Denny Chan: All right, let’s get started. Welcome to today’s webinar, everyone. Today’s webinar is Justice for Tribal Elders, A Resource Roundup. I’m Denny Chan and I’m the managing director for Equity advocacy here at Justice in Aging, and I’m joined by my colleague Shahar Takshi. So thank you so much for joining today’s webinar and we are very excited to present to you information critical to the needs and the programs that serve tribal elders. Next slide. So before we dive into the nuts and bolts of today’s webinar, I’d like to go over some logistics. Again, welcome to all of you for coming. You are all on mute, but we welcome your participation in today’s presentation through the Q&A function on the Zoom control panel. Also available in that same control panel is the CC button, which enables closed captioning should you need it.
I’ll be watching for questions as they come in throughout the webinar today. And so I will also uplift those questions and high-level themes through the Q&A segment at the end of today’s presentation. Unanswered questions through the webinar today will be addressed via email following the conclusion of our presentation. And you can also always request technical assistance through the Q&A function on Zoom and our team here will do our very best to assist you like all Justice in Aging webinars, our webinar today is being recorded, and after the conclusion of this webinar, the slides and the recording will be available on our website. You should also see part of that dropped into the chat and it will also be emailed to all registrants. We would very much appreciate your participation in a post-webinar survey that will pop up on your screen following the close of the webinar. Next slide.
And a bit about us here at Justice in Aging. We are a national legal advocacy organization dedicated to using the power of law to fight senior poverty. We focus on healthcare, economic security, and courts for older adults with limited resources. We’ve been around for well over 50 years and our efforts really have focused on those communities of older adults who have been marginalized and excluded from justice, such as women, people of color, LGBTQ individuals, and older adults with limited English proficiency. Next slide. Our commitment to advancing justice here at Justice in Aging, we’re committed to advancing justice for low-income older adults in the [inaudible 00:03:05] areas that we work in. We want to ensure that all people have access to what they need as they age, since aging is a universal experience, without discrimination and regardless of their personal and social identities. And we advocate for policies that will ensure that those experiencing the greatest barriers to programs and services can exercise their rights and fully access the services that they need.
All right. Next slide. If you would like to join us here at Justice in Aging, we produce a wealth of information like today’s webinar and you can get that along with fact sheets, issue briefs, alerts, and other materials that keep you up to date on important developments. As you all know, this is an area policy has been changing quite a lot and so if you want the latest, you can feel free to join our network, and if you aren’t a member of our network, you can go to our website, sign up or send an email to info@justiceinaging.org. Next slide. All right. And so with that I’m going to hop off quickly and pass it over to my colleague, Sahar, to take us through the beginning of the presentation.
Sahar Takshi: Thank you so much, Denny, and thank you all for being here today. Before we jump into the substance of our presentation, I want to give a bit of an overview about what we’re talking about. So our agenda for today, we just went through our introductions and housekeeping, thank you to Denny. Next we’ll be diving into the content of the presentation and we’ll close out by sharing a few additional resources and then opening it up to Q&A. I want to begin by talking about the reasoning behind not just putting on this webinar, but Justice in Aging’s commitment to tribal elders and advancing equity for tribal elders. As Denny mentioned in the introduction, our organization at Justice in Aging has always been focused on the connections between older adults and others in marginalized communities and drawing the intersection between age and other identities. This effort was reiterated in 2021 with the development of our strategic initiative to advance equity, which really helped our staff hone in on what those intersections look like and how we can best serve older adults.
And it was this strategic initiative that we were called to develop a project area specific to tribal elders, which I’m excited to tell you more about today. The first impetus for us was through the use of our equity advocacy tool, which is an internal framework that we use to help us ground our advocacy and our litigation in equity. And one of our colleagues in using our equity advocacy tool came to us and noted that we had some opportunities to learn more about tribal elders. At around the same time, our equity advisory council came to us with a similar thought. Our equity advisory council is a group of external partners who are similarly committed to advancing equity for older adults with a focus on many different populations of older adults. And one of the members, Larry Curley, who is the former executive director of the National Indian Council on Aging and a long-time advocate for tribal elders, came to us again reiterating that we had room to learn more and that we could really help in advancing equity for tribal elders. And that is how we got started.
