Where Clinton and Trump Stand on Caregiving and Long-Term Care
What the candidates have said, or not said, on these vital topics
(This is the fourth in a series of Next Avenue's Election 2016 blog posts on where presidential candidates Hillary Clinton and Donald Trump stand on key issues of interest to Americans over 50. The first article was about where they stand on Social Security. The second article was about health care and Medicare. The third article explored their views and policies on retirement security.)
Considering that Americans 65 and older are the demographic group most likely to vote, it is astounding how little the major parties’ presidential candidates have talked about two issues that loom so large in older adults’ lives: caregiving and long-term care.
About 34 million Americans provided unpaid care to an adult 50 or older in 2014, according to a 2015 report by the National Alliance for Caregiving and AARP. Half of those so-called “informal” caregivers were caring for a parent or parent-in-law. And the impact of that caregiving on their pocketbooks is profound. About one in five said caregiving created a financial strain on them.
The availability and affordability of long-term care is another growing concern for the aging boomer population. About 8 million people received long-term care services in 2012, according to the Centers for the Disease Control. Those services those provide through home health care, nursing homes, assisted living centers, adult day centers and hospice care. Among people 65 or older, 69 percent will develop disabilities and 35 percent will enter a nursing home at some point, according to a 2007 Urban Institute study.
Hillary Clinton has more detailed plans on these topics, and has spoken more often and more in depth about them, than Donald Trump, who rarely mentioned them until his Sept. 13 announcement of his child care and elder care proposals. Let’s drill down to explore further:
Social Security, Taxes and Caregiving
Clinton: As my colleague Richard Eisenberg wrote in his Next Avenue article about the candidates’ positions on Social Security, Clinton wants to increase Social Security benefits for people who take time off from their paying jobs for family caregiving duties. Currently, leaving the workforce can result in reduced Social Security retirement benefits, since they are based on earnings during your top 35 working years.
Clinton wants to change that. “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 AARP.
Clinton also announced last year that she would invest in the “caring economy,” as reported by the Associated Press. She favors a new tax break for individuals caring for aging parents or grandparents. Under the proposal, a family caregiver would be able to deduct 20 percent of caregiving expenses, up to a total of $6,000. That would result in a total tax savings of up to $1,200. (The proposal would not apply to those taking care of a spouse, however.) “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 AP.
Trump: Next Avenue could find no mentions by Trump of caregiving in general. But he responded to a question about Alzheimer’s at a campaign event by saying the disease is “a total top priority for me… That’s something that we should be working on and we can get an answer.” And his September 13 child care/elder care proposal said (on his website): "The ability to set aside funds for elder care is critically important because taking time off from working to care for elderly family members reduces a woman's financial readiness for retirement, and can increase a woman's risk of living in poverty in old age."
His elder care proposal would allow a deduction of up to $5,000 per year for "elder care costs necessary to keep a family member working outside the home." The costs could include home care or adult day care for elderly dependents when those expenses are needed to keep family members in the workforce.
Trump also proposed letting Americans open Dependent Care Savings Accounts of up to $2,000 a year, so they "can plan for future expenses relating to child and elder care." Annual contributions and earnings on the account wouldn't be taxed. The savings account funds could be used for "adult day care, in-home or long-term care services."
One passage of the 2016 Republican Party platform refers to “homecare:” It says: “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 will implement programs to protect against elder abuse.” As for taxes, the Republican platform says, “We will be mindful of the burdens on families with children and the impact on an aging population. We will seek simplicity and clarity so that every taxpayer can understand how much of their income is consumed by the federal government.”
Respite Care for Caregivers
Clinton: She favors greatly increasing the amount the federal government spends on its Lifespan Respite Care program, which provides money to states to give family caregivers a temporary break. It spent $2 million in 2015, according to CNN. Obama asked for $5 million for 2016, and Clinton proposes increasing funding to $10 million a year.
Trump: We found no evidence of Trump commenting during the campaign on government-subsidized respite care for caregivers. However, he recorded a guest spot for an Alzheimer’s Foundation of America telethon in 2010 urging viewers to contribute to the foundation for its helpline, educational materials, hands-on care programs and “grants to families for respite care.”
Paid Family Leave for Caregivers
Clinton: Under the heading, “Supporting Working Families,” the Democratic Party platform states “...Democrats will make sure that the United States finally enacts national paid family and medical leave by passing a family and medical leave act that would provide all workers at least 12 weeks of paid leave to care for a new child or address a personal or family member’s serious health issue.
“Our work and family policies must also help family caregivers,” the platform continues. “We will 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, and giving workers the opportunity to come together to make their voices heard in support of a stronger system. We will address the conditions that make it hard for workers with unpredictable or inflexible schedules to meet caregiving responsibilities… and support the millions of people paying for, coordinating, or providing care for aging relatives or those with disabilities.”
Trump: Fox Business Network’s Stuart Varney asked the Republican nominee last fall what Trump’s position was on paid family leave (he didn’t specify under what circumstances). Trump’s response: “Well, it’s something that’s 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.”
He has not talked specifically about paid leave for those taking care of older relatives, as far as Next Avenue could find.
Long-Term Care Costs
Other than the comments noted above, both candidates have been virtually silent on how to make the cost of long-term care more affordable for Americans.
Clinton: The Democratic nominee states in a fact sheet: “Hillary Clinton knows that as baby boomers age, more and more families will need to provide care for or will need care from loved ones. In fact, the number of Americans needing long-term care and support is projected to grow from about 12 million today to 27 million by 2050, and nearly 7 in 10 people turning age 65 will need long-term care at some point in life.” That’s why she has proposed the tax break for caregivers and the Social Security adjustment, the fact sheet says. But those would not affect the difficulties many families face in paying for other types of long-term care, such as assisted living centers and nursing homes.
The Democratic platform includes a section titled “Ensuring Long-Term Care, Services, and Supports” that is low on specifics. It reads: “Our country faces a long-term care crisis that prevents too many seniors and people with disabilities from being able to live with dignity at home or in their communities. The vast majority of people who are aging or living with a disability want to do so at home, but face challenges finding and affording the support they need to do so.... 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.”
Trump: He has made no statements that Next Avenue could find regarding long-term care costs.
The Republican platform mentions the issue once, in the context of Medicaid — which pays for nursing home care for people who have exhausted their assets. The platform says: “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,” the platform says. “It is simply too big and too flawed to be administered from Washington.”