Rural Aging Investments in Indian Country

Introduction: Our Approach

It may come as no surprise that there are tremendous opportunities to increase philanthropic engagement in Native communities.  According to a recent report by Philanthropy Northwest, only roughly 2% of all philanthropic dollars in the Northwest US are directed to Native peoples [1].   While at EHF we have been working with regional partners to reduce health disparities in Indian Country since 2011, we have found a unique opportunity with our Rural Aging Services Initiative, devoting approximately 22% of this initiative's funding to strengthen and build new relationships in the three tribal communities in our funding region.  Shared results, community engagement, and a focus on sustainability converge to form the basis of our funding partnerships throughout Eastern Washington, and this approach, aimed at achieving full co-ownership of the work, takes on a particular shape in our efforts to serve elders living in tribal communities in the region. 

Current Partnerships: October 2015

Currently, our Rural Aging Portfolio includes strategic projects with the Spokane, Kalispel, and Confederated Tribes of the Colville Reservation, each of which we are co-designing with our on-the-ground partners in order to meet select needs identified by each community.  Of course, each of these partnerships is different, so we took on different approaches to engaging with the communities and with community leaders.  However, throughout these collaborations, we have maintained a commitment to co-ownership of investments and strong community engagement with a focus on shared, measurable results.  The way we see it, once we agree with our partners on what we want collectively to achieve, how we get the results we are seeking is best left to the experts – them.

Spokane Tribe of Indians

Like many of our initiatives, our partnership with the Spokane Tribe is a multi-pronged effort, which is aimed at improving health outcomes and reducing unnecessary emergency service use for elders living on the Reservation.  While the program kicked off in May 2015, we began working with the Tribe’s Health and Human Services department in late 2014 to design a program that would meet the community’s self-identified needs and respect each partner’s priorities.

Since it was the first of our tribal partnerships within our Rural Aging Services Initiative, we had no preconceived notions of what the partnership or project would look like, which meant that we needed to have at least a few in-person meetings to establish a rapport and begin a dialogue.  Enlisting the support of a strategic consultant, we held a preliminary design session (pictured below) with some representatives from Health and Human Services, as well some community conversations with small groups of elders.  A focus on safety, a need for sustainability, staff development and providing services for elders with the highest need emerged as priorities from these early conversations.  For example, one community member told the group about an elder who walked eight miles in the snow after being discharged from the hospital without somehow securing a ride back to the Reservation.  Stories such as these showed us that oftentimes elders will simply make do with what they see as available, and demonstrated a need for consistent, reliable supports rather than one-off interventions.

February 2015 meeting with Spokane Tribe Health & Human Services and EHF Rural Aging Team, facilitated by strategic consultant.

February 2015 meeting with Spokane Tribe Health & Human Services and EHF Rural Aging Team, facilitated by strategic consultant.

Based on the identified priorities, we co-designed the program to include (1) in-home health coaching with locally trained community health workers, (2) monthly educational community gatherings at the Tribe’s Senior Center, and (3) minor home modifications/repairs depending on need.  Through our shared commitment to seeing measurable results, we are looking to achieve a 20% increase in Patient Activation – a short-term survey-based assessment which is strongly correlated with long-term health improvements [2] – and a 20% reduction in emergency service use for program participants.  Over the course of the two-year program, we are hoping to reach approximately 115 elders living on the Reservation.

The two-year program achieved almost 25% of its enrollment target in the first three months, and we are working closely with Health and Human Services to ramp up the program and coordinate with other resources available to elders on the reservation, such as Indian Health Services and the Tribal Health Program.  Fostering collaboration with other organizations on the Reservation supports sustainability efforts, and ensuring the continuation of important services for elders will go a long way towards strengthening our relationships within the Spokane Tribe community.

Kalispel Tribe of Indians

Having developed an initial model for serving rural seniors, we started our collaboration with the Kalispel Tribe of Indians on their Rural Aging project in June 2015, and the program kicked off in early September.  Based on the community health worker model mentioned above, the Kalispel Tribe’s Elder Support Program includes support for a Rural Aging Resource Specialist, who will offer in-home and phone-based health coaching support and connect elders to other services available on the Reservation, such as healthy meals, transportation, and educational events.  Other program components will be developed based on community stakeholder meetings, to be administered by the Tribe, ensuring that elders’ voices are heard and incorporated into the program.  As Felipe, the Tribe’s Grants Manager, wrote in the project proposal, “In Native American communities, Elders are a venerable population and regarded as the keepers of tribal culture and traditions.”  For us, this means that ensuring robust community engagement is critical to building and maintaining strong relationships with this community, and we are making investments to this end with the long-term goal of supporting this partnership.

Confederated Tribes of the Colville Reservation

In addition to direct service programs like those mentioned above, we are also making investments in partnership with the Confederated Tribes of the Colville Reservation aimed at making strategic systems improvements to better serve the community at large.  We began by meeting with the Tribes’ Services Director, who stressed that while eldercare is certainly important for her community, the prerequisite for a successful initiative to improve health outcomes for elders would be an operational plan for the entire Services Division.  Simply pouring in resources to start another program would miss a larger opportunity to strengthen collaboration and cohesion throughout the Division, which would have positive effects not only for elders but also for the whole community, and would moreover set the stage for a successful eldercare project later down the line.  In order to address this community need, we leveraged our connection with a local strategic planner who specializes in working with Tribes, and have made a relatively modest investment that we think will go a long way toward improving health outcomes on the Colville Reservation.  In short, meeting select community needs – especially supporting needed systems change – is often a key step in creating trust and building co-ownership between partners.  Not only are we investing in a specific program down the line, but we are investing up-front in the relationship that makes the program possible.

Conclusion:

In sum, our approach to working with Tribes in our funding region has evolved since 2010, with the formation of our Rural Aging Services Initiative and with the new funding opportunities it created.  Our commitment to shared results, community engagement, and sustainability remains, but these components take on different meaning in strengthening established partnerships and creating new relationships with Tribes.  Especially in these communities, investing in results means investing in relationships, and we are starting already to see the positive effects these relationships are having on the ground.  We are excited to continue these collaborations, working together to make Eastern Washington the state’s healthiest region.

About the Rural Aging Services Initiative:

EHF’s Rural Aging Services Initiative kicked off in 2014, with the sole purpose of assisting seniors in rural Eastern Washington live full, meaningful lives with dignity and independence.  As part of the Foundation’s efforts to improve health outcomes in our region, the program serves Adams, Ferry, Lincoln, Pend Oreille, Stevens, and Whitman Counties, as well as the Colville, Kalispel, and Spokane Indian Reservations.