Assembly Standing Committee on Aging and Long-Term Care

You all right? Can everyone hear me? All right. Good afternoon. Thank you, everyone, for joining us today for the first aging hearing of 2024. I am very excited to chair this Committee for the second year. I am the first medical Doctor to chair Aging and Long Term Care, and I bring that lens to all of my policy work. I bring the commitment to underserved communities, specifically an underserved community that I represent, Kern County and other rural and underserved areas that continue to struggle.

I am grateful to all the advocates who have met with me over the past year and look forward to working together in the future. Transparency is very important. Not everyone has the opportunity or ability to be in Sacramento or have representation in Sacramento. We will remain accessible through live streaming. However, the Assembly is no longer allowing for phone in testimony. To ensure Members of the media and public have access to our proceedings,

today, this hearing will be streamed on the Assembly's website, and Members of the public can provide testimony in person here in room 126. If any Member of the public in the room would like to speak during public comment at the end of the hearing, please sign in with the sergeants in the back. I will ask you to approach the microphone at the appropriate time. So I would now like to call this hearing of the Aging and Long Term Care Committee to order. All right.

There has been an incredible amount of change and attention given to Aging and Long Term Care through the master plan for aging. It is moving into year four and has thus far been very, very successful, but can only continue to be successful with our support and support seen in the Governor's Budget. The pandemic didn't create disparities for aging and disabled Californians. It actually highlighted what has long existed. And as we often hear, our budget is a value based document. Who and what do we value?

With every policy and budget asked before us, we should be asking, how does this impact older Californians and people with disabilities? Do any other Members wish to say anything?

It's just me.

All right. Well, I would like to now introduce Susan Demoris, Director of the California Department of Aging, to give background on the master plan for aging. Susan, thank you so much for being here.

Good afternoon, Madam Chair.

Closer.

You got it? All right. Better.

Good afternoon, Madam Chair, and consultants staff consultants. Thank you so much for focusing your first hearing of the year on the Master Plan for Aging, which I'll be referring to hereafter as the MPA. It is absolutely an honor to speak to California's incredible progress. Building off the solid foundation we established in 2021. The plan's inaugural year, the MPA is not a report that sits on a shelf.

Okay.

Today, you'll hear countless examples of how the MPA stays relevant, dynamic and impactful on this, our fourth year of implementation. One measure of our shared success is the historic level of investment in programs, services and system change efforts in support of the populations we all care deeply about. It is remarkable that as a state, we have already invested close to $9.5 billion across the MPA's five bold goals, and this number doesn't even reflect broader investments like transit and climate readiness that benefit Californians across the lifespan.

We know there is still much work to be done across all goal areas to drive system change in the policy realm, through the budget process and in collaboration with local, state and federal partners. I want to specially acknowledge the governor's commitment in the January 10th budget to protect vulnerable populations, including older adults, people with disabilities, and family caregivers. And we can point to the MPA, as you said, as a statement of our values in good budget years and bad.

From the outset, the MPA has led with equity. We embrace the strong and varied cultural traditions around aging in our state, as well as addressing lifelong disparities and inequities faced by older Californians. We remain laser focused on equity to ensure all Californians have options to live how and where they choose, irrespective of age, disability, race ethnicity, language, immigration status, gender identification, sexual orientation, rural setting and other demographics.

We're proud of our efforts to embed and uplift equity throughout the MPA, as demonstrated through a number of targeted initiatives. This includes development of a first of its kind MPA equity framework. Of special note, the Legislature has helped support California's first ever LGBTQIA Plus survey of older adults, and nearly 4,000 Californians have responded to this survey before the March 31 deadline. In addition to centering on equity, the MPA's success relies on four key components, first, leadership from Governor Newsom and the Legislature.

Governor Newsom's bold leadership to establish the MPA has resulted in a 10 year blueprint for California. Transformational change requires engagement and collaboration between state and local agencies, the Legislature, and the private sector. This leadership starts with the governor's Executive order N1419, cabinet workgroup and senior advisor on aging, disability and Alzheimer's. The Administration is closely linked to the statutory framework established by the Legislature in SB 288, authored by Senator Hanna Beth Jackson.

As outlined by the governor's Executive order, the California Health and Human Services Agency, under the leadership of Secretary Mark Ghaly, has primary responsibility for leading implementation of the MPA. I'm honored as Director of the Department of Aging to partner with and coordinate efforts across our sister departments and agencies. We're fortunate to have the staff resources to stand up the CDA division of policy, research and equity, where the MPA is permanently housed. Second, breaking down silos with a comprehensive whole of government and whole of society approach.

Meeting complex health, social, housing and transportation needs requires a comprehensive approach to system change spanning across programs, agencies and sectors. Each of the MPA's five bold goals reflect this whole person approach. One, housing for all ages and stages two, health reimagined three, inclusion and equity, not isolation four, caregiving networks and five, affording aging. This past year, with funding made available by the Legislature, 21 local communities were awarded MPA planning grants to build aging and disability capacity, all part of our whole of government approach.

