Health care is a treaty-guaranteed right for all federally recognized American Indian and Alaska Native tribes.  Although enrolled members of federally recognized American Indian tribes have a legal right to federally funded health care, American Indian Elders have a lower life expectancy and are more likely to experience poor health and barriers to care compared to all other aging populations in the United States. These inequities are due in part to chronic underfunding of the Indian Health Service (IHS), the health care system that delivers care to 2.56 million American Indians. IHS patients receive less healthcare spending per person than federal prisoners, as well as users of Medicaid, Medicare, and the Veterans Administration. Underfunding means that many Elders visit outdated medical facilities with truncated service hours and severe staffing shortages. To reduce these disparities, the 2010 Patient Protection and Affordable Care Act included provisions to encourage American Indians to enroll in health insurance. However, American Indian Elders often struggle with the bureaucratic and technological complexity involved in finding, enrolling in, and using health insurance to get care within and outside the IHS.
Led by Dr. Cathleen Willging, the Seasons of Care project was designed in collaboration with a group of American Indian Elders and allies who were concerned about Elders’ ability to access care. The community-driven, mixed-method study used quantitative surveys, in-depth qualitative interviews, and concept mapping (a participatory method of organizing and prioritizing information) to understand Elders’ experiences with health care and health insurance. Participants included 96 American Indian Elders and 47 professionals, including outreach workers, health system administrators, healthcare providers, and tribal leaders. Based on the results of the study, the Seasons of Care research team, including Dr. Elise Trott Jaramillo and Dr. Emily Haozous, designed and tested a website called the Seasons of Care Native Elder Health Guide, which provides culturally relevant, up-to-date information, resources, and tools about health care and insurance. The Seasons of Care team is now working to share the guide with Elders, their families, and healthcare professionals to help them navigate the healthcare and health insurance systems so they can receive the best possible care.