Among the 280 million people over the age of five living in the United States, 6.1 million (2.2%) reside in institutional settings and the majority of them have disabilities. More specifically, people with disabilities comprise 97.5% of persons (2.1 million) living in skilled nursing facilities, 27.1% of persons (569,000) living in adult correctional facilities, and 65.9% of persons (1.3 million) living in other residual institutions. In comparison, persons who reside in non-institutional community settings (i.e., their homes) have a disability prevalence rate of 16.4% (44.9 million persons).

In Olmstead v L.C. the Supreme Court ruled that under the American's with Disabilities Act (ADA), unnecessarily placing individuals with disabilities in nursing homes and other institutional residential settings was in violation of the law. The Court that Title II of the ADA contained an "integration mandate" requiring public agencies to provide services in community settings rather than in institutions. The Court explained that the states must administer programs in the most inclusive setting appropriate to the needs of the individual with a disability. The Court held that integration is required when: (1) the state determines community placement is appropriate; (2) the individual does not oppose the less restrictive setting; and (3) "the placement can be reasonably accommodated taking into account the resources available to the State and the needs of others with … disabilities."