Sens. Barack Obama and John McCain need to start addressing the issue of long-term care.

Reforming long-term care delivery is an issue of vital importance for people with disabilities and our families and friends. But there has been little discussion of it during the presidential campaign.

I am one of millions of Americans with disabilities who rely on the assistance of others to navigate through each day. I hire people to help me get out of bed and into my wheelchair and to perform activities of daily living. My workers are paid through a state program essentially funded by Medicaid.

This program is central to my freedom and independence. Without it, I might be forced to surrender myself to a nursing home. But because federal long-term care policy still heavily favors institutionalization, countless people with disabilities are forced to give up their freedom in exchange for assistance.

Those of us using community assistance programs like the one in my state are just a budget cut away from joining them.

For everyone who has been or may be caught in this painful trap, reversing this institutional bias in Medicaid policy is key.

Neither Obama nor McCain lists long-term care as an issue on their main Web pages.

Obama does have a nine-page platform addressing disability issues, in which a small section proclaims his support of a major piece of proposed legislation that would make it much easier for people to receive Medicaid-funded assistance in their homes. There is a paragraph on Obama’s Web site about giving seniors long-term care choices that are “consistent with their needs, and not biased toward institutional care.” McCain’s Web site proposes no specific disability agenda. The only long-term care discussion I could find was a paragraph that proposes creating more “pioneering” programs to help seniors receive home assistance.

Both candidates are giving the issue of long-term care short shrift.

I know: Most people don’t like to think about what they would do if they or a loved one needed long-term care until faced with a crisis.

But the time to confront this issue is before the crisis hits.

And there is no better time than during a presidential campaign to raise it, discuss it and try to resolve it in a humane way.