Master Plan for Aging Implementation

Early Implementation of California’s Master Plan for Aging Report #276 | December 2023 Milton Marks Commission on California State Government Organization and Economy www.lhc.ca.gov LITTLE HOOVER COMMISSION Dedicated to Promoting Economy Pedro Nava, Chair and Efficiency in California State Anthony Cannella, Vice Chair Government Dion Aroner David Beier The Little Hoover Commission, formally known as the Milton Marks “Little Hoover” Commission on California State Government Asm. Phillip Chen Organization and Economy, is an independent state oversight agency. Gil Garcetti† José Atilio Hernández* By statute, the Commission is a bipartisan board composed of Jason Johnson five public members appointed by the governor, four public members appointed by the Legislature, two senators and Sen. Dave Min two assemblymembers. Asm. Liz Ortega Janna Sidley In creating the Commission in 1962, the Legislature declared Sen. Scott Wilk its purpose: †Served as subcommittee chair ...to secure assistance for the Governor and itself in *Served on study subcommittee promoting economy, efficiency and improved services in the FORMER COMMISSIONERS transaction of the public business in the various departments, WHO SERVED DURING THE agencies and instrumentalities of the executive branch of STUDY the state government, and in making the operation of all Bill Emmerson state departments, agencies and instrumentalities, and all expenditures of public funds, more directly responsive COMMISSION STAFF to the wishes of the people as expressed by their elected representatives... Ethan Rarick, Executive Director Tamar Foster, Deputy Executive The Commission fulfills this charge by listening to the public, Director consulting with the experts and conferring with the wise. In the Krystal Beckham course of its investigations, the Commission typically empanels Daniel Harris-McCoy advisory committees, conducts public hearings and visits Ashley Hurley government operations in action. Shara McAlister Its conclusions are submitted to the Governor and the Legislature Allie Powell for their consideration. Recommendations often take the form of legislation, which the Commission supports through the legislative process. Contacting the Commission All correspondence should be addressed to the Commission Office: Little Hoover Commission 925 L Street, Suite 805, Sacramento, CA 95814 (916) 445-2125 | LittleHoover@lhc.ca.gov This report is available from the Commission’s website at www.lhc.ca.gov. 2 | LITTLE HOOVER COMMISSION Table of Contents EXECUTIVE SUMMARY ......................................................................5 INTRODUCTION .................................................................................7 DEVELOPING CALIFORNIA’S MASTER PLAN FOR AGING ............7 OBSERVATIONS OF EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING .............................................................10 COORDINATED LEADERSHIP MODEL CONFUSES ACCOUNTABILITY, DESPITE STRENGTH OF INDIVIDUAL LEADERS ..........................................................................................10 Recommendation 1 .......................................................................................13 MISSED OPPORTUNITIES FOR GREATER LEGISLATIVE INVOLVEMENT .................................................................................13 Recommendation 2 .......................................................................................13 CONTINUED STAKEHOLDER ENGAGEMENT COULD IMPROVE OVERSIGHT AND ACCOUNTABILITY ...............................................14 Recommendation 3 .......................................................................................15 ACCOUNTABILITY TOOL REFLECTS AMBITIOUS SCOPE OF WORK, BUT COULD BE MORE TRANSPARENT ...........................................15 Recommendation 4 .......................................................................................16 FUTURE INITIATIVES SHOULD EMPHASIZE PROGRAMS THAT DIRECTLY BENEFIT CALIFORNIANS ...............................................16 Recommendation 5 .......................................................................................17 Recommendation 6 ......................................................................................17 A ROADMAP FOR IMPLEMENTATION COULD FOCUS PROGRESS, ENHANCE ACCOUNTABILITY ..........................................................17 Recommendation 7 .......................................................................................18 CALIFORNIA’S DATA ASSETS COULD BE MORE STRATEGICALLY APPLIED TO MASTER PLAN GOALS & FUTURE PLANNING EFFORTS ............................................................................................18 Recommendation 8 .......................................................................................20 ROBUST SPENDING, BUT GREATER TRANSPARENCY NEEDED 20 Recommendation 9 .......................................................................................21 NOTES ...............................................................................................23 EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 3 Letter from the Chair December 14, 2023 The Honorable Gavin Newsom Governor of California The Honorable Toni Atkins The Honorable Brian Jones President pro Tempore of the Senate Senate Minority Leader and members of the Senate The Honorable Robert Rivas The Honorable James Gallagher Speaker of the Assembly Assembly Minority Leader and members of the Assembly DEAR GOVERNOR AND MEMBERS OF THE LEGISLATURE: California’s Master Plan for Aging presents a bold, vision of the future, where older and disabled Californians have access to affordable, accessible housing and healthcare, and live in communities where they are valued and protected from isolation, discrimination, abuse, and neglect. In the years since releasing the Master Plan, an enormous amount of work is well underway through hundreds of implementing initiatives. The Commission applauds these early efforts by the Newsom Administration to drive progress, while recognizing that achieving the Master Plan’s vision will require sustained focus and commitment. Our hearings highlighted key opportunities to strengthen forward momentum through improved oversight and accountability: ◊ Clarifying leadership responsibilities and creating institutional momentum to keep the Master Plan work alive through different Administrations and budget cycles. ◊ Sustaining a shared commitment to the success of the Master Plan by ensuring the Legislature and others have a seat at the table through the duration of its reforms. ◊ Urgently implementing program and policy changwes that directly benefit older Californians. ◊ Articulating a clear path forward, with milestone targets and metrics to help rally partners and hold leaders accountable for progress. The stakes are high. Through reforms envisioned in the Master Plan, state leaders have the potential to benefit millions of Californians, their families, and their communities. Any delays mean ongoing challenges. The recommendations in this report present opportunities to advance the Master Plan’s bold vision and help ensure its long-term success. We hope you will consider this report in that light and stand prepared to help. Sincerely, Pedro Nava, Chair Little Hoover Commission 4 | LITTLE HOOVER COMMISSION Executive Summary In response to California’s rapidly aging population, set forth in the Master Plan will require greater Governor Gavin Newsom called for the development legislative oversight and ongoing engagement of a 10-year Master Plan for Aging. Issued in 2021, between lawmakers and the Administration the state’s Master Plan identified 5 broad goals and throughout the duration of the Plan. The Commission more than 20 action areas for the state to focus recommends establishing a joint committee to its implementation efforts. In the three years since oversee implementation through 2030. releasing the Plan, the state has launched more than Ensure Continued Stakeholder 200 implementing initiatives. Engagement The Commission has long called for systemic change to address the needs of older Californians The high level of stakeholder engagement involved and applauds the Administration’s foresight in in the development and ongoing implementation producing such a comprehensive and ambitious of the Master Plan is seen by many as one of its plan for the state. This review sought to examine greatest successes. Yet the role and function of early implementation of the Master Plan and IMPACT Committee – which was created to formalize explore opportunities for improved oversight and stakeholder input on implementation activities – accountability to ensure the state progresses towards is not enshrined in statute. To ensure continued its goals. and diverse stakeholder engagement and improve oversight and accountability, the Commission In this report, the Commission outlines nine recommends codifying the membership, length recommendations that focus on strengthening of service, purpose and duties of the IMPACT implementation through the duration of the Master Committee. Plan effort. Update The Implementation Clarify Leadership Tracker to Enhance Responsibilities and Functions Usefulness, Transparency in Statute The Department of Aging quickly developed Implementing the Master Plan involves fulfilling the Master Plan Implementation Tracker as an a number of important functions, but despite accountability tool to monitor the hundreds of the strength of individual leaders, the Master initiatives underway through the Master