Hi everyone.
Thank you for joining us today.
On behalf of the Centers of Medicare and Medicaid Services, the Administration for Community
Living, and the Indian Health Service, I would like to welcome everyone to the Long-Term
Services and Supports webinar series.
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With those announcements made I would like to welcome everyone to today's webinar.
Today's webinar is entitled, "Identifying Our Needs: a Survey of Elders, Data that Makes
a Difference for Our Native Elders."
Our presenter today is Collette Adamsen, MPA.
Collette is the Director of the National Resource Center on Native American Aging at the University
of North Dakota School of Medicine and Health Services.
Thank you, Collette for taking the time to join us today.
I will now turn it over to you for an introduction to today's topic.
Thank you.
Hi everyone.
I'd like to start off by thanking all of you for being a part of the webinar today.
So glad.
Um, so I am Collette Adamsen, the Program Director for the National Resource Center
on Native American Aging and I've been with the Center for about four years now.
Back in October I was put in the position of interim director and then in January I
became director.
So before that I was Project Coordinator for the program over three years and I ended up
working at the Center and being a resource for these elders in our Native Elders Programs.
I sure love what I do.
I enjoy work every day.
So with that being said, I will begin the presentation.
So I guess identifying our survey elders' data base makes a difference for our native
elders.
So I'd like to start off with providing you a little bit of a background about the
National Resource Center on Native American Aging.
Um, we're one of the three centers that are funded by the Administration for Community
Living.
We have two sister centers, the National Resource Center for American Indian and Alaska Native
and Native Hawaiian Elders which is located in Alaska and the director there is Jordan
Lewis.
Um, and our other sister center, the National Resource Center for Native Hawaiian Elders
which is located in Hawaii and under the directorship of Collette Brown.
Um, *** (indistinct - 00:03:20).
We were established in 1994 under Dr. Allen Allery who is an enrolled member of the Turtle
Mountain Band of Chippewa.
Dr. Allery dedicated 30 years of his life to advocating for American Indian people and
for our Native Elders *** (indistinct - 00:03:36) Center.
He started the program back in 1994 which our Center *** (indistinct - 00:03:44) and
Center for Mental Health and the School of Medicine and Health Sciences at the University
of North Dakota in Grand Forks, North Dakota since 1994.
Um, the mission of our center is to identify and increase awareness of the evolving native
elder health and social issues and our mission is to empower native people to develop community-based
solutions while honoring and helping to maintain their cultural values.
So I'm going to give you a little bit of background about our program and resources
that the center offers.
To just give you a quick brief list of the resources we have, first, we have to identify
our needs of serving elders; well-balanced program which is why there is elders living
longer; the native elder caregiver curriculum; a service locator map; *** (indistinct - 00:04:43)
project; and I forgot to list there our Native Indian Business Newsletter.
But to begin with I want to talk about our main project, identifying our needs of serving
elders.
This project is, as I mentioned, funded by ACL and our needs assessment assesses the
health and social needs of native elders in tribal communities and this needs assessment
runs on three year cycles.
It provides tribal communities the opportunity to collect information for their tribal communities
about their native elders in terms of health and social issues and then also we provide
technical assistance.
There's a full process.
So if your tribe is participating with the survey; we're available to you by program
email.
So if you need any help, we're there for you from start to finish of the survey process.
We also offer training *** (indistinct - 00:05:50) to the tribe or the Title VI grants here that
we're working with and we can provide that training online or in person if, um, interest
in it or our funding would allow us to at that point.
So I guess as I said to kind of talk about what a needs assessment is just to have a
better understanding about what our survey is and does.
So a needs assessment allows us to understand and identify health and social issues.
We have to determine what is going on in the communities among our native elders in terms
of health and social needs to find out what areas we need to fund these services for.
So after you finish conducting the needs assessment you actually have a documentation that tells
you the story of your elders in your community and from there you're able to better assess
and recognize the different needs in particular areas.
