| LONG
TERM CARE
1)
Do you agree that federal and state policies should allow people who
need long-term care to receive the services and supports in the least
restrictive setting possible, including the home and community?
[ Bush ]
Response Pending
[ Braun ]
Providing care to the elderly and the disabled in their homes and in
the community allows the community to continue to benefit from their
talents and contributions. Institutionalized care is often less effective
for the overall well being of individuals whose needs might be met in
less restrictive settings, and is certainly more costly. I support efforts
to provide long-term care and assistance to individuals in less restrictive,
community-based settings.
[ Clark ]
Yes
[ Dean ]
Our leaders can no longer afford to ignore America’s aging population.
In 25 years, nearly one in five Americans will be over 65 years of age.
In 8 years the first boomers turn 65. Nowhere is this challenge more
evident than in the area of long-term care. It is a challenge we are
ill-prepared to meet. Our current long-term care system spends nearly
three out of four dollars on nursing home care. It is a care setting
few families would choose. President Bush’s plan would cap federal
assistance to states already struggling to cope with the demands of
long-term care and he proposes to give more tax breaks for long-term
care insurance without requiring policies to meet adequate minimum standards.
Apparently, President Bush’s solution to every problem is to give
a tax cut to those who need it least.
[ Edwards ]
The Supreme Court's Olmstead decision upheld that the ADA requires states
to offer services to individuals with disabilities in the most integrated,
community-based setting. This was a critical victory for disability
rights. Unfortunately, states are still struggling to implement Olmstead.
The federal government must help states by supporting the transition
to community-based services and offering additional technical assistance,
and then, for states that do not come into compliance, there must be
a strong enforcement effort. There needs to be significant reform in
Medicaid, as I discuss in my Living with Dignity Initiative below.
As with Medicaid, Medicare continues to operate as it has for decades
by promoting institutional care over home and community-based care.
I will promote community-based care by stopping the unfair and bureaucratic
rules that prevent Medicare beneficiaries from getting the things they
need to live at home, such as wheelchairs. I will also stop the 24-month
waiting period for disabled persons to enroll in Medicare.
[ Gephardt ]
Yes. I believe we should increase our support for long-term care services
that are provided in the home and community. With proper attendant services,
many of those who require long-term care services can live fulfilling
and productive lives in the community.
[ Kerry ]
Yes, we need to develop a comprehensive long-term care system that gives
seniors and people with disabilities the choices they need to get the
care they need. Some people need a home health aide to help with basic
needs, others have a child or spouse who are caregivers but those caregivers
need help and support. We need to make Medicaid more flexible so that
it can cover home and community-based services in addition to institutional
care.
Too often Medicaid pays thousands of dollars for nursing home care
when many people could live at home with a home health aide or caregiver.
We need to change this and make sure that people with long-term care
needs get the services that make sense. I support a tax credit for caregiving
- that can be used for whatever long-term care services are needed.
[ Kucinich ]
Dennis Kucinich supports policies which allow people who need long-term
care to receive services and support in the least restrictive settings
possible. Kucinich supports and encourages community-based senior services,
home-care, and adequate resources for families struggling with a variety
of day-to-day challenges. One of the best models in the nation for these
kinds of programs can be found in Congressman Kucinich's own 10th District
of Ohio, in the city of Cleveland and the county of Cuyahoga. Cuyahoga
County has developed an innovative program for seniors called the "Benefits
Checkup." At a senior center or senior living facility, a senior
citizen can speak to a social worker or senior coordinator and by use
of a computerized screening program, find which federal, state, and
local community assistance programs may benefit them.
Another program supported by Dennis Kucinich is the Ohio Department
of Aging's PASSPORT program, which provides in-home alternatives to
nursing home care for low-income seniors. Any older person considering
nursing-home placement is screened by a PASSPORT assessor, and if eligible
for the program, the older person then meets with a case manager to
arrange an appropriate mix of in-home services to supplement care provided
by family members and friends; services include adult day care, chore
service, home medical equipment and supplies, emergency response systems,
home delivered meals, homemaker services, independent living assistance,
minor home modifications, nutrition consultation, occupational therapy,
personal care services, social work/counseling, and medical transportation.
