THE SENATE BUDGET FISCAL REVIEW
SUBCOMMITTEE NUMBER THREE ON
HEALTH AND HUMAN SERVICES I'M A
WELCOME EVERYONE HERE TODAY --
TODAY WE WILL BE ADDRESSING THE
STATE OF LONG TERM.
CARE SERVICES AND SUPPORTS FOR
CALIFORNIA SENIORS --
THE PURPOSE OF THIS HEARING
ACTUALLY IS --
TO ESSENTIALLY LAY OUT THE
TEACHER DEMOGRAPHIC CHANGES HERE
IN CALIFORNIA AND ITS IMPACT
IT'S GOING TO HAVE ON SERVICES.
FOR SENIORS AND THE DISABLED --
RECOGNIZING THAT THIS IS
ACTUALLY A VERY SIGNIFICANT
PORTION OF OUR STATE BUDGET --
IT'S ALSO A A GROWING NEED AND
OUR COMMUNITY AS WELL AND IN
FACT -- MANY
OF THE SERVICES ARE PROVIDED. TO
IN THIS REGARD ARE ACTUALLY --
PROVIDED IMPLICITLY BY CARE
GIVERS FAMILY CARE GIVERS AND
THAT -- IN
MANY WAYS --
WITH --
CHANGING FAMILY DYNAMICS AND SO
FORTH -- WE
ALSO NEED TO THINK SUPPORT --
THESE TYPES OF SERVICES AS WELL --
SO BETWEEN THAT AND CHANGING
DEMOGRAPHICS --
I THINK THIS IS SOMETHING THAT --
THIS HEARING IS REALLY TO SORT
OF HELP --
OUTLINE THE CHALLENGES THAT WE
FACE THE STATE IN THE STATE
BUDGET --
GOING FORWARD REGARD TO BE SURE
TO PROVIDE THOSE TYPES OF
SERVICES.
I WOULD MAKE NOTE THAT AND ARE
HEARINGS THAT WE'VE HAD OF THIS --
BUDGET SUBCOMMITTEE AND THIS
PAST YEAR --
WE HAVE INCLUDED IN --
THIS YEAR'S BUDGET A US STUDY --
WORKING WITH --
CHISS BUT THAT NEEDS --
LIKELY TO BE AND ARE --
OF THOSE NOW AND LOOKING TO THE
FUTURE --
COMPARED TO WHAT WE'RE ACTUALLY
ABLE TO DELIVER --
I WOULD ALSO MAKE NOTE THAT AND
ALSO IN DISCUSSIONS OF THIS
BUDGET SUBCOMMITTEE --
WAS REMARKS THAT --
THAT THE STATE HAS NOT DONE --
EXTENSIVE ONLY FAIRLY LIMITED
PLANNING INTO FUTURE AROUND THIS --
AND TESTIMONY BY --
THE AGING AGENCY AND I'M SURE WE
WILL HEAR MORE FROM OUR AGENCIES --
BEFORE BUT I THINK IT'S VERY
IMPORTANT AS WE ARE STARTING A
WITH THE NEW GOVERNOR --
WE HAVE A THE CHANGES THAT ARE
GOING ON LOOKING AT WHERE --
THE NEEDS WILL BE FOR AND BETTER
DEFINED THAT AND HOPEFULLY --
THIS SUBCOMMITTEE AS AS IT MOVES
FORWARD FUTURES WHILE THE OTHER
COMMITTEES OF THE LEGISLATURE
WORLD DIVE MORE INTO THE
SOLUTIONS ISSUES OF HOW DO WE
ADDRESS THIS BUT I THINK FOR
TODAY WERE MAINLY BE GOING TO BE
FOCUSED ON TRYING TO DEFINE WHAT
THE ISSUES ARE.
AND ALSO THE THE LEVEL OF THE
DAD IS GOING TO THAT IS --
OUT THERE IN THE COMMUNITY SO --
WITH THAT AND WHEN I FIRST OF
ALL I THINK ALL OUR SPEAKERS --
IN ADVANCE FOR FOR BEING HERE --
AS A ONE I THINK --
MY SUBCOMMITTEE STAFF
PARTICULARLY --
SCOTTO GUESTS AND THERESA PENA
FOR WORKING ON THIS HEARING --
I KNOW THIS COMES ACTUALLY ON
THE THIS YEAR --
BUT ALSO --
OTHER THE STAFF HAS BEEN NO
WE'RE NOT SET THE STAFF'S BEEN
VERY TO VIEW OF THE AUTHORITY
FOR THAT THANK IS --
AFTER -- BUT
THAT THOUGH THIS IN SOME SENSES
HELPS SET THE PLATFORM FOR
MOVING FORWARD --
FOR NOW THE NEXT YEAR'S BUDGET
FOR FOR FUTURE BUDGETS AS WELL
AND US ISSUES THAT NEED TO BE
CONSIDERED --
SO THAT I WON THE FIRST --
BRING UP FOR OUR FIRST
PRESENTATION AS SIERRA ASTON
HAUSEN SENIOR POLICY ADVISER AT
SCANNED FOUNDATION WHO'S GONNA
TALK ABOUT THE STATE OF LONG
TERM SERVICES AND SUPPORTS.
SO WELCOME THANK YOU SO MUCH FOR
BEING HERE TODAY.
GOOD MORNING AND THANK YOU
SENATOR PAN --
IT'S A REAL PLEASURE TO BE HERE
TODAY AND WHAT I'M GOING TO DO
IS PROVIDE A BROAD OVERVIEW.
OF OUR L. TSS SYSTEM WHERE THE
SERVICES ARE PROVIDED WHO
PROVIDES THEM WHO PAYS FOR THEM
AND THE RANGE OF RELATED SYSTEM
ISSUES --
I'M GONNA BE REFERENCING THEY
HAND OUT PROVIDED --
AND REALLY STARTING ON PAGE TWO
OF THE HAND OUT WITH THE SLIDE
ENTITLED THIS PERFECT STORM.
SO FROM A POLICY PERSPECTIVE
CALIFORNIA IS CONFRONTING A
PERFECT STORM THE STATE'S
POPULATION IS AGING AS YOU KNOW
AND BY --
TWENTY THIRTY IT'S ESTIMATED
THAT INDIVIDUALS OVER THE AGE OF
SIXTY FIVE WILL INCREASE BY FOUR
MILLION AND AT THE SAME TIME THE
POPULATION IS BECOMING MORE
DIVERSE AND THIS REALLY WILL
DRIVE THE DEMAND FOR CULTURALLY
COMPETENT SERVICES.
SO PEOPLE ARE LIVING LONGER BUT
THAT THIS DOESN'T NECESSARILY
MEAN THAT THEY'RE LIVING BETTER.
OLDER ADULTS AND THEIR FAMILIES
ARE STRUGGLING TO ACCESS THE
SERVICES AND SUPPORTS THAT THEY
NEED AND ARE OFTEN FORCED INTO
IMPOVERISHMENT TO PAY FOR THEIR
CARE.
AND REALLY ULTIMATELY THE SYSTEM
DOESN'T HAVE THE RESOURCES NOR
IS IT STRUCTURED IN A WAY TO
MEET THE POPULATION NEEDS.
THIS IS NOT TO SAY THAT AGING
ITSELF AS A PRO I THINK WE CAN
ALL CELEBRATE THE FACT THAT
PEOPLE ARE LIVING LONGER THE
REAL PROBLEM COMES IN.
TERMS OF HOW PUBLIC POLICY IS
STRUCTURED TO MEET THE NEEDS OF
THE GROWING POPULATION WHICH
SERVES NOT ONLY OLDER ADULTS BUT
PEOPLE WITH DISABILITY AS WELL.
SO THE PROBLEM REALLY IS MULTI
FACETED IT STEMS FROM A NUMBER
OF FACTORS INCLUDING STIS SYSTEM
FRAGMENTATION AT THE STATE AND
LOCAL LEVEL A LACK OF ACCESS
THAT PEOPLE HAVE TO INFORMATION
AND IN SOME.
LONG TERM CARE FINANCING
CHALLENGES AND IN INFRASTRUCTURE
THAT'S UNABLE TO KEEP PACE WITH
POPULATION NEED.
SO BEFORE I GO ANY FURTHER I
JUST WANT TO CLARIFY WHAT IS
MEANT WHEN WE TALK ABOUT LONG
TERM SERVICES AND SUPPORTS OR
WHAT I'LL REFER TO AS L. TSS --
AS YOU KNOW L. TSS ARE THE NON
MEDICAL FUNCTIONAL SERVICES AND
SUPPORTS THAT INCLUDE HELP WITH
ACTIVITIES OF DAILY LIVING LIKE
EATING BATHING DRESSING
TRANSFERRING EXORA.
AS WELL AS INSTRUMENTAL
ACTIVITIES OF DAILY LIVING SUCH
AS MEDICATION MANAGEMENT MEAL
PREPARATION MONEY MANAGEMENT AND
OTHERS --
LTO SAYS CAN BE PROVIDED IN
EITHER A HOME SETTING OR IN A
COMMUNITY BASED SETTING LIKE AN
ADULT DAY HEALTH CARE CENTER
SUCH AS WHAT WE CALL SEA BASS IN
THE STATE.
AS WELL AS ASSISTED LIVING
FACILITIES --
IN THEN LONG TERM CARE SERVICES
CAN ALSO BE PROVIDED
INSTITUTIONAL SETTINGS SUCH AS
NURSING HOMES BUT THE BULK OF
ALL EL TSS ARE PROVIDED IN THE
HOME AND COMMUNITY ENVIRONMENT.
NOW IF YOU LOOK AT PAGE FIVE AND
SIX IT SHOWS THAT EL TO ASSESS
IS PROVIDED BY BOTH PAID CARE
GIVERS SUCH AS CERTIFIED NURSE
ASSISTANTS HOME HEALTH AIDES
PERSONAL CARE ASSISTANCE.
AS WELL AS UNPAID FAMILY CARE
GIVERS THAT TWO WHO ACTUALLY
MAKE UP THE BULK OF OUR L. TSS
PROVIDER POPULATION.
IN FACT IN CALIFORNIA --
THERE ARE FOUR POINT FIVE
MILLION FAMILY CARE GIVERS.
ACROSS OUR STATE.
NOW ON PAGES --
SEVEN EIGHT WE USE THE RISK OF
NEEDING L. TSS IS HIGHLIGHTED.
IT'S PROJECTED THAT HALF OF
ADULTS AGE SIXTY FIVE AND OVER
AT SOME POINT.
AND IN OF THIS POPULATION A
LITTLE OVER HALF WILL NEED --
CARE FOR LESS THAN TWO YEARS AND
THEN A QUARTER OF THE POPULATION
WILL NEED SERVICES BETWEEN TWO
TO FIVE YEARS.
AND THEN ANOTHER QUARTER WILL
NEED SERVICES FOR MORE THAN FIVE
YEARS THE CHALLENGES THAT NOBODY
KNOWS WHERE THEY'RE GOING TO
FALL ON THAT SPECTRUM YOU DON'T
KNOW IF YOU'RE GOING TO FLL IN
THE HALF OF THE POPULATION THAT
NEEDS A HIGH LEVEL OF CARE.
YOU DON'T KNOW IF THAT CARE WILL
BE LESS THAN A YEAR OR MORE THAN
FIVE YEARS AND THE FINANCIAL
IMPLICATIONS OF THAT ARE REALLY
SIGNIFICANT.
NOT ONLY FOR CONSUMERS BUT ALSO
FOR THE STATE AND FOR FAMILIES --
SO IN TERMS OF THE IMPLICATIONS
OF THIS POPULATION SHIFT ON THE
MEDI CAL BUDGET PAGE NINE SHOWS
THE DISPROPORTIONATE SPENDING
FOR THE AGED AND DISABLED
ELIGIBILITY GROUPS.
IN COMPARISON TO THE BROADER
MEDI CAL POPULATION. FOR EXAMPLE
MEDICALS LOW INCOME POPULATION
CONSTITUTES APPROXIMATELY 82% OF
THE MEDICARE POPULATION BUT
ACCOUNTS 430% OF THE SPENDING.
AND IN CONTRAST THE AGENT DATE
DISABLE REPRESENT 19% OF THE
POPULATION BUT ACCOUNT 470% OF
TOTAL SPENDING IN MEDICARE OUT
SO THIS HAS REALLY SIGNIFICANT
IMPLICATIONS WHEN CONSIDERING
THE GROWING POPULATION AND ITS
IMPACT ON THE SERVICE DELIVERY
SYSTEM AND HOW WE PAY.
FOR CARE.
SO PAGE TEN HIGHLIGHTS THE
FINDINGS FROM A TWO THOUSAND
FIFTEEN STUDY OF THE CALIFORNIA
MEDICAID RESEARCH INSTITUTE.
THAT EXAMINE SERVANTS SERVICE
USING EXPENDITURES AMONG TO WILL
ELIGIBLE CALIFORNIANS SO
MEDICARE MEDICAID ELIGIBLES.
THIS STUDY FOUND THAT MOST
PEOPLE WHO USE MEDI CAL FUNDED
L. T. S..
START THESE SERVICES AFTER AN ER
VISIT HOSPITAL ADMIT ADMISSION
OR REHAB STAY AND THEY'RE OFTEN
DISCHARGED WITH LESS FUNCTION
THAN WHEN THEY ENTERED --
AND FURTHER THE SUPPORT SYSTEM
IS HOME AT HOME SUCH AS THE
FAMILY CARE GIVERS ARE UNABLE TO
OFTEN MEET THE NEEDS AND PROVIDE
THE THE APPROPRIATE CARE BECAUSE
THEY DON'T HAVE THE TRAINING OR
THE SUPPORTS THAT THEY NEED.
THE STUDY ALSO FOUND THAT
INITIATING L. TSS WAS ASSOCIATED
WITH A REDUCTION IN THE RATE OF
HEALTH CARE SPENDING.
AND SPECIFICALLY PROGRAMS THAT
PROVIDE CARE COORDINATION SHOWED
REDUCED HEALTH CARE SPENDING SIX
MONTHS AFTER SPENDING THE
SERVICE --
STARTING THE SERVICES.
SO REALLY THESE FINDINGS RAISE A
FUNDAMENTAL QUESTION ABOUT HOW
TO RESTRUCTURE THE INTERACTIONS
BETWEEN INSTITUTIONAL CARE AND
COMMUNITY BASED SERVICES.
AND MOST IMPORTANTLY THE STUDIES
THAT SUGGEST THAT IN GENERAL THE
L. TSS SYSTEM IS NOT
APPROPRIATELY IDENTIFYING OR
TARGETING.
PEOPLE WHO NEED L. . S. US NOR
IS IT PROVIDING THE RIGHT SET OF
COORDINATED SERVICES THAT CAN
HELP PEOPLE MAINTAIN THEIR
DIGNITY AND INDEPENDENCE.
IT'S IMPORTANT TO NOTE THAT
THESE FINDINGS PLAY OUT BOTH FOR
PEOPLE WHO ARE LIVING IN THE
COMMUNITY OR WHO ARE TRYING TO
BE YOU KNOW DIVERT FROM ENTERING
A AND SITUATIONAL SETTING --
AS WELL AS PEOPLE WHO RESIDE IN
INSTITUTIONAL SETTINGS BUT MAY
WOULD WISH TO RETURN TO THE
COMMUNITY.
SO DATA FROM OUR L. T. DOES THE
NATIONAL L. TSS SCORE CARDS
SUGGEST THAT IN CALIFORNIA.
THERE ARE SIGNIFICANT POPULATION
ELEVEN THOUSAND PEOPLE AND WHO
ARE LIVING IN NURSING HOMES BUT
THEORETICALLY COULD LIVE IN A
COMMUNITY SETTING WITH SERVICES
AND SUPPORTS THE CHALLENGES.
GETTING THE CARE COORDINATION
AND THE SERVICE IS LINED UP AND
THE HOUSING FRANKLY IN THE
COMMUNITY TO FACILITATE THESE
TRANSFERS.
SO NOW JUST TO STEP OUTSIDE OF
MEDI CAL --
WAS WHICH IS WHAT I'VE FOCUSED
ON THE IT'S IT'S IMPORTANT TO
LOOK AT THE MANY INDICATORS OF
OUR BROADER LONG TERM CARE
FINANCING SYSTEM AND HOW WE CAN
SEE THAT IT'S ULTIMATELY BROKEN.
UP PAGE ELEVEN TO TWELVE SHOWS
THAT THE BULK OF L. TSS
EXPENDITURES OR 53% OF ALL
NATIONAL EL TSS SPENDING.
COMES FROM INDIVIDUAL OUT OF
POCKET EXPENDITURES THIS MEANS
THAT MANY FAMILIES ARE PAYING A
LOT OF MONEY AND USING THEIR
SAVINGS TO PAY FOR L. T. S. US.
IN FACT THE AVERAGE LIFETIME
SPENDING FOR L. TSS IS A HUNDRED
AND THIRTY EIGHT THOUSAND
DOLLARS.
SO A MANY OF THESE FAMILIES ARE
FORCED THEM TO SPEND ON TO
MEDICAID LEVELS AND MEDICAID IS
RESPONSIBLE THEN FOR ABOUT 42%
OF OUR NATIONAL L. TSS
EXPENDITURES.
THIS REALLY WASN'T IS NOT AN
IDEAL WAY TO FINANCE A LONG TERM
CARE SYSTEM.
UNFORTUNATELY LONG TERM CARE
INSURANCE IT WAS HOPED WOULD
PLAY A GREATER ROLE IN FINANCING
LONG TERM CARE SERVICES BUT IT
ACTUALLY ONLY PLAYED PAYS FOR
ABOUT 5%.
OF ALL EL TSS EXPENDITURES
NATIONALLY.
SO THESE CHALLENGES CONFRONTING
OUR SYSTEM ARE MANY --
ISSUES THAT HAVE TREMENDOUS
TREMENDOUS IMPACT NOT ONLY ON
OURS ON OUR STATES FINANCING
SYSTEM BUT ON CALIFORNIA'S OLDER
ADULTS PEOPLE WITH DISABILITIES
AND FAMILIES WHO ARE STRUGGLING
TO ACCESS THE SERVICES THEY NEED --
SO THAT THEY ALL CAN AGE WITH
DIGNITY AND THESE ARE ISSUES
THAT VOTERS CARE ABOUT.
AGES THIRTEEN FOURTEEN SHOWS
THAT TWO THIRDS OF THE OF
CALIFORNIA'S VOTERS WHO WERE
SURVEYED AS PART OF THE WE STAND
WITH SENIORS INITIATIVE.
BELIEVE THAT CALIFORNIA IS NOT
PREPARED TO DEAL WITH THE HEALTH
AND EL TSS NEEDS OF THE AGING
POPULATION.
THERE IN STRONG SUPPORT OF THERE
BEING A VISION AND A PLAN FOR AN
AGING CALIFORNIA.
AND IN FACT DURING HIS CAMPAIGN --
GOVERNOR ELECT NEW SIM DID
COMMIT TO DEVELOPING A MASTER
PLAN FOR AGING IN CALIFORNIA.
AND ASSUMING THIS PROCESS PLAYS
OUT I THINK THE LEGISLATURE WILL
HAVE A SIGNIFICANT ROLE AN
IMPORTANT ROLE TO PLAY AND NOT
PROCESS.
SO TO CLOSE THERE IS NOW AN
OPPORTUNITY TO ADDRESS THESE
CHALLENGES AND MEET THE NEEDS OF
OLDER ADULTS AND PEOPLE WITH
DISABILITIES WHO ALL DESIRE THE
SAME THING. TO LIVE WITH DIGNITY
AND INDEPENDENCE THANK YOU FOR
BRINGING ATTENTION TO THESE
ISSUES AND I'M HAPPY TO ANSWER
ANY QUESTIONS YOU MAY HAVE.
THANK THANK YOU SO MUCH FOR YOUR
PRESENTATION --
AND AGAIN --
I KNOW THAT --
THERE WE DO NEED TO THINK ABOUT
SOLUTIONS MOVING FORWARD --
BUT THEY JUST WANT THE QUESTIONS
I HAVE IS IS THAT IN TERMS OF
THANK YOU YOU YOU TALKED BOUT
THE REAL.
HOW PEOPLE ENTER?
THROUGH SENSUALLY ACUTE CARE
POSSIBLY SO FORTH.
IS IS.
ARE THERE WAYS TO IDENTIFY A
THESE NEEDS EARLIER ON AND AND
TO WHAT DEGREE THE SOME OF THE
CUTE KERR RESULT FROM LACK OF
ACCESS TO DAHLE TSS TYPE
SERVICES FOR ENTRY INTO HOT
HOSPITALIZATION OR SOME OTHER
EVENT AND I THINK.
THAT IS A TERRIFIC QUESTION AND
I THINK A LOT OF IT GETS TO WHEN
A PERSON IS ASSESSED FOR THEIR
NEEDS AND WHAT THEIR ASSESSED
FOR SO TYPICALLY OUR MEDICAL
CARE SYSTEM ASSESSES PEOPLE.
BASED ON THEIR HEALTH RISK
ASSESSMENT BUT MORE THAT THEY'RE
ABLE TO ACTUALLY LOOK AT
FUNCTIONAL NEED THEN THEY CAN
SEE THE THOSE ISSUES THAT PEOPLE
NEED HELP WITH LIKE THE L. TSS
SERVICES.
AND IN FACT THERE ARE THERE ARE
FINDINGS THAT SHOW THAT IT AT
THE NATIONAL LEVEL IN THE
MEDICARE PROGRAM THE REAL COST
THAT'S DRIVING CARE IS THE
FUNCTIONAL NEED.
SO WHEN YOU LOOK AT CHRONIC
CONDITIONS ALONE.
THERE HALF THE COST OF WHEN YOU
LOOK AT SO IF IF THERE'S A WAY
TO TARGET INDIVIDUALS AND ASSESS
THEM EARLIER ON IN THE PROCESS
THEN YOU CAN MEET THEIR NEEDS.
IN THE HOME AND COMMUNITY AND
AND POTENTIALLY AVOID.
THE ACUTE CARE PLACEMENT --
I THINK THE COORDINATED CARE
INITIATIVE IS MADE --
YOU KNOW THE SIGNIFICANT IMPACT
IN LOOKING AT WAYS TO BETTER
TARGET PEOPLE EARLY EARLIER ON
IN THE PROCESS PARTICULARLY
THROUGH THE CAL MEDIC CONNECT
PROGRAM I THINK WE'RE STILL
LEARNING A LOT ABOUT HOW THAT'S
PLAYING OUT AND SOME OF THE
CHALLENGES WITH THAT BUT I KNOW
IN CALIFORNIA ONE OF OUR
CHALLENGES.
IS THAT FOR THE MEDICARE PART IN
MEDI CAL POPULATION IF THEY
DON'T HAVE.
FINANCIAL RESPONSIBILITY FOR THE
RANGE OF ACUTE.
AND LONG TERM SERVICES AND
SUPPORTS ITS TARGET PEOPLE WHEN
THE REAL SAVINGS COMES ON THE
MEDICARE SIDE THAT'S WHERE THE
THE REAL OPPORTUNITY IS --
THROUGH THE CAL MEDIC CONNECT
PROGRAM.
IN A THE ANOTHER QUESTION I HAVE
ISN'T.
AS YOU MENTIONED THAT --
IN MANY WAYS WERE VERY RELIANCE
ON ESSENTIALLY UNPAID FAMILY
CARE GIVERS RIGHT --
TO TO SENSUALLY PROVIDE MADE THE
SERVICES AND SERVE IMPLICIT
PAYING FOR NOT EXPLICIT --
AS OUR POPULATION.
AGESAND I LIKE IN A KNOWLEDGE
THAT --
THESE SERVICES ARE NOT ONLY JUST
FOR SENIORS --
AS IS A PEDIATRICIAN WHO TAKES
CARE OF PEOPLE THE OTHER END OF
THE AGE SPECTRUM I KNOW THAT --
FRANKLY ACTUALLY DUE TO OUR
SUCCESSES AND AND BE ABLE TO
PROVIDE.
CARE AND ACTUALLY PROLONGING THE
THE THE LIVES AND AND OF BUT
IT'S CHILDREN --
PEOPLE OTHER AGES TO HAVE
DISABILITIES THAT --
IT'S IMPORTANT THAT THESE
SERVICES ARE AVAILABLE SO THAT --
PEOPLE CAN --
LEAD PRODUCTIVE LIVES IN MANY
WAYS I THINK FOR MANY PEOPLE
ACTUALLY WHAT THEY'RE ABLE TO
DâN CONTRIBUTORS RESULT OF
RECEIVING THE SERVICES ACTUALLY
IS.
AS AN AT THE IS A NET POSITIVE
IN TERMS OF YOU KNOW EVEN
FINANCIALLY --
IN TERMS OF BEING ABLE TO TO TO
HELP PEOPLE --
SUCCEED --
BUT AS OUR POPULATION
ESSENTIALLY --
GOES FROM ESSENTIALLY MORAL
PYRAMID FOR YOU ALIVE YOUNGER
PEOPLE AND FEWER OLDER PEOPLE TO
SOMETHING IS MORE LIKE A
CYLINDER RIGHT --
WHAT COULD AND AND TALK ABOUT
SANDWICH GENERATION I'M ONE OF
THEM -- SO I
HAVE PARENTS OF KIDS --
IN TERMS OF EVEN THAT CAPACITY
OF FAMILIES TO BE ABLE TO
PROVIDE THAT KIND OF CARE.
GIVEN THE DEMANDS THAT THEY HAVE
ASIDE FROM EVEN JUST WORK AND
THE OTHER PRESSURES THAT WE'VE
CREATED --
THE AT AND AND EVEN WHEN YOU
MENTIONED ABOUT THE THE FACT THE
OF PEOPLE IN NURSING HOMES TO
PRY COULD LIVE IN THE COMMUNITY.
I DON'T OF THE WHAT DEGREES THAT
BECAUSE THERE'S A LACK OF YOU
KNOW SOME.
THOSE STRUCTURE IT I MEAN THE
OUT WAYS TO BECAUSE THAT WAS WAS
A I HAD PEOPLE STAY IN THE
HOSPITAL BECAUSE THERE'S NO
PLACE TO GO.
TO GET THE OTHERS NOT NEARLY A
THIRD DAY HAVE PEOPLE AT HOME
TAKE CARE OF THEMSELVES.
WE WERE SIR STOCK THERE --
AND THEN PUT INTO IS NO WAY TO
PAY FOR THOSE OTHER SERVICE WE
DID QUESTION BUT MAYBE CAN SPEAK.
TO CHANGING POPULATION AND
ACTUALLY HOW THAT'S ACTUALLY
EVEN IMPACTING V. --
THE AT THE FAMILY CARE GIVERS TO
AT LEAST AT THIS POINT AND WE
SHOULDN'T AS A DEPEND ON THIS
WHO ARE PROVIDING A LOT OF THIS
CARE.
FOR QUOTE FREE ABSOLUTELY I I
MEAN YOU'VE RAISED SOME REALLY
IMPORTANT ISSUES AND AND IN
TERMS OF PEOPLE TRANSITIONING
OUT TO THE COMMUNITY I THINK
IT'S REALLY COMPLICATED IT TAKES
A LOT OF WORK AND TO ACTUALLY.
FACILITATE THE TRANSITIONS FROM
A CARE COORDINATION PERSPECTIVE
BUT THEN YOU HAVE HOUSING
CHALLENGES AND THEN SERVICE
DELIVERY IN AND AS YOU MENTIONED
THERE'S A HEAVY RELIANCE ON
FAMILY CARE GIVERS.
AND AS THE POPULATION AGES WE
HAVE FEWER CARE GIVERS BOTH PAID
AND UNPAID TO MEET THE NEEDS OF
THE POPULATION.
AND I THINK WHAT'S REALLY
IMPORTANT IS TO HIGHLIGHT SOME
OF THE FINDINGS THAT --
A RECENT TASK FORCE THE TASK
FORCE ON FAMILY CARE GIVING CAME
OUT WITH --
THERE ARE SOME FOR FOR FAMILY
CAREGIVERS WHO CAN ACCESS SOME
OF THE PAID FAMILY LEAVE
BENEFITS A LOT OF THEM ARE AWARE
THAT THOSE BENEFITS ARE THERE SO
THERE'S A LOT OF OPPORTUNITY TO
RAISE AWARENESS ABOUT THAT --
AND THERE'S ALSO A NUMBER OF
OTHER WAYS TO SUPPORT THE
POPULATION THAT I KNOW I KNOW
THAT.
THAT -- THE
MEMBERS COULD COULD SPEAK TO BUT
ULTIMATELY THIS REALLY IS THE
LYNCH PIN OF OUR SYSTEM AND
NEEDS TO BE RECOGNIZED AS SUCH
AND AND BOLSTERED WITH THE
PROGRAMS SUCH AS CARE GIVER
RESOURCE CENTERS THAT PROVIDE
THESE VALUABLE SERVICES.
STRENGTHENED SO THAT THEY CAN
REALLY ASSIST PEOPLE AND DOING
THEIR JOBS.
OFFERING HISTORY MUCH ACTUALLY
IF YOU DON'T MIND I'M GONNA HAVE
USED CONTINUE STAY UP THERE WE
HAVE A WE NOW HAVE OUR NEXT
PRESENTERS NO TALK ABOUT DATA
GAPS -- AND
UNDERSTANDING CHANGES IN L. TSS
NEEDS AND USE ASIAN PATTERNS AND
YOU MIGHT HAVE SOME COMMENTS ON
THAT TWO ONE THREE OF THIS
PRESENTATION DONE --
SO WE HAVE PETER CANCEL CHIEF
EXECUTIVE OFFICE --
IT'S STILL PERSON YOU'RE.
A SIMPLE K. AS ALSO A MEMBER OF
THE CALIFORNIA HEALTH INTERVIEW
SURVEY LONG TERM SERVICES WORKER
THANK YOU.
HE WAS RENTAL THANK THANK YOU
MISTER CHAIRMAN --
PLEASURE TO BE HERE THANK YOU
FOR LETTING ME FILL IN TODAY I
THINK FOR SOME RESEARCHERS WHO
WERE NOT AVAILABLE SO.
I AM THE CEO CAL PACES YOU
MENTIONED SO WHERE THE STATE
ASSOCIATION OF PROGRAMS OF ALL
INCLUSIVE CARE FOR THE ELDERLY
SO WE HAVE A PROVIDERS
PERSPECTIVE ON THIS GROWING NEED --
THAT I'M THAT I'M HAPPY TO SHARE.
OUR NICHES WE PROVIDE
COMPREHENSIVE CARE INTEGRATE
CARE FOR THE HIGHER AND NEED
NEEDY SENIORS THAT ARE ACTUALLY
OUT OF NURSING HOME LEVEL OF
CARE.
AND TRY OUR HARDEST TO KEEP THEM
IN THE COMMUNITY WHICH WE ARE
PRETTY PROUD OF OUR ABILITY TO
DO THAT --
I'M ALSO PART OF THE ALLIANCE
THAT BROUGHT FORWARD THE BUDGET
PROPOSAL THAT YOU MENTIONED --
WE'RE VERY PROUD OF THAT WE WANT
TO THANK YOU FOR YOUR SUPPORT
AND THE COMMITTEE --
TO BACK OUT INTO THE BUDGET --
IT IS AN IMPORTANT STEP FORWARD --
IN TERMS OF TRYING TO THE DATA
ON AT A POPULATION LEVEL ON WHAT
ARE THE LONG TERM CARE NEEDS AND
THAT THE STATE IS FACING --
IT WILL REALLY PROVIDE A GREAT
FOUNDATION FOR PLANNING GOING
FORWARD --
AND THEN I'M ALSO ON THE
ADVISORY COMMITTEE THAT'S
HELPING DEVELOP THE CONTENT FOR
THE SURVEY AND I THINK THAT
MAYBE PRIMARILY MY MY ROLE TODAY
SO.
ANYWAY BRING A NUMBER OF HATS SO --
SO I'M GONNA BE DESCRIBING THE
NATIONAL WORK THAT WE'RE DOING
WITH THE RESEARCHERS AT UCLA
THROUGH THIS COMMITTEE AND THE
AND THE WORK THAT THEY'RE DOING --
TO DEVELOP THE QUESTIONS --
THAT'LL BE PART OF THIS --
I THINK YOU HAVE COPY A COPY OF
WRITTEN TESTIMONY THAT DOCTOR
KEYS MAN DEVELOPED --
FOR THE COMMITTEE --
AND SHE'S UNFORTUNATELY NOT ABLE
TO BE HERE BUT I'M GONNA TRY TO
HIT SENATE SUMMARIZE SOME OF THE
HIGH POINTS OF THAT --
IF -- IF
THAT -- IF
YOU HAVE THAT IN FRONT OF YOU.
SO I THINK IN A NOT SHOW WHEN I
WANT TO SAY --
FROM MY PERSPECTIVE IS DESPITE
THIS UNPRECEDENTED GROWTH IN
NEEDS FOR LTE SS AND I THINK
THAT THE DEMOGRAPHIC ISSUES IN
THE SYSTEM PLANNING ISSUES THAT --
SIR A SCENE HOUSING OUTLINED WE
REALLY DON'T HAVE THE DATA --
TO REALLY GET A HANDLE ON WHAT
SAYS WHO.
WHO HAS NEEDS WHO RECEIVES IT
WHO DOESN'T HOW TO THE RECEIVER?
WHO HAS --
UNMET NEEDS AND WHAT WHAT'S WHAT
WHAT'S WHAT HAPPENS WHEN THEY
HAVEN'T MET NEEDS SO THOSE ARE
ALL BASIC QUESTIONS.
I THINK WE HAVE A LOT OF
ADMINISTRATIVE DATA AND I KNOW
YOU'LL BE HEARING FROM
DEPARTMENT SO I THINK WE KNOW
PRETTY WELL WHAT HAPPENS TO
PEOPLE WHEN THEY GET INTO A
FORMAL SYSTEM --
THE RECESS SO THERE'S DATA ON
THEIR USE OF SERVICES AND SO
FORTH APOPTYGMA CLIENT --
OR THE DONE FISHERY ENROLLMENT
LEVELS AND SO FORTH BUT WE DON'T
HAVE A PICTURE OF WHAT'S OUT
THERE AT LARGE AND CRITICALLY WE
DON'T HAVE A PICTURE OF WHAT'S
GOING ON WITH.
THIS GROWING UP POPULATION
THAT'S AT RISK OF SPEND DOWN
BECAUSE THEY'RE KIND OF IN
BETWEEN THERE NOT POOR ENOUGH TO
QUALIFY FOR PUBLIC PROGRAMS BUT
THEY'RE NOT RICH ENOUGH TO PAY
FOR THE SERVICES ON AROUND SO.
THEY'RE VERY MUCH AT RISK OF
BEING YOU KNOW AN EVENT AWAY A
HOSPITALIZATION --
AN ILLNESS OF OF ENTERING THAT
TRAJECTORY I THINK THAT WAS JUST
JUST DESCRIBE --
SO THE SOLUTION --
THANK YOU AGAIN FOR THE BUDGET
AUGMENTATION AT LEAST THE
INITIAL SOLUTION WE THINK IT IS
INVESTING IN DATA SO --
THE BUDGET PROPOSAL THAT WAS
APPROVED --
A PROVIDES THREE MILLION DOLLARS --
FOR INCORPORATING QUESTIONS IN
INTERVIEW SURVEY ON ON LPS US --
NEEDS IN CALIFORNIA --
IT IS THERE'S ENOUGH FUNDING TO
DO THAT AND TWO CYCLES THERE'S A
NINETEEN TWENTY CYCLE AND THEN
THERE'S A TWENTY THREE TWENTY
FOUR CYCLE SO WILL HAVE THE
BENEFIT OF SOME FAIRLY NEAR TURN
DATA AND THEN A LITTLE BIT OF A
COMPARISON --
WITH A BREAK IN BETWEEN --
THE CHOOSES YOU KNOW IS LIKE THE
PREEMINENT --
HEALTH STATE LEVEL HEALTH
INTERVIEW SURVEY IN THE COUNTRY --
IT GOES OUT ABOUT FORTY THOUSAND
HOUSEHOLDS SO IT'S IT'S VERY
ROBUST AN ACCOUNT AND CAPTURES A
LOT OF DATA ON A HEALTH CARE
NEEDS HEALTH CARE STATUS HEALTH
CONDITIONS.
HEALTH INSURANCE COVERAGE --
AND SO FORTH SO IT'S REALLY A
PERFECT VEHICLE TO AMEND THESE
TYPES OF QUESTIONS ON TO SO AS I
MENTIONED IT WILL BE GOING ON IN
TWO CYCLES --
THERE IS ALSO --
WILL BE SOME SHORT TERM EFFORTS
TO COLLECT DATA BASED ON THE FOR
CYCLE WHICH WE EXPECT TO
HOPEFULLY SEE --
SOMETIME --
AT THE END OF TWO THOUSAND
NINETEEN BUT THE BOOK AT THE
DATA WILL BE COMING OUT IN TWO
THOUSAND TWENTY ONE FROM THAT
FOR CYCLE --
SO AS AS THE WORK GROUP IS --
WORKING ITS WAY THROUGH THE
CONTENT --
FOR THIS --
I WANT TO MENTION ON NUMBER
NEEDS I THINK THERE ARE ALREADY
EMERGING THAT I THINK WE HAVE
WERE BEGINNING DEVELOP CONSENSUS
AROUND DEVELOPING QUESTIONS. FOR
THOSE ARE OUTLINED ON PAGE TWO
OF DOCUMENTS --
TESTIMONY.
BUT THE FIRST OF COURSE IS --
WHO NEEDS EL TSS SO ARE THERE A
LOT OF REALLY GOOD SURVEYS
INCLUDING SOME REALLY ROBUST
NATIONAL SURVEYS THAT CAPTURE
THINGS ABOUT DISABILITY?
DIFF ACTIVITY DIFFICULT
DIFFICULTIES OF BREEZE KINDS BUT
THEY OFTEN DON'T DRILL DOWN TO
WHO ACTUALLY NEED SERVICES AND
OF WHAT KIND AND ARE THEY
GETTING THEM SO.
OR IF THEY DO THEY DON'T HAVE A
BIG ENOUGH SAMPLE SIZE TO ALLOW
US TO EXTRAPOLATE DOWN TO THE
STATE AND LOCAL LEVEL --
SO I THINK WE ARE ARE HOPEFULLY
GOING TO BE SEEING QUESTIONS
COMING FORTH THAT WILL GET MORE
SPECIFICALLY OUT THOSE KINDS OF
THINGS.