You also have data results and statistical numbers that assist you and the tribe in planning
the work to distribute resources and funding for those particular needs and also, I mentioned,
the data can be used to apply for grants and strengthen your argument for a particular
need that the assessment has identified.
*** (indistinct - 00:07:11) who the chances of secured resources and funding to address
the need and bring a most vital program into the community to serve our native elders.
But overall the needs assessment provides you with information and data that tells us
what is going on in our communities and where the big issues lie and how we can address
the needs and find community-based solutions that bring in *** (indistinct - 00:07:38)
funding to develop programs to address that need and then also that need we will be improving
and reducing the number of health and social issues for our native elders.
Overall this will help us to provide a better quality of life in terms of health and social
needs for our native elders.
This is very important.
So the needs assessment provides us with a data roadmap.
On the side I included a picture of our goal with going all over and questions on the side.
But once you've conducted a needs assessment all those...the questions on the sign-ins
will be answered in terms of who, what, when, and where this will help with social needs
which are occurring within your native elder population.
It gives us a snapshot of our native elder population.
It provides us with trending data in terms of health and social needs providing us insight
on the areas we need to address and find solutions for and all the questions on the sign-ins
will be answered for the data provided from the needs assessment that you've conducted
in your communities.
So in terms of tribal diversity, the resource center uses a research model that comes to
address diversity between and within the tribes.
So we know that each tribe is unique and diverse and that is why we use a research model that
attempts to address this diversity between and within those tribes.
We know that the measures are unique to that particular tribal community.
So we try to use a custom fitting measure and then attempt to use the research process
that acknowledges that a "one size does not fit all" approach, um, with the tribes
we work with and we know that each tribe has unique cultures and circumstances and we try
to be respectful of each tribe's diversity.
Um, so like I said, we try to adjust the research process knowing that a "one size does not
fit all;" um, that there's diversity within each tribal community and we definitely have
to take that into account in our research process.
So, the population that participates in the survey are usually our native elders that
reside primarily on reservations, Alaskan villages, and Hawaiian homesteads.
For the most part we work with native elders that are eligible for services for Title VI;
so they're usually the ones that are participating in the needs assessment.
Also, we are ages 55 years or older and for this I just wanted...
I thought it was important to know that our native elders 55 years and older is comparable
to non-native elders 65 years and older in the general population and that has to do
with the fact that the life expectancies for our population, that is native population,
is 4.4 years less on average than compared to the general population, but each tribe
is different in this as well, because some of those statistics are even lower and there's
a larger gap in life expectancy for particular tribes in particular areas.
Um, so our needs assessment...
The sections we have on our survey...
(Coughing.)
Excuse me.
I'm kind of battling a cough and a cold.
(Sound of coughing.)
But the surveys use data that we have, um, it's pretty concrete in some of our surveys,
but it includes sections that is the general health status, diagnosis, and chronic disease
to ADL to health care access and all the way down to demographics such as age and gender.
So here's an example of our survey.
This is our new survey, cycle seven.
Um, so just to give you an idea of a couple of last year's.
This is page 1; question one, "Would you say your health is generally excellent versus
good or poor?"
Question three asks about chronic disease.
"Has a doctor ever told you that you've had any of the following diseases?"
And then here is page 2 of our survey.
Some of the questions there are, "Have you been diagnosed with Alzheimer's disease,
dementia, or other problems with memory or thinking?"
To questions about health care access, "What type of healthcare coverage do you have?"
And then also, one that I thought was a good question was, "*** (indistinct - 00:12:34)
rights about your health to which of the following do you...are usually goals and for the option
there, I thought it was really good that we included traditional healer because it kind
of allows us to bring in some of the cultural competency and sensitivity to some of these
questions where we include some of the native elders that might seek out a traditional healer
for their healthcare needs.
So that data would also be really valuable in maybe securing resources for their program
for native elders that prefer, you know, cultural aspect to their healing.
Um, page 3 we have for example the legend; "Over the past 38 days what good exercises
do you do?"
Um, another example was a really good question, I think, is, "Do you take care of grandchildren
and are you the primary caregiver of your grandchildren?"
