BILL ANALYSIS Ó
SB 547
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Date of Hearing: June 21, 2016
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Cheryl Brown, Chair
SB
547 (Liu) - As Amended January 26, 2016
SENATE VOTE: 35-4
SUBJECT: Aging and long-term care services, supports, and
program coordination.
SUMMARY: This bill creates the Statewide Aging and Long-Term
Care Services and Coordinating Council (Council), chaired by the
Secretary of the California Health and Human Services Agency
(CHHS) and requires the Council to develop a state aging and
long-term care services strategic plan to address how in 2020,
2025, and 2030 California will meet the needs of the aging
population. Specifically, this bill:
1)Requires the Secretary of CHHS (Secretary) to be responsible
for the inter- and intra-agency coordination of state aging
and long-term care services, supports, and programs, to ensure
the efficient and effective use of state funds, and maximize
the drawdown, and efficient and effective use of federal
funds.
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2)Creates a Statewide Aging and Long-Term Care Services and
Coordinating Council (Council), chaired by the Secretary and
consisting of the heads, or designees, representing 22 state
departments.
3)Requires the Council to develop a state aging and long-term
care services strategic plan to address how in 2020, 2025, and
2030 California will meet the needs of the aging population.
4)Requires the strategic plan to incorporate clear benchmarks
and timelines for achieving the goals set forth in the
strategic plan, and include a cost benefit analysis for each
goal or recommendation included in the plan.
5)Requires consultation with specified experts, practitioners,
service providers, advocates and stakeholders in developing
the strategic plan, and requires the findings and
recommendations of the California Task Force on Family Care
Giving be incorporated in the strategic plan.
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6)Requires the strategic plan to address all of the following:
a) Integration and coordination of services that support
independent living, aging in place, social and civic
engagement, and preventative care;
b) Long-term care financing;
c) Managed care expansion and continuum of care;
d) Advanced planning for end-of-life care;
e) Elder justice;
f) Care guidelines for Alzheimer's disease, dementia,
Amyotrophic Lateral Sclerosis, and other debilitating
diseases;
g) Caregiver support;
h) Data collection, consolidation, uniformity, analysis,
and access;
i) Affordable housing;
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j) Mobility;
k) Workforce;
l) The alignment of state programs with the Federal
Administration for Community Living (ACL); and,
m) The potential for integration and coordination of aging
and long-term care services with services and supports for
people with disabilities.
7)Requires the Council to examine model programs and consider
how to scale up local, regional, and state-level best
practices and innovations to overcome long-term care services
delivery.
8)Requires the strategic plan to be submitted to the specified
committees of the Legislature by July 1, 2018.
EXISTING LAW:
1)Establishes the California Health and Human Services Agency
(CHHS), an umbrella agency over the Departments of Aging,
Child Support Services, Community Services and Development,
Developmental Services, Health Care Services, Managed Health
Care, Public Health, Rehabilitation, Social Services, and
State Hospitals.
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2)Establishes the California Department of Aging (CDA) to
administer programs that serve older adults, adults with
disabilities, family caregivers, and residents in long-term
care facilities throughout the state.
3)Sets forth legislative findings and declarations regarding
long-term care services, including that consumers of those
services experience great differences in service levels,
eligibility criteria, and service availability that often
result in inappropriate and expensive care that is not
responsive to individual needs.
4)Sets forth legislative findings and declarations stating that
the laws governing long-term care facilities have established
an uncoordinated array of long-term care services that are
funded and administered by a state structure that lacks
necessary integration and focus.
5)Establishes, under federal law, the U.S. Administration for
Community Living (ACL), bringing together the Administration
on Aging, the Office on Disability and the Administration on
Developmental Disabilities to: reduce fragmentation in federal
programs that address the community living service and support
needs of aging and disabled populations; enhance access to
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quality health care and long-term supports and services (LTSS)
for all individuals; and, promote consistency in community
living policy across other areas of the federal government.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
Likely ongoing costs of about $300,000 per year for CHHS to
coordinate state policy and support the new Council (General
Fund). In order to coordinate programs and activities between
various state agencies and provide ongoing staff support to
the newly created Council, CHHS is likely to need additional
staff positions.
Likely one-time costs of about $600,000 to develop the
required strategic plan (General Fund). Given the breadth of
issues facing an aging population and the complexity of the
current system for providing services to senior citizens, it
is likely that CHHS will need to dedicate a significant amount
of staff time to performing the necessary research,
facilitating the Council's deliberations, and drafting the
required strategic plan.
COMMENTS:
Author's statement. According to the author, "California's
population of residents 65 years old and older will grow from
about 13 percent of the population to almost 20 percent of the
population by 2030. The state is not prepared for this "silver
tsunami." ?California's aging and long term care "system" of
services and supports is fragmented to the point of being almost
impossible for consumers, caregivers, and providers to navigate.
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There are 112 aging and long term care programs spread over 20
state agencies and departments and very little coordination
among them. ?California must begin now to organize our services
and supports delivery system and plan our investments in long
term care to maximize returns in the form of improved quality of
life and cost savings to consumers and taxpayers before we are
faced with an overwhelming crisis."
Senate Select Committee on Aging and Long Term Care report. The
Senate Select Committee on Aging and Long Term Care's 2014
report, "A Shattered System: Reforming Long Term Care in
California" (report) was the result of a comprehensive effort in
2014 to identify the structural, policy, and administrative
changes necessary to realize an ideal long-term care delivery
system and develop recommendations and a strategy to achieve
that vision. The report found that California's fragmented
organizational structure leaves the state with a leadership
vacuum that complicates any effort to undertake comprehensive
Long Term Care reform. Among state agencies there is no
distinct leader who is responsible for establishing and
implementing a vision for comprehensive LTC service delivery.
Instead, the current structure offers a piecemeal approach to
system change; there is no overarching plan for creating an
integrated system.
The Little Hoover Commission in its 2011 report, A Long-Term
Strategy for Long-Term Care, found California's long-term care
system broken. The state has no reliable means of gauging what
clients need, what benefits they receive, which services are
used by whom, how much each service costs the state, and which
programs work the best and are the most cost-effective in
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keeping people in their homes. There is virtually no
coordination or communication between programs and staff
responsible for long-term care services. There is no integrated
management or coordination of financing, service delivery or
assessment of long-term care client needs or of providers.
These fundamental structural flaws leave the system unable to
effectively or efficiently deal with current needs and make it
woefully unprepared for the "silver tsunami" of seniors who will
lack services in the years to come. Furthermore, California
lacks a single leader within the Health and Human Services
Agency accountable for managing and modernizing long-term care
in the state, which creates significant challenges to any
attempt to systematically harness the dozens of long-term care
programs and the many billions of dollars spent on them.
Arguments in Support: Writing in support of this bill, The
California Commission on Aging states "silos and fragmentation
have long impeded the delivery of services to the state's most
frail and vulnerable adults. Through creation of the Council,
this bill focuses the attention of 23 state departments and
divisions on their shared role in meeting the needs of a growing
population of older adults and persons with disabilities. The
Council's development of an Aging and Long-Term Care Services
Strategic Plan will spell out the steps to better organize and
coordinate the administration and delivery of critical Long Term
Care Services."
REGISTERED SUPPORT / OPPOSITION:
Support
California Alliance for Retired Americans (CARA)
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California Commission on Aging
California State Retirees
County Welfare Directors Association of California
Little Hoover Commission
National Association of Social Workers-California Chapter
(NASW-CA)
Solano County Board of Supervisors
Opposition
None on file.
Analysis Prepared by:Barry Brewer / AGING & L.T.C. / (916)
319-3990
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