[Senate Hearing 107-601]
[From the U.S. Government Publishing Office]
S. Hrg. 107-601
NATIVE AMERICAN ELDER HEALTH ISSUES
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
ON
OVERSIGHT HEARING TO EXAMINE THE LONG TERM CARE AND HEALTH CARE NEEDS
OF NATIVE AMERICAN ELDERS
__________
JULY 10, 2002
WASHINGTON, DC
U. S. GOVERNMENT PRINTING OFFICE
81-132 WASHINGTON : 2002
___________________________________________________________________________
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COMMITTEE ON INDIAN AFFAIRS
DANIEL K. INOUYE, Hawaii, Chairman
BEN NIGHTHORSE CAMPBELL, Colorado, Vice Chairman
KENT CONRAD, North Dakota FRANK MURKOWSKI, Alaska
HARRY REID, Nevada JOHN McCAIN, Arizona,
DANIEL K. AKAKA, Hawaii PETE V. DOMENICI, New Mexico
PAUL WELLSTONE, Minnesota CRAIG THOMAS, Wyoming
BYRON L. DORGAN, North Dakota ORRIN G. HATCH, Utah
TIM JOHNSON, South Dakota JAMES M. INHOFE, Oklahoma
MARIA CANTWELL, Washington
Patricia M. Zell, Majority Staff Director/Chief Counsel
Paul Moorehead, Minority Staff Director/Chief Counsel
(ii)
C O N T E N T S
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Page
Statements:
Allery, Alan, director, National Resource Center on Native
American Aging............................................. 12
Annette, Kathleen, M.D., area director, Bemidji Area, Indian
Health Service............................................. 5
Baker, Frederick, chairman, Mandan, Hidatsa and Arikara
Elders Organization, Three Affiliated Tribes, North Dakota. 23
Baldridge, Dave, executive director, National Indian Council
on Aging................................................... 21
Campbell, Hon. Ben Nighthorse, U.S. Senator from Colorado,
vice chairman, Committee on Indian Affairs................. 2
Conrad, Hon. Kent, U.S. Senator from North Dakota............ 16
Finke, Bruce, M.D., elder specialist......................... 5
Inouye, Hon. Daniel K., U.S. Senator from Hawaii, chairman,
Committee on Indian Affairs................................ 1
Jackson, Yvonne, director, Office for American Indian, Alaska
Native and Native Hawaiian Programs........................ 3
Ludtke, Richard L., director of research, Center for Rural
Health, University of North Dakota......................... 14
McDonald, Leander ``Russ'', researcher, Center for Rural
Health, University of North Dakota, Grand Forks, ND........ 12
Vanderwagen, Craig, M.D., acting chief medical officer,
Indian Health Service...................................... 5
Walker, Edwin, director, Centers for Wellness and Community-
Based Services, Administration on Aging.................... 3
Appendix
Prepared statements:
Allery, Alan (with attachments).............................. 46
Annette, Kathleen............................................ 39
Baker, Frederick............................................. 78
Baldridge, Dave.............................................. 69
Cantwell, Hon. Maria, U.S. Senator from Washington........... 31
Ludtke, Richard L. (with attachments)........................ 46
McDonald, Leander ``Russ'' (with attachments)................ 46
Walker, Edwin................................................ 32
Note: Other material submitted for the record retained in
committee files.
NATIVE AMERICAN ELDER HEALTH ISSUES
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WEDNESDAY, JULY 10, 2002
U.S. Senate,
Committee on Indian Affairs,
Washington, DC.
The committee met, pursuant to other business, at 10:15
a.m. in room 485, Senate Russell Building, Hon. Daniel K.
Inouye (chairman of the committee) presiding.
Present: Senators Inouye, Campbell, and Conrad.
STATEMENT OF HON. DANIEL K. INOUYE, U.S. SENATOR FROM HAWAII,
CHAIRMAN, COMMITTEE ON INDIAN AFFAIRS
The Chairman. The committee meets this morning to receive
testimony on an ongoing study that is being conducted by the
National Resource Center on Native American Aging within the
Center for Rural Health at the University of North Dakota
School of Medicine and Health Sciences. This study examines the
long term care and health care needs of America's Native
American elders.
Despite the fact that the American Indian population is one
of the fastest growing populations in the United States, the
status of elderly Native Americans is, to put it simply, poor.
As the testimony today will indicate, almost three out of five
elderly Native Americans live well below the poverty level.
Diseases such as diabetes afflict Indian elders at epidemic
rates, and the mortality rate from diabetes is five times
higher than the national average. Deaths associated with kidney
disease are three times the national average among Native
American elders.
These statistics are overwhelming and the need for age
sensitive health care and for long term care is obvious.
Unfortunately, the long term care options for most Native
American elders are minimal at best and often require decisions
that break families apart. With few long term care facilities
available on most Indian reservations, elders requiring such
care may have to be placed hundreds of miles from their homes
and families. Poor families don't have the means to travel back
and forth to visit their grandmothers and grandfathers, and
sadly, we know that many families in Indian country are
constrained in this way.
Home health care alternatives are also extremely limited in
most tribal communities. So while families may ultimately
decide that it is best to keep their loved ones at home, like
most families across America, few have the professional
training to adequately care for their elders. These are the
tragic circumstances that many Native American elders face as
they enter into their twilight years.
Today we hope that the testimony will shed some light not
only on the conditions in Indian country as they affect the
elderly, but what can be done to better address their needs. As
one who qualifies under almost any definition as an elder, I
take these matters very seriously. And I look forward to the
constructive solutions that we anticipate will be forthcoming
from the testimony received today.
And may I recognize the vice chairman.
STATEMENT OF HON. BEN NIGHTHORSE CAMPBELL, U.S. SENATOR FROM
COLORADO, VICE CHAIRMAN, COMMITTEE ON INDIAN AFFAIRS
Senator Campbell. Thank you, Mr. Chairman.
We don't normally make headlines in the New York Times and
the Washington Post about the activities in this committee, but
they are extremely important to one segment of the American
population, and that's the Indian people. The hearing today is
one of those that involves Native elders, a group revered in
Indian cultures, but also a group that is often quiet and in
the background when it comes to public debate. As the 2000
census makes clear, the Native population, like the U.S.
population, is growing at a very fast pace.
I think that when we talk about the future of elders, I
might mention that during the break I went to Montana, visited
the Northern Cheyenne, where I happen to be a member. I was
asking the tribal chairman up there about the growth of that
tribe. There are about 8,000 enrolled in that tribe. But 75
percent are under 25 years old, which of course gives us a
whole host of problems with education and jobs and all that.
But those youngsters are some day going to be elders, too. And
we don't seem to be ahead of the curve when we talk about
what's going to happen in another 20 or 30 or 40 years about
those young people now who are all going to have these
problems. These include, as you know, diabetes, which leads to
poor circulation, gangrene and then amputation of the lower
extremities, things of that nature.
I think your comments about the difficulty of families
visiting is really important. I know that in the case of that
little community, Lame Deer, MT, one of the places that elders
are put after the have had their legs amputated, which happens
too often, is clear in Glendive, MT, about 100 miles away. That
means if their family, their grandkids, their youngsters want
to visit them, and they don't have transportation, they just
don't see them any more, because it's just too far to go to be
able to visit the elderly that are in the hospitals with their
extremities cut off. That means they have a mighty lonely
existence in the last years of their lives, which shouldn't be
anything that anyone should have to go through. It seems to me
one of the great things about growing older is your ability to
be close to your kids and your grandkids. But when they suffer
these debilitating problems brought on by diabetes, that's not
the way too many elderly Indian people finally go to their
Maker.
Thank you, Mr. Chairman, for convening this hearing.
The Chairman. I thank you very much. You are so correct,
your autumn years should be the happy years. But in too many
cases, such is not the case.
We have two panels this morning. The first panel, Director
of the Centers for Wellness and Community-Based Services,
Administration on Aging, Edwin Walker. He will be accompanied
by Dr. Yvonne Jackson, Director of the Office of American
Indian, Alaska Native and Native Hawaiian Programs,
Administration on Aging. And then we have the Area Director of
the Bemidji Area Indian Health Service of Bemidji, Minnesota,
Dr. Kathleen Annette, who will be accompanied by Dr. Craig
Vanderwagen, Acting Chief Medical Officer, Indian Health
Service, Rockville, and Dr. Bruce Finke, Elder Specialist.
Dr. Walker.
STATEMENT OF EDWIN WALKER, DIRECTOR, CENTERS FOR WELLNESS AND
COMMUNITY-BASED SERVICES, ADMINISTRATION ON AGING, ACCOMPANIED
BY YVONNE JACKSON, DIRECTOR, OFFICE FOR AMERICAN INDIAN, ALASKA
NATIVE AND NATIVE HAWAIIAN PROGRAMS
Mr. Walker. Good morning, Mr. Chairman and members of the
committee. On behalf of the U.S. Administration on Aging, I
appreciate the opportunity to discuss the health concerns of
Native elders and to provide some information about our
programs. I commend this committee's commitment to Native
Americans and the support you have shown for aging issues in
Indian country.
As indicated, I am accompanied by Dr. Yvonne Jackson, the
Director of our Office of American Indian, Alaska Native and
Native Hawaiian Programs at the Administration on Aging.
Josefina Carbonell, our Assistant Secretary for Aging, has
identified health promotion and disease prevention among her
priorities for the Administration on Aging. Our focus is on
encouraging Americans of all ages to live healthier lives.
Healthy living can prevent diseases and certain disabilities,
and it can ensure that today's older persons, as well as our
future generations, not only live longer, but also better.
Great strides have been made in improving the health status
of American Indians and Alaska Natives. Yet, cardiovascular
disease remains the leading cause of death for all populations
in the United States, and one-half the adults have diabetes.
Diabetes complications are some of the major causes of
morbidity and mortality among older Indians. The Administration
on Aging is working with the Indian Health Service, tribal
health and social service departments and universities to
assist in developing programs and services for preventing and
controlling diabetes.
