A Long-Term Outlook:

Disability Among
Californias Seniors

YEARS OF

SERVICE

M A C T AY L O R

LEGISLATIVE

ANALYST

N OVE M BER 2 016

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EXECUTIVE SUMMARY

Rapidly Growing Senior Population and Changing Demographics of California Seniors Raise
Issues About Long-Term Supports and Services (LTSS) System. Seniors are major users of LTSSdefined
broadly as services and supports provided to the disabled (of any age) who have difficulty performing
daily activities. The senior population (adults aged 65 and older) in California is projected to increase
more than twofold from roughly 5million in 2015 to nearly 12million in 2060. The demographics of the
senior population are also projected to change during this period. For example, the senior population
is projected to shift from being majority white to majority nonwhite by 2030. The rapid growth and
changing demographics of Californias senior population raise issues about seniors LTSS needs, LTSS
system capacity, and the financial impact of LTSS on personal and state finances. This report presents the
results of our projections of disability levels of Californias seniors through 2060 to inform the Legislature
and stakeholders about levels of disability and the potential need for LTSS among Californias seniors
over the next several decades. These projections provide a useful starting point in understanding how
Californias changing population demographics will impact the LTSS delivery system.
Population of California Seniors With Disabilities Projected to Grow Faster Than Overall
California Senior Population. We project that the number of seniors in California with disabilities
(as defined by limitations in routine activities of daily living, such as dressing or bathing) will increase
from 1million in 2015 to 2.7million in 2060. This represents 160percent growth in the population of
seniors with disabilities, while Californias overall senior population is projected to grow by 135percent
over this period. The faster growth of the senior population with disabilities is partially driven by the
increasing share of seniors aged 85 and older and increasing racial diversity of the senior population.
California Seniors Turning 65 Between 2015 and 2019 Projected to Spend 4.5 Years on
Average With a Disability. On average, seniors turning 65 between 2015 and 2019 are projected to
live for 23.6 years after age 65 and spend 4.5 of these years with a disability. The average number
of years lived with a disability varies based on demographics of the seniors in this cohort. For
example, white seniors in this cohort are projected to spend 3.6 years on average with a disability,
while Hispanic seniors are projected to spend 5.8 years on average with a disability and nonwhite,
non-Hispanic seniors are projected to spend 5.6 years on average with a disability. (Data constraints
prevent us from breaking out the nonwhite, non-Hispanic race category into additional groups.)
California-Specific Projections Are a Necessary First Step in Planning for the Growing Senior
Population. California-specific projections are necessary to inform the conversation around the future
of the LTSS system as Californias senior population grows over the next several decades. Available
national-level projections of disability levels (and the related issues of LTSS utilization and LTSS
financing), while a useful starting point, are not sufficient to reflect Californias unique demographics
and LTSS system. (For example, Californias senior population is projected to be majority nonwhite by
2030, while the senior population nationwide is projected to remain majority white through at least
2060.) As the Legislature, administration, and stakeholders continue to engage in planning for the
impact of the growing senior population on the LTSS system, it is necessary to have projections that
accurately reflect the uniqueness of Californias population and LTSS system to inform policymaking.

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INTRODUCTION
Over the next several decades, the senior
population (adults aged 65 and older) in California
is projected to increase more than twofold from
roughly 5million in 2015 to nearly 12million in
2060. This increase is largely driven by the aging of
the Baby Boomer population who began turning 65
in 2011. A similar increase in the senior population
nationwide will also occur during this time frame.
However, differences in the demographics of
Californias population when compared to the
population nationwide will lead to important
differences between Californias senior population
and the senior population nationwide. For example,
Californias senior population is projected to shift
from being majority white to majority nonwhite
by 2030, while the senior population nationwide is
projected to remain majority white through at least
2060.
Long-term supports and services (LTSS) are
broadly defined as services and supports provided
to the disabled (of any age) who have difficulty
performing daily activities. The rapid growth and
changing demographics of Californias senior
population raise issues about seniors LTSS needs,
LTSS system capacity, and the financial impact
of LTSS on personal and state finances. (We

