The Community Health Representative (CHR) Program was established by Congress in 1968 to provide an outreach component meeting the specific healthcare needs of tribes and tribal communities. This program predates the official recognition of non-tribal Community Health Workers (CHWs) by the American Public Health Association. The CHR workforce goal is to reflect the IHS’s mandate to provide health services to American Indian and Alaska Native (AIAN) populations. An assessment of the CHR role in elder care must include consideration of the role of American Indian and Alaska Native (AIAN) culture in elder care practices. The recent COVID-19 pandemic exacerbated health service delivery challenges for tribal nations already facing an underdeveloped and underfunded healthcare and public health infrastructure. Tribal elders living in their homes or in multigeneration housing often suffered from reduced services, isolation, and a lack of resources during the pandemic. The purpose of this project was to assess whether the workforce in Tribal and urban clinic settings has a sufficient supply of workers with access to training and resources, and to identify the barriers and facilitators to meeting the health care needs of elders. This project aimed to address three research questions: What is the role of the home care workforce for Tribal elders and how do they vary across tribal urban and rural areas? Is home care training available to Tribal workers and is it culturally reflective of unique Tribal community needs? What are barriers and facilitators in providing the needed home care in Tribal communities?

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