Third, meaningful stakeholder engagement. The real strength of the MPA comes from people with lived experience and community Members who are working on the ground with and on behalf of older adults, people with disabilities and caregivers. In fact, it was stakeholders who first called for the plan, contributed thousands of volunteer hours to develop recommendations to inform the MPA, and today steward the work in countless ways.

The Administration regularly engages with 100 diverse stakeholders through six standing advisory committees addressing home and community living, elder and disability, justice, equity, Alzheimer's and dementia, data and research, and MPA oversight. I'm pleased that you'll hear next from Kevin Prindiville. As a representative of the Impact Committee, our stakeholder engagement is not limited to these six committees.

Last year, CDA led a robust public process you'll hear more about from an exceptional leader in our network, Victoria Jump. Known as California 2030, we conducted a comprehensive assessment of our aging network, the 33 Area Agencies on Aging, or AAA's, that span 58 counties with more than 100 in depth stakeholder interviews and survey responses from over 17,000 older adults in all 58 counties.

We are well positioned to seize on the incredible momentum happening at the local, state, and federal levels ahead of 2030, when one in four Californians will be 60 or older. What's more, with our generous philanthropic partners, we're thrilled to be able to convene for the second time the Cal For All Ages and Abilities Day of Action in Sacramento this October eighth, where we are excited to refine and further focus our MPA initiatives for the next two years, prioritizing the need for person-centered system change.

And the fourth area I want to focus on is accountability and transparency. Five areas in particular: One, the annual report to the Legislature and opportunities like this to present to relevant committees. Two, the MPA initiative tracker. Three, the MPA Impact Committee. Four, our data dashboard for aging. And five, key outcome measures under development by our aging and disability research partnership. To date, we have produced three on time annual reports to the Legislature available to the public online.

We launched a publicly accessible, real time online MPA initiative tracker. We welcome the oversight of the impact Committee, including their objective report on our work. Each spring, we continue to expand and refine the data dashboard on aging, and we are finalizing our first key outcome measures on critical topics such as housing and homelessness, behavioral health, and caregiving. We're proud of our part in delivering on the promise of building a California for all ages and abilities by 2030.

Just two weeks ago, the US Senate introduced federal legislation to adopt a national strategic plan on aging modeled on our state's MPA. All eyes are on California and our leaders as we continue to model the way to other states and the nation. But most importantly, our eyes are fixed on how the MPA is reimagining how we serve and support older adults, people with disabilities, and family caregivers here in our home state.

I'll now turn to my colleague I'll now turn to my colleague Sarah Steenhausen, our Deputy Director of CDA's Division of Policy, Research and Equity. Sarah will discuss the MPA moving forward and the key priorities on which we are centering our work.

Thank you, Susan, and good afternoon, Madam Chair and Members. It's an honor to be here today to speak with you about the advancement of the Master Plan for Aging at the start of the MPA's fourth year. We are so proud of our accomplishments, and we also recognize that tremendous work lies ahead to build a home and community care system that works for all Californians.

The issues facing older adults, people with disabilities, and family caregivers are multifaceted, resulting from a system that was built in silos without an eye towards planning for the future. These system level issues translate into real life issues for the people who depend on these programs and services to remain in their homes and communities as they age. Achieving meaningful system change relies on our collective ability to address four key interrelated elements.

The MPA provides a framework to advance Long Term Services and Supports System change, which I'll refer to as LTSS through these four interrelated elements. The first element of LTSS, system change focuses on navigation and streamlining access to information. For many Californians, it's often difficult to find the information needed to make informed choices.

This system is extremely fragmented, without a known place to go for information and support, people are often left without meaningful choices, making it more difficult to find the services they need when they need them. In response, the MPA is developing solutions to streamline access to information. Earlier this month, California kicked off the state's No Wrong Door state Leadership council. Part of this effort entails planning for statewide adoption of a contact center and consumer facing web portal that will provide streamlined access to local, regional, and statewide information.

This ambitious but essential effort includes promoting sustainability of California's aging and disability resource connections network that provides enhanced information, assistance, and referral to local programs and services at the community level. The second element of LTSS, system change focuses on enhancing access to programs and services, including affordable, accessible housing in all communities. California has long been a leader in developing home and community based services so that people can remain at home and avoid institutionalization. However, many who need these services are unable to access them.

Whether due to lack of program availability, say, in rural areas or in other areas of the state where there are long waiting lists for other programs, we need to ensure that all Californians can access the services they need when they need them. Through the MPA, California is developing a home and community based services gap analysis and roadmap that will set a path forward to build out the service infrastructure.

This endeavor, which is being led by both the Department of Healthcare Services and the Department of Aging in partnership with other Health and Human Services departments, includes a gap analysis and roadmap for the home and community based services provided through both MediCal and outside of the MediCal system. Ultimately, this initiative seeks to improve access to services statewide, prioritizing planning for programs that serve underrepresented populations in underserved areas of the state.

Part of this home and community based services gap analysis includes a focus on housing access. A key to advancing the master plan for aging goals is identifying more housing options for older adults and people with disabilities. This need is critical. We have seen a 64% increase in older adult homelessness from 2017 through mid 2023, which brings great urgency to focus on solutions.

