Influencers Opinion

How should we care for the state’s rapidly-growing senior population?

‘California Priorities’ panel examines health and care for seniors

At a Focus on Health Care program hosted by The Modesto Bee, local and state experts discuss issues and solutions tied to our families — most specifically, our children and seniors.
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At a Focus on Health Care program hosted by The Modesto Bee, local and state experts discuss issues and solutions tied to our families — most specifically, our children and seniors.

Note to readers: Each week through November 2019, a selection of our 101 California Influencers answers a question that is critical to California’s future. Topics include education, healthcare, environment, housing and economic growth.

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California Influencers this week answered the question: How will we care for California’s rapidly growing senior population? Below are the Influencers’ answers in their entirety.

We need to act now before it’s too late

Kassy Perry - President and CEO of Perry Communications Group

California is graying, and as a typical Hollywood starlet she’s in denial. Unless we face reality and make significant changes to the way we provide services and address the needs of the growing senior population, California will see generational poverty the likes of which we have not seen since the Great Depression.

Aging is everybody’s business and the services needed to prevent skyrocketing poverty rates among our seniors require the attention and coordination of all government agencies. In transforming our system, we must consider marginalized communities, transportation needs, affordable and accessible housing, health care and long-term care services, as well as infrastructure and financing challenges.

At the urging of senior stakeholders and We Stand With Seniors, Governor Newsom issued an executive order calling for a Master Plan for Aging. That’s a start, but the hard work is still to come.

“Women are often expected to shoulder the care of children and the elderly in their family”

Richard Pan - California State Senator (D-Sacramento)

Thanks to advances in modern medicine, people are living longer and more productive lives. In addition, families are having fewer children leading to a rapidly growing senior population with a smaller workforce in proportion. Women are often expected to shoulder the care of children and the elderly in their family, but this is not sustainable or equitable. The State Senate has been working on this issue, including the work of Senator Liu’s Select Committee on Aging and last year’s informational hearing of the Budget Subcommittee on Health and Human Services I chaired on the impact of the aging population on the state budget.

With the support of the California Aging and Disability Alliance, I authored SB512 to develop a benefit for middle class families to fund long term services and supports for their loved ones. I welcome Governor Newsom’s leadership in developing a master plan on aging, and I look forward to working with the administration on this critical issue.

Planning ahead is vital to providing quality care to California’s seniors

Marie Waldron - California State Assemblywoman (R-Escondido)

First and foremost, we need a strategy for how we will care for our state’s aging population. This is an extremely important issue, and a trial-and-error approach to it just won’t work. That’s why I support Governor Newsom’s proposal to create a Master Plan on Aging. This will create a comprehensive plan to provide a trained workforce, adequate funding and an understandable benefit system to ensure seniors get the services they need. Navigating our healthcare system can be daunting and making sure seniors get timely referrals to specialists, test results and records management that are in synch with appointments would greatly help ensure quality in senior care.



Our work to improve access to care for California’s entire population will also yield important benefits for our state’s seniors. Expanding the use of telemedicine will help people with limited mobility stay connected with their health care providers. Encouraging preventative care and wellness programs will reduce chronic illnesses and the costs associated with treating them. Other reforms to improve care and reduce costs will allow us to use our limited resources more efficiently so we can provide care for everyone who needs it.

“California should take additional steps to hold the health industry accountability”

Anthony Wright - Executive Director of Health Access California

The projected growth of California’s senior population highlights the urgency to reform our health system. Since they need care the most, seniors feel our system’s inequities most acutely.

California should be proud that this last state budget eliminated the so-called “senior penalty” in Medi-Cal, bringing the income eligibility threshold up to the same level as those under 65. The additional affordability assistance to buy a health plan through Covered California will disproportionately help those approaching 65, who face premiums as much as three times as much as a 20-year-old.

But there’s more to fix in the future — additional investments to prevent seniors from ‘yo-yo”ing on and off Medi-Cal or other coverage programs, and expanding Medi-Cal to all income-eligible seniors regardless of immigration status.

