Elías Carmona Alejandro never imagined that death would find him far from Puerto Rico. As terminal cancer eroded his cognitive abilities, the devoted admirer of Puerto Rican culture and jíbaro music spent his final three months in Chicago, where he died in 2024 at 79.
His adult children, Sandra and Elías Carmona Rivera, 50 and 52, said they were grateful that their father’s condition kept him from realizing he had been taken to Chicago for treatment.
“He never knew he was outside the island. If he had been aware, he would have wanted to die in Puerto Rico. We would have wanted that transition to happen on the island,” said Sandra.
Like many contemporary Puerto Rican families, Carmona Alejandro’s immediate family network was shaped by migration, particularly during the last 15 years of his life.
While Sandra remained in Puerto Rico and settled in Loíza, a coastal town on the island’s northeastern shore, his son Elías is among the more than 700,000 working-age Puerto Ricans estimated to have migrated to the United States over the past two decades, according to the U.S. Census. He settled in Humboldt Park, the heart of Chicago’s Puerto Rican community and a major hub of the diaspora since the mid-20th century.
While Puerto Rico has lost a significant share of its working-age population, the proportion of older adults on the island has grown rapidly. According to U.S. Census data, that share rose from 13% in 2010 to 21% in 2019. This shift has created a reality in which nearly 70% of older adults’ children live outside the island, said Puerto Rican demographer Amílcar Matos Moreno, a professor and postdoctoral researcher at Penn State University’s Center for Healthy Aging. In his view, the combination of accelerated migration, a lack of accessible services and outdated public policies leaves many older adults alone or dependent on care coordinated from the diaspora, a phenomenon that is redefining aging on the island.
“If you have three children, two of them are expected to be living outside the island and one to be here in Puerto Rico,” Matos Moreno said. “If you have one child, the odds that they live abroad are much higher. If you have two children, one — or perhaps both — are likely to be living outside the island.”
The figures Matos Moreno cited come from the academic paper “Kinship Structures for Left Behind Older Adults in High Outmigration Contexts: Evidence From Puerto Rico,” published in 2025 in The Gerontologist, a peer-reviewed journal on aging. The study focuses only on daughters of older adults, but Matos Moreno said the research team, which included Puerto Rican demographer Alexis Santos Lozada, is updating the model and has found the same patterns apply to children of all genders.
According to 2025 World Health Organization data, Puerto Rico ranks eighth worldwide in the share of residents ages 60 and older, at 32.3%. Only Vatican City, Monaco, the British overseas territory of St. Helena, Japan, Martinique, Guadeloupe and Italy rank higher.
Matos Moreno called the figures alarming. As fertility rates fall and life expectancy rises, older populations are growing worldwide, he said, but Puerto Rico faces the added strain of accelerated migration. That combination has changed how older adults who remain on the island are cared for, reshaping family dynamics and the emotional, social and practical supports they rely on, especially in their final years.
A Farewell Far From Home
In 2023, shortly after his wife’s death, Carmona Alejandro was diagnosed with myelodysplastic syndrome, a group of blood and bone marrow cancers that can progress to acute myeloid leukemia. At the time, his daughter was his primary caregiver in Puerto Rico, balancing full-time work with raising two teenagers.
Photo by Vanesa Baerga | Centro de Periodismo Investigativo
As the disease progressed, caring for Carmona Alejandro became increasingly complicated and expensive, prompting Sandra and her brother to look for other options. They explored services through San Juan’s municipal homemaker program and an elder care facility, but Sandra said costs at the facility “didn’t go below $3,000 a month.” In the process, she used up the sick leave she had accumulated at work, and the search for care for her father remained fruitless.
From Chicago, where he works as a visitor experience manager at the National Museum of Puerto Rican Arts and Culture, Elías suggested to his sister that they bring their father to the city to continue treatment. They made the arrangements and found a long-term care facility in Chicago’s Puerto Rican community that accepted his Medicare coverage and could admit him in his fragile condition. The facility — geared toward older Hispanic adults in Chicago — also had Spanish-speaking staff, an important detail because Carmona Alejandro did not speak English.
