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Tribal Elders and Ombudsman Services

Ombudsman programs are likely to provide information and/or services to Tribal Elders living in every state. Thirty-five states have federally recognized tribes living within their borders.  There are eighteen long-term care facilities in Indian Country, so the majority of Tribal Elders living in long-term care facilities reside in facilities in other communities. This page contains resources and information to increase your effectiveness in serving Tribal Elders.


NORC Resources

Long-Term Care Ombudsman Services to Tribal Elders (TA Brief: Technical Assistance for LTCO Practice)
This brief includes prompts to consider in order to gain a better understanding of the tribal elder population in your state, communication and coordination tips from LTCO programs currently working with tribal elders, and additional resources. 

Title VI Ombudsman Services
Tribes may use Title VI funds for ombudsman services, the services are to be “substantially in compliance” with provisions of Title III (Section 614(a)(9) of OAA).

  • Title VI Directors: Contact Cynthia LaCounte (cynthia.lacounte@aoa.hhs.gov), Director, Office for American Indian, Alaska Natives and Native Hawaiian Programs, ACL/AoA for contact information for Title VI Directors by Tribe and geographic location.


CMS Resources

Tribal Nursing Home Best Practices: Trauma and Person-Centered Care
A report that defines trauma-informed care and highlights the approaches to patient centered care used by nursing home staff to care for residents that have experienced trauma.  

LTSS in Our Community: Tribal Nursing Home Directory (April 2018)
CMS recently released an updated directory of tribal nursing homes. This directory lists contact information for the 18 nursing homes in Indian Country that offer long-term services and supports (LTSS). It includes details about certification, the number of beds, and each facility’s ombudsman and Quality Innovation Network–Quality Improvement Organization.

Tribal Nursing Home Best Practices for Cultural Sensitivity (March 2018)
Strong connections to culture and traditions enhance the quality of life for AI/AN elders as they age. Many tribal nursing homes and assisted living facilities have developed strategies for providing culturally sensitive care to their residents. A new report from CMS describes how four tribal long-term care facilities provide culturally sensitive care for elders. The report highlights recommendations other tribal programs can follow to provide care that honors individual lifeways and preferences. The report outlines tips for honoring tradition, coordinating cultural activities, incorporating spirituality into care, and training staff to be culturally sensitive.

Tribal Nursing Home Best Practices for Emergency Preparedness (February 2018)
The report was developed by the Department of Health & Human Services and Centers for Medicare & Medicaid Services. In November 2016, CMS implemented a regulation requiring health care facilities that participate in Medicare and Medicaid to create emergency preparedness plans. Many tribal nursing home emergency plans provide examples of culturally sensitive planning measures that other tribal facilities can emulate. This report describes the emergency preparedness approaches of five tribal nursing homes. It compiles emergency preparedness recommendations from nursing homes that have successfully created emergency plans and shares what has worked for these facilities, including leveraging partnerships, securing funding, and implementing staff training.

Tribal Nursing Homes: Best Practices for Patients with Dementia and Alzheimer’s Disease
The report was developed by the Department of Health & Human Services and Centers for Medicare & Medicaid Services. Increased life expectancy in Indian Country means the American Indian and Alaska Native (AI/AN) elder population is expected to double by 2030. With an increasing number of elders, Alzheimer’s disease and dementia are becoming more visible in Indian Country. Tribal communities are starting to take notice and are seeking ways to provide the best care they can to elders with dementia and Alzheimer’s disease, their families, and their caregivers. Tribal nursing facilities are implementing a number of approaches to care for patients with dementia and Alzheimer’s disease. Some have dedicated “memory care units,” while others house patients with dementia within their general population. Many of these programs are in their infancy, and long-term services and supports providers are seeking ways to improve care and increase capacity. AI/AN nursing homes are joining forces to share their wisdom, survey existing programs, develop best practices, and identify areas for further research and program development.

Tribal Nursing Home Best Practices: Traditional Foods
This CMS report was produced in cooperation with Uniting Nursing Homes in Tribal Excellence (U.N.I.T.E.). The report explains how to plan a traditional foods menu, offers tips for sourcing traditional foods and navigating regulatory issues, provides links to webinars and additional resources. Valdeko (Val) Kreil with the Maniilaq Association says they serve traditional foods, like caribou and moose, to elders at the Utuqqanaat Inaat nursing home in Kotzebue, AK. “These are the foods they grew up on. These are the foods they’re comfortable with—home cooking, if you will.” While CMS’ new report on traditional foods was written as a nursing home best practices guide, much of the information in it applies to elder food programs offered to elders in their homes or tribal senior centers.