These steps would make our health programs more inclusive, but the real reform that seniors need, in Medicare, Medi-Cal and/or private coverage, is the transformation of the health system to be more transparent, simpler, integrated and patient-focused. California should take additional steps to hold the health industry accountability for better quality and outcomes. Creating a better system for our seniors can help make our health care work better for everyone.

Get ready to take the wheel, millennials…

Robin Swanson - Swanson Communications

It’s hard to imagine that in just over a decade, our 60-and-over population will be 40% larger than it is now. This creates a whole host of issues we’ll need to address; and there clearly is not one easy answer for addressing this drastically graying population shift.

Governor Newsom’s call for a “Master Plan for Aging” may sound academic, but in truth, is a clarion call that we’re all going to be paying for an aging workforce and growing demands on our already overwhelmed health care system. Of the many troubling statistics California is facing, one of the more shocking revelations is that our state will need to recruit 9,000 more doctors to care for this population by 2030.

As Californians, we’re simply going to need to re-shift our priorities, and our finances, to address the math that just won’t add up otherwise. The good news is that older populations vote; so I’m actually not worried about this generation not having a voice. The real question is whether the younger population that will be footing the bill for their aging parents and grandparents will step up to the plate. Will they enroll in our health care exchanges so the system of pooled insurance doesn’t crumble? Will they train to be nurses and doctors who can treat the aging population? Will they create a sustainable and growing economy so that the pie is big enough for all? And will they take in their aging parents as the need arises? Time will tell, and as always, necessity will be the mother of invention.

“Our growing number of seniors deserve a life with dignity and connection”

Chet Hewitt - President and CEO of the Sierra Health Foundation

The urgency of effective action on behalf of California’s oldest residents is clear: by 2030, California will be home to 9 million seniors, and have a larger proportion of seniors than Florida.

These Californians, known as Baby Boomers, are healthier and living longer. But a closer examination reveals that not all seniors are doing well, and all of them are going to require increasing support.

California seniors’ average annual income is $25,000; one third don’t have enough income to meet their basic needs. We need to emphasize affordable senior housing (independent and assisted living) and quality nutrition. With the largest increases in senior populations in inland areas, we also need to build and ensure access to affordable public transportation.

Californians seniors will spend 20% of their remaining years with a major disability. A focus on expanding California’s IHHS program can meet their needs, and provide necessary employment for Californians.

The planning process for Governor Newsom’s Master Plan on Aging must be inclusive, visionary, and move quickly to action. Our growing number of seniors deserve a life with dignity and connection.

“It is imperative that California invests in behavioral health services”

Le Ondra Clark Harvey - Director of Policy and Legislative Affairs for the California Council of Community Behavioral Health Agencies

It is estimated that by 2030, there will be an increase of four million adults over the age of 65. The demographics of the population are changing as there are more Latino and Asian, and divorced and separated older adults than ever before. Additionally, 15 percent of older adults suffer from a mental disorder. These factors impact the demand for health care services, housing facilities, nursing homes, senior centers, in-home and community-based services.

When behavioral health services are examined, there is a paucity of professionals who have been trained and are available to address the needs of older adults. As such, it is imperative that California invests in behavioral health services, and the workforce who must meet their needs. It is necessary to educate the public about behavioral health careers, expand and provide additional funding for the growth of community college certification programs including peer providers and community health workers, Masters and Doctoral level training programs, and practicum and internship training sites. Governor Newsom has taken a step in the right direction by commissioning the Master Plan for Aging which will help provide a roadmap for how to provide the best care for older adults in California, and it is imperative that it includes a focus on behavioral health care.

Together we must engage to build an age-friendly California

Mark Ghaly - Secretary of the California Health and Human Services Agency

Spending our golden years in the Golden State should be a time of possibility, joy, and vitality, not one of poverty, displacement, and isolation. The Governor has called on all of us to come together to develop a Master Plan for Aging that will take a comprehensive look at the multifaceted issues facing older Californians and lays out a long-term plan that seeks to ensure Californians age with dignity.

