Growth of Senior Population Outpacing Programs to Care for Them

Sen. Myron Jackson, chairman of the Senate Committee on Culture, Historic Preservation, and Aging, listens to testimony during Friday’s hearing on St. Croix. (Photo by Bernard Matthew)
Sen. Myron Jackson, chairman of the Senate Committee on Culture, Historic Preservation, and Aging, listens to testimony during Friday’s hearing on St. Croix. (Photo by Bernard Matthew)

The portion of the USVI population designated as seniors – 65 years of age and older – is growing faster than programs needed to provide health care services for them, witnesses told the Senate Committee on Culture, Historic Preservation and Aging Friday on St. Croix.

Assistant Commissioner of Human Services Michal Rhymer-Browne said the V.I. has a growing population of people 65 and older, about 18 percent of the population, and that is expected to increase after this year’s census.

“Seniors are living longer and with that comes an increased demand for senior services,” Rhymer-Browne said. She added this also will result in rising health care costs and increased risk for seniors to obtain a chronic illness.

Though Rhymer-Browne said most seniors want to stay at home, it is not a reality for many whose care goes beyond what can be provided by friends and family.

Tracy Sanders, the president of Continuum Care, Inc. and director of Continuum Care Home Health, LLC, founded Continuum Care Hospice, along with her husband, Herbert Sanders, in 2000. It was the first Medicare-certified hospice in the territory.

“We provide home hospice care on all four islands and have maintained Medicare certification. Continuum Care recently expanded operations to include Medicare certified Home Health Care and Durable Medical Equipment on St. Croix,” Sanders said.

These services were initiated only recently on St. Croix, Sanders said, because there was no Medicare certified home health or medical equipment provider.

“This is a tremendous accomplishment, as in the past Medicaid did not pay for home health services,” Sanders said.

But she has concerns for her home-care patients because many have no primary care physician and if they do, they do not maintain routine visits for care and maintenance.

“Thus, they end up going to the emergency room when their condition exacerbates or worsens. As we know, our Gov. Juan F. Luis Hospital is under duress and although they hire locums or temporary physicians, continuity of care for our seniors is lost,” Sanders said. Medicare regulations will change in January, she added, with more stringent criteria for eligibility to receive home care. Unless physicians who refer to home health care have proper coding, care will be deemed not medically necessary.

Sanders told the Senate panel that seniors who require custodial care “are an underserved population with tremendous needs” because they do not meet the eligibility requirements for Medicare services under either hospice or home health.

“They may be bed bound, homebound and require care 24-hours per day. Unless they have a skilled need for care or are terminal, they fall through the cracks for care and services. Medicare forbids any provider from providing care and services unless eligibility is clearly met and documented,” Sanders said.

When this happens it is common for these seniors to pay out of pocket for their care unless they have long-term care insurance in place, Sanders said, but long term insurance is expensive and unless purchased at a younger age, “becomes cost prohibitive to purchase during their senior years.”

Sanders agreed with Rhymer-Browne about the need for the community to step in to take care of its growing senior population.“As a community, we must ensure that those persons and/or businesses that provide non-certified personal care services are qualified, competent and supervised,” Sanders said. “Again, to underscore, our seniors are among most vulnerable in our community.”

Mary Clarke, director of Lutheran Social Services of the V.I. Housing Management Division, also told lawmakers about the “plight of our seniors.”

LSSVI operates five independent living facilities with 139 federally subsidized apartments for qualifying seniors and adults with disabilities, Clarke said, but many times the facilities are not equipped to handle the challenges faced by the ailing seniors.

“We have had seniors who faced debilitating health challenges and required extensive in-home health care. LSSVI is not equipped to offer the kind of services required to allow such residents to remain in independent living settings, particularly without the support of family and friends,” Clarke said.

It is a challenge to maintain these types of residents in their units without risking violating U.S. Department of Housing and Urban Development housing standards, she added.

Complaints of mold in facilities, lack of generators in other facilities, a demand for qualified medical personnel and subpar equipment were also noted.

“We cannot overemphasize the urgent need for adequate assisted living facilities and/or another nursing home for the community,” Clarke said. “Watching our senior residents become homebound orphans, many of whom have sacrificed their best days to build our community, is a challenge that I believe our community and this committee must address. It can no longer be ignored.”