Elder care in America is expensive, with Alzheimer’s topping the charts. According to the Alzheimer’s Association, more than half of Alzheimer’s caregivers are cutting back on everyday necessities in order to cover the cost of Alzheimer’s care. The National Institutes of Health (NIH) website carried an article published in the Health Tidbits section of the Journal of the National Medical Association that says: “Patients in most nursing homes are not receiving proper care due to a shortage of workers.” This is not to say that many U.S. nursing homes aren’t superb, but it is true that care is extremely expensive and in far too many cases, less than optimum in quality.
When Barbara Drake, who had lived and taught in Peru for a number of years, decided that her dad, who had Alzheimer’s disease, would need nursing home care, she went back to her home state of Florida to check into options. Spoiler: She took her dad back to Peru with her.
Following is Part 1 of HealthCentral’s email interview with Barbara Drake, who is a writer, educator, and former TV field producer. She lived in Peru for a total of seven years (2007 - 2014). After her experiences with her dad’s Alzheimer’s, she began writing the award-winning blog, An American in Lima. Drake now runs a blog titled A Peruvian Alzheimer’s Adventure: Eldercare Lessons from the Land of the Incas.
Her articles and essays have appeared in the Miami Herald, NBC.com, Huffington Post, and the Village Voice. Barbara currently lives with her husband and their teenage son in Gainesville, Florida, where she teaches at an intensive English program for non-native speakers at the University of Florida.
HealthCentral: Barbara, before deciding to take your dad to Peru, did you investigate Alzheimer’s care here in the U.S.?
Barbara Drake: Yes, we did investigate group dementia care for him in Florida, and we looked into hiring full-time, live-in home health aides. We also talked to my father’s estate-planning lawyer in Florida and asked him about our options. The lawyer was an interesting person to bounce ideas off because he is a longtime Floridian, but his wife is from Paraguay, so he had a wider perspective. It was pretty obvious early on that moving my father to Peru was a better option, both for him and for us. We didn’t have extra money ourselves, and my father’s pension was about $3,000 a month, so we had to keep it (his care) in that range.
HC: Considering finances as well as quality, how did the care between the two countries compare?
BD: Financially and care-wise, the solution we came up with in Peru was leaps and bounds beyond what we could have afforded in the U.S. We needed round-the-clock care for my father, and at that time, we were quoted between $8,500 and $12,300 for monthly, live-in Alzheimer’s care. We could never have afforded that. In contrast, in Lima, we paid the equivalent of US$760 per month for two live-in caregivers. They were licensed home health workers from a service that specialized in geriatric care, and they alternated 24-hour shifts.
We had to go through about four different health aides the first month, but finally we found the right fit for my dad, and from there it was smooth sailing.
The quality of care given by our two at-home caregivers, Elvia and Erika, was outstanding. They oversaw all the daily tasks — bathing, dressing, changing his diapers, giving pills, overseeing meals — and they kept him entertained. They set up a daily routine — playing cards, coloring, going for a walk — and that was very important for my dad’s wellbeing.
The thing that struck me most of all was their patience and kindness. They would hold his arm and walk him round the park at this snail’s pace, and they never got irritable or distracted. Their sweetness enabled them to weather the times when my dad got stubborn or angry. I feel so blessed that we were able to give my father that level of care during his illness.
HC: Did you find knowledgeable neurologists or other doctors in Peru for your father’s care?
BD: Yes, we found excellent doctors for him. Normally we went through the American Embassy in Lima, which has a list of approved English-speaking doctors in Peru, but in this case we did research online. We found the Memory Institute in Lima (Instituto de la Memoria), which offers educational and therapy programs for people with dementia, and arranged for my father to be seen by one of their staff members, a geriatrician who was also on the staff of the Peru Naval Hospital.
When my father first arrived in Lima, that doctor was away for two weeks at a conference in Los Angeles, so we had to wait to establish the relationship, but after that, he became my father’s primary doctor. Like many doctors, especially geriatricians, in Lima, he made house calls, so my father didn’t have to leave home, which was a big help in caring for a dementia patient.
