BILL NUMBER: AB 324INTRODUCED BILL TEXT INTRODUCED BY Assembly Member Beall (Principal coauthor: Senator Liu) FEBRUARY 18, 2009 An act to amend Sections 9002, 9014, 9100, 9102, 9400, and 9545 of, and to add Section 9009 to, the Welfare and Institutions Code, relating to aging. LEGISLATIVE COUNSEL'S DIGEST AB 324, as introduced, Beall. Aging: Elder Economic Security Standard Index. Existing law, the Mello-Granlund Older Californians Act, creates the California Department of Aging, with prescribed duties. This bill would require the department, beginning in 2010, to annually update the Elder Economic Security Standard Index (Elder Index), as defined, for each county. This bill would require the department to use the Elder Index to make prescribed calculations and analyses relating to elders living below the Elder Index's poverty threshold. This bill would also require the department to report Elder Index data to each service area included in the state plan. Existing law requires each area agency on aging to create a plan that considers available data and population trends, assesses the need for services, identifies sources of funding for services, and develops and implements a plan for the delivery of services based on the need. This bill would delete the requirements that the plan consider available data and population trends, but would require that the plan utilize the Elder Index, specify the cost of meeting basic needs for elders in each service area, and identify which elders are living at or below the Elder Index. Under existing law, the department allocates funds to area agencies on aging to implement various programs, with allocations to be made in accordance with a prescribed funding formula. Under existing law, the Linkages Program, a community-based services program, provides care and case management services to frail elderly and functionally impaired adults to help prevent or delay placement in nursing facilities. This bill would declare it to be the policy of the state that specified state needs-based programs for elders use the Elder Index to establish income eligibility standards. This bill would also require area agencies on aging to annually update the intake form for the Linkages Program to include the most current Elder Index, in order to identify elders in economic need and refer these elders to other appropriate resources and programs. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. This act shall be known, and may be cited, as the Elder Economic Dignity Act of 2009. SEC. 2. The Legislature finds and declares all of the following: (a) The United States Census Bureau projects that the population of people 65 years of age and older is expected to more than double from the year 2000 to the year 2030, both nationally and in California. People 65 years of age and older comprised 10.6 percent of California's population in 2000 but will be 11.5 percent of the state's population by 2010, and 17.8 percent in 2030. (b) The United States Department of Health and Human Services uses the Federal Poverty Guidelines as a benchmark to determine eligibility for public assistance programs, and the Federal Poverty Guidelines are derived from the United States Census Bureau's Federal Poverty Thresholds, which are used to determine poverty rates. In 2008, the Federal Poverty Guidelines were ten thousand four hundred dollars ($10,400) for a one-person household and fourteen thousand dollars ($14,000) for a two-person household. In 2007, the official poverty rate for the total population was 12.5 percent, according to the most recent calculation by the United States Census Bureau. (c) The Federal Poverty Guidelines are an inadequate and antiquated measurement tool that uses a nearly 50-year-old methodology. The method is based solely on one expense: food. It also inaccurately assumes that households today still spend one-third of their income on food when in fact the United States Department of Agriculture states the number is actually one-tenth, or 10 percent. Instead of food, the United States Bureau of Labor Statistics, Consumer Expenditure Survey indicates that households spend closer to one-third of their budget on housing. The Federal Poverty Thresholds exclude the actual costs of housing, health care, transportation, and other essential services. Although updated annually using the Consumer Price Index, the Federal Poverty Thresholds are calculated in the exact same way today, in 2009, as they were in 1962. According to a Senior Fellow at the Brookings Institute, no other economic statistic in use today relies on these antiquated methods. Moreover, this "one-size-fits-all" measurement tool does not take into account factors such as the significant variation in the cost of living across the states, counties, and cities, or the ages of household members. (d) Despite these significant shortcomings in the underlying data and methodology, the Federal Poverty Guidelines continue to be used to determine eligibility for 82 different state and federal programs, and are used by state and federal policymakers as a benchmark to determine funding allocations to local communities, and to justify cuts to public benefits. Without a precise poverty measurement tool, policy and fiscal decisions intended to tackle poverty will continue to be imprecise. (e) Many of California's elders often do not receive any public assistance because their incomes are just above the official Federal Poverty Guidelines, and are therefore forced to make untenable choices among basic needs, such as choices between eating three meals a day, foregoing medications, or paying for shelter. Most of these elders have worked hard all of their lives, yet still struggle to pay their bills and live with dignity and economic security in their later