Building a Tribal Long-Term Services and Supports System
Why Long-Term Care Matters
Long-term care is not only about meeting the immediate needs for our Elders and people with disabilities — it is a strategic investment in the well-being and stability of the entire community. Building long-term care programs supports healthcare sovereignty while keeping people as independent as possible for as long as possible. Implementing a long-term care program can also create economic opportunities that benefit the tribe as a whole. The points below highlight why long-term care is an essential priority for your community today and in the years ahead.
Planning for the Whole Community
Tribes may develop and administer long-term services and supports (LTSS) to address aging and disability needs within their communities. These are LTSS choices and care options that can include informal supports, home and community-based services (HCBS), and residential care settings such as assisted living, tribal retirement communities, tribal nursing homes, and nursing facilities.
Strategic Planning for Aging and Disability Services
As the tribe develops a strategic plan for aging and disability needs, it’s important to consider factors such as cost, resources, and time. Building residential care options is a significant undertaking, but it can ensure improved health outcomes for Elders and individuals with disabilities and address issues such as isolation and depression by keeping people in their communities. HCBS services provide a solid initial support option that can generate revenue to support further planning and development while also meeting the immediate needs of Elders and people with disabilities.
Costs and Resources
Residential options such as assisted living and nursing homes come with higher associated costs than HCBS. These projects will naturally require more time and resources, including planning for staffing, equipment, and compliance with licensing regulations. By considering the entirety of choices for LTSS options, tribes can ensure that every member has access to the appropriate care that supports their independence and ensures the best health outcomes.
Supporting Healthcare Sovereignty
When tribes build and direct their own long-term care systems, they:
- Reduce dependence on external systems that may not meet cultural, geographic, or clinical needs
- Create care structures that align with tribal values and priorities
Self-governed long-term care ensures that community members receive care rooted in respect, cultural tradition, and community standards.
Keeping Vulnerable People Close to Home
Many tribal communities already provide informal long-term care through families and community members, but formal systems are increasingly needed.
Data highlights the urgency:
- American Indian and Alaska Native populations have higher disability prevalence than the general U.S. population.
- According to the National Resource Center on Native American Aging, a large portion of Native Elders rely on home and community-based services (HCBS) supports such as transportation, help with meals, and assistance with daily activities.
- Most tribes do not receive reimbursement for the HCBS they are already providing, especially through Medicaid.
Funding and Reimbursement Opportunities
One of the most important considerations for leadership is sustainability. Tribal nations can draw on federal and state sources to support HCBS and residential care.
Key reimbursement pathways include:
Medicaid HCBS Waivers
- May reimburse tribes for personal care, homemaker services, adult day services, transportation, case management, and more
- Helps cover the costs of services already being provided in many communities
- Requires coordination with state Medicaid agencies
State Aging and Disability Programs
- Some states fund caregiver support, nutrition programs, respite, or home-based services
- These can supplement tribal resources