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Testimony of AARP in The Virgin Islands In Support of Bill No. 36-0003, An Act to Establish Nursing Home and Assisted Living Care Standards in the Virgin Islands Health, Hospitals, & Human Services Committee July 7, 2025 Given by Troy A. de Chabert – Schuster, State Director, AARP in The Virgin Islands Honorable Senator Ray Fonseca, Chair of the Committee on Health, Hospitals, & Human Services, and Senators of the 36th Legislature. Thank you for the opportunity to provide comments on this discussion about establishing standards and protections our older Virgin Islanders deserve. This legislation not only acknowledges their enormous contributions but also creates a pathway for a comprehensive continuum of care that reflects the unique values of the Virgin Islands. As the State Director of AARP in The Virgin Islands and a proud native son, I have seen these islands shaped by persons of great strength and resilience. They are the matriarchs and patriarchs of our families and bearers of our rich culture- deserving to live with dignity and remain in their island home as they age. I am pleased to present this testimony in strong support of this legislation, sponsored by Senator Angel Bolques Jr. Today, I am here not only on behalf of the more than 22,000 AARP members living in this territory, but on behalf of the elders of this community and those generations to come. This bill signifies a monumental turning point in long-term care policy for the Virgin Islands. The U.S. Virgin Islands is rapidly aging. According to the U.S. Census Bureau, over 20% of our population is now age 60 and older, with projections showing continued growth in our aging population over the next two decades. Yet our territory currently lacks the infrastructure necessary to meet this demand. We no longer have a Medicaid-certified nursing home. Our elders—our beloved bearers of culture, faith, and wisdom—are aging without adequate supports, and our caregivers—mostly family members—are overburdened and under resourced. With this reality many Virgin Islanders are forced to seek costly and often isolating care options off-island. This bill introduces long-overdue structures and definitions—and for that, we commend Senator Bolques. We support this bill as a step in the right direction – putting the needs of older adults first by focusing on the kind of care and supports they need—that we all need and deserve—right here at home. But support must come with clarity. AARP is concerned that unless this legislation is strengthened with clear federal Medicaid alignment and rooted in community-focused care, it risks replicating the very systems that continue to fail elders across the mainland United States. At AARP, our values are rooted in dignity, equity, and transparency. We believe all people—especially those living here in this territory – who are often excluded because of our geographic local—deserve care models that culturally sensitive and the untethered right to age in place with dignity. We also believe that this care can be delivered in an innovative appropriate way right here in our island home. As is stands, federal funding streams that have too long bypassed this community are available to us, if we do this right. AARP’s Support and Recommendations AARP has drafted a package of amendments that we are ready to share with Senator Bolques. My testimony today will highlight the core values these amendments represent so that, with our support, this bill can evolve from promising to transformative: • Expand Definitions for Justice-Aligned Care: The law must define terms such as Small Home Nursing Homes, Home, and Community-Based Services (HCBS), and person-centered planning in ways that align with Medicaid 1915 and 1115 waiver dollars to unlock federal partnership and opportunities for investment. • Establish Transparent Licensing and Oversight: New licensing language must require clear staffing ratios, workforce training standards, and Green House Model alignment for small home care. This is how we ensure high quality, patient-centered care. • Build a True Continuum of Care Plan—Not an Institution: This bill must pivot toward home- and community-based care as the ideal model of care. Virgin Islanders deserve more than nursing homes. We can build de-institutionalized, intergenerational, inclusive systems from the ground up. • Codify the Right to Access and Oversight: Mandate the development and submission of Medicaid State Plan Amendments and federal Waiver applications by 2028. Prioritize local governance—including elders, caregivers, community advocates, and community leaders—in all oversight boards. • Promote Equity, Accountability, and Workforce Development: Empower a new care workforce rooted in universal worker models. Require transparency, public reporting, and ongoing monitoring systems that protects both workers and those they serve. Economic and Cultural Impact Beyond the care benefits, this legislation can serve as a powerful economic driver for the Virgin Islands. Creating a system of Medicaid-supported small homes and HCBS programs would generate new employment opportunities in the caregiving and health services fields and pathways to private investments. It would allow Virgin Islanders to receive specialized training and fair wages while providing care to our elders within their communities. The bill, as amended, could serve not only as a care strategy but also as an economic development engine for the Virgin Islands – one that is most needed right now. We also recognize the importance of cultural relevance in care. Too often, care systems in mainland disregard the cultural values of the populations they serve. The Virgin Islands has a unique heritage that must be embedded into any long-term care framework. This includes hiring staff who for us, about us and understand the importance of honoring the family-centered caregiving that is the foundation of our communities. A Call to Action The time for us to act now has come. We have a rare opportunity to shape a system that not only meets compliance standards, but truly reflects the values, voices, and needs of all Virgin Islanders. The amendments we are proposing will strengthen this bill’s foundation and ensure that it fulfills its promise of creating a continuum of care that is just, comprehensive, and sustainable. In conclusion, AARP stands ready to work alongside this body to make this bill a beacon of what aging can look like. Not a hand-me-down system from the mainland. But a bold, homegrown future worthy of the elders who built this place—and the generations who will inherit it. To the members of this committee: we urge you to support this legislation unanimously when the opportunity to vote arises and to adopt the proposed amendments. Let your vote reflect a commitment to the well-being and dignity of every Virgin Islander who has contributed to building this community and who deserves to age at home, and in dignity. And to our community members: this is your moment. Advocate bold. Stand with AARP for our elders. Secure your – our future. Let your elected officials know that care for our elders—is not option. It is our moral obligation. Together, we can create a care system that honors our past and protects our future. To this end, Senator Fonseca, we respectfully submit our full amendment package to the Legislature and is prepared to assist in its integration into this legislation. Thank you, Senator Bolques, for this bold and transformative legislation. I welcome your questions and thank this body for this opportunity to speak on behalf of older Virgin Islanders and their families.