That's another example of questions and then the last page (coughing) question 16,
"Are you now using or if at some point you became unable to meet your own needs if you'd
be willing to use the following services?"
And they have a choice there from anywhere from adult day care; government assisted housing,
and long-term care services.
So that just gives us a good idea, that question about what services are needed within tribal
communities.
And then we have general demographic questions that refer to under-age, education, and unemployment.
So our research model and process, we start out with first and foremost we tell the participating
tribe or the federal *** (indistinct - 00:14:38) we're working with, um, that we need a title
resolution for permission from your tribal government in order for that tribe to participate
in the survey; otherwise if we don't have permission we won't be able to process your
surveys.
Um, we've had circumstances where some tribes have put in a lot of work in collecting their
surveys, but then they weren't able to get their tribal resolution in and that's usually
sometimes because tribal elections were happening at that moment and it was really hard for
them to get signatures on the tribal resolution.
So we really encourage the tribes that are participating to get that tribal resolution
right away, but I do want to point out that you can still start, like request your surveys
and start collecting your data without the tribal resolution, but when you send it in
to process, uh, to us for processing then that's when we'll need the tribal resolution
for sure.
So when you contact us we'll ask you for an elder count.
This is usually the number of native elders that are being serviced by Title VI and then
from there we'll take that number and calculate it to get this random sample number and that
number just basically is telling you, "This is the number to shoot for to get a good representation
of your population so the results will be that much better and more true to what's
happening in the population."
And then we'll send you out your surveys with a helpful guide that tells how to get
started, an interviewing guide for the survey, then they'll tell you how to fill out your
grant application using the data, and then also a sample resolution if you need that.
And then what we ask is that a native staff member, a volunteer from your program administer
the survey to the native elders, because there might be a medical issue or some other communication
about the questions that makes it hard for the elder to understand.
So, we always encourage to have somebody administering the survey for the native elder.
So once you send back the survey, once they're all completed, collected, then we end up scanning
it through our scanners and converting it into like a statistical software package where
it allows us to analyze the data.
After we analyze that data we get the results for the tribe and we're using those frequency
tables and a comparison sheets for the tribes to compare themselves to the tribal aggregated
data and national data numbers.
Also, I want to point out that the tribe owns their own data.
This is per our agreement through the tribal resolution.
Um, the tribe owns their data.
We have them stored for them on a secure server.
We cannot analyze any tribe's particular data for any other reason besides, you know,
sending them their own results, unless the tribe requests that they're applying for
a grant.
We've had this before where they're applying for a grant and they ask us to analyze the
data and create some graphs for them that they submit with their grant application.
So we will do that for tribal communities that request that.
So once the comparison stage...
Here's an example of what the comparison stage kind of looks like.
This is just the first question.
We have over 20 pages of these columns and information.
So here we have the question, response, and then your tribal data with, you know, for
example, your tribal data, the aggregated tribal data which is all the tribes that have
participated in the survey combined, um, all that data and those results and then the national
data which is a general population data.
So the tribe is allowed to compare their results to the tribal aggregated results and the national
data.
So they can kind of have a better understanding of where their native elders are sitting compared
to those two groups in terms of health and social issues and needs.
I just wanted to give you a little bit of an example.
This is some data from cycle six.
I know it's kind of hard to read right there, um, but the Alzheimer, dementia, and disability
question section that we have on there, and so what I did was I just kind of did some
simple frequencies, numbers.
I created this graph.
So here we can see that 4.2% of our native elders were diagnosed with Alzheimer's disease.
From here we can see that 80.8% of native elders felt that their wishes were listened
to and respected in terms of the type of care, um, they wanted or required.
So this is just a, like I said, a simple frequency bar table graph that I created just to give
you an idea of how you can utilize some of that data.
Also there's another section.
This is another bar graph, just set up differently, but on their nutritional health data for our
stakeholders.
So we can see here 35% of our native elders take three or more prescription or *** (indistinct
- 00:20:36) drugs per day.
Um, 23% have an illness/condition affected the type or amount of food they were able
to eat.
