Long-Term Care: The Ignored Issue in the 2016 Election

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By Bob Blancato / Next Avenue 

Earlier in October, I traveled to Texas to speak at an aging conference. As I got ready to begin my remarks, I connected where I was to the 2016 presidential election. I was in the city of Longview, which should be the focus — that is, a “long view” — but sadly, is not.

We have endured two presidential debates. Some, like me, hoped the second’s Town Hall format might elicit questions from real people about real issues. It did — but only to a limited extent.

Long-Term Care Touches So Many
One issue I fervently wanted raised (but sadly was not) is one that millions of Americans face each day. And it’s one that, left unaddressed, will also be the biggest financial liability facing the boomer generation. I’m talking about long-term care and the services and supports for it.

There were questions about caregiving at the Town Hall debate. You just didn’t see them being asked.
I had the good fortune to address a summit on this topic convened by The SCAN Foundation in September.

I’m sorry to say you can’t find much to celebrate in either of the parties’ respective platforms about long-term care.

The Republican platform barely checks the box when it says, “We will make home care a priority in public policy.” The Democrats go further, but more with lofty aspiration than action, proposing to “take steps to strengthen and expand the home care workforce, give seniors and people with disabilities access to quality, affordable long-term care, services and supports and ensure that all of these resources are readily available at home or in the community.”

What the Candidates Say
Moving to the candidates, Hillary Clinton has proposed a family caregiver tax credit and would restore lost Social Security credits for family caregivers’ benefits. She has also authored the first law on respite care ever adopted. Donald Trump says he would repeal the Affordable Care Act (ACA), a law which expanded our largest program providing long-term care support — Medicaid. (This Next Avenue article goes into more detail on the candidates’ positions on long-term care.)

Sen. Tim Kaine co-sponsored the Older Americans Act reauthorization of 2016, which addressed home and community based services. Gov. Mike Pence allowed Medicaid to be expanded in Indiana, but while in Congress, voted against the ACA and then voted to repeal it.

Why So Little Discussion?
One reason long-term care matters have stayed in the political shadows is the national media’s failure to press candidates on significant issues, rather than “gotchas.”

But here’s something that will surprise you: There were questions about caregiving at the Town Hall debate. You just didn’t see them being asked. The Presidential Open Questions Internet platform, from which the moderators selected questions to ask the candidates, included ones on caregiving and on Alzheimer’s research.

The demand for answers is out there. Don’t the news anchors and moderators know that the TV audiences determining ratings care about the cost of nursing home care and the stresses of family caregiving? Don’t they have older relatives or caregiving responsibilities of their own?

Don’t they want answers, too?

Bipartisan Ideas in 2016, Legislation in 2017?
Despite the invisibility of this issue in the Presidential campaign, 2016 has seen important activity in developing bipartisan ideas on long-term care services and supports.

The Bipartisan Policy Center, the bipartisan Long-Term Care Financing Collaborative and LeadingAge all produced substantive reports with recommendations that could form the basis of legislation in 2017 in a new Administration and possibly a changed Congress.

How to Get This Issue on the Election Radar
So for the remaining weeks of this campaign and beyond, how do we get long-term care noticed in 2017 and beyond? We should do what comes naturally to this issue: localize and humanize it.

We need to raise the issue at all local forums and events where those running for President, the Senate or the House may be in attendance. We need to use incessant social media to keep the issue in front of candidates.

We also need to discuss who benefits if we have a national long-term care services and supports policy — boomers, women, caregivers — all are powerful political constituencies who vote.

The Value Proposition
We must put forth the value proposition that if people are offered long-term care choices other than the expensive option of nursing home care, we can save future dollars in Medicaid and Medicare and offer people the opportunity to remain at home and in their community, where they prefer.

Simply put, the missing ingredient here is political will. Long-term care, more than ever, is becoming a kitchen table discussion. It must next become a Main Street political issue in this election.

Caregivers, older adults and their advocates need to raise their voices and instead of candidates raising their voices at each other, let them lend their voices to address this pressing issue.

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