The research is clear. Food insecurity and social isolation lead to health problems such as depression, heart disease, and other stress-related illnesses. Similarly, a growing number older Californians are homeless and are battling complex health conditions. Yet the current patchwork of services are not person-centered nor do they attempt to address the holistic needs of the individuals or their caregivers.

Government cannot do this alone. It is our collective responsibility to build an age-friendly state. This is why we must find the courage to put forth new, bold and collaborative ideas, while having the humility to listen and learn from each other. I challenge you to join us in building a California Dream that is inclusive of our older and disabled neighbors. Let us roll-up our sleeves and get to work.

We need to “focus on empowerment rather than frailty”

Jeannine English - Former National President of AARP

Longevity is here to stay, due in large part to the unprecedented increases in life expectancy. We must embrace this opportunity.

And Singapore is a great model, for us to consider. They focus on empowerment rather than frailty. Their seniors are not considered a drain on society but rather an opportunity for the community to benefit from their wisdom, and judgment.

We need to design solutions to benefit all society and take advantage of this immense human capital. We should quit focusing on the challenges of supporting the frail and elderly and instead build a society that supports people throughout their lifespans.

Multigenerational teams are more productive so we should incentivize those companies that develop inclusive, multigenerational hiring practices. And to ensure that our healthspan equals our lifespan we need to provide health insurance for all that is comprehensive and affordable. To do this, much like Singapore, we need to redesign our institutions and policies to accommodate the way people actually live their longer and, in many instances, healthier lives.

Guaranteed long-term care is the answer for seniors, families. We can achieve this with Medicare for All.

Bonnie Castillo - Executive Director of the California Nurses Association and National Nurses United

Nurses know that California’s skyrocketing older adult population — and their unpaid family caregivers (often women who are forced to leave the workforce) — face an alarming future if we do not see meaningful, systemic change statewide and nationally.

The Medicare for All Act of 2019 addresses this crisis by guaranteeing long-term services and supports (LTSS) — a critical benefit for seniors and people with disabilities. Medicare for All’s guaranteed LTSS includes nursing and medical services, long-term rehabilitative and habilitative services, and daily life supports, with an emphasis on services provided at home and in the community. And there are no copays, deductibles and premiums that can wipe out a life savings overnight.

In our current system, LTSS is usually not covered by private insurance or existing Medicare, and few people can afford these services out of pocket. According to a 2018 survey, the average annual cost of a home health aide in California is $59,488, and a private nursing home room averages $117,804. Seniors can access LTSS through Medi-Cal, but with strict income and asset limits, they are often forced into poverty to qualify.

Enough is enough. It’s time to pass Medicare for All, to ensure a supported, empowered future for California’s seniors

“Implement the Master Plan, and invest in the health workforce career pipeline”

Robert Ross - President and CEO of The California Endowment

I have three words in response to the matter of our state’s growing senior population: The Health Workforce.

We at The California Endowment partnered with the California Health Care Foundation, The California Wellness Foundation, the Blue Shield of California Foundation, and the Gordon & Betty Moore Foundation to support a statewide Commission – of health system executives, university and community college leaders, physicians and nurses – about our state’s health workforce, and their report can be found here. In sum, we now have a master plan to address the issue, but it’s implementation will require a public-private partnership, leadership, and resources in the decade to come to fully implement.

While the projected health workforce needs for our aging population are troubling (we’ll need an estimated 600,000 or more new workers in the decades ahead), here’s the good news: we receive a double-bottom line return by investing in the pipeline to produce these health workers. The obvious benefit is that our aging community receives the care it needs, but health career investments can also be an important economic driver for the state. These jobs generally offer between livable and middle-class wages, typically come with benefits, have career ladder opportunities for advancement, and tend to be resistant to being outsourced overseas, “droned”, or automated.

With the political and civic hair-pulling and anxiety about “where will good jobs come from?” – the health workforce opportunity is staring us right in the face. Our young people badly need these opportunities, and we aging baby boomers need these young people. Implement the Master Plan, and invest in the health workforce career pipeline.