Photo by Vanesa Baerga | Centro de Periodismo Investigativo
Carmona Alejandro arrived in Chicago on Sept. 13, 2024. He was admitted to the long-term care facility, where a nurse, a primary care physician and an oncologist had already been assigned to him. The facility transported him to medical appointments, and his son met him there. That support made coordinating his care far easier: Unlike his sister in Puerto Rico, his son in Chicago did not have to miss work repeatedly to look after their father.
“Back in Puerto Rico, I had to miss work to pick him up, take him to appointments, wait with him for five or six hours, and then wait for the referrals so he could see the oncologist and get treatment,” said Sandra.
The Carmona Rivera siblings take some comfort in knowing that, in his fragile condition, their father never realized he was in Chicago. They said that when they took him out for lunch at Dominican eateries in Humboldt Park — where merengue played and servers spoke with the cadence of a Dominican accent — he believed he was back on the streets of Santurce, the San Juan neighborhood he had walked all his life.
Photo by Vanesa Baerga | Centro de Periodismo Investigativo
Accelerated Migration
Between 2000 and 2020, Puerto Rico’s population fell sharply. The island went from 3.8 million residents in 2000 to 3.2 million in 2020, according to U.S. Census data.
The steepest drop came between 2010 and 2020, when migration to the United States accelerated dramatically and Puerto Rico lost 11.8% of its population — about 440,000 people — according to the U.S. Census.
Perfil del Migrante 2021-2022, a report by the Puerto Rico Institute of Statistics, estimates that the median age of people who emigrated over those two decades was 30. Researchers have largely attributed the outflow of working-age adults to the economic crisis that began in the mid-2000s, compounded by the devastation of Hurricanes Irma and María in 2017, according to the 2021 research brief “Migration is the Driving Force of Rapid Aging in Puerto Rico: A Research Brief,” co-authored by Matos Moreno and Santos Lozada.
The Void Left by Distance
Most older adults whose children live outside Puerto Rico — or are otherwise absent from their lives — experience it as a kind of grief or loss, said Matos Moreno and María Arroyo Bermúdez, a social worker at Hogar Santa Teresa de Jornet in Cupey, a neighborhood in San Juan. In some cases, Arroyo said, those absences can affect cognitive functioning, memory and mood, and may even contribute to depression, especially among older parents.
Of the 110 residents at Hogar Santa Teresa de Jornet, Arroyo said about 10 are older adults whose children live outside Puerto Rico, leaving another relative or a designated guardian legally responsible for them. In such cases, she said, the family members who remain on the island must step in and, together with the assisted-living facility, play a critical role in their care.
“The most important thing is for the family to have a plan and organize a support network of friends or relatives to accompany the older adult,” the social worker said.
Arroyo noted that older adults with children or close relatives living abroad experience more intense feelings of emotional isolation and loneliness.
“There are many older people who wait for a phone call that never comes, or who expect a visit from a son or a sister on a certain date, and then no one shows up,” she said.
The lack of companionship to run errands or keep appointments — such as medical visits — is a major concern, Arroyo added, and a source of added stress for older adults who live alone.
Although many families try to stay connected and offer emotional support through phone calls, video chats and other digital tools, that contact does not always translate into practical help, Matos Moreno said. The loss of hands-on support, he added, can take a toll on older adults’ health, making it harder for them to access medical care or adequate nutrition.
“We’re talking about things like, ‘Can you take me to the corner store?’ or ‘Can you pick up my prescription?’ — things that may seem minor,” the researcher said. “But for an older adult with mobility limitations or some degree of cognitive impairment, these are essential tasks where family members used to play a crucial role.”
Family Support From Afar
For Ana Belaval, a Puerto Rican journalist and news anchor at Chicago television station WGN-TV, 2025 was a particularly difficult year. From afar — and during frequent trips to Puerto Rico — she watched her parents’ health decline. Her mother, Anaví, 86, has Parkinson’s disease and relies on a wheelchair. Her father, Mario, 87, has begun to show signs of cognitive decline.
After her mother was diagnosed with Parkinson’s in 2017, Belaval decided her parents would no longer travel to Chicago and that she would instead visit them in San Juan, where her brother also lives. That way, if a health emergency arose, her parents would be close to their doctors.