years. Although often described as "falling through the cracks," this group is neither small nor marginal, as that phrase suggests, but rather, it is a substantial proportion of California's aging community. (f) Using the antiquated Federal Poverty Threshold, the United States Census Bureau reports that, for 2006, only 7.9 percent (295,000) of California's elders live below the official poverty level. This is a significant underestimate of the number of Californians 65 years of age and older who do not have enough to adequately cover their most basic needs. A recent study conducted by the University of California, Los Angeles, in collaboration with the Insight Center for Community Economic Development, found that approximately 47 percent (1.76 million) of California's elders 65 years of age and older do not have enough income to adequately cover their most basic needs, including food, shelter, medicine, and transportation, the study documents that approximately 40 percent (1.46 million) of California's elders "fall through the cracks" because they have incomes above the official Federal Poverty Thresholds but below what they actually need to make ends meet in today's economy. (g) The Elder Economic Security Standard Index (Elder Index) is a more sophisticated and updated 21st century calculation of poverty that provides a more accurate picture of the true economic needs of elders and their families. Calculated by the University of California, Los Angeles, in partnership with the Insight Center for Community Economic Development, Wider Opportunities for Women, and the Gerontology Institute at the University of Massachusetts, Boston, the new Elder Index quantifies the actual costs elders, 65 years of age and older, face in meeting all of their basic needs, including food, shelter, health care, transportation, utilities, and essential household items, in the private market. (h) The Elder Index is specific to the costs that elders face. It factors in state and local differences in the cost of living, as well as an elder's housing situation and health care needs. (i) The Elder Index serves as the guiding tool for broad-based planning, evaluation, research, advocacy, and outreach at the national, state, and local levels. By 2012, each county in every state across the nation will have a customized Elder Index. Among the current five pilot states using the Elder Index, the State of Massachusetts is already using it for planning, programming, and increasing the asset limits for Medicaid home- and community-based services from two-thousand dollars ($2,000) to ten thousand dollars ($10,000). The Pennsylvania Department of Aging, Illinois Congressional Representative Jan Schakowsky, and former Wisconsin State Assembly Speaker Michael Huebsch have also endorsed the Elder Index in their respective states. (j) A more accurate calculation of the poverty rate among elders will result in a more targeted distribution of federal funding to states to support elders, more effective programs, and strategic planning. SEC. 3. Section 9002 of the Welfare and Institutions Code is amended to read: 9002. The Legislature finds and declares all of the following: (a) Programs shall be initiated, promoted, and developed through all of the following: (1) Volunteers and volunteer groups. (2) Partnership with local governmental agencies. (3) Coordinated efforts of state agencies. (4) Coordination and cooperation with federal programs. (5) Partnership with private health and social service agencies. (6) Participation by older individuals in the planning and operation of all programs and services that may affect them. (b) It shall be the policy of this state to give attention to the unique concerns of our most frail and vulnerable older individuals. (c) Recognizing the diversity in geography, economy, culture, and lifestyles in California and the diversity of local senior citizen networks, it shall be the policy of this state to encourage and emphasize local control to achieve the most effective blend of state and local authority. (d) In recognition of the many governmental programs serving seniors, and as specified in paragraph (2) of subdivision (c) of Section 9102, the California Department of Aging should coordinate, as existing resources permit, with other state departments in doing all of the following: (1) Promote clear and simplified access to information assistance and services arrangements. (2) Ensure that older individuals retain the right of free choice in planning and managing their lives. (3) Ensure that health and social services are available that do all of the following: (A) Allow older individuals to live independently at home or with others. (B) Provide for advocacy for expansion of existing programs that prevent or minimize illness or social isolation, and allow individuals to maximize their dignity and choice of living. (C) Provide for protection of older individuals from physical and mental abuse, neglect, and fraudulent practices. (4) Foster both preventive and primary health care, including mental and physical health care, to keep older individuals active and contributing members of society. (5) Encourage public and private development of suitable housing. (6) Develop and seek support for plans to ensure access to information, counseling, and screening. (7) Encourage public and private development of suitable housing and recreational opportunities to meet the needs of older individuals. (8) Encourage development of efficient community services including access to low-cost transportation services, that provide a choice in supported living arrangements and social assistance in a coordinated manner and that are readily available when needed. (9) Encourage and develop meaningful employment opportunities for older individuals. (10) Encourage