Long-term care reform package making its way through Legislature

Long-Term Care Reform Package Making Its Way Through Legislature

Monday, April 27, 2015

California Healthline -- California legislators are considering a package of 24 bills this session collectively aimed at improving the state's support network for aging services and long-term care.

The bills -- 12 in the Assembly and 12 in the Senate -- deal with a variety of issues involving some of the 112 separate programs for aging and long-term care overseen by 20 different agencies and departments in the state and county governments.

Many of the reforms are in response to a report by the Senate Select Committee on Aging and Long Term Care, which spent more than a year reviewing services for older people in California. The committee's report -- "A Shattered System: Reforming the Aging and Long Term Care System in California" -- contends that the state's disparate efforts to support aging Californians are disjointed and less effective than they could and should be.

The bills from more than a dozen lawmakers range from sweeping reforms, such as those proposed by Sen. Carol Liu (D-La Cañada Flintridge), to specific, finite changes, such as a 60-day limit for investigating nursing home complaints and broadening the scope of practice for nurse practitioners.

Liu, chair of the Senate Select Committee on Aging and Long Term Care, introduced legislation that would create a new HHS department -- the Department of Community Living, create a new post -- Assistant Secretary of Aging and Long Term Care, and develop a state Aging and Long Term Care Plan. Another Liu bill calls for the creation of a statewide web portal linked with regional websites giving consumers and caregivers information on aging and long-term care services and supports.

We asked stakeholders and legislators to assess the package -- either collectively or as individual bills.

We got responses from:

Sen. Carol Liu (D-La Cañada Flintridge) |Chair, Senate Select Committee on Aging and Long Term Care

Need for Change Is Great and Growing

California is the most populous state in the nation with just over 38.3 million residents. It is anticipated that this number will increase by 27% over the next 20 years, in part due to the size and longevity of the aging population.

The Senate Select Committee on Aging and Long Term Care, which I chair, has developed a package of legislation for the 2015-2016 legislative session. These bills will help implement recommendations made in our comprehensive report. The need for positive change is great, and the need will continue to grow.

In 2011, the largest generation in history -- the baby boomers -- started turning 65, resulting in a rapid increase in the number of older Americans in the United States. In California, the number of individuals age 65 and older is projected to increase almost 100% over the next 20 years, from 4.41 million in 2010 to 8.4 million in 2030.

All told, the increase in both the aging population and the working-age adults with disabilities compounds the need for a comprehensive system of long-term care services. Alzheimer's disease and other dementias are increasing in prevalence and California will see a doubling of the number of residents with these conditions by 2030, from 588,208 Californians in 2009 to more than 1.1 million in 2030.

Not only is the California population aging, but it is also becoming more racially and ethnically diverse. At the time of the 2000 census, 70% of seniors were white, 13% were Latino, 10% were Asian and 5% were African-American. By 2020, white seniors will be 50% of the aging population, with Latinos at 27%, Asians at 15% and African-Americans at 5%.

The increasing diversity of the state's senior population will have important implications for how long-term care services will need to be organized and delivered to ensure that they are culturally appropriate and available in local communities across the state. As the package of bills moves forward, I look forward to working with all concerned parties as we find better ways to care for our aging population.

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Assembly member Cheryl Brown (D-San Bernardino)|Author, co-author of several aging and long-term care bills

Stakeholder Work Group Exploring Options

Over the past decade, numerous reports, hearings and legislative proposals have highlighted the deficient, often duplicative and unsustainable characteristics of California's fragmented approach to delivering long-term services. With roughly 1,000 baby boomers turning 65 every day for the next 14 years, further inaction will have negative economic and social consequences.

Based upon recommendations from a report by the Senate Select Committee on Aging and Long-Term Care, "A Shattered System: Reforming Long Term Care in California" Legislators have responded by introducing dozens of legislative initiatives to transform our existing long-term services and supports into a functional and efficient system that meets clients' needs and protects the state from unnecessary costs.

Bills addressing more frequent or more thorough facility inspections, long-term care financing, universal assessment, increased community-based services options, caregiver data collection and establishing Community Based Adult Services in statute all passed Assembly policy committees this past week.

The Assembly Committee on Aging and Long Term Care, in partnership with the Senate Select Committee on Aging and Long-Term Care and the Senate Human Services Committee, held the first of multiple informational and oversight hearings to investigate the needs associated with financing long-term service. The hearing reviewed the state-level needs to accommodate a rapidly expanding cohort of impoverished elders who will likely be dependent upon social services, as well as middle-class options for consumers concerned about the long-term care insurance market. As a result, an informal stakeholder workgroup has undertaken preliminary efforts to explore long-term care financing models in other states. Options under consideration and study by the group include:

The Japanese model which established a broad-based worker mechanism;
Hawaii's burgeoning model; and
Recommendations advanced by the bipartisan long-term care commission.

The workgroup will continue investigating options and make recommendations until a strategic financing objective appropriate for California's demographics is realized. Obstacles already confronted by the group include the limitations of the state administration which limits policy and financing projections to only five years, thereby failing to acknowledge the dire implications of California's demographic profile which shows that 20% of the population will be over age 65 in 2030.

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Assembly member Ian Calderon (D-Whittier)|Author AB 74, AB 332

Bills Are First Step Toward Thoughtful Policies

As the state's population over the age of 65 continues to grow, aging and long-term care is one of the pressing issues we face in California. The reform bill package introduced for the 2015-2016 Legislative Session addresses the needs of our aging population by tackling issues, such as infrastructure, caregiver support, long-term care insurance and quality of care, among others.

One of my bills, AB 74, addresses an important aspect of reform: improving the quality of care we provide to our elderly population and protecting them from dangerous situations of neglect and abuse.

California's licensing program performs the essential function of protecting the basic health and safety of children and adults in care. Budget cuts over the past few years and compliance procedures have resulted in a program that provides inadequate oversight and monitoring of community care facilities. Many recent news reports have highlighted the lack of frequent inspections in facilities across California and the dangers faced by children and elders.

AB 74 will implement a phased-in plan to require the Department of Social Services to conduct annual unannounced inspections of all community care facilities by July 1, 2018. By July 1, 2016, DSS will inspect facilities no less often than once every three years with a 30% random sample to be subject to an annual inspection. By July 1, 2017, DSS will inspect facilities no less often than once every two years with a 20% random sample.

Without having annual unannounced visits, our state will continue to provide inadequate oversight of these facilities and continue to put our most vulnerable populations at risk. AB 74 provides the oversight that our elderly population deserves.

Another bill I have authored this year addresses the lack of affordable options for many Californians to pay for long-term care.

Every day, more than 10,000 Americans turn 65. In California, the number of citizens 65 or older is projected to increase to almost nine million by 2030, or about 18% of the expected population. California does not have a sustainable option for seniors and people with cognitive or physical disabilities to obtain the affordable long-term care services they need. Without alternatives for people to obtain long-term care, the aging middle class must decide whether to spend down their assets in order to qualify for Medi-Cal or to exhaust their personal assets to pay for private care services.

AB 332 would create the Long-term Care Insurance Task Force to provide recommendations to the Insurance Commissioner of California to come up with sustainable options for long-term care insurance -- a first step toward establishing a long-term care system in California. It's critical that we find an affordable solution to providing long-term health care insurance for all families who are at risk of not being able to afford the care they need.

The introduction of these bills is a first step towards implementing thoughtful and effective policies that address the needs California's aging population.