Californians are getting old. Or at least, getting older. The number of state residents over 60 grew from 1.6 million in 1950 to 4.7 million in 2000. By 2020, nearly 20% of California’s population is expected to be 60 or older. By 2050, that number is expected to be 25%. The California Department of Aging (CDA) provides services for older adults, adults with disabilities, family caregivers and residents in long-term care facilities. It oversees implementation of the Older Californians Act, which was passed by the state Legislature in order to comply with federal legislation mandating the availability of certain community services to senior citizens. The department has an annual budget of more than $200 million and is part of the Health and Human Services Agency. CDA coordinates and directs the use of federal funds through local service providers and 33 Area Agencies on Aging to fulfill the requirements of federal legislation and the state’s Mello-Granlund Older Californians Act, and parts of the Medi-Cal plan.  These programs include support services and meals, the Multipurpose Senior Services Program, the National Family Caregiver Support Program, Alzheimer’s Day Care Resource Centers, Respite, Adult Day Care, Adult Day Health Care, Brown Bag, Foster Grandparent and Senior Companion. 

About the California Department of Aging (CDA website)

California State Plan on Aging, 2009-2013 (CDA website) (pdf)

California first explored the societal implications of aging in 1948, during Gov. Earl Warren’s administration, with an exploratory body called the Interdepartmental Coordinating Committee on Aging. The committee served in an advisory capacity and did not administer any programs or provide funding. Further action was taken after the first Governor's Conference on Aging in 1955, when a Citizens’ Advisory Committee on Aging was authorized by the state Legislature. The committee consisted of eight members, appointed by the governor and approved by the Senate; and two members of each legislative chamber, chosen by their respective houses. The committee was assigned four tasks: studying the problems of aging and recommending necessary action to the governor; giving local  communities guidance and consultation in helping develop programs for senior citizens; acting as an information clearinghouse for issues concerning aging; and consulting and cooperating with the state’s departments and agencies in developing programs for the elderly.

On July 14, 1965, Congress enacted the Older Americans Act as part of the Johnson administration’s Great Society program, creating the Administration on Aging and establishing a series of benefits for the older population in the United States.  Upon signing the bill, President Lyndon Johnson said: “Under this program every state and every community can now move toward a coordinated program of services and opportunities for our older citizens.”

Following passage of the new law, the Citizens' Advisory Committee on Aging became California’s administrative agency for the federal grants. The name was changed to the California Commission on Aging and it became part of the Department of Human Resources Development within the Health and Welfare Agency. The commission was charged with advising the governor’s office, coordinating efforts and consulting with local governments and agencies, senior organizations, as well as business, industry, and labor. In 1973, the Burton Act established the Office on Aging as a department within the Health and Welfare Agency. The Commission on Aging continued in its capacity as an advisory body, while the new Office on Aging took operational responsibility for the state’s programs by dividing the state into thirty-three Planning and Service Areas to be administered by Area Agencies on Aging.

In 1976 the Office on Aging became the California Department of Aging. The department’s duties were further defined and extended by the Older Californians Act of 1980, and the Area Agencies on Aging were designated as “principal advocates” at the local governmental level.

Inventory of the Department of Aging Records (Online Archive of California)

Biographical History (Social Archive)

The department contracts with the 33 local Area Agencies on Aging, which are run independently or as a part of county or city agencies, to deliver numerous mandated services as defined by federal and state legislation. The CDA administers and provides funding for programs that include home-delivered meals, the Multipurpose Senior Services Program (MSSP), a Health Insurance Assistance Program (HICAP), and certifies Adult Day Health Care (ADHC) centers for the Medi-Cal program. Additionally, the department includes an ombudsman’s office to investigate complaints involving long-term care.

Area Agencies on Aging

All spending for services is done through the 33 local Area Agencies on Aging (AAA). CDA contracts with this network to plan, develop, coordinate and administer services to older adults in one of the 33 designated Planning and Service Areas (PSA).  The AAAs may provide services directly or by contract with an outside agency or company. The PSAs consist of one or more counties (and the city of Los Angeles) within the State.

