How can you make a complex, very specialized topic accessible and interesting to an interdisciplinary audience (from architects to social workers)? At our recent AHWGO salon Wendy Peterson, director of the Senior Services Coalition of Alameda masterfully introduced the imminent changes in Medi-Cal and Medicare that will combine healthcare and supportive services and will affect many low income seniors and people with disabilities. This is a paradigm shift that is long overdue and represents a break through. It recognizes that people with disabilities and frailties can be supported in leading meaningful lives through integrated services. In her words this is the result of a ‘steam engine time’ when the powers to be all at once realize that it makes sense to take action in the same direction. It is a win-win situation that does not only move us towards more human centered, integrated services but also plays into the effort by the State of California to save money. A local delivery of such services embedded in managed care plans together with a unified Medi-Cal and Medicare program are meant to achieve this goal. The ‘Coordinated Care Initiative” or CCI was enacted in the California budget of 2011/12 and will be launched in October of 2013 as a pilot in eight California counties with the rest to follow within the next year. It will affect approximately 65,000 people in Alameda county.

The vision is that doctors will have a social worker’s perspective and look at a person’s health problem as part of their life. A doctor for example will be able to help somebody with eating problems, not just through medical advice but will also by knowing how the person gets their food and what programs they are already or could potentially be enrolled in.

Wendy pointed out some of the road blocks to a launch of CCI, the scattered regulations, the local differences, the complex choices, the starved support service system, all that will most likely account for a bumpy start of this new standard of care delivery. Flaws are fixable though if people take the opportunity to be civilly engaged to make this a successful, sustainable shift. It is also a call for action to get it right.

For me as an architect, not at all familiar with the landscape of healthcare policies Wendy’s take on policy making is cross disciplinary and wonderfully motivating as she quoted MLK’s words – ‘The Arc of the Moral Universe is long, but it bends toward Justice’.

Taking this further into the built environment, I would like to see the arc bending towards supporting people with age friendly designs that go beyond design for accessibility but take into account an individual’s abilities and life’s circumstances and support them in continuing to live meaningful lives as they age. The Affordable Care Act carries the seed for integrating age and needs appropriate housing into supportive care services. Maybe the ‘steam engine time’ is also dawning in environmental design.

How to be prepared for upcoming changes:


—Know what your current coverage is and the date of any imminent coverage changes

—Watch your mail

—Keep notices you receive from Dept. of Health Care Services

—Contact HICAP if you receive a letter and have questions

—Find out if your Doctors are “in Network” of Alameda Alliance for Health or Anthem Blue Cross


—Be clear about your role (assist vs. refer)

—Get on SSC’s email list

—Attend trainings (NSCLC webinars, CHA trainings, SSC training events)

Resources and Contacts:

Wendy Peterson, Subscribe to mailing list at

California’s Coordinated Care Initiative

National Senior Citizen’s Law Center and http/

SCAN Foundation for policy briefs fact sheets, other publications on senior health and LTSS issues.

Covered California,

California Health Advocates

Legal Assistance for Seniors


Copyright © At Home With Growing Older