Cultural Humility: Empowering elders through engagement


On behalf of the Centers of Medicare and Medicaid
Services, the Administration on Aging, and the Indian Health Service, I would like to
welcome everyone to the Long-Term Services and Supports webinar series. My name is Julie Cahoon, and I work for Kauffman
and Associates. I’ll be the moderator for today’s webinar. First, before we begin, I’d just like to
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is being recorded and that the recording will be made available online in the near future
on CMS.gov. With those announcements made, I’d like
to welcome everyone to today’s webinar. Today’s webinar is titled, “Cultural Humility:
Empowering Elders Through Engagement.” Today, we have several presenters that have
joined us to share their knowledge and experience. I will introduce each person. We have Debbie Dyjak who has served as the
Education Coordinator at the Archie Hendricks Senior Skilled Nursing Facility on the Tohono
O’odham Nation since 2011. She has been an adjunct faculty member with
the Arizona Geriatric Education Center and the Geriatric Workforce Enhancement Program. She holds a bachelor’s degree in nursing
and a master’s degree in support psychology, specializing in wellness and stress management. Since 2015, Debbie has been an integral leader
for United Nursing Homes and Tribal Excellence Group. Agnes Sweetsir is the administrator for the
Yukon Koyukuk Elder Assisted Living Facility in Galena, Alaska. The facility is a tribally owned and operated
ALH for primary tribal elders. Her mission is, “To honor our elders by
providing safe and compassionate care and support in a culturally sensitive home.” Regis Pecos is the co-director of the Santa
Fe Indian School. Joseph Ray is an independent living specialist. He has spent 25 years as an advocate working
with people with disabilities. Joseph is a Laguna Rainbow Corporation Elder
Care Services Board Member and has focus for elders in Long-Term Care and Community-Based
Services. Jordan Lewis is the Director of the National
Resource Center for Alaska Native Elders and an Associate Professor for the University
of Alaska Anchorage for the WWAMI School of Medical Education. He has trained as a cross-cultural community
psychologist and social worker and a credentialed…a credentialed professional gerontologist. Gary Ferguson is a licensed neuropathic doctor
living in Anchorage, Alaska. For the past 16 years, Dr. Ferguson has worked
across Alaska to address the social, economic, cultural, and environmental factors that contribute
to the health and well-being of Alaskans. Thank you to all the presenters for joining
us today. I will now turn it over to Debbie to provide
an introduction to today’s topic.Good morning. Good afternoon, everyone. Thank you for your patience. Just briefly, the learning objectives for
today have to do with defining cultural humility and understanding that relationship in long-term
support services with patient-centered care. We will be talking about some challenges related
to cultural humility, especially in a long-term setting. And we will talk about understanding the empowering
benefits to the elders, to the staff, to the family, and to the community of using this
approach. Ultimately, we want to find ways to help our
elders settle in and feel at home. As Julie mentioned, I co-lead UNITE, the Uniting
Nursing Homes in Tribal Excellence collaborative. The Tribal Nursing Home collaborative is open
to all tribal nursing homes and assisted living facilities across the country. We formed in 2014. We have monthly calls. We have a Steering Committee that also meets
monthly and an annual meeting. And we are committed to establishing best
practices and building relationships nationwide with our identified stakeholders. We work closely with Indian Health Service,
with the Administration on Community Living, with CMS. And some of our stakeholders include the QIOs,
along with the GWEPs, the Geriatric Workforce Enhancement Programs. We are open to membership with the ombudsmen
and cultural experts and educators. The collaborative was formed to promote opportunities
for tribal nursing homes to network, discuss best practices, and promote evidence-based
education and training. And we want to work towards the common goal
of providing culturally responsive and exceptional care for the elders throughout Indian Country. We do have a website, and we can also be found
on CMS.gov. So, cultural humility. It could mean, roughly defined, as a lifelong
process involving self-critique and self-reflection, and this idea that there’s bidirectional
learning. So, you are in a position where you understand
you don’t know everything about the individual or the culture and you can learn from the
elder that you’re interacting with and spending time with, and they can learn from you. And so, there’s no experts, but you are
the experts about your own identity in your culture. And cultural humility also, kind of, gets
at that power imbalance between a provider and an elder, and being aware that that exists,
and taking time to set that aside and understand that you can learn from them. So, you want to develop mutually beneficial
partnerships. And I would like to also point out the difference
between cultural competency and cultural humility. Where cultural competency can be understood
