hospice care

Tohono O'odham Nursing Care Authority - Our Story

Producer
Harvard Project on American Indian Economic Development
Year

This video -- produced by the Tohono O'odham Nursing Care Authority using its monetary award from the Harvard Project on American Indian Economic Development's Honoring Nations awards program -- explains the history and development of the Archie Hendricks, Sr. Skilled Nursing Facility and the Tohono O'odham Hospice, which are located on the Tohono O'odham Nation in Arizona.

Native Nations
Citation

Tohono O'odham Nursing Care Authority. "Tohono O'odham Nursing Care Authority - Our Story." Rock Steady Productions. Sells, Arizona. 2009. Film.

This Honoring Nations "Lessons in Nation Building" video is featured on the Indigenous Governance Database with the permission of the Harvard Project on American Indian Economic Development.

[Singing]

Frances Stout:

“I was on what they call an advisory committee and the group was very passionate about what they did. They were determined to build a facility in spite of the cost. They were very determined to bring their people home. This past year we were honored by Harvard University and their project, which is called Honoring Nations, with an award. It gave us an opportunity to share our story and we feel that the information that we have given will help others perhaps be as successful as we are. This facility opened in November of 2003 and it’s located on sort of in the middle of the reservation close to the Mexican border on Indian Route 15.

[Singing]

When we share our story about success, we always mention passion, that we feel that if someone doesn’t champion the idea that probably it just won’t go. In our case, it was a group of ladies who just kept approaching the nation asking, ‘Do we have money now to start the program?’ And then it moved to an advisory group, which actually by that time, we had money. And we also need a government that listens to the people and who honors the elder because I think we’ve seen a lot of times when someone said, ‘Yes, we do honor our elders,’ but there was no action taken to care for them. In our case, we have executives who followed through with the money, appropriated the money and this gave us the ability to move forward with the building, staffing and the programs that we have here.

Funding for the facility comes from gaming, but not all of it. One third is from our, we’re reimbursed by ALTCS which is the Arizona Long-Term Care System, which is Medicaid. Then there are a few that are on Medicare. We also are licensed to take veterans so if we do the Veterans Administration would pay for their care here. There are very few private pay. The rest, anything that’s not paid for by any of these entities, then our tribe then pays for it.

As far as jobs go, we have, especially all our managers, they are all O’odham except one and they’ve all had special training. We’ve been able to have consultants come in and work directly with them, help them with policy making for their specific department, help them even if need be, be certified. So this has been a very outstanding thing for the people here on the reservation.”

Caroldene Garcia:

“After a couple of months of being here and having the board, dealing with the board, working with the board, I happened to have the opportunity with the administrator -- who also runs another facility, who has their own HR [human resources] department -- and was willing to provide that training for me. So the board allowed me to do that, set up a contract where she would monitor me and give me some advice and help me upgrade my skills that I already had in place.”

Frances Stout:

“We truly bend over backwards to bring our staff in and to keep them. We have bonuses for our nurses. The benefits for the, that the nation provides for all their employees are very, very good. This includes medical care, dental care and a 401k. We do have housing and we have housing also that takes care of the shifts. For instance, if we have person on 12-hour shift and they want to spend a couple of nights here, we have facilities for them.

[Singing]

In the area of communication, we do try to communicate quarterly with the districts, with our oversight committee, with the executive. And we do feel that any plan that we have, we try to maintain transparency with everyone so that there are no surprises to anyone and then we also get their input. We find now that planning is very important and we try to be very sure that we implement. It’s not just a plan that’s put on the shelf. We do work at implementing every goal.”

Charlene Conde:

“In addition to the Archie Hendricks Skilled Nursing Facility, we also have the hospice program. The hospice program is taking care of O’odham people that are reaching their life’s end. Before we had a hospice here on the nation, our people had to go out to the city and the hospitals, Tucson, wherever they’re sent to get hospice care there, so this is a good thing for our people. I worked as a CNE on the nursing unit before I transferred over to the hospice care. I wanted to work for my people.”

