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elder care
Here's Why Harris and Democrats Are the Best Choice for Seniors
This election will determine whether current and future seniors—and their families—can count on the government to keep the promises of Social Security and Medicare and to improve eldercare.
Nov 03, 2024
For seniors and their families, the choice in this election couldn’t be clearer. Before Donald Trump took office, our organization did not endorse candidates for president of the United States. But Trump was such a four-alarm fire for us and our members (older Americans across the country), that we felt a duty to endorse Joe Biden in 2020, breaking with nearly 40 years of precedent. This cycle, we have endorsed Kamala Harris as the candidate who will genuinely protect seniors’ interests, including the two programs in our organization’s name, Social Security and Medicare. We have also endorsed scores of candidates for House and Senate as “champions” for older Americans.
From a policy standpoint, this is a no-brainer. Kamala Harris, like Joe Biden, has pledged to protect Social Security and Medicare from Republican proposals to cut both programs—by raising the retirement age, means testing, and reducing COLAs. But she also has endorsed the idea that the wealthy should begin contributing their fair share in payroll taxes, which would go a long way toward safeguarding the financial health of both Social Security and Medicare. With additional revenue flowing in—plus billions of dollars in savings on prescription drugs from the Inflation Reduction Act—we could not only strengthen, but expand, seniors’ earned benefits.
In October, the vice president laid out a plan to expand Medicare to cover long-term, in-home care for seniors (and people with disabilities). That is a historic proposal. Under the current system, seniors must impoverish themselves in order to qualify for long-term care under Medicaid—and may well end up in nursing homes. Otherwise, the main alternative is for families to provide home care, often at a high financial and personal cost.
Kamala Harris also wants to expand traditional Medicare to include hearing and vision coverage. We have been fighting for the enhancement of benefits for decades, because seniors’ health and safety depends on proper hearing and vision care. These coverages were part of President Biden’s original Build Back Better plan, a noble effort that can be revived with a new Democratic president and Congress.
On the other hand, it’s almost laughable that anyone would think Donald Trump is the better choice for seniors and their families. Trump is unserious about policy, except insofar as it helps him score political points. He knows that Social Security and Medicare are tremendously popular, so he claims he will protect them, while embracing proposals that could devastate both programs.
Many of Trump’s public statements over the years do not inspire confidence. He once called Social Security a “Ponzi scheme,” comparing America’s most successful social insurance program with a petty criminal enterprise. This year, he said he’d be “open” to cutting “entitlements,” a comment his campaign tried to walk back in the face of understandable backlash.
Each year that Donald Trump was president, he submitted White House budgets that would have cut Social Security and Medicare by billions of dollars. He recklessly suspended the FICA payroll tax during the pandemic and said that he hoped it would be “eliminated” entirely, never mind that this is Social Security’s main funding source. Now, he proposes to repeal taxes on Social Security benefits that were put in place during the 1983 reforms (signed into law by President Reagan) to help fund the program.
The Center for a Responsible Federal Budget, hardly a liberal group, estimates that Trump’s plans would cost Social Security up to $2.75 trillion over ten years—and would accelerate the projected depletion of the program’s trust fund reserves by three years. That’s just six years from now!
In the end, though, this election comes down to values. Kamala Harris and her running mate Tim Walz came from the middle class and understand the struggles of working Americans. Harris was raised by a single mother in a modest Oakland neighborhood and cared for her aging mom when she was dying of cancer. Tim Walz lost his father at age 19, and credits Social Security survivor benefits with keeping his family from falling into poverty. These candidates’ lived experiences inform their policies affecting seniors and families.
The Harris/Walz ticket reflects the preferences of most Americans across when it comes to seniors’ earned benefits. Public opinion surveys consistently show that bipartisan majorities of Americans oppose cuts to Social Security and Medicare, and agree that the wealthy should begin contributing their fair share. On the other side, the now-infamous blueprint for a second Trump term, Project 2025, calls for radical changes to Medicare that would end the program as we know it. Meanwhile, the Heritage Foundation, which authored Project 2025, has advocated raising the Social Security eligibility age and other cuts to the program.
Donald Trump has (unconvincingly) attempted to distance himself from Project 2025, but he is a member of an elite financial class that focuses on lining the pockets of the already wealthy and powerful. It’s no coincidence, perhaps, that the GOP has recruited millionaire candidates for Senate in key battleground states who, unlike their Democratic rivals, do not represent the interests of working people. Many of these candidates have supported raising the retirement age and privatizing Social Security, while championing more tax cuts for the rich. Their hostility to the interests of seniors is apparent. The GOP Senate contender in Wisconsin even suggested that nursing home residents aren’t truly capable of voting.
This election will determine whether current and future seniors—and their families—can count on the government to keep the promises of Social Security and Medicare and to improve eldercare. Growing old in America is increasingly costly. Without these bedrock programs, not only seniors, but their family members in the “sandwich generation” will find it even harder to navigate the cycles of life. In this clarifying light, the choices for President and Congress shouldn’t even be close.Keep ReadingShow Less
Climate Change Is a Current Crisis for Family Caregivers
It is imperative that adaptation strategies and emergency response plans include the unique needs of the elderly.
