LTSS Newsletter—July 2020

Upcoming webinar: Long-term Care in Indian Country, Part 2
Wednesday, July 22

Long-Term Services and Supports

Technical assistance for culturally competent care

July 2020

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LTSS Technical Assistance Center

Visit the online LTSS TA Center for videos, best practices, toolkits, a resource library, and a step-by-step planning roadmap.

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Adapting cultural practices during COVID-19

Social wellbeing and connection to culture and tradition are important components of tribal LTSS, as they support overall health.

To help prevent the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) recommends social distancing (keeping a safe physical distance from others). Continuing cultural practices and social engagement while physically distancing may require some creative approaches.

Physically Distant but Socially Close, a fact sheet from Seattle Indian Health Board’s Urban Indian Health Institute, offers ideas on how to adapt cultural practices to meet social distancing guidelines. Ideas range from online drum circles to ways to greet others without hugs or handshakes.

The importance of culture in long-term care facilities

Maintaining ties with community, family, tradition, and culture promotes quality of life for elders as they age. These aspects of wellbeing are important considerations for enhancing the health of residents at tribal long-term care facilities.

See a report from the CMS LTSS Technical Assistance Center (PDF, 4 MB, 11 pp) on how tribal long-term care facilities integrate culture into care.

A young indigenous woman wearing a mask

COVID-19 information

Caring for elders this summer

Extreme heat can be dangerous, especially for elders, so it is important for them to stay cool and hydrated. Summer safety for elders requires some additional considerations this year.

To help avoid the spread of COVID-19, masks are recommended and sometimes required in public places. As essential as masks are, they can be hot and make it difficult to remember to drink enough water. Here are some tips to help elders stay safe in summer heat while wearing a mask:

  • Plan breaks when you are in indoor, public spaces so elders can safely remove their masks to stay hydrated and cool.
  • Carry extra masks. Sweat can reduce a mask’s effectiveness.
  • If possible, provide lightweight surgical masks.
  • Where there is at least a 6-foot distance between people, masks are not usually required outdoors. As an alternative to a mask in these situations, help elders keep safe distances from others and remind them not to touch their faces.
  • Handwash cloth masks in between uses and dispose of paper masks.

It is also important to care for masks appropriately so they stay effective. This infographic from the Urban Indian Health Institute describes how to properly wear and take care of cloth masks.

Infographic from Urban Indian Health Institute with a graphic of an older woman wearing a fabric mask:
(1) Wash your mask every night or as often as possible.
(2) Do not share your mask with anyone.
(3) Do not put a fabric mask on children under 2 years old.
(4) Wash hands before and after putting on your mask.
(5) Do not touch your face when removing your mask.
(6) Mask needs to have several layers of fabric.
(7) If you can't breathe in it, removing a layer may help.
(8) Mask should fit snugly but comfortably.
(9) Smize (Smile with your eyes).
For more resources visit

Dementia caregiving and COVID-19

Caregiving for people with dementia presents unique challenges, and caring for them while trying to protect against COVID-19 can add to these challenges. Updated guidelines from the CDC can help caregivers adjust their approaches to caregiving during this time to limit physical contact when possible and watch for symptoms.

Although respiratory symptoms are the most common for COVID-19, other symptoms can occur, and in those with dementia, a "worsening" of dementia can be a sign of infection. Caregivers are first responders for many patients with dementia, as their history with the elder makes spotting COVID-19 symptoms easier for them than for someone without that history.

Cancer and COVID-19

People whose immune systems have been weakened by cancer or cancer treatment are at risk for serious illness from COVID-19.

To help reduce that risk, an updated version of the Urban Indian Health Institute’s COVID-19 Information for Native Cancer Patients and Survivors is now available. The resource includes:

  • Tips for staying healthy
  • Steps to take if you experience symptoms of COVID-19
  • Suggested sources for additional information on COVID-19
Upcoming webinar

Supporting Tribal Long-Term Care Facility Heroes During COVID-19 Pandemic

Wednesday, July 22, 2020

Join UNITE (Uniting Nursing Homes in Tribal Excellence) in a panel discussion with nursing home administrators. The panelists will discuss how they support and honor their staff.

Participants will learn:

  • the impacts of COVID-19 among facility staff and the community
  • what tools and resources staff use to protect residents and themselves

Have questions for our presenters?