more of an intellectual understanding of culture—and it’s built on understanding of the cultures
to more appropriately provide services, which is also a good thing; and it’s more based
on academic knowledge and learning with this idea that you may work towards becoming more
culturally competent—versus cultural humility, this idea that it’s more of an introspective
understanding of culture. It’s continually evolving. It’s a lifelong process. And it involves personal reflection and growth,
and you’re doing this more to increase your awareness of the differences that exist. And there’s really no end goal. And so, when you think about cultural humility,
some examples—and we’ll definitely cover more of these throughout the presentation—uh,
to practice cultural humility is asking open ended questions. Use reflective listening to understand their
perspective of what their concerns are, their thoughts, their ideas. And through listening, finding strength in
the culture, strength in the elder you’re working with. And then, finding ways through interaction
of seeking and learning from their experiences. So, I’d like to turn it back over to Debbie. All right. Thank you, Dr. Lewis. I appreciate that. Our next slide says, “The process of obtaining
cultural humility,” and I would like to invite Dr. Gary Ferguson to speak. Yes. Good morning everyone from the great land
of Alaska. So, you know, as we settle into talking about
cultural humility, as Dr. Lewis has shared, you know, it’s really about understanding
that many of us will never fully understand somebody’s culture, but we—through the
process of active listening and really being inquisitive—we can discover ways that we
can work with people and honor their cultures. And when we think of cultures across Indian
Country… We have currently 567 federally recognized
tribes. And here in Alaska, we have 229 tribes. So, when we think of… Like even… I’m a tribal member in the Aleut Region,
the Unangan people, and as I travel, I learn so much about our cultures, and I’m learning
all the time. And so, for me to see it through my perspective,
I have to also listen and learn and engage other cultures. And it’s fluid depending upon the age of
our elders, certain things that we may have as, um, maybe even a stereotype of that culture
might not exist. So, it’s really important to listen and
to engage elders. And we’re going to talk further about this
topic, but it’s really helping elders settle in and help them understand that we want to
honor them with, “What are your food preferences? What are some of your cultural foods?” And when we think of honoring that piece,
elders feel so nurtured and cared for when we ask those questions. And we work at finding ways to prepare and
access these traditional foods. And there’s some, really, some wonderful
best practices across Indian Country of providing these cultural foods that truly are like medicine. They’re truly soul food, and they allow
for elders to settle in and feel like they’re being honored. And I’m going to hand it back to Debbie. Okay. Agnes Sweetsir, would you like to also speak? (Silence.) Is Agnes… Agnes? Okay. All right. We’re going to also talk a little bit about
the importance of cultural humility. And the reason we put this iceberg picture
here, other than in honor of Alaska, is to think about the deeper aspects of the work
we do and some of the importance of things that, maybe, we don’t always think about. And so, I’d like to invite Joseph Ray to
speak to us right now. *** (Speaking in native tongue 00:11:17.) Good morning, everyone. Thank you. Joseph Ray from Laguna Pueblo. While here in New Mexico with our 22 tribes,
um, 20 of them…19 of them, the pueblos and then the Apache and, of course, the great
Navajo Nation, we have quite a mix of cultures at our nursing facility in Pueblo here. And so, maintaining the folks’ ties to the
culture, I believe—now that I’m an elder and my perspective serving on the board of
directors for the nursing home—our folks really appreciate being as close as possible
to their home communities. And through the family, they maintain their
ties to their culture in the best way they’re able to practice. For the people, participation in the ceremonies
is so key, but when a person has reached the point in their life when they need nursing
home placement, it’s very difficult, again, for those individuals unless they have strong
family who can transport them to their home communities, which can be a few miles away
and up to hundreds of miles away for our non-Pueblo members. It’s really hard to, again, maintain their
ties to the culture. Um, the various communication that is, again,
because of our diversity of our communities. We have almost, up to 10 various languages
that are spoken by our residents in the nursing home. So, being able to convey yourself in a delivery
of care in an appropriate manner, again, is a big challenge. It varies from tribe to tribe, pueblo to pueblo,
again, how someone…a CNA administers care, um, very key in maintaining one’s cultural
humility, as was explained by the doctors. Again, the broad issues may impact elders,
such as the financial impact that they’re receiving at times. Some of our residents are aware of the financial
process, because they, again, are involved in the Medicaid application in our facility—99%
of our residents are Medicaid, institutional Medicaid financially financed. So, again, the families are, at times, not
