ADMININISTRATION ON AGING

The Administration on Aging (AoA) is the U.S. federal agency charged with administering the Older Americans Act (OAA), the principal federal legislation promoting client advocacy, system building, and the delivery of social services for America's elderly population. AoA was created by Title II of the OAA, and is currently directed by the assistant secretary for aging within the office of the secretary of the Department of Health and Human Services (DHHS).

History and development of AoA

With some minor modifications, AoA has had two principal responsibilities since enactment of the OAA in 1965. First, AoA is the federal agency designated to administer all but one of the titles of the Older Americans Act. The largest of the grant programs is Title III, State and Community Programs, through which AoA works closely with a network of 9 federal regional offices, 57 state units on aging, 661 substate area agencies on aging, 228 Native American, Alaskan, and Hawaiian tribal organizations, and some 27,000 providers of services to elderly people. Through the considerably smaller Title IV program, AoA oversees the awarding of discretionary funds to public and private agencies and universities for building knowledge, developing innovative model programs, and training personnel for service in the field of aging. Under the Title VI program, AoA awards grants to provide supportive and nutrition services to older Native Americans, Alaskan Natives, and Native Hawaiians. Title VII, the Vulnerable Elder Rights Protection, addresses the needs of especially disadvantaged older people and brings together four separate programs: the long-term-care ombudsman program; programs for the prevention of abuse, neglect, and exploitation; state elder rights and legal assistance programs; and insurance/benefits outreach and counseling program (Administration on Aging, http://www.aoa.gov). (Title V, the Senior Community Service Employment program, is administered by the Department of Labor.)

AoA's second mission is broader, involving promoting awareness of the needs of the aging beyond grant administration, oversight, and evaluation. The wide-ranging charge to AoA is revealed in several of the duties and functions of the assistant secretary for aging, who heads AoA:

• To serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and across the federal government more broadly
• To collect and disseminate information related to problems of the aged and aging
• To gather statistics in the field of aging that other federal agencies are not collecting
• To stimulate more effective use of existing resources and available services for the aged and aging, and to coordinate federal programs and activities to that effect
• To carry on a continuing evaluation of the programs and activities related to the objectives of the OAA, with particular attention to the impact of Medicare, Medicaid, the Age Discrimination in Employment Act, and the National Housing Act relating to standards for licensing nursing homes and other facilities providing care for vulnerable individuals
• To provide information and assistance to private organizations for the establishment and operation by them of programs and activities related to the OAA
• To strengthen the involvement of the Administration on Aging in the development of policy alternatives in long-term care by participating in all departmental and interdepartmental activities concerning development of long-term-care health services, review all departmental regulations regarding community-based long-term care, and provide a leadership role for AoA, state, and area agencies in development and implementation of community-based long-term care.

In short, AoA is the "federal focal point and advocacy agency for older people" (Koff and Park). As such, it is charged with providing leadership within the aging network of state and area agencies and of service providers for the elderly, and with coordinating activities of other federal agencies involved with aging. It is a very encompassing mandate and has been a challenging one for AoA to carry out over the years.

Organizational challenges to AoA

While attempting to carry out this encompassing mandate, AoA has had only limited organizational resources.

Funding. The monetary resources at the disposal of AoA are severely limited, given the breadth of its responsibilities. First, appropriations under the Older Americans Act are relatively small—$933 million in 2000 (excluding Title V)—especially given that the formal mandate of both AoA and the OAA includes addressing the needs of all 43 million Americans over the age of sixty. Thus, there is not quite $22 in OAA funding theoretically available to each older American. This is not, however, to say that the federal government overall does not devote enormous resources to older people, but rather that they are largely administered outside of AoA: expenditures for Social Security ($420 billion) and Medicare ($273 billion) benefits total $693 billion. However, these programs are administered by the Social Security Administration and the Health Care Financing Administration, respectively. With respect to funding, the situation described by Binstock at the time of AoA's origin remains largely unchanged today: AoA is given a somewhat vague responsibility to coordinate all activities of the federal government related to aging but is not given the resources to do so.

Organizational standing. Since AOA's founding in 1965, a major issue has been where it should be placed within the federal government. The struggle has largely been an institutional one, with advocates for the elderly in Congress generally wanting AoA to have high status and visibility, and officials within the executive branch wishing to keep AoA closely tied to other agencies within what is now the Department of Health and Human Services. Thus, in 1965 the secretary of the Department of Health, Education and Welfare (DHEW) succeeded in putting AoA in the Welfare Administration, against the strenuous objections of advocates of the aging who did not want AoA, the OAA, or older people themselves associated with "welfare." In 1967, advocates succeeded in having AoA placed in a new unit within DHEW, the Social and Rehabilitation Service, which advocates found preferable to the previous placement but not as high or as autonomous as they would have liked. In 1973, AoA was moved to the new Office of Human Development Services (OHDS), which also included agencies serving children, families, and the developmentally disabled. AoA remained there for many years, with a minor elevation in the late 1980s (reporting "to the secretary," not to "the Office of the Secretary"). Finally, in 1991 AoA was elevated out of OHDS and became a line organization within DHHS with the same formal standing as the Social Security Administration, the Health Care Financing Administration, and the Public Health Service, all much larger agencies than AoA (Koff and Park). The most recent change was the elevation of the commissioner on aging to assistant secretary for aging within DHHS, in order to facilitate the head of AoA's being able to deal more effectively with other federal agencies (Gelfand).