Let us know before the webinar by emailing

Please note your
location's call-in time:

8 a.m. Hawaii
10 a.m. Alaska
11 a.m. Pacific
11 a.m. Arizona
12 p.m. Mountain
1 p.m. Central
2 p.m. Eastern


Tami Reed
Morning Star Care Center

Tiffany Shangreau
Oglala Sioux Lakota Nursing Home

Brandi Moran
White River Health Care Center

Deb Arbogast
Medicine Wheel Village

Rosie Abad
Archie Hendricks Sr. Skilled Nursing Facility

Caregiver’s corner

Tips for sharing caregiving responsibilities

Caregiving does not have to be limited to the primary caregiver. Whether caregivers live near or far, there are many options for sharing tasks. The National Institute on Aging (NIA) offers tips to help split caregiver responsibilities, which include:

  • Consider each other’s strengths when divvying up caregiving responsibilities – Is someone better at finding information, speaking with medical staff, or handling finances?
  • Consider each other’s limits – Does anyone have travel, emotional, work-related, financial, or family-related limitations?

During the COVID-19 pandemic, many caregivers are providing as much care from a distance as possible to help slow the spread of the virus. For long-distance caregivers, the tips listed in NIA’s infographic can help determine how to share the caregiving workload without being present in person.

Six Tips for Long-Distance Caregiving

Anyone who is caring for a friend, relative or parent from far away can be considered a long-distanced caregiver. Whether you are helping with finances, arranging for care, or providing emotional support, long-distance caregiving can bring a host of unique challenges.

Keep these tips in mind to help make life more manageable.
(1) Learn as much as you can about your loved one’s health, treatments and available caregiving resources. You can understand what is going on, anticipate the course of an illness, prevent crises, and assist in healthcare management.
(2) Organize important paperwork. Keep all vital information in one place and up-to-date, including healthcare documents, wills and financial information. Provide copies to other caregivers.
(3) Make sure at least one caregiver has written permission to receive medical and financial information. To the extent possible, one person should handle conversations with all healthcare providers.
(4) Plan your visits. Find out in advance what the person would like to do. Aim for simple and relaxing activities. And check with the primary caregiver to see if you can help with any priority tasks.
(5) Stay connected. Schedule calls with healthcare providers and facility staff to discuss the person’s well-being. Update trusted family members on your loved one’s health and needs.
(6) Consider caregiver training. Some local chapters of the American Red Cross or other not-for-profit organizations might offer caregiving courses. Medicare and Medicaid will sometimes cover the cost of this training.
Visit Long-Distance Caregiving to learn more.
Funding opportunities

Public transportation on tribal lands

Deadline: August 24, 2020
Apply: Public Transportation on Indian Reservations: Tribal Transit Program

Under this funding opportunity, the Federal Transit Administration is providing $5 million to fund programs to support tribal public transit services.

Supporting tribes to increase commercial tobacco cessation

Deadline: August 28, 2020
Apply: Supporting Tribes to Increase Commercial Tobacco Cessation (Word, 118 KB, 10 pp)

The National Indian Health Board is providing this funding opportunity in support of tobacco cessation in Indian Country through evidence-based services and activities.

Tribal injury prevention cooperative agreement program

Deadline: October 1, 2020
Apply: Tribal Injury Prevention Cooperative Agreement Program

Through the Indian Health Service, this program seeks to reduce injuries among American Indians and Alaska Natives. Awardees will implement evidence-based strategies to prevent injuries and promote behavior change. Elderly fall prevention is a priority area of the program.

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Join the conversation on LinkedIn

Want to learn more about or discuss LTSS in Indian Country? Looking to connect with others working in the same field? Join the Tribal Affairs Group on LinkedIn. If you are a member of the group already, you can access it by clicking the group name under Groups on the left side of your LinkedIn landing page.
About the TA Center

The LTSS Technical Assistance Center provides a roadmap for American Indian and Alaska Native communities who are planning and implementing LTSS programs to care for their elders and people with disabilities.

About the Newsletter

Long-Term Services and Supports Solutions is published monthly by the CMS Division of Tribal Affairs to share information, funding opportunities, and resources with LTSS planners, tribal leaders, and supporters.

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Do you have news to share about LTSS in Indian Country? Send it to, and we’ll include it in a newsletter. Contact us with other comments or feedback, too.

Centers for Medicare & Medicaid Services Indian Health Service Administration for Community Living