[Singing]

Frances Stout:

“We have a mission. This mission has not been changed since I’ve been because it’s such a strong mission. It sets up the reason for our existence and we feel very passionate about it. It talks about continuum of care and that’s one of the new passions that we have is hoping to put together a model of continuum of care for our aging population we do have, beginning with the nursing care facility here.

[Music]

We also have started an organization or a consortium. It’s called the Elder Care Consortium and we realized that there were many issues and this group alone could not solve the problems. So we, this is how the consortium came into being and we, it consists of the tribal Health and Human Services, the Indian Health Service, and the community college, and of course us. So the four entities meet monthly, we talk about the issues of aging and we have put together a white paper for the new administration so that they see what we see and we also have a few recommendations for them. We will continue to update that white paper as time goes on.”

Priscilla Ortiz:

“I work with children. I worked at a school and then from school I went to elders and I enjoy doing what I do. I love it. I like being a clown, I like letting the residents know that we’re here for them. And we did wonderful. I didn’t understand their language. Now they’re teaching me how to say certain words. I’ll say it, they laugh at me, but they correct me, which is okay. It’s been a rewarding thing for me to learn their language.”

[O'odham language]

Frances Stout:

“I think right in the beginning that was the main thing we wanted to do was to deliver care in accordance with what we call Himdag. Himdag is our way of life and that includes foods that we eat, some of the traditions that we do and the medicine person, having the medicine person come and always be I would say almost on call.”

Lisa Folson:

“We made this healing room, one of the nurses Richard Hix made this, painted this area and it was requested on behalf of the staff, O’odham here mainly to bring the medicine people in and to have healing here. It’s really good that we have this because there’s a lot of people that don’t recognize our culture, don’t recognize our tradition, but because we’re at home, they see this as something that we need and it’s just, it’s like you going to the doctor, or it's somewhere where you can pray. So it would be something like your church or your temple.”

Frances Stout:

“There were many obstacles. I think the first one was staffing the place. We do not have very many professional people here on the reservation so it was, we needed to go out and look. And I mean we went all over the country looking for a DON, an administrator. The administrator has to be licensed and we went through three administrators, the third one being our present administrator, and he’s done a fantastic job. So that was the biggest obstacle. The other was finding a Director of Nursing Services and we went through several before we found our present one who was willing to stay and I think she’s doing a very good job. That obstacle is the fact that we are out in the middle of the desert and we are, people, our professional people have to commute and that gets old after awhile. I think we pretty much accomplished what we set out and that’s get the building up, to bring most of our people home. There are a few who cannot come home because of the level of care. However, we do keep in touch with those people. Perhaps at some time in their life they may be able to come home.”

[Singing] 

Frances Stout: Archie Hendricks, Sr. Skilled Nursing Facility and Tohono O'odham Hospice

Producer
Native Nations Institute
Year

In this interview with the Harvard Project on American Indian Economic Development's Joseph P. Kalt, Frances Stout of the Tohono O'odham Nursing Care Authority discusses what led the Tohono O'odham Nation to establish the Archie Hendricks, Sr. Skilled Nursing Facility and Tohono O'odham Hospice, and the positive differences the facilities have made for the nation and its citizens.

Native Nations
Resource Type
Citation

Stout, Frances. "Archie Hendricks, Sr. Skilled Nursing Facility and Tohono O'odham Hospice." Native Nations Institute for Leadership, Management, and Policy, University of Arizona. Tucson, Arizona. March 18, 2011. Interview.

Joseph Kalt:

Hi. I’m here with Frances Stout. Frances is chair of the board of the Tohono O’odham Nation’s Nursing Care Authority, which governs an award-winning program, a nursing home called the Archie Hendricks, Sr. Skilled Nursing Facility. And Frances, welcome. Thank you for joining us. Let me first ask you just to describe this...I’ve been there, I’ve seen your nursing home operations. It’s state of the art; it’s truly fascinating what you’ve accomplished. Describe what the Archie Hendricks Sr. Nursing Care Facility does, the kind of services you provide, and what you’re trying to do with it.

