Let's Create a 21st Century LTSS System in CA

Governor Gavin Newsom, Senate President Pro Tempore Toni Atkins, Assembly Speaker Anthony Rendon, and members of the California Legislature

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Today, California’s system of Long-term Services and Supports (LTSS) leaves too many people without the services they need to live and age with dignity and economic security in their community. People are living longer. The senior population will double between 2015 and 2030, with eight and a half million Californians over the age of 65. This increase in older adults, combined with the growing number of people living with significant disabilities, will dramatically increase the need for LTSS. According to the U.S. Department of Health and Human Services, the average person over the age 65 will need at least one year of personal assistance. Yet, very few have the resources to afford it. Very low-income persons can access limited care through Medicaid—one of the largest budget items in the state and a system that is facing unsustainable demands. Nearly everyone else must pay out of pocket, eventually spending down their assets to become eligible to access Medicaid services and supports. Too often seniors and working people with disabilities must rely on an unpaid family member, friend or loved one who often experience their own stress, health impacts and loss of income as a result of caregiving demands.

Furthermore, caregiving professionals are amongst the lowest paid workers, contributing to high turnover and a growing workforce shortage. According to US Homecare Workers: Key Facts, a 2018 PHI study, there are 2.1 million U.S. home care workers who earn a median wage of $11.03 an hour and $15,100 a year. Thus, twenty percent of home care workers live in poverty, compared to seven percent of all U.S. workers. And the vast majority don't have retirement savings to pay for the LTSS they may one day need.

Given these facts, CA needs to develop at 21st century system of LTSS to ensure that it:

  • Is affordable and accessible to all who need it, regardless of income,

  • Is sustainable (has a revenue mechanism that is stable and solvent),

  • Offers flexible benefits (a range of supports and services that respond to what a person needs to live and participate in their community), and

  • Promotes quality of care and supports the needs of the direct care workforce.

Governor Newsom's commitment to addressing the needs sharpened by the demographic shifts in the state provides us with an incredible opportunity to plan for that 21st century LTSS system. Organizations of older adults, people with disabilities, advocates, service providers, family caregivers, and the direct care workforce are coming together to ensure that we plan now for the system we need.


To: Governor Gavin Newsom, Senate President Pro Tempore Toni Atkins, Assembly Speaker Anthony Rendon, and members of the California Legislature
From: [Your Name]

We commend your efforts to prepare the state for our growing aging population. As part of that effort, we ask that you prioritize investment in our state’s Long-term Care and Long-Term Services and Supports System (LTSS) so that all Californians can live and age with dignity.

Today, California’s LTSS system leaves too many people without the services they need to live and age with dignity and economic security in their community. People are living longer. The senior population will double between 2015 and 2030, with eight and a half million Californians over the age of 65. This increase in older adults, combined with the growing number of people living with significant disabilities, will dramatically increase the need for LTSS. According to the U.S. Department of Health and Human Services, the average person over the age 65 will need at least one year of personal assistance. Yet, very few have the resources to afford it. Very low-income persons can access limited care through Medicaid—one of the largest budget items in the state and a system that is facing unsustainable demands. Nearly everyone else must pay out of pocket, eventually spending down their assets to become eligible to access Medicaid services and supports. Too often seniors and working people with disabilities must rely on an unpaid family member, friend or loved one who often experience their own stress, health impacts and loss of income as a result of caregiving demands.

Furthermore, caregiving professionals are amongst the lowest paid workers, contributing to high turnover and a growing workforce shortage. According to US Homecare Workers: Key Facts, a 2018 PHI study, there are 2.1 million U.S. home care workers who earn a median wage of $11.03 an hour and $15,100 a year. Thus, twenty percent of home care workers live in poverty, compared to seven percent of all U.S. workers. And the vast majority don't have retirement savings to pay for the LTSS they may one day need.

Given these facts, in the spirit of collaboration, we ask that you continue to engage seniors, people with disabilities, family caregivers, and the direct care workforce to develop a 21st century LTSS system that:

Is affordable and accessible to all who need it, regardless of income,

Is sustainable (has a revenue mechanism that is stable and solvent),

Offers flexible benefits (a range of supports and services that respond to what a person needs to live and participate in their community), and

Promotes quality of care and supports the needs of the direct care workforce.