Presidential hopeful Pete Buttigieg’s plan for long-term care, released last week, would establish federal standards for assisted living communities, including staffing ratios, required access to mental health clinicians and annual inspections.
“Over the last several decades, residential care communities evolved from being a community-based, more humane alternative to nursing homes, to a multibillion dollar industry that houses over 800,000 people. Yet there are no federal quality standards in place, and state-level standards vary considerably,” according to the 19-page “Dignity and Security in Retirement” plan put forth by Buttigieg, a candidate for the Democratic nomination in the 2020 election. “In some states, residential care communities are given weeks to report resident abuse or deaths. Others allow people without appropriate training to be caregivers, or don’t require clinicians to be on staff,” the document adds.
Buttigieg is the current mayor of South Bend, IN.
Other aspects of his plan are likely to elicit cheers or groans from senior living providers:
- Provide eligible adults aged 65 or more years who need assistance with two or more activities of daily living a benefit of $90 per day for long-term services and supports, including offsetting the cost of assisted living, through a program called Long-Term Care America.
- Cover most catastrophic long-term care costs through Long-Term Care America, “to help make it viable for insurers to offer long-term care coverage to people who need lower levels of care.”
- Set a $15-per-hour minimum wage for everyone, including direct care workers, and index it to inflation.
- Expand opportunities and training for people to become direct care workers, and create a local “Community Renewal visa” to allow communities to invite immigrant caregivers to live and work where they are deemed to be needed the most.
- Create a National Direct Care Workforce Standards Board to work with the Labor and Health and Human Services departments on direct care workforce issues, including rate-setting recommendations, compensation and benefits, training and credentialing, recruitment and turnover, and also work with states on these issues.
- Raise the maximum asset limit for eligibility for Medicaid LTSS from $2,000 to $10,000 (based on 2019 figures) and the monthly income limit from $771 to $2,313.
- Permanently extend spousal impoverishment protections to prevent spouses from losing their homes or incomes when their partners need Medicaid LTSS.
- Make permanent the coverage of home- and community-based services through Medicaid.
- Increase funding for Adult Protective Services and the Long-Term Care Ombudsman programs so they can investigate claims of abuse, neglect and exploitation in assisted living communities, nursing homes and other settings.
Democratic presidential nomination contenders Joe Biden of Delaware, former vice president; and Amy Klobuchar and Cory Booker, U.S. senators from Minnesota and New Jersey, respectively; also have introduced plans for long-term care. Potential candidates Sen. Elizabeth Warren of Massachusetts and Sen. Bernie Sanders of Vermont included long-term care in their Medicare-for-All proposals. Democratic nomination contender Michael Bennett says his healthcare plan will “support seniors and caregivers.”