The need to obtain further adequate nursing care for patients whose acute medical and surgical conditions have been helped but not completely cured in the hospital has come sharply into focus within the past few years. Although many hospital physicians have long been uneasy about the blind use since the 1940's of nursing home facilities for such cases, the shortcomings of the unorganized system of nursing home referrals from general hospitals have been painfully exposed in recent years. The advent of Medicare has contributed much to this recently developed awareness, but locally activated efforts to study and improve the system antedate Medicare in some geographic areas. In Massachusetts, nursing homes have been licensed since the late 1940's. Since assuming his post in mid-1963, the state director of the Division of Nursing Homes and Related Facilities has stressed efforts by his staff not merely to regulate nursing homes and police their