Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

N A R : 

URSE  IDE  EGISTRIES
S C
TATE  OMPLIANCE AND 

P
RACTICES

Inspector General 
February 2005 
OEI-07-03-00380  Office of Inspector General 

http://oig.hhs.gov 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, 
as amended, is to protect the integrity of the Department of Health and Human Services 
(HHS) programs, as well as the health and welfare of beneficiaries served by those 
programs.  This statutory mission is carried out through a nationwide network of audits, 
investigations, and inspections conducted by the following operating components: 
Office of Audit Services 
The OIGs Office of Audit Services (OAS) provides all auditing services for HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others. 
Audits examine the performance of HHS programs and/or its grantees and contractors 
in carrying out their respective responsibilities and are intended to provide independent 
assessments of HHS programs and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout the department. 
Office of Evaluation and Inspections 
The OIGs Office of Evaluation and Inspections (OEI) conducts short-term management 
and program evaluations (called inspections) that focus on issues of concern to the 
department, the Congress, and the public. The findings and recommendations contained 
in the inspections reports generate rapid, accurate, and up-to-date information on the 
efficiency, vulnerability, and effectiveness of departmental programs.  The OEI also 
oversees State Medicaid fraud control units, which investigate and prosecute fraud and 
patient abuse in the Medicaid program. 
Office of Investigations
The OIGs Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries 
and of unjust enrichment by providers.  The investigative efforts of OI lead to criminal 
convictions, administrative sanctions, or civil monetary penalties. 
Office of Counsel to the Inspector General 
The Office of Counsel to the Inspector General (OCIG) provides general legal services to 
OIG, rendering advice and opinions on HHS programs and operations and providing all 
legal support in OIGs internal operations.  The OCIG imposes program exclusions and 
civil monetary penalties on health care providers and litigates those actions within the 
department.  The OCIG also represents OIG in the global settlement of cases arising 
under the Civil False Claims Act, develops and monitors corporate integrity agreements, 
develops compliance program guidances, renders advisory opinions on OIG sanctions to 
the health care community, and issues fraud alerts and other industry guidance.    E X E C U T I V E   S U M M A R Y
I N T R O D U C T I O N
OBJECTIVE 
To determine State compliance with Federal regulations for 
(1) updating the nurse aide registry records of nurse aides who had 
substantiated findings of abuse, neglect, or misappropriation of 
property, (2) removing the records of nurse aides who had not performed 
nursing or nursing-related services for 24 consecutive months, and (3) to 
review State nurse aide registry practices. 
BACKGROUND 
The Omnibus Budget Reconciliation Act of 1987 contained provisions 
designed to assure delivery of quality care to long-term care facility 
residents. Federal regulations (42 CFR  483.156) require each State to 
establish and maintain a registry of individuals who have completed 
training and who the State finds to be competent to function as nurse 
aides. Nurse aide registries also must include information on any 
substantiated finding of abuse, neglect, or misappropriation of property 
made by the State survey agency related to an individual. 
Used properly, State nurse aide registries prevent unemployable 
individuals from being employed in long-term care facilities. Federal 
regulations require that States update the nurse aide registry records of 
nurse aides with a substantiated finding within 10 working days of 
substantiating that finding.  States also must remove from the registry 
the records of nurse aides who have not performed nursing or 
nursing-related services for a period of 24 consecutive months, unless 
the records include substantiated findings.  Those records must remain 
on the registry indefinitely, except under specific circumstances, such as 
notification of the death of the individual. 
FINDINGS 
Some States failed to update registries with substantiated adverse 
findings. 
At least 24 of the 38 States that we analyzed in detail did not meet 
Federal regulations for updating registry records of nurse aides with 
substantiated findings within 10 working days.  Records of 1 in 4 nurse 
aides (450/1,978) with recent substantiated findings were not updated 
on the appropriate State registry 10 working days after the last possible 
substantiation date in our review period.  Of the 450 nurse aide records 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  i  EE XX EE CC UU TT II VV EE    SS UU MM MM AA RR YY
not updated, 236 still were not updated on the appropriate nurse aide 
registry 3 months after our initial verification. 
Over half of State survey respondents reported failure to remove 
records of inactive nurse aides from registries; some individuals 
with substantiated adverse findings in one State were actively 
certified in others. 
Twenty-eight State survey respondents reported that they did not 
remove records of inactive nurse aides from their registries as required, 
and over 99,000 nurse aides had active certifications in multiple States. 
Additionally, more than 1,500 nurse aides with substantiated findings 
had certifications in at least 1 other State, and were, therefore, 
potentially employable in that other State. More than 300 nurse aides 
had substantiated findings in more than 1 State. 
Some State-specific practices could make it more difficult to prevent 
certain individuals from working as nurse aides. 
State survey respondents reported using status classifications in their 
registries other than, and in addition to, those required in Federal 
regulation. In addition, some registries lacked complete information 
and many States relied on nurse aides to keep registry information 
up-to-date, contributing to inaccurate or out-of-date information 
existing on registries. 
RECOMMENDATIONS 
To assure that nurse aide registries effectively fulfill their intended 
purpose, we recommend that the Centers for Medicare & Medicaid 
Services (CMS): 
 	 Ensure States update records of nurse aides with substantiated 
adverse findings timely and remove registry records of nurse aides 
who have not performed nursing or nursing-related services for 
24 consecutive months, in accordance with Federal regulations. 
CMS could achieve this by: (1) issuing program memoranda that 
address updating nurse aide registry records, (2) conducting periodic 
reviews of State registries, or (3) implementing greater oversight. 
 	 Reduce the potential for nurse aides with substantiated findings to 
commit similar acts in another State. CMS could achieve this by 
seeking legislative authority to create a national nurse aide registry 
(a national registry also could be used to address identified data 
limitations, such as the lack of dates when substantiated findings 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  ii  E X E C U T I V E   S U M M A R Y  
are placed on registries).  CMS also could work with States to 
increase information sharing. 
 	 Work with States to ensure registry records contain current 
information on nurse aides.  CMS could achieve this by requiring 
long-term care facilities to report current information of nurse aides 
they employ to the State registry upon hire and periodically 
thereafter. 
AGENCY COMMENTS 
We appreciate the level of detail that CMS provided in their comments 
to our recommendations.  CMS generally concurred with our 
recommendations, and we note that CMS has taken action to address 
some of the findings raised in our report. 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  iii    T A  B L E   O F   C O N T E N T S  
EXECUTIVE SUMMARY ......................................... i 

