California Has a Master Plan for Aging. Now What?
Why the answer could be important for people across the nation
When California's Democratic Governor Gavin Newsom took office in January 2019, he announced the state would embark on creating a "Master Plan for Aging." Now that the ambitious 44-page Master Plan for Aging has been released, I wanted to find out what will keep it from sitting on a shelf, like so many other blue-ribbon government reports.
After speaking with numerous people who helped create California's Master Plan for Aging (government officials, academics and nonprofit leaders) and reading analyses from others, I came away pleasantly surprised about the blueprint's prospects to "build a California for All Ages by 2030."
We really framed it as a 'California for all ages.' Not as this [aging] deficit and decline."
In fact, I learned, some of its team's recommendations have already taken effect. For example, the state health department revised its pandemic triage rules to avoid prioritizing younger people with COVID-19 over older ones.
Other recommendations from the Master Plan for Aging are in the works for 2021 and 2022. The pandemic led to, and accelerated, many of them.
"Most older Californians have been disproportionately impacted by the pandemic," said California Health and Human Services Deputy Secretary Marko Mijic at a recent webinar about implementing the Master Plan for Aging.
The Immediate and Long-Term Needs
The number of Californians age 60 and older is due to nearly double from roughly 6 million in 2010 to about 11 million in 2030 (a quarter of the state's population). California currently has the second highest average life expectancy in the nation (81.9 years). And one in five older adults in the state is living in poverty, one of the highest rates in the country. Older adults also comprise the fastest growing group of homeless people in California, said Fernando Torres-Gil, a UCLA professor of social welfare and public policy and Master Plan for Aging team member.
The needs are urgent as well as long-term.
"We did both a ten-year vision of where we want to be and a two-year work plan to be really specific about what we can do right now," California Department on Aging Director Kim McCoy Wade told me. "Some of these things are going to take ten years and even more; we're reimagining health care and housing… These are big ships to turn around, but there are concrete things we can and will do during the next two years to get going."
If you don't live in the nation's largest and most diverse state with the largest older population, or don't plan to move there, why should you care?
Simple: we're all aging.
A California for 'All' Ages
So, some initiatives and proposals in California's Master Plan for Aging could be replicated in the 49 other states and Washington, D.C., making lives better not only for their older residents, but their younger ones, too. Only four other states — Colorado, Massachusetts, Minnesota and Texas — have made their own Master Plan for Aging, according to The SCAN Foundation, which works to transform care for older adults.
"People don't always like to think about aging or talk about aging," said McCoy Wade. "So, part of what we're doing is reimagining that conversation. We really framed it as a 'California for all ages.' Not as this [aging] deficit and decline."
Kevin Prindiville, the executive director of Justice in Aging in Oakland, Calif., worked on the Master Plan for Aging and said: "The demographics in California, like the country, and really a lot of the world, are shifting rapidly. Unfortunately, in California and in many other places, the strategic thinking and strategic investments haven't been made to really prepare for the growing need… And so, it was the right time for California to start to put a plan in place."
Paul Irving, chairman of the Milken Institute Center for the Future of Aging and also a Master Plan for Aging team member, agreed.
He said the living document is "frankly in many ways, an overdue acknowledgement of the need to prioritize healthy aging, financial wellness, health care, caregiving, housing and other issues." Irving hopes it creates "an example and a precedent that other states will follow."
Newsom, who is fighting an effort to recall him by Republicans and some small business owners, just released a 2021-2022 budget with specific earmarks for aging issues, such as $5 million for Master Plan for Aging leadership and operations; $15 million for Alzheimer's research, caregiver and provider training and an education campaign and $17.5 million for senior nutrition.
"The Governor took our recommendations and used a good portion of the fifteen-billion dollar state surplus to increase funding for the priority areas that came out of the Master Plan," said Torres-Gil. "One thing the plan does say is that the state will continue to work on big-ticket items to the extent that money becomes, or is, available."
The Master Plan for Aging laid out five broad and bold goals, along with 23 strategies for them and more than 100 short-term initiatives that have been adopted by California's 10 state agencies in partnership with business, the federal government, other stakeholders and the California Legislature.
