Recidivism, or “relapse into criminal behavior” (as defined by Merriam-Webster), is a factor for States participating in the Center for Medicare & Medicaid Services’ National Background Check Program (NBCP) to consider when identifying how long each disqualifying crime will bar an individual from employment (i.e., disqualification periods) and when establishing their appeal processes.

Section 6201 of the Patient Protection and Affordable Care Act of 2010 requires that NBCP participating States have procedures in place to:

… provide an independent process by which a provisional employee or an employee may appeal or dispute the accuracy of the information obtained in a background check performed under the nationwide program, including the specification of criteria for appeals for direct patient access employees found to have disqualifying information which shall include consideration of the passage of time, extenuating circumstances, demonstration of rehabilitation, and relevancy of the particular disqualifying information with respect to the current employment of the individual… (Emphasis added.)

While research on recidivism for direct access employees in long term care is very limited, existing studies of recidivism among the general population indicate that the likelihood of committing another crime decreases with the more time a person is “clean,” that is the more time a person goes without a new arrest or conviction. These findings suggest that after a certain period has elapsed, which depends on the type of crime, prior offenders are no more likely to reoffend than the general population.

The resources listed below provide States with information needed to make informed decisions about the disqualification timeframes and how to account for the passage of time in the appeal process.

Additional Resources

  1. Blumstein, A. & Nakamura, K. (2009). Redemption in the presence of widespread criminal background checks. Criminology, 47(2), 327-359.
  2. Blumstein, A. & Nakamura, K. (2012). Paying a price, long after the crime. New York Times. Retrieved from
  3. Bureau of Justice Statistics. Prisoner recidivism. Last retrieved Aug. 13, 2012, from
  4. Bushway, S. D. & Sweeten, G. (2007). Abolish lifetime bans for ex-felons. Criminology, 6(4), 697-706.
  5. Craig, L. (2011). The effect of age on sexual and violent reconviction. International Journal of Offender Therapy and Comparative Criminology, 55(1), 75-97.
  6. Deschenes, E.P., Owen, B. & Crow, J. (2006). Recidivism among female prisoners: Secondary analysis of the 1994 BJS recidivism data set. U.S. Department of Justice. Document no. 216950.
  7. Gendreau, P. (1996). Offender rehabilitation: What we know and what needs to be done. Criminal Justice and Behavior, 23(1), 144-161.
  8. Kurlychek, M.C., Brame, R. & Bushway, S.D. (2006). Scarlet letters and recidivism: Does an old criminal record predict future offending? Criminology, 5(3), 1101-1122.
  9. Kurlychek, M.C., Brame, R. & Bushway, S.D. (2007). Enduring risk? Old criminal records and predictions of future criminal involvement. Crime & Delinquency, 53, 64-83.
  10. Antenangeli, L. & Durose, M. (2021). Recidivism of prisoners released in 24 states in 2008: A 10-Year Follow-Up Period (2008-2018). Bureau of Justice Statistics Special Report. U.S. Department of Justice. Office of Justice Programs. NCJ 256094. Accessed at
  11. Alper, M. & Durose, M. (2019). Recidivism of sex offenders released from state prison: A 9-Year Follow-Up (2005-14). Bureau of Justice Statistics Special Report. U.S. Department of Justice. Office of Justice Programs. NCJ 251773. Accessed at
  12. Lipsey, M. W. (1992). Juvenile delinquency treatment: A meta-analytic inquiry into the variability of effects. In T.D. Cook, H. Cooper, D.S. Cordray, H. Hartmann, L.V. Hedges, R.J. Light, T.A. Louis & F. Mosteller (Eds.), Meta-Analysis for Explanation: A Casebook (83-127). New York, NY: Russell Sage Foundation.
  13. Payne, B. K. & Gainey, R. R. (2006). The criminal justice response to elder abuse in nursing homes: A routine activities perspective. Western Criminology Review, 7(3), 67-81.
  14. Peters, R. H. & Murrin, M. R. (2000). Effectiveness of treatment-based drug courts in reducing criminal recidivism. Criminal Justice and Behavior, 27(1), 72-96.
  15. Pew Center on the States. (2011). State of Recidivism: The Revolving Door of America’s Prisons. (Washington, D.C.: The Pew Charitable Trusts, April 2011.)
  16. Piquero, A. R., Farrington, D. P. & Blumstein, A. (2007). Key Issues in Criminal Career Research: New Analyses of the Cambridge Study in Delinquent Development. New York: Cambridge University Press.
  17. Soothill, K. & Francis, B. (2009). When do ex-offenders become like non-offenders? The Howard Journal of Criminal Justice, 48(4), 373-387.