In developing this project area, it was really important to us to be building very meaningful and strong partnerships with tribal leaders, tribal organizations, older adults who are American Indian or Alaska Native, and other advocates who have been committed to this work for a very long time. I wish I could list every person who has lent their time to us, but I’ve listed a few of them on the screen here. Folks at the National Indian Council on Aging, the Native American Elder Justice Initiative, Michigan Indian Legal Services, and more recently folks from the Money Follows the Person Tribal initiative who have been so generous in helping us to understand the needs of tribal elders from the perspective of folks who have direct experience.
We’ll be talking a lot about various programs that tribal elders might use, but I wanted to start just by talking about who tribal elders are. By some estimates there are over 1 million American Indian and Alaska Native people who are age 65 or older living in the US. There are 574 federally recognized tribes in the US. And so while in this webinar we’re going to be talking about tribal elders as one population. I do want to emphasize that there is tremendous diversity in terms of the history, the traditions and culture as well as the geography and even some of the barriers that might be faced by various tribes depending on the part of the country and their specific history. Okay. We are going to launch our first poll question for our audience. I’m curious to learn what you are most interested in learning about today. Is it A, best practices for engaging with tribal elders, B, programs targeted to tribal elders, C, navigating legal issues and legal exceptions for tribal elders, or D, all of the above. We’ll leave that open for another 30 seconds.
I think we can go ahead and end the poll and I will share the results. I’m not sure if folks are able to see the results, but in case you aren’t, seems that 17% were looking for best practices. Another 17% looking to learn about programs, 8% navigating legal issues, and the vast majority, 58% looking for all of the above. Next we’re going to be talking about cultural considerations. I want to start the section off with this quote from the National Congress of Indian Americans. The quote says, “Tribal sovereignty is a legal word for an ordinary concept, the authority to self govern.” Tribal sovereignty is a concept that is central to tribal governance and to tribal culture and their interactions with the various programs that we’re going to be talking about today.
So what is tribal sovereignty? Tribal sovereignty is something that has been continuously affirmed through treaties, through Supreme Court rulings, through statements by congressional and executive leaders over many, many years. And tribal sovereignty affirms that tribes within the US retain their inherent powers of self-governance. So what does this mean? This means that in dealings between the US federal government and tribal nations, those are considered government-to-government relationships. Our partners have emphasized to us again and again that any solutions relating to tribal communities, including tribal elders, do need to center tribal sovereignty, including in the way that programs are set up, in the way that tribal nations were consulted in decisions affecting them and so on.
Another theme that is central to our work around tribal elders has been cultural responsiveness. As I mentioned earlier, there is tremendous diversity among different tribes in terms of their history, their geography, their culture, but also in terms of the barriers or inequities that might impact their group. So for outreach and service delivery to be impactful and meaningful in tribal communities, folks will have to consider targeted approaches to the particular tribal population, to the particular geography that is at issue. So I’m going to talk through a few examples of those. So one consideration when it comes to targeting around language might be that some tribal elders may know their native language and may appreciate materials in that language, while others may not know it due to the history of oppression and Indian boarding schools, folks may not have had the opportunity to learn the language. Similarly, spiritual practices and traditions and celebrations are vital to many tribal elders’ well-being.
