Restructure LA elderly services to improve efficiency

The next step in state Rep. Joe Harrison’s war on efficiency in state government may end up backfiring in becoming the impetus to more efficient government in the area of elderly affairs policy.

For the past few years, Harrison has tried to birth an entire new bureaucracy in this area, commencing when the Gov. Bobby Jindal Administration sought to fold oversight of all elderly affairs matters into the Department of Health and Hospitals. This would have threatened the absurdly decentralized system that empowers and directs money to local nonprofit agencies, one in each parish, known as Councils on Aging. Federal law has states designate Area Agencies on Aging to disburse federal dollars, overseen by a designated state agency, in Louisiana’s case the Governor’s Office of Elderly Affairs.

GOEA’s functions would have been subsumed by DHH, but resistance from COAs, where Harrison became their legislative point man, resulted only in a partial transfer. Unlike other states, most of which create a dozen or two AAAs as implementers, in Louisiana half of all AAAs are COAs, with four others acting as umbrella organizations directing the other half. This creates much inefficiency in administration, with many functions duplicated and lack of standardization of processes and procedures that falls to GOEA to coordinate. Worse, it gives COAs as a whole outsized influence in this policy area with little incentive to induce efficiency as that would scale back their individual authority and budgets.

To prevent a streamlining that would threaten the established structure, Harrison was willing to build a kingdom to shield it from future attempts. He convinced the Legislature to pass a law that would create a vessel to stuff authority into this area if the Constitution were amended to allow it to become a Cabinet department – even though few functions could have been transferred without gubernatorial reorganization of the executive branch and without that would have served mainly to create more bureaucracy with no service delivery improvement. Asked to give their assent this fall, voters instead rejected that amendment by 70 percent against it, the largest margin of failure of any on the ballot.

Given the crushing defeat the measure endured, it’s doubtful whether the performance audit of GOEA released last week by the Legislative Auditor would have made any difference at all in the outcome. While typically every couple of years GOEA has received a financial audit, performance audits attempt to assess the workings of an agency and typically are done by requests forwarded officially on behalf of the Legislature, but behind the scenes are products of the requests of legislators who convince leaders to issue marching orders to the LLA. It is likely the request for this particular one originated from Harrison or other allies.

If the plan had been to get it issued prior to the election, either the deadline could not be attained or there was a sense the amendment would go down big and the legislators involved signaled to the LLA that there was no immediate rush involved on completing it. Regardless, even if it could not be used to carry the amendment to victory, it still could retain value as a tool for future moves against GOEA by highlighting presumed deficiencies in its operations.

And the audit did make some critiques, some more relevant and valid than others, and regardless of merit offered ideas for changing operations, which could serve that political purpose. But as a whole, it also made clear that many of what it defined as shortcomings presumably could be rectified by reining in the extremely decentralized nature of policy-making and delivery of elderly affairs services.

For example, at several junctures the audit maintained that GOEA wasn’t doing enough to make sure things like certain procedures were being followed by AAAs, that these reported administrative costs according to uniform standards and/or were appropriately sized, that it could use data in a way to promote better planning and delivery, etc. However, all of these things could be accomplished more easily, rather than tinkering dramatically with GOEA operations, if so many subunits didn’t have so much discretion in program implementation courtesy of the fusing of AAA and COA roles.

So overall the audit made a stronger case for system restructuring than for changing the way GOEA does business, which is not what Harrison or his ilk intended. The primary lesson that legislators should act upon from the audit is to do something like create only ten AAAs that parallel the ten human services districts used by DHH that successfully administer much more complex programs for many more people and remove any policy-making power from COAs acting as AAAs, rendering the former only as implementers. If not moving all operations into DHH, at least GOEA will experience reduced obstacles in management this way.

In addition to eliminating this form of duplication and overlap, another method of doing so would be a restatement of functions concentrating on ensuring that COAs don’t do the same thing already undertaken by other agencies from the state. For example, some services they offer are like those that are part of the Medicaid Community Choices waiver program run by DHH. In fact, DHH currently is performing a streamlining of all Medicaid waiver programs for better coordination and therefore cost savings. COAs should become part of this with an intake system that accurately steers the eligible elderly towards these kinds of services rather that operate a similar structure beside it.

Real efficiency will come to the state’s elderly affairs service delivery only by this kind of streamlining, not just by tinkering at the margins. Next year the Legislature should undertake reform of this policy-making and delivery structure along those lines in order to save money and to improve services.