Problem: Rural areas lack facilities with comprehensive skilled nursing and health care services. This forces many residents, especially the elderly, to move far away from their loved ones to access needed services.
Background: As a young girl on a Navajo reservation in northeastern Arizona, Frances Stout, R.N., had the good fortune of living near the Sage Memorial Hospital School of Nursing, the nation’s first accredited nurse training program for Native American women.
Stout, 74, recalls seeing young Navajo women clad in traditional white nursing garb on the hospital campus near her home on the Ganado Mission—an image that inspired her to follow suit. Stout got a job as a teenager at Sage Memorial Hospital and, after she graduated from the mission’s high school, enrolled in the school of nursing at the Methodist Hospital of Dallas—leaving her friends and family some 800 miles behind.
With a nursing diploma in hand, Stout returned to Ganado and practiced nursing at Sage Memorial. She later joined the Indian Health Service, a federal agency that provides health care for American Indians and Alaska natives, and eventually ended up working on the Tohono O’odham Reservation in southwestern Arizona, the home of her ancestral tribe.
Stout spent more than three decades at the agency, and during her tenure became acutely aware of the many health challenges facing American Indians. One of the biggest hurdles to good health, she says, is the lack of public transportation systems on reservations.
Without access to buses or railways, many tribal members have no way to get to the Indian Health Service hospital. This puts an especially heavy burden on tribal elders, many of whom do not have cars or are not able to drive.
Compounding this problem is the absence of local long term care services on many reservations.
This forces many families to move aging relatives out of their homes and off the reservation altogether—often to nursing homes in cities hundreds of miles away. The moves tear apart families and devastate elders, who are unaccustomed to non-native food, often are not fluent in English and aren’t able to participate in traditional ceremonies.
“It’s a very painful experience,” Stout says.
The Solution: While working at the Indian Health Service, Stout and others hatched a plan to build a facility for the elderly on the Tohono O’odham Reservation so tribal elders would not be forced to choose between their health and their homes.
“That was our passion,” Stout says, “to bring our elders home.”
Stout first served as a liaison to an advisory group working on the project and continued her advocacy after retiring from the Indian Health Service.
The advisory group worked for more than a decade to realize its dream. Stout and her colleagues conducted feasibility studies, explored potential building sites, negotiated contracts with construction companies, studied inspection requirements, and interviewed candidates for staff positions.
The guiding principal was to offer skilled nursing care and honor the Tohono O’odham way of life at the same time. Creating this balance, Stout and others believed, was key to maintaining elders’ physical, mental and psychological health.
The Tohono O’odham Nursing Care Authority opened in 2000 in Sells, Ariz.—in the heart of the reservation—and has since helped residents find that balance.
The 60-bed facility is certified by the Centers for Medicare and Medicaid Services (CMS) and boasts a staff of registered and licensed practical nurses as well as physical, occupational and speech therapists.
Since its opening, the facility has received numerous accolades, including a 2008 award from the Harvard Project on American Indian Development, a 2008 local impact award from the National Indian Health Board, a 2009 award from the Indian Health Service and a star rating from CMS.
It has also received visitors from a number of other American Indian tribes hoping to replicate the program on their reservations.
In what has now become a second career, Stout is chairperson of the nursing home’s governing board. This month, she won a Community Health Leaders award from the Robert Wood Johnson Foundation (RWJF) for her work to improve the health and quality of life for Native Americans.
RWJF Perspective: The Foundation has long supported efforts to improve access to health care services for underserved populations—including those in rural areas. Now in its 16th year, the Foundation’s Community Health Leaders Award honors outstanding individuals like Stout who work to improve the health and quality of life for disadvantaged or underserved men, women and children across the United States.
The Community Health Leaders Award carries a prize of $125,000 and helps raise awareness about barriers to health for underserved populations.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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