This week, the Trump administration began a large-scale reorganization of the US Department of Health and Human Services (HHS), including laying off staff at the National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration.
Among the hardest hit was the Administration for Community Living (ACL). A relatively small agency, the ACL coordinates federal policy on aging and disability and funds programs such as Meals on Wheels and centers for independent living across the US.
As part of the HHS’ reorganization, about half of the ACL’s staff of 200 were laid off, including most of the agency’s leadership and policy staff, as well as budget staff and regional offices that coordinate with organizations across the country. Now, ACL programs will be split up among three different offices at the HHS: the Administration for Children and Families, Office of the Assistant Secretary for Planning and Evaluation, and Centers for Medicare and Medicaid Services. Together, the staff cuts and reorganization will make it more difficult to effectively administer the programs the ACL once oversaw.
The ACL is critical to ensuring adults with disabilities and older adults can access supports they need to live and fully participate in their communities, including as they age. Dismantling the ACL and its programs will make it more difficult and costly for communities across the US to serve disabled people and older adults and will put residents at risk of institutionalization and food insecurity.
What is community living?
When asked, a majority of Americans—but especially disabled people (PDF) and adults older than 65 (PDF)—say they want to live and age in their homes and communities, rather than live in a nursing home or other institutional setting.
Research shows independent living benefits all members of a community. It fosters independence, social belonging, and well-being. Studies have found that people with intellectual and developmental disabilities who transition from institutional settings to community living arrangements see continued development of their daily living skills (PDF).
Enabling people to live in their communities is also cost-effective, with home- and community-based services costing significantly less than institutional care. Though the share of older adults and people with disabilities living in their communities has increased in recent decades, disabled people and older adults still face challenges accessing the supports they need.
Just 10 percent of homes (PDF) in the US offer single-floor living and have an accessible bathroom. Many households lack the financial resources they need to modify their home, with many older adults and people with disabilities living on fixed incomes. Households with a disabled adult are more likely to experience food insecurity. Inaccessible neighborhoods and communities also pose barriers to people with mobility disabilities. These realities leave older adults and people with disabilities at higher risk of social isolation.
The ACL helps people across the US access the supports they need to live in their communities
Since 2012, states and localities have relied on funding and support from the ACL to help address these barriers to community living among their residents. A small agency with wide reach, the ACL operates on a $2.6 billion budget, part of HHS’ overall $1.7 trillion budget. These funds sustain local programs such as Meals on Wheels, senior centers, centers for independent living, Area Agencies on Aging, and others nationwide.
More than 10 million Americans ages 60 and older, including those in US territories, received personal care supports, home-delivered meals, congregate meals, adult day care services, or transportation services. Other ACL-supported services include homemaker services (e.g., preparing meals, light housework, etc.), help with chores (e.g., heavy housework and yard work), case management, and nutrition counseling.
However, there is large variation across the country. About 81 percent of older adults in Maine and 74 percent in Kansas received at least one of these services, but fewer than 5 percent of older adults in Delaware, Virginia, Oklahoma, North Carolina, South Carolina, and Georgia received them. This reflects, in part, differences in the amount of funding each state receives from the ACL for these services, which is based on a state’s share of the national population ages 60 and over.
But the ACL doesn’t just serve adults ages 60 and older. It also helps communities support disabled people and the more than 1 in 5 Americans who serve as informal caregivers (PDF) to a loved one. Informal caregivers are often critical to a person's ability to live in the community. Without adequate supports, though, these informal caregivers can experience stress and declines in physical and mental health.
In 2022, the ACL provided more than 261 million meals to older adults, assistance such as respite care to more than 1.5 million family caregivers, and independent-living services to nearly 250,000 people with disabilities.
These services are administered at the state and local level through the ACL’s national network of 56 state agencies on aging, 618 Area Agencies on Aging, nearly 20,000 service providers, 281 Tribal organizations, and one Native Hawaiian organization representing 400 Tribes.
Restructuring the ACL and cutting key staff undermines people’s right to live in their community and will likely limit communities’ capacity to deliver the critical programs needed to support their residents.
Dismantling the ACL will make it more difficult for communities to meet the needs of the nation’s aging population
Reducing ACL staff and moving the agency’s functions to different offices also ignores the reality of our aging population. Since 2012, the number of older adults has increased by 34 percent (PDF), compared with an increase of 2 percent in the population younger than 65. Older adults will outnumber children in the US within the next decade.
The cuts to and reorganization of the ACL comes on the heels of other policy changes that could harm disabled people and older adults, including staffing cuts at the Social Security Administration (SSA), the proposed closure of SSA offices, proposed cuts to the Supplemental Nutrition Assistance Program and Medicaid, and the elimination of the US Department of Education.
To ensure all people can live and age in the community of their choosing, federal policymakers should continue providing communities with the resources they need to support their residents.
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