Navajo Council Naabi talks COVID-19 health & social services costs, 5.27.20

SPEAKER DAMON reconvenes Naabik’iyati from one hour recess.
Confirmation that Office of President & Vice President Chief of Staff Paulson Chaco ok report by Division of social Services director Gieshy on social services, CHRs, Long term care to Naabik’iyati..
Continue working on getting ok for report from Department of Health director Roselyn Tso.

1 PM, NAABIK’IYATI COMMITTEE WORK SESSION CONVENES AFTER WORK SESSION TO HEAR FROM NAVAJO NATION DEPARTMENT OF HEALTH DIRECTOR ROSELYN TSO AND DIVISION OF SOCIAL SERVICES DIRECTOR DEANNAH NEWSWOOD-GISHEY
Roll call – Five members present.
SPEAKER DAMON
Now hear from social services on what need now and in the future.
Remember everyone callingin – delegates, presenters, staff – to put your phones on mute.

NAVAJO SOCIAL SERVICES DIVISION DEANNAH NEWSWOOD-GISHEY
Three programs – dept of child care development; child and adult protectin services; Az long term care; work with elders and long term care.
Dept for Self Reliacne or TANF, assistance to families, single families to become self suificient with post ed.
Developmental Disabilities – work with youth and adults, youth primarily
Indian child welfare Act program which is services for children off rez, children in 26 states.
Navajo Treatment Center for Children
13,877 clients thru 58 offics and cetners.
We are one of bigger divisions.
Unforeseen expenses since march: need masks, gloves, sanitizer,
Burial assistance: more than $1,000. 8 and 10 perda which is $25,000 aday. 218 requests servced.
Add ons of PPEs have staff working directly with families and where PPEs necessary cuz may have children with virus so staff need N95 masks. Received home made masks but with children need proper protection.
UNMET NEEDS SINCE MARCH 16 closed until June
Currently we are at 95 percent of staff essential and majority returned March 27. Employees have return work plan, Need additional funding for Hazard Pay.
Best Practices for Navajo Employees
Despite field offices closed still do case management via phone, email, and provide documents via email, phone and drop off box.
SPEAKER DAMON
We would need a copy of your proposal.
SOCIAL SERVICES DIRECTOR GISHEY
It was submitted to OPVOP Chief of Staff Paulson Chaco.
And I’ll ask to have proposal forwarded to Council.
DELEGATE EUGNE TSO
Regarding Indian Child Welfare Act program: As long as Dine’ women, always have clan and always be Navajo. That is our definition but dk what call Dine’ woman if go off rez and continue with her life.
GISHEY
Dept of Self Reliance provides service to anyone, not just Navajo. If anyone in household has Certificate of Indian Blood and live in fordertowns, they are provided full service.
If any Navajo child picked up by county, state or city, they are required to notify a potential Navajo child in their care. So when receive info, work with census office to find out if child Navajo. Look at lineage of child and biological parents with child. Not particularly blood quantum but child has connection to Navajo nation and potential to be member of Navajo Nation.
1:31 pm
SPEAKER DAMON
Overall goal is projection of overall dollars needed so not leave anyone out in future especially your division.
Dk if you included budget for CHRs, staff with long term care and child care services. What do you need keep workers safe as well as receipients. You have breakdown and looks like $10.5M.
Roselyn Begay submitted
SOCIAL SERVICES DIRECTOR GISHEY
Working on telecommute system so files are secure when employees work from home due to pandemic.
We have 58 direct services offices, such as 24 Child Care Centers, to do off site training. Had meeting with Frist Things First to keep Child Care Centers. Have no data system for one stop shopping to get services immediately from six programs to people.
DELEGATE WILSON STEWART JR.
You reported 95 percent back to work so how are you dealing with lack of PPEs for staff to provide services directly to families.
Heard HCOC positive. Employee supervisor dk what to do when positive. Emplyoees told its in the booklet.
