Issue Brief: California’s Aging Population

Issue Brief: California’s Aging Population October 2023 Executive Summary This Issue Brief presents data on California’s aging population as part of the Commission’s review of early implementation of the state’s Master Plan for Aging, a 10-year effort that aims to promote healthy aging and prepare California for coming demographic changes. THE NATION’S POPULATION IS AGING, BUT CALIFORNIANS ARE RELATIVELY YOUNGER Populations across the globe are getting older, but the demographic shifts are relatively less dramatic in the United States than for most developed countries, and less so for California than most states: ◊ Among the United Nations’ list of 36 “developed” countries, the United States’ median age was the fourth lowest in 2022. ◊ California’s median age consistently falls below that of the nation overall and is 11th lowest among states. CALIFORNIA MUST RECKON WITH A MASSIVE DEMOGRAPHIC SHIFT Nonetheless, California must adapt to an aging population: ◊ California’s median age is rising. In 1970, it was 28. By 2060, it is projected to be over 45. ◊ Some counties are older than others. California’s youngest county, Merced, has a median age of 32 years, while the state’s oldest county, Sierra, has a median age of nearly 54 years. ◊ The state’s 55-plus population will increase by 10 percentage points, or nearly 4 million adults, over the next forty years; meanwhile, the state’s 17 and under population will decrease by 5 percentage points, a reduction in over 2.1 million children. ◊ Older California females outnumber older California males. In 2022, there were just 61 males for every 100 females aged 85 years and older. ◊ By 2060, California’s older adult population will be as diverse as the state’s overall population—which will look much like the state does today. MAJOR FACTORS CONTRIBUTING TO CALIFORNIA’S AGING POPULATION The state’s aging population can be attributed to several major factors, including: ◊ Life expectancy has generally been on the rise in the U.S.—from 57 years a century ago to 79 years in 2019, at which point California had one of the longest life expectancies in the nation. Issue Brief: California’s Aging Population October 2023 ◊ California’s fertility rate has declined sharply, falling by almost a quarter in recent years. ◊ Since 2001, more people have left California each year than have moved in from other states. ◊ International immigration has been slowing for years. Immigration often occurs during the working-age years, thus increasing the pool of younger Californians. THE IMPACT OF AN AGING CALIFORNIA It is likely that the impact of California’s rapidly aging population will continue to reverberate across nearly all areas of government in the coming years. As the state’s older adult population grows California will likely: ◊ See an increase in the need for affordable, accessible housing, in-home services, and neighborhood supports and amenities. ◊ Experience an even greater demand for costly healthcare services and supports. ◊ Increasingly face workforce-related challenges ranging from worker shortages to figuring out how to best support older workers. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 2 Issue Brief: California’s Aging Population October 2023 Introduction This Issue Brief presents data on California’s aging population in four parts.1 The first section focuses on a demographic shift facing our nation and how California compares. The next section examines California’s demographics and what changes the state might expect to see in the coming decades. The third section explores some of the major factors contributing to the state’s aging population. The final section highlights key policy implications of an aging population. This Brief is part of the Commission’s study on implementation of California’s Master Plan for Aging, a 10-year state-led plan launched in 2021 to address five broad challenges facing older Californians: housing, health care, inclusion and equity, caregiving, and affordability.2 In 2023, the Little Hoover Commission launched a study to examine preliminary implementation of this ongoing effort to consider whether there are opportunities for improved oversight and accountability and to ensure progress toward the Master Plan’s important goals. Part 1: The Nation’s Population is Aging, But Californians Are Relatively Younger The United States as a whole is aging rapidly. From 2010 to 2020, the American older adult population experienced its fastest growth rate of any decade in 130 years, even as the country’s overall population grew at its slowest rate since World War II.3 By 2020, nearly 56 million Americans were 65 years or older.4 This outsized growth is due in large part to aging baby boomers—those born between 1946 and 1964 during the post-World War II birth surge—who started reaching retirement age in 2011. By 2030, just seven