Partnership Opportunities to Support the Health of Native Elders��The IHS Alzheimer’s Grant Program

Jolie Crowder, PhD, MSN, RN, CCM

Valerie Jones, MPA, MA

Bruce Finke, MD

November 16, 2022

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The Agenda Today

• Introduce the team
• Brief overview of Indian Health – salient features
• IHS & workforce development
• The IHS Alzheimer’s Grant Program
• Opportunities for partnership

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The Team�IHS Alzheimer’s Grant Program

Marcy Ronyak, PhD, LCSW, CDP;

Director, Division of Clinical and Community Support (DCCS)

Jolie Crowder, PhD, MSN, RN, CCM;

National Elder Services Consultant, DCCS

Valerie Jones, MPA, MA;

Elder Health Care Data Coordinator, DCCS

Bruce Finke, MD;

IHS Elder Health Consultant

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Indian Health Service

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Vision: healthy communities and quality health care systems through strong partnerships and culturally responsive practices

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The Indian Health Service, an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. 

Mission: to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level

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Historical & Legal Basis for IHS

• The Indian Health Service was established in 1955
• The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between tribes and the federal government
• The Snyder Act of 1921, the Indian Health Care Improvement Act (1976), reauthorizations, and permanent reauthorization (2010) provide specific legislative authority for Congress to appropriate funds specifically for the health care of Native people
• Numerous other laws, court cases, and Executive Orders have reaffirmed these relationships

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Self–Governance & Self Determination

• Indian Self-Determination and Education Assistance Act or ISDEAA (Public Law 93-638) in 1975

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• Tribal Self-Governance Amendments (Public Law 106-260) created Title V of the ISDEAA and authorized the IHS Tribal Self-Governance Program (25 U.S.C. § 458aaa et seq.; 42 C.F.R. Part 137) in 2000.

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“Today, over sixty percent of the IHS appropriation is administered by tribes, primarily through self-determination contracts or self-governance compacts.” (based on 2015-2020 data)

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https://www.ihs.gov/newsroom/factsheets/ihsprofile/

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At a Glance

• The IHS provides a comprehensive health service delivery system for approximately 2.6 million American Indians and Alaska Natives
• Serves members of 574 federally recognized Tribes in 37 states through 170 IHS and tribally managed service units
• 41 Urban Indian Organizations provide health care and referral services for Urban Indians throughout the United States
• IHS total staff consists of more than 15,000 employees, including nurses, physicians, pharmacists, sanitarians, physician assistants, and dentists

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https://www.ihs.gov/newsroom/factsheets/ihsprofile

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At a Glance (continued)

Of the 46 hospitals, five IHS and nine Tribal hospitals are critical access hospitals.

https://www.ihs.gov/newsroom/factsheets/ihsprofile/

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12 IHS Area Offices Across the Country

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IHS-OHR-Division of Health Professions Support

The Office of Human Resources (OHR) Division of Health Professions Support (DHPS) provides and administers the following:

• IHS Scholarship Program
• IHS Externship Program
• IHS Loan Repayment Program
• Recruitment activities
• Grants and other career support services

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IHS-OHR- Division of Health Professions Support

• Focus is clinical recruitment nationwide to build AI/AN workforce
• Recipients serve in Federal, Tribal, & Urban Programs

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IHS-OHR- Division of Health Professions Support

• Loan Repayment
• Licensed clinicians secure a job within IHS and apply for loan payment
• Not limited to AI/AN
• Grants
• Indians Into Medicine Program
• American Indians into Nursing Program
• American Indians into Psychology Program
• Uniformed Services of Health Sciences
• Supports a few medical students to go to school as an active duty commissioned core officer and then they repay via their service to the IHS population

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IHS-OHR-Division of Health Professions Support Contact Information

https://www.ihs.gov/dhps/contactus/

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“Now, at times, she thinks that Dad is out fishing and will be home soon. In some ways, this is good, because she does not always have to know that he is gone, and continuously have to suffer the pain that loss can bring after a lifetime like theirs together.

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But there are many times that she is totally lucent and knows that he is not with her, but is waiting for her to be with him when her times comes too. We have as a family kept Nana in her home, in the surroundings most familiar to her.