SOCIAL SERVICES DIRECTOR GISHEY
Before gave Return to Work memo, worked with Navajo Justice Department. Met with staff regarding return and called Special Duties. Time and half. Exempt administrative leave. Some dept have money for special duty pay. We world be working with Personnel which may have some additional funds for special duty case. And not listed cuz some dept have funds.
Staff infected HCOC and impacted us so we had to close our offices. Had three distribution of masks, gloves from HCOC and privat donaor. Make sure they are safe. Majority not making contact with family mmbers. Using office phones and not opening office so reduces community spread.
Fortunate continuing business that way.
Once businesses open; we do gradual reopening. Right now staff there but not open to public.
1:46 pm
INDIAN HEALTH SERVICES ROSELYN TSO
I’ll send report later. Not in location to send.
Asked for breakdown of all funds received by HIS and how distributed to HIS and 638.
Second area cover, all efforts for water improvements and asked staff break into five categories: temp watering points and we estimate work $620,000 cosst; Phae 2 permanent water $7.4M for 35 chapters needing repairs and complete two year period. Phase 3 is 15 projects on sanitatin deficiency list, $13M. phase 4 are five projects ID by BIA director and five are shovel ready and just need ROW. Haven’t gotten to Phaze 5,
Rally all partners to finih projects, HIS engineers, talked with Army Corp of Engineers.
Third thing raise for your consideration, cost of tracers. Once ID positive patient right behind them to interview them and ID contacts. Broken down cost, 1,000 tracers $384,000 for one period.
Right now secure volunteers but better to have people we can train. Looking at need for t racers to ID people looking for.
Fourth, past 60 days met with female delegate regarding incarcerated patients and no clear ID of who care for. See about 1800 incarcerated needing health care. HIS responsible for health but BIA responsible for jails. So estimating two years of seed money to build program. And not cme to HIS but whatever entity. Little over $16,000.
Discussed medical examiner and not what HIS does but need to keep work on NN essential especially when talking COVID-19. Maybe not die in HIS facilities but tracing not ID all causes of death so having NN medical examiner to benefit of Nation. Don[‘t have cost but can get one for you.
1:55 pm
DELEGATE EUGENE TSO
I believe ask question every time, rregarding testing and send home, like when testing at Burnside. Chinle community center working on. Hear people sent home test positive and no one checks on them. Family asked why no one checking on her. Many Farms same thing. No food deliver. It’s dark inside home and so dk if there.
Think they know what they are doing so don’t get in the way.
Tracers, I dk. We dk who they are. If knew we would try to help them and also stay away. if test positive then know where are. Western law over confidential blocks that.
Are DOH collecting doantions.
Been confronted by CHR that not been tested and want. They delivering food and water. Saying positive by hearsay.
So many people email and calk, Bothers me. Not saying you’re not doing anything but this is what I am hearing.
IHS DIRECTOR ROSELYN TSO
I will try to meet Thursday on the ground with delegates. There is opportunity for me to help a bit more if meet with delegate.
DELEGTE CARL SLATER
Are there any HIS projects that will get completed with this funding.
IHS ROSELY TSO
We have this huge list of projects and asking for four or five Council delegates to review and prioritize this list which will help us develop plans that we don’t have. Looking at immediate needs but comprehensive plans still in front of us such as water projects. Still struggling with this. Ask again for help from four or five delegates to pPut dollar figure and time lines on this list of projects.
DELEGATE RAYMOND SMITH
The curve is not flattening. Daily reports show numbers are not declining. Is HIS going to build more hospitals, clinics. What about GMIC? When? Have 638 but clinic closed. We need services and medical facilities. Folks are talking about tooth ache and no one wants to help them. Focus on COVID-19 and not want to go in because fear might get infected.
NAVAJO AREA INDIAN HEALTH SERVICE DIRECTOR ROSELYN TSO
SIMC is with president and consider Rehoboth or Fort Wingate. And once here back from president and then move forward.
