California is aging – are candidates for governor paying attention?

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OPINION – On November 7, candidates vying to be California’s next governor took the stage in the Inland Empire for the Health Matters gubernatorial forum. They discussed a myriad of health care issues affecting Californians. One critical issue received less attention: how they will work to ensure that California truly supports its older adults.

Older adults are the fastest-growing demographic in the state, especially in rural areas, where more than one in five Californians are ages 65+. This rapid growth represents an opportunity to build a California where aging is not a challenge to solve, but an opportunity to ensure all Californians can age at home and in community. Most say that is what they want – with three out of four (77%) adults age 50+ and older wanting to age at home.

Unfortunately, many older Californians and their families face challenges when it comes to accessing the long-term services and supports (LTSS) needed to age at home and in community. By 2033, 89% of Californians 75 and older will not have enough financial resources to pay privately for LTSS. These older adults represent the “forgotten middle” – they have too much income to qualify for assistance programs but do not have enough to afford services on their own. An inadequate caregiving workforce and unaffordable housing present additional barriers to aging well.

In addition, analysis shows that nationally, the population of middle-income older adults of color will increase from 12% in 2020 to 25% by 2035. Policies that fail to account for this growing diversity risk widening inequities.

As California’s population grows older and more diverse, our LTSS system must reflect and respect cultural identities, multigenerational families, and the dignity and quality of life of every Californian. Ensuring inclusive access to LTSS is one of our state’s greatest opportunities to build collaborative, intentional policy solutions that make aging well possible for all.

There is a wide spectrum of options for expanding access to LTSS, including eliminating the Medi-Cal asset test, partnering with CMS on a Medicare home and community-based services (HCBS) benefit, and developing a public long-term care benefit for all Californians.

It isn’t just the right thing to do; policies in support of LTSS also make good fiscal sense.  A recent analysis found that nursing facility care costs California between $34,000–$60,000 more per recipient per year than HCBS. The study also showed that helping people age at home reduces avoidable hospitalizations, delays nursing home placement, and curbs public spending.

As the candidates explore these issues, it is important to note that they all have a place to start. The California Master Plan for Aging (MPA), provides a practical policy roadmap for the next leader of the state. The MPA, established in 2020, encourages accountability and collaboration across state agencies and has resulted in a more holistic view of aging and disability.

Each candidate for Governor must be able to answer important questions about California’s older adults:

• How are you going to address the unique needs of California’s aging population?
• How do you plan to finance long-term care, so all older Californians can access LTSS and HCBS?
• What is your plan to support paid and unpaid caregivers of older adults and people with disabilities?
• What is your plan for older adults and people with disabilities in rural communities?
• How will you implement California’s MPA so we can all age well, including addressing the rise in unhoused older adults?

We hear from older adults throughout the state about their dreams of aging well. As Cooper from San Francisco said in an interview as part of The People Say, which features insights from older adults on issues important to them: “[What I would need to age in my home is]…comprehensive care and services. A social worker, a case manager that will not only call me or text me, [but] come out to visit…”

Cooper represents many Californians. The policies we set today will determine not only how well older adults like Cooper live, but the kind of California we ourselves will grow old in. It is our next governor’s job to create opportunities for all of us to age well and with dignity.

Sarita A. Mohanty, MD, MPH, MBA serves as the President and CEO of The SCAN Foundation. Christina Mills is the Executive Director of the California Association of Area Agencies on Aging