WHO HAS ON BAD KNEES AND ONE OF
THE CONSEQUENCES OF SOMETHING
THAT -- I
THINK MOST.
PEOPLE PARTICIPATING THIS
PROCESS THANK A REALLY IS REALLY
IMPORTANT --
YOU KNOW WHAT IMPACTS ON THEIR
THEIR QUALITY OF LIFE THEIR
FUNCTIONING THEIR ACCESS TO CARE
THEIR ACCESS TO HEALTHY FOOD.
THEIR HOUSING SITUATION AND SO
FORTH AND THE BEAUTY OF CHESS
ISN'T ALREADY CAPTURES A PRETTY
ROBUST PICTURE OF A LOT OF THESE
OTHER DOMAINS SO WE'LL BE ABLE.
TO KIND OF CORRELATE EL TSS
RELATED ISSUES WITH THESE OTHER
BROADER HEALTH INDICATORS --
OUR PEOPLE AWARE OF SERVICES I
THINK IT'S SOMETHING THAT PEOPLE
WOULD LIKE TO SEE ADDRESSED THE
REALLY IS NOT A LOT OF DATA ON I
THINK WE HEAR ANECDOTALLY OF
PEOPLE AND AND SERRA MENTIONED A
CASE WHERE PEOPLE ARE NOT
THEY'RE JUST NOT AWARE.
THAT THERE ARE SERVICES
AVAILABLE --
AND THEY DON'T REALIZE IS THAT
THEY MAY QUALIFY FOR SOMETHING
THAT'S OUT THERE AND THERE'S
REALLY NO --
PROCESS FOR THEM EASILY GET THAT
INFORMATION WE DON'T REALLY HAVE
A VERY COORDINATED INTAKE SYSTEM
FOR A VARIETY OF LONG TERM CARE
PROGRAMS.
SO WE WANT TO CAPTURE SOME
INFORMATION ABOUT YOU KNOW WHAT
IS THE LEVEL WERE NICE AND WIRE
PEOPLE NOT AWARE IF THEY'RE NOT.
AWARE -- WE
WANT TO KNOW ABOUT --
WHAT KINDS OF THINGS SEEM TO BE
ASSOCIATED WITH PEOPLE REPORTING
THAT THEY HAVE PROBLEMS?
IS IT AWARENESS IS IT GEOGRAPHIC
BARRIERS IS IT A LACK OF
PROVIDERS --
IS IT A LACK OF RESOURCES IS A
LACK OF ACCESS --
TO TO OTHER TYPE SECURE CARE
GIVERS.
AND CONVERSELY WHAT KINDS OF
THINGS MEDICAID THE NEED FOR L.
T. S. US.
IN OTHER WAYS SIMILE SITUATED
PEOPLE SO COULD BE.
WE'LL FIND THAT SOME PEOPLE ARE
FINDING A WAY TO ADAPT THROUGH
USE OF HOME HOME MODIFICATIONS
OR EQUIPMENT AND VARIOUS OF
KINDS MOBILITY AND ASSISTIVE
DEVICES --
WHICH IS BUT TO BE USEFUL TO
KNOW BECAUSE THOSE COULD BE
FAIRLY EASY --
AND STRAIGHTFORWARD
INTERVENTIONS THAT COULD HELP
ADDRESS NEEDS --
WE WANT TO KNOW WHAT TYPE OF
CARE PEOPLE GETTING --
WE'VE ALREADY DISCUSSED AND
YOU'VE ALREADY DISCUSSED IN
SERVICE DISCUSSED THE OVER
RELIANCE ON INFORMAL CARE AND SO
WE WANT A LITTLE BIT.
BETTER PICTURE OF THAT --
WHAT KIND OF INFORMAL CARE HOW
MUCH TO WHAT EXTENT IS IT
COMPLEMENTED WITH FORMAL CARE --
HOW TO PEOPLE USE IT --
WHEN THEY WHEN THEY DO AND I
THINK OURS OURS --
I THINK OUR ASSUMPTION IS THAT
INFORMAL CARE AT SOME POINT
GIVES OUT --
SO PEOPLE GET TO A BREAKING
POINT IT'S IT BECOMES SORT OF
P2P TOO MUCH OF A BURDEN --
HOPEFULLY THAT'S NOT THE CASE
FOR A LOT OF US --
FACING THE SITUATION BUT THE
REALITY IS IS PEOPLE'S CARE
NEEDS GO UP AND CARE GIVERS HAVE
OTHER DEMANDS ON THEIR TIME AT
SOME POINT SOMETHING SOMETHING
HAPPENS AND THE NICE HAVE A
PICTURE OF WHO'S IN THAT CORD
AND WHAT WHAT ---HOW TO PEOPLE RESOLVE THAT --
WHEN THEY GET TO THAT?
QUALITY CUSTOMER EXPERIENCE HOW
PEOPLE HOW WILL ARE PEOPLE
SATISFIED IF WE DO IDENTIFY
PEOPLE THAT ARE GETTING SERVICES
PARTICULARLY.
THOSE THAT ARE PUBLICLY FUNDED --
ARE THEY DO THEY FEEL LIKE THE
ADDRESS THEIR NEEDS ARE THEY
FEEL IKE THEIR CULTURAL AND
LINGUISTIC LINGUISTICALLY
APPROPRIATE --
TO THE FEEL COMFORTABLE WITH
THEM.
ARE THEY HAPPY WITH THEIR CARER
CARE GIVERS AND AND SO FORTH --
IT'S SO AND THEN I THINK ANOTHER
REALLY IMPORTANT POINT TO WE'D
LIKE.
TO TRY.
TO CAPTURE TO THIS IS WHAT IS
THIS POPULATION THAT IS AT RISK
OF SPEND DOWN --
SO THERE'S SOME THERE'S BEEN
SOME WORK DONE AND NATIONALLY TO
LOOK AT WHAT KIND OF
CHARACTERISTICS ARE ASSOCIATED
WITH PEOPLE.
WHO DO SPEND DOWN TO ELIGIBILITY
FOR MEDI CAL AND I HSS?
SO -- WE
THINK IT'S QUITE POSSIBLE THAT
WE CAN --
MARVELING AT THE STATE LEVEL.
AS A FUNCTION OF THE RESOURCES
THAT ARE RECENT UTILIZATION OF
SERVICES THEIR LIVING SITUATION
AND SO FORTH WE MIGHT BE ABLE.
TO BE ABLE TO GET A HANDLE ON
WHAT IS THAT POPULATION THAT'S
REALLY -- AT
RISK OF COMING INTO ELIGIBILITY
THAT WE'D LIKE TO BET COURSE
BETTER SERVE BUT ALSO --
HELP --
DISTRICT MANAGER IT'S IT'S
RESOURCE NEEDS SOME.
SO THAT'S KIND OF A JEEP AND
ANNA AND YOU KNOW IT'S AN
ESSENCE WHAT THE SERVICE
DESIGNED TO DO.
SUBMISSION IS GOING TO FILL A
LOT OF GAPS --
IT WILL PICK UP WHERE A LOT OF
NATIONAL SURVEYS LEAVE OFF THE
WERE VERY VERY OPTIMISTIC --
THAT IT WILL FILL IN A LOT OF A
LOT OF PLANKS.
IT WILL BE DONE IN TWO STAGES AS
I MENTION --
THE THERE WILL BE OUR USE OF
SOME SCREENING QUESTIONS --
THAT WILL BE GO OUT IN THE
FORMAL COACHES SURVEY ITSELF TO
ALL FORTY THOUSAND HOUSEHOLDS.
TO TO BE SOME KEY MARKERS TO
LOOK AT TWO PEOPLE HAVE.
OF PHYSICAL COGNITIVE OR MENTAL
CONDITIONS THAT RESULT IN
DIFFICULTIES IN PERFORMING
ACTIVITIES OF DAILY.
LIFE -- SUCH
AS BEATING ADDRESSING THOSE ARE
GONNA BE MARKERS TO IDENTIFY A
UPSET ABOUT WE THINK ABOUT FOUR
THOUSAND HOUSEHOLDS THAT WILL
RECEIVE A MORE DETAILED FOLLOW
UP SURVEY.
WHICH WILL INCLUDE THIS MORE
DETAIL CONTENT ARE JUST THAT IT
JUST WENT WENT THROUGH SO.
SO ANYWAY THAT THE GOAL IS A
COURSE TO LEARN A LOT MORE ABOUT
HOW TO ASSESS NEEDS --
AND WORK AND VERY VERY THANKFUL
THAT THE RESOURCE IT'S GOING
FORWARD I THINK WE SENSE A LOT
OF EXCITEMENT ON IN THE IN THE
COMMUNITIES AMONG STAKEHOLDERS.
AS WELL AS THE ECONOMIC PEOPLE
THAT ARE WORKING ON THIS THAT
REALLY IS GOING TO BE --
A GAME A GAME CHANGER I JUST
BEFORE I FINISH I WANT TO TOUCH
ON SOME OF THE AREAS WHERE WE
PROBABLY WILL NOT BE ABLE TO
FILL IN THE GAPS SO I THINK IT'S
IMPORTANT TO KNOW --
THIS IS PROBABLY NOT GOING --
TO BE ABLE TO GET TO THE LEVEL
OF EVALUATING SPECIFIC PROGRAMS --
THAT ARE THAT ARE CURRENTLY
OFFERED THAT WE MAY BE ABLE TO
IDENTIFY THE TYPES OF SERVICES
GENERICALLY THE PEOPLE RECEIVING
BUT IT'S PROBABLY NOT CAN BE
POSSIBLE FOR THEM.
TO A FORMALLY IDENTIFY ONLINE
I'M I'M GONNA SEE BASS CENTER
I'M GETTING AYE HSS AND TO LOOK
AT IT QUICKLY AT THAT THAT'S
QUITE THAT DISCREET ARRIVAL --
PROBABLY NOT WE WON'T BE ABLE TO
GET GOOD INFORMATION ON
EXPENDITURES HOW MUCH PEOPLE ARE
ACTUALLY SPENDING OUT OF POCKET
WE MAY BE ABLE TO GET SOME
BALLPARK STUFF BUT PROBABLY --
WILL NOT HAVE THE FULL PICTURE
IN THAT AREA.
THIS IS SURVEY DATA THAT'S
HOUSEHOLD SURVEY SO IT'S
SOMEWHAT SUBJECTIVE IT'S BASED
ON PEOPLE'S IMPRESSIONS SO
THERE'S ALWAYS A LIMITATION OF%
YOU KNOW HOW ACCURATE IS.
YOU KNOW ON THE OTHER HAND I
THINK COMING DIRECTLY FROM
PEOPLE WITH THE NEEDS OR THE
PEOPLE ASSOCIATED WITH THEM --
SO IT WILL BE --
CERTAINLY INDICATIVE OF NEEDS IF
NOT -- FULLY --
YOU KNOW FULLY DISPOSITIVE --
WE HAVE TALKED TO YOU A BIT
ABOUT THE CHALLENGE REACHING
PEOPLE IN INSTITUTIONAL SETTINGS --
AND THAT'S SOMETHING THAT IS.
I THINK THE PLAN --
WILL BE TO TRY TO USE PROXIES AS
MUCH AS WE CAN --
TO IDENTIFY PEOPLE IN THE
HOUSEHOLD WHO ASSOCIATED WITH
THE CARE RECIPIENT TO CAN SAY
SOMETHING ABOUT IF THEY'RE NOT
IN THE HOUSEHOLD.
BUT THERE --
SOMEWHERE ELSE --
THERE'S ALSO ENOUGH FUNDING TO
TO DO A TARGETED --
SUPPLEMENTAL SURVEY A MORE IN
DEPTH IN PERSON SURVEY OF A
SMALLER COHORT.
OF OF RESPONDENTS --
IN BETWEEN THE TWO SERVICE CYCLE
SO THAT'LL HOPEFULLY ADDRESS
SOME OF THAT --
THERE IS THE WILL BE A FAIR
AMOUNT OF DATA TO DRILL DOWN TO
LOCAL ASSESSMENT A NEED BUT
MAYBE NOT IN EACH AND EVERY
COUNTING SO THAT'S ALWAYS A
PROBLEM THAT'S A PROBLEM WHICH
IS WHICH IS ALREADY --
BUT WE DO THINK THE DATA WILL BE
SUFFICIENT TO GET TO A REGIONAL
LEVELS AND THERE MAY BE A WAY.
TO MODEL --
RESULTS AT A SMALLER COUNTY
LEVEL MOVE BY LINKING TO LARGER
AND NATIONAL DATABASES SO. FOR
EXAMPLE SOME OF THE SCREENING
QUESTIONS ARE COME RIGHT OUT OF
THE AMERICAN COMMUNITY SURVEY
WHICH IS A HUGE SURVEY SO WE MAY
HAVE SOME MARKERS THAT WE CAN.
USE A MATCH TO INTO MODEL ALTIS
OF US --
ISSUES AT A LOWER LEVEL --
AND THEN MAYBE MOST IMPORTANTLY --
THE DATA WILL PROBABLY SHOW SOME
ASSOCIATIONS WE THANK BETWEEN L.
TSS NEEDS AND OTHER THINGS WHICH
COULD WELL SEE AN ASSOCIATION
BETWEEN.
BERRIER CELSIUS US AND OTHER
TYPES OF HEALTH OUTCOMES POOR
HEALTH STATUS POOR ACCESS TO
SERVICES.
AND SO FORTH BUT IT PROBABLY
WILL NOT BE CONSERVATION SO --
IT'S IT'S CERTAINLY NOT THAT
KIND OF A NOT THAT KIND OF A
LEVEL OF OF STUDIES SO IT'S
REALLY KIND OF LOOKING MORE TO
SERVE HOW.
HOW VARIOUS THINGS ARE CONNECTED
TO EACH OTHER STAND OUT SO?
SO ANYWAY THAT'S AN OVERVIEW OF
THE WORK THAT'S BEING DONE WERE
VERY VERY HAPPY TO BE PART OF IT --
I'M HAPPY TO ANSWER QUESTIONS.
THANK YOU VERY MUCH APPRECIATE
THE DESCRIPTION GLAD TO KNOW
THAT WE'RE MOVING FORWARD THIS
IT'S ALWAYS GOOD YOU KNOW WE
PASSED THE MONEY WILL LIKE TO
KNOW WHAT'S HAPPENING.
WITH THE RECORD --
SO I UNDERSTAND FROM WHAT YOU'RE
SAYING YOU'LL CHOOSE IS A
HOUSEHOLD LEVEL SURVEY SO
BASICALLY THERE'S GONNA BE
SOMEONE IN THE HOUSEHOLD.
THE PROBABLY SOME PRIMARY PERSON
HE'S ANSWERING THE SURVEY AND
THEN THEY'LL BE REPORTING ABOUT
OTHER PEOPLE IN THE HOUSEHOLD
AND IF WE'RE TALKING ABOUT
SOMEONE WHO.
MAYBE AN INSTITUTION BUT STILL
FEELS CONNECTED TO THE HOUSEHOLD
OR SOMEONE WHO MAY HAVE --
THE FIRST RACE REASONS --
MAY NOT BE ABLE --
TO ANSWER DESERVE IT INTEGRATES
A NOW IN TERMS OF TRYING TO GET.
ME THERE ARE STILL WHAT PEOPLE
GET SERVICES WHO COULD ANSWER
THE SURVEY --
IS -- IS
VERY GOOD AT LEAST SOME EFFORT
TO WEAR THAT POSSIBLE TO TRY TO
NUDGE.
SO I AM SAYS LIKE TWO STAGES YOU
CAN DO SOME SCREENING QUESTIONS
ARE YOU HIT THE SCREENS I WANT
TO GO AND GET MORE IN DEPTH THE
RIGHT.
SO -- AND OF
THERE'S A WAY. TO TO DEGREE
POSSIBLE THE PERSON WHO ACTUALLY
RECEIVING THE SERVICES TO HELP
ANSWER SOME OF THE QUESTIONS
RELATE AND I REALIZE WHAT
ANSWERS ANY SURVEY ARE YOU DOING
SO I THINK THE PHONE SURVEY
REMEMBER CORRECTLY YET SO. TO
ACTUALLY.
NOT JUST TALK TO WHOEVER THE
LEAD PERSON ISN'T A HOUSEHOLD
BUT TO ACTUALLY TO MAYBE.
THE END OF THEIR SOME THOUGHTS
ABOUT THAT ABOUT WHO ACTUALLY
ANSWERING THE SURVEY DURING ITS
THE BEHALF OF SOMEBODY OR WE
ACTUALLY TALK TO THE PERSON
WHOSE CONTRACT EXPERIENCING AT
NAY REALIZE SOME OF THE
QUESTIONS MAY BE MORE RELEVANT
TO THE PERSON WHO'S.
PROVIDE A WHO'S TRYING TO HELP
THE PERSON VERSES THE BUT SOME
OF THE KEY SPEAKER THAT.
I AM UNFORTUNATELY NOT WELL
VERSED IN THE PROTOCOL THAT IS
USED AYE AYE WE CAN CERTAINLY
GET THAT FOR YOU AT THAT'S
PUBLIC QUESTION THE DOCTOR
KIDMAN COULD COULD ANSWER SHE
WAS HERE BUT WILL DEFINITELY
FIND OUT I BELIEVE THE INTENT IS
TO TRY WHEREVER POSSIBLE TO TALK
TO THE TO THE PRINTER.
MERRY --
PERSON WITH THE LONG TERM CARE
NEEDS -- BUT
WE CAN CERTAINLY GET MORE
DETAILS ON THAT.
AREA.
AT AND THEN THE OTHER PART IS IS
THAT AND AGAIN RECOGNIZING
THERE'S LIMITATIONS TO ANY SORT
OF SURVEY OR AS YOU MENTIONED --
YOU KNOW WE TALK ABOUT PEOPLE
WHO MAYBE INSTITUTIONS TO AN
AREA BITING THE A YES BUT THAT
AND THE BOTH OF YOU CAN.
TOUCH A ANSWER THIS QUESTION.
IN SOME SENSES THE THE MULTI TO
PEOPLE WHO ARE MOST LIKELY TO
RESPOND ARE PROBABLY THE PEOPLE
WHO TO THE SYSTEM IS BEST
WORKING.
FOR RIGHT USUALLY THE THE RIGHT.
SO THE PEOPLE GET WHO ARE
ESSENTIALLY THE THE PEOPLE ARE
STUCK IN A NURSING HOME BECAUSE
WHO COULD BE UP THE COMMUNITY --
PROBABLY ACTUALLY BE LESS LIKELY
TO BE SAMPLED RIGHT.
THERE IN AN INSTITUTION IF I
DON'T HAVE THE PRICES SOMEBODY
HOUSEHOLD IT'S AT THE TO TAKE IT
THIS CHARGED BECAUSE OR THE
PERSON WHO ACTUALLY ISN'T
RECEIVING THE SERVICES BECAUSE
THEY'RE HOMELESS AND HAVE NO
FAMILY MEMBERS AND SO FORTH SO --
AGAIN RECOGNIZING THE
LIMITATIONS OF OF ANY SURVEY AND
THEN YOU COME BACK AND SAY HEY
WE NEED A LOT MORE MONEY.
TO FIGURE THIS ALL OUT --
THAT THAT IT ARE THERE SOME WAYS
THAT.
BAD WEATHER JUST OTHER DATA
SOURCES ARE THE I MEAN SO WE
HAVE WE'RE GONNA DO THIS SURVEY
AND AND TRY TO GET AS MUCH AS WE
CAN -- BUT
THEN THINK ABOUT WHAT ELSE WHAT
OTHER SOURCES OF INFORMATION CAN
WE LINK --
TO TO ACTUALLY GET OUR ARMS
AROUND SOME OF THE SO. TO AND
EIGHTY YOU MADE REFERENCE TO THE
OF THE OF THE AMERICANS ME
SURVEY OTHER THINGS THE STATE
MAYBE COLLECT THE OTHER TYPES OF
DATA SETS AND SO FORTH SO.
THAT WE CAN ROUND OUT THE
PICTURE NOW.
YEAH I THINK THAT'S I THINK
THAT'S CORRECT --
THAT THE SURVEY IS LIMITED TO
PEOPLE IN A HOUSEHOLD WITH WITH
THE PHONE WHERE THERE'S A FOR
THE PHONE NUMBER SO IT DOES.
I THINK IT WOULD CAPTURE
PEOPLE'S AN ASSISTED LIVING IN A
LIVING A LIVING ON IT THAT HAS A
PHONE BUT CERTAINLY FOR ANYBODY
IN SKILLED NURSING HER EYES.
ICF TYPE.
SITUATION THAT'S THAT'S PROBABLY
TRUE -- YES
THERE AREN'T THERE AREN'T OTHER
SURVEY DATA --
THERE'S ALSO THE POSSIBILITY OF
YOU KNOW COMMISSIONING --
MORE DIRECT IN PERSON SIR IN
PERSONS SERVING IS DONE AND
INSTITUTIONS FOR OTHER OTHER
REASONS SO --
IT'S IT'S NOT THE EASIEST THING
I'M SURE BUT I'M SURE IT COULD
BE SOMETHING THAT COULD BE COULD
BE LOOKED AT AS A SUPPLEMENT.
SOME POINT ON AND PERHAPS --
MISTY HOUSE IN THE ONE OF A. B.
COMMENT ON THAT ISSUE OR OTHER
ARE WE THINK OUR OTHER GAPS --
I THINK PETERS DEFINITELY THE
THE PRO ON THESE ISSUES SO I'LL
DEFER TO HIM ON ALL OF THAT BUT
I DO THINK THAT --
ONE DATA SOURCE THAT'S HELPFUL
IN TERMS OF IDENTIFYING PEOPLE
IN INSTITUTIONS HAVE EXPRESSED A
WISH TO RETURN OF THE COMMUNITY
IS THE MINIMUM DATA SET.
THERE'S A SECTION Q. THAT
ACTUALLY FOCUSES ON IDENTIFYING
THOSE PEOPLE QUESTION IS WHAT
YOU DO WITH THAT DATA.
AND THAT'S WHERE THE CHALLENGES.
OKAY NOW THAT'S VERY HELPFUL.
AND IT IS SO IN TERMS OF ALRIGHT
WE DO THE SURVEY RIGHT --
WE STERN WE START GETTING THE
INFORMATION OUT THERE SCHOOL
ACTUALLY OF YOUR AND YOU'RE
TRYING TO AND IS THAT --
YOU ARE COVERING A LOT OF GROUND
THAT'S GREAT I ALSO AS SOMEONE
WHO'S INVOLVED SURVEY DESIGN
REALIZE THAT THERE'S YOU KNOW.
YOU CAN ONLY MAKE A SURVEY SO
LONG EFORE PEOPLE START HISTORY
QUESTION SO --
BUT IN.
IF IT'S IN THE END EIGHT U. D.
WERE COLLECTING THIS DATA FOR
THIS SURVEY.
HOW HOT --
WHAT DO YOU THINK ARE THE
OPPORTUNITIES BEYOND JUST THIS
ONE THROUGH I MEAN WE'RE WE'RE
AGAIN PART REASON HAVING THIS
HEARINGS ARE TRYING TO GET OUR
ARMS AROUND THIS ISSUE OBVIOUSLY
THIS WILL BE A MAJOR
CONTRIBUTION TO HELPING US
UNDERSTAND WHAT'S GOING ON --
EDITOR IN TERMS OF THE
RESEARCHERS ASIDE FROM JUST THE
DATA WERE AGAIN THE SURVEY WHICH
WILL ADD CONSIDERABLY TO OUR
KNOWLEDGE TO OUR KNOWLEDGE GAPS.
IN TERMS OF BE ABLE TO
SYNTHESIZE THIS AND OTHER DATA
SOURCES --
WHAT DO YOU THINK THE NEXT STEP
SHOULD BE THAT SAID BEYOND JUST
WHAT WE GET FROM THIS SURVEY TO
TRY TO GET THE BIGGER PICTURE?
IT'S A REALLY GOOD QUESTION --
IN WE DO NEED TO THINK ABOUT
WHAT WE DO MOVING AHEAD WITH THE
STATE A WE'RE KINDOF FOCUSED ON
ON GETTING THE DATE AND PLACE
WERE TRYING TO ENGAGE WITH THE
RESEARCH COMMUNITY TO MAKE THEM
AWARE THAT THE STATE IS
AVAILABLE.
I THINK WE'D LIKE TO SEE WHAT
THEY COME BACK WITH --
ENGAGE THEM --
SO I DO THINK THOSE BE SOME OUR
REACH THIS WILL DO.
MORE ACADEMIC FOCUS TO TREAT AND
MARK NOW FORMS TO LOOK
SPECIFICALLY AT WHERE WHERE
SHOULD WE GO WITH THIS AND HOW
DO WE BUILD ON IT BUT I DON'T
WANNA GET TOO FAR AHEAD I THINK.
I THINK THE GOOGLE --
PRIMARILY --
WE'RE HOPING THAT --
YOU KNOW WE'LL JUST.
GET THE BEST AND BRIGHTEST TO
KIND OF TAKE A CRACK AT THAT AND
AND COME UP WITH RECOMMENDATIONS
THE CLARIFIED.
THE STATE IS IT IS IT STATUS AS
A PUBLICLY AVAILABLE TAUGHT
RESEARCHERS ACCOUNT IT IS NINE
THIS'LL BE DISTILLED INPUT INTO
REPORT BUT IT'S ALSO AVAILABLE
THROUGH DATA USE AGREEMENT IF
PEOPLE REALLY WANT ACCESS TO
DIRECTLY.
AND IT'S ALSO PUBLISHES PART OF
SOMETHING CALLED ASK CHOOSE
WHICH IS A PUBLIC A PLATFORM
THAT ANYBODY CAN --
PULL DOWN DATA FROM THERE FROM
SOME.
AND ACTUALLY --
I DON'T KNOW IF YOU KNOW THE
ANSWER THIS QUESTION WHAT WHAT
ON THE STATE --
BUT DATA SETS THE TRY TO LOOK AT
THIS PARTICULAR ISSUES THAT YOU
KNOW IF THERE'S FEDERAL FUNDING
FOR THAT AND OR ANYTHING SO I'M
I'M IMAGINING THERE WOULD BE A
LOT OF GRANTS I'VE ALREADY HEARD
FROM -- SOME
RESEARCHERS AT UCSF THEY'RE
TRYING TO CREATE A OF A STUDY
CENTER ESSENTIALLY A DEVOTED.
TO ONGOING RESEARCH AROUND THIS
AND I THINK THEY'RE LOOKING FOR
FOUNDATIONAL SUPPORT --
AS WELL AS GOVERNMENT GRANTS TO
GET STARTED --
SO.
YEAH I THINK THINGS WILL BE.
MORE PEOPLE COME FORWARD --
ONCE ONCE IT STARTS ONCE ONCE
THE DATA FALLS IS ACTUALLY OUT
THERE IN ACCESSIBLE ON OKAY CAM.
AND I KNOW SUMMER AGENCY FOLKS
WILL BE TESTIFYING A LITTLE
LATER SO IF YOU'RE OUT IN THE
AUDIENCE MIGHT THINK ABOUT THE
ANSWER THE QUESTION OF HOW DO
YOU PLAN TO USE THE STATE AT
HELP INFORM WHAT YOU'RE AGENCIES
GOING TO BE DOING. TO ADDRESS
THE ISSUE.
THEY'LL COME UP.
SO.
OKAY -- ALL
RIGHT -- ANY
OTHER AND ANY OTHER COMMENTS ON
ALL RIGHT WELL.
THANK YOU FOR CONDUCTING THE
HEARING YES NO THANK YOU THANK
YOU FOR SO MUCH ABOUT THE FOR
FOR BEING HERE AND FOR
PRESENTING AND MOVE VERY MUCH
LOOKING FORWARD --
TO THE STATE AND NOW I ALSO
RECOGNIZE THAT THIS IS GONNA BE
COLLECTOR TWO CYCLES IT'S GONNA
BE SEVERAL YEARS I WOULD.
ALSO ADMONISH --
PEOPLE NOT --
THAT WE COLLECT ALL THE STATE IT
FOR YOU DO ANYTHING.
OKAY SO THE STATUS CAN BE VERY
INFORMATIVE IT'S VERY HELPFUL AS
WE MOVE ALONG AND IT TAKES TIME
TO DO THIS RIGHT COLLECTED NASRI
QUESTIONS AND SO FORTH BUT ALSO.
PARTLY REASON WE'RE HAVING THIS
HEARING TODAY IS NOT TO SAY THAT
WE HAVE TO WAIT TILL WE GET ALL
OF THIS I'M STILL INFORM US
MOVING FORWARD FROM WHATEVER
POINT WE ACTUALLY GET THE STATE
OUT BUT WE ALREADY HAVE A LOT OF
INFORMATION TO SAY THAT THERE
ARE THINGS.
WE NEED TO START DOING IT NOW.
AND THE CERTAINLY HOPEFULLY AS
WE GET THE STATED THAT WILL HELP
US MAKE ADJUSTMENTS AND
DIRECTION AND AS WE MOVE FORWARD.
OKAY THANKS VERY MUCH THANK YOU
THANK YOU THANK YOU.
RIGHT SO WHAT ARE NEXT TO THE
PANEL IS --
PRESENTATION LONG TERM CARE
OUTLOOK DISABILITY MY CALIFORNIA
SENIORS WE HAVE A RYAN LOOSELY
WELLESLEY WE'LL SEE THAT
PRONOUNCE IT CORRECTLY ALL RIGHT
FROM --
RESPONSIBLE FISCAL POLICY
ANALYST AT THE LA YOU KNOW.
AND JACQUI RTO OF THEM FISCAL
POLICY AT LA L. WE ALWAYS LOVE
ARE ELLIE --
FOLKS THAT THANK YOU SO VERY
MUCH OF A THIS THING SELL HAPPY
TO HAVE YOU SHARE WITH US WHAT
ALEJO'S LOOKED INTO COMES TOO
LONG. TO THE LONG TERM OUTLOOK
OF THIS THANK YOU.
HI AGAIN MY NAME'S JACKIE --
WE WERE MAINLY ASKED TO PROVIDE
AN OVERVIEW OF THE DISABILITY
PROJECTIONS THAT OUR OFICE HAS
DONE --
WHICH WE PUBLISHED IN NOVEMBER
TWENTY SIXTEEN MY COMMENTS WILL
MAINLY FOCUS ON PROVIDING KI?M
FOR BACKGROUND INFORMATION ON
HOW WE DEFINE DISABILITY IN THE
CONTEXT OF LTO SAYS.
ON WHAT MOTIVATED OUR OFFICE TO
KIND OF DO THIS CALIFORNIA
SPECIFIC LOOK.
AND ALL KICK OFF WITH BY
PROVIDING A HIGH LEVEL --
SUMMARY OF OUR PROJECTIONS AND
RYAN MY COLLEAGUE KILL --
SPEAK MORE IN DETAIL ABOUT OUR
PROTECTIONS ACROSS VARIOUS
DEMOGRAPHIC --
CHARACTERISTICS SO TO BEGIN.
ON THE WAY THAT OUR OFFICE TO
FIND DISABILITY WAS THROUGH
LIMITATIONS IN ACTIVITIES OF
DAILY LIVING OR ADL AND THIS IS
A METRICS THAT COMMONLY USED
ACROSS VARIOUS ULTI SS --
PROGRAMS TO ASSESS LEVEL OF NEED --
A DEALS CAN REFER TO ROUTINE
DAILY PERSONAL CARE ACTIVITIES
SUCH AS EATING OR DRESSING.
WE WOULD NOTE THAT DISABILITY
RATES AS MEASURED BY A DEALS
THEY DO TEND TO VARY BY CERTAIN
DEMOGRAPHIC CHARACTERISTICS
SPECIFICALLY BE FOUND THAT
DISABILITY RATES ARE HIGHER
AMONG OLDER INDIVIDUALS CERTAIN
RACIAL AND ETHNIC MINORITIES.
INDIVIDUALS WITH LESS FORMAL
EDUCATION AND WOMEN --
SO WHEN YOU'RE THINKING ABOUT L.
TSS ONE OF THE KEY REASONS WHY
PEOPLE NEED THE SERVICES ARE TO
THESE DISABILITY RATES --
AND THAT WAS PREVIOUSLY
MENTIONED DEL TSS IT'S A
SPECTRUM OF SERVICES IT COULD BE
IN HOME COMMUNITY BASED CARE ALL
THE WAY TO INSTITUTIONALIZED --
LONG TERM CARE SUCH AS A SKILLED
NURSING FACILITY AND ALSO
INCLUDED IN THAT SPECTRUM IS
INFORMAL WHAT'S CALLED INFORMAL
UNPAID FAMILY CARE GIVING THAT'S
HAPPENING WITHIN THE HOUSEHOLD
SELF -- SO
IN THE CONTEXT OF LTO SAYS
SENIORS ARE ONE OF THE PRIMARY
USERS OF THE SERVICE SAYS SO
WHEN WE'RE TALKING ABOUT
CALIFORNIA'S SPECIFICALLY WHILE
THE STATE IS YOUNG WE ARE AN
AGING POPULATION --
WE JUST NOTED THAT OVER THE PAST
TEN YEARS THE SHARE OF PEOPLE
OVER THE AGE OF SIXTY FIVE HAS
INCREASED FROM 11% OF THE STATE
POPULATION.
AND IN 20007214% AND TWENTY
SEVENTEEN AND IT'S EXPECTED THAT
THIS GROWTH RATE WILL CONTINUE%
IN FUTURE YEARS --
IT'S OUR UNDERSTANDING THAT THAT
POINT WILL BE FURTHER FLESHED
OUT BY FUTURE SPEAKERS BUT
SOMETHING TO KEEP IN MIND WHEN
YOU'RE TALKING ABOUT THAN.
ON CALIFORNIA'S RAPIDLY GROWING
SEATING YOUR POPULATION DOES
THAN RAISE QUESTIONS ABOUT OUR
CURRENT L. TSS SYSTEM IN THE
STATE BOTH ON CAPACITY AND THEN
THE FINANCIAL IMPACT IT WOULD
HAVE NOT ONLY ON THE STATE'S
FINANCES BUT ALSO PERSONAL
FAMILY FINANCES.
I'M.
A LARGER REASON WHY WE ALSO --
CONSIDERED CALIFORNIA SPECIFIC
PROJECTIONS BECAUSE CALIFORNIA
IS VERY DIFFERENT FROM THE REST
OF THE NATION.
I'M NOT ONLY READ THE MOST
POPULOUS STATE IN THE NATION BUT
ALSO WE ARE ONE OF FIVE STATES
THAT ARE QUOTE UNQUOTE A
MAJORITY MINORITY STATE SO OVER
HALF OF CALIFORNIANS --
ARE NON WHITE AND AS I
PREVIOUSLY STATED WHEN YOU'RE
TALKING ABOUT DISABILITY RATES
AN LTO SIZE ON THE FACT THAT
THEY DO VERY BY KEY DEMOGRAPHIC
FACTORS A THRILL IT PLAYS A BIG
ROLE THAN WHEN YOU WERE TALKING
ABOUT THE CONTEXT OF FUTURE USE --
SO FOR THOSE REASONS WE WERE
MOTIVATED --
TO LOOK AT TO CALIFORNIA
SPECIFIC AS OPPOSED TO RELYING
ON NATIONAL LEVEL DATA --
OUR PROJECTIONS MAINLY FOCUSED
ON LOOKING AT PEOPLE AGED OVER --
SIXTY FIVE IN THE COURT OF
BETWEEN TWENTY FIFTEEN AND
TWENTY NINETEEN LOOKING AT THEIR
CURRENT DISABILITY RATES
BREAKING IT OUT BY CERTAIN
DEMOGRAPHIC FACTORS AND THEN
JUST CARRYING THOSE DISABILITY
RATES FOR IT AND APPLYING THEM
TO FUTURE POPULATION.
PRODUCTION --
AS WE GO THROUGH OUR PROJECTIONS
ONE THING THAT WOULD KNOW.
GIVEN THAT THESE ARE POINT IN
TIME ESTIMATES TO THE EXTENT
THAT POPULATION COUNTER
DISABILITY RATES HAVE CHANGED
SINCE WE DID OUR LOOK IN TWENTY
SIXTEEN OF COURSE ARE
PROJECTIONS WOULD BE DIFFERENT --
BUT THIS IS REALLY JUST TO GIVE
YOU A SENSE OF WHAT DO WE HAVE
TO LOOK FOR IN THE FUTURE.
I'M SO ON PAGE THREE WE NOTE
THAT BASED OFF OF OUR
PROJECTIONS THE NUMBER OF
CALIFORNIA SENIORS WITH THE
DISABILITY THEIR PROJECTED TO
GROW FROM ONE MILLION IN. TWENTY
FIFTEEN TO TWO POINT SEVEN
MILLION IN TWENTY SIXTY AND AS
YOU SEE IN THE GRAPH WE BREAK --
UP THE GROWTH INTO TWO SEGMENTS --
BASED OFF OF A DETAILS --
ONE HIGHLIGHTING THE NUMBER OF
SENIORS THAT WOULD HAVE AT LEAST
ONE ADL OR A LIMITATION WITH
ACTIVITIES OF DAILY LIVING AND
THEN THOSE THAT WOULD HAVE TWO
OR MORE AND THE REASON WHY WE
DID THIS IS BECAUSE WE FOUND
THAT -- TWO
OR MORE MAY BE A BETTER
UTILIZING --
AN LTO SIZE PROGRAM ITSELF.
THESE GROWTH RATES WHEN YOU
COMPARE TO THE OVERALL SENIOR
POPULATION WE FOUND WERE FASTER
AND THEIR VARIOUS REASONS WHY
THIS COULD BE THE MAIN BEING
THAT.
GROUPS THAT ARE MORE LIKELY TO
USE ALL TSS OR TO HAVE --
THAT TYPICALLY HAVE HIGHER
DISABILITY RATES WILL IN THE
FUTURE MAKE UP A LARGER SHARE OF
OUR STATE'S POPULATION TO THEM
THAT'S WHY WE'RE SEEING THESE
TWO DIFFERENT GROWTH RATES --
MY COLLEAGUE NOW WE'LL TALK MORE
IN DEPTH ABOUT HOW THESE
PROJECTIONS ON PLAY OUT ACROSS
CERTAIN DEMOGRAPHIC
CHARACTERISTICS.