aware of what…how the financial side of nursing home placement can impact their elders,
and it can be a heavy load and a stressful issue for our elders being placed in the nursing
home. So, it’s very key for our staff there in
our nursing home to be able to convey the fact that they are looking out in the best
interests and establish those healthy relationships of caregiving. Many times, our elders have been so independent. And giving up their independence, as far as
their care, is really another challenge in maintaining their dignity, maintaining their
self-esteem. And again, the goal there is for healthy placement
and a healthy transition into the life of the nursing home, which can be scary for non-tribal
nursing homes. So, again, it’s a very deep, um, so many
issues and again, we’re thankful to have UNITE trying to bring these issues and best
practices to the forefront. And again, thank you, Debbie. Thank you, Joseph. Agnes, are you on the call? Are you hearing? (Chuckle.) I hope so. Yeah. Can you hear me? Yes. I’m sorry about that. This is so synonymous to practicing cultural
humility in a broader world. Thank you for your patience. I think you’ve hung in there this long;
that’s a good indication that you are going to practice cultural humility. I looked at this slide of the iceberg and
really, really struggled with it. And then, I got to realize, saying that that
really was related in so many ways to cultural humility. We all have a really, really good intention
in our practice and want to do the best job that we can; however, we don’t always experience
the outcomes that we want. You know, people criticize and complain, “Our
customers, our elders don’t seem happy.” And to me, cultural humility is about looking
at things differently, looking at what’s actually underneath, you know, what this iceberg
is about. For example, in 2013, we experienced the worst
flood in history. So, I couldn’t appreciate the beauty of
this iceberg. You know, it… It almost destroyed my life. So, I had to reflect on that and cultural
humility, and then it just came so clear to me that culture, for a lot of our elders,
they were punished for practicing their culture. And so now, this is new, you know, new to
them and frightening to them, and a lot of us don’t know what we’re doing. We need to look at caring for them differently. We need to break away from practice as it
is and especially if it’s not working. We need to humble ourselves and feel confident
enough to ask for help and change the way we practice and take care of them. We need to honor. You know, cultural humility, to me, is about
honoring a person for who they are. And I think I appreciate that more and more
as I mature. You know, I’m Athabascan, you know, from
Alaska, and my cultural values continue to grow more important, and I have to remember
that as it is so much who I am. It’s even more probably, who are the people
I am caring for, who they are and to… You know, I’ve learned ways to be able to
honor that and practice and, you know, I’m more than happy to share that. All right. Thank you very much. Would any of the other speakers like to comment
on this slide? I appreciate that, Agnes. Um, we also wanted to touch on this cultural
humility and the relationship there with patient-centered care, elder-centered care. And so, I’d like to call on Dr. Jordan Lewis. Great. Thank you. So, I just wanted… Um, thinking about the relationship between
practicing or engaging in cultural humility and connections to elder-centered or patient-centered
care, um, and thinking about, you know, we’ve touched a little bit about some of the skills,
some of the techniques we can use, not only for ourselves, so this idea of self-reflection
and a skill we can use in our *** (indistinct—00:20:05) model for caregivers or frequently that we
have good intentions, but we can always fine-tune our skills. We can learn from others who are practicing
cultural humility. And so, as we think about developing skills
for caregivers and for ourselves and others, we need to also remember to be open to changes,
be flexible, because what may work for one person, may not work for somebody else. And not making these assumptions across cultural
groups or gender or different experiences of cultural groups—that they all have the
same experience or same beliefs. And so, being aware of how to ask questions. What would be some culturally based practices
that may be appropriate for individuals? You know, one example I learned from a mentor
of mine is that a lot of Alaska Natives like to eat salmon, but we’re realizing that
they don’t all like it the same way. So, thinking about how we prepare traditional
foods. What are some preferences? One example that’s been done in a facility
in Alaska is engaging the elders in sharing recipes in preparing foods—and so, getting
them engaged, finding out what their preferences are, and also learning from them on how food
preparation can be handled. So, also thinking about honoring preferences,
again, being flexible. This could include… You know, we talked a little bit about communication,
but also traditional foods, types of music they may enjoy, religious preferences. What are some protocols around family engagement
and care, family engagement in the facility, being involved in the elder’s life? Also, in terms of health care beliefs, because,
