Our audit of 8 Maryland nursing homes disclosed 51 employees that, according to FBI records, had been convicted for a variety of crimes. The employees included certified nurse aides as well as staff holding jobs not subject to background checks. Also, our background check of 35 individuals who had been convicted of elder abuse in Maryland showed 7 had prior convictions for other types of crimes, including those against people. An audit of Illinois nursing homes demonstrated similar results. These audits plus surveys in other States clearly indicate that, among other things, the Health Care Financing Administration (HCFA) and the Administration on Aging (AoA) should work with the States to improve the safety of long term care residents and to strengthen safeguards against the employment of abusive workers by elder care facilities. The HCFA should also consider establishing Federal requirements and criteria for performing criminal background checks. The HCFA and AoA generally agreed with our findings and recommendations.