Series

Elderly Support System Fragmented in the Midst of Pandemic

May 25, 2020

Socorro is a social worker at a center that provides services to older adults in Santurce, a neighborhood in San Juan. Since physical and social distancing measures began as a prevention strategy to contain COVID-19, she has received referrals to take in new participants who need help in the midst of the pandemic. However, the center’s team has been cautious, and although she stays in touch with the new participants, she has been unable to meet them in person.

“Most of the people are in need and if we add to that, that many   in that area of Barrio Obrero work offering services and cleaning houses, [now] can’t work,” she told the Center for Investigative Journalism (CPI, in Spanish), while talking about the cases of older adults who have stopped earning money since the COVID-19 lock-down began in mid-March.

“Some of our participants have had difficulty seeing doctors. Some doctors have called them on the phone,” Socorro said.

More than 10 kilometers south of Barrio Obrero, a family of three who lives on a street in Cupey waits for their daily lunch. Ramón, whose fictitious name protects his identity, is 61 years old and goes out to pick up the three plates of food delivered by a volunteer from a religious entity in Río Piedras.

Inside the home, the man cares for his 82-year-old mother and 91-year-old father. His mother fell off a few weeks ago and broke four ribs. His father is bedridden, and since the quarantine due to the COVID-19 pandemic began and with the ensuing decline in home services, the son is responsible for his care.

“His situation got complicated since the distancing began. And all three are older adults,” Samuel Pérez, a theology student and Brother of the Sociedad Fraterna de Misericordia, told the CPI after getting in the van for his daily route to deliver plates of hot food.

Puerto Rico’s older adult population is among the most vulnerable groups that will suffer from COVID-19, both in the health and social aspects. Although only 25% of the positive cases detected with the virus in Puerto Rico are people 60 or older, this same group represents 78% of deaths related to the virus, according to Department of Health data published in the Senior Leadership Brief report through May 12.

However, the government lacks a comprehensive plan that integrates agencies to meet the needs and fight the dangers this demographic sector is facing in the context of the current pandemic, the CPI found.

There is no central government structure that coordinates the efforts of the different public entities and non-governmental organizations that provide services to this group during the pandemic. There is a protocol for nursing homes the Department of the Family established, which in broad terms offers guidelines on how to avoid transmission in these centers, what to do with people who are infected with the virus, as well as stressing the need to restrict visits from family and non-essential services staff, among other recommendations.

Mabel López Ortiz from the Puerto Rico College of Social Work Professionals (CPTSPR, in Spanish), Amada García Gutiérrez from the Brigada de la 3ra Edad and José Acarón from AARP told the CPI that while there are nonprofit and community-based organizations that have been attending to this group for years, the absence of official data on older adults in need and the lack of State coordination with the groups that work in favor of this demographic group, prevent the rapid response in emergency situations related to COVID-19.

“One of the reasons why aid is so disjointed is the lack of information from the   government. Everyone works independently. There should be a chart of how many organizations are offering services. Community leaders are with the people, but there’s no record of that,” López Ortiz told the CPI.

Faced with hunger, the need to guarantee food to this population represents one of the priority issues, according to specialists on the subject of old age and community leaders who spoke with the CPI. The greatest difficulty lies in the absence of data that allows locating people who need   food.

“There are people who need food and don’t get food stamps. Hunger on this island has the face of an elderly person and a working woman. You don’t know where there is an elderly person dying of hunger,” Carmen Villanueva, who is a community leader at Hills Brothers Sur sector in San Juan, told the CPI.

“When we talk about isolation, we forget that these older adults can also be victims of domestic violence. Many of them depend on caregivers. These are issues that we knew were going to skyrocket when La Fortaleza’s response was to shelter in place,” said López Ortiz, who is also a professor at University of Puerto Rico in Río Piedras.

Without a map of needs, food allocations are uncertain

Last March, President Donald Trump’s administration signed the reauthorization of the federal mandate known as the “Older Americans Act” (OAA). The budgetary allocation associated with that law has as one of its goals to provide services to older adults without them having to leave their homes in the midst of the pandemic. These services include food delivery to their homes.