years from now, all boomers will be at least 65. However, compared to most “developed” countries, the United States is aging at a slower rate. Among the United Nations’ list of 36 developed countries, the United States’ median age was the fourth lowest in 2022. By 2036, the U.S. median age is anticipated to drop to the lowest among developed countries, where it will remain until 2048.5 AMERICANS OVERALL ARE OLDER THAN CALIFORNIANS 4 Older adults make up a smaller share of the population in California than they do in the United The U.S. is fourth youngest States overall. Over the last twenty years, the state’s among “developed” countries. median age has consistently fallen below that of the United States as a whole. In 2020, California’s 11 median age ranked 11th lowest in the nation.6 California is the eleventh Projections from the University of Virginia’s Weldon youngest state in the nation. Cooper Center for Public Service indicate that this trend will continue through 2040.7 LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 3 Issue Brief: California’s Aging Population October 2023 U.S. States by Median Age in 2020 WA 38.1 NH VT 43.6 ME MT ND 43.5 45.1 40.5 35.8 OR MN 39.9 ID 38.4 MA 36.8 SD WI NY 39.9 WY 37.7 40.1 MI 39.0 RI 38.7 40.1 CT 40.5 IA PA NV NE 38.6 41.0 NJ 41.1 36.9 OH 39.9 CA 38.6 3 U 1 T .3 CO 3 I 8 L .8 3 I 8 N .2 39.8 WV 4 D 1 E .1 37.5 37.2 3 K 7 S .4 3 M 9 O .0 3 K 9 Y .4 42.9 3 V 8 A .7 3 M 8 D .8 NC TN 39.4 AZ OK 39.1 38.9 NM 37.3 AR SC 39.2 38.8 40.5 43.1+ MS AL GA 39.0 39.7 37.5 41.1 to 43.0 TX 39.1 - 41.0 LA 35.6 38.1 37.1 to 39.0 AK FL 35.6 43.0 37.0 or less HI 40.8 Source: U.S. Census Bureau, Census 2000 Summary File 1 (SF1), 2010 Census Summary File 1 (SF1), 2020 Census Demographic and Housing Characteristics File (DHC). https://www.census.gov/library/visualizations/interactive/how-has-our-nations-population-changed.html. Part 2: California Must Reckon With a Massive Demographic Shift THE MEDIAN AGE IS RISING IN CALIFORNIA Even though California is younger than the nation as a whole, the state’s population is getting much older. In 1970, the state’s median age was just 28. By 2060, it is projected to be over 45.8 California’s Median Age Anticipated to Reach over 45 Years in 2060 California’s Estimated and Projected Median Age (1970 to 2060) 50 45 40 35 30 25 20 Source: California State Department of Finance. “Population Pyramid 1970 to 1960.” July 2021. https://esd.dof.ca.gov/DRU-Data-In-Action/ population-pyramid/. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 4 Issue Brief: California’s Aging Population October 2023 SOME PARTS OF THE STATE ARE OLDER THAN OTHERS Median age varies among regions and communities throughout the state. The San Joaquin Valley is relatively young when compared to the rest of California—all eight of the region’s counties are among the youngest 13 counties.9 Meanwhile, many of the state’s oldest counties are located in the North State and Eastern Sierra regions. The difference between the state’s youngest and oldest counties is stark. Merced is California’s youngest county, with a median age of 32 years while the state’s oldest county, Sierra, has a median age of nearly 54 years.10 Twenty-Five California Counties Have Median Ages over 40 Years California Counties by Median Age (2020) 50.1+ 45.1 - 50.0 40.1 - 45.0 35.1 to 40.0 35.0 or less Source: U.S. Census Bureau, Census 2000 Summary File 1 (SF1), 2010 Census Summary File 1 (SF1), 2020 Census Demographic and Housing Characteristics File (DHC). https://www.census.gov/library/visualizations/interactive/how-has-our-nations-population-changed.html. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 5 Issue Brief: California’s Aging Population October 2023 THE COMPOUNDING IMPACTS OF CALIFORNIA’S CHANGING POPULATION The share of California’s population that is 55 years and older will grow by ten percentage points in the next forty years. In raw numbers, this cohort will increase by nearly 4 million people, according to state projections.11 Compounding the impact of this growth, the state is expected to see reductions in younger age groups, both as a share of the population and in raw numbers. Reductions will occur for those population groups defined as youth (17 years and younger), college-age (18 to 24 years), and working age (25 to 54 years). Notably, the share of Californians 17 years and younger is anticipated to decrease by 5 percentage points. The total number of Californians in that category will fall from 9.1 million to 7 million, a reduction in over 2.1 million children. Nearly Four in Ten Californians will be 55 Years or Older in 2060 California’s Population by Age Group (2020, 2040, and 2060) 9.1M 4.1M 15.1M 4.8M 6.3M 2020 (23%) (10%) (38%) (12%) (16%) 7.6M 3.6M 15.4M 4.3M 9.1M 2040 (19%) (9%) (39%) (11%) (23%) 7M 3.3M 14.2M 5M 10.1M 2060 (8%) (8%) (36%) (13%) (25%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 