Tag Archives for Terry Fulmer

HHS Shake-Up Sends Shockwaves Through Aging Network

Published on April 31, 2025

Taking a page from President Donald J. Trump’s to “Make America Great Again,” last week the U.S. Department of Health and Human Services (HHS) announced a major restructuring of the federal agency to “Make America Healthy Again.” The dramatic restructuring in accordance with Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

The U.S. Department of Health and Human Services (HHS), under management of HHS Secretary Robert F. Kennedy, Jr., last week announced a major restructuring and renaming of the federal agency under the initiative “Make America Healthy Again.” This dramatic reorganization follows Trump’s Executive Order, Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.

“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,” said HHS Secretary Robert F. Kennedy, Jr. in a statement announcing the massive overhaul. “This Department will do more—much more—at a lower cost to taxpayers.”

“Over time, bureaucracies like HHS become wasteful and inefficient, even when most of their staff are dedicated and competent civil servants,” Kennedy added. “This overhaul will be a win-win for taxpayers and those HHS serves. That’s the entire American public, because our goal is to Make America Healthy Again.”

During the Biden administration, HHS’s budget increased by 38%, and its staffing grew by 17%, prompting the new HHS chief to place the federal agency on the budgetary chopping block.

According to HHS, this restructuring will not impact critical services while saving taxpayers $1.8 billion per year through a reduction of approximately 10,000 full-time employees. When combined with other cost-cutting initiatives, including early retirement, and the Fork in the Road program, the total downsizing will reduce HHS’s workforce from 82,000 to 62,000 employees.

HHS also plans to streamline departmental functions. Currently, the agency’s 28 divisions contain redundant units. Under the restructuring plan announced on March 27, 2025, these units will be consolidated into 15 new divisions, including a newly created Administration for a Healthy America (AHA). Additionally, core organizational functions—such as Human Resources, Information Technology, Procurement, External Affairs, and Policy—will be centralized. The number of regional offices will be cut from 10 to five.

As part of the restructuring, several agencies will see workforce reductions. The U.S. Food and Drug Administration (FDA) will cut approximately 3,500 full-time employees, focusing on streamlining operations and centralizing administrative functions, though HHS asserts these reductions will not affect drug, medical device, or food reviewers, nor inspectors.

Similarly, the U.S. Centers for Disease Control and Prevention (CDC) will downsize by approximately 2,400 employees, refocusing its efforts on epidemic and outbreak response. The National Institutes of Health (NIH) will eliminate 1,200 positions by centralizing procurement, human resources, and communications across its 27 institutes and centers. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) will cut around 300 positions, targeting minor duplication within the agency. HHS insists these changes will not impact Medicare or Medicaid services, but improve them.

Restructuring HHS to Focus on Chronic Illness Prevention

HHS’s overhaul aligns with the agency’s new priority of ending America’s chronic illness epidemic by focusing resources on ensuring safe, wholesome food, clean water, and the elimination of environmental toxins.

The Administration for a Healthy America (AHA) will consolidate five 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 single entity. This unification aims to enhance health resource coordination for low-income Americans, emphasizing primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce development.

Additionally, the Administration for Strategic Preparedness and Response, responsible for national disaster and public health emergency response, will be transferred to the CDC to strengthen its core mission of protecting Americans from health threats.

To combat waste, fraud, and abuse, HHS will create a new Assistant Secretary for Enforcement, overseeing the Departmental Appeals Board, the Office of Medicare Hearings and Appeals, and the Office for Civil Rights.

Furthermore, HHS will merge the Assistant Secretary for Planning and Evaluation with the Agency for Healthcare Research and Quality to form the Office of Strategy, enhancing research to inform policy decisions.
Critical programs under the Administration for Community Living (ACL), which supports older adults and people with disabilities, will be integrated into other HHS agencies, including the Administration for Children and Families, the Office of the Assistant Secretary for Planning and Evaluation, and the Centers for Medicare and Medicaid Services (CMS). HHS assures that these changes will not impact Medicare or Medicaid services.

Sounding the Alarm

Following the announcement of HHS’s restructuring plans, which would broad without a lot of detail, aging advocacy groups quickly released statements to voice strong concerns.

“For decades, the federal health programs that retirees and people with disabilities depend on have been ably administered under both Democratic and Republican administrations. However, the radical cutbacks proposed by the Trump administration place the delivery of these programs in jeopardy,” warned Dan Adcock, Director of Government Relations & Policy at the National Committee to Preserve Social Security and Medicare (NCPSSM).

Adcock also noted that HHS plans to eliminate the ALC and divide its responsibilities between two offices with no prior experience in this area. “This administration has already demonstrated a reckless disregard for public interests in favor of slashing operations and staff under the guise of ‘efficiency,’” he added. “So far, all they have done is create chaos and confusion, disrupting essential programs for seniors and the disabled. We view Secretary Kennedy’s plans with alarm.”

Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer at AARP, also urged HHS to prioritize older Americans’ health needs. “HHS must ensure access to senior centers, community health centers, nutritious meals, Medicare assistance, and other vital services that countless older Americans rely on. Health is central to the lives, well-being, and financial security of AARP’s members and the more than 100 million Americans over age 50,” she emphasized.

Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, echoed these concerns. “The announcement of workforce cuts at HHS comes at a time of unprecedented growth in America’s aging population. The proposed reorganization of ACL and its integration into other agencies requires careful consideration.”

Fulmer stressed that ACL administers programs essential to older adults’ daily lives, such as meal delivery, transportation to medical appointments, and chronic disease management. Absorbing these functions with far fewer staff demands careful planning. The government’s commitment to older adults requires a cautious approach, she said.

The Center for Medicare Advocacy also expressed deep concerns, particularly regarding plans to restructure ACL and consolidate oversight of Medicare appeals. “Given what we have seen with Social Security Administration cuts and restructuring, HHS’s claim that these changes won’t impact critical services rings hollow,” said Co-Director David Lipschutz.

LeadingAge, a national association representing nonprofit aging services providers, called for HHS to ensure older adults and their caregivers are not overlooked. “Cutting staff responsible for critical agency functions raises serious concerns. How will the work our members rely on get done? How will this impact quality care for older adults?” asked President and CEO Katie Smith Sloan.

Sloan also cautioned that reducing HHS’s field offices from 10 to five could impact CMS’s ability to oversee nursing home surveys and provider compliance. “A 25% workforce reduction must be undertaken with extreme care—especially given the millions of older adults who depend on these services,” she emphasized.

For a fact sheet on the HHS restructuring, visit https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html

National survey says care for older adults needs urgent rethinking 

Published in RINewsToday on January 27, 2025

With President Trump’s administration beginning and a new Congress poised to rethink, among other issues, Social Security, Medicare and federal aging programs and services, it might be prudent for the president and lawmakers to take a quick glance at the findings of a recently released national survey, “Meeting the Growing Demand for Age-Friendly Care: Health Care at the Crossroads.”

This 52-page national report, was released on Sept. 17, 2024 by Emeryville, California-based Age Wave, a think tank that studies the social, financial, healthcare, and business impacts of aging and The John A. Hartford Foundation (JAHF), a New York based-foundation dedicated to improving care of older adults. The survey was conducted by The Harris Poll, a marking and analytic company tracking public opinion in existence for over sixty years ago.  

According to the U.S. Census Bureau, America’s population of adults over 65 is expected to skyrocket, from 56.1 million in 2020 to 82.1 million by 2050. The enormous  increase in the number of older adults is forcing states, Congress, and the private sector to rethink their approaches to health care, social services, housing and more, to help older adults live well as they age.

As millions of Baby Boomers (born 1946 to 1964) age, living longer than previous generations and seeking ways to maintain wellness and independence to age in place, this nationwide survey shows deep dissatisfaction among older Americans aged 65 and over with health care and services they receive that do not meet their specific needs and preferences. 

Finding Policy Solutions to Maximize “Golden Years”

The national survey reported that four in five older adults (82%) say the U.S. health care system is not prepared for the growing and changing needs of America’s aging population. Just one in 10 (11%) give the health care system an ‘A’ grade. Instead of the status quo, older adults say they want solutions that will maximize their golden years, like interventions that make care more affordable, innovations to reduce or prevent cognitive decline and health care providers who understand what matters most to them when assessing care options.

“Older adults are stuck in a health care system that is not responsive to their goals and preferences. Boomers want health care that maximizes their health and ability to function, and they want their providers to listen to them,” said Terry Fulmer, JAHF’s president, in a Sept. 17 statement announcing the release of the report. “It is not too late to pivot to age-friendly care, which prioritizes the needs and desires of older adults in their care plan. There are many innovative approaches to help older adults live every year to its fullest, not just increase the number of years they live,” she says.

International longevity and aging expert, Ken Dychtwald, founder and CEO of Age Wave, added: “The United States is on the brink of an age wave of unprecedented proportions, and American health care requires a radical and immediate rethink to match our health spans, or being able to live every year to its fullest, to our lifespans.”

Dychtward urged policy and business leaders to prepare for older adults making up a large and growing percentage of the U.S. population. “Everyone knows this day has been coming, but our survey shows that older adults do not like the choices or care currently offered to them. And the fact that although we spend more per capita on health care than any country in the world yet have worse lifespans and health spans is cause for alarm,” he said.

The age 65 and over survey respondents called for America’s health care system to offer “age-friendly care.” Most older adults (94%) say it is more important to maintain quality of life than it is to live as long as possible.

Only three in five older adults with a health care provider (58%) report that their providers currently ask about what matters to them. Though older adults fear Alzheimer’s and dementia more than any other health condition, for example, less than half (40%) say their health care providers routinely evaluate their cognitive health and brain functioning. Similarly, less than half of older adults (45%) say their health care providers evaluate their mental health, and although the ability to walk freely without pain is top of mind for older adults, just 55% say their medical care providers evaluate their mobility and physical fitness. 