When it is necessary for an older person to move into a nursing home,
Congressman Kucinich supports mandatory staffing regulations which require
sufficient staff to prohibit warehousing conditions that dehumanize
our elderly.
[ Lieberman ]
Absolutely. We owe our seniors the best care we can give them-especially
for what they're paying. Not just medical treatment. Care with dignity.
Community. And as much independence as possible.
[ Sharpton ]
Response Pending
2)
How would your administration support and enhance current state efforts
to move people from institutions to the community and to prevent premature
or inappropriate nursing home placement?
[ Bush ]
Response Pending
[ Braun ]
Providing adequate funds to states to administer transitional programs
for individuals who need long term care would be a priority of my administration.
Unfunded mandates at the federal level leave states with massive budget
shortfalls, resulting in program cuts. Although we must ensure that
community-based service organizations provide high quality long-term
care that meet federal standards, I support efforts to expedite the
waiver process.
[ Clark ]
As the baby boomers approach retirement and seniors enjoy longer lives,
it's more important than ever to improve and expand our system for long-term
care. Seniors and their families need better options for helping loved-ones
who need daily assistance in completing basic tasks. This is a multi-faceted
challenge that requires a multi-faceted solution. First, we need to
understand that the primary caregivers for nation's chronically ill
of all ages are family and relatives, particularly women. Second, we
have to recognize that Medicare does not offer significant coverage
of long-term care. Third, the nation's primary payer and insurer for
these costs is Medicaid, a program that faces enormous fiscal challenges.
And, finally, while we would all like to have a more vibrant private
insurance system, it remains a fairly modest element of our long-term
care infrastructure.
While there are no silver bullets to address the long term care challenge,
we can, and we must do better. We need to reorient our system away from
institutionalization and towards home and community-based services.
We need to improve and expand our end-of-life programs for the terminally
ill, including building on the successful Hospice model. We need to
better manage our limited resources by using proven chronic care management
techniques that improve medical outcomes and constrain cost growth.
We need to better coordinate those services that duplicate one another
in the Medicare and Medicaid programs. We need to provide caregivers
with the support they need to supplement and not supplant the services
they provide. In so doing, we should consider expansions of the Older
Americans Act, caregiver initiatives, and innovative tax credit policies
that provide direct resources to these populations. And as we succeed
in moving our long term care system to one that is more grounded within
the community, we need to make certain that we ensure quality care for
these home-based services by improving training, increasing inspections
and better rewarding providers that consistently give high quality care.
[ Dean ]
States need flexibility to offer alternatives to nursing home care.
The Medicaid home and community-based waiver program should be streamlined.
The federal government should not condition dollars for homecare on
withdrawing support for nursing home care. We need to invest modest
new federal resources in home and community based care. American families
have been, and will continue to be, the backbone of our nation’s
long-term care system. I will propose a more favorableMedicaidfederal
match rate to provide respite care and training for spouses and other
family caregivers who bear the brunt of caring for a loved one at home.
[ Edwards ]
In October, I offered a long-term care policy based on basic American
principles: consumer direction of service, the chance to get care in
the home and community, dignity and respect for workers, and accountability
for providers and the government. My Living with Dignity Initiative
will:
- Fund State Efforts to Expand Home Care and Reform the Long-Term
Care System. I will finance state-level reforms like, Medicaid eligibility
expansions, long-term care tax credits, asset/income protection programs,
and private insurance reforms. I am a cosponsor of the Medicaid Community-Based
Attendant Services and Supports Act (MiCASSA) to offer personal attendant
services. It must become easier for states to use Medicaid for long-term
care.
