Hillary Clinton puts the spotlight on family caregiving

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December 17, 2015

Recently, Democratic presidential frontrunner Hillary Clinton proposed a package of ideas aimed at assisting those who are caring for aging parents or other family members.

Clinton raised the profile of a key issue that is often ignored in policy debates—the challenges of caring for frail parents or younger people with disabilities. The proposals fit with her campaign’s basic message of helping middle-class families. They focus especially on women, who are most likely to be both recipients of care and givers of care (as adult daughters). But her ideas are modest, and research shows they won’t provide the level of help many family caregivers need.

Clinton made four proposals:

A 20 percent tax credit of up to $1,200 to subsidize out-of-pocket costs of family members caring for aging parents. The full credit would help offset the first $6,000 of caregiving costs. However, it would phase out for families with higher incomes and disappear for those making $200,000 or more. The proposal is based on Americans Giving Care to Elders Act, a bill offered in past years by Democratic senators Amy Klobuchar of Minnesota and Barbara Mikulski of Maryland. The tax credit is a back-door way of subsidizing caregiver out-of-pocket costs and yet another example of turning what the evidence says should be direct spending into a more politically palatable tax cut.

A new initiative to improve the lives of direct care workers. Rather than endorsing specific proposals, Clinton urged a “coordinated, government-wide initiative” aimed at improving training, promotions, and better pay for home health aides and other care workers. She also called for better ways to connect trained workers with families who need their assistance. Higher pay for direct care workers is extremely controversial. Worker advocates are pushing for a $15 minimum wage but their effort is opposed by some disability rights groups that fear those higher costs would be offset by cuts in other Medicaid benefits.

Giving credit toward Social Security benefits for people who leave the paid workforce to care for loved ones. Clinton’s proposal is based on the Social Security Caregiver Act, a bill sponsored by Representative Nita Lowey (D-NY). Research shows that giving Social Security credits to workers who stay home to help family members has merit, but Clinton has not said how she’d finance the additional burden on the Social Security system.

Expanding funding for caregiver respite.  Almost a decade ago, Congress passed the Lifespan Respite Care Act. The law was supposed to enhance access to adult day care and other programs aimed at giving caregivers an occasional break. But it was poorly funded over the years and achieved very little. Last year, for instance, its budget was only $2 million. Clinton said she’d ask for $100 million for the initiative over 10 years. The evidence tells us that $10 million annually won’t go far to help more than 44 million family caregivers, but it is a small step towards reducing the caregiver burnout that often leads to the institutionalization of those receiving care.

Far more could be done in this area. A new Urban Institute study by Melissa Favreault and colleagues analyzes several new insurance options that could bring boost the financial resources of the frail elderly.

But the details of Clinton’s modest plan are less important than her overall message: Caregiving is an important issue that needs policy attention. 

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