Denver-Seattle VA Center of Innovation for Value Driven & Veteran-Centric Care, Rocky Mountain Regional VA Medical Center at VA Eastern Colorado Health Care System, 1700 N. Wheeling St., Aurora, CO 80045, USA.
Department of Health Care Policy & Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
Int J Environ Res Public Health. 2022 Oct 14;19(20):13243. doi: 10.3390/ijerph192013243.
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.
2017 年 9 月,飓风“玛丽亚”重创波多黎各,造成了大规模的基础设施损坏和大量人员死亡。自那以后的数月乃至数年里,“玛丽亚”飓风的灾后恢复工作进展缓慢,原因是财政援助迟迟不到位、存在腐败现象、经济困难以及波多黎各的殖民地地位。与此同时,波多黎各的人口老龄化速度正在加快,数以十万计的年轻波多黎各人正离开波多黎各去追求更多的机会。许多年龄较大或残疾且需要长期护理的波多黎各人在居家环境中接受护理,因为波多黎各的机构长期护理基础设施很少,扩大护理规模的资金也有限。美国退伍军人事务部(VA)为波多黎各的退伍军人提供了几种居家长期护理选择。在这项定性案例研究中,退伍军人、VA 工作人员、退伍军人的护理人员、护理人员的家庭成员以及接受或参与提供这种护理的退伍军人的家庭成员接受了采访,内容涉及他们在飓风“玛丽亚”期间和之后的经历。具体而言,本研究重点介绍了居住在或参与退伍军人事务部居家长期护理项目的人的健康社会决定因素如何影响飓风“玛丽亚”后的恢复情况,以及这些发现如何为今后的灾害恢复和居家长期护理提供信息。
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