COMMENTARY | COLUMNISTS | PAUL DOWNEY

Report would revamp state system of long-term senior care

California’s system of long-term care for older adults is broken, costly, fragmented, lacking leadership and has no mechanism of accountability or improvement. That is the disturbing conclusion of a report by the Senate Select Committee on Aging and Long-Term care entitled “A Shattered System: Reforming Long-Term Care in California.”

The report comes after a yearlong series of hearings and investigation by the committee under the excellent leadership of its chair, state Sen. Carol Liu, D-Los Angeles.

Long-term care is generally defined as support, often provided by family caregivers, which allows seniors to receive care at home rather than in an institutional setting. Some examples of assistance include eating, dressing, bathing, using the toilet and transferring from bed or chair. It can also mean help with housework, managing money, taking medication, grocery shopping and caring for pets.

The report minces no words in laying out what is wrong with the system: “Absent substantial reform of the state’s aging and long-term care system, the costs of over-institutionalization, lost productivity and degraded quality of life will far exceed the cost to implement integrated, evidence-based solutions. “

Liu and her colleagues offer a thoughtful and well-reasoned approach to creating an “ideal” long-term care delivery system through 30 specific recommendations. They argue California’s economic recovery provides the catalyst for building a system of care that meets the needs of seniors and will save the state money in the long run.

The recommendations are grouped into several areas:

State leadership: The report cites a “vacuum” of leadership and fragmented services spread over six different state departments. It proposes creation of a “czar” position to oversee an integrated approach to long-term care rather than the current piecemeal approach. A Department of Community Living would be created to develop a state long-term care plan and oversee its implementation.

Legislative Leadership: Most long-term care decisions are made in a budget context rather than a policy context, with several different committees in both houses having jurisdiction. The report proposes creating a standing Senate Committee on Long-Term Care and the Assembly Committee on Aging and Long-Term Care to have expanded jurisdiction. Each committee would have full oversight of the state’s long-term care services.

Fragmentation and lack of integrated data: The current fragmented system results in a lack of meaningful data to help policymakers make informed decisions. The recommendation would create a universal assessment to improve service delivery and allow development of quality measurements.

Infrastructure: Lack of funding has drastically affected the quality of access to services throughout California. The report recommends that the state’s Health and Human Services Agency establish uniform standards for safety net services, including identification of gaps.

Workforce: The increasing senior population in California – 5.1 million this year and growing to 8.4 million in 2030 – will create growing demand for trained caregiving professionals. The report outlines a strategy to analyze workforce needs, including family caregiving, to ensure the best possible care is given in home settings whenever possible.

Funding: The long-term care system has been devastated by years of budget cuts. The report calls upon the Legislature and governor to make care for seniors a priority in the state budget. It notes failure to do so would mean “consumers, families, and, ultimately, society as a whole will bear the brunt of a dysfunctional system.”

Recommendations would also improve integrating the Coordinated Care Initiative for dual eligible (Medicare and Medi-Cal) seniors and working on federal issues that have a direct impact on care, such as reauthorization of the Older Americans Act.

Liu and the Senate Select Committee deserve major kudos for their comprehensive and bold approach to fixing this “shattered” system of care. This report will not be gathering dust on a shelf in the capital.

Liu is working with the bipartisan Women’s Caucus in the Legislature to carry bills relating to each of the recommendations. Her goal is to have each of the 30 recommendations enacted in 2015.

Politicians often talk a good game when it comes to seniors. Liu has significantly upped the game by putting forth realistic and rational proposals. The unanswered question is whether Gov. Jerry Brown, age 77, and the Legislature have the political will to stop talking and start doing.


Downey is president and CEO of Serving Seniors, a nonprofit agency dedicated to increasing the quality of life for San Diego seniors living in poverty. Learn more at www.servingseniors.org.

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