INTRODUCTION ................................................ 1 

FINDINGS ....................................................... 8 

Failure to update registries with substantiated adverse findings .  8 

Failure to remove records of inactive nurse aides from registries 

and individuals with substantiated adverse findings in one State 

were actively certified in others .............................. 10 

Practices make it more difficult to prevent certain individuals    

from working as nurse aides ................................. 13 

RECOMMENDATIONS ......................................... 16 

AGENCY COMMENTS ......................................... 18

APPENDIXES .................................................. 23 

A: 	Many States do not update registry records with  

substantiated adverse findings timely ..................... 23 

B: 	Nurse aides with substantiated adverse findings may have 

active certifications in other States ........................ 24 

C: 	Nurse aides with pending adverse findings may have 

active certifications in other States ........................ 25 

D: 	State suggestions and improvement efforts................. 26 

E: 	State compliance with specific registry components ......... 27 

F: 	Information available on the State nurse aide registry....... 28 

ACKNOWLEDGMENTS ......................................... 29 
 C T I
OBJECTIVE
To determine State compliance with Federal regulations for
(1) updating the nurse aide registry records of nurse aides who have
substantiated findings of abuse, neglect, or misappropriation of
property, (2) removing the records of nurse aides who have not
performed nursing or nursing-related services for 24 consecutive
months, and (3) to review State nurse aide registry practices.
BACKGROUND
Federal Regulation
The Omnibus Budget Reconciliation Act of 1987 was designed to assure
delivery of quality care to long-term care facility residents. Federal
483.156) require each State and the District 
regulations (42 CFR 
Columbia (hereinafter referred to as a State) to maintain a nurse aide
registry of all individuals .who are certifed to work as nurse aides in
that State (all individuals who have completed nurse aide training and
that the State deems competent to function as nurse aides!) as well as
all individuals who have been prohibited from employment as nurse
aides in long-term care facilities because of substantiated findings of
abuse, neglect, or misappropriation ofproperty.2 Throughout the
report, we use the term "substantiated findings" to refer to State survey
and certification agencies' substantiated findings (against a nurse aide)
of abuse, neglect, or misappropriation of property.
Nurse aide registries must include at a minimum: (1) the full name of
the individual, (2) identifying information, (3) the date the individual
became eligible for placement in the registry, and (4) information
regarding substantiated findings (as appropriateP
1 Nurse aide refe7rs to an5y indivi(dual ewho is) not a) licen.sed  health professional
, a registered
dietitian, or someone who volunteers to provide nursing or nursing-
related services
without pay and who provides nursing or nursing-related services to residents in a facility
(42 CFR  483.
2 The applicable regulations define abuse as "
... the wilful infliction of injury,
unreasonable confinement, intimidation, or punishment with resulting physical harm
pain or mental anguish." Neglect is defined as ". . . failure to provide goods and services
necessary to avoid physical harm, mental anguish, or mental ilness." Misappropriation of
resident property is defined as ". . . the deliberate misplacement, exploitation, or wrongful
temporary or permanent use of a resident's belongings or money without the resident'
consent. . ." (42 CFR  488.301).
42 CFR  483.156(c)(I.
OEI-07.03-00380 NURSE AIDE REGISTRIES: STATE COMPLIANCE AND PRACTICES I N T R O D
 U C T I O N  
The nurse aide registry should include information only on those 
individuals who have active certifications and are thus employable 
and individuals whose records include substantiated findings.  Federal 
regulations require States to remove registry records of individuals who 
have not performed nursing or nursing-related services for a period of 
24 consecutive months, thus becoming inactive and no longer 
employable.4  Individuals with records of substantiated findings must 
remain on the registry permanently, unless the findings were made in 
error, the individual was found not guilty in a court of law, or the State 
is notified of the individuals death.5 The Balanced Budget Act of 1997 
(Public Law 105-33  4755) established the only exception, which allows 
nurse aides with substantiated findings of neglect to petition the State 
to have their name removed from the registry.  Such an individual must 
wait at least 1 year from the date on which the substantiated finding 
was added to the State nurse aide registry, and the State must 
determine that the employment and personal history of the nurse aide 
did not reflect a pattern of abusive behavior or neglect, and that the 
neglect involved a singular occurrence. 
Purpose of State Nurse Aide Registries 
State nurse aide registries are intended to assure that long-term care 
facilities employ only certified nurse aides who do not have 
substantiated findings.  Federal regulation requires long-term care 
facilities to not employ individuals who have a substantiated finding 
entered into the State nurse aide registry6 and to check the State 
registry before hiring nurse aides to verify competency.7 Assuring the 
integrity of States registries is a critical step in providing a safe living 
environment for more than one million, mostly elderly, residents in 
long-term care facilities nationwide.8 While the majority of nurse aides 
perform their duties without committing acts of abuse, neglect, or 
misappropriation of property, those who do create concerns. Examples 
of investigative case histories follow: 
 	 A nurse aide pushed a resident, causing the resident to fall to the 
floor.  The nurse aide later retrieved a snow shovel from the kitchen, 
4 42 CFR  483.156(c)(2). 

5 42 CFR  483.156(c)(1)(iv)(D). 

6 42 CFR  483.13(c)(1)(ii)(B). 

7 42 CFR  483.75(e)(5). 

8 We will refer to nursing homes and skilled nursing facilities as long-term care facilities in 

this report. All CFR references refer to these facilities as long-term care facilities. 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  2  III NNN TTT RRR OOO DDD
 UUU CCC TTT III OOO NNN
and while the resident was still on the floor, struck the resident with 
the shovel and yelled that she was going to kill the resident (from 
the Virginia registry). 
 	 A nurse aide neglected a resident by leaving the resident in the 

facility transport van. The nurse aide left for the day at 

approximately 5:00 p.m. The resident was found alone in the van 

later that day at approximately 6:20 p.m. when he could not be 

located in the facility (from the North Carolina registry). 

