Category: Health and Health Care

6 - Through The Looking Glass: Creating Culturally Competent Care For Aging American Indian/Alaska Natives


Aging is inevitable--it happens to all of us--but it is not a homogeneous experience.  American Indian and Alaska Natives (AI/ANs) face special issues due to cultural, political, and geographical considerations.  


This study examines the availability, accessibility, and acceptability of health care services for aging AI/ANs, with a focus on culturally competent care and the role of community health workers in communities with traditions that support resiliency.


We did an analysis of literature, considered case studies, and convened thought leaders representing a range of AI/AN communities on issues of aging.  We visited Pine Ridge Reservation in South Dakota, the poorest county in the United States and home of the Oglala Lakota Sioux tribe, to speak with representatives from IHS.  We also hosted a conference on Flathead Reservation in Polson, Montana convening founding members of the National Alaska Native American Indian Nurses Association (NANAINA) and the Georgetown University Health Law Initiative.  The conference consisted of nurses, doctors, lawyers, and other public health professionals--mostly Natives--from around the country who shared experiences and anecdotes of health care coverage and accessibility issues in their communities, with a focus on culturally competent care for aging Natives.


Findings revealed barriers to health care, lack of understanding about important cultural traditions, misunderstanding medical instructions, and special issues related to jurisdiction and distance.  We identified cultural sources of support that buffer aging and decline, such as close family support and acceptance of the signs of aging as a natural process. 


Aging peoples are among the most vulnerable populations in the world, and thus deserve our care and compassion.  This is particularly true of aging AI/ANs, who face unique barriers to accessing health care due to geographic constraints, language and cultural barriers, and a lack of infrastructure and resource support.  We formulated recommendations to ensure acceptable, culturally appropriate health care is available and accessible for this important yet often forgotten population.


Mehgan Gallagher

Law Fellow
O'Neill Institute for National and Global Health Law
Washington, District of Columbia

Mehgan Gallagher, J.D., LL.M. is a law fellow who is jointly funded by the O’Neill Institute and the Health Law Initiative, a collaboration between Georgetown University’s School of Nursing and Health Studies and the O’Neill Institute at Georgetown University Law Center. Her work focuses on a variety of topics including aging and the law, issues of health and justice for Native Americans, and increased collaboration among global faith-based health systems. She holds an LL.M. from Georgetown University Law Center, a J.D. from New York Law School, and a B.A. from Clark University. Prior to joining the Institute, she worked with a variety of international human rights organizations including UNAIDS, the Jacob Blaustein Institute for the Advancement of Human Rights, and Human Rights Watch. She has also clerked for the High Court in Johannesburg, South Africa. Mehgan’s key areas of interest are global health and human rights, especially disability rights and the right to refuse treatment, women’s rights, aging, and access to affordable medicines.

Nicole Heydt

Program Director, Health Law Initiative
Georgetown University, School of Nursing & Health Studies
Washington, District of Columbia

Nicole is a double-Hoya with a passion for health law and policy. Nicole received her BA in Classical Studies from Georgetown in 2013. During her undergraduate career, she was awarded the Rev. Daniel E. Power Scholarship and the 2013 Lena Landegger Community Service Award for her distinguished contributions to community service. After graduation, Nicole went on to serve as the area business manager and event coordinator for the Georgetown Army ROTC Department, as well as the liaison between the Army and the University. In November of 2015, Ms. Heydt was a recipient of the University’s 2015 President’s Excellence Award which recognizes Staff for outstanding service and extraordinary contributions to the University. The following May Nicole transitioned to a role with the Georgetown University Medical Center Advancement team. Nicole joined the Health Law Initiative (HLI) in January of 2017 as the Program Director of the Health Law Initiative. Most recently she earned her Executive Masters in Health Systems Administration in May of 2017. Nicole coordinates the HLI portfolio and manages the projects.

Bette Jacobs

Professor, Health Systems Administration; Distinguished Scholar, O’Neill Institute for National and Global Health Law
Georgetown University, School of Nursing & Health Studies
Washington, District of Columbia

Through the Health Law Initiative, Bette Jacobs invigorates the vision and momentum by leading new thematic programs associated with national and global health law. Her diverse skill set draws from experience as a corporate leader for a multinational engineering company, a decade of service as Dean for Georgetown University School of Nursing and Health Studies and the creation of complementary courses and programs of study on the common good, conflict resolution, leadership in for-profit and non-profit/non-governmental organizations, and health policy. Dr. Jacobs is noted for innovative solutions, growing transdisciplinary work, and mentoring a wide range of emerging problem solvers. Her career emphasizes engaging multiple disciplines and methods in mission-centered performance organizations. As a key participant in founding the O’Neill Institute for National and Global Health Law, Dr. Jacobs has contributed over the past decade to the growth of the O’Neill Institute.