to 17 18 to 24 25 to 54 55 to 64 65+ Source: State of California, Department of Finance. Demographic Research Unit. Report P-1B: Population Projections by Individual Year of Age, California, 2020-2060 (Baseline 2019 Population Projections; Vintage 2023 Release). July 2023. https://dof.ca.gov/forecasting/demographics/ projections/. THERE ARE MORE OLDER CALIFORNIA FEMALES THAN OLDER CALIFORNIA MALES, ALTHOUGH THE GAP IS NARROWING Due to a range of factors, including biological and behavioral differences, women tend to live longer than men. As a result, older women generally outnumber older men. The difference is especially evident among those 85 years and older. In California, the sex ratio (number of males for every 100 females) was 61 in 2022 for this age group. However, as male life expectancy continues to rise, this gap is expected to narrow and by 2060, the ratio will jump to 71.12 In California, there were 61 males for every 100 females aged 85 years and older in 2022. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 6 Issue Brief: California’s Aging Population October 2023 CALIFORNIA’S OLDER ADULTS ARE NOT YET AS DIVERSE AS THE STATE OVERALL California is the first large state and the third state overall without a White plurality, behind Hawaii and New Mexico.13 In 2014, Hispanic Californians became the largest population group in the state.14 In 2021, they made up 40 percent of the state’s overall population, while White Californians made up 35 percent.15 However, California’s older adult population remains less diverse than the state’s population overall. Slightly more than half of Californians aged 65 years and older are White. Yet, when compared to other states, California’s older adult population is more diverse. Nationally, three in four older Americans are White.16 California’s Older Adults (65-Plus) Population is More Diverse than the American Older Adult Population but Less Diverse than California Overall Population by Age, Race, and Ethnicity in California and the United States (2021) 100% 9% 5% 6% 90% 5% 17% 16% 80% 9% 70% 22% 60% 40% 50% 75% 40% 30% 54% 20% 35% 10% 0% USA (65+) CA (65+) CA (Overall) White Hispanic Asian Black Multiracial American Indian/Alaska Native Note: Hispanic includes individuals who identify as either Hispanic or Latino, other groups are non-Hispanic. Asian includes those who identify has Pacific Islander or Native Hawaiian. Source: America’s Health Rankings analysis of CDC WONDER. Single-Race Population Estimates. United Health Foundation. https://www. americashealthrankings.org/. In the coming decades, the greatest racial and ethnic demographic changes among older adults will occur between White and Hispanic populations. Between 2020 and 2060, the share of older White Californians will decrease by 17 percentage points, while older Hispanic Californians will pick up that growth and more, with an 18 percentage point increase. At the same time, the share of older Californians of Black, Asian, and other races and ethnicities will remain relatively steady.17 As a result of these shifts, the racial and ethnic makeup of California’s older adult population in 2060 is projected to look much like the state’s overall population does today. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 7 Issue Brief: California’s Aging Population October 2023 Hispanic Four in Ten Older Adult Californians Projected 2t3o% be Hispanic in 2060 Estimated and Projected 65-Plus Population in California by Race and Ethnicity (2020, 2040, and 2060) Black 2020 2040 5% 2060 White 52% Asian 18% 40% 32% 22% 53% 44% 5% 5% 36% 5% 18% 18% 18% White Hispanic Black Asian Multiracial American Indian/Alaska Native Note: Hispanic includes individuals who identify as either Hispanic or Latino, other groups are non-Hispanic. Asian includes those who identify has Pacific Islander or Native Hawaiian. Source: State of California, Department of Finance. Demographic Research Unit. Report P-3: Population Projections, California, 2020-2060 (Baseline 2019 Population Projections; Vintage 2023 Release). July 2023. https://dof.ca.gov/forecasting/demographics/projections/. Meanwhile, due to an anticipated lack of growth and changing fertility rates—predominately falling Hispanic fertility rates and slightly higher White fertility rates—the racial and ethnic composition of the state’s overall population is not expected to change much in the coming decades.18 Nationally, White Americans are expected to remain the single largest race or ethnic group until 2045. For older Americans (60-plus), they will remain the majority until after 2060.19 Part 3: Major Factors Contributing to California’s Aging Population LIFE EXPECTANCY IN CALIFORNIA IS AMONG THE LONGEST IN THE NATION Generally, life expectancy at birth—an estimate of the average number of years that a person of a given age can expect to live—has been on the rise in the United States. A