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There, every day she is close to all of her family who love her and accept her, wherever she may be mentally. She knows that she is home, and that she is safe and loved, despite her confusion.”

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Marquart K. Nana. The IHS Primary Care Provider. Vol 29 No. 5. May 2004.

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The IHS Alzheimer’s Grant Program�

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FY 2021: $5M

FY2022: $5.5M

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Funded in FY22�Addressing Alzheimer’s Disease in Indian Country: �Models of Care

The purpose of this program is to support the development of comprehensive and sustainable (models of) dementia care and services in Tribal and Urban Indian communities that are responsive to the needs of persons living with dementia and their caregivers.

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Awardees will:

1. Plan and implement a comprehensive approach to care and services for persons living with dementia and their caregivers, that addresses:
1. Awareness and recognition
2. Accurate and timely diagnosis
3. Interdisciplinary assessment
4. Management and referral
5. Support for caregivers

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• Develop (in collaboration with the Alzheimer’s Grant Program) best and promising practices, tools, resources, reports and presentations to share with others

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• Identify and implement reimbursement and funding streams to support sustainability

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2022 Grantees�

Indian Health Board of Minneapolis, Inc.

• Standardize diagnostic approach, using culturally appropriate toolkits
• Culturally relevant outreach materials, working with CHRs, and elders
• Early recognition using the Mini-Cog
• Strengthen referral networks and resources
• Caregiver support and coaching

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Indian Health Council, Inc.

• Use AWV to increase early diagnosis
• Training for front-line staff in cognitive screening and recognition cognitive Impairment
• Interdisciplinary assessment and care planning (using Medicare codes)
• Integrated care management by RN care manager with training in ADRD
• Formalize referral networks with Tribal and other organizations providing services in the community
• Patient-center care planning and access to specialized services
• Caregiver support using PHNs and CHRs and links to support services in the community

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Nez Perce Tribal Health Authority

• Clinical staff training in early recognition and diagnosis
• Development of partnerships with Tribal services in the community to increase recognition of cognitive impairment and services.
• Caregiver needs assessment and supportive services

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Northern Valley Indian Health

• Increase early recognition and referral for individuals with cognitive impairment
• Use of AWV to recognition leading to assessment and care planning
• Caregiver coaching and support
• Individualized health plans integrating caregivers

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Training & Education�

2022 Indian Health Geriatric Scholars pilot

• Adaptation of the VA Geriatric Scholars Program
• Intensive week-long training course
• Application of training to improve care locally (formal project)
• Tailored practicum experience
• Community of practice / learning
• 8 sought, 19 accepted, 17 continuing

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Dementia ECHO, in partnership with the Northwest Portland Area Indian Health Board

• Soft launch in 2022 with plans to expand in 2023

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Indian Health Division of Oral Health pilot project

• Recognizing and responding to cognitive dementia in dental care

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IHS Division of Nursing Geriatric ED Accreditation Initiative

• in partnership with ACEP
• 3 of the 11 IHS and Tribal EDs seeking accreditation as Geriatric EDs have received Bronze Level accreditation

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On-line training links to:

• HRSA Dementia Curriculum
• VA training through the TRAIN platform
• www.ihs.gov/dccs/alzheimers

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What’s Coming Up?

• FY2023 tribal and urban Indian health funding opportunities – watch for grants.gov forecast coming soon

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• Funding opportunities for Tribes that choose to partner with their IHS direct services programs through program awards to IHS facilities.

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• Recruitment of FY2023 Geriatric Scholars

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• Continued partnership with Northwest Portland Area Indian Health Board in the growth and expansion of the Dementia ECHO with attention to two audiences:
• Clinical staff with support for diagnosis, assessment, management
• Staff supporting caregivers

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Partnership Opportunities?

• Support for your Tribal and Urban partners in applications for IHS Alzheimer’s Grant Program funding and IHS Program Awards

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• Practicum/Mentorship for IHS Geriatric Scholars – both FY22 Cohort and upcoming FY 23 Cohort

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• Faculty support for the Dementia ECHO

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• Dissemination opportunity for GWEP educational materials and training – especially those developed for Indian Country

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• Other ideas…..?????

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