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New Reports Shine Light on Long-Term Care Problems

For a couple decades now, advocates for seniors and aging Californians have warned that long-term care problems will get larger and more numerous if government and health industry officials don’t make some policy changes.

Three new reports are turning up the pressure on policymakers:

  • A report titled, “A Shattered System: Reforming Long-Term Care in California,” from the state Senate Select Committee on Aging and Long Term Care said California’s fragmented system for caring for aging residents needs to be overhauled soon. The critical assessment makes several policy recommendations, including consolidating programs and improving workforce and training efforts.
  • new study from UC-San Francisco predicts the long-term care industry will experience substantial growth in coming years but notes that more people are leaving long-term care jobs than entering them.
  • study published this month in the Annals of Internal Medicine suggests the country’s health care system is getting worse rather than better at dealing with patients in the last year of life. The number of U.S. residents who experienced pain in the last year of life increased by nearly 12% and reports of depression and periodic confusion during that period increased by about 26% between 1998 and 2010, according to the study.

Not a New Situation

“A lot of us have been yammering about all this for decades,” said Bonnie Burns, veteran training and policy consultant for California Health Advocates, a not-for-profit advocacy and education program for Medicare and long-term care.

“We have a huge number of people heading into the part of their lives when they’re going to need long-term care and we’re really not ready for it,” Burns said.

Ten thousand people a day will turn 65 over the next 17 years in the U.S., according to Pew Research Center projections. By the year 2030, 24% of California’s population will be 60 or older.

“It’s not like anybody didn’t see this coming,” Burns said. “But everybody’s been kicking the can down the road for years.”

Senate Report Full of Ideas, But Not Funding

The comprehensive 211-page state Senate committee report makes several concrete suggestions for improving California’s long-term care system, but the committee does not suggest how the state might pay for making changes.

Gov. Jerry Brown (D) has repeatedly demonstrated resistance to new spending and many legislators agree with him.

Sen. Carol Liu (D-Glendale), chair of the committee, said she’s confident legislators and the governor are willing to talk about ways to pay for improving the system.

“The state budget is finally getting better, and recent forecasts from the Legislative Analyst’s Office indicate that revenues for the upcoming fiscal year will be even larger than anticipated,” Liu said. “And most forecasts expect the economic recovery to continue for several years.”

“I think there is room for discussion about implementing the recommendations. We are all getting older, and we need to have an honest talk about how to improve services to our aging population,” Liu said.

Hurdles Higher, More Numerous for Low-Income

While all Californians face similar challenges involving health care for themselves or family members as they age, the hurdles for low-income people tend to be higher and more numerous than those for middle-class and wealthy people.

“Upper- and middle-income families already have more options to provide care for their aging family members. The harder burdens fall on the poor, and that’s not right,” Liu said.

“We need to focus on helping the people who need it most, whether that’s assisting with more home care providers and support services or making sure that low-income seniors have access to fresh and nutritious meals every day. And we need to make sure that government provides those services in a streamlined and efficient manner. The current system is far too convoluted,” Liu said.

Investment in Training, Education Recommended

A common thread in reports and studies dealing with long-term care is the recommendation to invest in training and education for long-term caregivers.

Authors of the UC-San Francisco Health Workforce Research Center recommend finding new ways to attract and retain long-term care workers.

“For many of the people in these roles, training and education doesn’t necessarily lead to anything specific like pay raises or job security,” said Joanne Spetz, director of UCSF’s Health Workforce Research Center and co-author of the report.

“A lot of these people are in poverty while they’re working in these jobs. If you look at the people exiting these jobs, many of them are not leaving for some other job — they’re going into unemployment.

“It’s painfully clear that there aren’t established ladders to success,” Spetz said.

Spetz suggested policymakers consider long-term caregivers on a career path through a jungle gym rather than a ladder.

“If you think of training and job movement as a jungle gym rather than a straight ladder, you can see options for growth and movement in different directions. For instance, if somebody has really good skills in finding and using community health programs, you can consider those population health skills and reward and support them,” Spetz said.

“There is some discussion about trying to figure out ways to check for skills individual caregivers might have developed that don’t necessarily fit into the specific job description.”

The UCSF report, based on national statistics, found that nearly all U.S. long-term care workers are women and that minorities represented about 40% of the workforce, almost double the minority average of the overall U.S. labor force. About 21% of the country’s workforce is comprised of minorities, according to the U.S. Census Bureau.

Call for Reform Generally Well Received

The state Senate report, which echoes the UCSF recommendations for improvements in training and education for long-term workers, estimates about five million Californians get long-term care through one or more of 112 different programs administered by 20 different state departments.

The report’s suggestions for consolidation and streamlining of many of those efforts have been generally well received, state officials said.

“So far the reaction has been positive, particularly among the stakeholders who have been working for years to provide more assistance for seniors and the elderly,” Liu said.

Liu added, “The challenge is making sure that younger folks — I will be 73 this year and can say that — start to pay attention to how important this issue is for not only their parents and family members but for the entire state of California. The longer we wait to make positive changes, the more challenges the younger generation will face to take care of this segment of the population.”

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