DELEGATE THOMAS WALKER
We are asking for testing blitz at Winslow.
Navajo has all these health care providers with strength and weakness but together then unity.
DELEGATE DANIEL TSO
Health, Education & Human Services Committee feel that Fort Wingale was former weapons site and there might be live ammo still on site so possibly become clean up site.
Understand Sen. Heinrick asked for more in depth investigation into GIMC.
Any info regarding Pueblo Pintado health clinic which remains on president’s desk.
IHS
Yesterday with Weakee at GIMC, today SR and Crownpont tomorrow. First time Weakee out here.
Challenging to be 2,000 miles from action and appreciate to understand what going through. Hope messaged to him that there is lot of coordination between HIS, OPVP, NNC and ask delegates to join visit.
He met with NM Governor. Lot of education going on.
I met with president yesterday and said I want to move forward. I will bring up GIMC and Pueblo Pintado. Rehoboth continues to be at top location site. And will begin working on Bodawy-Gap health clinic.
DELEGATE NATHANIEL BROWN
I’m still trying to coordinate testing blitz for Kayenta and western agency.
Is it easier for hosptials and clinics that are 638 to be more creative in bringing testing kits which do not have a long shelf life and so hoping using all donated test kits.
Told that have to go thru Navajo HCOC which is bottleneck. So how long take for donated test kits to go thru system?
Are any tests for antibodies for people testing positive?
When your doctors send our positive to go home cuz on death door. No fight left to fight HIS and virus. Send info to NNC what send home with positive? Families not nurses and doctors. Kayenta doctor, been hearing, very heartlss and sweepiong deaths under the rug instead of not following through. I’ll bring name and incidences. Need ot brng remedy to Kayenta dn maby why not get testing.
NN side, told I have to work with Navajo epideminoly on contact tracing while other organization wiling to do. I on own looking for teeing on own. Few weeks you said look into so mak that info known to us.
Thank you for work and team but being t gros root level and would have been great if he was at gournd zero and se doctorsand nurses. Meantime continueot advocate.
On call this moring, funeral arrangements. Lacking back hoe. Three chpas sharing back hoe. Tying bour best. It is heatbreaking and in community wnad relatie dying and being turned away
Thee are ple sharin ginof wht me and trying to keep contact with thm. Not trying to find fault with His but remdeisl utlimatley I feel for my people.
2:44 pm
HIS ROSELY TSO
Medical doctor f concern, sooner the beter.
Testing two ways. Test kits can suse in facilities. Make sure that it is donation to HIS and no strings attached such as results. Clear how we expect donations from private section cuz federal govt has clear policy ion doantions. Equally we do testing, we need tracers and isolation units. Need in place for mitging any test results. I will call on Delegate Brown.
SLATER
Attachment 1, what is HMS?
Second said more tests coming in, cud you email. Hear verbal reports but need written report on what fol
Is cure flatteing?
Your budgets for $600M.
Numbers in report of pot appropriations and unclea if HIS carry cost or split funding with NN.
ROSELYN TSO
Could we set report as separate convestion. Traveling and wanted report so clarify on followup report. Asked to keep with delegates.
SPEAKER DAMON
Set up meeting between IHS director Roselyn Tso and Slater to answer questions.
DELGATE BEGAY
Lechee and kaibeto an dinsprition house and copper mine. Talked with page mayor. Need education about tracing and teting to flatten the cure.
TSO
I wil move vack to Page to get that done and we need to keep focus on facilities.
Asking curve, see more positive results in terms of our ability to get in front of COVID. Towards end of April, amost maxed out, daily tracked bed space and determined who need ventilator and need higher level of care. That is comin down.
While see positvi caes pple not ending up in hospital. Certainly no more positive but mkre have then know who psoite and ot.
