Navajo Elderly People in a Reservation Nursing Home: Admission Predictors and Culture Care Practices

By Mercer, Susan O. | Social Work, March 1996 | Go to article overview

Navajo Elderly People in a Reservation Nursing Home: Admission Predictors and Culture Care Practices


Mercer, Susan O., Social Work


The aging of the American Indian population presents many of the same challenges for long-term care provision as does that of the general U.S. population. Manson and Callaway (1988) suggested that planning for long-term care among American Indians is less often discussed and more uncoordinated than care for other elderly people. Furthermore, the Indian Health Service (IHS) has emphasized children and family concerns more than those of older Indians.

Unlike the general U.S. population, which has more than 19,000 nursing homes available, American Indian communities on reservations have few skilled- and intermediate-care facilities. Most elderly Indians who require nursing home care must leave the reservation and their families. About 4,600 elderly Indians reside in non-Indian nursing homes (Manson & Callaway, 1988; Mercer, Garner, & Leon, 1991), which rarely employ Indian staff, serve traditional foods, or encourage traditional customs. These voids can lead to social isolation, loneliness, depression, and diminished quality of life and health status (Mick, 1983).

Few researchers have done in-depth studies of American Indian nursing homes (Mick, 1983), and no major social work journal has published an article on Indian elders in nursing homes in more than 15 years. Research on the reasons Indians use nursing homes, including events and circumstances that heighten vulnerability to placement, and on culture-specific caregiving practices does not exist.

Because of their cultural uniqueness, American Indian nursing homes deserve closer attention. This article describes ethnographic research conducted at the Navajo Nation nursing home in Chinle, Arizona, and answers two research questions: What primary events and circumstances result in nursing home placement? What culturally sensitive care principles and practices exist in the nursing home?

Background

Navajo History

Early Spanish colonizers in North America referred to the Navajos as Apache de Navaho (strangers of the cultivated fields). Navajos called themselves Dine (pronounced DEE-neh, meaning "The People") and called their beloved land Dinehtah (Gilpin, 1968; Locke, 1989; Suppee, Anderson, & Anderson, 1990).

Navajo tradition says that generations of ancestors wandered through inhospitable country, eventually coming together to settle the fifth world (the fourth world in some tellings) of their mythology. This land was bounded by Blanco Peak (Sisnaajini) to the east in Colorado, Mt. Taylor (Tsoodzil) to the south in New Mexico, San Francisco Peak (Dook'o'oosliid) to the west in Arizona, and Mt. Hesperus (Dibe Nitsaa) to the north in Colorado. The mountains were the source of ritually required herbs, communal strength, and traditional legends. When and exactly how the Navajos arrived in this land is still conjecture. It is possible that they have lived in the southwestern United States for at least 1,000 years.

The Navajos were influenced by the neighboring Pueblo or village-dwelling Indians who shared weaving, the making of painted pottery, and agricultural skills. Spanish colonizers introduced silversmithing as well as horses, sheep, and goats, changing the Navajo lifestyle and economy (Kluckhohn & Leighton, 1974; Locke, 1989; Seymour, 1988). The Spanish colonizers established settlements among the Pueblo Indians in New Mexico beginning in 1568. For the next 200 years, the Navajos existed uneasily with their neighbors, alternating between raiding and trading with other tribes and warring over land and resources with Spanish and Mexican colonizers. In turn, the colonizers and Pueblo Indians raided the Navajo settlements for slaves.

When Anglo-Americans arrived on the land in the 19th century, the land was opened for settlement. Continuing raids and military retaliations eventually led the U.S. government to send Kit Carson in 1863 to Canyon de Chelly to subjugate the Navajos. The Navajos were skilled warriors who used the canyons, mountains, and desert to their advantage, but Carson's tactics of burning their homes and crops and destroying their livestock subdued them in less than a year. …

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