Health Affairs Blog
Meeting The Needs Of Aging Native Americans
Jessica Bylander
Doi:
10.1377/hblog20180305.701858
Editor’s Note: This blog post was supported by a yearlong Reporting Fellowship on Health Care Performance sponsored by the Association of Health Care Journalists and supported by the Commonwealth Fund. Additional pieces in the series were published in Health Affairs in April 2017, August 2017, and January 2018.
Jordan Lewis, a professor at the University of Anchorage Alaska and director of the National Resource Center for Alaska Native Elders, doesn’t like the phrase “silver tsunami.” As a glib nod to the rapidly aging US population, it unfortunately “assumes destruction,” he says. He has a point: These are people we’re talking about, not natural disasters. Still, without a solid infrastructure in place to care for our nation’s elderly, the results indeed could be devastating. That fact is keenly felt in Indian Country, where the long-term care infrastructure leaves much to be desired. Today, American Indians and Alaska Natives are living longer, with more functional disabilities than the rest of the population, suggesting that the population needing long-term care will balloon in the coming years. In 1940, the life expectancy of American Indians was about 52 years—now it’s nearly 74 years (although still lower than the most recent life expectancies reported for whites, blacks, and Hispanics). Between 2000 and 2010, the number of American Indians and Alaska Natives age 65 or older increased by 40.5 percent, growing at double the rate of the overall older population. Existing mechanisms for funding long-term care in Indian Country will be hard-pressed to keep pace with demand.
Currently, tribes pay for long-term care with a mishmash of funding from various federal agencies, such as the Centers for Medicare and Medicaid Services and the Administration for Community Living, along with their own resources from tribal ventures such as casinos. Dedicated funding from Congress for long-term services and supports for tribes, authorized under the Affordable Care Act (ACA) but never appropriated, would allow them to devise creative ways to support older natives and those with serious disabilities. However, is there any additional funding on the table for the taking?
Indian Health Service: We Have Authority But No Funds
The Indian Health Service (IHS), which provides direct health care services to more than 40 percent of tribes and provides funding and support to nearly 60 percent of tribes who manage all or part of their health systems themselves, was initially set up to deliver only hospital-based, acute care. Today, the system does much more, and with the lowest per capita budget of most government health programs. The agency’s authority to provide long-term services and supports wasn’t solidified until 2010, when a permanent reauthorization of the Indian Health Care Improvement Act passed as part of the ACA. The updated Indian Health Care I