A Long-Term Outlook: Disability Among California’s Seniors

A Long-Term Outlook: Disability Among California’s Seniors YEARS OF SERVICE MAC TAYLOR • L E G I S L A T I V E A N A L Y S T • NOVEMBER 2016 AN LAO REPORT 2 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT EXECUTIVE SUMMARY Rapidly Growing Senior Population and Changing Demographics of California Seniors Raise Issues About Long-Term Supports and Services (LTSS) System. Seniors are major users of LTSS—defined broadly as services and supports provided to the disabled (of any age) who have difficulty performing daily activities. The senior population (adults aged 65 and older) in California is projected to increase more than twofold from roughly 5 million in 2015 to nearly 12 million in 2060. The demographics of the senior population are also projected to change during this period. For example, the senior population is projected to shift from being majority white to majority nonwhite by 2030. The rapid growth and changing demographics of California’s senior population raise issues about seniors’ LTSS needs, LTSS system capacity, and the financial impact of LTSS on personal and state finances. This report presents the results of our projections of disability levels of California’s seniors through 2060 to inform the Legislature and stakeholders about levels of disability and the potential need for LTSS among California’s seniors over the next several decades. These projections provide a useful starting point in understanding how California’s changing population demographics will impact the LTSS delivery system. Population of California Seniors With Disabilities Projected to Grow Faster Than Overall California Senior Population. We project that the number of seniors in California with disabilities (as defined by limitations in routine activities of daily living, such as dressing or bathing) will increase from 1 million in 2015 to 2.7 million in 2060. This represents 160 percent growth in the population of seniors with disabilities, while California’s overall senior population is projected to grow by 135 percent over this period. The faster growth of the senior population with disabilities is partially driven by the increasing share of seniors aged 85 and older and increasing racial diversity of the senior population. California Seniors Turning 65 Between 2015 and 2019 Projected to Spend 4.5 Years on Average With a Disability. On average, seniors turning 65 between 2015 and 2019 are projected to live for 23.6 years after age 65 and spend 4.5 of these years with a disability. The average number of years lived with a disability varies based on demographics of the seniors in this cohort. For example, white seniors in this cohort are projected to spend 3.6 years on average with a disability, while Hispanic seniors are projected to spend 5.8 years on average with a disability and nonwhite, non-Hispanic seniors are projected to spend 5.6 years on average with a disability. (Data constraints prevent us from breaking out the nonwhite, non-Hispanic race category into additional groups.) California-Specific Projections Are a Necessary First Step in Planning for the Growing Senior Population. California-specific projections are necessary to inform the conversation around the future of the LTSS system as California’s senior population grows over the next several decades. Available national-level projections of disability levels (and the related issues of LTSS utilization and LTSS financing), while a useful starting point, are not sufficient to reflect California’s unique demographics and LTSS system. (For example, California’s senior population is projected to be majority nonwhite by 2030, while the senior population nationwide is projected to remain majority white through at least 2060.) As the Legislature, administration, and stakeholders continue to engage in planning for the impact of the growing senior population on the LTSS system, it is necessary to have projections that accurately reflect the uniqueness of California’s population and LTSS system to inform policymaking. www.lao.ca.gov Legislative Analyst’s Office 3 AN LAO REPORT 4 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT INTRODUCTION Over the next several decades, the senior also note that similar issues could be considered population (adults aged 65 and older) in California for the working-age disabled population, but a is projected to increase more than twofold from discussion specific to that population is beyond roughly 5 million in 2015 to nearly 12 million in the scope of this report.) At the national level, 2060. This increase is largely driven by the aging of detailed projections of the disability levels and the Baby Boomer population who began turning 65 potential LTSS needs of seniors over the next in 2011. A similar increase in the senior population several decades are available to inform the nationwide will also occur during this time frame. discussion around these issues. However, given However, differences in the demographics of California’s demographic differences compared California’s population when compared to the to the United States as a whole, the national-level population nationwide will lead to important results may not be applicable to