Where Clinton and Trump Stand on Long-Term Care
October 14, 2016 04:32 PM
We are now less than one month from the 2016 general election so NAHC Report would like to highlight the relevant policy positions of the two major candidates, Republican Donald Trump and Democrat Hillary Clinton. This article is not meant to serve as any form of voting or political advocacy; it is intended solely for the purpose of providing information to our readers.
The most recent estimates show about 40 million family caregivers in the United States provided approximately 37 billion hours of care to adults in 2013, according to a report released by the AARP’s Public Policy Institute. The estimated economic value of the unpaid contributions of family caregivers was about $470 billion in 2013, up from approximately $450 billion in 2009.
However, the ratio of potential family caregivers to the growing number of older people is in a precipitous decline. In 2010, there were seven potential caregivers available for each person 80 or older; by 2030 there will be only four, and by 2050, when baby boomers are between 86 and 104, there will be fewer than three.
Caring for an elderly or disabled relative carries a financial toll, both in terms of lost income and additional expenses. Those who care for people with Alzheimer’s disease typically spend more than $50,000 a year on expenses related to their duties.
About eight million people received long-term care services in 2012, according to the Centers for Disease Control, but that number will only increase in the coming years, as millions of baby boomers enter their golden years. Sixty nine percent of people at least 65 years old will develop a disability, many of whom will require long-term care.
On the subject of the cost of long-term care, both candidates are a bit light on the details, which is common during election races. The Republican platform mentions long-term care once: “As the dominant force in the health market with regard to long-term care, births, and persons with mental illness, (Medicaid) is the next frontier of welfare reform. It is simply too big and too flawed to be administered from Washington.”
A Clinton fact sheetnotes that nearly seven in ten people turning 65 will need long-term care, so the candidate has proposed a tax break for caregivers and the Social Security adjustment. Of course, this would do little to help families who face difficulties paying for nursing care or assisted living. The Democratic platform does address the issue in a section entitled “Ensuring Long-Term Care, Services and Supports.” After noting that the vast majority of people who are aging or living with disability wish to do so at home, the platform promises that “Democrats will 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.”
As noted above, many caregivers are forced to take time off from work or quit their jobs entirely. This results in lost wages and reduced Social Security retirement benefits. Trump appears to have made no comments about caregiving, but there is one mention of homecare in the Republican platform. It reads: “Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and implement programs to protect against elder abuse.” No mention is made of lost wages or Social Security benefits, though that portion of the platform does include language against taxes.
Clinton would increase Social Security benefits for people who take time off from jobs to be caregivers. “Americans should receive credit toward their Social Security benefits when they are out of the paid workforce because they are acting as caregivers,” she told the American Association of Retired Persons.
Clinton also favors a tax break for people caring for aging parents and/or grandparents that would allow a family caregiver to deduct 20 percent of caregiving expenses, up to $6000 per year, for a total tax savings of up to $1200. “The lost wages and the work that is sometimes given up are costing families – especially women, who make up the majority of both paid and unpaid caregivers,” Clinton told the Associated Press. Clinton’s proposal would not apply to caregivers who are caring for a spouse.
NAHC has a long-held position in support of improved caregiver support through respite care and tax incentives for family caregivers.
Trump promises the option of opening dependent care savings accounts (DCSA) so people can plan for future expenses relating to child and elder care. Annual contributions to the DCSA would be limited to $2000 per year, but it would not be taxed and balances in a DCSA would roll over from year to year. The Trump plan would also allow an above-the-line deduction for elder care costs necessary to keep a family member working outside the home.
A topic of considerable concern to many caregivers is paid family leave. Trump has not spoken in any detail on this subject, though he did say to Fox News that the subject is “being discussed. I think we have to keep our country very competitive, so you have to be careful of it, but certainly there are a lot of people discussing it.”
The Democratic party platform favors “passing a family and medical leave act that would provide all workers with at least 12 weeks of paid leave to care for a new child or address a personal or family member’s serious health issue.” The Democrats promise to “ensure that family caregivers have the support, respite care, and training they need to support their loved ones. We will create a strong, stable, paid caregiving workforce to help meet families’ needs, by raising wages, improving access to training…”
Clinton also favors a substantial increase in federal spending on the Lifespan Respite Care program, which provides funds to states to assist family caregivers taking time off from work. The program spent $2 million in 2015, but Clinton proposes to increase spending to $10 million per year.