In early 2000, the Center on Human Policy started to receive reports that children with complex medical needs were being placed in nursing homes because of home care nursing shortages. Sensing that framing the issue as a nursing shortage directed solutions that revolved around nursing agency staff recruitment and retention strategies, the authors view the problem as a permanency issue, giving primacy to the relationships in a child's life, and advocate that putting permanency philosophy into practice can successfully enable some children with the most severe disabilities to live at home.