April 07,2004

Grassley, Waxman Seek Information on Nursing Home Care

WASHINGTON — Sen. Chuck Grassley is asking the government to report on the use of feeding assistants in nursing homes and provide more accurate data to the public about nursing homestaffing.

Grassley made his request for information with Rep. Henry Waxman in a letter to theSecretary of Health and Human Services. Under new rules issued last fall, feeding assistants are nowallowed to feed nursing home patients. Previously, only trained health care workers could performthis job.

"The new rules governing who can feed nursing home patients need to be carefullymonitored," Grassley said. "Our inquiry is part of that effort. On behalf of nursing home residentsand their families, we want to make certain that the more relaxed rules do not result in malnutritionand dehydration in nursing homes. We also want to make sure that accurate staffing data is publicly available so that nursing homes can be compared."

The text of the letter from Grassley and Waxman to Secretary Tommy Thompson followshere.

April 7, 2004

The Honorable Tommy G. Thompson
Secretary of Health and Human Services
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Mr. Secretary:

We are writing with regard to the new Department of Health and Human Services (HHS)regulation permitting feeding assistants in nursing homes. In particular, we are requesting that HHScollect adequate and reliable data on the number of hours worked by feeding assistants. We requestfurther that the information not only be collected but that the information also be disseminatedpublicly.

Residents and family members have a right to know what amount of nursing home care isbeing provided by feeding assistants and what amount is being provided by registered nurses,licensed nurses, and nursing assistants. Such data will enable family members to make informeddecisions about the proper nursing home in which to place a loved one.

It is also critical that policymakers and researchers be provided with data on the use offeeding assistants in order to evaluate the impact of this regulation. For example, such data wouldallow policymakers to determine if nursing homes that hire large numbers of feeding assistants arereducing or increasing staffing in other areas, or whether nursing homes with large numbers offeeding assistants are more or less likely to violate federal nursing home standards. Without suchdata, Congress and outside experts cannot evaluate the effectiveness of the feeding assistantregulation.

Therefore, we request that the following measures be implemented immediately:

(1) HHS should require nursing homes to accurately report to state inspectors and/or HHSthe number of hours worked by feeding assistants;

(2) HHS should include this data on the Nursing Home Compare website currentlymaintained by HHS; and

(3) The Nursing Home Compare website should provide an easy-to-understand comparisonof the number of hours worked by feeding assistants, registered nurses, licensed nurses, and nurseaides.

Moreover, we understand that the nurse staffing data currently reported on the Nursing HomeCompare website may not be accurate for many or even most facilities and that HHS now hasresearch showing how accurate staffing data can be collected using payroll records and invoices. Wewould like to know when HHS will begin collecting staffing data using payroll records and invoicesand when such data will be made available to Congress and the public.

We would appreciate a response to our letter by May 5, 2004. Thank you.


Henry A. Waxman
Ranking Minority Member
Committee on Government Reform
U.S. House of Representatives

Charles E. Grassley
Committee on Finance
U.S. Senate