Employers who place staff in nursing homes, home care agencies, assisted living communities, and adult day programs are not just running a criminal background check. Several states keep a separate registry of substantiated findings against caregivers, and federal rules require a specific type of registry, the nurse aide registry, for anyone working as a certified nurse aide in a long term care facility or home health agency. These registries are a distinct screening step, with their own rules for how a finding gets placed, how long it stays, and how a worker can dispute it.
Two different kinds of registry, often confused
Employers and applicants often use the term “elder abuse registry” loosely, but there are generally two separate systems:
- Nurse aide registries. Every state must maintain one under federal nursing home rules. The registry tracks who has completed nurse aide training and competency testing, and it records any state finding of abuse, neglect, or misappropriation of resident property by that individual.
- State adult or elder abuse registries. Separate from the nurse aide registry, some states maintain a broader caregiver or adult abuse registry through their department of health, department of human services, or adult protective services (APS) program. Coverage, who is listed, and how long a finding stays vary by state, and not every state operates one in the same way.
A home care agency, nursing home, or adult day program may need to check both, depending on the state and the role being filled. Checking only a general criminal history search will miss findings that live solely on a state’s nurse aide or caregiver registry.
The federal rule behind nurse aide registries
Nursing homes that participate in Medicare or Medicaid are governed by federal long term care requirements, and 42 CFR 483.156 requires each state to establish and maintain a registry of nurse aides. Under that rule, only the state survey and certification agency can place a finding of abuse, neglect, or misappropriation of property on the registry, and the entry must include documentation of the state’s investigation, the date of any hearing the aide requested, and its outcome. A worker may also add a statement disputing the finding. Once entered, a finding generally stays on the registry permanently, unless it was made in error, the individual was found not guilty in a court proceeding, or the state is notified of the person’s death. States may also allow home health aides on the same registry if they completed an approved competency evaluation.
Because the rule is federal, every state nurse aide registry follows this same basic structure, even though each state runs its own registry and website. The Centers for Medicare and Medicaid Services oversees state survey and certification programs that enforce these long term care requirements, including nurse aide registry rules, as part of its survey and certification program.
State adult abuse and caregiver registries
Some states run a separate registry, often tied to adult protective services, that can cover a wider group of caregivers than the federal nurse aide rule reaches, including home care workers, personal care aides, or staff in adult day programs. These systems are not uniform. A few examples illustrate the range:
| State registry example | What it generally covers | Agency that maintains it |
|---|---|---|
| Illinois Health Care Worker Registry | Nurse aides and other health care workers, including findings of abuse, neglect, or theft from a patient or resident | Illinois Department of Public Health |
| Pennsylvania Nurse Aide Registry | Certified nurse aides, required training and competency records, and substantiated abuse or neglect findings | Pennsylvania Department of Health |
| California Adult Protective Services program | Investigations of reported abuse, neglect, or exploitation of adults, generally handled at the county level under state oversight | California Department of Social Services |
See the Illinois Health Care Worker Registry, the Pennsylvania Department of Health nurse aide certification page, and the California Department of Social Services adult protective services program for how each state structures its own system. Because coverage and process differ this much from state to state, an employer operating in more than one state generally cannot assume one state’s registry rule applies in another, and should check the specific state agency page for the state where the role is located rather than relying on a single national registry.
How a finding gets placed, and how it can be challenged
Placing a finding on a nurse aide registry is not instant and not automatic. Under the federal structure, a state survey agency investigates a reported incident, documents the allegation and the evidence, and generally gives the individual an opportunity to request a hearing before the finding becomes part of the permanent record. The worker’s own statement disputing the finding, if submitted, becomes part of what appears when the registry is checked. State adult abuse or caregiver registries typically follow a similar pattern of investigation, notice, and an opportunity to respond, though the exact procedure, appeal window, and standard of proof are set by each state’s own statute and agency rules rather than by one federal standard. Employers should not assume a listed finding was never contested, and should not treat a pending allegation the same as a substantiated one.