century ago, it was 57 years. Fifty years ago it was 71 years. In 2019, it was 79 years. Longer life expectancies have increased the share of the population that is older, both nationally and in California. In 2019, California and Hawaii had the longest life expectancy in the nation at 80.9 years.20 Recent Declines in Life Expectancy In recent years, life expectancy across the nation has declined. Mainly as a result of the COVID-19 pandemic, but also in part due to so-called “deaths of despair” (e.g., drug overdoses, alcohol liver disease, and suicide).21 An increase in deaths of despair is a nationwide problem that pre-existed, but was also exacerbated by, the pandemic. In 2020, life expectancy in the U.S. dipped to 77 years and in California to 79 years.22 LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 8 Issue Brief: California’s Aging Population October 2023 Declines in life expectancy have been deeper and continued longer in the U.S. than in other high- income countries. Some experts attribute this persistence to COVID-related challenges, including vaccine hesitancy and health inequities, as well as the ongoing opioid epidemic.23 Nonetheless, these recent declines do not erase the dramatic gains in life expectancy accumulated over the past century, and these gains continue to drive an increase in the share of California’s population that is over 65. Racial and Ethnic Disparities in Life Expectancy Life expectancy varies by race and ethnicity. In 2019, it was shortest among Black Californians and longest among Asian and Hispanic Californians. This highlights a phenomenon referred to as the “Hispanic Paradox,” in which—despite facing greater socioeconomic disadvantages and lower healthcare access—Hispanic Americans have had longer life expectancies than White Americans.24 Researchers estimate that these disparities have shifted in recent years while pandemic- related declines in life expectancy were not experienced evenly across communities, as some populations were exposed to higher COVID-19 infection, hospitalization, and death rates. Estimated reductions in life expectancy were sharpest among Black and Hispanic Californians—who lost 3.9 years and 5.8 years, respectively—with Hispanic life expectancy dropping below that of the White population. Reductions were smaller among White and Asian Californians, who lost an estimated 1.9 years and 3.1 years, respectively. Estimated Pandemic-Era Declines in Life Expectancy Have Been Greatest among Black and Hispanic Californians Estimated Life Expectancy in California by Race and Ethnicity (2019 and 2021) 2019 2021 Difference White 80.6 78.7 -1.9 Black 74.9 71.0 -3.9 Hispanic 82.6 76.8 -5.8 Asian 86.6 83.5 -3.1 Note: Persons of Hispanic origin may be of any race but are categorized as Hispanic for this analysis; other groups are non-Hispanic. Source: Hannes Schwandt, et al. “Changes in the Relationship Between Income and Life Expectancy Before and During the COVID-19 Pandemic, California, 2015-2021.” July 7, 2022. https://jamanetwork.com/journals/jama/fullarticle/2794146. More Californians Will Be 85 Years or Older than Ever Before As Californians continue to live longer, the state will see a large increase in its over-85 population in the coming decades. By 2060, the state is projected to have over 2.4 million Californians aged 85 or older, a four percentage point increase from 2020.25 LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 9 Issue Brief: California’s Aging Population October 2023 Over Six Percent of Californians Will Be 85 Years or Older by 2060 Share of California’s Population by Older Adult Age Groups (2020 to 2060) 30% 30% 25% 25% 20% 20% 15% 15% 10% 10% 5% 5% 0% 0% 2020 2030 2040 2050 2060 2020 2030 2040 2050 2060 65 to 74 75 to 84 85 to 99 100+ 65 to 74 75 to 84 85 to 99 100+ Source: State of California, Department of Finance. Demographic Research Unit. Report P-1B: Population Projections by Individual Year of Age, California, 2020-2060 (Baseline 2019 Population Projections; Vintage 2023 Release). July 2023. https://dof.ca.gov/forecasting/demographics/ projections/. FALLING FERTILITY RATES California’s general fertility rate (births per 1,000 women aged 15 to 44) has broadly declined since the early 1990s.26 Fertility rates vary across the state. The general fertility rate from 2017-2020 (average) was highest in the central and lower San Joaquin Valley and the North State regions, peaking in Lassen County at 79.3 births per 1,000 women. Average rates were lowest among many of the state’s coastal counties—although Yolo County in the Sacramento Valley had the state’s lowest average fertility rate during this time period at 38 births per 1,000 women.27 Fertility Rates Vary Across California Counties General Fertility Rates by California County (2017 to 2020 Average) 66.0+ 55.1 - 65.9 55.0 or lower Source: National Center for Health Statistics, final natality data. U.S. Census Bureau. Population estimates based on bridged race categories released by the National Center for Health Statistics. https://bit.ly/3Q2FPCp. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 10 Issue Brief: California’s Aging Population October 2023 Declining fertility rates are not unique to California. In 2020, 43 states recorded their lowest general fertility rates in at least thirty years. Researchers at Pew examined these reductions by comparing each state’s general fertility rate in 2020 to the state’s average rate between 2001 and 2010. In California, the general fertility rate was down nearly a quarter from its average of the decade ending in 2010. With this change, California was one of 10 states that experienced reductions exceeding 20 percent. The state’s decrease was also fifth largest overall.28 California’s General Fertility Rate in 2020 Was Down Nearly 25 Percent from Its Average Over the Decade Ending In 2010 General Fertility Rates across States (1990 to 2020) Note: The general fertility rate is the number of births per 1,000 women 15 to 44 years old. Source: Jeff Chapman. “The Long-Term Decline in Fertility—and What It Means for State Budgets.” Pew Charitable Trusts. December 5, 2022. https:// www.pewtrusts.org/en/research-and-analysis/issue-briefs/2022/12/the-long-term-decline-in-fertility-and-what-it-means-for-state-budgets. NEGATIVE DOMESTIC MIGRATION Since 2001, more people have left California each year than have moved in from other states. During the pandemic, this trend accelerated, and negative net domestic migration reached record levels. Last year, the state lost 407,000 residents to other states on net, or about one percent of the total population.29 In the decade before the pandemic, an average of 135,000 Californians left the state each year on net.30 National research shows that before the pandemic, older Americans moved less frequently than younger people. Of those older adults who moved, those 85 years or older were more likely to do so within the same county, while those between the ages of 65 and 74 years were slightly more likely to move between states.31 LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 11 Issue Brief: California’s Aging Population October 2023 SLOWING INTERNATIONAL IMMIGRATION For decades, international immigration has contributed to California’s increasing population. During the 1990s, for example, the state’s immigrant population grew by 37 percent, or 2.4 million people. That influx began to slow in the early 2000s, and has generally continued to slow in more recent years.32 During the pandemic year of 2020-21, net international immigration was essentially zero.33 International immigration appears to be bouncing back—California gained approximately 90,000 international immigrants on net in 2021-22—but this level remains below the pre- pandemic average, and well below the rates of earlier decades. This long-term slowdown in international immigration can contribute to an increase in the share of the population that is older, because individuals tend to immigrate when they are younger, of child-bearing age, and often have more children than the rest of the population.34 California’s Net Negative Domestic Migration and Reduced International Immigration Can Contribute to an Aging Population Net Annual Fiscal Year Domestic Migration and International Immigration in California (2000 to 2022) 350,000 250,000 150,000 50,000 -50,000 -150,000 -250,000 -350,000 -450,000 Source: State of California, Department of Finance. E-6: Population Estimates and Components of Change by County—July 1, 2000-10, 2010-2021, 2020-22. https://dof.ca.gov/forecasting/demographics/estimates/. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 12 0002 1002 2002 3002 4002 5002 6002 7002 8002 9002 0102 1102 2102 3102 4102 5102 6102 7102 8102 9102 0202 1202 2202 Net Domestic Migration Net International Migration Issue Brief: California’s Aging Population October 2023 Part 4: The Impact of an Aging California WHY THIS IS IMPORTANT The impact of a rapidly aging population is likely to reverberate across nearly all areas of government—presenting an opportunity for state leaders to rethink how best to address statewide problems and provide services. A few key policy areas impacted by an increasing older adult population include: Housing and Homelessness. As the state’s older adult population grows, California will likely see an increase in demand for affordable, accessible housing, in-home services, and neighborhood supports and amenities.35 Low incomes, high housing costs, and limited availability of affordable housing are significant causes of homelessness among older adults. This is a problem in California, where over 40 percent of those 65 years and older pay more than 30 percent of their income on housing.36 Unsurprisingly, older adult homelessness is on the rise. One study estimates