Growing Old In Thailand

[Swelters]

In a recent thread we have discussed the question of expats growing old in Thailand which led to calls for possible facilities catering to this apparent need, maybe even drawing elders from abroad. The Phillipines have been aggressively promoting this as a business opportunity (I hear you can buy a comlete package, including a companion!) and some Japanese have suggested this as a great opportunity for Thailand. Some posters thought the whole subject was too gloomy but exploring new ways of improving things in life is not gloomy in my view.

Wikipedia has a pretty good starter article with links on "nursing homes"

http://en.wikipedia.org/wiki/Nursing_home

What I'd like to do here is propose some desirable local planning factors and invite others to add to the discussion. Here's a few for starters:

-Thai people have a positive attitude toward old folks, the human body.

-Thai people are not finicky in dealing with matters of personal hygene.

-A well ventilated light structure with easy in/out access is a lot more suitable and pleasing than a sealed cold-weather environment for ill of disabled people. Low land costs allow for this kind of distributed living.

-Gardening in Thailand is a good year-round activity yielding quick rewards

-Upcountry land and construction costs are very low. It may not matter where you are from the customers point of view.

-Super internet and comm facilities will keep you in as close touch with old friends and family as living on the other side of town.

-You're never too old for Thai massage.

-studying a new language is good for the brain

-Skilled labor here in the country is about 100 baht per day, nursing not too much more (?)

-Budhism is a potentially helpful way for people affected by difficulties

-Medcare in the countryside is pretty good now, maybe just as good as it was in US/UK not so long ago.

-Thailand has already shown a capacity to delver international standads of medcare.

-Thai kids are charming, polite and respectful of elders

Other ideas?

Swelters

[rak sa_ngop]

-You're never too old for Thai massage.

...or an oil one (I think).

[roietjimmy]

In a recent thread we have discussed the question of expats growing old in Thailand which led to calls for possible facilities catering to this apparent need, maybe even drawing elders from abroad. The Phillipines have been aggressively promoting this as a business opportunity (I hear you can buy a comlete package, including a companion!) and some Japanese have suggested this as a great opportunity for Thailand. Some posters thought the whole subject was too gloomy but exploring new ways of improving things in life is not gloomy in my view.

Wikipedia has a pretty good starter article with links on "nursing homes"

http://en.wikipedia.org/wiki/Nursing_home

What I'd like to do here is propose some desirable local planning factors and invite others to add to the discussion. Here's a few for starters:

-Thai people have a positive attitude toward old folks, the human body.

-Thai people are not finicky in dealing with matters of personal hygene.

-A well ventilated light structure with easy in/out access is a lot more suitable and pleasing than a sealed cold-weather environment for ill of disabled people. Low land costs allow for this kind of distributed living.

-Gardening in Thailand is a good year-round activity yielding quick rewards

-Upcountry land and construction costs are very low. It may not matter where you are from the customers point of view.

-Super internet and comm facilities will keep you in as close touch with old friends and family as living on the other side of town.

-You're never too old for Thai massage.

-studying a new language is good for the brain

-Skilled labor here in the country is about 100 baht per day, nursing not too much more (?)

-Budhism is a potentially helpful way for people affected by difficulties

-Medcare in the countryside is pretty good now, maybe just as good as it was in US/UK not so long ago.

-Thailand has already shown a capacity to delver international standads of medcare.

-Thai kids are charming, polite and respectful of elders

Other ideas?

Swelters

Swelters,

I don't think the subject is gloomy. We all are born and then grow old. When the time comes in life when help is needed to just get through the day it would be nice to know there are places where one can live with dignity, care and comfort. Thailand has much to offer in this regard as you point out. Unless a person has vast financial resources, living in the typical full care facility "nursing home" in the US is a far cry from dignified, caring or comfortable. Although I am not a spring chicken and have retired in Thailand after working here for 15 years, I am in very good health. My mom who is now 88 years old had a stroke about 5 years ago and as a consequence is confined to a wheel chair. Her mind is very sharp but she has no control over her left leg or arm. She sure can scoot around in that chair with her right leg and arm. Immediately after she had the stroke, I returned to the US to look into getting her in to a full care facility. I was shocked at the appalling conditions in nearly all the places I looked at. The prices were outrageous averaging about $8,000 per month plus medical expenses and the staff clearly viewed the patients as prison inmates rather than people deserving respect and care. I then and there decided there was no way I was going to leave mom in one of these joints. After much discussion and objections, mom finally agreed to come to Thailand. She has now been here 5 years and is very happy. She has her own rented 1 bedroom condo in Bangkok with full time live in nurse and maid. She calls the nurse and maid her daughters and they treat her with the respect you would expect from Thais when it comes to parents. Her monthly expense for salaries, rent and food is 80,000 baht. So enough of the background and back to the subject of your post.