- Crack Down on Abuse and Improve Nursing Care Quality. I will increase
enforcement against nursing home and home health chains that abuse
patients, expand inspections, and increase penalties for poor care.
I will work with experts to establish care standards; offer provider
grants to improve quality; and offer awards to excellent providers.
I am also the sponsor of the Senate companion to The Nursing Home
Staffing Act, which ensures minimum nursing home staffing levels.
- Offer Respite Care and Other Support to Families Who Care for Loved
Ones. I will double resources for respite care and establish an Internet
clearinghouse with information on available services.
- Better Recruit and Retain Nursing Home and Home Care Workers. I
will improve wages, training, working conditions for aides; I will
establish workplace safety regulations like the ergonomics rules discarded
by President Bush.
[ Gephardt ]
I believe efforts taking place at the state level with regard to long-term
care are vital to ensuring accessible and affordable care for senior
citizens. As president, I would direct my administration to help states
with this effort, including the granting of waivers when safe, necessary,
and appropriate. I would also seek to help states coordinate with one
another so that the best practices regarding long-term care can be repeated
throughout the country.
[ Kerry ]
I will support state efforts by strengthening and protecting Medicaid,
not tearing it apart. I am firmly opposed to the Bush Administration's
proposals to turn Medicaid into a block grant to the states. By investing
in Medicaid, we can improve the health and independence of the millions
of Americans with disabilities throughout our country. No one should
be forced into a nursing home or have their most basic needs go unmet
just because they live in a state that chooses not to offer needed community
living services.
[ Kucinich ]
Refer to the LTC response above (Question 1)
[ Lieberman ]
I believe that with the right leadership, we can help all America's
seniors afford high-quality long-term care today and be ready as the
challenges grow exponentially tomorrow. I support the ability of states
to design programs that best fit the needs of their populations, but
I do not support waivers in the Medicaid program that short change funding
for programs for seniors. I want seniors to be able to stay in their
homes and communities as long as possible before going into institutions,
and that requires adequate funding. I have supported such legislation
in the Senate. With that goal in mind, I have proposed a long-term care
affordability plan to complement state efforts to help people with their
long term care needs. The plan includes the following ideas:
- Provide a tax credit for family caregivers. I recognize the financial
and emotional burden that family members shoulder when a loved one
needs care. Estimates of the number of family caregivers vary between
45 million and 52 million individuals nationwide. To help these often
overlooked and under-supported caregivers, I'll give people caring
for relatives a tax credit worth up to $3,000 to cover some of the
cost of this care.
- Eliminate the outdated assets test for seniors in the Medicaid program.
Today, low-income seniors have to spend themselves into the poor house
to meet an indefensible assets test of $2,000 per individual to qualify
for long-term care benefits under Medicaid. That's wrong. As President,
I will extend access to home health care, assisted living, and nursing
home care, along with all other Medicaid benefits such as prescription
drug coverage, to an additional two million needy seniors. This will
also give low-income families the same opportunity to hold onto their
homes that wealthy families who can afford estate planning have and
it will cut down on paperwork and bureaucracy in the system--a common
complaint of Medicaid recipients and overworked state workers.
- Give taxpayers a long-term care insurance tax deduction to help
cover the cost of premiums. Private long-term care insurance is one
of the best ways for Americans to prepare for the day when they will
need additional assistance. I will enable middle-class Americans to
deduct half the cost of insurance premiums, whether or not they itemize
their taxes. This will not only take the edge off rising coverage
costs; it will encourage the purchase of long-term care insurance
before people need it, and help Americans plan ahead.
- Encourage long-term care insurance policies to be offered under
employer benefit package "cafeteria" plans and flexible
spending accounts. Just as employers can offer health care, life and
disability insurance policies under "cafeteria" plans, or
offer employees flexible spending accounts to put aside pre-tax dollars
to pay for health care and child care needs, I will give workers more
access to long-term care policies by pushing employers to offer them
in benefit packages at work. And he will allow workers to set aside
part of their salaries pre-tax to pay for long-term care costs.
