The residents at Utuqqanaat Inaat, an 18-bed skilled nursing facility in Kotzebue, Alaska, are immersed in a rich and significant culture. Utuqqanaat Inaat, in partnership with the Maniilaq Health System, serves its community’s most vulnerable residents from the area’s 12 federally recognized tribes located in Northwest Alaska. Affectionately and traditionally referred to as Elders, Utuqqanaat Inaat’s residents live in a homelike environment that is intentionally created to reflect the local culture.
In 2015, Utuqqanaat Inaat began a multi-year journey to bring their mission of providing culturally sensitive quality care to its food service. This endeavor was inspired by the center itself, whose name translates to “a place for Elders” and aims to make its settings feel as close to home as possible. In the case of its food service, creating a homelike environment meant serving traditional foods that many of its Elders were accustomed to preparing and eating, including seal oil, local tundra-grown vegetation, and caribou and moose meats.
Utuqqanaat Inaat recognized the cultural significance of these foods, but the center was up against an administrative battle. These locally sourced and locally cultivated foods were not approved for serving within a healthcare environment. Each food item would need special permission to be prepared for the Elders, and permission would need to be granted by multiple organizations on both the state and national levels. The journey to getting these foods approved ultimately took six years and an untold commitment by the long term care and hospital administrators, team members, and the Maniilaq Board of Directors.
The Tundra Is our Garden
The Alaskan tundra is home to many berries and plants that are commonly incorporated into the local diets and cuisine of families and residents, including those who called Utuqqanaat Inaat home. Items such as salmonberries, lingonberries, and sourdock grew in the tundra’s soft ground but were largely unavailable in traditional markets and food supply stores. Many families harvest their own berries, and Utuqqanaat Inaat believed their residents should be able to continue this lifelong tradition at their new home in the center. Thus began “The Garden Project,” which brought the tundra to residents so that as many as possible could reminisce or continue their subsistence lifestyle. There was a large space in the front of the facility that was available that was turned into a local garden for the Elders. Community members willingly donated their old dogsleds, seal oil caskets, and a fishing boat that could be repurposed as planters, which were designed to be accessible via wheelchair.
Val Kreil, the administrator of Utuqqanaat Inaat, got in touch with the Kikiktagruk Inupiat Corporation and asked for permission on behalf of the Elders to transplant some of the plants to the nursing home garden. Because gardens above the Arctic Circle are rare, the corporation was glad to help in a tangible way. Staff at the facility worked over the summer to harvest everything from berries to beach greens for the garden and planted them into an old fishing boat with designated sections for each plant, much like a grocery store.
The Seal Oil Project
The Garden Project created both an avenue of recreation and sustenance for the Elders, but a critical part of the local cuisine was facing a complicated route to inclusion within the Utuqqanaat Inaat nutritional plan. Seal oil, which is commonly used in dipping and preparing meals in Kotzebue, was never approved by federal or state regulatory bodies for use within restaurants or to be sold in stores, primarily because of its high connection to botulism, a foodborne illness. Because of these regulatory restrictions, the use of seal oil within Utuqqanaat Inaat was prohibited by the Centers for Medicare & Medicaid Services.
One hope prevailed: if Utuqqanaat Inaat and its larger team of Kotzebue supporters could prove a safe way to prepare and preserve seal oil that prevented botulism, seal oil could become part of the nursing home cuisine in an official way.
According to Pam Truscott, Director of Clinical and Regulatory Services at the American Health Care Association/National Center for Assisted Living, the commitment to person-centered care must include an appreciation for the culture and community in which residents live.
“Core characteristics of person-centered care revolve around the unique individuals wants, needs, desires, and wishes. Valuing and respecting each person as an individual who is an important member of society, while providing supportive opportunities for them to engage in their culture is essential,” Truscott said. “Residents grew up following certain customs and rituals. These traditions help make the person who they are. One way that long term care facilities can support resident needs is through culinary engagement. Bringing in foods that the individual person grew up eating, and that they enjoy, is part of their culture and is a great way to support the person and provide person-centered care.”
Because Canadian tribes and commercial manufacturers do not use a rendering process for seal oil, there was very little information available regarding the process of safely creating seal oil. This was complicated further by the fact that fresh blubber was required for the testing process, but access to seal blubber was limited to the seal hunting season, which for natives occurs only twice a year and generally for a window of less than two weeks.
The team of invested players grew in tandem with the complexity of getting seal oil approved for use in the Maniilaq Health System. The local Hunter Support Director for the Maniilaq tribal association, Cyrus Harris, as well as the area health sanitarian, Chris Dankmeyer, became integral to the Seal Oil Project. They worked alongside administrator Val Kreil, researchers Brian Himmelbloom and Chris Sannito, and Dr. Eric Johnson of the botulism lab at the University of Wisconsin in Madison.
With time and significant testing, the team was successful in finding a solution that kept the original rendering process intact—thus preserving the flavor and substance of the oil—but also meeting required safety standards as noted by the CDC. The safely rendered seal oil was put to the ultimate test: it was shared amongst locals to assess its taste, flavor, and thickness. The oil was not only accepted by the locals, but it was also considered an improvement in color and flavor.
The team wrote up a production plan and submitted it to the state for approval, including a variance that demonstrated the final step in the process—the one step that made seal oil consistently safe from botulism. In January 2021, the variance was approved for usage.
Ramifications of the Traditional Foods Project
Providing person-centered care was demonstrated through the Traditional Foods Project for the Elders at Utuqqanaat Inaat. A small-but-mighty team of dedicated staff, volunteers, and researchers committed themselves to a single issue: getting local foods, including seal oil, approved for serving to the Utuqqanaat Inaat Elders. This meant they were able to enjoy the foods they cooked with, ate, and served to others their entire lives. And while the population of 18 Elders cannot justify an official, replicable study, the staff know the impact of their efforts based on the joy they see among the Elders.
“Subsistence is their heritage. It’s their way of life,” said Kreil. “We see them eat better and socialize more because a part of their life has been brought back to them. For the team members, I think they all felt a sense of pride in being able to make a difference in the Elders’ lives ”
The reaction of their residents replicates results found in larger, similar studies that found that person-centered care can reduce agitation and symptoms of depression and improve the quality of life.1
Above all, culture reigned supreme for the people of Utuqqanaat Inaat, and that culture created a quality of life and quality of care that are not found in text books or CDC recommendations. It comes from knowing and understanding the lives of the people who live within the walls of a center.
1 Hunters Provide Traditional Wild Foods for Alaska’s Elderly-CityLab, Charlee Catherine Dyroff, July 25, 2018