The providers' assumptions about eligibility, actual eligibility criteria, and perceived quality of care are sometimes barriers to using many services. Elders' lack of awareness, uncertainty about eligibility, perceived need, and possible stigma are barriers to some services. Larger tribes and self-governance tribes could investigate a tribal specific Medicaid waiver. Since many programs are currently providing information and referral assistance, it may be of value to review what information and referral assistance is available and how it is being provided to elders in order to better coordinate and improve the assistance. All service providers need to be trained in working with elders, including social and cultural considerations, in order to provide more sensitive and relevant services.
Legislative reform is one important step.