California and to differences between California’s senior population our knowledge similar projections are not available and the senior population nationwide. For example, for California’s senior population. To address this California’s senior population is projected to shift information gap, we projected disability levels from being majority white to majority nonwhite of California’s seniors through 2060. This report by 2030, while the senior population nationwide is presents the results of our projections to inform projected to remain majority white through at least the Legislature and stakeholders about levels of 2060. disability and the potential need for LTSS among Long-term supports and services (LTSS) are California’s seniors over the next several decades. broadly defined as services and supports provided These projections provide a useful starting point to the disabled (of any age) who have difficulty in understanding how California’s changing performing daily activities. The rapid growth and population demographics will impact the LTSS changing demographics of California’s senior delivery system. The results presented in this report population raise issues about seniors’ LTSS needs, can also be built upon with further analysis focused LTSS system capacity, and the financial impact on utilization and financing of LTSS over the long of LTSS on personal and state finances. (We term. DISABILITY AND LTSS LANDSCAPE In this section, we discuss how disability is Defining Disability and LTSS measured and what types of LTSS services are Disability Is Measured by Limitations in provided to people with disabilities. This applies to Daily Activities. Disability is often measured by the broader population of people with disabilities, limitations in daily activities. These limitations including seniors as well as working-aged adults are typically grouped into two categories: and children. However, this report focuses on (1) limitations in activities of daily living (ADLs) seniors, and where possible in this section, we and (2) limitations in instrumental activities of present data specific to the senior population. www.lao.ca.gov Legislative Analyst’s Office 5 AN LAO REPORT daily living (IADLs). As shown in Figure 1, ADLs who pay out-of-pocket for their own LTSS. Within are limitations in routine, daily, personal care the state and federal governments, Medi-Cal and activities, such as eating or dressing. IADLs are Medicare are the two main payers of LTSS. limitations in more complex skills necessary to live Medicare Covers Limited LTSS. Medicare is independently, such as grocery shopping or money the federal health insurance program for qualifying management. persons over age 65 and certain people with LTSS Are a Range of Services and Supports disabilities, and is overseen by the federal Centers Provided to People With Disabilities. LTSS for Medicare and Medicaid Services (CMS). As a are commonly grouped into three categories: contrast to Medi-Cal (discussed below), individuals (1) institutional care, such as skilled nursing are eligible for Medicare regardless of income. facilities (SNFs); (2) home- and community-based Medicare only pays for a limited amount of LTSS. services, such as outpatient facility-based services For example, Medicare covers up to 100 days of or paid in-home services, aimed at helping people long-term care in a SNF for individuals receiving with disabilities live in the least restrictive setting skilled care, such as physical therapy, following a possible; and (3) informal, unpaid care that is recent hospital stay of at least three days. often provided at home by a spouse or other family Medi-Cal Covers a Broader Range of LTSS. member. Medi-Cal—a joint federal-state health care program for low-income Californians—covers Paying for LTSS a much broader range of LTSS than Medicare. Payers of LTSS include the state and federal (Medi-Cal is California’s Medicaid program.) The governments, private insurers, and individuals costs of Medi-Cal services are shared by the state Figure 1 Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) ADLs IADLs Grocery Eating Shopping Housework Money Management Getting In and Out of Bed Bathing Medicine Laundry Getting Around Getting Around Toileting Outside Inside Telephone Use Getting Preparing Dressed Meals Going Places Outside of Walking Distance 6 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT and federal governments. Generally, the federal • SNFs. SNFs provide nursing, rehabilitative, government pays for one-half of most Medi-Cal and medical care to facility residents. costs (although, in some circumstances the federal Generally, SNF residents receive their government pays for a larger amount of the costs), medical care and social services at the SNF. with the state paying the balance. Examples of Nationally, Medicaid Is the Largest Payer of LTSS covered by Medi-Cal include: LTSS. According to data from CMS on national • In-Home Supportive Services (IHSS). The health spending in 2013, Medicaid spending IHSS program provides personal care and represented 43 percent of all LTSS spending domestic services to individuals to help nationally while Medicare spending accounted them remain safely in their own homes. for 22 percent. Figure 