So for example, a tribal elder living in a nursing facility may really want the staff to know that they have a sacred object or a celebration that they would like to attend so that they can be enabled to communicate with their community in that way. Folks who are collaborating with tribes would want to learn about indigenous values, which often focus around the collective and around sharing wisdom with younger generations. And these are things that might impact the way decisions are made. And then of course, as I’ve mentioned a few times, geographical concerns and even digital concerns might vary for tribes. So for example, folks who live on more remote parts of a reservation or more remote reservations may face difficulty in getting to something like a health clinic or a field office. Similarly, digital barriers might be a concern for some. If broadband internet is not super accessible in a part of the country, you want to be considerate as such if you’re communicating with tribal communities.
I wanted to share this graphic that I think really highlights the view of elders in tribal communities. It’s from a article that was published just this year, and as you can see in this graphic, as I mentioned, the view around elders and tribal community is not necessarily related to one’s chronicle age, one’s numerical age, but has so many other factors that make up elderhood. So some of those might be an elder’s contributions to the community and the way they provide care, it might also be an elder’s recognition for knowing and living and teaching traditional experiences and transmitting that to next generations. It also can include the elders who provide a vision and who ground the community in traditions. Okay. We are going to launch our next poll question for today. Our next poll question is, have you had any training on cultural competency relating to American Indian or Alaska Native communities? The responses are yes, somewhat, or no. We’ll leave this open for another 15 or 20 seconds.
I think we can end the poll and we’ll share our results. About 34%, or split pretty evenly, about 34% said yes, 32 said somewhat, and 34 said no. Thank you. Okay. So we’re going to dive into our next section focused on healthcare. So before we begin, I want to emphasize that we’re going to be talking about sources of healthcare, but there are many, many issues impacting tribal communities when it comes to healthcare that we could cover and I will point to some of our resources at the end of the presentation that talk about them. What’s important to note is that American Indian and Alaska Natives in the US face some of the largest health disparities of any population, and this is particularly true in the areas of chronic illnesses such as diabetes, but also in terms of other conditions including mental health conditions as well as a significantly shorter lifespan.
And this is of course particularly concerning and striking given the tribal sovereignty that tribal nations are supposed to have and the obligation of the US government to provide healthcare services to tribal nations. I’ve listed a few of the barriers that contribute to some of these health inequities, but of course this is a few bullets of what could be a much longer list. I also want to emphasize that the root of many of these barriers is due to the legacy of many, many centuries of oppression, of displacement and genocide, and then of course continuous underfunding of health care services directed at tribal communities. But a few modern barriers that impact tribal communities’ access to healthcare coverage include difficulty in getting information about eligibility and enrollment and just the challenges that come with navigating these difficult processes. We’ve heard from many of our partners that the limited number of providers on reservations and in other rural areas where tribal elders might live is quite a concern.
And lastly, limitations in accessing culturally competent care. So for example, care that is provided by somebody who is from the community or folks who have the appropriate training for that. Next I’m going to be talking about some sources of healthcare and healthcare coverage that tribal elders can access. And the first of these is the Indian Health Services or IHS. IHS is a federal program that provides healthcare through 45 hospitals and 780 clinics across the US, serving over 2.5 million American Indian and Alaska Natives in the country. And IHS is a very vital source of care. It is a physical place that people who belong to federally recognized tribes can go to get care, but it does come with some of its own gaps. Namely funding restrictions limit the number of IHS facilities that are available. And so for folks that live in geographically remote areas, it can be very challenging to get to an IHS facility. These funding restrictions also impact the availability of providers, including specialists.
Built into IHS is a process called Purchased and Referred Care. So if somebody needs to go outside of the IHS network to see a provider, for example, if they don’t live close to a facility or if their facility doesn’t have the kind of specialists or machinery that they need, they can use the Purchased and Referred Care process to get a referral to go outside of the IHS network. Unfortunately, Purchased and Referred Care is not entitlement, meaning it is not guaranteed. So somebody can submit a request for a referral and it might not get authorized depending on funding or other concerns. IHS does also operate what are called Urban Indian Health Programs that provide services for folks that live off of the reservation. So I just wanted to flag that as well.