THANK YOU RAM WILL THE WITH THE
LA -- WE
LOOKED AT A COUPLE DIFFERENT
CATEGORIZATIONS OF OF
DEMOGRAPHIC FEATURES AND JUST
WANT TO NOTE AT THE OUTSET THAT
OUR ANALYSIS --
WAS NOT INTENDED SO MUCH TO
IDENTIFY THE CAUSES OF THE
CONNECTIONS BETWEEN THESE
DEMOGRAPHIC FACTORS.
AND DISABILITY RATES FOR MORE
JUST TO HIGHLIGHT THOSE
RELATIONSHIPS AND GIVE A SENSE
OF WHAT.
THE AGING SENIOR POPULATION AND
THOSE WITH DISABILITIES WILL
LOOK LIKE IN THE FUTURE --
THE FIRST GROUP THAT WE LOOKED
AT WAS -- BY
SEX AND AS YOU CAN SEE ON THE
TABLE ON PITCHER THAT PAGE --
FOR SENIORS OVERALL ARE
PROJECTED --
TO HAVE --
AN AVERAGE LIFE EXPECTANCY OF
TWENTY FOUR YEARS AFTER THEY
REACH AGE SIXTY FIVE NINETEEN
POINT ONE OF THOSE YEARS WOULD
BE PROJECTED TO BE WITHOUT ANY.
ACTIVITY OF DAILY LIVING --
LIMITATIONS --
ONE POINT SEVEN WOULD BE WITH
ONE EIGHTY A LIMITATION AND TWO
POINT EIGHT YEARS WOULD BE WITH
TWO OR MORE.
AND THE PROJECT NUMBER OF YEARS
WITH TWO OR MORE --
LIMITATIONS IS IMPORTANT TO KEEP
IN MIND AS MY COLLEAGUE
MENTIONED BECAUSE THIS GIVES YOU
A SENSE OF THE LENGTH OF TIME
THAT SOMEONE WOULD POTENTIALLY
NEED.
L. TSS.
NOW LOOKING AT THE DIFFERENCE --
AMONG FEMALES AND MALES AND YOU
CAN SEE THAT THE AVERAGE LIFE
EXPECTANCY AFTER SIXTY FIVE AS
LONGER. FOR FOR WOMEN AND THAT
THERE'S A LARGER NUMBER OF YEARS --
WITH A DISABILITY --
VERSUS MEN IN ADDITION TO THAT
IF YOU LOOK AT THE SHARE OF LIFE
AFTER AGE --
SIXTY FIVE FEMALE SENIORS ARE
PROJECTED TO HAVE OTHER TIME
AFTER SIXTY FIVE THIRTEEN POINT
7% -- WITH
TWO MORE ADL LIMITATIONS VERSUS
ONLY TEN POINT 3% FOR MEN.
ON PAGE.
FIVE WE LOOK AT THE PROJECTED
LENGTH OF TIME --
AFTER SIXTY FIVE FOR THE
DISABILITY BY --
RACIAL AND ETHNIC CATEGORIES --
DUE TO DATA LIMITATIONS --
WE THOUGH IT'S NOT IDEAL --
HAD TO FOCUS ON THREE VERY ROUGH
LARGE CATEGORIES --
HERE BEING WHITE HISPANICS AND
THEN EVERYONE ELSE --
WHAT YOU CAN SEE IN THE TABLE IS
THAT --
WHITE SENIORS ARE PROJECTED TO
HAVE RELATIVELY FEWER YEARS
AFTER AGE --
SIXTY FIVE BUT ALSO --
A SHORTER NUMBER OF THOSE WITH
DISABILITIES WHILE AM HISPANIC
SENIORS AND ALL OTHER SENIORS
ARE PROJECTED TO LIVE LONGER BUT
HAVE.
A LARGER NUMBER OF YEARS AND
WITH DISABILITIES AND ALSO A
LARGER SHARE --
WHITE SENIORS ARE PROJECTED TO
SPEND --
NINE POINT 3% OF THEIR LIVES
AFTER SIXTY FIVE WITH TWO OR
MORE EIGHTY AT LIMITATIONS
VERSES OVER 15% FOR OTHER
SENIORS.
INSERTED ARE THAT BUSINESS THERE
WAS THERE ANY EFFORT DAR WAS
THEIR DATA AVAILABLE TO FOR
EXAMPLE WE ARE LOOKING AT THESE
RACIAL THE SPURS RECOGNIZING A
FAIRLY LIMITED DATA. TO ACTUALLY
ADJUSTS BY A WELL SOME PRODUCTS
FOR SAYS ECONOMIC --
SO HOW MUCH IS THIS IS RAY SPACE
THOMAS'S SOCIO ECONOMIC --
WE KNOW OF COURSE THEIR EXISTING
DISPARITY SO HOW HOW INDEPENDENT
ARE THEY OF THOSE PARTICULAR
FACTORS.
THAT'S A VERY GOOD QUESTION I
THINK TH BEST ANSWER WOULD BE
NOT VERY INDEPENDENT --
YOU'RE CORRECT THAT --
SOCIO ECONOMIC STATUS DOES PLAY
A VERY IMPORTANT ROLE ALSO IN
DETERMINING DISABILITY AND THAT
AFFECT IS PROBABLY MIXED IN WITH
BOTH THESE --
RACIAL ETHNIC CATEGORIES AS WELL
AS THE EDUCATION CATEGORIES THAT
WILL COME TO NEXT --
FOR CERTAIN MATHEMATICAL
METHODOLOGICAL REASONS WE
AVOIDED DIRECTLY GOING AFTER
SOCIOECONOMIC STATUS BUT THAT IS
CERTAINLY REPRESENTED TO EXTEND
HERE -- SO
THEN AS YOU MENTIONED THE THE
LAST --
CATEGORIZATION THAT WE LOOKED AT
IS IS EDUCATION LEVEL --
SENIORS WITH GREATER THAN HIGH
SCHOOL EDUCATION HAVE THE
LONGEST LIFE EXPECTANCY AFTER
AGE SIXTY FIVE BUT ALSO HAVE
FEWER --
YEARS WITH A DISABILITY.
I AM ON THE OPPOSITE SIDE THOSE
WITH LESS THAN A HIGH SCHOOL
EDUCATION HAVE THE SHORTEST LIFE
EXPECTANCY AFTER SIXTY FIVE IN
THE GREATEST NUMBER.
OF YEARS WITH A DISABILITY SO
THAT THE SHARES OF COURSE --
OF LIFE AFTER SIXTY FIVE THE
MUCH SMALLER FOR THOSE WITH WITH
GREATER EDUCATION.
BRING ALL OF THIS BACK TOGETHER --
MY COLLEAGUE PREVIOUSLY
MENTIONED THAT PART OF OUR
MOTIVATION --
IN DOING THIS WAS TO LOOK AT HOW
CALIFORNIA MAY BE DIFFERENT IN
THE REST OF THE COUNTRY AND ON
PAGE SEVEN OF OUR HAND OUT WE
SUMMARIZE --
AT THE AGGREGATE LEVEL OUR
FINDINGS ABOUT HOW CALIFORNIA
MAY BE DIFFERENT.
SPECIFICALLY --
WE PROJECTED THAT OVERALL
SENIORS TURNING SIXTY FIVE
BETWEEN TWO THOUSAND FIFTEEN AND
TWO THOUSAND NINETEEN ARE
PROJECTED TO SPEND TWO POINT
EIGHT YEARS --
WITH. TWO OR MORE EIGHTY L.
LIMITATIONS THAT'S ABOUT
EIGHTEEN ELEVEN POINT 9% SORRY
OF THEIR LIVES.
THIS COMPARES TO NATIONAL
PROJECTIONS BY THE URBAN
INSTITUTE.
THAT THE SIMILAR POPULATION
WOULD ONLY SPEND TWO YEARS OR
ABOUT NINE POINT 6% OF THEIR
LIVES.
WITH ADL LIMITATIONS.
LOOKING FORWARD TO WHAT THE
STATE AND THE LEGISLATURE CAN DO
TO PLAN FOR THE GROWING SENIOR
POPULATION.
IDEALLY WE THINK IT WOULD BE
GOOD TO FOCUS ON CONTINUING TO
DEVELOP --
CALIFORNIA SPECIFIC PROJECTIONS
OF NOT ONLY RATES OF DISABILITY.
BUT ALSO UTILIZATION OF LTE SS
AND HOW MUCH THOSE SERVICES
WOULD COST AND AND AND THAT IN
TURN WOULD LEAD TO HOW THOSE CAN
BE FINANCED --
HOWEVER THIS REMAINS A A LONG
TERM GOAL BECAUSE AS HAS BEEN
MENTIONED BY THE PREVIOUS
PANELISTS.
THERE ARE SIGNIFICANT DATA GAPS
THAT NEED TO BE FILLED BEFORE --
RIGOROUS AND AND AND AND
RELIABLE ESTIMATES CAN BE MADE.
SO JUST LIST A FEW OF THE THINGS
THAT HAVE BEEN MENTIONED ALREADY --
TO WHAT EXTENT ARE PEOPLE THAT --
FEEL LIKE THEY NEED TO THE
SERVICES ARE GETTING THEM TODAY
BY THE CURRENT SYSTEM --
HOW MANY INDIVIDUALS BASED ON
THE RELATIONSHIP BETWEEN
DISABILITIES AND SERVICE
UTILIZATION WOULD NEED THE
SERVICE IN THE FUTURE WHICH
SERVICES WILL BE THE MOST
IMPORTANT IN THE FUTURE --
AND THEN FINALLY HOW DOES THAT
ALL GET FINANCED AT MANY OF
THESE PROGRAMS WHICH WILL BE
DISCUSSED AND LATER PANEL ARE --
FINANCED IN PART BY THE STATE --
SO THIS HAS OF COURSE
SIGNIFICANT IMPLICATIONS FOR THE
STATE'S BUDGET --
GOING FORWARD.
AND WITH THAT WE'RE HAPPY TO
ANSWER ANY QUESTIONS YOU HAVE.
THANK YOU THANK YOU SO MUCH FOR
THE PRESENTATION --
SO I HAVE GUESTS.
THIS CAMERA BACK OF AN ACTING
KIND OF CALCULATION RECOGNIZING
IS LOTS OF DATA GAPS AND SO
FORTH -- BUT
SO FIRST OF ALL WHEN WE AS WE
LOOK ON PAGE THREE AND YOU SHOW
THE GRAPH AND HOW THE FACT THAT --
YELLED AND SAID THE NUMBER OF
CALIFORNIANS DISABILITY
PROJECTED A TWO POINT SEVEN
MILLION SO.
AND SO.
WHAT WOULD YOU SAY IS GIVEN THIS
GRAPH IS THE PERCENTAGE RISE?
EACH ANNUAL RISE OF PEOPLE WITH.
TO TWO OR MORE ADL SIDE TRYING
TO SEE THE CURVE THAT I DON'T
KNOW IF YOU'VE TO HAVE THAT
NUMBER RIGHT YEAH SO WE HAVE THE
TWO ENDPOINTS THEIR TERMS OF
BILLION SO WE'RE TALKING ABOUT A
AVERAGE ANNUAL RISE.
OF HOW MUCH OF THE IT'S
AVAILABLE OR NOT.
A YOU MENTIONED IT'S GOING
FASTER IN THE SENIOR POPULATION
IS GROWING RIGHT.
I DON'T THINK WE HAVE THE AT AND
YOU'LL AVERAGE RATE CARE WE CAN
CALCULATE THAT OF COURSE AT I
THINK RIGHT THE BEGINNING TO WIN
TWENTY FIFTEEN TO TWENTY SIXTY
WAS A HUNDRED AND 60% WASN'T --
US SPECIFICALLY ABOUT TWO OR
MORE EIGHTY ELSE YEAH WHAT WE
CAN DO THE WHOLE WE CAN DO ONE
YEAH SORRY WE HAVE THE NUMBER
FRONT OF YOU I MEAN I GUESS ARE
FOCUSING A LITTLE MORE ON THE TO
PLUS BECAUSE THEY'RE THE ONES
WHO MORE LIKELY GOT AND THE
SERVICES.
SELL BUT IF YOU HAVE HAVE
AVAILABLE.
THE NUMBER WE HAVE AVAILABLE IS
JUST THE OVERALL GROWTH IN THE
NUMBER OF SENIORS WITH
DISABILITIES THAT WOULD INCREASE
AGAIN FROM ONE MILLION TO TWO
POINT SEVEN WHICH OVERALL THAT
WOULD BE A 160% GROWTH SO IF YOU
DIVIDED IT BY THE NUMBER OF
YEARS BE COVERED YOU CAN GET.
A ROUGH ANNUAL PERCENTAGE GROWTH --
BUT IT OF WHAT WE DON'T HAVE IS
LIKE SPECIFICALLY FOR THE TWO OR
MORE WHICH WE CAN FOLLOW UP AND
GET YOU THAT NUMBER WELL I GUESS
THE BACK OF THE NAPKIN
CALCULATION I WAS LOOKING FOR
ADD TO BUILD ON THAT.
OBVIOUSLY IS THIS THE BUDGET
SUBCOMMITTEE RIGHT SO --
AND SO IF YOU TAKE A LOOK AT
THESE NUMBERS AND YOU FIGURE OUT
WHAT WE SPEND CURRENTLY OF
COURSE AND WE MAY CHANGE THE WAY
WE DO THAT IS A DATA ISSUES
RIGHT AND ALSO POLICY THE CITY
ISSUES THAT --
LOOKING FORWARD BUT S. LET'S
JUST MAKE THE ASSUMPTION THAT.
WE JUST KEEP DOING WHAT WE'RE
DOING NOW.
OKAY AND FUN THINGS THAT WHAT
WE'RE DOING NOW WHICH MAY NOT BE
ENOUGH AND ALL THIS OTHER STUFF.
AND JUST PURELY ON DEMOGRAPHICS
ALONE BASED ON THE DATA YOU HAVE
ON THE PEOPLE WHO NEED GIVEN THE
RATE IF THE RAT RISE OF PEOPLE
WITH WHO HAVE EIGHTY ELSE AND SO
S. THE AND SAINT SIMEON THAT THE
IF YOU JUST TAKE WHAT WE SPEND
NOW.
IDEA.
MALTA IN YOU MAKE THAT INCREASE
AT THE VERY SAME RATE IS THE
PERCENTAGE OF PEOPLE SEARS
DISABILITIES THAT POPULATION
INCREASE.
HOW MUCH?
BASICALLY HOW MUCH.
HOW MUCH FASTER THAT GROW THEN
THE OVERALL GDP YELL THAT ARE
THAT THE POPULATION GROWTH OF
THE TOP A LITTLE?
WHAT HAPPENS IS THAT YOU'LL
CERTAINLY FROM A BUDGETARY
STANDPOINT --
IF WE'RE LOOKING OUT TO THE
FUTURE SAY WHAT IS THE NEED NOW
THE NEED IS YOU HAVE THE BETTER
IF THERE'S AUDIO GAP THAT SET UP
EVEN WE SAY WE JUST DO WHAT
WE'RE DOING NOW.
WHICH IS DO WHAT WE'RE DOING NOW
IS SUFFICIENT INSUFFICIENT
WHATEVER ELSE AND AND MAYBE
THERE'S POLICY THERE'S ALSO
POLICY CHANGES MADE A COMPUTER
BUT WE JUST DO OR DOING NOW.
AND WE SIMPLY SAY THAT WELL IT'S
WE'RE JUST GOING TO INCREASE AT
THE SAME RATE THE PERCENTAGE OF
PEOPLE WITH [inaudible]
DISABILITIES.
HOW MUCH FASTER IS THAT GROWING
THEN OUR --
OUR CURRENT BUDGET OR A KIND OF
THE OUR POPULATION I'M JUST AYE%
COMPARATIVELY ALERTS HOW MUCH IS
IT SHOULD BE CONSUMING OF OUR
STATE BUDGET NOW I REALIZE
THERE'S A LOT OF CARRY OUT SO WE
DON'T KNOW HOW BAG DEAL THE
ECONOMY IT'S EITHER A BUT I
THINK THAT'S ONE OF THE THINGS.
THAT.
I'M. ONE SIR TO THINK ABOUT IT
BECAUSE AND WE CAN YEAH WE CAN
ARGUE ABOUT HOW FAST SHOULD WE
SPEND ON K. THROUGH TWELVE
EDUCATION GIVING OUT WE WERE
KIDS WE HAVE AND SO FORTH AND
LOTS OF OTHER COMPONENTS OF THE
BUDGET AS WELL BUT I THINK ONE
OF THE THINGS.
THAT AND AND PERHAPS MAYBE SOME
OF OUR AGENTS OTHER AGENCY FOLKS
WILL TOUCH ON THIS TOO BUT AS
WE'RE LOOKING AT YOUR HOUSE THE
HOUSE OF THE FACT THAT WE HAVE
AN AGING POPULATION WITH MORE AS
WE TRY TO DO THAT.
YEP THAT TO NOT ONLY SERVE THEM
BUT TRY TO PREVENTED IT CETERA
BUT IF WE JUST KEEP GOING AS
WE'RE GOING NOW --
MY CONCERN IS THAT BASICALLY
UNLESS WE BASICALLY QUOTE CUT
BACK ON WHAT WE'RE DOING NOW I
MEAN JUST.
JUST DOING WHAT WE'RE DOING NOW
IS GOING TO CONSUME.
YOU'LL EVER INCREASING PORTIONS
OF THE STATE BUDGET MAYBE CAN
COMMENT ON THAT STATEMENT THEM
IRATE.
WELL A COUPLE OF THINGS ON THAT
POINT I'M NUMBER ONE I'LL JUST
NOTE THAT OUR OFFICE YESTERDAY
RELEASED ITS --
ANNUAL FISCAL OUTLOOK
PUBLICATION IN WHICH WE PROJECTS
STATE EXPENSES OVER THE NEXT
FIVE YEARS AND ONE OF THE THINGS
WE LOOKED AT AS PART OF THAT
PUBLICATION IS HOW DEMOGRAPHIC
TRENDS.
ARE AFFECTING STATE SPENDING AND
ONE OF THE INTERESTING FINDINGS
THERE WAS THAT --
THERE'S DOWNWARD TREND IN --
AT THE AGE GROUP THAT TIME
DETERMINES K. TWELVE SPENDING AT
LEAST IN THE CURRENT LAN
PRACTICE --
AND THEN AS YOU'VE MENTIONED --
AND AND COSTS ASSOCIATED WITH
THAT WHAT WE FOUND IS THAT AT
LEAST OVER THE THE RELATIVELY
NEAR TERM --
THE THE DOWNWARD PRESSURE
BECAUSE OF DECLINING NUMBERS OF
STUDENTS --
IS IS IT BECAUSE OF MORE
SIGNIFICANT FORCE THEN THE
UPWARD PRESSURE BECAUSE OF ON
THE AGING POPULATION HOWEVER
PART OF THAT.
HAS TO DO WITH WHAT WE MENTIONED
EARLIER ABOUT --
HOW OLD AND WHAT CHARACTERISTICS
DOWN THE SENIOR POPULATION HAS
AND IN PARTICULAR THE?
GROUP OF SENIORS THAT ARE MOST
LIKELY TO HAVE HEALTHY ASSESS
NEEDS.
THAT --
POPULATION WILL START TO GROW
MORE QUICKLY A LITTLE BIT
FURTHER OUT SO THOSE TRENDS
COULD CHANGE --
ON THE QUESTION OF WHETHER AND
THERE IS INCREASED COSTS ON
THESE PROGRAMS --
CERTAINLY I THINK YOU KNOW IN IN
THE MEDI CAL PROGRAM --
THE THE SENIORS AND AND PERSONS
WITH DISABILITY CASELOADS ARE.
THE CASES THAT ARE GROWING --
AND AND MY COLLEAGUE CAM.
THAT MISS BRAZIL CAN CAN COMMENT
ON SOME OF THE OTHER PROGRAMS
THAT ARE --
ADMINISTERED BY --
DEPARTMENTS.
I'M EXPERIENCE INCREASED COSTS
IN IN RECENT YEARS.
VERY SUMMER STORE WHERE WE ARE
SEEING.
INCREASED COSTS NOT ONLY
ASSOCIATED WITH CASERTA COULD
ALSO JUST BE ASSOCIATED WITH
STATE POLICIES THAT WE HAVE
IMPLEMENTED OR FEDERAL POLICIES --
SPECIFICALLY WITH I JUST SAYS
STATE MINIMUM WAGE OR FEDERAL
OVER TIME SO YOU HAVE A LOT OF
FACTORS THAT ARE DRIVING COST --
I THINK LIKE YOU MENTIONED ANY
FORM OF TRYING TO MAKE A ROUGH
BACK OF THE ENVELOPE I'D
ASSESSMENT OF FUTURE COST.
IT WOULD REALLY THEN HAVE TO
BRING UP POLICY DECISIONS AT THE
STATE WOULD BE TO MAKE BECAUSE
ALTHOUGH YOU COULD MAKE THOSE
ROUGH ASSUMPTIONS IT'S WHETHER
THEY'RE REALISTIC CAN I JUST ASK.
A FIXED --
COST GROWTH OVER TIME --
AND I AM THESE PROGRAMS THEIR
SPECIFIC TO SERVING --
CERTAIN INDIVIDUALS WITH CERTAIN
TYPES OF DISABILITIES AS WELL SO
GETTING A SENSE OF NOT ONLY THE
NEEDS ACROSS THE POPULATION --
BUT THEN WHAT.
PROGRAM I THINK WOULD BRING UP A
LOT OF QUESTIONS ABOUT HOW DO WE
WANT TO STRUCTURE --
TSS SYSTEM MOVING FOR THAT WOULD
THAT AFFECT COST LIKE I GETS A
YES. ONE ONE OF MY FOCUS A
LITTLE BIT ON JUST FOR RIGHT NOW
BECAUSE SEAT WITH WHEN WE TALK
ABOUT BUDGET DOES LOTS DISEASE
AT THIS LOTS OF OTHER FACTORS
BUT TO WHAT HOW MUCH PRESSURE.
GIVEN THE DEMOGRAPHICS IS
CASELOAD ITSELF RIGHT --
SO SUE ME THAT WE DON'T PUT IN
POLICIES TO DISCOURAGE PEOPLE
FROM SIGNING UP OUR OUR OTHER
TYPES OF THINGS THAT JUST GIVE
IN.
AND AND ACTUALLY THERE MAY BE
SOME INDICATIONS THAT THERE ARE
PEOPLE WHO DON'T ELECTION WE'VE
HEARD FROM FEES ASSESSMENT
ACTUALLY PEOPLE DON'T KNOW SO
THEY MAY BE UPWARD PRESSURE AND
THAT SENSE IN TERMS OF CASELOAD --
BUT EVEN JUST FROM PURELY
DEMOGRAPHICS HOW MUCH OVER TIME --
YOU HAVE OUT TO TWENTY SIXTY BUT
EVEN OVER LET'S SAY THE NEXT TEN
YEARS RIGHT --
EIGHT EIGHT FIFTEEN YEARS. ONE
OR TWO GOVERNOR CYCLES RATE --
HOW MUCH PRESSURE IS CASE GIVE
IT JUST GIVEN THE RATE OF RISE
IN THE CASELOAD HOW MUCH
PRESSURE DO YOU THINK CASELOAD
IS GONNA APPLY SO ASIDE FROM WE
HAVE OTHER --
OBVIOUSLY OTHER FACTORS DO YOU
THINK IS GOING TO BE A WELL
WE'RE SERVING NOW OKAY SO
OBVIOUSLY THERE'S POLICIES WE
CAN CHANGE THE EXPAND THE LEVEL
SERVICE WE COULD DO POLICY
CHANGES TO DECREASE THE LEVEL
SERVICE BUT GIVEN WHAT WE'RE
LEAST ATTEMPTING TO DO NOW HOW
MUCH.
OF WHAT THE GREASE CASELOAD
ITSELF --
GIVEN WHAT YOU PER DAY 80% IS
GONNA PUT PRESSURE ON IN TERMS
OF HOW MUCH SPENDING WE WOULD
NEED TO DO TO JUST MEET CASELOAD --
INCREASES BECAUSE OF THE
DEMOGRAPHIC INFORMATION THAT
YOU'VE PRESENTED TODAY.
I THINK WE COULD SAY THAT WE
WOULD EXPECT OVER THE LONGER
TERM THE CASELOAD WILL BE A
SIGNIFICANT FACTOR HOW WE'RE NOT
PREPARED TO TALK ABOUT SPECIFIC
NUMBERS AT THIS TIME AND IN
LIGHT OF THE THAT SIGNIFICAN
DATA GAPS REMEMBER OUT UP --
YOU KNOW THEY'RE THEY'RE THEY'RE
PERHAPS OR SOME THINGS WE COULD
LOOK INTO IT IS AN AREA THAT OUR
OFFICES INTERESTED IN CONTINUING
TO WORK ON OVER THE LONGER TERM
AND ARE HAPPY TO CONTINUE TO
WORK WITH YOU AND YOUR STAFF --
TO KEEP EVERYONE IN THE LOOP ON
THAT.
YEAH I THINK WOULD BE HELPFUL IS --
GAIN A SENSE OF PROPORTIONALLY.
WHAT TO WHAT DEGREE CASELOAD
[inaudible]
RIGHT --
GIVEN THE DEMOGRAPHICS.
IS WHAT KIND OF PRESSURES THAT
IS GOING OF PUT GREAT THERE'S
OTHER POLICIES OTHER POLICIES
WERE TRYING TO FIND.
ROUTE DOING RESEARCH SAID THAT A
FIGHT GAPS AND OTHER THINGS BUT
JUST UNDERSTANDING.
OF WHAT HOW.
CASE LOAD IS THE GOING TO BE
DRIVING A WHAT KIND OF PRESSURE
CASELOAD PUTS ON THINGS THAT
EXEMPTS PORTENT NOW AND MY SAY
PRESSURE.
MEAN IT I DON'T AT FRAME THAT
AND NEGATIVES I THINK THAT THE
THING IS WHAT THIS HOW DO WE
PREPARE IS A STATE.
FOR ESSENTIALLY --
A LARGER NUMBER OF PEOPLE WHO.
WHO NEED HELP WITH --
TO BE SURE TO GET SERVICES --
SO THEY CAN --
BE SUCCESSFUL WITH THAT AND AND
ADDRESS THE THE THE DISABILITIES
THAT THEY THEY THEY HAVE THEY
HAVE FRIGHTENED DOES THAT SO I
THINK THAT THAT'S SOMETHING THAT.
WE WANT TO TRY TO UNDERSTAND
THAT ARE PLANNING RIGHT AND
OBVIOUSLY WE WILL BE DISCUSSING
VARIETY DIFFERENT POLICY LEADERS
CERTAINLY HOPE SO ANY PART OF
THE REASON FOR THIS HEARING IS
THE SORT OF TRY AT OUTLINES A
OKAY WE'RE TRYING TO HELP.
THE FINAL THE THE PROBLEM SO
THAT WE CAN START HAVING PUSHING
TOWARD A CONVERSATION ABOUT ARE
THERE.
OTHER POLICY THINGS THAT WE NEED
TO DO --
WHAT KIND OF BUDGETARY
PREPARATIONWE NEED TO DO US
WERE LOOKING FOR LOOKING FORWARD
SO?
I KNOW GOVERNOR BROWN WILL SEEK
OF WHAT GOVERNOR --
KNEW SOMEONE TO DO BUT YOU KNOW
THOSE SAY WELL WE DO A BUDGET
WHILE THE BUDGET FOR NEXT YEAR
WE WANT TO PROJECT OUT SEVERAL
YEARS SO.
AND I THINK THAT THIS IS
CERTAINLY PORTION OF THE BUDGET
THAT -- WE
DELTA WHAT HOW WE FIND --
L. TSS IS SOMETHING THAT WE NEED
TO REALLY LOOK AT AND AND AND
THINK OUT RIGHT --
BECAUSE OTHERWISE ALTERNATIVE IS
IS THAT WE DON'T.
YOU KNOW SOME WILL HAVE A BUDGET
CRUNCH WAS THIS IS THE DEMAND
GROWS AND DENVER ABOUT.
TRAIN FIGURE HOW WE CUT SERVICES
ARE CUT RATES FOR SERVICES
INSTEAD OF SAYING WELL CTUALLY
IF WE ONLY HAD THOUGHT ABOUT IT
MAYBE WE COULD.
YOU KNOW COME UP WITH OTHER
TYPES OF APPROACHES TO TO TO TO
ADDRESS THIS ISSUE AND BE SURE
PEOPLE CAN STILL GET HELP.
NOW.
SO I REALIZE THAT IF YOU DON'T
WANT TO PICK A NUMBER I GET THAT
BUT WE MIGHT WANT TO THINK ABOUT
SOME KIND OF SENSITIVITY
ANALYSIS RELATED TO AND RIGHT
NOW YOU HAVE TO MAKE CERTAIN
ASSUMPTIONS IF YOU DON'T WE
DON'T IF WE THAT'SWHY SOURCE AT
GIVEN IF.
WE JUST DO THE WHAT WE'RE DOING
NOW WHICH I DON'T THINK YOU KNOW
HOPEFULLY WE'LL WE'RE NOT GONNA
BE DOING WHAT WE'RE DOING NOW
TEN YEARS FROM NOW. FIFTEEN
YEARS NOW TWENTY YEARS FROM NOW
BUT WE ARE WHERE WE GO AND THAT
JUST BECAUSE THE CASE LOW
PRESSURE RIGHT.
THE THING THAT SOMETHING WE CAN
TAKE A LOOK AT WE CAN CERTAINLY
TAKE A LOOK AT SOME WHAT ROUGH
AND THIRTY OUTS WE COULD LOOK AT
AND AND CIRCLE BACK WITH YOUR
STAFF ON ON WHAT WE COULD.
DO THERE OKAY ALL RIGHT I THINK
THAT MAY INFORM.
BUDGET DISCUSSIONS CELL.
OKAY RIGHT TAKE HIS REVENGE
THANK YOU.
ALL RIGHT SO --
WE I KNOW THERE'S SO MANY OF OUR
STATE AGENCIES ARE.
WORKING AND DEALING WITH THIS
ISSUE AND I THINK THEM FOR BEING
HERE WE HAVE --
AMERICAN WELL --
CHIEF DEFEAT DIRECTOR OF HEALTH
CARE SERVICES COMPANY FIGURED A
MAJOR FUNDER OF AS A THESE
NURSING --
SERVICES AND STATE --
DEBBIE THOMPSON DEPUTY DIRECTOR
OF THE L. PROGRAM DIVISION
DEPARTMENT SOCIAL SERVICES YOU
HAVE I JUST US I THINK.
WE HAVE FLORA CONNELLY DIRECTOR
DEPARTMENT AGING AND EAST AND
SURE AGAIN DEMOGRAPHICS USE
DEPARTMENT OF FINANCE --
WILL COME AND I KNOW THAT --
HOPEFULLY THIS OF THIS WILL BE
OF GREAT INFO --
INTEREST TO FINANCE SO.
THANK YOU SO.
IT'S GOING WELL THANK YOU.
ACER AMERICAN WELL THE PART OF
HEALTH CARE SERVICES.
CAN APOLOGIZE IN ADVANCE BECAUSE
I BOTH GOT HOME LAST LATE LAST
NIGHT FROM DC.
FRANK WITH BEING WITH ALL MY
MEDICAID RIGHT TO COLLEAGUES AND
I SWEAR LIKE THE SMOKE IS IN MY
HEAD SO I MAYBE A LITTLE FOGGY
SO I APOLOGIZE FOR THAT --
SPEC MORE MONEY THAT RIGHT
[inaudible]
YEAH.
I THINK AS YOU GUYS KNOW THE
DEPARTMENT OBVIOUSLY PROVIDES A
FULL RANGE OF SERVICES I'M LONG
TERM SERVICES AND SUPPORTS
THROUGH THE MEDICAID PROGRAM.
ALL NOTE --
A FEW THE PROGRAMS THAT WE DO
YOU -- HAVE
SERVED ARE OPERATED THROUGH
MEDICAID FUNDS ARE ACTUALLY
OPERATING FOR A DATE MORE
DIRECTLY BY MY COLLEAGUES OVER
HERE SO.
I WILL NOT BE MENTIONING THEM
NOT BECAUSE THEY DON'T KNOW THEY
EXIST BUT JUST BECAUSE SOMEONE
ELSE WILL HAVE SPEED MORE A
DIRECTLY TO THOSE.
SO I THINK OBVIOUSLY AS NOTED IN
THE BACKGROUND AVERAGE.
OBVIOUSLY FOR SKILLED NURSING
FACILITY --
FOR BOTH OUR STREET MEDICAL
MEMBERS AND ARE DULY ELIGIBLE
MILIK MEDICAL MEMBERS.
AND THOSE CAN BE EITHER PROVIDED
THROUGH MANAGED CARE FEE FOR
SERVICE.
BUT BEYOND THAT REALLY OVER THE
LAST MANY YEARS I THINK THE
DEPARTMENT --
HAS TRIED TO HAVE A STRONG FOCUS
ON HOW DO WE KEEP PEOPLE IN THE
COMMUNITY OR TO THE DEGREE WE
CAN ACTUALLY GET THEM OUT OF
INSTITUTIONS AND BACK INTO THE
COMMUNITY WHETHER IT BE IN THEIR
HOME OR OTHER COMMUNITY BASED
RESIDENTIAL SERVICES.
SO WHAT WOULD WE DO OPERATE A A
FAIR NUMBER OF L. TSS PROGRAMS
TO VARIOUS WEAVERS AND STATE
PLAN OF SORTIES --
MANY OF THEM HAVE.
THE ABILITY TO PROVIDE SERVICES
TO THOSE WHO ARE SIXTY FIVE PLUS
SINCE WE ARE TALKING ABOUT --
THE AGING POPULATION HERE SOME
OF THEM ARE LIKE PEDIATRIC
PALLIATIVE CARE THINGS LIKE THAT
MORE TARGETED FOR A YOUNGER
POPULATION SO I WILL NOT FOCUS
ON THOSE --
SO IN TERMS OF THE WAYS THAT WE
CAN PROVIDE LONG TERM SERVICES
THE PORTS LIKE I SAID THERE ARE
STATE PLAN SERVICES.
THAT'S WHERE YOU FIND PEACE
WHICH I'LL TALK ABOUT A LITTLE
BIT THAT YOU HEARD PETER CANCEL
TALK ABOUT.
IT TO SAYS OBVIOUSLY AS MY
COLLEAGUE HERE WE'LL TALK ABOUT --
WE ALSO HAVE A LOT OF WHAT ARE
CALLED WEAVER'S --
WE ACTUALLY OPERATE EIGHT
NINETEEN FIFTEEN C. WEAVER'S A
SEVEN OF WHICH ARE TARGETED TO
OF THE POPULATION OR ALLOW
SERVICES THE POPULATION FOR
SIXTY FIVE AND OLDER.
UNDER THESE WAIVERS WE ARE ABLE
ESSENTIALLY TO PROVIDE SERVICES
THAT AREN'T TYPICALLY OTHERWISE
COVERED BY MEDICAID --
INTO THE SORT OF THE MAIN
FEDERAL APPROVAL IS THAT THE
COST OF THOSE SERVICES ARE NO
MORE THAN WHAT IT WOULD HAVE
COST OF AN INDIVIDUAL WAS A
SIGHTING IN AN INSTITUTIONAL
FACILITY.
SO JUST TWO OF THE NINETEEN
FIFTEEN C. WAIVERS THAT I THINK
ARE --
HELPFUL TO TALK ABOUT AND REALLY
HIGHLIGHT THE KINDS OF THINGS
THAT WERE ABLE TO DO THE FIRST
IS OUR HOME AND COMMUNITY BASED
ALTERNATIVES --
WAIVER BETTER KNOWN AS EACH CBA.
RECENTLY RENAMED FROM.
THE AT NEW PHAGE FOR THOSE
PEOPLE WHO HAVE MORE THINK WHO
THINK ABOUT IT THAT WAY --
BUT WE MADE A SIGNIFICANT NUMBER
OF CHANGES IN THE WAIVER WHEN WE
WHEN WE RECONSTITUTED AS EACH
CBA.
REALLY TRYING TO PROVIDE BETTER
DIRECT CARE AND HE'S MANAGEMENT
IN THE COMMUNITY FOR THE
INDIVIDUALS THAT ARE ENROLLED IN.
INTO THAT WAIVER SO THE WEAVER
PROVIDES ESSENTIALLY CARE
MANAGEMENT SERVICES THROUGH A
MULTI DISCIPLINARY TEAM THAT
INCLUDES NURSES AND SOCIAL
WORKERS.
AND THIS TEAM ESSENTIALLY THEN
IS RESPONSIBLE FOR COORDINATING
ALL THE SERVICES THE MEMBER
RECEIVE SIR NOT JUST THE
SERVICES TO THE WEAVER BUT
WHETHER THEY'RE RECEIVING
SERVICES THROUGH FEE FOR SERVICE
OR IF THEY'RE RECEIVING SERVICES
THROUGH THEIR MANAGED CARE PLAN.
AND TEY ALSO ARRANGED FOR OTHER
SUPPORTS THAT ARE AVAILABLE IN
THE COMMUNITY SO OUTSIDE OF CASE
MANAGEMENT SOME OF THE SERVICES
THAT AND THIS CARE TEAM IN
PARTICULAR PROVIDES.
OR CONTRACTS OUT FOR OUR HOME
AND FAMILY RESPITE SERVICES
WHICH YOU KNOW AS WE TALKED
ABOUT BEFORE SORT OF A LOT OF
PRESSURE ON FAMILIES WHO ARE
DEALING WITH.
HAVING TO TAKE CARE FOR
INDIVIDUALS SO NOT ONLY DO --
WE'VE SERVICES A LOT OF TIMES IN
CONJUNCTION WITH OUR AGES AS
PROGRAM AS WELL AS PRIVATE DUTY
NURSING.
WE HAVE ABOUT FOUR THOUSAND
INDIVIDUALS CURRENTLY ENROLLED.
IN -- EIGHT
CB A AND WE THINGS TO THE
LEGISLATION THAT WAS PASSED
WE'RE LOOKING TO CONTINUALLY
INCREASE THE NUMBER THAT WE CAN
SERVE IN THAT WAIVER.
