Frances Stout

Bringing Our Elders Home

20091123u6stout Before 2003,Tohono O’odham elders, like the elders located on many other reservations, had to leave their Nation and go into the city if they needed skilled nursing care. This was painful for them because they missed their home and family; the food was unfamiliar; the caregivers didn’t speak to them in their Native language; and they couldn’t take part in traditional ceremonies. Family and community members also found it difficult and painful to be separated from their elders.


Tohono O’odham elders wanted to come home. Their families wanted to bring them home. Thanks to a determined group of O’odham people, including Frances Stout, Tohono O’odham, RN, elders can now stay in their home community for nursing care, and even hospice care, if needed.

Building the Facility and Program

In the 1990s, when family members complained about sending their elders to nursing homes and other facilities off the reservation, a task force was established to look into this issue. Stout, who was then a nursing administrator at the Indian Health Service (IHS) hospital on the reservation, was asked to be a liaison between the IHS and the Nation. Stout and the advisory group, which succeeded the task force, pursued their dream for many years, exploring potential building sites, hiring an architect, working with an advisor who helped with the business plan and much more.

After Stout retired from the IHS, the advisory group was still hard at work, so Stout continued her advocacy for the project. She was amazed that the group remained so determined to create a skilled nursing facility. After serving more than 30 years as a nurse on three reservations with the IHS, she knew that funding and staffing the project would be an enormous challenge.

Later, speaking about the advisory group, Stout said, “They were determined to have their own place with their own people. Some of that passion rubbed off on me, We really worked at it. We got the funding. Now the dream is a reality.”

AHSNF board - staff TONCA board of directors. Back row L to R: Lee Olitzky, Administrator, Malinda Folsom, board member, Frances Stout, Chairperson, Janice Felix, Secy/Treasurer, Richard Ramirez, Vice Chairman. Front row, L to R: Judith Dworkin, Corporate Counsel, Priscilla Domingo and Madeline Saklestew, board members.

In 2002, after almost 10 years of hard work, the
Archie Hendricks Sr. Skilled Nursing Facility and the Tohono O’odham Hospice indeed became a reality. In place of the advisory group, there is now the TONCA Board of Directors (also known as the Tohono O’odham Nursing Care Authority) on which Stout serves as chairperson.

SDC10422 Elders enjoy a variety of activities

Located in the same building, the nursing facility and hospice have 60 beds and a staff of 130 people. Residents of the nursing care facility include people who are staying for a short time as well as people who will live at the facility long-term. Residents are helped to feel valued, respected and at home in the nursing care facility. “We have cultural food,” says Stout. “We celebrate the traditional holidays. We are open to families all the time. Families bring potluck meals and celebrate birthdays. When there are events on the Nation, we make sure that residents, who are able, can attend these events, if they want. Residents take part in the Nation’s well-known annual rodeo. They participate in the parade and have won some awards.”

IMG_0782 Children entertain the elders

Hospice care is provided in elders’ homes in the community. If their home is the nursing home, they can receive care there. Occasionally people who receive hospice care in their homes in the community need to come into the nursing home for a short period of time, for example, to relieve pain symptoms.

In addition to western nursing and hospice care, residents can ask for traditional healers at any time.

Employees are Well Treated

The nursing care facility requires employees with a variety of skills and knowledge. Lee Olitzky serves as the administrator. There is a medical director who is supported by adult nurse practitioners, registered nurses, licensed practical nurses, and certified nursing assistants. Several of the nursing staff members have additional certifications in such areas as wound care and intravenous medication administration. In addition, the facility has a physical therapist and an occupational therapist. Restorative care aides work under the supervision of these therapists and the nursing supervisor. In addition, a pharmacist and a podiatrist serve as consultants to the nursing facility.

Each department is supervised by a trained manager and, in most cases, an assistant manager. These departments include, human resources, business office, social services, therapeutic recreation, environmental services, plant operations, and dietary services. Dietary employs a part-time dietician.

