Currently showing: Funding longer lives > Long-term care

06 Jan 14 09:28

I've just read the attached BBC article about a Swiss woman, Sybille, who opted to send her Alzheimer's-stricken mother to Thailand for long-term care.

Deciding how to care for a parent or parents as they age is never an easy task to face, even in the best of circumstances. Determining how to balance the best possible care against health challenges and resource limitations can often seem like a losing battle, where all options feel like some sort of loss.

I'm lucky that my parents are still healthy and thriving, but I've witnessed the struggle they went through caring for my grandmother during the last five years of her life. They had it easier than some - my grandmother didn't have any major health issues, she was an easy-going and fun woman, and financially, my parents could afford for my mother to stay home and be her mother-in-law's primary care giver. Even so, there were many difficult calls to make along the way and it was not without its challenges for everyone involved.

Having participated in some of my family's decision making around my grandmother's well being, my heart goes out to people who have to make choices about the future of their parents' care with far less resource than we could afford.

I can't imagine the path Sybille, the woman from the article, had to walk to get reach the decision to send her mother to Thailand. Or what it must have felt like to board the plane with her mother, knowing that this woman would never return to her homeland again. I don't say this as a judgment but to acknowledge the heartache that must have accompanied the choice, even though it was the best option to meet the needs of both Sybille and her mother. For Sybille, the quality of care available in Thailand versus the price just could not compare to what she could have offered her mother in Switzerland. The article spells out the costs:

"In Switzerland, people are expected to contribute to costs amounting to anything between US$5,000 (£3,036) and $10,000 (£6,073) a month. In Thailand the figure is closer to US$3,000 (£1,821) a month - and that for a care package that is likely to be more comprehensive."

I wonder if solutions like this will become increasingly necessary while resources and options in the West continue to be insufficient to meet the needs of an ageing population. A similar idea was struck upon during Swiss Re's Open Minds Forum in Zürich last August, where one participant suggested that retirees be sent to Mozambique for its lower cost of living: Could you imagine retiring in Mozambique? Or traveling all the way to Thailand to visit an elderly parent? Is it something you could or would do if you had the choice?

I can see the individual benefit of taking advantage of developing countries' relative affordability when it comes to retirement, health and long-term care. But thinking of the bigger picture, this solution seems like it might be a temporary work around. Ultimately, I believe better systems and resources to afford quality care for the elderly must be developed locally. But, like deciding how to best care for an ageing parent, I fear that taking steps to achieve this remains a daunting prospect.

Exporting Gran to care homes abroad

Category: Funding longer lives: Long-term care

Location: Thailand


Alicia Montoya - 6 Jan 2014, 10:30 a.m.

In Germany there is a whole network of Polish ladies (living in Germany with their families) who take care of the elderly at the latters' homes. It's a win win: The carers earn a better salary in Germany than they would in Poland and the German families get to stay together and provide good care for their elderly. The network of carers is so well organized that they even cover for each other during holidays without you having to worry or move a finger! Brilliant.

This is indeed a huge issue as we head for a projected population of 9-10 bn by 2050. So... Maybe immigration could help by providing new opportunities for overseas workers while keeping families together. And that's before we look at all the other positive aspects of immigration (more on that in a separate blog).

Paritosh - 6 Jan 2014, 5:40 p.m.

Medical tourism is quite famous here in India. Its cheap and it's efficient. With a better buying power of better performing currencies, I believe outsourcing care, would be the only way to support an ageing population.... Only makes me wonder, where would the emerging and yet to emerge worlds would go??

One such successful organization in India has been Shantikunj at and it's not only for old people.

It's at Haridwar in India a place considered as a doorway to heaven as per ancient Hindu beliefs, also witnesses many abandoned senior citizens...

I furiously believe in the power of charity and a proper regulatory framework could bring out the best in all the worlds. I see it as the only way to tackle the troubles, humanity is yet to face....

Jennifer Rodney - 7 Jan 2014, 8:56 a.m.

"Only makes me wonder, where would the emerging and yet to emerge worlds would go?? " Exactly Paritosh! Immigration - and "exporting" the elderly may be a solution for developed nations, but it doesn't address the elder care needs of developing countries.

And while I am a big fan of immigration, I feel like a dependence on cheap labor cannot be the only solution to making sure a country's ageing population receives adequate care. But this might be because I'm NOT a fan of cheap labor, regardless of the industry...

Alicia Montoya - 7 Jan 2014, 9:49 a.m.

Remember all is relative, my friend. What is cheap labor to you is a handsome salary to many. I think fair wages is a better concept. For me cheap labor is salaries that do not enable workers to afford 3 meals a day, a home, an education.. Sadly there's tons of that (and I agree with you, we should eradicate it!).

But letting the invisible hand act (keeping labor movement fluid) while offering employees dignified wages and conditions I think will be key in navigating the population changes ahead (first exponential growth -during the last 30 years-, now the slowing down of that growth -as fertility rates drop worldwide- and eventually, the huge contraction in global population that will take place as the effects of the changes -slowdown in population growth- already taking place kick in).

