As director of healthy aging for the Choctaw Nation in Oklahoma, Betty Wharton regularly experiences the gratification that comes from helping tribal elders stay in their homes as they age and encounter health concerns like dementia.
To support the Choctaw Nation in the care of its elders, Wharton and her team are actively involved with the Oklahoma Dementia Care Network (OkDCN), a program of the University of Oklahoma Health Sciences campus in Oklahoma City. The aim of the network is to improve the health of people living with dementia, as well as their caregivers, and to grow the workforce of geriatric healthcare providers in the state.
For Wharton, the OkDCN provides a constant stream of resources and training to enhance the work of her team. One of the Choctaw Nation’s initiatives is to support tribal elders so they can live at home for as long as possible.
“In our program, we go to our elders’ homes—they don’t have to come to us,” Wharton said.
“We see what their homes look like and what their safety issues are. Sometimes we create a plan so they remember to take their medications and go to appointments. Other times we’re connecting them with resources that help with transportation and meals. If we can’t meet their needs, we have access to so many resources through the Oklahoma Dementia Care Network. They have given us the tools we need to care for our elders on an ongoing basis.”
The OkDCN is funded by a federal grant awarded by the Health Resources and Services Administration of the U.S. Department of Health and Human Services. The program earned its initial funding five years ago and recently received another five-year grant awarded to the University of Oklahoma.
During the first iteration of the grant, accomplishments include training 1,578 nursing home direct-care workers in dementia-specific care; supporting 10 primary care clinics and 9 nursing homes as they achieved national Age-Friendly Health System recognition; training 586 family caregivers; creating a dementia training program for community health workers; and delivering aging- and dementia-sensitivity training annually to more than 330 health profession students at OU.
In this second iteration of the grant, that work continues, but with a greater focus on tribal, rural and medically underserved areas, each of which significantly overlaps the others in Oklahoma. The Indian Health Service will continue as a major collaborator with the OkDCN, in Oklahoma and in other states. In 2022, OkDCN developed a dementia care training for the IHS community health representative workforce, which interacts with tribal elders and caregivers to help them to remain safe and healthy. In January 2024, the national IHS community health representative program implemented a cognitive screening pilot program based on the training they received.
‘When we learn about their lives, we can create happiness for them.’
“Through dementia training, we have built the capacity in our community health representatives to learn the signs and symptoms and how our roles as educators, advocates, translators and patient navigators can support individuals living with dementia,” said Michelle Archuleta, IHS Community Health Representative Program Lead.
Nursing homes also will continue to be a major partner for the OkDCN. In a largely rural state like Oklahoma, the OkDCN offers trainings around the state to help nursing home staff provide the type of care that keeps residents safe and engaged. Learning the 4 M’s framework—What Matters, Medication, Mentation, and Mobility—was especially helpful for McLoud Nursing Center, located just east of Oklahoma City.
McLoud Administrator Caleb Craig said the staff strives to manage residents’ medication in a way that maintains its effectiveness but doesn’t add side effects that decrease quality of life. Similarly, staff members care for each resident’s mental state with compassion, affirming what they are feeling, not dismissing them, and managing conditions like dementia, depression and delirium. Safe mobility is also prioritized so that residents gain the physical and mental health benefits of movement.
Asking residents what matters to them, then aligning care with those goals in mind, may be the most important question, Craig said.
“When we learn about their lives, we can create happiness for them,” he said. “If a resident has been an artist, we gear their activities toward creating something. Other residents are sports fans who enjoy the games that we play. What matters to them is what matters to us, too.”
OU students will gain a greater understanding of the care of older adults through several clinical rotations established with the latest grant funding. OU nursing, medicine and social work students will train at rural nursing homes, a federally qualified health center, and several tribal health facilities, learning skills that are evidence-based and culturally relevant.
OU College of Medicine student Shaida Kamali said she looks forward to participating in clinical rotations involving the care of older adults. Thus far in her medical school career, she has assisted with research activities at OU and, this summer, took part in the Medical Students in Aging Research program at Harvard Medical School. One of the research projects focused on addressing pain in older adults in a way that allows them to maintain the activities they enjoy; another centered on preventing frailty in older adults.
“It has become clear to me that geriatric care is what I want for my career,” Kamali said. “Through the research I’ve been involved in, I’ve learned what it means to care for the whole patient. They sometimes have a long life of health issues, and I love the challenge of caring for everything together, centered around what they want to do in their lives.”
Another new initiative involves working with nursing homes to create career advancement opportunities for certified nursing assistants (CNAs). The training required for CNAs in Oklahoma is 75 hours, and the median annual salary is only $16 an hour. Turnover tends to be high in nursing homes, but a career ladder could start to change that.
Grant leaders plan to create a new apprenticeship program in collaboration with the OU College of Nursing, Oklahoma’s Career Technology Centers, and the Oklahoma State Department of Health to help qualified CNAs advance their training to LPN (licensed practical nurse) and then to the level of BSN (bachelor of science in nursing).
OU geriatrician and faculty member Lee Jennings, MD, who directs the Oklahoma Dementia Care Network, said the renewed federal grant will deepen the impact of the work, which is especially important in Oklahoma, where 65% of residents live many miles away from specialized geriatric care.
“We have a great opportunity to support and grow the geriatric workforce in Oklahoma,” she said. “This new grant is exciting because it will help us expand access to high-quality dementia care by growing our workforce, as well as making health care overall more age-friendly and dementia-friendly.”
April Wilkerson is senior marketing and communications coordinator for Health Sciences Research at the University of Oklahoma Health Sciences Center.
Photo caption: Tai Chi class at a senior facility.
Photo credit: Courtesy of OU Health Sciences Center.