CMS Website
This website includes additional resources from CMS.


AoA/ACL Resources

Long-Term Care Ombudsman Services in Indian Country PowerPoint (August 2015)
The Long-Term Care Ombudsman Program was included on the agenda of the 2015 National Title VI Training & Technical Assistance Conference in DC. The conference was sponsored by the Administration on Aging (AoA), Administration for Community Living (ACL). This session provided information about the LTCOP, how services can be accessed, and explored opportunities for the LTCOP to increase and improve culturally competent services to Native Americans in facilities.

Administration on Aging, Services for Native Americans (OAA Title VI)

Native American Issue Brief (October 2017)
The Administration for Community Living released a new Native American Issue briefing. It is designed to: 1) assist the aging network, which includes many organizations serving American Indian, Alaskan Native, and Native Hawaiian elders; and 2) share information about some of the innovative programs that promote health and support community living for elders. 


Outreach and Cultural Competency

A Healing Journey for Alaska Natives - Video Series
This educational video series was made by ​The Office for Victims of Crime (OVC) and is designed for federal, state, local, and tribal victim service providers, criminal justice professionals, and others who work with Alaska Native victims of domestic violence, sexual assault, and human trafficking. The videos in this series will increase awareness about violence committed against Alaska Natives; identify first responders to Alaska Native victims of crime; illustrate the challenges faced by Alaska Native victims and the critical role that culture and tradition play in both the well–being of Alaska Natives and in helping victims and communities heal; present techniques and strategies for enhancing responses to and the investigation of violence against Alaska Natives; and illustrate – through case studies and personal experiences – how local customs, traditions and best practices underscore the need for a multidisciplinary, multijurisdictional, collaborative response to violence committed against Alaska Natives. View the videos online or order the DVD from the OVC Resource Center.

Culture Card: A Guide to Build Cultural Awareness, American Indian and Alaska Native 
This card provides a general briefing of five elements of cultural competence, including topics such as the role of veterans and elders, health and wellness challenges, and spirituality. It is a useful, concise reference guide.

Engaging American Indian and Alaska Native Medicare Beneficiaries: Senior Medicare Patrol Toolkit
This toolkit provides background information on Tribal Elders, outreach strategies, cultural competency tips, specific information on individual Tribes, and a list of resources. Much of the information in the Toolkit is applicable to ombudsman services.

Working Effectively with Tribal Governments
A curriculum consisting of short modules providing an introduction to working with Tribes. The curriculum was developed by the Substance Abuse and Mental Health Services Administration. One module, Cultural Orientation and Working with Tribal Governments provides tips on communication and beliefs and values. There is a link to a list of resources for additional information and federal agencies serving Tribes. Registration is required to access the curriculum but there is no charge.

Long Term Care Ombudsman Program for Tribal Residents, pp. 91 - 93 (May 2013)
Tiffany Yazzie, Regional Ombudsman Coordinator, AAA, Region 8, Inter-Tribal Council on Arizona, Inc., Phoenix, AZ. Ombudsman services to Tribal Elders from seventeen tribes living off Tribal lands is described. Examples are given of cultural differences, the needs of elders, and the impact on ombudsman services.  

Long Term Care Ombudsman Program: Opportunities for Services for American Indians, pp. 94 - 94 (May 2013)
Becky A. Kurtz, Director, Office of Long-Term Care Ombudsman Programs, ACL, Washington, DC. A description of the ombudsman program, creating or expanding tribal ombudsman services, serving residents of facilities on tribal lands, and the availability of Title VI funds are discussed.

Cultural Communication Information - Alaska Native Tribal Health Consortium
This page contains audio recordings of Residents' Rights in Alaska native languages as well as additional resources on how to communicate effectively with Alaska Native Elders.

What Works for Us: Culture and Community
Many tribal LTSS programs have reached success by reflecting their unique cultures and involving their communities in the services they provide. Learn more about the strategies that worked for these programs by watching the LTSS Technical Assistance Center’s video, “What Works for Us: Culture and Community.”


Resource Centers

National Indigenous Elder Justice Initiative
The National Indigenous Elder Justice Initiative was created to address the lack of culturally appropriate information and community education materials on elder abuse, neglect, and exploitation in Indian Country.

National Indian Council on Aging
The National Indian Council on Aging focuses on 1) access to information; 2) more effective options for self-care and longevity information and awareness; and 3) to streamline and increase access to aging.