Um, so this is enough data for us to use in maybe securing resources or funding to help
address some of these issues with nutritional health for our native elders.
And then here, this is a trending bar graph.
So as I said, these have different cycles of data.
We do it every three years.
So, one graph for cycle three all the way up to cycle six.
That's 12 years of data.
So when we look here for the family member caregiver, um, from the native elder that
has a family member who is caregiving for them, we can see the trending data.
So in cycle three it was 42.5% and then fast-forward all the way to cycle six, it's 33.7%.
Um, so it's improved.
Caregiving for grandchildren, that was at 31.3 to 28.3% over 12 years.
So it's slightly improved.
And then we look at this area here for primary caregiver of grandchildren.
We didn't have this question on the previous cycle; so we only have one cycle of data for
that particular question.
But you can kind of see a difference with, you know, who participated in all of the cycles.
You can kind of see if you're improving, if that area is remaining stagnant or if it's
becoming worse.
So it's really valuable in that it helps you to see what direction these health and
social issues are going.
So, here is another graph that I wanted to just give you an example of an.
So here we see chronic disease by gender and native, uh, among native elders.
So the yellow line represents female native elders and the purple line represents the
male elders, native elders.
So as we can see, high blood pressure diabetes are kind of around the same for both genders,
but then once we get to arthritis we then see female elders have a higher prevalence
and that leads to depression and that's almost one and a half times more than the
native male elders and then as we look at osteoporosis it's almost five times more
than native male elders compared to female native elders.
So this also gives us some good information.
You can use programs for something to address osteoporosis for female elders.
So remember this little graph that I just wanted to give you an example of how we can
use or set up that data so that we can maybe put it in a grant application or other resources
you may need it for.
So, the answer of data for tribal communities.
But when we look at a community level, we can use the data to renew your grants specifically
Title VI grants.
Today we're driven by a number world.
They always want to see what is going on and they need to see that number to show proof
of what is going on.
So it helps to strengthen your grant proposal by having this documentation of the native
elder health and social needs.
It can also help with tribal planning and infrastructure.
So the tribes could take this information and to see where the vagrancy's are and
allocate funding or resources towards those needs.
On the national level, it can help to train our native elder's service providers to
provide better culturally sensitive and competent care to better serve our native elders, to
also advocate for resources and funding at the state, regional, and national level, and
another important one is filling the research gap for native elder information.
I know myself even as a person who advocates the types of base awareness about being an
elder means, I have a hard time finding current or recent information about these certain
topics or areas.
So it's good to have that information out there and helps with the needs assessment
survey.
Also, training native researchers in the aging field; um, this is a big one too, to help
our own native research to be able to go out and learn more about the gerontology field
and how to help our native elders and to address their needs and find solutions.
So it's good to have our native researchers because they understand our population very
well.
Um, decision making and policy.
So legislators will probably end up receiving less information.
So they see a need or the numbers show a great need for what kind of areas our programs they're
going to allocate funding to.
So it's important to get this information in front of those policy makers to advocate
and secure resources for our native elders to help improve their quality of life overall.
So now I'm just going to do a little example of our needs assessment participation.
So here's a pie chart and if you look at cycle one, um, that was over 18 years ago.
We had 9,403 elders participate with 190 tribes are presented.
Fast-forward to 18 years later, 2016, we had 18,134 elders which is almost twice the amount
of participants; so it almost doubled and 257 tribes are represented in this current
cycle.
Overall we had 89,436 surveys collected since we began the needs assessment survey.
So this is a summary of our last cycle just to give you an idea of participation and our
representation within the nation.
So the data was collected from April 1, 2014 to March 31, 2017 and then as I said, we had
18,134 American Indian, Alaska Natives, and Native Hawaiian elders participate.
That represented 164 sites and 267 tribes and their representation from 11 out of 12
Indian Health Service regions, 9 out of 10 Department of Health and Human Services regions,
and 20 of 50 states.
So we had a really good representation from those areas and now we begin cycle seven on
April 1, 2017 and that will end March 31, 2020.