Together, the Health and Human Services Agency and the Business, Consumer Services and Housing Agency are developing a multipronged approach to address older adult homelessness, including examining options that address housing affordability and supply, institutional transitions, data and systems development, and tailored programs and services. Just recently, California was selected to participate in a federal housing partnership accelerator, which will further our collaborative work across agencies to address the housing needs of our aging population.

Access to services also involves addressing the growing epidemic of older adult loneliness and isolation. Changing family structures family systems have exacerbated loneliness and isolation among older adults and people of color, as well as LGBTQ plus. Older adults face unique challenges and barriers to accessing behavioral health services. The Administration and the Legislature's commitment to behavioral health has never been more important.

Last year, the state budget invested $50 million for the Department of Aging to lead an older adult behavioral health initiative that focuses on addressing stigma through an ethnic media campaign, fighting isolation by extending the successful work of the friendship line and building community capacity through local grants to our community partners. The third element of LTS system change centers on addressing the needs of our paid and unpaid direct care workforce.

Ensuring that we have the workforce needed to care for our aging population is a critical goal of the master plan for aging. This includes supporting California's nearly 5 million family caregivers who provide care for their parents, for their spouses, for their friends in the community, as well as the paid direct care workforce that provides the critical hands on care in home, community and congregate settings.

Over the past two years, the Administration and the Legislature have invested $2.5 billion to meet the growing needs of the direct care workforce through training and incentive programs, as well as other initiatives that build the workforce pipeline to increase the number of direct care workers needed to care for our growing aging population. And finally, the fourth element to LTSS system change focuses on financing and affordability.

Californians confront many challenges in how to pay for long term services and supports Medicare doesn't pay and most Californians cannot afford to purchase private long term care insurance. So for most people, paying out of pocket for these services is cost prohibitive and creates a significant financial and social burden for our families. These services bring high costs not only to the individuals and the families, but also to taxpayers and the government as more people quickly deplete their limited incomes to cover the cost of care.

Through the Master Plan for Aging, the Legislature and the Administration invested $5 million for the Department of Aging to lead a cross agency initiative to support data and research of LTSS financing options for older adults and people with disabilities. This recently launched initiative will outline data focused on the current and projected needs of California's aging population that is currently not eligible for any funding of their LTSS through MediCal. So we call this population the missing middle.

This initiative will also identify a comprehensive set of sustainable policy solutions to consider for addressing the needs of those who fall in this missing middle population. In conclusion, by addressing the four interrelated elements of MPA's system change framework, which is navigation, access, workforce, and financing. We will continue to find ways to meet the population's needs and build a system for the future.

We no longer have the option of doing one or the othe. As state and federal budgets tighten, California is fortunate to have a strong stakeholder foundation and the MPA framework put in place by Governor Newsom, which will guide us in the coming years. We look forward to working with our state, local, and private partners to continue advancing this important work on behalf of California's older adults, people with disabilities, and family caregivers. It's now my honor to introduce Kevin Prindiville, who will talk about the IMPACT Committee.

Thank you.

Thank you, Sarah. Thank you, Madam Chair and Vice Chair Mathis, and to the Committee for Gathering us today for this important hearing. I'm Kevin Prindiville. I'm the Executive Director of Justice in Aging. We're a national, nonprofit legal advocacy organization that uses the power of law to fight senior poverty and advance equity for all of us as we age. We are a national organization, but we do a lot of special work in California because the issues here are so critically important.

I've been involved in the Master Plan for Aging since the work on the plan began. I was a member of the original Master Plan for Aging stakeholder Advisory Committee that helped develop the plan, and I'm here today as a Member of the Impact Committee. IMPACT stands for Implementing the MPA in California Together, I'm one of 11 Members of the Committee. Together we provide oversight, advice, and general feedback to the Department of Aging and CalHHS on the implementation of the plan.

We have quarterly public meetings, and we write an annual report providing feedback to CDA on MPA implementation. That report will be ready by April 25, I think is our next public meeting. It's been a tremendous opportunity and challenge to work on the MPA, and I'm really proud of what the state has been able to accomplish since this work began over four and a half years ago.

From my view as the Executive Director of a national organization, I can also attest to the comments that were made by others that California has really, truly become a leader on aging issues that other states and the Federal Government are looking to. And today I'm going to talk to you about three things. I'm going to celebrate some successes of the master plan for aging to date.

I'm going to implore you all, the Legislature and the Governor, to protect these successes, even as the state's fiscal situation has changed. And I'm going to ask you as the Legislature and the Governor to direct your focus as we move forward on the MPA to two areas, home care and elder homelessness. So first to touch on successes, the first three years of the MPA has been full of just a tremendous flood of activity that you've heard about from colleagues up here today.

There's been many initiatives spread across many agencies and departments that move forward each of the goals identified in the MPA. It's hard to keep track of it for us on the outside, and I'm sure it's difficult to manage for those that are working in CDA and across the government to make it happen.

This activity, combined with a good budget the last couple of years, led to expanded existing and creation of new programs that created real life, tangible benefits in the lives of tens to hundreds of thousands of older adults across California.

