There are long-held beliefs of reservations as the middle of nowhere, something to avoid. But they are really heroic places.

The Colville Reservation in north-central Washington, where cascading yellow highlands and meandering rivers exist quietly under a vast, azure sky, is home to over 5,000 residents. Both Colville tribal members and their families and other non-Colville members live across 1.4 million acres in small communities or rural settings.

For Lucille Pakootas, of the Colville Indian Area Agency on Aging, bringing value to the long-term care field on the reservation is critical. She is a trusted long-term care coordinator advocating for the many Home Care Aides living and working on the reservation.

In the long-term care field, it can be challenging to identify Home Care Aides that Consumers will trust. Many of the common health concerns affecting Consumers on the reservation – diabetes, arthritis, fibromyalgia, and Alzheimer’s – require trustworthy, well-trained, and confident HCAs.

“(Consumers) would rather have family members or close family friends take care of them. It’s difficult establishing trust with non-family members,” Pakootas says. Building trust, requires diverse and accessible training for Home Care Aides living on the Colville Reservation.

Long-term care coordinator Lucille Pakootas sits in a Consumer’s home. She and her team make a lot of ends meet for the HCAs and Consumers on the reservation. Photo by Sara McCaslin

Pakootas says, “For Individual Providers, (the reservation) is really far from training centers. It’s hard to travel to Spokane or Wenatchee,” and having to “pay for hotel, gas, food, and sometimes a babysitter for two weeks.” The long trips and expensive travel can be a barrier to cultivating a robust community of well-trained and trusted Home Care Aides. But, online training is no easier.

With just one computer per library with a one-hour time limit and inconsistent Internet service that is incredibly delicate in the winter, the rural Colville Reservation is ill-equipped to handle the needs of multiple HCAs who might need to register for a class, check their email, or even complete the necessary online training hours. For Lucille and her colleagues, it means they need to get a bit more creative.

Recently, Pakootas spent a better part of a week assisting one HCA take online CE courses on her office computer.

Starting a career in caregiving often begins when taking care of a family member in need. But the skills, experience, and confidence are just as important when providing long-term care for non-family members.

Marietta “Etta” Grunlose, a current HCA living and working on the Colville Reservation, began providing care for her father-in-law in Oregon. “There is no ‘you can’t do it.’ It’s your parent, you have to do it. I took him to the doctor and shopping, bathing, cleaning, cooking,” Grunlose says. Her current Consumer is not a family member.

As an HCA on the Colville Reservation, building a trusting relationship with Consumers doesn’t come by chance. Grunlose has to do her job well and care about her Consumer’s quality of life. “I work with him to set goals. One time I got him out for a walk,” she smiles while remembering the story, “I got him to walk a mile up the hill and back down. Back in his day, he used to run and do marathons.”

Grunlose describes the evolution of her relationship to her Consumer,“The most rewarding part is he has become more open to trusting me, doing more things and getting more healthy since I started working with him.” Trust has meant finding new ways to provide high quality care to a Consumer with short-term memory loss. “I’ll text him everyday to check up on him when I’m not there. They like to tell their stories, too. And, I’m here, I’ll listen.”

On the Colville Reservation there are many Consumers that still need caretakers.

“I’m working on getting my daughter into training. There are so many young people entering into the workforce that need the jobs,” Grunlose says. Thinking of becoming a nursing assistant, she hopes that her experience as an HCA will make her better prepared.

Trust, the common denominator in the relationship between HCAs and their Consumer, can be difficult to create. But throughout her career, Pakootas has helped cultivate it on the Colville Reservation. She has made it easier for Consumers to find trustworthy, non-family HCAs, such as Delores George – an avid hunter, prolific quilt-maker, and ardent gardener – in need of long-term care after a brain surgery caused a stroke.

Sitting in their home, a mere five minutes away from Lucille’s office, along a winding road, George’s daughter Carlene Yacinich reflects on her mother’s story. It wasn’t easy to get to the level of trust she has now with tag-team HCAs Jackie and Gary Fisher.

“Before her stroke she lived independently, she lived on her own. From then, you know, she’s needed caregiving 24 hours a day,” Yacinich says, who could no longer stay home full-time with her mom. “I was in search of caregivers and I found Jackie and Gary Fisher. To have them here at home for mom so that she can stay home is a blessing” she says, expressing the importance of not having to put her mom in a nursing home.

For the Fishers, married 45 years, providing this type of care works because of their partnership and teamwork. Gary Fisher typically does the morning shift, and Jackie Fisher the afternoon shift. They sometimes cross shifts, so they’ll help each other.

This is Jackie Fisher’s first experience, but Gary Fisher has been an HCA for other Consumers prior to working with George. “Well, you just have to want to help people. You have to have it in your heart to do that,” Jackie Fisher says.

“It’s just rewarding that we’re helping her stay in her home.”

Two years into caregiving for George, the Fishers reflect on the lessons learned from their work. Gary Fisher says, “Until you get to know your Consumer inside and out, they may not really trust you right off the get-go. So you have to be patient.”

HCAs Jackie and Gary Fisher work as a team to provide
care for their Consumer Delores George. Photo by Sara McCaslin

Jackie Fisher adds, “And you have to be patient, especially with someone with a disability or stroke. It’s going to take them longer to do something that before wouldn’t have taken long at all…not hurry them along and just let them have their life.”

It is in allowing George to live her life, in her family home, that has allowed a genuine relationship to develop between a Consumer and her Home Care Aides. The vulnerability of caregiving has taught them patience; the continued care for George has fostered greater trust.

“It makes you grow,” says Gary Fisher, as they smile at each other in a room filled with care, friendship, and the familiar aroma of George’s favorite stew.