also note that similar issues could be considered

for the working-age disabled population, but a
discussion specific to that population is beyond
the scope of this report.) At the national level,
detailed projections of the disability levels and
potential LTSS needs of seniors over the next
several decades are available to inform the
discussion around these issues. However, given
Californias demographic differences compared
to the United States as a whole, the national-level
results may not be applicable to California and to
our knowledge similar projections are not available
for Californias senior population. To address this
information gap, we projected disability levels
of Californias seniors through 2060. This report
presents the results of our projections to inform
the Legislature and stakeholders about levels of
disability and the potential need for LTSS among
Californias seniors over the next several decades.
These projections provide a useful starting point
in understanding how Californias changing
population demographics will impact the LTSS
delivery system. The results presented in this report
can also be built upon with further analysis focused
on utilization and financing of LTSS over the long
term.

DISABILITY AND LTSS LANDSCAPE

In this section, we discuss how disability is
measured and what types of LTSS services are
provided to people with disabilities. This applies to
the broader population of people with disabilities,
including seniors as well as working-aged adults
and children. However, this report focuses on
seniors, and where possible in this section, we
present data specific to the senior population.

Defining Disability and LTSS

Disability Is Measured by Limitations in
Daily Activities. Disability is often measured by
limitations in daily activities. These limitations
are typically grouped into two categories:
(1)limitations in activities of daily living (ADLs)
and (2)limitations in instrumental activities of

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daily living (IADLs). As shown in Figure1, ADLs

are limitations in routine, daily, personal care
activities, such as eating or dressing. IADLs are
limitations in more complex skills necessary to live
independently, such as grocery shopping or money
management.
LTSS Are a Range of Services and Supports
Provided to People With Disabilities. LTSS
are commonly grouped into three categories:
(1)institutional care, such as skilled nursing
facilities (SNFs); (2) home- and community-based
services, such as outpatient facility-based services
or paid in-home services, aimed at helping people
with disabilities live in the least restrictive setting
possible; and (3) informal, unpaid care that is
often provided at home by a spouse or other family
member.
Paying for LTSS
Payers of LTSS include the state and federal
governments, private insurers, and individuals

who pay out-of-pocket for their own LTSS. Within

the state and federal governments, Medi-Cal and
Medicare are the two main payers of LTSS.
Medicare Covers Limited LTSS. Medicare is
the federal health insurance program for qualifying
persons over age 65 and certain people with
disabilities, and is overseen by the federal Centers
for Medicare and Medicaid Services (CMS). As a
contrast to Medi-Cal (discussed below), individuals
are eligible for Medicare regardless of income.
Medicare only pays for a limited amount of LTSS.
For example, Medicare covers up to 100 days of
long-term care in a SNF for individuals receiving
skilled care, such as physical therapy, following a
recent hospital stay of at least three days.
Medi-Cal Covers a Broader Range of LTSS.
Medi-Cala joint federal-state health care
program for low-income Californianscovers
a much broader range of LTSS than Medicare.
(Medi-Cal is Californias Medicaid program.) The
costs of Medi-Cal services are shared by the state

Figure 1

Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
ADLs

IADLs

Eating
Getting In and
Out of Bed

Housework

Grocery
Shopping

Money
Management

Bathing

Medicine

Laundry
Getting Around
Outside

Toileting

Getting Around
Inside

Telephone
Use
Getting
Dressed

Preparing
Meals
Going Places Outside
of Walking Distance

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and federal governments. Generally, the federal

government pays for one-half of most Medi-Cal
costs (although, in some circumstances the federal
government pays for a larger amount of the costs),
with the state paying the balance. Examples of
LTSS covered by Medi-Cal include:

SNFs. SNFs provide nursing, rehabilitative,

and medical care to facility residents.
Generally, SNF residents receive their
medical care and social services at the SNF.

