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LTCI Watch: Where's the woof?

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Long-term care (LTC) policy actually crept into the Democratic presidential primary debate that CBS aired Saturday, but in a quiet, sideways way.

Bernie Sanders said at the beginning of the debate that, when Americans are talking about the long-term consequences of war, they ought to think about the service members who come home with post-traumatic stress disorders and traumatic brain injury (TBI).

“I would hope that, in the midst of all of this discussion [of the attack on Paris] this country makes certain that we do not turn our backs on the men and women who put their lives on the line to defend us,” Sanders said.

Toward the end of the night, when John Dickerson, the chief moderator, asked Sanders what experience he could draw on in a crisis, he mentioned the work he did to develop and pass the Veterans Access, Choice and Accountability Act of 2014. That act includes a brief but important provision that extended an assisted living services pilot program for veterans with TBI. 

See also: Vietnam vets’ nightmares may unlock hidden link to dementia

So, in an indirect way, Sanders was using his involvement in getting a veterans’ LTC bill passed as evidence for his readiness to carry the United States’ nuclear football.

Sanders mentioned family leave twice, and the moderators referred to Hillary Clinton’s and Martin O’Malley’s family leave proposals in passing, when asking the candidates how they would pay for their proposals.

At one point, Sanders said he and his supporters are going to “do a political revolution which brings working people, young people, senior citizens, and minorities together.”

At another point, Clinton and Sanders discussed whether Sanders’ single-payer health care system proposal would eliminate Medicare.

But, aside from touching, briefly, on the family leave proposals, the moderators never asked any questions related to acute care or long-term care for older Americans. The candidates themselves never said a word about supporting informal caregivers, other than, possibly, through the family leave references, or about paying for formal LTC services for civilians.

See also: AALTCI to candidates: Talk about LTC policy

In a story about Sherlock Holmes, its author, Sir Arthur Conan Doyle, had Holmes deduce the identity of a murderous horse thief by noting that the stable watchdog did not bark at the thief. The obvious conclusion was that the dog must have known the thief.

Maybe the fact that this year’s presidential candidate primary debate moderators, and primary candidates, are not mentioning civilian LTC policy, even to complain about how difficult the problem is to solve, shows who the U.S. LTC villain is: all of the major candidates on both sides, all of the media organizations responsible for moderating the debates, and all of the debate viewers (and all of the voters who have not bothered to watch the debates) who have kept quiet about this omission.

We as a society have, in effect, decided that it’s fine if, aside from a few relatively young veterans with TBI, the people in this country who need help with the activities of daily living get lousy care, no care at all, or whatever care the random hand of fate happens to provide, whether that be a kind home care attendant, a lovely nursing home, or a box on the sidewalk.