Perspectives: Leading California’s Long-Term Care System Beyond Ideas to Action


Author: Bruce Chernof

Originally published: Tuesday, March 24, 2015

In December, California entered another two-year legislative cycle, with almost 40 new lawmakers arriving in Sacramento ready to tackle pressing issues facing our state. As the state’s population over the age of 65 continues to grow, the beginning of a new legislative session is a timely reminder of the need to transform our long-term services and supports (LTSS) system to ensure that all Californians can age with dignity and independence.

The Senate Select Committee on Aging and Long-Term Care, chaired by Senator Carol Liu (D-Glendale), recently released a report featuring 30 recommendations to create an “ideal” long-term care delivery system. Ranging from governmental reorganization to a rededication to building a sustainable infrastructure to meet the needs of the state’s aging population, the report is a valuable roadmap for moving from ideas to action. Though the report focuses on California’s pressing needs, many states are facing similar demographic shifts and should consider the recommendations as ideas for potential policy exploration. .

While many of the recommendations reflect an overall long-term strategy, there are at least three short-term actions that stakeholders, lawmakers, and the administration can take now to lay meaningful cornerstones for a more comprehensive overhaul.

The first is to strengthen the Legislature’s engagement with LTSS systems, starting with the conversion of the Senate Select Committee on Aging and Long-Term Care to a standing committee. While the Assembly has a standing committee, its jurisdiction is greatly limited and should also be expanded. By formalizing the Senate committee into a standing committee and expanding the jurisdiction of the existing Assembly Committee on Aging and Long-Term Care, our lawmakers will have both a bigger stake in shaping the LTSS system and more incentive to move on these issues. California would also benefit from enhanced legislative oversight of the state’s Coordinated Care Initiative (CCI), with a particular focus on its implementation. Currently, several fiscal and health policy committees have that responsibility, which makes dedicated oversight and the ability to make needed policy changes all the more challenging. Shifting these responsibilities to the Assembly and Senate Committees on Aging and Long-Term Care would allow for more flexibility to address emerging issues and improve the system of care.

Second, the Legislature and the administration should renew their commitment toward implementation of universal assessment by making it a permanent state initiative. Universal assessment benefits consumers by eliminating multiple, redundant assessments, and facilitating better care coordination among providers.

It also benefits the state by providing policymakers with reliable and consistent data to make informed policy decisions. Current plans are to pilot this assessment in two CCI counties. In the near term, the state should remove the 2017 sunset provision and expand this effort to all seven CCI counties.

Lastly, California should establish a long-term plan for LTSS transformation beyond the current Coordinated Care Initiative. Both Minnesota, the top-ranked state on the 2014 LTSS Scorecard, and Mississippi, a low-ranked state that is showing significant improvement, have indicated their respective successes are grounded in a cohesive, long-term vision and plan for transforming systems of care that transcend changing political winds. To this end, we urge our state’s policymakers to identify a clear long-term vision for LTSS, and develop a strategic plan focused on this vision as a measure for setting priorities and accountability for moving forward. We concur with the Senate Select Committee’s recommendation for California’s Health and Human Services Agency to develop a system-wide plan with clear benchmarks and timelines that serves as a blueprint for setting priorities and maximizing the use of limited state resources. Key success metrics should include appropriate reinvestment in home- and community-based services and active engagement of California’s 6 million unpaid family caregivers in new models of organized care.

Forty new legislators have recently begun their legislative careers, seeking pressing issue areas to champion. The Senate Select Committee’s report provides compelling and ready-made action items to foster a renewed and sustainable system of care for all older Californians as well as provide a blueprint for other states to follow.


Bruce Chernof, M.D., is president and CEO of The SCAN Foundation, an independent, non-profit public charity devoted to transforming care for older adults in ways that preserve dignity and encourage independence.

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