Legislating Compassion: Dems, Ernst, and the AARP-sponsored Credit for Caring Act Panel July 13

A friend asked me to listen to the AARP-sponsored panel yesterday featuring Sen. Ernst (R-IA, my senator), Sen. Baldwin (D-WI), Rep. Donovan (R-NY), and Rep. Grisham (D-NM). Certainly, Ernst will be using this to promote her bipartisan cred and to mollify Iowans who overwhelmingly disfavor the ACA repeal. So what’s right and what’s wrong with a tax credit for families providing at-home care to their elderly, ill, or disabled family members? Here are my observations (augmented by comments from a friend who has spent most of her life caring for aging/declining parents).

Republicans promote home care as the best care

Obviously, many people want to stay at home for as long as possible in their declining years. I completely believe and understand that, and of course I think this credit helps them because, ya know, it gives them money. As Sen. Baldwin says, it’s a “modest first step” but steps are good. All of the Congresspersons shared personal stories from their lives and constituents’ lives, emphasizing their shared passion for this issue and desire to work together to help people. So that’s great, well-done Ernst for doing the job you were hired to do. And well-done Dems for working hard to do anything possible to mitigate the damage that BRCA will do to vulnerable populations and their families.

That said, both Republicans focused exclusively on home care as the best option, and the bill benefits only people who are working as well as providing (or hiring providers for) care. The tax credit is $3000, more than zero (yay), but a small amount. I don’t have experience with the complexities and expenses of elder/disabled care, but I do have experience with childcare, which is straightforward full-time caring and feeding of kids. $3000 would cover 2 months of childcare for me, and that’s in a center [this study just showed up in my inbox. It’s a survey conducted by a company, but it highlights the price of FT childcare]. A private care provider would be far more, and I can only imagine that specialized care for the elderly, ill, or disabled would reach beyond that.

This is a driving reason that people leave work to become FT caregivers. So, how we aid those who are in the most disadvantaged financial situation when they have to be working to earn the tax credit goes unaddressed in this bill. The Democrats were clear on this: it’s a first step, it’s a good step, but it doesn’t address the far-ranging and broad issues that care providers face, and the broad impacts of care-giving on the economy and on health care. Sen. Baldwin and Rep. Grisham both used this panel as an opportunity to highlight how far-reaching this issue is and how complex:

  • Baldwin emphasized that this act could benefit care providers as well as families by raising their wages to something livable. Just like our daycare teachers, care providers are often overworked and undercompensated. Considering the reality that our population will be super old in the next decade and a half, we need to encourage more people to join this industry and that means making the industry fair, competitive, and valued. This also enhances the quality of care available to people in care.
  • Grisham further emphasized that the growing aging population puts increasing pressure on state budgets. She asserted that we need to start a “serious conversation of Long Term Care” as a priority because the cost of caring for an aging population outstrips our economy. Pause to let that sink in. We’re facing a possible financial crisis because our economy — our budgets — do not have room for the emergence of this complex reality as part of everyone’s lives.
  • Grisham emphasized the health impacts of providing in-home care to the infirm — the fact that people may be making a choice between their own care and that of an aging parent, may not be able to afford or make time for their own care. The Family Caregiving Alliance remarks
More than a third of caregivers continue to provide intense care to others while suffering from poor health themselves… Emotional, mental, and physical health problems arise from complex caregiving situations.”

Reminder that most of these caregivers are women. My friend remarks, “This would assume that there is someone who has a home that is handicap accessible, and someone with the knowledge and physical abilities to DO caregiving. Is the average 70 yr old able to care in-home for their 95 yr old mother?” How will we ensure that the care provided is adequate and that abuses aren’t occurring in-home? Who takes care of that? Ohhhhh social workers do. Well, Iowa is out of them, so…

My thought during the panel was “what is this compensating for in the repeal/replace health care act?” Clearly this is a bit of a crumb-toss to make up for defunding the aspects of medicaid that pay for nursing homes, which will displace the elderly and infirm.

