We are continuing our discussion, which started in Eldercare Lessons from the Land of the Incas: Part 1, with Barbara Drake. Drake took her father, who had advancing Alzheimer’s disease, from where he’d lived in Florida to live with her in Peru, where she was teaching. Drake is a writer, educator, and former TV field producer who 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. She now runs a blog titled A Peruvian Alzheimer’s Adventure: Eldercare Adventures in the Land of the Incas.
When we left Part 1 of Eldercare Lessons from the Land of the Incas, HealthCentral and Barbara Drake were discussing, via an email interview, how health insurance, or lack thereof, affected the move to Peru.
Barbara Drake: I should add a caveat for anyone thinking of moving an elder to Latin America. Our experience involved caring for an elderly person who was relatively healthy. Apart from Alzheimer’s, my octogenarian father didn’t have any major chronic illnesses. He had an enlarged heart that wasn’t giving him trouble at the time we moved him. Our care focus was on getting help with the daily tasks of living, not caring for someone with a chronic illness who needed serious medical interventions.
Another factor that made paying out of pocket relatively painless was the low cost of prescriptions. My father’s drugs cost a fraction of what they cost in the U.S. — Omeptrazol, Sertralina (a generic version of Zoloft), Mimetix, etc. Eight drugs in all. The only big expense for us, drug-wise, was the Exelon patch, which was still under patent in 2011-2012. We paid about $100 for a 45-day supply, but the U.S. manufacturer offered promotions, such as “buy one box, get the other half off,” to sweeten the deal.
A while ago, I heard there was a generic version available in Peru. You can see current prices per pill/unit on drugs in Peru at this government website. Type in the name of the drug in capital letters. It helps if you know what the drug is called in Latin America.
A final word on insurance: Even if you are not a Peruvian citizen, you can get a pensioner’s visa, which is a type of permanent visa issued to foreigners who have a guaranteed monthly income of US$1,000 or more.
We got my father one of those, and with it he was theoretically eligible to get insurance, but there were a few problems with that.
- He got paranoid about leaving the house, so we were loath to drag him to downtown Lima to do the paperwork.
- He was over 80, and some insurance companies didn’t issue insurance to people that old.
- He had been diagnosed with dementia, which made him ineligible for nearly every plan.
As you can see, private insurance for an elderly foreigner diagnosed with dementia isn’t really feasible in Peru, but the low cost of medical services compensates for that.
HC: Did your dad ever enter a nursing facility or was it all home care?
BD: My father initially lived at home with us for eight months. Then, in December 2011, we moved him into a private nursing home (for a variety of reasons, including the fact that our landlord didn’t renew our lease). We were caught by surprise, so we had to do all our research on nursing homes in just one month.
At that time, there were several hundred nursing homes in metropolitan Lima, and we concentrated our search in upscale areas — the neighborhoods of Miraflores, San Isidro, San Borja, Monterrico. Lima is full of poor and unsafe districts, and so it was important that my father be well situated, near us, and close to a good hospital.
It was a lot of work finding a home that met our standards. Peruvians traditionally care for their elders in the home, and there wasn’t much of a demand for nursing-home care back then. Again, that was 2011, and I understand that the situation is changing there now. As Peru’s economy improves, more people are working full time and don’t have the time to care for elders in the home. As a result, you are starting to see more nursing homes in and around Lima that offer a higher level of care, more comparable to what you’d find in the U.S., so maybe it’s easier to find one now. I have a page of resources devoted to that on my blog.
We got lucky finding an excellent nursing home for my father back in 2011. When his geriatrician was away at that conference in Los Angeles, he had another doctor take his calls, and that doctor (who saw my father a few times) was co-owner of a small-group nursing home in the district of San Isidro.
The nursing home was just a few blocks away from a 450-year-old olive-grove park, in a very restful part of the city. We put my father on a waiting list and he was able to move in there one month later. The home has only 20 residents, nearly all of them dementia patients, so there’s usually a longer wait time. No doubt it helped that we knew the doctor who ran it personally.
The nursing home was an excellent value, especially when you compare it to what you’d pay in the States. As I said, he had a private room overlooking a garden. Room, board, and laundry services were US$850 a month in 2011-2012. Every day, the doctor visited each patient, checked their vitals, etc., and wrote prescriptions, if necessary. That was part of the monthly cost.