Dec 09, 2023
In discussions about climate change, we often gravitate towards those affected by devastating wildfires, catastrophic hurricanes, and vanishing coastlines. Rarely do we zoom in on the intimate, day-to-day ways it reshapes the individual lives of everyday people. As a caregiver for my elderly parents, I've experienced firsthand how climate change impacts the aging population, a narrative told less frequently but just as critical in weighing the costs of our inaction on climate.
In the blink of an eye, many of us went from sons and daughters to climate responders for our parents. During Michigan's infamous "Snowmageddon" in 2015, for example, my father, who was relearning to walk after a health scare, constantly fell into steep snow drifts. This meant he had to wear wet pants in the freezing cold and through doctor appointments, risking hypothermia. That same winter, my mom had to mail canned foods to my great aunt, who was trapped in her Grand Rapids home without groceries because relatives and even neighbors could not safely reach her due to the massive amounts of snowfall. These life-threatening situations, no different from what other families experience, were induced by our changing climate.
Living with these challenges means perpetual fear. I'm terrified of my mother slipping on black ice and breaking her hip, of my blind father's inability to detect and avoid ice patches, especially as snow-muffled sounds interfere with outdoor navigation. When a severe ice storm led to a power outage, ensuring my parents' safety in their unheated home was a logistical nightmare, from planning how to navigate slippery sidewalks and driveways in the middle of the night, to undriveable road conditions without traffic lights, to replacing the lost food. The situation was further complicated by the fact that their landline is tied to the internet, hampering their inability to make calls in a power outage. My own cell phone lost service because the cell tower was out.
Creating a rain garden to manage increased rainfall and flooding is a daunting task for someone with a bad back or severe allergies.
But the impacts of climate change extend beyond newly increased winter extremes. For my mother, who relies on walks with friends for mental and physical wellness, unpredictable weather patterns like poor air quality or extreme heat have imprisoned her indoors more frequently. Our lives now revolve around a complex choreography of scheduling doctors' appointments between forecasted weather extremes and finding ways to mitigate newfound environmental hazards.
These climate shifts bring new responsibilities for family caregivers. Each decision, from managing the heightened frequency of snow removal services to ensuring safe, accessible outdoor spaces, is a balancing act between health, safety, and financial constraints. Creating a rain garden to manage increased rainfall and flooding is a daunting task for someone with a bad back or severe allergies.
Climate change has subtly altered our natural environment, bringing unexpected challenges. Overgrown yards in our neighborhood release rampant pollen, aggravating my father's allergies. His thin and tearing sclera makes each sneeze a cause for anxiety. New growths of poison ivy near our porch, previously unheard of, threaten his sensitive skin.
Beyond the immediate environmental hazards, there are indirect, equally unsettling effects. The nutritional value of food is changing, with implications for elderly health. Delivery of essential prescriptions, like those from the VA, gets complicated with intense rainfall, heat, cold, and snow, risking delays or damage.
Often, people ask why family caregivers don't opt for institutional care. The answer is twofold. Culturally, my upbringing emphasizes family-based care. I believe that our elders should be surrounded by love and familiarity, and that caring for them is an honor. This perspective is reinforced by broader arguments for deinstitutionalization, which champions dignity and independence for the elderly and disabled in their communities.
Not that climate challenges are exclusive to home settings. Costly facilities also face power outages, complex evacuation challenges, and disrupted staff and supply chains due to extreme weather. Such instances further unveil broader systemic issues, pointing to the need to better support caregivers in the face of climate change.
As our population ages, our laws and regulations must acknowledge and address the unique hurdles of home-based elder care. We need infrastructure adaptations and proactive policymaking that accommodate a range of familial choices and take into account the changing environmental realities.
Organizations like Area Agencies on Aging and the Veterans Administration already offer comprehensive, hands-on training programs for family caregivers. To help caregivers effectively manage extreme weather risks, their curricula should be updated to provide at least 20 hours of focused instruction on how climate change affects vulnerable populations. Topics covered should include how to create detailed emergency plans and how to proactively prepare for environmental changes.
Beyond practical skills, these programs should also address the socioemotional impacts of climate emergencies on the elderly and disabled. Events like hurricanes, wildfires, heat waves, and drought can heighten feelings of vulnerability and anxiety, adversely affecting mental health. Caregivers, who often bear the brunt of these disruptions, risk burnout without adequate support. Training should therefore include emotional first aid strategies to help them maintain a reassuring presence, discuss fears and concerns, and foster resilience and security.
Last but never least, caregiver self-care is vital. Training needs to cover how to recognize burnout signs, stress management techniques, and the importance of a supportive community. A holistic approach to care safeguards the mental and emotional well-being of both caregiver and care recipient. This stability is crucial for sustainable caregiving in the face of climate change's challenges.
