An effort is being made to keep the elderly independent and to prevent their placement in institutions which are unsuitable. Bureau of Indian Affairs adult care-taking funds pay for institutional placements of disabled Indian people who do not require skilled nursing care. Many tribes are using their BIA funds to support in-home services instead of institutional placements. This is important because placing the elderly in institutions can result in physical isolation and a lack of emotional and cultural support for them and for disabled Indian people. The most common services provided are group meals and in-home support services.
Case management encourages tribal elders to take part in other federal, state, and tribal programs.
Programs operated by tribes stress the importance of continuing to depend on traditional values. These values emphasize the extended family's responsibility for the care and well-being of family elders. They have two entirely different meanings. It is important to have a clear understanding of their definitions. On one side, there is aggressiveness, a behavior that includes hostile words and actions.