2 shows national LTSS spending by payer in 2013 (such a breakout is not • Community-Based Adult Services (CBAS). available for California). In California, the most The CBAS program—sometimes referred recent analysis released by CMS indicates that to as “Adult Day Health Care”—is an Medi-Cal spending on LTSS was over $14 billion outpatient, facility-based service program. total funds in the 2012-13 federal fiscal year. This Program participants live in their own includes LTSS-related spending for the entire homes, but attend a day program with population served by Medi-Cal, including children, services provided by a multidisciplinary staff, working-age adults, and seniors. An analysis by the including: professional nursing services; Kaiser Family Foundation found that 42 percent physical, occupational, and speech therapies; of all LTSS spending in 2010 was for the senior mental health services; therapeutic activities; population. social services; personal care; meals and nutritional counseling; and transportation Figure 2 to and from the Medicaid Is the Largest Payer of participant’s residence. Long-Term Supports and Services in the U.S.a • Multipurpose Senior Services Medicare Program (MSSP). The MSSP benefit provides intensive case management Medicaid and home visits for Out-of-Pocket Medi-Cal recipients aged 65 or older who meet the eligibility criteria for a SNF Privateb Other Public but live outside of a Data are from 2013 and are based on an analysis by the Congressional Research Service. institutional settings. b Includes private insurance and other private payers such as philanthropic support. www.lao.ca.gov Legislative Analyst’s Office 7 AN LAO REPORT Informal, Unpaid Care Also an Important caregivers spent an average of 24 hours per week Part of LTSS. In addition to paid LTSS, a large providing care such as helping the recipient with amount of LTSS is provided through informal, ADLs and IADLs or communicating with health unpaid care. This type of care is most often care professionals on the recipient’s behalf. In provided by spouses, adult children, or other California, more than 6 million adults provided relatives and may be in addition to paid LTSS. The informal care for a family member or friend in AARP and the National Alliance on Caregiving 2009 according to an analysis by the University of estimate that nationwide 34.2 million adults California Los Angeles. These caregivers provided (about 14 percent) served as an unpaid caregiver an average of 21 hours of care per week. of an adult aged 50 or older in 2014. These unpaid CALIFORNIA’S POPULATION PROJECTED TO CHANGE SUBSTANTIALLY BETWEEN 2015 AND 2060 In this section, we provide an overview of the increase more than twofold from 5.2 million to changing population characteristics in California 12.2 million, while the under 65 population is through 2060. The information presented in projected to grow only 17 percent from 33.7 million this section is based on projections from the to 39.5 million (see Figure 3). The largest growth California Department of Finance and the United of seniors during this time period is projected to States Census Bureau and our analysis of data occur among the population of seniors aged 85 and from the Current Population Survey (a survey older. The number of seniors aged 85 and older is of U.S. households that provides demographic and Figure 3 economic information about Growth in Senior Population to Americans). See the Appendix Far Outpace Growth of Under 65 Population for a full list of data sources used in this analysis. Percent Change From 2015 to 2060 Senior Population 300% Projected to Increase Over Twofold, With Largest 250 Growth Among 85 and Older 200 Population. In 2015, seniors 150 represented 13 percent of California’s population, but 100 by 2060, seniors are projected 50 to represent 24 percent of California’s population. Under 65 65 and Older 65-84 85 and Older Over this period, the senior Seniors population is projected to 8 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT projected to increase over threefold from about at least 2060. As discussed later in this report, rates 700,000 in 2015 to over 2.5 million in 2060. This of disability vary by race; therefore, this projected corresponds to a projected increase in the share of shift in demographics is likely to have an impact seniors aged 85 and older from 14 percent in 2015 on the number of seniors with disabilities in to 21 percent in 2060. California. Ratio of Working-Aged Adults to Seniors California’s Senior Population May Be More Projected to Decrease by 50 Percent From 2015 Well-Educated if Current Trends Continue. to 2060. The projected rapid growth of the senior Consistent with research at the national level, we population relative to the rest of the population find that the rate of adults in California attaining results in a projected decrease of roughly 50 percent more than a high school education is increasing, in the ratio of working-aged adults to seniors by as shown in Figure 5 (see next page). This has also 2060. In 2015, there were 4.7 working-aged adults translated into higher levels of education among for every senior in California. By 2060, this ratio seniors in California. Assuming these trends is