SECTION 1.
The Legislature finds and declares the following:(a) The Public Policy Institute of California estimates that by the year 2030, California’s population of people 65 years of age and over will increase by four million people and become more racially and economically diverse.
(b) The aging of California’s population will impact all areas of the service delivery system, including, but not limited to, increasing the demand for long-term services and supports (LTSS), housing, transportation, dental care, healthcare, and behavioral health services.
(c) Ensuring a well-trained, culturally competent workforce is
critical to meeting the needs of California’s aging population. Yet, the supply of trained paraprofessionals and professionals cannot keep pace with population demand now, let alone in the future. It is estimated that an additional 600,000 home care providers will be needed by 2030 to meet the needs of aging Californians.
(d) This workforce is composed of the following three categories:
(1) Paid paraprofessionals.
(A) Home care workers provide critical personal care services that help individuals remain at home and avoid institutionalization. The
California Future Health Workforce Commission estimates that an additional 600,000 home care workers will be needed by 2030. safely and with dignity in their own homes. Home care workers may be employed through public programs such as the In-Home Supportive Services (IHSS) program, or in the private market.
(B)The commission further finds that improving working conditions, benefits, and payment for home care workers will be required to meet future workforce needs. Home care workers face challenging working conditions, with low wages and insufficient training that lead to high turnover rates. Meeting future demand will require living wage compensation, career ladders, training, and advancement.
(C)The commission recommends establishing and scaling a universal home care worker category of jobs that would include a career ladder and associated training by adopting a new job category for home care workers. The job category would include three levels based on the types of services provided and the skills necessary to deliver those services. The commission’s
recommendation outlines a process to define the necessary competencies for each level, training requirements, compensation expectations, and amendments of the Nursing Practice Act to authorize greater delegation.
(B) The IHSS program, established in 1974, is a Medi-Cal funded program for eligible low-income seniors and persons with disabilities. The IHSS program currently has a workforce of over 500,000 home care providers caring for 593,000 recipients across the state.
(C) Approximately 113,000 home care workers are employed by private agencies throughout the state.
(D) Low wages and meager benefits result in
low workforce retention rates in home care. Treatment of home care workers under federal and state law has historically reflected stereotypical assumptions about the nature of this work-, specifically that employment within a household is not “real” work. An example of this inequity is the “family employment exception” in the federal Internal Revenue Code.
(E) Improving the wages and benefits of home care workers improves the economic well-being of workers and their families, substantially reduces industry turnover, and improves access to reliable and quality services. To ensure that workers get paid a living wage with health benefits and retirement security, the state must create an independent, sustainable financing mechanism.
(2) Paid health care professionals.
(A)The commission finds that less
(2) Paid health care professionals.
(A) Less than 5 percent of today’s health professions workforce is certified in geriatrics. The
(B) The American Geriatrics Society estimates the nation will need to train approximately 6,250 additional
geriatricians by 2030.
2030 to meet population needs.
(B)The commission recommends widespread training and the adoption of existing competencies in geriatrics, palliative, and hospice care for all health care professionals, with educational curricula incorporating geriatric-related competencies and specialized training to primary care providers to manage care for the aging population.
(3) Unpaid family caregivers.
(A) Family caregivers have emerged as the backbone of the LTSS system, by providing unreimbursed care and support to aging family and friends in the home and community settings.
(B) The
AARP Public Policy Institute reports that in 2015, over four million family caregivers in California provided approximately $57 billion worth of unpaid care. Nationally, other data shows that nearly two-thirds of older adults with LTSS needs receive all help from unpaid family caregivers.
(C) Despite their critical role, family caregivers continue to face daunting challenges in navigating the service delivery system, balancing employment and caregiving responsibilities, and financing their loved ones’ care needs.
(D) As reported by the California Task Force on Family Caregiving, the financial burden of caregiving is significant, with caregivers often losing income from taking time off from employment or entirely leaving paid employment prematurely. Few caregivers know of California’s family leave benefits that can provide much needed benefits to eligible workers.
(E) “Respite care” is broadly defined as support services that provide caregivers with a break from caregiving, and are provided to meet the caregiver’s needs. These respite services can positively impact both the caregivers’ and family members’ health and well-being.
(F) Respite care is one of the most sought-out services for caregivers in the state, and is particularly important to caregivers who live with the person they care for, are attending to a person with Alzheimer’s disease, or are caring for someone with a mental health issue or other condition that requires a significant level of care.
(G) Multiple organizations in the state are knowledgeable about distributing respite care services, including California caregiver resource centers (CRCs), area agencies on aging, and regional centers.
(H) The state should elevate policies that support unpaid family caregivers, better serve the needs of older adults, and promote greater efficiencies in public spending.
(I) The final report of the California Task Force on Family Caregiving outlines a range of recommendations to meet the needs of family caregivers now and into the future, including the following: supporting the financial well-being of caregivers; standardizing caregiver assessments; enhancing access to information, education, and training; increasing access to affordable caregiver services and supports; integrating family caregivers into the healthcare process; increasing funding for CRCs; and creating a statewide advisory council on caregiving.
(J) The challenges facing California’s family caregivers reflect issues plaguing the broader service delivery
system. A 2015 report by the Senate Select Committee on Aging and Long-Term Care, entitled “A Shattered System: Reforming Long-Term Care in California,” identified a number of system challenges including fragmentation, lack of access to services, workforce challenges and cultural competency, and a crumbling infrastructure.
(K) The aging of California’s population demands a thoughtful, deliberative approach to meeting the needs of older adults, people with disabilities, and family caregivers.
(e) It is, therefore, the intent of the Legislature to enact legislation to establish a Master Plan for Aging that provides a comprehensive strategy for issues affecting California’s aging population, including health care, LTSS, financing, and service delivery. It is the further intent of the Legislature that the range of issues addressed in the legislation include recommendations regarding
preparing and supporting California’s paid paraprofessional and professional workforce, as well as the unpaid family caregiver workforce.