you know, they may be coming from a different background, a different understanding of what
health care means, and being open to different approaches to care, different illness beliefs. And so, thinking about all of these and how
we can focus on these and build on them and continue to be open to the idea that we’re
continually learning how this all works. So, thank you. Debbie, I’ll pass it back to you. Okay. Thank you, Dr. Lewis. Do you want to make a comment also…? (Background noise.) Okay, I don’t know what that was all about. But anyway, I think using these four, trying
to give (indistinct—00:22:20) skills to the, um, help them attain skills, our caregivers,
we need to give them permission to be, you know, culturally sensitive, practice cultural
humility, and all that, because, what I have found is that the caregivers really want to
do a good job, and the measurements are in that things are *** (indistinct—00:22:48)
patients get their showers, and, you know, those kind of things. But, we need to give them permission to really
connect with the elders and to take that time to slow the tempo down, to listen more, to… You know, I see caregivers, not so much as
giving to care, but as partnering with the elders and helping them to take care of themselves. You know, food, it just… Since we opened the facility, I’ve always
appreciated my traditional foods just like everybody else, but I see it even more different
now. At one point, we were…served beaver meat,
and then I… You know, I asked one of the elders “Is
everything okay?” And he just went at myself to leave him alone,
that when they’re eating their food, it’s not traditional food, it’s spiritual food. And, wow, that was very enlightening to me. You know, and I think, if we practice cultural
humility, then we treat them more as, not only as cultural beings that they are, but
just as individuals that are still living life. I always tell the staff, “You know, they’re
not being put away. They’re still living. They still have a lot to contribute and are.” So, it’s our job to allow that to happen. Thank you. Thank you, Agnes. That’s incredibly important. Um, I’m going to move on, and I want to… This next slide has to do with the empowering
benefits of what we’ve been talking about on this webinar today, and I would like to
invite Dr. Ferguson to talk a little bit about remaining in the community and the importance
of home. Thank you, Debbie. Um, and you know, we look at nursing homes
and the movements to facility-based care, because often, families can’t care for their
elder back at home, because in our cultures—at least from the culture that I come from—we
like to care for our elders. And often, due to the constraints of the family
and their needs, sometimes we can’t do that. And elders, by and large, want to be home. And so, if they can’t be home, how can we
create home where they’re at? And by asking those questions, as Agnes shared,
you know, by really stepping outside of ourselves and kind of our worldview, how do we step
into their worldview? So, how can we make the experience in our
facility as close to home as possible? And that’s going to be individual by the
elder. But at the same time, there is a goal for
many elders, is to go home. And in Alaska, the Alaska Native Tribal Health
Consortium and our palliative care program, which really is a more integrated (indistinct)
of palliative care in today’s world, and really looking at reference services and helping
people have the highest quality of life no matter where they’re at on their journey. And often, we are working hard at helping
train our local…our people in our villages, our community health aides, our providers
in our small communities. And then also using tele-medicine and using
technology to bring care back home again, should an elder or a family be able to work
at bringing that elder home, because many elders do want to go home. They want to have the communities around them. We have so many cultural practices that are
based upon having elders home, and many of our communities are facing a deficit without
having elders home, like in our home region right now, and we’re working very hard to
address this. We have more elders living in our city than
in our region, and so, we’re working very hard at bringing elders home and having the
best quality of care for them and also educating families about what it means to have a quality
of life for our elders and to not be afraid of caring for our elders. So, I feel like it’s one that we also need
to understand that not all of our elders are going to want to stay in facilities for their
entire rest of their lives, but while they’re there, we want to make it as close to home
as possible. Thanks, and I’ll hand it back to you, Debbie. Thank you, Dr. Ferguson. And I think Agnes, you wanted to talk a little
bit on this about the benefits to the elder, family, and caregiver. Um, okay. Yeah. Can you hear me now? Yeah. Perfect. Okay. Um, you know, we have been in business for
almost 8 years now and have really grown, and there have been so many benefits. And by the way, the practice of cultural humility
and having a culturally sensitive home actually started in Day One. We started by adopting a mission and a philosophy
of how we were going to do business, and that really helped. But, you know, practicing that, the benefits
