After Maria, the threat isn’t over for Puerto Rico’s most vulnerable — the elderly

UTUADO, Puerto Rico (En español)

Almost a year after Hurricane Maria raked through this part of central Puerto Rico, Héctor Cruz says the threat isn’t truly over for the island’s most vulnerable — the elderly.

The director of the emergency management office in Utuado, Cruz was navigating his pickup truck along pitted dirt roads and across temporary bridges on a recent weekday when he fielded a call from a panicked community leader.

The man was worried that fresh rains were going to leave the rural hamlet cut off once again.

“There’s a group of old people there who live alone and have health problems,” Cruz said. “And if they ever need an ambulance, it’s going to be very difficult to get to them.”

Last year’s storm hit the town of Utuado in the central highlands, about 55 miles southwest of San Juan, particularly hard. The hurricane destroyed or damaged 20 bridges, washed roads and homes off the mountainside and cut power to the area for nine months. One community became known as “Los Olvidados,” or “The Forgotten Ones,” after their only bridge failed, leaving them isolated for months.

And while life has in many ways returned to normal on the island of 3.3 million, its seniors — particularly those in rural areas — are still coping with the aftermath.

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What remains of a home battered by the Atlantic Ocean along the coast in La Boca, Barceloneta, Puerto Rico, is shown a year after Hurricane Maria hit the island. Al Diaz adiaz@miamiherald.com

Puerto Rico has a higher percentage of people 65 or older than any U.S. state. Not surprisingly, seniors accounted for a disproportionate number of the 2,975 deaths attributed to Maria, according to a recent report by the Milken Institute for Public Health. Men over 65, in particular, were still seeing elevated death rates four months after the storm, as the island’s health services continued to limp back to life.

Cruz’s own 93-year-old grandfather was an indirect victim of Maria. He had lived for eight months without electricity after the storm and cut himself in the dark on his way to the bathroom. Because he was a diabetic, the wound turned into a lesion and the doctors ordered an amputation. His grandfather couldn’t handle the stress, Cruz said, and had a fatal heart attack as he was headed to surgery.

“We can’t say it was directly related [to Maria] because it didn’t happen at that time,” Cruz said, just weeks after burying his relative. “But we do know that his sense of desperation, anxiety and the difficulty of living without light led to all of this.”

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Héctor Cruz, director of the emergency management office in Utuado, Puerto Rico, walks past the remains of a collapsed bridge. Cruz said his town is still recovering a year after Hurricane Maria destroyed or damaged 20 bridges, washed roads and homes off the mountainside and cut power. MATIAS J. OCNER mocner@miamiherald.com

Even before Maria made landfall, the island was aging at a breakneck pace. According to the Puerto Rican Statistics Bureau, in 2010, about 15 percent of the population was 65 years or older. By 2017, that number had jumped to 20 percent.

That tendency has only been exacerbated since Maria. While there are no definitive statistics about the storm-related exodus, the Milken Institute study estimates that almost 300,000 people have left the island since the storm — many of them young, working-age adults.

One of the consequences of this demographic shift is that, since 2016, Puerto Rico has seen more deaths than births, said Health Secretary Rafael Rodríguez.

“The young people, the professionals, those of child-bearing age, are leaving the island or deciding not to have children,” he said. “What we have is an older population, seniors, and from an economic and healthcare perspective that creates great challenges for the government of Puerto Rico.”

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Puerto Rico’s elderly are also hard to reach. According to the AARP, a U.S.-based nonprofit that advocates for people over 50, only about 2 percent of Puerto Rico’s seniors live in nursing homes or assisted living facilities. The vast majority live at home, relying on a network of friends and family to stay healthy.

But that societal safety net has been fraying amid the decade-long economic crisis.

Wendy Matos, the executive director of the University of Puerto Rico Hospital faculty practice plan, said access to healthcare has always been an issue on the island. And Maria only complicated matters when it disrupted public transportation and washed away roads.

“On the other hand, many people migrated and left their old ones behind,” she said. “There was no one to go shopping for them and they suffered.”

Maria Méndez Rodríguez was 1,175 miles away from her nearest relative when the monster storm hit Utuado. Communications were so damaged that it took Rodriguez, a 70-year-old with high blood pressure, asthma and arthritis, more than 40 days to communicate with her grown children in the United States and let them know she was alive.

“They told me they cried the entire time. ... And I missed my family so much, because there’s no one like family,” Méndez recalls, as she stood outside her one-bedroom apartment. “But in the name of Christ, my neighbors acted like my family.”

Méndez said she survived the storm thanks to the kindness of others in her apartment block, who helped her run errands and buy food and kept tabs on her.

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Maria Méndez Rodríguez, 70, of Utuado, Puerto Rico, says communications were so damaged after Hurricane Maria that it took more than 40 days for her to talk to her children on the U.S. mainland. “I missed my family so much,” she recalls. But, she adds, “my neighbors acted like my family.” MATIAS J. OCNER mocner@miamiherald.com

Rafael Rosario Quintero, 70, and his wife, Luz E. Ortiz, 76, saw their seaside home in La Boca, in northern Puerto Rico, badly damaged by Maria and her thrashing waves, which eroded the beach. The couple managed to repair the house with emergency aid and using their life savings, only to see their work destroyed six months later by a minor storm that finished tearing off the front of their house.

“It took the rooms, the living room, the kitchen — everything,” Quintero said. “And there went everything they had given me to fix the house [after Maria].”

The couple’s three grown children live in the United States and haven’t been able to visit in more than a year. Ortiz said her daughters want them to move to the United States, but she had a stroke in 2015 and suffers from fibromyalgia, and is afraid to fly.

“When our children can help us out financially they do, but they have no obligation. They have their own lives,” she said. “We are all alone here in La Boca.”

The private sector has seen a business opportunity in the isolated seniors. Shortly before Maria, MMM Healthcare opened up a chain of Vita Care Clinics that cater to the aging population, offering them free transportation and helping them control chronic issues like hypertension and diabetes.

After the storm, those services became even more important, and the company expanded its offerings and hours.

“When the clinics started, we visualized a chronic care clinic to address the population needs — where our physicians are leaving [the island], and the population is old and alone,” said Nury Toledo-Nuñez, the COO of nine Vita Care Clinics on the island. But it soon became apparent that many of their patients lacked the social support network that might allow them to access the care.

Diabetics weren’t controlling their blood sugar, not because they couldn’t afford the treatment, but because they were lonely and depressed, she said.

“So we started bringing in psychologists, social workers, nutritionists and health educators,” she said. “It was far more complex than saying, ‘You have diabetes and need XYZ drug.’ ”

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A collapsed home in Utuado, Puerto Rico. Abandoned homes like this one are common in the city of Utuado, where people continue to recover a year after Hurricane Maria devastated the area. MATIAS J. OCNER mocner@miamiherald.com

Méndez in Utuado says her sons — one in Michigan and another in Orlando — try to persuade her to move to the mainland, but she refuses to leave her longtime home. And she doesn’t think they should return to Utuado, where she says jobs are poorly paid and hard to find.

“I want my children to have a better life than me,” she said. “And here they wouldn’t even be able to feed themselves.”