The Future of Tribal Healthcare

Indigenous peoples have long faced unique challenges accessing adequate healthcare in the U.S. But new facilities are emerging to address their needs, in buildings that weave together advanced medical practices, preventive health resources and meaningful cultural accommodations.

On a small piece of land along Clear Creek in the northern Sacramento Valley, Redding Rancheria tribal leaders are trying to reverse generations of heart disease, high cancer rates and chronic health issues among their people.

“Our tribal council is taking a proactive approach to healthcare because we believe if a Native American ends up with diabetes, then we have failed them,” says Glen Hayward, Executive Director of Health Services for the Redding Rancheria Tribal Health System. “Our goal is to eliminate diabetes in Indian country.”

LPA designers are working with Redding Rancheria, the descendants of the Pit River, Wintu and Yana people, to build a three-story, 180,000-square-foot health and wellness village facility that will change the paradigm of the tribe’s healthcare. The Redding Rancheria Tribal Health & Wellness Village, the largest of its kind in California, will merge primary care, health and well-being resources into one facility, creating the type of continuum of care and focus on whole-person health rarely found in tribal communities.

“We’re thinking long-term, not quarterly profits,” Hayward says. “We’re asking, how is this going to be better for our people for the seventh generation — our grandkids’ grandkids?”

Across the U.S., LPA teams are working with tribal groups like Redding Rancheria who are determined to correct the trajectory of their community’s health and well-being. They are investing time, money and labor to develop a new generation of multipurpose health and wellness centers to address mental health, poverty, addiction, food security and other daily challenges facing indigenous communities.

“We have an opportunity to create facilities that uplift the tribe’s health and spirit,” says LPA Managing Director Kelly Angell. “These healthcare centers will give place and meaning to all members, from the young to the old, and ensure that they’re taken care of.”

A Growing Crisis

The need for better, more holistic care is stark for indigenous peoples, who have a life expectancy 5.5 years shorter than the rest of the U.S. population. Many tribal communities are dealing with inequities that impact health, such as low educational attainment rates, lack of health insurance and less access to healthy food. According to statistics from the Indian Health Service, Native Americans are 50 percent more likely than non-Hispanic white individuals to be obese, which can lead to high blood pressure, diabetes and heart disease. Substance abuse, teen pregnancies and depression are well-documented issues within tribal communities.

In many remote communities, it may be difficult to even get to a healthcare appointment. A 2017 survey by a team of University of Minnesota researchers found nearly 68% of one tribe’s members have no way to get to their appointments. When they do make it to a clinic, they’ll likely confront long lines in a bare-bones environment with few treatment options.

For many tribes, there is a pressing need to bring together multiple health services in one place in facilities that can play multiple roles. Many families don’t have the time or resources to visit more than one provider.

“By the time someone gets to their appointment, they should be able to accomplish more,” LPA Managing Director Laura Jeanne Andrews says. “The more types of accommodations we can include in one facility, the better.”

In smaller communities, where resources are stretched, LPA designers are working with tribes to develop more flexible, integrated, targeted clinics that can serve a variety of needs and help patients maximize their time. On tight footprints, healthcare centers are developing into “one-stop shops,” with dental, behavioral health and primary care services and social workers on site for vulnerable populations.

“You can get a Band-Aid; you can get headache medicine. They’ll stitch you up if you have minor things,” Andrews says.“It is a whole-person, well-being model.”

Every Tribe Is Unique

Needs vary, depending on the tribe. And each tribe has its own culture, goals and budget. Communication and transparency are essential throughout the planning process. In its work, LPA utilizes a variety of in-person and online strategies to engage tribe members and stakeholders, ensuring all voices are heard. The most productive strategy is often one-on-one time with people from multiple perspectives. “It’s through those individual, smaller conversations that we learn more about the challenges they’re trying to overcome,” Angell says.

The challenges on reservations are complicated and deep-rooted. To combat serious concerns associated with addiction, poor diets, depression and poverty, many tribal health leaders are incorporating more educational resources and social services into healthcare centers. For many tribes, substance abuse and addiction is a crisis-level issue. For them, small, nimble clinics designed to handle large flows of patients needing immediate medication in a secure setting are a top priority.

