I. Supporting Seniors With Long-term Care Needs, and The Invisible Army of Caregivers that Support them:

· Enacting a new $3000 Caregiving Tax Credit to provide financial relief to millions of seniors, people with disabilities and their families. Hillary will also invest more than $300 million per year to support unpaid family caregivers .

· Giving more seniors the ability to access long-term care services where and when they need them, including in their homes.

· Doubling the elderly standard deduction to provide additional financial relief for 11 million elderly tax filers. II. Helping the Elderly Prepare for Long-term Care Needs by Making Long-Term Care Insurance More Secure and Affordable:

· Requiring tough new consumer protections for long-term care insurance, including ending discrimination against veterans and helping states create consumer advocates for long-term care insurance .

· Offering consumers the same secure long-term care insurance options that members of Congress enjoy.

· Providing a new Long-Term Care Insurance Tax Credit to make secure, high-quality insurance plans affordable.

III. Protecting our Seniors By Improving the Quality of Our Nursing Homes:

· Tripling federal support for nursing home ombudsmen programs to protect consumers of long-term care.

· Directing the Department of Justice and the Federal Trade Commission to assist state consumer advocates and prosecutors to tackle persistent abuses and new challenges in the long-term care industry.

· Reversing the inexcusable policy of the Centers for Medicare and Medicaid Services (CMS) of withholding information on poor-performing nursing homes and giving seniors full access to usable data on nursing homes , including data on nursing home ownership structures.

· Strengthening our nursing and direct care workforce with a national system of background checks for long-term care workers and $125 million investment in Workforce Improvement Programs . I. Supporting Seniors With Long-term Care Needs, and The Invisible Army of Caregivers that Support them:

· Enacting a new $3000 Care giving Tax Credit : Ninety percent of all long-term care received is informal, primarily provided by spouses and adult children. Overall, as many as 52 million Americans are informal, un-paid caregivers. Many are in the so-called sandwich generation, playing dual care giving roles as “working parents” and “working children” for their own parents as well. According to a new study by the National Association of Care giving, the average out-of-pocket costs for long-term care giving, usually by a spouse or a child, is $5,531 – more than double previous estimates . That is more than 10 percent of a typical caregiver’s salary and more than what most Americans spend in a year on their own health care and entertainment combined. Many caregivers meet this financial burden by dipping into their retirement savings or forgoing their own personal health care.

To ease this financial burden, Hillary is proposing a new $3000 Care giving Tax Credit. This new partially refundable tax credit will be available to any person with substantial long-term care needs or to their caregivers (the credit would be phased out for couples earning more than $150,000). The credit will not require a complex accounting of out-of-pocket costs, but instead would be available directly to any individuals with substantial long-term care needs or their caregivers. The credit will offer generous assistance to more than 3 million seniors and their families, and also to more than a million families with children and young adults with long-term care needs.

In addition, Hillary will invest more than $300 million per year in stepped-up state support for unpaid family caregivers . Providing temporary relief for these caregivers helps keep families together and healthy while also saving money that would otherwise be spent on institutionalized long-term care services. As President, Hillary will ensure that caregivers have support by fully funding the Lifespan Respite Caregiver Act at about $60 million per year ($300 million over 5 years), and doubling funding for the National Family Caregiver Support Program to $250 million per year.

· Allowing more seniors to access long-term care services where and when they need it, including in their homes: Our current long-term care system is biased towards institutional care, even though many seniors would prefer the opportunity to remain independent and stay in their own homes and communities for as long as they are able. To address this problem, Hillary will:

o Expand ability of states to provide Medicaid home and community-based care for seniors and individuals with disabilities by creating parity with the eligibility levels for nursing home care. Under current law states may only cover individuals in home and community-based settings up to 150% of the poverty level, but may cover individuals in nursing homes up to 300% of the federal Supplemental Security Income threshold.

o Provide incentives to states to expand the availability of home and community-based services. Because of a proposal that Hillary got signed into law, states have the option of providing home and community-based care through their Medicaid programs without seeking special permission from the federal government. However, they have been reluctant to do so because of cost. Hillary will provide an increased federal match for state investments in home and community-based services.

o Provide grants to states to strengthen efforts to streamline and coordinate long-term care services. Building on pioneering state models, Hillary would provide grants to state Aging and Disability Resource Centers to strengthen their efforts to coordinate and ensure quality long-term care for those who need it.

· Doubling the elderly standard deduction to provide additional financial relief for 11 million elderly taxpayers: To help offset the growing financial burden of long-term care—as well as prescription drugs and other health needs—Hillary will provide additional tax benefits to the elderly. She will double the additional standard deduction available to elderly taxpayers, which would provide tax benefits to at least 11 million seniors.

