PIERRE, S.D. - The South Dakota State Tribal Relations Committee voted to send a series of letters to President Bill Clinton, the state's congressional delegation and Gov. William Janklow in an effort to improve long-term health care prospects for elderly American Indians.
Committee members were upset with the state's congressional delegation for failing to appear at the Aug. 30 meeting that focused on addressing nursing home care for American Indian seniors.
Committee Chairman Robert Benson, fulfilling his last duty before leaving office, said he was disappointed at the federal government balking to fund elder care and federal agencies' failure to address a critical disparity in funding for health care programs at Indian Health Service Hospitals.
Cynthia Myers, state program coordinator for the Denver Office of the Health Care Financing Administration, said there are a limited number of American Indian-owned nursing homes. She said tribes face enormous challenges in getting federal agencies together to tap into funding for nursing homes since one agency isn't devoted specifically to that task.
Complicating matter further, tribes face a disadvantage when seeking Medicare and Medicaid reimbursement because of a lengthy application process and waiting period for certification.
"I wish I had the answers. In Denver we have an office that works with tribal entities. It would take a lot of coordination," Myers said.
The Rosebud Sioux Tribe is the only one in South Dakota which operates a nursing home, but the Blackfeet and Crow tribes in Montana run nursing homes for their elderly tribal members.
Plans are on the drawing board to build a nursing home on the Standing Rock Sioux Reservation, said Standing Rock Councilman Ron Brown Otter.
State Rep. Dick Hagen said the Oglala Sioux Tribe wanted to build a nursing home, but the state's moratorium on the number of facilities allowed stopped the tribe's efforts.
"We had the money during John Steele's administration. The money wasn't the problem, it was the moratorium," Hagen said.
The wait for reimbursement while undergoing federal inspections can be up to 120 days which makes it difficult for many to operate. If a deficiency is found during the waiting period, reimbursements are withheld until deficiencies are corrected. The tribes can opt out of receiving the reimbursements, she said.
State officials and the committee members suggested the federal government had once again backed away from its promise under the treaties to provide health care to American Indians.
"I feel IHS is a federal government responsibility. By not doing it, they are ignoring the people they put on the reservation," said Mike Vogel, a spokesman for the South Dakota State Department of Social Services.
"Instead of trying to involve the state, we need to get the federal government involved," said Rep. Bill Napoli.
Sarah DeCoteau, health coordinator for the Sisseton-Wahpeton Sioux Tribe, said just getting what most people consider basic health care is difficult enough for tribal members because IHS is severely underfunded.
"It is light years away from being able to fund long-term care," DeCoteau said.
A Level of Need Study found the federal health care agency charged with administering funds to Indian Health Service hospitals is operating with only 45 percent of the budget needed to adequately fund health care for American Indians.
"It will take $1.2 billion to fund just the core health services for current health care. To close the gap, we need a $230 million increase," she said. This is money she said federal officials are reluctant to spend.
Funding health care costs for the average American is $3,766 per capita while only $1,351 per capita is spent for American Indians.
"IHS is so poorly funded, they can't even talk about long-term care," DeCoteau said.
A new, reauthorization bill offered new hope because it included hospice and long-term care as part of a promise of sweeping changes in health care for American Indians, but the bill is now under the scrutiny of the Office of Management and Budget.
"They think it is going to cost too much," she said.
DeCoteau encouraged the committee to join in a lobbying effort for additional appropriations for IHS.
Steve Scheuermann, IHS public health program who has delivered care to some of the elders in the region, confirmed DeCoteau's statements about budget woes.
IHS is eyeing an entire package for long-term care including home health care, assisted living, hospice and nursing home care, but it will require coordination and collaboration between IHS and other agencies.
Sisseton provides housing for the elderly, hiring nurses to go into the home, and he said Lower Brule is looking for the same services. The Lakota Home Health program is available in Mission. There is one hospice care program in Pine Ridge.
"There is a need for nursing home care. In January 1999, there were 267 Indian elders in nursing homes, which represents 3.4 percent of the total nursing home population in South Dakota. These were nursing homes not on reservation sites," Scheuermann said.
"The needs for home care and long-term care are going to increase proportionately," he said.
"I think we have a lot of people who would be in a nursing home, but won't leave the reservation. I don't think those figures don't include them," Hagen said.
He pointed to a relatively new IHS hospital, which like many, suffers from a revolving door for personnel.
"I think what we're getting down to is the dollars. Why would we build a facility of that nature and not be able to staff it," Hagen asked.
"Apparently they have given the issue a lot of lip service to IHS, but no money," Benson said.