Indian Health Service outlines dementia support, warns sanitation and staffing gaps limit care

Dr. Jolie Crowder, representing the Indian Health Service (IHS), told the council that IHS is a provider-first federal health system for American Indian and Alaska Native communities and outlined persistent gaps that limit dementia care.

"We serve 2,800,000 American Indian and Alaska native people from 575 tribes," Crowder said, noting the system spans 37 states and that IHS has "about 5,000,000,000" in budget authority—an amount she said feels small relative to the need. She described three service streams (IHS-run facilities, tribally operated programs, and 41 urban Indian health organizations) and said roughly 65% of the IHS budget goes to tribes as of 2025.

Crowder stressed nonclinical infrastructure deficits that affect health, saying in some communities "we have people who don't have running water" and others lack paved roads or reliable electricity. She also described the Purchased/Referred Care program and its limits: when referral funds run out, patients can be denied access to specialty care, producing what she called "a very rationed situation of care."

Workforce shortages are acute, Crowder said: IHS employs roughly 14,000 people and has seen vacancy rates as high as about 37% in clinical roles, constraining routine care and complicating efforts to address conditions such as Alzheimer's and related dementias.

On dementia-specific work, Crowder highlighted grants and local models of care, saying the agency funded 18 communities for model-of-care projects and is investing in community-based interventions that range from caregiver toolkits to screenings.

"A lot of what our grantees do are really big, but they're also just sort of that personal connection in their community to change hearts and minds," she said, describing programs such as mini-cog screening pilots led by Community Health Representatives, a dementia clinical support line for clinicians and nursing homes, and quarterly competency-based dementia trainings. Crowder invited council members to an upcoming summit and said resources such as training videos and a listserv will be shared with providers.

Why it matters: Crowder framed these items as operational barriers to improving diagnosis and care for American Indian and Alaska Native people. The combination of limited referral funding, infrastructure deficits, and high vacancy rates shapes how, when, and whether people in these communities can access specialist evaluation, follow-up care, and supportive services.

What the transcript shows: Crowder repeatedly linked structural deficits and funding limits to service rationing and emphasized that tribal programs vary locally; she described concrete programs (mini-cog pilots, a support line, ECHO sessions) intended to raise detection and clinical capacity.

Next steps: Crowder asked for engagement and visits by stakeholders, noted ongoing grant work and trainings, and invited the council to the agency's summit to view grantee models and materials.