How Amy Klobuchar's health plan could help family caregivers

Sen. Amy Klobuchar, one of more than a dozen Democratic candidates for president in 2020, has not become a breakout star. But the Minnesota senator is one of the few hopefuls who released a plan addressing concerns of older adults and family caregivers, as well as providing broader health coverage for all Americans.

Her proposal homes in on Alzheimer's disease and would lower the cost of prescription drugs, according to the campaign. That would be good news for the millions of Americans who care for parents, in-laws, spouses, partners and friends with Alzheimer's and other dementias.

Klobuchar has spoken frankly about her father's battle with Alzheimer's; she has firsthand knowledge of the difficulties that family caregivers face. She wants expanded training and support services for families and caregivers of people living with dementia and other chronic conditions. It's an approach she thinks will improve caregivers' well-being and allow more people with dementia and chronic conditions to remain at home longer.

That could help Patrick Dwyer, 49, who cares for his former romantic partner and good friend John, near Boston. John, now 80, has no family able to care for him, so it fell to Dwyer, who describes John as "the father I never had."

In addition to vascular-related dementia, John has congestive heart failure, is partially blind, and has peripheral neuropathy, among other chronic conditions. When he could no longer live alone, Dwyer made the tough decision to quit his job at the University of Massachusetts Boston and became a full-time caregiver.

Dwyer says he had to learn to care for John as he went along. "I vowed that I'm keeping him at home as long as possible. There's no way I'm putting him into a nursing home that will basically just warehouse him," he says.

While Dwyer was fortunate to have savings to dip into to care for John, they're rapidly being depleted. Many family caregivers are not so lucky and Medicare, generally speaking, doesn't cover long-term care costs.

"If you are very poor, you can get help from Medicaid," he says. "If you are very wealthy, you can send the loved one to a good memory care center or nursing facility, but that's going to cost in the neighborhood of $10,000 to $15,000 a month. If you are a retired schoolteacher out on a disability pension, then what?"

According to the Alzheimer's Association, caregivers like Dwyer provide an estimated 18.5 billion hours of care annually at a cost of nearly $234 billion. Klobuchar's plan would expand Medicare-covered services for people with Alzheimer's and their caregivers, like in-home assistance and respite care.

It would also enhance efforts to make patients and their families aware of the care-planning and other services that are covered.

There are many resources and services available through Medicare to help those with Alzheimer's and their caregivers that people are not aware of, says Rachel Conant, senior political director of the Alzheimer's Impact Movement, the advocacy arm of the Alzheimer's Association.

"Care planning is so critical to those with the disease, and allows individuals and their caregivers to learn about medical and non-medical treatments, clinical trials, and support services that are available on the ground. But most people don't realize it's out there," Conant says. However, during the first year that care planning was available under Medicare, fewer than 1% of those with Alzheimer's and other dementias received the benefit.

Among Klobuchar's proposals is a new refundable tax credit of up to $6,000 a year for caregivers to help offset the costs of long-term care. The credit would be available to help pay for nursing facility care or home- and community-based services. It could also be used for additional expenses like assistive technologies, respite care and necessary home modifications. The money to pay for the credit would come from increasing taxes on profits from certain investments. Klobuchar also wants a tax credit to help offset the cost of long-term care and one that's equal to 20% of long-term care insurance premiums.

As Next Avenue wrote in an article about the recent AARP Forums with the Democratic presidential candidates, Sen. Elizabeth Warren has proposed a $3,000 caregiver tax credit and former Vice President Joe Biden wants a $5,000 caregiver credit. Sen. Cory Booker prefers expanding the Earned Income Tax Credit to $4,000 to help cover family caregivers' expenses.

Ann Collins, who lives near Atlanta, cared for both of her in-laws and her mother at various points over the past two decades. She was also raising two small children and worked part-time. Some days were "very trying," she says. Broken hips, dementia, stroke, depression — she somehow handled it all. "When I'm in a situation and there's something that needs to be done, I just go with it," she says.

But it wasn't easy for Collins, now 72. At various times, each of her in-laws lived with her. With her husband working full-time, almost all of the caregiving fell to her.

The cost for staying at home and taking off from work and keeping someone at home as long as possible adds up, says Conant. She thinks Klobuchar's focus on offsetting long-term care costs and respite care is promising. "It gets these issues on the table and starts that discussion, so folks realize that this is a need that must be addressed," she says.

More broadly, Klobuchar favors universal health care coverage, with an eventual transition to a "Medicare for All" type plan. However, unlike some of her rivals, she says the best way to get there is through a public option that expands Medicare or Medicaid.

Klobuchar supports Rep. Brian Schatz's expansion plan, which would allow states to create public health insurance plans through Medicaid. Premiums would be capped at a maximum of 9.5% of family income. They could be offered on state insurance exchanges alongside commercial plans.

That, too, could be a huge help for caregivers like Dwyer, who pays the full cost of health insurance. "You put your entire life on hold for a year, or two or five, to care for somebody who you love; you need resources, and you need help," he says. "Let's start with health insurance."

Klobuchar's plan would also let the government negotiate Medicare Part D prescription drug costs and let people buy less expensive prescription drugs imported from Canada. There is ongoing debate among policy experts, however, about whether this will really net worthwhile cost savings.

In an opinion piece in the Star Tribune last October, Klobuchar wrote, "seniors shouldn't have to worry about putting food on the table and paying for the insulin they need. Every month we fail to act means another month when Minnesotans and people across the country continue to struggle and don't get the care they need."

Klobuchar is also forthcoming about her family's struggle with mental health issues. Her health plan expands mental health treatment for older adults, as well as depression treatment and suicide prevention efforts that focus on older Americans.

Klobuchar says she is committed to putting the U.S. on a path toward developing a cure and treatment for Alzheimer's disease by 2025. She says one way to get there is by supporting researchers with funding that is reliable and consistent.

She also wants to increase federal research into racial disparities in the incidence and outcomes of Alzheimer's and other forms of dementia. Klobuchar's campaign points out that African-Americans and Latinos will represent nearly 40% of the 8.4 million American families affected by Alzheimer's disease by 2030, according to the Alzheimer's Association.

Dwyer knows his story is one that's repeated over and over, "with people who have chosen to make sacrifices for somebody they love and find themselves on the outside of society with no help whatsoever," he says.

This article originally appeared on NextAvenue.org.