The Indian Health Service (IHS) announces the availability of up to $600,000 for competitive grants through the Elder Care Initiative Long Term Care (ECILTC) Grant Program to support planning and implementation of sustainable long-term care services for American Indians and Alaska Native (AI/AN) elders.

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This program is authorized under the Snyder Act, Indian Health Care Improvement Act, as amended, 25 U.S.C.

1653(c), and Public Health Service Act, Section 301, as amended.

This program is described at 9 3. 933 in the Catalog of Federal Domestic Assistance (CFDA).

The AI/AN elder population is growing rapidly and the AI/AN population as a whole is aging.

The prevalence of chronic disease in this population continues to increase, contributing to a frail elder population with increasing long-term care (LTC) needs.

LTC is best understood as an array of social and health care services that support an individual who has needs for assistance in activities of daily living over a prolonged period.

LTC supports elders and their families with medical, personal, and social services delivered in a variety of settings to support quality of life, maximum function, and dignity.

While families continue to be the backbone of LTC for AI/AN elders, there is well documented need to support this care with formal services.

The way these services and systems of care are developed and implemented can have a profound impact on the cultural and spiritual health of the community.

Home and community-based services have the potential for meeting the needs of the vast majority of elders requiring LTC services, supporting the key roles of the family in the care of the elder and the elder in the care of the family and community.

A LTC system with a foundation in HCBS will also comply with the United States Supreme Court interpretation of the Americans with Disabilities Act in Olmstead v.

L.C., 527 U.

S.

581 (1999).

The 28 CFR %901 3 5. 130(d) ruling obligates States and localities to provide care for persons with disability "in the most integrated setting appropriate to the needs of qualified individuals with disabilities." An efficient and effective LTC system would make use of all available resources, integrating and coordinating services to assist families in the care of their elders.

The primary focus for planning and program development for AI/AN LTC is at the Tribal and urban community level.

Tribes and communities have very different histories, capabilities, and resources with regard to LTC program development.

Each Tribe or community will have different priorities in building LTC infrastructure.

It is critical that the development of LTC services be well grounded in an assessment of need based on population demographics and rates of functional impairment.

LTC services should be acceptable to elders and their families and consistent with community values in their implementation.

The services should be a part of an overall vision and plan for a LTC system to support elders and their families.

There are a number of elements (Tribal sovereignty and the government-to-government relationship, the unique funding structure of Indian health, and the importance of the cultural context) that distinguish AI/AN LTC.

Tribes and AI/AN organizations have found it useful to look both inside and outside of the Indian Health system (IHS, Tribal, and urban Indian health programs) for LTC strategies and models.

The planning and design of LTC services must identify the revenue source(s) that will support the delivery of care.

Finding resources for LTC services presents a formidable challenge.

Funds appropriated through the IHS (whether direct service or Tribal) can provide healthcare services which are part of a LTC system, but do not provide for a comprehensive set of LTC services and cannot support housing or social services of a non-medical nature.

Programs funded through the Administration on Aging American Indian, Alaska Native and Native Hawaiian Program (e.g.

Title VI A and Title VI C Family Caregiver Support Program) have been key elements in the LTC infrastructure in AI/AN communities.

Additional Older American Act resources may be available through State Units on Aging and Area Agencies on Aging.

Other resources are available to provide LTC services on a reimbursable basis for eligible AI/AN elders.

The majority of formal LTC services in this country are funded by reimbursements from state Medicaid and HCBS programs.

The Veterans Administration may be a source of reimbursement for LTC services for eligible AI/AN veterans.

Federal housing programs are a potential resource in developing the housing component of the LTC infrastructure.

Each of these resources has unique eligibility requirements.

Development of reimbursement-based LTC services often requires an ongoing investment of funds to support delivery of services during the initial period of client recruitment, start-up of services, and the receipt of reimbursement for those services.

This grant program is designed to provide support for the development of AI/AN LTC, with funding for either assessment and planning, or program implementation.

LTC services developed with support of this grant program must be those which the IHS has the authority to provide, either directly or through funding agreement, and must be designed to serve IHS beneficiaries.

Most Tribes and urban communities are building toward their ideal LTC system incrementally, adding new or integrating existing services over time.

The goal of this grant program is to support Tribes, Tribal Organizations, Tribal consortia, and Urban Indian health programs as they build LTC systems and services that meet the needs of their elders and that keep elders engaged and involved in the lives of their families and communities.