For example, the state made healthcare more affordable by expanding MediCal coverage to undocumented older adults, by increasing the income limit for the MediCal program, and becoming the first state in the country to lift the asset test for MediCal services for older adults and people with disabilities that need that access to long term care that Sarah talked about. The state has increased economic security of the poorest older adults by increasing the SSP for people on SSI.

The state has created temporary worker support programs to strengthen our caregiver workforce in the state. And the state temporarily expanded funding for a wide variety of aging services. So some real benefits that have impacted families'pocketbooks and their ability to afford living in California. So these are real important measures for us to celebrate.

And as I mentioned a minute ago, these expansions and new programs were possible because of the state's positive budget situation, one that included surpluses, as well as one time federal funds and the IMPACT Committee and at Justice in Aging, we understand that the fiscal condition of the state has changed. The MPA was created as a roadmap to guide the state, not just when the budget was up, but also when the budget was down.

So in previous fiscal downturns, these programs that I'm talking about and these communities that we represent, this is often where the first cuts were made. They were made to programs that older adults and people with disabilities relied on home and community based services, long term services and supports, caregiver resource centers, other safety net programs that millions of families rely on across California. So we're thankful to see that so far, no severe cuts to those core services have been proposed in the Governor's January budget.

And we really implore the Governor and the Legislature as you get more information about the state's budget situation to maintain your commitment to services for older adults and people with disabilities, and to refuse to balance the budget on the backs of older adults, people with disabilities, and their families. With 2030 rapidly approaching, the state needs to deepen and certainly not pull back from its investment in and attention to California's growing aging population.

So now, looking ahead some as we enter the fourth year of implementation of the plan, we're at really a critical transition point. This is a 10 year plan, so year four represents we're now squarely in the middle of the plan. If we were in our 60s, we'd be saying that we're in our mid 60's now, not our early 60's or our late 60's.

So it's time for us to start thinking seriously about where we want to be as a state by 2030, to ask whether we are on track to get there, and to determine with clarity what additional steps need to be taken to get us from where we are now to where we need to be. The IMPACT Committee has identified two issues that need special focus right now in order to get us to where we want to be in 2030.

And those two areas are home care and elder homelessness. And in each of these areas, equity and the needs of underserved communities like those you mentioned at the start of the hearing, Madam Chair need to be at the center of the work that we do. We're not suggesting that work on other initiatives or goals stop, but we are calling on the Administration and the Legislature to really focus on ensuring transformative change in these areas.

And transformative change requires setting specific goals of where we want to be by 2030 and charting a clear path year by year for how we're going to get from here to there. I'd like to speak just briefly about each of these two issues. The first, home care, and I'm using the term home care to be inclusive of the broad array of supports that people need to stay at home and in their communities to meet their long term care needs.

For the NPA to be successful, it's critical that we build a home care and community care system that works for all Californians. The majority of older adults and people with disabilities want to live at home and in community, even as their needs change over time. But California lacks a clearly affordable, inclusive, and equitable system to support them. Right now, too many families are sitting around kitchen tables panicked about how they're going to meet the care needs of their older family members.

I just lived through this in my own family. Many people, especially those with complex needs and people of color are forced to receive their care in institutional settings like nursing facilities. Doesn't have to be that way. With systems change and adequate funding, California can build a system where everyone can afford the care they need, a system that is easy to navigate, a system where services are accessible at the time and in the settings people prefer.

A system where those providing care, both paid and unpaid caregivers, are treated with honor, dignity, and the respect that they deserve. And you heard Sarah talk about many of these same issues. Now, we realize there's not funding available in the current budget to do this, but we also realize that there's not suddenly going to be funding next year or the year after that if we're not making a plan for it.

We need to be working now to create and execute a plan that generates the revenue we need to take care of our families. Home care and home care financing must be a focus of the MPA.

The Governor and the Legislature need to be focused on that now if we're going to be where we want to be in 2030. The other issue I talked about is elder homelessness. As I'm sure you've heard us say, as we've been talking about this for years now, older adults are still the fastest growing part of the homeless population in the state. In some counties, older adults now make up half of the homeless population.

And,

And significant numbers of older adults who are homeless experienced homelessness for the first time after age 50. The number of homeless older adults in California is a tragedy. It's a preventable tragedy. We can fix this. We have to fix this problem. We need dedicated attention, dedicated strategies, dedicated funding for older adults experiencing homelessness. And unfortunately, despite the activity that's happened in the MPA around homelessness, we haven't seen enough results yet on the ground.

We're calling for more action at the state level to advance the one intervention that we think would be most effective at addressing elder homelessness, which is a targeted rental subsidy program. We've seen success with this model in many local jurisdictions, and we need a statewide strategy and approach now.

So here we implore the Governor and the Legislature to use this next phase of the MPA to set specific goals for ending elder homelessness by 2030 and for identifying the steps we will take over the next one to two years to develop a statewide targeted rental subsidy program for older adults and people with disabilities. As you've heard throughout our MPA process, and I don't think we've mentioned it again today, but 30% of California's population will be 65 and over in 2030. Thirty percent of the population, in now just six years.