Jennifer Rodney - 7 Jan 2014, 10:43 a.m.

Thanks Alicia! Fully agree, it's important to make the distinction between fair wages and too-cheap labor. I'm all for supporting folks from emerging markets through the power of salaries earned in stronger currencies.

However, my fear is that long-term, a system that is only ever looking to keep costs down for the benefit of unending profit eats away at a living wage as labor is outsourced to who/where ever is the cheapest at the moment, furthering the rich-poor divide.

Rashunda Tramble - 7 Jan 2014, 2:43 p.m.

All of these points are valid, but there's one line from the article that gets in my craw: "In contrast, Thailand has a strong culture of looking after its elderly."

I know I'm overreacting with my political correctness, but this made me feel - I don't know (I'm thinking as I type, apologies). It seems to be another case of "developed" countries taking advantage of the culture and openness of another country. Yes, my brain knows they're making good wages, but my heart has issues with this for some reason.

Paritosh - 7 Jan 2014, 3:59 p.m.

A person is ready to sell something which other person wants... Its business... Every one is at advantage....

But why one would want to do service for a thing like this? This question is out of scope... As Jenny rightly mentions above... The system is a crazily greedy one...

TerryCRG - 29 Jan 2014, 10:56 p.m.

The problem is significant. In the US where social safety nets are poor, the cost of long term care is a growing issue. This can bankrupt multiple generations in a family but the answer is not to "export" the sick and elderly but to develop more robust insurance solutions. Life Insurance and LTC ownership is at record low levels in The US, in part because the industry has failed to innovate with new products and solutions.

Jennifer Rodney - 30 Jan 2014, 8:06 a.m.

Hi Terry. I'm no expert on the topic but from what I've read and what I've experienced in my own family, I think the challenge to fund/resource long term care in the US is a complex one.

I fear people are still catching up to the reality of just how expensive it is and that social security is not sufficient. The financial crisis has had a significant impact in many people's savings. Culturally, we've tended to be a people who spend in the now rather than save for the future.

Beyond that, the living wage in the US makes saving a challenge for many many families (I'm so glad that Obama is turning his attention to the battle to raise minimum wage). Even if the insurance industry makes new products available, paying for insurance against a future that feels far away may not be a priority when you're just trying to keep a roof over your head in the present. I think the insurance industry needs to keep this in mind when developing solutions - and perhaps it needs to play a role in educating people as well.

And to Alicia's point, immigration is a part of the solution for now as well - all of the wonderful elder care professionals I know in the States are from outside the US.

Ebrima Balajo - 6 Feb 2014, 11:35 a.m.

I want to make a blend of the two cultures (European and African) as possible strategic solution.
The custom in Europe is taking old people to “old peoples´ home” and usually financed partly by Insurance Companies while on the other hand in Africa, the old peoples´ have no insurance instead their children serves as their insurance (It is the responsibility of the children to take care of their parents when they get old).
I take an example of myself. My wife was living alone when I meet her. After a while of weekly visits to her parent, I got convinced that we could stay together (like in Africa where parents, children and even grandchildren live in the same compound). I tried to convince my wife to live together with her parents in the same house to support each other. Which she accepted after a while of talks and analyzing the pros and cons.
Today, if we were not living together with her parents, they would have been in the old people´s home since two years ago. My wife and I have a little girl who is at the verge of talking but can already walk. She keeps the grandparents continually busy. They play and sing all day long; which they both love. They are never bored. Health wise, Spitex use to come by to check their health status.
This has enabled my wife and I to have time for our work with less stress.
It is true that at some point the parents will have to go the old people´s home. Nevertheless the point at which they will have to go there is prolonged. Probably the parent can stay with us for the next five years as they enjoy being with grandchild and we on the other hand have time for our work. This means we have saved two years expenses that should have been spent on old peoples´ home and expecting to save another five years cost.
I think the slight combination of these two systems will prolong the time/point at which the parents will have to go to the old people´s home thereby increase saving.
Cultures that are extreme individualism, this will be hard to exercise. But I believe extremist in anything is negative (be it work, learning, eating, drinking, cultural values, etc)

Jennifer Rodney - 17 Feb 2014, 5:20 p.m.

Ebrima, thanks so much for sharing this example from your personal life. I think there is SO much value that can be gained by intergenerational living as you illustrate. My grandmother lived with my parents for the last four years of her life. During that time, her first great grandchild was born and she got to see him nearly day as my mother looked after him (both his parents work - another part of this financial and social equation is how often multiple incomes are needed just to meet basic expenses of living, and balancing this against the cost of child care). She got SO much out of her time with him - and vice versa. Not to mention all of us getting to know her better by having more time with her.

The thing is though, I think my family is lucky. My grandmother was well enough that my parents could manage to look after her. If she was seriously ill, my mother would have been overwhelmed - and under-qualified - to care for her. The situation was also financially viable for my family as they could afford for my my mother to be home with my grandmother and nephew. I have to imagine for a lot of families, financial need may play a bigger role - and I CAN'T imagine what sort of pressure that adds to the situation. For families that don't have the luxuries that mine did, I feel there need to be other solutions - other means of support.

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