Plan. Yet, Plan’s coordinated leadership model confuses the Commission noted several shortcomings: It is accountability. To strengthen leadership through difficult to learn what is underway, what has been the duration of this effort and through inevitable accomplished, what has been merged or modified changes in Administration, the Commission into a new initiative and what has stopped. It does recommends codifying key leadership responsibilities not indicate why initiatives were closed, completed, and functions. or discontinued. It is not updated on a consistent basis. The Commission recommends several updates Enhance Legislative Oversight to improve transparency around the status of work There are limited opportunities for lawmakers and enhance the Tracker’s usefulness for oversight. to provide robust oversight of the Master Plan’s implementation efforts. Realizing the bold vision EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 5 the Administration’s intention to use data to inform Emphasize Initiatives That planning and promote accountability but is ill suited Directly Benefit Californians for this purpose. California’s data assets could be more strategically applied to the Master Plan Half of the currently active Master Plan initiatives goals and inform other future planning efforts. contemplate study and research or communicate The Commission recommends the Governor and information rather than take action to deliver Legislature take further action to merge datasets results to individual Californians. Given the major across the Administration. demographic changes taking place in the state, implementation should be conducted with an Track State Investments in urgency not typical of government operations. Master Plan Initiatives The Commission recommends future initiatives emphasize delivering results. It also suggests that Today, the state has produced no overall budget the Implementation Tracker be updated to include for the Master Plan, nor has there been a categories for each initiative’s area of focus rather comprehensive estimation of how much it would cost than producing separate reports containing these California to fully implement the Plan. Without an designations. ongoing, systemic spending tracker, the process to account for Master Plan spending is time consuming, Establish a Roadmap for unnecessarily labor intensive, and falls short of Implementation providing real-time information. To enable the Administration and lawmakers to more easily and The Master Plan established high-level targets for the thoroughly assess investments and plan for future state in each of its five goal areas, but these targets initiatives, the Commission recommends tracking are too vague and do not adequately articulate the state investments in Master Plan initiatives online outcomes California hopes to ultimately achieve. and offers several data elements that should be Without a roadmap for implementation of the included. Master Plan, it will continue to be difficult for policymakers and stakeholders to track progress, assess needs and next steps, understand gaps in the state’s capacity, and build support for the work. The Commission recommends developing a roadmap for implementation that includes short- and long-term aspirational goals and timeframes for completion. Going forward, new initiatives should include specific, measurable metrics that align with and drive progress toward these interim benchmarks. Merge the State’s Data Assets In 2021 the Department of Aging launched the Data Dashboard for Aging as an online accountability tool to track progress on each of the Master Plan’s five goals. The dashboard currently includes more than 80 indicators. The dashboard demonstrates 6 | LITTLE HOOVER COMMISSION Introduction California’s population is aging. The share of state. With this review, the Commission set out to Californians aged 65 and older will increase from examine early implementation of the Master Plan, one in six today to nearly one in four by 2040. Along exploring opportunities for improved oversight with the overall population, older Californians are and accountability to ensure progress toward the becoming more diverse. By 2040, nearly one third Plan’s goals. With this report, the Commission offers of Californians aged 65 or older will be Hispanic, up solutions to help the state continue to appropriately from a little over 20 percent of older Californians prioritize policy and budgetary responses to our today. Caused by longer life expectancies, falling increasingly aging population. In the coming months, fertility rates, and decreases in domestic and the Commission intends to issue a subsequent international migration, this aging wave will impact report that explores implementation of a subset the state in numerous significant ways.1 As one of the Master Plan’s goals around housing and example, these demographic shifts will soon homelessness prevention in greater depth. challenge California’s policy leaders to rethink how In pursuing research for this study, the Commission best to provide services given that affordability convened two full-day public hearings, bringing in challenges particularly for housing and healthcare expertise of researchers, advocates, philanthropy, are disproportionately felt by older people of color.2 and leadership from key agencies and departments In response, Governor Gavin Newsom issued across the Administration. In addition, Commission an Executive Order in June 2019 calling for the staff received valuable feedback from more than development of a 10-year Master Plan for Aging.3 This 50 knowledgeable individuals representing key initiative presented a historic opportunity to develop stakeholder groups and thought leaders in California statewide leadership and coordination around a and across the country. broad set of challenges facing older Californians, Developing California’s Master including housing, affordability, health care, long- term care, and social supports. With extensive Plan for Aging stakeholder input, state leaders released the Master Plan in 2021,4 identifying five broad goals and Six months after taking office, Governor Newsom more than 20 action areas for the state to focus its called for the development of a Master Plan for implementation efforts. Aging to serve as a “blueprint” for state and local government, the private sector, and philanthropy to In the three years since releasing the Master Plan, promote healthy aging and prepare for the state for the state has launched more than 200 implementing the coming demographic changes. In doing so, the initiatives. Other states are following suit, borrowing Governor signaled his Administration’s prioritization California’s model to engage leaders across of older Californians, people with disabilities, and government and various stakeholder communities family caregivers.7 Legislative leaders quickly showed to create multi-sector plans for aging that identify support for the effort and in October 2019 enacted common goals and establish both short and long- a bill that established the administrative parameters term priorities.5 for specified state agencies and departments to lead the effort. The bill also required ongoing reporting The Commission has long called for systemic change to the Legislature on implementation of the Master to address the needs of older Californians6 and Plan.8 Together, participants saw this effort as a applauds the Administration’s foresight in producing historic opportunity to develop statewide leadership such a comprehensive, ambitious plan for the and coordination around a broad set of challenges, EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 7 including housing, affordability, health care, long- 240 policy recommendation letters, 1,000 public term care, and social supports.9 comments, and 800 stakeholder advisory committee recommendations for consideration in the Master The Secretary of the Health and Human Services Plan.11 Agency led development of the Master Plan, receiving input from a new Cabinet-level Work Group When the Administration released the Master Plan in on Aging, new stakeholder advisory bodies, and 2021, it’s 44-pages amounted to an ambitious 10-year extensive participation from advocates, stakeholder “blueprint for a California for All Ages and Abilities.” organizations, and members of the public.10 The Master Plan delineated five policy goals: Together, these groups ultimately generated over housing for all stages and ages, health reimagined, Defining “Old Age” There is no single, universally accepted definition of old age. Age typically is defined in chronological terms – how long an individual is alive. Old age may encompass a range of ages nearing or surpassing average life expectancy, which in California is 79 years old.12 Both the federal and state governments use different ages to establish eligibility for key government programs for older adults. For example, eligibility for the federal Medicare program begins at age 65, and Social Security benefits can kick in as early as age 62, though the full-benefit age is 66 or 67 depending on an individual’s year of birth. In California, statutory protections against elder abuse and elder financial abuse define “elder” as a person who is age 65 or older.13 But eligibility for Medi- Cal recently was lowered to begin at age 50 for low-income adults. The Master Plan itself does not establish an official age threshold for those targeted in the Plan. Traditionally, researchers and global organizations such as the World Health Organization and the United Nations analyze