Medical care would be the biggest worry for my wife and myself no matter how beautiful the water might be and how delicious the food may be. I had a medical problem about 10 years ago on SXM and when I went to a doctor for the problem, he had to look it up on his computer. Still wasn't sure what to do! That did it for me! My wife had appendicitis a few years ago while on Turks and Caicos and they have a first class medical system. It is a Canadian healthcare system and the doctors were great. In and out in a few days without her appendix. Only problem was that she couldn't leave until I paid the bill. Bill was close to $5,000, but they took my credit card without any problem. My health insurance reimbursed me when I got home. Only problem is that we don't enjoy Turks and Caicos as much as we do SXM. So, we decided we will enjoy our visits to the various islands in the Caribbean, but still call the good old USA home. Medical care is too important to us at our age.