Nationally, Medicaid Is the Largest Payer of

LTSS. According to data from CMS on national
health spending in 2013, Medicaid spending
represented 43percent of all LTSS spending
nationally while Medicare spending accounted
for 22percent. Figure2 shows national LTSS
spending by payer in 2013 (such a breakout is not
available for California). In California, the most
recent analysis released by CMS indicates that
Medi-Cal spending on LTSS was over $14billion
total funds in the 2012-13 federal fiscal year. This
includes LTSS-related spending for the entire
population served by Medi-Cal, including children,
working-age adults, and seniors. An analysis by the
Kaiser Family Foundation found that 42percent
of all LTSS spending in 2010 was for the senior
population.

In-Home Supportive Services (IHSS). The

IHSS program provides personal care and
domestic services to individuals to help
them remain safely in their own homes.

Community-Based Adult Services (CBAS).

The CBAS programsometimes referred
to as Adult Day Health Careis an
outpatient, facility-based service program.
Program participants live in their own
homes, but attend a day program with
services provided by a multidisciplinary staff,
including: professional nursing services;
physical, occupational, and speech therapies;
mental health services; therapeutic activities;
social services; personal care; meals and
nutritional counseling;
and transportation
Figure 2
to and from the
Medicaid Is the Largest Payer of
participants residence.
Long-Term Supports and Services in the U.S.a

Multipurpose
Senior Services
Program (MSSP).
The MSSP benefit
provides intensive
case management
and home visits for
Medi-Cal recipients
aged 65 or older who
meet the eligibility
criteria for a SNF
but live outside of
institutional settings.

Medicare

Medicaid
Out-of-Pocket

Privateb

Other Public

a Data are from 2013 and are based on an analysis by the Congressional Research Service.
b Includes private insurance and other private payers such as philanthropic support.

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Informal, Unpaid Care Also an Important

Part of LTSS. In addition to paid LTSS, a large
amount of LTSS is provided through informal,
unpaid care. This type of care is most often
provided by spouses, adult children, or other
relatives and may be in addition to paid LTSS. The
AARP and the National Alliance on Caregiving
estimate that nationwide 34.2million adults
(about 14percent) served as an unpaid caregiver
of an adult aged 50 or older in 2014. These unpaid

caregivers spent an average of 24 hours per week

providing care such as helping the recipient with
ADLs and IADLs or communicating with health
care professionals on the recipients behalf. In
California, more than 6million adults provided
informal care for a family member or friend in
2009 according to an analysis by the University of
California Los Angeles. These caregivers provided
an average of 21 hours of care per week.

CALIFORNIAS POPULATION PROJECTED TO

CHANGE SUBSTANTIALLY BETWEEN 2015 AND 2060
In this section, we provide an overview of the
increase more than twofold from 5.2million to
changing population characteristics in California
12.2million, while the under 65 population is
through 2060. The information presented in
projected to grow only 17percent from 33.7million
this section is based on projections from the
to 39.5million (see Figure3). The largest growth
California Department of Finance and the United
of seniors during this time period is projected to
States Census Bureau and our analysis of data
occur among the population of seniors aged 85 and
from the Current Population Survey (a survey
older. The number of seniors aged 85 and older is
of U.S. households that
provides demographic and
Figure 3
economic information about
Growth in Senior Population to
Americans). See the Appendix
Far Outpace Growth of Under 65 Population
for a full list of data sources
Percent Change From 2015 to 2060
used in this analysis.
Senior Population
300%
Projected to Increase Over
250
Twofold, With Largest
Growth Among 85 and Older
200
Population. In 2015, seniors
150
represented 13percent of
Californias population, but
100
by 2060, seniors are projected
50
to represent 24percent of
Californias population.
Under 65
65 and Older
65-84
85 and Older
Over this period, the senior
Seniors
population is projected to
8

