The new top staff at the WahZhaZhe Health Center and the board that oversees the clinic are planning some major changes to care better for elderly and disabled Osages.
On Nov. 17, much of the Si-Si A-Pe-Txa board’s meeting was spent discussing imminent improvements to elder care, a longtime aim of former board member and longtime nurse Cecelia Tallchief – who was hired on as a consultant in furtherance of that goal. The board also renewed a consultant contract for Rick Richards, the retired head of Cherokee Nation Home Health who has been working on a plan for Osage elder care and an assisted living facility since January.
Mark Rogers, who took over leadership of the clinic in July, said that while building three assisted living facilities in each of the three Osage districts is moving forward, his overarching goal is to prevent most elders from ever needing to move into such places. To that end, he is implementing nearly immediate changes so elders will see improved care and quality of life.
Rogers said he is going to hire long-term care, benefits and activities coordinators within 60 days using money from a $654,000 Medicare “Money Follows the Patient – Tribal Initiative” grant that was awarded to the clinic in October. The grants are designed to help tribes provide home- and community-based services and Rogers wants to diligently pursue that.
Within three months Rogers intends to integrate all elder services within the Nation, coordinating such services as the existing community health representatives and benefits advisors to better serve elders and the disabled, including by calling them to check in regularly to see if they have needs.
“We might just talk to them,” Rogers said. “They might be lonely.”
Changes are already afoot at the Title VI senior nutrition program, which has sought input from elders on what they want to eat, started providing weekend meal packages to tide over some seniors who complained of hunger, and upped the quality of ingredients such as meat that are used in meals. Rogers said that he has hired a nutritionist who has also explored new sources of food to improve the diet of elders.
Those first steps have proven successful: At the Pawhuska nutrition site, attendance is up by about 25 percent and Fairfax has seen about 10 percent growth.
One small example: On Nov. 8, the two sites served Indian tacos and ran out of food after serving more than 300 people.
“Food impacts people’s well-being,” Rogers said. “And it’s not just the food but the visiting and communication and friendships made by breaking bread together.”
Title VI has vast room to grow, Rogers, Tallchief and Richards have all said. Not only can it be an activity and nutrition center for elders, but it can be a base from which caring eyes can watch out and advocate for elders.
In addition to boosting the role of Title VI and other elder services, the clinic is planning on building three 12-bed assisted living facilities, one in each district. They intend to build small, homey communal living quarters called “green houses” that are less expensive to operate. The Osage Nation Congress appropriated $8 million in American Rescue Plan Act money for the homes, but the board is worried about funding their operations.
“I like the idea of green houses,” said board chair Cindra Shangreau. “We can build it. But we can’t sustain it without money. Are we going to charge rent?”
Rogers replied that the dilemma of affordable elder care is a persistent challenge. His own mother-in-law, he said, woke up one day suddenly paralyzed and was deemed too old for surgery to repair her spine. She had to go to extreme lengths to get nursing care: She was forced to get a divorce and liquidate all of her assets.
Ultimately, Rogers said, the decision on whether to charge residents or subsidize their stays in assisted living is a political one that will have to be tackled by elected officials.
Board member Michael Bristow noted a certain truth, echoing the old saying about the certainty of death and taxes: “The thing is that we’re all headed that way.”
Rogers replied that 90 percent of health care costs are spent in the last 20 percent of people’s lives.
Congress member Paula Stabler said that she supported the green house program, which will cost about $3,500 a month per resident.
“We put millions and millions of dollars into the education of our kids and we don’t even blink about it,” she said. “This is 100 percent doable and 100 percent affordable. It’s just getting used to it. Change is hard.”
Casey Johnson, the director of development for the Nation, told the board that it needed to act quickly to spend the federal ARPA funds set aside to build the three assisted living homes. By law, the money has to be encumbered by December 2024 and the project completed by 2026 – or the feds will demand the money be returned, he said.
“You don’t have a lot of time,” he said. “Four years from now, we have to be mission completed.” He said he was also concerned that $8 million might not cover the costs because of inflation.
The Nation has also faced some issues with poor water pressure for a new Primary Residential Treatment facility built west of Pawhuska; the state fire marshal has refused to approve plans, and the Nation might have to put in as many as three new water towers to get the water pressure up to an acceptable level – another cost overrun. New tribal construction on fee land likely will face a similar hurdle, he said.
Principal Chief Geoffrey Standing Bear also sounded a few alarms, noting that the Chickasaw Nation recently got approval to introduce mobile gaming – on electronic devices – that could cut into Osage casino profits that fund the Nation’s programs. The Osage Nation, he said, is still stuck without a recognized reservation thanks to a disastrous ruling by the 10th Circuit Court of Appeals in 2011, while other Oklahoma tribes are benefitting from the more recent Supreme Court ruling in McGirt v. Oklahoma that affirmed other reservations exist because the U.S. Congress never expressly disestablished them.
“That’s what’s on our plate,” Standing Bear said. “We think you guys should move faster.”
Rogers didn’t appear fazed.
“We have a lot of major programs going on,” he said the day after the board meeting. “You just have to divide and conquer, especially when you have a robust agenda.
“I didn’t come here for a good time, I came here for a long time – and I’m in the process of moving four generations of my family here.
“Like the Chinese adage says, the journey of 1,000 miles begins with a single step.”