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Focus on Rural Health

Aging in Place

New project will help Native elders stay in their homes and communities.

By Nikki Massmann on

Paula Carter
Paula Carter

On the last Monday of each month on the Spirit Lake Reservation near Devils Lake, North Dakota, the community hosts an Elders' Day Out. Elders and others come together to visit, eat, and play a little bingo, all in an effort to celebrate and enhance the quality of life for their treasured elders. The Native Aging in Place Project (NAPP) follows closely that same effort of enhancing the quality of life for the Spirit Lake elders through a mission of assisting them to "age in place."

Aging in place refers to the idea that elders can stay in their homes and communities longer as they age. Often the option of moving to a long-term care (LTC) facility is not feasible because of many factors, including cost and distance to the facility from home. The need for healthcare workers, family members, and friends to train in caregiving for the elders still living at home becomes crucial.

The newly funded Native Aging in Place Project is helping to fill that need. By engaging community resources and the National Resource Center on Native American Aging's (NRCNAA) Native Elder Caregiver Curriculum, the NAPP has launched a pilot project on the Spirit Lake reservation to build local capacity to care for the community's elders while they remain in their homes. The Native Elder Caregiver Curriculum was developed through a collaboration with the Cankdeska Cikana Community College and input from elders and community members of the Spirit Lake Nation, and is a tool to assist family and community members in learning to care for their elders.

"You often hear that it takes a village to raise a child," said Paula Morin-Carter, PhD, program director for the NAPP and NRCNAA. "It also takes a village to care for elders. If you have an elder without anyone to care for him or her for instance, especially if they're isolated and possibly lonely, their quality of life will not be the same as an elder who has access to home care services and is surrounded by family and friends. In some rural communities such as reservations, there may not be a long-term care facility in that tribal community. The nearest facility may be too far away for elders' families to visit regularly. Many times a family member can take care of their elder, but that caregiver may just need some guidance and support. The NAPP project aims to give the caregivers and community health workers the opportunity for training and resources for support so caregivers can feel empowered as they take care of their elders. One of the goals of the NAPP is to build the community resources of training and support so that caregivers can feel confident in caring for their elders."

Along with the rest of the capacity building comes a crucial piece of support for caregivers and community health workers, and that is respite. Much of the elder care in Indian Country comes through unpaid caregiving by family members. Some of the caregivers do not have the resources even to allow them to take a day off, so it is imperative to build capacity for respite caregivers within the community. Training additional family and friends to be able to step in when needed is essential to the health and well-being of the elders and their caregivers.

"Respite care is the 'make or break' circumstance for successful caregiving at home. The more people we have trained, the less we have to worry about burning people out," Carter said. "In my own family, my sister was the nurse and cared for my mother around the clock. If my sister needed a break or a vacation, I would step in. But I needed training from my sister on everything from basic denture care to how to set up medications for the week. She taught me what signs and symptoms to watch for that indicated certain acute issues, and what to do about them if they occurred. Had I not had the support and training from my sister, I would not have been able to give her the break she needed in caring for our mother."

Since the project began a few months ago, Spirit Lake tribal leaders have begun the basic building process of securing office space, hiring project staff, and looking toward the purchase of a van with a lift for the elders' transportation needs. The next level of building will include training the workforce needed, and some of that training will utilize the NRCNAA's Native Elder Caregiver Curriculum.

The tribe will own this idea, and it is built on their own identification of a need in their community.

"I'm excited about the hiring of the personnel because it's capacity building for the reservation and will aid in the project's sustainability," said Morin-Carter. "It's jobs; it's the training of the elder care providers and healthcare professionals in elder care. The whole mission of NAPP is dear to our hearts. The tribe will own this idea, and it is built on their own identification of a need in their community.

The elders' input has been critical in identifying what was needed.

The elders' input has been critical in identifying what was needed. They're keen on what they need to age at home and what supports would contribute to their quality of life. Simply put, we want to allow or assist elders to age in place. Although at times it's necessary for some elders to be in a residential care facility, the majority of the elders want to age at home, because that's what's comfortable for them; that's what makes them happy. They want to have visitors, but as our communities age, it's important these visitors can also provide some basic care or recognize health issues that need attention. This initiative offers the opportunity for true tribal capacity building so that elders can live out their lives at home if they so choose."

As the program grows, Morin-Carter, along with Christine Burd, PhD, RN, with the University of North Dakota College of Nursing and Professional Disciplines, who is an instrumental part of the NAPP, hope to implement the model on other reservations as well. This initial pilot project at Spirit Lake will develop a model, templates, and best practices in helping Native elders age in place.

The Native Aging in Place Project is located at the Center for Rural Health at the University of North Dakota School of Medicine & Health Sciences. It is funded by Margaret A. Cargill Philanthropies.

This article originally appeared in the Spring 2017 issue of North Dakota Medicine.

Nikki Krueger Nikki Krueger is the Director of Communications at the Energy and Environmental Research Center (EERC). Prior to her position at the EERC, she served as Communication Coordinator at the Center for Rural Health at the University of North Dakota's School of Medicine & Health Sciences.