So here's a program well-balanced.
This is an example of a program that was developed because of our data.
The numbers show the need that needed a solution.
So this program was developed Dr. Lori Redding who is a physical therapist and was the director
of the Wellness Center at the University of North Dakota.
They found a need whenever they were looking at our data.
So, the top five kinds *** (indistinct - 00:28:35) pieces in the 12-year period.
So when we look at this chart - this is a trending chart from cycle three to cycle six
- so we can see that diabetes, high blood pressure, and arthritis we made consistently
the most prevalent chronic diseases among the native elders that participated in the
survey.
Then today our data cycle six shows tribal aggregated data and all of the regions show
us that a man with diabetes, high blood pressure and arthritis are the top three chronic diseases
that are prevalent in our native elders.
And when we look at 12 trending data - so this is over a 12 year time period, also - and
you see from cycle three to cycle six it goes anywhere from 38 to 39% of our data AI/AN
elders have experienced one or more falls in the past 12 months.
So there's the data there with a need identified.
So Dr. Redding was working with, interviewing and developed a well-balanced program which
is why elders are living longer and it was designed to promote fall prevention, strengthening
and balance, engaging in social activities.
So native elders, they're going out and being a part of this exercise program, but
they're also socializing with their friends and other people who are taking part in the
program which is positive for their mental health as well.
It also manages diabetes, arthritis, and high blood pressure, and dementia because of the
data that we've seen which showed a need and it helped...
It developed strategies for independent living while having fun.
Last fall we created this video just to give you an example of some of the exercises that
the wellness program has to offer.
So I will let them queue up that video.
It's another tremendous video.
Hi folks.
This is Kaitlin with Kauffman and Associates, again.
We are queuing up that video and I just wanted to let you know that because of Adobe Connect
functionality you won't hear any audio, but that will not affect the information that
you get from the video and if you would like a link to the video it will be posted within
the presentation which will be at CMS.gov in a couple of days.
Thank you.
So that was just an example of some of the exercises that I put in the program.
An actual manual may have native elders demonstrating the movements.
The video, we would have preferred to have native elders in the video, but we're waiting
for more interest and so in the future we're hoping that we can have a video where the
native elders are performing the exercises.
Our next resource or curriculum is our native elder caregiver curriculum.
It is a training resource for family members services and American Indian elder caregivers.
And the NAPC model uses a model of network for delivery of elder care in community-based
long-term services and support in American Indian communities.
Care of elders is the main focus that includes, um, kind of branches off the traditions and
culture, takes *** (indistinct - 00:34:00) healthy areas of tradition and culture, health
services and community providers, tribal, regional, state, and federal resources, extended
family structure and family and friends as caregivers.
The program was developed because we recognized that there was a long need for native elders
to age in place in their homes and in their tribal communities.
As we all know, the options for long-term care services such as nursing homes and retirement
homes that are kind of not available in tribal communities and they tend to be located far
away from their home.
So the NAPC recognizes that training native elder caregivers will help keep the native
elder in their homes and tribal communities longer.
The NAPC also serves as a toolkit with community health workers and community health representatives
to address the needs of the native elders that they serve.
But overall NAPC was developed with the guidance about awareness of the modern contract with
rural tribal communities and the historically rich traditions and strengths of American
Indian nations and this is embedded in the framework of the NAPC curriculum which includes
and to give you a few examples of our curriculum is what the reasoning is for it is helping
families and professional in-home caregivers have additional gerontology related knowledge;
help families learn how to access information from healthcare providers that is essential
to planning and providing quality care and prevent re-hospitalization; help families
understand the healthcare payment system and eligibility criteria for Medicare/Medicaid,
etc.; and these are only a few examples of what the NAPC provides in the training.
Our consultant, Chris, she doesn't believe in *** (indistinct - 00:35:57) to presenting
the curriculum and when she rolls into tribal communities she adjusts her training to meet
the needs of the community taking into account cultural sensitivity and competency, but if
you're interested in the program just contact our center and we will give you more information.
