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Jon Dauphiné currently works for AARP in its elections and voter education department. Prior to joining AARP, Jon was the executive director of the Long Term Care Campaign, a coalition of 150 aging, disability, labor and consumer groups dedicated to ensuring that all Americans have access to affordable, high-quality long term care. Jon directed the Campaign's grassroots organizing activities, media outreach, policy development and other functions. Before he joined the Campaign, Jon worked on health issues and grassroots campaigns in the public affairs arena and as an attorney at a major DC firm. Jon is a graduate of Harvard Law School and Vassar College.
FCA: What do you see as the emerging long-term care issues across the national and state elections?
Jon Dauphiné: In this cycle I think we're really looking at how we're going to help families address long-term care issues. We haven't got to the point yet where we're talking about a national comprehensive strategy for long-term care; we're looking at more piecemeal approaches. For example, the Democrats have proposed a $3,000 tax credit for those who care for relatives or perhaps friends with disabilities at home and the Republicans have also proposed various tax incentives for long-term insurance and things of that nature. So I think we're looking at the margins of the problem now in terms of addressing it. I think, again, there's sort of a focus now on providing some help to caregivers and also looking at ways to help people prepare themselves for the eventuality they may need long-term care. Unfortunately, I don't think this does nearly enough to address those who need long-term care services right now. That's what's going on on the national front.
At the state level we're seeing a variety of issues. One of these is the implementation of Olmstead, which was a Supreme Court decision that really ratified the notion that the ADA requires that states move away from institutionalizing folks who need long-term care services and move more toward a home- and community-based service paradigm. Different states are trying to address this decision and come up with plans. Many long-term care activists are really hoping to push the implementation of those plans and to have input into those plans. At the state level, we're also seeing issues around quality in nursing homes -- do for-profit homes provide as good care as nonprofit homes? Staffing has become a really big issue in some states and also at the federal level. We're looking at staffing of nursing home facilities in particular: Is staffing adequate? What ratios should there be? Can we implement rules or regulations or laws that address the staffing deficits - both in institutional settings and community settings (like assisted living and home care)? It has been a real problem with the good economy to get and keep qualified staff and so there are many issues associated with that as well. Finally, we're looking at long-term care insurance. For example, providing incentives for people to buy these insurance products. There are arguments about whether relying a lot on that as an answer to this problem is wise, frankly. But that is certainly an issue that legislators are looking at and that some are talking about in their elections.
Have there been any debates about whether or not across the board within the Medicaid system that families should be paid to provide the care for somebody in the home, given the labor shortages that you alluded to earlier?
Well you know I think that's a really good idea - something I think the Long-Term Care Campaign has been supportive of in the past, but it is a hotly-debated issue. Opponents of paying family members to provide care suggest that it leaves open a lot of opportunities for fraud and abuse. Also, some would say that it leads to financial drain because they're going to pay families for services they would otherwise provide. But I think your point is excellently taken. The fact is that we are finding a real shortage of workers here and typically the most responsive person to provide care is going to be a family member or loved one. But it is not being debated much in state-level elections that I'm aware of. [Editor's note: Some states, such as California, allow family members to be paid for providing care services.]
How are these proposals playing out during the campaign?
I think there has been some media awareness of long-term care. It's growing year by year. When the Long-Term Care Campaign did events in this past year we found there was a lot of media attention and it was really quite easy to raise the interest of the media and voters. I think the one thing we need to do is make the leap from looking at long-term care as just a family issue -- some might even say a family burden because it can be very draining emotionally and financially - and view it more as a policy problem (as a sort of systematic healthcare problem). Voters need to feel empowered so they know that it's not 'just about my family' - that this is a problem that a lot of American families are struggling with. We need to really press the candidates to address it and address it in a comprehensive way. Again, moving it away from just helping the caregiver - not that that's not extremely important -- but also going a little bit beyond that and looking at ways to give more than a tax credit, but to really help people in a more substantive way.
In terms of what's going on politically on Capitol Hill right now, you're seeing the Republicans looking at ways to ease a different tax burden such as the estate tax and you're seeing the Democrats turn around and say one of the priorities should be looking at a long-term care tax credit. So, we are seeing a debate in terms of what our priorities should be when we are tweaking the tax code.
What is AARP doing to track the issues of concern to older adults and in particular long-term care, during this election season?
AARP conducts membership polls; speak-outs where we get our members together and ask them to talk about their families, their priorities and their political ideas; and focus groups. We employ a variety of techniques to generate member input. We also track all the letters, phone calls, e-mails and other communications from our members and keep a close watch on what people are talking about and problems identified. We've recently moved to a 50-state structure so AARP will have offices in every state to ensure that we are close to the membership base. I have worked extensively with our members and there's a huge concern about long-term care which is only going to snowball as the baby boom generation gets older.
How would an individual voter find out about the positions of candidates?
It is so important to pick our candidates based on where they stand on the issues. The AARP/VOTE department's mission is to educate folks on the substantive ideas and plans of the candidates. In this election, we have been hearing a lot of good talk from both parties about prescription drugs, social security, and long-term care, but not as much as we'd like. Our website at www.aarp.org has nonpartisan voter guides for the presidential elections and for many congressional races. We ask the major candidates to submit answers to questions on our issue areas, including long-term care. They have a word limit and we do not edit them. So, people can log on to our website, click on voter guides and they can go right to their candidates and see what they are saying they intend to do about long-term care. Also, check the candidates' own websites. If candidates feel strongly about long-term care, they'll have a section on their website about that. Visit a candidate's website and e-mail a question about their stand on long-term care or go to a candidate forum and ask the hard questions. AARP is holding forums across the country but there should be many other opportunities to ask the candidates - just check your newspaper or call their campaign offices.
How important is it to have caregivers and others concerned with long-term care have their voices heard by their candidates now?
It is so important. I really can't emphasize that enough. One of the things the Long-Term Care Campaign encouraged in Iowa - a state that is very important because of the early caucuses - is for voters to contact the candidates' campaigns in the state, tell them what their family is dealing with, and ask what would your candidate do to help? It's really important because it shows a groundswell of concern and support for addressing this issue. It's not a guarantee that it's going to become one of the hot issues, because I think in a lot of ways the main issues have already been defined by the candidates for this election. But talking about long-term care raises the issue in our electoral landscape and pushes it into a national dialogue. We have to keep asking our candidates, keep pushing the issue. And if it doesn't happen in this election cycle, it's going to happen in the next one or the next one. We have to keep the pressure on, so it's very important that families contact their candidates about this.
I think we really need to push on the two fronts - we need to push on quality and we need to push on access and affordability. Pretty much everything else is linked to those two issues - and again, I think that it's absolutely key that regular families keep the pressure on, because that's what will ultimately lead to success.
Copyright © 2001, Family Caregiver Alliance. All rights reserved.
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