Eldercare in Indian Country: In the Long Term, on Their Own
Goins, R. Turner, Aging Today
More than 5.2 million American Indians and Alaska Natives (AI/ANs) live in the United States, with a projected three-and-a-halffold increase between 2010 and 2050 of AI/ANs ages 65 years or older. Much of what we think about aging among AI/ ANs is largely based on anecdotal information and cultural stereotypes.
There is surprisingly little empirical information about formal and informal care systems that support AI/ANs, but the need for long-term-care services for AI/ANs is clear; this population has some of the highest rates of chronic disease and disability in the United States. AI/ANs are twice as likely to have Type 2 diabetes, and almost twice as likely to die from diabetes compared to non-Hispanic white cohorts. Moreover, evidence suggests that the pace of aging among AI/ANs might exceed that of other racial groups. High rates of physical disability mean AI/ ANs are experiencing an expansion, not compression, of morbidity. These combined factors create a greater need for services, particularly long-term care.
Who Are the Caregivers?
Similar to other racial and ethnic groups, AI/AN elders receive the bulk of their long-term care from informal caregivers. Family care for dependent members is a value and stated preference of AI/ANs. Most families want to care for their elders in ways that preserve and promote their dignity and honor cultural traditions. The question is whether the ??/AN experience of caregiving is similar to or different from that observed in other racial groups.
In a study my colleagues and I published in The Gerontologist (51:3, 2010), we analyzed data from 5,207 American Indian adults living on two closely related Lakota Sioux reservations in the Northern Plains, and one American Indian community in the Southwest. Results indicated that attending and participating in Native events or traditional healing practices increased odds of caregiving. Only in the Northern Plains did we find that speaking some Native language at home was also associated with increased odds of being a caregiver.
Probably because large aging studies haven't included AI/?? in sufficient numbers to examine, the role of cultural practices in ??/AN care networks had not been extensively examined, but our study suggested they might be relevant to caregiving in ??/AN communities. To support informal caregivers, it is important for researchers and practitioners to gain a better understanding of how culture and tribal values influence AI/AN family dynamics.
The second aspect of ??/AN care networks needing further clarification is how formal supports- home health, homedelivered meals, adult daycare- can support ??/AN elders and their families. This cohort's unique political status complicates the delivery of formal support systems and influences their access to and funding for health services. The United States has a trust responsibility to provide healthcare to members of federally recognized tribes. However, the health system in place for AI/ANs often falls short of meeting this population's needs.
According to Jim Roberts of the Portland Area Indian Health Board: "The federal responsibility for the United States to provide health services to Indian people has resulted in a meager and chronically underfunded health system. Many Indian people are reluctant to enroll in other federal health programs like Medicaid or Medicare. They believe that the Indian Health Service, an agency within the U.S. Department of Health and Human Services, is responsible for providing their healthcare and should be financed better to do so. …