LTSS Newsletter—November 2020

Next LTSS webinar: December 16, 2020

American Indian/Alaska Native Long-Term Services and Supports

Technical assistance for culturally competent care
November 2020
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Reducing loneliness for nursing home residents

As the pandemic continues, the behavioral health of nursing home residents continues to be a concern. A new survey of nursing home residents (PDF, 1.74 MB, 46 pp) by Altarum looked into how residents’ lives have changed due to the pandemic.

The survey found that social interactions inside and outside of nursing homes have dropped sharply. More than half of the respondents said they no longer leave their rooms and feel lonelier since the pandemic began.

The survey report recommends that long-term care facilities regularly check in with residents to see if they are feeling isolated or lonely. To help ease these feelings, it is best for facility staff to develop ideas ahead of time on how to safely reduce loneliness, such as offering to assist the resident in setting up a video call with a loved one. Additionally, the report recommends that long-term care facilities add these processes to their facility assessment plans.

Shortly after this report’s publication, CMS released updated guidelines (PDF, 179 KB, 11 pp) on ways nursing homes can safely facilitate visits during the pandemic. Like the recommendations in the survey report, these guidelines support nursing homes in their efforts to reduce loneliness and social isolation for residents by detailing how to host safe visits, as appropriate.

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    Behavioral health resources for Indian Country
    For more resources on supporting the behavioral health of elders and Indian Country as a whole, explore the new Tribal Behavioral Health page on
Who is it for?
This site is intended for people seeking behavioral health care for themselves or loved ones, health care providers, tribal leaders, and tribal health directors who would like to share information with their patients.
What does it include?
  • Tribal behavioral health coverage
  • Preparation for a behavioral health appointment
  • Substance use disorders
  • Behavioral health terms
  • Additional resources
  • A service locator to find local services by state
Screenshot of the service locator

Celebrating family caregivers

November is National Family Caregivers Month, a time to honor those who provide care for their family members and to raise awareness about caregiving needs and challenges.

A sample graphic from the Administration for Community Living that reads "Recognize Family Caregivers: National Family Caregivers Month"

According to the AARP, about one in every five people in the United States cares for an elder or family member with disabilities, and that rate is higher in Indian Country, where multigenerational households are common.

The Administration for Community Living offers materials to honor and raise the visibility of family caregivers, including graphics and recommended hashtags for social media.

While it is important to raise awareness about caregiving challenges during this time, acknowledging rewarding aspects of caregiving can help offset the stress that comes with it. Positive aspects of caregiving may include strengthened connections between the caregiver and the person receiving care and the knowledge that providing care helps those who need support to stay at home longer, rather than moving to a long-term care facility. See more about the rewards of caregiving and consider sharing some of them to encourage the caregivers in your community.

Supporting healthy minds for wisdom keepers

A sample poster from the Wisdom Keepers campaign title "Healthy Heart, Healthy Brain"

About 1 in every 3 AI/AN elders age 65 or older is at risk for dementia.

According to the Centers for Disease Control and Prevention, heart health is closely connected to brain health. To raise awareness about dementia and encourage elders to keep their minds and hearts healthy, the National Council of Urban Indian Health recently launched its Wisdom Keeper campaign. Campaign materials include a social media toolkit, videos, posters, and links to more information on ways to help elders stay healthy.

Tribal snapshots: How tribes are supporting elders while social distancing

The pandemic has required many elders to stay home. In response, tribes have designed many solutions to continue serving their elders during this challenging time. Below are just a few of the ways in which tribes and tribal citizens are stepping up to support their elders.

Passamaquoddy Tribe at Pleasant Point

several sheets of colored construction paper

Passamaquoddy Tribe at Pleasant Point created the colored paper project to easily identify the services and supplies elders need without knocking on their doors. Through this project, elders place colored paper in their windows to indicate what they need, such as medical care (red), supplies like toilet paper or soap (yellow), or social interaction (blue). Staff drive by the elders’ houses twice a day to monitor and respond to the papers.

Muckleshoot Tribe

Photo of a vehicle stopped at a testing tent

In response to the pandemic, Muckleshoot Tribe created an emergency operations center. They used the Federal Emergency Management Agency emergency operations center model as a starting point and tailored the facility to meet the tribe’s needs. The tribe also obtained funding to establish a drive-up testing tent, which is open daily. Through this arrangement, the Muckleshoot Elders In-Home Support Services program was able to screen all caregivers early in the pandemic and continue providing in-home caregiving support as needed, assured that caregivers were not likely to spread the virus.

The Muckleshoot Elders In-Home Support Services program conducts pharmacy and home supply deliveries for elders using door hangers, and they partnered with Indian Health Service and Amazon to obtain high-demand supplies. Additionally, home health aides increased phone contact with elders to support them during the pandemic.

