What to do about Dad? (International edition)
October 15, 2016 5:57 AM   Subscribe

Our increasingly elderly father has survived another health crisis, but is going to need more care than we can afford or provide. Difficulty level: he's an ex-pat on the other side of the world, but wants his kid(s) to take care of him. Wall of text and some Whiskey Tango Foxtrot-ness inside.

Our (American) father lives in Thailand and is married to a Thai national. His Social Security check, until recently, has been sufficient to cover his living expenses and medical crises. He recently suffered another expensive health crisis, though, and his wife's family asked us to get him "US government welfare" health insurance. (He is a veteran, but his health problems are not service related and there are no VA hospitals in Thailand.)

In the past he's floated the idea of wanting his son to declare him a dependent and put him on his health insurance, but said son is unwilling/unable. He's also repeatedly asked for his oldest daughter to come visit/live with/take care of him, but eldest daughter has responsibilities here. None of us has money to throw at the problem, and the Thai wing of the family even less.

Complicating factors include (but are not limited to):

-It's difficult to communicate with the Thai wing of the family; their English is spotty and our Thai is nonexistent.
-We fully recognize that he is not their problem, and they've done us a great deal of service in taking care of him thus far
-His Thai is spotty at best, too, and we think he'd have trouble communicating with staff if he was in a nursing home
-His wife has health problems of her own, can no longer be of assistance, and likely needs care as well
-He's likely an alcoholic (though he doesn't believe he is), and we would not be surprised to discover that a significant portion of his income has gone to, or continues to go to, alcohol
-Past efforts to get him to spend less on alcohol have only resulted in an entrenched "I can do what I want with my money" attitude, so we think that even if he could afford to pay a caregiver, the alcohol would come first
-Recent problems with their air-conditioning have resulted not in the air-conditioning being fixed, but with him taking up nudism instead. (See alcoholism, above.) This is going to make it difficult to hire a caregiver.
-His most recent hospitalization has left him depressed and refusing to get out of bed, though he is physically able to. This is greatly wearing on the patience of the Thai family, and eldest daughter sees it as a ploy to get her to drop everything and fly over.
-He may or may not be detoxing now; we haven't managed to figure out from the Thai family if they're supplying him with alcohol or not
- If his bank account dips below a certain level ($5000) the Thai government can send him packing. (None of his kids want him here. See alcoholism, above, again.) If he did get sent back, isn't there a 2 year waiting period before he would be eligible for Medicare?
posted by anonymous to Health & Fitness (12 answers total) 4 users marked this as a favorite
Oh hey I had similar issues with an aging alcoholic parent who basically wanted to flop around and not take care of himself and have someone else swoop in and handle things while he made no life changes whatsoever. I am sorry, this situation sucks.

So I am here to say a few things

- your father is an adult and has made some adult choices about how to live his life that are not his children's responsibility
- creating boundaries with people with addictions is very difficult because often there is a lot of early grooming to make the servicing of a person with an addiction seem like the only possible outcome

The only thing that I see that is a question in this is about Medicare. That can be answered by going to this page and answering some questions. I filled out some sample data based on what you said and got to a page that said "If you live outside the U.S., contact any United States Consular office to find out how to enroll in Medicare." Here's a link to the US Consulate in Thailand.

But ultimately I think your question boils down to "What should we do?" and a lot of that really depends on how much you want this to be your problem (or culturally feel like it is your problem) and how much you do not. The immediate steps I think are

- contact the consulate to ask about Medicare
- notify wife's family of outcome
- make some decisions about what you are going to do about that

I don't mean to be callous about any of this but the tricky parts of this are emotional and not mechanical. If there is a family member who wants to help him, that family member should try to do some things. If there isn't, well, things are complicated dealing with infantile parents. My parent did actually, eventually, die (as all parents will) but not because I didn't try to help, though it can be hard to untangle those parts. Therapy and ACOA meetings can help the individual members of your family determine how much they want to help and how much they don't. If all the siblings are on the same page about whatever you decide, things will be easier, but don't let people tell you that it's your job to save someone who won't help themselves. Addiction is horrible, but there's only so much you can do in the face of it. Apologies for not bringing better news.
posted by jessamyn at 7:27 AM on October 15, 2016 [43 favorites]

There are nursing homes in Thailand that cater to foreigners; they were in the news quite a bit last year as a cheaper option for Europeans (yeah, send granny off halfway around the world, that'll work) but while cheaper than in the West, they are not cheap.