projected to decrease to 2.3 working-aged adults continue, California’s senior population will be for every senior. Researchers have suggested this more highly educated in 2060 than in 2015. Rates may be problematic for the provision of informal of disability vary by education level, meaning care as there may be more seniors who need LTSS that trends towards higher levels of education are and fewer working-aged adults to provide informal important to consider when projecting the number care. We revisit this issue later in this report. of disabled seniors in the future. We discuss this California’s Senior Population Projected to further later in this report. Become Majority Nonwhite While National Senior Population Projected to Remain Majority White. Both Figure 4 in California and nationally, California's Senior Population Projected to Be Majority Nonwhite Much Sooner Than National Population the share of the senior population that is nonwhite Percent of Nonwhite Seniors is projected to increase (see 100% Figure 4). However, the United States nonwhite senior population California is projected to become the 75 majority in California well before this shift happens 50 nationally. In California, the senior population is projected to shift from being majority 25 white to majority nonwhite by 2030, while nationally, white seniors are projected to 2015 2030 2060 remain the majority through www.lao.ca.gov Legislative Analyst’s Office 9 AN LAO REPORT PROJECTIONS OF SENIORS WITH DISABILITIES IN CALIFORNIA FROM 2015 THROUGH 2060 In this section, we provide projections of the as a result of changes in the size and demographic population of seniors with disabilities in California makeup of the senior population. from 2015 through 2060. These projections assume Disability Defined Based on Limitations current rates of disability remain constant for in ADLs. For the remainder of this report, we subgroups of the senior population. For example, define disability based on limitations in ADLs (see the rate of disability for married Hispanic women Figure 1 for a list of ADLs). We generally present who hold a high school degree and are between the results for seniors with limitations in one or more ages of 65 and 84 is held constant. This means that ADLs and for seniors with limitations in two or any changes in population-wide levels of disability more ADLs. (We include results specific to seniors projected in our analysis result from projected with limitations in two or more ADLs because in changes in the size and demographics of the senior many cases individuals are required to have at least population as opposed to increases or decreases in two ADL limitations to trigger private long-term disability rates. While we project the majority of care insurance benefits if they have such coverage.) the senior population will not be disabled in any Substantial Increase in Number of Disabled given year from 2015 through 2060, we project Seniors, but Majority of Senior Population Not there will be substantial growth in the population Disabled. The number of seniors in California of seniors with disabilities during this time period with any ADL limitations is projected to increase from 1 million in 2015 to Figure 5 2.7 million in 2060 (see Adults in California Are Figure 6), although the vast Attaining Higher Levels of Education majority of seniors in any given year from 2015 to Percent of Californians Aged 25 and Older 2060 are not projected to be 70% disabled. Specifically, among 60 More Than HS the population of seniors projected to have a disability 50 in 2060, about 1 million 40 are projected to have one ADL limitation and about 30 HS or GED Credential 1.7 million are projected 20 to have two or more ADL Less Than HS 10 limitations. Population of Seniors 1993 1998 2003 2008 2013 With Disabilities Projected HS = high school. to Grow Faster Than Overall Note: Data from the Current Population Survey. Senior Population. While California’s overall senior 10 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT population is projected to grow Figure 6 by 135 percent from 2015 to Population of Seniors With Disabilities 2060, the population of seniors Projected to Increase Substantially by 2060 with disabilities is projected Californians Aged 65 and Older (In Millions) to grow by 160 percent (see 14 Figure 6). This is the net result of the factors discussed 12 below. (We note that our 10 results do not reflect a causal relationship between these 8 characteristics and disability. 