Frances Stout:

Well, Archie started because of our elders were far away from their home and we really needed to bring them back. They were lonely, they were...it was just painful for everybody, families. And so when Archie opened, we immediately had many elders come in and mainly because they were frail and families couldn’t take care of them. So one of the things I think we did right in the beginning was to provide comfort and food that they could eat, plus they had people who spoke to them in their own language. And they also had family visiting. This was a biggie. But I think the main thing that really, I would say, made a difference was in the ability of the elder to relax or to feel the comfort. And that took a while. As you know, when you move elders from one facility to another, it’s very painful and it’s a big adjustment. So when they came from the Tucson homes into our facility, there was an adjustment and you really could see it, and it took a while for them to say, ‘Am I really here?’ So the hospice program is new and right now we have...and it’s actually a new concept for our people, too. We don’t normally talk about death, we don’t normally talk about, ‘When I get to that point, do this for me.’ Those are things you never talk about. So it’s been new and we’ve...although we have a program where they...it’s called 'Pathways.' We have a program now where our people go into the home and talk with them about medications they’re taking, the type of treatment they’re getting and maybe getting them to the point where they feel or they can comfortably say, ‘I don’t think I want to go back for any more treatment. I don’t want any more procedures done on me. I would like to just pass comfortably.’ So this is what Pathways does and they may either stay in their home or they may come to the facility.

Joseph Kalt:

When we go around Indian Country, tribe after tribe is struggling with the same issue you faced of the elderly essentially having to leave home at a critical time in their lives when they’d like to be with their families. And tribe after tribe asks us, ‘How did Tohono O’odham do that?’ How did you do it? This is a world-class facility at Tohono O’odham Nation. What was the impetus and what was the drive behind this that allowed it to happen and now to be sustained is this premier operation in the United States?

Frances Stout:

Well, as you know, most Natives have always cared for their people from birth to death, but with all the lifestyle changes and all the things that have entered into our lives, we no longer can do that. And there are families that still make an effort. In fact, we’ve had people say, ‘I have to quit work now because I’m going to start taking care of my grandmother.’ But that’s a small number, very small number who can do that. The majority of them just finally say, ‘It’s too much. We have to take you away or put you somewhere.’ So the people...I think there was a small group who really felt badly and felt like we really needed to work towards getting a home on our reservation and that little task force -- which was I believe all women at first -- would come to the administrator’s office or our chair, the chair of our nation’s office and ask were there monies? And no, there weren’t any monies. But they were persistent and after a while, when money was available, the chair did call them and say, ‘Here’s the money. Now who’s going to stand up and work towards bringing the home here?’ And then there was silence in the council and finally two of the women stood up and said, ‘We’ll do it.’

So they again set up what they called an advisory group and this is when I came in. And they worked very hard. They...and I think they spent their money wisely. They got an excellent consulting service who had done nursing homes in the past and they were wonderful. They helped us put together a plan, a business plan, a fantastic business plan. In fact, every once in awhile even now we look at it because whoever wrote it was very future-oriented and that’s what you need. We are not...most Natives are not future-oriented. We live...we’ve had to live from day to day, so it’s difficult to plan sometimes.

But I think the board, when they finally got to the point where the board members were appointed, that was when I think we decided, ‘How are we going to do this? We’ve got the money, we’ve got the architect, we’ve got the plans and we’re ready for construction.’ And as soon as construction started, it was difficult to really realize this was happening. But the board I think was very...I wasn’t on the first board. It was the second...a position opened up and then I joined the board and I’ve been on it ever since. The board that I work with now is fantastic. They are very passionate. They’re very, as I said, strategic in their thinking and every once in a while...in the past...the past board I think, every once in a while somebody got a wild hair and off they went in a different direction. So we try to stay focused and it has worked for us.