TARGETING TO HOPEFULLY HAVE NINE
THOUSAND AND RULED BY. TWENTY
TWENTY ONE ONE OTHER A NINETEEN
FIFTEEN SEE WAY FOR ALL TOUCH ON
IS THE ASSISTED LIVING WAIVER
AL W..
WHICH SIMILARLY PROVIDES LONG
TERM SERVICES AND SUPPORTS TO
INDIVIDUALS LIVING IN A
COMMUNITY SETTING AND IN THIS
CASE TYPICALLY --
EITHER PUBLICLY SUBSIDIZED
HOUSING OR A RESIDENTIAL CARE
FACILITY FOR THE ELDERLY --
THESE ARE INDIVIDUALS WHO
OTHERWISE ARE ASSESSED AS
NEEDING A NURSING FACILITY LEVEL
OF CARE BUT WERE ABLE TO KEEP
THEM IN THESE COMMUNITY SETTINGS
WITH THE ADDITIONAL SERVICES
THAT ARE PROVIDED --
UNLIKE THE ECB WEAVER THE LW
WAIVER ONLY OPERATE IN FIFTEEN
COUNTIES IN CALIFORNIA AND WE
HAVE ABOUT. THIRTY SEVEN HUNDRED
AND FORTY PEOPLE IN THE PROGRAM.
EACH OF THESE MEMBERS HAS A
SPECIFIC CARE DEVELOPMENT PLAN
THAT'S THAT'S CREATED BY THEIR
CASE MANAGERS TO HELP THEM
IDENTIFY.
BOTH WHAT SERVICES THEY NEED --
WHAT SERVICES THEY MAY NOT BE
AND THEN HELPS TO COORDINATE AND
MANAGE THOSE SERVICES?
SO SOME OF THE ADDITIONAL
SERVICES PROVIDED THROUGH THIS
WAIVER AND AGAIN IN ADDITION TO
THE FULL SCOPE OF MEDICAL
SERVICES.
ARE ASSISTED LIVING SERVICES
SELECT INCLUDE HOME HEALTH
PERSONAL CARE THINGS LIKE THAT.
CARE COORDINATION AS WELL AS
RESIDENTIAL REHAB SERVICES.
WE HEARD MR HAS OBVIOUSLY
EARLIER TALK ABOUT THE PEACE
PROGRAM THAT IS ANOTHER --
PROGRAM THROUGH WHICH WE PROVIDE
LONG TERM SERVICES AND SUPPORTS
ITS THE PROGRAM OF ALL INCLUSIVE
CARE FOR THE ELDERLY.
WE ALWAYS LIKE TO HAVE LONG
NAMES WITH FUN ACRONYMS AND MEDI
CAL I FEEL LIKE --
SO IT'S ANOTHER OPTION FOR
MEDICAL MEMBERS AGAIN LIVING IN
AREAS WHERE THE PROGRAM OPERATED
IT IT DOES NOT OPERATE STATEWIDE
AT THIS POINT --
IT'S L. THERE ARE PEOPLE WHO ARE
ELIGIBLE OR FIFTY FIVE YEARS OR
OLDER WHO HAVE BEEN ASSESSED
AGAIN FOR MEETING.
THE NEED FOR NURSING LEVEL OF
CARE.
ODD THERE CAN BE JUST STRAIGHT
MEDICAID ELIGIBLES OFF AS WELL
AS DUAL ELIGIBLE MEMBERS THAT
THAT ARE PROVIDE OUR OUR ROLE IN
PEACE --
PEACE REALLY DOES PROVIDE A
COMPREHENSIVE FULL SET OF
SERVICES OF BOTH MEDICAID AND
AGAIN IF THERE MEDICARE MEDICARE.
SERVICES THAT INCLUDE MEDICAL
BEHAVIORAL HEALTH DENTAL EACH
CBS -- THE
TYPE OF SERVICES I JUST AS WE
TYPICALLY PROVIDER PROVIDED
THROUGH HE PIECE --
SERVICE IN THIS CASE WE ZACH
WE'VE ACTUALLY SEEN A VERY
SIGNIFICANT INCREASE.
IN THE NUMBER OF PEACE PROVIDERS
AS WELL AS THE NUMBER OF
ENROLLEES WE CURRENTLY HAVE
EIGHT ADDITIONAL PEACE PLAN
APPLICATIONS FOR EITHER NEW
PEACE PLANS OR EXPANSIONS OF
AREAS FOR PEACE PLANS THAT WE
ANTICIPATE WILL BE UP COMING IN
SORT OF THE NEXT THREE YEARS.
SURE AAIN AS MR CANCEL COULD
HAVE DESCRIBED THE PROCESS OF
ACTUALLY --
CREATING A NEW PACE PROGRAM IS
PRETTY INTENSIVE GIVEN THAT IT
IS ACTUALLY A LIKE YOU HAVE A
PLACE IT'S NOT JUST A HEALTH
PLAN YOU HAVE TO HAVE.
BUILD THE INFRASTRUCTURE --
AND HAVE THE ACTUAL PEACE CENTER
IN ADDITION TO THE CONTRACTS
WITH EVERY ALL OF THE PROVIDERS
THAT ARE NEEDED SO IT IS VERY
INTENSIVE FOR THOSE THAT ARE.
LOOKING TO START A NEW PIECE
PROGRAMS AND OBVIOUSLY THIS PAST
BUDGET PROVIDED SOME ADDITIONAL
MONEY FOR SOME OF THOSE PIECE
PROGRAMS IN ORDER TO HELP THE
MAKE MAKE IT OVER THAT HUMP AND
BE ABLE.
TO HAVE MORE OF THIS AS AN
OPTION FOR MEMBERS IN MEDI CAL.
AND THEN FINALLY --
OF COURSE WE HAVE THE CAL MANY
CONNECTS PROGRAM IN THE
CHARACTER COURT COORDINATED CARE
INITIATIVE WHICH IS IN SEVEN
COUNTIES --
THE COMEDY CONNECTS PROGRAM AS
WE'VE TALKED ABOUT IN IN THIS
COMMITTEE MANY TIMES YOU KNOW IS
IS REALLY A PROGRAM AIMED AT
BRINGING TOGETHER THE FRAGMENTED
SYSTEM OF MEDIC HOW AND MEDICARE.
SO THAT AN INDIVIDUAL CAN
RECEIVE ALL OF THEIR SERVICES
THROUGH ONE HEALTH PLAN AND NOT
HAVE TO FIGURE OUT.
WHICH SYSTEM DO I NEED TO GO TO
IN ORDER --
ENTITLED TO WE ARE IN A SEVEN
COUNTIES AS I MENTIONED WE HAVE
ABOUT A HUNDRED AND TWELVE
THOUSAND TOOL ELIGIBLE MEMBERS
WHO ARE ROLLED AND HOW MAY TO
CONNECT AND THAT'S IN ELEVEN
DIFFERENT HEALTH PLANS ACROSS
THOSE COUNTIES.
THE INTENTION OF THE C. C. I. N.
OF COMEDY CONNECT IN PARTICULAR
REALLY WAS AGAIN A FOCUS ON HOW
DO WE SHIFT AWAY FROM
INSTITUTIONAL CARE.
EITHER BY.
HELPING PEOPLE WHO ARE IN
INSTITUTIONAL CARE BE ABLE TO
MOVE OUT WHICH IS WHAT MORE
CHALLENGING BUT ALSO REALLY
PREVENTING PEOPLE FROM EVER
ACTUALLY HAVING TO GO INTO A
SKILLED NURSING FACILITY.
AND REALLY PROVIDE THAT IN THE
HOME AND COMMUNITY BASED
SERVICES THEY NEED TO STAY AT
HOME OR IN SOME OTHER COMMUNITY
BASED RESIDENTIAL --
SERVICE I THINK YOU KNOW IN
TERMS OF THIS YOU SEE I IN ALL
OF THESE PROGRAMS.
REALLY WE ARE TRYING TO USE THEM
TO INFORM WHAT WE WANT THE
FUTURE OF MEDICAL TO BE I THINK.
YOU MENTIONED YOU KNOW FIVE TEN
YEARS OF OF THE FUTURE OF
CALIFORNIA CERTAINLY --
AS MANY PEOPLE KNOW WE HAVE HAD
OVER THE LAST SEVERAL MONTHS SEE.
CARE COORDINATION ADVISORY
COMMITTEE THAT IS BEEN COMPRISED
OF ABOUT FIFTY DIFFERENT PEOPLE.
INCLUDING PEOPLE STANDING UP
HERE AND I'M SURE MANY.
MANY PEOPLE IN THE AUDIENCE
REALLY CALIFORNIA WITH LOTS OF
DIFFERENT EXPERTISE ISN'T WAS
NOT FOCUSED SOLELY ON LONG TERM
SERVICES THE SUPPORT FOR THIS
POPULATIONBUT THE MEDICAL
PROGRAM MORE BROADLY.
BUT REALLY ABOUT HOW DO WE WANT
THE PROGRAM TO LOOK AT HOW WOULD
WE STRUCTURE IT IF WE WERE
STRUCTURING IT A NEW TODAY.
WHICH AGAIN FOR THOSE MEMBERS
WHO PARTICIPATED NOW I KEPT
PUSHING FOR LET'S HAVE SOLUTIONS
LET'S THINK LIFTING CREATIVITY.
AND ELSE HE SAYS IS REALLY A BIG
PART OF THAT BECAUSE I READ IT
REALLY IS ABOUT HOW DO WE KEEP
PEOPLE AT HOME.
HEALTHIER YOU KNOW I REALLY
HAVING A BETTER QUALITY OF LIFE
THAN.
THAN SOMETIMES WE ARE PROVIDING
THEM TODAY AND SO THAT THAT IS
ONE OF THE SORT OF CORE PLACES
WHERE WE'RE TAKING THE LESSONS
LEARNED OF ALL THESE PROGRAMS
THAT WE HAVE EVERYTHING WE'VE
HEARD FROM THIS COMMITTEE AND
OBVIOUSLY ADDITIONAL INPUT THAT
WE GET.
AND REALLY TRYING TO COME UP
WITH A ROAD MAP FOR WHAT THE
PROGRAM SHOULD LOOK LIKE IN FIVE
TEN FIFTEEN YEARS AND THEN HOW
DO WE GET THEIR FINANCING IS IS
CHALLENGING AND AGAIN THOSE WHO
ATTENDED THOSE MEETINGS ITEM I
START EVERY MEETING SAYING PUT
ASIDE THE FINANCING WILL.
TALK BOUT IT BUT LET'S THINK
ABOUT WHAT WE NEED AND THEN SEE
IF WE CAN FINANCE IT AND SO
THAT'S REALLY WHAT WE'RE TRYING
TO DO.
AS WE THINK ABOUT THE FUTURE AND
OBVIOUSLY --
AVENUE GOVERNOR AND WE'LL SEE
WHAT WHAT HAPPENS WITH THAT --
BUT YOU KNOW REALLY SEE A DO YOU
IN TRYING TO FIGURE OUT HOW DO
WE CONTINUE TO IMPROVE THE
SERVICES.
I THANK YOU OF ITS ONE BRIEF
QUESTION ON THE LINE AND OUT OF
MORE QUESTIONS LATER ON BUT Là
THE WAIVER PROGRAM YOU TALKED
ABOUT --
LIKE PACE AND OTHERS YOU SAID
THEY'RE THEY'RE NOT STATEWIDE
THERE.
WELL WE HAVE A ME COUNTIES IN
STATE.
FIFTY EIGHT SO THEIR DUTY I'M
HEARING NUMBERS LIKE YOU KNOW
SEVENTEEN COUNTIES FIFTEEN
COUNTIES ETCETERA --
IS THAT A COUNTY ISSUES ESTATE
ISSUES THAT FEDERAL ISSUES.
AND I REALIZE THERE'S MULTIPLE
WAIVERS YOU TALKED ABOUT AND I
COULD PROBABLY SAY YES TO ALL OF
THOSE SO --
IT'S REALLY IN TERMS OF I WOULD
SAY FOR LIKE PEACE ORGANIZATIONS
AS AGAIN AS I SAID YOU KNOW IT'S
A VERY INTENSIVE PROGRAM.
AND IT'S COSTLY FOR A PROVIDER
FOR PEACE ORGANIZATIONS TO
DEVELOP AND HAVE THE CAPITAL TO
BUILD WE'VE SEEN AGAIN I THINK A
DOUBLING PETER MIGHT BE ABLE.
TO CORRECT ME ON THAT SO WE'RE
HOPING TO SEE IT CONTINUE TO
GROW BUT IT'S IT IS VERY
INTENSIVE TO DO THAT AND YES
THERE IS FEDERAL APPROVALS
REQUIRED AND WHAT THAT THERE ARE
DIFFERENT RULES UNDER THAT. FOR
OUR SOME OF OUR EIGHT JUST FOR
FOR SOME OF OUR HOME COMMITTEE
BASED.
BUT IF THEY DON'T IT'S REALLY IS
THEIR INTEREST OR ENOUGH --
PROVIDER TYPES IN THE COUNTY TO
BE ABLE TO USE PROVIDE THE
SERVICES THAT WE'RE TALKING
ABOUT -- AND
THEN YOU KNOW AND I THINK IT AT
TIMES WE'VE HAD LIMITS ON SOME
OF OUR WEAVER --
YOU KNOW A BILL BEAVER CAPS AND
THINGS LIKE THAT.
FROM A BUDGETARY STANDPOINT --
BUT I THINK WE'VE BEEN PRETTY
SUCCESSFUL OVER THE LAST SEVERAL
YEARS OF REALLY BEING ABLE TO
DEMONSTRATE THAT THESE WAIVERS.
ARE AT LEAST COST NEUTRAL IF NOT
COST SAVING BECAUSE OF THE COST
OF INSTITUTIONAL CARE BEING HAS
TIES IT IS WHEN YOU SAID
BUDGETARY LIMóN STATE BUDGETARY
YES.
ALL RIGHT OKAY ART THANK YOU.
RIGHT.
NOW.
GOOD MORNING DEBBIE THOMPSON
FROM.
US SOCIAL SERVICES IT'LL
PROGRAMS AND I'M GONNA TALK A
LITTLE BIT ABOUT THE IN HOME
SUPPORTIVE SERVICES PROGRAM THAT
I'M.
SURE MOST OF YOU ARE ARE
FAMILIAR WITH I A TO SAYS
SERVICE LOW INCOME AGED BLIND
AND DISABLED INDIVIDUALS WITH
THE A PURPOSE OF ALLOWING THEM
TO REMAIN IN THEIR OWN HOME AND
PREVENT THE NEED FOR OUT OF HOME
CARE.
CURRENTLY WERE CLOSING IN ON
CLOSE TO SIX HUNDRED THOUSAND
RECIPIENTS STATEWIDE.
AND ABOUT A HALF A MILLION --
PROVIDERS THAT SERVICE SERVE
THEM AND PROVIDE THAT CARE --
PAGES AS IS NOT A MEDICAL MODEL
IT'S A SOCIAL MODEL IT'S BASED
ON INDIVIDUALS ABILITY TO
PERFORM THEIR ACTIVITIES OF
DAILY LIVING INSTRUMENTAL
ACTIVITIES OF DAILY LIVING IN
THEIR HOME.
A SOCIAL WORKER GOES TO THE HOME
THEM OBSERVES THEIR ABILITY TO
PERFORM THOSE ACTIVITIES AND
THEN ULTIMATELY AUTHORIZES
SERVICES.
I AGES AS IS THE SELF DIRECTING
PROGRAM SO ONCE THE SERVICES
AUTHORIZED RECIPIENTS ARE THE
EMPLOYER FOR THE PURPOSES OF
HIRING AND TRAINING AND
SCHEDULING AND SUPERVISING.
THEIR CARE PROVIDERS.
ABOUT 70% OF CARE PROVIDERS ARE
FAMILY MEMBERS --
ABOUT 50% OF PROVIDERS LIVE WITH
THE RECIPIENTS.
ON THE AVERAGE NUMBER OF
AUTHORIZED OURS IS ABOUT A
HUNDRED AND THREE PER MONTH.
THE MAXIMUM NUMBER OF AUTHORIZED
HOURS FOR THE PROGRAM IS TWO
HUNDRED EIGHTY THREE A MONTH
WHICH TRANSLATES INTO ABOUT NINE
AND A HALF HOURS.
OF SERVICE PER DAY --
ON THE PROVIDER SIDE PROVIDERS --
DO NOW GO THROUGH AN ENROLLMENT
PROCESS WHEN THEY ARE --
INTERESTING INTERESTED IN
PROVIDING SERVICES WHICH
INCLUDES AN ORIENTATION AND
AGREEMENTS TO FOLLOW THE RULES
OF THE PROGRAM AS WELL AS A
BACKGROUND CHECK CHECK THROUGH
THE DEPARTMENT OF JUSTICE --
THERE HAVE BEEN SOME NEW --
THINGS THAT HAVE HAPPENED FOR
PROVIDERS IN THE LAST FEW FEW
YEARS --
SICKLY WAS INTRODUCED THIS YEAR
AS A PART OF SB THREE SO IN JULY
SO OUR I'D SAYS PROVIDERS ARE
NOT ELIGIBLE FOR SICK LEAVE.
OVERTIME BEGAN IN TWO THOUSAND
SIXTEEN FOR PROVIDERS WORKING
MORE THAN FORTY HOURS A WEEK AND
LAST YEAR WE INTRODUCED OUR
ELECTRONIC TIME SHEETS --
WHICH HAS BEEN A VERY --
WARMLY RECEIVED BY --
THE PROVIDERS HAVE CHOSEN TO
USES LIKE TRY TIME SHEETS ON AS
FAR AS INCREASING THE SPEED WITH
WHICH THEY CAN RECEIVE PAYMENT.
FOR THEIR SERVICES AND WEWILL
BE MOVING INTO AN ARE BIG.
HAN.
OVER THE NEXT IS TRANCES
TRANSITIONING TO AN ELECTRONIC
VISIT VERIFICATION SYSTEM ON AT
THAT OUR PROVIDERS AND
RECIPIENTS WILL BE UTILIZING.
THAT WILL BE EITHER ONLINE OR
TELEPHONIC SYSTEM --
FOR DOING --
REPORTING OF THE TIME WORKED AND
IT WILL LINK TO OUR PAYMENT
SYSTEM.
WE'VE BEEN DOING --
MAJOR ON COLLABORATION WITH ALL
OF OUR STAKEHOLDERS AND THAT'S
BEEN A VERY POSITIVE PROCESS --
WITH THEM AND LEAVE OB I THINK
FOUND AN APPROACH THAT PEOPLE
FEEL IS.
THE BEST WAY WE CAN DO IT BASED
ON THE FACT THAT WE HAVE TO DO.
THANK YOU WHO.
GOOD MORNING MISTER CHAIRMAN OR
COMING FROM DEPARTMENT OF AGING.
OTHER DEPARTMENT AS AS WE HAVE
SHARED BEFORE IS OF THE
FEDERALLY DESIGNATED STATE UNIT
ON AGING AND WE HAVE A VERY
BROAD ROLE --
IN PROMOTING THE HEALTH AND WELL
BEING OF OLDER ADULTS AND FAMILY
CAREGIVERS THROUGHOUT THE STATE --
WHO HAVE CHRONIC CARE NEEDS --
MERION DEBBIE HAVE DISCUSSED THE
MEDI CAL PROGRAMS THE KEY MEDI
CAL PROGRAMS --
BUT IN FRAMING THESE ISSUES I
THINK IT'S IMPORTANT FOR US TO
REMEMBER WHEN WE'RE TALKING
ABOUT THE AGING POPULATION IN
GENERAL THAT REALLY ONLY A
QUARTER OF OLDER ADULTS --
ARE CURRENTLY ELIGIBLE FOR THE
MEDICAL --
EVERYONE WHO'S JUST ABOVE THAT
ELIGIBILITY LEVEL ON THEIR ON
THEIR OWN IN TERMS OF NAVIGATING --
PAYING FOR THAT CARE IF IT'S
NEEDED.
WHILE THE DEPARTMENT OF AGING
THREE MAJOR RESPONSIBILITIES AS
AN ADMINISTRATING THE FEDERAL
OLDER AMERICANS ACT --
AND MANAGING TO OF THE MEDI CAL
PROGRAMS OF HE DEPARTMENT ALSO
REALLY TAKES VERY SERIOUSLY IT'S
ADVOCACY ROLE.
AND ITS ROLE IN FOSTERING
IMPROVEMENTS IN THE STATE SYSTEM
OF CARE AND AGING POLICY ISSUES --
QUITE SERIOUSLY.
AND JUST FOR A COUPLE OF
EXAMPLES OF THOSE --
WE HAVE SECURED A NUMBER OF
FEDERAL DEMONSTRATION GRANTS --
AND PARTNERSHIP WITH THE NETWORK
OF THE ALZHEIMER'S ORGANIZATIONS
AND IN PARTNERSHIP WITH
DEPARTMENT OF HEALTH CARE
SERVICES --
AND THE COMEDY CONNECT PLANS TO
HELP THOSE PLANS TO A BETTER JOB
THROUGH THEIR CARE MANAGERS IN
TERMS OF IDENTIFYING INDIVIDUALS
WITH DEMENTIA AND LINKING THEM
TO SERVICES --
AND THAT PROGRAM HAS BEEN QUITE
QUITE SUCCESSFUL AND VERY WELL
RECEIVED BY THE HEALTH PLANS AND
CREATED SOME REAL SYSTEMS
CANGES WITHIN.
THE HEALTH PLANS IN TERMS OF
THEIR MODELS OF CARE.
WE'VE ALSO SOUGHT FEDERAL
DEMONSTRATION GRANTS TO
IMPLEMENT PROGRAMS THAT HELP
EMPOWER OLDER ADULTS TO BETTER
MANAGE THEIR CHRONIC CARE
CONDITIONS.
AND SOUGHT --
OTHER FUNDING SOURCES OF TO HELP
PREVENT FALLS AND BOTH OF THOSE
FACTORS ARE.
ALSO QUITE KEY IN TERMS OF THE
PROJECTIONS IN TERMS OF THE LONG
TERM CARE POPULATION --
MANY OF THOSE HEALTH CONDITIONS --
TRANSLATE INTO --
ACTIVITIES OF DAILY LIVING NEEDS
LATER IN LIFE --
AND THOSE ARE CERTAINLY TRENDS
THAT WE ALSO NEED. TO TO BE
LOOKING AT HOLISTICALLY --
PEOPLE HEAR ME SAY AGING BEGINS
AT BIRTH --
AND SO SOME OF THOSE HEALTH
CONDITIONS --
BETTER CHRONIC CONDITIONS --
BEGIN EARLY IN LIFE AS WELL --
AND APARTMENT A PUBLIC HEALTH
HAS BEEN VERY KEY WITH AS AND
BOTH AS CHRONIC DISEASE AND FALL
PREVENTION EFFORTS.
THE DEPARTMENT --
HAS ALSO FOSTER CARE
COLLABORATIVE --
EFFORTS ACROSS AGING AND
DISABILITY ORGANIZATIONS SO THAT
THE VOICES AND THE NEEDS OF MANY
DIVERSE GROUPS OF INDIVIDUALS --
WITH DISABILITIES ARE HEARD FULL
OF THIS WAS DURING THE CMS
DISCUSSIONS WITH STATES AND
ADVOCACY GROUPS --
IN TERMS OF THE IMPLEMENTATION
OF THE CMS --
HOME AND COMMUNITY BASED
SETTINGS REGULATIONS --
THERE ARE A NUMBER OF US HAD
CONCERNS IN TERMS OF HOW CMS
STAFF WERE INTERPRETING THOSE
REGULATIONS --
AND HOW THEY WOULD IMPACT
PARTICULAR SETTINGS OF THAT
WOULD POTENTIALLY BE DEEMED --
UNDER HIGHER SCRUTINY OF THAT
ACTUALLY PROMPTED --
COLLABORATION OF BOTH WITH A
NUMBER OF AGING AND DISABILITY
DEVELOPMENTAL DISABILITY --
ORGANIZATIONS IN REALLY RAISING
ISSUES ABOUT THOSE CONCERNS AND
I THINK HAD A POSITIVE IMPACT IN
TERMS OF WHERE CMS HAS.
EVOLVE TO NOT COMPLETELY LANDED
PRETTY FAULT --
TO ANY PARTNERSHIP WITH
DEPARTMENT OF REHABILITATION
WE'VE ALSO --
OF PARK I'VE BEEN INVOLVED IN
THE PLANNING PROCESS SAYS AND
ENVY AND REVIEWED PRIOR CALTRANS --
THEIR STATE PLANS AS WELL AS A
HOUSING AND COMMUNITY
DEVELOPMENT --
WORKING AGAIN COLLABORATIVELY
LOOKING AT ACROSS AGING AND
DISABILITY ISSUES AND OFFERING
OUR FEEDBACK IN TERMS OF THAT SO
IN TERMS OF THAT LONG TERM.
STRATEGIC PLANNING THAT
CERTAINLY A ROLE --
THAT WE TRY TO BE ACTIVELY
INVOLVED IN IS THE COME UP IN
BUDGET HEARINGS BUT I THINK --
MAY BE HELPFUL TO OUR HELPFUL TO
KNOW TODAY AS WE DISCUSSED THAT
LONG RANGE --
PLANNING EFFORT.
THE DEPARTMENT OF AGING --
REGULARLY PROVIDES --
AN OVERVIEW OF OUR CORE OLDER
AMERICANS ACT PROGRAMS DURING A
PROJECT BUDGET PROCESS THE
NUTRITION PROGRAMS --
INFORMATION ASSISTANCE
SUPPORTIVE SERVICES THE LONG
TERM CARE OMBUDSMAN AND HIGH CAP --
THOSE AS I'VE SHARED PREVIOUSLY
ARE GRANT PROGRAMS BASED ON THE
AMOUNT THAT WE GET FROM THE
FEDERAL GOVERNMENT.
NOT ALL TIED TO OUR OUR
POPULATION --
PROJECTIONS BUT WERE I THINK
PRIMARILY FOCUSED HERE TODAY ON
OUR MEDI CALPROGRAM SO LET ME
I'M JUST GOING TO DIVE IN ON
THOSE.
THE DEPARTMENT THROUGH AN
INTERAGENCY AGREEMENT WITH --
HEALTH CARE SERVICES IS
RESPONSIBLE FOR THE MULTI
PURPOSE SENIOR SERVICES PROGRAM
IN MISSISSIPPI --
AND MERRY WENT THROUGH THE
NINETEEN FIFTEENS THAT THE SUN
AND THAT AND TERMS A WAIVER
PROGRAMS --
THE DEPARTMENT CONTRACTS WITH
LOCAL ENTITIES THAT DIRECTLY
PROVIDE THE EMPHASIS P. SERVICES
TO UP TO TWELVE THOUSAND
INDIVIDUALS --
A YEAR.
CURRENTLY THERE ARE THIRTY EIGHT
EMESIS P. SITES STATEWIDE THE
PROPOSAL PROVIDE SOCIAL AND
HEALTH CARE MANAGEMENT --
TOO FRAIL OLDER ADULTS WHO ARE
CERTIFIED AS BEING NURSING HOME
ELIGIBLE --
THE EIGHT EIGHT SIXTY FIVE IS
THE EARLIEST --
POINT SOMEONE COULD BE ON THE
PROGRAM BUT THE AVERAGE AGE IS
EIGHTY FIVE IN TERMS OF PROGRAM
PARTICIPANTS AND THE GOAL THE
EMPHASIS P. PROGRAM IS REALLY TO
DELAY OR AVOID
INSTITUTIONALIZATION.
OF THESE INDIVIDUALS BY USING
COMMUTER --
IT'S REALLY A A COMPLIMENTARY
PROGRAM TO IN HOME SUPPORTIVE
SERVICES ALMOST EVERYONE --
IN EMESIS P. IS ALSO ON AYE HSS
BUT NEED ADDITIONAL SUPPORT OF
SERVICES AND MORE INTENSIVE CASE
MANAGEMENT TO BE ABLE --
TO REMAIN AND THE COMMUNITY.
MERRY SPOKE TO THE COSTS
NEUTRALITY FEATURES OF THESE
PROGRAMS --
AND I THINK THAT THAT'S KIND OF
A QUICK OVERVIEW IN TERMS OF
THAT PROGRAM.
AND THEN THE SECOND PROGRAM THAT --
DEPARTMENT OF AGING HAS
RESPONSIBILITY FOR IS THAT --
DAY TO DAY MANAGEMENT OF THE
COMMUNITY BASED AT ALL SERVICES --
PROGRAM.
THESE ARE LICENSED ADULT DAY
HEALTH CARE --
PROGRAMS THAT --
I AT THIS POINT UNDER THE MEDI
CAL TWENTY TWENTY WAIVER IT'S A
BENEFIT THAT'S UNDER THE MEDI
CAL MANAGED CARE PLANS.
SO THE PLANTS HAVE A AN
IMPORTANT ROLE IN TERMS OF
DETERMINING ELIGIBILITY AND ALSO --
THE NUMBER OF DAYS OF SERVICE
THAT THOSE IN THAT INDIVIDUALS
WILL BE RECEIVING A SEA BASS
CENTER.
A SEE BEST CENTER IS A COMMUNITY
BASED ADULT DAY PROGRAM THAT
PROVIDES OLDER ADULTS AND
YOUNGER ADULTS.
WITH CHRONIC MEDICAL OF
COGNITIVE OR BEHAVIORAL HEALTH
CONDITIONS AND DISABILITIES AND
ARE AT RISK OF INSTITUTIONAL
CARE.
OF THE PROGRAM PROVIDES SKILLED
NURSING SERVICES SOCIAL SERVICES
THERAPIES --
PERSONAL CARE MEALS AND
TRANSPORTATION --
TO THESE OUTPATIENT FACILITIES.
AND ON THEIR CURRENTLY TWO
HUNDRED FORTY ONE SEA BASS
CENTERS AND APPROXIMATELY THIRTY
FIVE OF THIRTY FOUR THOUSAND
INDIVIDUALS THAT ARE RECEIVING.
THE SERVICES THERE WAS A
MORATORIUM ON EXPANSION OF THE
SEA BASS CENTERS --
AND TOLD TWENTY FOURTEEN SINCE
BEEN LIFTED.
AND IN TWENTY SIXTEEN SEA BASS
BEGAN -- AB
CA -- BEGAN
RECEIVING SOME PRE APPLICATION
REQUEST FROM --
ORGANIZATIONS THAT WERE
INTERESTED IN BECOMING SEA BASS
CENTERS AND NOW ON AVERAGE WE
ARE --
PROCESSING AND APPROVING ABOUT
FIVE TO SEVEN NEW CENTERS --
ANNUALLY.
WE'RE ALSO SEEING --
I THINK THIS IS REALLY A
POSITIVE OUTGROWTH OF THE
INCORPORATION OF MANAGED CARE IN
THE PROCESS.
THAT THE MANAGED CARE PLANS HAVE
ACTUALLY INCREASE THE AUTHORIZED
A DAYS A PARTICIPATION FOR MANY
OF THE WAIVER CLIENTS --
AND THEY ARE RELEASING THE VALUE
OF THIS CRE AND THAT LEVEL OF
COORDINATION IS --
CERTAINLY BEING.
SEEN.
AND THE CALL CENTER [inaudible]
THANK YOU [inaudible]
FINANCE.
THE GRAPHICS I'M YOUTH AND
SHERRY IN.
PLACE TO REPRESENT THE
DEMOGRAPHIC RESEARCH UNIT --
THANK CHAIRMAN FOR THE
INVITATION TO PARTICIPATE TODAY
AND OFFER SERVICE TO IN A SENSE
IS A SUBCOMMITTEE WORK.
ON TRUST MY COLLEAGUES IN THE
FRONT LINE WE ARE MORE CONSUMERS
OF THE DATA ON INSURANCE --
HEALTHY AGING BURDEN OF DISEASE
THAN WE ARE PRODUCERS --
WE ARE RESPONSIBLE FOR
ESTIMATING AND PROJECTING THE
STATE'S POPULATION --
SOMETIMES THIS IN THIS
DISCUSSION ON THE SIXTY FIVE
PLUSPOPULATION ON A TO SPEND
LITTLE TIME TALKING ABOUT THE
THE DATA THE MODELS.
AND THE ASSUMPTIONS AGO INTO
PRODUCING THIS KIND OF
FOUNDATIONAL DATE UPON WHICH THE
THE OTHER AGENCIES AND PARTIES
ASSUMPTIONS ON DISABILITY AND
AGING ARE BASED.
SO THE REPRESENT HAS ALREADY
LAID OUT ABOUT OUR PROJECTIONS
SHOW CALIFORNIA'S AGING --
WE HAVE APPROXIMATELY FIVE AND A
HALF MILLION SENIORS RIGHT NOW
465- AND THAT NUMBER WE HAVE
DOUBLING THE NEXT TWENTY FIVE
YEARS.
HOUSING BY A QUESTION --
TO VALLEY --
COLLEAGUES AND WE HAD ABOUT
THREE HUNDRED THOUSAND PEOPLE
EVERY YEAR AND OF THAT TWO
HUNDRED FIFTY THOUSAND ARE IN
THE SIX FIVE PLUS.
SO -- THAT'S
ABOUT 80% OF THE GROWTH EVERY
YEAR IS NOT GROUP.
ARE WE DO STILL HOW IT'S PERCENT
YOU SAID.
BUT ABOUT 80% I THINK HERE BUT
80% OF THE GREAT FEATURE.
BUT BUT AGING IS REALLY ABOUT
MORE THAN JUST THE NUMBER OF
SENIORS -- I
WAS LOOKING AT A TWENTY TEN
CENSUS AND WE HAD TWICE AS MANY
SENIORS IN TWENTY TEN AS IT DID
IN.
NINETEEN SEVENTY SEVEN BUT IN
BOTH CASES THERE ONLY 10% OF THE
POPULATION IS AGING IS REALLY
ABOUT THAT DISPROPORTIONAL RATES
OF GROWTH.
SO WE MEAN NOT JUST OF THE
POPULATION AGE SIXTY FIVE PLUS
IS GROWING BUT IS GROWING.
MORE RAPIDLY THAN OTHER PARTS OF
POPULATION BECOMING LARGER SHARE
THE TOTAL POPULATION.
AND THAT'S HAPPENING FOR THREE
REASONS.
OF THE POPULATION SIXTY FIVE
HOUSES GROWING BECAUSE A LARGE
COHORT OF PEOPLE JUST.
ENTERING THOSE HERE AS THE BABY
BOOM CARD REACHING RETIREMENT
AGE.
THE SECOND REASON IS HAPPENING
AS A PEOPLE SPENDING MORE YEARS
AND SIX FIVE PLUS HEALTH
LONGEVITY BY AGES IMPROVING
THROUGHOUT THE STATE'S AT AGES
OVER --
SIXTY THAT STREET IMPROVEMENTS
LONGEVITY FOR CURRENT SENIORS AS
WELL AS MORE HEALTHY COURTS
ENTERING THEIR SENIOR YEARS.
OTHER THIRD REASONS HAPPENINGS
OF FERTILITY RATES ARE FALLING
OUT OF COLLEAGUES TALKED ABOUT.
ARE PROJECTIONS OF EDUCATION
ENROLLMENTS GOING GOING DOWN.
SO WE'VE ALREADY ACTUALLY
REACHED THE POINT AT WHICH THE
UNDER EIGHTEEN SEGMENT OF THE
STATE'S POPULATION IS NO LONGER
GROWING.
AND BY TWENTY THIRTY WE PROJECT
THAT THERE WILL BE MORE SENIORS
OVER SIXTY FIVE THE MINORS UNDER
UNDER --
EIGHTEEN SO THAT THE FIRST GRAPH
ON HAND OUT ILLUSTRATES THE
POINT.
NOW WE DO PROJECT CONTINUED
GROWTH AND TWENTY FIVE PLUS AND
WORKING H. R. PRIME WORKING AGE
TWENTY FIVE SIXTY FOUR
POPULATION TO SOMETHING THAT
SOMETIMES MISSED IN THE
DISCUSSION WE DO PROTECT GROWTH
THERE.
BUT IT JUST WON'T BE AS RAPID.
THE NEXT FIGURE THE NEXT SERIES
OF FIGURES AS FROM A TOOL WILL
BE PUBLISHED ON OUR WEBSITE FOR
VISUALIZING THE RATIO OR
VISUALIZING THE POPULATION
GROWTH IN IMPAIRMENTS OVERALL ---AS WELL AS IS BEING ABLE TO LOOK
AT THE RATIO OFOF SAUCES FIVE
PLUS TO TELL POPULATION INTO
OTHER SEGMENTS OF THE POPULATION --
THE FIRST FIGURE THERE'S SO
SERVICE EACH FIGURE SHOWS ON THE
Y. AXIS XIN SIZE --
MINERAL ONE SIDE WOMEN ON THE
OTHER IN THE LENGTH OF THE BARS
AS HORIZONTAL BARS SHOWS THE
SIZE THE POPULATION BY AGE.
THE FIRST FIGURE THERE'S NO
TWENTY TEN CENSUS.
AND SOME THERE'S A LOT TO
PROCESS THEIR BUT I WOULD JUST
DRAW YOUR ATTENTION TO THE TOP A
SHADED BAR --
THEREOF AND THAT'S WHEN COLOR
BLACK MY PERCENT TOP ARE WHICH
IS SIXTY FIVE PLUS.
AND IT'S THAT.
CUMULATIVE GROWTH IN THAT
SECTION --
THAT THE NEXT COUPLE FIGURES
HIGHLIGHTED TWENTY TEN LIKE I
MENTIONED IT WAS 10% OF THE
POPULATION --
THE NEXT FIGURE SHOWS --
TWENTY EIGHTEEN AT THIS TIME
THAT'S ABOUT 15% OF THE
POPULATION AS SIXTY FIVE PLUS --
THERE'S A A BAR THERE ARE A A
LINE SHOWING THE TWENTY TEN OVER
LAID OVER TWENTY EIGHTEEN SIR
CAN SEE HOW MUCH THAT GROW
PARTITIONS GROWN SINCE SINCE.
TWENTY TEN ALREADY --
IN THE FUTURE ARE TEN YEARS FROM
NOW -- THAT
WAS SHARE WILL GROW TO ABOUT 20%
ABOUT EIGHT POINT FIVE MILLION.
AND IN THE DISTANT FUTURE OF
INCLUDED THIRTY YEARS OUT TWENTY
FORTY EIGHT AND SHALL BE EVEN
LARGER THAT THAT ABOUT 2025% OF
THE POPULATION.