So here's our service locator map and I was going to give out a slight demonstration
for this map.
It's another resource that we maintain and it's a web-based service.
So if I could...
I'll try to pull it up here.
So this is right on our webpage.
So all you have to do is if you're looking for behavior in, I guess, Minnesota, so it
gives you the area where these services are, the tribal areas, and then you can just click
on them and they'll tell you what services are offered in that tribal community and we
try to update this often.
We usually call the tribal communities and ask if they still have these services or new
services we know that are made available.
Hey, Collette.
Yeah.
Hey, real quick.
We can't see your screen.
Can you try to share your screen with us, again?
Oh, yeah.
Thank you.
Sorry about that.
Here we go.
I'm sorry everybody.
I thought I my screen was being shared.
Sorry.
Um, so here.
Okay.
There are examples here that...
Can you see it now?
Yes.
Okay.
So say you want to click on Arizona, you can see what services are available in tribal
communities.
So we can click on Hopi Tribal Council and then it just shows you all the services that
are provided in that area within the tribal community area.
You can also view it by service.
So I believe they'll see here...
So it just shows you which areas have one to two centers, three to four centers by color
coded, um, by color coded legend.
So this is really helpful in trying to find services in a tribal area for native elders.
And now for our other projects we have is the NR...
Oops.
Sorry.
For other projects is NRCNA heroes and this project honors individuals who have dedicated
their time, challenge, and energy to help native elders, um, either their neighbors
whose efforts often go unrecognized.
Um, heroes are people who help those stronger communities by supporting and nurturing their
elders and these people are people who are making a difference for our native elders
within their tribal communities and even off tribal communities.
So for this program they're actually currently accepting submissions for 2018 and if you
have somebody in your community, a native elder or somebody who advocates for native
elders and want to recognize them, please submit a nomination and we're hoping to
recognize them at this next year's Title VI conference and then here's our native
Aging Business Newsletter.
This newsletter is just to let you know what is going on within our center as well as offering
information about our programs, healthy aging tips, recipes, and our Times article featuring
a native elder.
So if you have somebody who is a native elder or someone who is caring for elders that you
fill should be featured in our newsletter, just let us know and we can start the process
of including them in our future issue.
For example, in one of our last issues we featured a native elder female veteran and
she really had an amazing story and I really, really enjoyed interviewing her and just learning
a lot of different things from her and it turned out to be a great story.
It actually was re-published in a couple of other local newspapers.
So I thought that was really neat.
So if you have anybody who is a native elder or that you think deserves recognition or
somebody who advocates for native elders, please contact us and we can try to speak
to them in our newsletter.
So with that, those are all of our resources that are available to our tribal communities
for our native elders.
If you have any questions, please feel free to contact myself or our NRCNAA staff.
I included our photos just so you could put a face with a name when you call us on the
phone and we also have a new project coordinator, Erica Grandville, and she's really nice
and she's ready to help anybody who needs assistance and she's more than willing to
help in any way she can and so are Nicole and myself.
So here's our contact information.
And you can get a hold of us or are interested in any of our programs that we have available,
or resources you need, don't hesitate to call us or contact us by email.
So with that I guess, are there any questions?
All right, folks.
So we're going to be moving on to the Q&A portion.
So if you'd like to submit your questions via Q&A box we would love to answer them.
Um, so I see a question.
"Is the well balanced program available nationwide?"
Um, yeah.
It's a big program that we offer.
All of our resources are at no cost to the tribe.
So we do...
Currently we're updating the manual.
The original developer of the curriculum, Dr. Redding, she generously agreed to help
us update certain areas of the curriculum.
So we should have the new manual available at the end of May.
Normally how we do it is we like to train two coaches who would implement the program
within the community for the native elders, but if you do have somebody with like a personal
fitness background or physical therapy or exercise clients, I think you can probably
navigate through the manual well.
So you just call us and we can send you out a manual and the forms and help you in getting
started with that program.
Awesome.
So our second question is, "What is the website for the service locator?"
Um, so that is on our overall website.
