Thursday’s announcement of as many as 10,000 job cuts at the US Department of Health and Human Services and a restructuring that will see the elimination of the Administration for Community Living, which includes the Administration on Aging, “raises obvious questions,” LeadingAge President and CEO Katie Smith Sloan said.

“How will the work that our members rely on get done? How will their ability to serve older adults, and ensure quality care, be impacted? And will today’s announcements limit older adults’ and families’ ability to access care and services?” Sloan said Thursday in a statement issued after the end of the business day on the East Coast.

In the moves, Sec. Robert F. Kennedy Jr. is making good on previously announced plans to streamline the agency he heads.

The current functions of the ACL will be divided across the existing Centers for Medicare & Medicaid Services, the Administration for Children and Families, and the Assistant Secretary for Planning and Evaluation, according to HHS.

“This reorganization will not impact Medicare and Medicaid services,” the department said of the ACL changes.

Sloan urged HHS “to ensure that older adults and the providers who serve them will not be an afterthought in this reorganization.” The department, she noted, operates programs and provides “critical services and guidance” that nursing homes, home health and other long-term care providers depend on.

Further, redistributing ACL programs “must be done in a way that supports and augments their value, rather than simply moving them solely for the sake of reducing the HHS office or employee count,” Sloan said. “These important programs that deliver vital services, including home care, food and transportation to millions of older adults in need nationwide, must be supported and not pushed into obscurity.” 

LeadingAge also expressed concerns about the consolidation of field offices, some of which have personnel who oversee the nursing home survey process.

The ACL, according to the agency website, “was created around the fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities. By funding services and supports provided primarily by networks of community-based organizations, and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans.”

The ACL’s Administration on Aging defines itself as the principal agency at HHS “designated to carry out the provisions of the Older Americans Act of 1965.” 

Kennedy: Changes reflect core mission, new priorities

Across HHS, as many as 10,000 full-time employees are expected to lose their jobs in the restructuring, in addition to 10,000 workers that already accepted buyouts and early retirement offers. The result will be a downsizing of HHS from 82,000 to 62,000 full-time employees, but the department said that the restructuring will save HHS $1.8 billion annually.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy stated Thursday. “Over time, bureaucracies like HHS become wasteful and inefficient even when most of their staff are dedicated and competent civil servants.”

According to HHS, the restructuring plan will consolidate the department’s 28 divisions into 15 and will centralize core functions such as human resources, information technology, procurement, external affairs and policy. Additionally, regional offices will be reduced from 10 to five.

Additional changes that HHS has announced to date:

• Creation of the Administration for a Healthy America, which will combine multiple existing agencies — the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health — into a new, unified entity.
• The Administration for Strategic Preparedness and Response, responsible for national disaster and public health emergency response, will become part of the Centers for Disease Control and Prevention.
• HHS will create a new position, assistant secretary for enforcement, to oversee the existing Departmental Appeals Board, Office of Medicare Hearings and Appeals and Office for Civil Rights to combat waste, fraud and abuse in federal health programs.
• HHS will merge the position of assistant secretary for planning and evaluation with the Agency for Healthcare Research and Quality to create an Office of Strategy.

Additional information is available in an HHS post.

Many other reactions

Thursday’s announcement of job cuts and reorganization at HHS brought additional reactions from other organizations:

• “The news of 10,000 jobs being cut at HHS is not just another number. It represents people that provide critical support to older adults and their caregivers,” said Marvell Adams, CEO of the Caregiver Action Network. “Additionally, the stated dissolution of the Administration for Community Living, a core part of our healthcare system that helps older adults stay in community and at home as they age, is a tremendous setback to our work.”
• “HHS’ Administration for Community Living is the only dedicated government agency that helps older adults age in their home and in their community, which is what people say they want,” said Sarita A. Mohanty, MD, MPH, MBA, president and CEO of the SCAN Foundation. “Any realignment of the agency or its functions must preserve the essential work the government has long done to improve the lives of older adults and ensure alignment with Medicare and Medicaid to improve and expand delivery of the services on which Americans rely.”
• “The announcement of workforce cuts at the Department of Health and Human Services could have serious consequences at this time of unprecedented growth in America’s aging population,” Terry Fulmer, PhD, RN, FAAN, president of the John A. Hartford Foundation, said in a statement. “The proposed reorganization of the Administration for Community Living and its integration into other agencies requires careful consideration. Every older adult relies, in some part, on these services and the government staff who administer them.”
• The cuts “will create a huge roadblock to efficient implementation of Medicaid, Medicare, community health centers, child care and other vital programs, Service Employees International Union President April VerrettIt said. “The elimination of the Administration for Community Living, which coordinates programs for seniors and people with disabilities, will make it more difficult to sustain community-based programs and the workforce that supports them.”
• “ACL is more than just an agency — it’s a hub for coordination across aging and disability networks,” stated Jason Resendez, president and CEO of the National Alliance for Caregiving. “Its loss threatens to undo years of progress in building a national caregiver infrastructure.”
• HHS cannot dismantle ACL without weakening “without causing irreparable damage” to the department’s functions, Fred Riccardi, president of the Medicare Rights Center, said in a statement.
• Meanwhile, the AARP urged HHS “to prioritize essential health needs – particularly for older Americans and their caregivers.” Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond noted in a statement that “health is central to the lives, well-being and financial status” of older adults.

Oz confirmation expected soon

News of the impending HHS cuts and reorganization follows the advancement of the nomination for the leadership position of one of its agencies earlier in the week.

The Senate Finance Committee on Tuesday advanced the nomination of Mehmet Oz, MD, for administrator of the Centers for Medicare & Medicaid Services along party lines, by a vote of 14-13, and the full Senate is expected to confirm him in the days ahead.

The expected confirmation comes despite Oz’s views, or lack of expressed views, on Medicaid cuts and nursing home staffing mandates during a March 14 confirmation hearing before the committee.

“When I asked him a yes or no question about whether he would protect Medicaid, he dodged and weaved and refused to answer,” Ranking Member Sen. Ron Wyden (D-OR) said Tuesday, referencing the hearing. 

Additionally, Wyden said, Oz did not answer questions about whether nurses are needed in nursing homes during his hearing, calling it a “complicated question.”