that older adults make up half of the state’s homeless population, up from just 11 percent thirty years ago.37 Healthcare. As more Californians continue to age into older-adulthood and live longer, the state is expected to experience an even greater demand for healthcare services and supports. In 2021, nearly half of adults aged 75 years and older and a quarter of adults aged 65 to 74 years reported that they have a disability. Challenges with mobility were the most commonly reported, impacting approximately 14 percent of adults 65 to 74 years and 33 percent of adults 75-plus.38 Moreover, when comparing the 75-plus population to those aged 65 to 74 years, rates of vision difficulties doubled while rates of hearing, cognitive, self-care, and independent living difficulties more than tripled. Nearly Half of Adults 75 Years and Older Have a Disability Share of Adults With Disabilities by Older Adult Age Group (2021) 50% 49% 45% 40% 35% 30% 33% 25% 28% 20% 23% 22% 15% 16% 15% 14% 10% 5% 7% 9% 8% 4% 5% 5% 0% Any Hearing Vision Cognitive Mobility Self-care Difficulty disability difficulty difficulty difficulty difficulty difficulty running errands independently 65 to 74 years 75 years and older Source: U.S. Census Bureau. 2017-2021 American Community Survey 5-Year Estimates. Tables B18101-7. https://data.census.gov/. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 13 Issue Brief: California’s Aging Population October 2023 By some estimates, nearly six in ten Americans turning 65 in 2022 will require long-term care services. This care does not come cheap—as these newly-65 adults can expect to incur an average of nearly $121,000 in costs for future long-term services and supports.39 Adding to this tension, California is struggling to keep up with related workforce demand. In the coming years, the state is expected to face a shortage of between 600,000 to 3.2 million paid direct care home workers, and an estimated 4.7 million unpaid family caregivers.40 Workforce. In the years ahead, it is probable that California will increasingly face workforce- related challenges ranging from worker shortages to figuring out how to best support older workers. The state’s old-age dependency ratio—which measures how many retired people (defined as those aged 65-plus) there are compared to working-aged people (defined as those aged 20 to 64)—is expected to increase by two-thirds in the coming decades, rising from 27.7 in 2020 to 46.7 in 2060.41 As older workers exit the workforce, they will leave behind positions that need to be filled and take with them years of knowledge and experience. However, at the same time, many older adults are working beyond traditional retirement age—32 percent of Americans 65-plus are working, up from less than one-quarter in 2000.42 Additional research on how California’s older adult population and anticipated demographic changes will impact various policy areas could help state leaders get a better sense of future needs, and importantly, provide insight into ways to efficiently target limited resources. LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 14 Issue Brief: California’s Aging Population October 2023 Notes 1. Note: There is no state Master Plan-identified or universal 2020-2060 (Baseline 2019 Population Projections; Vintage 2023 definition of what it means to be an “older adult.” Definitions vary Release). July 2023. www.dof.ca.gov/Forecasting/Demographics/ across sources, as they do throughout this Brief. Projections/. 2. Office of California Governor Gavin Newsom. Executive Order 13. Javier Panzar. “It’s Official: Latinos now outnumber whites in N-14-19. June 10, 2019. https://www.gov.ca.gov/wp-content/ California.” Los Angeles Times. July 8, 2015. https://www.latimes. uploads/2019/06/6.10.19-Master-Plan-for-Aging-EO.pdf. com/local/california/la-me-census-latinos-20150708-story.html. 3. Richard Frey. “Census 2020: First results show near historically 14. Note: In 2014, 38.6 percent of the state’s population was Hispanic low population growth and a first-ever congressional seat loss or Latino, while 38.3 percent of the state’s population identified for California.” Brookings Institution. April 26, 2021. https://www. as White alone (non-Hispanic/Latino). U.S. Census Bureau. 2014 brookings.edu/articles/census-2020-data-release/. American Community Survey (ACS), 1-year estimates. https:// 4. Zoe Caplan. “U.S. Older Population Grew From 2010 to 2020 at dof.ca.gov/reports/demographic-reports/american-community- Fastest Rate Since 1880 to 1890.” U.S. Census Bureau. May 25, survey/#ACS2014x1. 