 	 A nurse aide took a residents debit card without permission, got the 
personal identification number, and withdrew money from the 
residents bank account totaling approximately $1,100 over an 
unknown period of time (from the Texas registry). 
State survey and certification agencies receive and investigate 
allegations against nurse aides regarding abuse, neglect, or 
misappropriation of property. Federal regulations require placing 
information regarding a substantiated finding on the registry within 
10 working days of substantiating that finding.9 In 13 States, the State 
survey agency was responsible for both investigations and maintenance 
of the nurse aide registry. In 38 States, investigations were performed 
by 1 State agency and maintenance of the registry by another. 
Overview of State Nurse Aide Registries 
As of September 15, 2003, State nurse aide registries contained 
2.6 million nurse aide certifications in the United States.10 Out of these, 
39,061 records (33,768 unique individuals)11 were of nurse aides who 
were listed with substantiated findings and/or had their certifications 
revoked.12 There were an additional 14,243 records (13,435 unique 
individuals) of nurse aides who were listed as suspended or under 
investigation for abuse, neglect, or misappropriation of property. We 
note that Federal regulations do not require State nurse aide registries 
to maintain records of suspension or findings under investigation. 
9 42 CFR  483.156(c)(1)(iv)(D). 
10 The results presented in this section are based on Office of Evaluation and Inspections 
analysis of nurse aide registry data during preparation for this report. 
11 There are more records than there are unique individuals because an individual nurse 
aide may be listed on more than one State registry. 
12 We use the term revoked to indicate nurse aides with denied, terminated, or revoked 
certifications or who have records with substantiated findings. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  3  I N T R O D
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The size and scope of the registries varied greatly among States, 
ranging from 2,690 nurse aides in Alaska to 298,327 in Florida.  The 
amount and types of information States stored on their registries also 
varied greatly.  Some States included many details regarding topics 
such as identifying information, method and date of testing, certification 
and expiration dates, and the nature, investigation, and dates of any 
allegations or substantiated findings against the nurse aides; other 
States maintained registries that included only the information that 
Federal regulations specifically require.   
Other Studies Found Weaknesses with Registries 
Previous studies of nurse aide registries identified a number of 
weaknesses with registry practices in some States and indicated that 
State compliance with Federal nurse aide registry regulations was 
inconsistent. A 1997 Office of Inspector General (OIG) audit on the 
Maryland nurse aide registry reported that the registry did not always 
include information on all nurse aides with substantiated findings.13 A 
1998 OIG audit reported that criminal background checks were limited 
to State records, and individuals with criminal histories were not 
recorded on registries.14 
A 2002 Government Accountability Office (GAO) report also identified a 
number of potential problems with nurse aide registries.15  Based on a 
review of three States, GAO found that there were frequent and long 
delays in including information about substantiated findings on 
registry entries.  The GAO also found that State registries only reflected 
a nurse aides history in that particular State, leaving open the 
possibility that long-term care facility residents could be exposed to 
nurse aides who had substantiated findings in other States, or whose 
registry records were not updated.  Further, the report found that 
variations in the way that States applied the definition of abuse caused 
inconsistencies in nurse aide registry information across States. 
Finally, GAO found that one States electronic registry failed to update 
its Web site with substantiated findings.  
13 State of Marylands Ombudsman Program for Processing Elder Abuse andNeglect
Complaints of Geriatric Nurse Aide Registry. Office of Inspector General, A-12-96-00016 
(11/97). 
14 Safeguarding Long-Term Care Residents. Office of Inspector General,  A-12-97-00003 
(09/98). 
15 United States Government Accountability Office, Long-term Ca
re Facilities: More Can
Be Done to Protect Residents from Abuse
, GAO-02-312 (Washington, DC: March 2002). 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  4  II NN TT RR OO DD UU CC TT II OO NN

METHODOLOGY 
This study was based on information from several different sources: 
(1) a review of Federal regulations regarding nurse aide registries; 
(2) a review of the existing literature and studies on nurse aide 
registries; (3) survey responses from the agencies responsible for the 
registries in all States; and (4) actual registry information and 
substantiated findings data from all States. 
State Survey 
We asked representatives from the State agencies that were responsible 
for maintenance of the registries and the investigative units in all 
States to complete an online survey regarding the practices, policies, 
and procedures they followed in maintaining their registries, their 
opinions on the effectiveness of their registry practices, and the 
challenges they faced in maintaining accurate information. We received 
responses from all such agencies. Where appropriate, we defined 
instances in which information came solely from survey data. 
Registry and Investigative Agency Data 
We requested and received data from all States comprising their entire 
nurse aide registry as of September 15, 2003. Per our request, the data 
included information on both employable nurse aides and those nurse 
aides with substantiated findings, as determined by the State survey 
and certification agency. For the 38 States that had a separate agency 
responsible for investigating allegations of abuse, neglect, or 
misappropriation of property, we also requested from the investigative 
agency a list of the nurse aides with substantiated findings between 
September 15, 2002, and September 15, 2003. Because a single agency 
handled both investigative and registry maintenance in the remaining 
13 States, we did not request a separate list of nurse aides with 
substantiated findings from those States because there was no data 
source independent from the registry itself to generate a list of nurse 
aides with substantiated findings in these States. These States were 
excluded from analyses used to determine if registries were updated 
timely with substantiated findings. 
Analysis 
For the 38 States with separate State registry maintenance and 
investigative agencies, we compared the list of substantiated findings 
provided by the investigative agency covering the period 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  5  I N T R O D
 U C T I O N  
September 15, 2002 through August 28, 200316 to the State registry 
data we received from the agency responsible for maintaining the 
registry to determine if all the nurse aides with substantiated findings 
on the investigative agency list also appeared on the registry having 
substantiated findings.  Where nurse aides with substantiated findings 
were included on the investigative agency list but not on the nurse aide 
registry, we accessed the appropriate State registry 3 months later, in 
December 2003, by telephone or online to determine whether their 
records had been updated.   
We combined the nurse aide registry data from all States, including 
those nurse aides with substantiated findings, to create a simulated 
national nurse aide registry as of September 15, 2003.  We then 
compared the data included in the simulated registry to determine how 
many nurse aides had active or revoked certifications in multiple 
States. We also analyzed the data provided by all 51 States to 
determine States compliance with Federal regulations regarding 
required information for nurse aides on the registry, including full 
name, identifying information, date of certification, and information 
regarding substantiated findings. 
Limitations of Updates to Registries and Multi-State Analysis 
Nurse aide registries did not consistently contain data regarding the 
date when findings were substantiated and/or when those findings were 
placed on the registries.  Therefore, we could not determine exactly how 
many States failed to update registries with substantiated findings 
timely, nor could we determine how long it took States to update 
registries with substantiated findings in the 38 States where 1 agency 
was responsible for registry maintenance and another agency was 
responsible for investigations.  We could not determine the number of 
records not updated timely that were at least 10 working days beyond 
the date the finding was substantiated. 
Our ability to definitively determine the number of nurse aides with 