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projected to increase over threefold from about

at least 2060. As discussed later in this report, rates
700,000 in 2015 to over 2.5million in 2060. This
of disability vary by race; therefore, this projected
corresponds to a projected increase in the share of
shift in demographics is likely to have an impact
seniors aged 85 and older from 14percent in 2015
on the number of seniors with disabilities in
to 21percent in 2060.
California.
Ratio of Working-Aged Adults to Seniors
Californias Senior Population May Be More
Projected to Decrease by 50Percent From 2015
Well-Educated if Current Trends Continue.
to 2060. The projected rapid growth of the senior
Consistent with research at the national level, we
population relative to the rest of the population
find that the rate of adults in California attaining
results in a projected decrease of roughly 50percent more than a high school education is increasing,
in the ratio of working-aged adults to seniors by
as shown in Figure5 (see next page). This has also
2060. In 2015, there were 4.7 working-aged adults
translated into higher levels of education among
for every senior in California. By 2060, this ratio
seniors in California. Assuming these trends
is projected to decrease to 2.3 working-aged adults
continue, Californias senior population will be
for every senior. Researchers have suggested this
more highly educated in 2060 than in 2015. Rates
may be problematic for the provision of informal
of disability vary by education level, meaning
care as there may be more seniors who need LTSS
that trends towards higher levels of education are
and fewer working-aged adults to provide informal
important to consider when projecting the number
care. We revisit this issue later in this report.
of disabled seniors in the future. We discuss this
Californias Senior Population Projected to
further later in this report.
Become Majority Nonwhite While National Senior
Population Projected to
Figure 4
Remain Majority White. Both
in California and nationally,
California's Senior Population Projected to Be
Majority Nonwhite Much Sooner Than National Population
the share of the senior
population that is nonwhite
Percent of Nonwhite Seniors
is projected to increase (see
100%
United States
Figure4). However, the
California
nonwhite senior population
is projected to become the
75
majority in California well
before this shift happens
50
nationally. In California, the
senior population is projected
to shift from being majority
25
white to majority nonwhite
by 2030, while nationally,
white seniors are projected to
2015
2030
2060
remain the majority through

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PROJECTIONS OF SENIORS WITH DISABILITIES

IN CALIFORNIA FROM 2015 THROUGH 2060
In this section, we provide projections of the
population of seniors with disabilities in California
from 2015 through 2060. These projections assume
current rates of disability remain constant for
subgroups of the senior population. For example,
the rate of disability for married Hispanic women
who hold a high school degree and are between the
ages of 65 and 84 is held constant. This means that
any changes in population-wide levels of disability
projected in our analysis result from projected
changes in the size and demographics of the senior
population as opposed to increases or decreases in
disability rates. While we project the majority of
the senior population will not be disabled in any
given year from 2015 through 2060, we project
there will be substantial growth in the population
of seniors with disabilities during this time period
Figure 5

Adults in California Are

Attaining Higher Levels of Education
Percent of Californians Aged 25 and Older
70%
More Than HS

60
50
40
30

HS or GED Credential

20
Less Than HS
10

1993

1998

2003

2008

HS = high school.
Note: Data from the Current Population Survey.

10 Legislative Analysts Office www.lao.ca.gov

as a result of changes in the size and demographic

makeup of the senior population.
Disability Defined Based on Limitations
in ADLs. For the remainder of this report, we
define disability based on limitations in ADLs (see
Figure1 for a list of ADLs). We generally present
results for seniors with limitations in one or more
ADLs and for seniors with limitations in two or
more ADLs. (We include results specific to seniors
with limitations in two or more ADLs because in
many cases individuals are required to have at least
two ADL limitations to trigger private long-term
care insurance benefits if they have such coverage.)
Substantial Increase in Number of Disabled
Seniors, but Majority of Senior Population Not
Disabled. The number of seniors in California
with any ADL limitations is projected to increase
from 1million in 2015 to
2.7million in 2060 (see
Figure6), although the vast
majority of seniors in any
given year from 2015 to
2060 are not projected to be
disabled. Specifically, among
the population of seniors
projected to have a disability
in 2060, about 1million
are projected to have one
ADL limitation and about
1.7million are projected
to have two or more ADL
limitations.
Population of Seniors
2013
With Disabilities Projected
to Grow Faster Than Overall
Senior Population. While
Californias overall senior

