Federal Agencies on Aging
FEDERAL AGENCIES ON AGING
A large number of departments and agencies within the federal government administer programs designed to help older Americans. There are multiple reasons why this public responsibility is spread across so many different government bureaucracies (Hudson).
First, older Americans have long had special needs that are absent or less intense among younger people. At advanced ages, people's strength tends to fail, and their health status may decline. Thus, it is often difficult for older people to work and support themselves. If they are ill, they may not be able to pay medical bills or gain access to health care services. It is also true that many older persons, especially very old women, are without family or nearby family members to assist them when they are in need. Thus, there has historically been a need for government to step in and help many people who have problems associated with old age (Binstock).
Second, the needs of older people for governmental assistance were acknowledged in the United States when assistance was not thought to be appropriate for other groups. In other industrial nations, many government programs were begun to assist workers and other working-age people, and were not targeted specifically to the old. The United States, however, proved more reluctant to put in place broad income and health care programs for working-age adults, holding more to a philosophy that such individuals should take care of themselves and their families (Rimlinger).
Third, older people make up a large percentage of the U.S. population today—12.6 percent of Americans are over age sixty-four—and have many of the same needs and demands for government programs that younger people have. Like other Americans, older people want safe streets, good transportation, a clean environment, and healthy food. Because of these interests older people have in common with younger ones, there are many agencies that address the needs of the old and the young on a largely undifferentiated basis.
The government agencies discussed here are confined to ones that devote their attention either exclusively or largely to older Americans. The best example of the first type of agency is the Administration on Aging (AoA) within the Department of Health and Human Services. AoA administers the Older Americans Act, which exclusively addresses the concerns of the 43 million Americans age sixty and above. An example of the second type of agency is the Social Security Administration, which is charged with administering most titles of the Social Security Act. Largely because of its old-age program for retired workers, most Social Security beneficiaries are elderly. However, because survivor, dependent, and disability benefits are also available through Social Security, roughly one-third of Social Security beneficiaries are under age sixty-five. An example of a third type of agency serving elderly and nonelderly is the Federal Transit Administration within the Department of Transportation. Though the elderly are frequent users of mass transit and this agency is very relevant to them, it serves a much broader population than just the old. As such, it is outside the bounds of the agencies discussed here.
Social Security Administration
The Social Security Administration (SSA), an independent agency, administers the largest titles of the Social Security Act, the largest social program in America. The formal name for what is often termed "Social Security" is the Old Age, Survivors, and Disability program (OASDI). Benefits under the OASDI program go to 27 million retired workers, 3 million spouses, 5 million widows and widowers, 2 million children of deceased workers, and 450,000 children of retired workers. OASDI expenditures in 2000 totaled $407 billion. This is the largest single expenditure of the U.S. government. SSA also administers Supplemental Security Income, a smaller program for low-income elderly, blind, and disabled individuals that expended $32 billion in 2000. Unlike OASDI, under which individuals receive benefits related to how much they earned while they were working, SSI beneficiaries receive benefits based on having very low incomes, regardless of their work history. It is because of this difference that OASDI is a "social insurance" program and SSI is a "public assistance" program.
SSA was separated from the Department of Health and Human Services in 1995. Dating to the 1930s, it has a longer and more distinguished history than many government agencies. Over the years its leadership has taken a central role not only in the design of social insurance policy in the United States but also in convincing Americans that Social Security is a needed program and fully in keeping with traditional American values of hard work and self-sufficiency (Derthick).
SSA headquarters are in Baltimore, Maryland, and today it has a staff of over 65,000 employees and 10 regional offices. SSA maintains 1300 field offices, and it is to these offices that individuals go to make inquiries about eligibility and benefits. SSA is one of the few federal agencies that individuals interact with directly; that is, the people serving them are employees of the federal government. (The other major example is the Internal Revenue Service.) The administration of most other government programs involves private nonprofit and proprietary organizations. These organizations contract with the appropriate federal agency, are monitored by that agency, and deliver services for that agency. Among others, this is true of the Medicare program, the Older Americans Act, and the food stamp program.
