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 Caring For Elders At The Top Of The World

The northernmost nursing home in the country cares for a unique population.

 

Ice fishing
When most people think of Alaska, they think of towering mountains, magnificent glaciers, incredible wildlife, bitter cold winters, endless summer daylight, and unique cultures. Above the west coast of Alaska is a similar but different landscape that is less known to most people who visit the state.
 
There, 35 miles above the Artic Circle, lies the northernmost nursing home in the country, Utuqqanaat Inaat. Located in Kotzebue, it serves a capacity of 18 residents, most of which are native Alaskans, specifically of the Inupiat tribe. In the community, they are referred to as elders.

Short Summers In The Village

The two-year-old facility is decorated with native artwork throughout, resembling more of an art gallery than a facility. The village in which it is located has 3,300 residents and is the hub of the Northwest Artic Borough. It is the gateway for four national parks: Cape Krusenstern National Monument, Kobuk Valley National Park, Gates of the Artic National Preserve, and Noatak National Preserve.
 
Because it is on the edge of a vast wilderness, it is not a typical village. There are no traffic lights, no fast food restaurants, no beauty shops, no vending machines, no movie theaters, no CVS’ or Wal-Marts, and no roads that lead out of the village. People that live here know that the average temperature will be below zero between December and March. Summer will be short.

Language First

Although nursing homes confront the same basic problems, the uniqueness of the location of Utuqqanaat Inaat and how that has shaped the lives of the elders play a significant role in solving them. Providing person-centered care here includes going on many roads that are less traveled.
Sharing some of the ways the home analyzed and addressed its problems may be useful to others.
One initial assumption was that staff were able to communicate effectively with residents. That wasn’t an accurate assumption.
Inupiaq words, phrases

Because only a few certified nurse assistants (CNAs) are from the area, the facility depends on temporary help, who come from diverse locations such as Oregon, Washington, Texas, and the Philippines. As mentioned before, most of the elders are Inupiat, and they primarily speak Inupiaq, of which there are two different dialects, coastal and upper Kobuk.
 
 
In looking at how to bridge the divide, it is important to know that the written language is fairly new. It was developed in 1946 by Roy Ahmaogak, an Inupiaq Presbyterian minister, and Eugene Nida, a member of the Summer Institute of Linguistics. Because of its newness, not everyone can read it, nor can everyone write it. Many of the young people prefer to learn English.
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Making Language A Priority

There are some materials available to help people learn the language. Among them are Rosetta Stone courses, the “Kobuk Inupiaq Literacy Manual,” and “Inupiaq Phrases and Conversations.” One of the writers of the latter was contracted by the facility to translate residents’ rights into Inupiaq for the very first time. A videotape was made for those who could not read the language. 
Resident cutting salmon
To help staff learn the language, management enlisted the help of two CNAs and one housekeeper, all of whom are elders, to help translate and teach a once-a-week course for four weeks. Information used came from the “Inupiaq Phrases and Conversations” manual. Both dialects are taught, and the dialects spoken by the elders were identified.
 
The manuals and CDs were loaded into the facility’s education computer so that staff could continue their learning while at work. Because there was no information about how to pronounce the words and phrases being taught, the teacher elders spent several weeks breaking the words down phonetically on paper so that others could further work on pronouncing the words when they were not at work.

Meeting Dietary Needs

As far as meeting resident needs, there are many things at Utuqqanaat Inaat that are not typical of other nursing homes. Food preferences are a challenge in that most all of the elders are used to local meat such as caribou, moose, whale, shiifish, and seal. Many of those are eaten raw, especially whale, which is called muktuk.
 
Beef and chicken are not foods that are found in the elders’ normal diet, and on the food pyramid located next to the hospital cafeteria they are not listed under the meat category. Once a month, community elders host a niqipaq (native foods potluck) in the center for the facility’s elders as well as for others in the community.
 
A special waiver form was given to residents so they could understand some of the risks of eating raw seal and fermented whale meat. Needless to say, some of them were confused as to why the facility would even ask such a question. There is talk of a USDA food processor coming into the area this year to process the local game that the facility can purchase. The dining experience does not include soft background music. Much of the music played comes from the only radio station in town, KOTZ, which everyone listens to. The mixture of music goes from gospel to country to hip hop to National Public Radio to local messages asking someone to pick someone up from school.
 
It has the feel of something out of “Northern Exposure.” Because it is played on the outdoor deck as well, it makes the facility the liveliest place in the village.
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Inventive Activities

Activities is one department that constantly needs to go the extra mile to provide quality programming to meet the elders’ needs. Many activities end up being specific to the area. The eldlers recently were taken fishing for shiifish, which resemble a smaller version of a Florida Tarpon. They can get up to 54” but typically are 24” to 36” long. Because they become more active in the spring, staff bundled up the residents and took them out on the ice covering the Kotzebue Sound, even though it was zero degrees outside.
 
Salmon drying on rack
One person from maintenance drilled several holes through the four-inch-thick ice, in which the residents would drop their jigs and move them up and down. All of the residents caught fish. It marked the first time wheelchairs were taken onto the ice, but staff made it happen, and all the elders that went had a great time.

Another recent activity included a native dancing show at Qatnut 2013, which brings Inupiat from the surrounding villages to compete and play Eskimo games. One set of dancers was from Russia, and they came over and gave the elders a private performance. One elder resident is an accomplished dancer and participated in one of their dances.
 
The 4th of July was different because there were no fireworks on display. The reason was because of the 24-hour sunlight, which starts on June 3 and ends on July 10. Interestingly, the elders with dementia show few signs of sundowning because it’s light all the time.
 
In the winter, it is more pronounced. One elder does react when staff go home for the day, because she thinks it is time to leave, too. To resolve this issue, staff instead exit one at a time through a less noticeable door.
 
One activity not specific to this area is an indoor drive-in movie. The staff built an 8-foot by 12-foot screen and host movies on a weekly basis. Windows have to be covered because of the amount of daylight late at night. The elders all have a great time.

Making Exercise Interesting

The range-of-motion exercise program is an area that had to be tweaked to get better participation. Most of the elders said that they were bored doing the typical range-of-motion exercises that nursing homes offer. So, staff set aside that activity and incorporated many movements from elders’ past activities, such as hanging fish on racks, reaching for high bush blueberries and putting them in a basket, and stretching like the ubiquitous ravens that live in these parts.
 
The exercises are also tied into upcoming activities. In preparation for fishing for shiifish, elders moved their arms up and down to simulate the jigging motion.

Utuqqanaat Inaat is a unique place in a unique community, and one hopes it will continue to remain that way. The elders are wonderful people, and many of them are famous in the community.
In a very real sense, both the community and the village live in two worlds. Either direction will be a challenge to stay there.
 
Valdeko Kreil, NHA, is administrator and Deborah Bragg, RN, is interim director of nursing at Utuqqanaat Inaat in Kotzebue, Alaska. Kreil can be reached at valdekoivar@msn.com.
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