Other factors, finaly isolation space, two weeks in farmingotn to hep mitage by providing spac if no place to go to self isoalve. When loing at stats, hospital busy but they are not at level towards end of April. Cirty points to evalutte number o caes and wha seeing in hsotal. Pple ar tesing psotie but not requiring hsotil care. Bu means do other itgint actors, such as sel fcare at home, seekend curew. Those are al lworkings, charts at beging in march , can see where at in this procs andstartn gsee changes in muber.
SPEAKER DAMON
Expecting you this morning to do presentation.
JILL JIM
Verbal presentation
638 ASSOCIATION CHRIS CURLEY
VIRGIL L. DAVIS, FEDERAL PORTION
COO for Winslow Health Care and told provide budget request for $600M. wanted 638 recogntion but strengthen local capacity in Az, NM, Utah
ID 6 factors in working with Dovid. Trusted community resources and doing daily. While no … HIS isolating..
Depleting budget so need
Prevention: exam gloves, face maks, disposal boots and gowns, test kits for impacting everyone at all age levels.
Staffing – patient care, response plan for at risk population, sufficiently staff 24/7, overtime pay, hire contract staff such as doctors and nures, not burn out staff, lot of tech for telehealth, fiber optics, followup, buy It equp and software to hold multi functions such as teleconfereing; patients and staff seerre for visits and hospitalization, meical transportation, supplies for monitoring and teting -0 kits,
Each 638 sumbitted dollar, $32 M, Utah 47m TC $900M; Pine Hill 10..4, fort 131.5m. almao 17.8m for t aol 1.5B
CHRIS
Do we need legislation for 638 cuz it will be for front line responders.
SPEAKER DAMON
This is for each 638 hospitals. Additional $32M and Ramah just vehicles, gravel, internet twoers, warehouse, PPEs, EMT substation, ambulance for respiratory patients.
DELEGATE DANIEL TSO
Response and mitigate does not mean new construction to me.
We were given some good legal overview using documents from U.S. Treasury as guidance. Is that what you folks received regarding what this $600M would be appropriate use.
We have requirements imposed by Treasury and NNC will follow. 638s needs copy of that. We are trying to flatten the curve and you are trying to fatten it with these requests.
Organizations have to realize that $600M has to be spent by 12.30.20 but some of this stuff not happen immediately.
That is my most basic response and not open to any request that is not exorbant three times $600M request.
CURLEY
$209M from all 638s. we can narrow that down when sit down with 638 and refine priorities. Understand $99M is needed.
FORT DEFIANCE HOSPITAL IC JEREMY KRAUS
Questions regarding Nahatahdziil clinic closed. Why closed? Has bd or anyone stated when reopen.
Closed to contain spread. Make sure enough PPEs. Discussing opening clinic regarding patients that need more care and doing telehealth so get care and in touch with providers. Have enough PPEs for meetings but burn rate. Surgijngand full ward. Believe rull ward after Memorial Day.
SPEAKER DAMON
Comments, first was water projects and then health care, first responders.
3:46 pm
JILL JIM
Present what president asked to present and budget related to epideminolgy and contact tracing, some support for first responders, some employees who are listed. We are doing contact tracing but need contact tracers, couple of hundreds, 500 or more. Do test coordination and gauge when pandemic decreasing or more negative test results and tet asymptomatic. But lacking tests for TseHotso Medical Hospitals.
Home Support: cleaning sup-plies and services. We are covering isolation. Lot deals with epideminology.
Main request from OPVP is contact tracing and testing as on eof efforts. One area not looked into but working with EMS so ask NNC to hear from EMS.
SPEAKER DAMON
Overall goal for Naabi was get something from you when NNC begins crafting expenditure plan. Can’t use oral report. Need written document. You conveyed what first responders looking at in your network.
My colleagues have had overwhelming response from public is how protect workers out there such as DALTAC and CHRs. Dk if plan in place. Those two organizations always talked about. Ones out there daily helping elders and community people.
Asking for so NNC can give you every possible funding to help our people through your division.
