Early next year, Indiana lawmakers will consider a proposal to require workers in nursing homes to undergo background checks, in an effort to provide better protection for vulnerable elderly residents.

Indiana Attorney General Greg Zoeller said he will also propose that the legislature make additional changes in state law to provide whistleblowers with legal protections. More broadly, Zoeller has asked an oversight panel that reviews licensing agencies to focus its scrutiny on the Indiana Health Facility Administrator (HFA) Board, the body that has disciplinary power over nursing home administrators.

"The HFA Board writes the licensing rules for nursing home administrators and the board acts as judge and jury to decide whether or not those rules were violated," Zoeller said.  "We have an opportunity through this evaluation committee to thoroughly examine the rule-enforcing process by the group of experts the Legislature created for that purpose, to determine if it is adequate to hold these licensees accountable for violations within the facility that occur on their watch."

Abuse toll

 According to the best available estimates, between one and two million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection, according to the National Center on Elder Abuse.

Nursing Home Abuse Resource, an advocacy group, says 30 percent of nursing home facilities in the U.S. are cited for instances of abuse. The group maintains that the majority of all nursing home abuse incidents are never reported.

Zoeller sent a letter to the Regulated Occupations Evaluation Committee, a newly-created oversight panel already assigned to review the authority and duties of licensing boards that issue professional licenses in Indiana. Zoeller's letter asked the committee to review first the HFA Board, its standards of practice, the rules it has written for nursing home administrators and its oversight of that profession.

Established when the Legislature passed Senate Enrolled Act 356 in April, the Regulated Occupations Evaluation Committee can recommend changes in state law to lawmakers. The committee agreed today to conduct a hearing on the HFA Board in January.

Separate from the committee's review, the Attorney General is proposing his own recommendations to the Legislature to consider in its 2011 session.

Enhanced screening

 To screen out individuals with criminal records from working around the vulnerable elderly, Zoeller supports legislation authored by Indiana State Senator Patricia Miller of Indianapolis, to require health professionals who work in nursing homes - such as nurses and administrators - to undergo criminal background checks when they apply for a license. 

Paid for at licensees' expense, the background checks would be sent to the Indiana Professional Licensing Agency (IPLA), which oversees licensing records for nurses and administrators. Also, county prosecutors would be required to notify IPLA if a health licensee is convicted of or pleads guilty to a crime, since a criminal conviction could be grounds for suspension or revocation of a health license.

Zoeller says he is also proposing that legislators change state law to extend whistleblower protections to nursing home administrators and staff who report misconduct. State law already protects whistleblowers who report health and safety violations from employment-related retaliation; and those who report Medicaid fraud can receive a portion of Medicaid's civil recovery. Zoeller proposes widening the existing legal protections to include whistleblowers, to encourage those aware of misconduct to report it.

Notice of termination

Zoeller said he also wants to change Indiana law so that nursing homes are required to notify the State whenever they terminate a licensed health care giver. Nursing homes would have to report terminations to the IPLA and to the responsible licensing boards. 

Zoeller also recommends that the Legislature require insurance companies to report to the State any judgments or settlements they pay out involving nursing home negligence.

Between 2005 and this year, the Medical Licensing Section of the Attorney General's Office filed 34 administrative complaints against Indiana nursing home administrators for various regulatory violations and obtained disciplinary actions from the HFA Board on 25 of them, with one currently pending. 

During the same time period, the Attorney General's Office filed 787 administrative actions against nurses and obtained discipline from the State Board of Nursing in 669 cases, with 87 still pending.