The AOA annually awards grants to provide supportive and
nutrition services for American Indian, Alaska Native and
Native Hawaiian elders. Our Older Americans Act Title VI
program has been funding services in Indian communities
throughout the country for the last 22 years, growing from
services in 85 tribes in 1980 to over 300 tribes serving nearly
100,000 Native elders today.
Our programs provide a wide range of services, including
congregate and home delivered meals, transportation to meal
sites and doctor's appointments, wellness programs, home health
services, adult day care and family caregiver support, just to
name a few. These services achieve the goal of assisting elders
to remain in their homes and communities for as long as
possible. In addition to our programs that directly assist the
elderly, AOA now assists those who care for the elderly and the
disabled through our Native American family caregiver support
program.
In order to assist the tribes in developing home and
community based services for their elders, AOA has awarded
grants to two national resource centers, one at the University
of Colorado and one at the University of North Dakota. AOA and
the resource centers collaborated on a study that concluded
that there is a wide disparity between the need for and the
availability of home and community based long term care
services. While emergency and acute primary health care is
usually met, other services, such as mental health, home
health, personal care and transportation are only moderately
met, and services such as adult day care, respite care and
assisted living are unmet.
In response to requests for assistance from tribes, we
asked our resource center at the University of North Dakota to
develop a needs assessment tool that provides tribes with an
accurate picture of the health status of their elders. Although
the resource center will discuss the results of the needs
assessment in detail, I would like to highlight just some of
the data noteworthy in developing home and community based
services.
Nearly 30 percent of Indian elders live alone. As compared
to elders in the general population, a greater percentage of
Indian elders consider their health to be fair or poor. Many
more Indian elders are overweight, and yet may be less aware of
their overweight status since they consider their weight to be
just about right. Most Indian elders indicated they would be
willing to go to an assisted living facility, while only 18
percent of the elders indicated they would be willing to use a
nursing home.
The feedback that we've received from the tribes who are
using the needs assessment has been very, very positive. They
are happy to have the data, but now they are requesting
additional assistance in interpreting the data and in how to
use the information in program planning. We are working with
the staff of the resource center in order to provide this
additional assistance.
Mr. Chairman, we are very proud at the Administration on
Aging that we are able to provide services and assistance to
American Indian, Alaska Native and Native Hawaiian elders and
their families. We are committed to working with you and your
colleagues to improve the quality of life in Indian country in
the years ahead. Thank you very much, and Dr. Jackson and I
would be happy to answer any questions that you have.
[Prepared statement of Mr. Walker appears in appendix.]
The Chairman. Thank you very much, Mr. Walker. May I now
recognize Dr. Annette.
STATEMENT OF KATHLEEN ANNETTE, M.D., AREA DIRECTOR, BEMIDJI
AREA, INDIAN HEALTH SERVICE, ACCOMPANIED BY CRAIG VANDERWAGEN,
M.D., ACTING CHIEF MEDICAL OFFICER, INDIAN HEALTH SERVICE,
BRUCE FINKE, M.D., ELDER SPECIALIST
Ms. Annette. Good morning. My name is Kathleen Annette.
Accompanying me is Dr. Craig Vanderwagen and Dr. Bruce Finke.
Dr. Bruce Finke is a geriatric specialist in the Indian Health
Service, and Dr. Vanderwagen is the chief medical officer.
I have a prepared statement, which you have, and I would
like to take the opportunity now to summarize this for you.
The Chairman. Without objection.
Ms. Annette. I am an American Indian physician, a family
doctor who has worked on reservations off and on most of my
life, and currently am an area director. I also have a mother
who is currently in dialysis, diabetic and dealing with
personally many of the issues that we're talking about today.
Who are these people that we're talking about, these Indian
elderly? In the tradition of my people, the best way for me
sometimes to explain this is really to tell you a story. And
this is a true story. I have, or had, an 84 year old great
aunt. She called me one 9day and said, as many of our elders
do, it's your turn to come and take me to the clinic to pick up
my pills.
So I picked up Aunt Mary and we headed to Cass Lake Indian
Hospital, where she had received her care for 84 years of her
life, and came to the one stop light in town. And the one stop
light in town stays red and red and red. So we pulled up and
wouldn't you know it, there was a very young couple that was
necking at the stop light. I don't know how else to put it. And
Aunt Mary looked, and I was embarrassed. She kept pushing me
aside and she kept looking. She said, look at them, they're
hot. I said, oh, Aunt Mary. She said, well, I used to be.
[Laughter.]
This is an 84 year old elder. I took this story about--have
any of you seen Wind Talkers? A wonderful, wonderful film about
the Navajo code talkers. I told this story at a national
meeting that I was attending where the code talkers brought in
the colors. I was so proud. And they listened, and they came up
to me afterwards, and I thought, gee, these wonderful elders
are going to really give me some encouragement. And what they
told me is they wanted to meet my Aunt Mary. [Laughter.]
But these are the people we're talking about in terms of
elders. They're the ordinary Indian people that are at home
dealing with issues every day, and they are Indian people that
have had extraordinary experiences and contributions to this
country.
What are they dealing with at home? When we ask them, and I
think the North Dakota study is fantastic, and you'll hear more
about that, it gives us some baseline data from 88 tribes, that
is incomplete. It has to be expanded to more, and we'll have a
much better data base and information to share with tribes.
The issues they bring to us and that we deal with in Indian
Health Service is of course long term care. Are we involved in
long term care? You bet we are. And the reason for that is long
term care is a spectrum. It's a spectrum. It's a spectrum of
services that ought to be available. We are responsible for the
hospital and clinic portions, along in partnership with tribes.
What is our responsibility? It's ongoing. We really need to
work with coordination of services. And we find that's a real
challenge at local, regional and national levels.
We also really must assure that when our doctors and nurses
and providers provide geriatric care, the care we provide can't
be good enough. Our care has to be outstanding. And whatever we
do to provide that piece, we need to assure that our primary
care providers have geriatric training as part of what they
bring to our table when they come to serve our people.
These are the people we serve, these are people that have
contributed so much to this Nation. Indian Health Service does
have a role. We must partner with others. We must continue to
do much of what we do and do it better. We have to partner with
tribes and say, ``what is it you really need''. Because I think
if we're going to have a successful program, we must work with
the tribes to develop what that program ought to be. And again,
we'll be talking at length I think with you in terms of the
services that define long term care and how we can best design
programs with tribes.
Thank you.
[Prepared statement of Ms. Annette appears in appendix.]
The Chairman. I thank you very much.
If I may ask, Mr. Walker, what gaps in Federal services
have you identified in diabetes or nutrition programs that, if
services were provided to fill these gaps would help alleviate
the high incidence of diabetes?
Mr. Walker. What we've noted is that, and as I mentioned,
we do provide a nutrition program for the elders. What we've
found is that we need to continue our educational efforts. We
have some pilot projects, and Dr. Jackson can speak directly
about those projects that include researchers pairing up with
elders and tribes to discuss the types of foods that they eat.
We had one case where they gathered foods, they tested the
glycemic level in the foods to determine the rate at which
glucose is generated, I guess, within the food. Then they
incorporated new practices of preparing foods and which foods
to use and eat into the Native culture.
Ms. Jackson. A couple of years ago, we had some funding for
some pilot breakfast projects. Some of the tribes, notably the
Rosebud Sioux Tribe, decided they could best serve their
elders, the diabetic elders, by serving a breakfast. Because
they would find the elders would come to the site at lunch and
hadn't had breakfast. And when they had their glucose
monitored, they would be either really high or really low. So
they for 1 year with funding from us, they provided breakfast
for the elders.
The program was so successful that even when our funding
ran out, the tribe picked up the funding of it. They have found
that the elders that participate in the two meal a day program,
their blood glucose levels are much better controlled.
So if we could find practices like that, programs like that
that really made a difference, and then be able to expand those
into other communities, I think we could see some real benefit
in the health of the elders.
The Chairman. What would it cost if we carried out that
practice on all of the reservations?
Ms. Jackson. I don't even have a clue. We would have to
look at that. Because some of our programs now are really
struggling to provide one meal a day. The number of elders has
increased so rapidly that the Indian programs differ from the
non-Indian programs in that we find many of the non-Indian
programs will cut off the number of people attending the meal
site. If they're running short on money, then they say nobody
else can come. The Indian programs, we don't say nobody else
can come. We'll continue serving people and feeding people, and
then we have to limit the number of days. So we'll feed
everybody for 3 days a week, rather than serving fewer people 5
days a week.
So we're finding a number of our programs now, due to the
funding level of the program, are only serving lunches 3 days a
week, rather than the 5 days a week.
The Chairman. Mr. Walker, as you can imagine, none of us
are experts here, so we have to depend upon you and other
experts to provide us with the necessary statistics and
information. Based upon that, we can act if moneys are needed.
When I became a member of this committee about 25 years
ago, I was told that if an Indian elder reached the age of 50,
the odds were that he had diabetes, and that the mortality rate
for those with kidney problems were 3 times the national
average. And apparently, it is still the same. Will any attempt
be made by AOA to let us know what it could cost to bring these
statistics above that of third world countries?
Mr. Walker. Mr. Chairman, the Administration on Aging, and
I'm sure the entire Department of Health and Human Services,
would be very pleased to work with you in reviewing the
statistics and discussing how we can best achieve better goals
in addressing the health status of Native Americans.
The Chairman. Has any comprehensive study ever been made?
Mr. Walker. Related to the?
The Chairman. The health of elders.
Ms. Annette. From an Indian Health Service perspective, I
think a comprehensive study as you speak of has not. I believe
we have elements. And a coordinated effort to look at those
elements will give us a better overall picture. And perhaps the
gaps can be identified then and we can give you a better feel,
I think, overall of what the need is. But I think the answer to
that, to my knowledge, no.
