Serving American Indian Elders

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New Mexico has two state Planning & Service Areas designated specifically to serve our Native American Indian populations and tribal service providers. These are PSA 5, which consists of the Navajo Nation, and PSA 6, which consists of the nineteen pueblos and two Apache tribes in New Mexico. The designated area agency on aging for PSA 5 is the Navajo Area Agency on Aging and the designated area agency on aging for PSA 6 is the Office of Indian Elder Affairs, which is housed in the Aging & Long-Term Services Department. These area agencies on aging provide technical assistance, program development and oversight for tribal providers and others serving American Indian elders. The Office of Indian Elder Affairs advocates on behalf of all Indian elders in the state in a coordinated and effective manner and works with tribal providers, statewide, to strengthen their capacity to deliver a wide range of services. The Office’s Director serves as a tribal liaison in collaboration with other state health and human services departments.

These area agencies on aging also conduct outreach at the community level to identify American Indian elders eligible for assistance under the Older Americans Act and other programs, both public and private, and inform them of the availability of assistance. Outreach efforts include the availability of multilingual staff and training materials in culturally and linguistically appropriate formats, as well as activities to increase American Indian elders’ access to all aging programs and benefits provided by the Department. These outreach efforts place special emphasis on reaching older individuals with the greatest economic or social needs, with particular attention to those with low incomes.

In general, New Mexico’s nineteen Pueblos, two Apaches tribes and the Navajo Nation can be described as rural and predominantly isolated from urban areas. This isolation impacts the tribes’ abilities to access services and resources for their elderly populations. Each tribe has its own government, many of which are traditional in nature, particularly in the Pueblos, where the Governor may be appointed by the religious leaders of a tribe or elected by the members of the tribe.

Communal living and decision making by consensus are two of the primary characteristics of Indian tribal life in New Mexico. Daily living is tied to a religious calendar, which emphasizes ceremonial activities to mark the seasons of the year. Traditionally, Indian elders have occupied an important, revered position in tribal life. Age has been equated with wisdom and experience.

Most Indian elders wish to remain at home and in the community, regardless of their degree of frailty; many live with several generations of their family under one roof. There are strong and compelling religious and cultural reasons for this choice. The role of the elder at the center of the family is of critical importance in the culture. In most cases, families want to care for their elders at home. The vast majority of frail Indian elders live at home, cared for by family members. These families are in need of respite services, to support them in their caregiving role. As tribes develop their health systems as sovereign nations, they are increasingly looking for models of care which are consistent with the desires of their elders and which cohere with their unique cultures. This most often means care that is based in the home. There is a cultural imperative to keep elders at home, in the community. Several tribes have developed adult day care programs to address this need; such programs are currently functioning at Zuni Pueblo, Isleta Pueblo and on the Navajo Nation. Many have also developed family caregiver respite programs. Some of the traditional ways are changing, however, as the impact of non-Indian culture becomes more prevalent. The rise of elder abuse and the need for tribal elder protection codes is an indication of these changes.

Over the past four years, funding has been fairly stable with no reductions in funding and minimal targeted increases. Essentially, programs are being impacted negatively by inflation and it is becoming increasingly more difficult to provide the current level of services. Tribal elders are concerned about the need to develop and support long-term care services on tribal lands, using available federal, state and tribal resources. Most tribal elderly programs have access to Title VI funding, USDA cash in lieu of commodities, and NM state funding. They also rely heavily on tribal in-kind support and fundraising efforts such as bake sales and raffles. Financial support in the form of cash, goods and services is provided by various tribal organizations.

The list of concerns of New Mexico’s Indian elders is in many ways similar to the list of concerns of the general elderly population throughout New Mexico. It includes chronic illnesses, long-term care, housing, disability, frailty, prevention of elder abuse, neglect & exploitation, support for caregivers and adequate nutrition. The major concerns of Indian elders in New Mexico fall into four categories: transportation, nutrition, long-term care and social support services. These needs were identified by the NM Indian Council on Aging and the NM Title VI Coalition, as well as through the results of the Administration on Aging OARS study. Our public hearing process has confirmed these priorities, and also the need for increased funding. In addition, Indian elders in New Mexico are specifically concerned about the role of the Indian Health Service in providing long-term care and geriatric care.

It has become increasingly apparent that the need for a coordinated system of health and social services to meet the health-related needs of Indian seniors is paramount. The current system consists predominantly of meal sites, transportation services, limited social services and home delivered meals. This system needs additional funding to meet increasing home health care needs and intensive long-term care needs. This system must be accessible, affordable, and culturally sensitive, it must focus on ensuring independence and not increasing dependency. Gaps in service delivery and their related barriers are numerous and complex for tribal elderly programs. Isolation, distance from health and support services, limited transportation, state and federal regulations, lack of adequate funding, language barriers, cultural and racial prejudice, and buildings in need of repair are some of the major issues effecting the service delivery system for Indian elders in New Mexico. Additional long-term care services, both home and community-based; access to adequate medical care and transportation; legal services to address issues of elder neglect, abuse or exploitation; and adequate housing are other critical needs. Preliminary research has identified gaps in addressing the housing concerns of at-risk Indian elders, and additional funding has been requested from the NM State Legislature to address this need.

The Department is addressing these needs and issues by promoting and supporting tribal programs that serve Indian elders in their own communities. We serve as clearinghouse for advocacy information, grant information and training resources for these programs and provide technical assistance to aid them in building capacity. Staff from the Office of Indian Elder Affairs and the Department’s Community Involvement Bureau conduct site visits and provide individualized technical support and culturally sensitive training at each site throughout the state. This staff works with local providers to maintain or expand services within tribal communities and has facilitated the development of relationships between various tribal and non-tribal service providers. Additional training and technical consultation is provided by the Office of Indian Elder Affairs through a series of sessions for Indian program directors and others in the New Mexico Indian Aging Network that have been, and will continue to be, held in conjunction with the Title VI Coalition meetings. The main focus continues to be providing services to older individuals with the greatest economic and/or social needs, with particular emphasis on persons with low incomes and those residing in rural areas.

