In Puerto Rico, a new hurricane season threatens the elderly

An elderly woman prays at a chapel of the San Rafael nursing home in Arecibo, Puerto Rico February 14, 2018. Picture taken February 14, 2018. REUTERS/Alvin Baez

By Nick Brown, Jessica Resnick-Ault and Ricardo Ortiz

ADJUNTAS, PUERTO RICO (Reuters) – At 84 years old and battling cancer, Israel Gonzalez Maldonado has lived without electricity for the nine months since Hurricanes Irma and Maria devastated Puerto Rico.

His wife, Zoraida Reyes, 77, struggles to keep the house stocked with fresh food without a refrigerator. At night, she fans her husband so he can sleep.

With another hurricane season starting, older Puerto Ricans have little to protect them from another storm on an impoverished island that remains far from fully recovered. Younger and wealthier people have been moving away for years, leaving an older and sicker population in the hands of an underfunded healthcare system. Tens of thousands more have fled since Maria.

“We wish we could move, at least for the time he has left,” Reyes said of her husband.

Senior citizens make up a larger share of the population here than in all but four U.S. states, according to federal Census data. About half are disabled, more than any state.

Forty percent of seniors rely on food stamps, more than three times the percentage in New York state, the second-highest nationally.

Yet the island has just six nursing homes – with a total of 159 beds – that are certified by the U.S. Centers for Medicare and Medicaid (CMS) to provide rehabilitative services.

Puerto Rico relies instead on a patchwork of about 800 nursing homes licensed by the island’s Department of Family. They are typically private businesses or nonprofit organizations that care for small numbers of elderly people with limited services – and limited budgets, strained further since Maria.

A fragile healthcare system is hardly the only problem that leaves the elderly here – and all Puerto Ricans – vulnerable to another catastrophic storm.

About 7,000 houses and businesses still lack power, after Maria leveled a grid that was ill-maintained before the storm. Power utility PREPA has patched together most of the system but remains years away from making the fundamental improvements needed to enable it to withstand another hurricane.

“The grid needs to be rebuilt – not just the lines,” PREPA Chief Executive Walter Higgins said.

Maria also damaged nearly half the island’s levees. Several major water pumps, used to remove floodwater, remain in disrepair.

“God help us, but we definitely can’t handle any more hurricanes,” said Tania Vazquez, the island’s secretary of natural resources.

Governor Ricardo Rossello’s office declined to comment on the island’s hurricane preparedness or on specific efforts to protect the elderly, referring questions to other agencies.

Glorimar Andujar, Secretary of the Department of Family, said officials learned a lot from Maria about how to prepare for the next storm.

“The emergency plans are much better,” Andujar said, “because we now have an experience that no other generation of agency leaders have experienced.”

ELDERLY AT RISK

Rosa Iturrizaga runs Hostal de Amigos, a small eldercare residence in San Juan.

The home barely broke even before Maria, relying on resident fees of between $2,000 and $3,000 a month. Since then, two of 11 residents moved to the mainland, and insurance has so far not paid for about $40,000 in storm damage, Iturrizaga said. The business carries $500,000 in debt, has fallen behind on loan and tax payments and now loses up to $5,000 a month.

“I don’t know what’s kept me going,” Iturrizaga said. “I love doing this, but I’m looking at other things to do with the land.”

Another private home, the nonprofit Asilo San Rafael in Arecibo, theoretically charges residents $1,200 a month; in reality, only three of 27 residents pay full price, and at least nine pay nothing, said board member Lucila Oliver.

Operating costs run about $700,000 annually, with about $110,000 coming from a handful of subsidies from the island’s central government – subsidies she says have declined sharply in recent years as the now-bankrupt Puerto Rican government fell into a fiscal crisis, Oliver said.

The Department of Family’s Andujar disputed that the subsidies have declined, but Oliver provided Reuters with balance sheets showing a drop in department funding to $59,000 this fiscal year from $80,000 last year.

Maria brought new costs: about $1,200 a month to bring in water tanks, and thousands more on diesel for generators. Oliver said San Rafael is “used to living on the edge,” but says the edge has drawn closer since the hurricanes.

Many elderly and disabled here find a way to get by at home, with little care. Some seek help from the Department of Family, applying for a caregiver to come by just a day or two a week, said Andujar.

Many are turned away, she said.

“The funding is very limited,” she said, “and the need is very big.”

PREPARING FOR ANOTHER HIT

This hurricane season, the department is making sure it has accurate locations for all licensed nursing homes after cell phone service disruptions stymied the response to Hurricane Maria. The homes, Andujar said, are now required to have 30 days of food on hand, and the department has also requested they have generators and water tanks.

She added that about 315,000 elderly people currently receive benefits as part of a $1.27 billion federal allocation under the Nutritional Assistance Program.

The U.S. Federal Emergency Management Agency (FEMA) remains on the island and said it has given municipalities money to improve community resilience.

Dr. Carmen Sanchez Salgado, Puerto Rico’s ombudsmen for the elderly, said her staff has been educating elderly people about the emergency supplies they need.

Charities and nonprofits have also helped. The nonprofit PRxPR, created in response to Maria, is funding solar panels for elderly people and community centers.

One such center in Naguabo had no power as recently as four weeks ago, said Carmen Baez, the group’s co-founder.

“Our installation was it,” she said.

