Care for California’s rapidly aging population requires ambitious strategy
by Jeff vonKaenel
It often starts with a phone call.
A daughter trying to help her aging mother stay at home. A senior recently discharged from the hospital. Someone facing eviction, unsure where to turn. They are looking for help: Care at home, transportation, housing, or simply an answer to what services they qualify for.
What they find instead is a system spread across multiple agencies, each with its own rules, eligibility requirements, and waiting lists. Some eventually connect to the support they need. Many do not.
California is aging fast, and the long-term care service systems designed to support older adults and people with disabilities is struggling to keep up.
Millions of Californians are moving into their 70s and 80s. Many will need help with daily living yet large numbers of people who qualify for services never receive them. At the same time, homelessness among older adults is rising, exposing deep gaps in both access and support.
“This is not something that gets solved in a year or two. It’s about continuing to build a system that works better over time and reaches the people who need it.”
Sarah Steenhausen, Deputy Director of Policy, Research and Engagement, California Department of Aging
The challenge is twofold. In some areas, there are not enough services to meet demand. In others, services exist but are difficult to find, navigate, or qualify for. The result is a system that too often fails people at the moment they need it most.
State leaders see the challenge clearly—but also the opportunity. As California’s older adult population grows, so does the need for a more connected approach to care and support. The Master Plan for Aging captures that vision, aiming to bring together systems that have too often operated in silos. To address the needs of California’s growing population of older adults, Gov. Gavin Newsom launched the California Master Plan for Aging (MPA) in 2021, a whole-of-government and whole-of-society approach to rethink how the state supports aging across health care, housing, caregiving, and economic security.
Facilitating this effort on behalf of the California Health and Human Services Agency is the California Department of Aging (CDA).
For Sarah Steenhausen, deputy director of policy, research and engagement at CDA, the plan represents a shift from a fragmented system toward one that works across sectors, bringing success through partnership and collaboration.
“Aging touches everything,” she says. “It’s not just health care. It shows up in housing, transportation, social services, affordability, and how those systems connect to meet the person’s needs.”
Over the past several years, that shift has led to tangible gains.
For example, the state has expanded Medi-Cal eligibility, allowing more older adults and people with disabilities—including some immigrant populations—to access health coverage and long-term care services. Investments have increased in programs that support people at home and in the community. And across state government, agencies are paying more attention to how their decisions affect older Californians—from housing to transportation to health care.
The gains are real. But there is recognition that much work remains to realize the vision of California’s MPA. Despite progress, the system remains challenging to navigate, demand continues to grow, and the number of people needing support is rising faster than the system is adapting.
Even with that progress, advocates say the state has not yet matched the scale or urgency of the moment.
Kevin Prindiville, executive director of Justice in Aging, says the MPA has led to meaningful gains, including expanded access to public programs and greater awareness across state agencies. But he says the progress falls short of what California needs.
“The progress hasn’t been ambitious enough to deal with the demographic changes we’re seeing,” he says.
Those changes are significant. California’s population is aging rapidly, with millions more residents expected to need long-term services and supports in the coming years. At the same time, the system remains complex and uneven, with access varying widely depending on where people live and what services they need.
Now, a new threat could make those challenges even harder to address.
H.R. 1, a sweeping federal budget and tax bill passed in July of 2025 and described by President Donald Trump as a “big, beautiful bill,” includes significant cuts to Medicaid and food assistance—reducing the funding states rely on to support older adults and people with disabilities. For California, that could mean difficult choices about which services to maintain and which to scale back.
Prindiville says history offers a clear warning.
“When states have less money, they cut what’s optional,” he says. “And that often means cutting home- and community-based services.”
Those services, including in-home care, adult day programs, and caregiver supports, are what allow people to remain in their homes and communities. They are also significantly less expensive than institutional care.
Cutting them may reduce costs in the short term. But over time, it drives up spending as more people are forced into institutional care.
“When people don’t get care at home, they end up in nursing homes,” Prindiville says. “And that care is much more expensive.”
That leaves California at a critical moment. On one hand, the state has developed a clear vision for aging—one that emphasizes independence, coordination, and the ability to remain in the community. On the other hand, the system remains under strain, facing rising demand, uneven access, and new fiscal pressures.
Steenhausen says the work of building a more coordinated system will take time and sustained commitment with leadership in all areas- state and local government, the Legislature, and public and private partners alike.
“This is not something that gets solved in a year or two,” she says. “It’s about continuing to build a system that works better over time and reaches people when they need it.”
That includes both expanding services and improving how people connect to them.
As California prepares to elect a new governor, the future of the MPA—and the broader system of long-term care—will depend on whether that next administration chooses to accelerate the work, adapt it to new fiscal realities, or scale it back.
For millions of Californians, the outcome will shape something fundamental: whether they can remain in their homes and communities as they age—or whether they are left to navigate a system that still hasn’t caught up to the reality they face.
For more information on various long-term services services and support systems visit The California Collaborative for Long Term Services and Supports at https://www.ccltss.org/
