Working Premise:

Budget proposals for new and enhanced LTC services should be made against the backdrop of a rich understanding of the services provided by the existing system, the needs of its clients, the funding sources available to the maintenance and expansion of the LTC system.

The Existing System:

The existing system is comprised of a broad range of services (personal assistance, social/quality of life, medical, behavioral health, and housing and economic support) funded by a mix of Federal, State, City and private dollars.  Key stakeholders include consumers of services and their families, as well as community based organizations and for profit service providers who work with consumers on an ongoing basis.

LTC³ F&P Project to Describe “The System”

We can start describing the system by using the analyses the Controller’s office has done over the past several years.  These have focused on programs for which City dollars are budgeted.  This includes a wide range of programs operated by HSA/DAAS, DPH, MOHCD, as well as a number of other agencies.  To these City-funded programs we would add programs that that are funded by State and/or Federal dollars, but which have no City dollars.  Last, we would add in programs (or services) that are funded in the private pay market, but have no public money in them.  For each program, we should include basic service descriptions, information on whom the programs are designed to serve, and estimates of dollars spent and numbers of clients.

Knowing What’s Not in the System (But Might Be)

We should have a good picture of what’s in the system as it exists today.  We should also have a list of programmatic concepts that are not represented in San Francisco, but which exist other places and are possible here (e.g., Medicaid waiver funded assisted living or adult foster care; services funded with subsidized long-term care insurance programs, etc.)

Knowing What We Can About Need

Although our knowledge about the adequacy of existing services and the amount of unmet need is not perfect, we do have some information about these topics (from needs analyses, waiting list data, census data, and previous studies aimed at assessing need in particular service areas).  This information should be part of the landscape as well.

Timing

The 17/8 budget development process is about to start.  Clearly, we will not be able to implement the above plan in time for this process.  We recommend that we move to assemble these data and organize them into a coherent report for use by the LTC³ and other interested policy makers by October 2017, to inform policy discussions that can influence the 18/9 budget making process.