1. WHITE EARTH RESERVATION L.T.C.C. CULTURAL ASPECTS OF CAREGIVING JENNIFER STEVENS, PHN, LTCC, WAIVER CASE MANAGER

2. FAMILY CAREGIVING  FAMILY IS PRIMARY SOURCE FOR INFORMATION  VERY DIFFICULT TO ASK FOR AGENCY SUPPORT –MINIMAL TRANSPORTATION –NO PHONE –DISTANCE FROM RESOURCES –PRIDE

3. BARRIERS TO CAREGIVING  HIGH LEVEL OF CARE  MULTIPLE PROVIDERS FOR MEDICAL CARE  FUNDING FOR RESOURCES IS LIMITED –I.H.S. REFERRALS DENIED –LIMITED PERSONAL FINANCES –RELUCTANT TO APPLY FOR MHCP

4. LEVEL OF CARE  HIGH NEEDS AT ENTRY INTO SYSTEM  SERVICE NEEDS AT ENTRY INCLUDE: –SKILLED NURSING –HOME HEALTH AIDE –HOMEMAKING –LIFE LINE –HOME MODIFICATION (RAMPS, BATHROOM FACILITIES) –MOW

5. LEVEL OF CARE (CONTINUED)  OTHER IDENTIFIED NEEDS –TRANSPORTATION TO SERVICES –RESPITE CARE –MEDICAL SUPPLIES (INCONTINENCE +) –BASIC NEEDS  WATER HEATERS  APPLIANCES  ADJUSTABLE BEDS  WHEELCHAIRS  DENTURES

6. MULTIPLE PROVIDERS  MOST COMMON PROVIDER LIST –INDIAN HEALTH SERVICE –VETERAN’S HOSPITAL –EMERGENCY ROOM PHYSICIAN (NON-I.H.S.) –FAMILY REMEDIES –TRIBAL HEALER OR “MEDICINE MAN”  “NON-COMPLIANCE” – WHY???? –NO PHONE TO CALL & CANCEL –NO TRANSPORTATION TO APPOINTMENT –PRIORITY OF MEDICAL NEEDS –LIMITED FINANCES – LUNCH, GAS, DAYCARE, CO-PAYS

7. FUNDING RESOURCES  I.H.S. PRIMARY SOURCE FOR MEDICAL CARE –OUTSIDE REFERRALS LIMITED –MEDICAL EQUIPMENT NOT COVERED  OUT OF POCKET EXPENSES –MEDICATION CO-PAYS –WAIVER OBLIGATIONS –PAYING FOR PRIVATE TRANSPORTATION TO SHOP  APPLYING FOR MHCP –“DON’T WANT ANYONE IN MY BUSINESS” –“THEY WILL WANT MY HOUSE AND/OR LAND” –DO NOT SEND IN REVIEW FORMS OR ATTEND INTAKE INTERVIEW. –MARRITAL ASSET REVIEW – USUALLY DECLINED

8. KEYS TO SUCCESS  STRANGERS IN THE HOME – –WHO ARE YOU? WHAT FAMILY? WHAT IS YOUR ROLE?  BUILDING A TRUST RELATIONSHIP WITH PROVIDERS – USUALLY OF DIFFERENT CULTURE.  ACCEPTANCE OF FAMILY VALUES –MOST IMPORTANT IS TO KEEP FAMILY TOGETHER BY PROVIDING ACCESS TO SERVICES IN THE HOME.