Joseph Kalt:

The facility and the programs are simply world-class because you have world-class care being provided to people as you say in their own language, with their own families around and you keep winning awards and rightly so. I know that the Archie Hendricks Sr. Nursing Facility has won one of the Honoring Nations awards from the Harvard Project. Our role of course is to take your wonderful stories and try to document them so other tribes can learn from them. From your perspective, things like the Honoring Nations award, have you found that that helps you? Have other tribes sought information from you directly? What role has it played in your work?

Frances Stout:

I think the main thing it did for us, at least for the board, was it validated the fact that we were going in the right direction. It really made a difference. After we won that award, we thought, ‘We are...we must be doing something right.’ And I think that just motivated us to work even harder. Yes, we’ve had some tribes come down, take a look, and one of the biggies that seems to be a big obstacle is money. The nation has to buy into it and then they have to get the money somewhere. We’re very fortunate to have gaming and we’re very fortunate that they have it set aside and...

Joseph Kalt:

For the facility?

Frances Stout:

And they are willing to, as I said, give us subsidy. We just went for our second, oh no, our...is it our third or our second request and we got that without...

Joseph Kalt:

From the council?

Frances Stout:

From the council. Well, we first have to go to the districts and let them know that we...and have their approval. That’s always I think a good way to find out what the people are thinking about your facility, what’s going on there.

Joseph Kalt:

Well, I can say you certainly are on the right track and we thank you for participating with us and allowing us to tell your story across Indian Country 'cause as I said earlier, tribe after tribe is struggling with this issue and your leadership has really been phenomenally important to all of Indian Country so thank you very much. Thank you.

Frances Stout:

Thank you for letting me tell the story.

Joseph Kalt:

Great.

Honoring Nations: Frances Stout: Archie Hendricks, Sr. Skilled Nursing Facility and Tohono O'odham Hospice

Producer
Harvard Project on American Indian Economic Development
Year

Frances Stout, Chairperson of the Tohono O'odham Nursing Care Authority, shares the inspiring story of the Tohono O'odham Nation's state-of-the-art elder care facility.

People
Native Nations
Resource Type
Citation

Stout, Frances. "Archie Hendricks, Sr. Skilled Nursing Facility and Tohono O'odham Hospice." Honoring Nations symposium. Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. September 16-18, 2009. Presentation.

"Good afternoon. My name is Frances Stout and I'm Chairperson, as she said, of the Tohono O'odham Nursing Care Authority, which is the governing body for the Archie Hendricks Skilled Nursing Facility and the Tohono O'odham Hospice, which are both located on our Tohono O'odham Nation. First we wish to thank Harvard Honoring Nations for the privilege of telling our story. Harvard's program motivated us to ask ourselves, 'What worked and why?' We hope that parts of our story will resonate with you today.

Let me begin by telling you a little bit about our Nation. It is the second-largest tribe in Arizona as measured by population and its geographic size. There are approximately 29,000 enrolled members and of these, 15,000 reside on the Nation. The Nation is comprised of four reservations which total about 2.8 million acres, about the size of Connecticut. Our elder population number around 4,000. These are elders over 55 years of age. Some speak only O'odham, which is our Native language. Others have strong -- most of them have strong cultural ties and strong family ties. Many are active in the workforce and some in tribal leadership. Our Nation suffers from chronic diseases that interfere with quality of life. Fifty-eight precent live with onset adult diabetes, 63 percent have been diagnosed with high blood pressure. These figures were compiled from the tribal health department in 2002 on elders who were 60 years and older. In addition, the survey reported that 8 percent of the surveyed population felt depressed all or most of the time and that 11 percent considered their health status poor.