Is there document near future? And that way there would be no need to go to UUFB. We are here to help and make sure your dept gets supplied. NNC make sure employees get what you need. Those on front lines, essential and nonessential or volunteers, the critical source to get ovr pandemic and whatever you need is now is the time to express to NNC. Not next month for year, two years, three years of supplies to take cre of crical needed care and stopping covid. And when second or third wave that we are ready.
Carl SLATER
Haven’t had report on how working with HIS?
Testing? Feel lot of scatter shot info. What is coordinated NN response and coordinating of response and tells NNC where flattening and who is ill and we move forward with that. Appreciate written response.
Has curve flattened? Flatening? Since you head NHCOC. Cant’ imagine clocking in and being tossed into biggest crisis of country and US.
Know case management in third week of unifed coordination group. We were doing case management individually at hospitals. HIS, NN and others in Unified. Training on phone pads
Whole pointcase mgmt. get eligible for care sites,
All cases start with mgmt. team and when call and lot of calls between posite and negative and those infected with … need more trained in case mgmt. and fill out 213 for food, etc. Finally workerd with three states. Met twice. Mass glitz affects our numbers.
Need more testing kits and when know floten cure with more negative and guage getting healthy and not getting infected. There are numbers for daily testing. If test too much without contact tracers and boots on the gournd, we run into family member go home and cud have immediate oxygen issue and some of hops that do testing get 50 to 90 positives and follow up each. Recovery impt there. And followup with recovery then better number of recovery.
Right now fear of exposre of command cente and lookinga thow function so only route is hire like census workers to help nation. In prsntion to present, had coupleo f hudnreds budget. Overall framework is how, not test to know but tet for proper care and folowup. Hat is measge ot stt partners and have enough stfff if mas testing and if need help for cotnct racing.
Impact and learning. With bliztz that is aftermath. Areas cud not keep up with case management became overwheoming very quickly. Impt get contact raceers and case mrgs.
Think starting flatten. Numbers going down but hae to sustain for ood amount of time. Areas not showing increased number like TC but then due to testing gliz number increased. Need better control of blitz testing and maybe directly supple.
Do more rural testing.
Sense tests but not overwhelming amount. Longer distance travel to hospital.
CARL SLATER
Alterternative care sirtes, projections needed and what set aside for $600M for that.
JILL JIM
We have two alternate care sites – Chinle, 50 beds and SR has 40 and no dent in that want. So need based on discharges happening. Barely fully operational so refer bck to isolation as dealing with ambulance service issues. T alking with them about ambulance between ACS and hospitals. Need awareness and media info from OPvP and handout s. depends on how fast fill up but other issues.
Working with NHS for costs and warp around series for ACS and isolation. Goodpartenr in working with us to cover expenses. Appreciate NHA partnership but expensive to operate.
Federal support paying for costs until can get operational costs.
$4M for national guard and Nation pay 4 percent.
ACS sites there; two. And there will be future waves that need to prepare for.
CROTTY
I’ve been reading Best Practices for tracing with communities with limited resources such as African continent and how dealt with ebolla. In terms of capacity, no budget for immediate needs. Shud NNC look to another entity and get trickle down effect from WR and how regionalize.
We want to hire hundreds of tracers but who supervise knowing DSS capacity. See as enhancing regional health care.
JILL JIM
Concept under case mgmt. and several involved training and testing by John Hopkins here on other projects and Cope. Talk how hire staff which cud be barrier. If you have something in mind, we invite you to meet with epi tem under public health branch.
SPEAKER DAMON
Hear from first responders at 9 am and then Judicial Branch. In the afternoon hear from broadband, cyber team and telecommunications.
Friday, 9 am, set up at chambers for in person Council special session. After that Naabi work session to discuss veterans, hear from Veterans Advisory Committee, and Navajo VA.
Report from BIA regarding site agreements.

NAABI WORK SESSION ENDS AT 4:35 PM, 5.27.20

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