6 We observe in current data No ADL Limitations that these relationships, such 4 as the relationship between 2 education and disability, exist One or More ADL Limitations and assume they continue 2015 2030 2045 2060 going forward. We are not speculating as to why these ADL = activity of daily living. relationships exist currently.) • Share of Seniors Aged the population of seniors with disabilities 85 and Older Is Projected to Increase, than the overall senior population (again and Older Seniors Have Higher Rates assuming current rates of disability by race of Disability. As the share of California’s do not change). Currently, white seniors senior population that is aged 85 and older have lower rates of disability than Hispanic increases, this shift is likely to have an seniors and nonwhite, non-Hispanic impact on the number of disabled seniors seniors. (Data constraints prevent us from in California. Currently, rates of disability breaking out the nonwhite, non-Hispanic among seniors aged 85 and older are higher race category into additional groups.) As than among seniors aged 65 to 84. If this the population of nonwhite seniors grows, difference continues as the share of seniors this contributes to faster growth in the aged 85 and older increases, there will be population of seniors with one or more faster growth in the population of seniors ADL limitations than the overall senior with disabilities than the overall senior population. population. • Share of Seniors With Higher Levels of • Senior Population Is Projected to Become Education Projected to Increase, and More Nonwhite, and Nonwhite Population Rates of Disability Are Lower Among Has Higher Rates of Disability. As Those With Higher Education. Currently, California’s senior population shifts from rates of disability are lower among seniors being majority white to majority nonwhite, who have attained more than a high this will contribute to faster growth among school education than among seniors with www.lao.ca.gov Legislative Analyst’s Office 11 AN LAO REPORT a high school or less-than-high-school seniors is projected to decrease roughly 50 percent education. (We note that education is from 2015 to 2060. This may mean there are fewer considered to be a proxy for socioeconomic caregivers available for seniors with disabilities. status.) Assuming this difference in rates However, focusing only on working-aged adults of disability and current trends towards ignores seniors without disabilities who may be able higher levels of educational attainment to provide care for their disabled spouses or other continue going forward, this will partially disabled relatives. A recent analysis by the National offset the impact of the trends in race and Academies of Sciences, Engineering, and Medicine age on the growth of the senior population found roughly one-third of family members who with disabilities. In other words, the provided care to seniors were aged 65 or older in growth rate of seniors with disabilities 2011. We project that the ratio of seniors without will not be as high as it would otherwise disabilities to seniors with disabilities in California be absent this impact of increasing will decrease only 13 percent from 4:1 in 2015 to educational attainment. 3.5:1 in 2060. This may suggest a greater role for seniors without disabilities in providing informal Potential Increased Caregiving Role for care over the next several decades. Population of Seniors Without Disabilities. As discussed above, the ratio of working-aged adults to PROJECTIONS OF LENGTH OF DISABILITY AMONG CALIFORNIANS TURNING 65 BETWEEN 2015 AND 2019 In this section, we provide projections of years column of Figure 7 depicts the average number lived with a disability for the cohort of Californians of years lived after turning age 65 broken out by turning 65 between 2015 and 2019. These results years lived with no ADL limitations, one ADL reflect only this cohort as compared to the results limitation, and two or more ADL limitations. presented in the prior section which reflect the full For example, we project seniors in this cohort population of seniors in California in each year will spend an average of 19.1 years with no ADL from 2015 through 2060. We focus on this cohort limitations, 1.7 years with one ADL limitation, because we can generally observe their entire and 2.8 years with two or more ADL limitations. remaining life in our projections through 2060. The right column of Figure 7 depicts the average percent of life after turning 65 broken out by no Disability Projections Among Californians ADL limitations, one ADL limitation, and two or Turning 65 Between 2015 and 2019 more ADL limitations. For example, we project Throughout this section, we discuss projections seniors in this cohort will spend an average of depicted in Figure 7. The figure begins with results 80.1 percent of life after turning 65 with no ADL for the total senior population turning 65 between limitations, 7.2 percent of life with one ADL 2015 and 2019 and then breaks out the results for limitation, and 11.9 percent of life with two or more this cohort by race, education, and sex. The left ADL limitations. 12 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT Figure 7 Length of Time Lived With ADL Limitations Varies by Demographics Among Seniors Turning 65 Between 2015 and 2019 Average Years Lived After Turning 65 With . . . Percent of Life After Turning 65 With . . . No ADL Limitations No ADL Limitations One ADL Limitation One ADL Limitation Two or More ADL Limitations Two or More ADL Limitations Total Population All Seniors 19.1 1.7 2.8 80.1% 7.2%11.9% 65 75 85 95 50 100% By Race Whites 20.1 1.52.1 84.1% 6.6%9.3% Hispanics 18.7 2.1 3.7 76.3% 8.6% 15.1% All Other Races 19.3 1.8 3.8 77.5% 7.2% 15.3% 65 75 85 95 50 100% By Education Greater Than 20.1 1.6 2.6 82.9% 6.5%10.6% High School High School or GED 18.1 1.8 3.0 78.9% 7.9%13.2% Credential Less Than 16.1 2.1 3.7 73.8% 9.4% 16.8% High School 65 75 85 95 50 100% By