populations using chronological measures, often defining older persons as those aged 60 or 65 years and older.14 Some may further classify old age in chronological stages, such as the youngest-old, the middle-old, the oldest-old, centenarians, and those at end of life, though there is no standard way to define these categories.15 Age does not account for mortality risks, health status, level of activity, functional or social capacity, or other socioeconomic characteristics which may impact what it means to grow older. From a policy perspective, it may be important to consider whether chronological age differs from other age measurements, such as physiological age (which considers the biological state of a person), psychological age (which considers a person’s cognitive capabilities), and social age (which considers a person’s social behaviors and interpersonal skills). For example, studies of unhoused populations have found that unhoused older adults undergo accelerated aging and have geriatric conditions at rates similar to or higher than those seen in housed adults who are 20 years older.16 8 | LITTLE HOOVER COMMISSION inclusion and equity, effective caregiving, and aging affordability, and established broad targets for each. CALIFORNIA’S AGING POPULATION To mark progress, the plan delineated 23 strategies, California must reckon with a massive demographic shift in further supported by 132 “action-ready initiatives” to its population. The Little Hoover Commission shared some be launched in the first two years. insights on these anticipated changes in its Issue Brief, California’s Aging Population. When California commenced its planning effort, only two other states – Colorado and Massachusetts – had 11 California is the eleventh attempted anything similar. However, the resulting youngest state in the nation. plans for both of these states lacked the scale and scope of California’s ambitious plan. Several By 2060, the state’s median age is projected elements made California’s plan stand apart:17 to be over 45. In 1970, it was nearly 28. ◊ It was developed with meaningful stakeholder The difference between the median age in the engagement from organizations representing state’s youngest and oldest counties is stark: older adults, people with disabilities, providers, 32 54 caregivers, direct care workers, labor, and other vs. years in years in industries and sectors. Merced County Sierra County ◊ Its development broke down government silos Over the next forty years, California’s... by engaging agencies across the Administration and purposely aimed for a “whole of government” 55-plus population will increase approach to planning. by 10 percentage points, or ◊ While focusing on older adults, California’s plan nearly 4 million adults. articulated goals for people of all ages and Meanwhile, the state’s 17 and abilities, and promoted inclusivity and equity under population will decrease by across race, class, gender, and sexual orientation. 5 percentage points, a reduction ◊ It is person-centered, prioritizing individuals’ needs in over 2.1 million children. and preferences. The share of California’s 65-plus ◊ It is intended to evolve overtime, adjusting to population that is White will decrease the state’s changing needs in two-year cycles by 17 percentage points, while the throughout the duration of the effort. share that is Hispanic will grow by 18 percentage points by 2060. ◊ It promotes accountability through its data dashboard and other tools. In 2022 there were 61 males for every 100 100 In the years since, at least 20 other states have 100 females aged 85-plus. 71 61 embarked on processes to emulate California’s As male life expectancy continues to efforts, either by developing or building on previous rise, this gap is expected to narrow aging plans, many through a collaborative led by the and by 2060, the ratio will jump to 71. 2022 2060 Center for Health Care Strategies.18 Nearly half of adults aged 75 or older have a disability. EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 9 attention and enthusiasm. Defenders of this network Observations Of Early approach to leadership suggest that it provides Implementation of California’s benefits that could not be achieved with stricter Master Plan for Aging and more narrow lines of accountability that are characteristic of traditional command and control Three years into implementation, the state has leadership models in government. Some view the identified and begun work on 227 separate state’s coordinated approach with pride and suggest initiatives to advance the Master Plan’s goals. The that California’s leadership “must continue to Administration and its leaders quickly invested emphasize an all of government approach” as a way in critical positions to support implementation, to infuse aging and equity issues across government created various accountability tools to help publicly entities that might not previously have considered track efforts across state agencies, and created them.21 Yet, this model is not without drawbacks. opportunities for stakeholders to provide comments. Responsibility for implementing the hundreds of While there is much to praise about California’s early programs and projects launched as part of the implementation efforts, the Commission offers the Master Plan is assigned to designated – sometimes following observations and recommendations with multiple – lead agencies and/or departments the intent of strengthening implementation through accountable for specific initiatives.22 In practice, the duration of this critical, decade-long endeavor. it is not clear which agency, if any, has ultimate responsibility for ensuring progress, leaving the Coordinated Leadership Model Commission to question the functionality of this Confuses Accountability, diffused leadership model. Despite Strength of Individual Leaders In practice, it is not clear which agency, if any, has California’s Master Plan was intended to be implemented through a “whole-of-government” ultimate responsibility for approach. The Governor’s Executive Order set ensuring progress, leaving the this expectation by calling on agencies within the Administration to “cooperate in the implementation Commission to question the [of the Master Plan].”19 Subsequent legislation further functionality of this diffused clarified the approach by naming the California leadership model. Health and Human Services Agency, along with the Director of the California Department of Aging, as leaders of the Master Plan’s implementation. It also tasked a Cabinet-level Work Group for Aging to identify strategies necessary to implement the Master Plan.20 Administration representatives and other involved stakeholders shared that thus far, the individual leaders in these various agencies have approached implementation collaboratively, and with focused 10 | LITTLE HOOVER COMMISSION Master Plan for Aging: Goals, Targets, and Strategies GOAL ONE: HOUSING FOR ALL STAGES GOAL FOUR: CAREGIVING THAT WORKS AND AGES Target: One Million High-Quality Caregiving Jobs Target: Millions of New Housing Options to Age Well Strategies: 1. Family and Friends Caregiving Support Strategies: 2. Good Caregiving Jobs Creation 1. More Housing Options 3. Virtual Care Expansion 2. Transportation Beyond Cars 3. Outdoor and Community Spaces for All Ages GOAL FIVE: AFFORDING AGING 4. Emergency Preparedness and Response Target: Close the Equity Gap and Increase Elder 5. Climate-Friendly Aging Economic Efficiency GOAL TWO: HEALTH REIMAGINED Strategies: 1. End Homelessness for Older Adults Target: Close the Equity Gap in and Increase Life Expectancy 2. Income Security as We Age 3. Protection from Poverty and Hunger Strategies: 1. Bridging Health Care with Home 2. Health Care as We Age 3. Lifelong Healthy Aging 4. Geriatric Care Expansion 5. Dementia in Focus 6. Nursing Home Innovation GOAL THREE: INCLUSION AND EQUITY, NOT ISOLATION Target: Keep Increasing Life Satisfaction as We Age Strategies: 1. Inclusion and Equity in Aging 2. Bridging the Digital Divide 3. Opportunities to Work 4. Opportunities to Volunteer and Engage Across Generations 5. Protection from Abuse, Neglect and Exploitation 6. California Leadership in Aging EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 11 Ongoing leadership of the Master Plan Having more clearly delineated leadership roles implementation entails fulfilling various critical for all the critical functions involved in Master Plan functions. However, when exploring the coordinated implementation would help foster accountability for leadership approach, the Commission heard progress and could make it easier for stakeholders inconsistent perspectives about where responsibility in various industries to take part in this ambitious for leadership ultimately lies. For example, the initiative. For example, it should be clear which Commission heard:23 entity is responsible for selecting and prioritizing new initiatives; assessing the extent of progress ◊ The Health and Human Services Agency on individual initiatives and broad goals; ensuring Secretary, in partnership with the Cabinet, other improvement; and, coordinating across agencies. state entities, and stakeholders, is responsible selecting new Master Plan initiatives, leading Without establishing more implementation, assessing the extent of progress, and ensuring progress. Meanwhile, the Aging clearly defined parameters for Director has delegated responsibility for day-to- fulfilling the various necessary day leadership and implementation of the Master Plan. leadership functions, there’s a ◊ The Health and