Services for aging need better coordination, experts say

Aging Californians depend on a wide range of connected services – health, housing, transportation and access for the disabled – that must be better coordinated to maximize the quality of their care, according to a panel of experts at a Tuesday conference on long term services and supports.

“In the homeless world, housing is health,” said Marty Lynch, executive director and CEO of LifeLong Medical Care, spotlighting this need for coordination at the Summit on Transforming California’s Long-Term Services and Supports, held in Sacramento.

Lynch’s comments echoed those of several experts during the day, who agreed that programs for aging adults must be planned holistically.

“At the end of the day, coordination is key,” said Whitney Barazoto, senior project manager of the Little Hoover Commission.

“It’s all seen as ‘How do we stay healthy?’” added Lynch.

The summit was sponsored by The SCAN Foundation, a Long Beach-based organization that helped fund a state-by-state ranking of long-term services for older adults, people with physical disabilities, and family caregivers. (The SCAN Foundation is also a sponsor of

States scoring the highest performed well in four categories of long-term support and services:

–       Affordability and access
–       Choices of settings and providers
–       Quality of life and quality of care
–       Support for family caregivers.

California tied for 15th place in the national rankings.

The report, however, identified a fifth critical category – coordination of care – yet acknowledged there was insufficient data available to rank the states.

One example of the pressing need for coordinated services is “Mrs. Smith,” a septuagenarian widow with two children, whose real-life story was recounted by Steven Wallace, associate director of the UCLA Center for Health Policy Research.

When her husband died after retirement leaving no pension, Smith was forced to subsist solely on Social Security, then suffered a series of health setbacks. After two heart surgeries she developed diabetes, and is now dependent on insulin and blind.  For five years she has had a fear of falling, and uses a cane.

But health concerns are only one part of her complicated story.

Smith is also supported by In-Home Supportive Services (IHSS), which pays her granddaughter to care for her at a senior living facility across town.  Smith uses transportation provided by a private company that contracts with the state.

In addition, Smith has two social workers: one provided by Kaiser Permanente, the other via the state’s Mental Health Stipend Program.

Finally, Smith uses a variety of equipment, including a talking clock, medical alert, custom toilet, handrails, and other assistive devices.

Wallace said Smith’s case is typical, and highlights a growing trend among rapidly aging Baby Boomers; they require a complex blend of services that must be coordinated to be successful.

“It is a web of services for most seniors,” said Wallace.

“Do you think they’re going to pay attention to their hypertension medicine,” asked Lynch, “if their PG&E is being turned off?”

Disabled Californians, in particular, have acute needs that must be considered in this complex equation, said Brenda Premo, founding director of the Harris Family Center for Disability and Health Policy at the Western University of Health Sciences, located in Pomona.

Despite tremendous medical breakthroughs in the past decades, Premo said that the progress of science has left many patients behind.

“It forgot that those people were individuals,” she said. The infirm or disabled who visited a doctor with no elevator, or the social services agency without a sign language interpreter, said Premo, don’t have adequate access.

The freedom to select aging services is pointless “if you can’t get there. And more and more people won’t,” she added.

“I hate to break it to the legislators, but they’re going to be 82 some day,” joked Premo, earning a laugh from the audience.

Lynch said the key to LTSS success is getting policymakers and healthcare providers to agree on coordinating services.

“We’ve got to break down these silos,” said Lynch.

What California desperately needs is a single leader who has the vision and power to coordinate LTSS care, argued Barazoto of the Little Hoover Commission, which investigates state government policy and operations.

“We need to have somebody who has the accountability and responsibility to take action,” said Barazoto, who spearheaded the commission’s April report A Long-Term Strategy for Long-Term Care.

Another essential element for success, she added, is creating a uniform assessment of LTSS services that legislators can use.

Today there is “data everywhere,” she lamented. “There really is no one bringing that information all together.”

The commission’s report recommended creating a new state agency to coordinate all long-term care programs within the Health and Human Services Agency.

This director of this agency would coordinate services by working with different agencies, seeking contract bids, and building coalitions across the entire spectrum of long-term services.

Former Assemblyman Hector De La Torre suggested that California follow a model established by the state of Washington, which has put all of its funding for disabled and aging services into one pot. This, he said, reduces bureaucratic and stakeholder rivalries and allows residents who need services to do one-stop shopping, dealing with a single caseworkers rather than going from program to program to find what they need.

“There’s one point of entry,” he said.

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