the development of barrier-free construction and the removal of architectural barriers, so that more facilities are accessible to older individuals. (11) Promote development of programs to educate persons who work with older individuals in gerontology and geriatrics. (12) Encourage and support intergenerational programming and participation by community organizations and institutions to promote better understanding among the generations. (e) The California Department of Aging shall ensure that, to the extent possible, the services provided for in accordance with this division shall be coordinated and integrated with services provided to older individuals by other entities of the state. That integration may include, but not be limited to, the reconfiguration of state departments into a coordinated unit that can provide for multiple services to the same consumers. Services provided under this division shall be managed, directly or through contract, by local area agencies on aging or other local systems. (f) It shall be the policy of the state that new California state needs-based programs, and current California state programs which are later modified to become needs based, shall use the Elder Economic Security Standard Index to establish income eligibility standards. SEC. 4. Section 9009 is added to the Welfare and Institutions Code, to read: 9009. "Elder Economic Security Standard Index" means an index that quantifies the costs that elders face in meeting their basic needs, including, but not limited to, food, shelter, health care, transportation, utilities, and essential household items, in the private market. It is derived by applying the existing publicly available methodology, developed by the Wider Opportunities for Women and Gerontology Institute, to publicly available data sources on the costs to live in each county of the state. SEC. 5. Section 9014 of the Welfare and Institutions Code is amended to read: 9014. "Greatest economic need" means the need resulting from an income level at or below thepoverty thresholdthresholds established by theBureau of the Census.Elder Economic Security Standard Index. SEC. 6. Section 9100 of the Welfare and Institutions Code is amended to read: 9100. (a) There is in the Health and Welfare Agency the California Department of Aging. (b) The department's mission shall be to provide leadership to the area agencies on aging in developing systems of home- and community-based services that maintain individuals in their own homes or least restrictive homelike environments. (c) In fulfilling its mission, the department shall develop minimum standards for service delivery to ensure that its programs meet consumer needs, operate in a cost-effective manner, and preserve the independence and dignity of aging Californians. In accomplishing its mission, the department shall consider available data and population trends in developing programs and policies, collaborate with area agencies on aging, the commission, and other state and local agencies, and consider the views of advocates, consumers and their families, and service providers. T he department shall also report the Elder Economic Security Standard Index data for each service area in its state plan. (d) The minimum standards for its programs shall ensure that the system meets all of the following requirements: (1) Have the flexibility to respond to the needs of individuals, their families and caregivers. (2) Provide for consumer choice and self-determination. (3) Enable consumers to be involved in designing and monitoring the system. (4) Be equally accessible to diverse populations regardless of income, consistent with existing state and federal law. (5) Have consistent statewide policy, with local control and implementation. (6) Include preventive services and home and community based support. (7) Have cost containment and fiscal incentives consistent with the delivery of appropriate services at the appropriate level. SEC. 7. Section 9102 of the Welfare and Institutions Code is amended to read: 9102. The duties and powers of the department shall be: (a) To administer all programs under the Older Americans Act of 1965, as amended, and this division, including providing ongoing oversight, monitoring, and service quality evaluation to ensure that service providers are meeting standards of service performance established by the department. This shall include, but is not limited to, all of the following: (1) Setting program standards and providing standard materials for training. (2) Providing technical assistance to area agencies on aging, program managers, staff, and volunteers providing services. (3) Development of the state plan on aging according to federal law. (4) Maintain a clearinghouse of information related to the interests and needs of older individuals and provide referral services, if appropriate. (5) Maintain a management information and reporting system; including a data base on service utilization patterns and demographic characteristics of the older population to be cross-classified by age, sex, race, and other information required for the planning process, and eliminate redundant and unnecessary reporting requirements. (6) Encourage and support the involvement of volunteers in services to older individuals. (7) Seek ways to utilize the private sector to assume greater responsibility in meeting the needs of older individuals. (8) Encourage internships to be coordinated with schools of gerontology or related disciplines, including internships for older individuals. (b) The department shall have primary responsibility for information received and dispersed to the area agencies on aging. (c) The department shall be responsible for activities that promote the development, coordination, and utilization of resources