The next source of healthcare coverage that is available to tribal elders is Medicare. Medicare is the federal health insurance program that is available to anyone who is over the age of 65 or who has certain disabilities, and this includes tribal elders who are over the age of 65 or meet those definitions of disability. Medicare is extremely important and it can help to fill in some of the gaps that might be left by IHS. However, Medicare does have cost sharing that might be high for the individual depending on their situation. So there are the costs of premiums and co-pays and deductibles. The good thing is there are programs that are available that can help lower those costs, and I’ve listed a few of them on the screen here. These can include the Medicare Savings Program that helps with premiums, the Qualified Medicare Beneficiaries program that helps with deductibles and co-pays and the Medicare Low-Income Subsidy that helps with the cost of prescription drugs.
Another health insurance program that is available to tribal elders is Medicaid. Medicaid is a joint federal and state health insurance program that is available for people with low income. Because it is a joint program with states, the income and asset limits for who can qualify will vary by state, but there are federal carve outs in the law that can make it a little more accessible for tribal elders, for people who are members of federally recognized tribes to qualify for Medicaid. So for example, certain types of income related to the resources on a reservation might be accepted.
Medicaid is another way to supplement healthcare for people that qualify because it not only helps make the cost of Medicare more affordable, some of those cost sharing pieces that we just talked about, but it also provides some services that are not covered by Medicare. And I would say the chief among these is home and community-based services, which are what allow older adults and people with disabilities to remain in their communities as opposed to going to an institutional setting like a nursing facility.
So taken all together depending on their age, disability, their membership to a federally recognized tribe and their income and assets, a tribal elder might be eligible for all three of these sources of healthcare, both Medicare, Medicaid, and Indian Health Services. And I emphasize this because as we were talking, you may have noticed each of these programs does have its own gaps and limitations, but of course taken all together an individual might have access to a more robust source of care. Okay, I am going to pass it to Denny for this next section.
Denny Chan: Thanks, Sahar. And I should have mentioned at the beginning, this was my oversight, but we called this a resource roundup because since 2023 when we started looking at the issues impacting tribal elders more closely, we’ve been releasing a number of resources. And so this is intended as an overview of some of those resources and to connect you to those resources as well. So we’ll be, and we have been dropping links in the chat to those resources and there’s also a slide at the end of the presentation with those resources as well. But I’m going to talk a little bit about economic security. So next slide. Similar to what Sahar highlighted in the healthcare space, the same types of inequities that tribal elders experience really at a higher proportion in economic security as well. So native elders experience poverty at twice the rate of all older adults in this country.
The rate is three times as much as the rate that White people experience and that goes even higher for those tribal elders who are living on reservations. This of course, is tied to and comes from many of the factors that Sahar already highlighted in some of her content, but it is made even worse by issues with healthcare coverage, cost of living, caregiving responsibilities, all continue to push tribal elders further into poverty. Many of those factors being universal, that many older adults experience, and some of them really coming from the discrimination and the long legacy of discrimination that Native American communities in this country have experienced. Next slide.
So in light of those economic inequities, what programs and what resources are available to tribal elders to really help them make ends meet? And the first really is a program that is available to many others, but including tribal elders, social security. So social security lifts millions of older adults including tribal elders out of poverty every year. And the general eligibility requirements are that you have to be 62 and older, you have to have worked a certain number of quarters, approximately 10 years, in order to be eligible to receive social security retirement benefits. And then a quick note here that people who are the spouse, ex-spouse, minor child, or disabled adult child of a deceased eligible beneficiary can receive survivor benefits. Next slide.