Because AoA has always been a small agency, this jockeying for organizational position has been more about status and symbols than about actual influence within the DHHS (Hudson, 1973). Nonetheless, symbols are important, and AoA's being at the same organizational level as much larger agencies and headed by an assistant secretary say a good deal about the positive view of older Americans that members of Congress wish to promote.

Personnel. After having long been a small agency within DHHS, AoA became even smaller during the 1980s. Between 1981 and 1989, AoA's staff declined from 252 to 162, a 36 percent decrease. A number of senior-level positions were left vacant for periods and then, often, filled with temporary appointments. Travel budgets were cut as well, the principal consequence being that AoA officials in the nine regional offices were unable to travel to their states to provide technical assistance and oversight to the agencies operating programs under the OAA (USGAO, 1991). Successive amendments to the OAA have brought additional responsibilities to AoA over the years, making these personnel cuts even more pressing (USGAO, 1992).

AoA in the twenty-first century

Despite the enormity of its charge and the relative paucity of its resources, the Administration on Aging has overseen many developments since its creation in 1965. As the agency principally responsible for implementation of the OAA, it helped bring into existence and nurture today's network for the aging. This is no small accomplishment; indeed, advocates for children have argued that there should be a "children's network" analogous to the one that AoA has created for the aging (Grayson and Guyer). Social services funded at a level of nearly $1 billion are delivered through these auspices every year; federal and state agencies in health and mental health care, long-term care, nutrition, and transportation have been made more responsive to elderly persons' concerns because of network activity that AoA helped bring about.

There have been many relatively minor changes in AoA's programmatic emphasis, but program administration and client advocacy remain the principal foci. The balance between these two has, however, changed over the years. The network agencies at the state and substate regional levels are well established and are able to operate quite well on their own, relatively independent of AoA. This reality should be understood as a compliment to AoA, not a critique of it. The founding spirit of the OAA was for these agencies to become self-sustaining and, in turn, influence other agencies and organizations serving the elderly at the state level. The success of AoA and of the agencies in attaining this status has allowed AoA to place relatively greater emphasis on its activities at the federal level and on promoting the needs of older people that extend well beyond the social services boundaries of the OAA delivery structure. Of the six goals set forth by AoA in its most recent strategic plan, most call on AoA to promote new ideas and awareness— "gerontologize America," "promote crosscutting initiatives," "build a partnership between the aging and disability communities," and "address the diversity and special needs of the aged."

AoA remains a relatively small federal agency, and the national network it helped create no longer requires the levels of support and advice from AoA that it once did. That frees the assistant secretary for aging and agency staff to promote the needs of elderly people at the federal level and through activities that extend beyond the service programs of the network for the aging. Because resources available to AoA remain scarce, major changes in these arenas will be difficult to bring about. But the role is an important one, and AoA can devote relatively more energy to it than has been historically the case.

Robert B. Hudson

See also Area Agencies on Aging; Federal Agencies and Aging; Older Americans Act.

BIBLIOGRAPHY

Binstock, R. B. "Interest Group Liberalism and the Politics of Aging." Gerontologist 12 (1972): 265–280.

Gelfand, D. The Aging Network, 5th ed. New York: Springer, 1999.

Grayson, H., and Guyer, B. "Rethinking the Organization of Children's Programs: Lessons from the Elderly." Milbank Quarterly 73, no. 4 (1995): 565–598.

Hudson, R. B. "Client Politics and Federalism: The Case of the Older Americans Act" Paper presented at the Annual Meeting of the American Political Science Association, New Orleans, 1973.

Koff, T., and Park, R. Aging and Public Policy: Bonding the Generations. Amityville, N.Y.: Baywood (USGAO). 1999.

U.S. General Accounting Office (USGAO). Administration on Aging: More Federal Action Needed to Promote Service Coordination for the Elderly. GAO/HRD 91-45. Washington, D.C.: U.S. Government Printing Office, 1991.

U.S. General Accounting Office (USGAO). Administration on Aging: Harmonizing Growing Demands and Shrinking Resources. GAO/PEMD 92-7. Washington, D.C.: U.S. Government Printing Office, 1992