During Tuesday's meeting of the Senate Committee on Health, Hospitals and Human Services, officials of the Department of Human Services testified that, while the territory waits for key disaster recovery projects to be built, a crisis of long-term care is placing a major drag on already-strained hospital budgets.
The issue of “boarders” at the territory's two hospitals has been discussed before. The problem, said DHS Commissioner Averil George, is increasing. “On average, between 7 and 10 individuals are classified as boarders at any given time,” Ms. George told lawmakers. These individuals, while no longer needing to be hospitalized, often need “intensive support services or discharge care” that family members may be unable or unwilling to provide, said Ms. George.
Currently, there are 11 at the Juan F. Luis Hospital on St. Croix that meet the criteria. According to CEO of the Schneider Regional Medical Center, Tina Commissiong, her facility houses 13 boarders and two people in the emergency room that may soon be classed as such.
The solution to this long-standing issue has not changed, the DHS commissioner said. More beds are needed at nursing homes, assisted living facilities. Independent senior living communities, and adult daycare drop-off services are also required, Ms. George noted. Efforts are being made to expand the Herbert Grigg Home for the Aged on St. Croix and replace the Queen Louis Home for the Aged on St. Thomas, but “these projects will not be completed until early 2028, leaving an immediate gap in care,” Ms. George noted.
Waiting lists exist for both facilities - six on St. Croix, and three or four on St. Thomas, said Alvin Milligan, DHS Administrator of the Division of Senior Citizens Affairs, responding to a query from committee chair Senator Ray Fonseca about the demand for spaces in the territory's senior living facilities. Those numbers are likely low, Mr. Milligan cautioned, as they represent only those who have registered their interest and may not capture the true needs of the community. Senator Fonseca agreed and requested updated figures from DHS officials. “I can’t believe those numbers,” he said.
Ms. George proposed a short term fix of making arrangements to accommodate 11 additional residents at the Herbert Grigg Home. However, the additional capacity would require additional staff – 13 altogether, at a cost of approximately $1.2 million per year. Alternatively, Ms. George suggested pursuing additional placements at nursing homes off-island, which would cost between $72,000 and $108,000 per year. DHS currently has 15 such placements in Puerto Rico and Florida, 10 of whom receive Medicaid benefits.
Despite these arrangements, “sustainable, in-territory solutions” must be implemented in the long term, Ms. George emphasized.
Senator Novelle Francis, who does not sit on the committee, was nevertheless present to ask questions during Tuesday's meeting. He wondered whether DHS had been involved with discussions with Governor Albert Bryan Jr. over legislation he vetoed, which would have provided $20 million for the expansion of capacity and services at senior care facilities in the territory. When the bill was first introduced, DHS officials were welcoming of the intent, but wanted more alignment with current department priorities.
DHS Assistant Commission Taetia Dorsett told Senator Francis that the department’s only input was their commentary on the legislation during the drafting process. “DHS stands in support of pretty much any measure that will give us additional funding to rehabilitate the homes that FEMA will not cover with the prudent replacements,” she offered.
However, because the measure was vetoed, she accepted that the agency would not have those funds available. “We do understand that we have ceilings that are attributed to our yearly budgets from this body, and we have to operate within those ceilings,” Ms. Dorsett noted. Senator Francis called the governor's decision not to use those funds to address the immediate needs of DHS in this regard “a mistake.”
