Tribal Community Health Representatives (CHR): Home care workforce insights, experiences, and recommendations for elder care

TitleTribal Community Health Representatives (CHR): Home care workforce insights, experiences, and recommendations for elder care
Publication TypeReport
Year of Publication2025
AuthorsKaslow, J, Schweigman, K, Donahue, C, Chapman, S
InstitutionUCSF Health Workforce Research Center on Long-Term Care
CitySan Francisco, CA
KeywordsCommunity Health Representative, culture, elder care, home care workforce, tribal
Abstract

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.