have been on so many levels, you know, to caregivers. You know, they’re more empowered. Our caregivers are, many times, very professional
about…unprofessional, as would be said, para-professional people that have become
really professional in their own light to their families, because they’re engaged
in the care of their loved ones, um, to the youth, because they’re expected and guided
to help with the care and help with the activities to the communities, because, you know, we
still have our elders as the heart of our community right along with our school and
the kids that are being educated there. But most of all, the benefits to the elders. The elders continue to live very active lives
where they are still really important and included and utilized in the community for
all the wisdom and experience they have gained throughout their lives. We create a forum in which they can pass that
on and it’s just… It’s been tremendously exciting. None of these things, you know, that I have
really expected. You know, we… You know, they’re being cared for by their
very own because our young people are working, are in…working in an environment where they
are respected for who they are and what they bring to the table, and we—when I say “we,”
I mean leaders—kind of let go of how we’ve been taught and educated and taught to believe
in a Western world. So, it’s really, really exciting for…even
for me. You know, I should be retired, but I love
it and it’s because we are honoring people for who they are. Thank you very much, Agnes. Uh huh. Uh, Joseph, would you or Dr. Ferguson like
to also speak at this time? Um, just real quit. Yes, thank you, Debbie. Um, this is Joseph. Um, excuse me doctor. Uh, the… One message I’m trying to convey in my goals
of being part of the Rainbow Board of Directors is educating our tribal leaders about the
necessary benefits and the necessary change in philosophy from the institution-, so much,
based care model to as a more of what we’re trying to…our mission with UNITE to try
and provide more culturally based services. It’s just a real challenge, because again,
being a Medicaid facility, we have to work within the constraints of the federal governments
and state government, and we’re doing our best here. But again, having our tribal leaders fully
educated about what the workings and the process is of a nursing home and administering the
care to the elders, for me, that has really…is really a necessary part of the work I’m
doing so that we can, again, provide all these benefits that are listed here: the improved
quality of care. Tribal leaders in my situation, um, based
level of care on the bottom line, and they’re not seeing the big picture, in my view, that
more investment in this, our elder care facility, needs to be made, such as rewarding our CNAs,
because they, again, are receiving some of the lowest pay in the Nation for our providers. So, having all the pieces, the dominoes lined
up so that tribal leaders understand the value of rewarding the caregivers, because there’s
a lot of words put forth by our tribal leaders, the effect of our elders are our greatest
resource. Our elders are our highest value, and, in
my opinion, in my humble opinion again, tribes are, in my case, aren’t investing as fully
as they should. But again, that’s my job to educate tribal
leaders and remind them of the fact that they can improve the quality of life for our elders
if they really, really thought about it and learned about it. Thank you. Thank you, Joseph. And Dr. Ferguson, I believe there was a comment
you wanted to make on some of the benefits of nature and the importance of nature. Yes. And as we did pre-work on this topic, we were
talking about, you know, in Alaska right now, spring is finally happening and the birds
are almost, um, amazingly loud as far as we spend some time outside. And the elders, when we think of… I think all elders, but I think, from an indigenous
perspective, that connection to nature is really important for many of our elders. And so, making time and creating time to have
space outside. And we talked about *** (indistinct—00:34:36)
wandering, and perhaps it’s tied to an elder’s desire to be outside more. And in our structured worlds, we, as providers,
often, we have our goals that we’re going to be doing each day, and we’ve got to get
this done, and we’ve got to get this done, and those are all really important, but we
also need to look at the pace. What’s the best for the elder that we’re
working with in finding ways to create space to have time outside? And that nature truly is medicine and the
more that we study it, the more that we understand time in nature is crucial for well-being,
and especially for elders, as we look at maintaining a quality of life. And perhaps it will even assist us in medication
management and keeping them settled and maybe not wandering as much as we are hoping. So, the value can’t be understated and we
have to look at our schedules and our…but sometimes, our ideas of what’s important
and really ask our elders and find ways that can allow them to spend time in nature. Thank you. Thank you very much, Dr. Ferguson. I think we’re… Were there any other final comments before
we get to the poll question by any of the speakers? (Silence.) Okay. Julie, would you like to introduce the poll
questions, please. Okay. At this time, everyone, we have a set of questions