There are two Medi-Cal funded programs: the Multipurpose Senior Services Program (MSSP) and the Adult Day Health Care (ADHC) Program.  The CDA administers MSSP and certifies ADHC centers for participation in the Medi-Cal Program, via an interagency agreement with the Department of Health Care Services.

The Area Agencies on Aging, or as they are more commonly known, the AAAs, are the agency’s means of delivering most of its services to the senior population. The 33 agencies throughout the state consist of county or municipal entities administered at the local level under the supervision and guidelines of the CDA, with funding provided largely (but not entirely) by the department from federal funding. As required by the Older Americans Act, the agencies provide a variety of services:

The Elderly Nutrition Program functions in two areas, the Congregate Nutrition Program, which provides meals outside the home at “congregate meal sites” to encourage social interaction, and The Home-Delivered Nutrition Program, which delivers meals to seniors who choose to remain home or are otherwise home-bound.

CDA’s Health Promotion and Disease Prevention Program includes routine health screening, medication management, education, nutrition counseling, physical fitness, home injury prevention and emotional well-being care.

Senior Community Service Employment Program

The Senior Community Service Employment Program provides part-time job training and job referrals at local community service agencies. Participants must meet eligibility requirements, and may receive up to 20 hours per week of subsidized job training. After the completion of training the area agency attempts to place the trainee into unsubsidized employment, and failing that, may offer additional training.

Medication Management provides screening and education to prevent incorrect medication and adverse drug reactions among seniors. The program’s stated goal is “to improve the quality of life for older adults and prevent premature institutionalization by working with them to manage their use of over the counter and prescription medications, vitamin, mineral, and herbal supplements.” 

Health Insurance Counseling and Advocacy Program (HICAP)

HICAP is a program that counsels seniors on health care insurance, the use of Medicare benefits, supplemental Medicare insurance and long-term care.  A federal grant program (SHIP) is used to support the 24 local office’s education and individual counseling assistance.

Multipurpose Senior Services Program

CDA’s Local Multipurpose Senior Service Program (MSSP) sites provide social and health care management for feeble elderly adults who are eligible for placement in a nursing facility but who decide to live independently. The program, which operates under a federal Medicaid Home and Community-Based, Long-Term Care Services Waiver, began in 1977. Participants must be 65 years old or older, and meet the criteria for placement in a nursing home. The program provides assistance in a number of areas: adult day care, housing assistance, chore and personal care assistance, protective supervision, care management, respite, transportation, meal services, social services and communications services.

Adult Day Health Care

The California Department of Aging has certified a network of some 300 adult day care centers, licensed by the Department of Public Health, to participate in the Medi-Cal Program as Adult Day Health Care centers. The centers are designed to provide health, therapeutic and social services to those at risk of being placed in a nursing home. The day care centers are tasked with helping older Californians remain independent and postpone institutionalization in a long term care or other facility.

ADHC centers  may provide medical services; nursing and personal care services; physical, occupational and speech therapy; psychiatric and psychological services; social services; therapeutic activities; hot meal and nutritional counseling; and transportation to and from the center.

Long-Term Care Ombudsman Program

CDA’s Long-Term Care Ombudsman Program investigates elder abuse complaints in long-term care facilities and in residential care facilities for the elderly. These facilities include nursing homes, residential care homes, and assisted living facilities. Residents or their family members may file a complaint directly with the local Long-Term Care Ombudsman or by calling the department’s 24-hour a day CRISISline. The ombudsman has 35 local program coordinators throughout the state.

State Plan on Aging

California is required under federal law to develop a State Plan on Aging in order to receive federal funding.  The plan developed by the CDA meets the requirements by defining state goals and objectives in implementing the OAO, and details information about local Area Agencies on Aging, provides demographics on the aging population, the state’s priorities and provider’s performance measurements.