Stout and her Board try to attract as many tribal members as possible, even members who have left the reservation. Today about 80 of the 130 nursing home and hospice care employees belong to the Tohono O’odham Nation. Eight employees are from other American Indian tribes; one is Alaskan Native. All of the managers are Native people. In the future, Stout and her colleagues would like to see even more Native people working in the higher-level administrative and health care professional positions. Stout said, “We desperately need for our own Native people to move into careers in which they care for elders.”

The nursing home and hospice invests in its employees. Caroldene Garcia, Tohono O'odham, Director of Human Resources for the Nation, said, "Our philosophy in part is that if we expect the staff to provide a caring and supportive environment for our elders, we need to ensure that the employees feel that the nursing home is equally concerned about each of them."

All of the managers have had special training, which includes working with outside consultants. For all employees there is regular in-service education, with presentations and on-line computers courses. “Monthly, the cultural director brings in people to speak about our culture,” says Stout. “This is especially helpful for young people and non-Natives.”

If employees want to pursue degrees in nursing, nutrition, and other professions needed for the facility’s programs, the Board considers paying their tuition. The desert Nation is in a remote area of Arizona, so employees have access to apartments on the campus and low-cost meals from the nursing facility’s dining room.

Elder Care Consortium

Stout and her colleagues have not been content to sit back and enjoy the fruits of their hard work. They realize that in order to provide the highest possible quality care to elders, they need to address the issues that have an impact on the health of elders, for example, transportation, housing and safety. Stout says, “We realized that there were many issues that we couldn’t address on our own, so we established the Elder Care Consortium. It consists of the Tribal Department of Health and Human Services, the Indian Health Service, the Tohono O’odham Community College, and us. “We meet monthly and talk about the issues of aging, says Stout. “We’re passionate about our mission.”

The Consortium wants to create a continuum of care for their aging population. One idea that is already underway is building an assisted living facility that will be close to the existing facility. The Consortium is also hoping that the college will be able to set up training program for needed employees, such as nursing assistants.

Many Awards

For her leadership role, in 2009, Stout was given the prestigious Robert Wood Johnson Foundation Community Health Leaders award. The Foundation also recognized Stout for establishing the Elder Care Consortium.

The Robert Wood Johnson Foundation award honors exceptional men and women from all over the country who overcome significant obstacles to tackle some of the most challenging health and health care problems facing their communities and the nation. The Foundation noted, “Mrs. Stout takes the idea of ‘creating opportunities for growth, leadership and power’ one steps further; she just doesn’t facilitate the opportunities, she literally reaches out her hand to others to assist them up that proverbial ladder. She merits further recognition as she does not accept the status quo health care for Native Americans; never has and never will.”

The Archie Hendricks Senior Skilled Nursing Facility and the Hospice Center (AHSSNF) itself was the recipient of numerous awards, including a 2008 award from the
Harvard Project on American Indian Economic Development, a 2008 local impact award from the National Indian Health Board, a 2009 award from the Indian Health Service, and a 5 star rating from the Centers for Medicare and Medicaid Services.

The AHSSNF was also cited by the
Wall Street Journal as one of the “Top Small Workplaces for 2009”. AHSSNF’s investment in its employees was an important factor in its receiving this award.

Stout says that the Honoring Nations award from Harvard provided an opportunity to share their story. “When we share our story about success, we always mention passion. We feel if someone doesn’t champion an idea, it probably won’t go. In our case there was a group of ladies who kept approaching the Nation asking if we had money now for starting the program.

“You also need a Government that listens to the people and honors the elders. A lot of times when we say, ‘We honor our elders,’ but there is no action taken to care for them. In our case, we had executives who followed through with the money. This made it possible to move forward with the building and our programs.”

Other Rewards

Stout says, “When I walk into our facility and see care taking place, I know the caregivers are feeling good by the looks on their faces – their gentle smiles. I think they get feelings of satisfaction of giving back, maybe not to their parents but to someone’s parents.” Stout also feels good about the wonderful care the elders are receiving.

Stout herself is in her 70s. She drives two and a half hours each way to the frequent board meetings at the skilled nursing facility. “Fortunately,” she says, “the scenery is beautiful and calming. I was raised with the idea that as long as you are physically and mentally able, you serve.”