On top of that, we paid another US$500 monthly for two private health aides (called enfermeras técnicas) who watched him 24/7. So all told, it came to US$1,350 per month. There was a head nurse supervising the health aides, and if one got sick, they always had replacements. The aides gave my father his pills, bathed him, dressed him, fed him, took him to the park, etc. They were as kind, attentive, and competent as the aides that my father had had at our house in Lima.
John Drake and his caregiver and dog Lola in Lima, Peru in 2011
Credit: Jorge Vera
HC: You’ve talked about the gentle in-home caregivers who helped your dad. How did cost compare with the U.S.?
BD: The costs were extremely reasonable in contrast with the States. We paid the equivalent of US$670 per month for both caregivers — it was the State-mandated rate at the time — and that was for 24-hour care, seven days a week. The aides alternated days, and on the days that they worked, they slept on a fold-out bed in his room. We also gave them three meals a day and hired a housekeeper to clean and to cook for them. That’s very possible to do in a developing country like Peru.
That was back in 2011. I recently called up the service (SEG PERU) where I hired the caregivers and their rates have risen to about US$900 a month for two caregivers (1500 Peruvian soles each), 24 hours a day, seven days a week. That’s an increase of roughly 35 percent, but still it’s reasonable compared to U.S. costs. Back in 2011, as I mentioned earlier, getting that level of care for an Alzheimer’s patient would have cost us upward of $8,500 a month if we had gone through an agency in our town.
HC: I read your blog post about how, at first, your dad was depressed and didn’t want to eat. With medical and in-home care, he rebounded. The amazing part was that he even learned Spanish. Did he learn to speak the language or just understand it? Either way, it’s impressive, and it proves that people like your dad can still learn.
BD: You know, we never took my father to Peru to learn Spanish. It was something that never crossed our minds could happen. We just wanted him to be well cared for and loved, which might be a strange word to use in the context of professional care, but love, or cariño, as it’s called in Spanish, is very much part of the Peruvian caregiving world.
And I think that having Spanish-speaking health aides with him 24/7 was like an immersion program for him in Spanish. They used to watch Spanish soap operas together, even though I told them to put on the English-language Discovery Channel. When I wasn’t around, they’d turn it to the telenovelas. It annoyed me at the time, but in retrospect, maybe it was his Berlitz course.
His nurses asked him some questions in English — we gave them phonetic cards — but after six months, he began to answer them directly in Spanish, and the English fell by the wayside. He only answered in one or two word phrases — “si,” “muy bien,” “mas jugo” — but he appeared to understand when the nurses asked him questions related to his care. They worked out a simple method of communication.
It was amazing.
I asked his neurologist about it, and he told me that Alzheimer’s affects a different part of the brain than the parts that are involved in learning a new language. My dad didn’t have late-stage dementia, so I guess he still had enough grey matter up there to take in new information. It just goes to show that our brains are capable of remarkable things and there is no one set pattern for the development of the disease.
HC: You’d lived in Lima, Peru for a number of years and speak the language, so this was obviously an easier decision for you than for someone who hasn’t been there. How would you advise someone to go about replicating your adventure?
BD: First, assess your tolerance for risk and change. How comfortable are you doing things differently? As a caregiver, you need to be comfortable with change or you are just going to stress yourself out more, moving to another country.
Next, I’d say that you need to do research online. Find out from expat boards what places are good for eldercare abroad, what the cost of home health aides is, etc. In Latin America, for instance, Ecuador and Costa Rica have burgeoning expat and retiree communities, and healthcare standards are quite high.
On my blog I focus on Latin America because service costs are inexpensive compared to North America, and there is a tradition of having paid health aides in the home, which is so necessary for Alzheimer’s and other dementia patients. We ended up moving my father to Lima because we lived there already, but if I were an American thinking of doing this for an elder, I would probably explore many options in Latin America.
The final thing that I would advise someone is to visit places in person. Narrow your search down to a few cities and spend at least two weeks doing research on the ground.
You can’t base your decision on what you see on the Internet. You need to see for yourself and ask questions — in the language. It goes without saying that you need to learn the language and have at least an intermediate level of proficiency. You’ll be learning lots of medical terms on your journey — like otolaringologo, a great big long word in Spanish that means “ear nose and throat doctor!”
HC: Thank you, Barbara Drake, for taking HealthCentral along on your Alzheimer’s journey! I found it fascinating and I’m sure that our readers will, as well. For more about Barbara Drake and Alzheimer’s care in Peru, visit her blog at A Peruvian Alzheimer’s Adventure: Eldercare Lessons from the Land of the Incas.