Last fall, Anáábaah and Freddy Begay, an elderly couple in their late 80s from To'Hajiilee, a Navajo community 90 miles south of Santa Fe, faced another bleak and potentially life-threatening winter [news, Oct. 4, 2011: "Winter is Coming"]. For the eighth year in a row, the Begays had been waiting for a septic tank to be installed so they could move into their new home. In the meantime, they lived with their granddaughter, Jerrilyn Nelson, and her four children in a crowded, two-room house with no indoor plumbing. Although Nelson attempted on several occasions to find help from various agencies, not one provided assistance until the Begays told their story to SFR through their niece, Patsy Chacon, who translated from Navajo.

Soon after visiting the Begays, Chacon went to talk to her sister, June Mexicano, the secretary for the To'Hajiilee Health Board, a group that oversees health care in the community. Agreeing that something needed to be done, Mexicano talked to the chapter president, Raymond Secatero, and gave a presentation at a chapter meeting, where the tribal governing body convenes in a place similar to a city hall. By spring, the federal Indian Health Service had provided the septic tank; one of the Begays' sons paid the $1,500 bill to give them electricity; neighbors donated wood and furniture; and a friend donated a wheelchair.

SFR recently returned to the remote Navajo community of To'Hajiilee to see how the Begays are faring.

Chacon, translating for A[náábaah, says she's grateful for the coverage.

"She believes that there was some kind of push to get the services they needed," Chacon explains. "The attention to their situation really helped her and her husband, Freddy. Now, they have moved into their home, and they have running water." A[náábaah adds that talking to Chacon in Navajo made a big difference, and that few proficient translators are available in To'Hajiilee, where most homes lack Internet service; no local newspapers or radio stations exist; and word-of-mouth communication in the Navajo language is the most effective form of communication.

Mexicano adds that the Begays' story, especially when communicated in Navajo, shed light on the poor conditions in which many Navajo elders live. Secatero estimates that approximately 300 Navajo elders over the age of 60 live in To'Hajiilee.

"My aunt Barbara is in the same situation, waiting on a home to move into," Mexicano says.

Elsie Werito, A[náábaah's 92-year-old sister, is in a similar bind.

"She would like to have electricity in her home," Chacon says, translating for Werito while she visits the Begays. Currently, Werito runs a power cord from her daughter's house for electricity, Chacon explains. Werito also says she badly needs other services—firewood, a new wood stove, home repairs and handicapped access. There are cracks in her door, paint is peeling off the walls, and the floorboards are buckling.

Local and Indian Health Service funds come up short when trying to meet all the elders' needs, and relatives and friends who at one time could have chipped in are also struggling to make ends meet. Secatero says that funding for services has declined over the past few years, with elders often hit hardest.

"They often get lost in the shuffle," he says.

Mexicano notes that New Mexico's Medicaid program could help fill some of the gaps in caring for Native elders, but that the program needs a Navajo language interpreter to explain the services.

Secatero says state representatives have come out "once in a great while, but it's only bilagaanas [Anglos] who come to To'Hajiilee to explain the Medicaid program." He adds that much is lost in translation if a speaker can't translate technical Medicaid terminology, and many elders live in such remote areas that even these occasional presentations don't reach them.

Matt Kennicott, the spokesman for the New Mexico Human Services Department, which administers Medicaid, notes that Native Americans can take advantage of some 40 Medicaid programs tailored to specific needs. The Coordination of Long-term Services (CoLTS) program, for instance, offers qualified elders and handicapped people in-home services like respite care, meal preparation and transportation.

Both of the state's current CoLTS providers, AmeriGroup and Evercare, employ tribal liaisons and outreach workers—but A[náábaah says she hasn't received any in-home services from them. As such, she's a perfect example of a Native elder who knows exactly what she needs, yet falls through the cracks when it comes to receiving help.

But Kennicott says the state's proposal to redesign its Medicaid program, currently pending federal approval, will help solve some of these problems.

"They will likely end up gaining more services under our plan," Kennicott writes in an email to SFR. Some examples: flexible plans, traditional healing services, referrals to specialists, tribal program subcontracting—and no co-pays will be required. (For a full list of these services, visit
Alicia Smith, the consultant hired by the state to help with the Medicaid redesign process, has acknowledged the need for improved services for Native Americans.

"Plans [under the current Medicaid providers like AmeriGroup and Evercare] have done a lousy job in reaching out to the Native American community and including them," Smith said at a press conference in February. She went on to discuss the "translation issue" and said that the state hopes to employ formal translators who can also explain things using tribal-language idioms that elders will understand.

But the Medicaid redesign appears to be at a standstill. Rumors spread recently that the Centers for Medicare and Medicaid Services, the federal agency reviewing the redesign, rejected the state's proposal because it lacked adequate tribal input and didn't comply with transparency rules. On June 1, however, Kennicott said that the rumor was inaccurate and that he had no idea where it was coming from.

"It was not rejected," Kennicott tells SFR.

CMS spokesman Alper Ozinal said he could not comment, but as of press time, CMS had not formally approved the redesign.

For Chacon, who is fluent in Navajo and already has the experience of explaining assistance services to her family members, the need for language translators presents a perfect job opportunity. So far, no one has come around offering translator jobs, she says, leaving the prospect of meeting Native elders' needs to a patchwork of mostly non-Navajo-speaking local, state and federal agencies—at least for now. But she and other To'Hajiilee residents hope that will change.

"Our elders are not going to be with us forever," Mexicano says. "We need to make them as comfortable as possible now."

In English, To'Hajiilee means "Bringing Up Water From a Natural Well." There are an estimated 1,658 members of the To'Hajiilee band of Navajo Indians, according to a 2005 US Census Bureau report.