II. Supporting the Elderly Prepare for Long-term Care Needs by Making Long-Term Care Insurance More Secure and Affordable:

Our long-term care infrastructure affects not only those with long-term care needs, but all Americans who wish to plan ahead for such an eventuality. For some, long-term care insurance can play an important role in safeguarding their future health, well-being, and financial security. But Hillary believes we need to do more to ensure that long-term care insurance provides real security and support, not false hope that falls short when seniors need it most. This issue is particularly important in Iowa, which has the 4th largest market penetration in long-term care insurance, with as many as 124,000 Iowans holding current policies. Therefore, as President, Hillary will take aggressive steps to increase consumer protections for long-term care insurance policies, alongside efforts to increase the affordability and access to high-quality long-term care insurance, by:

· Requiring strong new consumer protections for long-term care insurance: When long-term care insurance is revealed as a false promise, it hits seniors at their most vulnerable moments, threatening health crises and financial devastation for entire families. It also increases costs for taxpayers, as the burden is shifted onto Medicaid, which already devotes 40 percent of its spending to long-term care. And it threatens to destabilize nursing homes and hospitals that rely on the stability of revenue from their patients to engage in long-term planning. As President, Hillary will require that all long-term care insurance companies that receive federal tax preferences abide by the National Association of Insurance Commissioners (NAIC) 2006 Model Regulations, including a requirement that insurers offer nonforfeiture benefits and inflation protection. She will also outlaw discrimination based on pre-existing conditions in long-term care insurance policies. Hillary will also:

o Put veterans on an equal footing in the long-term care insurance market by ending the discriminatory military-service exception: Many current long-term care insurance policies discriminate against veterans by including an “armed services exclusion” which allows benefits to be denied for long-term care needs that are due to service in the armed forces. Hillary will end this discriminatory practice, and update our law so that that tax benefits will only be extended to long-term insurance carriers that eliminate this discriminatory exception.

o Provide Grants to Help States Create Consumer Advocates for Long-Term Care Insurance: Hillary will provide grants to help states develop independent Consumer Advocates for long-term care insurance. These advocates will give a voice to consumers facing insurance abuses, who are too often ignored or lost in the system. These new advocates would: 1) investigate complaints of illegitimate benefits denials, rate hikes and other abuses, 2) provide assistance to state prosecutors such as the Attorney General to prosecute abuses, 3) collect data on such abuses to assist regulators and legislators, and 4) advocate on behalf of insurance holders with state regulators and legislators for additional protections where needed.

· Allowing consumers to purchase the same secure long-term care insurance policies that members of Congress have access to: Hillary will give all American access to same type of long-term care insurance options that federal employees currently have. This approach will increase choice and offer more secure and affordable options for those who are interested in purchasing long-term care insurance. Plans offered through this option would include a robust set of consumer protections similar to those offered through the existing federal plan. They would also be affordable. The Government Accountability Office recently found that the federal program offered annual premiums that were 46 percent lower for single people and 19 percent lower for married couples than five major private insurance suppliers.

· Providing a new Long-Term Care Insurance Tax Credit to make secure insurance plans affordable: Once she has secured strong new consumer protections in the long-term care insurance market, Hillary will offer a new tax credit to help those planning for retirement be able to afford high-quality insurance policies that are right for them. This new tax credit will cover 75 percent of long-term care insurance premiums up to $1500 per year for qualified long-term care insurance policies that would meet the new consumer protection requirements (the credit would be phased out for couples earning more than $150,000). The credit will reward middle-class families who take steps to prepare for their long-term care needs, and put qualified insurance in reach for many middle-class families.

III. Protecting our Seniors By Improving the Quality of Our Nursing Homes

While the majority of the nation’s nursing homes provide quality care to their residents, when persistent quality violations go unaddressed and when our seniors are subjected to unconscionable neglect, it erodes confidence in the system and makes it more difficult for all operators to function effectively. And sadly, the problem of poor nursing home quality extends far beyond the list of 54 under-performing nursing homes that the Centers for Medicare and Medicaid Services has recently released. In 2006, nearly one in every five nursing homes that received federal funds was cited for serious deficiencies in care. And from 2000-2005, nearly half of the 63 nursing homes that regulators had identified as having an established history of serious medical deficiencies continued to repeatedly fail federal requirements and still receive federal funds.

