-Seniors will be CA’s fastest growing population
-Between 2018 and 2026, Californians 65+ will grow to 2.1M
-CA needs to focus on budget and policy planning for graying of CA (services, budget)
-Burden on fragile network of long-term services and supports (IHSS aides; skilled nursing facilities)
-Issues: Higher Healthcare Costs (low-income seniors on Medi-Cal) – 1.2M 65+
-Issues: Poverty from 2014 to 2016 was 20% for seniors (US Census Bureau’s Supplemental Poverty Measure)
-Issues: Homelessness in LA County 62+ surged by 22% in 2018
-Issues: As population of low-income seniors grows, demand for safety-net will rise
-Issues: Retiring government workers – needing additional $230B over 30 years to cover pension and healthcare
-Issues: Revamping transportation system – people no longer can drive
-Issues: Housing – ADA compliant
-Issues: Air quality – typically, issues increase over 65
-Medi-Cal – Department of Health Care Services
-In-Home Supportive Services Program – Dept of Social Services (by each county)
-Caregiver resources – Department of Aging
-Aging Vets – Department of Veterans Affairs
Medicare: The federal healthcare program for seniors (doesn’t cover long-term care).
Medicaid: The federal program provides health coverage to low-income seniors. About 8.3 million seniors are enrolled in both programs.
Medi-Cal: California’s Medicaid program, which covers long-term care.
California Department of Aging: Provides resources to caregivers and seniors.
California Department of Veterans Affairs: Operates homes for aging vets.
In-Home Supportive Services: Pays for home care for Medi-Cal eligible seniors and disabled people.
The high cost of aging in California
$116,000: Median yearly cost for a private room in a nursing home
$57,200: Median yearly cost for a home healthcare aide
$2,956: Average basic monthly living costs for an older couple (with a mortgage)
$3,700: Average annual premium for long-term care insurance for a 65-year old couple
$11: Average hourly wage for In-Home Supportive Services workers
Sources: Genworth, AARP, Department of Aging
By many measures, California is not ready to meet the demand for long-term care. Just under 2% of residents are insured for it, according to the state Department of Insurance. A 2014 poll found that just 3 in 10 Californians over age 40 felt very confident about their ability to pay for future care. And the Employment Development Department projects that the state will need 250,000 more personal care aides by 2026, a growth rate of 40%.
Nancy McPherson, the California state director for AARP, said long-term care is the No. 1 issue for the retiree advocacy group.
“It’s not enough to have service delivery,” McPherson said. “You need to have a coordinated system, and you need to have a means for middle-income Californians to get the support they need.”
Though wealthy Californians can rely on long-term care insurance or ample savings and the poorest can qualify for safety-net programs, the middle class is especially vulnerable when it comes to paying for care. The out-of-pocket costs can be staggering, and Medicare, the federal healthcare program for seniors, does not cover long-term care. A 2017 survey by Genworth, a long-term insurance company, found the average yearly cost for a home healthcare aide was $57,200. The median cost for a private room in a nursing home was more than $116,000.
Lower-income Californians have some relief through Medi-Cal, which covers long-term care — including an estimated $13 billion in costs this fiscal year for nursing facilities and home-based aides. A key part of that safety net is the state’s In-Home Supportive Services program, which advocates for the aging credit with enabling seniors and disabled residents eligible for Medi-Cal to stay in their homes and receive paid care, usually from a family member. But the $11.6-billion program, which is jointly funded by the federal government, the state and counties, has been a frequent subject of recent budget squabbles. The cost of IHSS, like other social services programs, is partly driven by caseload — as long as someone meets the eligibility requirements, they’re entitled to care. Caseload has increased by 30% in the last 10 years, and funding out of the state’s general fund has nearly doubled in that time, driven by clients needing more paid hours of care as well as minimum wage and overtime pay for workers. The spiraling costs are just one reason for concern. Advocates for the program say it is increasingly difficult to find enough caregivers to meet participants’ needs, even when a county determines a client is eligible for a set number of hours of care.