2023. https://www.census.gov/library/stories/2023/05/2020- 15. America’s Health Rankings analysis of CDC WONDER. Single-Race census-united-states-older-population-grew.html. Population Estimates. United Health Foundation. https://www. 5. United Nations, “World Economic Situation and Prospects 2023.” americashealthrankings.org/. Page 117. January 25, 2023. https://www.un.org/development/ 16. America’s Health Rankings analysis of CDC WONDER. Single-Race desa/dpad/publication/world-economic-situation-and- Population Estimates. United Health Foundation. https://www. prospects-2023/. Also, United Nations, Department of Economic americashealthrankings.org/. and Social Affairs, Population Division (2022). World Population 17. State of California, Department of Finance. Demographic Research Prospects: The 2022 Revision. http://bit.ly/46f0qsk. Unit. Report P-3: Population Projections, California, 2020-2060 6. U.S. Census Bureau, Census 2000 Summary File 1 (SF1), 2010 (Baseline 2019 Population Projections; Vintage 2023 Release). July Census Summary File 1 (SF1), 2020 Census Demographic and 2023. https://dof.ca.gov/forecasting/demographics/projections/. Housing Characteristics File (DHC). https://www.census.gov/ 18. Commission staff communication with Walter Schwarm, Chief library/visualizations/interactive/how-has-our-nations-population- Demographer, California Department of Finance. August 2023. changed.html. 19. Jonathan Vespa, Lauren Medina, and David M. Armstrong. 7. Note: Exact proportions and median ages from the Census “Demographic Turning Points for the United States: Population Bureau estimates and the University of Virginia projections Projections for 2020 to 2060.” U.S. Census Bureau. March differ; however, they both indicate that California’s population 2018. https://www.census.gov/content/dam/Census/library/ remains younger than that of the United States. University of publications/2020/demo/p25-1144.pdf. Also, William H. Frey. Virginia Weldon Cooper Center, Demographics Research Group. “The US will become ‘minority white’ in 2045, Census projects.” (2018). National Population Projections. https://demographics. Brookings Institution. March 14, 2018. https://www.brookings. coopercenter.org/national-population-projections. edu/articles/the-us-will-become-minority-white-in-2045-census- 8. Note: The Department of Finance projections from July 2023 projects/. forecast a median age in 2060 that is slightly higher than its 20. Eric McGee and Hans Johnson. “COVID-19’s Sobering Effect on projections from July 2021. However, the more recent projections Life Expectancy.” Public Policy Institute of California. January 27, included fewer historical estimates. Thus, we have opted to include 2023. https://www.ppic.org/blog/covid-19s-sobering-effect-on-life- the projections from July 2021. Despite this sight difference, both expectancy/. projections reflect an increasing median age. Source: State of 21. David Leonhardt. “Life Expectancy, Falling.” New York Times. July California, Department of Finance. “Population Pyramid 1970 22, 2021. https://www.nytimes.com/2021/07/22/briefing/life- to 1960.” July 2021. https://esd.dof.ca.gov/DRU-Data-In-Action/ expectancy-falling-covid-pandemic.html. population-pyramid/. 22. Elizabeth Arias, et al. “U.S. State Life Tables, 2020.” National Vital 9. Note: This definition of the San Joaquin Valley includes Fresno, Statistics Reports. Page 3. August 23, 2022. https://www.cdc.gov/ Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, and Tulare nchs/data/nvsr/nvsr71/nvsr71-02.pdf. Counties. 23. Tanya Lewis. “Why Life Expectancy Keeps Dropping in the U.S. as 10. U.S. Census Bureau, Census 2000 Summary File 1 (SF1), 2010 Other Countries Bounce Back.” Scientific American. November Census Summary File 1 (SF1), 2020 Census Demographic and 21, 2022. https://www.scientificamerican.com/article/why-life- Housing Characteristics File (DHC). https://www.census.gov/ expectancy-keeps-dropping-in-the-u-s-as-other-countries-bounce- library/visualizations/interactive/how-has-our-nations-population- back1/. Also, Claire Klobucista. “U.S. Life Expectancy Is in Decline. changed.html. Why Aren’t Other Countries Suffering the Same Problem?” Council 11. State of California, Department of Finance. Demographic Research on Foreign Relations. September 8, 2022. https://www.cfr.org/ Unit. Report P-1B: Population Projections by Individual Year of in-brief/us-life-expectancy-decline-why-arent-other-countries- Age, California, 2020-2060 (Baseline 2019 Population Projections; suffering-same-problem. Vintage 2023 Release). July 2023. https://dof.ca.gov/forecasting/ 24. Note: Hispanics have lower mortality rates than Whites for nine demographics/projections/. of the 15 leading causes of death, but higher death rates from 12. Note: The sex ratio for the 65-plus population was 82 in 2022 diabetes and chronic liver disease. Further, country of birth and and is forecasted to reach 87 in 2060. Source: State of California, cultural heritage can impact health behaviors and outcomes. Department of Finance. Demographic Research Unit. Report P-1C: Source: Kenneth Dominguez, et al., “Vital Signs: Leading Causes of Population Projections by Sex and 5-year Age Group, California, Death, Prevalence of Diseases and Risk Factors, and Use of Health LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 15 Issue Brief: California’s Aging Population October 2023 Services Among Hispanics in the United States — 2009–2013.” 