SSA undertakes a number of activities in support of its principal mission of making payments to beneficiaries under the OASDI and SSI programs. To better inform current workers about how Social Security works, SSA sends individualized statements to them that inform them of the benefits they may receive when they retire. Because a worker's future employment and wages are unknown, these estimates are made on certain assumptions tied to the worker's employment history.
SSA also maintains a research, analysis, and evaluation division. It keeps track of how much money the system is currently expending and currently taking in. In conjunction with the Social Security Advisory Board, created in 1994 as the SSA was becoming an independent agency, SSA staff also undertakes important forecasting activities, advising the president and Congress about the future status of the Social Security trust fund. Because the program is so big and because the American population is aging, these estimates have become very important in discussions about ways in which the Social Security system might be modified or overhauled in the future.
Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMMS), formerly the Health Care Financing Administration (HCFA), is located in the Department of Health and Human Services and administers Medicare, Medicaid, and the State Children's Health Program. The name was changed in 2001. Medicare and Medicaid were enacted in 1965, and were originally administered by the SSA. HCFA was created as a separate agency within the Department of Health and Human Services in 1977. When Medicare was enacted, it was directed exclusively to people age sixty-five and above; today it serves 33 million older individuals, 4 million disabled individuals, and 162,000 individuals with end-stage renal disease. Medicaid is a federal-state grant program in which the states receive federal reimbursements for expenditures they make on behalf of low-income individuals eligible for Medicaid coverage. Medicaid serves low-income individuals of all ages. However, it is especially important for older people who have long-term chronic illnesses and live in nursing homes or other institutional settings (Coughlin, Ku, and Holahan). Through Medicare and Medicaid, CMMS insures some 75 million Americans.
Medicare beneficiaries may receive their benefits through the traditional fee-for-service system or through a managed care organization, such as a health maintenance organization. In the former case, CMMS contracts with insurance companies, known as "fiscal intermediaries," that actually process claims from beneficiaries, hospitals, doctors, and other health care providers. Providers receive 80 percent of the fee established by the intermediary, following rules established by CMMS, with the beneficiary responsible for the remaining 20 percent. Prior to 1992, these reimbursements were based on a standard of "reasonable and customary charges;" since that date, reimbursements are based on a fee schedule established by HCFA that reduces reimbursements for surgeries and other selected procedures while increasing them for basic office visits (Moon).
In the case of managed care organizations, CMMS contracts with the managed care organization and provides a fixed amount per beneficiary to that organization, which manages all health care services available to the enrollee. The amounts vary widely around the country, using a complex formula based on 95 percent of the costs per beneficiary under the traditional fee-for-service model (Koff and Park). Other financing and delivery models CMMS is experimenting with include the social health maintenance organization, which includes social as well as health services, and the Program for All-Inclusive Care of the Elderly (PACE), which provides adult day care services for older persons who would otherwise need to be living in nursing homes or other institutional settings.
In purchasing health care services for beneficiaries of these programs, CMMS assures that the programs are being properly run by contractors and states; establishes policies for paying health care providers; conducts research on various aspects of health care management, delivery, treatment, and financing; and assesses and assures the quality of health care being provided through the programs. Of particular concern in recent years have been efforts to rein in fraud and abuse within the Medicare and Medicaid programs, and efforts to assure quality of care.
National Institute on Aging
The National Institute on Aging (NIA) is one of twenty-five separate institutes within the National Institutes of Health (NIH), the principal federal organization sponsoring and conducting scientific research related to health, which in turn is a part of the Department of Health and Human Services. For many years research on aging was centered within the National Institute of Child Health and Human Development (NICHD). However, those concerned with the particular medical, social, and behavioral problems associated with aging felt that NICHD's principal interests lay elsewhere, as did funding; only about 11 percent of the agency's budget was devoted to research on aging from 1962 to 1974 (Koff and Park). Delegates to the 1961 and 1971 White House conferences on aging pressed for a separate research entity within NIH. Despite the initial opposition of President Richard Nixon to creation of the NIA, he signed legislation authorizing its creation in May 1974.
