Amid new hurricane season, Maria still taking a toll on Puerto Rico’s elderly

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• Judy Woodruff:

  Now a different health care story, on the problems of providing care for the elderly in Puerto Rico.

  Just a few weeks back, a protest broke out in the capital, triggered by a study that found some 4,600 Puerto Ricans died in the months after Hurricane Maria. Many were seniors and died because of delayed medical attention.

  As Sarah Varney reports, Maria revealed just how precarious daily life has become.

  This story was produced with our partner Kaiser Health News.

• Sarah Varney:

  Eight months after Hurricane Maria devastated Puerto Rico, Mariela Miranda drives along the winding roads in the central mountains, still on an urgent mission.

• Mariela Miranda:

  I started noticing, 'OK, this lady needs. This other lady needs. This other one needs.' And then I said, 'You know what? I'm going to start helping people.'

• Sarah Varney:

  It's her second trip here to Maricao this week. She's dropping off supplies for Maria Solar, a 72-year-old former coffee picker who hasn't left her bed in months. Maria has diabetes. Her husband, Basilicio Solar, says after the hurricane, his wife's blood sugar levels spiked and she had a massive stroke.

  He points to the roof, and describes how entire sections blew off during the storm and landed in the forest. Miranda is just a concerned neighbor who has been delivering supplies to this family and other isolated and frail seniors since the hurricane. She says the government isn't stepping in to help them, so she is.

  And nine months later, she's still finding elderly people in need, tucked away in houses along the mountain roads.

  Here in Castaner, a small village in Puerto Rico's coffee growing region, Miranda and her friend Shelly Guerra have turned this town bathroom into a storage room for donated supplies. At this home, the electricity came back on two days before we visited.

• Marilia Lugo:

  I filled this with water, halfway water, and I put the insulin in a Ziploc.

• Sarah Varney:

  Until then, with no working refrigerator, Marilia Lugo kept her mother's insulin in a bowl of water on the counter. She worried that eight months of so-called hurricane food would worsen her mother's high blood pressure.

  And what were you not able to have?

• Marilia Lugo:

  We couldn't eat meat. We couldn't eat salads. We couldn't eat — we had to eat everything in the…

• Sarah Varney:

  In the cans?

• Marilia Lugo:

  In the cans, and that's not healthy food.

• Sarah Varney:

  Her mother, Claudia Sanabria, is 93 years old. She has dementia and often becomes aggressive. The family has no choice but to keep her at home.

  Unlike the rest of the United States, Medicaid doesn't pay for long-term nursing home care in Puerto Rico. Miranda found the family a new wheelchair. Now she's trying to replace the broken electric bed.

• Mariela Miranda:

  I'm just trying to see if there's any way we can go and talk to the mayor of the city. There's not much that we can do. We just can knock on the doors, and try to get somebody to help us.

• Sarah Varney:

  Miranda is tenacious, but the unending misfortune of her fellow Puerto Ricans is taking a toll on her.

• Mariela Miranda:

  It gets to us. It gets to a point where you drain yourself. You see this, and you want to do so much, but you can't. You don't have sometimes the time or the money or your health to keep on doing it.

• Sarah Varney:

  At times, she's angry at the government in San Juan — and in Washington. She's watched people deteriorate from the living conditions and she's watched some die.

  At a protest in San Juan in June, Puerto Ricans placed shoes to represent the estimated 4,600 people who died after the hurricane.

  Local Senator Rossana Lopez Leon has been sharply critical of the government's official death toll of 64. And she says those in charge of state agencies failed to protect the vulnerable, especially the elderly, after the storm — and continue to do so today.

• Rossana Lopez Leon:

  People with chronic conditions, they didn't get the medical services needed or dialysis or especially insulin for people with diabetes.

  People with cancer didn't get the medical services that they needed as soon as they needed. So, we get a lot of deaths at the beginning. And it's still having — we're still having now a lot of deaths. Because it's a lot of municipalities that didn't have electricity right now.

• Sarah Varney:

  Hurricane Maria first came ashore here in Yabucoa, and much of the town still has no municipal power. Despite that, Alberto Rodriguez has been keeping his wife alive for eight months.

  Distraught over her farm's destruction, Mirella Sepulveda had a massive stroke and heart attack a month after the storm. Doctors released her from the hospital under hospice, saying she would die without electricity.

• Alberto Rodriguez:

  I add some more batteries. I add the solar panels.

• Sarah Varney:

  So, Rodriguez, who is an electrical technician, jerry-rigged a fan and solar panels that charge a stash of car batteries.

  And you and your brothers did all this work on your own? All by yourselves?

• Alberto Rodriguez:

  Yes.

• Sarah Varney:

  It's enough to power everything his wife needs.

• Alberto Rodriguez:

  If I don't have power, she's going to die, because she can't — she needs everything, the power for the different machines, the respirator, the feeder. We cannot run without power.

• Sarah Varney:

  Municipal power isn't expected to reach this part of Yabucoa for another few months. The disruption of daily life has led to a rise in depression and anxiety, health experts here say, and it's taking its toll on the elderly.

  A grim measure of that misery is the recent spike in calls to the suicide hotline from Yabucoa.

  Zenaida Navarro lives just blocks from Playa Guayanes. She says the violent trauma of the storm is hard to shake.

• Zenaida Navarro:

  The refrigerators, furnitures…

• Sarah Varney:

  Were all just here, refrigerators on the streets.

• Zenaida Navarro:

  Everything was flying. Everything was flying.

• Sarah Varney:

  But she says the hardships after the storm have pushed some friends and neighbors into dark depression.

• Zenaida Navarro:

  They're like, they don't want to be living anymore if things keep going on the way they have. So it's like something to be really concerned about.

• Sarah Varney:

  Across the island, the suicide rate increased 29 percent in the months following Hurricane Maria. But for people age 65 to 69, the rate more than doubled, and tripled for those aged 75 to 79.

  At Victor and Blanca Colon's home in Cacao, chickens and horses were blown off the ridge during the hurricane and drowned. The road collapsed in both directions. They were isolated for weeks and had to build back from the storm on their own.

  Eight of their nine children live in Pennsylvania and Texas while they care for their severely disabled son, Victor. Nearly 500,000 Puerto Ricans have fled the island's faltering economy over the last decade for better jobs in the states, leaving more older people to age alone.

  The government here estimates another 200,000 will be gone by the end of this year. The question of who will care for Puerto Rico's aging population is a growing crisis. Lacking Medicaid-funded nursing homes, families often pay small, private homes licensed by the island's Department of Family to care for their relatives.

  In the days after Hurricane Maria, emergency calls from these homes poured in, but no one in the government had a complete list of the homes or knew where they were. Some operators of the homes failed so badly to care for their patients, they are being prosecuted by the U.S. Department of Justice.

  Glorimar Andujar is secretary of the Department of Family in Puerto Rico. She says the island's government, and its elderly population, have been starved of resources.

• Glorimar Andujar:

  One of the main things that developed from the hurricane is that everyone confronted reality of our elderly population. That is something that we always deal with. But it was evident to everyone's eyes. So, this is a call for help. We need more funds. We need more ways to help them.

• Sarah Varney:

  With hurricane season under way here, many Puerto Ricans are anxious and afraid. They are still repairing power lines and roofs, and still trying to recover from the wreckage of Hurricane Maria.

  Back in Castaner, Mariela Miranda called us after we finished reporting this story. She was shaken up. Maria Solar, the stroke victim who lived quietly by the river with her husband, had died.

  "I'm not sure how much longer I can do this," she said.

  For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in Castaner, Puerto Rico.

• Judy Woodruff:

  Thank you for that terrific reporting.