Oregon is a recognized leader in home and community-based care and has more than 20 years of experience in moving long-term care clients from institutional settings to home and community-based settings. In 2002, 82 per cent of Oregon's Medicaid long-term care clients were served in the community. Additionally, Oregon was the only state in the nation whose spending for institutional care was less than half of the state's total Medicaid long-term care spending in 2000, with only 37.2 per cent spent on institutional care compared to the national average of approximately 70 per cent. Oregon officials recognize that with the aging population and increasing cost, they may need to rethink the design of their current system. They hope to incorporate a concept of 'bounded choice' where a person's wishes are considered within the boundaries of service capacity and fiscal constraints.