NIA's missions are (a) to support and conduct high-quality research on aging processes, aging-related diseases, and special problems and needs of the aged; (b) to train and develop highly skilled research scientists; (c) to develop and maintain state-of-the art resources to accelerate research progress; and (d) to disseminate information and communicate with the public and interested groups on ongoing and needed health and research activities (www.nih.gov/nia/about/history).
Because aging-related research is relevant to and conducted by other institutes within NIH, it has been important for NIA to coordinate its activities with them. Put differently, NIA and NICHD are "population focused" (i.e., largely about older people and children, respectively). However, most of the other institutes in NIH are organized around particular diseases (e.g., National Cancer Institute, National Institute on Alcohol Abuse and Alcoholism) or specific organs (National Heart, Lung, and Blood Institute, National Institute of Diabetes, Digestive, and Kidney Diseases). Because all people can contract diseases and all people have bodily organs, there is inevitable overlap between institutes organized around population and around diseases and organs. Thus, NIA has coordinated its activities with other parts of NIH along the following lines, among others: (a) Alzheimer's and related diseases; (b) genetic and environmental bases for differences in the aging process; (c) impact of diet and exercise on health and functioning of older people; (d) means for preventing the need for long-term institutionalization; (e) research to improve the longevity of ethnic and racial minority populations; and (f) cross-cultural comparative studies concerning diverse populations (Koff and Park).
NIA sponsors research on aging through both extramural and intramural programs. The extramural program funds research and training at universities, hospitals, medical centers, and other public and private organizations. The intramural program conducts basic and clinical research in Baltimore and on the NIH campus in Bethesda, Maryland.
Administration on Aging
The Administration on Aging (AoA), within the Department of Health and Human Services, is charged with being an advocate for older people within the federal government and with administering all but one title of the Older Americans Act, which supports a range of socially supportive services for elderly people through a network of state, regional, and provider organizations.
Employment and Training Administration
Two programs administered within the Employment and Training Administration (ETA) of the Department of Labor (DOL) have particular relevance to older people: the Senior Community Service Employment Program (SCSEP) and the Job Partnership Training Act.
SCSEP is Title V of the Older Americans Act (OAA), and it is the only title of the act that is not administered by the Administration on Aging in the Department of Health and Human Services. SCSEP is run by the Employment and Training Administration within DOL. It serves people who are fifty-five or older and have low incomes and poor employment prospects. ETA does not directly oversee the employment of these individuals, but contracts with both national and state organizations to provide employment services. The three principal national contractors are the National Council of Senior Citizens, AARP (formerly the American Association of Retired Persons), and the National Farmers Union (or "Green Thumb," an elder employment program targeting rural America). The state-level contracts are administered through the state units on aging, created through Title III of the OAA.
ETA also administers the Job Partnership Training Act. which is the latest in a series of employment and training programs enacted by the federal government that date back to President John F. Kennedy's administration in the 1960s. Most of the jobs are intended for younger workers, but provisions in the Title II adult training program require that services be provided to "older individuals on an equitable basis" (Sec. 204).
Employment Standards Administration
A relatively small agency, the Wage and Hour Division within DOL's Employment Standards Administration, is charged with administering and enforcing the Family and Medical Leave Act (FMLA) of 1993. FMLA was the first piece of domestic legislation signed by President Bill Clinton and has been at the heart of heated arguments about what role, if any, the federal government should play in easing the tensions that have emerged between the roles of work and family among today's employees. The growing presence of women in the American labor force has been the impetus behind this legislation. Being at work has made it difficult for many women to meet traditional family obligations; yet allowing these women workers time off for such obligations has put strains on employers (and other employees) in getting jobs completed at the workplace.
FMLA is still in its infancy, but it has the potential in future years of being increasingly relevant to older people. One of the provisions of the law is that a worker can take time off from work to care for "an immediate family member," which includes a parent. As both the overall population and the workforce age, there will be an increasing need for workers to help meet the needs of parents who are frail. If, as has been proposed, FMLA were liberalized to include paid leave, the number of workers helping parents would grow even larger. To this point, implementation of FMLA has been complicated (Scharlach and Grosswald, Hudson and Gonyea) and it will continue to pose challenges for the Wage and Hour Division.