[ Sharpton ]
Response Pending
3)
What, if anything, will you do to streamline or eliminate the home and
community-based services waiver process for states under Medicaid?
[ Bush ]
Response Pending
[ Braun ]
Refer to the above Long-Term Care response (Question 2)
[ Clark ]
Refer to the above Long-Term Care response (Question 2)
[ Dean ]
Refer to the above Long-Term Care response (Question 2)
[ Edwards ]
Refer to the above Long-Term Care response (Question 2)
[ Gephardt ]
I support flexibility to allow seniors to be cared for in their homes,
which is why I am a cosponsor of H.R. 2032, the Medicaid Community Attendant
Services and Supports Act (MiCASSA). This proposal would require state
Medicaid plans to allow those are eligible for nursing home and other
long-term care facilities to choose to receive community attendant services
and supports in lieu of institutional care. It requires that services
be provided in the most integrated setting appropriate to the needs
of the individual. As president, I will continue to promote this policy.
[ Kerry ]
It is essential that we put an end to the institutional bias in Medicaid
and make sure those with disabilities get a wide range of choices. Today,
Medicaid sometimes pays tens of thousands for nursing home care when
the person could live at home with just a home health aide. I will change
the Medicaid law so that states can implement home- and community-based
services without a federal waiver.
[ Kucinich ]
Refer to the above Long-Term Care response (Question 2)
[ Lieberman ]
Refer to the above Long-Term Care response (Question 2)
[ Sharpton ]
Response Pending
4)
In addition, how would your administration support unpaid or family
caregivers who provide the majority of long-term care to older people
and people with disabilities?
[ Bush ]
Response Pending
[ Braun ]
Refer to the above Long-Term Care response (Question 2)
[ Clark ]
Refer to the above Long-Term Care response (Question 2)
[ Dean ]
Refer to the above Long-Term Care response (Question 2)
[ Edwards ]
Refer to the above Long-Term Care response (Question 2)
[ Gephardt ]
First, I would support and encourage current workplace initiatives,
such as flex-time and job sharing, that give family caregivers flexibility
at work so they can fulfill their obligations at home. Similarly, I
also support strict enforcement of the Family and Medical Leave Act
(FMLA), a law I helped pass as House Democratic Leader. Employees should
not have to jeopardize their continued employment because they took
time off to care for their family members' health problems. I would
also support the continuation of current programs, such as the National
Family Caregiver Support Program, that help caregivers gain access to
services, and provide them with information, training, support, and
counseling.
[ Kerry ]
Family caregivers are the backbone of the long-term care system, providing
about 80% of the care for people who need assistance with daily activities,
such as bathing, dressing, preparing meals, and taking medications.
My administration will support these caregivers and make sure they receive
appropriate recognition. I will expand the Family and Medical Leave
Act. And I will provide family caregivers with access to information,
training and counseling services. Caring for a loved one with long term
care needs is some of the most important work- but it is difficult.
We need to provide support to Americans with long term care needs and
their caregivers.
[ Kucinich ]
Refer to the above Long-Term Care response (Question 2)
[ Lieberman ]
Refer to the above Long-Term Care response (Question 2)
[ Sharpton ]
Response Pending
5)
Would your administration support, enhance or replace the current federal/state/local
infrastructure to provide home and community-based services to older
people (i.e. Older Americans Act programs and the aging network, SSBG,
senior transportation programs, elderly housing programs, etc.), and
how would your administration do this?
[ Bush ]
Response Pending
[ Braun ]
My Administration will support existing programs that address the needs
of America's elderly by more fully funding federal programs for the
aged to ensure that states are not faced with unfunded mandates and
budget shortfalls.
[ Clark ]
The federal government should play in important role
in providing financial support for long-term care. We should also promote
initiatives that encourage families to save for their retirement while
they're still young.
