Principles: Master Plan for Aging
Principles: Master Plan for Aging
These principles are presented to guide Disability Rights California’s participation in the Master Plan for Aging and related program and policy development.
Following his 2019 State of the State address when he called for the creation of a Master Plan for Aging, Governor Newsom issued on June 10, 2019 an Executive Order (N-14-19) directing the Secretary of the California Health and Human Services Agency to convene a cabinet-level Workgroup for Aging to advise the Secretary in developing and issuing a Master Plan for Aging https://www.gov.ca.gov/wp-content/uploads/2019/06/6.10.19-Master-Plan-for-Aging-EO.pdf. The California Health and Human Services Agency, along with other state partners, has convened a Master Plan for Aging Stakeholder Advisory Committee, which includes a Research Subcommittee and a Long-Term Care Subcommittee, with an interest in building an age-friendly California. These subcommittees include older Californians, adults with disabilities, local government representatives, health care providers, health plans, employers, community-based organizations, foundations, academic researchers and organized labor. Disability Rights California (DRC) is represented on the Advisory Committee. The Master Plan is intended to serve as a blueprint that can be used by state government, local communities, private organizations and philanthropy to build environments that promote an age friendly California. Policy recommendations are expected to build on California’s work supporting people with disabilities and older adults living independently. The Long-Term Care Subcommittee was tasked with issuing a report to the Governor on stabilizing state long-term care programs and infrastructure, including In-Home Supportive Services, with the full Master Plan completed by October 2020. The Long-Term Services and Supports Subcommittee submitted their stakeholder report on May 26, 2020.
After the work of the Master Plan for Aging and its Long-Term Care Subcommittee started, California, the nation and the world were hit with the COVID-19 pandemic. Persons with disabilities, older adults and persons of color are disproportionately impacted by this public health crisis. The pandemic has exposed critical fractures in the services and programs serving the aging population and must be addressed in the moment and will require rethinking, retooling and reimagining essential services and policies to meet the demands of the future. Of dramatic note is the fact that over half of COVID-19 deaths have been in long-term care facilities. The Master Plan for Aging blueprint must therefore recognize the dangers and inadequacies of congregate care and focus on individualized, person-centered supports in community-based settings, including the family home.
Long-term services and supports (LTSS) refer to the daily living supports that people with disabilities and older adults need. LTSS includes home and community-based services (HCBS), which are the overwhelming preference of service delivery for the disability community and older adults. Most LTSS is funded through Medicaid, called Medi-Cal in California. LTSS includes In-Home Supportive Services (IHSS), Medicaid Home and Community Based Services Waivers (Waivers), Community Based Adult Services (CBAS), and institutional settings such as nursing facilities.
These Master Plan for Aging Principles incorporate and complement the following existing DRC Principles:
- Universal/Integrated Long-Term Services and Supports (No. 1048.01, adopted 9/15/2018)
- Health Care and Long-Term Services and Supports (No. 1045, Amended 01/26/2018)
- Community Integration (No. 1018, Amended 03/24/2017)
- Public Benefits (No. 1043, Amended 09/21/2019)
- Personal Assistance (No. 1007, Amended 01/26/2018)
- Personal Autonomy (No. 1024, Amended 09/16/2017)
- Cultural and Linguistically Competent Services (No. 1044, Amended 09/16/2017)
- Disability Discrimination (No. 1008, Amended 12/15/2016)
Any proposals and policy recommendations to the Master Plan for Aging Stakeholder Advisory Committee and the Research and Long-Term Care Subcommittees should promote access for all people with disabilities including those in underserved communities, such as those with sensory disabilities, and ensure that the proposals and recommendations:
- Advance the economic security of people with disabilities and older adults in California by setting goals and developing strategies to reduce their poverty rate. This should include, for example, proposals to restore past cuts and ensure annual cost-of-living increases to the state supplemental payment to the SSI benefit. Also, in an economy that has been shattered by the pandemic and a state budget reeling from its impact, critical services and programs serving persons with disabilities and older adults must be protected from budget cuts and not used as a solution to balance the budget. Local, state and federal governments must be responsible for ensuring critical services and programs are maintained and expanded.
- Enable people with disabilities and older adults to receive the long-term services and supports (LTSS) they need while remaining in their homes and communities by setting clear goals for the provision of LTSS and expanding access to home and community-based services. This includes the creation of a social insurance LTSS benefit, as proposed by the California Aging and Disability Alliance (CADA), for people in California who are not eligible for IHSS.
- Establish In-Home Supportive Services as the backbone of our current LTSS system, and ensure it remains fully-funded with a plan for growth as income inequality widens and the population ages. This should include, for example, permanently restoring the 7% cuts and allowing for flexibility in program administration, including streamlined assessments and redeterminations.
- Ensure all services, providers, and agencies serving persons with disabilities and older adults offer choices and provide services that are accessible and culturally and linguistically competent. Services should be provided in the language or communication mode preferred by the individual, including removing barriers to effective communication with individuals who are Deaf and Hard of Hearing and blind.
- Support, empower, and strengthen the ability of people with disabilities and older adults to live with dignity and independence through informed decision-making about their own care, and by further integrating and coordinating California’s health care and LTSS delivery systems. This should include ensuring that, for example, Whole Person Care pilots, Money Follows the Person, Home Health Programs, Mental Health Services Act, and other community-based programs that are intended to comprehensively address the needs of people with complex health needs and community transition services, such as CCT and Home Upkeep Allowance, become available statewide to avoid unnecessary institutionalizations or continued institutionalization. This could also include, for example, formalizing mechanisms for education, training, and supported decision-making to ensure that people with disabilities and older adults are participating in their service decisions and living environments.
- Meet the needs of a growing number of older Californians living with dementia by ensuring that California’s health care delivery system is incorporating best practices related to dementia care.
- Enable people with disabilities and older adults to maintain and secure housing that is affordable to all and decrease the rate of those people experiencing homelessness by developing strategies to increase the availability of accessible housing. This could include, for example, creating state-wide standards which require a percentage of housing to be accessible and affordable to people with a range of disabilities.
- Ensure the rights, independence, and safety of people with disabilities and older Californians are protected by developing strategies to prevent and address elder abuse, neglect, domestic violence in all its forms, and exploitation.
- Ensure that the recommendations of the Master Plan for Aging can be implemented by building leadership on disability aging issues within state and local governments, including within the Governor’s Cabinet, within and across state agencies, and within the Legislature.
- Ensure the caregiving workforce is integral to the success of any LTSS plan in California by ensuring access to living wages and benefits, support and training, and career pathways to ensure a thriving, valued profession. This could include, for example, providing opportunities for individuals with high unemployment rates to be trained to provide these services.
- Ensure that people with access and functional needs are safe before, during, and after natural and manmade disasters and public safety power shutoffs, utilizing public and private collaborations and comprehensive, centralized planning for their particular health needs and well-being, as well as for maintaining their accustomed level of independence through access to home and community-based services and community living options during these types of events.
- Promote equitable employment and volunteer opportunities for people with disabilities and older adults.
- Promote and expand transportation options throughout the state for people with disabilities and older adults. This could include, for example, ensuring that Transportation Network Companies’ platforms and services and autonomous vehicle designs are accessible for persons with disabilities and are used to improve the mobility of persons with disabilities and older adults.
- Ensure equity and eliminate discrimination across age, place, race, ethnicity, religion/faith/irreligion, income, disability, sex, gender identity, sexual orientation, and immigration status and ensure that all services and programs are accessible and usable by people with disabilities and older adults and address ableism in all of its particular forms of discrimination.