By Eli Gelardin, Marin Center for Independent Living Executive Director
The Wheel is Broken
At this year’s AAI Convening, we had a dynamic discussion on Governor Newsom’s Master Plan on Aging (MPA). Recognizing that California’s older adult and disabled population is anticipated to grow to 8.6 million residents by 2030 (an increase in 4 million), Governor Newsom singed an executive order in June 2019 calling for a stakeholder advisory committee to present a draft Master plan on Aging by October 2020. The recommendations address four broad goals: Long-Term Services and Supports, Livable Communities, Health and Well-Being, and Economic Security and Safety and came with over 800 policy recommendations. Of these recommendations, two major themes emerged: 1) the need for the development of a coordinated system to expand access to long-term services and supports (LTSS) and 2) the need for the development of a financing mechanism to pay for LTSS and break the cycle of poverty for individuals who are aging, disabled, and/or caregivers.
Expanding a Coordinated System of LTSS
Access to long term services and supports (assistive technology, caregiving, care coordination, food access, housing, transportation etc.) is critical in order to keep Californians living safely in the community. Presently, our LTSS system is fragmented and difficult to navigate (2015 Senate Select Report, The Shattered System). To address this barrier, the MPA calls for a coordinated system of community-based long term services and supports that must ensure that individuals can choose where to live and provides access to the services and supports they need to honor their values and preferences. On the local level, a coordinated system of care means person-centered services that are coordinated by public, private, and healthcare partnerships.
A local example of this improved coordination is seen in Marin’s “One Door” Aging and Disability Resource Connection, a partnership between Marin Center for Independent Living and Marin County’s Aging and Adult Services and other key stakeholders that ensures older adults and individuals with disabilities get the services they need, without bouncing back and forth between multiple LTSS providers.
Financing Long Term Services and Supports
California faces an unprecedented crisis related to the financing of long-term services and supports. Typically, when paid services are needed, most Californians do not have the financial resources or reserves to cover these costs on an ongoing basis. Facing limited options, many older adults and individuals with disabilities are forced to spend down their life savings to qualify for public benefits. California’s In Home Support Services and other Medi-Cal waiver programs that support low-income older adults and individuals with disabilities such as Adult Day Health Care and Multi-Senior Services Program were not designed to accommodate an influx of 8 million additional recipients.
State leadership and action will be necessary to establish a new universal benefit that offers a flexible range of benefits that is sustainable and enables families of all incomes to plan and pay for their daily care needs both now and in the future. In addition, an LTSS benefit will provide a much-needed investment into building the infrastructure of the caregiver workforce. According to a PHI national, a majority of direct care workers are women, people of color (59%), and have a median wage of $12.27. Most caregivers do not receive health insurance, opportunities for professional development, or retirement planning. Investing in a care economy will provided a much-needed access to both individuals who receive care and equity for those that provide it.
COVID has spotlighted the consequence of a broken system and the dire impact of congregate living on isolated older adults, individuals with disabilities, and the caregiver workforce that supports them. According to the Kaiser Family Fund, COVID has accounted for more than 70,000 deaths of residents and staff as of mid-August and overall, people in long term care facilities make up 8 percent of coronavirus cases but 45 percent of all deaths. We cannot afford to force more individuals into social isolation and congregate living. While the wheel of LTSS is broken, the state’s Master Plan on Aging provides a starting point for solutions. It is time to roll up our sleeves and get to work on fixing it.
Eli Gelardin serves as the CEO of the Marin Center for Independent Living (Marin CIL). For the past 41 years Marin CIL has provided person centered services and advocacy to Marin’s aging and disabled communities with the goal of promoting equity & independence.