SO VIRTUALLY ALL OF THAT
POPULATIONS ALREADY WITH US
SIXTY FIVE PLUS POPULATIONS ARE
HERE TODAY --
MIGRATION IS NOT REALLY
IMPORTANT THAT THOSE AGES WE DO
WATCH MIGRATION BY AGE --
THERE ARE THERE ARE YEAR ON YEAR
FLUCTUATIONS MIGRATIONS OF THE
SIX FIVE PLUS --
SOME DISCUSSION ABOUT WHAT ARE
NOT YOU KNOW THE FIRES OF PUMPS
MIGRATION --
TO BUT AT THE PRESENT TIME --
THERE'S NOT EVIDENCE MIGRATIONS
PORTENT DOES AGES SO THE BIGGEST
DETERMINANT OF THE POPULATION
SIZE SIX FIVE CLASSES MORTALITY.
SIMPSON'S IMMIGRANT RETIREE VERY
IMPORTANT --
WE RECEIVE DATA FROM THE STATE'S
DEATH REGISTRATION SYSTEM ON
PUBLIC HEALTH.
WE USE THOSE DATA TO KEEP THE
ESTIMATES UP TO DATE BUT WE ALSO
USE THEM.
TOGETHER WITH A POPULATION
COUNTS TESTAMENT MORTALITY RATES
AGE SPECIFIC MATADI RATES WHICH
WERE USED. TO FORECAST WE WITH
MODEL THEM AND WE ALSO BASS A
FORECAST ON THOSE MODERATES.
AND CALCULATE PROSPECTIVE LIFE
TABLES FOR MUCH FOR EXAMPLE WE
CAN MAKE STATEMENTS ABOUT.
THE NUMBER OF REMAINING YEARS OF
LIFE EXPECT ON HAVE AN EXAMPLE
HERE THE SIX FIGURE FOR ALAMEDA
COUNTY --
WHICH IF IS NOT LEGIBLE AND
HAPPY TO SHARE THIS WITH ANYONE --
AFTER THAT THE HEARING --
WHAT YOU CAN SEE AND THAT
FIGURES IS ACTUAL DATA WE
RECEIVE FROM OUR PUBLIC HEALTH
IN CIRCLES THERE SOME NOISE
THERE --
WITH MATADI RACER UP AND DOWN
EVERY YEAR AND PARTICULAR
DEMOGRAPHIC GROUPS WHICH THERE'S
NOT A LOT OF MORTALITY IN --
TEN TO FOURTEEN IS A VERY NOISY
AGE GROUP FOR EXAMPLE --
WE YOU WE FIT MODELS THERE WHICH
ARE SHOWN IN US THOSE HEAVY
LINES.
AND SO THE MODEL CAN DO THAT
PRETTY ACCURATELY WITHOUT
INTRODUCING.
ERRORS AND AND THAT THE
STATISTICS THAT WE WATCH THIS IS
SUCH AS LIFE EXPECTANCY WHICH IS
SHOWN ON THAT RIGHT RIGHT.
FIGURE ON THE PANEL --
THE DECLINES IN THE MORTALITY
RATES ABOVE AGE SIXTY HAVE BEEN
PRETTY STABLE --
THE BILL AND PAY ROBUST OVERTIME
DOES THE TOP COUPLE LINES IN THE
ON THE FIGURES IN THE LAST TWO
PANELS SHOWN SEPARATELY FOR MEN
AND WOMEN --
THE Y. AXIS THERE IS LOG
MORTALITY RATE SO NEGATIVE.
ONE IS ABOUT 35% [inaudible]
MORTALITY RATE AND ARE THE
CLIENT MATADI TO A NEGATIVE TWO
ANALOG SCALE.
IS ABOUT 14% CHANCE SO IT'S IT'S
A NON LINEAR DECREASE START
THAT'S 3240% DECLINE BETWEEN
EACH POINT ON EACH TAKE ON THE
Y. AXIS.
THE LAST FIGURE SHOWS HOW --
WHERE WE GET WITH OUR
PROJECTIONS AGAIN JUSTFOR ONE
EXAMPLE WE DO THIS FOR EVERY --
COUNTY AND WE ALSO HAVE A METHOD
FOR PRODUCING A RACE AND
ETHNICITY SPECIFIC --
WIFE TABLES RIGHT NOW WE JUST
WORK WITH A COUNTY WIFE TABLES --
THIS ORDER DETAIL THERE BECAUSE
ALL THE AGES ARE SHOWN --
BUT I'VE SHOWN. FIVE YEAR AGE
GROUPS I THINK UP UNTIL A
HUNDRED PLUS IS THAT TOPLINE.
ARE THE GAINS A PRETTY SAFE
STABLE SIGNIFICANT LIKE I
MENTIONED.
SO -- SINCE
WE'VE TO ADOPT THESE PROJECTIONS
IN TWENTY FOURTEEN WE SEEN ABOUT
LES MIS IN LESS THAN 1% ERROR --
EACH YEAR AND IN OUR PROJECT
MENTALITY VERSUS THE ACTUAL
MCCARTY WE THAT WE WE GET FROM
PUBLIC HEALTH SO WE HAVE --
A PRETTY GOOD TRACK RECORD LAST
COUPLE YEARS FOR THESE GROUPS --
SO THAT'S THE BACKGROUND ON
WHERE OUR SIX FIVE PLUS
POPULATIONS COME FROM --
WE DON'T SPECIFICALLY IN ENGAGE
IN MODELING OF OF DISABILITY
RATES [inaudible]
ON IF THERE.
I THANK YOU THANKS VERY MUCH AND
JUST THE JUST DOING A QUICK
CALCULATION SO IS LOOKING AT THE
TWENTY EIGHTEEN RADIOS THAT THE
THE COLLEGE OF GETTING MORE MORE
SQUAD.
AS WE GET OLDER WE GET TOO FAR
JUST.
QUICKLY TWENTY EIGHTEEN TO
TWENTY TWENTY EIGHT SO BASICALLY
LOOKING OUT TEN YEARS.
THE NUMBER OF PEOPLE WHO ARE
SIXTY FIVE AND OLDER WILL
INCREASE BY 45%.
RIGHT SO WE'RE GONNA SO
BASICALLY ALMOST HALF AGAIN WHAT
WE HAVE NOW [inaudible]
AND AND ACTUALLY.
TRY TO GO BACK AND MAYBE AND LA
SITTING IN THE AUDIENCE WHAT
PERCENTAGE OF OUR SIXTY FIVE AND
OLDER HAVE ONE OR TWO EIGHTY ELS.
YEAH BUT I DID IT TWICE.
AT A TWO POINT SEVEN OF I'M
TAKES ABOUT OF THE PARTY FOR
OVER SIXTY FIVE WHAT PERCENTAGE
HAVE -- A
TWO EIGHTY ARE MORE EVEN RIGHT
NOW.
I MEAN WE CAN.
WELL SEE WELL SEE --
FOR TWENTY FIFTEEN SOMETHING
AROUND WHAT WAS YOUR YEAH I MEAN
THAT'S THE WE GOT.
YEAH WE HAVE.
ONE RIGHT SAYS TWENTY RIGHT.
SIR 20% RIGHT [inaudible]
OKAY.
SO BUT I GUESS WHAT I WOULD SAY
IS IS THAT.
SERVE THIS AGAIN BACK TO THE
NAPKIN BUT AND I REALIZE WE'RE
LOOKING AT DIFFERENT MODELS AND
SO FORTH --
BUT OVER THAT MEANS OVER THE
NEXT TEN YEARS IF WE'RE GONNA
SUSTAIN WHAT WE'RE DOING NOW
FROM CASELOAD ALONE.
ASSUMING THAT SOMETHING
DRAMATICALLY DOESN'T HAPPEN TO
AGING AND SO FORTH.
WE NEED TO FACTOR IN A ALMOST
50% INCREASE AND HOW MUCH WE ARE
WILLING TO SPEND.
IT FOR A PLAN TO CUT BACK
[inaudible]
CORRECT.
WELL ANYWAY WE'LL TALK OF THE
I'M JUST I'M JUST SAYING I COULD
ONLY SAY THAT WE'RE DOING
SUFFICIENTLY ENOUGH I MEAN JUST
SO SO I GUESS IT NOW OPPOSE THE
QUITE SO FOR EXAMPLE I KNOW --
ICE SS RATE LEAF --
I'VE HEARD MANY TIMES PEOPLE
SAID THAT --
YOU KNOW IT'S GROWING SO FAST
COUNTY IS SAYING WE CAN'T KEEP
UP IT CETERA.
ARE WE PLANNING FOR I MEAN WHAT
IS YOUR PROJECTION OVER THE NEXT
TEN YEARS ON HOW MANY PEOPLE ARE
GOING TO BE SERVED BY HSS.
YEAH.
I'M SURE OVER THE NEXT TEN WE'RE
GOING ABOUT 5% A YEAR SO.
USING CAL.
SINCE IN MY HEAD --
TEN YEARS WOULD BE WELL I MEAN
IT'S COMPOUNDING THING IF YOU DO
FIVE YEARS.
MILLION PROBABLY YEAH SO SO SO
AND SO THAT MEANS FORM WE BUDGET
RIGHT WE NEED TO BUDGET THAT
NICK AND ACTUALLY WE THINK ABOUT
THE NUMBER OF PEOPLE OVER.
SIXTY FIVE IT.
THAT FACTORS --
SALE BOOK --
THAT IF YOU'RE 5% A YEAR DOUBTS
ABOUT ON TRACK THEY'RE VERY.
YEAH AND WE ALSO SERVE DISABLED
WHICH IS ANOTHER RIGHT EXACTLY
OTHER GROWING POPULATIONS
EXACTLY RIGHT I'M DAYS AND
NIGHTS AND I THINK WE NEED.
TO REMOTE REMEMBER THAT AND WOOD
FOR SIR FOCUSING ON SENIORS JUST
PARTIALLY BECAUSE WE CAN JUST
LOOK AT THE OVERALL WE'RE DOING
A LOT OF BACK AND ACT AND STUFF
BUT AND IT.
AT IN THIS POINT ARE DISABLED
POPULATION IS A HIGHER
PERCENTAGE OUR TOTAL.
OKAY AND SO BUT YOU'RE GONNA
HAVE THIS AGING PRESSURE TO
COMING IN RIGHT AS I SAID WITH
THE AND HOW HOW IS SO I DON'T
KNOW WHETHER THE PROPORTION WHO
NEED NURSING HOME CARE AND WE'RE
TRYING TO KEEP PEOPLE IN THE
COMMUNITY --
BUT WE'RE GONNA HAVE A L. ARE WE
EXPECTING TO HAVE THOSE THOSE
ARE THE AGING POPULATION IS
GOING TO BE 45% AND TEN YEARS.
ARE GOING TO HAVE THOSE A 25%
MORE NURSING HOMES IN TEN YEARS
THEN BECAUSE THAT BEHALF OF THAT
RATE ASSUMING WE'RE ABLE TO KEEP
PEOPLE MORE PEOPLE ON THEIR
HOMES SO.
HOW HOW YOU DOING THERE?
I THINK IF USUALLY LOOK AT
NURSING FACILITY SERVICES IT'S
BEEN VERY INTERESTING TO WATCH
THIS SORT OF THAT CHANGE WE
ACTUALLY HAVEN'T HAD A
SIGNIFICANT INCREASE THE NUMBER
OF PEOPLE WHO NEED NURSING
FACILITY SERVICES.
BECAUSE AND YOU KNOW AS LOWER
MENTIONED IT'S NOT.
ALL MEDI CAL OF I MEAN NURSING
FACILITY IS A LOT OF MEDI CAL
BUT BUT PRIOR TO THAT --
IS IS NOT NECESSARILY FIRST
POPULATION AND SO I THINK OUR
OUR CONTINUED FOCUS HAS BEEN ON
HOW TO WHAT CAN WE DO BETTER TO
KEEP PEOPLE IN THE COMMUNITY --
BECAUSE THERE ARE A LOT OF
SERVICES BEING AN EXCELLENT ONE
BUT THERE ARE A LOT OF OTHER
ONES.
THAT IT DOESN'T YOU KNOW IF
SOMEONE DOESN'T NEED TO HAVE YOU
KNOW WHAT OF MEDICAL
PROFESSIONALS WATCHING THEM HOW
TO WE BETTER HAVE OTHER TYPES OF
LIVING FACILITIES AS WELL
WHETHER THEY'RE NURSING
FACILITIES AND WE DO HAVE
OBVIOUSLY A RANGE OF ASSISTED
LIVING.
RESIDENTIAL CARE FACILITIES AND
THINGS LIKE THAT SO OUR FOCUS
HAS REALLY BEEN ON HOW TO WE
HAVE THOSE SERVICES AVAILABLE TO
INDIVIDUALS.
THAT PEOPLE DON'T END UP WHERE
THEY DON'T NEED TO BE.
A AND AND I AGREE WITH THAT I
MEAN IT'S WITH ANYTHING.
BUT THAT.
BUT I THINK AND AND I APPRECIATE
THAT WHAT YOU SAID WAS THAT
LOOKS WELL WE'RE GONNA TRY TO
FIGURE OUT WHAT THE I DEALS MADE
UP THE RIGHT WORD BUT YOU KNOW
WHAT TO BETTER.
I THINK I PROBABLY SAID THAT.
OKAY RIGHT WILLIAM WITH A BETTER
SYSTEM OF FOR FOR THE CLOSER IT
IDEAL --
THAT WE CAN GET TO AND IT'S
GREAT TO BE ABLE TO SAY WELL
LET'S NOT WORRY ABOUT THE
FINANCES FIRST WE FIGURE THIS
OUT AND I GOT THAT LITERALLY
WHATEVER ONE HOLD ME WHEN I SAID
THAT RIGHT.
BUT IN THE END THOUGH WE'RE
GONNA BE SUCCESSFUL IN
IMPLEMENTING WHATEVER THIS THING
IS.
RIGHT WE ARE GOING TO EVENTUALLY
OF THE BOOK THE MONEY ABSOLUTELY
AND IT JUST PURELY ASIDE FROM
HOW MUCH WOULD ACTUALLY COST TO
DO WHATEVER WE'RE GOING TO COME
UP WITH OKAY --
JUST FROM ROB DEMOGRAPHICS RATE
WHAT YOU'RE SAYING IS THAT.
IT SIDE FOR WHATEVER ADDITIONAL
MONEY WE NEED TO DO INNOVATION
RIGHT WHETHER IT'S PROVIDING
MORE MONEY FOR MORE PEOPE DO
PAYS OR OTHER TYPES OF THINGS --
WE WILL STILL NEED TO INCREASE
OUR FUNDING.
FOR I'LL TSS AT THE RATE WERE AT
LEAST BASED ON DIRECT LOANS
WHERE WE HAVE AT LEAST A FORTY
FIVE YEAR OLD BUT ESSENTIALLY 5%
ISSUE YEAR.
RIGHT THAT THAT THAT'S
RESOLUTION BECOMING THIS
COMMITTEE O BE A 5% INCREASE N
HEALTH SPENDING HOWEVER WE
DISTRIBUTED INTO WHATEVER VERY
SERVICE AND SO FORTH BUT JUST TO
KEEP UP THE DEMOGRAPHICS ALONE.
YES DEFINITELY AND I THINK ONE
OF THE THINGS AND YOU KNOW AND I
GET I THINK A LOT OF MOST PEOPLE
DON'T.
THINK OF ME AS A POLLYANNA
PERSON BUT WHEN I TOLD THEM TO
PUT THE THE FINANCING ASIDE IT
WAS REALLY ABOUT.
I THINK IS YOU KNOW VERY WELL
THE MEDICAID PROGRAM THE
FINANCING OF IT IS VERY
COMPLICATED SO IT'S NOT JUST
THAT IT'S A LOT OF MONEY WHICH
IT IS.
BUT THE STREAMS OF FUNDING ARE
SO DIFFERENT AND HAVE DIFFERENT
RULES TIED TO THEM.
AND SO THAT'S REALLY WHAT I WHAT
I WAS TALKING ABOUT HOW DO WE
NOT SORT OF LET THE FINANCING
STRUCTURES DRIVE THE POLICY
DECISIONS THEY HAVE TO INFORM
THEM AND IN THE END WE NEED THE
MONEY TO BE ABLE TO DO THIS.
BUT I THINK THAT WE HAVE BEEN
YOU KNOW AND AND AGAIN AS AS
PEOPLE HAVE HEARD ME TALK ABOUT
THERE'S NO LIKE I AM I AM.
YOU KNOW AFTER FIFTEEN YEARS IN
THIS WORLD I'VE IS THAT WE A
FINANCE THINGS BUT IT'S ALSO
DRIVEN I THINK SOME STRUCTURES
THAT MAYBE DON'T MAKE THE BEST
SENSE AND SO HOW DO WE ACTUALLY.
LOOK AT ALL THE MONEY WE HAVE
AND IS THERE A BETTER WAY TO
SPEND IT.
IT ADDITION TO THE OF COURSE AS
POPULATION GROWS AND MORE MONEY
BEING NEEDED BUT HOW DO WE
BETTER SPEND WHAT WE HAVE TODAY.
TO NIGHT AND AND I APPRECIATE
FROM WHAT YOUR TRADE I MEAN I DO
THAT MYSELF FOR WE SAY OKAY
LET'S FIGURE OUT WHERE WE WANT
TO GO AND THEN WE FIGURE OUT HOW
TO FIND THE MONEY FOR IT.
SO I MEAN I I I DON'T HAVE AN
ISSUE WITH.
BUT HAVING THOSE KIND OF
DISCUSSIONS AND SO FORTH --
BY THINK PART OF WHAT WE WANT TO
TALK ABOUT HERE TODAY IS YOURIN
THIS MANY IF YOU'RE NOT YOU KNOW
IF WE'RE LOOKING AT THESE THINGS
AND I SAID.
WERE THIS IS THIS HEARINGS MORE
OF A PLATFORM FOR HOPEFULLY
FUTURE DISCUSSIONS AND HEARINGS
AND NOW THE BUDGET DISCUSSIONS
IN TERMS OF LIKE WHAT WHAT WHAT
KIND OF POLICY CHANGES DO YOU
WANT TO DO HOW EXACTLY HOW MUCH
MONEY.
IS TO SAY THAT.
BEYOND THE OKAY LET'S SIT THERE
AND FIGURE THAT OUT BUT WHEN YOU
FINALLY DO TURN BACK AND SAY
OKAY NOW WE FIGURE OUT WHERE WE
WILL TRY TO GET.
TO HOW MUCH MONEY WE HAVE TO
REALIZE THAT THE BASS LINE MONEY.
WHAT THE BASS LINE ACTUALLY HAS
TO BE SOMETHING THAT'S GROWING
AT 5% AND THEN MAYBE EVEN SOME
MONEY BEYOND THAT TO HELP
IMPLEMENT INNOVATION OR WHATEVER
POTENTIALLY SO --
SO I THINK WHEN WE'RE LOOKING AT
HOW WE MOVE FORWARD --
LOUIS WE HAVE THE REAL IT YOU
CAN'T SAY THAT WELL WE'RE WE'RE
WE ARE BASS LINE IS THE SAME
ABOUT A MIGHTY BECAUSE
DEMOGRAPHICALLY IT DOESN'T EVEN
WORK OUT RIGHT YOU HAVE MORE
PEOPLE SERVE AND MAYBE WE CAN
FIND THE SAVINGS AND SO FORTH
AND THE NEW INNOVATION WILL.
BE -- COSTS
A LOT LESS MONEY IT'S THAT'S
WONDERFUL AND THAT THE AD BUT
BUT I THINK THAT.
YOU KNOW WE JUST HAVE TO
RECOGNIZE THAT.
THIS IS SOMETHING WE NEED TO
PLAN FOR BUDGETARY EARLY I MEAN
TO YOU WE CAN'T SIT THERE AND
SAY WELL WE ONLY SPENT THIS MUCH
LAST YEAR SO THE MIXTURE WOULD
SPEND THE SAME AMOUNT.
THE FACT THAT AT THIS UP BEYOND
INFLATION AND OTHER SITES
BACKING.
BAND RIGHT BECAUSE HE DOES HAVE
MORE PEOPLE IN NEED SERVICES
RIGHT YES YES I MEAN OBVIOUSLY A
IN IN THE AGGREGATE A MEDIC HELP
POPULATION HAS.
GOTTEN FAIRLY STABLE OBVIOUSLY
AS YOU KNOW AFTER A HUGE GROWTH --
BUT WHERE WE ARE SEEING THE
GROWTHS IN POPULAR SOME OF THE
POPULATION THAT WE'RE TALKING
ABOUT HERE AND HOW DO WE MAKE
SURE THAT WE'RE ADEQUATELY
PREPARING FOR THAT AS WE
CONTINUE TO MOVE FORWARD.
AND I REALIZE THERE'S MOVE TALK
ABOUT MULTIPLE PROGRAMS ANNA TO
ANYONE HAVE NEVER HOW MUCH DO WE
SPEND RIGHT NOW ON EL TSS.
SERVICES I WOULD NOT BE ABLE TO
TELL YOU THAT OFF THE TOP OF MY
HEAD BUT I'M SURE WE COULD
COLLECTIVELY FIGHT. FOR TO GET
YOU THAT AND GET THE BIG GET
BACK TO YOU AND YOUR STAFF.
OKAY THAT DOUBT THAT WOULD BE
HELPFUL YEAH --
BECAUSE A SAID BITS I KNOW
THERE'S LOTS OF DIFFERENT PIECES
THERE ARE HERE.
RIGHT -- BUT
I MEAN I THINK THAT --
AND EXACTLY HOW WE DISTRIBUTED
AMONGST THE DIFFERENT PIECES --
YOU KNOW THIS.
SOMETHING THAT WILL BE I'M SURE
VIA -- THE
PART OF FUTURE BY DISCUSSIONS
BUT NO TWO YEARS AGO WE HAD TO
WORK OUT WHAT WE CAN DO IT I
JUST US RIGHT VIGT WE REDID
THE NINETY ONE REALIGNMENT
DISTURBIA SOME OF THAT STUFF SO
I MEAN -- SO
AND AND FRANKLY IT'S IS SOMEONE
IT IS THE CHAIR OF THIS BUDGET
SUBCOMMITTEE I'VE IT ACTUALLY
KIND OF SURPRISED HOW LITTLE WE
TALK ABOUT WHERE WE'RE GOING
WITH.
THESE SERVICES AND HOW MUCH IT
COST OUT TO THE FUTURE.
AS WE'RE TALKING ABOUT THE A
MULTI YEAR PROJECTIONS AND SO
FORTH --
BECAUSE I THINK THAT --
AT THE I MEAN THIS THIS IS THE
THIS IS THE THING THAT --
IT IF YOU JUST GONNA BE A LOT OF
PEOPLE WHO ARE.
TO BE A LOT OF TROUBLE ON THE
NEXT RECESSION HITS IF WE'RE NOT
HAVING THIS CONVERSATIONS OR
EVEN IF IN THE RECORD AND EVEN
BEYOND THE NEXT RECESSION OF
ROUTE PLANNING.
AHEAD SO I REALIZE YOU KNOW
THERE'S A LOT OF DIFFERENT
PROGRAMS YOU A LOT OF DIFFERENT
PIECES.
AND THEIR SUMMER SESSIONS WE
NEED TO FIGURE OUT HOW TO PULL
THE STUFF [inaudible]
TOGETHER [inaudible]
SO -- IT IS
SO I MEAN IN TERMS OF SIZE YELL
YOU'VE YOU MENTIONED --
YOU KNOW WE HAD.
A A DID ASK A QUESTION ABOUT.
COUNTY IS AND HOW HE COUNTY.
IS THE GOAL TO HAVING SOME OF
THESE SERVICES --
AND REALIZE WE HAVE A VARIETY
DIFFERENT COUNTIES FROM LA TO
YOU KNOW.
THAT TO MODOC OR WHATEVER I OF
THE COUNTY OF THE SOURCE ALWAYS
COUNTIES IN TERMS OF TRYING TO
MAKE SOME OF THE SERVICES
AVAILABLE ACROSS THE STATE --
WHAT WERE WE WAS TRYING TO DO
THAT TO ME THAT IF YOU'RE IF
YOU'RE YOU PILOT IN THE MALL YOU
KNOW EX NUMBER COUNTY?
SAY HEY WORKS PRETTY WELL PEOPLE
LIKE IT WE'RE GETTING BETTER
RESULTS WHAT WHAT ARE WE DOING
TO TRY TO FOR THAT I MEAN TO
DISAPPOINTING TO CONTACT MOST OF
OUR E. CBS PROGRAMS ARE
STATEWIDE --
I JUST HAPPEN TO MENTION SOME
THAT THAT WEREN'T --
SO ALE W. LIKE I SAID IS IN
FIFTEEN COUNT OUR STATE WIDE
OTHER THAN --
THE HIV AIDS WAIVER WHICH IS
ALSO A SIR DEPENDENT ON
POPULATION PIECE --
AGAIN I THINK THAT WHAT FIFTEEN
COUNTIES ELEVEN PLANS --
WE WE LIFTED WITH THE
LEGISLATURE OR A COUPLE OF YEARS
AGO THOUGH CAP ON THE NUMBER OF
OF PLEASE PLAN WHICH IS WHY
YOU'VE SEEN THE PROLIFERATION --
WE'RE CERTAINLY NOT TURNING
PEOPLE AWAY --
FROM HAVING --
PEACE PEACE PROGRAMS COME INTO
US TO APPLY AND WORK VERY I
THINK CLOSELY AND I I WOULD I
WOULD HOPE THAT PETER AND AND
THEIR ASSOCIATION WOULD AGREE
THAT --
WE'RE DOING THAT IT TAKES IT
TAKES A LONG TIME TO GET A PIECE
CENTER UP I WOULD SAY IT. TWO
THREE YEARS PROBABLY FROM LIKE
START TO TO YEAH SO WHO --
YOU KNOW SO THERE'S A LITTLE BIT
OF A LAG BUT AS I SAID WE'RE WE
HAVE EIHT TO ALREADY IN THAT
PROCESS AND WILL CONTINUE TO TO
FOCUS WITH THAT AND THEN --
AMASIS BE IS ALMOST STATEWIDE
FORTY SIX COUNTY SOMETHING LIKE
THAT.
SEE HOW I KNEW I HAD I WAS
PRETTY CLOSE --
YEAH SO I MEAN I THINK THAT THAT
IS.
OUR GOAL I THINK AGAIN THE THE
STEP BACK THAT I'VE BEEN TRYING
TO TEACH IS.
WE IF WE WANTED TO HAVE A
PROGRAM THAT WAS MORE FULLY
INTEGRATED INSTEAD OF HAVING.
FIFTEEN DIFFERENT TYPES OF EIGHT
CBS PROGRAMS AND I'M SURE
THERE'S EVEN MORE THAN THAT BUT
LET'S JUST SAY THAT'S THE NUMBER.
HOW DO WE ACTUALLY AS A DELIVERY
SYSTEM LOOK AT THESE ARE JUST
COURSE SERVICES AND HOW DO WE
BUILD THAT INTO WHETHER IT'S OUR
MANAGED CARE DELIVERY SYSTEM OR
SOMETHING ELSE AND THAT'S REALLY?
WHERE MY FOCUS HAS BEEN WITH MY
TEAM IS HOW DO WE START TO LOOK
AT THAT BECAUSE I THINK PART OF
THE COMPLEXITY BESIDES THE
FUNDING THAT WE ALREADY TALKED
ABOUT?
IS THAT IF SOMEONE ACCESSING
SERVICES THROUGH FIVE DIFFERENT
DELIVERY SYSTEMS AND THEY HAVE A
CASE MANAGER IN EACH OF THOSE
THAT'S ALSO NOT PARTICULARLY
HELPFUL FOR THE MEMBER.
AND SO REALLY LOOKING AT IT MORE
HOLISTICALLY IS HOW DO WE JUST
MAKE THIS BE THE MEDI CAL
PROGRAM INSTEAD OF ITS D. THIS
GETS THE ALE W. OF A MEDICAL
PROGRAM AT ST CBA IT'S NO THIS
IS.
YOU GET THE SERVICES YOU NEED IF
YOU NEED THEM AND NOT BECAUSE
YOU'RE AN S. PARTICULAR.
PROGRAM THAT IS BEING OPERATED
UNDER SEPARATE RULES WITH
SEPARATE FINANCING.
IN TERMS OF AYE HSS MEANS WERE
LOOKING OUT.
NEXT TEN YEARS FOR OF WHAT WERE
YOU SEE ARE THINGS THAT WE NEED
TO I MEAN OR GAVE BILL KEEP UP
AT 5% A YEAR.
THE BILL AND I JUST KEEP IN MIND
THAT OUR GDP OR STATE GDP EVEN
THOUGH WE'VE BEEN HAVING A GREAT
ECONOMY DOESN'T GROW AT 5% A
YEAR.
I'M GONNA BE SOMETHING WE HAVE
TO CONTINUE TO WORK ON AND LOOK
AT AND CERTAINLY WE ALL.
REALIZE THAT.
IT'S A BENEFIT FOR PEOPLE TO BE
ABLE TO STAY IN THEIR HOME RIGHT
PEOPLE HAVE THAT AS A PREFERENCE
TYPICALLY IT'S LESS COSTLY THAN
A WAY OF PROVIDING SERVICE.
AND JUST THE IDEA OF TRYING TO
BUILD ENOUGH SKILLED NURSING
FACILITIES TO MEET.
THAT NEED VERSUS BEING ABLE TO
SERVE PEOPLE WHERE THEY ARE AND
WHERE THEY PROBABLY PREFER TO BE.
IS IS THE GOAL SO I THINK THAT.
SO THE ONE OF THE THINGS THAT
I'VE BROUGHT UP THAT.
ON SEVERAL OCCASIONS IN THE
BUDGET SUBCOMMITTEE A NIGHT OF
CHALLENGED LA --
WILL --
BECAUSE LA --
WELL.
WORSE FOR THE LEGISLATURE BUT
AND DIED BECAUSE I CAN'T MAKE
THE ADMINISTRATION DO.
THINGS --
BUT I WILL THAT SINCE YOU'RE
HERE I'LL CHALLENGE US WELL
SYMBOL ACTION WHEN THE THINGS WE
NEED TO ALSO BILL PUT TOGETHER
AN OUT I THINK KELLY --
DID REPORT LOOKING AT HSS AND
HOW IT.
THAT REDUCES --
ACTUALLY INSTITUTIONAL CARE
RIGHT.
IS ACTUALLY TO HAVE THAT KIND OF
INFORMATION --
BECAUSE ULTIMATELY --
WHAT HAPPENS IS WE'RE GONNA LOOK
AT THESE THINGS WE HAVE ARE
DEMOCRATIC PRESSURES GO BUT
BUDGETARY PRESSURE WE ALL WHO
WILL SEE WHAT ECONOMY GOES IN
THE FUTURE SO FAR SO GOOD BUT WE
KNOW ECONOMIC CYCLES ETCETERA?
BUT IS WHEN WE START HAVING
THOSE CONVERSATIONS ABOUT CUTS
AND WHEN I CAME INTO LEGISLATION
TWENTY TEN YOU KNOW GOVERNOR
BROWN CAME IN TWENTY EIGHT
BILLION DOLLAR DEFICIT CETERA SO --
THAT IS WERE TRYING TO MAKE
POLICY DECISIONS AND POLICY
CHOICES TO RECOGNIZE A WHAT IS
THE ALTERNATIVE TO WHAT WE'RE
DOING NOW RATE AND SO.
THINGS LIKE --
LOOK WE'RE SPENDING THIS MUCH ON
THIS PROGRAM IS GOING VERY
QUICKLY LET'S SAY I TO ASSESS
BUT CUTTING THAT BACK THEN BE IS
NOT.
IN THE MUSCLE PLAY A PLANE JUST
ALLOW PEOPLE TO YOU KNOW
LANGUAGE AND STREETS THAT MEANS
WE'RE PUSHING PEOPLE TOWARD A
MORE EXPENSIVE OPTION.
RIGHT.
AND SO WE NEED.
TO QUANTIFY THAT LEADS TO THE
BEST OF OUR ABILITY BECAUSE AT
THE END BUDGETS ARE ABOUT
NUMBERS NINE WE SAID TO THE
BUDGET COMMITTEE AND MORE AT THE
SIZE WHAT IS THE NUMBER BECAUSE
THAT'S THE ULTIMATELY THAT'S
WHAT BECOMES THE ON SOME.
AMOUNT OF MONEY AND SO --
HAVING THAT KIND OF DATA AND
THEY KNOW LA AS YOUR CHALLENGE
AND THE CONTINUED FISHERY FOLLOW
UP ON THAT.
RECOGNIZING AS WERE MAKING OUR
VARIOUS POLICY CHOICES SOME OF
THEM WILL BE UNDER OR
POTENTIALLY ECONOMIC PRESSURES
BUT OTHERS BECAUSE YOU KNOW BUT
HEY LOOK WE COME WE HAVE ANOTHER
IDEA THAT WE VALUE WAITED WE
HAVE A PILOT THAT WE HAVE SOME
RESULTS FROM.
BE ABLE TO HAVE THAT.
KIND OF DATA --
TO SAY OKAY IF WE DO ACCESS.
WE'RE GOING TO GET THESE KIND OF
OUTCOMES WHICH IS VERY IMPORTANT
AND AND THIS IS WHAT THE FISCAL
IMPACT WILL BE I THINK IS
SOMETHING.
IMPORTANT SO --
CUTS AND APPROACH SAVINGS MADE
JUST LEAD TO INCREASE A CUT THAT
WILL REDUCE ABOUT WE SPENT ON
THAT PROGRAM BUT WILL INCREASED
AMOUNT WE SPEND IN ANOTHER
PROGRAM AND MAYBE MORE SELF SO.
BE SURE WE HAVE THAT KIND OF
INFORMATION AND THAT DATA AND
THAT PEOPLE ARE COLLECTING AND I
THINK IT'S GONNA BE VERY
IMPORTANT SO WE MAKE THE RIGHT.
CHOICES AS WE MOVE FORWARD.
NOW DAHLE HOPE THAT WE CAN.
SURE SO I APPRECIATE YOU SAYING
YES I AND AND I KNOW THERE'S
THERE'S THERE'S A TO SAVE MY
* WITH QUANTIFY THAT RIGHT
AND WHAT THE AS WE'RE LOOKING AT
THESE WAIVERS AND SO FORTH AND
HOW AND RIGHT FOR EXAMPLE.
YOU COMMON TELL US DOC YOU KNOW
SHOULD WE SPEND MORE MONEY TO
INVEST IN CASE RATES ARE YOU
MORE COUNTIES DO PAYS RIGHT THEY
CAN SAY LOOK WILL ACTUALLY SAVE
MONEY THREE YEARS NOW WHEN THEY
ACTUALLY HAVE THE PROGRAM TAKES
TWO YEARS EMPLOYMENT BLAHBLAH.
RIGHT AND IT'S IT'S A IT'S WORTH
DOING THAT RIGHT THE KIND OF
THING SO --
DOING OUT OF FRONT MONEY SO JUST
PICKING THAT'S EXAMPLE OF ART.
OKAY.
ALL RIGHT --
SO ALIVE THANK YOU SO MUCH FOR
PRESENTING I THINK WE'RE HAVING
YOU MAKES.
AFTER WE HAVE A REACTOR PANEL
AND STUFF SIDE TO JUST SURVEY
BECAUSE MAKE ANY FOLLOW UP
COMMENTS TO THAT THE PUBLIC
COMMENT SOPHISTIC AROUND FOR
THAT APPRECIATED AND NINE THAT I
PRECIADO AND HIS CAROLINA YOU
JUST FLEW BACK FROM DC.
ALL RIGHT.
I THINK THE TRYING TO CAN BE
SURE THAT THERE'S AN TO WOOD
SMOKE IN THIS ROOM AT LEAST.
OKAY [inaudible]
ALL RIGHT.
OKAY SO --
AFTER LET'S SAY FAIRS AND
CALIFORNIA ASSOCIATION HEALTH
FACILITIES CRISTINA BASS
HAMILTON LET'S SAY DIRECTOR OF
U. D. W. ASKED ME LOCAL THIRTY
NINE THIRTY ROBERT TERRORISTS
FROM S. YEAH YOU.
MIKE MCCONNELL DON'T SERVICES
DIRECTOR SANTA CRUZ COUNTY IS A
COMMON EXACT DIRECTOR --
THE LONG TERM CARE OMBUDSMAN
ASSOCIATION AND SUSAN MORE
STRICTER GUN FEARS OF THE
ALZHEIMER'S ASSOCIATION.
SO I GUESS WHAT WE ASK YOU TO DO
IS SORT OF EIGHT WHICH WE ARE
STAFF FOCUSING ON LIKE LOOKING
FORWARD AND WHAT THE DEMOGRAPHIC
PRESSURES ARE AND WHAT YOU SEE --
SO YOU CAN --
COMING OF WHAT YOU'VE HEARD FROM
THE VARIOUS PRESENTATIONS IN
RELATION TO WHAT YOUR
ORGANIZATION IS THINKING ARE THE
ISSUES WE SHOULD LOOK AT AS IT
COMES TO LOOKING OUR DEMOGRAPHIC
CHALLENGES AND THE PRESSURES
THAT WE WERE GOING TO FACE IN
TERMS OF OF PLANNING FOR THE
FUTURE --
RECOGNIZING THAT WHILE THIS
HEARING WE'RE NOT REALLY TALKING
AS MUCH ABOUT SOLUTIONS --
BUT MAYBE SAYS TALK ABOUT WHERE
SOME OF THE THINGS RELATIONSA
LOOKING AT TERMS OF THINGS WE
NEED TO EXPLORE THAT RELATION
[inaudible]
AND I'D.
TRY TO KEEP IT BRIEF OKAY.
MR OFFICE ALSO IF YOU'LL JUST
WORK AROUND.
THANK YOU MISTER CHAIR MATT
ROBINSON CALIFORNIA ASSOCIATION
OF HEALTH FACILITIES HOW WE
REPRESENT SLIGHTLY OVER A
HUNDRED FIFTY SKILLED NURSING
FACILITIES IN CALIFORNIA.
