Josephine is 84-years old and from an Ojibwe nation in northern Minnesota. She has lived most of her life with severe, type 2 diabetes and requires kidney dialysis three times per week following a kidney infection that occurred 26 years ago when she lived on the reservation.

Josephine was born on and grew up on the reservation in the traditional part of the village. While her family was very poor, her mother was known as a matriarch to the tribe and often lived on the river in a wig-wam in the warm season, to practice traditional cooking and ceremonies. Josephine remembers the strength of her mother well and her two sisters, all who passed early in their lives. Her mother taught her to cook many different types of wild game such as venison and rabbit, and how to make fried bread.

Josephine has three children, but because of poverty on the reservation, she could not provide for her children’s most basic needs.  Her children were removed from her home by the state child welfare agency and placed in non-Native American foster homes several hours away. When her children were taken, Josephine lost contact with them and lives with deep depression and anxiety.

It’s been many years since that time, and Josephine moved to a large metropolitan area closer to where her oldest son lives.  She lives in a one-bedroom subsidized apartment in a senior hi-rise building. She continues to require dialysis three days a week, each session lasting 4 hours. She is picked up by Metro Mobility, a shared public transportation service, and returned home after dialysis. When she is not at dialysis, she enjoys her independence using a walker to get around and takes the city bus to the bingo hall downtown, stopping at Wendy’s for her favorite meal if she has money left from her social security check. She has a close friend and neighbor Kristine, who lives in the same building, and they visit regularly. Josephine’s oldest son and several grandchildren visit her on holidays.

Josephine completed the third grade, and her vision is poor so that she has a hard time reading instructions and medication bottles. Therefore, she doesn’t follow her medication guidelines and pours all medications into a large dish on the coffee table and takes some when she remembers. She attends dialysis reliably and her dialysis nurses enjoy her company as they have learned much about her life of transitions from the reservation to life in the city.

At her high-rise apartment, the management company deals frequently with mice and cockroach infestations. As she cannot see well, and her glasses prescription is out of date, she finds it difficult to do housecleaning to prevent infestations. Despite these challenges, Josephine finds solace in her health care, being near her son, and her ability to be independent.

For Josephine to continue to receive medical, community, and financial support the state has asked you as a public health nurse to visit and assess her safety at home and her health needs. Your hope is with these continued services, Josephine can reside as she wishes in her apartment, in the least restrictive environment, and delay institutionalization to a nursing home or assisted living facility.

As part of preparation to visit Josephine, answer the following questions:

1. Describe in detail the traditional wigwam that is known to the Ojibwe and First Nations communities. Explain its construction and materials used.  Where in the United States could you see a wigwam?
2. Describe the Indian Child Welfare Act (ICWA). Include the reasons for its inception and its status today.
3. Discuss what you have learned about the life expectancy of American Indians and Alaska Natives in the United States and health trends expected for the future.
4. After your assessment with Josephine, you want to increase cultural support for her and other Native American elders in the area. Name at least three cultural resources you think will be helpful for her to connect with.  
5. What are your primary concerns for Josephine so that she can continue to live where she desires?

Root cause of health inequity

Centuries of US federal policy that has threatened natural Native American kinship and family structure and forced assimilation of Native Americans into the White culture. Also, “…health outcomes for Native Americans are adversely impacted by wholly inadequate access to comprehensive health services” (Smith, 2022).

Policy Considerations

Calls to Action

• It is of utmost importance that Elders are treated with respect and reverence.
• Encourage more programs in tribal and urban areas to support and care for elders.

References

National Indian Council on Aging Incorporated. (2021). Recommendations for older Americans act reauthorization. nicoa.org