Joe is 80-years old and lives in a small, one room dwelling in a rural area of northeast Oklahoma. He is a member of the Cherokee nation and has lived in this home for most of his life. Earlier in his life he hunted and farmed and is well known as one of the tribe’s best baseball pitchers for the men’s team. Currently, he prefers to stay in this home away with no plumbing or electricity, a wood burning stove, and no telephone.

According to a friend and owner of the local bar and grill, Joe visits weekly to fill his containers with fresh water and walking a half-hour there and back to his home. Joe has type 2 diabetes, does not have a medical provider, obtains most of his food from the distribution program in town and from friends and relatives who bring meals for him when they can. Joe is also well-known in the community as his father and grandfather were medicine men. Several friends check in on him when they can and bring food. Joe has great pride in his tribe, community, and has no desire to leave the reservation.

Joe has one son who lives four hours away. His son visits when he returns home for pow-wows a few times each year. Joe lives on his social security checks along with some tribal support income for elders when it is available.  

One evening as Joe walked back home with water from the bar and grill, he became very tired and sat down on the side of the road and fell asleep. Some out-of-town visitors driving by found Joe and assisted him to his home and then called the county police. The police informed Cherokee Nation Tribal health who are sending a public health nurse to talk with Joe about his health and to assess his safety and well-being at home.  You are the nurse planning to visit Joe to do the assessment and to develop a relationship with him to hopefully continue visits to promote his health and safety at home. Ultimately, you know he would best be served in a different living situation where there is more support readily available, but you also understand his strong commitment to continue living where he has been for his life on the Cherokee reservation.

Answer the following questions:

1. Describe the status of aging Native Americans in the United States including social, economic, and health status implications.  
2. Research the geographic location, history, and health indicators of the Cherokee Nation. What would be helpful to know about this tribe as you prepare to visit Joe and attempt to understand his needs? 
3. What is a medicine man and how does a medicine man serve a tribal community? How does traditional Native American medicine differ from the current health care system in the United States? (Conley, 2007)
4. After your health assessment you would like to highlight and support Joe’s strengths to him and to his son. What strengths would you like to discuss with Joe from what you have learned today?  Give specific examples on what words/phrases you would use to describe these areas and what questions you would ask of Joe in this conversation.

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

In 2005, the National Congress of American Indians (NCAI) prepared several policy recommendations for Native Elders. One set of recommendations was focused on increasing the availability of health care and other services in rural reservation areas. Some of these recommendations that apply to Joe:  

1. Increase senior centers for frontier Native Elders
   • The Federal Administration on Aging (AoA) Office for American Indian, Alaska Native, and Native Hawaiian Programs needs to advocate with states and other federal agencies to increase senior centers for frontier Native Elders. Recognizing the vital link in the service delivery network, senior centers function as meal sites, screening clinics, recreational centers, social service agency branch offices, mental health counseling clinics, older worker employment agencies, volunteer coordination centers, and community meeting halls. The significance of senior centers cannot be underestimated. They provide a sense of involvement in the community, offer the opportunity to pursue activities of personal interest, and bring a sense of belonging to elders. Senior centers could also serve as a central location for provision of information technology services. These could include assisted telecommunication links with public services such as Social Security. Increasing the availability of senior centers for Native elders residing in frontier counties has the potential of enhancing the network for Native elders and provide a common gathering place in which other community members can learn from and interact with Native elders. The inter-generational connections are essential to sharing and preserving culture and community, especially for those most geographically challenged. Additionally for senior centers, telecommunication needs should be identified. (NCAI, 2005).
2. Home safety audits
   • A special initiative under the US Department of Housing and Urban Development (HUD) needs to provide assessments on a regular basis of Native elder’s current housing environments in relationship to their health needs. An implied goal of independent living is embedded in these recommendations. Individual homes need to meet the needs of their residents. Home safety audits are needed as standard practice for the elder population to ensure optimal conditions for independent living. These environmental assessments can be broadly defined to include medical equipment such as safety bars in bathrooms, toilet risers, and such items that enable elders to function at optimal levels in their home environments. By assuring that Native elders live in homes appropriately equipped for their health needs, they can remain in their homes and communities rather than be moved to alternative care sites. In addition, maintaining elders in their preferred home and communities is cost effective, and adds to their quality of life. Communities also benefit by having their elders living among other generations. Some Native elders’ housing is so sub-standard that they would require new housing options if their homes were audited for safety.
3. Funds to assist Native elders upgrade their current living environments
   • Funding is needed to be set aside for this purpose in addition to funds to implement more home safety audit programs.
4. Improve plumbing and sanitation conditions for frontier Native elders and all Native Americans
   • Congress should increase funds for the Native American Housing Assistance and Self-Determination Act (NAHASDA) to improve plumbing and sanitation conditions for frontier Native elders and all Native Americans. Plumbing was identified as an unmet health need for frontier Native elders. Access to plumbing and proper sanitation is essential to maintaining good health. As some frontier Native elders assist in providing care for their children and grandchildren, improvement in their living conditions translates to improved living conditions for their families. It is a basic public health function that needs to be available to all Native elders. Improvements in plumbing and sanitation require funding which is currently unavailable at the level of need.

Calls to Action

• Prioritize tribal infrastructure programs, namely, tribal water settlements.
• Funding is needed for affordable broadband access to the Internet
• Increase funding for the Native American Housing Assistance and Self-determination Act for long term housing and community development

References

Conley, R. J. (2007). Cherokee medicine man: The life and work of a modern-day healer. University of Oklahoma Press. 

National Congress of American Indians. (December 2021). NCAI policy research center. https://www.ncai.org/prc