National Resource Center for American Indian, Alaska Native and Native Hawaiian Elders
This Center focuses on: 1) empower Native communities to incorporate traditional and contemporary health practices within community health care systems; 2) provide technical information to promote culturally sensitive and functionally appropriate services to maintain social well-being; and 3) provide an arena for discussions about the increasing problems of elder abuse to help Native communities in developing their own plans to reduce and control occurrences. 

National Resource Center on Native American Aging
The goal of the program is to improve the quality of life for Native elders through research, training, and technical assistance. UND seeks to identify and increase awareness of evolving Native elder health and social issues and to empower Native people to develop community-based solutions to meet their most pressing needs.

National Resource Center for Native Hawaiian Elders
The National Resource Center for Native Hawaiian Elders focuses on improving the well-being of Native Hawaiian elders by forging stronger collaborative relationships between the University, Native Hawaiian and gerontology communities.

Tribal Resources, National Center on Elder Abuse and the Administration on Aging



Kiowa-Choctaw artist and filmmaker Steven Paul Judd describes ways tribes can provide long-term care to elders and people with disabilities in five new videos from the Centers for Medicare & Medicaid Services (CMS). The videos use animation to illustrate culturally appropriate and tribally driven ways to improve the lives of elders, people with disabilities, and their families.

Traditional Foods for Tribal Elders (0:31)

Dementia and Alzheimer’s Care for Tribal Elders (0:46)

Home-Based Care for Elders and Tribal Members with Disabilities (0:34)

Tribal Support for Caregivers (0:41)

Financing Tribal Long-term Services and Supports (0:47)


Additional Resources

NCEA Fact Sheet: A Spotlight on Two Spirit Elders and Elder Justice (June 2021)
This  factsheet is based on findings from the Two Spirit Elders Resource and Information Guide. The term “Two-Spirit” is an attempt to embrace the ways in which distinct American Indian/Alaska Native (AI/AN) communities had and continue to practice sexual and gender expressions that exist outside of the European binary labels imposed on tribal communities through the process of colonization.  

Disrespect of Our Elders: Elder Abuse in Indian Country
This brief was written by Dr. Jacqueline Gray of The National Adult Protective Services Association (NAPSA), in conjunction with the National Committee for the Prevention of Elder Abuse (NCPEA). The R2P series links cutting-edge research with everyday practice in adult protective services. This brief is a follow-up to the webinar of this subject. This brief and others are available on the NAPSA website.

Traditional Foods Resource Guide
This Traditional Foods Resource Guide was made by SEARHC Health Promotion grant funds from the National Native Network and Administration for Native Americans. This resource will increase the knowledge of Traditional Foods to support the health, well-being, and prosperity of Alaska Native and American Indian People. Included in the resource guide is an introduction to a few traditional and local foods resource tools available in four Indian Health Service areas of the United States:  Alaska, California, Great Plains, and Portland. 

National Council of Urban Indian Health
This is the only National 501(c)(3) organization devoted to the support and development of quality, accessible, and culturally-competent health services for American Indians and Alaska Natives living in urban settings. The website contains fact sheets, including one on myths and realities and data about urban Indians. The members page contains an interactive map showing the location of the urban health centers across the country.

The Urban Indian Health Institute
This Institute is a tribal epidemiology center funded by the Indian Health Service. The mission is to support the health and well-being of urban Indian communities through information, scientific, inquiry, and technology. It is an excellent resource and has several fact sheets, tool kits and other information.

Native One-Stop- Benefits.gov
Benefits.gov, the official benefits website of the United States, launched a portal of resources for Native American, Alaskan Native, and tribal populations. The portal, Native One-Stop, provides information about the services that are available through the Federal government. Native One-Stop conveniently houses any service that these populations may need with topics ranging from assistance for populations with severe disabilities to congressional internships for Native Americans.

A Healing Journey from Alaska Natives
The Office for Victims of Crime (OVC) released a video series, developed in collaboration with the Office on Violence Against Women, supporting Alaska Native victims of crime. A Healing Journey for Alaska Natives is an educational video series designed for federal, state, local, and tribal victim service providers, criminal justice professionals, and others who work with Alaska Native victims of domestic violence, sexual assault, and human trafficking.


Ombudsman Program Examples

View Ombudsman program examples on tribal elders


Information to Share with Consumers

Traditional Food Resource Guide

Native One-Stop – Benefits.gov

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