certifications and/or substantiated findings in multiple States was 

compromised by the lack of a nationally unique identifier (i.e., Social 

Security number or national certification number) in nurse aide 

16 42 CFR  483.156(c)(1)(iv)(D) requires that information be included within 10 working 
days of the finding; therefore, we reviewed substantiated findings up to 10 working days 
prior to September 15, 2003, or August 28, 2003.  Federal law allows nurse aides with 
findings of neglect to petition to have their names cleared after 1 year; thus, we limited 
our scope to a period of 1 year. 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  6  III NNN TTT RRR OOO DDD UUU CCC TTT III OOO NNN
registries across all States. Therefore, we included only exact matches 
based on nationally unique identifiers that did exist (e.g., we matched 
Social Security numbers for States that provided us this information) 
when identifying nurse aides with certifications and/or substantiated 
findings in multiple States. Because of these limitations, our estimate 
of the magnitude of nurse aide movement between States was 
conservative. 
Standards 
This inspection was conducted in accordance with the Quality 
Standards for Inspectionsissued by the Presidents Council on Integrity 
and Efficiency. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  7  Federal regulations require
Some States failed to update registries with
that State survey and
substantiated adverse findings
certification agencies list
nurse aides with substantiated findings on the State nurse aide registry
within 10 working days of the substantiation ofthe finding.1 Based 
the previously described data limitations, we believe our estimates of
failure to comply, both in terms of number of States and number of
records not updated timely, are conservative.
Twenty-four States reviewed did not meet Federal regulations for updating
registry records of nurse aides with substantiated adverse findings timely;
one in four nurse aide records were not updated with recent substantiated
adverse findings.
Based on our comparison of investigative agency and registry data, at
least 24 of the 38 States with separate registry maintenance and
investigative agencies18 had substantiated findings that were not
updated in their respective registries as of September 15, 2003
A).
10 working days after the end of our review period (see Appendix 
In addition to the 24 noncompliant States, survey respondents from
4 other States acknowledged that it typically took them more than the
required 10 working days to update their registries with information
about substantiated findings. However, survey respondents from 19 of
the 24 States that we found to be out of compliance based on registry
data indicated that they believed they typically met the 10 working day
requirement contained in the regulation.
Thirty-eight States with separate registry maintenance and
investigative agencies had substantiated findings against 1 978 nurse
aides from September 15, 2002, through August 28, 2003. 19 Of these
23 percent (450/1 978) ofthe nurse aides' records were not updated with
substantiated findings on the appropriate States registry as of
September 15, 2003, 10 working days after the end of our review period.
Although the State survey and certification agencies had substantiated
findings for these 450 nurse aides, the nurse aides were potentially
employable in any long-term care facility in that State because their
17 42 CFR ~ 483. 156(b)(2) and 42 CFR ~ 483. 156(c)(I(iv)(D).
18 Thirty-eight States had two separate agencies responsible for investigating allegations
and maintaining the registry. Thirteen States had one agency responsible for both
investigating allegations and maintaining the registry; therefore, it was not possible to
obtain an independent list of the nurse aides who had substantiated findings.
19 August 28, 2003, is 10 working days prior to September 15, 2003.
OEI-07-03-00380 NURSE AIDE REGISTRIES: STATE COMPLIANCE AND PRACTICES F	 I N D I N G
 S  
registry records did not include information on their substantiated 
findings. 
Because most States did not record the dates they added substantiated 
findings to their registries, we were unable to determine when the 
remaining 1,528 (1,978 less 450) substantiated findings were updated 
on the appropriate registries.  It is, therefore, possible that the number 
of noncompliant States and the number of nurse aide records not 
updated within the required 10 working days could be higher.  For 
example, had a record with a substantiated finding been updated 
30 days after substantiation, but before September 15, 2003, we would 
not have identified it based on the methods available to us to assess 
compliance. 
Almost one in eight nurse aide records with substantiated adverse findings 
were not updated 3 months later. 
In December 2003, we accessed the registries of those 24 States in 
which we found 450 nurse aides with substantiated findings whose 
records were not updated as of September 15, 2003.  Upon completion of 
the second review, 236 records of nurse aides still were not updated 
with substantiated findings.20  Thus, 3 months later, and after States 
were aware of our study, 12 percent (236/1,978) of the records of nurse 
aides with substantiated findings, representing 19 States, still were not 
updated. 
Two examples of the behavior that led to substantiated findings for 
nurse aides whose records were not updated on the registry, taken from 
information the investigative agencies provided, follow: 
 	 A nurse aide poured milk on a residents head, grabbed his arms 
and pushed him back into the wheelchair, and hit him on the head, 
causing multiple skin tears and bruises (from the Texas 
investigative agency). 
 	 A nurse aide struck a resident in the face, fracturing his nose, and 
breaking his glasses (from the Alaska investigative agency). 
20 Florida State officials indicated that responsibility for the nurse aide registry transferred 
among different agencies within the State.  Few record updates of nurse aides with 
substantiated findings occurred during these transitions.  None of the 109 nurse aides 
with substantiated findings in Florida during our review period were identified as such 
on the nurse aide registry at any time during our review. 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  9  FF II NN DD II NN GG SS
  