AND OVER FIVE HUNDRED IN MAY
CARE FACILITIES FOR THE DROPPED
ABOUT MILLION DISABLED --
OR SKILLED NURSING FACILITY
SERVE ABOUT THREE HUNDRED
SEVENTY THOUSAND RESIDENTS A
YEAR -- WE
HAVE ABOUT A HUNDRED FORTY ONE
THOUSAND EMPLOYEES --
IN OUR SECTOR --
FIRST OFF --
OWNERS --
WANNA PROPER FRESH OUR TALK
ABOUT SOME OF THE CHALLENGES AND
ESPECIALLY THE DEMOGRAPHICS WERE
FACING.
A CURRENTLY RIGHT NOW QUALITY OF
CARE IN OUR NURSING HOMES --
RANKS -- TOP
FOR THE NATION CMS QUALITY
MEASURE CATEGORIES I WISH GREAT
FANTASTIC ON THAT HAS IMPROVED
ON IN A LOT BECAUSE OF THE
CURRENT REIMBURSEMENT SYSTEM WE
HAVE WITH A. B..
SIXTEEN TWENTY NINE WITH THAT
SAID WE'RE NOT STAGNANT WITH
THOSE IMPROVEMENTS WE WANT TO
CONTINUE TO GET BETTER --
BUT WITH THAT THERE'S OBVIOUSLY
SOME CHALLENGES --
THAT WE'RE CURRENTLY SEEING
RIGHT NOW --
WITHIN THE SKILLED NURSING
FACILITY SECTOR --
AND AND THE TYPES OF RESIDENTS
WE SERVE --
IS WHO WHO WE ARE CURRENTLY
SERVING IN A SKILLED NURSING
FACILITY IS MUCH DIFFERENT THAN
WHO WE WERE SERVING TEN YEARS
AGO -- WE
ALLOW THE SKILLED NURSING
FACILITIES NOW IT LOOKS VERY
MUCH LIKE A CUTE KERR HOSPITAL.
A RATHER THAN A SKILLED NURSING
THAT YOU THOUGHT OF TEN YEARS
AGO IN ASSISTED LIVING
FACILITIES LOOK MUCH MORE LIKE
WHAT A SKILLED NURSING FACILITY
TEN YEARS AGO.
WE ARE ALL ABOUT --
WANTING TO MAKE SURE THAT THAT
RESIDENT HAS APPROPRIATE
PLACEMENT --
WHETHER IT'S AYE HSS WHETHER
SKILLED NURSING WAS RECESS
LIVING OR SOMEWHERE ELSE IN THE
COMMUNITY --
BUT THERE'S A LOT OF CHALLENGES
THAT THAT WERE SEEN ESPECIALLY
RIGHT NOW --
CURRENTLY RIGHT NOW WITH WITHIN
OUR SKILLED NURSING FACILITIES
WERE WE HAVE REMAINED AT ABOUT
88% OCCUPANCY --
FOR THE LAST TWO YEARS --
IT WILL BE INTERESTING TO SEE
THAT SHIFT IN SKILLED NURSING
FACILITIES GOING FORWARD --
WITH ME A ONE IN THREE
CALIFORNIANS ON MEDI CAL ONE OF
TWO KIDS BORN ON MEDIC COW WITH
THE SKILLED NURSING FACILITIES
AS A SAFETY NET IN THAT HEALTH
CARE WORLD.
WILL BE INTERESTING TO SEE HOW
MUCH OF THAT --
COMES WITH WITHIN THE WITH THE
WITH SEASON COMES WITHIN THE
SKILLED NURSING WORLD --
ON AVERAGE TO THIRD HOW
RESIDENTS --
SO AGAIN IT'S ONLY IT'S ONLY A
MATTER OF A NUMBERS GAME BUT WE
WANT PEOPLE TO BE AN APPROPRIATE --
CARE AND GET THE PROPER
TREATMENT --
IN IN THE RIGHT SETTING.
WITH THAT SAID WHAT WE'RE
STARTING TO SEE --
OUT A LOT MORE FREQUENT IN OUR
FACILITIES --
THROUGH THROUGHOUT THE STATE --
WE'RE SEEING A LOT MORE
BEHAVIORAL HEALTH ISSUES --
NOT ONLY ARE WE SEE MORE MORE
RESIDENTS WITH ALZHEIMER'S AND
DEMENTIA PERSON A LOT MORE
BEHAVIOR HEALTH ISSUES NOT JUST
SO MUCH IN THE OLDER POPULATION
BUT ALSO IN THE YOUNGER
POPULATION --
YOU'RE SEEING A LOT OF ISSUES --
WITH THE YOUNGER POPULATION.
EARLY TWENTIES INTERSTELLAR
FACILITIES HOMELESS --
SOMETIMES WERE REPORT SAUNDERS
FOR SKEWS ME --
IT IN THEIR HOME ON TO HAVE A
OPIATE ADDICTIONS --
THERE AT OUR EARLY TWENTIES
WHICH OBVIOUSLY HAS AN EFFECT ON
THOSE OLDER RESIDENTS WE HAVE --
INTER SKILLED NURSING FACILITIES.
BY THE LAST THING I JUST WANT TO
TALK ABOUT IS AGAIN A
DEMOGRAPHIC CHALLENGE --
WHILE IT'S A GOOD THING ABOUT
THE STATE HAS A VERY LOW
UNEMPLOYMENT RATE RIGHTNOW --
THAT IS DIRECTLY AFFECTING OUR
FRONTLINE WORK FORCE --
IS YOU KNOW CERTIFIED NURSING
ASSISTANTS --
THEY ACTUALLY STARTED OUT OF
SKILLED NURSING FACILITIES --
BACK IN A SENSE THAT'S LIKE HOW
THAT POSITION WAS CREATED I MEAN
THEY ARE THE BACKBONE IN MANY
WAYS.
OF WHAT GOES ON IN SKILLED
NURSING FACILITY --
BUT WITH THIS NEW STAFF TO
MANDATE THAT WE HAVE IN FACT LA --
PREDICTED IT WAS WE NEED ABOUT
TWENTY I WANT ONE THAT MANDATE
CAME AND IT'S NOT ONLY VERY HARD
TO FIND CERTIFIED NURSING
ASSISTANTS TO WANT TO WORK IN
OUR WORK FORCE --
BECAUSE AGAIN I MEAN WITH
MINIMUM WAGE GOING UP TO WHAT
YOU CAN WORK ELSEWHERE IT'S A
VERY DIFFICULT CHALLENGING JOB --
BERASA FIND IT TOUGH TIME
KEEPING THOSE CERTIFIED NURSING
ASSISTANTS --
I IN OUR FACILITIES WERE
LOOSENED ACUTE CARE HOSPITALS A
PRIVATE IN HOME PAY --
WHATEVER MAY BE MORE THAN JUST
GOING INTO ANOTHER SECTOR WHERE
THEY CAN MAKE WE CAN MAKE MORE
MONEY SO WE NEED AGAIN QUALITY.
QUALITY STAFF TO BRING A PRIEST
QUALITY CARE OUTCOMES AND ON ON
VARIOUS FRONTS WHETHER IT'S THE
BEHAVIOR HEALTH ISSUES --
BUT ALSO JUST BY A LONG TERM
CARE RESIDENTS [inaudible]
THANK YOU.
THANK YOU SENATOR PAN FOR HAVING
THIS HEARING MY NAME IS
CHRISTINA BOSS HAMILTON --
I AM THE LEGISLATIVE DIRECTOR
WITH YOU W. ASKED ME AND I'M
HERE WEARING TWO HATS TODAY ON A
TALK REALLY FAST --
TO I'M REPRESENTING THE
CALIFORNIA ALLIANCE.
AGING AND DISABILITY ALLIANCE
I'M SORRY MENTAL.
BLOCK THERE --
WHICH IS AN ORGANIZATION WE'RE
WE'RE A COALITION OF ABOUT
TWENTY GROUPS THAT HAVE BEEN
WORKING OVER THE LAST EIGHTEEN
MONTHS TO ADDRESS EVERYTHING
THAT WE'RE TALKING ABOUT TODAY.
AND TWO SINGULARLY.
FOCUSED ON HOW DO WE DEAL WITH
THE FACT THAT WE HAVE AN AGING
POPULATION AND AN INCREASE IN
THE POPULATION OF PEOPLE WITH
DISABILITIES.
AND NOT NOT ENOUGH AFFORDABLE
SERVICES AND NOT ENOUGH SERVICE
WORKERS TO PROVIDE ALL THE
SERVICES TO THE FOR THE PURPOSES
OF THIS HEARING I WOULD REALLY
NOT GET INTO SOLUTION SO MUCH
BUT TO SAY.
IN TERMS OF PLANNING THAT A LOT
OF GOOD LITERATURE HAS BEEN IN
IN TERMS OF HOW WE CAN BEGIN TO
ADDRESS THESE ISSUES --
PLANS HAVE BEEN DRAWN UP AND
THERE'S REALLY NO REASON.
WITH THE NEW GOVERNOR TO SPEND
ANOTHER YEAR DRAWING UP A PLAN
FOR THE WE WHAT WE'D LIKE TO SEE
IS.
ACTION QUICKLY PERHAPS
CONSOLIDATING PLANS PICKING THE
BEST PIECES OF THE VARIOUS PLANS
DOING A LITERATURE REVIEW AND
FIGURING OUT.
OKAY HERE HERE'S SOMETHING
WORKABLE WITHIN THE FIRST YOU
KNOW HUNDRED DAYS.
AND THEN ASIDE FROM THAT WELL WE
ALL KNOW IS IT'S ABOUT
COORDINATION YOU KNOW WE HAD
VARIOUS DEPARTMENTS JUST SITTING
HERE AT THE TABLE AS YOU CAN SEE
WE JUST TALKED ABOUT IT THERE'S
PROGRAMS ARE SPREAD ACROSS
AGENCIES DEPARTMENTS --
THESE THINGS NEED TO BE
COORDINATED CONSOLIDATED AND
BROUGHT INTO SOME WAY THAT MAKES
MUCH MORE SENSE AND IS MORE
EFFICIENT AND MORE RATIONAL --
AND ULTIMATELY WHAT WE LIKE TO
SEE IS A NO WRONG DOOR APPROACH
FOR BOTH SENIORS AND PEOPLE WITH
DISABILITIES TO ACCESS THE SAME
SERVICES.
SO THERE'S A LOT THAT WE THINK
WE CAN START AND HIT THE GROUND
RUNNING AND WE'D LIKE TO DO THAT.
AND I HAVE MUCH MORE TO SAY ON
ON SPECIFICALLY REGARDING I JUST
US ON BEHALF OF U. D. W. THE
WORKERS THAT I REPRESENT --
I JUST ANT TO LEAVE IT AT THIS
ALL OF THIS CONVERSATION IS
EXTREMELY IMPORTANT.
BUT WHAT MY COLLEAGUE HERE JUST
TOUCHED ON WHICH IS A LACK OF
WORKERS TO PROVIDE SERVICES.
IS SOON ALL OF THIS IS ALMOST
MEANINGLESS OF WE'RE DON'T TALK
ABOUT HOW PEOPLE GOING TO GET
THE SERVICE.
IN IF YOU CAN GET PAID AND
STARBUCKS MAKING CAPPUCCINOS
RATHER THAN THE HARD WORK THAT
THIS ENTAILS AND THE EMOTIONAL
BLOOD WEAT AND TEARS WE
REPRESENT.
I JUST AS WORKERS IN BUTTE
COUNTY WHO LITERALLY SAVE THEIR
RECIPIENTS LIVES [inaudible]
LAKE.
YOU KNOW GRAB THEM AND WENT
RIGHT SO.
THE THE HOW DO YOU PAY SOMEONE
ENOUGH. TO DO THAT A IN A IN A
AND YOU KNOW YOU IT'S A LABOR OF
LOVE IT'S IT'S DOING GOD'S WORK
SO WE HAVE TO DRESS WAGES.
BELOW THE JOB ITSELF YOU KNOW
MAKING IT SOMETHING THAT PEOPLE
ACTUALLY WANT TO DO AND NOT AS
SOME OF THE FUNDAMENTAL
CHALLENGES FACING THE NEXT
ADMINISTRATION THANK YOU.
KAREN PATTON --
KAREN PAN ROBERT HARRIS BUT TOP
SEIU CALIFORNIA AND JUST.
AS SOME SMOM BUT BACKGROUND
WE'VE LONG TO TO THE COALITION
TOO AND WE ARE COMMITTED.
TO MAKING NETWORK AND WHAT WHAT
WHAT STUFF WE CAN DO BECAUSE I
THINK IT WAS FORM BECAUSE PEOPLE
WERE WORRIED THE STATE WASN'T
COORDINATING.
AND THAT WE FIGURED THEN MAYBE
WE'LL FIGURE OUT THE
COORDINATION FORM.
OUR SEIU REPRESENTS TWO HUNDRED
SIXTY FIVE THOUSAND I HSS
WORKERS EIGHTEEN THOUSAND PEOPLE
IN SKILLED NURSING FACILITIES.
FIFTEEN HUNDRED YEN UP PRIVATE
HOME CARE AGENCIES.
WERE SOON TO REPRESENT SEVERAL
HUNDRED E. AND IN THE WAIVER
PROGRAM THE SAN WE REPRESENT
ABOUT FOUR THOUSAND PEOPLE IN
THE DEVELOPMENTALLY DISABLED
COMMUNITY [inaudible]
AND PART OF WHY I BRING THAT UP
IS BECAUSE AS YOU MENTIONED THAT
DEVELOPMENTALLY DISABLED FOLKS
AREN'T AREN'T.
EVEN AT THE TABLE WHAT WHERE WAS
THE DEPARTMENT OF DEVELOPMENTAL
SERVICES TODAY I MEAN THEY
SHOULD HAVE BEEN HERE YOU KNOW
THEY USE OUGHT I TO ASSESS
SERVICES.
AND THERE'S ALSO A BIG GROWTH
THING HAPPENING THERE THAT NO
ONE'S THINKING ABOUT ABOUT
FIFTEEN THOUSAND CHILDREN OLD
WORLD UNDER THE PROGRAM NEXT
YEAR.
MUSCLES CHILDREN HAVE AUTISM
THOSE CHILDREN WILL BE IN THIS
IN THE SYSTEM AND USING LONG
OF THEIR LIVES.
AND IT'S STARTING TO HAPPEN
RIGHT NOW CRISIS.
IS THE FOLKS WHO HAVE BEEN
TAKING CARE OF A METER IS ITS
HOUSE FOR CRUISES AS PRIVATE
HOME CARE ARE DYING.
WHICH MEANS THEN BABY COME AT I
AM INCREDIBLY MORE COST RIGHT.
ALL OF A SUDDEN TO THE SYSTEM
AND WE ARE AND WE HAVEN'T
ALLOWED FOR THAT --
SOMEONE TOLD ME A LONG TIME AGO
THAT.
THE TOP PROVIDER FROM ILLINOIS
SAID.
TO EVERYBODY MOSTLY WHO USE LONG
TERM CARE SERVICES IS THE THE
PUBLIC PAY OR PRE PUBLIC PAY
BECAUSE I'M GONNA SPEND DOWN.
IF THEY LIVE LONG ENOUGH AND
THEY'LL BECOME PUBLIC PAY WE
HAVEN'T LOOKED AT HOW WE
TRANSITION PEOPLE HOW WE MAKE
THEIR MOVE BONE MONEY LASTS
LONGER THAT'S SOMETHING THAT'S
REALLY IMPORTANT COALITIONS
TALKED ABOUT AND THERE WAS
LEGISLATION YEARS AGO TO DO THAT.
THAT THE GOVERNOR SCHWARZENEGGER
VETOED BUT SPECIFICALLY WHAT I
CHECKED WITH SCA USE THINKS WE
NEED WE NEED STABILIZER FUNDING
[inaudible]
RIGHT.
BECAUSE EVERYTHING ELSE FOLLOWS
FROM THAT.
OF WE NEED WORKFORCE DEVELOPMENT
BUT THAT INCLUDES PAYING PEOPLE
A DECENT AMOUNT TO DO THE
HARDEST WORK AND MOST
COMPASSIONATE WORK.
THE PEOPLE CAN GO AND THAT'S
FROM I HSS TO NURSING HOMES TO
PRIVATE HOME CARE ALL OF IT.
WE NEED TO PAY THEM ENOUGH --
WE NEED TO LOOK PAST THE SILOS
LIKE I SAID THE BIGGEST SIDE YOU
COULD SEE IT THREE DEPARTMENTS
APPEAR IN ONE MAJOR ONE MISSING.
RIGHT AND THERE JUST ISN'T
COORDINATION.
AND THEN FINALLY --
THE STABILIZE FUNDING BACK TO
THAT AGAIN.
IS A ONE YOU KNOW WE STILL GOT
ON THE BOOKS ABSOLUTE APPS
[inaudible]
OBSOLETE.
ALMOST ABSOLUTE OBSOLETE
LEGISLATION FOR A 7% COTTON
SERVICES DIGEST SENSE RECIPIENTS.
WE OUGHT TO GET RID OF THAT AND
FIGURE OUT HOW WE'RE GOING TO
FUND THAT.
IT'S YOU BROUGHT UP IN A BIG
IMPORTANT ISSUE WHICH IS LIKE.
THE RATE OF GROWTH JUST ON THE
BASELINE 5% A YEAR.
THERE'S NOTHING GROWS LIKE THAT
EXCEPT FOR THE COSTA HEALTH CARE.
SO MAYBE HE I HEALTH CARE TAX.
CONTINUATION IS THE WAY YOU HELP
ON THIS BECAUSE BECAUSE ANY
OTHER FUNDING SOURCE YOU PECK
RIGHT IS GONNA ROAD OVER TIME.
SO -- THOSE
ARE THINGS WE'RE LOOKING AT
COORDINATION.
GOOD PAY CARE ABOUT THE PEOPLE
AND A FUNDING SOURCE THAT LAUGHS
AND GROWS WITH THE PROGRAM.
THANK YOU.
THANK YOU THAT THAT SOMEONE MAY
COME ONE COME BEFORE THE LINE SO
FOR THAT FIRST OF ALL AS I TYPE
THIS CERTAINLY IS A PEDIATRICIAN
AND AS CHAIR THIS COMMITTEE I BY
KNOWLEDGE THAT.
NOW I CHILDREN BUT WE HAVE --
DAHLE TO ART SENIORS TO WHO
CERTAINLY --
BOTH NEED AND RECEIVE --
THESE SERVICES --
BILLY FOR THIS HEARING WE KIND
OF BECAUSE WE HAVE MORE OF A
DEMOGRAPHIC FOCUS WE SORT OF
NARRATIVE MORE TOWARD SENIORS SO
I'D AT THAT THE PART OF THE
REASON DIVIDE DEVELOP SERVICES
WE DIDN'T EXACTLY INVITE THEM
BUT BECAUSE WE WERE HAD MORE AND
FOCUS ON THAT SO I JUST.
WANT TO SAY THAT BUT I ALSO
APPRECIATE YOU BRINGING THAT UP
AND AND CERTAINLY I PERSONALLY --
THAT LIKE KNOWLEDGE THAT --
THAT -- WE
RECOGNIZE THAT THIS IS ALSO PART
OF THE NEED FOR THE SERVICES AND
AND SO FORTH SO IT'S THE WORD
OUT OF WHAT WE COULD DO THAT BUT
THAT SEE THAT ISSUE AND THAT
PEOPLE.
NOW THAT THAT WE DIED I DO
UNDERSTAND THIS COMMITTEE DOES
UNDERSTAND THAT --
THAT'S ALSO ANOTHER VERY
IMPORTANT POPULATION THAT ALSO
IS GROWING --
AND THAT --
THAT --
REQUIRE --
THAT MANY OF THESE --
ALTI AS A SERVICES AND
APPRECIATE BRING THAT UP OKAY
THANK YOU.
WENT.
HELLO SENATOR MY NAME'S MIKE
MCCONNELL I'M REPRESENTING
COUNTY SOCIAL SERVICE AGENCIES --
I'VE WORKED FOR TWO COUNTIES I'M
CURRENTLY THE DIVISION DIRECTOR
FOR ADULTSSERVICES IN SANTA
CRUZ COUNTY WHICH IS A SMALLISH
MEDIUM SIZE COUNTY AND
PREVIOUSLY WITH RIVERSIDE COUNTY
WHICH IS A VERY LARGE COUNTY --
AND I'M HERE TO TALK ABOUT THE
ROLE THAT WE PLAY AND LONG TERM
SO --
SUPPORT SERVICES IN SPORTS --
WE DO THREE TWO MAIN PROGRAM SO
I HSS WHICH EVERYBODY'S TALKED
ABOUT QUITE A BEEN HERE BUT ONE
THAT HASN'T BEEN MENTIONED.
HIS ADULT PROTECTIVE SERVICES
ALL TALK A LITTLE BIT MORE ABOUT
THAT -- AS
YOU KNOW I HSS SERVICE LOW
INCOME ADULTS AND OUR SOCIAL
WORKERS DO ANNUAL ASSESSMENTS SO
THEY'RE SAYING --
OUR CLIENTS ONCE A YEAR SO
THAT'S THOSE SIX HUNDRED
THOUSAND CONSUMERS.
AND THEN OUR LOCAL PUBLIC
AUTHORITIES THEY AND ROLL
ORIENTED ENSURE PAYMENT FOR
ABOUT THE FIVE HUNDRED THOUSAND
AN IN HOME CARE GIVERS THE
PROVIDERS.
TOM FOR APS PS IS AN EMERGENCY
RESPONSE SYSTEM WAS SHORT TERM
CASE MANAGEMENT THAT SERVICES
THE SAME POPULATION BUT HAS NO
INCOME RESTRICTIONS --
AND I THINK PEOPLE OF MENTION
THAT L. T. S. S. AS A BIT OF A
FRACTURED SYSTEM.
WITH SERVICES SPREAD OUT OVER
ELIGIBILITY REQUIREMENTS AND THE
PEOPLE THAT FALL THROUGH THOSE
GAPS IN THE FRAGMENT USUALLY END
UP APS.
SO APS IS A BIT OF A BELLWETHER
FOR HOW EL TSS IS DOING --
FOR THE FIRST TIME EVER OF THE
NUMBER OF ACTIVE APS CASES HAS
EXCEEDED THE NUMBER OF CPAS
CASES IN OUR COUNTY SANTA CRUZ
COUNTY AND THE TRAJECTORY IS
ACCELERATING.
WITHIN THIS GROWING POPULATION --
THERE'S AND UNDERSERVED SUBSET
THAT I WANTED TO POINT OUT AND
THEY STRUGGLE WITH COGNITIVE
IMPAIRMENT. FOR EXAMPLE ADULTS
EXPERIENCING DEMENTIA BUT WITH
NO PRESENTING HEALTH OR MENTAL
HEALTH ISSUE --
AND THOSE DIAGNOSED WITH A
TERMINAL BRAIN INJURY OR
DEVELOPMENTAL DISABILITY AFTER
THE AGE OF EIGHTEEN THESE ADULTS
HAVE LITTLE OR NO ACCESS TO
HEALTH.
BEHAVIORAL HEALTH --
REGIONAL CENTER SAFETY NET SO
THEY COME TO THE ATTENTION OF A
PS.
HI TESTIS N. A. P. HAS WORKED
DILIGENTLY TO KEEP PEOPLE IN
THEIR HOMES AND COMMUNITIES AS
LONG AS POSSIBLE.
HIGHTAIL SAYS IN APS RELY ON
MULTI AGENCY COLLABORATION --
FOR EXAMPLE WE TEAM UP A LOT
WITH LAW ENFORCEMENT WITH OUR
LOCAL PUBLIC GUARDIANS AND
CONSERVATIVES WHICH IS ANOTHER
PROGRAM ADMINISTERED BY COUNTY --
AGENCIES SERVING THE SAME
POPULATION --
AND ONE STATE AND OF ATION --
THAT HAS WORKED IN THE
COORDINATION OF COURSE PEOPLE
HAVE MENTIONED CCI THE
COORDINATED CARE INITIATIVE --
THAT INCREASES COLLABORATION
BETWEEN THE HEALTH PLANS AND I
HSS I WAS WORKING FOR RIVERSIDE
COUNTY WHICH IS ONE OF THE
COUNTIES THAT IMPLEMENTED.
AND ARE I IT JUST CLIENTS
DEFINITELY BENEFITED FROM THAT
COORDINATION --
SO WE HAVE SOME RECOMMENDATIONS --
AND I'M WILLING TO GIVE UP TO
VALIDATE PARKING TO MEET SOME OF
THESE --
RECOMMENDATIONS --
SO THE THE GROWTH AND I IT JUST
SAYS WHAT YOU'VE HEARD ABOUT AND
HAVE BEEN PROJECTING A NAPKIN
SAYS IT'S ALSO WIDENING A GAP
BETWEEN THE PROGRAM COSTS
INCURRED BY THE COUNTIES AS THEY
PICK UP MORE AND MORE
RESPONSIBILITIES TO REALIGNMENT.
AND THE REALIGNMENT REVENUES ARE
NOT.
ABLE TO FILL THAT GAP AND MANY
CASES -- SO
WE URGE YOU TO REALLY IDENTIFY A
SUSTAINABLE --
FUNDING STREAM --
FOR HSS --
IN THE SPIRIT OF CC I WE SHOULD
EXAMINE AND AND ENCOURAGE
PROMISING PRACTICES THAT
STREAMLINE AND SIMPLIFY L. TSS
AND I THINK IF YOU GOT SOME OF
THESE GREAT MINDS TOGETHER WE
COULD REALLY LOOK AT THAT --
WE SHOULD RECRUIT AND PREPARE
AND SUPPORT A CARE GIVER
WORKFORCE TO MEET THE DEMAND FOR
IN HOME CARE SO I YOU KNOW I
TOTALLY UNDERSTAND WHAT YOU'RE
SAYING AND SUPPORT THAT --
WE NEED TO BRING A FOR A PS WE
NEED TO BRING STAKEHOLDERS
TOGETHER TO DEVELOP A PLAN. TO
BETTER SERVE THOSE WITH
COGNITIVE IMPAIRMENT OR
DIMINISHED CAPACITY.
BECAUSE THEY TEND NOT TO BE ABLE
TO EITHER BE AWARE OF LTE US
NAVIGATE L. T. S. US OR THE END
UP PLACING THEMSELVES AT RISK OF
ABUSE AND NEGLECT --
AND WE NEED --
TO APS A PROFESSIONAL WORK FORCE
WE NEED --
PERMNENT FUNDING FOR THE APS
TRAINING PROGRAM.
AND GRANDSON STIPENDS TO SUPPORT
GREASE AND GERONTOLOGY AN AGING
WHICH IS OF AVAILABLE FOR CHILD
WELFARE AND MANY OTHER FIELDS --
WE ALSO NEED TO CREATE THE
ABILITY FOR SOCIAL SERVICE
PROGRAMS LIKE APS TO PROVIDE
LONG TERM CASE MANAGEMENT SO AS
I MENTIONED THEY HAVE SHORT TERM
CASE MANAGEMENT.
THEY OFTEN FACILITATE --
CONNECTING THOSE ADULTS TO L.
TSS.
BOMB BUT FOR THOSE THAT ARE
UNABLE TO MANAGE THAT PROCESS
WITH LONG TERM CASE MANAGEMENT
WE CAN ASSIST WITHOUT FOR MOST
VULNERABLE.
AND HOUSING SUPPORTS AS WELL FOR
THOSE FOLKS THANK YOU.
PLEASE THE COLEMAN WITHOUT
CALCUTTA SO I I I KNEW I WAS
GOING TO BE AT THE END SO I
WROTE A LOT SO I COULD SCRATCH
OFF.
THANK YOU JUST DID IT WHEN DID
IT WHEN DID OUT --
AND THEN LIKE I DO I TAKE MY TWO
MINUTES TO TALK ABOUT STUFF OR
DO I ANSWER YOUR QUESTIONS
BECAUSE I COULD HAVE SOME OF
THOSE QUESTIONS THAT YOU HAD.
SO I GUESS THE OVER ARCHING
THING IS IT'S THE LACK OF
UNIFORMITY AND ACCESSIBILITY OF
THE SERVICES.
WE DON'T HAVE ENOUGH NO COST LOW
COST BUT MORE IMPORTANTLY SHARE
OF COSTS.
WE HAVE A LOT OF SYSTEMS THAT
ARE FOR PEOPLE THAT ARE
IMPOVERISHED WE DO NOT HAVE A
SUBSTANTIVE PROGRAM FOR THE
MIDDLE INCOME CALIFORNIANS.
AT A SHERIFF COST WHICH WHICH
WOULD SHARE THE BURDEN THAT THE
STATE IS PUTTING IN TOWARDS THE
MEDI CAL PROGRAMS.
OF WITH PEOPLE THAT HAVE THE
ABILITY TO PAY.
WE NEED TO HAVE UNIFORMITY IN
ALL REGIONS.
THIS IS A LIVING WAIVER LOVE
THAT PROGRAM FIFTEEN COUNTIES
BUT IS IT FAIR TO SAY THAT
CINEMA COUNTY COUNTS WITH ONLY
TWO SLOTS.
IS THAT REALLY SAYING THAT BACK
COUNTY IS REPRESENTED.
YES WE HAVE SEE BASS IN EVERY
PROGRAM BUT IT'S NOT.
WE HAVE GREAT.
CASE AND CARE MANAGEMENT
PROGRAMS THEY ARE AMAZING AND
WHAT THEY DO BUT THEY ARE NOT
ADEQUATELY RESOURCE AND MANY OF
THESE PROGRAMS ARE RESOURCE
BASED ON THE RECOMMENDATION OF
THE LOCAL TRIPLE WAY.
SO.
WE NEED SOME UNIFORMITY ACROSS
THE STATE SO THAT ALL OF OUR
CITIZENS HAVE ACCESS TO THESE
PROGRAMS IS IS HE SAID WE HAVE
PEOPLE THAT ARE LIVING IN HIGHER
LEVELS OF CARE.
NOT BECAUSE IT IS SOCIALLY
APPROPRIATE OR EVEN MEDICALLY
NEEDY IT'S BECAUSE IT'S WHAT'S
AVAILABLE.
AND A IT'S SO DIFFICULT TO
UNDERSTAND THE SYSTEM.
I CONSIDER MYSELF A PRETTY
KNOWLEDGEABLE PERSON ABOUT THE
SENIOR PROGRAMS AND YET EVEN
WITH MY KNOWLEDGE I SPENT HOURS
FRUITLESS FRUSTRATING HOURS ON
THE PHONE TRYING TO FIND
ASSISTANCE FOR MY MOTHER IN
LAW'S SISTER.
WHO CURRENTLY LIVES IN SOUTHERN
CALIFORNIA?
ULTIMATELY I HAD TO TAKE TWO
WEEKS OFF OF WORK OF TWO MONTHS
TO GO DOWN AND DO THIS IN PERSON
BECAUSE YOU JUST CAN'T DO IT
OVER THE PHONE [inaudible]
AND EVERY FEW MONTHS I STILL
HAVE TO GET BACK IN THE CAR
BECAUSE CARE PLANS ARE NOT ONE
AND DONE WHEN YOU'RE LOOKING AT
PEOPLE'S NEEDS CHANGING.
MY ANSWER RESOURCES SHE'S
CURRENTLY GOING IN THE HOLE BY A
COUPLE HUNDRED DOLLARS EVERY
MONTH.
AND MY UNDERSTANDING OF THE
DISEASE PROCESS SHE'S GOING TO
OUTLIVE HER RESOURCES PROBABLY
BY EIGHTEEN MONTHS.
SO WHAT AM I GOING TO BE DOING.
I'M GOING TO BE LOOKING TO PUT
HER INTO A SKILLED NURSING
FACILITY THAT ACCEPTS MEDICARE.
NOT BECAUSE SHE IS NOT
APPROPRIATE IN THE CARE SHE'S.
CURRENTLY RECEIVING GETS GREAT
CARE THERE.
BUT BECAUSE ULTIMATELY I'M GONNA
RUN OUT OF MONEY [inaudible]
SO.
IT'LL THE CARE GIVING
PROFESSIONAL WORK FORCE.
INCENTIVIZING GERONTOLOGY --
ETHNOLOGY ING AMAZING PROGRAMS
YOUR BACK BACK OF A NAPKIN
NUMBERS SO IF WE GOT FIVE
MILLION SENIORS THAT ARE OVER
THE AGE OF SIXTY FIVE AND THE LA
WROTE A REPORT SAID IN TWO
THOUSAND FIFTEEN WE HAD A
MILLION SENIORS WITH AT LEAST
ONE EIGHTY L..
THEN THAT MEANT BY.
TWENTY THIRTY AND WE'RE ONLY
FORTY FIVE DAYS AWAY SO IT'S
ELEVEN YEARS I DON'T TALK TWENTY
SIXTY THINK IT'S TOO FAR AWAY
ELEVEN YEARS FROM NOW WE'RE
GOING TO GO FROM A MILLION. TO
ONE POINT.
SEVEN FIVE THAT.
CURRENTLY WE'VE GOT THREE
HUNDRED THOUSAND BEDS WE GOT A
HUNDRED THOUSAND SKILLED TWO
HUNDRED THOUSAND ASSISTED LIVING
WE'RE LOSING ASSIST A SKILLED
NURSING BEDS WE ARE GAINING
ASSISTED LIVING THAT'S SO IF YOU
TOOK.
THE ONE MILLION. EIGHTY ELS WITH
THREE HUNDRED THOUSAND BEDS.
AND YOU DO THE MATH AT ONE POINT
SEVEN FIVE MILLION EIGHTY ELSE
THAT'S GOING TO MEAN YOU'RE
GONNA NEED AN ADDITIONAL SIXTY
FIVE THOUSAND SKILLED NURSING
BEDS.
AND AN ADDITIONAL HUNDRED AND
THIRTY FIVE THOUSAND ASSISTED
LIVING THAT'S I THINK THE GROWTH
IS GOING TO BE IN THE ASSISTED
LIVING THAT BUT I THINK IT'S
GOING TO BE IN PLACES.
BETTER NOT WHERE PEOPLE HAVE
GROWN.
DO YOU LIVE IN A COMMUNITY ALL
OF YOUR LIFE AND THEN YOU
DISCOVER THAT YOU CAN'T AFFORD
YOUR INCOME HAS BEEN OUTPACED
WITH THE COST OF TWENTY FOUR
DOLLARS AN HOUR FOR IN HOME CARE
OR THREE TO SIX THOUSAND OR TEN
THOUSAND DOLLARS A MONTH.
PERSISTED LIVING SO THE GROWTH
IN THESE --
ASSISTED LIVING FACILITIES ARE
LIKELY TO BE IN COUNTIES THAT
ARE LOWER INCOME --
AT THE ELDORADO OMBUDSMAN IS
HERE TODAY IN EL DORADO COUNTY
THEY HAVE LESS THAN A THOUSAND
BEDS CURRENTLY.
BUT CCL IS IN THE PROCESS OF
EXCEED RECEIVING --
I BELIEVE UP TO FIVE HUNDRED
ADDITIONAL BEDS BECAUSE FULSOME
HAS NOW JUMPED FIFTY AND WE'RE
NOW DEVELOPING ON THE SOUTH SIDE
OF FIFTY FIVE HUNDRED NEW BEDS
[inaudible]
IN [inaudible]
OF AT SO I'M IS THE THE
POLLYANNA THAT SAYS WERE
ACTUALLY CLOSER TO THE SOLUTIONS
THAN YOU THINK.
IF WE ACTUALLY RESOURCE THE
PROGRAMS THAT ARE IN THE OLDER
CALIFORNIANS ACT WE BRING BACK
THE PROGRAMS THE LINKAGES WE WE
EXPAND THEM.
RESOURCE THEM YOUR 5% EVERY YEAR
IS GREAT BUT IT'S MAKING A
FAULTY ASSUMPTION THAT WE ARE
CURRENTLY FUNDING THEM
APPROPRIATELY.
SO IF YOU PUT A ZERO BEHIND
EVERYBODY'S BUDGET NEXT YEAR I
THINK WE COULD START WITH THAT.
AND THEN WE'LL WORK WITH OUR 5%
AFTER THAT.
AND I TO WILL GIVE UP MY VOUCHER
PARKING VOUCHER IF WE ADD THE
EXTRA --
ZERO AND AND JUST TO SAY CHALCO
IS SO EAGER TO BE A PARTNER IN
THIS AND JUST THANK YOU CHAIR
FOR HOLDING THIS HEARING.
THANK YOU --
WHAT WE'LL SEE WHAT THE GOVERNOR
JANE?
BUT AT THE ZERO OR THAT. TO
START WITH BUT WILL.
GOOD AFTERNOON I'M SUSAN TO
MORRIS REPRESENTING THE
ALZHEIMER'S ASSOCIATION AND I
WANT TO THANK YOU SENATOR PAN
FOR INCLUDING.
THE PERSPECTIVE OUR OF OUR
ORGANIZATION ON THIS PANEL --
WE KNOW THESE ISSUES VERY WELL
OVER THE LICENSE LIFE COURSE OF
ALZHEIMER'S DISEASE ARE
CONSTITUENTS TOUCH ON EVERY
SINGLE DEPARTMENT EVERY PROGRAM
AND EVERY SERVICE.
AND WE ALSO INTERACT WITH EVERY
JOB TYPE FROM AN ON LICENSED
HOME CARE WORKER THROUGH A
NEUROLOGIST AND GERIATRICIANS
SPECIALTY PHYSICIANS --
WE HEAR DALY ABOUT THE PRESSURE
POINTS IN OUR SYSTEM AND IT'S A
SAD SAD BUT TRUE REALITY FOR
MANY FAMILIES THAT WHEN A LOVED.
ONE IS FINALLY PLACED IN HOSPICE
OR PALLIATIVE CARE THEY HAVE
ENORMOUS RELIEF THAT THEIR LOVED
ONE IS FINALLY RECEIVING.
WHOLE PERSON CARE --
BY AN INTERDISCIPLINARY AN
INTEGRATED TEAM THAT'S LOOKING
AT THEIR THEIR MEDICAL AND
SOCIAL NEEDS.
IN DEVELOPING A STATE PLAN FOR
AGING WE HOPE WE CAN INTERVENE
MUCH EARLIER AND GET IT RIGHT
LONG BEFORE END OF LIFE CARE IS
NEEDED. FOR THE SECOND TIME I
WANTED TO FOCUS ON JUST TWO
TOPICS OUTCOMES AND OUTPUT --
IN TERMS OF OUTCOMES OUR CURRENT
SYSTEM IS PRODUCING THESE
RESULTS.