I assume you are asking for ideas related to establishing a full care facility in Isarn. I believe it's a good idea. I agree with your points related to; the nature of Thai people and attitudes; the cost of land and facilities; and communications infrastructure. Your costs for skilled labor (nurses and aides) are way too low so this needs to be factored in planning. Generally "old folks" are set in their ways especially as it relates to food, religion and language. Changing habits is really hard for them (us to). To these points suggest the following:

- Offer Thai language training to those who want it but must have lots of multiligual staff. Mom still thinks hello is "sweaty cow".

- When it comes to food, must have plenty of western dishes.

- Need lots of activities on offer. Here is where I think Thai arts and crafts would be good.

- "Meditation" is a potentially helpful way for people affected by difficulties.

- Would need to focus on a particular market. English speaking countries or ???. This would serve two purposes. Reduction of multiligual staff cost and give residents a common language in which to communicate.

- Need to investigate Thai government issues, rules, et al related to running a "nursing home". This might be a show stopper as it is amazing there are not more in Thailand.

All for now but will contribute more as the Post develops.

[jaideeguy]

I'm the same boat with roietjimmy as my 88 yr old father took my invitation to 'finish it off' here in CM with me. he is dealing with osteosporosis [a slow degenerating bone disease] and survived a broken hip, that motivated us kids to look at alternatives to 'the institution' and it seemed that i was the most prepared to care for Pop as i am settled in LOS with a thai wife and family.

So, he has been here a year already and I've built him a small bungaloo designed with handicapped friendliness for the long term. We live in a quiet rural area and he can walk [shuffle with a cane] in safety. It has had somewhat of an impact on my family life, but so far, he is still somewhat independant.

We can manage his needs at this point and I have him hooked up with a good bone dr for his osteosporosis, but he is getting older and will need more care than we are qualified to give. At that point, we plan to hire a live in nurse, as we have space for a room to be added to his bungaloo. I do have limits and have to spread myself thin with family needs. luckily i'm retired and can oversee his needs.

One thing that I've NOT found is a geriatics specialist here and was told by his bone dr that geriatrics is not a popular speciality because of tha Thai family system caring for their own.

I think that building a care [retirement] home for the elderly would be a good idea with good affordable medical and caregivers available here as well as the [mostly] good weather here, and have considered doing a limited care facility here on our land, but the idea of dealing with 'old strangers' is not appealing, so I wish you luck, swelters.

let's keep in touch thru this forum and maybe we can share ideas and resources as well as support for the caregiver as well as the patient.

[Swelters]

Thanks for the last two excellent posts.

The local wages for skilled labor I got from what villagers told me of the pay rate (100 baht/day) at the Jim Thompson factory 30 km south of Korat. The hot Satanic mills?

A friend of mine, American midwest, wrote the following comment which would appear to cast further limitiations:

.........

Main problems: distance from City and hospitals. Generally, I think

Americans, myself included, regrettably, are disinclined to hand themselves

over to foreign doctors. A major obstacle, but one perhaps more of

perception than reality.

Panama has the advantage of being "nearer". Another perception maybe, but

real enough to me.

13+ hrs on a plane to BKK, would keep your loved ones from visiting, or

let's be honest, would give them a good excuse not to visit.

...............

My experience living in Thailand make these issues seem not important, I think they may represent a kind of mental distance many Americans feel between themselves and "the orient". How much "further" (door to door time, or cost) from say Los Angeles is rural Panama compared to say Korat? Also I'm not excited about the idea of associating old age with doctors and medicines, this strikes me as an odd late 20th century abberation, longevity at all costs.

I am not thinking about trying to market this idea to the masses in America, at first I only had the expat scene (including myself) in mind.

I don't think all Americans (or other fahlang) necessarily are resistant to a change in diet or language. My parents became adventurous travellers in their late sixties, my father loved studying spanish every morning. A charming young teacher would have added to his enjoyment.

Government complications are definitely an issue. I would think that strong Thai partners or even some existing institution like a hospital would be essential.