The MPA gives us a path forward and a vehicle for navigating the challenges and opportunities that come with that. But now, nearly halfway through the plan, we have to take stock and turn our attention and focus to the most critical issues in front of us and in front of families across the state. Home care and elder homelessness. Justice in Aging and the IMPACT Committee

look forward to working with you all to bring that focus that we need to achieve transformational change envisioned by the MPA and to bring the transformational change that our families and communities are expecting of us. Thank you.

Good afternoon, Madam Chair and Members. Victoria Jump I work for the County of Ventura Human Service Agency, and in my role there I oversee all Aging and Disability programs, which include IHSS, APS, Public Administrator, Public Guardian, sorry, Public Authority, but also the area Agency on Aging programs. So area agencies on aging have been governed by a set of rules, funding formulas and programs for the last 50 years.

As the only purposely built national delivery system for older adults, we have provided services that keep older adults in home and out of institutions. We have provided home delivered meals, congregate dining meals, case management, rides to doctors appointments, personal care assistance, help with chores, home modification, supports for family caregivers, and more. State investments have allowed us to expand services to more people. Despite all of this, it's still not enough.

We are facing a significant growth in the population of older adults and do not have the resources, programs, or policies in place to be able to meet the current needs, let alone the future needs. We have experienced increases in nonwhite and mixed race Californians, which require more service providers to be bicultural and bilingual. More Californians live alone, and there is a shrinking birth rate contributing to the short and long term challenges of paid and unpaid care provision for older adults and public funding for programs.

California 2030 is our opportunity. It's about the millions of Californians who struggle to make ends meet. It's about their caregivers who are overwhelmed and don't know where to go for help. It's about our residents who live in rural areas where there are limited or nonexistent services. It's about a network of 33 area agencies on aging created over 50 years ago that have evolved, but also a network that was never designed.

In the fall of 2022, the California Department of Aging convened the California 2030 steering Committee, comprised of 11 representatives that included area agencies on aging, independent living, resource centers, county supervisors, California welfare directors, California State Association of County, amongst other representatives. The role of the steering Committee was to advise on the definition of and research and recommendations for what a future ready California looked like.

While the Master Plan on Aging is far reaching in multisector, California 2030 supports the master plan in intentionally planning for the strengthening of our network of area agencies on aging. Who we were designing the system for was central to the process. Older adults, people with disabilities, and caregivers were always front and center. This is not about CDA or individual AAA's, but about the people that need the help that are not getting it.

And how can we design a system for them where they get all of the resources and connections to services that they need the first time they come through the door and not make them go through the door over and over and over again? A tremendous amount of research was done, including interviewing 162 AAA staff Members, 80 external stakeholders, and conducting a statewide needs assessment where over 17,000 people participated.

Qualitative and quantitative research was core of the project in areas of focus included geography, governance programs and services, key performance measures, funding, marketing, branding and communication. So some of the findings in the report and the plan, the needs of older adults, people with disabilities and family caregivers are very different from generations past. People carry different life experiences, economic and social needs, cultural preferences, and consumer expectations. The income gap between high and low income residents in our state continues to widen.

The health sector has evolved and now demands more integration with social services. Public perceptions of aging and disability, while improving, are still riddled with negative stereotypes. With the advancement of new technologies, growth of value based and managed care services, widening economic and social disparities, and elevated consumer expectations for quality services, the California Aging network must prepare for and situate itself within a more complex, integrated and demanding environment.

So during the interviews with the stakeholders, key informant and subject matter experts, when asked what really an ideal, future ready California aging network look like, the following traits emerged. It must be aging and disability focused forward. The network must understand prevent combat negative stereotypes associated with aging and disability by promoting positive images and strengths of all people. It needs to be inclusive and equitable. It must address ageism, ableism, racism and implicit bias.

It will manage resources and programs to meet our California's evolving needs, ensuring equitable distribution and reach across programs of populations and rural and isolated geographies. It needs to be well known and accessible. It will be visible, recognized and accessible to all Californians. It has to be consistent. It will provide a reliable standard of quality and core services across the state. It shouldn't matter where you live, you should get the same level of service across the state. It must be locally responsive.

It needs to adapt and develop policy, services, practices and programs to address community specific needs as well as opportunities. It should be strategic and action oriented. It invests in and relies on leaders who anticipate and respond to internal and external opportunities and threats by leveraging the strengths of their stakeholders, communities, partners and agencies. It needs to be performance based and outcome driven.

It demonstrates the value and impact of programs and services by measuring and monitoring performance and demonstrating the social, health and economic outcomes and results and investments. It also has to be integrated. It connects the public and private stakeholders spanning the continuum of human services, healthcare, behavioral health, public health, serving as the trusted aging services resource advocate and ally. So the 2030 blueprint contains many recommendations that will take years to realize, and all are centered around moving us towards the traits of this ideal network.

