Tuesday, March 31, 2020

[Orange County] We’re about to get really old, really fast. Is Orange County, and the state, ready?

The senior population will double by 2030. Bureaucrats are planning for it, but big questions remain.


Blog note: toward the end, this opinion piece references a 2016 grand jury report.
Over the next 10 years, the number of California residents ages 65 and older is expected to nearly double, reaching 8.6 million.
And one of the places that population bulge will be most acutely felt is Orange County, where seniors represent the one age group projected to expand over the next couple of decades. All other age groups will decline.
Today, people age 65 and older make up 15 percent of Orange County’s nearly 3.2 million residents, according to 2018 statistics from the U.S. Census Bureau. By 2040, that cohort is expected to account for 1 in 4 people living in Orange County. By 2050, that age ratio will be true for all of California.
For government leaders and others, around the state and in Orange County, the projected trends raise a worrisome question: Are we ready?
It’s been asked before. In fact, much of the planning for the coming aging boom involves assessments and projections that have been produced on a regular basis since the enactment of the federal Older Americans Act in 1965, and, later, the Older Californians Act of 1980. Both laws created official guidelines to help determine how federal and state dollars should be spent on issues related to aging.
But other initiatives are more recent and urgent. These are driven by both the ballooning census figures and by the personal experiences of a growing world of elder caretakers, including family members and service providers.
Still, much of the current prep work for our grayer future isn’t being tracked by the average resident. And, in the eyes of some, the planning might not be getting enough input from the people most directly affected — senior citizens.
In Orange County, some who work with seniors are calling for a concerted, collaborative approach that would involve both public and private dollars. That’s how the Be Well Orange County initiative has launched construction of a $40 million regional campus in Orange, which is set to open in early 2021. That public-private partnership promises care to anyone dealing with mental health or substance use issues, regardless of the patient’s ability to pay, and coordination of services.
“There’s a need to develop a comprehensive plan on aging for the county,” said Lisa Wright Jenkins, president and chief executive officer of the Council on Aging – Southern California. “As a community, we aren’t acting quickly enough to make that happen.
“The county would benefit by having an initiative for older adults similar to the Be Well initiative.”
Gray future
Those who worry about both the politics and practicalities of providing meaningful and accessible services to older people — especially the money and labor to make that happen — are optimistic about some of the efforts now underway. But they also worry about wasted effort.
The state’s ambitious Master Plan for Aging is the result of an executive order signed in June by Gov. Gavin Newsom. In fulfilling a campaign promise, Newsom was partly driven by watching his father, former state appellate judge William Newsom, battle dementia and other health issues before he died in 2018, at age 84.
People who track public spending on older people applaud the idea.
“Now is the time to do this,” said Adam Willoughby, a spokesman for the California Dept. of Aging. “In his State of the State address last year, Gov. Newsom talked about how he experienced challenges navigating the system when his father was aging.”
Newsom is looking to create a blueprint for what he envisions as an “age-friendly” California. The master plan is due to him by October. (Weekly webinars on the plan, which include public engagement, can be accessed through the website Together We EngAGE.)
At least one expert offered a positive assessment of the work being done so far, tempered with a hint of caution.
“The state is really engaging in a purposeful and well-rounded initiative that’s bringing together stakeholders from business, health care, academics and service providers,” said Debra Rose, director of Cal State Fullerton’s Center for Successful Aging and co-chair of the Orange County Healthy Aging Initiative team that in 2016 put together a county-focused older adult profile.
“I hope this is not just another dotting of the I’s or crossing of the T’s.”
Rose sees Orange County’s healthy aging initiative, and the Strategic Plan for Aging produced last year by the same group of local leaders, as a forerunner to the state’s master plan.
The hard part, she added, will be implementation.
“We need the financial support to carry out those goals.”
Opportune moment
The bulk of the money now used to provide services to seniors flows from the Older Americans Act and the Older Californians Act. Funding is tied to reports that, by law, must be produced every four years and submitted to the California Dept. of Aging for monitoring and compliance.
Officials determine fiscal allocations for each of 33 designated Area Agencies on Aging established in California — such as the Office on Aging in Orange County — using a formula based on the number of older adults in an area and how many of them live below the poverty line. Other local funding for services comes from tobacco settlement revenue, the county’s general fund, and Measure M transportation tax dollars.
Demographic projections from a year ago by the California Dept. of Aging estimated Orange County’s population of people 60 and older, the group covered by the Older Americans Act, at 674,732 — the fourth highest among Area Agency programs. (A draft of Orange County’s four-year plan is using a lower figure, 576,841, based on a 2019 update of the U.S. Census Bureau’s American Community Survey.)
The increase in older adults already is posing challenges for health care providers, said Jeremy Zoch, chief executive officer for St. Joseph Hospital in Orange. At St. Joseph, he said, doctors and other care providers are seeing many more patients in their 80s and older in the emergency room.