Sex Female 19.5 1.9 3.4 78.6% 7.7% 13.7% Male 18.6 1.42.3 83.4% 6.3%10.3% 65 75 85 95 50 100% ADL = activity of daily living. www.lao.ca.gov Legislative Analyst’s Office 13 AN LAO REPORT Seniors Turning 65 Between 2015 and 2019 Seniors in This Cohort With More Than a Projected to Spend 4.5 Years and 19 Percent of High School Education Projected to Live Fewer Remaining Life With a Disability. On average, Years With a Disability. The average number seniors turning 65 between 2015 and 2019 are of years lived with a disability among seniors in projected to live for 23.6 years after age 65 and this cohort also varies by educational attainment. spend 4.5 of these years (about 19 percent) with one Seniors turning 65 between 2015 and 2019 who or more ADL limitations. This reflects an average have greater than a high school education spend of 1.7 years with one ADL limitation and 2.8 years fewer years on average with one or more ADL with two or more ADL limitations. The average limitations than seniors with a high school degree number of years lived with a disability varies based or GED credential and seniors with less than a on demographics of the seniors in this cohort, as high school education (4.2 years vs. 4.8 years and discussed below. While Figure 7 shows the average 5.8 years, respectively). years lived with ADL limitations, not all seniors in Not only do seniors with more than a high this cohort are projected to have ADL limitations school education live longer on average than during their life after age 65. Twenty-three percent their counterparts with less education, they are of seniors in this cohort are projected to spend no projected to spend a smaller share of their life after years with ADL limitations. turning 65 with one or more ADL limitations on Nonwhite Seniors in This Cohort Projected to average than seniors with a high school degree or Live More Years With a Disability. While seniors GED credential and seniors with less than a high on average in this cohort are projected to spend school education (17.1 percent vs. 21.1 percent and 4.5 years with any ADL limitations, the number of 26.2 percent, respectively). years lived with ADL limitations varies by race. White Female Seniors in This Cohort Are Projected seniors in this cohort are projected to spend 3.6 years to Live More Years With a Disability. Female on average with ADL limitations, while Hispanic seniors turning 65 between 2015 and 2019 are seniors are projected to spend 5.8 years on average projected to live more years with a disability with ADL limitations and nonwhite, non-Hispanic on average after turning 65 than male seniors seniors are projected to spend 5.6 years on average in this cohort. Female seniors are projected to with ADL limitations. (Data constraints prevent us live 5.3 years on average with one or more ADL from breaking out the nonwhite, non-Hispanic race limitations while male seniors are projected to category into additional groups.) live 3.7 years on average with one or more ADL While nonwhite seniors are projected to live limitations. longer than white seniors in this cohort, nonwhite Female seniors in this cohort are projected to seniors are also projected to spend a larger share of live longer after turning 65 than male seniors on life after age 65 with ADL limitations than white average, but female seniors are also projected to seniors. White seniors in this cohort are projected spend a larger share of life after turning 65 with to live, on average, 15.9 percent of life after turning one or more ADL limitations on average. Female 65 with at least one ADL limitation, while Hispanic seniors are projected to spend 21.4 percent of life seniors and nonwhite, non-Hispanic seniors are after turning 65 with at least one ADL limitation projected to live 23.7 percent and 22.5 percent, on average compared to 16.6 percent of life after respectively, of their life after turning 65 with at turning 65 lived with at least one ADL limitation least one ADL limitation. on average among male seniors. 14 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT California Seniors Compared to Figure 8). The Urban Institute projects that seniors Seniors Nationally nationwide will spend two years on average with two or more ADL limitations compared to our Compared to Seniors Turning 65 Between projection of 2.8 years on average for California’s 2015 and 2019 Nationwide, California’s Seniors seniors. California’s seniors in this cohort are Projected to Live More Years With Two or More also projected to spend a larger share of life after ADL Limitations. Seniors in California turning turning 65 with two or more ADL limitations than 65 between 2015 and 2019 are projected to spend seniors nationally (11.9 percent vs. 9.6 percent). nearly one year longer on average with two or more ADL limitations than seniors nationally (see CALIFORNIA-SPECIFIC PROJECTIONS ARE A NECESSARY FIRST STEP IN LTSS SYSTEM PLANNING This analysis demonstrates the need for are not sufficient to reflect California’s unique California-specific projections to inform the population and LTSS system. As the Legislature, conversation around the future of the LTSS administration, and stakeholders continue to system as California’s senior population grows engage in planning for the impact of the growing over the next several decades. The national-level senior population on the LTSS system, it is projections that provide information on disability necessary to have projections that accurately reflect levels (and the related issues of LTSS utilization the uniqueness of California’s population and and LTSS financing), while a useful starting point, current LTSS system to inform policymaking. Figure 8 California’s Seniors Projected to Spend More Years With a Disability Than Seniors Nationallya California’s Seniors Turning 65 U.S. Seniors Turning 65 Between 2015 and 2019 Projected to Spend . . . Between 2015 and 2019 Projected to Spend . . . 