Using data to care for Native Elders

A needs assessment facilitated by UND’s National Resource Center on Native American Aging may help shape change

Editor’s note: This article originally appeared in the Summer 2023 issue of North Dakota Medicine, the quarterly publication of the UND School of Medicine & Health Sciences.

By Jena Pierce

Often driving on dirt roads, meal delivery drivers provide a much needed lifeline for the elderly population of the Navajo Nation. In rural locations where phone lines are rare and Internet connections are rarer, when an elderly individual or family needs something, they discuss the matter with their local driver. Whether the need is wood to keep a house heated during the winter; water to use for drinking, cooking, or cleaning; or medical care, it is the delivery drivers who are in touch with these residents and who bring their needs and concerns to one of 80 senior centers across three states: Arizona, New Mexico, and Utah.

Reflecting on all this, Anslem Lewis, Jr., shares something his grandma reminds him: the reason he has a job is because of the Elders on the Navajo Nation reservation. So he needs to continue to take care of them. It is advice he has taken to heart. He uses it in his everyday work and with it helps inspire the drivers and other staff that serve the Elders.

“It goes back to our teaching,” shares Lewis, interim health service administrator charged with overseeing the Division of Aging and Long-term Care Support for the Navajo Nation. “We do as much as we can to respect our Elders, take care of them, no matter whose grandma or grandpa they are.”

Having worked with the Division for three years, he is all too familiar with the needs of the Elders his department serves. Heat, food, reading glasses, hearing aids, dentures, and knowing others care for them are some of the most pressing needs his office sees.

Lewis oversees five agencies, 80 senior centers, and a staff of 250, including drivers, cooks, program supervisors, and office staff. He is also overseeing the finance personnel, including the vital Title VI funding. And he understands the significance of grasping the needs of the elderly population.

COVID challenges

Lewis knows he wouldn’t be able to serve the large Elder community without the dedication of his staff. This was especially true throughout the pandemic, when congregate meals were halted at the senior centers. Only curbside or home-delivered meals were available.

“Big shout out to my team,” Lewis continues. “If it wasn’t for them, a lot of the Elders wouldn’t get the supplies they need. It was the field staff, senior center staff, the supervisor, cook, and drivers; they are the ones that kept giving our Elders hope. We are thankful, because without them none of this would have been possible.”

The pandemic presented several challenges for Lewis and his staff. One of the team’s primary goals is to ensure Elders have nutritional options. So when the senior centers closed indoor dining, requests for home-delivered meals greatly increased, leading to food shortages from their vendors. These vendors were competing with other organizations for food supplies, often had limited hours, and the number of people allowed in facilities was reduced.

Another challenge was transportation. The additional wear and tear on vehicles making the deliveries created breakdowns and increased time spent trying to secure another vehicle. Another transportation need from Elders was bringing them to get vaccinated or, if they were sick, a ride to get tested.

The Navajo Nation, like many reservations across the country, had many great losses of all sorts due to the pandemic, including Elders and even Lewis’s staff.

“We lost some staff,” says Lewis, “who were still working and caught the virus. It didn’t end well for them. It hit home for us, because we lost some Elders, and when it is a routine to deliver to someone and they aren’t there anymore, it takes a toll. And when you lose staff, that hurts too. We lost six or seven drivers.”

The Elders really missed the socializing that COVID took from them, so Lewis’s staff worked to hold five to six Elder Fests around communities to bring people together and provide lunch. To help people stay active, they have been providing some exercise activities, stress balls, exercise bands, and are working on procuring more crossword books and puzzles.

Little things, big rewards

The most rewarding part of his job is when he hears stories from the senior centers. One of the programs allows Elders to apply for items such as reading glasses, hearing aids, or dentures. Often Elders are not aware of the program, so a meal delivery driver might ask about a need. One woman was asked if she needed glasses. Her response was that she was able to see, so it was good enough. But when she put the glasses on and was handed a newspaper, she was able to read the news herself. She no longer had to rely on anyone to read it to her. Because of a simple item, she gained some of her independence back.

“The price of everything is going up,” Lewis says, “so we try to help out as much as we can. Sometimes Indian Health Service (IHS) or Medicaid will provide services, but often we are a last resort. This program has been really successful. I think within our first quarter we served over 800 Elders with one of those three needs: glasses, hearing aids, and dentures. I would like to advocate more with our council because that funding is based on the stock market since it’s in a trust fund. If the stock market does well, we do well, but I wish we could have a set allocation for that.”

He is grateful for a recent donation of 10,000 reading glasses that his department was able to distribute in January. “It really is the little things that most of us take for granted that bring light into people’s life,” he said.

The importance of data

In 1978, the Older Americans Act was amended to include Title VI, which established programs for the provision of nutrition and supportive services for American Indians, Alaska Natives, and Native Hawaiians, according to the Administration for Community Living (ACL).

The program has since expanded to include caregiver support services. Eligible tribal organizations receive grants in support of the delivery of home- and community-based supportive services for their Elders, including nutrition services.

The National Resource Center on Native American Aging (NRCNAA), within the Center for Rural Health, at the UND School of Medicine & Health Sciences, facilitates the Title VI Needs Assessment, Identifying Our Needs: A Survey of Elders.

This survey assists tribes, villages, and homesteads in creating a record of the health and social needs of their Elders. Survey results document the needs of Elders to help with tribal planning, long-term care discussions, and grant applications. The results also satisfy the requirement for Title VI grants from ACL, which are awarded every three years.

The following services are provided to participating organizations: a survey instrument, assistance with sampling, technical support, data entry, data analysis, statistical profiles of our Elders, comparisons with national norms, and infographics.

Typically, the surveys are given to Elders at congregate meals or events. This allows more Elders to participate, and if they have questions, staff are available to assist. The anonymous surveys are mailed to NRCNAA to process. After the data analysis is completed, NRCNAA provides data results to participating organizations.

Dr. Collette Adamsen, the director of NRCNAA, oversees the needs assessment survey process and says the staff understood the challenges the Title VI programs had trying to complete the surveys throughout COVID. Senior centers had to move away from congregate meals as more were picked up curbside or delivered to homes. Prioritizing the health and safety of Elders, families, and staff, programs were encouraged to add measures such as COVID-19 testing, mask requirements, and distancing when Elders were brought together.

In order for tribes to take part in the survey, they must have a signed tribal resolution. In a previous cycle, the Navajo Nation began the survey inquiry. Due to the lack of the tribal resolution, however, the Nation was unable to get the survey results processed. This time, the Navajo Nation Council signaled its full support through a resolution.

Planning for future needs

When asked why the council was ready to complete the survey process this time, Lewis said, “We want to extend our contract with Title VI through the 2023-26 cycle, but also the information we provide will play a big part in helping us plan for the future. We now have accurate and up-to-date numbers we can present to our council and oversight committee. It will lead us to where we need to be, where services will be needed in the future.”

The Elder count the Navajo Nation provided for the needs assessment was 31,741. Based on that number, a random sample size of 389 was recommended. A total of 397 surveys were completed and analyzed.

“We were very pleased with the number of surveys we received from the Navajo Nation,” said Adamsen. “As the largest reservation in the country, we understand the importance of finding out what the Navajo Elders might be missing, or what they are pleased with. The data we are able to provide to Anslem and his team helps them advocate for the specific needs and resources to allow them to continue to serve their Elders.”

About the author:

Jena Pierce is communications manager for the Center for Rural Health at the UND School of Medicine & Health Sciences.