guatemala and puerto rico have mechanisms to oversee longstay institutions in guatemala longstay institutions are monitored by the ombudsman for older persons and in puerto rico the governors office of elderly affairs has a longterm care ombudsman programme in demographic terms the country s low fertility levels and low birth rate are expected to fall further and mortality will likely continue to be pushed towards older ages with the combined effects of fertility mortality and migration population growth will be slow and could even stop or go into reverse in coming years