Photo courtesy of the family
Because of her parents’ advanced age, Belaval chose to travel to Puerto Rico every three months to support her brother, Mario, who manages their parents’ day-to-day care.
When she is not in Puerto Rico, Belaval tries to stay as connected as possible to her parents through phone calls.
“The hardest part has been that no matter how much I try to help, I’m not there in Puerto Rico,” said the 51-year-old journalist.
Belaval believes taking care of her parents “is what you do” — a responsibility you accept. She grew up visiting her grandmother once a week and watching her mother look after the older adults in the family. Being far from her parents left her feeling guilty and wondering how she could help.
At first, she tried to ease that guilt by searching for items that might make life easier for her parents — bed rails, lidded cups — and ordering them online for shipment to Puerto Rico. It was a way to feel useful from a distance.
Now, Belaval says she is at peace with her parents’ decision to stay in Puerto Rico, though one challenge she has noticed during her trips to help care for them is the shortage of specialists with available appointments.
For their part, her parents prefer to remain in Puerto Rico, close to their doctors, their other son, their friends and their social life.
“My mother told me, ‘If I lose my mind and don’t know where I am, then you can take me to Chicago,’” Belaval recalled.
Two Homes, One Root
With distance and limited access to affordable caregiving services, many Puerto Rican families find themselves juggling improvised arrangements to care for aging relatives. In some cases, that collective effort means returning to the island to provide care or accompanying parents who choose to grow old where their lives began.
That was the case for the Valderrama Ocasio family, part of Chicago’s long-established Puerto Rican diaspora. They found ways to ensure their father, Rafael Fernando Valderrama, who died last month at 92, was always accompanied by one of his children.
Don Fernando, as he was known in his hometown of San Sebastián in western Puerto Rico, arrived in Chicago in the 1950s. There he met Gloria; they married and raised a family, but he always held on to the dream of returning to Puerto Rico. When Gloria retired in 1981, the couple bought a house in San Sebastián, near the Buenos Aires neighborhood in the nearby town of Lares, where she had grown up. The purchase set in motion a pattern of back-and-forth migration between the Windy City and Puerto Rico.
After Don Fernando’s wife died in 2012, the family decided to honor his wish to spend at least half the year at the home in San Sebastián and the other half in Chicago, where six of his seven children live. The arrangement required careful coordination of everyone’s schedules.
1/5 Before Rafael Fernando Valderrama died in December 2025, his seven children (six are shown) divided his care for years between Chicago and the town of San Sebastián in Puerto Rico. Photos by Herminio Rodríguez | Centro de Periodismo Investigativo
2/5 Before Rafael Fernando Valderrama died in December 2025, his seven children (six are shown) divided his care for years between Chicago and the town of San Sebastián in Puerto Rico. Photos by Herminio Rodríguez | Centro de Periodismo Investigativo
3/5 Before Rafael Fernando Valderrama died in December 2025, his seven children (six are shown) divided his care for years between Chicago and the town of San Sebastián in Puerto Rico. Photos by Herminio Rodríguez | Centro de Periodismo Investigativo
4/5 Before Rafael Fernando Valderrama died in December 2025, his seven children (six are shown) divided his care for years between Chicago and the town of San Sebastián in Puerto Rico. Photos by Herminio Rodríguez | Centro de Periodismo Investigativo
5/5 Before Rafael Fernando Valderrama died in December 2025, his seven children (six are shown) divided his care for years between Chicago and the town of San Sebastián in Puerto Rico. Photos by Herminio Rodríguez | Centro de Periodismo Investigativo
Starting with his 80th birthday, Don Fernando’s children also coordinated annual trips — each going separately — to San Sebastián to care for their father.
“We couldn’t have him climbing onto the roof, doing electrical work, so we started coordinating the trips,” said Adrián, 51, the youngest son.
For 12 years, every January, Don Fernando traveled from Chicago to Puerto Rico with one of his daughters. The next month, one sibling would arrive and another would leave, a rotation that continued through June, when Don Fernando returned to Chicago with one of his daughters. The family plan also included video calls among the siblings to discuss new approaches to caring for the family patriarch.