The Nation does not have sufficient housing for its membership, and this makes it very difficult to care for the elder at home. Other issues of the O'odham elder include lack of transportation, social service, and home-based health services. In addition, there is elder abuse. However, our Nation has enacted an Adult Protection Services, an ordinance which has improved the situation. Our facility is a shelter for the elders for this program. Until the opening of our skilled care nursing facility and hospice, there were no long term care services on the Nation. Does this all sound familiar? I think all of us can in one way or another relate to some of these issues. And in your program, I think it described it as an endless cycle of poverty and social distress. But I also remember what Oren said, 'What happens to us is in our hands.' So this is pretty much how we work, what we were thinking when our program came into being. About 10 years ago, the elders who needed long-term care had to be sent away to neighboring cities. This was very painful for everyone. The families reported when they returned from visiting that their loved ones were in worse shape. They were not eating because the food was foreign, they were not speaking because the language was foreign and they wanted to come home. This outcry began the process to bring our elders home. An advisory group worked for about a decade to realize the dream of having our own skilled nursing facility. On November 17th, 2003, we opened the doors of Archie Hendricks, Sr. Skilled Nursing Facility. It is now home to 60 elders. In 2007, our hospice program began.

Our facility, the Archie Hendricks Skilled Nursing Facility, is a state-of-the-art facility. The design includes large social areas for gathering and community activities. We also respond to our cultural needs by a separate healing room for our residents and medicine people. Critical to the quality of care provided to our people, is the quality of professional staff. The board believed that a combination of highly trained staff and sufficient staff to provide care would result in a higher quality of care. We established a ratio of one certified nursing assistant for every five residents. Our facility currently employs 135, of whom 80 percent are O'odham or Native American. Our turnover rate is less than 2 percent. This compares favorably to any jurisdiction. For example, the annual turnover rate for certified nursing assistants within the state of Arizona is 84 percent. We believe our strategy, staffing strategy, was and is effective as evidenced by our receipt of a five-star rating from the Centers of Medicare and Medicaid. The awards that this facility has received speak for the caliber of our staff. In 2009 our facility received, as I said, from the Centers of Medicare and Medicaid, a five-star rating. This is based on positive results of an annual federal inspection. Superior staffing and positive performance reflected in the key quality indicators. Only 14 percent of homes in the United States receive five stars. We are a finalist in A Winning Workplace. This is a small business award from The Wall Street Journal, businesses that provide competitive wages, superior benefits, opportunities for growth and development, opportunities for training and education. This describes our facility. Tucson Indian Health Service awarded us the Area Director's Award. The Tucson Indian Health Service director selects programs, services and individuals who have partnered with and enhanced the healthcare in the service area. The National Indian Health Board awarded us the Local Impact Award. Selections for this award is based on, as the word implies, a health program that has impact on the health and well being of Native Americans at the local level. And of course in 2008, we received highest honor awards from Honoring Nations. This award, as you all know, is based on successful contribution toward Native American self-determination, economic development and tribal sovereignty.

A little bit about our governance; two things that we are very, that we feel are very important. One is that we have to know who we are. We identify ourselves -- and we do this every time we present to our council or to our villages -- because once they know who we are and we do this over and over again, once they know who we are they began to trust us and when we bring new programs or come for requests, they know that we know who we are and that we know what we're asking for. The other thing is our purpose. A purpose tells us where we're going and this is something that I think the board feels is very important because the leadership, we are responsible for the continuum of care of people on our Nation. We operate the skilled nursing care facility and hospice. Our charter established and approved by our Nation's government provides substantial independence to the seven-member board. Our board is comprised of tribal leaders with relevant professional and technical knowledge in nursing, business and care giving. In addition to providing policy direction, we insure our cultural values. O'odham Himdag is part of all that is done within our service. In creating TONCA, the Nation directed us to take a leadership role in providing a continuum of care and services to meet the changing needs of our aging population. To establish this mission, the TONCA board invests in projects and programs that will bring value in the future.

In closing, we do strategic planning for the facility, but it is now apparent we need to connect, communicate and collaborate with other entities on the Nation that are charged with responding to the growing social and health needs of our Nation. We are convinced that we will have better coordination and reduce fragmentation of the services that currently hinder the provision of services to the aging O'odham population.

Thank you."