34. Summer Lin and Terry Castleman. “The U.S. population is older Centers for Disease Control and Prevention. May 8, 2015. https:// than ever. What that means.” Los Angeles Times. June 23, 2023. www.cdc.gov/mmwr/preview/mmwrhtml/mm6417a5.htm?s_ https://www.latimes.com/world-nation/story/2023-06-23/us- cid=mm6417a5_w. population-is-older-than-ever. 25. State of California, Department of Finance. Demographic Research 35. Jennifer Molinsky. “Housing for America’s Older Adults: Four Unit. Report P-1B: Population Projections by Individual Year of Problems We Must Address.” Joint Center for Housing Studies of Age, California, 2020-2060 (Baseline 2019 Population Projections; Harvard University. August 18, 2022. https://www.jchs.harvard. Vintage 2023 Release). July 2023. https://dof.ca.gov/forecasting/ edu/blog/housing-americas-older-adults-four-problems-we-must- demographics/projections/. address. 26. Jeff Chapman. “The Long-Term Decline in Fertility—and What 36. America’s Health Rankings analysis of U.S. Census Bureau, is Means for State Budgets.” Pew Charitable Trusts. December American Community Survey PUMS, 2021. United Health 5, 2022. https://www.pewtrusts.org/en/research-and-analysis/ Foundation. https://www.americashealthrankings.org/explore/ issue-briefs/2022/12/the-long-term-decline-in-fertility-and-what-it- measures/cost_burden_sr/CA. means-for-state-budgets. 37. Margot Kushel. “Homelessness Among Older Adults: An Emerging 27. National Center for Health Statistics, final natality data. U.S. Census Crisis.” Generations Journal. Summer 2020. https://generations. Bureau. Population estimates based on bridged race categories asaging.org/homelessness-older-adults-poverty-health. released by the National Center for Health Statistics. https://bit. 38. U.S. Census Bureau. 2017-2021 American Community Survey ly/3Q2FPCp. 5-Year Estimates. Tables B18101-7. https://data.census.gov/. 28. Note: The general fertility rate reduction in California was tied 39. HHS Office of the Assistant Secretary for Planning and Evaluation. with Oregon and was behind Arizona (-31.1 percent), Utah (-30.4 Office of Behavioral Health, Disability, and Aging Policy. “Long- percent), Colorado (-25.1 percent), and New Mexico (-25 percent). Term Services and Supports for Older Americans: Risks and Jeff Chapman. “The Long-Term Decline in Fertility—and What Financing, 2022.” August 2022. https://aspe.hhs.gov/reports/ltss- It Means for State Budgets.” Pew Charitable Trusts. December older-americans-risks-financing-2022. 5, 2022. https://www.pewtrusts.org/en/research-and-analysis/ 40. Master Plan for Aging. Long-Term Services and Supports issue-briefs/2022/12/the-long-term-decline-in-fertility-and-what-it- Subcommittee Report. Page 32. May 26, 2020. https://cdn-west- means-for-state-budgets. prod-chhs-01.dsh.ca.gov/chhs/uploads/2020/05/MPA-LTSS- 29. State of California, Department of Finance. E-6: Population Subcommittee-Report_FINAL-May-2020.pdf. Estimates and Components of Change by County—July 1, 2000-10, 41. State of California, Department of Finance. Demographic Research 2010-2021, 2020-22. https://dof.ca.gov/forecasting/demographics/ Unit. Report P-1B: Population Projections by Individual Year of estimates/. Age, California, 2020-2060 (Baseline 2019 Population Projections; 30. State of California, Department of Finance. E-6: Population Vintage 2023 Release). July 2023. Estimates and Components of Change by County—July 1, 2000-10, 42. David H. Montgomery. “Who’s not working? Understanding the 2010-2021, 2020-22. https://dof.ca.gov/forecasting/demographics/ U.S.’s aging workforce.” Federal Reserve Bank of Minneapolis. estimates/. February 27, 2023. https://www.minneapolisfed.org/article/2023/ 31. Peter J. Mateyka and Wan He. “Domestic Migration of Older whos-not-working-understanding-the-uss-aging-workforce. Americans: 2015-2019.” U.S. Census Bureau. September 2022. https://www.census.gov/content/dam/Census/library/ publications/2022/demo/p23-218.pdf. 32. Hans Johnson. “Just the Facts: Immigrants in California.” Public Policy Institute of California. https://www.mtsac.edu/president/ cabinet-notes/2020-21/04-apr/1b_Immigrants_in_California-Public_ Policy_Institute_of_California.pdf. 33. Note: In 2020-21, net foreign immigration in California was -523. Source: State of California, Department of Finance. E-6: Population Estimates and Components of Change by County—July 1, 2000-10, 2010-2021, 2020-22. https://dof.ca.gov/forecasting/demographics/ estimates/. Issue Brief: California’s Aging Population October 2023 (916) 445-2125 | LittleHoover@lhc.ca.gov 925 L Street, Suite 805, Sacramento, CA 95814 LITTLE HOOVER COMMISSION WWW.LHC.CA.GOV | 16