¹²Some among the provider community had moved to reduce use of physical restraints prior to the enactment of OBRA '87. The most notable example of this trend was the "Untie the Elderly" initiative sponsored by Kendall-Crossland, a group of nonprofit facilities in Pennsylvania. Although the idea was gaining acceptance among providers and staff, few facilities had actually implemented programs or achieved significant reductions before October 1990, when reductions were required by the new regulations (Hawes et al. 1997; Kane et al. 1993). The change in use of psychotropics was nearly as striking, and there is some evidence suggesting facilities began reducing the use of psychotropics between the passage of the OBRA '87 legislation and the effective date for implementation of the new regulations in 1990 (e.g., Hawes et al. 1997; Kane et al. 1993).[Return to Text]