HC: Sorry to interrupt, Barb, but house calls? Wow! The value of that kind of service is beyond measure. Just last year there was some talk about this type of care being cost effective in the U.S., but I won’t hold my breath on that. Okay, back to our interview…
BD: While we were waiting for the geriatrician to return to Lima, my husband and I decided that my dad needed a full neurological assessment to figure out how far advanced his Alzheimer’s was. (He had been in a rehab home in Florida for a month and a half, where he’d been assessed for the first time as having “mild dementia, Alzheimer’s-type,” but we thought it was worse than that). The head neurologist of the Memory Institute had an opening on the day we called — he was a Peruvian doctor who’d studied at Johns Hopkins — and so he came over.
The neurologist performed some tests, including an EEG (electroencephalogram), at our house and determined that my father did have Alzheimer’s and that it wasn’t mild; it had likely been going on for years. (My father’s geriatrician in Florida was supposed to have been monitoring my father for memory problems, but he had obviously not been doing his job. Believe me, we were very upset about that.)
The Peruvian neurologist also diagnosed my father with depression — he was the first to identify that — and put him on Zoloft, which helped him greatly. In all, getting a competent neurologist in Lima was one of the best things we could have done for my father.
Both the geriatrician and the neurologist worked together on treatment plans for my father’s Alzheimer’s, which included the Exelon patch. (My dad had been on Aricept for a month prior to coming to Peru.)
The two months leading up to his move had been rough on my father. He had been hospitalized for a urinary tract infection and spent time in a rehab center, which was where he was first diagnosed. All that, combined with the move to Peru, made him disoriented and angry. He even went on a hunger strike when he first moved in with us. So these doctors were really responsible for putting him on the road to recovery.
I can’t compare the Peruvian neurologist’s competency with that of an American neurologist because, as I’ve mentioned, my dad was never seen by a neurologist in the States. That was due to the negligence of his U.S. geriatrician, who I think, in retrospect, was more interested in getting patients in and out of the examination room quickly.
In contrast, the Peruvian geriatrician was knowledgeable and effective, and he never rushed the visits. I think it was very important that both of my father’s Peruvian doctors were fluent English speakers, because that helped them communicate and establish trust. It’s actually fairly common for doctors in Latin America to receive all or some of their medical training in the States.
HC: Presumably, you didn't have any kind of insurance, and you aren't a citizen of Peru, so how did you pay for medical care?
BD: We paid cash for everything. My father had Medicare, plus two private insurance plans, but none of those would pay for care abroad.
In general, medical costs in Latin America are much lower than they are in the States. For instance, for my father’s first visit with the geriatrician — a two-hour-long assessment — we paid the equivalent of US$72, and that was a house call.
After that, we paid about US$60 per house call, and sometimes he would come, do a quick checkup, and not charge us anything. Likewise, the neurologist’s costs were extremely reasonable. He did the first assessment for US$80, and prices were about half that for follow-up visits. He even did an EEG in our house for US$80 — he brought the equipment and computer into our dining room, and did it there. It’s just a very different system than in the U.S.
One time my father blacked out and fell in our house so he had to be rushed to the hospital with a head wound. We were living in the district of Miraflores, which has free ambulance service for all residents, so we didn’t have to pay for that (an ambulance ride in his town in Florida cost $450).
He was admitted to the ER at Clinica Good Hope, got brain scans and 10 stitches in his scalp. The cost was about US$200, including the doctors’ fees. On the way to the ER, we called my father’s geriatrician, just to let him know what had happened, and he met us at the hospital. We didn’t even ask him to do that, and he refused to charge us for coming.
HC: To be continued...
Part 2 of Eldercare Lessons from the Land of the Incas will complete our health insurance discussion and take readers through the rest of Barbara Drake’s Peruvian Alzheimer’s Adventure. Hint: Her dad’s caregivers were wonderful and he even learned a little Spanish.