The Chairman. What would it take for us to have this
coordinated study to identify the gaps?
Ms. Annette. I think that to look at this, it may be best
to have, this is my idea, perhaps have an inter-agency group
look at this along with tribes and sit down and say, what has
been done, what needs to be asked. I think we have a beginning
of that with the North Dakota study. We have some tools to take
a look at that.
Again, it may be that from a tribal perspective, they would
like to have data, to find out where are we today. It's similar
to what you're asking for, Senator.
The Chairman. Do we need legislation to bring this about?
Mr. Vanderwagen. Mr. Chairman, I would think that
legislation is probably not necessary. I know this Secretary,
Secretary Thompson and Deputy Secretary Allen are very
supportive of exploring ways we can eliminate disparities in
health. This is one of the major initiatives I think that this
Department is pushing forward at this time. So I believe that
there is support within the executive branch for this kind of
interest.
I don't know at the moment that there's a specific
requirement necessarily for legislation. But that's something
that probably needs to be studied a little more
comprehensively. As we've suggested to you, we don't have a
comprehensive look at what the impact of many of these issues
are in aging Indian populations. With study, it may be that
some legislative corrections may be needed.
The Chairman. What can we do to bring about this study?
Ms. Annette. I think we certainly will, you have expressed
to us such an interest that it's something----
The Chairman. How much would it cost?
Ms. Annette. Good question.
The Chairman. We would try to provide it. But we do not
know. You will have to tell us.
Ms. Annette. I'm not prepared today to come up with that
number. But I certainly will make sure that we coordinate with
other agencies to get that information to you.
The Chairman. Will both of you get together and tell us
what you need?
Mr. Walker. Absolutely. And in fact, the Secretary operates
the Department of Health and Human Services as one department.
As a result, we are working better together, more so than we
have ever done in the past.
Ms. Annette. I would like to interject, we also have
another piece of information that I believe we've provided for
you, and that's a roundtable that was done really looking at
long term care needs within Indian country.
The Chairman. I have the report here.
Ms. Annette. You have the report.
The Chairman. Mr. Vice Chairman.
Senator Campbell. Thank you, Mr. Chairman.
Before I ask a couple of questions, let me just maybe make
a few comments. If you were to go into most committees here on
the Hill, and you asked them what the word commodities brings
to their mind, they wouldn't have a clue. But many of the
people that come in this committee, they know what the word
commodity means. Basically, what it means for anybody in the
audience that's not here is Government surplus food that is
given to Indian tribes that is primarily high starch, some of
it is white cans with no labels, it's just written on the can
what's inside. Surplus cheese, almost all the commodities have
a high starch content or a high content of what creates
cholesterol, as you know.
So it seems to me that when we do more studies or we talk
about putting more money into the problem, we need to go back
and address the underlying problem that got us there. If we
don't change that, we can pour tons of money into it and it
still won't correct it. We've got to deal, it seems to me,
through education and recognize that there is a lifestyle
problem and maybe in some cases, a difference of heredity too.
But when I talk to elders about their elders, I don't know
any that would tell you that their grandparents that lived
before the turn of the century had a problem with diabetes.
Maybe after the reservation system was initiated, but certainly
not when they had plenty to do. They might have died of a lot
of other things, but it wasn't diabetes. They had a different
kind of a diet. And I think that has an awful lot to do with
it.
I happen to live on the Southern Ute Reservation. They just
built a very, very nice facility there that is comprised of,
it's really a gymnasium but it's really a wellness center.
Because they offer cooking classes and they do a number of
things to try to teach people that just exercise alone isn't
going to cut it. You've got to do a lot of other things, too. I
think that's really important.
And that makes it all the more difficult, because you can
educate young people about having a better diet, but if they
don't have access to money, i.e., a job to buy what they need
for a better diet, they're still reduced to living on
commodities. So you have this kind of endless cycle that they
can't get out of, and so it seems to me the health of Indian
people is really related to a lot of things just based on the
circumstances which keep them in that hole where they can't
seem to get out.
Let me just ask a couple of questions. One of them is, I
mentioned that maybe heredity plays a part and so on. The
Native Alaskans, they still live, I think, to a higher degree,
on subsistence and gathering, probably more than many in the
lower 48. I know that having gone up there a number of times
and eaten muktuk, high fat from a seal and whale and so on,
which doesn't taste great, by the way, but I'm interested in
knowing if there is any disparity between the elders in Alaska
and the elders in the lower 48 on diabetes or diet related
illnesses.
Ms. Annette. Yes; there is, there has been. In the past,
when Alaska Natives lived a life that you describe, their rates
are much, much lower. What we have found is that as they become
more acculturated, perhaps, with the western diet as we know
it, the rates of diabetes are going up. So I guess that goes to
really support the point that you've made, that it truly is
lifestyle.
I'm really intrigued by the fact that you put, and it's so
true, we have to put an emphasis on prevention. What I've found
in some of our elders is they seem to think that they're beyond
prevention at that point when some of these illnesses have hit.
One of our education challenges is to say to the elders,
``prevention never stops''. There are ways we can maintain, get
better, by doing some prevention, interventions throughout a
person's lifetime. That's a challenge we have and that's a
message we must get out to our elders. Prevention is always,
always important, those activities.
Senator Campbell. Along that line, I might also suggest
that 50 years of commodities can't be turned around in a matter
of 1 day or 2 days or 1 year. Some of the damage that's done by
poor diets over the years, you just don't fix it by taking a
couple of pills for 1 week. That's something that takes a long
time.
Let me mention one other thing I wanted to get your opinion
on, either you or maybe Mr. Walker. I understand that in the
case of the Pimas, there are American Pimas and Pimas that live
in Mexico. The American Pimas, like many of us, they eat more
processed foods, their kids probably watch more TV and have
less exercise, like any other kid in America does now, compared
to years ago when they had to work the land. But the Mexican
Pimas have a higher corn diet and different lifestyle, probably
not as many things that we have on this side of the border. Do
you know of any difference between the Mexican Pimas related to
diabetes and the American Pimas?
Mr. Vanderwagen. Yes; there are about 1,500 tribal members
of the Tohono O'odham Nation that live in Sonora. We have in
the last few years conducted some health fairs and health
surveys in that population, because the Tohono O'odham Nation
of course is, federally recognized and these are tribal
members. In fact, the rates of diabetes are lower in Sonora
than they are across the border in Arizona. Unfortunately,
those folks are dying of accidents much more frequently, so we
have a different set of issues to cope with there. But at least
they don't view Spam as a traditional native food.
Ms. Jackson. The research that's been done on the foods
that they eat is what prompted us to work with Utah State
University on doing the nutrient content of foods of the Utes
in Utah and the northwest. Because down in the Pimas in Mexico,
they're still eating much more of their traditional food. And
even though it's corn, a high starch diet, the corn has a lower
glycemic index than the bread that the Pimas on this side of
the border are substituting for it.
So we're using the research that was done down there to
hopefully incorporate more native foods in the Utes in Utah and
the northwest tribes to again maintain their culture by eating
more of the traditional foods, but also substituting some of
the better foods for the commodity foods and the store-bought
foods.
Senator Campbell. Is it less processed, too?
Dr. Young. Yes; a lot less processed.
Senator Campbell. A few years ago, some of us on the
committee tried to initiate a program with the surplus buffalo
from the Federal herds to go to nutrition programs for Indian
elders. We weren't very successful with that, but we are still
trying. I know part of it has to do with low protein, too, in
diets.
Let me ask one other thing. Since the University of
Colorado was brought up, and I am from there, could you
describe to me the kinds of activities that resource center is
going to participate in? Mr. Walker?
Ms. Jackson. The Resource Center in Colorado is developing
a lot of training materials for health care professionals
working with tribal members, and especially urban Indian
elders. We find on the reservations there is much more cultural
sensitivity. But in the urban areas, there is essentially no
sensitivity to the needs of elders. They have developed one on
diabetes, one on cancer, they've just developed one on
depression and cardiovascular diseases and alcoholism. So their
focus this next year is going to be on training professionals
and paraprofessionals for working with Indian elders.
Senator Campbell. Is that the center that's being developed
at the old Fitzsimmons site?
Ms. Jackson. Yes.
Senator Campbell. Oh. Well, you'll have to come to the
unveiling. They've named the thing after me. [Laughter.]
I wondered what the connection was. You'll have to come to
that. It's a beautiful building, by the way.
Ms. Jackson. That's what I understand.
Senator Campbell. Maybe the last thing I mentioned, about
the elder population and how many youngsters are coming up now,
the 2000 census reported only 12 percent of the Indian elder
population is 55 or older. It seems to me that logically, what
we need to do is cultivate in youngsters lessons about
exercise, good health habits, that kind of thing. Is that
outside of the scope of your agencies, Mr. Walker?
Mr. Walker. No; not really. What we are doing is broadening
our scope. While we are certainly focused on the needs of the
elderly, we believe that we need to prepare people to be older
by giving out broad based messages about prevention, about
lifestyle changes that need to take place that will impact the
quality of life you have when you are older.
Senator Campbell. Good. And perhaps one last question, you
mentioned that you just awarded caregiver grants to 177 tribes.
What was the total amount of the grants, and what was the
average amount given for the grants?
Mr. Walker. The total amount was $5.5 million, and the
average award was about $18,000.
Senator Campbell. Were those grants given on some
competitive basis, or how do you give the grants?
Mr. Walker. All federally recognized tribes are eligible to
apply. And they indicate an interest in the ability to provide
caregiver services and the statute prescribes five services
that they choose from in terms of the provision to their elders
and to family caregivers. So they have to meet those criteria.
Ms. Jackson. They're non-competitive, and everybody that
applied received a grant.
Senator Campbell. Everybody that applied received a grant?
So that means about 300 and some odd tribes didn't apply, is
that correct?
Mr. Walker. That's correct.