5 Goals for the California Master Plan for Aging
The five goals:
1. Housing for All Stages & Ages —That means helping Californians live where they choose as they age in communities that are age-, disability- and dementia-friendly and climate- and disaster-ready. Its target: millions of new housing options to age well.
"We have a broken housing system in California. We are short millions of homes."
The median home price in San Francisco is $930,000. In Los Angeles, it's $710,000. Nationwide, according to Kiplinger's Personal Finance, it's $310,800. Rents last year rose 11%, on average, in Fresno and 8% in Bakersfield.
"We have a broken housing system in California. We are short millions of homes," said California State Senator Scott Wiener at the Master Plan for Aging implementation webinar. "We need to build housing of every variety to stabilize this very unstable situation."
Newsom's new state budget calls for taking the state's Project Homekey — which buys motels and converts them into transitional housing for the homeless — and spending $250 million to do something similar for homeless older adults or those at risk for homelessness.
2. Health Reimagined — That means providing access to the services Californians need to live at home in their communities and to optimize their health and quality of life. Its target: closing the equity gap and increasing life expectancy.
One way to help is by increasing broadband access for older and especially older rural Californians; 34% of Californians over 60 don't use the internet, according to the Master Plan for Aging report.
"We have seen within this pandemic the need for having telemedicine and quite frankly, there are many places within the state where we have not closed the digital divide," said Janet Spears, a Master Plan for Aging team member and CEO of Metta Fund, a private foundation to advance the health and wellness of San Francisco's aging population. "If this is the way in which we are planning to carry health services in the future, we definitely need to work on that. You need water, electricity and broadband."
The Master Plan also calls for digital literacy training for older Californians. "Someone can have a smartphone or a tablet but you have to know how to use it," said Rigo Saborio, who runs the St. Barnabas Senior Services nonprofit in Los Angeles and served on a Master Plan for Aging committee.
3. Inclusion & Equity, Not Isolation — That means offering Californians lifelong opportunities for work, volunteering, engagement and leadership and protection from isolation, discrimination, abuse, neglect and exploitation. Its target: to keep increasing life satisfaction as Californians age.
"Older adults don't just have needs, they have experience and they're looking to give back," said Saborio. "There are opportunities for volunteerism in the Master Plan. We want to create the opportunities for people who want purpose and want to contribute."
As Torres-Gil told me: "A number of us promoted the equity lens. The pandemic really dramatized that certain populations were at terrible risk, especially Black and brown communities, low-income communities, older adults, nursing homes and skilled nursing facilities and persons with disabilities and chronic conditions."
The Master Plan for Aging also proposes creating an Elder Justice Council, similar to one the federal government has. "California hasn't been well organized in its approach to elder justice and elder abuse," said Prindiville. "There have been lots of entities doing lots of different things, but not always well coordinated." He expects the new council will begin holding meetings in several months.
"It's a moment to really reimagine the nursing home model."
4. Caregiving That Works — That means helping Californians be prepared for and supported through the rewards and challenges of caring for aging adult loved ones. Its target: one million high-quality caregiving jobs.
"The [Master Plan for Aging's] calling for a senior adviser inside the Governor's office whose responsibility is oversight over aging, Alzheimer's and disability is something we've been championing for some time. We were very pleased to see that," said Dr. Sarita Mohanty, president and CEO of The SCAN Foundation.
Nearly 700,000 Californians age 65 and older are living with Alzheimer's.
The plan also suggests looking at ways to innovate nursing homes and reduce both physical and social isolation. "It's a moment to really reimagine the nursing home model," said McCoy Wade.
What the Master Plan for Aging didn't propose, however, was a way to help middle-class Californians afford long-term care.
5. Affording Aging — That means providing Californians with economic security for as long as they live. Its target: closing the equity gap and increasing elder economic sufficiency.
California's state government lets some full-time public employees switch to do their jobs part-time in retirement. "I think we need to make that more the norm," said McCoy Wade.
The Master Plan for Aging creators included a few ways to hold themselves accountable to help ensure their ideas turn into reality. There's a Data Dashboard for Aging tracking the progress of the proposals and initiatives. Also, the Master Plan for Aging team will be meeting quarterly, producing an annual report.
"The Master Plan makes a really compelling case that older adults need attention. And we need systems and responses to ensure that that's the case," said Irving. "This is exactly what government should be focused on."