So it's www.NRCNAA.org and then you would just go under - um, let me double check here.
Oops.
So you would just...
You'd just go under the project of services and then just click on the service locator
and then it will bring up the map and then you can navigate the map from there.
Great.
And that link is also supplied in the web link pod.
So question number three is, "In regards to the amount dementia diagnosis in tribal
communities have you found that dementia is seen as a normal part of aging which may prevent
individuals from seeking care?
Are health literacy initiatives in the community...
Uh, are there health literacy initiatives in the community regarding this issue?"
Um, so I think that now that we're becoming more aware of Alzheimer's, dementia and
I actually looked putting it on there.
I think people are recognizing that native elders and tribal communities and I see they're
starting to recognize it more.
With their health literacy in their communities regarding this issue, um, I think there's
more interest in this area.
So now I think we're starting to collect, monitor, maintain the data in this area to
try to start defining *** (indistinct - 00:44:53) and see what's going on within our population
so we can develop solutions or programs to help in this area.
Although Alzheimer's is not a *** (indistinct - 00:45:07) disease but just, you know, *** (indistinct
- 00:45:09) for resources out there to offer care, so...
Thank you.
Question number four is, "How many elders typically participate per tribal site?"
Um, that is a big deal, because some of our consortiums.
You know some tribes only have one or two people and then they combine it, you know,
into the consortium.
So we've had anywhere from, you know, 10 surveys sent in to 600 surveys sent in.
So it just depends.
Depending on the size of the population at that elder's home, you know that's where
we determine the amount that you would have to collect and usually that number is a good
representation of your population.
So usually six.
We try to collect at least 30, um, 30 to 50, because that will give us an okay data for
you.
Of course, a lot more is better for that.
Excellent.
Okay.
The next question is, "Are there any questions on opioid use being included in the survey?"
Um, not at this point.
We haven't looked into it, but maybe in the future.
We can look into something for cycle eight survey, but at this point, no, we haven't.
Sometimes that information is sensitive.
I think it's a sensitive issue, too.
So sometimes you've got to find ways to work *** (indistinct - 00:47:02) and so we're
not going too invasive either.
Great.
That makes sense.
Um, the next question is, "Would you suggest the CDC-BRFSS as another reliable source for
American Indian or Alaska Native elder population data?"
Well, we use some of the BRFSS questions or modify some of the questions when the survey
was first started, but normally their sample size is much lower compared to ours and they
don't...
Like for our survey, we have the participant identify whether they're American Indian,
Alaska Native, Native Hawaiian, descendants, or other; so then you can actually see, um,
specifically what area, you know, what that person identifies as.
But with the BRFSS data it kind of...they kind of lump it together so like you're
one population.
So, I mean, it is a reliable source, but the numbers aren't as high for the sample and
like I said, they lump them in together for the AI/AN and you know Native Hawaiians and
things.
Uh, great.
So I just have a couple more questions for your and we're running close on time.
So we're going to do a few more questions and then, Collette, is it all right for people
to reach out to you via email if they have any more questions?
Yes.
Definitely.
They can contact via email or phone.
Awesome.
Okay.
So I'm just going to give you two more questions.
Um, "Is there any surveying plans for urban Indian communities?"
Um, at this point we're really looking into it.
We are hoping we will be able to offer that, but right now we're kind of in the beginning
planning stages to see if it's possible for us to do so.
We keep everybody updated on that too as we find out more information.
Great.
And our final question is, "Do you publish aggregate data state-by-state or by IHS regions?"
Um, I guess we haven't published any of the data, um, when especially like on our
websites or anything, but right now we're in the process...
We're trying to work on publishing some of the aggregate data on the aging website.
So we're hoping to have that available soon or in the near future and I believe that this
overall like just the whole tribal aggregate, but we can break it down to state-by-state
or IHS regions for other publishing ambulatory sites.
Great.
Well, thank you so much for all this information today, Collette.
Thank you for presenting.
We'd like to thank everyone for being here and we hope you had a great experience and
keep your eye on the CMS.gov website for this to be published and have a great day.
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