Friend needs full care-assisted living, costly here, looking outside USA
February 10, 2021 3:25 AM   Subscribe

A good friend of mine has this gawdawful illness, genetic in nature, resulting in degenerative nerve damage throughout his entire body. The level of care needed will cost a small fortune here in the states. Where can he go to have quality living at a discounted cost, due to the dollar being stronger? Wherever he goes has to have not only high quality assisted living care but also good medical care available. Ideally, somewhere beautiful, temperate climate -- he's lived in Texas his entire life and heat is no problem.

This guy has an iron will, he was told 30 years ago to just bag it, get into a wheelchair but he stubbornly refused that, and only in the past five years has he been tied to a chair. In the past two years he's lost the ability to drive; fortunately he did not get into any accidents but at the end of his driving it really was a crap shoot, really scary. He's broken arms and legs inside his house and out, he has had railings put on all walls of his home(s) and has clung to them and gotten around, falling often, but that is over now also.

I described how my fingers and toes felt from stepping pretty deeply into hypothermia a couple of times, how painful they were, and my complete inability to use them; he told me it sounds like an exact match to how he feels now -- pain, tingling, inability to make his fingers/hands do whatever needs done. In the past year he's had to (gotten to?) use Alexa, from Amazon, on a Windows 10 machine.

He now needs help getting to the bathroom, needs help in the shower, he needs help with meals, on and on.. He needs help, period. He had a woman in his small town help him these past five years, give or take, but she needed more money and took another job.

He is now like the frog put into warm water and didn't want to notice as it became hotter and hotter, but facts are facts, and he is in hot water now.

He has (online) found a few places in Mexico but he doesn't speak Spanish, plus the idea of living within 200 miles of the US border, the terror of those drug wars, it really puts him off.

My first thought was the Philippine islands, many (most?) people speak English, high quality health care, the dollar is strong there. But Duterte seems to me to be insane, and while US citizens get a pass in many ways (no way does that government want to chase off the US dollar, both vacationing and/or ex-pats) while US citizens I think get a bit of a pass that their own citizens wouldn't get, it's still a big red flag waving. Duterte is unpredictable as hell.

Thailand maybe? I know that both Thailand and The Philippine island have top drawer medical care at a fraction of its cost here in the states. I believe that there is more English spoken by the moment in Thailand, and in any case he'd be in an assisted living, with one criteria being English speaking staff.

South America? Central America? Or? Anyone with any experience with a situation such as this, where did you find, or did you?

Any experienced help in this greatly appreciated -- that water he's in is getting hotter by the minute.
posted by dancestoblue to Health & Fitness (9 answers total) 3 users marked this as a favorite
Best answer: I think it's important to think bugetary here, I understand you may be hesitant or he is to say just how much money he has to spend on this, but it will make a difference in what is realistically possible. So a ballpark figure (per year or per month) would be helpful. Because what will he do if he runs out of money? In addition some benefit programs like SSDI require residency, so of he moves abroad he will lose that income.

Do you know if he has specific concerns about medicaid ? It is THE thing that pays for long term care in the US once he has gone through his assets. If this person has so many assets that they believe that moving to another country, paying for 24 hour care for however long he believes he will live, with medication and healthcare will still leave him with assets left over for whatever he was planning to do with it after his death, then maybe moving to another country is a good idea vs staying in the US. If he doesn't have a plan for his assets, then it is okay to find a facility he likes and pay for it until he ends up on medicaid. Some facilities have arrangements where if you can put so much down then they will allow one to stay with medicaid rates until they pass. The assets/money thing is not fair by any means but it is something that done all the time. Of course , this assumes he is eligible for medicaid, most non us citizens are not, but some legal permanent residents can be.

Most countries don't just let people (especially people with disabilities) move there for long term care unless they can prove up front that they have significant, significant amounts of money. Because it's expensive, and many countries have more people who need care than they know what to do with already.
posted by AlexiaSky at 3:57 AM on February 10, 2021 [19 favorites]

Just to reiterate what was said in Alexia Sky's comment - most countries will not consider giving residency to someone with any kind of incapacity unless they can show evidence of A LOT of funds, that are going to last for a long time. As in families are rejected for residence all the time because they have a child with a disability, even if the parents are very well paid and need residency to fulfill much needed jobs.
posted by Megami at 4:34 AM on February 10, 2021 [7 favorites]

Except for in certain places like Cuba and North Korea, people receiving SSDI can continue to receive payments (pdf link) even if living overseas. But, like AlexiaSky said, most countries don't want you unless you can prove you have significant assets and, in some cases, can also afford to buy private health insurance.
posted by ruddlehead at 4:37 AM on February 10, 2021 [3 favorites]

Yeah, the private health insurance is likely to be the hurdle. In most of the kinds of countries you describe, this is a requirement.
posted by frumiousb at 6:48 AM on February 10, 2021 [1 favorite]

I was thinking Vietnam or Cambodia, but that's just me dreaming.
posted by kschang at 7:51 AM on February 10, 2021 [1 favorite]

Is moving to a state with a better Medicaid program an option? Medicaid quality can vary a lot between states and Texas's is pretty awful compared to places like Washington.
posted by Anonymous at 3:43 PM on February 10, 2021

Response by poster: First, thank you all for your inputs. I've sent my friend a link to this page, so he can read/digest what you all have posted here.

AlexiaSky -- Best answer. Most comprehensive, for sure, and lots of food for thought. Thank you.