TODAY ONLY 45% OF PERSONS WITH
ALZHEIMER'S HAVE AN ACCURATE
DIAGNOSIS.
DOCUMENTED IN THEIR MEDICAL
RECORD THAT FOLLOWS THEM ACROSS
ALL OF THE SETTINGS AND PROGRAMS.
MEDICAID SPENDING WE WE HEARD
THE QUESTION HOW MUCH ARE WE
SPENDING ON L. TSS WE KNOW THAT
WE SPEND TWENTY THREE TIMES MORE.
FOR EVERY BENEFICIARY WITH
ALZHEIMER'S THAN WE DO FOR THE
AVERAGE SENIOR.
AND THIS YEAR CALIFORNIA WILL
SPEND FOUR BILLION ON MEDICAID
ON ALZHEIMER'S SERVICES ALONE.
IN THE MEDICARE PROGRAM AND AS
ONLY POINTED OUT.
ONLY ONE IN FOR SENIORS QUALIFY
FOR MEDI CAL SO WITHIN THE
ALZHEIMER'S POPULATION THAT
EQUATES TO ONE HALF FIVE HUNDRED
THOUSAND OR HALF A MILLION.
CALIFORNIANS WITH ALZHEIMER'S
WHO ARE NOT ON MEDI CAL --
THE LACK OF AVAILABLE ACCESSIBLE
AND AFFORDABLE HOME AND
COMMUNITY BASED SERVICES.
DRIVES EMERGENCY ROOM USE AND
HOSPITAL READMISSIONS.
WE DON'T HAVE THE DIRECT
COROLLARY --
BUT FOR EVERY ONE PERSON WITH
ALZHEIMER'S IN CALIFORNIA.
THERE IS A ONE AND ONE HALF ER
VISITS A YEAR SO WE ARE HIGH
USERS OF THE OUR SERVICES.
AND WE ALSO KNOW THAT AFRICAN
AMERICANS LATINOS SOUTHEAST
ASIANS AND WOMEN ARE
DISPROPORTIONATELY IMPACTED BY
THIS DISEASE.
AT THE RATE OF ONE AND A HALF TO
TWO TIMES CAUCASIANS.
WE WOULD URGE THIS COMMITTEE.
LEAPING TO SOLUTIONS AND THE
ADMINISTRATION. TO ADOPT PUBLIC
HEALTH STRATEGIES TO ASSESS PLAN
INTERVENE AND EVALUATE OUTCOMES.
THAT'S ANOTHER DEPARTMENT THAT'S
MISSING AT THE TABLE AND THEY
HAVE A GREAT TRACK RECORD --
IN PLANNING FOR POPULATION
HEALTH AND THIS IS A POPULATION
IS A LARGE POPULATION AS WE'VE
HEARD.
IN TERMS OF OUTPUT I JUST WANTED
TO SHARE. ONE FOLDER WITH SCOTT
STAFF --
JUST OF THE ALZHEIMER'S REPORTS
THAT HAVE BEEN DONE IN THE LAST
DECADE IN OUR STATE --
INCLUDING A LEWIN GROUP REPORT
SPENDING --
AND AS YOU KNOW DOCTOR PAN WERE
ABOUT TO RECEIVE A REPORT ON THE
HEALTH CARE WORKFORCE THAT ALL
OF US ARE WAITING ON THAT WILL
HAVE SOME IMPORTANT UPDATES. ONE
OF THE PLANS IN THIS FOLDER IS
CREATING IS THE STATE
ALZHEIMER'S PLAN --
IT WAS DEVELOPED TO GOVERNOR'S
AGO AND WORLD WILL NOW BE
SHARING IT WITH THE THIRD
GOVERNOR AND THE NUMBER ONE GOAL
IS TO CREATE A COORDINATED STATE
INFRASTRUCTURE.
THAT ENHANCES THE DELIVERY OF
CARE.
WE HAVEN'T YET ACHIEVE THAT GOAL
IT WAS THAT IN TWENTY ELEVEN
THAT PLAN EXPIRES AND TWENTY
TWENTY ONE AND OUR VISION IS.
CALIFORNIA'S MASTER PLAN FOR
HIGHER EDUCATION ISN'T --
A BOOKLET OR A BINDER THAT SITS
ON A SHELF IT'S A FRAMEWORK FOR
DELIVERING SERVICES.
AND WE ENVISION A SIMILAR
FRAMEWORK FOR AGING POPULATION --
WERE ENCOURAGED BY THIS HEARING
WERE EXCITED BY NEW ENERGY.
AND LEADERSHIP BY YOU AND BY THE
INCOMING GOVERNOR.
AND WE LOOK FORWARD TO WORKING
WITH YOU IN THE FUTURE.
RIGHT WELL I WANT TO THANK ALL
OF YOU FOR YOUR PRESENTATIONS --
I THINK THERE'S WELL MAYBE YOU
CAN THINGS I THINK WE HEAR SOME
VERY CONSISTENT THEMES THAT --
GONNA ASK THE AGENCIES TO
COMMENT ON IF.
THEYGROW WE TALK ABOUT --
THE YES TO THINGS.
OF THE GENTLEMAN FROM THE
DEPARTMENT OF FINANCE SAID THAT
VA DO NOT FORECAST RATES OF
GROWTH FOR PEOPLE WITH
DISABILITIES AND I WAS JUST
WONDERING WHY THAT IS --
RELATIVE TO PEOPLE AGING
POPULATION AND THEN SECONDLY THE
ELLIE -- DID
DO A REPORT ON THE COST SAVINGS
OF AYE AGES SAYS FIRST IS MORE
EXPENSIVE CARE BUT THAT WAS A
VERY LONG TIME AGO.
SO I THINK IF THE LEGISLATOR
SUCH AS YOURSELF DOCTOR PAN
REQUESTED AN UPDATE ON THAT
REPORT --
YOU EAT I I GUESS.
FORMALLY REQUESTED I THINK THAT
WOULD BE VERY VERY HELPFUL THANK
YOU OKAY.
THANK YOU I THINK I DID --
DE AGENCIES BUT I WOULD ALSO
URGE.
LA -- TO
LOOK TO TO TO TO RE EXAMINE AN
UPDATE TO TO REPORT AND I SEE MY
CHALLENGED BOTH THE LA --
INTO THE STATE AGENCIES IS TO
AND SO THAT WE HAVE THAT
INFORMATION --
SO I WOULD SAY THAT NOW I THINK
ONE IS THAT WE WE HAD THREE
BEGINNING ISSUES AROUND DATA
THINKS HERE ABOUT FRAGMENTATION
NEED FOR GREATER COORDINATION --
WORK FORCE A BIG ISSUE I A I
KNOW THAT ONE LEVEL OF COURSE WE
FOR FOR THE AGENCIES THEY TALK
ABOUT THE CO COST PRESSURES OF
IN A RAISING THE WAGES SO FORTH
BUT I THINK.
CUTS SAME TIME --
VISIT ROOM POINTED OUT YOU NEED.
PEOPLE WHO ARE ANY THIS IS HARD
WORK ANYONE IS DOING IS EVER
DONE CARE WORK THIS IS
CHALLENGING WORK AND AND YOU YOU
NEED TO BE ABLE TO ATTRACT
PEOPLE AND WE CAN ALWAYS COUNT
ON PEOPLE JUST TO DO IT YOU KNOW.
TO TO DO IS A CELL SACRIFICE
RIGHT IN THE FACE OF THE FORTY
THAT'S THE WAY WE HAVE HANDLED.
THIS ISSUE RIGHT FROM FAMILY
MEMBERS AND OTHERS RIGHT AND I
THINK WE HAVE TO FIGURE OUT HOW
TO STEP UP ON ON ON THAT AS WELL
SO.
THE AND SO --
I WILL ITS AGAIN WHY THANK YOU
ALL FOR YOUR PRESENTATIONS AND
WE DISCUSS AND TAKING NOTES SO
FOR ALL THOSE DOWN THERE AND
WOLF -- AND
CERTAINLY --
HOPE TO FOLLOW UP ON THAT SO
THANK YOU EXTRA MUCH THANK YOU.
OKAY SO I'M GONNA DO NOW IS --
WILL TAKE --
PUBLIC COMMENT THEN WHY ASK THE
AGENCIES JUST A STEP BACK UP
HERE -- FOR
SO I THINK WE'LL TAKE PUBLIC
COMMENT ON THAT MICROPHONE.
CORD THERE.
HELLO QUE.
OF SORRY.
ALL OF THE AREA --
IF [inaudible]
FIVE FATE [inaudible]
IN.
SO IT ASKS THE NEED --
THAT IF SOMEONE SAID THAT BEFORE
YOU CAN SAY ME --
TO THAT WORKS.
OUT SO IF GUY --
SO -- AND
DOES ASK THAT YOU TRY TO KEEP
KEEP THIS FREE SO WE HAVE
SOMETIME FOR THE AGENCIES
RESPOND AS WELL SO --
I'M GONNA PUT A RING GENERAL TRY
TO KEEP IT WITHIN A MINUTE I
REALIZE WE HAVE A LOT AT SEIZE
COVER BUT BASICALLY YOU CAN MAKE
REFERENCE TO OTHER PEOPLE'S
TESTIMONY HE SAID YOU'RE NOT
ALLOWED RATE ON THAT.
OKAY SO WITH THAT HAVE PLEASE
SAY SO YOUR NAME ANY
ORGANIZATION YOU'RE REPRESENTING
IF YOU ARE AND APPRECIATE YOUR
COMMENTS SO WELCOME.
ADJUSTING HERE WITH THE
CALIFORNIA STATE ASSOCIATION OF
COUNTIES JUST WANT TO THANK YOU
FOR THIS HEARING TODAY AND BRING
ATTENTION TO THIS ISSUE THIS
REALLY WOULD REINFORCE.
OTHER TESTIMONY FROM MIKE
MCCONNELL SANTA CRUZ COUNTY --
COUNTIES HAVE A CRITICAL ROLE IN
INTO THIS POPULATION AND WE LOOK
FORWARD TO BEING A PARTNER --
WITH THE STATE AND LEGISLATURE
AS AS THESE CONVERSATIONS BEFORE
THANK YOU [inaudible]
WELCOME.
DEBORAH ROTH WITH DISABILITY
RIGHTS CALIFORNIA THANK YOU VERY
MUCH CHAIRMAN PAN.
FOR HAVING THIS HEARING LIKE
MANY OTHERS WE'VE NOTED THAT ARE --
ORGANIZATION HELPS PEOPLE WITH
DISABILITIES OF ANY AGE WON'T GO
ANY ANY MORE THAN THAT ON THAT
ISSUE TALK TO SCOTT ABOUT IT.
I WOULD LIKE TO POINT OUT I
DON'T THINK I HEARD ANYBODY
MENTION THE U. S. SUPREME
COURT'S OLMSTEAD DECISION.
AND THAT'S SOMETHING THAT REALLY
GUIDES US BECAUSE IT IS ABOUT
PROTECTING AN INDIVIDUAL'S RIGHT
TO CHOOSE WHERE THEY WANT TO
LIVE.
AND THAT IF FATE RECEIVE
SERVICES THEY'RE REQUIRED TO BE
IN THE LEAST ARE IN THE MOST
INTEGRATED SETTING WHICH IS
GENERALLY THE LEAST RESTRICTIVE
ENVIRONMENT PEOPLE WANT TO BE AT
HOME.
AND SO THE FINAL S. IN L. TSS
SUPPORTS IT'S NOT JUST CARE
GIVING.
IT SOMETIMES CAN BE OTHER KINDS
OF YOU KNOW HOUSING ADJUSTMENTS
TO HELP PEOPLE ACHIEVE THAT
INDEPENDENCE [inaudible]
YOU.
WELCOME DISMISSED CHAIRED GIRL
COACH WITH THE AREA AGENCIES ON
AGING WE ALSO APPLAUD YOUR
EFFORTS AND LOOKING AT THE
DEMOGRAPHICS AND THE IMPLICATION
AND HAS SOME PLANNING AND
BUDGETING.
BUT WE NEED TO RECOGNIZE THAT
SERVING OLDER AND DISABLED
PERSON GOES BEYOND EL TSS.
IT'S A VERY LIMITED DEFINITION.
AND WE SHOULD BE LOOKING AT TO
HELP. FOR A HELD HIS SAYS SHOULD
INCORPORATE HOME COMMUNITY BASED
SERVICES.
THESE ARE THESE ARE PROGRAMS
THAT ARE OUTLINED IN THE OLDER
AMERICANS ACT IN THE OLDER
CALIFORNIANS ACT.
OUR EFFORTS IN THE COMING YEARS
GOING TO BE LOOKING AT DOING.
A DEVELOPING A MASTER PLAN ON
AGING WHICH WE THINK LED TO WHAT
YOU'RE GONNA LEARN HERE.
CAN ACTUALLY PLAY INTO THAT AND
ALSO --
LOOKING AT THE RISK CALIFORNIANS
ACT IN THE DEPARTMENT OF AGING
[inaudible]
THE WE'RE GOING TO ALSO IS
CRISTINA I THINK MENTIONED
EARLIER ADVOCATE FOR THE CONCEPT
OF THE WRONG DOOR --
CON HIM POLICY --
WE ALSO LOOK FORWARD TO WHAT THE
OUTCOME OF THIS.
A HEARINGS GONNA BE AND LOOK
FORWARD TO WORKING WITH YOU AND
YOUR STAFF [inaudible]
THANK YOU.
WELCOME THANK YOU.
JANET HEATH MULTIPURPOSE SENIOR
SERVICE PROGRAM SIDE ASSOCIATION
THANK YOU FOR HOLDING THIS
HEARING TODAY WE REALLY
APPRECIATE THE TIME THAT YOU'VE
TAKEN TO LISTEN TO OUR CONCERNS --
ONE THING THAT WAS MENTIONED IS
THAT MANY OF THE WAIVER PROGRAMS
ARE COST NEUTRAL OR COST SAVING
AND I THINK THAT'S A BIT
MISLEADING.
BECAUSE THAT WE FIND WITH OUR IN
MISSISSIPPI PROGRAMS AS A HOST
AGENCIES ARE OFTEN.
OF CHIPPING IN.
CONSIDERABLE AMOUNTS OF MONEY TO
KEEP THE PROGRAMS ALIVE AS MUCH
AS A MILLION DOLLARS IN ONE CASE
IS BEING SHIPPED IN BY HOST
AGENCY.
AN EXAMPLE OF HOW THAT'S WORKING
FORCES TEN OF OUR CONTRACTORS AS
25% OF OUR CONTRACTS HAD TO GIVE
UP THE CONTRACT BECAUSE THEY
COULD NO LONGER SUPPLEMENT THE
PROGRAM.
IN ALL THIS IS DUE TO HAVING
SEEN NO INCREASES IN THIRTEEN
YEARS AND AND EXPERIENCING TO
CUTS.
SO A TO TAKE THAT INTO
CONSIDERATION WHEN YOU HEAR COST
NEUTRAL COST SAVINGS HAS NOT
TRULY WHAT'S GOING ON THANK YOU.
THANK YOU.
WELCOME.
HELLO MY NAME IS LOUIS
BROWNSTONE I AM THE CHAIRMAN OF
CALIFORNIA LONG TERM CARE
INSURANCE SERVICES.
AND I COME HERE NOT BECAUSE I I
REPRESENT MY AGENCY.
BUT BECAUSE I'M A CONCERNED
CITIZEN AND I AM VERY WORRIED
ABOUT THE HUGE COST THAT MEDI
CAL IS GOING TO INCUR IN FUTURE
YEARS -- OF
BECAUSE OF THE DEMOGRAPHICS THAT
YOU'VE HEARD.
I THINK THE HIDDEN THING THAT
COULD CHANGE THIS IS INSURANCE
RIGHT NOW INSURANCE HAS DONE A
VERY BAD JOB.
OF PENETRATING UP CALIFORNIA
CITIZENS IN IS REALY ONLY
SERVING ABOUT THE TOP 10% OF THE
POPULATION.
THE BOTTOM 50% MUST RELY ON
MEDICARE ALL BUT IT'S THE GROUP
IN BETWEEN THAT COULD BE
SEARCHED BY INSURANCE AND
THERE'S BEEN A RECENT BILL
PASSED S. B..
TWELVE FORTY EIGHT AND SIDE BY
THE GOVERNOR EIGHT WEEKS AGO
THAT ESSENTIALLY GIVES THE
PARTNERSHIP FOR CALIFORNIA --
THE CALIFORNIA PARTNERSHIP FOR
LONG TO OFFER PLANS FOR PEOPLE
WITH MODERATE INCOME AND ASSETS
WHICH COULD SAVE MEDI CAL
BILLIONS BILLIONS.
OVER THE NEXT THIRTY YEARS.
AND I'D LIKE TO TALK WITH YOU
AND ANOTHER TIME IN AND EXPLAIN
FURTHER ABOUT THIS.
THANK YOU.
THANK YOU [inaudible]
WELCOME.
HELLO AND THANK YOU SENATOR PAN
FOR THIS OPPORTUNITY I'M SCARLET
HUGHES I'M THE EXECUTIVE
DIRECTOR FOR THE CALIFORNIA
STATE ASSOCIATION OF PUBLIC
ADMINISTRATORS PUBLIC GUARDIAN
SOME PUBLIC CONSERVATORS.
AND OUR MEMBERS REPRESENT WE
REPRESENT THE PUBLIC GUARDIAN
CONSERVATIVES WHO ARE APPOINTED
BY THE COURT TO TAKE
RESPONSIBILITY FOR BASICALLY
ELDERS WHO ARE SEVERELY DISABLED
AND CAN'T MAKE ANY DECISIONS FOR
THEMSELVES.
WE TAKE CONTROL OF ALL OF THEIR
ASSETS AND ALL THEIR MEDICAL
DECISION MAKING EMPLACEMENT.
AND OUR MEMBERS THE PROBABLY THE
TWO BIGGEST ISSUES THAT THEY'RE
STRUGGLING WITH IS PLACEMENT --
WE WIND UP WITH GETTING
REFERRALS FROM.
ACUTE CARE HOSPITALS USUALLY AND
THERE'S A BACKUP IN THE QUEUE
CARE HOSPITAL SYSTEM LOOKING FOR
A PLACEMENT FOR SOMEONE A
RESPONSIBLE PARTY TO PER SIGN UP
PERSON IN.
AND SO OUR MEMBERS GET A LOT OF
PRESSURE TO CONSERVE SOMEONE
SIMPLY TO PLACE THEM IN A
FACILITY SOMEWHERE.
AND IN SOME OF OUR COUNTIES THE
PUBLIC GARDEN CONSERVATIVES ARE
SO UNDERSTAFFED THEY CAN'T TAKE
THOSE CASES SO THE ACUTE CARE
HOSPITALS GET BACKED UP.
IN THE OTHER ISSUE THAT WE ARE
SEEING IS A DRAMATIC INCREASE
AND THE ELDER ABUSE CASES THAT
WERE RECEIVING FINANCIAL FUNDS
THERE'S A TREMENDOUS AMOUNT OF
MONEY.
TRANSFERRING WITH THE CURRENT
BABY BOOMERS FROM THERE AT ALL
THEIR ASSETS ARE GOING ARE
BECOMING AT RISK BECAUSE OF THE
INCREASE AND ELDER ABUSE SO
THOSE ARE THE TWO BIGGEST THINGS
THAT WE'RE SEEING IN THE ELDER
POPULATION.
THANK YOU YOU.
WELCOME THE GOOD AFTERNOON IN A
WIDER HARM ON A OR P. CALIFORNIA
I STOOD IN SUPPORT.
OF THE COMMENTS FROM OUR
PARTNERS SO CALIFORNIA AGING AND
DISABILITY ALLIANCE.
THE WRONG DOOR COALITION.
I KNOW THAT THIS HEARING IS AN
ABOUT SOLUTIONS BUT I DO WANT TO
TOUCH ON A COUPLE THINGS THERE
ARE P. L. A. R. P..
IS INTO TO INSTITUTIONAL
AFFILIATE FOR THE WORLD HEALTH
ORGANIZATION AGE FRIENDLY
COMMUNITIES AND WE ARE CURRENTLY
WORKING WITH OVER TWENTY LOCAL
MUNICIPALITIES AND COUNTIES.
ON AGE FRIENDLY DESIGN WHY
BECAUSE PEOPLE WANT TO STAY IN
THEIR OWN HOME AND COMMUNITIES.
WE THINK THAT AGE FRIENDLY WOULD
ACTUALLY BE A A NICE PIECE OF A
LARGER MASTER PLAN ON AGING.
WHAT I ALSO WANT TO SAY IS
CALIFORNIA SHOULD BE LEADING ON
THE ISSUE OF LONG TERM CARE
INTEGRATION?
ON A MASTER PLAN EVERY THREE AND
IN A R. P. YOU DO OUR REPORT --
CALL THE LTE HAS A SCORE CARD
CALIFORNIA RANK NICE.
WE COULD DO BETTER I REALLY DO
THINK THAT'S GREAT BUT WE COULD
BE DOING BETTER WE HAVE STATES
LIKE WASHINGTON COLORADO WHICH
INCORPORATED AGE FROM THE
CONCEPT AND EVEN IN OUR OWN
STATE WE HAVE SAN FRANCISCO.
THAT HAS LED THE WAY IN TERMS OF
HOW DO WE BETTER INTEGRATE
SERVICES. TO NOT JUST COVER.
A LOWER INCOME INDIVIDUALS BUT
ALSO OR MIDDLE CLASS WHO OFTEN
ARE LEFT OUT OF PROGRAMS.
SO I JUST WANT TO THANK YOU
AGAIN FOR TAKING THE LEAD AND
PULLING HIS TOGETHER AND THANK
YOU FOR LISTENING TO MY COMMENTS.
THANK YOU.
WELCOME.
THANK YOU SENATOR PAN MY NAME IS
KATHERINE DRIVER AND I AM THE
SENIOR SERVICES PROGRAM
COORDINATOR AS WELL SO --
SORRY SENIOR SERVICES PROGRAM
MANAGER AND MOTHER LOW LONG TERM
CARE OMBUDSMAN PROGRAM
COORDINATOR --
WE COVER FOR COUNTIES AMADOR
CALAVERAS.
THE INTERPOL ME ALL RULE
FORESTED AREAS --
I USED TO CALL US --
SAY THAT WE LIVE IN THE BY FIRE
ZONE BUT AFTER THE LAST SEVERAL
FIRES WE KNOW THAT IT'S NOT JUST
HAPPENING IN OUR RULED MOUNTAIN
AREAS.
WITH THAT SAID IT'S VERY
IMPORTANT THAT WE CONTINUE TO
WORK IN STRENGTHENING.
OUR IN OUR RELATIONSHIPS WITH
OUR PARTNERING AGENCIES ALTHOUGH
WE DO OVERLAP WE DO VERY
DIFFERENT THINGS --
AND WE'VE FOUND I THINK THAT WE
HAVE BEEN SUCCESSFUL IN OUR AREA
WORKING WITH ADULT PROTECTIVE
SERVICES WORKING WITH COMMUNITY
CARE LICENSING I'VE HAD TO WORK
WITH COMMUNITY CARE LICENSING
SEVERAL TIMES ON TWO FIRES.
IMPACTING TO WORK COUNTIES AND
IT WAS A GREAT WORKING
RELATIONSHIP --
AND WE WERE ABLE TO DO WHAT
NEEDED TO BE DONE --
SO I JUST WANT WE NEED TO FOCUS
ON HOW WE CAN WORK TOGETHER. TO
PROVIDE THE SERVICES THAT OUR
ELDERS NEED --
AND MOVE FORWARD IN A REALLY
GOOD WAY THANK YOU [inaudible]
YOU [inaudible]
WELCOME.
HELLO MY NAME IS MELISSA
FLAHERTY FROM THE STANISLAVSKY
PROGRAM.
THANK YOU US IN TO PAMPER
RECOGNIZING THAT THERE'S A LOT
OF DATA THAT'S BEEN COLLECTED
WE'VE HEARD BOARD STAY IN OUR
PRESENTATION SUCH AS STUDIES
DONE FINDINGS THAN.
A STRUCTURE DONE DATED DâN A
SURVEYS COMPLETED.
UP PROJECTIONS.
AND FOLLOWING WITH THAT.
MODUL RATES IDENTIFYING AND GOOD
LEAD LITERATURE A STRATEGIC.
WITH THAT SAID I DON'T FEEL LIKE
WE NEED TO GO FORWARD OR DELAYED
THE ACTION.
WE NEED TO CONTINUE THE PLANNING
WORK WE NEED TO WORK
COLLABORATIVELY WITH.
UP EXISTING PROGRAMS AND
RESOURCES THAT WE HAVE AVAILABLE
THANK YOU [inaudible]
YOU.
WELCOME.
THANK YOU DOCTOR PAN JET HAMPTON
REPRESENTING LENI AGE CALIFORNIA
WE'RE TERRY SAYS ATION
REPRESENTS OVER SIX HUNDRED NOT
FOR PROFIT PROVIDERS OF SENIOR
FOR A HOUSING.
HOME TO BE A SERVICES ASSISTED
LIVING SKILLED NURSING CARE
THROUGHOUT THE STATE --
THERE'S NOT MUCH ELSE TO SAY
THAT QUICK THINGS AND AND RE
FROM THEM --
ONE THAT MY COLLEAGUES --
MATT ROBSON FROM THE
COMPENSATION IN HEALTH STUDIES
INTERESTING ABOUT HIM WITHIN A
FEW TO BE MENTIONED WORKFORCE IS
CRITICAL IT'S A HUGE ISSUE AND I
KNOW I KNOW YOU KNOW THAT ON
THAT THAT'S SOMETHING THAT.
AS WERE LOOKING INTO THE FUTURE
HAS TO BE.
CREEK CRITICALLY EXAMINED --
AND HOW WE MOVE FORWARD BECAUSE
WORKFORCE --
THE WERE FIRST CRISIS THE RULING
THROUGH AN IN HEALTHCARE SECTOR
IS VERY REAL AND ALL THE
PROVIDERS ACROSS THE STATE ARE
FEELING IT.
SECONDLY I I ALSO WANTED TO TO
AGAIN HIGHLIGHT THE FACT LOOKING
AT THE MIDDLE CLASS IN THE STATE --
IN RELATION TO THE SERVICES
PROVIDED.
ALL THOSE ARE ALL OF OUR
PROVIDERS KNOW OUT THERE ON THAT
SPEND DOWN IS A VERY REAL THING.
AND THAT --
THERE REALLY IS NO OPTION TO PAY
FOR THE SERVICES FOR THE MIDDLE
CLASS IT'S VERY MUCH FOR THE 1%
AND THOSE WHO WHO QUALIFY FOR
MEDI CAL WE DO THINK THAT THERE
NEEDS TO BE SOMETHING THAT NEEDS
TO HAPPEN TO ADDRESS THAT ISSUE --
KNOWLEDGE TO EITHER PREVENT OR
DELAY SPEND DOWN BUT UNDER THE
UNDERSTANDING GIVE THAT THESE
FILMS ARE VERY REAL CHANCE OF
ACTUALLY PAYING FOR THE SERVICES
OR CONTRIBUTING TO THE PAYMENT
OF THE SERVICES AS THEY MOVE
FORWARD TO AGAIN THANK YOU VERY
MUCH.
FOR HOLDING THIS HEARING TODAY
REALLY APPRECIATED.
THANK YOU [inaudible]
WELCOME.
HI DOCTOR PAN I'M GERRY PASSPORT
PRESIDENT THE CONGRESS OF
CALIFORNIA SENIORS.
AND IN FACT NEXT MONTH'S
DECEMBER MARK HERE IN THIS AREA
AND I'VE GOT TO SAY THAT OVER
THESE EIGHTEEN YEARS THIS HAS
BEEN.
THE MOST PRODUCTIVE AND I THINK
HONEST HEARING I'VE ATTENDED.
ALL AND I THANK YOU FOR THAT I
THANK YOU FOR YOUR LEADERSHIP IN
HELPING US GET MONEY. TO TO DO
THE RESEARCH NECESSARY WITH
CHEST LAST YEAR AND I LOOK
FORWARD VERY STRONGLY WORKING
WITH THE NEW GOVERNOR.
AND HOPE YOU DO TOO AND COMING
UP WITH SOME SOLUTIONS TO THE
INTRACTABLE PROBLEMS WE'VE HEARD
ABOUT TODAY.
THANKS [inaudible]
THANK YOU.
YOU'RE WELCOME GOOD MORNING I'M
DEBBIE JOHNSTON AND I SERVE WITH
THE EL DORADO COUNTY LONG TERM
CARE OMBUDSMAN PROGRAM.
THE NUMBER ONE COMPLAINT THAT
WE'VE MANAGED OVER THE PAST YEAR
HAS BEEN ILLEGAL DISCHARGES FROM
SKILLED NURSING FACILITIES.
NOW THE LAST PLACED MY RESIDENTS
WANT TO MEET ME ARE IN THIS LAST
PLACE RESORT THE HOME THAT THEY
RELUCTANTLY ARE HAVING TO CALL
HOME.
SO ONE IN FIVE OF THOSE
RESIDENTS THAT WE ASSISTED HAD
INDICATED THAT THEY HAD NOT.
ACCESS OR THE UNLIMITED ACCESS
TO LONG TERM SERVICES AND
SUPPORTS PRIOR TO
INSTITUTIONALIZATION.
SO I CHALLENGE YOU TO THINK.
IF THEY HAD BEEN ABLE TO ACCESS
THE COORDINATION OF CARE THAT
THEY NEED.
PRIOR TO INSTITUTIONALIZATION
WITH THEIR STORY HAVE BEEN
DIFFERENT IN EL DORADO COUNTY
WHERE SMALL RURAL AREA SO WE
LOOK AT BARRIERS OF GEOGRAPHY
AWARENESS OF SERVICES.
AVAILABILITY OF PROVIDERS ADD
INFORMAL SUPPORT SERVICES.
NOW I DO BELIEVE THAT I'M GOING
TO BE MEETING THESE RESIDENTS
AGAIN AND A SKILLED NURSING
FACILITY AS THEY'RE GOING TO
COME THROUGH THAT REVOLVING DOOR
FROM HOME TO Q. KERR. TO THE
SKILLED NURSING FACILITY.
BUT THEIR STORY BE DIFFERENT IF
WHEN THEY GO HOME THEY ACCESS
THE COORDINATED SERVICES THAT
THEY BEAT I DO BELIEVE CELL.
IN OUR COUNTY WE HAVE RECEIVED
MIXED OF FUNNY THE LONG TERM
CARE.
OMBUDSMAN PROGRAM STILL HAS THE
ONLY PAID STAFF MEMBER IN THIS
PROGRAM I DO BELIEVE THAT I'M
GONNA BE ABLE TO PROVIDE
ADDITIONAL SUPPORT TO THEM WHEN
THEY COME BACK. TO THE SKILLED
NURSING FACILITY AND I
APPRECIATE THAT BECAUSE OF THE
EXTRA FUNDING THAT WE RECEIVE
THIS YEAR.
THANK YOU [inaudible]
WELCOME.
WELCOME THANK YOU AND THANK YOU
SENATOR PAN FOR HOLDING THIS
HEARING MY NAME IS GRETCHEN
ZIEGLER IN THE INCOMING DIRECTOR
TO THE CALIFORNIA COMMISSION ON
AGING.
AND I WANT TO SAY THANK YOU TO
EVERYBODY HERE WE SHARE AND
EVERY CONCERN THIS BEEN RAISED.
AT THIS HEARING AGAIN THANK YOU
FOR IT AND STAND READY TO ASSIST
YOU AND OUR COLLEAGUES IN ANY
WAY WE CAN [inaudible]
THANK YOU.
RIGHT OF SAYING NO ONE ELSE THAT
PUBLIC COMMENT SO AGAIN THANK
YOU SO MUCH FOR COMING BACK UP
HERE -- CAN
I ASK YOU TO SORT OF RESPOND TO
THE RIVER REACTOR PANEL AND SOME
OF PUBLIC COMENT I BUT BUT
HEALTHY SPECIFICALLY HELP YOU
CAN ADDRESS --
ACTUALLY --
PARTICULARLY THREE ITEMS THAT
THIS IS THE THING THAT'S COME UP
SO ONE I THINK I RAISED BEFORE
WHEN WE UPDATED PEOPLE COME --
IN TERMS OF HOW BIRTH DATE YOU
HAVE BUT ALSO SEE WHAT WE CAN DO
TO LEVERAGE THE DATA THAT THE
STATE'S INVESTING IN WHICH IS
HOW YOU MIGHT TRY.
TO AND OTHER DATA SOURCES TO TRY.
TO HELP PLANNING AND AND
PROTECTING FOR THAT PROGRAMS
YOUR AGENCIES.
WHICH ARE A LOT ABOUT
CORONATIONS OF FRAGMENTATION
CORONATION AND WE'VE HEARD IT --
THERE THERE ARE A LOT OF PLANS
OUT THERE AND TRYING --
TO HOW TO BETTER COORDINATE OUR
VARIOUS PROGRAMS AND AND MAKE
THEM.
MORE AT SIMPLER FOR PEOPLE TO
ACCESS WE HEARD A LOT ABOUT THAT
AWARENESS AND THE MORE COMPLEX
HE GETS IN THE MORE NUMBER
PROGRAMS THAT WHILE EACH PROGRAM
AS VALUE OF COURSE MAKES IT MORE.
LIKELY THAT PEOPLE EITHER DON'T
KNOW ABOUT THEM OR DON'T KNOW
HOW THEY ALL FIT TOGETHER.
AND THEN WE'VE HEARD A LOT ABOUT
WORK FORCE RIGHT HOW WE RECRUIT
TO PEOPLE I MEAN.
GREAT WE'RE GONNA PROVIDE A
SERVICE AND WE DON'T HAVE THE
PEOPLE PROVIDE THEM RIGHT
WHETHER IT'S A NURSING OF ITIS
ETCETERA.
SO FIVE YOU CAN SPECIFICALLY --
TO THE DEGREE THAT'S RELEVANT TO
YOUR AGENCY ADDRESS THOSE THREE
ISSUES AND THEN ALSO OF ANY
OTHER COMMENTS --
ANY OTHER REACTIONS TO WHAT --
WAS REFLECTED --
FROM --
AFTER THE REACTOR PANELED PUBLIC
COMMENT SO.
THANK YOU.
HI MERRY CABLE DEPARTMENT HEALTH
CARE SERVICES --
I THINK YOU KNOW THE BIGGEST ONE
THAT I WOULD A COMMENT ON IS THE
ISSUE COORDINATION I CERTAINLY
AGREE THAT THERE CONTINUES TO BE
CHALLENGES --
WE DO OPERATE IN DIFFERENT
DEPARTMENTS A SOMETIMES
DIFFERENT AGENCIES DEPENDING ON
WHAT OTHER DEPARTMENTS YOU'RE
TALKING ABOUT.
I DO THINK THAT AT LEAST IN THE
YEARS YOU SEE AN AD GROWTH IN
THAT RELATIONSHIP AND THAT
COORDINATION.
I THINK YOU KNOW THE CHALLENGES
TO BE PERFECTLY FRANK IS THAT WE
OPERATE UNDER DIFFERENT RULES.
DIFFERENT YOU KNOW DIFFERENT
LINES OF COMMUNICATION AND
SOMETIMES THAT CAN BE
CHALLENGING AND DOING OUR OWN
DAY JOBS BUT ALSO WANTING TO
MAKE SURE THAT.
THAT WERE COORDINATING I DO
THINK THAT THAT IS A BIG PART
THAT MENTIONED THE CARE
COORDINATION BY THREE COMMITTEE
FROM THE DEPARTMENT OF HEALTH
CARE SERVICES PERSPECTIVE --
YOU DO THESE DEPARTMENTS AS WELL
AS OTHERS THAT WERE NAMED AND
HAD TO ENTER NOT HERE I HAVE SAT
ON THAT COMMITTEE AS A WAY TO
THINK ABOUT AGAIN IF WE IT
SOUNDS POLICY AND I KNOW BUT IF
WE WERE GONNA BUILD IT TODAY IF
IT DIDN'T EXIST.
WOULD WE BUILD IT THE WAY IT IS
AND IF WE WOULDN'T WHAT WOULD WE
DO AND EVEN IF WE CAN'T COMBINE
THINGS AND INTEGRATE THEM SORT
OF FUNDAMENTALLY UNDER THE SAME
YOU KNOW.
ORGANIZATION OR WHATEVER HOW DO
WE BETTER COMMUNICATE AND HOW DO
WE HAVE PEOPLE WHO ARE ON THE
GROUND HELPING OUR BENEFICIARIES
AND THAT'S ONE OF THE KEY THINGS
OF COME OUT OF THE CARE
COORDINATION ADVISORY COMMITTEE
THIS CONCEPT OF A SINGLE CARE
MANAGER.
THAT WOULD BE RESPONSIBLE FOR
COORDINATING ACROSS EVEN IF
THEY'RE IN A WAIVER PROGRAM I
JUST S. EMESIS P. A HEALTH PLAN
THAT COUNTY SPECIALTY MENTAL
HEALTH PROGRAM.
OFTENTIMES AS PEOPLE HAVE
MULTIPLE CARE COORDINATORS
WITHIN EACH OF THOSE PROGRAMS
AND THAT'S CONFUSING THAT IS NOT
HOW IT WOULD WORK FOR ANY OF US
AND USER INDIVIDUALS WERE
PARTICULRLY VULNERABLE SO THAT
IS ONE OF THE THINGS WE'RE
TRYING TO REALLY LOOK AT IS BOTH.
SINGLE CARE COORDINATION EVEN
THOUGH THAT WOULD THAT BE
COORDINATING THINGS IN OTHER
DEPARTMENTS BUT RECOGNIZING THAT
IF WE WORK TOGETHER WE CAN MAKE
THAT HAPPEN.
AS WELL AS A BETTER SINGLE
ASSESSMENT SO THAT PEOPLE AREN'T
BEING ASSESSED FIVE DIFFERENT
TIMES FOR THE SAME ESSENTIALLY
THE SAME QUESTIONS --
SO WE GOT A LOT OF REALLY GOOD
FOR YOU HOW DO WE MOVE FORWARD
SO -- IT
DEFINITELY AGREE THERE'S STILL
WORK TO DO THERE BUT I THINK
THAT --
LEAST ALL OF US HERE IN AND
WITHIN OUR AGENCY OR SUPER
COMMITTED TO THAT --
THE WORK FORCE ISSUE IS AN ISSUE
OBVIOUSLY.