In Puerto Rico, the Office of the Ombudsman for the Elderly (OPPEA, in Spanish) has received funds from the OAA to buy food for the elderly population. The lack of a registry at the government level of the services and areas that benefit from the organizations that attend to this demographic sector has forced the head of the OPPEA to put together her own informal network to identify which centers and communities could be recipients of these food purchases.

That office has 133 employees. According to information OPPEA provided to the CPI, all of its employees have been active during the pandemic, either at the San Juan headquarters or working remotely.

“The advantage I have is that I have been in the field of gerontology for many years. I don’t reach all (of the organizations), but there are colleagues who tell me about situations,” said the Elderly Ombudswoman Carmen Delia Sánchez Salgado, after the CPI asked her if the government has a registry of the organizations offering services and delivering food to older adults in need.

Sánchez Salgado said that in addition to her contacts, she has been in communication with mayors and some 140 multi-use activity centers, most of which are administered by municipal governments. She has also accessed the Department of the Family’s list of Senior Activity Centers (CAMPEA, in Spanish) that provide nutrition, transportation, recreational activities and socializing for low-income people 60 years or older. The Department of the Family has nine CAMPEA centers throughout the island.

OPPEA recently sent food purchases for CAMPEA centers to distribute to about 300 participants. The CPI called the Department of the Family’s nine CAMPEA centers and their employees confirmed they had received a food delivery from OPPEA and said they had distributed the groceries among their participants.

Of all the CAMPEAs, the one in Aguadilla has the largest number of participants: 54. One employee who spoke to the CPI said only 30 participants requested the service for home food deliveries. The Department of the Family’s nine CAMPEA centers serve different regions and are located in the towns of Aguada, Aguadilla, Bayamón, Cidra, Yabucoa, Juana Díaz, Arecibo, Lares and Guayama. The total number of registered participants for the food delivery service is 323. People 60 years or older with incomes below $936 per month qualify to participate in the CAMPEA centers.

According to data from the US Census through 2018, the segment of people over 65 in Puerto Rico constitutes 20.7% of the population. However, when the calculation is done starting at the age of 60, the census data through 2016 indicate that this age group totals 855,708 people, or 25% of the island’s total population, according to a report OPPEA published in December 2017.

OPPEA also announced in late April that it was “helping” about 1,500 older adults in the Public Housing Elderly Homes and other homes identified in the town of Humacao, and that it would arrange the shipment of food to the homes subsidized under Law 173 and Section 8, although the Ombudsperson could not specify how many older adults will benefit from the food purchases delivered to those centers.

In the case of the municipal multi-use activity centers, Sánchez Salgado said the goal is to reach a number of people greater than the official number of participants, but was unable to specify how many will benefit, other than the  estimate of about 100 in most centers.

“We have to change the vision about who the vulnerable population is because municipalities have to consider not only those who benefit from the PAN (Nutritional Assistance Program). There’s a limited acceptance of the real needs of people on the street. We continue to think that the island has changed, but the government structures haven’t changed,” José Acarón, state director of AARP Puerto Rico told the CPI, while explaining that the instability of the older adult population increasingly comprises more people and is not limited only to those who are considered to be below the poverty level according to government standards.

“There are condos that are full-blown elderly homes. How  do you assist people who live alone? People at nursing homes are taken care of, but when people are alone, who supports them?” Acarón questioned.

Meanwhile, Sánchez Salgado said it’s tough to get information on the needs and location of older adults living alone or with a partner in a private residence. For this reason, OPPEA is urging community leaders to contact the agency and report on the needs of its residents. He said they can call 787-721-6121.

“I have no way of identifying people in communities if not through community leaders,” said the attorney, who also acknowledged that communication with mayors helps manage the delivery of food to older adults.

She added that she tells the municipal executives that the OPPEA will send them the resources “and they have to make the purchases” to address the difficulties that come up when it is unable to get local suppliers that deliver food to some regions and towns.

