Long Term Care Service Gaps for Population Age 65 and Older: A Rapidly Growing Issue Now and Decades to Come


Mi Familia es Mexicana (my family is Mexican), our culture has a strong belief that taking care of the elders in the family is not an option, it is an expectation. Fortunately, my paternal and maternal grandparents’ care, health, and safety needs were met by family (children, in-laws, and grandchildren) up to their last day of life. I learned at a young age that caring for the elderly is not easy; however, being involved with my grandmother’s care, helped develop a special relationship and bond despite all the difficulties. I was actively involved in every aspect of her care and health needs. Family dynamics were affected due to caregiver burnout, although, while alive, my grandmother received the utmost care, health, and attention. Our family had frequent gatherings around my grandmother and everyone was able to put aside any differences to love and create unforgettable memories with and for my “Chiquita.”

Unfortunately, this is not always possible or the case for many of our aging population. Some elders have family, for some their family is estranged, unable to, and or want no involvement in their loved one’s care, health, and safety needs. Many have no family while others are homeless and facing additional challenges. If that is not enough, elders continue to live independently or homeless despite suffering from a variety of neurological disorders including memory/cognitive and or psychological decline, there’s also physical, and chronic health conditions that prevent them from meeting their basic needs even with at-home services in place from one or more community-based agencies including; Adult Day Center, In-Home Support ServicesAt Home Health Care Agencies, CenCal Case Management, Family Service Agency for Seniors, Center for Successful Agingall falling under the Long Term Care Services umbrella. 

I have been employed through the County of Santa Barbara Adult Protective as a Services Social Worker (APS SW) since 2013. Part of APS’s role is, gathering relevant information from as many sources possible to complete thorough investigations. Information is gathered from many sources including, service providers, medical staff, housing authority, law enforcement, emergency medical transportation, public guardian office, family, neighbors, the elderly, and many more. I have learned that there are gaps in services for the population aged 65 and older. Furthermore, the concerns go beyond what is reported, some of the concerns include: 

Many people don’t even know what Long Term Care services are, and how or where the private and public sector allocates funding for this population. The lack of appropriate care services for individual needs causes this population to suffer endless consequences. Unreasonable private home care cost for the elderly on a fixed income, High Residential Care Facility for the Elderly (RCFE) cost making it difficult for placement. For individuals aged 60 and over federal poverty level is $11,600, In Santa Barbara County 5,230 persons or 7% of the population live below the poverty level. The City of Santa Barbara has the highest number (1,425) of persons living in poverty while the City of Guadalupe has the highest percentage, 18 % of its population aged 60 and over living below poverty level. Between living in poverty, being over income, not meeting eligibility criteria and inability to pay the costs for care makes this concern merely impossible for the population aged 65 and older to resolve. Without community, county, state, and nationwide collaboration, support, and involvement, this population and more to come  will be faced with challenges that are unimaginable. 

Santa Barbara County has countless great services and resources in the Senior Directory for the population 60 years of age or older. However, issues continue to exist with this population meeting agency/ organization criteria for services. Furthermore, clients/patients have terminated services if there exist risk factors involving elderly behavioral, environmental, safety and/or lack of support for progress, elderly home environment not appropriate, staff safety concerns, and or agency/organization liability concerns. This leaves elders vulnerable and at high risk for falls resulting in moderate to severe injuries, having no access to basic needs (food, clean clothes, clean home, medication, personal hygiene), health complications and or developing new health conditions, ultimately causing great harm to their social, psychological, emotional and mental wellbeing. 

“I did not plan to end up like this, it was not in my plan to need help getting out of bed, walk, get dressed or depend on others to feel safe, the worse is asking for help and no one wants to help me, what has happened to the world, to being humanitarian?”—APS Client                                                                     

According to The American Prospect, 70 percent of individuals over the age of 65 will need long-term care at one point in their lives, and 7% of Americans 50 years and older own LTC policies—fewer than 1 out of 30. Just because there is demand does not mean there are sufficient service agencies, establishments, and/or facilities available to provide the appropriate or necessary care for the population aged 65 and older. Therefore purchasing LTC service coverage may not be available when the coverage is needed. 

LTC refers to the health, social and residential services provided to fit the individual needs of persons with physical, psychological, and or chronic health conditions. The demand for LTC services and Supports will continue to increase as human life expectancy keeps increasing. The Baby Boomer generation is causing fast-growing numbers of the aging population age 65 and older. In 2009, the U.S spent approximately 24 billion dollars on LTC services and supports are financed by both private and public sources.

