WHITE EARTH RESERVATION L.T.C.C.

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.