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population is projected to grow

by 135percent from 2015 to
2060, the population of seniors
with disabilities is projected
to grow by 160percent (see
Figure6). This is the net
result of the factors discussed
below. (We note that our
results do not reflect a causal
relationship between these
characteristics and disability.
We observe in current data
that these relationships, such
as the relationship between
education and disability, exist
and assume they continue
going forward. We are not
speculating as to why these
relationships exist currently.)

Figure 6

Population of Seniors With Disabilities

Projected to Increase Substantially by 2060
Californians Aged 65 and Older (In Millions)
14
12
10
8
6
4
2
One or More ADL Limitations
2015

Senior Population Is Projected to Become

More Nonwhite, and Nonwhite Population
Has Higher Rates of Disability. As
Californias senior population shifts from
being majority white to majority nonwhite,
this will contribute to faster growth among

2030

2045

2060

ADL = activity of daily living.

Share of Seniors Aged

85 and Older Is Projected to Increase,
and Older Seniors Have Higher Rates
of Disability. As the share of Californias
senior population that is aged 85 and older
increases, this shift is likely to have an
impact on the number of disabled seniors
in California. Currently, rates of disability
among seniors aged 85 and older are higher
than among seniors aged 65 to 84. If this
difference continues as the share of seniors
aged 85 and older increases, there will be
faster growth in the population of seniors
with disabilities than the overall senior
population.

No ADL Limitations

the population of seniors with disabilities

than the overall senior population (again
assuming current rates of disability by race
do not change). Currently, white seniors
have lower rates of disability than Hispanic
seniors and nonwhite, non-Hispanic
seniors. (Data constraints prevent us from
breaking out the nonwhite, non-Hispanic
race category into additional groups.) As
the population of nonwhite seniors grows,
this contributes to faster growth in the
population of seniors with one or more
ADL limitations than the overall senior
population.

Share of Seniors With Higher Levels of

Education Projected to Increase, and
Rates of Disability Are Lower Among
Those With Higher Education. Currently,
rates of disability are lower among seniors
who have attained more than a high
school education than among seniors with

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a high school or less-than-high-school

education. (We note that education is
considered to be a proxy for socioeconomic
status.) Assuming this difference in rates
of disability and current trends towards
higher levels of educational attainment
continue going forward, this will partially
offset the impact of the trends in race and
age on the growth of the senior population
with disabilities. In other words, the
growth rate of seniors with disabilities
will not be as high as it would otherwise
be absent this impact of increasing
educational attainment.
Potential Increased Caregiving Role for
Population of Seniors Without Disabilities. As
discussed above, the ratio of working-aged adults to

seniors is projected to decrease roughly 50percent

from 2015 to 2060. This may mean there are fewer
caregivers available for seniors with disabilities.
However, focusing only on working-aged adults
ignores seniors without disabilities who may be able
to provide care for their disabled spouses or other
disabled relatives. A recent analysis by the National
Academies of Sciences, Engineering, and Medicine
found roughly one-third of family members who
provided care to seniors were aged 65 or older in
2011. We project that the ratio of seniors without
disabilities to seniors with disabilities in California
will decrease only 13percent from 4:1 in 2015 to
3.5:1 in 2060. This may suggest a greater role for
seniors without disabilities in providing informal
care over the next several decades.

