Other Free Encyclopedias » Medicine Encyclopedia » Aging Healthy - Part 1 » Administration on Aging - History And Development Of Aoa, Organizational Challenges To Aoa, Aoa In The Twenty-first Century

Administration on Aging - Organizational Challenges To Aoa

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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).

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