May 26, 2021
Cuidadores en Tiempos de Emergencia / Caregivers in Times of Emergency
By: Diverse Elders

Editor’s note: The following article provides the English translation of part of a half-hour documentary on eldercare in Puerto Rico. The full program was broadcast this April in Spanish with English subtitles [ ]. Mayra Acevedo wrote and produced this documentary in Spanish for WIPR (Puerto Rico Public Television) with the support of a journalism fellowship from The Gerontological Society of America, Journalism Network on Generations and the Commonwealth Fund. She also provided this English translation. In addition, it is being published in Spanish in various digital platforms for Revista de Medicina y Salud Pública.

By Mayra Acevedo. WIPR-TV Puerto Rico Public Television

San Juan, P.R. — Puerto Rico has experienced one emergency after another during the past three years. – Hurricanes, and earthquake, the pandemic and more. The scars are still visible.

There is also underlying damage that escapes our sight, which is silent and scattered among thousands of homes throughout the island. One crisis after another has left thousands of older adults and the people who care for them without the resources they need and deserve.

Herme has taken care of his wife since she became sick 10 years ago. At 75 he is a nurse and  herb informal caregiver — an older adult taking care of another senior without pay, a compromise for love

No one knows how many are like Herme in Puerto Rico, elders taking care of another one ,an invaluable task.

“The truth is, the number of people dedicated to caring for an older adult , informally, which means non-paid, has increased in recent years,” said Dr. Vanessa Sepulveda, a gerontologist and professor of internal medicine at the University of Puerto Rico School of Medicine. “I imagine you have seen the statistics. For example, they show that there has been a 5% increase in the amount of people who are informal caregivers between 2015 to 2020.”

She added, “Not only that, what has struck me the most when I look at those statistics is that . . . many of these caregivers are not only caring for one, but for two adults.”

Nearly 900,000 elders living in Puerto Rico., the fifth highest total among US states and territories, according to the us census, by percentage of concentration of people age 60-plus.

In addition, Puerto Ricans are living longer; their life expectancy has increased consistently during the last 20 years, as shown in data from the World Bank.

Furthermore, Puerto Rico has lost as much as one percent of its population annually for the past decades. According to different estimates., from 350,000-500,000 have fled the island in those years, leaving many grandparents and older adults behind with little or no support.

The Puerto Rico Statistics Institute (Ciencia Puerto Rico) found the migration pattern was triggered by the economic crisis the island is facing and the crisis that followed with natural disasters such as hurricanes Irma and Maria , and the subsequent earthquakes.

Add to this seems grim picture that there is no registry of how many informal caregivers there are, But a recent study sheds light on how they are living (striving, and surviving). The 2019 study, titled, “Profile of the Older Adult Caregivers in Puerto Rico” [] conducted by Professors and students at the Pontifical Catholic University in Ponce, found that these caregivers are living on the brink of poverty.


“Our study found something alarming,” said lead researcher Angel M.  Muñoz Alicea, PhD. “Over 60% of caregivers interviewed had an annual income under $20,000. With the high cost of living — their health problems, medicines — we heard stories of caregivers telling us that they could not get all their medical prescriptions because there wasn’t enough money.”


This study also found that these caregivers had no support from other family members and that a vast majority saw their emotional health affected.

Carmen, caregiver for her 87-year-old father, who has Alzheimer’s disease, said, “This is not easy.” Her words echo those often heard at Muñoz’ clinic at the School for Caregivers of the Aging in ponce, where the study was done.

Muñoz explained, “At interdisciplinary clinics for the community in our University, where we offer emotional and psychological services, the therapists and  clinicians have seen that these caregivers, tending to the elderly, have higher levels of anxiety, are overwhelmed and also have had to make adjustments to their personal and work life.”

The study, conducted in 45 municipalities throughout the island, is a snapshot of the current situation caregivers there confront. Muñoz explained, “Our “profile” is the first published about this group. It’s the first to start giving them a face, a voice. It enables physicians, social workers, psychologists — even the government — to listen to the voice of those with real necessities.”

He added, “Our study not only presents a profile of the caregiver, it also includes health issues, their anxiety levels and depression symptoms that our caregivers are manifesting. We interviewed them and visited them to talk the them in person.”

Muñoz continued that the COVID-19 pandemic has increased caregivers’ hardships in the resulting economic and social crisis. “We also have a population that was in the workforce, who were laid off or had their salaries reduced, so they didn’t have means to pay for services.”

For example, he said, many of those who attended programs at the campus clinic “are caregivers who are cleaning ladies or domestic workers mostly over 60 years old. When their work hours were reduced and they had someone under their care, they didn’t know how to access aid they were entitled too. They didn’t have access to the internet, not even email.  That part of getting access to aid was difficult for them.

Muñoz added, “We have seen in increase in people under 50 that have had to take on the role of caregiving  because of a reduction in income and they can’t pay for the care or long-term services for their loved ones. So now they have to provide   those services.

What’s more, he said, “We have also seen an increase among men taking on the role of caregiving for older adults and men taking care of spouses. Yet definitely, women continue to be the queens of caregiving in Puerto Rico. We continue to see women over 50 assuming this role day to day.”

Of the growing number of older adults on the island, Muñoz noted that 20% of those ages 65 or older eventually require care, according to the Pan American Health Organization. [] And 85% of them want to age at home. This means, as the pandemic is showing, a family member will most likely have a prominent role in caregiving. This is why it will be important to continue helping them and also studying their needs of the elderly, as well as those of the caregivers.”


The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.