So, here goes. I do not know my friends dollars and cents situation but I know he's great with a buck, he can take a one dollar bill and stretch it out enough to wallpaper a good sized bedroom. I met him when were both training to become mainframe computer programs, we both ended up working in banks there in Houston but my gig folded when First Interstate Bank went from four data centers to two. My friend, meanwhile, was at a bank in a job that held, he was an extremely valuable employee,

I know he made some good money in those years. Also, when he set up his insurance package, he opted for the highest amount to be paid in (in case of disability) and that of course transferred to the highest amount paid out to him monthly, from the time that gig folded due to his illness. I believe that he is on SSDI also, and if so he'd be on the highest that they pay out to anyone per year, due to the fact that he was making a great living when he officially retired due to the illness. He owns one home. As close as we are I didn't want to try and dig around inside his wallet, none of this "Hey, how much exactly do you own / How much exactly is your monthly/yearly income?" People are shy with that information, or some are anyways, I'm pretty open but not everybody is.

So anyways. I sent him a link to this page, via both email and text, left him a voicemail also, letting him know that this is out here. It can take him some time to get back to me sometimes, not as easy for him to just pick up the phone or a keyboard -- we're lucky. Well, I'm not sure about everybody else but I consider myself fortunate, I've got my problems but I don't have that illness that he has.


kschang -- From what I've read (considerable) Vietnam and Cambodia are both gorgeous countries, and they are on their way back. But neither has a good health care system going on, not yet, many ex-pats who opt for either of those countries go to Thailand (or the Philippines) for their medical care. Vietnam still in the shade some from all the years of war they suffered, and then years of a fairly repressive communist regime, it's coming around now but it's just not yet where people who need (or might need) good health care. Cambodia *still* has not recovered from Pol Pot. My understanding is that it was one of the most wonderful places on the planet in so many ways but then Pol Pot came along and killed anybody/everybody in any professional class; it's sortof like Stalin did when he killed all of the generals in his army, it pretty much was cutting off the head of his army, and in the fight against the Germans one of his biggest problems (early on anyways) is that he had very few solid officers.


I'll check back in here after I hear back from him, let you know what he's looking at. Thank you all, again, for inputs.
posted by dancestoblue at 4:49 PM on February 10, 2021

I've worked with many disabled people, some disabled due to neurodegenerative or chronic physical illness and others from accidents/injuries that were complex and life altering. As part of working with them, they share a lot with me about what they've done to cope with the financial burden. It will be hard for him to immigrate to another country with his medical condition - many immigration systems require a doctor's exam and disclosure of health problems as part of the application process, they don't want to take on immigrants that will increase the burden on their health care systems and social safety nets.

If I were him I would think about selling his home, moving to the US state with the most well-funded Medicaid program, and finding a facility he likes there to stay long term. I would also talk to a lawyer/accountant ASAP about how to protect his assets if possible, while still getting the care he needs. He may be able to set up a trust or something like that, but the rules around those instruments vary from state to state and he needs local advice from a professional.
posted by zdravo at 5:20 PM on February 10, 2021 [2 favorites]

If he can prove a stable income of roughly $2,500/month, he should look at South Africa. That’s the income you need to get a retiree visa. It’s a beautiful country with a low cost of living and a great healthcare system - the world’s first heart transplant took place in South Africa, as well as (much more recently) the first penis transplant. I don’t know if this is still the case, but when I was there three or four years ago, even those with temporary retiree visas could access the public health system virtually for free, which was a problem because medical tourists would go there for things like hip surgeries and other expensive, somewhat high-stakes procedures. The public health system IS a bit grungy and sometimes slow by U.S. standards so most people who live there full time and can afford to opt for private insurance, but this is also quite affordable. I’m not sure that the home health aid market is as developed as it is in places like Mexico and Thailand that are better known for this kind of thing, but wages are significantly cheaper than the U.S. overall and the skills are definitely there.

Lots of people think Cape Town when they think South Africa and it’s a wonderful city, but I would look at Durban - very different (more balmy) weather, much cheaper cost of living, beautiful beaches. Nearly everyone speaks English as a first or second language. The government is absolutely flawed (corruption, mostly, and this flourished under the previous administration much more than the current) but it is a real democracy with real rule of law and a functioning bureaucracy, no Duterte-style authoritarians.

Downsides: it will always be cheaper than the U.S., especially in terms of medical care, but much of the reason South Africa is sooo affordable is because of its haywire exchange rate. It’s been low for several years now and there’s no reason to think that will necessarily change anytime soon, but it is volatile and organizations like the economist rank it as one of the most undervalued currencies in the world. So one would want to either convert a significant sum of dollars into rand at the outset, or be ready for costs to rise 20%-30%, maybe overnight, if you get unlucky. Also, the racial animus is deep and ever-present, hard to deal with even for somebody used to the U.S.’s (very different) race issues. The amount to which you’re exposed to this or can overcome it will vary depending on your lifestyle - might not be a big deal if you’re mainly at home. Crime is a real issue (really - I’m happy to message you about the nuances of this more if he looks seriously at this option), though it didn’t really limit what I felt like I could do during my two years there. Finally, South Africa, like many places you mention, is simply very far away. You have to accept that you’ll have to travel 14 (best case scenario, nonstop from Johannesburg to New York) to 30+ hours if you want to get back to the U.S., hard for anyone but maybe especially difficult with his medical issues.
posted by exutima at 5:31 PM on February 10, 2021 [1 favorite]

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