A community that is safe, healthy, affordable and equitable for older adults is good for everyone else, too. This is the message of California’s “Master Plan for Aging.”
The plan, released earlier this year, calls for:
- adequate and affordable housing;
- better access to health care;
- inclusion, equity and social connectedness;
- more pay and support for caregivers; and
- greater economic security for all.
In Riverside County, where a four-year Area Plan on Aging already acknowledges many of these issues, leaders in aging see the state plan as a call to collaborate.
But it will be a long road. The goals are lofty and the problems have been exacerbated by the COVID-19 pandemic. Meanwhile, there are a growing number of individuals in urgent need of these changes. One in every five people in the United States will be 65 or older by 2030, according to the U.S. Census Bureau. By 2035, there will be more older adults in the country than children under 18.
“This has profound implications for our families, for the kind of housing we want, for our communities, for our workplaces (and) for the services we need,” said Kim McCoy Wade, director of the California Department on Aging, during a symposium in June.
Over the next two years, a work group will implement more than 100 short-term initiatives. The state has created a data dashboard that is intended to publicly track the plan’s progress. McCoy Wade said one of the state’s goals is for all 58 counties to have their own plans.
Riverside County’s plan was updated mid-May to include the release of the state plan.
“It’s nice to have the weight of a state Master Plan for Aging to really push what’s possible there,” said Gary Robbins, deputy director of programs and operations at the county’s Office on Aging. “It really supported a lot of the ideas we’ve been working around the periphery of.”
Here are the state’s goals — and how they overlap with current county objectives.
Goal 1: Housing for ‘all ages and stages’
Not only does California want an affordable roof over every resident’s head, it also wants those homes to be within 10 minutes of a community park and close to public transportation.
Part of the state’s strategy includes accelerating the production of new housing units, including multi-family developments and accessory dwelling units — the ones meant to house an aging in-law, not the kind rented to weekend visitors.
The plan cites Propositions 13 and 19 as related measures. Though Prop 13 limited property taxes “to support affordability as people age,” it may have discouraged moving, according to plan documents. A possible remedy comes with Prop 19, enacted this year, which gives Californians age 55 and older a tax break when buying a new home. This could incentive seniors to downsize.
In the short-term, the state is looking at:
- enforcing housing production laws;
- issuing tax credits for the production of low-income units; and
- prosecuting violations of anti-housing discrimination laws.
In Riverside County, nearly a third of residents age 65 and older spent more than 30% of their income on housing in 2016, according to the Office on Aging. Continued financial stress may lead older adults to sacrifice other necessities to have a place to live.
“There is an affordable housing crisis and people forget that one of the major groups that’s victimized by this is seniors living on fixed incomes,” said Steve Mehlman, newly elected chair of the Riverside County Council on Aging, which acts as an advisor to the Office on Aging and the county’s Board of Supervisors.
Riverside County plans to continue offering emergency assistance “in the form of housing, rental, utility, transportation, home repairs and modifications, falls prevention, and mobility management assistance,” according to its Area Plan on Aging.
Both the county and state seek to address homelessness among older adults. Californians age 50 and above are the fastest growing group experiencing homelessness for the first time, according to McCoy Wade.
Just over 30% of Riverside County’s unsheltered residents were age 50 and up during the 2018 point-in-time count. The total count of older adults living on the street that year was 542 — 27 were age 70 or older, according to county documents.
The state intends to build off its existing program, Project Homekey, which launched during the pandemic and utilized federal funding to house homeless residents in hotels and motels, and expand supportive housing programs.
Riverside County received $10.5 million from the state last September to help build three affordable housing projects throughout the region.
The county’s Office on Aging has a goal of providing supportive, wraparound services directly to a minimum of 20 older adults who are homeless or living in unstable housing. Through a case management program, adults age 55 and older are assessed for immediate risk and referred to the county health system, before being referred back to the office for ongoing case management and potential placement into housing.
Goal 2: Health care reimagined
When it comes to health care, some short-term state initiatives call for advocating and asking for more help and funding from the federal government for long-term care services and support.
A key component is providing more incentives for providers to receive geriatric training.
Statewide, only 5% of providers are trained in gerontology, which focuses on the needs of older adults, according to the state’s master plan.
California plans to diversify and expand this population of providers through incentives like workforce shortage and loan forgiveness programs. Additionally, it will explore adding geriatric training requirements via all state health licensing boards.
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The state plans to produce a report on skilled nursing facilities and COVID-19, which will include information on lessons learned and recommendations for national policy reform. It calls for more exploration into smaller congregate living arrangements — homes that care for as few as six older adults.
The plan also calls for more focus on services provided in veterans homes as well as state hospitals and correctional facilities.
The state plans to modernize Medicare counseling services and the enrollment process for Medicare Savings. It also plans to partner with drug manufacturers to lower prescription costs.
And when it comes to implementing care, the state points to the Inland Empire Health Plan as a model. The nonprofit, state funded health maintenance organization manages the health care of more than 1.4 million seniors and low-income residents — those on Medi-Cal or Medicare — in Riverside and San Bernardino counties.