Human Services Agency risk that new appointees could Secretary, the Aging Director, and the Governor’s disrupt or stall implementation Office Senior Advisor for Aging, Disability, and of Master Plan’s initiatives Alzheimer’s collectively share responsibility for implementing the Master Plan initiatives, with the in favor of other work more Aging Director specifically tasked with assessing central to their individual and communicating progress. agencies. ◊ The Health and Human Services Agency Secretary has primary responsibility for leading implementation of the Master Plan for Aging. Further, the Commission notes that the timeframe to ◊ Cabinet Secretaries and Department Directors are accomplish the Master Plan’s goals extends beyond involved in developing every Master Plan initiative, the terms of office for the current Administration. working directly with stakeholders. The individual leaders who have been tasked to take ◊ Agencies defer to the Aging Director when setting charge of the Master Plan today are, by nature of Master Plan goals. their appointments, in positions that will be filled by someone else in the future. There is no guarantee ◊ The role of the Governor’s Office Senior Advisor is that new appointees will bring the same enthusiasm, simply to advise the Governor broadly on aging- focus, and expertise that the current leaders exhibit. related issues. Indeed, leaders in similar Master Plan efforts in ◊ The Governor’s Senior Advisor liaisons with the Colorado, Texas, and Massachusetts affirmed that Cabinet Work Group and is best positioned to changes in administrations can break continuity address issues related to coordination of the of work and delay implementation.24 Without Master Plan across the Administration. establishing more clearly defined parameters for fulfilling the various necessary leadership functions, there’s a risk that new appointees could disrupt or 12 | LITTLE HOOVER COMMISSION stall implementation of Master Plan’s initiatives in and workforce, transportation, and climate change. favor of other work more central to their individual Though these broader issues certainly appear before agencies. various legislative committees and lawmakers have weighed in on important spending decisions RECOMMENDATION 1 to support various Master Plan efforts to date, the The Legislature should define in statute the Legislature lacks an established committee structure leadership of implementation of the Master Plan, to monitor and provide ongoing, broad oversight for specifically assigning responsibility for critical implementation of the Plan. functions, such as selecting and prioritizing new initiatives, assessing the extent of progress toward Realizing the bold vision set forth in California’s individual initiatives and broad goals, ensuring Master Plan requires greater legislative oversight improvement within specified timeframes, and and ongoing engagement between lawmakers and coordinating across agencies. the Administration throughout the duration of the Plan. Establishing a Joint Legislative Committee on Missed Opportunities California’s Master Plan for Aging to meet through for Greater Legislative 2030 could facilitate these important conversations Involvement among California’s policymakers and give legislators the opportunity to ensure the Plan’s success. Regular Legislators played an important role in establishing oversight hearings through such a committee could the statutory framework to create California’s Master invite the Department of Aging, along with the Plan. Lawmakers carved out an ongoing oversight other departments and agencies responsible for role for the Legislature by requiring the Department administering programs or funding included in the of Aging to report annually on ways to effectively Master Plan, to share progress and provide status implement and administer the Master Plan, provide updates in greater detail than the current annual updates on the status of progress, and share data reporting requirements provide. These regular metrics, best practices, and model policies.25 updates also would create a continuity of leadership around aging issues in the state, particularly through Yet today, lawmakers appear to play a minimized inevitable leadership changes in the Administration, role in oversight of the overall Master Plan. In part, and give lawmakers a more robust role in monitoring this may be due to a lack of a standing or joint progress and ensuring accountability for achieving committee to address the breadth of policy issues the Master Plan’s goals. raised in the Master Plan. While many Master Plan initiatives would clearly fall under the purview of an RECOMMENDATION 2 aging committee, only the Assembly has a standing The Legislature should establish a Joint Committee Committee on Aging and Long-Term Care. Indeed, on California Master Plan for Aging to oversee this committee held an informational hearing on implementation through 2030. Leaders in this implementation of the Master Plan for Aging in committee should coordinate with other relevant February 2023 and, according to staff, intends to committees to ensure aging and disability issues are hold similar general oversight hearings annually.26 embedded in appropriate policy discussions in both Yet, even if the Legislature bolstered oversight houses. in aging policy committees, many aspects of the Master Plan fall outside of the typical gamut of aging issues, and address issues like housing, labor EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 13 1) focusing efforts on two big issues included in the Continued Stakeholder Master Plan: creating a long-term care system and Engagement Could Improve addressing older adult homelessness; 2) integrating Oversight and Accountability equity through implementation efforts; and 3) drawing on the Governor’s leadership to elevate the The Commission heard that the level of community Plan’s goals.29 These recommendations were largely engagement by the Department of Aging, and the echoed in the Committee’s Year 2 Review.30 Administration in general, has been one of the biggest successes to date, creating opportunities for Given the ever-evolving nature of projects and older adults and people with disabilities, community programs underway as part of the Master Plan, the organizations, service providers, local government IMPACT Committee offers several important benefits officials, advocates, researchers, and others to inform to the state. Its charge to offer broad, continuous every step of the Master Plan’s rollout. oversight by stakeholders outside of government can infuse fresh perspectives into the State’s Several stakeholder committees currently advise implementation strategies. By giving stakeholders the Administration on various aspects of the Master a “seat at the table,” it can expand buy-in and Plan implementation – some created specifically for support for ongoing efforts, and eventually help this purpose, while the other that existed previously protect against changing policy priorities when new have been leveraged for their expertise.27 However, leaders take office. It also serves as an accountability one committee, the Implementing the Master Plan mechanism to help ensure that the Administration for Aging in California Together (IMPACT) Stakeholder stays true to the goals of the Master Plan and Committee, plays a particularly important oversight maintains an appropriate focus on implementation role. activities. Finally, given the opportunity, it could play a larger role in helping the Administration prioritize Established by the California Health and Human future initiatives. Services Agency in 2021, the IMPACT Committee was created to provide external oversight of the Master However, the IMPACT Committee’s existence is Plan’s implementation, specifically focusing on not currently enshrined in statute. Without such improving accountability, outcomes, and continuous statutory protections, there is no guarantee that improvement toward its five broad goals.28 Appointed the Administration will continue to support this by the Secretary to serve for a two-year term, its type of work for the duration of the Master Plan’s members are dedicated thought leaders, advocates, implementation. Further, statutory guidance could providers, philanthropists, and members of the aging provide clarity on how to rotate leadership and and disability communities who bring expertise in committee composition throughout the duration of aging, disability, and racial justice programs and the Master Plan to ensure state leaders hear from policies. diverse relevant perspectives, including those with expertise outside of the traditional aging stakeholder In its first biennium, the IMPACT Committee communities in fields such as transportation, produced two annual reviews of the Master Plan’s housing, and labor. Given the role families play in progress. These reports summarized some of caring for their elderly, it also will be important to the state’s key accomplishments, but also called ensure this committee includes broad representation out opportunities to guide implementation going from diverse ethnic and racial communities, forward. For example, the IMPACT Committee’s Year particularly those hard-to-reach communities that 1 Review offered three recommendations: 14 | LITTLE HOOVER COMMISSION may not be aware of or do not regularly access Despite the abundance of information included in government programs. Codifying the Committee’s the tracker, it is not clear what work is currently creation, membership, purpose, duties and function underway. For example, the tracker shows that of would help to ensure continued accountability for the 132 initiatives launched in 2021, two are “closed,” the state through 2030. 