At its first meeting as an independent tribal enterprise, the Si-Si A-Pe-Txa Board of Directors introduced its new chief executive officer and had a bit of a brainstorming session about establishing an assisted living facility, including improving the Title VI senior nutrition program.
The new CEO, Mark Rogers, received an effusive welcome.
“We’re so happy to have you on our team,” board chair Cindra Shangreau told Rogers. “We’ve heard nothing but good about you.”
Rogers has a raft of experience as a health care administrator and came to the Osage Nation from the Absentee Shawnee Tribe, where he was the health system CEO and nearly quadrupled its revenue and assets in nine years.
“I take the care of our tribal people very seriously,” Rogers said. “We can’t get it wrong. Historical trauma is part of our history and that’s an important challenge.
“I am here to take care of people. Patients are the No. 1 priority. Take care of the patient and everything else will take care of itself.”
Rogers also noted that “there’s always a fire burning in every tribe,” adding that he wanted to tamp out the sparks that would set off forest fires. To that end, he gave all present his cell phone number and urged anyone to call him anytime about concerns.
“If it’s bothering you, it’s bothering me,” he said. “I’m here for patient care. If there’s a patient need, call me and let me know.”
Title VI: Unseized opportunities
A long portion of the meeting was spent discussing plans for an assisted living facility and bolstering the Title VI senior nutrition program to better serve elders.
Rick Richards, the board’s consultant on assisted living and the retired head of Cherokee Nation Home Health, reported that he had visited facilities at the Isleta and Laguna pueblos in New Mexico and saw much that could be replicated at the Osage Nation.
“When you look at all the things that are available for Title VI funds. That list is as long as I am tall,” Richards said. “It is amazing what you can do with Title VI. You can be as creative as you want to be.”
At Laguna, he said, many elders spend the entire day at the nutrition site, which is rich with activities. “They get there early, have breakfast, then go right into activities,” he said. “One man was doing silverwork.
“Working people need someone to help watch their elders and they can’t always have someone in their home.
“You don’t need a licensed daycare as long as they can take care of themselves.”
Elders, he said, benefit from having their interests encouraged, whether they are sewing, making jewelry or engaged in some other activity. But creating a hub for such activities also has another benefit: Caregiver support.
“Those caregivers are gold in your community,” Richards said. “You’ve got to find ways to keep them from burning out.”
And giving them a break is key. He recalled an incident when he was still working for Cherokee: A tribal councilor asked him to check on an elderly man. When he arrived at the humble house, he thought it odd that there was a hasp with a padlock hanging from it on the front door. He settled down to talk with the man’s wife, who told him that all was well but every now and then she wearied of caring for her husband, who had dementia, and felt lonely.
“I leave two gallons of ice cream in the freezer and I lock the door so no one will bother him, and I go to Kansas City for the weekend,” she said.
Title VI money can also be spent on paying people to do chores and provide personal care for elders, help apply for Medicaid and Medicare, and much more. Fully using Osage Nation nutrition sites in Pawhuska, Fairfax and soon Hominy could go a long way toward easing caretaker burdens – and improve the lives of elders, Richards noted.
The board also revisited building three small, assisted living facilities, each with 10-12 beds, in each of the tribal districts.
Rogers popped up from his chair and said that the Absentee Shawnee spent 20 months looking at assisted living solutions – and agreed with Richards that small homes worked best and that increasing activities and services at Title VI was great – but he had a new layer to add.
“What we want is a community,” Rogers said. “We don’t want to stick our elders in a building and not have anything else there.”
At AST, he said, the idea they came up with was to have tiny homes surrounding the assisted living home; independent elders who might want to downsize or pass their tribal homes on to younger relatives returning to the tribe could live in the small houses, eat at the Title VI site, and be a part of the community.
“It would become a tribal village that is mutually supportive,” Rogers said. “This would be easy to build in three or four phases. We could dig a fishing pond, lay out a walking path, an area to tell stories. And now you’ve got a community.”
Richards said what the Nation lacks is data about its people’s needs and health, data that is needed to apply for more Title VI funding. To that end, the board is working on a survey that will cover a broad range of topics, including specific questions about the status of respondents’ health, activity, household, income and other benchmarks.
Operational funding for assisted living uncertain
The Osage Nation Congress has voted to spend about $8 million to build three assisted living centers but at the meeting Congresswoman Jodie Revard, the chair of the congressional health committee, asked about the cost of operating them.
“Thirty-six hundred dollars per person per month,” replied board chair Shangreau.
Revard then asked if the board would invest some of its revenue into the assisted living centers to help defray the costs.
“Right now, we don’t see that,” Shangreau said. “We don’t see that we’re generating enough revenue to subsidize assisted living.
Revard: “So what are we doing with the revenue?”
Shangreau: “The revenue right now is going right back to the clinic.”
In fact, the clinic is required to spend revenue derived from Medicare, Medicaid and other federal sources on health care – and assisted living is not a legitimate health expense per Medicare standards. It is generally paid for by a portion of residents’ Social Security income and subsidized by tribes; the Chickasaw Nation, for example, gives an allowance of $2,500 a month for assisted living.
“When you gave us the $8 million in ARPA (American Rescue Plan Act) dollars, did you not think to ask how is this going to continue, to survive and be paid for?” asked health board secretary Cecelia Tallchief.
Revard said that it had been discussed and that if Congress needed to fund it, the health board should let Congress know.
The ARPA money was an opportunity that had to be seized, noted Congresswoman Brandy Lemon.
“I knew when I voted for this that there was not a plan in place for funding it,” she said. “Assisted living sounds great but it costs a great amount, too. Can we do it? If we compacted a clinic and you’re still here and you’re still making money, we can do this too.”
Said Shangreau: “We just need consistent funding year after year after year. We don’t want to have to close it down after five years because we have a new congress, a new chief, a new whatever. I just want to make sure it’s sustainable if we build it.”
Congresswoman Paula Stabler, whose father was an early proponent of building assisted living in Osage territory, said she was prepared to dedicate tribal funds to assisted living if it turns out to be needed: “After 25 years, I’ll lead the march down Main Street if we have to.”
Editor’s Note: Si-Si A-Pe-Txa (The Healing Place) is phonetically pronounced See-See Ah-Peh-Tkuh.