EDITOR’S NOTE Second of four stories in the series “Pliegues en su piel, vacío en su corazón” (“Folds in the skin, emptiness in the heart”), which analyzes the progressive number of older adults alone in hospital facilities in Puerto Rico. This work was supported by the Journalists on Aging Fellowship, awarded by the Gerontological Society of America, along with the Journalists Network on Generations and the Silver Century Foundation.

A 63 year old man whom we will refer to as Federico -to protect his identity- was left alone after being discharged from the hospital. After a three day hospitalization, when he returned home, his partner did not receive him. When the ambulance took him back to the hospital, the man became depressed and attempted suicide. This is just one of the many situations of abandonment of the elderly faced by the 69 hospitals in Puerto Rico, acknowledged the president of the Asociación de Hospitales de Puerto Rico (Puerto Rico Hospital Association), Jaime Plá.

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“It’s not just (economic) losses for the hospitals,” he said, referring to the patient’s physical and mental health. In Federico’s case, he was able to be placed in a long term care facility after 66 days of waiting in the hospital.

The matter, said Plá, is being discussed by the government and organizations in search of possible solutions.

Ramón Alejandro Pabón, former president of the Colegio de Administradores de Servicios de Salud (College of Health Services Administrators), commented that hospitals and Puerto Rico Department of the Family (DF) should handle these cases quickly.

“I am concerned about increasing fines for relatives (for abandoning older adults in hospitals) because it could cause them to leave them abandoned in other places. It would be worse,” he opined.

Henry Rodríguez, of the Oficina de Organismos Reguladores (Regulatory Agencies Office) of the Servicios de Salud Mental y Contra la Adicción (Office of Mental Health and Addiction Services, Assmca), reported that under the Servicios Transicionales de Salud Mental (Transitional Mental Health Services) there are 113 facilities licensed to receive these geriatric cases.

Sheily Jiménez, also from Assmca, revealed that, as of the end of May, there were 371 older adults in different levels of care.

“There are many cases in which the family does not want them back or the person forgets to take their medications (and cannot live alone),” she said, acknowledging that they will need more spaces to relocate them.

Several factors have affected this population sector, explained demographer Judith Rodríguez. One of them is that Puerto Rico’s birth rate is lower than its mortality rate. In addition, the migration wave, accelerated by Hurricane María and the COVID-19 pandemic, has accentuated and uncovered the loneliness of older adults.

“Puerto Rico stands out because families love their elderly. We have to understand why this process occurred,” she said.

Return migration - Puerto Ricans who returned from the United States between 1980 and 1990 - stopped, the economic crisis, among other events. But recent factors have reactivated the departure of young populations, and many old people are again being left alone, Rodríguez explained.

In addition, she said that many “baby boomers” -the generation of those born between 1946 and 1964- are no longer working, are sick and require care, while, at the same time, there are more and more childless couples, an important factor that reduces support for these older adults.

“Most of those hospital neglect cases are mental health and the caregiver has to stop working. That brings costs and burnout. They have to be supported,” she argued.

According to the Census Bureau’s 2022 Community Survey, 51.2% of adults 65 and older in Puerto Rico have a disability, while 59% live below or near the poverty level.

“Many caregivers die before the persons they care for. Labor policies must be established so that they can work while caring for their elders,” she suggested.

Demographer Amílcar Matos Moreno, associate professor at Universidad Carlos Albizu, agreed on the accelerated level of aging and brought up data from the Census: while in 2010 people aged 65 and over made up 13% of the population, by 2021 this sector rose to 23%.

“This rate of aging has never been seen in any other country,” he said, explaining that this produces smaller families.

According to him, it is estimated that 16% of this population lacks or no longer has any kind of support, and that 48% of the 65 and older sector has a child living in the United States. “There are networks beyond the family, support among friends, but legally they cannot respond for this older adult,” he said.

On the other hand, he warned that imposing greater penalties on family members for abandoning their elderly in hospitals could cause them not to seek treatment for them, if they cannot take responsibility for them.

There are many reasons for the increase in older adults abandoned in hospitals, agreed Dr. Astrid Santiago Orria, associate professor in the Department of Social Work at Universidad Ana G. Méndez.

“In some cases, the older adult does not want to use their money because they feel it is their family’s responsibility to take care of them now, since they took care of them before,” said the gerontologist.

She added that some consider that delegating the care of the elderly to the government should not be sanctioned, since it avoids risks. The academic said that, in some cases, the motivations are, for example, difficulties between family and work responsibilities, as well as the deterioration of the caregivers health. She stated that, in certain circumstances, a hospitalization avoids violence and mistreatment.

“We cannot emphasize that it is the family’s fault,” she said.

She recommended strengthening Law 82 of 2023 -that establishes the public policy on informal caregiving- granting incentives to caregivers and more programs for older adults. Santiago Orria also recommended to review the Minimum Wage, Vacation and Sick Leave Law (1998) so that caregivers can receive this benefit.

Meanwhile, Dr. Luis Colón, director of the Alianza por la Salud del Pensionado (Alliance for the Pensioner Health), pointed out that more than 66% of the people who call them are older adults who live alone.

He added that although there are children who are responsible for their parents during their old age, there is abuse in other families. Colón urged the strengthening of workshops and educational campaigns for caregivers.

For doctor Ángel Muñoz, director of the Escuela de Cuidadores (School of Caregivers) of the Pontificia Universidad Católica de Puerto Rico, it is urgent to understand the scenario of each family. In some families, he said, there are traumas due to previous mistreatment.

As he explained, many times caregivers are women who work while raising children or grandchildren. The Carta de Derechos de los Adultos Mayores (Bill of Rights of Older Adults), Muñoz recalled, makes families responsible for the care of their elderly.

Currently, House Bill 2032 seeks to amend Act 121 of 2019 to establish a protocol to address the abandonment of older adults in hospitals. Meanwhile, Senate Bill 1085 also seeks to expand the responsibility of families in the abandonment of older adults in hospitals.

“Soon, four out of 10 (people on the island) are going to be seniors. The government does not have the capacity to take care of all of them. It is not about legislating, but identifying the necessary resources,” Muñoz stressed.

Carmen Delia Sánchez, Procuradora de Adultos Mayores de Puerto Rico (attorney for the Older Adults in Puerto Rico), said that last year there were more than 20,000 cases of mistreatment against this population, because for every reported case there are seven unnoticed.

She remarked that the Ley para el Fortalecimiento del Apoyo Familiar y Sustento de Personas de Edad Avanzada (Law for the Strengthening of Family Support and Support of the Elderly), a law passed in 2000, needs to be modified, since many older adults are afraid to accuse their relatives of not taking care of them.

“Sometimes you can’t intervene unless it has an impact on their livelihood,” she said, lamenting that there are older adults living on the street.

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This content was translated from Spanish to English using artificial intelligence and was reviewed by an editor before being published.