The national survey findings indicated that the older respondents say that there are not enough qualified care providers. Nearly all older adults (94%) say that health care providers should be trained on the unique health issues of people 65 or older, but only 10% of medical schools require a rotation in geriatric care, compared to 96% that require a rotation in pediatric care. 

Between 2000 and 2022, the U.S. population of adults aged 65 and older rose 60%, but the number of geriatricians dropped by a whopping 28%. says the report. 

Not surprisingly, the survey findings indicate that health care costs are viewed as “unaffordable” and of a bigger concern to older adults than living expenses, inflation, tax increases and an economic downturn or recession. For instance, just 16% give an ‘A’ grade to satisfaction with their out-of-pocket costs. Older adults are especially concerned with the cost of long-term care, stressing that one of their greatest concerns is not being able to afford future health and long-term care needs (68%), and that the government should prioritize having Medicare cover long-term care (80%).

Differing Views of the Quality of Nursing Home Care

An estimated 36 million Americans have a family member or friend living in a nursing home or memory care facility today, according to the survey. Just 37% of those adults ages 18+ say their family member or friend living in a nursing home or memory care facility receives high-quality care. Only half (50%) say these facilities are the safest place for them.

There must be more coordination between primary care providers and other health care providers. While 52% of Medicare beneficiaries see more than three physicians per year, half of older adults from the survey say their primary care provider does not coordinate their treatment with their other health care providers. The report notes that this may be attributed to the increasing shortage of primary care providers, which makes it less likely for people to have a usual source of primary care or long-term relationship with a primary care provider.

As noted in Primary Care in Rhode Island, in 2024, from 200,000 to 400,000 Rhode Islanders lack access to a primary care provider, resulting in a shortage of 133 to 266 primary care physicians to treat them.

Finally, more than half of older adults (56%) say it is challenging and very stressful to navigate the current health care system, while nearly two in three (62%) say health insurance plans provide too many confusing choices. Research has shown that more than half (55%) mistakenly believe Medicare will cover a long-term stay in a nursing home, the report added.

As the new Congress begins its debate on aging policy, regardless of political party, the national survey reports that their older constituents want public policies enacted that support quality care.  The survey findings indicate that adding long-term care to what Medicare covers is supported by most Republicans (76%), Democrats (84%) and independents or people with other political affiliations (79%). Additionally, there is bipartisan support for improving quality at U.S. nursing homes also earns bipartisan support (Republicans 62% support, Democrats 68% support, independents or people with other political affiliations 65% support). 

“Better federal and state policies can encourage the development of age-friendly health systems, that focus on improving patients’ well-being and quality of life,” predicts JAHF’s Fulmer. “Policies could include new options for affording long-term care insurance and developing a federal strategy to ensure disadvantaged populations are prioritized in a national strategy for age-friendly care,” she says.

Report Offers 5 Key Suggestions to Improve Care to older Americans 

After reviewing all survey findings, JAHF identified five key recommendations to improve health care provided to older adults and to promote healthier, happier aging.

JAHF calls for promoting age-friendly care that can assist the nation’s older adults maintain their health, ability to function, thus maintaining their independence in the community. Pursuing scientific breakthroughs could bring the end to diseases like Alzheimer’s adds JAHF, calling for social isolation must be addressed. 

Assist family caregivers with skill-building tools, policies that allow flexibility in taking paid leave and ensuring care providers coordinate among multiple providers the health care system easier to navigate. 

Finally, JAHF calls for the creation of a ‘national master plan for aging’ that will be focused on meeting the needs of older adults. This plan would identify and address barriers that contribute to inequities, also creating a strategic plan that would provide a roadmap to reform the financing of long-term care, enhance the quality of nursing home care and to create systems to assist people to age in place at home rather than being admitted to acute and congregate settings. 

“We are at a unique crossroads. However, changing America’s health care system to meet older adults’ expectations is possible, practical and could lead to greater health at a far lower cost—and can benefit the government, private enterprise and consumers,” said Dychtwald. “Older adults deserve health care partners who understand what they are going through, have the skills to most effectively support their patients and act on what their customers want,” he says.

The Nuts and Bolts Behind the Study 

The study was conducted by Age Wave on behalf of The John A. Hartford Foundation and in partnership with The Harris Poll. After thorough review of secondary research and through qualitative research with older adults through online focus groups, a  nationally representative online survey was conducted from April 17 to May 9, 2024. Of 5,023 adult (age 18+) respondents, 2,516 were age 65 and older. Data were weighted where necessary to align them with their actual proportions in the population, including by age, gender, race/ethnicity, region, education, household income, size of household, marital status, and political party affiliation. 

Note:  The full report, Meeting the Growing . for Age-Friendly Care: Health Care at the Crossroads, can be found at https://www.johnahartford.org/images/uploads/resources/The_Growing_Demand_for_Age-Friendly_Care_Report_FINAL.pdf.

To watch the “Webinar: What Older Adults Want: Emerging Breakthroughs & Opportunities for Age-Friendly Care, go to https://www.youtube.com/watch?v=ZK6D4-G3KPw.