Hello again, 
Carolyn here. Just wanted you to hear about this shocking story.
An article in the BBC news, Exporting Grandma to care homes abroad http://www.bbc.co.uk/news/health-25438325, describes how a middle aged daughter in Switzerland chose to send her 91 year old mother with dementia to a care home in Thailand, where quality care is much more affordable. Her reasons included that her mother has dementia and doesn’t really know where she is and that she is happy and well taken care of there. Her mother became too difficult for the daughter to continue caring for at home. She can get a lot more care for the money in Thailand than she can in Switzerland.
And from the description, the cost of private elder care in Switzerland is as expensive as it is in the U.S. Is exporting our elders the answer?
In my view, it is probably not a good solution for most people. No matter where elder care takes place, it is up to family to ensure that our elders are kept safe. There is no guarantee that just because caregivers are located in Thailand, the Philippines or in any other country that has a tradition of giving good care to its own elders, that one of our family members would always receive appropriate care there. Neglect can happen in the best of assisted living homes and nursing homes here, no matter what you pay for the care. If Mom is 8000 miles away, how would you know if she were being improperly treated, or had bruises or a bedsore?
I spent a fair amount of my ten year nursing career caring for aging people at home and in nursing homes. Some had dementia, some had other illnesses and conditions needing attention. The common ground among all of them was the need for loving vigilance by family over what happened to them as they moved through the last phases of their lives. I would not want to give up that responsibility to caregivers so far away that I would rarely have a chance to see my loved one. With the personal experience I have, I couldn’t trust anyone at such a distance to maintain proper care.
I believe that the biggest drawback to sending a loved one, even with dementia to a care facility in a foreign country is that care needs change over time. Everyone is different and we can’t expect grandma to be the same next year as she is right now. It would make me extremely uncomfortable to lose touch with those changes by being too far away to monitor them. There is no substitute for a face to face meeting.
What about electronic monitoring, you might ask? Can’t you visit on Skype or another means of video imaging? The Swiss daughter talks to her mother nearly every day on Skype. Yes, but you will see your loved one at a time the caregiver chooses and you will never see the whole picture. To me, that’s dangerous.
There is no question that we have a serious and mounting problem around the world with the care needs of aging persons. We are living longer than ever and our aging parents can easily outlive their assets. Longevity is great as long as you’re healthy in mind and body. But the older we get, the more we are at risk for the health issues that accompany aging. Dementia, and the underlying Alzheimer’s Disease of which it is most often a part are forcing millions of families everywhere to grapple with the financial impact of an aging parent or other loved one losing independence. Someone has to care for the vulnerable elders among us. Someone has to bear the cost. We are not prepared for this as a country and our government is not likely to be a source of help for the majority of aging loved ones until they run out of assets.
This scenario does make a case for purchasing long term care insurance for yourself and your aging parents. But, since only about 10% of elders have this coverage, to at least help defray a part of the high costs of care, it is not going to help most people. Exporting an aging parent to a foreign country is not going to appeal to most of us either.
There are no easy solutions. We need to get working on how to create programs to assist those who are not wealthy enough to pay for elder care, nor low income enough to qualify for Medicaid. Does this mean government involvement and taxpayer burden? It just might. Otherwise, more families might find that the best way to manage the problem is to export the ones they love to foreign countries where care is affordable.
As for your own family, what are you doing to address the possible (or likely) costs for an aging loved one’s long term care? I would like to hear from you.
Until next time,
Carolyn Rosenblatt
AgingParents.com
If you are having to make financial decisions for your aging parent, be sure you know what to do and what legal paperwork you need. Get great practical tips in a short book, How to Handle Money For Aging Loved Ones, at AgingParents.com
If I had a daughter like that, I would probably want to be as far away from her as possible.
Providing affordable care that is also excellent for individuals with dementia is a world wide issue, and is a growing issue. It is sad that someone would feel the need to fly her mother thousands of miles away for affordable care. If it were me, I would worry about the care that mom would get, without me watching over the staff. There is such a need for adequate training in long term care facilities, and in my experience of working in LTC there isn’t enough emphasis on training staff to work effectively with individuals who have dementia. That is why it falls on the family to ensure proper care of their loved ones in long term care.
You may be shocked but this is not new. For sometime families in the UK, for example, have sent parents to India for care. The cost for care in Thailand is far more affordable and since a new paradigm for keeping parents at home when funds are short has not yet been created, people see this as a good option for quality care.
As a nurse who has some experience in LTCs I feel that much could be done to lower costs without hurting patient care, starting with pruning management staff. Perhaps we could look into letting unlicensed employees handle some of the patient care where it would not cause harm, for instance, couldn’t extra staff be hired for serving, feeding and the like? Why must we waste our licensed personnel to do what others could do, which would free up nurses and CNAs to spend more time on the skilled patient care for which they have been trained?