Go East, Old Man: As Germany And Western Europe Rapidly Ages, Soaring Health Care Costs Pushing More Elderly To Asia For Quality Care

 @Gooch700
on January 06 2014 12:33 PM
Chiang Mai, Thailand
Chiang Mai, Thailand Wikipedia

Like many advanced Western states, Germany and Switzerland face rapidly aging demographics and, in tandem, a growing number of elderly residents needing significant (and costly) health care management and therapy. But some intrepid Germans and Swiss have found a more  cost-effective way of dealing with the medical problems of their senior relatives  – send them on a one-way flight 6,000 miles away to Thailand, where medical care comes much cheaper.

Sybille Wiedmer, a Zurich native, is visiting her 91-year-old Alzheimer's disease-stricken mother, Elisabeth, who has been living in a nursing home in Chiang Mai, in northern Thailand, for about four years with 12 other fellow elderly Germans and Swiss. "A lot of people were shocked in the beginning and said, 'How can you do this? How dare you do this?'" Sybille Wiedmer told BBC. "And I said if I visited her here, half an hour later she didn't know any more. She had forgotten." 

Sybille explained that her family chose Thailand for her mother’s final years because the cost of care is far lower than in Germany, while the quality of such care is still quite high. "The treatment is so much more individual, and, how shall I say, with love. So I wouldn't hesitate to put anyone like that [in a Thai facility]," she said.

More Germans and other Western Europeans may soon be forced to make a similar decision for their aging parents – people in the West are simply living longer and need significant health care in their advanced years. The Alzheimer’s Society estimated that four-fifths of all current nursing-home residents suffer from some form of dementia or major memory problems. Moreover, the number of people who reach their 80th birthday will quadruple to almost 400 million by the year 2050, according to data from The World Health Organization. At that age (80), about one-sixth of all people develop dementia. Also, by 2050, the number of people in the world older than 60 will more than treble to 2 billion.

Along with an aging population in Europe, health care costs are climbing even faster – and all this is happening amid a deeply entrenched financial crisis in the euro zone. BBC noted that in Switzerland, monthly costs at a good nursing facility can run as high as $10,000 – while in Thailand, the cost is less than one-third of that figure (with a more comprehensive care program to boot). In addition, in Thailand, like virtually all Asian cultures, care for the elderly is considered an honor and a privilege. "You can have three or four caretakers for one person and you can organize that [and] this is possible 24 hours [a day]. This wouldn't be possible in Europe," said Martin Woodtli, the director of a Chiang Mai care home (who is himself of Swiss origin). Woodtli had spent four years in Thailand with the campaign group Doctors Without Borders prior to returning home to Switzerland to take care of his Alzheimer’s-afflicted mother.

But he decided it would be better to have her in Chiang Mai, as the first “guest” of the nursing facility there (his wife and son also live in a nearby residence). He advocates exercise for the elderly patients at the facility. “Movement is important. Tensions are also relieved if they have freedom to move. Our [caretakers] allow our guests a lot of space as long as it does not pose a danger to them,” he told AP. “In Switzerland we don’t have opportunity for such care.”

Ulrich Kuratli is a Swiss man who made the tough decision to move his wife of 41 years, Susanna, to a care facility in Thailand. But he says the care in Thailand is far more personal, comprehensive and much cheaper than in Switzerland. AP noted that each patient in the facility where Susanna lives is provided with round-the-clock care, with three caretakers working in shifts to look after each patient. They even take them for trips to markets, temples and restaurants. “Sometimes I am jealous. My wife won’t take my hand, but when her Thai [caretaker] takes it, she is calm. She seems to be happy,” Ulrich told AP. “When she sees me she starts to cry. Maybe she remembers how we were and understands, but can no longer find the words.”

Ironically, the elderly advocacy group HelpAge International and the U.N. Population Fund ranked Ulrich’s native Switzerland as the best place in the world for the elderly in terms of health care. But the costs are prohibitively high.

Thailand is eager to upgrade and promote its image as an attractive destination for Western medical tourists and retirees, AP reported.  Government officials are planning to construct a $10 million nursing home by the middle of this year, designed primarily for Westerners suffering from Alzheimer’s.

Cost is, of course, a paramount concern and attraction for places like Thailand. Although Switzerland has quite a generous national health insurance plan, the government typically does not pay for treatments performed abroad. Kuratli said that the Swiss government would cover about two-thirds of his wife’s care if she stayed in Switzerland – but given that high-end clinics can cost at least $15,000 per month, it would still cost him more in Switzerland than to keep her in Thailand.

But some health care specialists in Europe are not convinced that dispatching elderly relatives to Southeast Asia makes sense. "The step from their own house into a nursing home is a big step. And the step going to Thailand is much, much bigger because there is the language, you are separated probably from your family," Markus Leser of the Association of Care Homes for the Elderly in Switzerland told BBC. "Of course it's cheaper if you go to Thailand. But the decision for my father or my mother, it shouldn't only be the costs in my focus."

Other Western medical professionals assert that sending dementia patients thousands of miles away only worsens their sense of displacement. The media in Germany has labeled this phenomenon as “gerontological colonialism,” AP noted. Sabine Jansen, head of Germany’s Alzheimer's Society, told AP that people suffering from Alzheimer’s should stay near their homes and familiar surroundings. “People with dementia should stay in their familiar environment as long as possible. They are better oriented in their own living places and communities,” she said. “Friends, family members, neighbors can visit them. Also because of language and cultural reasons, it is best for most to stay in their home country.”

For Americans (where the average monthly care for the elderly is about $6,900 in a private skilled nursing facility, according to the American Elder Care Research Organization), the Philippines provides a cheaper alternative – care facilities cost up to $3,500 a month. The Manila government is planning a marketing campaign to attract more Americans to spend their golden years there.

Patients Without Borders currently estimates that some 8 million people are seeking medical treatment abroad (though not necessarily for Alzheimer’s). This number is likely to grow substantially in the coming decades. Alzheimer’s Disease International of the U.K. estimates that there are now more than 44 million people around the world suffering from Alzheimer’s – that figure is projected to triple to 135 million by 2050. The costs of taking care of such patients is astronomical -- the Alzheimer’s Association estimates that in the U.S. alone, costs related to managing the disease will surge to $1.2 trillion by 2050 from $203 billion this year. 

For Germany, Europe’s biggest and most powerful economy, its aging demographic presents some difficult problems. Indeed, Germany is burdened with one of the fastest aging (and declining) populations in the developed world. The American Institute for Contemporary German Studies (AICGS) warns that Germany’s shrinking population could have dire economic consequences for both Germany and Europe as a whole. “With a birth rate of only 1.36 children per woman in 2009, Germany will also witness the size of its working-age population plunge 27 percent to roughly 36 million people,” AICGS stated. “How can Europe’s largest economy maintain future economic growth when its overall population is shrinking and its elderly population is supported by a smaller working-age population?”

As a result, Germany’s social welfare systems may eventually collapse. The German government estimated last year that at least 400,000 of its elderly citizens cannot afford to stay in a German nursing care home – and this figure is increasing by 5 percent every year. Moving them overseas for cheaper care facilities has come under sharp criticism. "We simply cannot let those people who built Germany up to be what it is, who put their backbones into it all their lives, be deported," said Ulrike Mascher, the president of The Sozialverband Deutschland (VdK), a German advisory group. "It is inhumane."

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