“We went to San Sebastián to enjoy my dad — the peace and quiet, morning cravings, the food we bought out or cooked together,” said Nilda Valderrama, 69, the oldest daughter. “We shared his tastes and his TV shows.”
For the family, caring for their father in the home he bought more than 40 years ago, hoping to reconnect with Puerto Rico, became a collective mission.
“As long as he could go (to Puerto Rico), if we could take him, we took him,” said Amalia, 68, the second-oldest of the Valderrama Ocasio siblings.
Loneliness and Abandonment
Not all older adults, however, have a large and committed support network. As Puerto Rican families have grown smaller, Arroyo Bermúdez and Matos Moreno said, many older adults are left alone because their children leave in search of jobs and higher wages they cannot find on the island.
In 2017, after a decade living in North Carolina, Carlos A. Rodríguez returned to Puerto Rico to help rebuild homes after Hurricane Maria. Rodríguez founded The Happy Givers, a nonprofit that serves people in vulnerable situations by providing food, employment, community support and sustainable development programs. Through the organization’s work, Rodríguez realized most of the cases he was seeing did not involve families or children, but older adults living alone in precarious conditions.
“When you drive through the mountains, through rural areas — through Morovis or Utuado — you see what look like abandoned houses. But older adults are living inside those houses,” he said.
Rodríguez called the situation for older adults in Puerto Rico “grim,” and he agreed with Arroyo that the main problems they face are loneliness, sadness and abandonment. He said he has even paid for the funerals of some of the older people he has helped “because there’s no one else in the family to take responsibility.”
From 2017 to 2024, about 4,000 older adults were abandoned at hospitals in Puerto Rico, according to data the Puerto Rico Department of the Family provided in 2024.
Among the people Rodríguez regularly assists — through The Happy Givers or through La Cocina Social, an initiative that provides healthy meals to older adults several times a week — are those whose children emigrated, as well as others who, after retiring, dreamed of returning to Puerto Rico. But Rodríguez said many come back alone, without their children, and no longer have the support networks they once had on the island decades earlier.
“Of course, they love Puerto Rico — they want to hear the coquí at night and go back to the places where they used to eat alcapurrias,” Rodríguez said, referring to the island’s iconic frog and a popular fritter. “But the system doesn’t work for them, and they return to suffer.”
The Puerto Rico Department of the Family said it recognizes the challenges older adults face, particularly isolation and difficulties managing basic day-to-day tasks. In written statements sent by the agency’s press spokeswoman, Yolanda Rosaly Alfonso, the department said changes in family dynamics require “a much more active response” from the government, municipalities and community organizations, though it did not specify what that response would be.
The department said the absence of a nearby caregiver directly affects an older adult’s stability and safety. Among the challenges it cited was a shortage of “people willing to work as homemakers, caregivers or in-home aides,” as demand for those services has increased.
“There aren’t enough available or trained staff” to fill those roles, the department said.
Even so, for fiscal year 2025, the Financial Oversight and Management Board for Puerto Rico authorized $15 million for the Homemaker Program in 64 municipalities. For fiscal year 2026, the board authorized $199.4 million to fund services for older adults, including $18.1 million for the Department of the Family’s homemaker services and $15 million for municipal programs to operate the Homemaker Program in 60 municipalities.
According to information the Department of the Family shared with the Centro de Periodismo Investigativo (CPI), the agency currently provides in-home aide services — also known as homemaker services — to 1,533 older adults who have no other support. A news report said the 2024-2025 Joint Budget Resolution served 314 older adults in 30 of Puerto Rico’s 78 municipalities. The Homemaker Program offers eligible participants assistance with meals, personal care, household chores and health-related needs.
“We work hand in hand with municipalities, which play a crucial role in wellness checks, transportation to medical appointments and community support activities for older adults who do not have family on the island,” the department said, adding that the collaboration has been essential in filling the gaps left by weakened family networks.
Intergenerational and Multigenerational Housing
To address the problem, Matos Moreno said public policy strategies should focus on the precarious conditions many older adults face, reflect today’s family realities and confront the accelerated outmigration of working-age people. Among the approaches he highlighted is intergenerational housing that pairs older adults with university students — a model used in the Netherlands and in senior living facilities in cities such as Lyon, France, and Cleveland. In those places, collaborative agreements between senior residences and universities provide students with housing, while students offer companionship and daily interaction in return.
