The Community Health Representative (CHR) Program, initiated by the Indian Health Service (IHS) in 1968, serves as a pivotal component of healthcare delivery in American Indian and Alaska Native (AIAN) communities. Distinct from non-tribal Community Health Workers (CHWs), CHRs are tribally-based community health workers who provide culturally responsive health services, primarily under tribal operation. This program emerged from the need to address specific healthcare gaps within AIAN populations, reflecting the IHS’s commitment to culturally informed health practices and strong community partnerships. Despite its expansion and significant role in tribal healthcare, the CHR program faces numerous challenges, particularly in elder care which were exacerbated during the COVID-19 pandemic.