Maybe dealing the aircon would be the first step and then hiring a caretaker which is an affordable option there.
posted by TWinbrook8 at 7:31 AM on October 15, 2016 [1 favorite]

It sounds cold, but he is the one who chose to move to Thailand, you and your siblings did not; just because he is your parent does not give him any moral, ethical, or legal right to insist that you or one of your siblings drop your own lives/jobs/homes/responsibilities indefinitely to take care of him.

He has a clear choice to make: he can move into a nursing home, either in Thailand or here in the US; or he can stay in his own home there in Thailand, with a full-time live-in caretaker. That's it, that's his only options: either way, even if he was the most loving father in the history of families, he cannot demand that anyone --- even his offspring --- drop everything and run halfway around the world on his say-so.

And seconding jessamyn's suggestion to contact the US Consulate about Medicare, or else have him and/or the Thai relatives do so.
posted by easily confused at 8:16 AM on October 15, 2016 [10 favorites]

Look, I am exactly the person with the very most feelings of guilt about Filial Piety, and even for me, culturally, as Only Daughter, I would not feel required to fly around the world to the place he has chosen to settle. The cultural thing for this is him moving in with kid and family, not them traveling to foreign lands to move in with him.

I think the real problem is probably that he sounds like kind of an ass and no one really wants him back here, and probably breathed a sigh of relief when he left. There are solutions, but they all involve moving back to the US.

If he is an elderly veteran, even if the illness is not service connected, he would most likely be eligible for an old soldier's home. VA also offers healthcare for both indigent veterans and veterans who served in certain conflicts, have certain illnesses, or had other circumstances happen to them - feel free to memail me details if you want to check his eligibility.

But all of these solutions are in the US. I strongly doubt there are solutions in Thailand where his money will be enough to pay for round the clock care for a nudist alcoholic.
posted by corb at 8:41 AM on October 15, 2016 [5 favorites]

My dear, I am sorry. But I saw a LOT of this when I lived in Thailand with what we called "sexpats." They support their Thai women AND those women's families and then, in the end ... well farang's farang children need to come and take care of him. Oh, and continue to help her and the family out, too.

>-We fully recognize that he is not their problem, and they've done us a great deal of service in taking care of him thus far

Assuming he supported his wife and her family before his illness ... he actually IS their problem. But contact the consulate for suggestions.

I've seen this in America, too, Dad is NOT going to a nursing home and dad is NOT leaving the farm in Beeweevil, Kansas ... so a child (why is it almost always dads and daughters?) needs to move back to Beeweevil and change diapers.

No. Just ... no. Please support your sister in this. I am sorry it's happening, but he made his bed.
posted by 2soxy4mypuppet at 9:04 AM on October 15, 2016 [39 favorites]

So, this is going to sound awful, and, I agree with the above, but wanted to state it more plainly: he is not your responsibility. You don't have to feel guilty or do ANYTHING in this situation to help him. He made the decision to move to Thailand and not get help for his various issues. He isn't taking responsibility for his actions and is basically expecting you guys as his kids to step in. This is, frankly, bullshit. You all have your own lives, and just because you are his kids you don't owe him a thing. I know societal pressure says otherwise, but I think that's just wrong. If I were in this situation, I'd just tell my dad, sorry, I can't help.

Look, this might be morbid too, but, he's going to die eventually. If you put yourself out money/time, how much longer will that get him? Is it really worth upending your life to buy him another few years (or whatever it is)?