Swelters

Edited July 8, 2007 by Swelters

[jaideeguy]

More on Pop's adjustment to LOS........

at 88 yrs, I knew he was taking a giant leap into the unknown by comming to a strange far away land, but in my 'sales pitch' to him i mentioned all the plusses we have to offer here.

good affordable health care [at least here in CM]....he dropped his HMO from the states which was pinching him for $400/mo and is [so far] ahead of the game.

cheap professional help [nurse/caregiver].....maid for 100bhatt/day, nurse/caregiver [10-20kbhatt/mo]

good food, he loves my wife's cooking and she likes it hot!!

friendly respectful locals....not frowned upon and shunned like old folks in the west.

good communications....I set him up with adsl and he can keep in touch with the outside world via skype for small bhatt.

"Main problems: distance from City and hospitals. Generally, I think

Americans, myself included, regrettably, are disinclined to hand themselves

over to foreign doctors. A major obstacle, but one perhaps more of

perception than reality."

yes, true, most Americans are afraid to get out of range of their HMO's.....i don't know what the hospital situation is in Korat, but here in CM, we have many fine hospitals with proficient dr's and modern equipment and a half hr drive from home.

"Government complications are definitely an issue. I would think that strong Thai partners or even some existing institution like a hospital would be essential."

I got my father here on a retirement visa and it was a breeze with immigration officials as they had utmost respect for an old guy like him.

more later....

[Swelters]

Just to add to the medical aspect (though that is not my main concern here) , my family used the famous Stanford hospital in california for 25 years, only one surgical procedure in that time. In that time they made 2 or 3 major life-threatening mistakes. This and other anecdotal evidence suggests to me that mistakes are not infrequent. Delays are of course the norm.

I think the quality control in Thai facilities is better. Instant access is the norm. Prescriptions are overdone, maybe dangerously so. Physician skill seems similar; the Thai docs have less prestigious degrees but they seem better motivated and good with their hands. American docs have told me that manual skill may be more important in surgery.

Both American and Thai systems seem similarly compromised by commercial interests.

Feeling bad in Thailand? You can get your problem checked out thoroughly in two different hospitals in Bangkok in a single day. Inexpensively, maybe 20 percent of America.

Unfortunately in what must only be for corrupt reasons, American expats get no use of their prepaid government medical insurance here.

On balance, I vote for the Thai system. The experience is faster and much more pleasant, the error rate is about the same, but you can get second reviews easily. This encourages the patient to manage his own care, not hand himself over to an unreliable system.

[jaideeguy]

re; medical.....after living here for the last 8 yrs, I feel quite comfortable with the Thai medical system, [or at least as comfortable as the states] and as in the west, i take anything said to me or prescribed to me with 'a grain of salt' and double check all meds and as mentioned above a second opinion is cheap enough to not think twice about.

and not to forget...the nurses are a lot nicer to look at here.

[mrtoad]

I think that it is a perfectly viable option, and I have discussed this with a couple of friends in the past and have drawn up some basic proposals for the setting up such a facilty. Not that I am going to divulge them over the board.

Suffice to say I do have considerable experience in this field having set up a community care team in the UK, so if someone is looking to set up something like this, then I would be more than interested to get involved.

[Naam]

I think that it is a perfectly viable option, and I have discussed this with a couple of friends in the past and have drawn up some basic proposals for the setting up such a facilty. Not that I am going to divulge them over the board.

Suffice to say I do have considerable experience in this field having set up a community care team in the UK, so if someone is looking to set up something like this, then I would be more than interested to get involved.

the idea is well founded and [in theory] viable. in fact i would be interested to invest substantially in a project of that kind and i have friends who'd be interested too.

alas... NOT in a country like Thailand with all the governmental red tape and depending on the mercy of thai majority shareholders.

[ProThaiExpat]

I like the idea and it has much merit. It is almost axiomatic that anyone on fixed income seeks a low cost of living country to make their income go further. Thailand qualifies for that.

In building your facility, it should be designed to accommodate each level of care required. From independent living single level cottages to full care nursing care facility. With so many underpaid CMU professors of medicine running around trying to augment their income, how difficult would it be to have a doctor on site for an hour or two every day to see patients in need of medical attention.

A common dining room for those who don't or can't cook for themselves and kitchen equipped cottages for those who take care of themselves. An easy transition to a higher level of care in the same facility is a desirable feature. Group activities for those who desire them are easy to arrange.

In a word, low cost labor is a big plus in Thailand and it is just that, expensive uncaring labor that makes western facilities for seniors so expensive. You can bet if you locate within 10 to 20kms from CM city center, songtells will be lined up to take senior residents into town for a jaunt, supervised or not, facility bus or not.