Senator Campbell. Do they know about it? One of the
problems we have sometimes, we put things in place here, it's
administered by the Administration, then we're told later by
tribes that they didn't know, because there is a disconnect, an
information disconnect about what is available to the tribes.
Are all tribes aware that they can get these grants?
Ms. Jackson. Only the tribes that receive the part A
grants, the nutrition and supportive services, were eligible
for the caregiver grants. We have 235 that receive the Part A.
So those were the only ones eligible for the caregivers grants.
And some didn't apply just because they didn't think they were
ready to begin a new program at this time.
Senator Campbell. I see. Thank you.
Thank you, Mr. Chairman.
The Chairman. I thank you very much.
If we may, we would like to submit questions for your
consideration and response. Thank you very much.
Our next panel consists of the Director of Research, Center
for Rural Health, University of North Dakota, Dr. Richard
Ludtke; Researcher, Center for Rural Health, University of
North Dakota, Leander ``Russ'' McDonald. He will be accompanied
by Alan Allery, Director of National Resource Center on Native
American Aging, University of North Dakota.
May I call upon Mr. Ludtke.
Mr. Ludtke. If Dr. McDonald would start, please.
STATEMENT OF LEANDER ``RUSS'' McDONALD, RESEARCHER, CENTER FOR
RURAL HEALTH, UNIVERSITY OF NORTH DAKOTA, GRAND FORKS, ND,
ACCOMPANIED BY ALAN ALLERY, DIRECTOR, NATIONAL RESOURCE CENTER
ON NATIVE AMERICAN AGING
Mr. McDonald. Mr. Chairman and other members of the
committee, I'm honored for the opportunity to speak on behalf
of my elders. My name is Russ McDonald, my mother is an Arikara
from the Three Affiliated Tribes and my father is a Dakota from
the Spirit Lake Nation. Both reservations are located in North
Dakota. I am a research analyst at the National Resource Center
on Native American Aging. The Resource Center is located in the
Center of Rural Health at the University of North Dakota School
of Medicine and Health Sciences. Established in 1993 with
funding from AOA, the Resource Center has a mission of
providing research, training and technical assistance to the
Nation's Native American elders.
Today we will be presenting new findings about prevalence
of chronic disease, their effect on functional limitations and
differences in life expectancy for Native American populations
from a nationwide elders needs assessment project called
Conducting Local Assessments: Locating the Needs of Elders. The
project entails conducting a survey on reservations that
voluntarily participate in this project and allows for
comparison of elders on reservations with their national
counterparts.
The results from the research not only provide us with new
information about Native elders, but also gives each tribe data
they can use to help guide them in developing long term care
infrastructure for their communities. The data has been used by
a number of tribal communities in their planning efforts,
program development and grant application, primarily directed
at addressing the need for long term care services within our
community.
To date, we have 83 tribes with 8,560 Native elders having
filed out the survey. Two additional tribes are being processed
this week and will be added to the aggregate file upon
completion.
With that background on the study, let me share with you a
picture of elder health and long term care needs on our
results. Life expectancy for Native Americans and Alaska
Natives are low relative to the general population. In addition
to important differences between Natives and the general
population, it is also very important to note that there is a
substantial variation across Native American and Alaska Native
tribes in life expectancy across the Indian Health Service
areas. Average life expectancy ranges from a low of 64.3 years
of age in the Aberdeen area to a high of 76.3 years in the
California area, a difference of 12 years. Life expectancy for
the general population is 76.9 years.
Earlier this year, I attended the high school graduation at
the Spirit Lake Reservation and watched as grandparents
congratulated their grandchildren in accomplishing a major
goal. When I graduated from high school in 1981, I had one
grandmother still living at age 77. She died 2 years later. My
other grandmother died during childbirth at age 37, with my two
grandfathers dying both from heart attacks, one at age 62 and
the other at age 64. So while the number of Native elders
living to be old is increasing, old age is still rare on our
reservations.
Chronic disease. While quantity of life is an important
indicator of health for the general population, the health
status of the aged is also an important focus. As populations,
including Native Americans, age, there is a likelihood of
developing chronic illness like arthritis or heart disease,
which can impact both life span and quality of life. For
example, the Native elders are 19.5 percent more likely than
the general population to experience arthritis. Similarly,
Native American elders are 48.7 percent more likely to
experience congestive heart failure, 17.7 percent more likely
to report high blood pressure, 17.5 percent more likely to have
experienced a stroke, 44.3 percent more likely to report
asthma, and 173 percent more likely to be afflicted with
diabetes. Only cataracts are reportedly higher in the general
population. So what we see here in this data is that the Native
elder is sicker than their United States general counterparts
but at least they're able to see a little bit better.
Our data, as seen in figures 1 through 6, suggests that
chronic disease rates are higher among Native American elders
in spite of their shorter life expectancy. These findings
suggest that the disparate health conditions of the Native
elder are the result of other factors, such as lifestyle,
socioeconomic status and access to timely and adequate care.
Furthermore, these findings, and the prevalence of chronic
disease, like life expectancy, varies across Native American
and Alaska Native tribes.
When the regional chronic disease rates in Native American
and Alaska Native elders are compared, we see apparent
differences between areas. Arthritis rates reported in the
survey tended to be lower in the area of the southwest and high
elsewhere. The same pattern holds true for congestive heart
disease. High blood pressure tends to be reported at higher
levels in the east and south. Asthma rates again appear lowest
in the southwest. Diabetes, while high generally, produced
lower rates for Alaska and the highest rates in the Phoenix
area. Persons reporting having experienced a stroke were lowest
in the Navajo and Phoenix areas, followed by the north central
and northwest areas.
On the last, I'd like you to keep in mind this represents
people who have been diagnosed with stroke and have survived.
The areas with the lowest life expectancies tended to also
report lower rates of stroke victims in their surveyed area. We
believe these lower and average rates of chronic disease to be
the result of lower life expectancy, rather than being
indicative of better health status. Chronically ill elders in
these regions have shorter life spans, resulting in regional
chronic disease rates that are lower. In a sense, only the
strong and healthy survive to be elders, which in turn affects
the chronic disease rates in the Midwest and Alaska regions.
My colleague, Dr. Ludtke, will address the issue of
increasing numbers of Native Americans with functional
limitations, reflecting a growth in the need for long term care
services. He will also comment on strategies for decreasing the
number of individuals with functional limitations.
I will be pleased to answer any questions now or after Dr.
Ludtke has completed his remarks. Thank you, Mr. Chairman.
[Prepared statement of Mr. McDonald appears in appendix.]
The Chairman. Thank you.
Dr. Ludtke.
STATEMENT OF RICHARD L. LUDTKE, DIRECTOR OF RESEARCH, CENTER
FOR RURAL HEALTH, UNIVERSITY OF NORTH DAKOTA
Mr. Ludtke. Mr. Chairman and honored members of the
committee, I'm also honored and grateful for this opportunity
to speak.
Chronic disease varies widely, with some people minimally
affected, while others have significant levels of disability.
The level of disability is related to functional limitations in
the population and used as a criterion for admission to nursing
homes, assisted living, to community based care, long term care
programs. Nearly all definitions of functional disability use
information about activities of daily living and instrumental
activities of daily living. Examples of the ADLs, activities of
daily living, include such items as eating and walking. IADLs,
on the other hand, focus on limitations like with cooking and
shopping.
When ADLs and IADLs are combined, people can be classified
into four levels of need. The associated care requirements can
be identified as ranging from no long term care services needed
to home and community based care, to assisted living, and to
skilled nursing care, as seen in table 1. Using these
categories, we are able to estimate the numbers of people at
these different levels of need and determine the needs for
different levels of long term care services. The prevalence of
functional limitations increases with age and the severity of
limitations also increases with age. Figure 1 contains the data
from our surveys regarding functional limitation for Native
American elders. It's clear that the rates for all levels, from
moderate to severe, increase with age and that they do so most
dramatically in the oldest cohorts.
As the population ages, there will be an increased need for
long term care services. The number of people classified as
elders in the Native American population is about to explode,
with the arrival of those born during the baby boom as shown in
figure 2. When one combines the population data with the
measure of functional limitation, a picture of growth in need
for long term care is generated.
The most dramatic growth will occur as a result of the
large number of the baby boom cohorts in the next decade growth
will expand the population of young old, and barring any
change, will increase the need for moderate levels of care
consistent with home and community based services that are
greater than the other cohorts.
Life expectancy for Native elders has been growing rapidly
and should be expected to grow in the future. Population
projections using IHS life tables and census data show that as
of the year 2000, the Nation has approximately 218,000 Native
American elders with functional limitations of a moderate or
greater level. As the population ages, the number of elders
with functional limitations will grow assuming the same rates
of disability are continued. By the year 2010, as shown in
Figure 3, we can expect a 51 percent increase, or approximately
329,000 Native elders, to have functional limitations of
moderate or more severe levels. The large number of people
becoming elders and the earlier ages of onset from any chronic
diseases that produce functional limitations creates a
conservative estimate in the growth of functional limitations
to the end of the decade.
The health and vitality of future elders depends on a
healthy lifestyle, including good diet, regular exercise, and
refraining from drinking and smoking. If people take care of
themselves, they can reduce the need for long term care
services. Access to preventive and other health services is
important for delaying the onset of illness, as well as
effectively treating disease. If we reduce only 10 percent of
the Native American and Alaska Native limitations, we would see
a significant decrease in the demand for long term care
services.
Figure 4 presents the changes in the numbers of people with
each level of limitation that would occur if we had a 10-
percent across the board reduction in functional limitation.
That could occur with improved health promotion and access to
state of the art health care.
The recommendations that we derived from these observations
is that we need an initiative to develop an intervention and
health promotion models leading to improved outcomes for Native
Americans and Alaska Natives as they enter their elder years.
There is a need for the development of long term care, it
requires solutions that are tailored in terms of both the types
of care that work best and the means by which local communities
can realistically produce the type of care required.
