Helping Elders age in place
The Native Aging in Place Project works to allow Elders to remain in their homes and provide services to an aging population
Caring for Native Elders is a way to show respect, honor, and love, and is a long-held tradition for many Native tribes. Providing caregiving is woven through centuries of culture and it takes time, patience, and training.
For these reasons and more, keeping Elders in their homes for as long as possible is a priority for many tribes. Enter the Native Aging in Place Project (NAPP), housed within the National Resource Center on Native American Aging (NRCNAA) at the UND Center for Rural Health (CRH), which has been providing services and resources to North Dakota tribes for a decade. NAPP understands this history and is ensuring that Elders who wish to age at home are getting the caregiving they deserve.
And thanks to a new $2.5 million grant from Margaret A. Cargill Philanthropies, it will continue to do so.
Value of aging in place
Through its work with the Native Elder Caregiver Curriculum, NRCNAA has understood since 2016 that by training skilled providers and caregivers, Elders could remain at home longer and live a fuller life.
“It was a great opportunity and something that was really needed,” said Dr. Collette Adamsen, director of NRCNAA. “Our Elders want to remain at home and in their communities. NAPP has provided this opportunity by working in partnership with tribes to build and sustain home- and community-based services (HCBS), so our tribal Elders have access to services that allow them to age in place at home and in their communities.
Without these services, our Elders would require higher level care, which oftentimes means having to go to a nursing home or a long-term care facility that is outside of the tribe. This takes them away from their supportive structure in the community. It can further impact their health negatively, since they are away from home in an unfamiliar place.”
Dr. Jacob Warren, director of CRH, is pleased to see Adamsen’s work not only continue but expand. “The Native Aging in Place Program has been a powerful connector between the NRCNAA, the Center for Rural Health, and the tribal nations in North Dakota,” said Warren. “The training and resources we’ve been able to share have made a difference in helping Elders age in their homes for as long as possible, while ensuring they receive care needed, especially through our partnership with Spirit Lake Nation.”
Building a QSP agency in Spirit Lake
Over the life of the program, NAPP has worked closely with Spirit Lake Nation to build a Qualified Service Provider (QSP) Agency. At the Spirit Lake office, located in Fort Totten, N.D., QSPs are trained as caregivers to work with clients who have been admitted into the program through North Dakota’s Health and Human Services Aging and Disability Resource Link (ADRL). The caregivers are then billed Medicaid for services, helping grow the local provider workforce while caring for others.
Heather Skadsem, Spirit Lake Tribal Health manager, knows the process from the inside-out. She spent six years as the long-term services and support tribal liaison during her time at UND before she moved to her new position. “As a former Title VI director, I realized we needed our outreach services in-place because we were finding a lot of our Elders were going to the nursing home for simple services that we could be providing at home,” Skadsem said.
Elisha Lawrence Poulsen is the QSP coordinator for Spirit Lake. She shared the challenges of finding workers as the need grows. “We have one lead QSP and one full-time QSP, but the rest are part-time, and it’s hard to keep those workers. It’s great if a college student wants part-time work, but often they have to leave. We are increasing our outreach efforts and hope to grow our workforce.”
The agency is currently serving 17 clients, a mix of Elders, some with disabilities, some vulnerable adults. There are a variety of services that clients may qualify for, including: home care, personal care, non-medical transportation, non-medical transportation escort (which means the QSP physically helps them shop in the store), and private pay medical transportation (out of town). The most popular request is for homemaker services, which consists of housework, shopping, laundry, and sometimes meal prep.
Darlene Myhre is the lead QSP with the agency. Her duties include outreach, medical transportation, non-medical transportation, and medication pick up for clients. She also works with families and individuals to help them navigate the application process through ADRL to get services, along with providing community resources that are available if there are additional needs. In addition to her other duties, Myhre sees that all client needs are met, especially those involving nutrition. She picks up food boxes and delivers them to clients in need who depend on access to food, especially when they have no transportation.
Myhre shared the QSPs even do some charting. “We know our clients,” she said. “We know who they are, how they talk, how they act, and how they walk. So when we see decline coming, we will chart that, report that, and when it’s time for them to go to a facility, we talk to them about it, so they know what’s happening. It can make the transition easier.”
Veteran support and resources
Along with the HCBS programs, NAPP has also focused on helping Veterans. The first Stand Down for Native Veterans event occurred in Spirit Lake, in partnership with Native Eco Solutions and the Fargo Veterans Affairs office, in 2023.
Dean Dauphinais, founder of Native Eco Solutions and a former Marine, consults on Veteran-related projects. He partnered with NAPP to bring the Stand Down event format to North Dakota. The two-day event focuses on bringing speakers to share information and education along with a resource fair which brings in people from the VA, and other nonprofits that offer services to Native Veterans. After the first day, a sit-down dinner is held, and often Veterans will bring their families to hear from keynote and motivational speakers.
“Each event has had more participants than the previous one,” said Dauphinais. “We are pleased this is a collaborative event focused on removing the barrier of not knowing, providing help, and improving the quality of life of our Native Veterans and their families who come and experience these events.”
The Stand Down has become an annual event and moved across the state. In 2024, it was held with the Turtle Mountain Band of Chippewa, near Belcourt, N.D., and in 2025, it was held with the Three Affiliated Tribes – MHA Nation near Bismarck-Mandan, N.D. In 2026 the event will be held with the Standing Rock Sioux Tribe south of Bismarck.
“This was a good opportunity to bring VA representatives to tribal communities and meet them where they’re at,” said Adamsen. “We’ve had some really successful stories about people who gave up, couldn’t navigate the complicated system, especially the Elder Veterans, and ended up getting signed up for benefits and getting the services they earned many years ago. It is a good feeling to hear those stories.”
