#2 Why a Solo Retired American Woman is Moving to Thailand for the Rest of Her Life
Part Two: American Nursing Homes (and Why They're So Much Better in Thailand)
As I mentioned in my last episode, I want to first say that I intend for Her Expat Retirement to be a fun, hopeful and inspiring place to listen, watch and read about my adventure of retiring for the rest of my life in Thailand. But, there's an elephant in the room that must be addressed, and that is the burning question as to why I feel the need to leave America. This is bound to be somewhat depressing information. However, I'll also cover why there is so much hope for a better life for retired women like me in Southeast Asia and especially in Thailand for today's subject. So, please stay with me past the depressing stuff.
Reason #2 as to why I want to leave America and move to Thailand is: I don't want to end my days in an American nursing home from hell.
In America, if you live long enough, odds are you will end up in a nursing home where you will stay until you die.
In a research study done in 2008 that was funded by the National Institute on Aging by a Dr. Muramatsu and others, titled "Place of Death Among Older Americans," they found that Most Americans prefer to die at home, but less than a quarter actually do. The majority dies in hospitals or nursing homes.
Said another way, more than 75% of us are going to die in a nursing home or a hospital, even if we'd rather die at home.
And what will that look like for us baby boomers who are going to hit the nursing home industry in a giant tsunami in the next decade?
What seniors first need to realize is that Medicare does not cover nursing home care. Many seniors don't know that. They need to make sure they get rid of any of their countable assets over $2,000 in most states, as we discussed last time, and they need to do that 5 years before they need nursing home care, so they will qualify for Medicaid. The only state that is different California where it's 3 years. Medicaid is the only government health insurance that covers nursing home care. If you end up needing nursing home care before you meet these requirements, you're pretty much screwed.
And even if you do end up covered by Medicaid, what are the odds that you'll be able to find an available bed? Or get decent care?
By the year 2030, all baby boomers will be at least 65 years old, and the Census Bureau estimates that there will be over 61 million of us. There will be one in five Americans at retirement age. And, America is already facing critical nursing staff shortages.
Plus, in a report by the Center for Disease Control (CDC) done in 2018, they determined that 70% of the nursing homes in America are for-profit enterprises.
And, I can tell you from my personal experience seeing my mother die in an American nursing home, that even the best of the private ones that cater to wealthier patients are absolute living nightmares from hell. I don't even want to imagine what a Medicaid nursing home will be like, but here's a frightening clue: A study done by a researcher at the University of North Carolina in 2004 discovered that residents in Medicaid nursing homes were nearly 15% more likely to die than residents in privately-funded nursing homes.
I'm sorry this is depressing information. But, it's something we have to face. And it's a huge reason why I want to end my days in Thailand instead of the US. Just a hint of better news here is that when I started researching what nursing homes are like in other countries I could afford to live in, I discovered that the care homes in Thailand are wonderful in comparison. For one thing, one of the care homes I got in contact with told me that their caregiver to patient ratio is 2 caregivers per patient.
My mom ended up in a memory unit at a privately funded nursing home for wealthier patients. And she was terribly neglected. Their nursing home staff had something like 10 dementia patients to try to take care of. That's just not possible. I'd be talking to one of her caregivers, who was finally changing my mom's diaper at my insistence, and her beeper would go off for an emergency and she'd have to run off. They just can't take care of people. These places care only about their profits.
And I personally watched them sneaking drugs into the patients while the patients were eating. They'd put a pill into a little paper Dixie cup, and stir in some applesauce, and while the dementia patient was spooning food into their mouths, a nurse was going around and putting her spoon with the applesauce and the pill into their mouths.
I also watched another caregiver there, who was assigned to a gentleman who kept trying to get out of his wheelchair, to make sure he didn't fall out of it. Apparently, they aren't allowed to strap the patients into their wheelchairs. But, while I was sitting right in front of this man in his wheelchair, next to my mother who was sitting beside me on a couch, I saw the caregiver get distracted by another problem happening in the vicinity and he went to deal with that, and then the man fell out of his chair right in front of me and cut his head and bent his eyeglasses all to heck.
And that was with me sitting right there, an outsider witness. I could tell you more, but no need to upset you any further. The bottom line is that even the best nursing homes in America are nightmares from hell. And I don't want to end my days in one, if I can find a better option.
Plus, I don't have anyone I can trust to come and check on me and make sure they're taking care of me. And many of us, even if we have kids, can't really rely on them, anyway. Our culture doesn't take care of our elders at home. We stick them in nursing homes and assume they'll take care of our elders. And, in fact, it's our children who are more likely to abuse us as we get older.
A criminal justice research paper published on iresearch.net found that "Estimates indicate that one million elderly people are victims of domestic violence every year. Forty percent of cases occur when adult children victimize their parents. The victimization includes psychological, physical, and financial abuse."
The notion that our own children might end up being our abusers rather than someone we can trust to protect us is a hard pill to swallow. But, I think if some of us really take a clear look at our relationships with our kids, we may conclude that we'd be safer away from them in another country. That's an awful thing to face, but it's something we may need to really look at with eyes wide open.
