A Long-Term Strategy for Long-Term Care

Report #205, April 2011


The Little Hoover Commission on Thursday called for focusing the leadership of long term care programs at the state level to improve local governments’ ability to help low income frail seniors and disabled Californians receive care in home and community based settings to avoid the need for nursing home care.

The Commission called for naming a long-term care champion at the state level who would be responsible for long-term care programs currently spread over seven different departments in the California Health and Human Services Agency. The state’s longterm care leader should be responsible for developing a state strategy that supports local government’s efforts to integrate long-term care services. The state’s long-term care leader also should be responsible for designing and implementing the consolidation of long-term care programs at the state level to improve efficiency and accountability.

“These are services that can best be delivered by local governments, and they need the support and flexibility to be able to put together integrated strategies that fit their local conditions,” said Daniel W. Hancock, chairman of the Little Hoover Commission.

In its report released today, A Long-Term Strategy for Long-Term Care, the Commission urges the Governor and Legislature to improve the state’s assessment, data collection and case management tools and give local governments the flexibility, control and support they need to best meet clients’ needs.

California serves more than a million low-income seniors through its long-term care programs. That number is expected to climb as the state’s senior population doubles over the next two decades. With responsibility for long-term care diffused, no single person is in charge of a collection of more than three dozen programs that serves a population whose needs change as they age. Duplication of programs and assessments diverts money that could be directed toward services and, despite overlap among programs, service gaps continue to exist. From the client perspective, what should appear as a system instead can be a confusing maze.

“This fragmented organizational structure and lack of a specific leader or entity responsible for long-term care in California leaves the state with a leadership vacuum that complicates any effort to take on comprehensive long-term care reform,” the Commission wrote.

“The leadership gap also thwarts local efforts to improve the system,” the report continues, “as forward-thinking counties seeking to integrate their programs try to obtain state approval for changes find themselves stymied in dealing with the different departments and are left with no one at the state who can facilitate their efforts at the local level.”

Universal budgeting of long-term care programs across departments would allow the state to better manage the system and identify cost trends more quickly until long-term care programs can be consolidated.

The state can aid local governments and gain information about beneficiaries useful to program management by developing a universal assessment tool that can be used to assess applicants and determine their eligibility for a range of programs at the same time. Such a tool would enhance local efforts to create a single point of entry into the system for low-income seniors and disabled Californians.

The Little Hoover Commission is a bipartisan and independent state agency charged with recommending ways to increase the efficiency and effectiveness of state programs. The Commission’s recommendations are sent to the Governor and the Legislature. To obtain a copy of the report, contact the Commission or visit its Web site: www.lhc.ca.gov.