As a certified nursing assistant, LPN, and RN, I've always served the elderly population. Many of the patients I cared for were unable to find a practitioner willing to provide primary care services paid for by Medicaid.

Locally, only two general practitioners are willing to see these patients, including those at the long-term care facility where I've been an RN unit manager for the past two years. Both have said that their commitment to the elderly is not for financial gain (there isn't any, they point out), but because it's the compassionate thing to do.

The Patient Protection and Affordable Care Act is a beginning, as Dr. Sochalski notes. The negative effect on some people during this process may seem unfair or frustrating. But what is the alternative? Living without basic health care is not just treatment for the citizens of one of the world's richest countries.

If we move toward enhanced home care, preventive care, and community-based services, people may be able to stay in their own homes with more dignity than they do now under our current health care delivery system.

Sharon J. Schuttauf, RN

Raynham, MA