to meet the long-term care needs of older individuals, consistent with its mission. The responsibilities shall include, but not be limited to, all of the following: (1) Conduct research in the areas of alternative social and health care systems for older individuals. (2) As specified in Section 9002, coordinate with agencies and departments that administer health, social, and related services for the purposes of policy development, development of care standards, consistency in application of policy, evaluation of alternative uses of available resources toward greater effectiveness in service delivery, including seeking additional federal and private dollars to support achievement of program goals, and ensure ongoing response to the identified special needs of the chronically impaired to provide support that maximizes their level of functioning. (3) Monitor and evaluate programs and services administered by the department, utilizing standardized methodology. (4) Develop and implement training and technical assistance programs designed to achieve program goals. (5) Establish criteria for the designation, sanctioning and defunding of area agencies on aging. (d) In conjunction with the management information and reporting system required under paragraph (5) of subdivision (a), beginning in the 2006 calendar year, the department shall annually submit by January 10 of each year, to the budget, fiscal, and policy committees of the Legislature, and the Legislative Analyst, all of the following information: (1) The number of persons served statewide in each of the prior and current fiscal years for each state or federally funded program or service administered by the department. This information shall also be provided for each Area Agency on Aging service area. (2) To the extent feasible, the number of unduplicated persons served statewide in the prior and current fiscal years for all state or federally funded programs and services administered by the department. To the extent feasible, this information shall also be provided for each Area Agency on Aging service area. (3) Total estimated statewide expenditures in the prior, current, and budget fiscal years for each state or federally funded program or service administered by the department. This information shall also be provided for each Area Agency on Aging service area. (e) The report required by subdivision (d) shall be suspended until the 2010-11 fiscal year. In lieu of that information, the department shall submit to the budget, fiscal, and policy committees of the Legislature, and the Legislative Analyst, by March 1 of each year, copies of the program factsheets for each state and federal program administered by the department. The department shall update the information included in the program factsheets annually, before submitting them as required by this subdivision. (f) The department shall annually, beginning in the 2010 calendar year, update the Elder Economic Security Standard Index for each county in the state, using the methodology developed for the 2008 Elder Economic Security Standard Index. The department shall annually, beginning in the 2010 calendar year, calculate the number, percentage, and demographic profile of elders living below the updated Elder Economic Security Standard Index for that year by utilizing the most recent demographic data available. The department shall analyze the number and percentage of elders living below the updated Elder Economic Security Standard Index for that year by county, race, ethnicity, gender, age, housing situation, and other relevant demographic factors. SEC. 8. Section 9400 of the Welfare and Institutions Code is amended to read: 9400. (a) The Legislature hereby declares and recognizes the area agencies on aging to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal Older Americans Act (42 U.S.C. Sec. 3001, et seq.), state and local government assistance, the private sector, and individual contributions for services. (b) Area agencies on aging shall operate in compliance with the Older Americans Act and applicable regulations. (c) Each area agency on aging shall maintain a professional staff that is supplemented by volunteers, governed by a board of directors or elected officials, and whose activities are reviewed by an advisory council consisting primarily of older individuals from the community. (d) Each area agency on aging shall create a plan thatconsiders available data and population trends,utilizes the Elder Economic Security Standard Index, specifies the costs of meeting basic needs for elders in each public service area, identifies which elders are living at or below the Elder Economic Security Standard Index, assesses the needs for services provided under this division reflective of the community needs, identifies sources for funding those services, and develops and implements a plan for delivery of those services based on those needs. Each plan shall include developing area home- and community-based systems of care that maintain individuals in their own homes or least restrictive environment, providing better access to these services through information and referral, outreach, and transportation, and advocating for the elderly on local, state, and national levels. (e) Area agencies on aging shall function as the community link at the local level for development of home- and community-based services provided under the department's programs. (f) The area agencies on aging shall implement subdivision (b) of Section 9100 at the local level, with particular emphasis on coordinating with the local systems to enable individuals to live out their lives with maximum independence and dignity in their own homes and communities through the development of comprehensive and coordinated systems of home- and