There is a need for increased support for targeted research
on Native American aging and related educational and capacity
building programs. These are essential to help fill the gaps in
information and help tribes anticipate emerging health care
needs.
Three points of relevance to the Native American and Alaska
Native people concerning long term care include the need to
reduce chronic diseases and functional limitations, to
eliminate disparities across tribes, between Native American
elders and the general population, and to increase life
expectancy. And lastly, to address the shortages and lack of
long term care options in Indian country.
I thank you for this opportunity to speak and would
entertain any questions, along with Mr. McDonald.
[Prepared statement of Mr. Ludtke appears in appendix.]
The Chairman. Thank you very much.
Senator Conrad, do you have any statement you'd like to
make?
STATEMENT OF HON. KENT CONRAD, U.S. SENATOR FROM NORTH DAKOTA
Senator Conrad. Just very briefly, Mr. Chairman.
First of all, I want to thank you very much for holding
this hearing. I especially want to welcome Dr. Ludtke and
appreciate the work that he did on this survey. It is really
sobering to look at the statistics that are revealed here. When
compared to the general U.S. population, Native elders are
almost 20 percent more likely to have experienced a stroke, 50
percent more likely to have experienced congestive heart
failure, more than 40 percent more likely to report asthma, and
perhaps most stunning of all, 170 percent more likely to be
afflicted by diabetes.
All of us have known before this survey was done that these
statistics would probably be alarming. And they are. When it
comes to life expectancy in the Aberdeen area, which includes
my home State of North Dakota, we have the lowest life
expectancy of any area for Native Americans, 64 years compared
to nearly 77 for the general population.
Mr. Chairman, these statistics cry out for action. This is
going to require a dedication of resources and a commitment of
effort. Unfortunately, we see in the President's budget that
there is not that commitment. And it is, I think, deplorable.
But it's not just the President's responsibility.
Fundamentally, the responsibility lies right here in the
Congress of the United States. We have the obligation to
dedicate the resources to make a meaningful difference. And
there has been a failure to do so.
Mr. Chairman, I hope this hearing will be the beginning of
a change in the level of attention and the level of commitment
by the Congress to address these issues, and once and for all,
to make a meaningful change.
I also want to thank Mr. McDonald for his contribution to
this study. I'm also pleased that Fred Baker, the chairman of
the Mandan, Hidatsa and Arikara Elders Organization is here to
share with us some of the experiences of Native elders in North
Dakota. I'd like also, Mr. Chairman, just briefly, to recognize
two other people who are here today, Alan Allery, the Director
of the National Resource Center on Native American Aging, and
Dr. Mary Wakefield, from the Center for Rural Health in North
Dakota. Dr. Wakefield is my former chief of staff, and she has
made a tremendous contribution to these issues, not only in
North Dakota, but here in Washington. I know of no one with
greater credibility to speak on these issues than Mary
Wakefield. I am so pleased that she has gone home to North
Dakota to make a contribution at our Center for Rural Health
there.
Let me say, Mr. Chairman, if I could, that you and the vice
chairman have been outspoken on the need to make a difference
on these issues. We appreciate your leadership. I think we've
got to find some way to convince our colleagues that more of
the same just isn't going to get the job done. I don't know
what it's going to take to put a focus on these issues in a way
that moves our colleagues.
I was just at one of our reservations over this break. We
had terrible fires break out on the Standing Rock Sioux
Reservation, more than 40,000 acres burned. While I was there
for an emergency meeting, with people who had lost their homes
as well as with the leaders of the reservation and Federal
officials who were part of the response team, it really struck
me once again, as I left that hall, a young woman came up to me
and said, Senator, something has got to be done. We are having
suicide on this reservation among young people in numbers we
have never seen before. She said, there is a sense of
hopelessness and despair, a sense that there is no future. Now,
that is a condemnation of what is occurring. And we have an
obligation to respond.
I thank the chairman, and I thank the witnesses as well.
The Chairman. I thank you very much, Senator.
If I may ask a question of Mr. McDonald, you have
accumulated much data. Do you share this with the Federal
Government?
Mr. McDonald. The descriptive statistics from the study are
posted on our web site underneath the research icon. So the
numbers are available to the general public. Those statistics
are from the aggregate data file.
The Chairman. Do you know whether the Federal Government is
making use of that?
Mr. McDonald. No, sir; I'm not aware.
Mr. Ludtke. Can I respond to that? These are being shared
as widely as we can. They are submitted to the Administration
on Aging. Each publication is submitted to the Administration
on Aging . They have been shared with the Indian Health
Service, and Dr. Finke has used them. So we are making every
effort to get them to the appropriate agencies.
The Chairman. Senator Conrad said we cannot do the same
thing for the same problem year after year. But since we are
not experts in this field, can you tell us what we can do? We
are awaiting your suggestions.
Mr. Ludtke. I think there are a number of things that we
can do. When we work with some of the tribes or State
organizations and they receive our data, they would like to
carry it forward, and they look to us for assistance. We're
frankly equipped to give some of the information and the data,
but not the counsel on how to develop long term care programs.
I think we could develop a concerted effort to assist people in
developing long term care programs on reservations. I think we
could develop demonstration projects that are unique and
culturally compatible with reservations. And these could be
tied to our research and educational efforts. I think these are
possibilities for responding that would, I think, have a short
start time and produce great results.
The Chairman. Have you looked into the possibility of
submitting such a request to the Government?
Mr. Ludtke. We have only talked about it. We have
considered it if we could find the vehicle, we would submit.
The Chairman. There is your vehicle right there.
[Laughter.]
Mr. McDonald, have you looked into the possibility of what
Dr. Ludtke has stated?
Mr. McDonald. We've talked about it a little bit within the
office, but as far as going further with it, we're still in
that process of thinking of what could be developed first,
before seeking assistance for that.
I'd like to maybe have Alan comment on that. He's the
director of the Resource Center.
Mr. Allery. Just a brief comment. We are going to be
meeting with some Federal agencies this afternoon to discuss
possibilities further. But the Indian Health Service is the
primary health care provider for American Indians. And
certainly, additional support for health promotion activities
would make a huge difference in the health status of elders.
The Chairman. Well, my concern is that, as a member of this
committee, we have been giving these impassioned speeches year
after year about the dismal health conditions in Indian
country. And it is the same every year. Some day, I hope we can
give speeches saying that we have done something about it. And
there isn't much we legislators can do unless we know what to
do. And no one has suggested to us what we can do, other than
add 10 percent or add 5 percent. And even at that, we are not
aware, or we are not certain what it will accomplish.
But apparently, you people have some scientific data that
could be put to use. If you come up with a pilot program of
sorts, I can assure you we'll look at it very seriously and put
it on the right vehicle, as you say.
Mr. Allery. We would like the opportunity to translate the
research into action by working with various groups on model
projects, including specific tribes, perhaps, in North Dakota
and other States that would develop some models, some ideas
that others could replicate.
The Chairman. Mr. Vice Chairman.
Senator Campbell. Thank you, Mr. Chairman.
This by the way, is tremendously informative. Probably also
predictable. I might say, Senator Conrad mentioned something
maybe along the line I was talking to, that we've got to really
get ahead of this curve, this population growth. We're not
putting enough resources in it, but I don't know if we'll ever
be able to put enough resources in it, because the underlying
problem is growing faster than even the resources that are
available. Before Senator Conrad came in, we talked about the
population growth and the baby boomers were mentioned and the
post-baby boomers, the boomers of the baby boomers.
And I'm not a scientist or a doctor, but I think in mighty
simple terms. I envision this problem like the shape of a
pyramid. You have the traditional number of people, and this is
pretty well, I think, alluded to in your study, traditional
number of people, X amount at that apex of the pyramid. Then
you have the adults that are on the reservations now, or Indian
people, nationally growing at a huge rate. Then you have the
youngsters. I mentioned before Senator Conrad came in that on
the Cheyenne Reservation, 75 percent are under 25 years old.
Well, if we have that kind of a growth rate, and I imagine
on many reservations it is the same, if you envision that
pyramid I was talking about, and turn it over, that's where we
have the problem. The apex is down at the bottom now, and we
have a number of people that are elders down there that have
existing problems and that we have got to deal with. But as you
go higher on that inverted pyramid, the base is getting bigger
and bigger, and the baby boomer and the post- baby boomers is
where the real problem is going to be in another 20 or 30
years.
I don't know how we get ahead of that, because it's just
not going to be resolved by more resources from the Federal
Government. Somehow, we've got to get to the underlying problem
of unemployment, lack of opportunity, all the things that
reservations face now that are somewhat similar to the things
we would see in developing countries. It's something we simply
have got to not just continue to play catch-up with, but try to
get ahead and recognize the problem we're going to face in
another 20 years. It's going to be huge compared to now.
Senator Conrad mentioned the suicide rate. I don't know if
that was in the study or not. But I'm told on some reservations
that almost half the teenage girls try to commit suicide before
they are out of their teen years, and about a third of the
boys. I'm not sure if that's a valid number or not, but I know
having been out to reservations a lot, it's higher than the
national average. And I'd like to know a little bit about the
problems that people are facing that are related to suicidal
tendencies. We're talking primarily with seniors here, so maybe
somebody could deal with that, if you could. Was there anything
done in the study that related suicide to bad health in
seniors, the elders?
Mr. McDonald. No; we had nothing on the mental health.
Senator Campbell. Nothing on that.
Mr. McDonald. No; and I think what you're seeing with the
elder population is that when we talk about suicides happening
on the reservation areas, that tends to be with the younger
population. With the older population, I think at least for my
people, is that we don't kill ourselves.
Senator Campbell. Well, we shouldn't, and traditionally
they didn't. But they are now. A lot of young people are now. I
know some tribes traditionally, they felt that suicide for men
was not a way you could go to the next world, you would lose
your way to the next world if you did that. And it was an
absolute no-no. They might have died a lot of ways, but they
didn't kill themselves. But they are now, as you know,
youngsters are. It's non-traditional, but it's happening.