16 are “completed” and 114 are “active.” All of the 95 initiatives launched in 2023 are “active.” This RECOMMENDATION 3 might lead a member of the public to assume that The Legislature should codify the membership, the initiatives are additive, each pursued until it is length of service, purpose, and duties of the IMPACT completed. However, in practice, the new initiatives Committee both to ensure its continued operation become the focus of work. A representative from the while the state is actively working on implementing Department of Aging clarified that initiatives do not the Master Plan for Aging and to continue to invite automatically roll over to the next year, especially broad and diverse participation in its progress. those that were never started; “some fall away, some are delayed, some are completed, and some are in Accountability Tool Reflects progress.”34 Ambitious Scope of Work, But Could Be More Transparent The tracker also does not explain how the status of each initiative is determined or who makes that The Department of Aging launched an determination. It is not clear if the designated lead Implementation Tracker in January 2023 to monitor agency, the Department of Aging, or some other the enormous workload generated by the 227 entity decides when an initiative is complete or initiatives included in the Master Plan.31 Set up as closed, for example, and what factors contributed to an online database, users can search the tracker by that determination. the Master Plan’s five goals, 23 strategies, or each It is reasonable – and expected as part of a multi- of the individual 227 initiatives. For each initiative, year effort – for the state to choose not to continue the tracker indicates where it falls within the Master all initiatives as it assesses and reprioritizes Plan’s scheme of goals and strategies, identifies lead work. Generating and maintaining hundreds of departments, and indicates whether its status is new initiatives each biennium would produce a active, completed, or closed. For some initiatives, it hefty, and perhaps unsustainable, workload for also includes a narrative description of progress to the State. However, there needs to be greater date.32 communication and clarity about what occurred to The Implementation Tracker certainly provides prior year initiatives. To enhance accountability and some level of transparency around Master Plan transparency, it should be easier for a member of the Implementation and the Administration should be public to use the tracker to learn what is underway, applauded for standing up this work so early. By what has been accomplished, what has been merged noting lead agencies and summarizing the status of or modified into a new initiative and what has work on each initiative, the tracker helps encourage stopped. Particularly for initiatives that are closed, accountability for progress.33 Yet, going forward, completed, or discontinued, it also should give some its usefulness as an accountability tool could be indication as to why. improved. EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 15 Additionally, elements within the tracker appear to be RECOMMENDATION 4 inconsistently updated. For example, two initiatives The Department of Aging should revise the Master do not have an assigned lead agency or department. Plan for Aging Implementation Tracker to improve Most initiatives include annual progress updates, transparency around the status of work underway and some appear to be updated more frequently, and regularly report its findings to the Legislature. but 27 initiatives launched in 2021 and 37 initiatives Specifically, it should: launched in 2023 have yet to include any progress information. The depth of information included in ◊ Assign lead agencies to each initiative. these updates varies greatly. Some highlight work ◊ Indicate which initiatives are currently underway, using government jargon, include statistics on what has been merged or modified into a new outcomes, or include budgetary information, others initiative and what has been discontinued. do not. These sporadic and inconsistent updates ◊ For all initiatives that are not currently active, are not sufficient to provide a sense of real time include a brief explanation of whether they were progress and should be conducted more thoroughly closed, completed, or discontinued, and which and frequently. Regular updates, according to some entity made that determination. stakeholders, would help to make the public more aware of the state’s efforts and drive stakeholder ◊ Provide concise, easy to understand progress updates that are free of government jargon. action.35 ◊ Provide consistent, regularly scheduled updates By addressing these issues, the state could enhance for all initiatives, regardless of which agency or the functionality and utility of the Implementation department is designated lead. Tracker, creating a more robust accountability tool Future Initiatives Should for lawmakers, stakeholders, and the public. Emphasize Programs that Directly Benefit Californians By addressing these issues, the state could enhance Half of the currently active Master Plan initiatives contemplate study and research or communicate the functionality and utility information rather than take action to deliver results of the Implementation for individual Californians, such as improving the Tracker, creating a more quality of services or increasing the number served.36 For example, among other work, the state is: robust accountability tool for lawmakers, stakeholders, and ◊ Reviewing local government rental subsidy programs for older adults and people with the public. disabilities. ◊ Reviewing mobility and demographic data regarding transportation use. ◊ Mapping statewide distribution of accredited Geriatric Emergency Departments. ◊ Exploring strategies to recruit retired health care professionals to work in clinical training programs. 16 | LITTLE HOOVER COMMISSION ◊ Convening information sharing sessions on RECOMMENDATION 5 economic innovation with other nations with As the Administration selects future Master Plan super-aged societies. initiatives, emphasis should be placed on supporting ◊ Conducting displaced worker analysis to programs or policies that deliver results rather than understand the impact of job loss on older those that analyze or consider various issues. workers’ employment, retirement, and health. RECOMMENDATION 6 ◊ Conducting outreach to older adults, people with The California Department of Aging should update disabilities and family caregivers about emergency the Master Plan Implementation Tracker to include situations brought about by climate change. categories for each initiative’s area of focus, rather ◊ Promoting “age-friendly health system principles” than producing separate reports containing these and encouraging adoption of evidence-based designations. practices to align with what matters most to older A Roadmap For adults and their families. Implementation Could ◊ Providing resources to county Adult Protective Services programs to facilitate financial institutions Focus Progress, Enhance reporting potential financial abuse to county Accountability officials. The Commission applauds the Department for The Master Plan established high-level targets for providing summary information to categorize the state in each of its five goal areas. However, the focus of initiatives and make it easier for these targets lack a level of specificity that could help stakeholders or members of the public to ensure that progress moves in the right direction. As understand the scope of work underway as part of an example, the Plan sets a target of “millions of new the Aging Master Plan. Going forward, to improve housing options to age well.” But this target does not accountability, this information should be built into call for a specific number of new housing options; the online, searchable Implementation Tracker. define “new” to clarify whether it includes options However, and more importantly given the major to modify existing housing stock to accommodate demographic shift taking place in the state,37 the needs of older individuals and those with implementation of the Aging Master Plan must disabilities or only refers to new housing stock with be conducted with an urgency not typical of most such amenities; or establish interim progress targets government operations. In future iterations, the and a timeframe for completion. In short, this target Commission underscores recommendations from and others established in the Master Plan are too the IMPACT Committee in its second report,38 and vague and do not adequately articulate the outcomes urges the Administration to place an even greater California hopes to ultimately achieve. (The targets emphasis on pursuing actionable initiatives that for all five Master Plan goals are listed on page 11.) would directly benefit Californians. Rather than California’s current implementation strategy does not analyzing or communicating about programs, the clearly align with these broad targets. Focusing on state should pilot, improve, or expand programs to a defined set of initiatives for each biennium helps drive change. If programmatic deliverables are stalled organize short-term work and allows policymakers to due to lack of available resources or commitment, adjust based on new policy and program information those obstacles should be swiftly