The well-being of long-term care facility residents was placed at risk 
because these nurse aides continued to appear employable due to 
registry records not updated to reflect their substantiated findings. 
As of September 15, 2003, 
Over half of State respondents reported failure 
2.6 million nurse aides were listed 
to remove records of inactive nurse aides from 
with active certifications on nurse 
registries; some individuals with substantiated 
aide registries nationwide, with 
adverse findings in one State were 
99,006 having active certifications 
actively certified in others  in more than 1 State (see Table 1). 
Many States failed to remove records of inactive nurse aides from their 
registries. 
Federal regulations do not prohibit nurse aides from holding 
certifications in different States simultaneously; however, Federal 
regulations require States to remove from the registries the records of 
nurse aides who have not performed nursing or nursing-related services 
for a period of 24 consecutive months, as long as the nurse aides records 
do not contain substantiated findings.21 
Survey respondents from 28 of 51 States 
Table 1: Number of Nurse 
reported that they did not remove the  Aides with Certifications in 
records of nurse aides who failed to  Multiple States 
maintain their certification. Five of these  Number of  Number of 
States  Nurse Aides 
twenty-eight States reported that the 
2  93,697 
status of records was changed when nurse 
3  4,919 
aides failed to maintain their certification;  4  342 
however, the remaining 23 States did not  5  35 
6  10 
report making a distinction between the 
7  1 
records of active and inactive nurse aides 
9  1 
on the registry. Oftentimes, the nurse aide 
10  1 
registry data available to us did not allow  Total  99,006 
us to determine if nurse aide records 
Source: OIG analysis of all collected
should be removed from the registry. 
nurse aide registry records 
States failing to remove the records of inactive nurse aides could lead to 
nurse aides being employed in long-term care facilities even though they 
have not maintained their certification or, more significantly, returning 
21 42 CFR  483.156(c)(2). 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  10  FF II NN DD II NN GG SS
  
