Jeff Ernste headshot
Jeff Ernste

Imagine a world where the personal information of your residents lies in the hands of individuals with secrets to hide, and those you count on to provide care have a history of abuse. This is not a far-fetched dystopian scenario but a genuine risk that senior living operators must prevent.

In the highly regulated senior living industry, background checks are a crucial safeguard for the safety of residents and their sensitive information. Getting background checks right must be a continuing concern, as noncompliance with state or federal government requirements and debarment lists can result in severe consequences, including losing critical Medicare or Medicaid funding.

Manifold challenges

Employers must be aware of inherent challenges concerning background checks. Some of the most considerable background-checking mistakes include failing to obtain proper consent, obtaining outdated information, not following an adverse action process, and failing to comply with “Ban the Box” legislation. Those problems can be avoided if human resources personnel are current on all applicable federal and state laws and using screening services that follow regulations on consent and other Fair Credit Reporting Act rules. Senior living operators, through continuous monitoring, also must avoid employing workers who have violated state and federal laws.

Those regulatory requirements seem burdensome but make sense given the sensitive, highly personal nature of work and the risk of infractions that are highly actionable from a legal standpoint: personal injury and mishandling of patient (resident) information.

Navigating debarment lists

One significant risk factor around background checks for senior living operators is the chance that an employee is identified by either the Office of Inspector General or System for Award Management as having committed an infraction that bars the individual from working in the senior living sector. The high standards placed on providers and staff members mean that employers must stay aware of the processes used by these federal bodies and the state-level regulators where they operate. Moreover, as mentioned, the penalties for noncompliance can be severe, with eligibility for Medicare and Medicaid reimbursements potentially at risk.

At the federal level, the OIG maintains the list of excluded individuals/entities, a database of individuals and entities excluded from participation in Medicare and Medicaid. The list includes individuals convicted of healthcare fraud, patient abuse and neglect.

Similarly, System for Award Management maintains the Excluded Parties List System, a database of individuals and entities excluded from receiving federal contracts, grants, and other forms of federal assistance. The EPLS includes individuals who have been debarred or suspended from participating in federal programs due to fraud and other criminal activities.

And at the state level, various specific requirements and potential infractions exist. For example, in Minnesota, rather than “staying” with whomever commissioned the screening, the background check “travels” with the employee via state-level monitoring.

Pre-screening and ongoing compliance benefits

Pre-screenings reduce the number of people who must be checked against debarment lists and save considerable time. They can be most effective when they detect offenses, such as elder abuse, that almost automatically would put a candidate on a debarred list.

In addition, the ongoing need to screen for misconduct has made monthly checks the norm for detecting criminal violations in the senior living industry.

But although technology has made it easier to automate screenings, it does not prevent the need for policies that define what happens if a candidate or employee is debarred at the federal or state level.

In conclusion

Senior living organizations face unique challenges regarding background checks and compliance in ensuring the safety and well-being of their residents. By diligently adhering to federal and state regulations, using pre-screening services and maintaining ongoing monitoring of current employees, senior living operators can minimize the risk of employing individuals with histories of abuse or other infractions. 

Recognizing the broader implications of those measures, investing in technology and employee education can streamline background check processes while maintaining strict adherence to appropriate policies and procedures. Ultimately, those efforts contribute to a safer and more secure environment for senior living residents, fostering trust and peace of mind for their families and the community at large.

Jeff Ernste is chief sales and marketing officer with Minneapolis-based Orange Tree Employment Screening. For more than 30 years, Orange Tree has provided technology-enabled background screening, drug testing and occupational health services for clients nationwide. Find more information at

The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.

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