About The California Department of Aging (CDA website)

Elderly Nutrition Program Best Practices (CDA website) (pdf)

California State Plan on Aging (CDA website) (pdf)

The CDA dispenses federal and state funds in myriad programs under a variety of topics. The bulk of the money spent, 84% of the budget, is from grants from the federal government, and targeted to specific areas per the grant guidelines. Money is allocated in five main areas: nutrition, senior employment, support service centers, Medi-Cal and administration.

The largest share of CDA’s expenditures is in the area of nutrition, $80.7 million in fiscal 2011-12. The Meals on Wheels program is a well-known example of this program, though Meals on Wheels is an independent organization which predates the CDA, and is not directly affiliated with the department.  In San Francisco, for example, the city’s Department of Aging & Adult Services, which is partially funded by CDA, provides 43% of Meals on Wheels San Francisco’s budget. Support service centers claim around $68 million of the budget for senior centers, elder abuse prevention, in-home services, information, and legal and transportation services.

3-Year Budget (pdf)

Brown Proposes Halting Medi-Cal payments to ADHC

In an effort to stem the tide of red ink that threatens to engulf the state, Gov. Jerry Brown has proposed halting Medi-Cal payments to adult day health care programs, which are administered by the CDA.

Facing a $24.5 billion deficit, Gov. Brown sought to eliminate the use of Medi-Cal funds at the more than 300 adult day health care programs that are certified by the California Department of Aging. Gov. Brown proposed a 10% cut in payments to doctors and other providers of services to Medi-Cal patients. Previous attempts by other states, and in 2008 by Gov. Schwarzenegger, have resulted in lawsuits by opponents that made their way to the U.S. Supreme Court. The court previously blocked about $1 billion in Medi-Cal cutbacks adopted by the Legislature in 2008. Brown’s proposal has resulted in several suits being filed.

Opponents argue that the cuts would in fact result in an increase of costs for the state, and not a reduction. Dawn Myers Purkey, manager of Woodland Healthcares Adult Day Health Center in Woodland, points to a May 2010 report by The Lewin Group, which says that the elimination of adult day health care would cost the state $51 million more than it saves because of cost-shifting to other more expensive settings. Additionally, she says that the state would forfeit $177 million annually in federal matching funds.

 Elizabeth Ashford, a Gov. Brown spokeswoman, said the federal courts had been a “roadblock” to allowing California to balance its budget. The issue before the high court, she said, was a matter of “state sovereignty.”

“It's incredibly important. The fact that they are taking this up indicates that they understand how important this issue is to the state.” Brown’s plan would lower the amounts the state pays healthcare providers by 10%, which would reduce the program’s costs by $719 million.

U.S. Supreme Court to Rule on Gov. Jerry Brown’s Proposed Medi-Cal Cuts (Voice of OC)

Don't Cut Funding for Adult Day Health Care (by Dawn Myers Purkey, The Davis Enterprise)

Liberate the Ombudsman

In March 2011, Democratic State Sen. Lois Wolk introduced legislation to make the Department of Aging’s long-term care ombudsman an independent office. The senator’s proposal echoed a long-running argument about the effectiveness of the long-term care ombudsman.

In 1991, the ombudsman’s office was deemed an effective program in a study by the inspector general of the U.S. Department of Health and Human Services. In its report on six case studies, “Effective Ombudsman Programs,” the CDA’s ombudsman office was chosen for “its size, dedication and training of paid and volunteer staff, strong enabling legislation, extensive publicity, and good relationships with the provider community and the State Unit on Aging [CDA].”

Recently, however, numerous groups have leveled complaints at the office, and called for its restructuring. The Committee for an Independent State Office made the case for separating the office from CDA in a 2010 letter to Assembly Member Mariko Yamada, Chair of the Assembly Committee on Aging and Long-Term Care. Yamada had convened a committee hearing as part of the oversight process.

The letter stated that due to a budget cut in 2008, local programs lost half of their funding. “When asked for help and intervention from the State Long-Term Care Ombudsman (OSLTCO), the local ombudsman coordinators were informed that the OSLTCO could not intervene or advocate for restoration of funding due to their status as state employees, or in the case of our State Ombudsman, and the Director of the California Department of Aging (CDA), governor appointees.”