2.8 2.0 Years Years 11.9% 9.6% of Life After Age 65 of Life After Age 65 With 2+ ADL Limitations With 2+ ADL Limitations a National projections are from the Urban Institute. ADL = activity of daily living. www.lao.ca.gov Legislative Analyst’s Office 15 AN LAO REPORT This report begins to fill the need for system, it would also be useful to have projections California-specific information by providing of LTSS utilization and financing. However, such projections of disability among California’s seniors projections are not available at this time. Our through 2060. To further understand the impact office will assess the feasibility of producing such of the aging California population on the LTSS projections in the future subject to available data. ADDITIONAL INFORMATION AVAILABLE ON LAO WEBSITE In addition to the findings presented in presented for nonwhite seniors who are this report, the LAO website (www.lao.ca.gov) married compared to nonwhite seniors contains additional resources based on our analysis who are not married). including: • Future work that will be added to our • A summary infographic that highlights key website over time, including analyses findings from our analysis. that provide projections of California’s population of seniors with disabilities • Supplemental results that provide under alternative scenarios in which rates additional details and explore results for of disability (1) decrease over time and additional subpopulations beyond what (2) increase over time. is in this report (for example, results are 16 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT APPENDIX Data Sources Used in This Analysis • American Community Survey, 2013 1-year • Rowland, Diane. (2013). What Would PUMS Data [Data file]. Washington, DC: Strengthen Medicaid Long-Term Services U.S. Census Bureau, 2013. Available from and Supports (LTSS)? [PowerPoint slides]. the American FactFinder website: Retrieved from: http://ltccommission. http://factfinder.census.gov org/ltccommission/wp-content/ uploads/2013/12/DRowland-PP.pdf • Favreault, Melissa, and Judith Dey. (2015). Long-Term Services and Supports for • State Population Projections by Race/ Older Americans: Risks and Financing. Ethnicity, Sex, and Age 2010-2060 [Data Washington, DC: US Department of file]. Sacramento, CA: State of California, Health and Human Services, Office of Department of Finance, 2014. Available the Assistant Secretary for Planning and from the California Department of Evaluation (ASPE). Retrieved from the Finance website: http://dof.ca.gov/research/ ASPE website: https://aspe.hhs.gov/basic- demographic/projections/ report/long-term-services-and-supports- • Survey of Income and Program older-americans-risks-and-financing- Participation 2008. Washington, DC: U.S. research-brief Census Bureau, 2015. • Health and Retirement Study (HRS) public • Survey of Income and Program use dataset. Ann Arbor, MI: University of Participation 2008. Cambridge, MA: Michigan with funding from the National National Bureau of Economic Research Institute on Aging, 2014. (NBER), 2015. Available from the NBER • HRS Data (Version N) [Data file]. Santa website: http://www.nber.org/data/survey- Monica, CA: RAND Center for the Study of-income-and-program-participation- of Aging with funding from the National sipp-data.html Institute on Aging and the Social Security • U.S. Population Projections: 2014-2060. Administration, 2014. Available from Washington, DC: U.S. Census Bureau, 2014 the University of Michigan Health and [Data file]. Available from the U.S. Census Retirement Study website: http://hrsonline. Bureau website: http://www.census.gov/ isr.umich.edu/data/index.html population/projections/data/national/2014/ • Integrated Public Use Microdata Series downloadablefiles.html (IPUMS), Current Population Survey (CPS) [Data file]: Version 4.0. Minneapolis: University of Minnesota, 2015. Available from the IPUMS-CPS website: www.ipums.org www.lao.ca.gov Legislative Analyst’s Office 17 AN LAO REPORT 18 Legislative Analyst’s Office www.lao.ca.gov AN LAO REPORT www.lao.ca.gov Legislative Analyst’s Office 19 AN LAO REPORT LAO Publications This report was prepared by Amber Didier and reviewed by Mark C. Newton. The Legislative Analyst’s Office (LAO) is a nonpartisan office that provides fiscal and policy information and advice to the Legislature. To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service, are available on the LAO’s website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000, Sacramento, CA 95814. 20 Legislative Analyst’s Office www.lao.ca.gov