So you don't have any, really anything to compare suicide
rates for Indian elders with the national population?
Mr. McDonald. No; and from our discussions with the tribe
that we've been working with over the past few years, this is
not an issue that has come out of the focus groups that we've
had or other groups.
Senator Campbell. Have you found any, in your study, any
concrete suggestions you could give the committee on improving
lifestyle habits to reduce some of the statistics you have in
here?
Mr. Allery. One of the groups that we worked with in
Minnesota, the groups of tribes in Minnesota developed a wisdom
steps program, which encompassed almost all elders in all the
tribes in Minnesota. And in working with the National Resource
Center, they were able to parlay their elder needs assessment
into a $250,000-grant from the Share projects at the University
of Pennsylvania. Their progress has been substantial. The last
session that I went to, they had over 400 elders exercising,
walking at least 2 miles a day. So that was, that's kind of how
the National Resource Center works with many groups. We depend
on the tribes to take the initiative. And we work closely with
them and the data is actually theirs. They can use it for
planning their own projects and developing programs that meet
the needs of their elders.
Mr. Ludtke. Could I followup on that for just one comment?
Senator Campbell. Yes.
Mr. Ludtke. In the data we have questions that reflect on
lifestyle issues. They weren't included as part of the report
this morning, but it's very interesting to observe that the
Native elders exercise more than the general population. The
Native elders drink far less than the general population. But
in the area of diet, they have greater problems.
As we looked at the lifestyle comparisons, we were kind of
stricken with the notion that they seemed to have relatively
good lifestyles, yet relatively poor outcomes. We're left with
the conclusion that that had to revert back to diet, and the
very thing you were talking about earlier.
Senator Campbell. Well, we've got to try to help, because
it's the right thing to do. But I also happen to think those
elders are one of the most valuable resources that tribes have.
Because those youngsters that are in that population boom, one
of the problems they're having is relating and finding and
learning about the old ways. The elders are the key, they're
the link. If we lose them, I think we've lost something that is
just simply not replaceable.
Thank you, Mr. Chairman.
The Chairman. Your discussion on suicide reminded me of a
trip that I took to Alaska for the first time 10 years ago. At
that time, I was advised that the suicide rate among young men
between the ages of 19 and 23 was 14 times the national norm. I
think that is unacceptable.
Senator Conrad.
Senator Conrad. I'd like to go back to the question of what
can be done. In your analysis, did you do any separation based
on economic circumstances for the health of elders? In other
words, did you look at different income categories and then
look at how that might relate to health?
Mr. Ludtke. We haven't. There is a great deal of analysis
yet to be done. We struggle to find the time to get the
information back to the tribes to this point, so we haven't
done extensive analysis.
One observation on the economic variable is that there's
not a great deal of variability. My guess is that as we apply
that, we'll find the absence of variability on that income
variable, that a large percentage of the population is below
the poverty line.
Senator Conrad. The two of you have spent more time with
this data than anybody else. Are there things that you
observed, are there things that kind of tickled your fancy, if
you will, as you looked at this data as to clues that might
make a difference?
Mr. McDonald. I think somebody was talking about
commodities earlier. I was raised on commodities, too, as you
can tell. But one of the things is that the highest thing, Dr.
Ludtke mentioned already, is the higher rates of exercise for
Native elders. So they exercise at higher rates, but they also
have higher rates of BMI, or they are more likely to fall into
overweight and obese categories.
Therefore, the only thing I could think of that would
otherwise affect their higher BMI would be the nutritionals. So
I think there would have to be something to provide better
nutrition and also maybe continue exercising, for those who
already are, and maybe increase exercise for those people who
aren't.
Senator Campbell. Would the Senator yield for a moment?
Senator Conrad. Yes.
Senator Campbell. You asked a question about different
socioeconomic backgrounds for elders. From my own experience,
you rarely find an elder with much money, because it's not a
traditional thing to accumulate money. If anything, they give
it away. They have giveaways, they do things to share it. So
you don't have much individual wealth among elders anywhere,
Indian elders. Not that I know of. But that doesn't mean the
tribes can't accumulate some wealth through different kinds of
opportunities, and provide some of the programs that the elders
need.
Thank you.
Senator Conrad. In terms of diet, did you make observations
with respect to dietary differences between the elders and the
Indian population and elderly people in other populations? Is
there some clue there as to what they're consuming that is
different from others in healthier populations?
Mr. McDonald. Somebody talked about Alaska, and they are
still eating much of their traditional foods, like fish and
wild game and that type of thing. And what we're seeing is that
that region tended to have lower rates in some areas.
Senator Conrad. Lower rates of?
Mr. McDonald. Of chronic disease.
Mr. Ludtke. The information that we gathered on nutrition
was relatively scant and survey data often tends to be scant,
we often ask one or two questions. What did happen was that we
were triggered to look at nutrition as kind of a key variable.
So if we have an opportunity to do a second generation
instrument, we plan to expand that significantly.
We think this is an area that needs attention. We think
health promotion needs to be directed at nutrition. We think
nutrition and low incomes are at odds with one another. It's
very difficult to have a nutritious diet if you don't have an
adequate income. It's difficult to buy fresh fruits and
vegetables. And people will end up on processed foods, which
are less healthy.
Senator Conrad. Thank you.
The Chairman. Thank you very much. Like the first panel,
we'd like to submit question to you for your consideration and
response. On behalf of the Committee, I thank you very much.
Our final panel consists of the executive director of the
National Indian Council on Aging of Albuquerque, Dave
Baldridge; and the chairman of the Mandan, Hidatsa and Arikara
Elders Organization of the Three Affiliated Tribes of North
Dakota, Fred Baker.
Mr. Baldridge, welcome, sir.
STATEMENT OF DAVE BALDRIDGE, EXECUTIVE DIRECTOR, NATIONAL
INDIAN COUNCIL ON AGING
Mr. Baldridge. Thank you, Mr. Chairman. I believe that over
the time I've been in this business I've heard you make some of
the most eloquent statements about Indian country since Chief
Joseph, probably, so it's a great honor to have you listen to
us this morning.
I know you need no one to tell you anything about the
Federal trust responsibility or that nowhere are the
disparities in minority health care so great, nowhere is the
mandate to the Federal Government so compelling as with the
well being of Indian elders. Today we're glad for this chance
to bring your attention to a few of them.
First, long term care. The need for long term care services
in Indian country is great. It continues to grow. And while
it's recognized that there is no national overall policy
regarding long term care for the Nation's elderly and disabled,
it's also true that billions of dollars in Federal and State
funds are spent on long term care, particularly for nursing
home and home and community based services under Medicaid. It's
important to understand that there are virtually no funds
available to Indian country for long term care.
States have the ability through Medicaid waivers and CMS
has the authority to approve requests to establish Indian only
waivers especially for home and community based long term care
services. We understand that no further legislative authority
is necessary, yet States are not seeking these waivers and we
hope this committee could provide leadership in working with
tribes and receptive States to put such waivered services in
place.
We're also extremely concerned that senior health insurance
counseling and assistance services, SHIP program, is still not
available for older Indians. Such funding is provided to all
States, but inexcusably, there's no counterpart for Indian
country, no analog. Despite our repeated requests, we're not
aware that CMS or DHHS has addressed this issue. Perhaps the
Committee could help us inquire of CMS.
Of the issues that elders face, those not related directly
to their health are generally legislated through the Older
Americans Act. I would like to talk to you about some issues
that are certainly related to long term care, such as elder
abuse. Title VII of the Older Americans Act, the vulnerable
elder rights protection, was created in 1992. It includes
subtitle B, which authorizes a program to assist Indian country
to prioritize and carry out elder rights activities. Yet funds
have never been appropriated, although they have been
appropriated for States for similar purposes. These programs
seldom reach Indian elders. Tribe have little or not access to
the agencies, departments, ombudsmen or other programs that are
available to States. Further, tribes have no additional source
of mandated Federal funding for elder protection activities.
So we request that you not overlook basic protections like
this that are available to most of the Nation. A demonstration
grant program for Indian country of a million dollars would
begin to address this very serious issue.
I would note on the side that our elders are living longer,
but they're living longer with the amputations and the
blindness and the renal failure that go with the diabetes.
That's putting extraordinary burdens on their family
caregivers. And we know that 90 percent of care for elders is
given by adult children in homes and communities. So we think
that may be a factor in abuse and that long term care is
certainly related there.
Title VI, as you've heard this morning, is an especially
important program in Indian country. The 238 programs funded
there are a primary source of services provided to reservation
elders. Since 1980, title VI funding has been so inadequate for
most of the years that its services have never really been
``comparable to those provided under title III'' as the OAA
often indicated. Nevertheless, this program still is the
cornerstone of Federal Services, including diabetes and health
education for our elders. Current funding for projects ranges
from about $71,000 to a top end of $174,000 per program. But we
need an immediate increase of more than $30 million nationally
to keep title VI directors able to deal with their great
responsibilities.
That's related to title IV of the Act, research and
demonstration grants. This title has historically provided
annual training for our title VI program directors. However,
since 1995, these activities have not been funded. The reality
is that title VI remains without a national infrastructure, no
paid staff, without a national training program at any level,
without the capacity for regional or national meetings, and
even without the capacity for its estimated programs to
communicate with each other, its 238 programs.
We urge you to sponsor a capacity building initiative
directed by NICOA, hopefully, to engender skill building,
communication, greater economic self sufficiency for title VI
programs. We request the sponsorship of $600,000 for training
title VI directors, so badly needed, and developing their
capabilities to better serve our elders.