“Does the state structure promote safety (and) well-being of 300,000 residents of (elder care facilities)? No,” said Linda Robinson, who coordinates the ombudsman program in Santa Cruz County, during the committee’s hearing. She said the state office has prevented local senior advocates from speaking to the media and about legislation that would benefit elder citizens.

Long-Term Care Ombudsman Joseph Rodrigues disagreed, saying that he had been assured by the Schwarzenegger administration that he can speak out freely on behalf of seniors. “Frankly, I feel like we already have an independent state office,” Rodrigues said in an interview with Christina Jewett of California Watch. “I don’t feel any restrictions on my ability to act and speak.”

State Sen.’s Wolk’s bill is a response to these and other complaints. “Senate Bill 345 works to provide more independent and cost-effective advocacy for seniors living in long-term care facilities who are among the most vulnerable citizens of California,” Wolk said in a press release. “Our long-term care residents and local ombudsmen look to the state long-term care ombudsman for leadership. The bill will create the autonomy necessary for ombudsmen to fulfill their duties effectively. The legislation is supported by a group called the California Long Term Care Ombudsman Association, and by the Committee for an Independent State Ombudsman Office.  Wolk’s bill would create an independent non-profit, similar to a model that has proved successful in several states such as Colorado and Washington. Rodrigues said that he prefers to leave the office as it is. “My personal preference” he said, “is to remain within state government, as it provides us with resources we need to carry out our mandate.”

Effective Ombudsman Programs, Six Case Studies (Office of the Inspector General) (pdf)

Senator Introduces Bill to Strengthen Protections for Elderly (Office of Sen. Lois Wolk)

Elder-Care Ombudsmen Seek Independence from State (by Christina Jewett, California Watch)

Restructure the Department

An “Expert Panel to Review California Department of Aging Structure,” convened by Assemblywoman Patty Berg, chair of the Assembly Committee on Aging and Long-Term Care, included past directors of the agency, legislators and area experts from around the country convened to examine the CDA and recommend changes. The 2004 report was highly critical of the agency and its methods. It concluded that the “administration of California’s long-term care programs reflects a piecemeal approach in program development and funding. The complexity of the system is the greatest barrier to improved service. Separate funding streams, varied eligibility criteria, lack of statewide standards, and uncoordinated services for California's aging population have created barriers in services for this population.”

The state’s independent Little Hoover Commission earlier had reached much the same conclusion. “California has delayed developing a strategy to manage its long-term care programs as a cohesive system for decades.  Now the state struggles with sharply reduced resources and faces a projected surge in its senior population.  California leaders must act to develop and implement a strategy to put increasingly scarce dollars to their best use in meeting the needs of low-income elderly and disabled Californians.”

Conflicts existed among several agencies, the commission said. “In the case of the In-Home Supportive Services program, one state entity, the Department of Social Services, is responsible for administering an entitlement program in which care is delivered through individual contracts at the local level, while much of the funding is supplied through a separate department, the Department of Health Care Services. A separate state program, Multiple Senior Services Program, located in yet another department, the Department of Aging, has responsibility for administering local efforts to provide case management for social and health care needs for frail seniors who wish to stay in the community rather than enter a nursing home. This program has a separate process for determining need and eligibility than does In-Home Supportive Services, though the programs’ clients often are the same people.”

Restructuring the Department of Aging and Long-Term Care Services in California (Expert Panel) (pdf)

A Long-Term Strategy for Long-Term Care (Little Hoover Commission) (pdf)

Eliminate the Department

The Department of Aging has long faced questions about its effectiveness from both critics and supporters of its mission. The independent Legislative Analyst’s Office (LAO) went so far as to recommend the elimination of the department in 2003-2004 and its consolidation within the state’s Department of Social Services. The proposal launched a firestorm of debate.