The Government’s Chief of Staff Antonio Pabón said he is confident that the municipalities will be able to identify the organizations that can do the job of delivering food to those who need it.

The president of Brigada de la 3ra Edad, Amada García Gutiérrez, believes the lack of a central government structure aware of the work being done in favor of the elderly population by municipalities, community and nonprofit organizations, results in not being able to efficiently supervise these institutions in their efforts to offer services or distribute food subsidized with public funds.

“Some of the problems that this can create for the population is that they be given food that is not nutritious and can worsen health conditions, the (lack of) control of who receives these deliveries and who is left out and why, the lack of information on how people reach them and let them know: ‘I need service’, García Gutiérrez, who is also a social worker and has investigated the issue of older adults in Puerto Rico, told the CPI.

“There’s poverty in Puerto Rico and 40% of our elderly population lives below the poverty level,” she said, referring to the Community Survey conducted by the US Census in 2015.

Meanwhile, Acarón said while there are many organizations that help by distributing food, sometimes these efforts are not organized to meet the needs in the island’s different regions.

“The role of the Ombudsman (for the Elderly) must be to integrate these services,” the director of AARP in Puerto Rico urged.

García Gutiérrez’s and Acarón’s concerns are similar to those expressed by parents of children and organizations regarding food distribution given the closure of school cafeterias. The Department of Education initially delegated food deliveries to nonprofit organizations, but, similar to the case of older adults, there is no government protocol or registry to ensure that these provisions reach students.

As a strategy to create a registry that oversees the delivery of the purchases for older adults, the Ombudswoman said she is asking organizations that receive OPPEA resources to provide information on people that benefit from the service. However, that task will be done after the food is delivered and is intended to gather data to inform the federal government, she said.

“We haven’t yet been able to do the calculation. We give the communities a list for people to sign when they receive [the delivery]. The supplier is asked to let me know to whom he sends each purchase,” said Sánchez Salgado, who also explained that in a few months she should be getting reports on how the multi-use centers used the money.

Advocating for greater access to information for older adults

Images of dozens of people lining up in front of grocery stores have been recurring since the Governor implemented the curfew on March 15. The presence of older adults in these lines has been constant, despite the fact that many of them may be at risk due to their age or prior health conditions. Sometimes they don’t wear a mask or gloves. Sometimes they do not have electronic payment tools as an alternative to reduce physical contact.

Many older adults who live alone believe they have no other option than to go to the stores to buy food and other items on their own. However, the risks of going out and being exposed to COVID-19 could lower if the municipalities and the government provided the information on the alternatives in an appropriate way and without limiting it to the use of digital platforms that are not always accessible to this demographic group. This includes the broad disclosure of information related to requesting food delivery at home.

“It is a misconception that they have access to digital media and the internet. Not everyone has the privilege of having these platforms and basic information. Most of the information they get is through television and radio,” García Gutiérrez warned.

“Is that information about available services reaching people? Does it reach community populations and regular people? It has been very difficult. Many people don’t get food because they don’t know what to do,” she added.

As a strategy to receive messages from those older adults who request deliveries of food and other basic items, OPPEA disclosed the availability of the csanchez@oppea.pr.gov email address. The CPI asked Sánchez Salgado how they would reach those people who lack access to the internet or who do not know how to send emails.

“Starting today (Thursday, April 23) we activate the [telephone] switchboard so that people can call and connect with us. We activated those numbers,” the Ombudswoman said, referring to (787) 721-6121.

According to AARP, more than 400,000 Social Security beneficiaries in Puerto Rico are in limbo as to when they will receive the $1,200 federal stimulus related to the COVID-19 pandemic. Acarón said there are several solutions to accelerate the payment of this federal money without having to force older adults to access the Unified Internal Revenue System (SURI, in Spanish).

“[In the case of] public employees, it can be done through the Retirement System, which has the information. Through AEELA (the public employees association), which also has people’s information. People who have applied for Seniors bonds [that people 65 or older or low-income retirees can request from the Department of Treasury], we also have information about these people,” Acarón stated during a television newscast.

Rafael R. Díaz Torres is a member of Report For America

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