INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Culturally Appropriate Consumer-Directed Care: The American Indian Choices Project


In healthcare and long-term care, American-Indian elders may be among the most neglected and underserved populations in the United States. They face the same health-related problems as the general population, but for them these problems are often magnified by such factors as a longstanding lack of tribal health services--particularly in remote locations--cultural tensions, and lack of information. Of the 2.41 million American Indians, nearly 170,000 are 55 years of age and older. Most do live in remote areas, on one of approximately 275 tribal land areas with populations of less than 10,000 people.

Many have had little formal education, and most live well below the poverty level. According to a recent report by the National Indian Council on Aging, Social Security constitutes the only source of income for 30.2 percent of American Indian elders. Moreover, many elders speak English only as a second language, if at all. This, plus a basic distrust of nontribal agencies and professionals, based on a history of broken promises and treaties, causes many elders to avoid seeking basic services to which they are entitled.