community-based care. Nothing in this division shall preclude local determination and designation of service coordinators other than area agencies on aging, for development and implementation of the long-term care integration pilot projects set forth in Article 4.05 (commencing with Section 14139.05) of Chapter 7 of Part 3 of Division 9. (g) In fulfilling their mission, area agencies on aging shall build upon the resources and the commitment unique to each community and shall be guided by a 10-point description of a community-based system that shall do all of the following: (1) Have a visible focal point of contact where anyone can go or call for help, information, or referral on any aging issue. (2) Provide a range of service options. (3) Ensure that these options are readily accessible to all older individuals, whether independent, semi-independent, or totally dependent, no matter what their income. (4) Include a commitment of public, private, and voluntary resources committed to supporting the system. (5) Involve collaborative decisionmaking among public, private, voluntary, religious, and fraternal organizations, as well as older individuals and consumers in the community. (6) Offer special help or targeted resources for the most vulnerable older individuals, those in danger of losing their independence. (7) Provide effective referral from agency to agency to ensure that information or assistance is received, no matter how or where contact is made in the community. (8) Evidence sufficient flexibility to respond with appropriate individualized assistance, especially for the vulnerable older individuals. (9) Have a unique character that is tailored to the specific nature of the community. (10) Be directed by leaders in the community who have the respect, capacity, and authority necessary to convene all interested persons to assess needs, design solutions, track overall success, stimulate change, and plan community responses for the present and for the future. SEC. 9. Section 9545 of the Welfare and Institutions Code is amended to read: 9545. (a) The Legislature finds and declares that the purpose of the Linkages Program shall be to provide care and case management services to frail elderly and functionally impaired adults to help prevent or delay placement in nursing facilities. For purposes of this section, "care or case management" means all of the following: (1) As appropriate, ongoing care or case management to frail elderly and functionally impaired adults to help prevent or delay placement in nursing facilities. (2) Client assessment, in conjunction with the development of a service plan with the participant and other appropriate persons, to provide for needs identified by the assessment. (3) Authorization and arrangement for the purchase of services, or referral, with followup, to volunteer, informal, or third-party payer services. Contractors shall maximize to the fullest extent possible the use of existing services resources before using program funds to purchase services for clients. Any benefits received as a result of these purchases either shall not be considered income for purposes of programs provided for under Division 9 (commencing with Section 10000) or shall not be considered an alternative resource pursuant to Section 12301. (4) Service and participant monitoring to determine that the services obtained are appropriate to need, of acceptable quality, and provided in a timely manner. (5) Followup with clients, including periodic contact and initiation of an interim assessment, if deemed necessary, prior to scheduled reassessment. (6) Assistance to older individuals entering or returning home from nursing facilities and who need help to make the transition. (7) Comprehensive and timely information, when necessary, to individuals and their families about the availability of community resources, to assist functionally impaired adults and the frail elderly to maintain the maximum independence permitted by their functional ability. (8) Short-term specialized assistance, including timely one-time-only assistance in securing community resources, counseling, and the arrangement of an action plan, when there is a temporary probable threat to the ability of the frail elderly person or functionally impaired adult to remain in the most independent living arrangement permitted by his or her functional ability. (b) Area agencies on aging shall be required to annually update the Linkages Program intake form to include the most current Elder Economic Security Standard Index, as adopted by the department pursuant to Section 9102, in order to identify elders in economic need and to refer these elders to other resources and programs.(b)(c) Contractors of the Linkages Program shall have experience in community long-term care services and capability to serve the frail elderly and functionally impaired adults, and where applicable, ensure separateness of the programs and demonstrate protective measures to avoid conflict of interest.(c)(d) Contractors of the Linkages Program shall have a systematic means of capturing and reporting all required community-based services program data.(d)(e) (1) Each county shall deposit funds collected pursuant to Section 1465.5 of the Penal Code in its general fund, to be available for use only for the support of services provided under this chapter in that county, including county administrative costs not exceeding 10 percent of the funds collected, except as otherwise provided in this subdivision. A county may join with other counties to establish and fund a program of services under this chapter. (2) Funds utilized pursuant to this section shall not supplant, be offset against, or in any way reduce funds otherwise appropriated for the support of services provided under this chapter.