WE IT'S NOT ONE THAT THE ACS
SPECIFICALLY CAN OFF OFTEN DO A
LOT ABOUT WE DON'T CREATE
WORKFORCE WE WE WE PAY FOR WORK
FORCE -- BUT
WE CONTINUE TO LOOK AT HOW DO WE
MAKE SURE THAT WERE ALLOWING
VARIOUS TYPES OF MODALITIES ARE
TYPES OF PROFESSIONALS WHO CAN
PROVIDE SERVICES THAT ARE WE'RE
NOT LIMITING WHO CAN PROVIDE
WHAT -- AS
LONG AS IT'S OBVIOUSLY WITHIN
THE SCOPE OF WHAT THEY'RE
ALLOWED TO DO FROM A LICENSE
PERSPECTIVE SO REALLY LOOKING AT
HOW TO EXPAND THAT.
INCLUDING --
OUR RECENT RELEASE OF OUR POLICY
ON TELL HEALTH AND REALLY TRYING
TO PROMOTE THE ABILITY FOR
PEOPLE TO FIND ACCESS TO
SERVICES THROUGH THAT IF IT'S
APPROPRIATE AND AVAILABLE --
SO THAT WE'RE NOT LIMITING THAT
AND THEN THE LAST THING I WOULD
JUST TOUCH ON BECAUSE I WAS
REMISS IN NOT COMMENTING ON IT
ORIGINALLY.
WAS THE ISSUE OF THE LONG TERM
CARE INSURANCE OBVIOUSLY AT THE
DEPARTMENT WE DO OPERATE THE
PARTNERSHIP FOR LONG TERM CARE.
INSURANCE PROGRAM IS NOT
MEDICAID SO I DIRECTOR --
AND I AND I DO THINK WE SEE A
LOT OF POTENTIAL THERE --
BUT IT HAS BEEN VERY CHALLENGING --
YOU KNOW WHAT I LEARNED FROM
THAT THE THE PROGRAMMER --
POLICIES COME OUT IN AUGUST OF
NINETEEN NINETY FOUR THROUGH
TWENTY SEVENTEEN THERE ABOUT A
HUNDRED AND FORTY THOUSAND
POLICIES THAT PEOPLE OF HAD.
BUT JUST TO GIVE THAT PUT THAT
IN PERSPECTIVE WE'VE ONLY HAD
THIRTEEN THOUSAND FIVE HUNDRED
POLICIES SOLD SINCE.
TWENTY TWELVE AND ESSENTIALLY
MOST OF THOSE WERE IN THE FIRST
PLACE IN TWENTY TWELVE AND
TWENTY THIRTEEN WE HAD LESS THAN
FORTY POLICIES THAT WERE SOLD IN
THE LAST TWO YEARS.
AND SO CERTAINLY THAT
LEGISLATION THAT WAS MENTIONED
FROM LAST YEAR --
WE'RE HOPING WILL HELP WE IT WE
DO THINK IT IS A SOLUTION FOR
PEOPLE WHO ARE NOT.
YOU WHO ARE NOT YET MEDICAID AND
HOPEFULLY COULD HELP PREVENT
THEM FROM BECOMING MEDICAID --
BUT IT IS ONE THAT THAT WE'VE
STRUGGLED TO SEE HOW DO WE
CONTINUE TO MAKE IT VIABLE MAKE
IT WORK FOR CALIFORNIANS WHO YOU
KNOW WHO MIGHT NEED IT GIVEN
THAT WE'VE SEEN A SERIOUS
DECLINE IN PARTICIPATION.
ACTUALLY HAVING TO FOLLOW UP ON
THE AND THE LA NOTE THAT --
SOMEONE WHO'S LOOKED IN THE LONG
TERM CARE INSURANCE IT'S PRETTY
EXPENSIVE SO OF I THINK A LOT OF
LASS FAMILIES THEY'RE LOOKING
AT THE TRADE OFF AND CERTAINLY I
THINK WE CAN TRY TO MAKE IT MORE
ACCESSIBLE BUT YET.
AGAIN THE THE ACTUARIAL
CHALLENGE AND I THINK CALPERS
TRIED A CHAIRED BIRDS COMMITTEE
ON THE THEY HAD SOME CHALLENGES
THERE -- TO
IN TERMS OF THE WORK FORCE PEACE
SO I I UNDERSTAND THAT ONE LEVEL
OF COURSE.
YOU KNOW MEDI CAL BASICALLY YOU
YOU'RE TO REIMBURSE FOR THE
SERVICES BUT IN TERMS OF ACCESS
RIGHT -- WE
HEARD FROM THE YOU KNOW FOR THE
NURSING OF A THE ANY WHETHER
IT'S THE EXISTING NURSING HOMES
THEY CAN'T FIND THE STAFF THEY
CAN'T TAKE CARE OF THE PEOPLE
AND AND ONE COULD ARGUE EXACTLY
HOW THE MORE WE NEED --
WE ARE TRYING KEEP MORE PEOPLE
AT HOME PREVENT THEM FROM GOING
TO INSTITUTIONS BUT THAT'S
INFLUENCED BY.
REIMBURSEMENTS RATES RATE THAT
RESOURCES RIGHT THE THICK IF
IT'S THE PAY TO ATTRACT PEOPLE
THAT.
GOES ABOVE WHAT THE
REIMBURSEMENT ALLOWS THEM TO PAY
THEN BASICALLY WHAT HAPPENS
EITHER FACILITY CLOSE DOWN OR
THEY DON'T TREAT PEOPLE DISTRICT
TO NUMBER BEDS OR SOMETHING DOES --
IS THAT SOMETHING MEDI CAL IS
MONITORING --
TO BE SURE THAT WE ARE RATES ARE
AT A LEVEL THAT SUFFICIENT TO
MAINTAIN THE KIND OF WORK FORCE
THAT WE'RE LOOKING AT I KNOW YOU
COULD HAVE A TO SAYS IT WILL
TURN A QUESTION I TO ASSESS BUT
SINCE YOU HAVE NURSING HOMES.
SURE YES CERTAINLY IT IS
SOMETHING WE'RE LOOKING AT AND I
THINK ONE OF THE ONE OF THE
CHALLENGES AGAIN BEING --
SORT OF THE PIPELINE ISSUE OF
INDIVIDUALS ACTUALLY BEING
TRAINED INTO THESE INTO THESE
PROFESSIONS --
AND SOME OF THE THINGS THAT WERE
TRYING TO DO THEIR WITH
PROVIDING SOME MORE FUNDING.
FOR EDUCATION AND THINGS LIKE
THAT THAT I THINK ARE IMPORTANT --
MET ICE I THINK SOMETIMES OUR
CHALLENGES ARE WITH CENTURY THE
SAME PEOPLE ARE COMPETING FOR
THE SAME THE SAME ORGANIZATIONS
ARE COMPETING FOR THE SAMEPEOPLE.
BECAUSE THERE'S JUST NOT ENOUGH
PEOPLE --
AND SO I THINK THAT'S WHERE WHEN
I SAID IT SORT OF NOT THE CORE
MISSION OF THE DEPARTMENT NIGHT
YOU KNOW I SORT OF LOOK AT
AUSTIN AND OTHERS AS AS SORT OF
BEING WORKFORCE DEVELOPMENT.
ON THE MEDICAID SIDE WE CONTINUE
TO TRY TO FIND WAYS TO
INCENTIVIZE PARTICIPATION --
HELP SORT OF BRING THAT ABOUT I
THINK SOME YOU KNOW NOT SPECIFIC
TO LONG TERM SERVICE AND SUPPORT
BUT OUR PHYSICIANS AND DENTAL
LOAN REPAYMENT THAT WERE THAT
WERE STARTING NOW HOW DO WE FIND
WAYS. TO ATTRACT PEOPLE TO OUR
BENEFICIARIES IN A WAY THAT IS
JUST DIFFERENT FROM WHAT THEY'RE
PAID ON A SERVICE BASIS WHAT
THEY'RE PAID IS OBVIOUSLY VERY
IMPORTANT --
IS ALSO CHALLENGING FOR US AS A
STATE AGENCY TO CONTINUE TO WORK
OBVIOUSLY WITHIN THE CONFINES
THAT WE HAVE AS PART OF THE
STATE BUDGET IN AN HUNDRED
BILLION DOLLAR PROGRAM IS.
LOTS OF QUESTIONS FROM ALL OF
YOU AND WE'RE SPENDING OUR MONEY
SO I DEFINITELY THE
REIMBURSEMENT IS ONE OF THOSE.
PIECES I THINK WHERE WE'RE GOING
AND WHAT I'VE BEEN TRYING TO DO
WITH BUT AS WELL AS OUR WHOLE
FOR SECURE PILOT PROGRAMS WHICH
I DID NOTMENTION IN MY EARLIER
TESTIMONY.
OF REALLY LOOKING AT AGAIN THAT
INTEGRATION NOT EVEN THAT IN
THIS CASE JUST ACROSS HEALTH
SERVICES BUT ACROSS SOCIAL
SERVICES.
AND REALLY MEETING PEOPLE OUT
WHERE THEY ARE IF YOU'VE IF IF
YOU HAVEN'T LEARNED A LOT ABOUT
IF YOU HAVEN'T HEARD A LOT ABOUT
SOME OF THE PROGRAMS I MEAN WE
REALLY HAVE COUNTIES.
PUTTING PEOPLE OUT IN THE STREET.
HELPING PEOPLE GET INTO HOUSING
AND THINGS LIKE THAT THAT ARE.
REALLY TIED TO THEIR LONG TERM
HEALTH IN A WAY THAT OUR IS NOT
FUNDAMENTALLY TYPICALLY A
MEDICAID ISSUE WE JUST WE DO
ALTHOUGH WE DID JUST HEAR
SECRETARIES ARE FROM HHS --
A COUPLE DAYS AGO OW TALK ABOUT
HOW MAY MAYBE MEDICAID WOULD
START HELPING WITH PAYING FOR
HOUSING SO I THINK LOOKING INTO
THAT -- AS A
WAY TO REDUCE THE BURDEN ON THE
TYPES OF SERVICES THAT WE NEED
BUT ALSO THAT HOW DO WE FIGURE
OUT HOW TO ENCOURAGE PEOPLE TO
COME INTO THE IN INTO THIS AREA
AND I THINK.
THERE'S SOME THAT WE COULD DO
WITH REIMBURSEMENT AND VALUE
BASED OUTCOME PAYMENT --
BUT OBVIOUSLY WOULD NEED TO
PARTNER WITH THOSE ENTITIES WHO
ARE REALLY YOU KNOW WORKFORCE
FOCUSED MORE THAN MEDICAID AS WE
JUST NEED FOR FOR SO YOU'RE
TALKING TO SOMEONE WHO --
ACTUALLY CAME TO SACRAMENTO
CALIFORNIA TALKING ABOUT SOCIAL
THE TERMS OF HEALTH SO.
I INSTANTLY RECOGNIZE THE ROLE
OF SOCIAL THE TERM IT JUST
HEALTHCARE --
SAME TIME I ALSO DID WORK FORCE
ACTUALLY WORKFORCE RESEARCH
ORIGINAL WORKFORCE RESEARCH --
DEL -- THE
LABOR ECONOMICS OF STRAINED IT
IS IT IS CERTAINLY STILL SLICE
RIGHT I MEAN IT'S A AND WHAT
THAT WHAT I MEAN BY THAT IS IS
THAT WE SHOULD AT LEAST BE
MONITORING --
THE ACCESS LEVEL THAT WE HAVE
RIGHT I MEAN THAT THAT IT'S NOT
ABOUT IT IS THAT IT'S NOT THE
IDEA IT THIS IS SO MUCH ABOUT
HOW MUCH WE'RE PAYING PEOPLE.
IN ITSELF --
IT'S WHAT IS THE LEVEL ACCESS
RAINY SO IF WE GET TO THE POINT
WHERE ARE PAYMENT LEVELS ARE
LEAVING TO ACCESS ISSUES.
BECAUSE WE CAN'T RECRUIT PEOPLE
WHO ARE WILLING TO DO THE WORK
BECAUSE THE THERE ARE
ALTERNATIVES ARE MUCH BETTER.
THAN WE HAVE TO STEP UP AND
FIGURE OUT HOW DO YOU TRACK
[inaudible]
PEOPLE.
TO DO I BECAUSE ULTIMATELY WHO
SUFFERS IS THE BENEFICIARIES AND
THAT'S WHY WE'RE HERE RIGHT
WE'RE I MEAN WE'RE PROVIDING A
SERVICE THAT WE HAVE TO PROVIDE
THE SERVICES THE SERVICES IN
THEIR BECAUSE WE BECAUSE THERE
S A SOMEONE TO DELIVER IT THEN
WE HAVE TO FIGURE OUT SOLVE.
THAT PROBLEM SO I THINK THAT I
THINK WHAT'S REALLY IMPORTANT IS
THAT WERE MONITORING THE LEVEL
OF ACCESS AND WE FIND WE HAVE
SHORTFALLS.
WITH THE THINK ABOUT WHAT THE
SOLUTIONS ARE ABOUT TO DO THAT%
SO -- SO
HOPEFULLY --
WE CAN GET.
I APPRECIATE IS THE PART THAT
PARENTS DOING THAT WE CAN GETS
REPORT BACKS ON HOW HOW WE'RE
GOING ABOUT BECAUSE WE'VE HEARD
IS LARGE SHORTFALL IN GETTING
SEE AN AIDS TO WORK AND ARE EVEN
EXISTING NURSING HOMES --
AND SO FORTH SO I I THINK THAT
AGREE IT AT A YOU KNOW RUNNING
INTO A CEILING BECAUSE BASICALLY
THE PEOPLE THEY WOULD RECRUITING
YES THERE'S FAULT HELP WELL THIS
IS A ALL OF US WERE LOOKING FOR
JOBS IN MULTIPLE CHOICES WE CAN
MAKE RIGHT.
SOMETIMES WILL TAKE A LITTLE
LESS PAY TO DO SOMETHING REALLY.
ONE BUT THAT ONLY GOES SO FAR
RAID SELLING THIS IS A CHOICE
EVERY INDIVIDUAL MAKES BUT WE
HAVE TO THINK ABOUT AT THE OTHER
END IS THE PAIRS.
OF IS THE WE DON'T OVERPAY BUT
WE ALSO NEED TO PAY ENOUGH TO
PEOPLE ARE WILLING TO DO THAT
THAT -- WITH
THE PEOPLE REALLY DO THE WORK
THAT NEEDS TO BE DONE SO AND
JUST TO RESPOND TO THAT BECAUSE
I I ABSOLUTELY WE MONITOR I
DIDN'T SAY THAT I DO I KNOW YOU
KNOW THAT WOULD HAVE THAT WE DO
THAT.
AND I THINK ONE OF THE GOOD
EXAMPLES OF WHERE OF THAT
PROCESS WORKED WAS REALLY IN OUR
YOU KNOW IN HAVING IT WITH THE
GOVERNOR PROPOSING A 50%
INCREASE IN.
ALL HEALTH RATES EARLIER THIS
YEAR IT WAS REALLY IT REALLY WAS
AS A RESULT OF US CONTINUING TO
SEE SOME CHALLENGES BOTH HEARING
AT WHICH IS YOU KNOW IT'S VERY
IMPORTANT AND WE APPRECIATE THE
STAKEHOLDER.
STAKEHOLDERS TO BRING THAT TO
OUR ATTENTION BUT YOU KNOW WE
BUT WE DID SOME DAIS VERY
SPECIFIC DATA ANALYSIS THAT
REALLY HELPED INFORM NOT ONLY
WHAT THE PROBLEM WAS BUT WHAT
HOW WE CAME UP WITH 50% RIGHT
LIKE I MEAN IT REALLY.
IT REALLY WAS DATA DRIVEN AND SO
WE DO CONTINUE TO DO THAT AS WE
TRY TO LOOK AT WHERE ARE WE
SEEING GAPS AND HOW DO WE HOW DO
WE FIX THEM IF THEY ARE RELATED
TO REIMBURSEMENT.
OKAY THANK YOU.
SERVICES FOR AGES SAYS AS FAR AS
THE PEACE IN COLLABORATION I
WOULD AGREE WITH MARY AND THAT
I'VE FELT LIKE THERE'S BEEN MORE
AND MORE ON COLLABORATION
BETWEEN THE DEPARTMENTS.
I'M SHARING WITH ONE ANOTHER
ANOTHER DOING THINGS JOINTLY
TRYING TO LOOK AT THINGS MORE
HOLISTICALLY.
AND OBVIOUSLY THAT NEEDS TO
CONTINUE --
AND SO THAT IS AT ODDS AN AREA
THAT WE CONTINUE TO TRY AND DO
MORE.
WITH AS FAR AS WORK FORCE I MEAN
I THINK WE JUST WITH THE GROWTH
WORK FORCES ALWAYS YOU KNOW
GOING TO BE OUT THERE AS A
CHALLENGE --
TALK ABOUT KIND OF INCENTIVES OR
THINGS TO TRY AND DRAW PEOPLE IN
IS --
CONVERSATIONS THAT WE HAVE AN IN
AS WITH OUR LABOR ORGANIZATIONS
LOOKING AT WAYS AND THINGS WE
CAN DO TO SUPPORT OUR PROVIDERS --
SOME OF THE OUTCOMES OF THAT
HAVE BEEN WITH ELECTRONIC TIME
SHEETS AND OUR ELECTRONIC
SERVICES PORTAL THAT ALLOWS MORE
SELF SERVICE OF THINGS ALLOWS --
PROVIDERS TO GET --
PAYMENTS HAPPENING MORE QUICKLY
BECAUSE THEY'RE NOT WAITING ON
MALES THOSE KINDS OF THINGS.
SO I'M LOOKING AT WAYS --
TO EXPEDITE THE PROVIDER
ENROLLMENT PROCESS IS SO THE
PEOPLE GET PAID AS QUICKLY AS
POSSIBLE SO WE LOOK AT ALL OF
THOSE KINDS OF THINGS AND HAVE
THOSE CONVERSATIONS AND CONTINUE.
TO EVALUATE OBVIOUSLY OUR
PROVIDERS WAGES AND BENEFITS ARE
NEGOTIATED LOCALLY --
SO THEY HAVE THAT PROCESS IN
PLACE.
TO ASSIST --
WE WE DO HAVE.
SOMEWHAT OF A LEASE FOR A LARGE
PERCENTAGE OF OUR POPULATION
KIND OF A BUILT IN THE WORK
FORCE AND THAT SO MANY OF THEM
ARE SERVED BY --
FAMILY MEMBERS AND NOT 70% RANGE
CERTAINLY THAT THERE ARE THOSE
THAT NEED TO IDENTIFY PEOPLE AND
WILL BE LOOKING FOR FOLKS.
I APPRECIATE THAT AND APPRECIATE
THE FACT THAT NIGHT TO SAYS AT
LEAST -- SO.
WE HAVE COLLECTIVE BARGAINING
THAT HAPPENS THAT HELPS --
TRY TO HELP ESTABLISH THE THAT'S
A NEGOTIATED --
EFFORT ON TRYING TO ESTABLISH
WHAT THE THE PAY AND BENEFITS
NOW.
THANK YOU YES.
NOT.
BRED SEEMS COUNTER INTUITIVE. TO
SAY THAT.
I'M FROM DEPARTMENT OF EIGHTIES
FOR SECTOR JUST WANTED TO ADD A
ONE OF THE THINGS THAT WE HAVE
BEEN DOING IN THE FOR YOUR
FEDERAL PLANS THAT WE ARE
REQUIRED TO PUT TOGETHER IS OVER
THE LAST NUMBER OF YEARS.
REALLY INCORPORATE --
A FAIR AMOUNT OF SO I ACTUALLY I
WAS ASKING FOR FINANCES --
INFORMATION SO THAT WE CAN
ACTUALLY INCLUDE THAT TORE
UPDATING OUR WEBSITE INFORMATION --
BUT WE'VE STARTED TO BREAK OUT
AND WE LIST BY EIGHT THE VARIOUS --
THREE THREE AREA ACTUALLY BY
COUNTY --
THE PROJECTED GROWTH --
POPULATION AGE SIXTEEN OVER
THAT'S OUR FEDERAL --
AGE BUT THEN ALSO BREAK THAT OUT
TO BE LOOKING AT THE EIGHTY FIVE
PLUS POPULATION WHERE YOU'RE
REALLY LOOKING AT ALL THE HIGHER.
PROJECTION IN TERMS OF THE RISK
OF HIGHER LEVELS OF ACTIVITIES
OF DAILY LIVING AND THEN WE'VE
ACTUALLY AND OTHER PARTS OF THAT
PLAN ALSO USE THE CHEST DATA. TO
LOOK AT KIND OF A SNAPSHOT IN
PROFILE OF WHAT WE'RE SEEING
STATE WIDE --
AT LEAST IN TERMS OF TRENDS AND
IN THE AGING POPULATION AND I
THINK THAT THAT'S HELPFUL ONE OF
THE AREAS JUST --
TO BE BACK ON SOMETHING THAT
MARRIED OR OF THE GRAMS AND
ETCETERA ETCETERA AND I THINK
PART OF THE CHALLENGE AND
CERTAINLY SEE ABOUT CENTERS AS
WELL.
IS CALIFORNIA YOU KNOW IT'S BY
THE FACT THAT WERE OF JURY URBAN
AND SUBURBAN STATE WE ARE A
LARGELY RURAL STATE.
AND OF THE INFRASTRUCTURE TO
SUPPORT THOSE PROGRAMS OFTEN
REQUIRES A CORE INSTITUTION IN
THOSE SETTINGS WHICH IS
CHALLENGING AND RURAL AREAS --
TO BE THE HUB FOR THE START UP
COSTS FOR THE PLANNING FOR YOU
KNOW WHAT AT THE TIME THAT IT
TAKES TO BECOME A PACE PROGRAM --
AND THAT INFRASTRUCTURE THAT
HEALTH INFRASTRUCTURE IN TERMS
OF HOSPITALS THIS THING PARTNERS
INCOMES TAT SOMETIMES ARE
ATTACH THOSE HOSPITALS IS
CHALLENGED --
SO.
FINDING THAT CORE FOUNDATION TO
BUILD UPON --
CAN BE CHALLENGING THOSE AND
THOSE ISSUES AND AGAIN YOU'VE
GOT POPULATIONS THAT ARE VERY.
DISTRIBUTED --
ALTHOUGH HIGHER.
AGE GROUP AND IN THOSE RURAL
AREAS BUT THE TRANSPORTATION
ISSUES AND GETTING BACK AND
FORTH TO THE CENTERS --
IS OFF OFF IS OFTEN CHALLENGING
TO PLAN FOR SO IT'S AN ADDED.
THE SET OF CHALLENGES FOR THEM
DIVERT THE RURAL AREAS IT'S OF
JUST MORE STATES.
DIRECTLY FOR YOUR DEPARTMENT I
MEAN WE WE'VE HEARD A LOT ABOUT
COORDINATION AND FRAGMENTATION
AND SO FORTH WHAT THEN SO WHAT
PARTICULAR ROLE THE THING.
YOUR DEPARTMENT AND PLAY TO TRY.
TO PAUL THE STRANDS TOGETHER FOR
PEOPLE WE HEARD ABOUT.
NOW TRYING TO GET CASE MANAGERS
SO AND AT THE EDGES IF AT THE
OTHER END OF THE SPECTRUM WE
HAVE THE EYES TURNS THE TERRACE
LIKE ME UNTIL SPECIAL NEED TO
HEAR ABOUT.
PARENTS TALKING ABOUT NEEDING TO
HAVE A CASE CASE MANAGING THE
CASE MANAGERS.
HAS BEEN A FRUSTRATION FOR THEM
RIGHT SO YOU HAVE KEYS MANAGE
THE DIFFERENT SILOS WHO THEN
I'LL NEED TO BE CASE MANAGED AND
IT'S A CERTAIN POINT SOMEONE
NEEDS SOME PEOPLE EVEN SAVE IF
YOU NEED A CASE MANAGER THREE
TWO COMPLICATED.
NOW I REALIZE.
DEL REALITY IS THAT YOU A
FEDERAL PROGRAM REQUIREMENTS THE
PROGRAM REQUIREMENTS THAT IT OUT
CENTER THAT'S WHY CAN'T WE JUST
CAN'T SIMPLIFY EVERYTHING BUT
WHAT DO YOU THINK.
GIVEN THE ON THE PART OF AGING
AND YOUR RELATIONSHIP WITH THE
HEALTH --
PULLS ON THE STRANDS TOGETHER
WORKING WITH SOCIAL SERVICES AND
DTS.
AS MERRY MENTION OF A NUMBER OF
HAVE BEEN PART PARTICIPATING ON
THIS MASSIVE FOR GROUP THAT --
DEPARTMENT OF HEALTH CARE
SERVICES HAS BEEN.
HAVING THE IT'S JUST GOTTEN A
TON OF FEEDBACK IN TERMS OF CARE
COORDINATION OF ALL JUST YOU
KNOW ARE JUST A START WITH THE A
FAMILY STORY --
I BURKE TOOK MY MOTHER OUT OF A
NURSING HOME.
OF BECAUSE SHE WAS DECLINING AT
AND BROUGHT HER TO SACRAMENTO
COUNTY OUTSIDE OF HER HEALTH
PLAN -- AND
BUT FORTUNATELY A GREAT
COORDINATION OUTSIDE THE COUNTY
AND SOMEBODY CAME OVER THE FIRST
DAY AND SAID I'M GOING TO BE
YOUR CARE MANAGER.
AND I KNEW WHAT THAT MEANT AND I
WAS LIKE OH GOOD AND I'M THE
PERSON YOU'LL.
YOU'LL CALL AND THEN TWO DAYS
LATER THE PHYSICAL THERAPIST
CAME AND GAVE ME HER CARD AND
SAID NOW I'M GOING TO BE IN
CHARGE OF YOUR MOTHER'S CARE AND
LONG STORY SHORT THERE WAS
ACTUALLY A THIRD PERSON.
SO WHO WAS ON FIRST AND I THINK
THEY'RE THE THE WORKGROUP HAS
YOU KNOW EGG COME TO THIS ISSUE
WHO IS ON FIRST --
YES SHE KNEW THAT PHYSICAL
THERAPY SHE NEEDED ONE BUT WHO'S
ON FIRST AT SO IT DOESN'T DEMEAN
THE CARE COORDINATION THAT'S
BEING DONE IN THOSE DIFFERENT
SYSTEMS.
BUT WHO DOES FOR THAT PERSON
NEED TO BE THE LEAD --
I THINK WHAT WE DIDN'T CARE
ABOUT IS FOR A LOT OF OLDER
ADULTS AND IN CONJUNCTION WITH A
LONG TERM CARE SERVICES --
THE ACUTE.
HEALTH CARE SYSTEM IS ALSO.
ON FIRST IN MANY CASES BECAUSE
THEY ARE THE HOME HEALTHCARE
AGENCY THAT'S COMING OUT AFTER
THAT HOSPITALIZATION WE DIDN'T
GET INTO A LOT OF THE NEW RULING
DOWN.
TO WHAT IS THE FRAGMENTATION BUT
FOR MANY OLDER ADULTS --
AT PARTICULARLY THOSE HER
OUTSIDE OF THE MEDICAL SYSTEM.
IT'S THAT COORDINATION BETWEEN
WHAT JUST HAPPENED IN THEIR LIFE.
IN TERMS OF THEIR HEALTH CARE
AND THEN.
IN HOME SERVICES BUT MAY NOT BE
PAID FOR BY MEDICARE HOME HEALTH
THAT THEY'RE TRYING TO
SUPPLEMENT WITH.
SO I THINK WE REALLY HAVE TO GET
MORE DOWN TO THE SPECIFICS TO
UNDER HAVE A BETTER UNDERSTAND
WHAT THE ISSUES ARE A LOT OF
PEOPLE FOR MANY PEOPLE THIS IS.
BECAUSE THEY'RE NOT ON MEDI CAL
AGAIN THEY'RE HAVING TO FIGURE
OUT HOW TO PAY FOR THIS
PRIVATELY OUTSIDE OF SOME
ORGANIZED HEALTH DELIVERY SYSTEM
[inaudible]
Q..
ALL RIGHT SO I KNOW MAINLY
DEMOGRAPHICS I GUESS MAYBE
VERTICALLY FOCUS ON LIKE THE
WE'RE LOOKING AT GETTING SOME
ADDITIONAL DATA AND HOW THAT
FITS INTO YOUR UNIT --
AND THEN ALSO PERHAPS --
WE DON'T REALLY --
PRESENTS OF DATA ABOUT EVERY
GOING TO BE ABLE TO BUT PEOPLE
WITH DISABILITIES OF ALL AGES --
AND FAILED AND AND HAVING THAT
AND FORMER A DECISION YOU KNOW
BUDGET DECISIONS --
FINANCE PERSPECTIVE MOVING TO
FOR THE FIRST TIME THAT THE
COMPANY.
CAME TO MY FROM THIS DISCUSSION
WAS ABOUT THE DIFFERENCE BETWEEN
AGING AND THE SIXTY OR SIXTY
FIVE PLUS VERSES THAT EIGHTY
FIVE PLUS WEBER IS MUCH HIGHER
DEMAND FOR SERVICES SO.
THE GROWTH IN THAT GROUP OF THE
NEXT FIVE YEARS IS ABOUT ABOUT --
TWO AND A HALF PERCENT PER YEAR
SO IT'S A LITTLE BIT SLOWER BUT
EVENTUALLY --
THE SIXTY FIVE PLUS GROUP WILL
BECOME EIGHTY FIVE PLUS GROUP --
AND SO.
YEAH WE ALSO DO THE THE
PROJECTIONS YOU KNOW AT THE
COUNTY LEVEL --
WE DON'T.
HAVE THEM FOR CITIES EQUITY FOR
ESTIMATES ARE FOR SMALL AREAS
BUT I I CAN PUT PEOPLE IN TOUCH
WITH WITH OTHER RESEARCHERS HAVE
TAKEN OUR DATA AND TRIED TO YOU
KNOW MAKE SOME ASSUMPTIONS ABOUT
WHERE.
WHERE IN THE COUNTIES ON PEOPLE
WILL BE LIVING SAYS --
GOT A QUESTION I WANT TO ADDRESS
WERE FROM FROM --
ESPOUSE HAMILTON ABOUT WHY WE
DON'T IN ENGAGE AND FORECASTING
HEALTH STATUS OR DISABILITY
STATUS I THINK COME.
IT'S IT'S AN OUTING WE WE COULD
ENGAGE ANOTHER CAN BE A GREAT
FOR US TO ENGAGE IN NOT --
WE DON'T HAVE A LOT OF IN HOUSE
EXPERTISE --
ON MORBIDITY DATA --
WE A LOT OF MORTALITY DATA AND
SO THAT'S REALLY OUR FOCUS ON WE
TRY TO KEEP UP WITH THAT
LITERATURE ON NOT HEALTH AND
AGEING.
SO -- I
DIDN'T REFERENCE DURING DURING
MY PREVIOUS TESTIMONY THE FACT
THAT WE EXPECT --
ONE OF THE THINGS IS ANY
CONTRIBUTING TO LOWER MORTALITY
RATES AT SIX SIXTY FIVE OR SIXTY
PLUS REALLY --
IS THE FACT THAT WE HOUSE MORE
HEALTHY COURTS ENTERING THERE'S
A MUCH LESS SMOKING ARE LOWER
PREVALENCE THERE'S A HIGHER
EDUCATION --
AND SEVERAL THE COMMONS RIVER
TODAY --
ALSO REFERENCE THOSE DYNAMICS
EVERYTHING WILL CONTRIBUTE --
TO TO A LARGER POPULATION OF
POSSIBLY A HEALTHIER POPULATION --
I THINK WE COULD DO MORE THE
BEST IF WE FOUND WAYS TO
COLLABORATE.
WITH --
WITHOUT LEO AND WITH --
C. PH WE WOULD ACTUALLY HAVE
BEEN COLLABORATING MORE WITH --
WITH CITY PAGE --
ONS YOU KNOW SOME.
ADVICE US TO DISQUALIFY SING ON
CONDUCTING RESEARCH FOR MATERNAL
AND CHILD EALTH OUTCOMES ARE
MORE ENGAGING WITH THEM ON A
PROJECTS --
CALLED THE CALIFORNIA COMMUNITY
BURDEN OF DISEASE.
IT'S GONNA VOLUNTARY BASIS OF
ANCHOR WE HAVE HIM JUST
CONSTRAINTS ON A TIME THAT WE
HAVE THESE OF THESE MANDATES AND
STAFF THAT ARE ASSIGNED TO
SPECIFIC PROJECTS AND SO WE YOU
KNOW WE'RE WE'RE ALL VERY
DEDICATED TO DOING MORE WORK ON
THIS BUT WHAT TO FIND WAYS WE
CAN.
WE CAN ENGAGE IN A MORE --
I THINK IN THE NEXT ROUND THAT
WE DO THE NEXT PRODUCTION ROUND
WE DO -- ONE
OF THINGS THAT'S ON OUR LIST IS
TO START THINKING ABOUT CAUSES
OF DEATH IN THE WAYS OF WAYS IN
WHICH CAUSES OF DEATH A SHIFTING
AND HOW THAT'S AFFECTING --
AGGREGATE MORTALITY TRENDS SO
CERTAIN CAUSES OUR ARE ARE ARE
ADDING OTHER CAUSES ARE A RISING.
AND AND THAT MAYBE --
BRIDGE TOWARDS ACTUALLY SOARING
TO DO MORNING THOUSAND HEALTHY
AGING -- WE
DO HAVE IN THE TOOLS IN THE TOOL
KIT THAT WE COULD USE BUT I
THINK IT'S IT'S REALLY RIGHT NOW
INITIATIVE OF PLANNING AND
COMING AND COMING THAT
ADDITIONAL WORK.
SO AT A RE SHEET THAT I THINK --
ONE OF THINGS THAT WE HEARD IN
OUR A AND FOR IF YOU PREVIOUS
BUDGET HEARING WAS IS THAT --
AND AND REALLY WAS AT MY
COLLEAGUES AND FINANCE TO MAY
NOT BEEN AWARE OF EVERYTHING
GOING OUT OF FINANCE BUT IS THAT --
BUT WE DID HEAR THAT THERE
WASN'T A LOT OF PEOPLE ARE
REALLY DOING A LOT OF PLANNING
LOOKING HEAD IN TERMS OF THE
NUMBER OF PEOPLE DISABILITIES
AND WHAT THE DEMANDS ARE GOING
TO BE.
BUT JUST BY THE REASON WE HAVING
THIS HEARING TODAY --
SO I THINK AT LEAST --
AND I AM NOT SURE A PERSON WHO
REALLY SPEAK FOR THE WHOLE
DEPARTMENT BUT I THINK THAT IT
DOES BEG THE QUESTION ABOUT IN
TERMS OF HIS WERE TRYING TO DO
BELL.
THE BUDGET PLANNING SO --
AND I DO THINGS ABOUT MONEY BUT
THAT'S WE'RE DOING BUDGET
PLANNING WE SHOULD BE LOOKING AT
NALLEY OF COURSE YOU KNOW WHAT
THE RAW NUMBERS ARE TERMS AGES
BUT WE HELP PEOPLE WHO NEED OUR
SERVICE NOW SEATS SERVICES
INCLUDING --
PEOPLE DISABILITIES THAT WE
SHOULD SERVICES IN THAT SENSE
BECAUSE HE TALKED ABOUT MAYBE
THERE'S GAPS THERE'S NEEDS ARE
UNMET BUT IS --
WAYS TO TRY TO WHAT THEY AND
THAT'S ALSO FOR J. CREATE THE
GOVERNOR SAYING THAT WE'RE GOING
TO BE DOING THE ADDITIONAL
SERVING WHICH IS AND SO FORTH
GETTING A BETTER HANDLE ON THAT
SO THAT WE KNOW THAT WE ARE.
ABLE TO TRY --
TO KNOW WHAT THE TO FOCUS THE
THE RESOURCES WE NEED TO ON
THOSE ISSUES CELL YEAH WE WITH
YOUR PERSONAL PROCESS SOON
ADVOCATING FOR ENOUGH FUNDING
FOR FOR OUR REACH OUT FOR THE
CENSUS TO SO I SHOULD CLARIFY
FOR THOSE OF THOSE OF US WHO
DON'T KNOW THAT THAT.
OTHER DEMOGRAPHIC RESEARCH AND
IS NOT A BUDGET UNIT SO WE ARE
WE'RE RESEARCHING IT WITH AN
ICON OF FINANCE AND WE DON'T --
IN A REVIEW BCP'S OR WE I MEAN
WE CAN ACTUALLY HAVE TO MAKE THE
CITY'S FORGOT WHAT THE QUESTION.
RIGHT AWAY SO WE CAN RELATE TO
THAT THAT TEAM YEAH--
AND YOU KNOW FOR SOME MY
COLLEAGUES WERE ON THE BUDGET
SIDE WEREN'T ABLE TO ATTEND BUT
TIME ONE OF THINGS THAT THAT --
YEAH COULD SEE WAS BRING BACKING
ASSEMBLY ISSUES THE DISCUSSIONS
WE'VE HAD AND COMMUNICATE WITH
THEM AND SO YOU KNOW THERE
THEY'LL CERTAINLY BE ACCESSIBLE
TO TO YOUR STAFF AND ONCE.
ALL RIGHT THANK YOU WELL THANK
YOU ALL FOR FOR BEING HERE AND
THANK YOU FOR TESTIFYING --
BUT THAT --
AGAIN WHAT THANK ALL OUR
SPEAKERS AND PRESENTERS SIDE
SAID THIS IS THE PURPOSES
HEARINGS TO START --
ARE WHICH IS A START
CONVERSATIONS BEEN GOING ON
SESSION START BEGINS AN ICE
AGAIN WHAT THANK EVERYONE FOR
BEING HERE --
THIS A HEARING OF THE SENATE
BUDGET FISCAL REVIEW
SUBCOMMITTEE NUMBER THREE AND
HEALTH AND HUMAN SERVICES
INFORMATIONAL HEARING ON STATE
LONG TERM SERVICES AND SUPPORTS
CALIFORNIA SENIORS IS NOW
ADJOURNED THANK YOU