In addition to social security retirement, there’s also social security disability. So this is relevant for individuals with disabilities including tribal elders with disabilities who also have the requisite work history can access social security disability benefits. They have to meet the government’s definition of disability. And the requisite work history is generally five out of the past 10 years. Next slide. There’s also Supplemental Security Income, otherwise known as SSI. This is available to individuals who are 65 and older, including tribal elders or those with a disability who have low income and assets. So there are eligibility requirements here that relate to income. A quick note and flag as an overview that there are carve-outs for eligibility requirements that exclude certain types of assets for members of federally recognized tribes. If you do meet the eligibility requirements, then SSI provides a modest monthly payment that really is critical for low-income tribal elders.
The maximum amount that you can get in 2025 is $967 a month. And of course any income or gifts that the individual receives gets subtracted from that amount. And I’m going to drop in the chat our link to a brief that we released earlier this year, I think, on supporting tribal elders through social security, which talks more about some of those carve-outs and the ways in which these programs can help tribal elders meet their costs. Next slide. And I think with that, that wraps up our economic security portion. I’m going to turn things back to Sahar who will talk through some other issues around nutrition, caregiving, and legal services support.
Sahar Takshi: Thank you, Denny. So as Denny mentioned, I’m going to be talking about some nutrition, caregiving, and legal services, and namely I’m going to be talking about the Older Americans Act or OAA. The OAA is the cornerstone piece of federal legislation that addresses the needs of older adults. The OAA does many, many things including establishing federal and state agencies that oversee programs impacting older adults, programs for older adults. It also is establishes Area Agencies on Aging, also known as AAAs, which administer these programs at the local level. The OAA provides authority for many different kinds of services to be provided for older adults in the US. These include nutrition services such as congregate meal sites and meal delivery services, as well as senior centers, support services for caregivers such as Respite. And it also establishes the long-term care ombudsman program.
There is a lot that the Older Americans Act does, but today I’m going to focus specifically on Title III and Title VI of the Older Americans Act. So Title III of the OAA is the part that authorizes funding to the states for residents of that state and the state can use those funds to provide services for anybody who is in that state and is 60 or older. There are a range of services that are available through the Older Americans Act. I listed a few of them on the slide before, but there are others as well, such as legal services. And while the Title III, Older Americans Act services are available to anybody in that state who is age 60 or older, there are no income requirements. The state is required to target those services and that outreach to people who have the greatest social and economic needs.
On the other hand, Title VI of the Older Americans Act provides funding directly to tribes or members of federally recognized tribes. Unlike Title III, the tribes are allowed to set the age limit for which an older adult can access Title VI funds. Many tribes have chosen age 50 or 55 as the age in which an elder can access Title VI services. However, Title VI services are more limited. The authority for that is specific to nutrition services, caregiver supports, and supportive services which can include things like transportation, case management, and outreach programs. So as you can imagine, there’s a world in which a tribal elder can access services through Title VI, but because they live in a particular state, they might also be able to access Title III services, right? If they meet the age requirements and if they are resident of that state, they might be able to access both. And in fact, the law does require coordination between Title III and Title VI to maximize the services that are available to tribal elders across the country.
So one example of what that coordination might look like and how those funds can be used to better serve tribal elders is a Title III fund to be used to provide services to tribal elders that are 65 and older while Title VI funds are reserved for people who are in that younger range. Other examples of coordination include a AAA, a Title III program providing funding or contracting with a Title VI program. It could mean a AAA establishing a role of a tribal liaison, somebody whose job it is to go meet with tribes to provide services and trainings and to report back.
It could also look like the Title VI program and the Title III program regularly meeting together, exchanging information, maybe co-hosting programming together. Based on the most recent survey of Title VI programs in the country, about 70% of Title VI programs have noted that there is some level of collaboration between the Title VI program and the Title III program in their state. However, less than 18 of those are financial coordination pieces and are more focused on meetings and co-hosting. Okay, I think we can launch our last poll question of the day. And the question is, what has been your experience in regards to coordination between state or county agencies and tribes? And this doesn’t have to be specific to Older Americans Act, this could be other types of coordination. We’ll leave it open for another 25 seconds or so.