(Reporting by Nick Brown, Jessica Resnick-Ault and Ricardo Ortiz; Additional reporting by Robin Respaut; Editing by Daniel Bases and Brian Thevenot)

U.S. flu-related hospitalizations highest in nearly a decade: agency

Emergency room nurse Christine Bauer treats Joshua Lagade of Vista, California, for the flu as his girlfriend Mayra Mora looks on in the emergency room at Palomar Medical Center in Escondido, California, U.S., January 18, 2018.

By Deena Beasley

(Reuters) – Flu activity worsened over the past week as more people headed to doctors’ offices and emergency rooms, with hospitalizations at the highest in nearly 10 years, U.S. health officials said on Friday.

Sixteen children died of the flu in the week ended Jan. 27, bringing total pediatric deaths to 53 for the season, according to the Centers for Disease Control and Prevention’s weekly report.

Out of every 100,000 people in the general population, an estimated 51.4 have been hospitalized for the flu, surpassing the rate in the last severe season of 2014/2015, when 710,000 were hospitalized and 148 children died. Adults aged 65 or older had the most hospitalizations, followed by those aged 50 to 64, and children below 5.

The dominant strain during this flu season is an especially nasty type called influenza A (H3N2) that in seasons past had been linked with severe disease and death, especially in the elderly and young.

“So far this year the cumulative rate of hospitalization is the highest since we began tracking in this way,” Dr. Anne Schuchat, acting director of the Centers for Disease Control and Prevention, told reporters on a conference call. The CDC began its current hospital flu surveillance program during the 2009-2010 H1N1 swine flu pandemic.

Schuchat was named acting CDC director earlier this week after Dr. Brenda Fitzgerald resigned from the post because of financial conflicts of interest, including purchases of tobacco and healthcare stocks while in office.

Flu is widespread in 48 states, down from 49 last week, with Oregon reporting less flu activity, the CDC said.

“We are not out of the woods yet,” Schuchat said, noting that sick people should stay home to avoid transmitting the virus to others, frequently wash hands and cover their mouth while coughing or sneezing.

The CDC official also said it was not too late to get a flu vaccine.

(Reporting by Deena Beasley; Editing by Richard Chang)

Death toll from overheated Florida nursing home rises to 10

FILE PHOTO: The Rehabilitation Center at Hollywood Hills is seen in Hollywood, north of Miami, Florida, U.S., September 13, 2017. REUTERS/Andrew Innerarity/File Photo

(Reuters) – A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday.

The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details.

Police have opened a criminal investigation into the deaths at the center, which city officials have said continued to operate with little or no air conditioning after power was cut off by Irma, which struck the state on Sept. 10.

Julie Allison, a lawyer for the nursing home, did not respond to a request for comment. Calls to the Rehabilitation Center went unanswered.

Florida’s Agency for Health Care Administration suspended the center’s license on Wednesday and terminated its participation in Medicaid, the federal-state healthcare program for the poor, disabled and elderly.

Medical personnel at the home had delayed calling 911 and residents were not quickly transported to an air-conditioned hospital across the street, the agency said in a statement.

Patients taken to the hospital had temperatures ranging from 107 Fahrenheit to 109.9 Fahrenheit (41.7 Celsius to 43.3 Celsius), it said. Average human body temperature is 98.6 Fahrenheit (37 Celsius).

Staff at the center also made many late entries to patients’ medical records that inaccurately depicted what had happened, the agency’s statement said.

One late entry said a patient was resting in bed with even and unlabored breathing, even though the person had already died, the statement said.

Last week, the agency ordered the center not to take new admissions and suspended it from taking part in Medicaid.

Irma was one of the most powerful Atlantic storms on record and killed at least 84 people in its path across the Caribbean and the U.S. mainland.

(Reporting by Ian Simpson in Washington; Editing by Daniel Wallis and Marcy Nicholson)

CDC Declares National Flu Epidemic

The Centers for Disease Control has officially declared a flu epidemic.

The number of states reporting high levels of flu jumped from 13 to 22 last week and the CDC says there are now flu outbreaks in every region of the country.

The CDC also said that 15 children have died as a result of this year’s flu outbreak, 6 of them in Tennessee alone.  East Tennessee Children’s Hospital has reported 442 children with flu already this year.

ABC Chief Medical Editor Dr. Richard Besser said on Good Morning America that about a hundred children a year die from the flu.  He said that children, the elderly and anyone with a compromised immune system are at highest danger for death.

The CDC says the H3N2 subtype is the strain in 90 percent of confirmed flu cases.

Dr. Besser said that the flu season has been striking earlier during the last few years and he called it a “worrying trend.”

He advised anyone in a high risk category to get a flu shot.

Swiss Organization To Allow Suicide For Healthy Elderly People

A Swiss right-to-die and assisted suicide organization has announced they are no longer going to limit their services to people suffering from some kind of terminal illness.

The group, “Exit”, has announced that “suicide due to old age” is now going to be considered a valid reason for use of their assisted suicide techniques.  The group says that older adults who are experiencing psychological or physical problems can now choose to end their life rather than deal with issues like arthritis.

The group also said they will be streamlining the process for elderly patients who do not want to experience the lengthy process for assisted suicide.

Assisted death is legal in Switzerland.

The Swiss Medical Association was quick to issue a condemnation of the group’s actions, saying that their decision could cause significant problems for elderly citizens whose families just don’t want to care for them in later years.  Families could force family members to say they want to die when they really don’t wish to die.