Pro

Many see the potential for re-energized leadership in a single department that could set and pursue broad goals of obtaining federal waivers, integrating services and maximizing flexibility. A single department, they argue, could have clear policy objectives that combine the best elements of existing operations, including the social model of programs under the Department of Social Services. A single department could ensure that the policy focus is on the consumer's needs rather than on bureaucratic convenience.

The LAO’s argument is not that the services provided by the department are unnecessary, but that CDA’s functions are much like those of the Department of Social Services, with many overlapping areas.

The report described CDA’s functions as providing “nutrition programs, supportive services, employment services, and preventive health services. The CDA administers federal Older Americans Act programs for supportive services, in-home services, and nutrition. The CDA contracts with, and provides guidance to, 33 Area Agencies on Aging (AAAs) ... coordinate and deliver services to senior citizens at the community level.”  It compared the two agencies, saying that “DSS also operates several programs that serve older Californians, including the Supplemental Security Income/State Supplementary Program (SSI/SSP), the In-Home Supportive Services program (IHSS), and the Adult Protective Services program. These programs are housed within DSS's Disability and Adult Programs Division.”

The analyst’s office said that the consolidation would in fact improve service to seniors. “We believe that combining programs that serve senior citizens into one division at DSS should result in program efficiencies, because one division would oversee the bulk of services for California senior citizens. For example, CDA operates the Linkages Program and MSSP. The purpose of these programs is to assist frail elderly clients in avoiding institutionalization. The IHSS program operated by DSS has the same mission—providing home-based services so that clients can live independently. Moreover, recipients of the DSS programs could be more easily linked to other services currently offered by the CDA, such as the nutrition programs, if most aging programs were under the control of one department.”

Merging CDA into the DSS would also save taxpayers money, by achieving economies of scale. “DSS achieves economies of scale and needs proportionately fewer staff for executive and administrative activities than does CDA. Specifically, for every one program staff at DSS there are .22 administrative (nonprogrammer) staff. Conversely, at CDA, for every one program staff, there are .72 nonprogram staff. Combining these departments would build on the economies of scale at DSS.” The LAO also noted that most states locate its aging programs inside a larger agency.

The LAO concluded that the AAAs “would continue to deliver aging services. The DSS would contract and guide the AAAs in the same manner as the CDA.”

Much of the LAO’s sentiments were echoed by the California Performance Review of 2004 and the Little Hoover Commission in 2009.

Con

The chairwoman of Kern County's Commission on Aging, Bea Smith, said that the LAO’s proposal would bury the CDA in a of welfare programs administered by the Department of Social Services, relegating it to minor status. Judy Clausen, writing in the Bakersfield Californian, said Smith was right to be concerned. “Kern seniors should be concerned, too. The Department of Aging shouldn't be relegated to a minor spot in Social Services. It needs to remain in a leadership role, protecting the benefits seniors enjoy under the Older Americans Act.”

When the Little Hoover Commission was reviewing the structure of government in 2009, it noted that not everyone agreed that consolidation of the various entities dealing with aging was a good thing. Dozens of residential care facilities wrote the commission objecting to a move that would place them in a grouping with license skilled nursing facilities. Many feared that the elaborate licensing requirements and exhaustive inspection processes would overwhelm residential care facilities.

Still others argued that neither prospective nor procedures would change. The problems within the Department of Aging, some argued, were not intrinsic to the state but were the result of constraints placed on it by the federal government. Changing how the state operates will not give programs new flexibility or unleash tightly controlled funds, they said.

Department of Aging Could be Buried (by Judy Clausen, Bakersfield Californian)

Analysis of the 2003-04 Budget Bill (Legislative Analyst’s Office)

Reorganization – The Department of Aging (California Performance Review)

Structure (Little Hoover Commission)

Lynn Daucher, 2007 – 2011

Lynda Terry, 2000 – 2007

Dixon Arnett, 1995 – 2000

Robert Martinez, 1992 – 1995

Christine Arnold (interim)

Gary Kuwabara (interim)

Alice J. Gonzales, 1983 – 1990

Jim Harrell (acting)

Janet Levy, 1975 – 1982