Often, in addition to whatever emergency medical problem they’re experiencing, older patients arrive in the ER with complex, chronic medical issues. A growing number of those patients don’t speak English as their first language, meaning interpreters — and cultural awareness — is needed to dispense medical advice, Zoch said. And once those older patients are discharged, he added, it is critical that they can connect to social services and nursing programs to continue their care.
“It’s really about getting out into the community, to help seniors where they are at.”
Zoch said his hospital helps provide a social worker to maintain contact with discharged seniors who have no family or are isolated, and need follow-up on aftercare.
But Zoch also noted that all hospitals need to beef up the resources they’ll need “to treat the illnesses that seniors are more likely to have,” like Alzheimer’s disease, Parkinson’s disease, and other neurological disorders.
“There’s an opportunity for the state to help with that, and the county.”
The so-called “Four-Year Area Plan” that agencies like the county’s Office on Aging must submit to the state set out local priorities, goals and objectives for services to be provided. In Orange County, those include nutrition, transportation, legal aid, family caregiver support, a long-term care ombudsman, and health insurance counseling.
The Office on Aging’s annual budget is a little more than $16 million and has only slightly deviated from that amount over the past 10 years, said Ericka Danczak, director of the county’s Office on Aging and Veterans Programs.
Soon, more will be needed.
“At the state level, they really are trying to take a look at what the priorities are, what the gaps are, and how funding needs to be adjusted to be commensurate with the aging population,” said Danczak, who became the Office on Aging director three months ago.
It helps that California still has a revenue surplus, estimated at close to $6 billion, and lawmakers currently focused on the needs of older adults.
“There’s a will on behalf of the administration to do something about this now,” said Willoughby at the state Dept. of Aging. “There also seems to be a lot of willingness and leadership in the legislature to do something about this now.”
Flat funding
On the federal level, the money situation is mixed.
Federal dollars earmarked for aging have been stagnant for years, reduced during the Great Recession. But there is legislation for a boost.
In October, the House of Representatives passed a bipartisan bill — the Dignity in Aging Act of 2019 — to reauthorize the Older Americans Act with increased funding recommendations (7% in the current fiscal year and 6% in each of the next four years). A Senate version waits approval, with a final bill expected soon.
It’s been a smooth bipartisan process so far. Although advocates had hoped for higher funding recommendations, they are pleased by the legislative support and anticipate President Trump’s signature.
“He is expected to sign it and, boy, we hope he will,” said Amy Gotwals, chief of public policy and external affairs for the National Association of Area Agencies in Washington, D.C.
Meanwhile, the 2020-2024 Orange County area plan is due to the state by May 1.
Danczak described the four-year area plan as more of a retrospective or accountability report. The county has already received the money it will use on aging, and now must tell the state what those services will look like and how they are being delivered.
“There are other factors that contribute to the amount of money that Orange County gets,” she added. “It’s not necessarily directed by just the area plan.”
And, historically, Danczak said, the four-year plan “has never been used as an advocacy document to bring about change or policy.”
But the plan sets spending priorities and establishes service goals and objectives for the contract programs. And it must include a needs assessment, which is where public input can play a role.
The Office on Aging recently held focus groups and sought input at a public hearing — and conducted its first-ever public survey — as a way to identify key needs for seniors. But only about 30 people attended the public hearing, held on Valentine’s Day, and almost all were service providers. And the 10 focus groups attracted a total of 75 participants. The survey garnered 2,188 responses, but some were invalid.
Overall, enhancing quality of life, safety, and security was a recurring theme, the county report says. Based on answers from 1,639 of the respondents, 82% listed “safety at home” and “help with personal affairs, such as finances,” as most important. The survey also found that “52% of participants said they are most concerned about falling and/or bodily injuries.”
While the Office on Aging serves as the lead advocate for older adults in Orange County, almost all of the services it oversees are provided under contracts with nonprofit organizations. The office says that’s the preference of county supervisors and of local seniors.
A 2016 report from the Orange County Grand Jury pointed to changes that might be needed to handle the coming aging boom.
The report, “Gray Matters,” described the Office on Aging’s work as “effective.” But it also said county management and the supervisors needed to make the Office on Aging a priority “to ensure that future services keep pace with growing demand.” Among the Grand Jury recommendations: kick in about $1.3 million in county general funds or “any other reliable, permanent,” source of funding — an amount that would be about $2.20 per senior resident.
At the time, the county’s general fund contribution to the Office on Aging was $778,438. Today, it is about $1.2 million, money that is earmarked annually and, according to officials, is enough to meet a required match for the state and federal funding. The office currently has 13 staff, one less than they had prior to cuts that came in 2007, the first year of the recession. But now there is additional administrative support shared with two other community resource programs that didn’t exist in 2016.
Still, aging experts fear already stretched resources could fall short as the county’s senior population grows. And Rose, the Cal State Fullerton professor, suggested the coming aging boom will be a stiff, social challenge.
“There is so much that we need to do in the state of California to make life better for older adults.”
February 28, 2020
The Orange County Register
By Theresa Walker


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