communicated to as well as budget constraints. However, the absence policymakers for a response. of a long-term roadmap and interim milestones EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 17 against which to guide and measure progress makes California’s Data Assets Could it exceedingly difficult to assess the Master Plan’s Be More Strategically Applied success. to Master Plan Goals & Future The IMPACT Committee has called for the state to Planning Efforts narrow the scope of Master Plan implementation efforts to three areas: building a long-term system Through a partnership between the California of services and supports, ending older adult Department of Aging, Department of Public Health, homelessness and advancing equity in aging.39 and West Health, the Administration in January 2021 Having a roadmap with specific, measurable short- launched the Data Dashboard for Aging as an online and long-term goals could help guide progress in accountability tool to track progress on each of the these or other defined areas and prioritize work Master Plan’s five bold goals over 10 years.41 through the remaining stages of implementation. The dashboard includes more than 80 indicators for Establishing measurable, aspirational goals is not the various strategies outlined in the Master Plan. unprecedented for California. In a recent example, For example, these include the number of subsidized former Governor Jerry Brown in 2012 set a goal to housing units per 10,000 population to track the establish the infrastructure necessary for 1.5 million state’s progress toward developing More Housing zero-emission vehicles on California’s roadways Options strategy within Goal One, and the percent by 2025. Earlier this year, the Governor Newsom of adults aged 60 or older who enroll in the CalFresh announced that California has achieved an surpassed Program to track the state’s progress toward the this goal two years ahead of this target and is Protection from Poverty and Hunger strategy continuing work to achieve target sales of zero- within Goal Five. It also includes a scorecard42 that emission vehicles over the next 20 years.40 summarizes the various indicators by goal and includes an explanation of why each of the five Until California produces a roadmap for Master Plan goals is important. This explanatory implementation of the Master Plan, with text is still under development and the scorecard accompanying goals, timeframes, and metrics, it currently only includes an explanation for Goal One. will continue to be difficult for policymakers and Representatives from the Administration reported stakeholders to provide robust oversight, track that data on the dashboard is updated on a regular progress, assess needs and next steps, understand timeline.43 gaps in the state’s capacity, and build partnerships and coalitions in support of the work. Just as California has served RECOMMENDATION 7 as a model in executing its The Administration should establish a roadmap for implementation of the Master Plan that includes ambitious Master Plan, the short- and long-term aspirational goals and state is primed to pioneer timeframes for completion. Going forward, new initiatives should include specific, measurable metrics strategies to harness public that align with and drive progress toward these data to inform policy decisions. interim benchmarks. 18 | LITTLE HOOVER COMMISSION Some view California’s Data Dashboard for Aging as a Traditional government analyses, like those included useful tool for explaining priorities in the Master Plan in the Data Dashboard, often examine trends and tracking initiatives – so much so that other states among various demographic and socioeconomic are emulating the model in their own processes to factors. But these analyses fall short of explaining develop or update similar statewide aging planning or predicting how these and other factors combined efforts.44 contribute to individual life trajectories.45 Instead with the use of advanced technology and statistical While the dashboard clearly demonstrates the modeling, California has the opportunity to leverage Administration’s intention to use data to inform its rich data resources to move beyond this static planning and promote accountability, both important scorecard model to a more dynamic, rigorous model and admirable objectives, the dashboard model itself of evaluation that has the potential to predict things is ill-suited to achieving these ends: like quality of life and life expectancy down to the zip code or city block. ◊ The dashboard enumerates specific indicators for each strategy, yet these indicators alone are not By partnering with researchers capable of applying sufficient to truly articulate how far the state has these rigorous analytical techniques to the state’s progressed. For example, to measure progress data, California could develop models that show toward developing more affordable housing what factors keep an age-diverse population healthy options the scorecard currently tracks one and financially secure. These models could be used indicator: the number of subsidized housing units to help identify pivot points where certain groups per 10,000 people. may start down a path of better or worse outcomes ◊ Each of the 80 indicators is presented alone than others.46 Ultimately, such knowledge could help as a trend over time, without the context of policymakers target where to invest resources to demographic, geographic or other indicators. This achieve the Master Plan’s vision of “a California for All presentation of univariate data cannot answer Ages and Abilities.” questions about whether or not the state’s To some degree, the Administration and the policy or programmatic interventions are making Department of Aging already have taken steps to improvements. For example, this summary data partner with leading academics. Through the Aging cannot answer more complicated questions such and Disability Research Partnership, a number of top as whether housing affordability is getting better researchers from universities across the state have or worse for low-income older adults or whether been tasked with assisting the Aging Department access to homeless prevention and rehousing to develop key outcome indicators to monitor and assistance is becoming more equitable. measure population-based outcomes overtime and ◊ With so many indicators, it is difficult to make to identify what inputs – programs or initiatives sense of each and pinpoint if and where the state – the state will use to drive progress.47 While this is making progress. partnership will likely improve the state’s ability to Just as California has served as a model in executing track policy outcomes overtime, the Administration its ambitious Master Plan, the state is primed to could leverage this expertise to lay the groundwork pioneer strategies to harness public data to inform for building the infrastructure necessary for policy decisions. researchers to conduct sophisticated, rigorous analysis of the state’s data assets. EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 19 RECOMMENDATION 8 programs and caseloads – they are either new The Governor and Legislature should take further initiatives or additive to better meet emerging needs action to merge datasets across the Administration. and growing populations.52 The Commission acknowledges that the practical Given the sum of this hefty investment, it is critical work of building this technological infrastructure that policymakers and others are able to effectively exceeds the scope of this report, but notes that track these expenditures to assess spending the State would derive many benefits from greater priorities as part of annual budget negotiations and centralization of data resources, including the ability ensure accountability for dollars spent. Additionally, to analyze progress toward California’s Master Plan. a detailed financial accounting of total Master Plan Robust Spending, But Greater spending would assist lawmakers in understanding how and where the money was spent and could arm Transparency Needed them with information necessary to consider if and where additional support might be needed in order Today, the state has produced no overall budget for to advance the state’s goals. the Master Plan, nor has there been a comprehensive estimation of how much it would cost California to fully implement the Plan. Neither the Master Plan A detailed financial accounting for Aging online Implementation Tracker48 nor the of total Master Plan spending Department of Aging’s annual progress reports49 consistently note funding amounts or sources for the would assist lawmakers in various initiatives. understanding how and where Until the Commission requested budgetary the money was spent and could information, the State had not even been able arm them with information to readily identify total current spending. At our necessary to consider if and request, the Department of Aging compiled this information, manually collating financial data using where additional support might publicly available sources.50 be needed in order to advance Data obtained from the Department show that the state’s goals. California spent nearly $9.5 billion dollars on programs and initiatives to implement the Master Plan for Aging, between Fiscal Year 2020-21 and Without an ongoing, systemic spending tracker, Fiscal Year 2022-23. Notable investments were made the process to account for Master Plan spending is across a number of goal areas, including funding time consuming, unnecessarily labor intensive, and to augment staffing within the Administration for falls short of providing real-time information. Going a Senior Advisor at the Governor’s Office and 16 forward there needs to be a systemic way to calculate permanent positions in the Department of Aging to Master Plan spending so the Administration and support the Master Plan’s progress.51 The majority lawmakers may more easily and thoroughly assess of these investments were made using General investments and plan funding for future initiatives. Fund dollars and nearly 90 percent were one-time In the future, this lack of financial information and investments. According to the Department of Aging, planning may challenge implementation, particularly “many of these investments build off existing, core in years when the state faces budget shortfalls. 