actions by six Health and Human Services departments — Aging, Health Services, Alcohol and Drug Programs, Mental Health, Social Services and the Emergency Medical Services Authority — to cross-check prospective employees.

However, the database, which would cost $500,000, was never set up due to budget restraints, he said.

Lopez, of Social Services, said the department believes the centralized system is the best solution, but funding has not been provided. In the meantime, the department is in talks with the other Health and Human Services departments to develop informational exchanges similar to the one with Public Health, she said.

Hill said he started investigating decertified nurse assistants after hearing reports that they were obtaining caregiver jobs.

The investigation used a narrow sample of workers with uncommon names because more exact identifiers, like Social Security numbers and dates of birth, were not available, he said.

The Senate Subcommittee on Aging and Long-Term Care has scheduled a hearing on the report for March 24.

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