I think we can close the poll. And our results, 14% said there is strong coordination with local tribes in my state, the majority of people, 62% said there is some coordination with tribes in my state, but there’s room for more, and 24% said there is little to no coordination with tribes in my state. Thank you all. Okay. And that closes out our substantive portion of the presentation. But before we move on to Q&A, I do want to share a few of our resources. So the title of the presentation today is Justice for Tribal Elders, A Resource Roundup. Denny and our staff have kindly been putting links to some of the resources that we’ve developed in the chat as they related to different parts of the presentation. I’m also listing them here on this slide and the slides will be made available after the presentation so you can access those links later on as well. I do encourage you to look through these and if you have any questions about them later, feel free to reach out to us. And with that, I think we can move on to Q&A.
Denny Chan: All right. Thank you, Sahar. So I’ve been looking at the Q&A as they come in and encourage all of you who are on to continue typing in questions. We’re going to give Sahar a couple of minutes to look at some of them, but just to kick us off, Sahar, I want to ask two questions off the top of the bat. The first is to go back to the slide on the three sources of coverage, Medicare, Medicaid, and IHS. If you go back to that slide, so traditionally when we work with advocates, we talk about how Medicaid is the payer of last resort. Medicare would be primary for services that are covered under both Medicare and Medicaid. And then IHS now introduces a third potential source of coverage slash to payer. So there’s a question here about how all that works with the triple eligibility and if you can say more about who’s paying when and then we can move on to some other questions.
Sahar Takshi: Yeah, of course. And to emphasize, like Denny said, it would depend on the individual’s specific situation, their age, their disability, whether they’re a member of a federally recognized tribe, their income in order to qualify for all these programs, to be triple eligible. But if somebody is triple eligible based on all those factors, IHS to emphasize is not a health insurance program, it is a healthcare provider, essentially. These are clinics and hospitals that are available to people who are members of federally recognized tribes. And so if you go into an IHS facility and you do qualify for IHS services, then IHS is the one who pays.
However, if your IHS hospital or clinic doesn’t have the services that you need, or if you don’t live near one, you might want to go outside of the IHS network. As I mentioned during the IHS section, there is a process for which you might be able to get the IHS to pay for you to go outside of that network, but that is not a guarantee, that money is not always available and there are many administrative burdens associated with that and that’s where Medicaid and Medicare might become incredibly useful to an individual because they are health insurance programs that can help to cover the cost if you don’t go to an IHS facility, if you go to somebody outside of that network. I hope that answers that question.
Denny Chan: I think that’s a helpful, more detailed description of how it all works behind the scenes since I know that can get confusing and these programs are confusing enough. So there’s another thread of questions really asking about all the changes this year, whether that relates to the impacts of H.R.1, otherwise known as the OBBA, or currently the federal government is shut down. Can you say anything about how any of these changes or any of these issues, whether it’s H.R.1 or the shutdown are impacting either IHS or other programs and services that work with tribal older adults?
Sahar Takshi: Absolutely, yes. There have been a lot of changes and a lot of uncertainty this year and unfortunately tribal elders have and will be impacted by them. H.R.1 does talk about IHS slightly, but it doesn’t necessarily cut funding from IHS. I do recommend reaching out or looking at the resources available from the National Indian Health Board on that particular topic as they have submitted letters that I think really highlight what the issues around H.R.1 are. But just because H.R.1 doesn’t talk too deeply about IHS, that does not mean that tribal elders will not be impacted by H.R.1. H.R.1 has some tremendously negative potential impacts for recipients of Medicaid. And as we talked about, Medicaid might be a source of coverage for many tribal elders. And in fact, depending on what kind of care they’re looking for, for example, home and community-based care, Medicaid might actually be one of their only sources of coverage there. So the cuts in funding, the proposed work requirements, all of these can have a tremendously negative impact for tribal elders as well, unfortunately.
