Date: Fri, 03 Dec 1999 02:28:07 -0600
`Falling apart' -- nursing homes scarce for America's Indians
1.38 a.m. ET (653 GMT) December 3, 1999

By Chet Brokaw, Associated Press

PINE RIDGE, S.D. (AP)  Dennis Hendricks is pretty sure his diabetes will
force him into a nursing home some day. 

"I'm falling all apart,'' he says, and then laughs, recounting how doctors
had to amputate some of his toes because of the disorder. 

But there is no nursing home on the Pine Ridge Indian Reservation, and a
difficult choice looms for the 61-year-old Oglala Sioux whose retirement
home provides food but no true medical attention. 

The care he will need is far away, miles from friends, family, customs and
home. With few nursing homes on the nation's reservations, experts say it
is a decision likely to face more and more elderly Indians. 

The number of Indians and Alaska natives over 60 isn't vast. Census Bureau
figures for 1990 place the total at about 166,000, less than 1 percent of
the nation's total, yet that is a 52 percent gain since 1980. 

Half of this rapidly growing population live in rural areas. Some live
alone. And according to a Bureau of Indian Affairs report in September,
most tribes need hundreds of millions of dollars to meet basic needs 
including assistance to the elderly. 

Dave Baldridge, executive director of the National Indian Council on Aging
in Albuquerque, N.M., says he knows of only about a dozen tribally operated
nursing homes in the nation. 

The Navajo, the nation's largest tribe, have one in Chinle, Ariz. But there
is only one other, on the Gila River Reservation, for the rest of Arizona's
21 tribes. 

Tribes have little money and lack the trained healthcare workers needed to
operate the homes, Baldridge says. Efforts are not helped by federal and
state rules, including South Dakota's moratorium on nursing home expansion. 

"The tribes, I think, across the country have the cards heavily stacked
against them,'' Baldridge says. 

On the Pine Ridge, 5,000 square miles of sprawling prairie that is about
the size of Connecticut, modern conveniences and services often seem a
world away. This is the home of Wounded Knee and the Badlands. 

Diabetes, alcohol and traffic accidents kill in the windswept region where
summers are hot and the winters bitterly cold. There is rampant
unemployment and Shannon County, which includes the Pine Ridge, was the
nation's most impoverished, according to 1994 census data. 

There are nursing homes in towns surrounding the reservation, in Martin,
Custer, Hot Springs, Rapid City and Rushville, Neb. But the Oglala Sioux
cannot afford to build and operate one, and the state and federal
governments have not provided Medicaid or other money to help. 

State Rep. Dick Hagen, a Democrat from Pine Ridge and a tribal member, has
worked for years to get a nursing home built here. 

He says Indians are living twice as long as they did in the early 1900s, to
about 60, and at least two-thirds of the Sioux either have diabetes or are
at risk of getting it. He has it himself. 

To Hagen, the need for nursing home care is clear. He is well aware that
treaties and other laws require the federal government to provide health
care for tribal members. 

"The treaty says the federal government will provide education and
health,'' he said. "With the growing numbers of elderly, I think a nursing
home is health.'' 

However, providing federal aid for a reservation nursing home in South
Dakota appears to be complicated, if not impossible. 

A nursing home must be certified by the state before it can get money from
Medicaid, a state-federal aid program for the poor. 

But Mike Vogel, deputy secretary of South Dakota's Department of Social
Services, says the state will not certify a nursing home on the Pine Ridge
because South Dakota has enough beds to meet demand. There is also a 1988
state law banning the addition of nursing home beds. 

The Indian Health Service, with a budget of about $2.5 billion, provides
health care for about 1.5 million of the more than 2 million American
Indians and Alaska natives in the country. The IHS runs reservation health
centers and clinics for Indians in urban areas. 

Daryl Russell, deputy director of the IHS in Aberdeen, says his agency
doesn't have enough money for existing clinics and hospitals  and
certainly not nursing homes. 

Hagen's fight has been a lonely one. Fellow lawmakers have consistently
rejected his attempts to allow a nursing home if no similar facility is
operating within 20 miles of the reservation. 

He'd like to build a 30-bed nursing home in Pine Ridge village, the tribe's
headquarters. He thinks it would be filled immediately. 

In the Sioux culture, younger people take care of parents and grandparents.
But privacy customs prevent men from doing some things for women, and vice

For now, those on the reservation drive for hours to visit relatives and
friends in off-reservation nursing homes. Those trips take a long time, and
many families cannot afford the gasoline. 

"After a while,'' Hagen says, "they fail to get there.'' 

And because workers at those homes often don't know much about Sioux
tradition and culture, they sometimes can't provide elderly Indians with
the support and services they need, Hagen says. 

"We Indian people seem to do a lot better, even through illnesses, if we're
around our own,'' he says. 

Like Hagen, Hendricks wishes a Pine Ridge nursing home had been available
when his mother was alive. He couldn't care for her properly and chose to
put her in a Rapid City nursing home, 90 miles away. 

If he must move to a nursing home, he figures he would be better off close
to family and friends on the reservation. 

"This is my home,'' he says. "This is where I was raised. It's where I'm

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           Tsonkwadiyonrat (We are ONE Spirit)

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