And I'll conclude, we're very proud of some of our
partnerships and projects with diabetes, which is front and
center for all of us. We're connecting some tribes through a
project with the Administration on Aging with the United States
Renal Disease System, so they can look at ESRD. For CDC, we're
conducting a grassroots diabetes education program for Indian
elders. As the NIH recently published in the New England
Journal of Medicine its DPPS study, showing that interventions
really make a difference in diabetes, we are creating an atlas
of diabetes for CDC, we are in the fifth year of an interactive
atlas of Indian elder health for the IHS. These data projects
are being extremely productive.
So thank you again.
[Prepared statement of Mr. Baldridge appears in appendix.]
The Chairman. Thank you very much, Mr. Baldridge.
Mr. Baker.
STATEMENT OF FREDERICK BAKER, CHAIRMAN, MANDAN, HIDATSA AND
ARIKARA ELDERS ORGANIZATION, THREE AFFILIATED TRIBES, NORTH
DAKOTA
Mr. Baker. Thank you, Mr. Chairman and honored members of
the committee. Thank you for allowing me to speak before this
distinguished group regarding the concerns of the Indian elders
of North Dakota, and in particular the elders of the Mandan,
Hidatsa and Arikara Tribes.
My name is Frederick Baker. I am chairman of the Mandan,
Hidatsa and Arikara Elders Organization, an organization that
was officially chartered and sanctioned by the Three Affiliated
Tribes Business Council to represent the concerns of our elder
population and provide some direct services. I have been
appointed to the Governor's Committee on Aging of the State of
North Dakota.
The elders of the Fort Berthold Reservation are those folks
who are 60 years and older. We were born between the years 1905
and 1942. Our oldest member is 97 years old. There are
approximately 573 of us that are in this age range; 307 of us
live on the Fort Berthold Reservation, 74 live outside the
reservation but in North Dakota, and 192 of us are sharing the
virtues of North Dakota with other States. [Laughter.]
Mr. Baker. As an age group, we have endured and survived
great change. Most of us were born in dire poverty. Most of us
saw family members die from causes of the frustrations of
poverty, such as alcohol, despair, poor to non-existent health
care. Most of us are products of off-reservation boarding
schools. Many of us were given a one way ticket to urban
communities, such as Los Angeles, Chicago, Dallas, with
virtually no preparation of urban survival skills and very
limited financial resources. Many of us still bear the scars of
that experience.
Our age group also went to war in defense of our country.
Many of us walked the jungles of the South Pacific, landed at
Normandy, defended the frozen ridges of Korea, and saw the
monsoons of the Mekong Delta. Many of us returned maimed in
body and sometimes in spirit. Many of us were returned for
burial.
Without question, the most devastating event for us was the
Garrison Dam. It was almost as devastating as the smallpox
epidemics of 1781 and 1837. Prior to the Garrison Dam, we were
settled in communities such as Independence, lucky Mound,
Nishu, Shell Creek, Elbowoods, Beaver Creek. We were raising
our own food, just like we had been for centuries. Beef
replaced the buffalo as our major protein supply, and we proved
to be excellent cowboys. The River, Missouri, and its
bottomlands provided us good soil for our gardens and crops,
shelter for ourselves and our livestock, timber to build our
homes. But especially, it allowed us to practice our cultural
traditions. These traditions helped us to be independent and
develop our own systems of caring for ourselves and one
another. We didn't need social programs. We took care of our
children, our elders, our ill. We had our own system of law and
order.
The Garrison Dam changed all that. We were forced to move
from the bottomlands up into the hills, where the quality of
the land was such that it was very difficult to raise gardens.
It took many more acres to raise livestock. Our homogeneous
communities were broken up and replaced by isolation. We did
not have access to capital, except the meager amounts of credit
that was offered through the Bureau of Indian Affairs. Most of
this credit was just enough to get one into serious difficulty.
Unfortunately, many of our people died in the process of
relocating from the Garrison Dam. Many of us turned to alcohol,
and ourselves and our families suffered as a result. Terms like
unemployment, welfare, foster care, spouse abuse, child abuse,
elder abuse, alcoholics, alcoholism, juvenile delinquency, low
rent housing became part of our vocabulary. Our languages are
in danger of being lost, and we get confused between poverty
culture and Indian Culture.
We have never had the mental health resources to deal
adequately with the problems that were posed to us through the
Garrison Dam.
Despite these difficulties, some members of our age group
were the first in their families to earn a college degree, to
enter professions such as education, nursing, social work,
medicine. We face many of the same problems today. Among those
are inadequate medical care, poor or substandard housing, lack
of specialized home health care, elder abuse issues, inadequate
transportation, and our reservation is large, and because of
the Garrison Dam, we're scattered, large traveling distances,
inadequate meal service. Our written testimony will more
clearly document these problems.
Let me highlight just a few things. The average health care
expenditure in the United States is approximately $3,500 to
what at Fort Berthold is $1,300; 75 percent of our elders have
some type of a depression problem. A lot of it is caused by
people who as a result of diabetes feel that their quality of
life is over. All of North Dakota is seeing a return of elders
who are seriously or terminally ill. Hence, the drain on the
already limited Medicaid resources is critical.
Set-aside for Indian reservations for meal sites under
title VI of the Older Americans Act only is enough to meet a
part of the needs. At the present time there are six
communities in Forth Berthold, one is being served through
title VI, the other five are being served by what resources we
can muster as a tribe. Housing is badly needed for elders, and
especially assistance is needed repairing homes. Many elders
live in very crowded conditions, because their children or
grandchildren have no housing, and therefore move in with them.
Our elders will not ask their children or grandchildren to move
out.
Elderly abuse is rampant and needs to be addressed. And
Social Security is something that we are trying to deal with
and also needs to be addressed. We are receiving a lot less
than the national average, because of some issues regarding
reporting and so forth.
Thank you for your time. I would be glad to answer any
questions that you may have.
[Prepared statement of Mr. Baker appears in appendix.]
The Chairman. I thank you very much, Mr. Baker.
Mr. Baldridge, can a Native American elder residing in an
urban area have access to State social services, or does he
have to rely upon American Indian Alaska Native type programs?
Mr. Baldridge. We know that probably 50 percent of Indian
people, including elders, are now urban. We understand from the
Seattle Urban Indian program that they are seeing third
generation urban Indians. Yet we know less about this
population than any Indian population or probably other
minority population in the country. They tend to not live in
ethnic neighborhoods. They tend to be transient, they tend
apparently to have frequently substance abuse or alcohol
problems.
So in answer briefly is, I think they fall through the
cracks very, very frequently. But they do rely on State
programs and of course, the non-ITU services that are available
in cities. I don't know that the Indian Health Care Delivery
System reaches them much at all.
The Chairman. You indicated that the title VI moneys are
inadequate. About how much more would you suggest is needed?
Mr. Baldridge. In 1992, we had $14 million. Currently I
believe we are at about $27 million. One of the staffers from
the House side back a few years ago estimated that it would
take $30 million just to get original title VI programs back to
their 1980 levels of service; $35 million would, I think, make
a huge dent in the ability of these programs to serve their
elders. Many of them still are able to provide only a few
communal meals a week, and very few home services or
supplemental services. It's a very pale shadow of the services
available through area agencies on aging.
The Chairman. Well, I can assure you I will look into that,
because I must confess, I have no idea how much the Government
requested for this program. But I would gather it must be much,
much lower than $35 million.
Mr. Baldridge. I believe we're at $27.5 million or so right
now. And certainly more money is at the top of our list of
needs.
The Chairman. Mr. Baker, do you have any suggestions as to
what we as Members of Congress can do?
Mr. Baker. Well, I think first of all, some of the things
that we're trying to do is try to access or have our people
access those programs that are available that don't come
through the normal Indian programs, so to speak. Because we are
citizens of the State of North Dakota and as such, have the
right to those programs. I think a lot of tribes, a lot of
people do not think that they're entitled to those programs. So
we're trying to do that.
Obviously, there is a need for more funding. One of the
things, I think there needs to be some type of Congressional
action, perhaps, regarding elderly abuse in terms of its
programs to try to deal with elderly abuse. I think it's one of
those issues that is kind of quietly not mentioned, yet it
exists in many ways. So I think those are perhaps some issues
that might be addressed.
The Chairman. In your presentation, you remarked that many
in your generation put on the uniform and participated in the
wars of this Nation. I think we should recall that in the last
century, on a per capita basis, more native people put on the
uniform to serve our country in every war of the last century
than any other ethnic group. That is saying a lot. More Indians
per capita served than German-Americans or Italian-Americans or
Chinese-Americans or Japanese-Americans. And I have said many
times, couple that with the fact that you have given up much of
your land suggests to me that you have already paid your dues.
The least we can do is to make certain that you receive what
you are entitled to.
Mr. Vice Chairman.
Senator Campbell. Thank you, Mr. Chairman.
Let me ask Mr. Baldridge a question or two, but I wanted to
say to Mr. Baker first, I thought your testimony was poignant.
Depressing. Absolutely true. It needed to be said. I just wish
more people here of our colleagues in the Senate could have
heard your testimony.
You mentioned elder abuse. I was talking to one of my staff
here, that I had an elderly gentleman at home, at Northern
Cheyenne, tell me one time that he doesn't turn his lights on a
night time because he's afraid somebody will know he's there
and come and beat him up. That's just a tragic kind of a thing
to know about. Yet at the same time, that certainly wasn't a
traditional value of Indian people anywhere. Elders were always
respected and trusted and learned from and revered. But I
suppose it's on the rise because of poverty and lack of
opportunities and so on. So we have this dichotomy, this
strange relationship between what Indian people believe and
want to believe from a traditional standpoint and sometimes
what is actually happening. I just wanted to mention that.
But I wanted to ask Mr. Baldridge a couple of questions.
Three out of five, as I understand it, three out of five Indian
elders are living at or below 200 percent of the poverty level.
But more tribes are trying to develop their economies,
certainly some of the gaming tribes have had some success. In
the Great Lakes region, some of them have had great success,
too. I have visited them.
Have you seen any increased resources from those successful
tribes that have gone toward elder care?
