Concerns about nursing home ownership and Vice President Kamala Harris' proposal to allow Medicare to cover home health care both reflect the political relevance of concerns that older Americans have, advocates say. (Getty Images)

Caregiving, especially for the elderly, is emerging as an important issue in the November election.

On the same day Democratic presidential candidate Kamala Harris rolled out a plan to extend Medicare coverage to include home care for the elderly, advocates held a press conference to discuss the results of a poll asking Wisconsin voters about their views on long-term care.

“I feel like the issue of long-term care in particular has been this kind of sleeping giant ready to be awoken,” said George Goehl, a community organizer with Addition Action, an advocacy group that focuses on small towns and rural communities around the country.

In Wisconsin, Addition Action has been working with community groups organizing to oppose the sale of county-owned nursing homes to private investors.

In Sauk County, a county home was recently sold to a corporation with several Milwaukee homes over the objections of local residents. In Lincoln County, the sale of a county home to a private investor was halted after community residents mustered widespread opposition.

The poll that Addition Action commissioned included a statewide sample of 400 people age 55 and older, as well as an oversample of 400 rural and small community residents.

Overall, 86% of those surveyed said long-term care costs, including nursing homes and assisted living, were unreasonable, including 57% who called those costs “very unreasonable.” Asked whether the government was doing enough to ensure access to quality, affordable long-term care, 68% said government should do more and 12% said it should do less, while 19% said the government was doing the right amount.

The survey participants gave a mixed assessment when considering private ownership and public ownership of nursing homes.

Public county-owned homes were trusted more by 16% while 35% trusted privately owned homes more. Both groups together, however, accounted for just over half of the survey group.

The remaining 49% were divided nearly equally between people who said they weren’t sure and people who said they trusted — or mistrusted — both kinds of owners equally.

But 64% of people in the survey opposed the sale of public, county-owned nursing homes to private companies, while 33% favored such sales — a margin of 2 to 1.

The survey results are largely bipartisan, according to the polling firm, Hart Research. Majorities of Republicans, independent voters and Democrats said they favored policies including high wages for long-term care workers, eviction protections for nursing home and assisted living residents, expanded access to Medicaid to enable more elderly to obtain long-term care and federal support for public nursing homes.

“Nursing homes are an important part of long-term care, but they are just one part of the care infrastructure we need,” said Judy Brey, who is part of a community campaign that opposed Sauk County’s sale of its public nursing home. Brey spoke on a Zoom call Tuesday to discuss the poll findings.

“This poll tells us that today, most seniors in rural communities like mine don’t believe there is enough affordable, quality long-term care, so the need for long-term care is only going to grow,” Brey said.

Also on the call was Dora Gorski, who has been part of a group in Lincoln County that successfully opposed the sale of a public home there a few years ago. “We know that more can be done to support seniors, especially since we’re growing in numbers in this community and throughout the United States,” Gorski said.

Majorities in the poll also told surveyors that they would view political candidates more favorably who have a plan “to protect public, county-owned nursing homes” from being sold to for-profit corporations.

According to Goehl, in three April 2024 county board elections board members in Sauk, Lincoln and Portage counties who had led efforts to sell county-owned homes to private firms were defeated by candidates opposed to such sales.

“This issue had stirred up a hornet’s nest,” Goehl said in an interview Tuesday.

The poll’s release came on the same day that Vice President Kamala Harris, campaigning for president, announced a proposal to allow the federal Medicare program to cover in-home health care.

Appearing on the television talk show The View, Harris said the expansion would be funded in part by savings that Medicare would receive as a result of negotiating prescription drug prices with pharmaceutical manufacturers.

Harris described the proposal as an effort to meet the needs of “the sandwich generation” — adults who bear the dual responsibilities of raising children and assisting aging parents who are no longer able to live on their own.

Currently, most people who cannot afford to pay for long-term care home services out of pocket can only get that covered through Medicaid — and then they have to divest themselves of most of their assets.

“They have to make themselves poor,” said Haeyoung Yoon, policy director at the National Domestic Workers Alliance (NDWA) a nonpartisan nonprofit for domestic workers including nannies, house cleaners, and home health workers that represents about 400,000 people across the country through local and state affiliate groups.

Home health workers are part of “the fastest- and largest growing occupation in our economy,” Yoon told the Wisconsin Examiner. “We’re going through the  graying of America — baby boomers are aging.”

Yoon said stronger public investment in care, including home health care, is needed so the work pays family-sustaining wages while being affordable to the general public. Currently the average annual wage in the field is less than $22,000 she said, and employees, if they have health care, are likely to be on Medicaid.