Climate change is not a distant threat for family caregivers; it's a current crisis reshaping the lives of millions. The experiences of caregivers like myself highlight the overlooked nuances in our response to this global challenge. It's imperative that adaptation strategies and emergency response plans include the unique needs of the elderly. Only then can we claim to be truly addressing the breadth and depth of climate change's impact on our society.
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Why We Must Beat Back Private Equity's Deadly Hold on Nursing Homes
The shoddy managing of elder care facilities controlled by Wall Street investors led to 20,000 early deaths over 12 years.
Apr 19, 2023
Unbeknownst to most people with loved ones in nursing homes, it's often nearly impossible to determine if the facility you've entrusted your family member to is owned by a private equity firm–an ownership structure that has been shown to result in worse health outcomes for patients, at greater cost. Within the past two decades, the once-obscure private equity industry has ballooned in size from $1 trillion in 2008 to nearly $4.5 trillion in 2021. Millions of people in the United States have been directly impacted by an industry that was once known mostly to finance insiders like institutional investors and financial journalists.
In February, the Center for Medicare and Medicaid Services (CMS) issued an important rule requiring the disclosure of beneficial ownership of nursing homes that would bring greater transparency to this complex ownership model. This step is critical to preventing further harm by private equity firms and is part of a broader effort to reign in the abuses of the private equity industry in key sectors of our economy.
Whether private equity drove the retail company where you worked into bankruptcy or bought the house you rent, private equity's rapacious business practices are hitting close to home for more people than ever. Whatever industry it enters, a private equity firm's risky business practices often burdens businesses with excessive debt, forces the sale of assets for short-term gain, squeezes workers, and compromises services at the expense of most stakeholders to drive profits to private equity executives.
Evidence of the dangerous role of private equity's takeover of nursing homes has emerged over the last decade, but due in part to the COVID-19 pandemic, its ownership in the industry has faced new scrutiny in the last three years.
The healthcare sector has not been spared from private equity's expansion and extraction. A growing body of evidence shows that the private equity industry is incompatible with providing people with stable, quality, affordable healthcare. In ownership of hospitals, private equity firms have bought and shuttered urban, suburban, and rural facilities, leaving healthcare deserts in those communities. Private equity firms created a business model of surprise medical bills that intentionally billed services out of insurance networks, leaving patients with huge out-of-pocket expenses through no fault of their own. During the COVID-19 pandemic, private equity-owned physician staffing agencies fired physicians in already understaffed emergency rooms who spoke out against the lack of personal protective equipment like masks, and other practices endangering patient safety.
The private equity industry's track record in other areas of the care economy are equally appalling. Stories of the results of private equity ownership in companies caring for vulnerable populations are downright grisly, including deadly neglect and abuse of residential centers for the severely disabled, denying care to medicare and medicaid patients with life-threatening eating disorders, and delaying access to wheelchair repair to bill for more profitable equipment replacement. Another recent study raises alarm over private equity's expansion into hospital at home programs without sufficient guardrails to protect acutely ill patients at home.
Evidence of the dangerous role of private equity's takeover of nursing homes has emerged over the last decade, but due in part to the COVID-19 pandemic, its ownership in the industry has faced new scrutiny in the last three years. At the onset of the crisis, infections and deaths among nursing home workers and residents was an early crisis point before the development of vaccines. As thousands of people died in nursing homes, advocates and policymakers looked for patterns in ownership and management practices of facilities that might shed light on life-saving interventions. Private equity's common business practice of hiding behind layers of ownership and avoiding disclosures became a matter of life and death in the COVID-19 context. Americans for Financial Reform published a study in 2020 uncovering evidence that the nursing home chains in the state of New Jersey that were owned or backed by private equity firms had "higher resident infection and death rates and a larger share of Coronavirus cases and deaths compared to their share of residents relative to for-profit, non-profit, and public facilities."
In 2021, academics at the Becker Institute for Economics at the University of Chicago examined the outcomes of private equity-owned nursing homes over a 12-year period. Their conclusions were unflinching: "Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying over 20,000 lives lost due to PE ownership over our twelve-year sample period."
Policymakers must take action to protect patients and their families from private equity greed. President Biden highlighted the need for action in the 2022 State of the Union Address, calling out private equity's role in driving down quality of care while raising prices. The Administration has cited ownership transparency as a critical step to address private equity's now well-documented abuses in healthcare and to implement further safeguards like staff-to-patient ratios. Transparency in the healthcare sector is also the subject of a recent report highlighting opacity in ownership in end of life care, home health, and reproductive health services, among others.
Given the widespread and deadly role private equity firms are playing throughout the healthcare sector, federal protections like CMS's proposed rule, which requires detailed ownership of nursing homes to be made public, are urgently needed–and we can't let them be weakened by industry pressure. You can add your voice by joining AFR's organizational sign-on comment or our individual sign-on. CMS has signaled intentions to issue further safeguards on nurse-to-patient ratios in nursing homes this year. We have to beat back private equity's predatory hold on healthcare companies. We also need fundamental reform with the passage of the Stop Wall Street Looting Act. But the momentum for change starts now, with this measure to protect some of the most vulnerable, our loved ones in nursing homes.
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