Pension and Welfare Benefits Administration
The Pension and Welfare Benefits Administration in the Department of Labor is charged with enforcing provisions of a very important piece of federal legislation, the Employee Retirement Income Security Act (ERISA), which establishes standards designed to protect private pension funds from collapse or insolvency. In this role it is responsible for protecting $4.3 trillion in pension assets owned by 90 million participants in 700,000 pension plans (www.dol.gov/dol/pwba/public/pubs/factsht1.htm). Prior to ERISA's enactment, several major plans had collapsed, leaving retired participants in those plans unprotected. Changes in the private pension world have made administration of ERISA increasingly complicated, and plans have been presented on ways to simplify its administration (Perun and Steuerle).
ERISA established the Pension Benefit Guaranty Corporation (PBGC), which guarantees certain benefits in the type of pension plan known as a defined benefit plan. PBGC is a federal government corporation established by Title IV of ERISA "to encourage the growth of defined benefit plans, provide timely and uninterrupted payment of benefits, and maintain pension insurance premiums at the lowest level necessary to carry out the Corporation's obligations" (www.pbgc.gov/ABOUT.htm).
The Corporation for National Service (Senior Corps) was created in 1993 to further the involvement of Americans in strengthening their communities. It merged the activities of two predecessor agencies, ACTION and the Commission on National and Community Service. For two decades ACTION administered VISTA (Volunteers in Service to America) and the three programs that comprise Senior Corps: the Senior Companion Program, the Foster Grandparent Program, and the Retired Senior Volunteer Program (RSVP).
The Senior Companion Program's dual purpose is "to create part-time stipendiary volunteer community service opportunities for low income persons aged sixty and older and to provide supportive person-to person services to assist adults having exceptional needs developmental disabilities, or other special needs for companionship" (Koff and Park, p. 265). Senior Companions can serve twenty hours per week and can receive a stipend based on 1,044 hours of service annually.
Responsibility for the Foster Grandparent Program was transferred from AoA to ACTION in 1971 and to Senior Corps in 1993. Foster grandparents must be fifty-five or older, no longer be in the regular workforce, and have no limitations that would affect their work with children. These older volunteers work with children (up to age twenty-one) in a variety of community and educational settings.
RSVP primarily involves retired professionals, giving them a chance to employ their skills on behalf of local service organizations. They must be available on a regular basis and over age fifty-five; they receive no stipend.
The Equal Employment Opportunity Commission, an independent government agency, is charged with enforcing laws prohibiting job discrimination, including the Age Discrimination in Employment Act (ADEA). There is a long history in the United States of discriminating against older workers (Graebner; Sandell), which ADEA is designed to address. Originally enacted in 1967, ADEA defined the covered ages to be forty to sixty-five; in 1978 coverage was extended to age seventy; and in 1986 the upper age limit was removed entirely. The last action legally eliminated mandatory retirement in the United States (except for select groups of employees). This was considered by advocates for elderly people to be a great civil rights victory equivalent to outlawing discrimination on the basis of race or gender.
Office of Multifamily Housing
The Office of Multifamily Housing (OMH), in the Department of Housing and Urban Development (HUD), administers two major housing programs directed largely to older people: Section 202 of the Housing Act of 1959 and Section 231 of the National Housing Act, originally passed in 1934. Section 202 provides capital advances to nonprofit organizations for financing the construction and rehabilitation of housing that will support very low-income older people, and providing rent subsidies to make the housing affordable. The program grew rapidly in the 1960s, was phased out in the early 1970s, and was reinstated in 1976. Funding support has ranged between $400 million and $700 million in recent years. Through OMH the federal government provides federal loans directly to private nonprofit sponsors (Gelfand). Section 231 insures mortgage loans for construction or rehabilitation of rental housing for elderly persons. Potential sponsors confer with OMH about their project and submit a preliminary application, including an application for financing through a HUD-approved lender (www.hud.gov/progdesc/231).
