LTSS Roadmap Tribal Involvement

After gathering information on the LTSS needs of your community and talking to existing LTSS providers, tribal leadership may have questions about how the Tribe will be involved in the delivery of LTSS. The following list provides examples of tribal involvement in LTSS by service type. Many Tribes use a combination of these service delivery mechanisms.

Are you starting a new program? Your Tribe may be interested in interim activities—what to do during and before a new LTSS program is set up.

Referral

Tribe refers tribal members to LTSS agencies or government offices with information on available LTSS options. Referral services are especially effective if a comprehensive network of LTSS services currently exists in your community.

Eligibility Assessment

Tribe determines eligibility of individuals for available LTSS options and Medicaid. Eligibility assessments are important for educating community members on available services and methods of financing the services.

Case Management

Tribe manages care of tribal members receiving support from LTSS agency or caregiver contracted by the LTSS service recipient. By providing case management services, Tribes can assist tribal members in navigating LTSS and health care systems. Furthermore, Tribes can act as patient advocates to ensure their members receive culturally appropriate care.

Contract

Tribe contracts with an agency to provide LTSS. If a Tribe does not have the resources or a sufficiently large population to sustain a tribally operated LTSS program or to provide all the services needed under the program, then contracting LTSS services may be the best alternative. Contracting services also may be advisable in instances where Tribes are in proximity to comprehensive LTSS programs, especially when such programs demonstrate a willingness to respect AI/AN culture in service delivery.

Direct Care

Tribe seeks licensure as a home care agency or facility-based LTSS program and provides LTSS to its own members

Elder Safety

• Elder task force: Tribe convenes an elder task force that meets, identifies, and advises the community on elder abuse issues.
• Elder safety code: Tribe develops an elder safety code to protect older community members from physical, mental, and emotional abuse.
• Prevention of elder abuse: Tribe implements best practices to address risk factors for elder abuse.

Other LTSS Considerations

Housing

Housing for older adults is an important need in many communities, and the availability of housing resources often determines whether a person can to stay in their own home (instead of receiving care in an institution). However, health-related services and housing services are funded in different ways, and by different agencies and organizations. For example, HCBS does not include funding for housing or home modifications, but other resources may be available through other programs.

• National resources: Housing Capacity Building Initiative for Community Living Resource Center
• Senior housing or independent living
  • Seasonal housing for seniors residing in remote locations
  • Housing clusters near caregivers or other health resources 

Interim Activities for Tribes

Tribes can begin some activities before an LTSS program is set up. These activities are designed to help tribes move forward and to learn more about LTSS in small steps.

• Get involved with current non-tribal programs to learn about providing LTSS, and to connect interested elders with services before a tribal program is up and running. Working with a non-tribal program can let a tribe see how services, assessments, and case management are conducted, as a way to learn what services work best for their people.
• Look for partner programs. Are there facilities or programs in your area that could share staff, resources, or equipment with? Another valuable thing to share is training or mentoring. Interested people can "shadow" health care professionals in a partner program to observe how things are done.
• Help tribal members with Medicaid applications and paperwork. Along with helping people qualify for Medicaid, tribes can become familiar with the application process and eligibility qualifications, as well as learning about how tribal supports (like per capita payments) fit into this picture.
• Consider additional supportive services. Some non-medical services for older adults (like help with chores, transportation, or home-delivered meals) can be provided as part of HCBS. Some services tribes already are providing may be eligible for reimbursement. For example, Medicaid transportation reimbursements are available in every state.
• Recruit and organize for caregivers now. If tribal members begin training with non-tribal programs, they can be ready to work in the tribal program once it is established, and elders will have Native caregivers.