PROJECTIONS OF LENGTH OF DISABILITY

AMONG CALIFORNIANS TURNING65
BETWEEN 2015 AND 2019
In this section, we provide projections of years
lived with a disability for the cohort of Californians
turning 65 between 2015 and 2019. These results
reflect only this cohort as compared to the results
presented in the prior section which reflect the full
population of seniors in California in each year
from 2015 through 2060. We focus on this cohort
because we can generally observe their entire
remaining life in our projections through 2060.
Disability Projections Among Californians
Turning 65 Between 2015 and 2019
Throughout this section, we discuss projections
depicted in Figure7. The figure begins with results
for the total senior population turning 65 between
2015 and 2019 and then breaks out the results for
this cohort by race, education, and sex. The left
12 Legislative Analysts Office www.lao.ca.gov

column of Figure7 depicts the average number

of years lived after turning age 65 broken out by
years lived with no ADL limitations, one ADL
limitation, and two or more ADL limitations.
For example, we project seniors in this cohort
will spend an average of 19.1 years with no ADL
limitations, 1.7years with one ADL limitation,
and 2.8 years with two or more ADL limitations.
The right column of Figure7 depicts the average
percent of life after turning 65 broken out by no
ADL limitations, oneADL limitation, and two or
more ADL limitations. For example, we project
seniors in this cohort will spend an average of
80.1percent of life after turning 65 with no ADL
limitations, 7.2percent of life with oneADL
limitation, and 11.9percent of life with two or more
ADL limitations.

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Figure 7

Length of Time Lived With ADL Limitations

Varies by Demographics Among Seniors Turning 65 Between 2015 and 2019
Average Years Lived After Turning 65 With . . .

Percent of Life After Turning 65 With . . .

No ADL Limitations

No ADL Limitations

One ADL Limitation

One ADL Limitation

Two or More ADL Limitations

Two or More ADL Limitations

Total Population
All Seniors

19.1

65

80.1%

1.7 2.8

75

85

95

7.2% 11.9%

50

100%

By Race
Whites

20.1

1.5 2.1

84.1%

Hispanics

18.7

2.1

76.3%

All Other Races

19.3

65

3.7

1.8 3.8

75

85

8.6% 15.1%

7.2% 15.3%

77.5%

95

6.6%9.3%

50

100%

By Education
Greater Than
High School

1.6 2.6

20.1

High School
or GED
Credential

18.1

Less Than
High School

16.1

65

75

82.9%

1.8 3.0

2.1

78.9%

3.7

85

73.8%

95

6.5% 10.6%

7.9% 13.2%

9.4%

50

16.8%

100%

By Sex
Female

19.5

Male
65

1.9 3.4

18.6

1.4 2.3

75

85

78.6%

83.4%

95

50

7.7% 13.7%

6.3%10.3%

100%

ADL = activity of daily living.

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Seniors Turning 65 Between 2015 and 2019

Projected to Spend 4.5 Years and 19Percent of
Remaining Life With a Disability. On average,
seniors turning 65 between 2015 and 2019 are
projected to live for 23.6 years after age 65 and
spend 4.5 of these years (about 19percent) with one
or more ADL limitations. This reflects an average
of 1.7 years with one ADL limitation and 2.8 years
with two or more ADL limitations. The average
number of years lived with a disability varies based
on demographics of the seniors in this cohort, as
discussed below. While Figure7 shows the average
years lived with ADL limitations, not all seniors in
this cohort are projected to have ADL limitations
during their life after age 65. Twenty-three percent
of seniors in this cohort are projected to spend no
years with ADL limitations.
Nonwhite Seniors in This Cohort Projected to
Live More Years With a Disability. While seniors
on average in this cohort are projected to spend
4.5years with any ADL limitations, the number of
years lived with ADL limitations varies by race. White
seniors in this cohort are projected to spend 3.6 years
on average with ADL limitations, while Hispanic
seniors are projected to spend 5.8 years on average
with ADL limitations and nonwhite, non-Hispanic
seniors are projected to spend 5.6 years on average
with ADL limitations. (Data constraints prevent us
from breaking out the nonwhite, non-Hispanic race
category into additional groups.)
While nonwhite seniors are projected to live
longer than white seniors in this cohort, nonwhite
seniors are also projected to spend a larger share of
life after age 65 with ADL limitations than white
seniors. White seniors in this cohort are projected
to live, on average, 15.9percent of life after turning
65 with at least one ADL limitation, while Hispanic
seniors and nonwhite, non-Hispanic seniors are
projected to live 23.7percent and 22.5percent,
respectively, of their life after turning 65 with at
least one ADL limitation.
14 Legislative Analysts Office www.lao.ca.gov

