California Health Report: Most Older Adults Want to Live at Home. Here’s How California Can Make it Easier (September 27, 2022)
Three weeks after her 84-year-old mother entered a skilled nursing facility for rehabilitation from a serious fall Carmen Brammer received a call.
“Come get your mother,” Brammer recalled a staff member telling her. “We’re going to put her on the curb if you don’t come get her.”
Even though her mother, Pauline Brammer, had had some rehabilitation, she still couldn’t walk or care for herself by cooking, bathing or cleaning the house. Brammer and her sister wanted to help, but they both had full-time jobs. Brammer picked her mother up from the nursing facility, but she didn’t know what to do next.
Most older adults want to stay in their homes and communities as they age, rather than go to a nursing home or assisted living facility. To do that, many eventually need assistance with routine care such as house cleaning, shopping and getting to medical appointments, and personal care such as bathing, dressing and eating.
Some have family members willing to step in and help (although that can be costly and time consuming for the relatives involved). Other older adults get caregiving support through the state’s Medi-Cal health insurance program for low-income people, or services such as meal delivery or transportation help from community-based programs. But 40 percent of older adults and adults with disabilities in California who need help to stay in their homes report receiving either no help at all or not enough, according to surveys conducted by the UCLA Center for Health Policy Research.
California is making efforts to rectify the problem. Last year, the state released its first-ever Master Plan for Aging, a 10-year blueprint for promoting healthy aging that includes provisions for improving access to home and community-based services and bolstering the caregiving workforce. The legislature has also created a Long Term Care Insurance Task Force to explore the feasibility of creating a statewide insurance program for long-term care services, most likely through a payroll tax. And recent changes to Medi-Cal will make more older adults eligible for caregiving services at home and in the community by lifting asset limits and making it available to undocumented people ages 50 and older.
Experts and advocates applauded these moves but said more must be done — more quickly — to meet the long-term care needs of California’s rapidly aging population, particularly in communities of color. Almost 1 in 5 Californians will be 65 or older by 2030, up from about 1 in 7 today. The fastest growth will be among older adults of color, with the Latinx elder population growing by 118 percent, Asian by 61 percent and African American by 90 percent by 2030 compared to 2016 levels.
Hagar Dickman, a senior attorney at Justice in Aging, applauded recent legislative changes that will help more older adults qualify for Medi-Cal, including the expansion in May to undocumented people ages 50 and older, and the phasing out of a $2,000 asset limit for older adults to qualify for Medi-Cal. These changes are expected to allow at least 18,000 more people to qualify for Medi-Cal.
But challenges remain, she said. Federal policies underlying Medi-Cal have resulted in a dearth of funding for home and community-based services, and uneven availability across counties. There’s also a workforce shortage. This means even people eligible for services often can’t find them or are put on waiting lists. New efforts to collect data on gaps in service could help, she said, along with California’s move to reform its Medi-Cal program under a process called CalAIM.
“California’s doing a lot,” Dickman said. “I think there’s more to be done.”