Studies stated Oregon has led the nation in the development of lower cost alternatives to institutional care since 198. Home and community-based alternatives to nursing facility care emphasize independence, dignity and choice. They offer needed care and supports at lower cost than medical models. Though state Medicaid funding in the state for 2005 is almost equally split between nursing facilities, community facilities and home care, more than 80 percent of clients receive services in their own homes or in their communities.