Whether you are staffing a Skilled Nursing Facility (SNF), an assisted living community, or a rehabilitation center, the pressure to hire quickly often clashes with the rigorous demands of hiring top healthcare talent.
For many providers in the post-acute and long-term care (LTC) sector, reliance on contract labor has shifted from a temporary staffing fix to a long-term operational necessity. While reliance on contract labor peaked during the pandemic, it remains significantly higher than pre-2020 levels, with nursing homes using agency staff for about 9% to 11% of their total nursing hours in 2023–2024, compared to roughly 3–4% before 2019.
Managing background screening for these contractors introduces additional needs to consider. Unlike your direct hires, contractors are often managed by third-party agencies, creating a potential gap where HR professionals may lack full visibility into a worker’s history or the background screening process as a whole. Here is a guide to navigating contractor management with a focus on robust, efficient background screening.
The “agency trust” trap
Many HR teams fall into the trap of assuming that because a staffing agency is “reputable,” their background screening processes are just as reliable. However, as an HR leader in the post-acute space, the regulatory and clinical responsibility for patient safety ultimately sits with your facility.
If a contracted nurse or therapist has an unidentified OIG exclusion or a criminal record that does not meet state healthcare worker requirements, “the agency said they were clear” is rarely a sufficient defense during an audit or a survey by The Centers for Medicare & Medicaid Services (CMS).
1. Standardize your screening requirements for contractors
The first step in effective contractor management is aligning your screening standards for contractors to meet, or even be more stringent than, those for your direct hires. Some places to start include:
- Specify criminal background check search scope and depth: Different types of criminal background checks may report different information based on their scope. If your agency only conducts county criminal checks, you may miss potentially disqualifying information about a candidate. So ask your agency how they conduct criminal background checks, what types of searches they run, what kind of information is included, and the duration of the lookback period.
- Healthcare-specific sanctions: If your agency is running background checks on your contractors, make sure they run FACIS Level 3 or equivalent searches for sanctions and exclusions screens. This covers federal and state-level exclusions (OIG, SAM, etc.) which are critical for any facility receiving federal funding.
- Abuse & neglect registries: In long-term care, employers may often need to check state-specific nurse aide registries and elder abuse databases. If necessary, ensure your contracts explicitly require these specific searches.
2. Get direct visibility into results
Relying on a staffing agency to email a PDF “clearance letter” has the potential to be a risky manual process. Those letters often lack the raw data an auditor may actually want to see. Modern LTC teams have chosen to close this gap in two ways:
Running your own final check: Some providers treat contractors like internal hires for the final screening step. By running background checks through your preferred background check provider, in most cases, you will get more visibility into results, more control over the kinds of searches that are conducted, and you can keep the original digital record in your own system.
Requesting copies of results: Some providers ask the agency to provide all background screening results for contractors for review and retention.
When considering either of these options, it may be best to consult with your legal counsel to evaluate whether they align with your operational policies and guidelines.
3. The importance of continuous monitoring
A background check can reveal important information about a contractor’s background, history and credentials. But a single background check only captures this information at a single point of time. Without a continuous monitoring program, you may not identify changes to a contractor’s eligibility in a timely manner. For instance, a contractor might meet your standards in January but incur a license suspension in March.
In long-term care, where staff-to-patient ratios are tight and oversight can be challenging, continuous monitoring is a game-changer. When an organization uses continuous monitoring, they are alerted in near-real time about important information about a staff member (direct or contracted) that might impact their continued eligibility to practice.
4. Perform regular audits
At least once a year, perform a “spot audit” of your staffing partners. Select a random percentage of contractors currently working in your facility and request their full primary-source background reports.
- What to look for: Does the date of the check precede their first shift? Are the names and aliases searched consistent with their ID? Are the medical license verifications current?
- The red flag: If an agency is slow to provide these reports or continuously comes up empty-handed, it might be a sign to work with a different agency or begin handling background checks on your own.
5. Develop workflows to manage the complexity of screening travelers
The rise of travel nursing and per-diem apps has made multi-state compliance more complicated, as different states have different criminal history restrictions for individuals working in LTC. (For instance, each state may have different requirements for low-level offenses as well as their own look-back period requirements that must be followed when evaluating a contractor’s criminal history).
If you are managing facilities in multiple states, confirm that your contractor screening protocol isn’t “one size fits all,” but instead tailored to all applicable federal, state and local requirements.
The goal of contractor management isn’t to slow down hiring—in the current staffing crisis, you can’t afford that.
By standardizing your requirements, seeking direct visibility into background check results, and using continuous monitoring, you can shift from a reactive approach to a proactive screening strategy.
In the end, a robust contractor screening process isn’t just about passing an audit. It’s about ensuring that everyone who works with your residents, direct or contracted, meets your standards and are eligible to practice.