to a State where they have an active certification despite having a 
substantiated finding in another State. 
Some States acknowledged failing to remove the records of nurse aides 
who had not maintained their certifications and our analysis showed 
that some of the nurse aides with multiple certifications held them in 
nonneighboring States. Thus, it was possible that some of the 
99,006 nurse aides with more than 1 active certification should have 
had their records in the other State(s) removed to reflect that the 
certification was no longer active. 
More than 2,000 nurse aides with substantiated or pending adverse findings 
in 1 State had active certifications in other States. 
A total of 1,552 nurse aides with either substantiated findings and/or 
revoked certifications, and another 450 nurse aides with pending 
findings in a State were also actively certified in 1 or more other States 
(see Table 2). A detailed State breakdown for substantiated findings 
can be found in Appendix B and pending findings in Appendix C. 
Nurse aides with 
Table 2: Nurse Aides with Substantiated or
pending or 
Pending Findings Actively Certified in Other
substantiated 
States
findings not only held 
active certifications  Number of Nurse  Number of 
in neighboring  Actively  Aides with  Nurse Aides
Certified in  Substantiated  with Pending
States, but also held 
Findings  Findings
active certifications 
across the Nation.  1 State  1,412  418 
2 States  122  29
For example, 
3 States  14  3
33 nurse aides with 
4 States  3  0
substantiated 
5 States  1  0 
findings from  Total  1,552  450 
Virginia had active  Source: OIG analysis of all collected nurse aide registry 
records 
certifications in 
Florida, and 19 nurse aides with substantiated findings in California 
had active certifications in Illinois. 
The data provided did not allow us to conclude where the nurse aides 
resided at the time of our study. In addition, the data did not allow us 
to determine the date the findings were substantiated in one State or 
the dates the certifications were granted in another State. Thus, the 
active certification in one State could have been granted before or after 
the nurse aide had a substantiated finding in a different State. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  11  FFFF IIII NNNN DDDD IIII NNNN GGGG
 SSSS  
More than 300 nurse aides had substantiated adverse findings in multiple 
States. 
Based on the data we received, we were able to conclusively identify 
314 nurse aides who had records with matching unique identifiers and 
substantiated findings in multiple States (i.e., the same individual had 
different substantiated findings in different States). Our analysis 
indicated that there could be as many as 4,569 nurse aides with unique 
substantiated findings in multiple States. However, due to how States 
maintained information in their registries, we could not definitely 
determine whether substantiated findings of some nurse aides were 
unique, independent events or were instead substantiated findings 
included on that States registry, but had occurred in another State. 
Some individuals who had substantiated adverse findings as nonnurse 
aides in one State were actively certified as nurse aides in others. 
The data that Arkansas provided allowed us to identify 3,391 nonnurse 
aides (e.g., staff who were not nurse aides, such as janitors) with 
histories of abuse. Of these, 1 percent (36/3,391) also had records listing 
them as active nurse aides in at least 1 other State. Since we were only 
able to assess the number of nonnurse aides with substantiated findings 
from one State, it was possible that similar situations existed in other 
States. 
Despite States efforts, nurse aides with substantiated adverse findings had 
active certifications. 
According to survey data, 33 States responded that they included 
substantiated findings from other States on their registries and that an 
out-of-State finding disqualified a nurse aide from certification and 
employment in their respective State.22 Yet, as of September 15, 2003, 
32 of these 33 States had an active certification for at least 1 nurse aide 
who was prohibited from working in another State. As previously 
stated, data available in State registries did not always allow us to 
determine when a substantiated finding was placed on a registry; 
therefore, we could not determine if the substantiated finding occurred 
before or after a certification was issued in these 32 States. Possible 
explanations as to how nurse aides with substantiated findings could 
become certified in a new State include: (1) while a certification in one 
State remains active, the nurse aide moves to a new State, becomes 
22 Twelve additional States indicated that a substantiated finding in another State would 
have to be reviewed before they might disqualify the nurse aide from working in their 
State. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  12  FF II NN DD II NN GG SS  
certified, and subsequently abuses, neglects, or misappropriates a 
residents property; (2) the State where the offense occurred does not 
enter the substantiated finding on the registry timely, thus allowing the 
nurse aide to appear employable in another State; or (3) the new State 
does not become aware of the substantiated finding because of 
inadequate information sharing. These problems are exacerbated when 
States do not remove records of nurse aides from registries as required. 
States have implemented
Some State-specific practices could make it 
varying practices in the
more difficult to prevent certain individuals
maintenance of their 
from working as nurse aides 
registries. For example, some 
States used status classifications other than those required in Federal 
regulation and States differed in their efforts to update registry 
information. Some of these practices, while beneficial to the individual 
States, may increase difficulties as other States work to prevent certain 
individuals (e.g., those with substantiated findings) from working as 
nurse aides. This problem is compounded when the information 
contained on registries is inaccurate or incomplete. 
Although we did not specifically ask State survey respondents about a 
national nurse aide registry, the most commonly suggested 
improvement was the creation of a national registry. Twenty State 
survey respondents expressed the opinion that a national registry would 
be helpful, both for reciprocity purposes and in preventing nurse aides 
with substantiated findings from working in other States.23 See 
Appendix D for examples of efforts some States have undertaken to 
improve their registry processes and State survey respondents 
suggestions for improvement. 
Eighteen States used status classifications in addition to those Federal 
regulations require. 
Substantiated findings leading to prohibition of employment as a nurse 
aide were not the only punitive sanctions that States established and 
maintained in their State registries. Eighteen States had various 
23 Reciprocity is a process by which a certified nurse aide from another State may qualify 
for certification in a new State by virtue of his or her status in the previous State. An 
individual is only eligible for reciprocity if he or she has been entered on a nurse aide 
registry in another State in accordance with the training and competency evaluation 
requirements of the Omnibus Budget Reconciliation Act of 1987, as amended, and if the 
individual is currently listed on that States nurse aide registry as active and without 
substantiated findings. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  13  F I N D I N G
 S  
status classifications to distinguish levels of misconduct. For example, 
we encountered status classifications such as Suspended, Revoked, 
Dismissed, Lapsed, and Lapsed-Conditional in one States registry 
(in addition to the federally required indications of nurse aides with 
substantiated findings).  Another State had 40 status classifications to 
classify the various dispositions of individuals listed on their registry. 
Nationwide, we found that 14,243 nurse aide records were listed as 
Suspended, Surrendered, Pending, or some similar status 
classification. From the information States provided, we were unable to 
determine if the acts indicated within these other status classifications 
fit the Federal definition of abuse, neglect, or misappropriation of 
property.  This created a potential challenge for another State 
attempting to use this information in determining whether to certify an 
individual as a nurse aide. 
While Federal regulations do not require States to do so, 10 of 51 States 
reported pending cases of abuse, neglect, or misappropriation of 