Ernst chimed in remarking that Iowa’s population — which is already old — will likely rise to 21% of the population in the next 10 years. That’s nearly a quarter of our population. She says that Iowa doesn’t have the nursing home capacity to support these people. She omits the way that continuously defunding Medicare/Medicaid, declining wages/low minimum wage/removal of worker rights and benefits, etc, directly contribute to that situation, and that these policies will dramatically disproportionately effect rural communities where resources (including jobs) are already scarce.

Ernst says that for these reasons, she has worked to protect pre-existing conditions and Medicaid funding for states in the repeal/replace healthcare act, which she refuses to comment on in town halls in her actual state or repudiate Cruz’s hideous amendment. She credits the advocacy of Iowans for making it clear that this is needed, SO KEEP CALLING, IOWA!! Clearly the pressure on her is pushing her towards more compassionate bills and bipartisanship. She has to keep going. Keep that pressure steady.

Ernst remarked that “We should follow those shared passions… we should put our heart and soul into these efforts.” Hey, Joni, I completely agree. I’d ask you to keep those values of compassion and support in mind when you look at policies effecting women and children, and people of color. Or the less obviously heart-tugging populations like addicts, those living with HIV/AIDS, the derelict, the homeless, or the mentally ill. She discusses the way that “we” must protect our most vulnerable citizens without defining what “vulnerability” is. AJMC defines the following categories of vulnerable populations:

the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness.

Considering the profound damage done to these populations by state-level and federal policy that Ernst supports, it’s clear that this credit is a bandage on an chest wound. We’ll take it because the Republicans give us no choice but to accept any crumb that might benefit our people, but she must be held accountable for the greater damage she is doing and will do on her current track of representation. At this point, her stated values are inconsistent with her voting. Her willingness to do what seems to be a bare minimum act of compassion is a good thing but it’s also a bare minimum of what she ought to be doing as a serious lawmaker. So I’ll give her a point for not sucking, and a point for giving a small shit about this issue. But I expect more. Not good enough, JE! But Dems, given your absolutely dire straits, thanks for working to accomplish anything good. Anything that remotely touches what we believe government can and should do for our people. ACES TO YOU!

I’d also ask how a person who describes her concern for care-givers as a “passion” can look at other issues facing other vulnerable populations with so little regard, or ignore the broader social circumstances that drive vulnerability, such as racism and sexism — the hallmarks of Republican ideology in the Trump era.

Final note: please don’t crap all over nursing homes

God, you’d think that we were imprisoning our elderly and infirm in the same kind of nightmare institutions featured in Nelly Bly’s journalism or American Horror Story Season 2. Let’s get this clear:

  • Nursing homes rely on health insurance for funding. No insurance, no funding.
  • Providing the kinds of programs, support, and quality of accommodation requires funding, see above. It is also impacted heavily by government regulations and licensure, which can enable or inhibit quality of care. (Want to read the same 20 page report I did? Probably not.)
  • Like schools, nursing homes can be institutions that desperately want to do better but don’t have the resources to do so.
  • Like schools, nursing homes can be institutions where power is abused and people are dehumanized. This is not limited to the institutional context: homes are places were abuse can and does occur. Displacing people from institutions isn’t an instant fix for elder abuse.
  • Like childcare, the quality of nursing home you can access is dependent on income, full stop.
  • Nursing homes can and should be places where people can age with full dignity in a caring community that preserves an holistic quality of life. That’s a tall demand. If we want quality care, we need to invest in it.

The implication, whether intended or not, is that all people want to provide at-home care but can’t afford to. The implication is that a truly caring family will take care of their aging parent at home. The implication is that an institution is always a less ideal choice. This is a dramatic oversimplification and only increases the stress and guilt of family members making decisions about care (note: I attended a forum for the Johnson County Elderly Consortium on just this topic).

Takeaway

  • Democrats are thinking big about this issue and recognizing its complexity in a comprehensive and coherent way. This is one tiny achievement that could have been so much more. So much more.
  • Democrats are thinking realistically and comprehensively about the economic and social impacts of long term care issues.
  • Democrats and Republicans share a passion and personal commitment to this.
  • Ernst wants to be seen as caring and non-obstructionist. Her actions are generally inconsistent with this. Use this pressure point.
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