Navajo Nation

As Navajo Nation works to lower the number of COVID-19 cases, a Navajo citizen created an organization to ensure Navajo elders receive the support they need. Monica Harvey founded Defend Our Community to deliver sanitized supplies to elders in need and check on them, especially during the hot summer months. The organization’s volunteers have helped more than 100 elders.

Cherokee Nation

Cherokee Respond, Recover, Rebuild logo

Cherokee Nation developed the Respond, Recover and Rebuild program to provide Cherokee elders COVID-19 relief services. As part of this program, elders can apply through an online portal to receive assistance with food and utility expenses. The tribe has supplied more than 73,000 Cherokee elders and families with food and distributed more than 13,000 prepared meals to elders while senior nutrition sites are closed. Cherokee Nation also has an Elder Safety Assistance program to further help elders recover from impacts of the pandemic.

Soboba Band of Luiseño Indians

Twice daily, Soboba Band of Luiseño Indians delivers free meals and checks on elders who are staying home. There is also a well-stocked pop-up shop on the reservation that provides food and household supplies for elders.

Morongo Band of Mission Indians

bags of produce

To support elders during the pandemic, Morongo Band of Mission Indians delivers free groceries and assists with prescriptions, health care and tele-medicine services, and transportation through its Dial-a-Ride program.

Torres Martinez Desert Cahuilla Indians

Torres Martinez Desert Cahuilla Indians prepares and delivers care packages to elders and provided the tribal council’s phone numbers to them so elders can communicate with the tribal council about their needs and how to best meet them.

Share your stories

If your tribe or tribal citizens have taken any measures to help elders stay safe while they stay home, let us know. Join the conversation on LinkedIn.

Training to help elders during a disaster

An older man sitting behind a bunch of pill containers.

The U.S. Department of Health and Human Services has released a free online training on how to assist elders during a disaster. Focusing on special considerations for elders, the training provides resources, tools, and strategies to address their needs during natural disasters and pandemics.

LinkedIn Tribal Affairs Group
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.
Upcoming webinar

Stay tuned for the December LTSS webinar

There is no LTSS webinar in November. The next webinar is December 16. The topic is HomeFit and Caregiving. Learn more about the December LTSS webinar.

In the meantime, check out an archived LTSS webinar, like this one from July: "Supporting Tribal Long-Term Care Facility Heroes during the COVID-19 Pandemic."

About the LTSS webinars

LTSS webinars share information and tools for tribal LTSS programs, with topics ranging from financing to elder abuse prevention to culturally appropriate dementia care.

Caregiver’s corner

Medicare enrollment

For caregivers who help the people they care for manage their health coverage, December 7, 2020, may be an important date. It is the deadline for (1) new enrollees to sign up for Medicare and (2) those who have Medicare to make changes to their plans.

New enrollment

A thumbnail image of the cover page of the Medicare & You 2021 Handbook

Elders age 65 and older, people with disabilities, and those with permanent kidney failure may be eligible to sign up for Medicare. Caregivers can check the eligibility of the person they care for at and learn more about how to get started at

Changes to Medicare coverage

For those who are already enrolled in Medicare, caregivers can help them review their current health coverage and make changes if the plan no longer meets their needs. Caregivers and those they care for can compare coverage options at or review the Medicare and You 2021 Handbook (PDF, 3.5 MB, 124 pp.) for more information.

Funding opportunities

Sage grants: Tobacco cessation

Deadline: November 30, 2020

Apply for a Sage grant

Through the Sage grants from the Urban Indian Health Institute, grantees will use AI/AN traditional, cultural, and regional knowledge to encourage tobacco cessation within urban Indian communities.

Social Care Referrals Challenge

Deadline: December 14, 2020

Apply for the Social Care Referrals Challenge

The Administration for Community Living released their Social Care Referrals Challenge to strengthen care coordination and track referral patterns and gaps in services. Grantees will develop and implement solutions that improve care coordination and health-related outcomes over time.

Sweetgrass grants: Chronic respiratory disease management and prevention

Deadline: December 21, 2020

Apply for a Sweetgrass grant

Through the Sweetgrass grants from the Urban Indian Health Institute, grantees will use AI/AN traditional, cultural, and regional knowledge to support the prevention and management of chronic respiratory disease among urban Indian communities.

Field Initiated Projects

Deadline: December 21, 2020

Apply for the Field Initiated Projects program

The Administration for Community Living released their Field Initiated Projects funding opportunity to support the self-sufficiency of people with disabilities and fully integrate them into their communities. Grantees will create models, methods, tools, systems, materials, devices, applications, standards, or intervention protocols that benefit the target population.

Send Us Your News

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.

About the Newsletter

American Indian/Alaska Native 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.

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