20 | LITTLE HOOVER COMMISSION RECOMMENDATION 9 The Administration should track and report state investments in all Master Plan for Aging initiatives in an easily accessible, online format. The Commission could envision this being done by the Department of Aging, the Department of Finance, or even the Legislative Analyst. Regardless of who is deemed responsible, this fiscal reporting should be conducted and reported to the Legislature on at least an annual basis and include: ◊ How much and in what year funding was invested. ◊ The source of funding. ◊ Which department or agency received funding. ◊ Whether investments are one-time or ongoing. ◊ Whether the spending supports new programs created as a result of the Master Plan for Aging or augmented funding for programs or services that existed prior to the Plan. EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 21 Master Plan for Aging Funding Sources and Spending Fiscal Years 2020-21 to 2022-23 SPENDING BY GOAL Goal 3: Inclusion and Equity, Not Isolation $368.7M (4%) Goal 4: Caregiving that Works $903.9M (10%) Goal 2: Health Reimagined $5.9B (62%) Goal 5: Affording Aging $1.4B (15%) Goal 1: Housing for All Ages and Stages $886.3M (9%) FUNDING SOURCES CONTINUATION OF FUNDING Other Ongoing $1.7B (18%) $932.4M (10%) General Fund with One-time federal funds $8.4B Three years $5.9B (63%) (89%) $106M (1%) General Fund Time period not $1.8B (19%) indicated $27.8M (<1%) Source: Susan DeMarois, Director, California Department of Aging. August 2023. Written testimony to the Commission. Analysis by Commission staff. Note: Other funding sources include American Rescue Plan Act Funds, California Emergency Relief Funds, COVID Response and Relief Funds, Housing and Community Based Services Funds, Enhanced Federal Funding, and other sources. 22 | LITTLE HOOVER COMMISSION Notes 1. Little Hoover Commission. October 2023. Issue 11. California Department of Aging. See endnote 4. Brief: California’s Aging Population. https:// Page 9. lhc.ca.gov/sites/lhc.ca.gov/files/Reports/275/ 12. Centers for Disease Control and Prevention. Life Report275.pdf. Expectancy at Birth by State. Year 2020. https:// 2. Dr. Jennifer Molinsky, Project Director, Housing www.cdc.gov/nchs/pressroom/sosmap/life_ and Aging Society Program, Joint Center for expectancy/life_expectancy.htm . Note: In 2020, Housing Studies, Harvard University. August 24, California, Massachusetts, and New Hampshire 2023. Testimony to the Commission. all had a life expectancy of 79. Just three states had a higher life expectancy: Minnesota (79.1), 3. State of California, Office of Governor Gavin Washington (79.2), and Hawaii (80.7). Newsom. Executive Order N-14-19. June 10, 2019. https://www.gov.ca.gov/wp-content/ 13. Penal Code Section 368(g) and Welfare and uploads/2019/06/6.10.19-Master-Plan-for-Aging- Institutions Code Section 15610.27. EO.pdf. 14. World Health Organization. Ageing. https://www. 4. California Department of Aging. January 2021. who.int/health-topics/ageing#tab=tab_1. Also, Master Plan for Aging. https://www.aging.ca.gov/ United Nations, Department of Economic and download.ashx?lE0rcNUV0zYXf9JtT7jkAg%3d%3d. Social Affairs. World Population Ageing 2019 Highlights. https://www.un.org/en/development/ 5. Dr. Carrie Graham, Director, Long-term Services desa/population/publications/pdf/ageing/ and Supports, Center for Health Care Strategies. WorldPopulationAgeing2019-Highlights.pdf. July 27, 2023. Testimony to the Commission. 15. Lee SB, Oh JH, Park JH, Choi SP, Wee JH. 6. Little Hoover Commission. April 2011. Report Differences in youngest-old, middle-old, and 205: A Long-Term Strategy for Long-Term Care. oldest-old patients who visit the emergency Also, Little Hoover Commission. December department. Clin Exp Emerg Med. 2018 1996. Report 140: Long-Term Care: Providing Dec;5(4):249-255. doi: 10.15441/ceem.17.261. Compassion Without Confusion. Epub 2018 Dec 31. PMID: 30571903; PMCID: PMC6301865.https://www.ncbi.nlm.nih.gov/pmc/ 7. State of California, Office of Governor Gavin articles/PMC6301865/. Newsom. See endnote 3. 16. Rebecca T. Brown, MD, MPH and others, Geriatric 8. SB 228 (Jackson), Chapter 742, Statutes of 2019. Conditions in a Population-Based Sample of 9. Long Term Services and Supports Subcommittee Older Homeless Adults, The Gerontologist, Report. February 25, 2020. “A Blueprint to Design, Volume 57, Issue 4, August 2017, Pages 757–766. develop and Deliver LTSS for All Californians.” https://doi.org/10.1093/geront/gnw011. https://cdn-west-prod-chhs-01.dsh.ca.gov/chhs/ 17. Dr. Carrie Graham. See endnote 5. uploads/2020/02/MPA-LTSS-Subcommittee- Report-Version-2.25.2020-to-post.pdf. 18. Center for Health Care Strategies. Multisector Plan for Aging Learning Collaborative: State 10. State of California, Office of Governor Gavin Newsom. See endnote 3. EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 23 Participants. https://www.chcs.org/multisector- the Commission. Also, Kim McCoy Wade, Senior plan-for-aging-learning-collaborative-state- Advisor for Aging, Disability, and Alzheimer’s, participants/. Also, the SCAN Foundation. Building Office of Governor Gavin Newsom. October 24, a Master Plan for Aging: Key Elements from 2023. Letter to the Commission. States Planning for an Aging Population. https:// 24. Holly Riley, Aging Services Coordination Director, www.thescanfoundation.org/publications/ Aging Texas Well. June 20, 2023. Personal building-a-master-plan-for-aging-key-elements- communication with Commission staff. Also, from-states-planning-for-an-aging-population/. Bonnie-May Shantz, Policy Manager, and Kathryn Note: These states include Connecticut, Florida, Downes, Policy Director, Executive Office of Elder Hawaii, Illinois, Indiana, Iowa, Maryland, Missouri, Affairs. June 26, 2023. Personal communication Nevada, New Hampshire, New York, New with Commission staff. Also, Jarett Hughes, Jersey, North Carolina, North Dakota, Oregon, Deputy Director of Policy and Research, Office Pennsylvania, South Carolina, Tennessee, Utah, of Governor Jared Polis at the State of Colorado. Vermont, and Washington. June 28, 2023. Personal communication with 19. State of California, Office of Governor Gavin Commission staff. Newsom. See endnote 3. 25. SB 228 (Jackson). See endnote 8. 20. SB 228 (Jackson). See endnote 8. 26. Elizabeth Fuller, Chief Consultant, Assembly 21. Dr. Sarita Mohanty, President and Chief Executive Committee on Aging and Long-Term Care. Officer, The SCAN Foundation. July 27, 2023. April 17, 2023. Personal communication with Testimony to the Commission. Also, Dr. Fernando Commission staff. Torres-Gill, Professor of Social Welfare and 27. Note: These committees include the 1) Public Policy and Director of the Center for Policy Alzheimer’s Disease & Related Disorders Research on Aging, University of California, Los Advisory Committee which was created in 1988 Angeles Luskin School of Public Affairs. July 27, and provides ongoing advice and assistance on 2023. Testimony to the Commission. Also, Dr. program needs and priorities of people who are Mark Ghaly, Secretary, California Health and impacted by Alzheimer’s disease and related Human Services Agency. July 27, 2023. Testimony dementia disorders; 2) the Disability & Aging to the Commission. Also, Susan DeMarois, Community Living Advisory Committee, which Director, California Department of Aging. July 27, was created in 2005 and advises CalHHS and 2023. Testimony to the Commission. other state entities, on community living policies 22. Dr. Mark Ghaly. See endnote 16. Also, Also, Dr. and programs, including but not limited to Carrie Graham. See endnote 5. long-term services and supports, transportation and housing, and employment opportunities; 23. Dr. Mark Ghaly. See endnote 16. Also, Susan 3) the Elder & Disability Justice Coordinating DeMarois. See endnote 16. Also, Susan DeMarois, Council, which increases coordination and Director, California Department of Aging. August develops recommendation to prevent and 24, 2023. Testimony to the Commission. Also, address the abuse, neglect, exploration, and Sasha Kergan, Deputy Secretary of Housing, fraud against older adults and adults with California Business, Consumer Services and disabilities, 4) the IMPACT (Implementing Housing Agency. August 24, 2023. Testimony to Master Plan for Aging in California Together) 24 | LITTLE HOOVER COMMISSION Stakeholder Committee, which advises on the Committee. June 2021. IMPACT Committee implementation of the Master Plan, focusing on Background. https://www.chhs.ca.gov/wp- accountability, outcomes, and improvement and content/uploads/2021/07/IMPACT-Background- issues annual progress reports with its findings 0621-FINAL-Accessible.pdf. Also, California and recommendations, 5) the California Aging Health and Human Services Agency. Master & Disability