New initiatives include researching and developing a comprehensive resource manual for tribal providers. Information dissemination is critical to the gathering and garnering support for aging & disability issues. Frequent communication helps to keep the Indian Aging Network in New Mexico informed about issues, meetings, funding opportunities, and proposed state and federal legislation impacting elders and adults with disabilities. Advocacy can only be accomplished successfully with the support of the aging network, the disability community and tribal and state government officials.

New Directions

• Research housing resources for Indian elders and provide training to contract providers regarding housing issues. Create a housing resource manual and seek additional funding for home repair and renovation.

• Partner with the University of New Mexico, NM Highlands University, the Title VI Coalition and the National Indian Council on Aging to develop grant writing resource to assist in maximizing funding sources for services to Native American Indians.

• Provide leadership and advocate for Indian elders by serving on community boards and coalitions and through active participation in the New Mexico legislative process.

• Create or partner with private organizations to solicit additional funding for seminars, conferences and classes to promote aging issues or agendas.

• Develop and initiate intergenerational activities and programs.

• Promote an annual Eating Healthier Awareness Week with cooking demonstrations and training sessions to demonstrate healthy eating.

• Create partnerships among health and aging organizations in order to develop and promote a long-term care summit.

• Conduct bi-annual training and leadership retreats for staff and contractors.

• Develop and conduct training venues to support grandparents raising grandchildren.

• Initiate Diabetes Summit and develop partnerships to address the critical issue of diabetes in tribal communities.

• Collaborate with other state health and human services agencies to sponsor a tribal consultation summit.

Efforts Directed at Meeting the Needs of Disabled Elders

• Funding to provide a lift-equipped van at each tribal senior center.

• Continuation and expansion of adult day centers where there are demonstrated needs.

• Outreach in coordination with tribal Community Health Representative programs.

• Renovation of existing senior centers to make them ADA compliant.

Expected Outcomes

• Improved efficiency, organization and utilization of staff resources.

• Improved access to housing resources.

• Focused and well-informed advocacy network and well-trained staff and contractors.

• Additional streams of funding revenue from diverse sources to provide a more comprehensive array of services to Native American Indian elders.

• Additional development of intergenerational activities.

• Enhanced nutrition education for elders.

• Improved awareness and advocacy regarding long-term services.

• Additional resources for grandparents raising grandchildren.

Goals

• Develop home and community-based services to keep elders in their own homes and support family and other caregivers.

• Collaborate with the Indian Health Service to expand and strengthen long-term care services within their health care structure.

• Increase options and access to Medicare and Medicaid services and reimbursement.

• Collaborate with tribal leaders to expand and strengthen long-term care services, health care, social services and advocacy efforts.

• Explore, identify and apply for additional sources of funding, particularly federal funding opportunities.

Objectives

Information and Assistance

Coordinate with tribal providers to ensure that the Aging & Disability Resource Center is informed of services available to Native American elders in their respective communities.

Outreach and Client Finding

Coordinate with tribal providers to ensure that eligible elders are identified and informed about services for which they are eligible.

Transportation

Review the transportation needs of each contractor and support legislative funding requests to meet additional needs.

Assisted Transportation

Review the transportation needs of each contractor, with regard to the specialized transportation needs of disabled individuals, and support legislative funding requests to meet additional needs.

Housekeeping/Homemaker Services

Review the home care needs of frail elders and assist each tribe in requesting additional state and federal funding to provide these services.

Chore

Review the needs of frail or medically incapacitated elders to ensure that appropriate funding is sought to provide this service.

Personal Care

Evaluate the provision of this service to ensure that it is not a duplication of services provided to Medicaid recipients.

Home Visiting

Provide technical assistance to those contractors delivering or developing this service.

Telephone Reassurance

Provide technical support to each tribe to assist in developing or improving their telephone communication skills when delivering this service.

Adult Daycare/ Day Health

Provide technical assistance to those contractors delivering or developing this service. In addition, legislative advocacy support is provided to fund these programs.

Recreation

Facilitate the provision of ethnic and cultural events, including intergenerational programming designed to impart and preserve cultural traditions.

Counseling/Peer Counseling

Facilitate the inclusion of this service in the NM Behavioral Health Purchasing Collaborative.

Assessment/Reassessment

Encourage and advocate for additional funding to ensure that all eligible elders receive a semi-annual formalized assessment to determine needs and eligibility.

Home Repair/Renovation/Maintenance

Conduct assessments to identify critical needs of at-risk seniors and those with low incomes.

Shopping Assistance

Encourage each contractor to provide this service to those seniors wishing to participate.

Senior Center Activities

Identify and expand the broad range of services provided by senior centers, and ensure that these services are properly documented.

Congregate Meals

Assess and evaluate this service to ensure that minimum compliance requirements are met; assist tribes in seeking additional funding to provide expanded services as demand increases.

Home Delivered Meals

Assess and evaluate this service to ensure that minimum compliance requirements are met; assist tribes in seeking additional funding to provide expanded services as demand increases.

Health Education Training

Expand services to include nutritional education and physical fitness training; especially targeted to Native American Indian elders are affected by diabetes.

Physical Fitness/Exercise

Assist each provider in developing physical fitness and exercise programs for their elders.

Health Screening

Encourage and support the efforts of providers that conduct health screening.

Home Safety/Accident Prevention

Identify partner organizations to effectively deliver this training to Native American Indian elders.