I applaud Nancy C. Sharts-Hopko (Letters, January) for drawing more attention to the issue of assisted living. Working at a rehabilitation center for the mentally and physically challenged, I'm often the only health care provider these people see for months. The majority of my patients live in privately owned residences governed by the Massachusetts Department of Mental Retardation.

As their advocate, I experience roadblocks daily. A social model rather than a medical model governs their care, and their care-givers are often overworked, undereducated, and extremely stressed. The nurse must not only educate caregivers and managers but also carefully expedite acute care without alienating the care-givers. For example, caregivers often struggle to rearrange a resident's dental appointment when, say, another resident has an urgent need for a computed tomographic scan. Few dentists will care for these patients because of low-paying insurance, which makes rescheduling difficult.

These people are often viewed as disposable. If they were truly valued, the Centers for Medicaid and Medicare Services would enforce quality-of-care standards. As health care professionals, advocates, and humanitarians, we must overcome the obstacles to helping this population.

Christal J. England, RN

Wareham, MA