Seniors in This Cohort With More Than a

High School Education Projected to Live Fewer
Years With a Disability. The average number
of years lived with a disability among seniors in
this cohort also varies by educational attainment.
Seniors turning 65 between 2015 and 2019 who
have greater than a high school education spend
fewer years on average with one or more ADL
limitations than seniors with a high school degree
or GED credential and seniors with less than a
high school education (4.2 years vs. 4.8 years and
5.8years, respectively).
Not only do seniors with more than a high
school education live longer on average than
their counterparts with less education, they are
projected to spend a smaller share of their life after
turning 65 with one or more ADL limitations on
average than seniors with a high school degree or
GED credential and seniors with less than a high
school education (17.1percent vs. 21.1percent and
26.2percent, respectively).
Female Seniors in This Cohort Are Projected
to Live More Years With a Disability. Female
seniors turning 65 between 2015 and 2019 are
projected to live more years with a disability
on average after turning 65 than male seniors
in this cohort. Female seniors are projected to
live 5.3years on average with one or more ADL
limitations while male seniors are projected to
live 3.7 years on average with one or more ADL
limitations.
Female seniors in this cohort are projected to
live longer after turning 65 than male seniors on
average, but female seniors are also projected to
spend a larger share of life after turning 65 with
one or more ADL limitations on average. Female
seniors are projected to spend 21.4percent of life
after turning 65 with at least one ADL limitation
on average compared to 16.6percent of life after
turning 65 lived with at least one ADL limitation
on average among male seniors.

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California Seniors Comparedto

Seniors Nationally
Compared to Seniors Turning 65 Between
2015 and 2019 Nationwide, Californias Seniors
Projected to Live More Years With Two or More
ADL Limitations. Seniors in California turning
65 between 2015 and 2019 are projected to spend
nearly one year longer on average with two or
more ADL limitations than seniors nationally (see

Figure8). The Urban Institute projects that seniors

nationwide will spend two years on average with
two or more ADL limitations compared to our
projection of 2.8 years on average for Californias
seniors. Californias seniors in this cohort are
also projected to spend a larger share of life after
turning 65 with two or more ADL limitations than
seniors nationally (11.9percent vs. 9.6percent).

CALIFORNIA-SPECIFIC PROJECTIONS ARE A

NECESSARY FIRST STEP IN LTSS SYSTEM PLANNING
This analysis demonstrates the need for
California-specific projections to inform the
conversation around the future of the LTSS
system as Californias senior population grows
over the next several decades. The national-level
projections that provide information on disability
levels (and the related issues of LTSS utilization
and LTSS financing), while a useful starting point,

are not sufficient to reflect Californias unique

population and LTSS system. As the Legislature,
administration, and stakeholders continue to
engage in planning for the impact of the growing
senior population on the LTSS system, it is
necessary to have projections that accurately reflect
the uniqueness of Californias population and
current LTSS system to inform policymaking.

Figure 8

Californias Seniors Projected to Spend

More Years With a Disability Than Seniors Nationallya
Californias Seniors Turning 65
Between 2015 and 2019 Projected to Spend . . .

2.8

U.S. Seniors Turning 65

Between 2015 and 2019 Projected to Spend . . .

2.0

Years

Years

11.9%

of Life After Age 65

With 2+ ADL Limitations

9.6%

of Life After Age 65

With 2+ ADL Limitations

a National projections are from the Urban Institute.

ADL = activity of daily living.

www.lao.ca.gov Legislative Analysts Office 15

AN LAO REPORT

This report begins to fill the need for

California-specific information by providing
projections of disability among Californias seniors
through 2060. To further understand the impact
of the aging California population on the LTSS

system, it would also be useful to have projections

of LTSS utilization and financing. However, such
projections are not available at this time. Our
office will assess the feasibility of producing such
projections in the future subject to available data.

