The Tribal Home Care Workforce Providing Culturally Informed Care

Project start: 9/01/2022

The COVID-19 pandemic revealed significant problems in occupational and client safety in systems that house and provide Long Term Support Services (LTSS). Workforce shortages and resource limits in systems that provide health care services to tribal nations were exacerbated and emphasized. While the COVID-19 pandemic exposed and magnified the impacts of these limits on American Indian/Alaska Native (AI/AN) population’s elder care, this issue is long-standing and persists during non-emergency periods.

AI/AN populations experience entrenched health inequities leading to lower health status and life expectancy compared with other Americans. For example, AI/AN life expectancy is 5.5 years less than the US all races population (73.0 years to 78.5 years, respectively). AI/AN populations are overburdened with myriad chronic conditions and often reside in geographically isolated and medically under-served areas lacking access to essential care and preventive services. The prevalence of chronic disease is highlighted in the aging AI/AN population, where “elders” (>55 years) experience significant disparities compared to counterpart non-Hispanic White populations, including higher rates of chronic disease, diabetes, and arthritis.

There is a need to examine and identify ways to build workforce capacity to provide equitable, culturally informed care and preventive services for elders in tribal communities. American Indian/Alaska Native (AI/AN) cultural tenets demand that tribal elders are supported in-home or in multi-generational housing, as opposed to skilled nursing or other long term care facilities. As a result, the lay tribal health care workforce, consisting of community health representatives (CHRs), family health workers, and home aides, are often the primary group tasked with caring for elders in tribal communities.

The purpose of this project is to assess whether the home care workforce in tribal areas has a sufficient supply of workers with access to training, and to identify the barriers and facilitators to meeting the LTSS needs of elders living in tribal housing. Findings from this project will used by tribal communities to assess and disseminate best practices and curricula for home care training and workforce recruitment and retention.


Key Questions:

This project aims to answer three questions:

  • What is the role of the home care workforce for tribal elders and how do they vary across IHS regions?
  • Is home care training available to tribal workers and is it culturally reflective of unique tribal community needs?
  • What are barriers and facilitators in providing the needed home care workforce in tribal communities?


For more information, contact Susan Chapman or Jackie Kaslow.