Mr. Baldridge. Yes, sir; I can. One comes to mind,
certainly, Sandia Pueblo, which just went into debt enormously
for a new casino. Yet with their gaming revenues over the last
decade, they have developed a very fine clinic. They're putting
all of their tribal members, including elders, through
secondary education and higher education at no cost. And their
health care has improved enormously because of that.
Other Pueblos around Albuquerque, with successful gaming
operations, have created partnerships with hotel chains to
create resort golf course, and it's interesting that our
seemingly more business wise tribes are developing initiatives
with States and private industry that are benefitting not just
the elders but all the tribal members. So we're really
encouraged by those tribes that are gaming.
Senator Campbell. I have talked to a number of them, and I
don't know of one single tribe I've talked with that has gaming
that has not dedicated a portion of their new-found income
towards senior programs. And I'm gratified that that is
actually happening.
Some in fact have even broadened it. I live with the
Southern Utes in Colorado. They are negotiating with the county
to build a huge hospital and health care facility that will
take care of everybody, not just Indian people. So they have
been, in most cases, I think, very, very generous with some of
the new money that the successful tribes have made.
Statistics from the IHS indicate Indian youth are the most
likely to commit suicide. I may have mentioned, asked this
earlier about suicide, I did, in fact, I think. But I asked it
of another panel. Do you have any comparative statistics to
deal with Indians or non-Indian comparison in suicide?
Mr. Baldridge. What little data we've seen from IHS seems
to indicate that once Indian people reach the age of 75, their
longevity is much greater than that of other races. I believe
that we see low suicide statistics for elders as well.
However, I visit from my tribe a medicine man, Crosson
Smith, and I asked him, what's the greatest problem we face as
Indian people. He said, we're losing our kids. It's what you
all have said to us. Indian teens, with 17 to 19 times the
alcohol and substance average of the Nation, suicide 7 or 8
times, we're winning some battles with the medicine, but we're
losing our kids. And it's a challenge for our elders and all of
us.
Senator Campbell. All the more reason we need to take care
of them.
Several tribal groups have submitted testimony that they
are being shut out of operating elder care facilities because
the IHS doesn't fund it. They can't get direct reimbursement
from Medicare or Medicaid for such facilities. And the states
won't license a facility for the tribes so they can get
different reimbursements from the State.
Do you have any comments on those issues?
Mr. Baldridge. Yes, sir. I believe South Dakota, we often
see, is the worst case State, where there is a more than 10
year moratorium on building nursing homes. The tribes there
very desperately want and deserve nursing homes on their own
reservation lands. Yet the State I think says, gee, we're
sorry, it's a Federal problem, but we have this moratorium,
even though it's self-imposed. It's very much, I think, a
critical situation for those tribes, a longstanding one, and
one that CMS has made some effort to resolve, but it's a very
difficult, as usual, interface between Federal policy and State
regulatory authorities.
Senator Campbell. In that case, even if you found all the
money you couldn't get a license, because they have a
moratorium on it.
Mr. Baldridge. Exactly. It's a very difficult situation.
Senator Campbell. Thank you for your testimony.
Mr. Chairman, thank you, I have no further questions.
The Chairman. Senator Conrad.
Senator Conrad. Thank you, Mr. Chairman.
First of all, I'd like to welcome Mr. Baker here. He is a
very valued and respected member of the Three Affiliated Tribes
of North Dakota and a very respected member of our State. And I
thought your testimony was outstanding. I thought you could
have focused on the disaster that the Garrison Dam has been to
the Indian people, not only of the Three Affiliated Tribes but
of the Standing Rock Sioux Nation as well. Because it
dramatically altered the way of life of the people. And the
compensation that has been forthcoming, while welcome, has not
been sufficient to reverse the damage that was done. So I
think, Mr. Baker, you put the focus right where it belongs.
Let me ask you, if you could wave a wand, if you could come
here and say, these are the things that must be done, what
would be the list that you would give this Committee.
Mr. Baker. Wow. I guess several things. One is probably
some type of a way to go back, if we can go back, I look at it
as probably going forward, to incorporate the traditional
cultural values that we had with the attempt to become a part
of the modern day society, through some type of language
preservation, cultural preservation program of some type. I
think that's the basis for a lot of our, perhaps the problems
that have to do with respect for elders, the respect for
ourselves.
Somewhere along the line, because of the things that have
happened, I think we've lost respect, to some extent, for
ourselves, and probably lost confidence in our ability to deal
with the issues. I think that's one of the things that I would
somehow, and I think maybe some of these other things would
kind of fall into place. Certainly we need some type of an
increased health care facility, those kinds of issues need to
be addressed. Certainly employment, although we're trying hard
to do that, employment issues, trying to find some type of way.
Also some way to help our people to be able to leave
successfully and become part of the rest of the community and
still maintain their Hidatsa, Arikara and Mandan affiliations.
Senator Conrad. Okay. Mr. Baldridge, if I could ask you the
same kind of question, if you had the ability to dictate
outcomes here, what would be the things you would point to?
What are the things that would leap to your mind as to things
that need to be done?
Mr. Baldridge. If this committee, sir, could help us find
some creative new solutions to home and community based care in
Indian country that would be at the top of my list, along with
a single other consideration, that's the empowerment of our
title VI program. These directors need help so badly and
training so badly, and it's not available for them. They could
be a real force in helping us deal with public health issues
for our elders. We've got to lift them up and really help them
get on their feet and be more viable.
Senator Conrad. How much of this is related to resources?
To put it bluntly, how much is related to money?
Mr. Baldridge. It seems that poverty is the thread that
ties everything together in Indian country. Certainly I believe
that's the case in this. But there's been no training money
available to them since 1995, I believe, through Title IV of
the OAA. It's just a stopper right there. That's very resource
related. Some of the other, the seeking for demonstration
programs to deal with new ways of community home based care is
not so directly resource related, but certainly some
demonstration projects need to be coordinated.
Senator Conrad. What would your answer to that question be,
Mr. Baker? The question of money, if you were to try to assess,
what could be done that would really make a difference, how
much of it is related to money being provided to have programs?
Mr. Baker. Well, I think they're probably of somewhat equal
value. I think there certainly needs to be a lot of thought
given to innovative ways to deal with the program. Sometimes
money is a rather simple solution, or probably a quick fix
attempt. So I think they are kind of equal value. We definitely
need money to do things. On the other hand, I think it's the
ideas or the attempts at programs. One of the things we're
trying to do as an elder organization, is to try to talk to the
elders, give them a place, have a forum to discuss some of
these issues and say, now what can we do.
Senator Conrad. All right, thank you. Thank you both for
not only excellent testimony here today, but I know in the case
of Mr. Baker, thank you for a lifetime of involvement in the
community.
The Chairman. Before we adjourn, I would like to make an
observation. I believe I have visited more reservations than
any other chairman of this. And I have noted one common thread
in most of my visits. Most tribes for good reasons want to show
their very best. So they guide me through all the developments,
the new buildings. I have yet to see one of the dilapidated
buildings. They show me the new houses, the new apartments. In
fact, in order to see the worst conditions, I have to ask that
I see where the asbestos is leaking from the school building
and such.
It is the same with wealthy tribes and poor tribes. They
want to show that they have done something. I would suggest
that when members of Congress come to reservations to visit,
show them the real world. I think they will understand the
situation much better.
I have had some of the best meals in poor reservations, and
I do not know why they do that. But they want to extend their
hospitality and show what friendship is like. But if they are
poor, show us that they are poor. If there are buildings that
are dilapidated and school buildings are filled with asbestos,
we should know about it.
So with that, I thank all of you for your testimony. This
hearing is adjourned.
[Whereupon, at 11:57 a.m., the committee was adjourned, to
reconvene at the call of the Chair.]
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A P P E N D I X
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Additional Material Submitted for the Record
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Prepared Statement of Hon. Maria Cantwell, U.S. Senator from Washington
Mr. Chairman, I thank you for the opportunity to speak concerning
Native American Elder Health Issues.
I am especially interested in the findings from this hearing
because I represent 29 federally recognized tribes, with 25,000 tribal
members.
The committee is well aware that Native Americans experience
significant disparities compared to whites for many health indicators,
and while the mortality rate for American Indians and Alaska Natives is
higher than for all races in the United States, life expectancy is
almost 6 years lower.
While life expectancy is certainly an important indicator of
population health status--the quality of one's life is also important.
This morning's testimony tells us that Native American elders are 78.7
percent more likely to experience congestive heart failure, 17.7
percent more likely to report high blood pressure, 17.5 percent more
likely to have experienced a stroke, 44.3 more likely to report asthma,
and 173 percent more likely to be afflicted with diabetes.
Diabetes complications, especially end-stage renal disease and
lower-extremity amputations are major causes of morbidity and mortality
among older Indians. Diet, sedentary lifestyle and obesity are risk
factors for the development of diabetes and its complications--factors
we can prevent or control.
And we know that heart disease--one condition, at least, which can
be somewhat mitigated through prevention and treatment--is the No. 1
cause of death in Native Americans over the age of 45.
1 think it is no great leap to ask if we actually funded the Indian
Health Service at more appropriate levels, would the health status of
our tribal elders not be better?
While the IHS is tasked with providing full health insurance for
the American Indian and Alaska Native population, it is so underfunded
that patients are routinely denied care. The budget for clinical
services is so inadequate that Indian patients are subjected to a
``life or limb'' test. Unless their condition is life threatening or
they risk losing a limb, their treatment is deferred for higher
priority cases; by the time they do become a priority, the treatment
required is generally more costly and there are often no funds left to
pay for it.
Finally, I also want to add that as Congress continues to consider
Medicare reimbursement issues, we need to make Indian-specific policies
and procedures to ensure that its billing requirements insure that
Indian health program receive fair reimbursement for services provided.
Again, thank you, Mr. Chairman for convening this hearing.
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