Yoon also is part of Care In Action — a separate organization that engages in political advocacy on behalf of the domestic workforce. Speaking in her role as a political advocate, she said the Harris proposal represented an important policy advance.

“It’s a historic and really big deal to say this is something that she wants to do when she’s elected,” Yoon said. 

Flanked by Marcia Kasieta, left, and U.S. Rep. Mark Pocan, right, FTC chair Lina Khan describes her agency's work in a conversation with reporters Thursday. (Erik Gunn | Wisconsin Examiner)

As consumers continue to face higher prices for groceries and other goods, the Federal Trade Commission is looking at whether some of those price hikes are driven by profiteering.

The agency is “using all of our tools to make sure that no American is paying more because of illegal business practices, be it at the grocery store, be it at the pump, be it at the pharmacy, on food and groceries in particular,” FTC Chair Lina Khan told reporters Thursday during a visit to Wisconsin.

Khan was in the Badger State for stops that included a round table discussion about a recent nursing home sale and a chat with reporters at the Madison office of Democratic Rep. Mark Pocan.

That conversation included a quick rundown of issues at the forefront of the FTC’s agenda. The agency enforces federal antitrust and consumer protection laws, “which are really about making sure that our markets are fair and honest and competitive, so that people can get a fair shake,” Khan said.

State price-gouging laws are intended to address momentary surges in the price of goods that take advantage of circumstances such as natural disasters. But the FTC focuses on “a broader set of corporate practices that we think may be unlawfully hiking up prices,” Khan said. 

Marcia Kasieta, business director of the Badger Prairie Needs Network, a nonprofit serving Dane County, said that the group’s food pantry has been pinched by soaring demand and soaring costs.

“This year my pantry is providing food assistance to 7,000 individuals a month,” Kasieta said — up from 2,200 a month just two years ago.

“Our purchasing budget has more than doubled in the last two years,” she said. “At today’s prices, with demand for food assistance continuing to climb, our budget next year will be eight times more than it was before the pandemic, and three times more than just two years ago.”

Khan said the FTC is looking at inflation in consumer prices from several angles.

One example is price discrimination. “Sometimes we hear from independent grocers they’re not able to get the same terms as the big retailers,” Khan said.

Some small retailers have reported that the prices wholesalers are charging them for an item exceeds the shelf price at a big chain store. “So, there seems to be potentially some discrimination going on there, maybe in unlawful ways,” she said.

The FTC has also opened a market inquiry to look at reports of “surveillance pricing — when companies may be able to charge each person a different price based on what they know about you,” she said.

For example, she suggested the possibility that based on consumer data that retailers collect from shoppers, a family whose child has a peanut allergy could be charged a higher price for a nut-free granola bar.

The FTC has ordered eight companies to submit information about their use of consumers’ personal information in setting prices. 

Business consolidation is another trend leading to higher prices, Khan said — whether by directly limiting competition, or by secretly and illegally colluding so that supposedly competing firms don’t undercut each other’s prices.

“We’ve seen some really serious allegations around this in housing, where some lawsuits have been brought, noting that different landlords have all been using the same algorithm to set their rents and they may effectively be engaging in price fixing,” Khan said.

In the food and agriculture sector, “more and more markets are controlled by fewer and fewer players,” she said. “We hear from a lot of farmers that they’ve seen their incomes go down even as consumers are paying more. That would suggest that it’s the entities in the middle that are taking a bigger and bigger cut.”

While prices spiked in the pandemic as supply chains were disrupted, prices have not come down on some products even as the costs to produce them have fallen again, Khan said. “So there’s a question — is it that the companies have the ability to keep prices inflated because there isn’t enough competition in the market?”

Because of concern it would reduce competition, the FTC is challenging the pending merger of supermarket giants Kroger and Albertson’s in federal court.

Khan said she couldn’t comment on details of the case because it remains in litigation, but Pocan observed Kroger and three other supermarket giants “control 70% of the grocery market in the United States.

It’s the FTC’s aim, Khan said, “to make sure that markets are not becoming further consolidated through mergers and acquisitions in ways that will further deprive people of choices that would result in lower prices.”

Before visiting Pocan’s office, Khan was in Baraboo Thursday morning for a community discussion about the recent sale of a county-owned nursing home to a for-profit company. The session was organized by a community group opposed to the sale.

Khan told reporters that while the transaction was in the purview of the Wisconsin Department of Health Services, which is reviewing the matter, and not the FTC, it raises issues about private equity that are on the FTC’s agenda.

“We are more generally concerned about the growing role of private equity, in particular, in parts of health care [and] nursing homes,” Khan said. “There has been some troubling research showing that mortality rates have actually increased after nursing homes have been bought by private equity.”