A top concern for most elders is continuing to live at home for as long as possible. It is widely believed more would remain at home if health aides and visiting nurses were covered as an intermediate step towards full skilled nursing. Medicaid is often described as possessing an "institutional bias" in favor of nursing homes over in-home care. Recent public and private studies suggest substantial cost savings could accrue from a revision of Medicaid policy. [cite?] Costs drive change, so new options should be watched for.