I'm sorry you are going through this. I'm not entirely without feeling, I know it sounds like I'm an asshole in this post, but I'm a firm believer in doing things for the right reasons, not out of some misguided sense of responsibility or guilt.
posted by FireFountain at 9:33 AM on October 15, 2016 [5 favorites]

Are there no US military bases in Thailand? Since he's a vet, he should qualify for Tri-Care, and could get medical help at most US military bases, I believe.
posted by Thorzdad at 12:57 PM on October 15, 2016

The booklet on Medicare Coverage Outside the U.S. suggests that that route will not be of assistance. He needs to live here to have Medicare coverage.
posted by yclipse at 1:11 PM on October 15, 2016

There are no US military bases in Thailand.
posted by cecic at 1:37 PM on October 15, 2016

You should look into veterans homes in your area or your siblings' area, or maybe in another state if you can't hang with it. Call and ask to speak to the administrator, the social worker or the care manager. Explain your situation and they may be able to help you get the ball rolling. I'm sure you could go about this by contacting the government agency directly but honestly I think you'd have better response dealing with nurses and social workers directly.

Your dad sounds like a bear and I understand that he made his bed. However, it sounds like he is not getting great care over there and it's likely to get worse. If you are unhappy with letting that happen it does not mean you have to move your dad in under your roof, you can keep your distance and do right by this guy at the same time.
posted by pintapicasso at 2:57 PM on October 15, 2016 [2 favorites]

What jessamyn said. My elderly dad is super cranky because I won't let him come live with me (ditto only more so when it comes to my siblings) cause he's a nightmare. If you've grown up with an alcoholic and/or mentally ill parent as I have, the default is to do whatever that person wants because you've been raised to say "How high?" When this person looks at you and yells, "Jump!" Going to Al-Anon meetings ripped the scales from my eyes on that one. I can love my dad without being a bitch martyr and put myself at the top of the care list without being disloyal.

Mind you, he thinks I'm disloyal because I have boundaries and say no to him when appropriate. But that's his problem, not mine. Because of earlier decisions and bad behaviour, my dad is going to die lonely and bitter--and that's not my fault. He's now a dry drunk who is just as manipulative as he ever was and who continues to think 99.9% of the time only about himself. There is nothing that I can do to make his life dramatically better without destroying my own. I've sacrificed myself for him and my mom in the past. I'm not doing it again.

My dad's way lucky in that he has a place to live that he can afford and some Medicare-paid medical help. His primary medical needs are taken care of by the local VA hospital. (It doesn't matter that his health problems aren't service-related.)

In California there are (not regulated so dicy) group homes; the VA also has some limited amount of what are essentially foster homes for elderly VA people. The VA may well have some resources but it's hard to get into a VA nursing home (I think). The money thing is a problem. It's a huge problem. But it's a different problem than the problem of deciding for yourself how much you are willing to do to help your dad.

My dad's ex once called me to say she had done all she could for my dad; it was time for me and my siblings to come get him and move him out of her place. And I was all, "Dad's never done anything he doesn't want to. If you want him out, you'd better take that that up with him."

So until and unless my dad's brain collapses so utterly that he needs an actual guardian, he does his thing several states away; I visit about every 4 months; and I call him daily. That's what I'm willing to do. It's lots more than my siblings are willing to do and that's okay--they have excellent reasons for avoiding their former abuser.

TL;DR: You're not obligated to do anything but breathe right now. Do not panic because the Thai family is asking you to panic. Take your time to figure out what can be done but, most importantly, what you are willing to do. You don't actually have any obligation to your dad. Or as someone in my program once pointed out, "We don't ask to be born, so it's ridiculous to claim that we owe our parents merely because of that."

You may want to help your dad, and that's fine. The main thing is remembering that you have a choice. It's up to you what you do, not what the Thai family says you should do or what your dad says you should do or what your siblings or neighbours say you should do. And if you dad isn't dying right this minute, you have time to investigate the situation and proceed based on what works best for you as well as your dad. I know this is a painful situation.

It sounds like I hate my dad. I don't, I love the asshole a great deal. He made me who I am and has many fine qualities. Sadly, being a decent human being to his family was never one of them. So put yourself first is my advice. Go to Adult Children of Alcoholics or Al-Anon if you need help with learning loving detachment and how to set appropriate boundaries. Good luck!
posted by Bella Donna at 3:27 PM on October 15, 2016 [11 favorites]

Although you say his health conditions are not service-related, it is possible that they would be considered to be so by the VA, which does offer some services to veterans abroad. It is worth at least looking into as an option. I imagine he is not the only vet who has ended up in Thailand and there may be a community (Facebook?) that can link him with resources.
posted by charmcityblues at 7:37 PM on October 15, 2016 [1 favorite]

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