These severe, and often long-standing, quality violations are more than a regulatory problem. They offend our solemn commitment to ensure that seniors live in dignity and security. Our seniors deserve better. That is why Hillary will take aggressive steps to improve quality in our nation’s long-term care facilities by:

· Tripling Federal Support for Nursing Home Ombudsmen Programs to Protect Consumers of Long-Term Care: Effective ombudsmen programs are crucial to combating fraud and abuse in the long-term care industry. Ombudsmen are on-the-ground and act solely on behalf of nursing home residents to monitor quality: identifying and investigating complaints, providing information, monitoring regulations and participating in resident advocacy organizations. However, ombudsmen programs such as Iowa’s are struggling to meet the many new challenges that nursing home residents face. Currently, the Iowa program ranks last among the 50 states in the number of ombudsmen per nursing home facility beds. Yet while Iowa has been making progress in strengthening its ombudsman program, the office still faces many new challenges. As President, Hillary would triple federal support for state ombudsman programs to $50 million per year. The increased resources will strengthen the capacity of ombudsmen to vigorously investigate complaints and offer new training programs on emerging issues like complex insurance fraud and the purchase of nursing homes by private equity firms.

· Directing the Department of Justice and the Federal Trade Commission to Assist State Consumer Advocates and Prosecutors to Tackle New Challenges to Long-term Care: For the past year, Hillary has been raising concerns about the new regulatory challenges that we face in long-term care. Earlier this year, Hillary called for the Government Accountability Office to investigate the unconscionable mistreatment of seniors who have purchased long-term care insurance by their insurance providers—many of whom were systematically denying benefits while forcing steep premium increases. And in October, Hillary called for an investigation into whether nursing homes with new hybrid ownership structures—created in many instances by private investment groups—were evading regulators for quality violations and sub-par standards. As President, Hillary will direct the Department of Justice and the Federal Trade Commission to lend their consumer protection prosecution expertise to state regulators who are struggling to tackle these new and complex challenges. State regulators need sufficient information and sophisticated tools to effectively police nursing homes and insurance carriers, and as President, Hillary will ensure they have the support they need.

· Reversing CMS’ Inexcusable Policy and Giving Seniors Full Access to Usable Data on Nursing Homes, including Data on Nursing Home Ownership Structures: Choosing a nursing home is one of the most important life decisions a senior and their family makes. When seniors and their families are empowered with information, they become not only effective consumers but effective regulators in the nursing home marketplace. But the federal government needs to do far more to ensure that seniors and their families have the information they need to make informed choices. As President, Hillary will direct CMS to release all information on the designations it makes about the quality of nursing home facilities. CMS’s unwillingness to freely and openly share its full list of 128 underperforming nursing homes is inexcusable, and must be reversed. Hillary will direct CMS to provide on the Nursing Home Compare website accurate, up-to-date data on nursing home staffing levels; the full—not just abridged—reports from inspections and complaint investigations; and any and all information about repeat offenses that CMS compiles. Finally, CMS should compile and post clear information about the ownership structures of long-term care facilities--so seniors can know who is in charge of the facilities they live in.

·Strengthening our nursing and direct care workforce with a national system of background checks for long-term care workers and a $125 million in Workforce Improvement Grants : While thousands of long-term care professionals provide admirable care to our elderly every day, abuse and neglect of our seniors in long-term care is on the rise. As President, Hillary will combat this abuse with a nationwide system of state criminal background checks for long-term care workers. I n addition to ensuring our long-term care workers are qualified, Hillary will also ensure that we have a strong well-trained long-term care workforce. She will invest an additional $125 million per year to improve recruitment and retention of health and direct-service professionals and provide greater consumer choice . The new investment will: 1) provide grants to states to adopt and expand successful organizational models for workforce tracking and coordination, including the development of worker registries through a new directed spending program; 2) make federal funding available to states, in partnership with local organizations, to develop a credentialing programs for direct support professionals (where as a condition of receipt of grants, states must collaborate with state universities and community colleges to allow credentialing program to count as college credit); 3) provide grants to states to encourage the expansion of successful agency models of care that give seniors and individuals more direct control over the services they receive and the people that provide them.

A COMMTIMENT TO FISCAL RESPONSIBILITY: The total cost of Hillary Clinton’s long-term care agenda is approximately $5 billion per year. Hillary will finance this cost without increasing the deficit by dedicating the revenue from closing two ineffective provisions in our tax code. First, Hillary will close the loophole that allows hedge fund managers to use offshore tax havens to defer paying taxes on their compensation. Second, Hillary will repeal the provision in the 2004 JOBS Act which allows U.S. Corporations to gain tax benefits from their foreign assets by allocating interest on a worldwide basis. (Enacted in 2004, this provision has yet to take effect.)