State of California’s Master Plan for Aging

 

As California governor, Gavin Newsom, called for appointment of an Aging Czar to lead a 15-member task force that would develop a Master Plan to address challenges related to long-term care and aging, Senate Bill 228 was passed on May 24, 2019. “California’s aging population is growing quickly and living longer. Without adequate services and planning, many of our state’s older adults face a risk of becoming homeless or losing access to essential care,” State Senator Hannah-Beth Jackson said in a statement. “We cannot afford to leave our aging adults behind. California must step up and prepare for this rapidly growing population.”

 

The aging czar and task force would examine and address system challenges to long-term care identified by the state Senate Select Committee on Aging and Long Term Care in a 2015 report titled “A Shattered System: Reforming Long-Term Care in California.” Those challenges, Jackson said, include system fragmentation, lack of access to services, workforce challenges and cultural competency, and infrastructure issues. The Aging Czar task force would include representation from consumers, healthcare, long-term services and supports, labor, transportation, housing, government and communities deemed to have been historically overlooked.

 

The challenges confronting the state are many, including system fragmentation, lack of access to services, lack of affordable/accessible housing and need for a trained and culturally competent workforce. To plan for population growth and ensure that older adults can live with dignity and independence, California needs a master plan outlining the state’s goals and objectives relative to the growth in this population and accompanying needs.

Recommendation: The state should develop a master plan with specified timeframes and objectives to plan for the needs of an aging California. Specifically, the plan should address the growth of the older adult and disabled population and accompanying service need across the health care, LTSS, behavioral health sector, system financing, integrated service delivery, workforce capacity and affordable housing, among other issues. The plan should be developed over a 12-month timeframe with opportunity for stakeholder input and legislative review.

 

The Master Plan for Aging is expected to have the following components:

• Name and give authority to a state leader who will build solutions for older Californians across all policy areas

Nearly all state agencies and departments have senior constituents – making aging everybody’s business. To prioritize and coordinate actions among the state entities whose services impact seniors, the state will need a visible, experienced leader.

Recommendation: The next governor should appoint a leader charged with problem solving and action on behalf of California seniors across agencies and departments, staff, appointees, the administration, community stakeholders and others.

 

• Support working families to plan for aging

California and the nation face an unprecedented crisis related to financing LTSS, which is limiting access to services. The primary payers for these services are individuals (i.e., out-of- pocket costs) and Medi-Cal, which requires that people be impoverished for eligibility. No state or federal financing system exists for LTSS beyond Medicaid, which is currently facing uncertainty amidst pending reform.

Recommendation: State and federal action is needed to enable working families of today to plan and pay for their daily care needs of tomorrow.

 

• Recognize and value our family caregivers

California’s family caregivers are the linchpin to our service delivery system. Nearly 4.5 million unpaid caregivers provide support to family members, friends and neighbors in our state, valued at $57 billion annually.

Recommendation: California must elevate policies to support unpaid family caregivers, better serve the needs of older adults and promote greater efficiencies in public spending. These actions are critical to avoiding burnout, as well as improving health and economic security of family caregivers: Assess family caregiver need when assessing individuals for programs; Protect family caregivers from employment discrimination; and Permit nurses to delegate more tasks to qualified home health aides, thereby reducing system costs and relieving caregiver burden.

 

• Design a common architecture for determining needs and preferences for seniors

California’s home and community-based programs operate with separate eligibility determination and assessment processes, creating inefficiencies in the administration of programs and difficulties for consumers in accessing necessary programs and services. A universal assessment (UA) system would enable needs to be evaluated in a consistent manner, with services tailored to each person’s needs and preferences in an equitable manner. At the state level, UA data would enable program planners to understand the needs of the population, support allocation of resources in a standardized way and evaluate quality. While the state endeavored to develop a universal assessment tool authorized through the Coordinated Care Initiative (CCI), it abandoned this commitment with the termination of the CCI. Without a UA tool and process, California cannot achieve a truly person-centered framework for service delivery.

Recommendation: The state should recommit to developing a universal assessment process with timelines for statewide implementation.

 

• Develop integrated data to better target services and plan for population need

California’s data sources differ depending on the funding source, and are used for different purposes, without connections across programs. As a result, the state lacks the comprehensive data necessary to understand population needs, identify gaps in service delivery and plan for future population changes. California needs an integrated information system that creates a comprehensive picture of population needs and service use patterns. Ultimately, individual data should flow from: The person-level, where it guides care planning; to The provider/program level, where it supports program planning; and to The state level, where it guides statewide policy development.

Recommendation: The Health and Human Services Agency should develop an integrated data infrastructure and platform, with specified timeframe for statewide implementation.

 

• Break bureaucracy by streamlining administration

The labyrinth of departments, agencies, programs and regulatory structures across the Health and Human Services Agency creates significant confusion and frustration for consumers and their families, and also affects access to care when services and supports cannot be located.

Recommendation: The governor should direct the Health and Human Services Agency to engage stakeholders in soliciting feedback regarding ways to reorganize its administrative structure. The goals of the reorganized structure should be to efficiently serve older adults, people with disabilities and family caregivers to enable a more person-centered, coordinated service delivery system that promotes access to services in the home and community-based setting and avoids unnecessary institutionalization.