Recommendations fall within the following categories. There's recommendations related to strategic planning and what that looks like services, communications planning and service area designations, data and information technology, workforce advocacy and funding. And I'd like to highlight the funding category, which is critical. The existing network, as it stands, is at capacity. At this time, unfortunately, where you live does depend upon what services are available for you. The best and most well intentioned strategic planning can be done.

We can all decide on a core set of services so that there is consistency across counties and we can increase marketing so that people are aware of our services. But unless we address funding issues, we will be spinning our wheels. Funding is critical and must go hand in hand with the other changes as we collectively transform the system.

It has been my privilege to participate in the California 2030 plan, and I thank the Department and the Administration for being forward thinking and inclusive in the process and always keeping that customer in mind. Change is hard and to fully realize the plan, it's going to be a lot of work. Everyone may not agree with all of the objectives or the order in which the state carries them out, which is okay.

What I do know from doing this work for the last 25 years is that change is needed. We cannot keep doing the same things as we have for the last 50 years with the same resources and expect different results. Thank you.

Thank you so much. Can you hear me? Okay, perfect. Thank you for all the speakers, for all of the information that was given. One of the biggest concerns that I'm seeing specifically in my county is support for IHSS workers. What's happening right now is the ball is in the county, the county is saying, no, this is a state problem. No, the state's saying, no, this is a county problem. County's not doing their job, state's not doing the job.

And state's response is, let's just increase the fees on the counties and county's response is 'I don't care, I'll just pay the fees'. So this is a huge problem. And how do we get behind on solving this problem? We can't continue providing band aids. IHSS workers, which are our workforce, for taking care of our elderly, our people with disabilities. It's very hard work. I was a primary caregiver myself for my grandmother. They deserve to be paid. What?

For me, forecasting as a physician, this is of utmost priority for not just us, but everyone in California to make sure that we do everything that we can to incentivize and take care of our IHSS and caregivers. Not just that, making sure that those caregivers at home have the training that's standardized throughout all caregivers. As a physician, I can write every prescription, but will that patient go and get the care that they need at home to be able to fulfill the prescription that I wrote?

I can do everything I can in that 15 minutes, sometimes two minute doctor visit. But if there's nobody at home providing a support service and the state's not doing the most that it can to make sure that that is in place, what are we going to do? 2030 looks really bleak for me, guys, and that's a big concern. How do we get behind this and solve this problem?

Because for my eyes, as a physician, this is the biggest problem that we will be dealing with in the space of Aging and Long Term Care.

IHSS is absolutely a key cornerstone of a home care system, as well as privately funded home care, home health, and others. I think that Victoria has a lot to contribute on this topic, running the program in Ventura County.

So it's a complicated issue. It is. So I administer both IHSS and the public authority, and I understand your question really is about the collective bargaining, that if you don't settle with the unions, then you have to pay a higher fee, I guess a penalty. Right now, as you're aware, that the state pays a certain amount statewide for the IHSS worker benefits. Anything above that is up to the county to pay.

And depending upon how many individuals that you have and the number of hours, it becomes very costly for the counties to do the right thing and to provide enough hours and enough workers. From the public authority side, it's a challenge due to the wages. When we're in a situation now where certain classes of workers, let's say like fast food workers, for example, now make more than IHSS workers, which is drawing people away from an existing small workforce.

The people that are called to do this, they're not in it for the money. Obviously, they wouldn't be there, but they need to pay their bills. And sometimes it's difficult. They can't work as many hours as they want because they need to go to a job that's going to pay more. From where I sit, most of the IHSS workers are women and minorities. They're low-income because of what we're paying know there are no statewide health benefits. There are no pension plan.

So we're asking people to delay their own financial future, right? Because they could be working in a higher paying job and potentially paying into something that in the end of their, when they retire, they get benefits, but they're not doing that because they're taking care of their family. And so we're just creating an ongoing potential issue where these same people are helping now, but they're going to be our participants in the future because they don't have the money to get out of it.

From my perspective, coming up with a better benefit package, better wages, better training, something so that people see this as a real career. Honor, what they're doing, let's train them, let's support them.

Yeah. And I'll just add from the perspective of beneficiaries, Kevin Prindiville, Executive Director of Justice and Aging, that this is an important issue to those that are providing the care, and it's an important issue to those that are receiving the care. If we don't have the workforce in place, then that means people go without care or that families check out of other parts of the workforce to care for families.

So the economic impacts of not having a workforce that can meet this need are tremendous for families as well as for the state overall. We have not built the workforce to provide for the care economy. That is the future of both care and of work in this state and across the country. So we have to do that.

We have a growing number of people that are now qualified for Medi-Cal because of the expansions to undocumented people and the elimination of the asset tests to increase the income limit. That's good that more people are now eligible to get help with care. But we are seeing this workforce crunch, and I think that both people that receive care and people that provide care are completely aligned in what we want to see happen, which is we want these to be good jobs.

We want the things that Victoria and Susan said and that you, Assembly Member said need to happen for these good, good jobs, job protections, good wages, good benefits. That has to be there so that we can receive care when we grow older, that our families can receive care, and then know that our families are taken care of so that we can go earn our own economic security and stability in our lives. So these interests are aligned.

And we have to start approaching this issue as a family and community issue to make the hard decisions to find the solutions we need.