“It’s a form of community service that helps students stay in school without the financial burden, while also sharing with an older adult and activating the social contact we all need,” Matos Moreno said.
Another option the academic proposed is multigenerational housing — arrangements in which two or more households from different generations within an extended family live under one roof while maintaining some independence. One example, he said, is converting a home’s second floor so grandparents or other relatives can live there, offering mutual support, companionship and shared expenses. The arrangement can also ease financial pressures by splitting utility costs and, in some cases, sharing the cost of purchasing a home — an approach that could be encouraged through government incentives, Matos Moreno said.
“It’s an investment so that older adults are healthier and suffer less,” he said. “It wouldn’t be an added cost to Medicaid or Puerto Rico’s public health plan. It would mean a more functional, healthier person. We have to see it as an investment in the future.”
Such housing could also make it easier for older adults to live with their children and grandchildren — and in some cases help middle-aged parents care for young children, he added. Although Puerto Rico’s government has not formally proposed these strategies, the Department of the Family, through its spokeswoman, described them as “excellent initiatives.” The agency’s secretary, Suzanne Roig Fuertes, was not available for an interview, and the CPI was denied entry to a news conference where she was expected to appear.
Insufficient Efforts to Slow Accelerated Migration
Matos Moreno said the only government effort in the past decade “clearly aimed at addressing” Puerto Rico’s demographic situation was the Plan de Reto Demográfico (Demographic Challenge Plan), a government report first published in 2011 that describes population aging and projected demographic shifts. According to the academic article “Reflexión sobre el Plan de Reto Demográfico y su impacto en la política pública de Puerto Rico,” by Julio César Hernández Correa, a professor of agricultural economics at the University of Puerto Rico in Mayagüez, the report was proposed by a Demographic Challenge Committee that included representatives from government agencies, academia and the private sector.
The committee was created after the Legislature approved Puerto Rico’s 2010 Demographic Challenge Act, with the goal of developing a plan to identify and craft strategies to address demographic change and the needs of different groups within the population. The report, the article noted, was intended to align Puerto Rico’s central government agencies around the demographic challenges facing the island.
Matos Moreno, however, warned that the initiative “was never followed through and became just another report.” The plan laid out recommendations for how government agencies could respond to Puerto Rico’s demographic challenge, but it was never implemented after agencies were left to define and carry out the recommendations on their own.
Among the public policies the government has adopted in recent years that could help blunt accelerated demographic change, Matos Moreno pointed to a law offering incentives to retain and bring back medical professionals, income tax deductions for each child and the Vivienda Joven program, which offers eligible residents ages 21 to 35 financing to buy a home in Puerto Rico. He said the housing program could help retain — and potentially increase — the number of young adults who want to return to the island and purchase property.
Still, Matos Moreno and Santos Lozada, along with University of Puerto Rico economist José Caraballo Cueto, agreed that so far none of these incentives has solved the problem of rapid population decline among working-age adults or the island’s accelerated aging. They attributed that largely to the absence of metrics to measure effectiveness and to what they see as a lack of sustained government effort to reverse recent demographic patterns.
“Strategies have to be designed to encourage demographic change,” Matos Moreno said. “Changing fertility patterns and migration patterns on an island isn’t easy, but it is possible.”
For Matos Moreno, the answer begins with services and public policies that respond to the needs of today’s population. Faced with shifts as profound as those of the past two decades, he added, the government must prepare to confront challenges experts have documented and warned about for years.
“Public policy has to focus on the Puerto Rico we have, not the Puerto Rico we wanted when people said we were going to be four million,” Matos Moreno said. “There’s so much public policy that could be put in place to create the conditions that would encourage people to stay. If we focus on those who are here in Puerto Rico and can provide a dignified living and a decent quality of life, the others — those who left — will come back. That’s always the migration debate.”
This report was made possible by a fellowship from the Centro de Periodismo Investigativo’s Journalism Training Institute.
This translation was generated with the assistance of AI and reviewed by our editorial team to ensure accuracy and clarity.