[ Dean ]
We also need more reliable and less expensive private, long-term care
polices. Since 2002, federal employees and retirees have had the option
to buy long-term care insurance that provides group discounts and standard
policies meeting federal guidelines. I would extend that option through
a parallel program to all American families. We also need to provide
more information to consumers on nursing home care, and a national registry
of long-term care workers with a history of patient abuse.
As governor, I significantly increased long-term care options for seniors
and people with disabilities while holding down costs and improving
quality. As president, I will continue those efforts to help transform
our long-term care system.
[ Edwards ]
My Living with Dignity Initiative builds on what works in today's system
and replaces what doesn't. In Question 9, I have articulated my plan
for long-term care.
[ Gephardt ]
My administration would support and enhance the current federal, state,
and local infrastructure to provide home and community-based serves
to older people. I would do this by making full funding of these programs
a priority, increasing coordination among states to spread the use of
best practices, and enacting legislation allowing seniors to choose
to be cared for in their homes - ultimately placing seniors in the long-term
care setting that's right for them.
[ Kerry ]
I will support and enhance the current infrastructure for providing
home and community based services. Home- and community-based services
that assist seniors with activities of daily living, such as personal
care, meal preparation, and taking medicine, are currently provided
through a number of federal government programs. The problem is these
programs are fragmented and reach only a portion of the population in
need due to different eligibility requirements, conflicting administrative
requirements, and limited funding. Creating a coherent system of easily
accessible community services is essential to support the goal of independent
living and to providing all seniors with flexibility.
[ Kucinich ]
Refer to the above Long-Term Care response (Question 2)
[ Lieberman ]
My administration would enhance the current infrastructure, specifically
by fully funding
the programs that serve the elderly and by restoring full funding to
the Social Services
Block Grant.
[ Sharpton ]
Response Pending
6)
The federal and state governments, together with individuals and families,
all bear some financial responsibility for long-term care. How should
these responsibilities ideally be distributed? Do you support the federal
government bearing an increased burden? If so, how?
[ Bush ]
Response Pending
[ Braun ]
The federal government has a responsibility to live up to the commitments
it makes to individuals and to states. In order to better serve the
needs of individuals seeking long-term care, the federal government
should more fully fund transitional programs that integrate these individuals
into community settings.
[ Clark ]
Refer to the above responses
[ Dean ]
Refer to the above responses
[ Edwards ]
Today, long-term health care and supports are funded primarily through
Medicaid. However, with baby boomers aging, America must identify new
systems and new funding sources to provide long-term care. My Living
with Dignity Initiative commits $3.5B in increased federal support for
long-term care. Through my support of MiCASSA and as the sponsor of
the Senate companion to HR 3355, The Nursing Home Staffing Act, I've
committed to increase federal support of states to provide long-term
care.
[ Gephardt ]
The financial burden of providing long-term care is often more than
individuals and families can bear. When the financial burden becomes
too much, state and federal governments should provide assistance. I
do support an increased role for the federal government in the provision
of long-term care. The federal government should take a lead role in
ensuring that long-term care is affordable and accessible for all Americans
who need it.
[ Kerry ]
Families, state and local governments all have a role to play in paying
for long term care. The federal government must bear a substantial burden
by providing adequate support to the Medicaid program. The Bush Administration
wants to deliver Medicaid funding in "block-grants" to states,
making it likely the program will be underfunded and cutbacks will be
necessary. I believe we need to put more of the burden for long term
care and Medicaid on the federal government- not less. And I believe
that we need to relieve pressures on state budgets to ensure the sustainability
of the Medicaid program. I have proposed spending $50 billion over the
next two years to help states struggling to bridge deficits, including
$15 billion specifically targeted to help states with health care costs.
[ Kucinich ]
Refer to the above Long-Term Care response (Question 2)
[ Lieberman ]
Please refer to the earlier answer, detailing my plan to make long-term
care more affordable.
[ Sharpton ]
Response Pending
|
