By Dr. Marcy Adelman–
California is at an inflection point to ensure the health and well-being of the state’s rapidly expanding senior population. California is home to one of the largest, fastest growing and most diverse senior populations in the country. By 2030, the state’s older adult population is projected to double. By 2050, 1 in 4 Californians will be age 60 and older. This longevity wave of California older adults will need policies and programs responsive to its needs and aspirations. Governor-elect Gavin Newsom has called for a master plan for aging to prepare for the rapid population growth of California’s older adults. Here are some of the issues that need to be addressed.
California’s older adult population will not only be larger, but it will also be older, have fewer financial and family resources, be more diverse and more invested in staying socially and civically engaged than previous generations. The Public Policy Institute of California (PPIC) estimates that the fastest population growth will take place in people age 75 and older and with a higher percentage of never married and/or divorced elders who are single, live alone and are childless.
LGB older adults are significantly more likely to live alone than heterosexuals. Older adults with limited family support systems will likely rely more on professional in-home care and community-based services to assist them to stay in their homes for as long and as well as possible. We can also expect an increase in the number of people who will need a higher level of care, such as nursing facilities, assisted living and dementia care. Currently, there is a state-wide shortage of nursing and dementia care facilities, and in-home care is too expensive for many Californians. More nursing facilities need to be developed and in-home services will need to be more broadly available and affordable.
But more services and facilities alone will not be enough to best serve a 75 or 85-year-old who lives alone and does not have the support of a spouse or an adult child. More often than not, when someone reaches out for services, they are already in some kind of crisis. Navigating the continuum of senior care services can be a daunting task even when there is a family member there to help. The long-term care system of senior services—affordable senior housing, community programs, adult day programs, in-home services, assisted living, dementia care and nursing facilities—needs to be more accessible, coordinated and affordable.
California is now faced with a shortage of doctors, nurses and mental health professionals who are trained in geriatric care. The most acute workforce shortage concerns the demand for physician’s assistants, medical assistants and home health aides. The PPIC recommends that the state’s workforce gap can best be addressed through the community college system with increased access and funding.
Latinos and Asians are the fastest growing elder communities in California. By 2030, Latinos will comprise 26 percent of the senior California population and the Asian population will have grown to 16 percent. The state’s LGB population over the age of 50 is estimated at 431,800 older adults or 3.5% of Californians age 50 and older. (There is little data on California’s transgender older adult population.) The California Department of Aging predicts that by 2030, the number of LGBT older adults will double. Mandated cultural competency training and a more Spanish and Chinese speaking workforce will provide better care for California’s richly diverse older adult population.
Communities of color and LGBTQI seniors have long histories of being marginalized and underserved. Longstanding health and socio-economic disparities will need to be addressed and investment made in reducing barriers to care and services. For example, investment in a more diverse workforce of senior-serving professionals that reflects the people served would create a more welcoming environment and greater confidence that diverse seniors will be treated with the dignity and respect they deserve.
California leads the nation in the percentage of older adults living in poverty. Currently, 21 percent of Californians age 65 and older are living at the federal poverty level, and the majority of those living with substandard income levels are women. The percentage of older adults living in poverty increases to 40 percent when income level is based on actual regional variations in cost of living, according to the California Elder Economic Security Index.
When the price of a food item increases, people stop buying it. When electricity prices increase, people reduce their usage. But when housing costs increase, they are not just by a dollar or two. Older adults may delay going to a doctor or stop buying their medicine and/or cut back on their food bill to make ends meet. More affordable housing and rent subsidies would provide a critical safety net for those challenged by poverty, or at risk for poverty and homelessness, and avoid the health spiral that typically accompanies housing insecurity.
Urban cities, as well as suburban and rural California communities, should be encouraged to have age-friendly programs and policies that empower older adults to continue to thrive and contribute to civic life. Investment in senior-centric community programs that esteem older adults and encourage and support elder engagement strengthen the bonds of community and enhance all of our lives. Policies that are age-friendly make transportation more dependable and affordable, make streets and neighborhoods safer and improve access to public buildings for people of all ages and abilities.
These are just some of the issues facing California’s long-lived older adults. A comprehensive master plan for California’s longevity wave should have direct input from all of the diverse communities that will be served—Latino, Asian, African American, Native American, the disability community and LGBTQI. Governor-elect Newsom has the opportunity to develop the most diverse age-friendly state in the nation.
Dr. Marcy Adelman, Co-founder of the nonprofit Openhouse, oversees the Aging in Community column. She is a psychologist and LGBTQI longevity advocate and policy advisor. She serves on the California Commission on Aging, the Board of the Alzheimer’s Association of Northern California and Northern Nevada and the San Francisco Dignity Fund Oversight and Advisory Committee.
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