For the Morongo Band of Mission Indians in California, recent design discussions for a new clinic focused on health, nutrition and wellness. Food insecurity is a pressing issue for the tribe; leaders want to ensure young and old members are fed and receive necessary care. The tribe’s new healthcare facility will provide resources, meeting spaces and opportunities for added personal and spiritual connections. For many tribes, healthcare visits are a family affair, with several people accompanying the patient to appointments.

“These are very tight communities,” says LPA Director of Healthcare Muhsin Lihony. “These facilities are not just healthcare providers; they can become a destination for community engagement and bringing people together.”

As tribal leaders consider their options, LPA’s team is going beyond the physical space to help with planning, strategy and finance options. The focus is always on getting the most bang for the buck for tribes trying to stretch resources. In Oregon, LPA collaborated with the Confederated Tribes of the Umatilla Indian Reservation to develop a feasibility study around expanding services and community support of the CTUIR Wellness Center, including physical therapy, wellness and childcare services. The study, which included LPA’s Sport + Rec designers, analyzed public and private options for financing the project, including grants.

For many tribes, healthcare facilities provide return-on-investment in multiple areas. New facilities are playing a key role in recruiting healthcare professionals to the tribal facilities, at a time when competition is at an all-time high. “The health village is going to be a huge draw for us,” Redding Rancheria’s Hayward says. Video of the new facility has already played a role in recruiting new physicians. “They see the vision of the tribe, and they say, ‘Man, I want to work in a place like that.’”

The development of the new healthcare centers also coincides with a universal need among tribes to better educate communities about nutrition, mental health and overall well-being, creating opportunities for different financing sources. For the first time, federal tax breaks for energy-efficient and carbon-reducing projects are available to tribes through the Inflation Reduction Act.

“We are approaching these issues very differently,” says LPA’s Lihony. “We are helping our clients invest in the future and make sure their communities are getting the same level of care and services and support as the rest of the country.”

A Natural Connection

For tribes, the new healthcare facilities are an investment in their future, inextricably linked to their past. The health centers reflect the tribe’s progress, connection to nature and focus on taking care of its people for generations.

Redding Rancheria wanted to take a proactive approach to the challenges facing its members. The Redding Rancheria Tribal Health Village, scheduled to open in 2026, will take a broad approach to elevating community wellness and generating better long-term outcomes for patients, while preserving the tribe’s culture and beliefs.

“Working with LPA, we were able to come up with a facility that is an all-encompassing, one-stop center that integrates modern care with Western and Eastern medicine, and a holistic approach to wellness,” Hayward says.

The Redding Rancheria Tribal Health Village will comprise three clinics devoted to primary care, behavioral health and dentistry. Community health, physical therapy, fitness training, senior nutrition and rehab services will be available as well, along with access to indoor and outdoor pools, a gym, and studios for yoga and fitness classes. LPA’s landscape architecture team helped develop active outdoor environments, walking trails, an indoor-outdoor auditorium and community gardens. The Sport + Rec team integrated the aquatic and recreation elements with the healthcare resources.

The facility will also include a demonstration kitchen where members can take nutrition classes and learn how to prepare healthier meals. Other community spaces will host programs on parenting, caring for the elderly and mental health/addiction counseling.

“This new facility is going to allow us to really bring in that whole wellness component,” Hayward says. Doctors will be writing prescriptions that include exercise classes, swimming and yoga, and everyone will know what the physician wants for the patients. “We’re expanding the prescription process,” he says. “Prescriptions for wellness as well as prescriptions for medication.”

In many ways, the health village will be one of a kind, a facility that could only be for the Rancheria. Symbols and elements of the tribe are woven throughout the facility, including a garden honoring the tribe’s founding elders. Each space is designed to support members for generations, making good on the leaders’ promise to provide a foundation for their people to thrive.

“This health village is going to do that,” Hayward says. “It’s going to take care of our tribe for the next 60 years.

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