In my next episode on why I want to leave America, I'll cover the frightening growing epidemic of fraudulent conservatorships where we can end up locked away for life, even if we still actually have capacity to take care of ourselves and manage our own money, powerless to do anything while our entire estates get stolen away from us. And sometimes it's our own kids who don't want to wait for their inheritance. But, I'll cover that in detail in the next episode.
Okay. Enough of that depressing stuff. Let's move on to why things are better in Thailand.
In Southeast Asia, families in countries like the Philippines and Thailand very rarely ever send their elders to nursing homes. It's really frowned on in their culture to do so. But, these countries are discovering that foreigners are good business. Thailand has a pretty big industry going already of care homes that cater to foreigners. And, they're really affordable. The Philippines is behind Thailand, but they're also starting to create long-term care facilities for foreigners.
Plus, both of these countries also have services that will provide an in-home caregiver -- even for advanced dementia patients. And those services are even more affordable.
Also, both of these cultures respect elders, as well as being known for having exceptionally well trained and caring nurses.
I've chosen Thailand over the Philippines, at least for now, because of their well-established care home facilities. My plan is to move to Thailand and just live in a condo and then either just hire an in-home caregiver service when I need one, or move myself into a care home at some point.
There's one in particular that I have spoken to where they have a swimming pool the patients can use. They provide a staff ratio of two caregivers per patient. If you want to look them up, the name is Care Resort Chiang Mai, located in Chiang Mai in Thailand. Their patients are allowed to come and go as they please or use their once-a-week shuttle to town, while they're still fairly independent. They also even take the dementia patients to visit the elephant sanctuary. And, instead of regimented meal times, they actually have a menu with both Thai and Western food options and you have a two-hour window where you can go to get breakfast, lunch and dinner, with snacks available all day long. This particular care home was created and is run by a man from the UK.
When I asked about cost, I was told I could move in as an active, independent senior and have all costs included, including meals and the once-a-week shuttle bus and access to the swimming pool whenever I wanted to use it, and be able to walk the grounds of their property -- it used to be a resort -- and at that level of care, my out-of-pocket total cost would be about $1,400 USD. If I ended up needing round-the-clock dementia care, the cost would be about $3,000/month, with some additional expenses as needed.
And, their caregivers are mostly Buddhists. They're loving and kind and revere their elders.
The in-home caregiver service I contacted that's based in Bangkok, will provide caregivers anywhere in Thailand. And I was quoted a maximum price for someone with dementia taken care of at home with round-the-clock one-on-one caregivers, of only about $1,000/month. Their prices are listed on their website and the name of this particular service is Health at Home and they have the option for an English version of their website.
Oh, and just as a quick aside on something I'll be covering more on in a later episode: I could buy a decent little condo with a pool in Thailand for about $1.4 million Thai baht, which is about $41,000 USD. Or, I could rent the same for about $250/month.
So, now you know my number 2 reason for wanting to move to Thailand. Decent long-term care options I can afford.
Now, I did mention in my last episode that I live on $880/month Social Security retirement benefits and that's true and that's what I expect to live on going forward. I do want to mention, however, that my mother did leave me an inheritance. Her estate was split between 7 people, but I did still end up with a nest egg that I intend to leave in the bank until I need it to help pay for my caregivers or nursing homes when I need them. It's a tiny fraction of what we're told we need for retirement in the US. But, it should be enough to cover the difference of what my SSA is and the cost of my caregivers. As long as I don't live too long, ha ha.
I mention this now because this is something that does need to be considered when looking at moving abroad for the rest of your life. You will need some money to pay for caregivers out of pocket down the road. As you've seen, it's really cheap compared to the US. But, it's not free.
If you want to help me out, feel free to use the Buy Me A Caregiver, I mean Coffee, tab on my website to help me grow my caregiver savings account.
I'm Kelly Portola. In the next episode of Her Expat Retirement, I'll cover the third reason I'm leaving America: The alarming rate of increasing fraudulent elder conservatorships in America, and how nobody in the US will be able to lock me away and steal my nest egg if I'm in Thailand.
You can always find everything I do on HerExpatRetirement.com. The letters spell "her," H.E.R., Her Expat Retirement.
I hope to see you again real soon.
References:
Baby boomer statistics from references within this article (see links within article):
https://online.marymount.edu/blog/top-5-impacts-aging-population-nursing
Already facing nursing shortages fact sheet here: https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce
Number of baby boomers: https://www.prb.org/resources/just-how-many-baby-boomers-are-there/
CDC - 70% of for-profit nursing homes in U.S. in 2018: https://www.cdc.gov/nchs/fastats/nursing-home-care.htm
Medicaid nursing home patients more likely to die than in private nursing homes: https://pubmed.ncbi.nlm.nih.gov/15377931/
Medicare 5 year look-back period in all states except California: https://www.payingforseniorcare.com/medicaid/look-back-period
Care Home Resort Chiang Mai:
https://www.careresortchiangmai.com
Health at Home in Bangkok: https://healthathome.in.th/en