May 16,2002

Agency Agrees with Grassley to Make Nursing Home Study Public

WASHINGTON – The Centers for Medicare and Medicaid Services has decided to makea key nursing home staffing study widely available to the public. The decision came after Sen.Chuck Grassley, ranking member of the Committee on Finance, and Rep. Henry Waxman urged themove.

“This is a good decision,” Grassley said. “The taxpayers paid for this nursing home study.They pay for most of the care in nursing homes. They deserve full access to a report that raisesserious implications for the government’s regulation and funding of nursing home staffing in thefuture.”

The newly available study is the second phase of a congressionally mandated study,“Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes,” which was completedrecently and had an original due date of January 1,1992. Its completion has been eagerly awaitedby members of Congress, researchers, nursing home owners, nursing home workers, nursing homeresidents, and their family members. The study is now available at

The text of a Grassley-Waxman letter to CMS urging public access to the study follows.

April 17, 2002
Mr. Thomas A. Scully
Centers for Medicare and Medicaid Services
200 Independence Ave. SW
Room 314-G
Washington, D.C. 20201

Dear Administrator Scully:

As you know, the second phase of a congressionally mandated study, “Appropriateness ofMinimum Nurse Staffing Ratios in Nursing Homes,” was recently released by the Department ofHealth and Human Services (HHS). The findings of the report, which had an original due date ofJanuary 1,1992, have been eagerly awaited by members of Congress, researchers, nursing homeowners, nursing home workers, nursing home residents, and their family members.

The report analyzed empirical data linking nursing home staffing levels with quality of careand concluded that 90 percent of nursing homes in the United States have staffing levels that are toolow to provide adequate care. The report should play a critical role in any executive or legislativebranch effort to improve nursing home staffing levels.

Given the landmark nature of this report, we were disappointed to hear from your staff thatthe Centers for Medicare and Medicaid Services (CMS) is not posting the report on the agency’s website. We hope this is not a final decision. The nursing home staffing study was mandated byCongress and paid for with federal tax dollars. The study provides critical information on nursinghome conditions and suggests possible ways to improve quality of care. As such, the study shouldbe easily accessible to members of the public. And since Phase 1 of the report is available on theCMS web site (although arguably difficult to find), it would be logical to include the second andfinal phase as well.

By declining to post the study on its web site, HHS and CMS impede public access to thereport and its important conclusions. We are concerned that this decision might leave the impressionthat HHS and CMS are unconcerned about the staffing problem.

As a temporary measure, we have posted a copy of the report on the web site of the minorityoffice of the House Committee on Government Reform, But this isnot a permanent solution. The report should be available on the CMS web site, where it can beaccessed by members of the public when they are searching for nursing home information. Pleaselet us know whether the decision against posting the report is final or whether it remains open forconsideration. Please respond by Monday, April 29, 2002.


Sen. Chuck Grassley 
Ranking Member

Rep. Henry A. Waxman
Ranking Member 
Committee on Finance Committee on Government Reform