This is part 2 of a two-part article exploring how California’s government is addressing the issue of the increasing number of seniors in the state. You can read part 1 here.
Part One opened a discussion of the California Master Plan for Aging initiative. In this continuation, we share some preliminary thoughts about what such a plan might include. At age 83, I’m older than most of the “stakeholder” representatives, who met on September 17th, but still younger than many who are coping with the most devastating impacts of aging. I also have lived for the past 13 years in senior housing, and that has given me a front-row seat for watching others move through life’s closing stages. It’s from that perspective that I offer the following suggestions for what a Master Plan for Aging might address.
Some needs, such as nutrition, socialization, and purpose, are already being addressed by the Older Americans Act and its California counterpart, the Older Californians Act. Implementation is not perfect, and the outreach to those who are homebound or, worse, homeless, is not what it should be. It’s likely that the Master Plan will simply suggest that these efforts be continued and strengthened. Environmental preservation is also a concern of the elderly but it’s not unique to them. The Master Plan should be environmentally sensitive without having that as a primary focus.
That said, here are some elements that are critical for those who are older, and for which one hopes that the Master Plan will offer practical, cost-effective solutions.
- Housing needs to be accessible and adapted for people as they age. Too many elderly people end up with no choice other than homelessness. That may be related to loss of cognition or other challenges. The Master Plan needs to provide practical solutions to help keep the elderly off our streets.
- The elderly need financial security. Many low-income, aging workers with long careers of service cannot afford available living choices. Even the affluent can face the loss of their homes through bankruptcies (like that recently at Air Force Village West) or through nefarious schemes or merely through escalating living costs.
- Mobility is as much a challenge as transportation. If an older person becomes infirm, they may need a driver who is able and qualified to come into their home to assist them to the vehicle. On arrival at the destination, they also need help from the vehicle to, say, the examination room.
- Our medical system is not adapted to the challenges of aging. PACE programs, already mentioned, and which serve a select few among the indigent, provide an attractive alternative. The program with which I am familiar, St. Paul’s PACE San Diego, requires all enrollees to receive their primary care from an onsite team of primary care physicians, nurses, and other professionals. Because they are able to observe the enrollees in congregate settings, the team can maintain a higher quality of life at a lower cost than is usual with the traditional visits-based, self-referral medical system. This is an integrated healthcare delivery model that might be replicated more generally.
- Many elderly, as they become frail, require one-on-one care support. This is often provided at personal sacrifice by unpaid family members. In part, it’s a by-product of our aging-in-place commitment since the efficiencies of group care – like that provided in the PACE setting – are not available for people living alone. The challenge of caregiving is one of the most difficult that the Master Plan will be expected to address.
- Medications become a challenge in their own right. Many older citizens are prescribed medications that never sunset. The result is that many are taking 10 or more different pills every day. Excessive medication can be counterproductive. The compounding impacts of multiple medical interventions need to be addressed as part of any Master Plan.
- Finally, I’ve left till last, the most difficult aspect of aging, and one that a Master Plan should definitely address, that is life’s final transition into death. Death is uncomfortable for many people to contemplate and, yet, it comes to all. Dealing with death differs from person to person. Some people feel the need for an afterlife while others do not. Some people want to take all conceivable measures to stave off the inevitable, while others peacefully accept their fate and turn toward palliation.
Quality of Life
Traditionally, the State has taken the position that it is obligated to preserve life. Those who reduce suffering at the expense of life prolongation can be prosecuted and meted out severe punishments for manslaughter and more. This is a clear issue that a Master Plan needs to face head-on.
As the technology to prolong life beyond meaningful existence has advanced, our cultural willingness to consider whether such prolongation is humane has lagged. There are no self-evident answers to this question, but we need answers to protect those innocent caregivers who do their best to help the dying to have the peaceful transition that our common humanity cries out for.
Governor Newsom has shown leadership by identifying aging as requiring a new, creative focus. The 1996 Older Californians Act addressed many of the same challenges. The Governor, through the development of a Master Plan for Aging, seems ready to move forward with that earlier vision.
Oftentimes, legislation and regulation are in reaction to specific unfortunate events. Such reactive enactments can pile up and become onerous. Moreover, the tendency is to place constraints on older people “for their own good” but, nevertheless, constraints that diminish life’s meaning. There is a need to rescind the plethora of reactive regulation and to replace it with proactive, principles-based concepts.
Regulations are frequently excessively detailed, counterproductive, lacking cohesion, and lacking effective enforcement. This is particularly true of enactments intended to protect the elderly as opposed to empowering them. We need a more reasoned balance between these aims. The futility of today’s regulatory constructs is evident, for instance, in the State’s impotency in addressing developments that might have averted the bankruptcy of Air Force Village West.
Let’s hope that the Master Plan for Aging, as it evolves and takes shape, moves beyond politics and mere political correctness to propose pragmatic, workable solutions to difficult challenges.