How this differs from the OIG exclusion list
A nurse aide or state abuse registry is a different tool from the federal exclusion list maintained by the Department of Health and Human Services Office of Inspector General, which bars excluded individuals and entities from being paid, directly or indirectly, for services billed to federal health care programs. The OIG List of Excluded Individuals and Entities covers program integrity issues such as fraud or certain criminal convictions, explained further on the OIG’s exclusions program background page, and it is checked separately from state abuse or nurse aide registries. A long term care employer, home care agency, or adult day program that bills Medicare or Medicaid generally needs to check the exclusion list in addition to, not instead of, the relevant state registry.
Who typically needs to run these checks
| Setting | Typical registry check |
|---|---|
| Nursing home or skilled nursing facility | State nurse aide registry, plus the OIG exclusion list for billing staff |
| Home health or home care agency | State nurse aide registry if the state includes home health aides, plus any separate state caregiver or adult abuse registry |
| Adult day program | State caregiver or adult abuse registry where the state maintains one, since coverage for this setting varies by state |
| Assisted living community | Varies by state; many require the same nurse aide or caregiver registry check used for nursing homes |
Employers that use a consumer reporting agency to run these checks as part of a background screening program still need to meet Fair Credit Reporting Act requirements separately from the registry check itself: a standalone disclosure, written authorization from the applicant, a pre-adverse action notice with a copy of the report and a summary of rights if a finding may affect the hiring decision, and a subsequent adverse action notice if the employer proceeds with that decision. A registry finding does not automatically mean an employer must reject an applicant; employers generally make an individualized decision and may want to consult counsel on how a specific state’s abuse registry finding interacts with other hiring obligations, including the Americans with Disabilities Act and applicable state fair chance rules.
Practical notes for employers
A background check that only searches criminal court records will not surface a nurse aide registry finding or a state adult abuse registry entry, because these are administrative findings, not criminal convictions, and many never go through a criminal court at all. Employers in long term care, home care, and adult day settings should confirm which registries apply in each state where they operate, how recently the registry was checked relative to the hire date, and whether the state requires periodic rechecks for current staff, not just a one time check at hiring. Because registry rules, retention periods, and the scope of covered workers vary by state and can change, employers should verify current requirements directly with the state agency that maintains the registry rather than relying on a single multi state summary.
For related hiring requirements, see our guides on home health and caregiver background checks and nursing home employee background check requirements. Learn more about how Reveal Background helps employers in caregiving settings build a compliant screening program.
Frequently asked questions
Is a nurse aide registry the same as a criminal background check?
No. A nurse aide registry tracks training completion and any state finding of abuse, neglect, or misappropriation of property against a specific individual. A criminal background check searches court and law enforcement records. Many employers in long term care and home care need both.
Does every state have a separate adult abuse registry beyond the nurse aide registry?
Not every state operates a separate caregiver or adult abuse registry beyond the federally required nurse aide registry. Coverage and structure vary, so employers should check the specific state agency, such as the state department of health or adult protective services program, for the state where the position is located.
How long does a finding stay on a nurse aide registry?
Under federal nursing home rules, a documented finding of abuse, neglect, or misappropriation of property generally remains on the registry permanently, unless the finding was made in error, the individual was found not guilty in a court proceeding, or the state is notified of the person’s death.
Can a worker dispute a finding before it is placed on the registry?
Generally yes. Federal rules provide that the individual may request a hearing before a finding becomes part of the permanent registry record, and any statement the individual submits disputing the finding becomes part of what appears when the registry is checked.
Is the OIG exclusion list the same thing as an elder abuse registry?
No. The OIG List of Excluded Individuals and Entities addresses eligibility to be paid through federal health care programs, generally for fraud or certain criminal convictions. It is a separate check from a state nurse aide or adult abuse registry, and many long term care and home care employers need to check both.
Does a registry finding automatically disqualify an applicant?
Not automatically. Employers generally review the specific finding, consider any applicable state fair chance or individualized assessment requirements, and follow Fair Credit Reporting Act notice steps before making a final decision. Employers may want to consult counsel on how a finding should factor into a hiring decision.
This article is general information for employers, not legal advice. State registry rules and federal requirements change, and employers should confirm current obligations with qualified counsel and the relevant state agency.
