The reduction in the allowed amount of skilled nursing services, from 42 hours a week to 21, creates a hardship for individuals in the community with complex medical conditions.  Many individuals formerly had round the clock nursing care in state institutions.  Their needs generally do not improve over time, but become more complex as individuals age, chronic conditions worsen or become more difficult to manage, new conditions develop (medication allergies, seizures, strokes, heart attacks, COVID, etc.)  Community nursing supports need to increase, or at least be maintained at the current level - not decrease.  We do our best to help individuals receive the care they need in integrated community settings, but we need systematic supports to maintain this.