Older people constitute roughly 40 percent of the residents of the 1.3 million units of public housing operated by local governments and funded through HUD. Older people also benefit from smaller grant programs HUD oversees for service coordinators and congregate housing services. Low-income individuals, including elderly people, are eligible for Section 8 rental subsidies—individuals are required to pay no more than 30 percent of their income in rent, with the Section 8 subsidy making up the difference to the landlord.
Food and Nutrition Service
The Food and Nutrition Service of the Department of Agriculture administers the food stamp program, one of the largest federal programs directed toward low-income individuals. Food stamps are a form of voucher which allows individuals to purchase many (but not all) food items from supermarkets and other food stores. Individuals of all ages are eligible for food stamps, and in 1998, 1.5 million elderly households used food stamps, representing 18 percent of all such households.
The Department of Agriculture also makes surplus commodities available to nutrition programs administered under the Older Americans Act by the Administration on Aging.
Department of Veterans Affairs
Nowhere has the aging of America been more notable than in the aging of those who served in the armed forces (Wetle and Rowe). Veterans of World Wars I and II and the Korean War are now all elderly, and many who served in Vietnam are in or are approaching old age. The Department of Veterans Affairs (DVA) is a very large agency which, in most instances, serves veterans directly. Two principal administrative units are especially relevant to older veterans. The Compensation and Pension Benefits Service administers benefits and services for veterans, their dependents, and their survivors, including service-connected compensation; non-service-connected pension, burial, and accrued benefits; and guardianship services. The Veterans Health Administration provides a broad spectrum of medical, surgical, and rehabilitative care to veterans. Pension and health care services are the DVA's services most relevant to older veterans. Non-means-tested pensions are paid to veterans with war-related injuries and disabilities; means-tested pensions are paid to veterans without such injuries and disabilities; and medical services are available on varying bases to all veterans at DVA hospitals throughout the United States.
The federal departments and agencies discussed in this entry are the principal ones serving older people. In dispensing benefits (notably OASDI and Medicare), regulating the private sector (notably ERISA and ADEA), and promoting roles and dignity for older Americans (notably AoA and Senior Corps), these agencies have successfully promoted the interests of older people in American life. Many other "functional" or "generic" agencies also provide benefits for older people in the course of their work involving most or all Americans. The principal administrative challenge to all of these agencies is in coordinating and integrating their activities.
Robert B. Hudson
See also Administration on Aging; Employee Retirement Income Security Act; Government Assisted Housing; National Institute on Aging; Social Security Administration; Social Services; Veterans Care.
Binstock, R. B. "The Aged as Scapegoat." Gerontologist 23 (1983): 136–143.
Coughlin, T.; Ku, L.; and Holahan, J. Medicaid Since 1980. Washington, D.C.: Urban Institute, 1994.
Derthick, M. Policymaking for Social Security. Washington, D.C.: Brookings Institution, 1979.
Gelfand, D. The Aging Network: Programs and Services. New York: Springer, 1999.
Hudson, R. B., and Gonyea, J. G. "Time Not Yet Money." Journal of Aging and Social Policy (2000).
Koff, T., and Park, R. Aging Public Policy. Amityville, N.Y.: Baywood, 1999.
Moon, M. Medicare Now and in the Future. Washington, D.C.: Urban Institute, 1996.
Perun, P., and Steuerle, E. ERISA at 50: A New Model for the Private Pension System. Washington, D.C.: Urban Institute, 2000.
Sandell, S. "The Labor Force by the Year 2000 and Employment Policy for Older Workers." In Retirement Reconsidered. Edited by R. Morris and S. Bass. New York: Springer, 1988. Pages 107–115.
Schlarlach, A., and Grosswald, B. "The Family and Medical Leave Act of 1993." Social Service Review 71 (1997): 335–359.
Wetle, T., and Rowe, J., eds. Older Veterans: Linking VA and Community Resources. Cambridge, Mass.: Harvard University Press, 1984.
National Institute of Health. www.nih.gov/nia/about/history
Pension Benefit Guaranty Corporation. www.pbgc.gov.ABOUT.htm
U.S. Department of Housing and Urban Development. www.hud.gov/progdesc/231
U.S. Department of Labor. www.dol.gov/dol/pwba/public/pubs/factsht1.htm
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