Historical and contemporary issues in nursing home reform.

Historical developments leading to the enactment of nursing home reform legislation (P.L. 100-203) were discussed. The results of the nursing home component of a nationwide University of Illinois at Chicago study of public mental retardation/developmental disabilities spending were also presented. Approximately 51,000 individuals with mental retardation and related conditions resided in nursing homes in 1989. The cost of their care was approximately $900 million annually. Within the first 12 months of the enactment of P.L. 100-203, 46 states had requested an extension to the original mandated services deadline imposed under that legislation. Under P.L. 100-203 guidelines, state agencies estimated that nearly 40% of all nursing home residents with mental retardation might need to be relocated to alternative settings. Implementation issues were also discussed.