ADDITIONAL INFORMATION
AVAILABLE ON LAO WEBSITE
In addition to the findings presented in
this report, the LAO website (www.lao.ca.gov)
contains additional resources based on our analysis
including:

A summary infographic that highlights key

findings from our analysis.

Supplemental results that provide

additional details and explore results for
additional subpopulations beyond what
is in this report (for example, results are

16 Legislative Analysts Office www.lao.ca.gov

presented for nonwhite seniors who are

married compared to nonwhite seniors
who are not married).

Future work that will be added to our

website over time, including analyses
that provide projections of Californias
population of seniors with disabilities
under alternative scenarios in which rates
of disability (1) decrease over time and
(2)increase over time.

AN LAO REPORT

APPENDIX
Data Sources Used in This Analysis

American Community Survey, 2013 1-year

PUMS Data [Data file]. Washington, DC:
U.S. Census Bureau, 2013. Available from
the American FactFinder website:
http://factfinder.census.gov

Favreault, Melissa, and Judith Dey. (2015).

Long-Term Services and Supports for
Older Americans: Risks and Financing.
Washington, DC: US Department of
Health and Human Services, Office of
the Assistant Secretary for Planning and
Evaluation (ASPE). Retrieved from the
ASPE website: https://aspe.hhs.gov/basicreport/long-term-services-and-supportsolder-americans-risks-and-financingresearch-brief

Health and Retirement Study (HRS) public

use dataset. Ann Arbor, MI: University of
Michigan with funding from the National
Institute on Aging, 2014.

HRS Data (Version N) [Data file]. Santa

Monica, CA: RAND Center for the Study
of Aging with funding from the National
Institute on Aging and the Social Security
Administration, 2014. Available from
the University of Michigan Health and
Retirement Study website: http://hrsonline.
isr.umich.edu/data/index.html
Integrated Public Use Microdata Series
(IPUMS), Current Population Survey
(CPS) [Data file]: Version 4.0. Minneapolis:
University of Minnesota, 2015. Available
from the IPUMS-CPS website:
www.ipums.org

Rowland, Diane. (2013). What Would

Strengthen Medicaid Long-Term Services
and Supports (LTSS)? [PowerPoint slides].
Retrieved from: http://ltccommission.
org/ltccommission/wp-content/
uploads/2013/12/DRowland-PP.pdf

State Population Projections by Race/

Ethnicity, Sex, and Age 2010-2060 [Data
file]. Sacramento, CA: State of California,
Department of Finance, 2014. Available
from the California Department of
Finance website: http://dof.ca.gov/research/
demographic/projections/

Survey of Income and Program

Participation 2008. Washington, DC: U.S.
Census Bureau, 2015.

Survey of Income and Program

Participation 2008. Cambridge, MA:
National Bureau of Economic Research
(NBER), 2015. Available from the NBER
website: http://www.nber.org/data/surveyof-income-and-program-participationsipp-data.html

U.S. Population Projections: 2014-2060.

Washington, DC: U.S. Census Bureau, 2014
[Data file]. Available from the U.S. Census
Bureau website: http://www.census.gov/
population/projections/data/national/2014/
downloadablefiles.html

www.lao.ca.gov Legislative Analysts Office 17

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www.lao.ca.gov Legislative Analysts Office 19

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LAO Publications

This report was prepared by Amber Didier and reviewed by Mark C. Newton. The Legislative Analysts Office (LAO) is a
nonpartisan office that provides fiscal and policy information and advice to the Legislature.
To request publications call (916) 445-4656. This report and others, as well as an e-mail subscription service,
are available on the LAOs website at www.lao.ca.gov. The LAO is located at 925 L Street, Suite 1000,
Sacramento, CA 95814.

20 Legislative Analysts Office www.lao.ca.gov