A new USC-led report, “Achieving Abundance in Eldercare,” examines how California can advance policy solutions in response to the state’s growing population of older adults and the related growth in demand for care by tackling barriers creating scarcity in the state, strengthening public health and broader well-being.
The report, authored by Mireille Jacobson, professor of gerontology and public policy at the USC Leonard Davis School of Gerontology, was published as part of the UC Berkeley Possibility Lab’s Abundance Accelerator. This report is one of three released February 25, 2026 through a partnership between the Possibility Lab and CalMatters Knowledge Hub focusing on exploring innovative solutions to improve access to health care.
“I just think we need to make older age in California a thing that works for everybody and is something where we celebrate the progress we’ve made and make it an opportunity rather than this thing we avoid,” said Jacobson, who is also the co-director of the Aging and Cognition Program at the USC Schaeffer Center for Health Policy & Economics and a senior scholar at the USC Schaeffer Institute. “It’s really about helping people live as older adults in the state of California and live well.”
California’s Potential Policy Responses to Growing Care Demand
Most older adults report that they hope to stay in their own homes as they age, but this is not a reality for many, as health needs and mobility options change. As California’s population ages, demand for eldercare is outpacing the system’s ability to respond, exposing deep structural weaknesses in the way society provides for the long-term services and supports that older adults rely upon, Jacobson said.
“One in four California residents is going to be 65 and over in 2040 and 1 in 13 will be 85 and over,” she said. “But we have this opportunity now, I think, to plan for that and make progress while we’re still a relatively young state.”
Highlighting the state’s leadership in this area through initiatives like the Master Plan for Aging and CalAIM, Jacobson and coauthor Jonathan Cloughesy, a USC doctoral student in health economics, described in the report how the state could further incentivize and invest in the supply of options for eldercare so that access keeps pace with the state’s growing need.
One of the most pressing gaps is the persistence of a “missing middle” in eldercare provision, Jacobson said. Between limited home-based services and costly institutional nursing facilities, low- and middle-income older adults and their families often have few appropriate options. By expanding services and supports for this middle tier, California could better match services to need and increase capacity without leaving families with only the most expensive or restrictive options.
Jacobson also pointed out that workforce constraints can further limit access to care as people get older. She noted how restrictive scope-of-practice rules prevent trained home health aides from providing routine care (like administering eye drops and medication), thus reducing flexibility in options and increasing costs. In her view, streamlining licensure and expanding scopes of practice, paired with appropriate training and oversight, would enable more qualified providers to deliver care for older adults who have limited resources.
Jacobson also called for broader statewide reform, such as through Medi-Cal policies that align reimbursements with the true cost of care and reduce administrative fragmentation. In this way, eldercare reforms can address underinvestment and miscoordination in service delivery while better providing for the diverse needs of California’s aging population, she explained.
Strengthening California’s Health Care System
“Access to quality, affordable healthcare, no matter what age or stage in one’s life, is critical to our wellbeing,” said Dr. Amy E. Lerman, executive director of the Possibility Lab and professor of political science and public policy at UC Berkeley. “The collective work of these researchers to explore the impacts on childcare, healthcare, and eldercare builds a foundation and intentional investment to expand healthcare policy for families and communities across the state.
In the summer of 2024, the Possibility Lab invited public policy researchers from across California to share their ideas addressing childcare, healthcare, and elder care. The reports are led by three policy experts: Anna Powell (childcare), Leif Haase (healthcare), and Jacobson (eldercare).
According to these researchers, California can achieve true abundance in health care, expanding supply and broadening access towards people-centered systems design.
Release courtesy of UC Berkeley Possibility Lab
