Where Do Presidential Candidates Stand On Community-Based Long Term Care? ADAPT Releases Results Of National Survey
January 26, 2004

For Immediate Release
Contact: Bob Kafka 512/431-4085
Stephanie Thomas 512/442-0252
Marsha Katz 406/544-9504

The Democratic front-runners in the campaign for the Presidency responded to a national survey on their position on community based long term care. ADAPT, the largest national grassroots, disability activist group, which did the survey, released the results today.

The goal is to inform voters - before New Hampshire and the other primaries -- where the candidates stand on issues related to long term care. Too often these issues are not addressed in general campaign information and debates. "Long term care and the bias toward nursing home and other institutional programs is the elephant in the room," said national ADAPT organizer Bob Kafka. "We spend 85 billion dollars a year on long term care services and Medicaid is the fastest growing part of every state's budget."

ADAPT hopes this survey and the responses and non-responses given, will spark debate on this critical issue.

All the candidates were surveyed but President Bush, Senator Lieberman, General Clark and Al Sharpton did not respond.

Here are the combined responses to the ADAPT Survey sent to all the Presidential Candidates. We received no response from President Bush, Senator Lieberman, General Clark or Al Sharpton. Clark has stated he is a MiCASSA supporter but Bush, Lieberman and Sharpton have not come out in support of MiCASSA. Carol Mosley Brown also responded to the survey, but since she has dropped out of the race we did not include her responses though we would like to acknowledge and thank her for responding. Below are the responses of Governor Dean, Senator Edwards, Senator Kerry and Congress person Kucinich. Their responses are listed in alphabetical order after each question.

Most, if not all, of the Candidates have disability platforms which can be found on their websites.

1. Do you support the passage and full implementation of the Medicaid Community Attendant Services and Supports Act, MiCASSA?

Dean Yes

Comments: One of the most important pledges in my Disability Rights Platform, which I released last July 26 on the 13th Anniversary of the ADA's enactment, was that I will work hard to enact MiCASSA. As I testified before the Senate Special Committee on Aging in July, 2001, "If a long-term care system were being designed from scratch today, I do no think we would conceive of building a system in which a bias is shown for institutional care, rather than for services designed to keep people independent in their homes or the community." MiCASSA is an important bill whose time has come.

Edwards YES

Comments I am a cosponsor of the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA) that allows individuals to choose community-based care with Medicare coverage.

In addition to supporting MiCASSA and other bills to help people with disabilities, I have proposed a $3.5 billion "Living with Dignity" Initiative. My plan is built on basic American principles: choice for families, the chance to get care in the home and community whenever possible, dignity and respect for both families and workers, and accountability for providers and the government.

The Living with Dignity Initiative will:

Kerry YES

Comments

Americans with Disabilities must be assured equal access to quality home and community living services. I am an original cosponsor of MiCASSA and the Money Follows the Person Act. Passage of both of these bills is vital to ending the institutional bias that makes it impossible for millions of Americans to exercise the most basic of human liberties: freedom, choice, and independence. I support increasing funding for independent living centers, areas agencies on aging and similar local organizations to build capacity and support people with disabilities in moving out of or keeping from needlessly going into a nursing home or another institution. I will work to provide decent wages and benefits to the community based services workers who help make independence possible.

Kucinich

Yes: Dennis Kucinich co-sponsored the bill.

2. Do you support the passage of legislation that will implement the concept of Money Follows the Person that is included in S.1394?

Dean YES

Edwards YES

Comments I support the Money Follows the Person Act of 2003. As part of my Living with Dignity Initiative, I also support initiatives that enable people with disabilities to choose how they receive their care and live their lives.

Kerry YES

Comments

See #1.

Kucinich YES

3. Will you work with the states to assure they implement the Supreme Court's Olmstead decision so all people with disabilities, old and young, have the right to support services in the most integrated setting?

Dean YES

3a. What specific actions would you take?

Comments I look forward to providing technical support as states implement Olmstead plans to provide viable, sustainable options for community-based living. In the 1999 case LC v. Olmstead, the Supreme Court interpreted the ADA to require that individual with disabilities be offered state services in the most integrated community-based setting appropriate to their needs. States are now modifying programs and activities to comply with Olmstead. The federal government must assist states making this transition by providing technical assistance and funding innovative model for full integration.

Edwards YES

3a. What specific actions would you take?

The Supreme Court's Olmstead decision held that the ADA requires states to offer services in the most integrated, community-based setting possible for individuals with disabilities. The ruling said that a disabled individual who is able to live in the community must be given the choice whether to do so. This was an important victory for disability rights.