for our audience members. To respond to a question, you can type in
your response in the box just below the question. It says, “Type your answer here.” You can go ahead and just type in your response
at that time. And we truly do appreciate your feedback. We do use this information to enhance our
programs. We’ll take about maybe 15 or 20 more seconds
to answer the poll question. I believe there are three poll questions today. Thank you very much. We’re starting to get some answers. For example, “Webinars like this and annual
trainings on cultural diversity.” We do appreciate these answers very much. “Brief presentations at orientations and
then ongoing opportunities to be part of educational presentations, events, and ceremonies, as
appropriate.” So, we’re up to about 30 answers right now. We totally appreciate people contributing
to this discussion. A lot of them say, “webinars.” So, we’re happy they always share that. (Chuckle.) We’re up to about 34 answers right now,
Julie. Trainings, webinars, and workshops were mentioned. Thank you for your feedback. Yearly and orientation training on cultural
competency, reading materials, and storytelling were also mentioned. “Hiring locally from within the community.” “Training, networking, long-term support
service training.” So, we have about 40 answers, Julie, if you
want to go on to the next question. Okay and the next question is, “How are
your program staff, um…” This next question is, “Give an example
of how elders in your program are empowered and benefit from culturally appropriate practices?” And again, please type in your response in
that white space just below the question. So, how do elders feel empowered? How do they benefit from the practices we
talked about today? One of the answers was “to feel safe,”
which I think is an excellent answer. And we do appreciate the feedback you’re
taking time to type into the boxes. “They settle in faster, decrease in behaviors,
and more open communication.” There was an answer that “It creates peace. Elders are taken to events in the community
where they are honored.” “They guide policy with customer survey
completion.” “They feel like they are listened to.” “Feelings of inclusion, quality of life.” “They guide policy with customer survey
completion.” I think already said that one. “Ask for their input.” We’re up to about 13 answers right now. “Elders feel respected, which helps to develop
rapport.” Okay. Excellent. Thank you all for that feedback. Do you want to go to the next question, Julie? Okay. And the last question is, “What challenges
have you experienced in developing and implementing culturally appropriate care practices within
your programs?” Again, to give a response, type in your response
in the white space just below the question. So, again, “challenges in implementing the
things we talked about today.” And we truly appreciate any feedback and answers
that you can give us. I’m starting to see some poll answers come
in, for example, “language” was one that was mentioned. “Lack of support from maybe administration
or board members.” “Everyone having their own idea of what
is appropriate culturally.” “Keeping staff engaged.” “Diversity of beliefs and influence of colonization.” “Acceptance.” “Mistrust.” “The requirement of individualization for
each resident.” “Lack of understanding of the resident…of
language.” I’m sorry. “Diversity.” “Earning trust.” Okay. “Every elder has a different view of their
culture, so it’s important to know how they want things done.” It talks about “community-to-community differences.” So, we got about 19 responses. Thank you very much for sharing. We totally appreciate that feedback. All right, Julie, I’ll let you take it from
here. Thank you. Okay. Great. Thank you, Debbie, and thank you to everyone
who participated in the questions. We will now have our question and answer session. So, if you have a question for any of our
participants, please type in your question in the Q&A box that is just below and to the
right of the presentation slides. Okay. Again, if you have a question for our presenters,
just type in that question in the Q&A pod that is just to the bottom right of your screen. Any of our speakers, we’re all happy to
answer any questions that we can or a discussion that you’d like to have. Okay. So, we did have one question come in, and
I will go ahead and read the question aloud and have the group respond. So, the question is, uh, this person is in
Alaska and has had a hard time getting cultural leaders in the community to participate in
the activities. How… What would be a good approach to encourage
the cultural leaders’ participation in activities? Okay. So, any of our speakers would like to address
that? Just to share… This is Joseph Ray in Laguna Pueblo. Just to share with the group, it really has
to go back in the investment of community, um, where is the place our elders hold in
our communities. And you need to at times, remind communities
that they do have an obligation to include the elders as residents of our nursing homes
in some of the process and some of the ceremony that goes on in the home community. Here in Laguna Pueblo, for example, we have
our medicine men bless our center annually, and it’s a tradition that’s been going
on for the 30-plus years of our facility. So, the local clans/leaders will come and
bless the facility for us. And on June 15, we will…Laguna Rainbow Center
