I am writing this letter to the editor in the hope of informing unknowing taxpayers of North Dakota of the barriers in our system of care for the elderly and disabled.

I did not personally realize the challenges of fighting the system until I started caring for my father-in-law in our home. I can tell you firsthand that the current system does not work.

Medicaid, Medicare and many private insurances will pay to keep you in a nursing home, but they will not help you to stay in your own home. Many people do not have any other choice besides nursing home placement because of the financial ramifications of being elderly or disabled.

It will most likely come to the point that my family will not be able to afford to take care of Grandpa.

This man took excellent care of his family, and now it is our turn to return the care to him. The only problem is there are no funds to help us keep him at home, where he wants to be.

There is a government grant that is being worked with right now titled the North Dakota Real Choice Rebalancing Grant. This grant was implemented in order to comply with the president's New Freedom Initiative and the Olmstead Decision, which call upon states to improve access and choice of continuum of care services for the elderly and people with disabilities.

To simplify this, the grant is designed to adjust the state's funding for long-term care. It is intended to increase community and home options, while reducing reliance on institutions such as nursing homes.

Its main focus is putting the choice back in the hands of the taxpayers.

If North Dakota could reduce its nursing home expenditures to the level of the national average, the state could rebalance $43 million annually into home- and community-based services without increasing total expenditures. (During 2005-07, $976.1 million is budgeted for Medicaid funding. Of the $976.1 million, $343 million is allocated for nursing homes. Some 35 percent of North Dakota's Medicaid budget is spent on institutional care. In contrast, all other states spend 20 percent of their Medicaid funds on nursing homes.)

North Dakota spends more than most states on institutional services, especially nursing homes and institutions for the developmentally disabled.

This is mainly due to the fact that North Dakota residents are more likely to enter nursing homes than are elderly residents of other states.

The reason for this is funding barriers because of how the state's system is set up. Most people faced with the decision of nursing home placement do not have a choice because of these funding barriers. Unfortunately, legislative action is required to restructure institutional reimbursement.

Contact your representatives. Put the choice of nursing home care versus community-based care back in the hands of the people, where it belongs.