property on the registry before the case had actually been 
substantiated, thus alerting employers of potential problems.  One State 
noted this as a special concern because it could result in nurse aides 
who did not have substantiated findings being prohibited from 
employment.  Four other States noted pending cases on a section of the 
registry that was not available to the public. 
Most States relied on nurse aides to keep registry information up-to-date. 
Survey respondents from 48 States reported that they relied mainly on 
the nurse aides themselves to report changes in personal information 
directly to the registry. However, this approach did not work 
effectively. Eighteen State survey respondents indicated that they 
experienced difficulties in keeping accurate and up-to-date personal 
information, such as names, addresses, and renewals of certification, in 
their registries.  Eleven State survey respondents expressed that nurse 
aides frequently changed employers and residences, making it difficult 
to assure that the nurse aides most recent information was available. 
  OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  14  FFF III NNN DDD III NNN GGG
 SSS  
Several State registries lacked complete information. 
We reviewed individual State nurse aide registry records for full name, 
certification date, and other identifying information as provided in 
42 CFR  483.156(c)(1). According to registry data, 45 of 51 States had 
at least 95 percent of all records with the 3 basic fields completed, while 
6 States had less than 90 percent of records with at least 1 required 
field complete (see Table 3 for general and Appendix E for specific 
information).24 A listing of data elements contained in State registries 
appears in Appendix F.25 Given that Federal regulations do not require 
States to maintain a nationally unique identifier for nurse aide records, 
information that could be used in lieu of such an identifier becomes 
more important. 
Table 3: State Level of Compliance with Federal Requirements 
Requirement  Level of Compliance  Number of States 
100%  24 
Full Name  90-99+%  26 
below 90%  1 
Identifying  100%  40 
Information*  99-99+%  11 
100%  19 
90-99+%  28 
Date Certified 
70-89+%  4 
below 70%  1 
*Social Security number, certification or license number, date of birth, or other State 
specific identifier 
Source: OIG analysis of all collected nurse aide registry records 
24 We included records of nurse aides deemed active on the registry, as well as those with 
revoked or terminated certifications and indications of abuse, neglect, or 
misappropriation. The table reflects key regulations as listed in 42 CFR  483.156(c)(1). 
25 Information in Table 3 is based on review of actual registry data, whereas, Appendix F is 
based on States responses to our survey questions. Discrepancies between the two tables 
result from differences between what States reported to us and what we observed in their 
data. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES 15  D A T I
N S
R E C 0 
RECOMMENDATIONS
Nurse aide registries are intended to assure that only certifed nurse
aides without substantiated findings on their records are employed in
long-term care facilities. Noncompliance with registry processes
, such
as the failure to list substantiated findings of nurse aides on registry
records timely, and the failure to remove nurse aides who have not
maintained an active certification, exposes long-term care facility
residents to greater risk of harm.
To assure that nurse aide registries effectively fulfll their intended
purpose, we recommend that CMS:
Ensure States update records of nurse aides with substantiated
adverse findings timely and remove registry records of nurse aides
who have not performed nursing or nursing-
related services for
24 consecutive months, in accordance with Federal regulations.
CMS could achieve this by: (1) issuing program memoranda that
address updating nurse aide registry records
, (2) conducting periodic
reviews of State registries, or (3) implementing greater oversight.
Reduce the potential for nurse aides with substantiated findings to
commit similar acts in another State. CMS could achieve this by
seeking legislative authority to create a national nurse aide registry
(a national registry also could be used to address identified data
limitations, such as the lack of dates when substantiated findings
are placed on registries). CMS also could work with States to
increase information sharing.
Work with States to ensure registry records contain current
information on nurse aides. CMS could achieve this by requiring
long-term care facilities to report current information of nurse aides
they employ to the State registry upon hire and periodically
thereafter.
AGENCY COMMENTS
We appreciate the level of detail that CMS provided in its comments to
our recommendations. CMS generally concurred with our
recommendations, and we note that CMS has taken action to address
some of the findings raised in our report.
OEI-07-03-00380 NURSE AIDE REGISTRIES: STATE COMPLIANCE AND PRACTICES R E C O M M E N D A T I O N S  
CMS has committed to issuing additional communications to States 
affirming that all findings of abuse, neglect, and misappropriation of 
resident property must be included in the nurse aide registry within 
10 working days of the finding, and the names of nurse aides who have 
performed no nursing or nursing-related services for 24 consecutive 
months must be promptly removed from the nurse aide registry.  In 
addition, CMS will follow up with some of the States that seem to have 
the most serious problems in maintaining an effectively functioning 
nurse aide registry and offer support for a limited number of States that 
wish to undertake quality improvement projects to improve the effective 
operation of their nurse aide registry.  Finally, CMS will consider a 
variety of methods to work with States to ensure registry records 
contain current information on nurse aides. 
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 A P P E N D I X   ~   A
Many States do not update registry records with substantiated adverse findings 
timely 
In 38 States, 2 separate agencies were responsible for maintaining the 
registry and investigating allegations of abuse, neglect, or 
misappropriation of property.  These States are listed below along with 
the number of nurse aides with substantiated findings based on 
information provided to us by the State investigative agency.  The 
number of nurse aides with substantiated findings identified in the 
registries in September 2003 and December 2003 is listed along with 
the remaining number of nurse aides yet to be updated on their registry 
record at the conclusion of our review.  Updated by 12/03 includes both 
nurse aides updated as of September 15, 2003, and those who were 
updated in the 3 months leading to December 2003.   
Nurse Aides  Nurse Aides 
with  Yet to be  with  Yet to be 
Updated  Updated  Updated  Updated 
State  Substantiated  Updated  State  Substantiated  Updated 
by 9/15/03  by 12/03  by 9/15/03  by 12/03 
Adverse  by 12/03  Adverse  by 12/03 
Findings  Findings 
AK  3  1  1  2  MT  49  0  38  11 
AL  98  98  98  0  NC  83  83  83  0 
AZ  93  89  92  1  NV  9  9  9  0 
CA  107  93  102  5  NY  102  83  86  16 
CO  36  32  35  1  OH  91  83  89  2 
CT  36  1  36  0  OK  101  60  84  17 
DC  1  1  1  0  OR  4  1  4  0 
DE  15  15  15  0  PA  29  27  28  1 
FL  109  0  0  109  SC  18  18  18  0 
HI  3  3  3  0  SD  6  6  6  0 
ID  15  14  15  0  TN  26  25  26  0 
IL  290  227  289  1  TX  97  54  59  38 
IN  18  15  15  3  UT  10  9  10  0 
KS  7  7  7  0  VA  45  45  45  0 
KY  42  40  40  2  VT  15  0  7  8 
LA  14  14  14  0  WA  78  78  78  0 
MD  19  17  19  0  WI  148  140  146  2 
ME  57  41  41  16  WY  5  5  5  0 
MI  33  28  32  1  Total  1,978  1,528  1,742  236 
MN  66  66  66  0  Source:  OIG analysis of all collected nurse aide registry records 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  23  
 A P P E N D I X   ~   B
Nurse aides with substantiated adverse findings may have active certifications in 
other States 
The table below summarizes the number of nurse aides with 
substantiated findings in one State and active certifications in another 
at the time of our review.1  In the table below, Certified Nurse Aides 
with Substantiated Adverse Findings in Other States refers to the 
number of active nurse aides in that State with substantiated findings 
in a different State.2  For example, Alabama (AL) had 42 active nurse 
aides who each had substantiated findings in at least 1 of 18 different 
States. 
Certified Nurse Aides  Certified Nurse Aides 
with Substantiated  Number of  with Substantiated  Number of 
