“Winter is coming,” Freddy Begay says, looking out from where he and his wife Atnáábaah are sitting at the expansive, sage-brushed landscape that stretches west to the mountain range Navajo people call Blue Mud Mountain.
Begay is speaking in Navajo to his niece, Patsy Chacon, in a slice of shade made by a small overhang from a makeshift building on their land deep in To’hajiilee, a Navajo community 95 miles southwest of Santa Fe.
Chacon says getting ready for winter is part of the Navajo way of life. But Freddy and Atnáábaah are in their 80s, and they say they can’t do it by themselves anymore. Freddy, now 87, worked for more than three decades for education programs supporting Native American families. Chacon has come to visit the Begays to find out if they are getting the services they need.
In a word, they’re not. Freddy and Atnáábaah are among a throng of Native American senior citizens who struggle to get health care and other basic services. Although an array of public and tribal programs exist to help this chronically underserved group, many of those programs are plagued with bureaucracy or underfunded. Winter is coming, and with it a very real struggle for survival.
According to New Mexico tribal epidemiologist Paige Best, Native American elders suffer some of the highest incidences of end-stage diabetes, cancer and heart disease in the state. Best broke out these statistics at a recent meeting of the New Mexico Indian Council on Aging, Health Committee (NMICoA), an advocacy group for Native American elders. She also noted that many Native Americans’ life spans are up to 20 years shorter than the rest of New Mexico’s population.
In order to raise awareness about the health concerns Native elders face, four such meetings were held over the course of the past year, drawing hundreds of people from the 19 New Mexico pueblos and the Jicarilla and Mescalero Tribes.
Historically, Native Americans received health care under Indian Health Services, the federal medical service that built hospitals and clinics around the country as part of the treaty obligations between American Indian Tribes and the US government. Over the past 30 years, though, services have steadily declined. Understaffed agencies leave patients waiting in line for months—if not years—to undergo surgeries or screenings for cancer and diabetes. At many facilities, only primary care services remain, NMICoA spokesman Ron Lujan (Taos/Ohkay Owingeh) says.
“We need cardiologists, cancer specialists, surveillance and prevention programs,” Lujan says—but adds that Native American elders need services as basic as transportation, nutrition and personal care in order to stay in their own homes.
According to a St. Louis University report, Indian Health Services has never actually provided aging services. Instead, in recent years, Native American elders have been shuffled into the state’s Coordinated Long-term Care Services (CoLTS). New Mexico contracts with two managed care organizations, AmeriGroup and Evercare, to provide in-home, medical and nursing care to all eligible senior citizen and disabled Medicaid enrollees in the state.
As of July, the two organizations served 38,957 enrollees, roughly 17 percent of them Native Americans, according to New Mexico Health Services Department spokesman Matt Kennicott. The companies billed the state for $861 million for this year, which ends June 30, 2012. (The federal government picks up 70 percent of that bill.)
But many Native Americans, including Freddy and Alnáábaah , have never heard of Evercare and AmeriGroup. And even people who are enrolled don’t necessarily enjoy all of the advertised services, Tribal Health Advocate Olivia Ortiz says.
Ortiz translates to other Keres-speaking Acoma tribal members. “They will ask me, ‘How come we don’t get this or that?’” Ortiz says. “We are thinking, ‘Why us? Why do we have to put up with this?’”
AmeriGroup Chief Operating Officer Laura Hopkins says part of the reason is that it’s often difficult to reach Native American elders.
“While we might have something translated into Navajo, the way Navajo is used compared to English or Spanish is very different, and so the words may not resonate the way they were intended,” Hopkins says. “It takes a lot of time, and a lot of repeat effort, to reach out to folks.”
Back in To’hajiilee, after Chacon explains in Navajo that she may be eligible for in-home Medicaid services such as transportation, meals and home renovation, Atnáábaah grabs her walking sticks and treks slowly and carefully, one step at a time, over the rocky, uneven path that leads to her granddaughter Jerrilyn Nelson’s house, where the Begays live temporarily with their five grandchildren. Several minutes later, she takes the same slow path back up to the hill with her Medicaid card in hand. “Yes,” she says in Navajo, she would like to know more about these services. After all, she adds, “Winter is coming.”
The next day, Nelson calls the CoLTS office to sign her grandparents up for in-home services—only to find out that the program has no funding and hasn’t had any for the past four years. “There are 18,000 people on the waiting list,” she says.
To facilitate services for its own elders, the Pueblo of Acoma applied to the state to become a provider of in-home aging services.
“This is a model for other tribes,” Robin Clemons, the director of the Acoma senior citizen program, says. Buffy Saavedra, Evercare’s regulatory affairs director, agrees that letting pueblos serve as providers would be an effective way to reach Native American elders in rural areas. “I think there would be nothing better than to this type of involvement,” she says.
Julie Weinberg, the state’s Medicaid director, also agrees, but cautions against the pueblos’ taking on too much.
“The MCOs have to be diligent and be sure that the contractors they are subcontracting with will be able to provide that care in a safe and successful manner, and meet all the quality requirements and other requirements that are in their contracts,” she says.
But, with a waiting list of around 18,000 senior and disabled residents, dwindling Indian Health services and recession-plagued state program, funding sources for tribal programs are increasingly scarce. The aging baby boomer population may exacerbate the problem, potentially doubling the current senior citizen population.
Even with these staggering budget concerns, Lujan says that health care is a treaty obligation and Native Americans shouldn’t have to wait in line or be destitute to get services. “We should turn it back to the federal government to say you are obligated to provide health care,” Lujan says. Tribal leadership from all the Pueblos, and the Apache and Navajo Nation need to get behind this effort, he adds.
“One of my responsibilities in Congress is to make sure that my colleagues from places that don’t have tribal communities understand [tribal] government to [federal] government relationships and the promises we made in those treaties, because it really is our constitutional duty,” Heinrich says.
If the federal government takes back the responsibility of fully covering Native American health care, the state would save money on Medicaid programs, Weinberg says. “We could certainly use that money to shore up other parts of the state’s budget or invest or use for other services that the Medicaid program needs to cover,” she says.
But landing federal funding won’t be easy, Heinrich says.
“I have never seen the budget pressures and gridlock in Washington that we see with some of my colleagues right now,” he says. “We are going to have to continue that fight.”
It’s a fight Heinrich says is important for everyone, native and nonnative, because Native American elders are the last fluent indigenous speakers in the country.
“I see the preservation of tribal languages as something important for our history and culture in the United States, and without these elders we can’t do that,” Heinrich explains. “They are incredibly important to their tribes, but they are also incredibly important to the fabric which is this nation.”
If Congress does fund the provisions of the Affordable Care Act that cover Indian Health Services, Heinrich says, New Mexico tribes will start to see funding in the next year or two.
“They need daily meals and wood—and a septic tank that was promised to them so they can move into an accessible house with indoor plumbing and electricity,” Nelson says.
“It’s all built and just sitting there,” she adds. “How can they make them suffer this way?”
For information about Native American Elder Care, contact the New Mexico Indian Council on Aging (NMICoA) at firstname.lastname@example.org.