Established by Congress in 1968, the Community Health Representative (CHR) Program provides outreach to address the specific healthcare needs of Tribal communities, predating the recognition of non-tribal Community Health Workers (CHWs). Aligned with the Indian Health Services (IHS) mandate to serve American Indian and Alaska Native (AIAN) populations, CHRs play a vital role in elder care, which must consider AIAN cultural practices. The COVID-19 pandemic further strained tribal healthcare infrastructure, leaving elders—especially those in multigenerational homes—facing service reductions, isolation, and resource shortages.

This report examines whether the workforce in tribal and urban clinic settings has an adequate supply of workers with access to training and resources. It also identifies key barriers and facilitators in addressing the healthcare needs of elders.