There have been a number of changes in the clinical practice of seating and wheeled mobility (SWM) for older adults in nursing homes. Twenty years ago, physical restraints were being used indiscriminately with the intent to protect the person from falling. Currently, we know that physical restraints increased the risk of falls, discomfort, functional limitations, and fatalities. Some of those restrained were in ill-fitting wheelchairs. Through specific projects, collaborative efforts, awareness, education, and improved products, clinical practice has changed. The 5-step mat assessment and common postural problems in elders remain the same. Major barriers to improved seating and wheeled mobility still exist such as insufficient funding, inadequate education of practitioners, and poor maintenance of equipment. These barriers inhibit the availability of improved seating and wheeled mobility for older adults in nursing homes. Continued attention by practitioners, policy makers, and payers is necessary to increase access.