will be having a fiesta. Because of the religious beliefs here, we’ve
incorporated the local custom of having a fiesta for the community. So, we have traditional social dancing event
and many traditional foods, like what we call feast burgers, which many of our elders grew
up on. And so, again, it’s… Again, it’s just, again, a way of us maintaining
some of the local ties to the culture and really just leaders, again, are aware of this
need. And hopefully, again, in your work in Alaska,
you can be able to reach out to the local leaders…leadership and you might need to
bridge that gap to bring in the, uh, bring people in with that craft. Thank you. Thank you, Joseph. This is Agnes, if I may, sometimes… Often times, I find it’s as simple as extending
a personal invitation to a local leader. Serving food and traditional food is always
a big one, but also, with that invitation giving them a little responsibility like,
you know, “Can you make this? I know you make this really well and the elders
would really enjoy it.” And maybe it plays on a little guilt, but
then that eventually leads to a commitment. Thank you very much, Agnes. Would anyone else like to comment on the first
question? (Silence.) Julie, do you want to read the second one? Okay. Great. So, the second question that came in, this
individual can relate to how cultural humility has been integrated into the nursing home
environment to a certain degree, but that certain difficulties still exist when seeking
healthy placement into non-tribal facilities. She works with elders that live outside of
the reservation, and she finds herself facing barriers when dealing with placement. Some elders do not want to return to the reservation
for various reasons, personal or financial, but they do not want to live in a non-Native
environment. Is there any in… Are there any suggestions in working with
placement to take into consideration when trying to place elders in the same environment
and in separating cultures? This is Agnes, if I may. You know, we do have elders from our villages
that are, you know, for various reasons, living in the cities sometimes not by their choice
or by their preference. And one of the things that I have found that
has been really helpful is to make sure the village people, their people know where they’re
at and how they can help, but to also connect them with somebody else in that larger community—maybe
a family of the same culture that practices—to adopt them, so to speak, to include them in
activities and take them out and celebrate their birthday or whatever is important to
them—to make that connection. And you know, people from home can send them
little care packages. Those of us that went away to boarding school
for our education remember getting those. Elders still really like that, and so getting
them that in that larger non-Native community is nice. Thank you, Agnes. Would anyone else like to comment on that
question? Um, this is Joseph. Just in my experience surrounding the family
member, elder—excuse me—with somewhat familiar surroundings as best you can, photographs,
pictures—excuse me—articles that, you know, maybe one or two. Because again, the nursing home sometimes
things can…do sprout legs. So again, but, as best an environment. It’s hard. My mother was in a non-tribal facility, and
she was easy, because we went to visit her almost every day. So, she didn’t really dwell, I don’t think,
on her surroundings so much. I can’t say, because she’s gone, but she
wanted to get healthy, get well, and get home. So, again, family is so key and it’s hard,
again, when there’s a transportation barrier or our elder being far away from home. It’s difficult, and I’m thankful for this
forum, because again, we’re working towards that goal of providing these best practices
for the greater world so they can, you know, non-tribal facilities can utilize the webinar
and call on the experience of this panel. Thank you. Thank you, Joseph. Any other comments from that question? (Silence.) Julie, do you want to read the next one? Yes. So, the next question is, “Can the panelists
recommend any training materials or curriculum for cultural humility?” I would just like to encourage people to log
on to CMS.gov under our UNITE website, because we do have some best practice reports that
we publish quarterly that are there on various topics. And also, these recorded webinars are also
there. Jordan Lewis, did you want to comment on any
other resources? Um, that’s… Um, thank you for mentioning the CMS website. I would say that’s a great resource as well. There is a resource that we’ve been putting
together. It’s in the stages of being copyrighted. There are… I mean, the best way I found resources is
using Google, but I do have a list of resources I can send and have available, also, that
I’ve been collecting over time that I can make available, and we can either put it on
the web…the UNITE website might be a great resource or location to put it, but also people
can reach out to me, and I can send them, as well. All right. Thank you very much. Okay. Julie. Okay. And the next question is, “How might a facility
address any sense of mistrust among residents and its staff or otherwise?” Would any of the speakers like to speak to
that? It’s my belief that as many trainings and
in-services for our staff is really the greatest educational tool we can use to remind people
