While I wouldn’t even consider sending a loved one with dementia to a foreign country and effectively out of my caregiving reach to obtain care, this practice is becoming an option that some people in developed countries are viewing as a viable choice.
An article in The Star, a Toronto newspaper, reported on this practice. According to The Star, some countries in the developing world, Thailand being one, offer cheaper care for people with dementia than in the Western world. Not only that, but because of better staff to care receiver ratios and some cultural differences, some think that these elders may receive better care than they would in areas of more developed countries.
Ulrich Kuratli, a software developer from Switzerland, said that at ‘Home for Care from the Heart’ in Thailand, patients live in individual houses within a Thai community, are taken to local markets, temples and restaurants, each with three caretakers working in rotation to provide personal around-the-clock care. The monthly $3,800 cost is a third of what basic institutional care would come to in Switzerland. Ulrich is spending six months living next to his wife at the care center in Thailand while he makes up his mind whether or not this is the solution to her care needs.
Even though many European countries have generous national health insurance, this insurance doesn’t normally pay for treatment in a foreign country. The Swiss government would cover two-thirds of the cost for Kuratli’s wife’s care if she stayed in Switzerland, but since high-end private clinics there can cost $15,000 or more per month, Kuratli could still end up paying more in Switzerland than he would in Thailand.
According to the same article, Germany is already sending several thousand people who have developed dementia or other illnesses that mainly afflict elderly people to Eastern Europe, Spain, Greece and the Ukraine. Although Switzerland was ranked No. 1 in health care for the elderly in a 2013 index compiled by the elderly advocacy group HelpAge International and the UN Population Fund, some Swiss people don’t feel the care is optimal. They like what they consider the kind and caring atmosphere with more people available per patient that is found in some less developed countries, along with the lower costs.
An article on BBC contributed more information on this topic. According to BBC, Swiss citizen Sybille Wiedmer cared for her mother in her home as long as she could, but her mother became too aggressive for Wiedmer to handle.
Wiedmer’s mother Elisabeth is 91, has dementia and now resides in a care home in Thailand. Wiedmer communicates with her mother nearly every day through Skype and visits twice a year. She says that since her mother doesn’t remember her visits, the personal visits aren’t that important. Wiedmer feels that her mother is getting excellent care for less money, and that she didn’t have much of a choice but to follow this path.
Markus Leser of the Association of Care Homes for the Elderly in Switzerland doesn’t agree that sending relatives to foreign care homes is the right way to go.
“The step from their own house into a nursing home is a big step. And the step going to Thailand is much bigger because there is the language [and] you are separated probably from your family,” he told BBC. "Of course it’s cheaper if you go to Thailand, he continued. “But the decision for my father or my mother, it shouldn’t only be the costs in my focus.”
I completely agree with Leser. Since I’ve ushered four elders with four different types of dementia through their care at a local nursing home, I’m not a novice. During my caregiving, I’ve needed to see my loved ones in their environment as often as possible whether or not they remembered my visit. I’ve needed to touch them, talk with them, bring them favorite foods or simple provisions that they wanted. I wanted to be a part of their care team and to monitor their care.
There is no way I, personally, could consider placing a loved one in a care home so far away.
According to the families who’ve place elders in Thailand’s care homes, the elders receive exceptional personal attention. That’s good. Personal hands-on care is vital for an elder to thrive. The solution, however, isn’t that we send our elders to foreign countries to be cared for. The solution is that we, as developed nations, must find a way to help nursing homes provide the care ratio and the types of varied care that people are receiving in other countries. We need to provide excellent, hands-on care for our own elders in their own communities.
We can, in Western cultures, provide this quality of care if we appropriately value the people cared for. Several organizations have been working hard for years to make that a reality.
- Dr. Bill Thomas is the creator of the Green House project, a radically new approach to long term care where nursing homes are torn down and replaced with small, home-like environments where people can live a full and interactive life. In 2005, the Robert Wood Johnson Foundation announced a five-year ten million dollar grant to support the launch of Green House projects in all fifty states.
- Pioneer Network calls for radical change in the culture of aging so when one goes to a nursing home / community-based setting it is to thrive, not simply survive.
- The Eden Alternative is a person-directed care philosophy dedicated to creating care environments that promote quality of life for Elders and those who support them as care partners. The Eden Alternative’s principle-based philosophy empowers all care partners (employees, family members, volunteers, and the elders themselves) to transform institutional approaches to care into caring communities where life is worth living.
The organizations above have proven that quality care is possible without raising the cost of care. Boomers - those next in line who will need nursing home care - shouldn’t rest until excellent care homes in the U.S. and other Western countries are the norm for those who can’t stay at home. Elders have the right to expect excellent care in facilities that enable their families to remain part of their lives.
Lacey, A. and Foulkes, I. (2014, January 4) Exporting Grandma to care homes abroad. Retrieved from https://www.bbc.co.uk/news/health-25438325
Gray, D. (2013, December 31) Western nations sending Alzheimer’s patients to Thailand for care. Retrieved from https://www.thestar.com/news/world/2013/12/31/western_nations_sending_alzheimers_patients_to_thailand_for_care.html
Carol Bradley Bursack is a veteran family caregiver who spent more than two decades caring for a total of seven elders. She is a newspaper columnist and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack is also a contributor to several books on caregiving and dementia, and is passionate about preserving the dignity of elders. Her website is www.mindingourelders.com. Follow Carol on Twitter @mindingourelder and on Facebook at Minding Our Elders.