Unfortunately, states are still struggling to implement Olmstead. I believe that the federal government must help states by supporting the transition to community-based services, and increasing enforcement to ensure compliance with the law. States need resources to do this, at a time when they are already cash-strapped. I have proposed to offer fiscal relief to states in these difficult times. These dollars will help states expand Medicaid coverage, including prescription drugs and personal assistance, to those with disabilities. It will also help states meet their obligation to give people with disabilities the choice of care in their communities and homes as well as in institutions. I will also give states the resources they need to reform their long-term care systems by providing benefits such as tax credits for long-term care, asset and income protection programs that prevent families from spending down their incomes, and experiments with long-term care insurance.

Kerry YES

3a. What specific actions would you take?

Comments

We must fully implement the Olmstead decision. I believe that states must be given increased resources and tools to carry out the Olmstead decision and must be held accountable for doing so. As with racial segregation, we must put an end to the institutional bias that prevents millions of Americans of all ages from living fuller lives in their own homes and communities. States are experiencing tough fiscal times and many are slashing Medicaid funding for home and community based services. The Bush Administration has done nothing to stop this from happening. I am committed to finding ways to relieve these pressures on states and make certain that people with disabilities and older Americans receive the support they need to live in their own homes and communities.

Kucinich YES

3a. What specific actions would you take?

Comments: As President, Dennis Kucinich will provide technical support to the states implementing the Olmstead decision, ensuring that people with disabilities receive the best community integration possible.

4. Will you appoint a Secretary of Health and Human Services that will have a Community First philosophy and will review all Medicare and Medicaid policies with the intention of removing all policies that contribute to the institutional bias that exists in the current long term care system?

Dean YES

Comments: I will appoint a Secretary of Health and Human Services who will understand the rights of individual with disabilities. As reflected by my support for MiCASSA, my administration will work to end the institutional bias in long-term health care.

Edwards YES

Comments The Edwards Administration will be committed to ending the era of forced institutionalization. The Department of Health and Human Services under President Edwards will ensure the dignity of all Americans with disabilities by enabling them to live and work in the community if they so choose and are able.

Kerry YES

Comments

Yes, my Secretary of Health and Human Services will have a Community First philosophy. There is an institutional bias that must be reversed to ensure that Americans with disabilities of every age have the services and supports to live in the community of their choice. To do this, I will appoint a national bipartisan Community First Commission made up of Members of Congress, Governors, distinguished older Americans, veterans, Americans with disabilities and other experts. The commission will identify short and long term policy reforms that could and should be pursued to:

The commission will submit findings and recommendations to the Kerry Administration and the leadership in both houses of Congress by July 26, 2005 - the 15th anniversary of the ADA.

Kucinich YES

Comments: Under a Kucinich Administration, everyone in America will be provided with comprehensive enhanced Medicare through a universal single payer health care system. This includes prescription drugs and mental health costs.

5. Will you appoint a high level task force to review the funding of long term services and supports and make recommendations on concrete ways to reverse the institutional funding bias?

Dean YES

Comments: I look forward to working with members of the disability community in many capacities to reverse the institutional funding bias and to ensure that my disability agenda is a national priority. Because individuals with disabilities provide a valuable perspective on federal policy and contribute immeasurably to the fabric of our nation, I will include people with disabilities in a wide spectrum of executive appointments.

Edwards YES

Kerry YES

Comments

I am the only candidate for President in either party to propose creating such a commission and I will do this in my first 100 days in office. Many say reversing the institutional bias that pervades so much of our health financing systems and robs so many Americans of the opportunity to live full lives is impossible. I believe it is not only possible but imperative to the future of our Nation. See #4

Kucinich YES

6. Will you support/develop long term service and support policies that enhance the consumer direction/self determination of personal attendant services by allowing persons to select, manage and dismiss attendants?

Dean YES

Edwards YES

Comments I believe that adults with disabilities should have the widest possible choice available for their services, including the ability to choose and manage their personal aides.

Kerry YES

Comments

Yes, I believe we should work to enhance consumer directed care. People with disabilities deserve the right to make decisions that directly impact their own lives and the services and supports they need. That includes selecting, managing and dismissing attendants.

Kucinich YES

7. Will you support/develop long term service and support policies that will demedicalize personal attendant services by allowing physician/nurse assignment/delegation as well as tasks being defined as non medical?

Dean YES

Comments: I will work with medical professionals, patients and patient advocates to ensure an appropriate division of responsibility in the area of personal attendant services. It makes sense to assign non-medical tasks to non-medical personnel.

Edwards YES

Kerry YES

Comments

Yes, I will develop policies that enable people with disabilities to access non-medical services which improve their quality of life. To make Medicare and Medicaid more responsive to the needs of people with disabilities of all ages, I will direct HHS to identify cost effective ways that best promote the health, independence and productivity of people with disabilities and improve upon the permanent risk adjustment payment system to promote better health care.

