California Aims to Address the Urgent Needs of Older Residents, But Will the Plan Work?

By Samantha Young, Kaiser Health News

Even as the pandemic derailed some of Gov. Gavin Newsom’s biggest health care proposals, such as lowering prescription drug costs, it crystallized another: the pressing need to address California’s rapidly aging population.

Already nine months into their work when Newsom issued the nation’s first statewide stay-at-home order last March, members of a state task force on aging watched as the coronavirus disproportionately sickened and killed older people, and left many isolated in nursing homes, assisted living facilities and their own homes.

“In many ways, it just accelerated and made more urgent that work,” said Kim McCoy Wade, director of California’s Department of Aging, who led the task force.

The group’s work culminated in the release last month of a 10-year “Master Plan for Aging,” a blueprint intended to guide state and local governments, the private sector and charitable organizations to improve housing, health care, caregiving, equity and affordability for California’s older residents.

The state’s existing system of programs and services can be confusing for seniors who must navigate a disconnected patchwork of public and private offerings. If they’re able to find a program that fits their needs, it’s often too costly for anyone other than low-income Medi-Cal recipients, whose participation is covered by public funding.

McCoy Wade hopes the state’s Master Plan website will serve as a destination for Californians looking for programs or support, much as the First 5 website is for caregivers of young children.

But right now, the site mostly lists scores of ideas, such as creating a variety of affordable housing options for Californians, improving public transit, expanding geriatric care, redesigning nursing homes to be smaller and more home-like, improving broadband access and expanding telehealth.

That broad, holistic approach to health care is needed to help the state’s aging population, said Dr. Sarita Mohanty, president and CEO of The SCAN Foundation, which advocates for older people. (Kaiser Health News, which publishes California Healthline, receives support for its coverage of aging and long-term care issues from The SCAN Foundation.)

The number of Californians age 60 and older is projected to grow to about 11 million by 2030, accounting for one-quarter of the state’s population. In 2019, that group made up roughly one-fifth of the state’s population, according to U.S. Census data.

“We can’t be reactive. We have to be extremely proactive,” said Mohanty, an internist. “It’s not just about health care; it’s about health and communities.”

But will the plan end up gathering dust on a shelf, as have so many other government reports? McCoy Wade pledged that won’t happen, pointing to an online dashboard that tracks the administration’s progress implementing the plan’s proposals through the state budget, the legislature and in communities.

There is already momentum. The administration has pledged to embark on more than 100 initiatives in the next two years, McCoy Wade said. In his proposed 2021-22 state budget, Newsom has asked for $250 million to buy and rehabilitate assisted living facilities for homeless seniors, and his administration is working with the federal government to determine how Californians can continue to use telehealth medicine after the pandemic.

McCoy Wade talked to California Healthline about why Newsom issued an executive order to create the plan, why it is so important for Californians and some ways to move it forward. The interview has been edited for length and clarity.

Q: Why does California need a Master Plan for Aging?

The executive order was really driven by the demographic change that we’re living longer, we’re having multiple stages of aging, and aging is diversifying.

Are you living in a single-family home that entire 30, 40, 50 years? Are you working perhaps longer, are you volunteering longer, are you living with three, four or five generations in one house? Are you living alone because your spouse, your friends and your peers may have died? That has been one of the “aha” moments but also one of the challenges: How do you plan for aging when it is so diverse?

Q: The Master Plan offers a blueprint for the next 10 years, but what are some proposals that can be tackled in the next few years?

In this pandemic, we learned a lot. It’s important that people can stay in the home they choose but also have services accessible to them. For middle-class people, Medicare doesn’t pay for the services people need, so you see the governor proposing a new Office of Medicare Innovation and Integration to help more Californians.

As we age, there are a couple of things that can be really helpful: taking care of housecleaning, taking care of shopping, taking care of cooking. We can retrofit houses to prevent falls. I think there’s a real recognition that we have to expand the ability for middle-class folks to afford and have access to services and supports.

Home and health go together at all ages. But as you age, in particular, and for the older adults who are not homeowners, keeping up with rent, keeping up with the house itself, really becomes a risk to health. How do we make sure there are affordable housing options?

You see the governor’s budget proposal for $250 million to purchase residential living facilities and dedicate them to older adults who either are at risk of homelessness or are homeless.

Q: What are some of the long-term goals?

The big issue for all of California is affordability. The governor has unveiled strategies around more housing, more housing, more housing and a range of housing in terms of families living together, caregivers living together, and affordable housing options. Older adults could either stay in the main house or move to a smaller unit. It just creates a whole lot of opportunities for those different ages and stages.

Getting health care costs and housing costs and care costs — the expense side of the ledger — down is incredibly helpful. But, the income has to somehow keep up to provide basic needs and basic quality of life. The SSI/SSP program is a top priority of our stakeholders, and there is a commitment to try to start walking that back up towards the federal poverty line and to begin to increase it in 2023. There’s a widespread recognition it is not keeping up with the cost of living, much less the federal poverty line.

Q: You say many older Californians have a hard time paying for the help and services they need as they age. Is it just too expensive?

“Expensive” feels like not a shocking enough word. In community forums, people cry about spending down their savings and their kids’ savings and they’re going bankrupt. It’s not hundreds of dollars. It’s in the five figures a month.

Q: How did the pandemic affect what you included in the plan?

We pivoted to check-in campaigns to call people and check in at home because we knew there were challenges around isolation or gaps in services. That check-in campaign was manual, list by list. So, one of the things we want to look at is how do we create more preregistration, more automated systems. All this calling and lists should not be a one-time thing, and, sadly, in California we need it for wildfires. Now we need it for vaccines. We may need it in an earthquake.

This pandemic had just a devastating impact on Black and Latino and South Pacific Islander communities. The catch line for the Master Plan became that equity is baked in; it’s not kind of the last paragraph. So, language access has become much more essential. Our department is doing a plan on diversifying our hiring and all the commission appointments. We just really need to do better.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.