LTSS Research
Guidance for reports, fact sheets, web links, and other resources that focus on research related to LTSS needs and successes in Indian Country.
This page provides access to reports, program profiles, and other resources highlighting LTSS-related needs and success stories in Indian Country.
An Introduction to LTSS
The need for LTSS in tribal communities is considerable, given the growing population of American Indian and Alaska Native people 65 and older and the high number of AI/AN people with disabilities. According to the Administration on Aging, the number of AI/AN people 65 and older was projected to increase by nearly 47% between 2019 and 2030. (Note, while tribes may understand elderhood as beginning at an earlier age, this web page defines "older adults" as 65 and older, because Medicare eligibility generally begins at 65.)
Additionally, AI/AN populations experience some of the highest rates of chronic disease and disability in the U.S.
Issues Affecting American Indians and Alaska Native Consumers with Disabilities (PDF) (23 pages)
A report that discusses Indigenous perspectives on disability, summarizes factors impacting the availability of LTSS in Indian Country, and features examples of programs serving AI/AN people with disabilities.
Caregiver Support
LTSS Research: Annotated Literature Review—Caregiver Support in Indian Country (PDF) (40 pages)
A discussion of caregiving challenges in American Indian and Alaska Native communities, available support for caregivers, and recommendations to overcome barriers.
Program Profiles
Each of the following program profiles highlights successful strategies, funding sources, and future considerations.
- Blackfeet Eagle Shield Senior Center (PDF) (2 pages)
- Inter Tribal Council of Arizona, Inc. (PDF) (2 pages)
- Oneida Nation Elder Services (PDF) (2 pages)
- Southeast Senior Services (PDF) (2 pages)
- South Puget Intertribal Planning Agency (PDF) (2 pages)
- Taos Pueblo Senior Citizen Center (PDF) (2 pages)
Elder Abuse Prevention
Elder Abuse Prevention Resources in Indian Country: National Indigenous Elder Justice Initiative (Video)
A webinar focused on the National Indigenous Elder Justice Initiative (NIEJI) and the resources available to prevent elder abuse in Indian Country.
Best Practices in Elder Abuse Prevention: A Snapshot of Research Findings (PDF) (1 page)
An overview of elder abuse research, including types of abuse, challenges to addressing abuse, and recommendations for establishing elder abuse prevention programs.
LTSS Research: Annotated Literature Review—Elder Abuse in Indian Country (PDF) (42 pages)
A discussion of the different types and causes of elder abuse as well as recommended approaches to addressing elder abuse, with special attention given to issues that are unique to AI/AN populations. The paper includes detailed summaries of 31 references.
Reclaiming What Is Sacred: Addressing Harm to Indigenous Elders and Developing a Tribal Response to Abuse in Later Life (PDF, 66 pages)
A report that explains the issue of elder abuse, offers strategies for preventing elder abuse in tribal communities, and encourages communities to look closely at how elders are treated and to use local strategies to respond to abuse compassionately and effectively.
Program Profiles
Each of the following program profiles highlights successful strategies, funding sources, and future considerations.
- Adult Services Program: Poarch Band of Creek Indians (PDF) (2 pages)
- Elder Abuse Prevention Interventions Program: Winnebago Tribe of Nebraska (PDF) (2 pages)
- Elder Abuse Prevention: Oneida Tribe of Indians of Wisconsin (PDF) (2 pages)
- Elderly Protection Team Department: Standing Rock Sioux Tribe (PDF) (2 pages)
- Elderly Services Program: Central Council Tlingit and Haida Indian Tribes of Alaska (PDF) (2 pages)
Emerging LTSS Issues in Indian Country
- LTSS Research: Improving Care for Adults with Disabilities in Indian Country—Highlights from the Field (PDF) (9 pages)
A report featuring three tribal programs and their approaches to care for adults with disabilities. - LTSS Research: Improving Care for Adults with Disabilities in Indian Country—Highlights from the Literature (PDF) (10 pages)
A review of key themes from research on the overall adult population with disabilities as a framework for future studies on the topic of AI/AN adults who have developmental and or acquired disabilities. Emerging LTSS Issues in Indian Country: Caregiver Training (PDF) (14 pages)
A paper highlighting the need to increase funding for and access to training for family caregivers in Indian Country.
Emerging LTSS Issues in Indian Country: Disability and Housing (PDF) (14 pages)
A paper highlighting the need to develop and fund culturally relevant housing programs for AI/AN people with disabilities.
LTSS in Our Community: Assisted Living—Summary Report (PDF) (17 pages)
A paper about the successful efforts of three different tribal communities to design, construct, and open their own assisted living facilities.
Emerging LTSS Issues in Indian Country: Executive Summary (PDF) (3 pages)
A summary of three reports (listed below) offering more in-depth coverage of LTSS funding for home- and community-based services, adult family homes, and Alzheimer's disease and dementia.
Emerging LTSS Issues in Indian Country: Rebalancing LTSS Funding for HCBS (PDF) (16 pages)
A paper about efforts to rebalance LTSS funding for home- and community-based services in Indian Country.
Emerging LTSS Issues in Indian Country: Adult Family Homes (PDF) (10 pages)
A paper about adult family homes, a viable option for tribes that want to provide culturally appropriate, affordable home- and community-based services for elders and people with disabilities.
Emerging LTSS Issues in Indian Country: Alzheimer’s and Dementia (PDF) (10 pages)
A paper about Alzheimer's disease and dementia in Indian Country, barriers preventing diagnosis, and recommendations to help address challenges.
Funding
Opportunities for Home- and Community-Based Services in Indian Country (PDF) (17 pages)
A report that provides an overview of potential funding sources for home- and community-based services (HCBS), highlights five HCBS programs in Indian Country, and offers insights and recommendations to the staff of HCBS programs that are new or in development.
Hospice and Palliative Care
Hospice and Palliative Care in Indian Country (PDF) (2 pages)
A fact sheet that analyzes, as a group, four hospice programs that serve Indian Country.
Hospice in Indian Country (PDF) (37 pages)
A paper that offers recommendations to increase access to culturally sensitive hospice care and includes detailed summaries of 26 relevant references.
LTSS Research: Hospice in Indian Country (PDF) (11 pages)
A review of research underscoring the need to increase the availability of compassionate, culturally appropriate end-of-life care across Indian Country.
Caring for Those Nearing End-of-Life: Providing Compassion and Dignity for our Elders (PDF) (1 page)
An infographic that provides an overview of hospice and palliative care, along with a list of strategies that tribal communities have used to create their own hospice and palliative care programs.
Program Profiles
The following program profiles share the experiences of tribes that have successfully established culturally sensitive end-of-life care programs.
LTSS for Native Veterans
LTSS Research: LTSS for Native Veterans—Annotated Literature Review (PDF) (38 pages)
A paper that offers recommendations to help increase Native veterans' access to LTSS and includes detailed summaries of 25 relevant references.
Program Profiles
The following program profiles share the experiences of tribes that have successfully established culturally sensitive programs for Native veterans.
Nursing Homes
Tribal Nursing Home & Assisted Living Facility Directory 2026 (PDF) (23 pages)
Lists each facility’s contact information and tribal affiliation.
LTSS Program Examples and Videos
Visit the Program Examples page for profiles of successfully implemented tribal LTSS programs.
Watch brief videos about additional examples of LTSS programs in Indian Country.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2020
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