Kucinich YES

8. Will you support/develop long term service and support policies that will develop wage and benefit incentives so that there is a large pool of attendants available to meet the growing personal attendant service needs in this country? Currently you can make more money working in a fast food restaurant than as an attendant.

Dean YES

Comments: In the past three years, the wages of personal attendants have fallen as the cost of living has risen. The big tax cuts that helped the multi-millionaires did not trickle down to these people. I agree that wages for personal attendants and others who provide human services are pitiably low and that this country must refocus its priorities so this is not the case.

Edwards YES

Comments We have a critical shortage of health care attendants and nurses in this country. That's why, under my Living with Dignity Initiative, I lay out specific steps to attract home health aides and attendants to the industry, by treating them with the same dignity and respect that we ask them to give to their patients. As President, I will provide resources to improve wages, training, and working conditions for aides. I will also establish strong workplace safety regulations such as the ergonomics regulations discarded by President Bush.

Kerry YES

Comments

We need to recruit and train more highly motivated Americans to become attendants, home health aides, nurses and paraprofessionals. These individuals work around the clock to it possible for millions of children, adults and older Americans with disabilities to live in their own homes and communities. We need to make sure these indispensable workers are well compensated, receive appropriate health coverage and other opportunities to advance in their life and career.

Margaret Mead said that every society must be ultimately judged by how much it values and supports its very young, its very old and those with disabilities. Today, we also must judge ourselves by a fourth critical criterion: how well we value, compensate and support those whose job it is to assist Americans with significant disabilities of every age with such essential tasks as eating, bathing, dressing, using the bathroom, and going to school or work. Sadly, we are failing badly at this throughout the nation. Together, we can and must change this.

Kucinich YES

Comments: Incentives must be offered to ensure a sufficient long term care service that will meet the needs of our rapidly expanding senior population.

9. Do you support the integration mandate in the Americans with Disabilities Act, ADA and believe this mandate is a federal civil right?

Dean YES

9a. If elected what actions will you take to protect this right?

Comments: The ADA is one of the most important civil rights laws in history. I support its goals and the legal rights that it provides. We need to restore the full promise of the ADA, by legislation if necessary.

Edwards YES

9a. If elected what actions will you take to protect this right?

Comments I believe strongly that we must ensure that the ADA remains consistent with the broad goal of achieving equal opportunities and breaking down barriers for people with disabilities. Fair treatment of people with disabilities is civil rights issue, and it must be a priority. As President I will support measures to achieve this goal, to help people with disabilities achieve full integration in society.

Kerry YES

9a. If elected what actions will you take to protect this right?

Comments

The integration mandate is a federal civil right. The letter and intent of the ADA is to put an end to the segregation that persons with disabilities historically have suffered, and June 22, 1999, marked a pivotal moment in that effort. On that date, the United States Supreme Court held in Olmstead v. L.C. that under some circumstances, the ADA requires states to provide community-based services rather than institutional placements for individuals with disabilities.

I believe that the de-institutionalization and integration of persons with disabilities into the community is of fundamental importance. By providing persons with disabilities the opportunity to work, participate in civic life, and become community leaders, we strengthen our entire community. As President, I would support programs such as MiCASSA that promote integration of persons with disabilities.

Kucinich YES

9a. If elected what actions will you take to protect this right?

Comments: As President, Kucinich will nominate equal rights-oriented judges who interpret the Americans with Disabilities Act (ADA) broadly, and he'll propose an amendment to the ADA to ensure the coverage that was intended prior to restrictive rulings by Republican-appointed judges. Kucinich will also increase resources to the Equal Employment Opportunity Commission and the Departments of Justice, Education and Health and Human Services civil rights divisions to enforce the right of people with disabilities.

10. Will you include people with disabilities, including ADAPT members, in the development of all policies that effect the community long term service and support system?

Dean YES

Comments: I look forward to appointing a Special Assistant to the President for Disability Policy.

Edwards YES

Comments Policies affecting people with disabilities can only be meaningful - and successful - if they are crafted with the help of people who understand first-hand the frustrations of disabled Americans. I welcome the inclusion and participation of people with disabilities in reforming our community long term service and support system so that it is more responsive to their needs and concerns.

Kerry YES

Comments

Absolutely. People with disabilities will always have a seat front and center in the Kerry Administration. I have released a comprehensive platform on disability issues which was developed in collaboration with leaders of the disability community from across the country. When I am President, Americans with Disabilities will play active roles not only in policy-making which effects the community long term service and support system but in every single area of public policy.

Kucinich YES

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