that we’re a team. I think we’re reminded that our center has
such a dedicated staff that they’re willing to overlook many of the tough challenges of
working in such a facility. And so, again, it’s just education, having
in-services by various groups that can just be helpful in reminding our staff of their
role in the elder’s life journey. Uh huh. Thank you. And this is Agnes, if I may. I think it’s really important to practice
really listening to, you know, what they might be saying and to always remember the contacts
and the conditions. You know, I think the mistrust might come
from history sometimes, and it might come because they have been traumatized, or it
might come from the fact that they have dementia and that is a symptom of that. I don’t think everything should be chalked
off to things like dementia, but to remember that…that that might be the issue. So, to treat everyone as an individual and
to get to know them, honor who they are, and just really listen to what might be going
on and what they might be communicating in their behaviors. And that comes with, I think, training, but
mostly the openness and the willingness to let go and get out of yourself and honor who
they are. Excellent. Thank you, Agnes, very much. Does anyone else want to speak to that? (Silence.) All right, Julie, do you want to pick up the
next one? Yeah. Okay. And our next question is, “How would the
panelists recommend facilitating getting primary care providers engaged with participating
in fostering cultural humility?” I think the concern with that question, too,
is that maybe some of the providers aren’t there for a long time, and so it’s kind
of an ongoing challenge. Uh huh. So, this is Gary. Um, what I would say there would be to have
standardized training for any provider that would be part of the orientation process,
so that you cover culture, some specific things relating to the tribal members that you’re
serving, and kind of a Cultural Humility 101 I think would be really great to standardize. Having worked at the Alaska Native Tribal
Health Consortium, there is a training in the orientation that’s a half day of training
around culture and Alaska Native cultures, and it’s really rich. It’s such a wonderful training for any provider,
actually, whether it’s elders or otherwise working with Alaska Native cultures, because
it helps people understand the complexity. And also, being willing to ask questions and
sometimes get it wrong; but at the same time, at least you’re listening and you understand
that you may never ever fully get the culture that you’re working with, but you have that
humility to understand that it’s a learning journey. And having these trainings in our organizations
being standardized and required, I think, are really a great way to get providers on
board. Thank you. Thank you very much, Dr. Ferguson. Would any of the other speakers like to comment
on that question? (Silence.) All right, Julie, I think we have one final
question. Okay. Our last question is, “What would the panelists
recommend when there are elders from different reservations being placed in the same facility
in the same area or wing, and is there a friction because of the different cultures?” Would any of the… This is Agnes, if I may. We do have that experience. I mean, a lot of our elders come from a period
of time when, you know, the Athabascan Indians were at war with the Inupiaq Eskimos, and
so they come in with that. And we’ve had people from those varying
cultures within those larger cultures have to be placed together. And I think that’s what really helps is
to remember that they are individuals and honor both, you know, and respect that history
and what it has done to them, but to find similarities and simple things that they both
have in common. And it’s the same thing with religion. You know, some people think their religions
are holier than others, and we have to deal with that. And it begins by, I think, listening, but
mostly honoring and letting go and modeling respect and expecting respect and hearing
their story about why they are feeling that way, again, so-and-so maybe. And you know, giving them that freedom to
hear that, but to bring it all back to, “Let’s respect one another;” because they want
to do that, but they have things to get off their chest. Yes. Thank you, Agnes, very much. Would any of the other speakers like to comment
on that? (Silence.) Okay. All right, Julie. Thank you very much, and I’ll turn this
back to you for the closing. Great. Thank you to all of our panelists for responding
to questions, and thank you to all of you for asking such great questions. So, this is the contact information for each
of our panelists should you have any follow-up questions that you would like to ask for any
of the presenters specifically. And I would like to thank all of our panelists
for joining us today and sharing information and resources about cultural humility within
tribal nursing homes and long-term care facilities and other programs. In closing, I would like to remind everyone
that today’s webinar was recorded and that the audio and PowerPoint will be available
online at CMS.gov on the LTSS Technical Assistance Center website. Thank you again for joining today’s call. Our session is now concluded. (End of webinar—01:00:06.)

Michael Martin

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