Yeah, it gets back to a lot of the programs that we discussed today. Right? The food, meals. We can provide as many meals to homes, but who's going to feed them? They'll just sit there and collect. If it's a person that has a disability, if there's not somebody feeding them, they could aspirate, be in the hospital with pneumonia. So everybody wants to talk about the situation, but nobody wants to provide solutions. This is a real problem, guys.

If our IHSS workers cannot afford good living wages and be able to take care of themselves and take care of their loved ones, you can throw as many meals, you can throw as many other services but if that person's home environment, they don't have that support structure, those dollars are going wasted.

So for me, the number one priority should be, especially when it comes to caregivers, is making sure that IHSS workers have access to all resources and we grow our workforce when it comes to taking care. There's nothing that surpasses this most, in my opinion, and I have not seen any actions by the Legislature or the Administration when it comes to taking action on this specifically.

It's been a lot of bandaids, but no one's done anything and there is going to be a silver tsunami and it's going to get much worse if we do not address this problem. Any other comments from my colleague?

Well, I can continue to echo the same concerns that I have, and this is not my first time in this Committee nor my first time as the Vice Chair of this Committee. So welcome back for me, I guess, but we've been talking about this for a decade, and I've got to say that the work that's gone into putting together the Master Plan and the oversight, you got to applaud the efforts because this wasn't an easy task. This wasn't something that started off easily.

And from where we were 10 years ago when I first got into the Legislature to where we are today is night and day just from then in the last decade, but yet here we are again with a lot of the same problems. So I do want to thank you all for putting it together and the work that your groups have done with all the stakeholders and really looking at how we can do this, because this isn't about big government growing.

This is about making sure this is fine-tuned to take care of our populations. And really it's looking at how area by area, for us, we call it district by district. But how does this work in the Inland Empire? How does it work in L.A.? How does it work in San Diego? How does it work in the San Joaquin Valley? South Valley versus North Valley? So with that, I want to thank you for what you're doing there.

But I also share the same concerns, as do a lot of people, and also want to know how moving forward, we're going to ensure that we can continue to look at those individual areas and to celebrate what they're doing there, to make sure that they still have input, that it's not a top-down situation. Because a lot of areas have different traditions, have different things. We need to make sure that they, as they're aging out, have that meaningful golden years.

Welcome back, Mr. Vice Chair, great to see you. Susan DeMarois, Director of the California Department of Aging. We're so fortunate to have this five-goal framework for 10 years, and I think having a constant that includes, right at the heart of it, caregiving that works. And that's caregiving for the paid workforce, as well as unpaid family caregivers who we know today provide the vast majority of long-term care in our state and our nation.

And that's an important recognition in the plan, is how can we lift up and shore up family caregivers. Earlier, I mentioned our local aging and disability planning grants and getting at the, really looking at what's bubbling up from the community level and hearing from members of our cities and counties around the state and finding a lot of commonality and reinforcement that those five bold goals really stand. Inclusion and equity, not isolation. We know in our local communities that family structures and systems have changed.

We heard earlier from the panel that family sizes are shrinking and families are more mobile. Part of why we want to see consistent and standard programs throughout the state is you may have a family member in Bakersfield providing support to a loved one in Sacramento remotely, and trying to navigate a system in an altogether different county, coming on the weekends, sharing responsibilities with other family members. So really just making sure that the system works in all 58 counties.

And as we heard, that there's one door, and that people get the support and resources they need the first time they enter that door, instead of being referred, passed around, and referred to other resources.

No, making sure it's a one-stop wraparound is extremely important because, as you just said with your scenario, family members are having to leave, take days off of work, and to come and make sure they get mom and dad or grandma and grandpa, whomever it is that they're taken care of in that door. And so that's time away from work. And if you've got to go back and forth and back and forth, you lose faith in the system really quick.

And there's a lot of apathy, I think, with people towards government systems, period, right now. And so we need to make sure that the services are there and that it makes sense. When we sit here and we go, we're just now getting a website that makes sense. I remember when I came in, I was the guy that's like, how come we don't have an app for this? And we're still not even to apps? Everything comes down to the cost. It's all about money, money, money.

But we're talking about the population that paved the way, and we need to take care of them and need to set up a system so as the silver tsunami and those coming behind it are going to be taken care of in a fair and equitable way that is going to ensure quality of life. I can continue on and on, but I think the bottom line, and it goes back to what Madam Chair had said without the workforce there. And you're right.

I mean, the increasing fast food minimum wage is probably the dumbest thing we did as a state in the last 10 years. And the workers may not agree with me, but everybody else and workforce is struggling now because of it. So now we have a situation where there are needed, impactful jobs that cannot keep up because the minimum wage differences and we always turn around and the answer is always, well, just increase wages. And it's like, yeah, and then you increase inflation across the board.

And then we still struggle. So we've got to be smart on how we do this. But we definitely need to look at workforce across the board.