Denny Chan: Great. Great as in great for answering the question, not a great impact on the communities we care about. There’s another bucket of questions as I sort through them that are really coming from people who I think are trying to do some outreach to tribal communities and who have not maybe gotten the same response or enthusiasm that they were hoping to get. And I know this is something that we’ve talked about. This is part and parcel to why we started off our work, really thinking through who are the right partners or who the partners we wanted to bring on board were. So any insights or tips for people who want to do more outreach but are finding it hard to really get their foot in the door?
Sahar Takshi: Absolutely. Yeah. I think it’s great that folks are thinking about this and asking those questions and there definitely was a learning curve for us in building partnerships with tribal communities and tribal advocates as well. One thing I do want to note is that depending on the tribe or the organization, staffing is sometimes an issue and so just the availability of time is a little bit limited. But what we found has been really helpful is thinking about native values when we’re building these relationships. We found and have been told by many of our partners in this arena that things like face-to-face communication or the opportunity to really get to know one another before diving into the more nitty gritty of the work pieces is really valued in the community, building that personal connection before getting into whatever the professional ask might be.
We’ve also found that it is really important to demonstrate the commitment to building that partnership, the commitment to that relationship as opposed to maybe a one or two off conversation, building a relationship with a tribe or with an organization that you intend to keep for a long time, that you intend to collaborate with for a long time and demonstrate what that might look like. We found that that has been really successful and has actually been much more informative than maybe meeting just one or two times to learn about a specific topic, but allowing the relationship to blossom into learning about other ways that we might want to collaborate as well.
Denny Chan: I think another piece to note and maybe, Sahar, you can talk more about why, I think even when we were doing some of our first work in this where we hit more walls than we were expecting, where does all that come from? And I think why is it that people are not experiencing the same enthusiasm as other outreach projects?
Sahar Takshi: Yeah, absolutely. We can’t ignore the legacy of oppression and harms done to tribal communities in the US. And I think that does show up in sometimes the way that we do outreach. I think so many tribal nations have had negative experiences with the federal government or even sometimes state governments not respecting tribal sovereignty, not respecting treaties obligations such as providing healthcare and just a relationship that has been much more about taking than collaborating and giving. And so I really do think that is sometimes the source of a lot of the mistrust and that’s why demonstrating why you can be a trustworthy and long-term partner and long-term advocate is so important.
Denny Chan: All right. So I’m going to jump us over to the OAA pieces and if you can move back to the Title III versus Title VI slide. There was a question here really just asking you to clarify how they’re different and how they can be coordinated and work in practice.
Sahar Takshi: Of course. Yeah. So Title III and Title VI are at their core, they’re just different parts of this large piece of legislation that is the Older Americans Act, but what they do is they provide different buckets of funding. And so these are different congressionally approved amounts. Title III goes to the states and can be used for residents of that state who meet the age requirement and the state can decide how they provide those services and what services are available. Title VI is its own separate bucket of funding and that goes directly to tribal nations to be used for members of federally recognized tribes. Like as shown on the screen, there are a few differences. The age requirements are allowed to be different for Title VI programs and the types of services that those funds can be used for are much more restricted for Title VI than for Title III.
But that is why coordination and collaboration is so important between the two. Right? So an individual, a tribal elder who is maybe a member of Navajo Nation living in Nevada might be able to access both Title VI and Title III through the Navajo Nation’s Title VI program as well as the state of Nevada’s Title III programs. That collaboration really does fill in some of the gaps that might be left by Title VI. As I mentioned, it’s a much more restricted amount of services. It is also a much more restricted pool of funds. So it is a lot less money that is directed to tribes than to the states.
And that collaboration and coordination is not just a nice thing to do, it is a legal requirement to happen, but the states and the tribes do have a lot of flexibility in what that coordination looks like. So I think on the next slide I listed a few examples of what that coordination might look like. And I think the majority, about 70% of Title VI programs do engage in some kind of coordination, but due to the limited funding that is given to Title VI, it can often be a big burden for them to initiate that or to be the ones to lead what that coordination looks like. So I think that’s an opportunity for a lot of Title III programs to step up and maybe initiate, be the ones to host the meeting, to take care of the schedule and things like that.