Research Partnership, which Plan for Aging Implementation and Oversight. advances research around opportunities for https://www.chhs.ca.gov/home/master-plan-for- Californians to thrive as they age and provides aging/#about-the-impact-stakeholder-committee. input on key performance indicators and data 29. IMPACT Committee. April 2022. Report: Master sources to benchmark the goals of the Master Plan for Aging’s Year 1 In Review. https://www. Plan, and 6) the Equity in Aging Advisory chhs.ca.gov/wp-content/uploads/2022/04/ Committee, which advises on implementation IMPACT-Committee-ReportFINAL_Accessible.pdf. of aging and disability policies, plans, programs, services, data collection, and staff development 30. MPACT Committee. May 2023. Report: Master and works to ensure that equity is incorporated Plan for Aging’s Year 2 In Review. https://www. throughout activities, service delivery, and chhs.ca.gov/wp-content/uploads/2023/05/ policies. Sources: California Health and Human IMPACT-Committee-Report-Year-2-accessible.pdf. Services Agency. Alzheimer’s Disease and Related Disorders Advisory Committee. https://www.chhs. 31. California Department of Aging. January ca.gov/home/committees/alzheimers-disease- 2023. Master Plan for Aging MPA Annual and-related-disorders-advisory-committee/. Report. https://www.aging.ca.gov/download. Also, Disability and Aging Community Living ashx?lE0rcNUV0zZ4fIvtjh8hzg%3d%3d. Advisory Committee. https://www.chhs. ca.gov/home/committees/disability-and-aging- 32. California Department of Aging. Master Plan for community-living-advisory-committee/#daclac- Aging Implementation Tracker. https://www. subcommittee-meetings. Also, California Elder mpaprogress.org/. and Disability Justice Coordinating Council. 33. Dr. Carrie Graham. See endnote 5. https://www.chhs.ca.gov/home/committees/ elder-and-disability-justice-coordinating-council/. 34. Susan DeMarois, Director, California Department Also, Master Plan for Aging Implementation of Aging. November 16, 2023. Personal & Oversight. IMPACT Stakeholder Committee communication with Commission staff. Membership. https://www.chhs.ca.gov/home/ master-plan-for-aging/#about-the-impact- 35. Dr. Sarita Mohanty. See endnote 16. stakeholder-committee. Also, California Aging & Disability Research Partnership. https://www. 36. California Department of Aging. California’s chhs.ca.gov/home/master-plan-for-aging/#about- Master Plan for Aging 2023-24 Initiatives: the-partnership. Also, Equity in Aging Advisory Delivering Results for Older Adults, People with Committee. https://aging.ca.gov/equity_in_aging_ Disabilities, and Caregivers. https://mpa.aging. resource_center/#implementation-meetings. ca.gov/UpdatesAndProgressReports/. Note: Of the 2023-24 Master Plan for Aging Initiatives, 28. California Health and Human Services Agency. 24 are categorized as “Analyze,” 5 as “Analyze/ Implementing the Master Plan for Aging in Deliver,” 2 as “Analyze/Deliver/Communicate,” California Together (IMPACT) Stakeholder 12 as “Communicate,” 45 as “Deliver,” and 7 as EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 25 “Deliver/Communicate.” Deck-01.20.23-accessible.pdf. Also, California Department of Aging. See endnote 31. 37. Little Hoover Commission. See endnote 1. 48. California Department of Aging. See endnote 27. 38. IMPACT Committee. See endnote 25. Also, Dr. Sarita Mohanty. See endnote 16. 49. California Department of Aging. January 2022. Master Plan for Aging MPA First Annual 39. IMPACT Committee. See endnote 25. Report. https://www.aging.ca.gov/download. ashx?lE0rcNUV0zbyxTsIDhE8hg%3d%3d. Also, 40. Office of Governor Gavin Newsom. April 21, California Department of Aging. See endnote 25. 2023. California Surpasses 1.5 Million ZEVs Goal Two Years Ahead of Schedule. https://www. 50. Susan DeMarois, Director, California Department gov.ca.gov/2023/04/21/california-surpasses- of Aging. August 24, 2023. Testimony to the 1-5-million-zevs-goal-two-years-ahead-of- Commission. schedule/#:~:text=WHAT%20YOU%20NEED%20 TO%20KNOW,state's%20ambitious%20 51. Susan DeMarois. See endnote 50. Also, Susan climate%20action%20plan. DeMarois. December 18, 2023. Personal communication with Commission staff. 41. California Health and Human Services Agency. Let’s Get Healthy California. Data Dashboard for 52. Susan DeMarois. See endnote 50. Aging. https://letsgethealthy.ca.gov/mpa-data- dashboard-for-aging/. Also, California Health and Human Services Agency. Master Plan for Aging. https://www.chhs.ca.gov/home/master-plan-for- aging/. Also, Dr. Mark Ghaly. See endnote 16. 42. California Health and Human Services Agency. Master Plan for Aging: Indicator Progress Dashboard. https://embed.clearimpact.com/ Scorecard/Embed/66348. 43. Dr. Mark Ghaly. See endnote 16. 44. Dr. Carrie Graham. See endnote 5. 45. Dr. Laura Carstensen, Director, Center for Longevity, Stanford University. July 27, 2023. Testimony to the Commission. 46. Dr. Laura Carstensen. See endnote 45. 47. Susan DeMarois. See endnote 16. Also, California Aging and Disability Partnership Meeting. January 20, 2023. Slide 14. https://www.chhs.ca.gov/ wp-content/uploads/2023/01/CADRP-Slide- 26 | LITTLE HOOVER COMMISSION Little Hoover Commission Members CHAIRMAN PEDRO NAVA | Santa Barbara JOSÉ ATILIO HERNÁNDEZ | Burbank Appointed to the Commission by Speaker of the Assembly Appointed by Speaker of the Assembly Anthony Rendon John Pérez in April 2013 and reappointed by Speaker in April 2023. Founder and CEO of IDEATE California, a of the Assembly Anthony Rendon in 2017 and again public relations and policy management firm. Also, founder in 2021. Government relations advisor. Former State and Board Chairman of ideateLABS. Former Director for Assemblymember from 2004 to 2010, civil litigator, External Affairs and Community Relations for ConnectEd: deputy district attorney and member of the state Coastal The California Center for College and Career. Commission. Elected chair of the Commission in March 2014. JASON JOHNSON | Napa Appointed by Governor Newsom in June 2023. Member VICE CHAIRMAN ANTHONY CANNELLA | Ceres of the Land Trust of Napa County Board of Trustees and Appointed to the Commission by the Senate Rules Horary Commander of Travis Air Force Base. Former Committee in March 2022. Civil engineer and principal with Managing Partner at Founders Den. Founder and former Northstar Engineering Group. Former State Senator from CEO at August Home Inc. 2010 to 2018. Previously served on the Ceres City Council and was twice elected mayor of that city. Elected Vice Chair SEN. DAVE MIN | Irvine of the Commission in July 2023. Appointed to the Commission by the Senate Rules Committee in September 2021. Elected in November 2020 DION ARONER | Berkeley to represent the 37th Senate District. Represents Anaheim Appointed to the Commission by the Senate Rules Hills, Costa Mesa, Huntington Beach, Irvine, Laguna Beach, Committee in April 2019. Partner for Aroner, Jewel, and Laguna Woods, Lake Forest, Newport Beach, Orange, Ellis. Former State Assemblymember from 1996 to 2002, Tustin, and Villa Park. chief of staff for Assemblymember Tom Bates, social worker for Alameda County, and the first female president ASM. LIZ ORTEGA | San Leandro of Service Employees International Union 535. Appointed to the Commission by Speaker of the Assembly Anthony Rendon in March 2023. Elected in November DAVID BEIER | San Francisco 2022 to represent the 20th Assembly District. Represents Appointed to the Commission by Governor Edmund G. Hayward, San Leandro, most of Union City, portions Brown Jr. in June 2014 and reappointed in January 2018. of Dublin and Pleasanton, and several unincorporated Managing director of Bay City Capital. Former senior officer communities. of Genentech and Amgen, and counsel to the U.S. House of Representatives Committee on the Judiciary. JANNA SIDLEY | Los Angeles Appointed to the Commission by Governor Edmund G. ASM. PHILLIP CHEN | Yorba Linda Brown Jr. in April 2016 and reappointed in February 2020. Appointed to the Commission by Speaker of the Assembly Partner at Ichor Strategies and appointed to the Board Anthony Rendon in October 2021. Elected in November of the Los Angeles City Employee Retirement System 2016 to represent 55th District. Represents portions of Los (“LACERS”). Former general counsel at the Port of Los Angeles, Orange and San Bernardino counties and the Angeles and city attorney at the Los Angeles City Attorney’s cities of Brea, Chino Hills, Diamond Bar, La Habra, Industry, Office. Placentia, Rowland Heights, Walnut, West Covina and Yorba Linda. SEN. SCOTT WILK | Santa Clarita Appointed to the Commission by the Senate Rules GIL GARCETTI | Los Angeles Committee in April 2023. Elected in November 2016 to Appointed to the Commission by Governor Gavin Newsom represent the 21st Senate District. Represents communities in November 2021. Professional photographer and author in the Antelope, Santa Clarita, and Victor Valleys. of ten books. Former Los Angeles County District Attorney, Full biographies are available on the Commission’s teaching Fellow at Harvard University’s Kennedy School, website at www.lhc.ca.gov. and president of the California Science Center Foundation’s Board of Trustees. EARLY IMPLEMENTATION OF CALIFORNIA’S MASTER PLAN FOR AGING | 27 “DEMOCRACY ITSELF IS A PROCESS OF CHANGE, AND SATISFACTION AND COMPLACENCY ARE ENEMIES OF GOOD GOVERNMENT.” By Governor Edmund G. “Pat” Brown, addressing the inaugural meeting of the Little Hoover Commission, April 24,1962, Sacramento, California Milton Marks Commission on California State Government Organization and Economy www.lhc.ca.gov