Revista Horizontes: primavera/otoño 2011 | Año LIV Núms. 104-105

37 of federal, state, and local planners, considering the fact that Puerto Ricans are one of the biggest Hispanic groups in the US (Smith, Raye & Smith 2008). The results of Monteverde et al. (2009) comparative study between Argentina, Mexico, and Puerto Rico shows that access to long-term care services have higher percentages in Puerto Rico, due to the high number of older adults in the island. The in-home care in Puerto Rico has the highest cost in comparison with the other two Hispanic countries: expected costs (during the entire dependence stage) are about $168,665 (2006) for females and $102,973 for males in Puerto Rico; while $43,732 (2006) for females in Buenos Aires and $20,050 for males; and, finally, $21,112 (2005) for females and $13,223 for males in Mexico. In terms of purchasing parity power (2003- 2004), these values correspond to $203,211 (females) and $124,064 (males) in Puerto Rico, $141,073 (females) and $64,679 (males) in Buenos Aires, and $28,565 (females) and $17,891 (males) in Mexico. The higher costs for long-term care of Puerto Rican older adults is determined by the fact that policies and programs which support the independence, health, activity, and productivity in the US has a greater unit cost of services (in US dollars) than in the other two Hispanic countries. The observed differences are due also to the fact that in Puerto Rico there is a higher prevalence of older adults and people dependent from public assistance than in Mexico and Argentina (Monteverde et al., 2009). O’Donnel´s (1989) study states that Puerto Rican older adults live in a functional disability due to a hard interaction between them and their environment. The main reasons for this are related to the low level of education that older adults have (56.3% did not completed a high school diploma), living in poverty (42.2%), having poor health outcomes and insufficient health coverage (Puerto Rico Community Survey, 2008). The important questions raised by these results are related to the possible overborne of responsibilities of the Social Security System in Puerto Rico and the management of healthier communities as a major public health strategy for older adults requiring long-term care. Financing Health Care Poverty plays an important role in the public assistance framework within the population of older adults. Close to half of the older adult population in Puerto Rico lives in poverty. According to the Puerto Rican Community Census of 2008, 42.2% of the population age 60 or older has an income that falls significantly under the federal standards. The median income for this segment of the population is $5,887 per person. The greater source of income for the population 65 or older comes from benefits of the Social Security. The median monthly payment for this benefit is $718.18, which is considered insufficient to cover all basic expenses. As so, 36% of the adults 60 or older receive benefits from the Nutritional Assistance Program and a lower quantity (17%) from retirement pensions. Puerto Rico has a higher proportion of older adults in comparison with all other United States territories (Administration of Aging, 2010; United Nations, 2009). Furthermore, around 50.3% are disabled living in their houses (Puerto Rico Community Survey, 2008). These are older adults in need of constant care and supervision. Puerto Ricans rely heavily on family members for the provision of care. According to Vélez Ortiz and Cole (2008): “Cultural obligations are subsumed under the concept of familism in Puerto Rico, like in other Latino cultures. Immediate and extended adult male and female family members are not only expected but also obliged to meet the needs and support the best interests of older adults in their family. As a result of these obligations, there is a strong stigma attached to family members who do not provide what is perceived as adequate care to older adult family members.” (p. 303). As so, when an older adult with a disability cannot cover all basic expenses with the available sources of income, family members are expected to step-in and support the older adult. Oftentimes, family members will have financial burdens that prevent them from providing money. However, providing attention and care is equally important in Puerto Rican society. Aging/Disability Services & Program Innovations Older adults with disabilities need assistance to meet their needs. Private or state provided financial aid programs somehow satisfy some of the needs of this population. However, older adults with disabilities frequently ask for other types of support that money cannot supply. Examples of this type of support are accompaniment, caring, visitation, care, attention, and quality of life (Coates, 1994; Dobelstein, 2003; Hartman, 2011). Since Puerto Rico is a Commonwealth of the United States, Puerto Ricans are born American citizens and are entitled to the same benefits, services, rights and privileges other U.S. citizens have. As so, older Puerto Rican adults with disabilities benefit from federal government funded programs created under the Older Americans Act and the Americans with Disabilities Act. Furthermore, the Government of Puerto Rico partially funds programs for the enhancement of the quality of life of this population. Like many other administrations around the globe, the Government of Puerto Rico strives to attend the population of older adults with disabilities through program innovations. For instance, the Act No. 193 of 2002 for the Improvement of Family Assistance and for the Support of Older Adults created the Program for the Support of People of Advanced Age (PROSPERA in Spanish ). PROSPERA is a program under the Department of Family Services of Puerto Rico that seeks to