Turning the Corner on LTSS for California Seniors ?

When I learned that Senator Pan,  Chair of the Senate Budget Health and Human Services Subcommittee, had scheduled  the informational hearing “The State of Long-Term Services and Support for California Seniors," I thought, maybe we "doom-sayers" had turned a corner in achieving legitimacy! What else could it mean when you had advocates and State officials who provide many of the services utilized by older adults coming together at the request of the Legislature? I choose to believe the November 15th hearing is a sign that the State Legislature is poised to address long-term services and supports (LTSS) as a priority and an indication of much-needed political will.

As the Executive Director of the California Long-Term Care Ombudsman Association, I was fortunate to have been included as a reactor panelist.  The hearing was opened by Sarah Steenhausen, Senior Policy Advisor with the SCAN Foundation. I don't think she was overly dramatic when she titled her presentation "The Perfect Storm" and explained why our rapidly increasing aging population, while living longer, is not always living longer with independence.

Peter Hansel, Chief Executive Officer for CalPACE, gave an update on the 2020 and 2023 California Health Interview Survey, which, for the first time, will include questions on LTSS. The questions, Hansel pointed out, will identify the "how, when and where" Californians currently access LTSS and the reasons they do not. It was encouraging to hear Senator Pan, a self-proclaimed "data geek," declare that data will be vital to enable the State to adequately budget for this growing population, while  cautioning against kicking the can further down the road awaiting survey results.. 

 It was encouraging to hear Senator Pan, a self-proclaimed "data geek," declare that data will be vital to enable the State to adequately budget for this growing population, while cautioning against kicking the can further down the road awaiting survey results. 

The Legislative Analyst’s Office and the Department of Finance provided actuarial charts that affirmed older adult advocates’ claims of current and future service program overload. The directors from Health Care Services, Social Services, and the Department of Aging shared what advocates know: California is fortunate to have some excellent LTSS service programs: PACE, IHSS and the other MediCal waiver programs and managed care systems, CalMedi-Connect, MSSP, CBAS, PACE, Linkages, and advocates like HICAP, APS, and LTC Ombudsman Programs. But the current lack of affordable LTSS options for the middle class is leading to financial impoverishment, and resulting in the over-utilization of Medi-Cal, the payer of last resort, which is unsustainable.

Also needed are more workers and career pathways that make hands-on care a desirable occupation. We also have to address the lack of coordination between medical and social service programs. Too much of our service delivery system is siloed, failing to accommodate health needs separate and in combination with the on-going functional needs of older and disabled adults.  The fragmentation of services causes confusion, delays, and duplication of efforts, unnecessary gaps in services, and greater reliance on hospitalization from potentially preventable events.

We advocates echoed each other's urgent requests to prioritize LTSS in the state budget. After years of flat funding and yet to be made whole after the budget cuts of a decade ago, many LTSS programs are ill-equipped to handle current and growing caseloads. ​

As I pointed out in my closing, we might be better off than I'd feared. We have effective, cost-efficient service models. But to be successful, we have to set priorities at the state and county levels to address pent up needs and anticipated growth. If we enhance LTSS programs, replicate successful models and make them available in all counties, and sufficiently resource them,  I remain hopeful for Californians in our "golden years."

About the author

Leza Coleman

Leza Coleman is the Executive Director of the California Long-Term Care Ombudsman Association (CLTCOA).  CLTCOA is a non-profit, membership-based association, dedicated to improving the accessibility and quality of long-term care ombudsman services for elders and vulnerable adults living in nursing homes, residential care facilities, and other long-term care facilities across California. The author describes herself as an unapologetic advocate for the frail and vulnerable, whose children joke about how long she can go without talking about older adults and their needs.