How I reported on Central California’s aging population and too-small health care workforce

The impact of an aging population on California’s Central Coast health care system poses looming challenges. With all baby boomers, one of the largest generations in U.S. history, reaching 65 and older by 2030, my reporting goal was to determine if the area is prepared for this demographic shift, and if not, to find out what more can be done. The project culminated in a series of news reports for KCBX Public Radio, a public radio station covering the region. 

The 65 and older population in the state of California is about 15% and is expected to grow to 20% by 2030. On the Central Coast, this age group in San Luis Obispo County is already at 20% and will surpass 25% in the coming years. The neighboring county of Santa Barbara is also slightly higher than the state average. 

The Central Coast area comprises distinct cities and rural communities, often miles apart, yet connected through employment, education, and health care. It was important to feature a variety of voices from around the region, so I donned a mask to conduct interviews and capture audio throughout the area. Due to the COVID-19 pandemic, most of the interviews took place outdoors, which can be a challenge with wind, traffic and other noises.

An aging population 

The first story in the series addressed the need to prepare for an aging population. California Gov. Gavin Newsom identified the need in his 2019 State of the State Address. 

“The Golden State is getting grayer. We need to get ready for this major demographic challenge headed our way. For the first time in our history, older Californians will outnumber young children,” said Newsom. He also signed an executive order to establish a master plan for aging to help communities prepare for the changes ahead. 

Peter Rupert, director of the UC Santa Barbara Economic Forecast Project, said that as the population ages, more health care is needed, and the Central Coast will need to increase incentives for health care workers to meet the growing demand. 

“What we’re going to need to see in the health care industry is rising wages, we're going to need to see better startup packages, more flexibility, maybe some shorter hours, all of those things combined are going to help attract workers into that industry,” he said. 

Joanne Spetz, Ph.D., director of the Philip R. Lee Institute for Health Policy at UC San Francisco, analyzes data on the nursing workforce in California. Her 2018 report, “Regional Forecasts of the Registered Nurse Workforce in California,” projects nursing shortages for the Central Coast region. Spetz’s forecasts gave shape to the project. My interview with her was highly informative. 

Lack of nurse education opportunities 

The UCSF research identified a lack of educational resources for nurses as a key factor affecting the Central Coast health care workforce. According to Spetz, areas of the state with large nurse education programs have more nurses, so shortages will vary by location. The second story in my series addressed nurse education. 

Data from community colleges and subsequent interviews with nurse educators uncovered a multilayered problem on the Central Coast. The local community colleges that offer associate degrees for registered nursing (ADN) programs are highly regarded and successful, yet they accept relatively few students, and many qualified applicants are on waiting lists. Class size is limited by a lack of faculty to teach the courses, as well as access to clinical rotations in local hospitals. 

Sarah Orr, director and chair of the ADN program at Santa Barbara City College, said nurse educators are in short supply. 

“We are in big need of full-time and part-time faculty right now,” she said. “This is a hard place to hire into — it’s a very expensive community.”

Additionally, the large public universities, UC Santa Barbara and Cal Poly San Luis Obispo, do not offer nursing degrees. Cal Poly SLO is one of the few California State University (CSU) campuses without a nursing program. Although CSU polytechnic schools are different by design, Cal Poly SLO has evolved into a university with a broad range of majors and course offerings. 

The CSU system graduates about 4,000 nurses each year that, for the most part, feed into California’s nurse workforce. To get some clarity on why Cal Poly SLO has not added a nursing program, I interviewed Rehman Attar, CSU health care workforce development director. 

Attar said the situation is being monitored and the potential does exist for a Bachelor of Nursing program at Cal Poly SLO in the future. The decision, he said, will be based on yearly workforce assessments. In the meantime, CSU campuses in Monterey and Channel Islands partner with the local community colleges for nurse education. This is a story I will follow going forward. 

A growing need for memory care 

The final segment looked at the projections for Alzheimer’s disease and dementia as the Central Coast population ages. Alzheimer’s and dementia are not a normal part of aging. However, the number one risk factor is being over the age of 65. I suspect that this will be a driving force for change on the Central Coast. Various nonprofits are stepping up their community outreach programs to educate the public, and approximately 50 members of the Santa Barbara police force were recently trained for dementia-related emergencies. Training and support of this sort will need to expand throughout the region in the coming years. 

Finding and using data 

This project relied on future projections which, of course, come with a degree of uncertainty. For this reason, I looked at trends and worked to understand the methodology behind the data. 

Most of my data requests were made early in the project, however, some surfaced as I became more entrenched in the stories. For example, I was focused on nurse shortages, but several individuals mentioned a lack of geriatricians in the region. They talked about physicians retiring and the need to drive long distances for appointments. Upon hearing this from multiple sources, I requested data on licensed geriatric specialists from the Medical Board of California. The Medical Board responded quickly with data, and I was able to confirm that the numbers are low on the Central Coast. 

My mentor Liz Lucas provided support and encouragement throughout the process. When I began this project, I had very little experience with large data sets and my Excel skills were minimal. A key takeaway from this fellowship is that data, when used sparingly and accurately, adds another layer of credibility to stories about real people.