Senate Select Committee on Senate Select Committee on Aging Aging and Long Term Care and Long Term Care

Final Report and Progress in Final Report and Progress in 20152015

Suzanne Reed, Chief of StaffSenator Carol Liu (Chair)Suzanne.Reed@sen.ca.gov

IssuesIssues2030: 20% of Californians will be 65

or olderOur population is increasingly diversePeople are living longer70% will need LTSS85+ (fastest growing segment of the

U.S. population) are 4X more likely to need LTSS than those age 65 to 84

Few people engage in advanced planning

WE AREN’T PREPARED!

ProblemsProblemsNo person-

centered, individualized care

Poor transitionsLimited access to

a range of services, especially in rural areas

Lack of cultural competency

Lack of skilled workforce across range of disciplines

No uniform dataNo Universal

Assessment tool Limited caregiver

supports

The Current SystemThe Current SystemFails to organize around

consumer needsIs plagued by fragmentation and

years of budget cutsIs difficult, if not impossible, to

navigate and accessLacks systematic and integrated

data collection and evaluation

State A & LTC ProgramsState A & LTC Programs

Current Service Delivery Current Service Delivery

Trying to Navigate the Trying to Navigate the SystemSystem

Establishing a New Establishing a New Structural VisionStructural Vision•What values underlie an IDEAL system?•What is the IDEAL system?•What are the essential components?•What are the major barriers & challenges?•How do we achieve the IDEAL?

Underlying Values:Underlying Values:• Age appreciated as a stage of life, not a social problem or

disease• Consumer centered/family focused• Culturally competent and linguistically accessible• Community based• Workforce trained in gerontology and geriatrics, in-home

health care career ladder• Systems that support interagency cooperation,

collaboration, and partnerships• Outcome and data driven accountability• Caregivers recognized and supported as part of the system• Preventative care, aging in place supports and LTSS

The IDEAL:The IDEAL:• Integrated senior services

with single point of entry and smooth transitions• Universally available and

sustainably funded system• Coordination across and

within state agencies and departments• Cost effective and

data/outcome-driven policies, programs and services• Parity of services in urban

and rural settings• Caregiver support

• Regional collaboration as the foundation of a statewide infrastructure

• Housing and mobility needs reflected in state/regional/ local plans.

• Trained workforce funded through public/private partnerships

• Culturally sensitive and compatible care

• Protections against fraud and abuse

• Strong consumer advocacy

Essential ComponentsEssential Components• Holistic approach through a

continuum of care

• Respect and social inclusion

• Communication and information on available health and social services

• Civic participation and employment opportunities

• Adequate and trained workforce

• Caregiver support services

• Cultural and ethnic considerations and linguistically accessible services

• Preventative information, care, and opportunities

• Public/private solutions for long-term care insurance

• Affordable housing, transportation oriented development, and home to office transportation services

• Universal design of buildings, outdoor spaces, and homes

• Effective use of technology

What is Missing?What is Missing?Coordinated

policy-making (Executive Branch and Legislature)

Statewide capacity to deliver services equitably

Data and system-wide planning

Workforce Cultural

CompetencyStrong advocates

with shared agenda/messages

Political leadership

Public awareness

Achieving the IDEAL:Achieving the IDEAL:• Raise awareness and build on the idea of shared risk• Shine a light on the current system’s dysfunction • Make aging and long term care a state priority• Improve data, monitoring, and oversight• Increase focus on prevention, aging in place• Improve access to and quality of older adult services

statewide• Reform Long-term care financing• Advocates develop a shared agenda

We have the population. We have the expertise. We know the needs. We know the challenges. We know what has to be done. What we need is the political will to do it..

ProgressProgressLegislative Package

37 bills introduced, 17 authors, 13 signed into law, 3 vetoed, several still pending

Committee Consultant collaboration Senate and Assembly consultants to

committees with A & LTC jurisdiction are coordinating on policy

Regional Capacity◦ Local events to encourage collaboration, the

statewide Collaborative, SCAN Foundation

Long Term Care FinancingLong Term Care Financing• LeadingAge – Hosted 3 facilitated sessions with

A & LTC stakeholders and policy analysts • 6 possible approaches developed• Senate Select Committee on Aging and Long

Term Care collaborative working group will continue to: Seek input Address regulatory issues (state and federal) Address political feasibility issues Refine proposal(s) Draft, introduce, advocate for, and advance

legislation

WorkforceWorkforceAccording to PPIC*: Over the next decade, California’s health workforce

is expected to require almost 450,000 new workers—mostly due to population growth and aging

40 percent of health care jobs to be filled over the next decade will require some college but less than a B.A.

California’s two-year higher education institutions need to provide training opportunities for jobs that are well matched with future workforce demand.

*http://www.ppic.org/content/pubs/rb/RB_914SMRB.pdf

WorkforceWorkforceSelect Committee Report* Recommendation:California LTC Plan that includes analysis of LTC

workforce needs, outlines training and education requirements, and aligns resources accordingly (p. 18)

Include primary care physicians (including osteopathic physicians), geriatricians, registered nurses, nurse practitioners, pharmacists, direct care workers, mental health and social workers

Examine career pathways and scope of practice.Address cultural competency*http://archive.senate.ca.gov/sites/archive.senate.ca.gov/files/committees/2013-14/

committeepages.senate.ca.gov/agingandlongtermcare/AgingLong%20TermCareReport.pdf

Workforce ActivitiesWorkforce Activitieshttp://doingwhatmatters.cccco.ed

u/ http://doingwhatmatters.cccco.ed

u/Portals/6/docs/SW/BOG_TaskForce_Report_v12_web.pdf (2015)

http://aebg.cccco.edu/http://www.oshpd.ca.gov/Reform/

CareerPathwaySubCommitteePhase2FinalReport.pdf (2012)

Workforce Activities Workforce Activities (cont’d.)(cont’d.)WIOAincrease access to education, training

and employment, particularly for people with barriers to employment

create a comprehensive, high-quality workforce system by aligning work force investment education and economic development statewide and regionally

www.edd.ca.gov/Jobs_and_Training/Workforce_Innovation_and_Opportunity_Act.htm

ConclusionsConclusionsAging and Long Term Care workforce covers a

broad spectrum of disciplines (including care coordination and case management) and levels of education and training

Meeting 21st Century health care workforce needs should be a high priority statewide goal

Identifying needs and aligning resources efforts are happening at a regional level

Engagement in regional activities is needed from all segments of education and training and the full range of service providers

Health care work should be a career, not just a “job.”