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Dr. Bruce A. Chernof, MD

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California's Pressing Need For Long-Term Care System Transformation

Posted: 09/27/2012 3:08 pm

It's been said that as goes California, so goes the nation. Right now, Californians are not prepared to grow old. A recent poll of voters in the state over the age of 40 shows that nearly half will need long-term care for a close family member within the next five years, yet the same amount say they couldn't afford even one month of nursing home care. Regardless of political party or income level, voters are also struggling in the current economy to meet their daily living expenses. The same poll showed that more than 40% of California voters over 40 have had to cut back on food and other basic expenses over the past year. Of those who currently help pay for a loved one's care, 70% are facing financial hardship. The wakeup call for the state is that the increased demand for support will come sooner than expected, and requires immediate and thoughtful action by state leaders.

California is not alone in this dilemma. Creating affordable and accessible long-term services and supports in the face of a downturned economy is an issue facing most states in the nation. Fiscal pressures are similar in states throughout the country and the effects are felt at the dinner table, in struggling community programs that lack funding and in scaled back state budgets. California's population is relatively young compared to other states, but as home to the world's sixth largest economy, it is a bellwether when it comes to addressing the needs of older adults.

California's system of care for older adults and people with disabilities is broken. Different programs at the state and local level serve overlapping clientele with varying goals and purposes. Many have also been severely eroded by cuts, leaving vulnerable adults without the support they need. Yet through it all, there exist tremendous opportunities to organize care that starts with the person first, streamlining the care delivery process while also maintaining the flexibility for programs to innovate and respond to local needs.

A starting point that everyone agrees upon is the need to develop person-centered care that provides the right care for the right person in the right place and for the right cost. Bringing this vision to fruition is a substantial task that will take creativity, ingenuity and synergy between disparate stakeholders, yet it is possible. On Tuesday, September 18, 2012, the Foundation brought together thought leaders from across California for an annual summit, fittingly titled "On the Path to System Transformation." Over 300 people attended the day-long summit, including consumer advocates, providers, state legislative and executive branch staff, federal health and human services leaders, media and philanthropy.

At this statewide summit, four overarching discussion themes described how to go about transforming California's system of care: the need for a grassroots movement to create unified language and messaging around longterm care that resonates with real people; making quality-of-care the cornerstone of system transformation; maximizing partnerships in changing the healthcare delivery system and addressing the needs of those who are eligible for both Medicare and Medicaid. This work has already manifested itself through social action at the local level, transformation of programs throughout the state, and drawing down federal dollars to make more person-centered care a reality.

Beyond the mechanics of building a new system that focuses on a person's needs, values and preferences, a critical point that Summit stakeholders emphasized was the need to keep in mind the people for whom accessible, affordable and dignity-driven services are necessary. These are our parents, other family members, loved ones, friends and neighbors -- and in the long run, ourselves.

 

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