And one of the bills that I'm running this year, not to go over into too much legislative side on a hearing, but is just looking at how we'll have a nursing shortage in areas and we can't even get. You might have an LVN or a CNA that's trying to get into an RN position in that local area and their employers are willing to pay for them to go to school, but those slots are taken up. So that's something that I'm looking at this year.

But other than that, I will turn it back over to our Chairwoman.

Awesome. No, just want to reiterate, everybody deserves livable wages and benefits regardless of what it is. And we should do as much as we can across the board that people have those, especially at a time where most Americans are living paycheck to paycheck. The only people that will understand that are those people that are working those jobs. So what the work that the Legislature has done to make sure that there are livable wages is very important and should be upheld.

I would like to go ahead and open this up for any public comments.

Peter Hansel. I am an advocacy volunteer for AARP California. We represent 3.2 million Californians who are members of AARP. And on behalf of our membership, we'd certainly like to thank the Committee, the Chair, and the Vice Chair for convening today's hearing. Very important. AARP, I think, would like to acknowledge just upfront the tremendous amount of work that has gone into implementation of the plan thus far. Here we are in the fourth year and certainly, there was a comprehensive review by the witnesses of all the initiatives.

Some of the funding that was put into the initiatives is very much appreciated. And the Governor's willingness to sustain the funding is very, very important as well, because those programs would be at risk going into the budget situation we have right now. I would say on behalf of AARP's membership, the critical underpinning of the Master Plan is equity. You've heard that today from the witnesses. Appreciate the acknowledgment.

It's really the guiding principle should be the guiding principle for the plan and something we're strongly in support of. AARP has specific priorities. Some of them overlap with the things that are presented today. Some are a little different.

I think, to start with, I think AARP's strongest priority is, as was discussed a little bit by some of the witnesses, establishing an LTSS benefit for the forgotten middle, as it's referred to, the folks that don't have eligibility for public programs and don't have access to long-term supports and services.

And I should mention that AARP is about to launch a public campaign to start educating the public, kind of a face the facts campaign, if you will, aimed at helping Californians understand the financial realities of what's involved with aging in California. A second priority, and it has not been mentioned, is the need for accessible transportation, very, very important to the seniors and persons with disabilities. Accessible options that are real for people that can access. Mobility is very, very important.

It's a social determinant of health and something we want to make sure continues to get a spotlight, although it may not fall always under the Department of Aging for responsibility. And then third and very important point for AARP and its Director, DeMarois touched on it, is accountability and transparency. And we'd actually like to urge the Committee and the Legislature to adopt the recommendations of the Little Hoover Commission, which came out with a really good report in late last year calling for additional reforms in that area.

I think that would advance. I think it probably goes to the point of drilling down a little bit to something that's a little more specific and a little more time-sensitive. I think Kevin Prindiville was trying to get this point across that really shows us how we're going to get to that 2330 milestone.

Can we please keep the comments brief? Thank you.

I'll wrap it up. So we'll be following up with a letter to outline this and in more detail, and that will be available afterwards. Thank you.

Thank you.

Hi, Madam Chair, I'm Darby Kernan. I'm representing Leading Age California, representing over 600 nonprofit providers serving the out-of-hospital continuum of care for older adults, including affordable housing, residential care facilities, life plan communities, skilled nursing facilities, home and community-based services, home health, and hospice. The Master Plan for Aging is a vital tool for ensuring the state is prioritizing the needs of older adults. We appreciate you holding this hearing today.

We applaud the Department of Aging, the Administration, the Legislature for following through with this plan, as well, engaging with stakeholders and addressing the challenges facing older adults in California. We encourage the Legislature to pass legislation in support of the goals of the Master Plan on Aging, in particular, expanding access to long-term care services and supports and increasing affordable housing for older adults. Thank you.

Hi, Karol Swartzlander, Executive Director of the California Commission on Aging. We're established in state statute to serve as the principal advocate for older Californians. First, I want to express my appreciation to the Department and the Administration for their tremendous work on the Master Plan for Aging. You're right, it wasn't an easy lift. There's still a lot of work to go. But the stakeholder engagement has been beyond. Beyond, what's the word? Beyond? It's been phenomenal.

So they continue to engage stakeholders both during the development and then also through implementation. The Commission has been involved since day one, and we continues to support implementation of the Master Plan generally, and then specifically by sponsoring SB 1249 with Senator Roth, which is focused on modernizing aging services in California for the many reasons expressed by Victoria Jump and his recommendation from the CA 2030 report.

And for perspective, my first job with the State of California was as a data analyst at the California Department of Aging. I still remember being appalled at the lack of consistent data across the AAA network and the lack of performance measures. So you can imagine, I am so excited and thrilled to be working with the Commission to sponsor improvements to the aging network, to modernize it, and agree with Victoria that the time for change is now and we need innovation. Thank you.

All right. Seeing no other couple of comments again, I'll bring it back home. Thank you guys so much for your work on the Master Plan of Aging. It's not an easy task, I know, and it can be really scary to see what's going to happen the next five to 10 years. But your work is super important. There's a lot of more work that we need to do. Thank you, guys. I hear clearly the engagement of the stakeholders. Thank you guys so much for your work.

With that, we will adjourn this hearing. Thank you.