These and other issues have been discussed for many decades with projections that we are now seeing. There is background information collected,  government financing programs, and also addresses quality of care issues and options for LTC reform. The article also shows a significant increase each decade in the population age 65 and older and a projected 18.3% by 2030. Furthermore, this article confirmed that the total population age 65 and older exceeded the projected percentage in 2010 and is expected to increase to 21% by 2050. 

“I worked very hard for over 30 years to have a pension when I retired, but now, my pension makes me ineligible for government services and I cannot afford to pay for the care I need.”— APS Client

Socioeconomic status/ and costs to purchase LTC insurance are not only a concern to the low-income but for the middle class and wealthy population, age 65 and older as well. Medicaid payment and coverage depend on the place of residency, financial situation, and level of need for assistance. Therefore, the low-income population age 65 and older, living in Santa Barbara, can be denied coverage. If income is a few dollars above the federal poverty level, an elder is denied and or incurs a share of cost in order to receive government-based services including CalFresh, Medi-cal, and In-Home Supportive ServicesIn California, 14% of the elderly population live at or below the federal poverty level, in Santa Barbara County there are under 150 Residential Care Facilities for Elderly (RCFE), capacity ranges from 6- 375 residents. The cost for  RCFE in Santa Barbara County ranges from $1200.00  to $10,000.00 +, depending on the level of care and or memory impairments. RFCE serve a population 60 years of age or older, they offer a variety of services, level of care, including supervision for the cognitive/memory impaired, extracurricular activities. All services provided are part of and fall under the LTC services umbrella and must meet and abide by all State Standards. Furthermore, all RCFE must be licensed and inspected by the Community Care Licensing Department.  

It is time to do something for the population that has been put to the side. We have the opportunity to make a difference for those who have worked for many years before us. The elderly population deserves to receive appropriate care, medical attention, and protection.

Getting involved with organizations, educating oneself about this topic and in’s and out’s of the LTC services and supports through the health care act. Understand how and where the funds are distributed and utilized. Is there room for de-funding in this category? Yes, there is, there are hundreds of agencies and organizations allocated hundreds of thousands of dollars to provide at-home services to individuals who can no longer continue living independently. Funded agencies and organizations allocated funds are distributed in organizations rents, utilities, insurances, staff payroll among many other expenses, taking up much of the funds that should be spent directly on those aged 65 and older.

The need to open RCFE continuously is crucial taking into consideration the projected fast-growing aging population. Re-designing RFCE’s with an “At-Home Feel” welcoming the elderly into a new “Home” rather than the institutionalized environments in facilities. Current RCFE settings have created negative perceptions in the elderly reducing their interest in moving into, despite the risks of remaining in an independent living setting. 

There needs to be a shift from expecting one agency to resolve the issues alone, and begin thinking of working as a unified community. Working in collaboration with all agencies, resources, and support networks involved in the elder’s care to identify the core of an issue,  understand the needs, and develop a realistic long term care plan.

Another way of helping is by involving the younger generations to learn about this issue.  Incorporating this topic in the education systems as part of the human development courses, beginning in elementary schools. This opportunity helps develop a sense of empathy, understanding, interest, and responsibility toward this population. Furthermore, younger generations will learn about aging changes in physical, memory, behaviors, attitudes, overall decline, needs, health, care, and support;  while learning how to treat, speak, interact, and help them. 

Younger generations need to be exposed to an inevitable stage of life that is minimally included in the education systems but will be facing sooner than later through family and eventually in themselves. Ultimately, the younger generations will be our future leaders and personally, I find it beneficial to all, knowing that our nation has provided sufficient education and a level of understanding to ignite an interest to pursue this topic as part of their career.

Additional Information on LTC Services

Long-Term Care (LTC) Insurance 

Poverty rate jumps among California seniors 

Which US States Have the Oldest Populations? – Population Reference Bureau 


About Author


Angelica Salazar-Flores

Angelica Salazar-Flores Has worked in the Human Services field for a total of 22 years, 9 years worked for different organizations in the community contracted by the County as Case Manager, Job Readiness Workshop Consultant, Career Advancement Specialist, WIA Youth Employment Counselor, Teen Pregnancy Program, and Family & Children's Services. For the remaining 13 years, Angelica has been employed by the County of Santa Barbara, 5 years in the Child Welfare Department, and the past 8 years have worked for Adult Protective Services as a Social Worker. Angelica will be completing her B.A Degree in Applied Psychology at AUSB and plans on pursuing her MA in Clinical Psychology with Healthy Aging and Somatic Therapy. Angelica has worked with every stage of life and has found that working with the aging population is where her passion lies.

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