“…The early stages of this transition were facilitated by policy responses to issues of inefficiency (Lee, Bott, Gajerski, & Taunton, 2009) and quality (US General Accounting Office, 2003) of nursing home care, as well as consumer preference to receive care within their own homes (Kelly, Knox, & Gekoski, 1998). Such policies include the Omnibus Reconciliation Act of 1981, the US Supreme Court Olmstead decision in 1999, and the New Freedom Initiative of 2001; all of which increased access to HCBS as an alternative to institutional care for individuals with disabilities (Putnam, 2011). HCBS allow adults who are nursing-home-eligible to receive health, support, and homemaker services within their own homes (Zarit, Stephens, Townsend, Greene, & Leitsch, 1999) and have demonstrated numerous benefits, such as reducing the risk of admission into institutional care (Burr, Mutchler, & Warren, 2005) and mortality (Albert, Simone, Brassard, Stern, & Mayeux, 2005).…”