How Social Determinants of Health of Individuals Living or Working in U.S. Department of Veterans Affairs Home-Based Long-Term Care Programs in Puerto Rico Influenced Recovery after Hurricane Maria

Abstract

In September 2017, Hurricane Maria devastated Puerto Rico, causing extensive infrastructure damage and a significant number of deaths. In the months and years since, recovery from Maria has been slow, hampered by delayed delivery of fiscal aid, corruption, economic hardships, and Puerto Rico’s colonial status. Simultaneously, Puerto Rico’s population is rapidly aging and hundreds of thousands of mostly younger Puerto Ricans are migrating out of Puerto Rico for more opportunities. Many Puerto Ricans who are older or disabled and need long-term care receive this care in home-based environments, as Puerto Rico has minimal institutionalized long-term care infrastructure and limited funding to expand it. The Department of Veterans Affairs (VA) offers several home-based long-term care options for Veterans in Puerto Rico. In this qualitative case study, veterans, VA staff, veterans’ caregivers, caregivers’ family members, and veterans’ family members receiving or involved with providing this care were interviewed regarding their experiences during and after Hurricane Maria. Specifically, this study highlights how social determinants of health of those residing in or involved with VA home-based long-term care programs influenced recovery from Hurricane Maria, and how findings can inform disaster recovery and provision of home-based long-term care going forward.

Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian

“…The proactive nature of the VA HBPC staff to create a new workgroup to improve future disaster preparedness and response and tracking systems to call Veterans before and after a disaster are examples that other institutions and groups that care for older adults who are primarily homebound can model. This is critical, as past research has shown time and again how older adults with complicated health histories are particularly vulnerable to hurricanes [ 27 , 28 ]. One study conducted in Puerto Rico following Hurricane Maria interviewed Veterans, their caregivers, and VA staff in home-based long-term care settings, regarding how social determinants of health influenced recovery from the hurricane [ 28 ].…”

“…This is critical, as past research has shown time and again how older adults with complicated health histories are particularly vulnerable to hurricanes [ 27 , 28 ]. One study conducted in Puerto Rico following Hurricane Maria interviewed Veterans, their caregivers, and VA staff in home-based long-term care settings, regarding how social determinants of health influenced recovery from the hurricane [ 28 ]. Applying the social ecological model of health, many interconnected social determinants played a role, including the strength of social networks, VA and local policies and support, the receipt of needed aide, and governmental and non-governmental partnerships.…”

“…With that advantage comes with the fact that they are not in a setting like an assisted living facility or a nursing home, where there are several staff members who may be able to readily support them. Much research on disasters and older populations have shown their reliance on social capital in times of crisis [ 28 , 32 , 33 , 34 , 35 , 36 , 37 ]. In turn, increases in social isolation and loneliness amongst older adults have been studied extensively in recent years as negatively effecting overall health after disasters [ 38 , 39 ].…”

Digital social determinants of health

“…They also observed how people with a strong community recovered better from health problems acquired by the hurricane. They emphasized that the effect of a united community not only had an impact on the direct help that person could receive, but also on his or her predisposition and will to recover and adhere to treatment [36]. As can be seen, the SDoH impact on the recovery of individuals and, in turn, during the recovery cycle, they also undergo modifications.…”