Denny Chan: All right. Thank you, Sahar, and hopefully that’s clear to the person who asked around how they’re different and how to coordinate. There’s a question here. So you started the presentation talking about some of the values that are important in undertaking this work. And so there’s a question about how do you integrate cultural responsiveness into this work? One question, this question specifically gets at the issue around language as an example, and I think you highlighted that on one of your slides where there was a situation where the elder was communicating and there was a miscommunication and instead of being moved, which is what the elder wanted in that moment, the people who were communicating with her misunderstood her and instead administered more morphine, which is what they thought she was saying. So any tips or insights on how to bridge some of that gap in terms of making sure that there is cultural responsiveness in working with tribal elders?
Sahar Takshi: Yeah, absolutely. That’s a really great question. I think the issue of language and language access is one that is relevant for tribal elders but for many other communities as well. I think this is an area where programs can think about targeting their services a little more based on the unique makeup in their own state or in their locality. So we talked today about tribal elders as being this one big group, but we all know that no community is a monolith. There’s going to be unique languages, cultural expectations, traditions, things like that based on the tribe, based on the area.
So I think language is an area in which folks can, if their program allows it, to explore what are the local tribes in your area. What are the languages that are spoken? Are they commonly spoken? For example, some native languages are predominantly oral traditions rather than written traditions. So you might want to know that and learn that, but of course it’s hard to get it right all the time. Somebody might not, you might not know that, you might not have had the ability to prepare for that. I think it’s really important to try to communicate with the older adult as much as possible. But occasionally in tribal communities, community and family are, there’s a lot of emphasis placed on community and family. And so we’ve heard from a lot of our partners that an individual might have a community member, a family member, another elder who they really do rely on, who they do look to. And so if they do give permission to talk to somebody else, that might be an opportunity to explore whether you can really better understand what that individual is wanting in that moment.
Denny Chan: Thank you. Yeah. So you all were not shy with questions and questions are still coming in during the Q&A, so I encourage you to keep asking questions. As a reminder, the questions we are not taking live, we will follow up over email to the best of our ability and either answer them there or connect you with other resources. If I zoom out and look at some of the other unanswered questions, Sahar, there’s another thread around housing and housing insecurity for tribal elders. Any resources or anything that you’ve come across in your work that we can point folks to on supports for tribal elders in the housing context?
Sahar Takshi: Yeah. That is definitely an area of much interest and unfortunately one that we don’t have a ton of internal resources on, but I believe the National Indian Council on Aging has done quite a bit of work around housing and so I would say that’s a really great place to start. If I’m remembering correctly, they have a sub web page on their website specific to housing for tribal elders.
Denny Chan: Great. And we just dropped, thank you to Shelby on our team for dropping the link in the chat. We’ll also connect with some of our housing attorneys internally here and see if there are other resources. Obviously to the extent that there are programs and services, tribal elders would be eligible like other older adults for them as well.
Okay. So I’m taking a look at the rest of the questions. I think it probably makes sense for us to do and to pick up on one of the things that someone else has said to do, maybe an FAQ. We can try and circulate an FAQ afterwards with some of the most frequently asked questions. There are some that are probably one-offs that we’ll try to answer our best over email. So with that, I’m going to say thank you for joining us. Feel free to keep those questions coming and reach out to me or Sahar over email. Our contact information was on that last slide there. You’ll get a recording and the slides after the presentation today. And a big thank you to Sahar for doing the heavy lifting on this, especially while she is a little under the weather. You probably couldn’t tell. But thank you, Sahar. Thank you everyone else for coming today and we look forward to reaching out and being in touch. So thank you very much.
