Diversion, transition programs target nursing homes' status quo.

As millions of Americans age and exercise their preference for long-term care in the least restrictive environment, policymakers search for ways to increase community-based services. A new federal program--Money Follows the Person--is off to a slow but promising start. The program's "downstream" approach moves residents out of nursing homes and into community care settings. For example, states with mature nursing home transition programs have managed to relocate 25-35 percent of their nursing home residents to assisted living. Other programs successfully using "upstream" strategies to keep people out of nursing homes have not been widely copied. The challenge for policymakers is to maintain funding and flexibility so that nursing homes are no longer the default option for older adults and people with disabilities.