This dramatic change is reflected in the numbers of people living in larger (16 or more) facilities.

Over the 20 year period, the number of people in larger facilities and nursing homes was less than half of what it had been – a drop from approximately 220,000 to approximately 107,000.

Basically, with the advent of the Home and Community Based Waiver, the incentive structure shifted. The full impact did not come until the 1990s, but began to have its effect in the 1980s.

Smiling Child
Photo courtesy Ann Marsden