State  State 
Adverse Findings in  Other States  Adverse Findings in  Other States 
Other States  Other States 
AK  1  1  MS  11  9 
AL  42  18  MT  8  5 
AR  35  10  NC  42  16 
AZ  9  7  ND  10  6 
CA  21  10  NE  13  6 
CO  21  10  NJ  15  5 
CT  40  17  NM  24  14 
DC  19  4  NV  5  3 
DE  4  4  NY  31  17 
FL  222  34  OH  132  30 
GA  45  19  OK  52  16 
HI  3  3  OR  6  4 
IA  12  6  PA  30  14 
ID  7  6  RI  4  2 
IL  280  29  SC  12  7 
IN  18  12  SD  28  12 
KS  27  10  TN  15  10 
KY  110  19  TX  62  17 
LA  135  20  UT  4  3 
MA  6  6  VA  26  16 
MD  18  6  WA  34  14 
ME  4  3  WI  1  1 
MI  6  5  WV  10  4 
MN  21  10  WY  3  2 
MO  31  9  Source:  OIG analysis of collected nurse aide registry records 
1 New Hampshire did not use a nationally unique identifier; therefore, we were unable to 
evaluate interstate movement for this State.  Vermont only supplied a nationwide unique 
identifier for nurse aides with substantiated findings; therefore, we were unable to 
determine whether nurse aides with substantiated findings from other States had active 
certifications in Vermont. 
2 There are 1,715 records for the 1,552 nurse aides because some nurse aides with 
substantiated findings may be listed as active in more than 1 State.  Only States with 
values are listed. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  24  
 A P P E N D I X   ~   C
Nurse aides with pending adverse findings may have active certifications in other 
States 
The table below summarizes the number of nurse aides with pending 
findings in one State and active certifications in another at the time of 
our review.3 In the table below, Certified Nurse Aides with Pending 
Adverse Findings in Other States refers to the number of active nurse 
aides in that State with pending findings in a different State.4  For 
example, Alabama (AL) had 12 active nurse aides who each had pending 
findings in at least 1 of 4 different States.   
Certified Nurse  Certified Nurse 
Aides with Pending  Number of Other  Aides with Pending  Number of Other 
State  State 
Adverse Findings in  States  Adverse Findings in  States 
Other States  Other States 
AK  1  1  MO  8  4 
AL  12  4  MT  3  1 
AR  5  3  NC  16  5 
AZ  9  3  ND  4  3 
CA  3  3  NE  5  2 
CO  4  2  NJ  2  1 
CT  10  2  NM  8  3 
DC  3  1  NV  2  1 
FL  116  9  NY  37  4 
GA  14  7  OH  28  8 
HI  1  1  OK  17  4 
IA  8  4  OR  2  1 
ID  3  1  PA  6  3 
IL  21  6  RI  5  3 
IN  1  1  SC  10  5 
KS  3  3  SD  8  3 
KY  11  5  TN  5  3 
LA  13  3  TX  13  2 
MA  15  4  UT  2  1 
MD  3  2  VA  11  6 
ME  2  2  WA  28  6 
MI  2  2  WV  3  1 
MN  1  1  WY  1  1 
Source:  OIG analysis of collected nurse aide registry records 
3 New Hampshire did not use a nationally unique identifier; therefore, we were unable to 
evaluate interstate movement for this State.  Vermont only supplied a nationwide unique 
identifier for nurse aides with substantiated findings; therefore, we were unable to 
determine whether nurse aides with pending findings from other States had active 
certifications in Vermont. 
4 There are 485 records for the 450 nurse aides because some nurse aides with pending 
findings are listed as active in more than 1 State.  Only States with values are listed. 
OEI-07-03-00380 NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  25    A P P E N D I X   ~   D
State suggestions and improvement efforts 
State Efforts 
 	 Some States shared with other States data on nurse aides with 
substantiated findings.  For example, 1 State received lists of nurse 
aides with substantiated findings from 13 States, and sent out their 
own list to all States every 3 months.  However, one State received 
information from other States, but had no way to record it on their 
present database. 
 	 Five States required long-term care facilities to periodically check 
their registry to ensure that employed nurse aides renewed their 
certifications. 
 	 Twenty-one of fifty-one States conducted criminal background 
checks before certification and may deny certification based on the 
results.  However, only 10 of these States reported the findings of 
those criminal background checks on their registries. 
 	 Of the States that conducted criminal background checks, 10 States 
reported conducting national checks.  One State reviewed every 
address where the nurse aide had ever lived, while another reviewed 
for convicted criminal acts within the past 20 years. 
State Survey Respondents Suggestions for Improvement   
 	 Twenty States proposed creation of a national nurse aide registry.  
 	 Eight States proposed increasing automation of the registry 
processes. 
 	 Three States suggested implementing better methods for keeping 
nurse aides personal information up-to-date. 
 	 Five States included results of criminal background checks on 
registry records. 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  26    A P P E N D I X   ~   E
State compliance with specific registry components  
The table below summarizes, by State, the percentage of records with 
full name, identifying information, and certification date fields complete 
as of September 15, 2003.  All numbers were based on the total 
population of active nurse aides and nurse aides with substantiated 
adverse findings. This population is labeled Records.  We excluded 
nurse aides with inactive records and nurse aides whose records were 
clearly marked on the registry as having substantiated findings from 
another State. 
Identifying  Certification  Identifying  Certification 
State  Records  Full Name  State  Records  Full Name 
Information  Date  Information  Date 
AK  2,690  99.963%  100%  98.959%  MT  9,632  100%  99.990%  99.886% 
AL  71,120  99.999%  99.999%  99.999%  NC  104,319  100%  100%  99.995% 
AR  22,422  99.996%  100%  99.938%  ND  15,469  100%  100%  76.023% 
AZ  22,311  99.996%  99.996%  97.176%  NE  25,141  99.992%  99.992%  99.992% 
CA  131,022  99.997%  100%  100%  NH  12,228  100%  100%  99.207% 
CO  25,462  99.988%  100%  100%  NJ  28,802  99.993%  100%  100% 
CT  61,762  99.953%  99.955%  99.955%  NM  23,629  99.979%  100%  99.945% 
DC  4,965  100%  100%  100%  NV  5,731  100%  99.215%  99.215% 
DE  5,624  100%  100%  100%  NY  102,646  100%  100%  100% 
FL  298,327  99.997%  100%  100%  OH  195,903  96.200%  99.999%  99.836% 
GA  57,876  99.998%  100%  100%  OK  44,753  100%  99.991%  99.806% 
HI  8,367  100%  100%  99.988%  OR  17,918  99.994%  100%  100% 
IA  38,080  100%  100%  71.657%  PA  85,997  100%  100%  100% 
ID  11,639  99.991%  100%  100%  RI  10,563  100%  100%  99.328% 
IL  283,717  99.994%  100%  100%  SC  23,849  100%  100%  100% 
IN  43,612  99.989%  99.998%  99.819%  SD  19,501  100%  100%  99.995% 
KS  38,443  100%  100%  100%  TN  32,704  99.997%  100%  99.966% 
KY  93,656  99.996%  100%  36.208%  TX  107,718  100%  100%  100% 
LA  121,816  99.984%  100%  100%  UT  14,360  100%  100%  100% 
MA  48,844  100%  100%  99.679%  VA  46,154  99.417%  99.417%  89.095% 
MD  18,769  99.995%  100%  99.995%  VT  4,674  100%  100%  99.080% 
ME  18,122  99.906%  100%  96.441%  WA  49,055  99.994%  100%  80.349% 
MI  41,098  100%  100%  100%  WI  58,237  99.998%  100%  99.840% 
MN  50,609  33.739%  100%  99.945%  WV  14,235  100%  100%  99.993% 
MO  62,288  99.989%  99.998%  99.255%  WY  4,996  100%  100%  100% 
MS  16,572  100%  100%  98.678%  Source:  OIG analysis of all collected nurse aide registry records 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  27    A P P E N D I X   ~   F
Information available on the State nurse aide registry 
This table summarizes States survey responses regarding the types of 
information contained in their registry. 
Number of States 
Description 
(including DC) 
Full Name  51 
Substantiated Findings  50 
Social Security Number  48 
Date of Birth  47 
Date of Certification  39 
Record of Changes to Registry  37 
Employment Verification  14 
Criminal Background Check  10 
Source: Data reported by State respondents 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  28  
 A C K N O W L E D G M E N T S
This report was prepared under the direction of Brian T. Pattison, 
Regional Inspector General for Evaluation and Inspections in the 
Kansas City regional office, and Gina C. Maree, Assistant Regional 
Inspector General.  Other principal Office of Evaluation and Inspections 
staff who contributed include: 
Brian T. Whitley, Project Leader 
Dennis Tharp, Program Analyst 
Michala Walker, Program Analyst 
Tricia Fields, Program Analyst 
Sandy Khoury, Program Specialist 
Tricia Davis, Director, Medicare & Medicaid Branch
Technical Assistance  
Barbara Tedesco, Mathematical Statistician 
OEI-07-03-00380  NURSE AIDE REGISTRIES:  STATE COMPLIANCE AND PRACTICES  29