Pennsylvania is at the forefront of a national discussion about the future of long-term living. The commonwealth currently ranks third nationally in percent of population over 65 and fourth over age 85. With such a large and growing population of older residents, we are about 10 to 15 years ahead of other states, which brings great urgency to making sure the long-term living system is prepared to meet present and future needs -- and that is exactly what we are doing.

This progressive view of long-term living in Pennsylvania was ignored in "Let's Be Honest About Home Health Care," the June 20 op-ed in the Post-Gazette offered by Dr. Stuart Shapiro, a lobbyist for nursing home operators, personal care homes and retirement communities.

Pennsylvania spends nearly $4 billion a year on long-term living services. That represents about 32 percent of the state medical assistance budget, one of the highest proportions in the country. More than 80 percent of that cost is driven by nursing facility payments: Pennsylvania has the second-highest per capita public spending on nursing homes in the nation -- 25 percent higher than the national average. Without aggressive system reform efforts now, over the next four years the cost to Pennsylvania taxpayers will grow by 25 percent, an increase of $445 million over current spending.

My administration is making needed changes to the system, saving taxpayer dollars and offering new options for Pennsylvanians who need long-term living services. As a result of deliberate and effective policy changes, more consumers than ever before are being given the option of choosing home-based services. Since 2003, the number of consumers choosing home and community-based services has doubled from fewer than 18,000 to more than 36,000. During this same period, the nursing facility population has remained constant or declined slightly.

What is remarkable about this shift is that it is occurring while the population of elderly residents is growing. Since 2000, Pennsylvania has experienced a 15 percent increase among those over the age of 80 and a 24 percent increase among those over the age of 85. Given the choice, older Pennsylvanians who were likely to use nursing facility care in the past are now opting for home and community-based care.

Home and community-based services offer Pennsylvania residents what they really want: the opportunity to remain independent in their own homes where they can continue to be a vital part of family and community life. A recent AARP survey showed that more than 80 percent of Pennsylvanians preferred home and community-based services compared to only 5 percent who preferred a nursing facility. Not only are home and community-based services a preferred option, they offer value to Pennsylvania taxpayers. On average, two older Pennsylvanians can be served in the community at half the cost of serving one in a nursing facility.

The real question before legislators as they make decisions about next year's budget is why 80 percent of long-term living funding should go to the part of the system that only 5 percent of Pennsylvania taxpayers prefer? If we are to successfully manage the challenges ahead, Pennsylvania must begin to align taxpayer resources with taxpayer preferences to create a market-based system that is driven by people buying and receiving the services instead of the business interests.

By doing that, we can create a system that gives Pennsylvania citizens meaningful choices in long-term living services.