It recently won an award for innovation from the California Department of Health Care Services for “using location intelligence to reach high-risk members and providers in geographic areas affected by power outages, wildfires, and other natural disasters.”
Goal 3: Inclusion and equity, not isolation
The state’s plan calls for more social engagement, volunteerism and protection from isolation, discrimination, abuse, neglect and exploitation. This is even more urgent thanks to the pandemic, according to Robbins with the county’s Office on Aging.
“It highlighted isolation in our communities and it also exacerbated it,” he said.
More than 2 million Californians don’t have access to high-speed internet and about 34% of older adults don’t use the internet at all, according to the state’s master plan.
These issues were at the forefront as many struggled to schedule COVID-19 vaccine appointments online — a problem related to the digital divide, according to Riverside County’s updated plan. The county recently began an “Isolation Technology Support Program” which aims to enhance access to services and support by providing tablet computers, low-cost internet and technical support to older and disabled adults.
The state seeks to address this digital divide through the expansion of broadband access, which would then expand access to telehealth services and online communities.
Communication, online or otherwise, needs to expand to ensure it is culturally and linguistically competent, especially because California’s older population is becoming more racially and ethnically diverse, according to the master plan.
The state plans to increase diversity in its departments and related boards, including its Commission on Aging.
Goal 4: Caregiving that works
The state has a shortage of caregivers and wages for home care workers haven’t increased at the same pace as other minimum wage jobs, according to the Riverside County Office on Aging.
If care falls to a family member or friend — nearly 5 million people in California — it is typically unpaid. This amounts to about 4 billion hours of unpaid care, valued at $63 billion each year, according to the state’s master plan. This burden disproportionately falls to women, particularly Black, Indigenous, Latino and Asian-American women.
The state aims to create one million high-quality caregiving jobs that also provide support, including benefits like paid family leave, for family caregivers.
There are more than 32,000 caregivers serving over 39,000 elder and dependent adults through Riverside County’s in-home supportive services program, county spokesperson Gene Kennedy previously told The Desert Sun.
The county has family caregiver support programs that provide resources — advocacy, education, counseling, in-home assistance and respite — to qualifying caregivers. Its “Care Pathways” program provides training and weekly support groups
Nonprofits have also stepped in to help fill some of the gaps. Alzheimers Coachella Valley, for example, offers state-certified dementia training at no cost to caregivers. In Riverside County, Alzheimer’s disease is the fourth-leading cause of death behind cancers, coronary heart disease and chronic lower respiratory disease, according to the Office on Aging.
“There’s a critical need for caregivers right now,” Alzheimers Coachella Valley Board of Directors President Dominic Calvano said. “It’s probably the most unthanked job in the medical profession … they go in and do the work that most people just can’t or won’t do.”
Within the state’s master plan, care for those with Alzheimer’s received a special focus and builds on a previously established task force, which released its recommendations last fall. These include:
- establishing a voluntary savings account for long-term care to make non-clinical costs incurred by individuals living with Alzheimer’s more affordable; and
- providing incentives to encourage health care workers to go into Alzheimer’s and dementia care.
Goal 5: Affording aging, not just retirement
When people age, there is often an assumption that they are either well off, have saved enough to support their retirement, or are totally incapable of caring for themselves and admitted into nursing facilities, Robbins said. But “there’s an in-between,” he said.
Retirement income is no longer enough due to rising costs of housing, health and care, according to the state master plan. Traditional sources of income — individual savings, employer-paid pensions and Social Security — aren’t what they used to be. Private pensions have declined and individual retirement savings are lower than in previous generations, according to the master plan.
With fewer employer-based resources, individuals will need to begin planning for aging, too. Part of the state’s short-term initiative is to promote existing programs designed to help Californians afford the costs — including CalSavers, a retirement savings program offered to residents who are self-employed or whose employers don’t offer a plan.
In Riverside County, more than 24% of older adults lived below the state Elder Index poverty level — which, unlike the Federal Poverty Line, takes into account the cost of housing, food and health care — according to the county’s Office on Aging.
Many older adults living below the Elder Index have more health problems and less access to health care, don’t qualify for many public programs, and don’t earn enough to pay out-of-pocket for care.
The state plans to increase older adult basic income and assistance to meet the needs of these Californians. It also highlighted the importance working with programs like CalFresh and Great Plates to address nutrition needs.
The county has health and wellness programs, including exercise classes, walking groups and a meal delivery service currently serving more than 1,200 homebound seniors — 395 in the Coachella Valley, according to Robbins.
Area senior centers and nonprofits also participate in the effort to help improve the overall well being of the aging population through programs like Great Plates and Meals on Wheels in addition to providing opportunities for community engagement and socialization.
The state has published a “Local Playbook” to go along with the master plan in order to help communities establish their goals, work together and learn from existing models. The Master Plan for Aging is intended to be a “living document” and will be updated. The county’s area plan has already been subject to updates since 2020.
Maria Sestito covers issues of aging in the Coachella Valley. She is also a Report for America corps member. Follow her on Twitter @RiaSestito, on Instagram @RiaSestito_Reporter or email her at email@example.com.