The answer is “better quality care, with less cost and inconvenience”

Carmela Coyle - President and CEO of the California Hospital Association

We will care for older adults the way they want to be cared for — in the least intrusive and most convenient settings possible.

The number of Californians over the age of 65 is expected to nearly double within the next decade — to nearly 9 million people by 2030. While there will always be a need for acute and emergency care for very serious conditions, the aging of our population demands that we radically innovate the way we provide care.

Technology that monitors vital signs and chronic health care conditions catches problems early and prevents conditions from worsening. This makes for better quality care, with less cost and inconvenience.

Pair that with some of the new health care workers of the future — people specially trained to work in the community and in peoples’ homes — who can link older adults with their doctors between visits, monitor their well-being and keep them connected with their communities.

Governor Newsom’s recent call for a Master Plan on Aging offers a tremendous opportunity to explore new ideas and non-traditional partnerships aimed at keeping seniors healthy and active. It holds the promise to provide a roadmap to a healthy California for all ages.

“We must shift our mindset to provide scalable access to appropriate care “

Joseph Alvarnas - Vice President of Government Affairs and Senior Medical Director for Employer Strategy at City of Hope

By 2030, the number of seniors in California will grow by 4 million people. This will present challenges that California will need to navigate, including ensuring that our state does a better job of managing the expertise gaps that patients encounter when getting care for conditions that become more common as people age, such as cancer. At the Center for Cancer and Aging at City of Hope, we have found that caring for senior cancer patients requires a special skill set to ensure that care and quality of life issues are appropriately managed. The Center established a geriatric assessment that analyzes aspects of a senior’s life, helping tailor treatment for each individual, and has also increased senior participation in cancer clinical trials. Far too few Californians get this level of cancer care today. As the senior population of California grows, we must shift our mindset to provide scalable access to appropriate care especially in cancer where prevalence grows with age. Nearly 70% of all cancer cases occur in people over 50. As we all age, our leaders must invest carefully in the health and care of our seniors for the benefit of our entire population.

“Caring for our senior population will take a holistic approach”

Zach Friend - Second District Supervisor for Santa Cruz County

It’s estimated that over the next 15-20 years our state’s senior population will nearly double.

While health care is a significant challenge, it can’t be viewed in isolation. In Santa Cruz County, over 25,000 seniors do not have enough income to pay for their basic needs. Many seniors have fixed incomes but expenses are not fixed. Rising housing costs which has increased homelessness in people age 50 and up, and rising medical, dental, transportation and food costs all are having a significant impact. According to a recent local survey, 90 percent of local Meals on Wheels participants say there’s a time each month when they don’t have enough money for food. And more than 1 in 3 seniors cited concerns about isolation and mental health challenges.

Caring for our senior population will take a holistic approach. Ensuring housing stability for healthy and safe aging in place, increasing senior-specific affordable housing, social safety net programs for food and transportation, improving access to dental care and behavioral health programs all provide the stability that is essential for mental and physical health - and are key steps to ensuring we take care of a population that has taken care of us.

“It’s time for a Master Plan for Aging in California”

Bruce Chernof - President and CEO of The SCAN Foundation

It’s time for a Master Plan for Aging in California. Compared to other states, California has a relatively young population that’s about to gray rapidly, and we are woefully unprepared. The state’s approach to aging services is a six-decade collection of well-meaning but one-off programs that are siloed from one another. They are provider- or funding-stream centric and not person-centered. Many of them have waiting lists that are months long. Thankfully, Governor Newsom recognized this potential catastrophic challenge by calling for the creation of Master Plan for Aging. Executive Order N-14-19 recognizes that ALL Californians will age and the reality is, most all will have needs. Thus, future solutions must involve state and local government, and the private sector as well as philanthropy to build a model that helps all Californians age with dignity, choice, and independence.

Dan Schnur, a veteran analyst and longtime participant in California politics, is director of the California Influencers series for McClatchy.
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