My mother at 88 was in a facility in San Diego that had a central dining room and residence there was allowed only to those who could ambulate to the dining room. Nurses assistants brought meds to each patient per individual requirements. Maid service was available and each room had its own toilet. Once the resident could no longer care for themselves, they went to a higher level of care facility.

[roietjimmy]

Swelters,

It seems the post is getting a lot of good replies. All make good points and suggestions. Dr. Namm's comment re "red tape" is for me perhaps the most pertinent. Given this and all the other "speed bumps", suggest we should focus less on getting others to come to Thailand and more on your thought about how to make life more rewarding and comfortable for aging folks like us who are already here!

Maybe an Old Geezer community forum? I can just imagine some of the posts it would have. It might just end up being one of the most interesting forums on TV.

[Swelters]

Swelters,

It seems the post is getting a lot of good replies. All make good points and suggestions. Dr. Namm's comment re "red tape" is for me perhaps the most pertinent. Given this and all the other "speed bumps", suggest we should focus less on getting others to come to Thailand and more on your thought about how to make life more rewarding and comfortable for aging folks like us who are already here!

Maybe an Old Geezer community forum? I can just imagine some of the posts it would have. It might just end up being one of the most interesting forums on TV.

Good idea.

What was the name of the old guy who used to write the famous column in the BKK Post about the bar scene? He could be honorary chairman.

I've got some more thoughts on the red tape issue, will write later.

Swelters

[dukkha]

Swelters,

It seems the post is getting a lot of good replies. All make good points and suggestions. Dr. Namm's comment re "red tape" is for me perhaps the most pertinent. Given this and all the other "speed bumps", suggest we should focus less on getting others to come to Thailand and more on your thought about how to make life more rewarding and comfortable for aging folks like us who are already here!

Maybe an Old Geezer community forum? I can just imagine some of the posts it would have. It might just end up being one of the most interesting forums on TV.

The guys name was Bernard Trink, his column was entitled "Night Owl"...dont know whether he is still alive or not..Dukkha

Good idea.

What was the name of the old guy who used to write the famous column in the BKK Post about the bar scene? He could be honorary chairman.

I've got some more thoughts on the red tape issue, will write later.

Swelters

[ThaiPauly]

Swelters,

It seems the post is getting a lot of good replies. All make good points and suggestions. Dr. Namm's comment re "red tape" is for me perhaps the most pertinent. Given this and all the other "speed bumps", suggest we should focus less on getting others to come to Thailand and more on your thought about how to make life more rewarding and comfortable for aging folks like us who are already here!

Maybe an Old Geezer community forum? I can just imagine some of the posts it would have. It might just end up being one of the most interesting forums on TV.

Good idea.

What was the name of the old guy who used to write the famous column in the BKK Post about the bar scene? He could be honorary chairman.

Swelters

Bernard Trink...the nite owl.

I wholeheartedly agree that a nursing home in CM would be a very good idea.

[Swelters]

Further thoughts on the "Red Tape" issue which unquestionably could be a serious problem for any non-Thai attempting to set up a profitable business especially one that could be perceived to compete with any local interests.

First, such an entity is beyond the scope of my interest here. I'm much more interested in the satisfaction of doing a successful prototype than making money which I don't really need at this age and also providing for myself eventually and making things easier for my (Thai) wife.

How about a small partnership, co-op, or non-profit "trust" that would include some Thai partners who would be participants. A "rest home club" so to speak. I think that there may be semi-westernized Thai who don't have the traditional family resources who might have some interest whether for themselves or for semi-westernized relatives, including those who are living rather unhappily in the US or elsewhere. The sort of people who might use Bumrungard or Samitivej.

Chiang Mai is an obvious choice because of climate and hospitals but I'm interested in Isan too, maybe Udorn or Korat areas. Nicer climate than Bangkok. Some good areas near Korat but no more than 3 hours to Bangkok. (I just like it there a lot more than Chiang Mai.) Land and development costs are very attractive, the former could be set up on a lease basis.

The best analogy I can think of is a school, and there must be plenty of experience out there on setting up new schools with an "international" flavor and clientel.

Also, I favor emphasizing the day-to-day comforts and enlivening challenges that many of us have discovered as expats in Thailand instead of the usual litany of medical issues and "familiar food and language" that seem to top the list abck in the old country. Those who want American TV, Bingo, mashed ptotatoes and peas, Disney, visits from reluctant grandchildren, topped off with $100,000 of wasted medical technology to stay alive another dreadful month in a urine-scented, $8000/mo facility might not be attracted to the kind of place I have in mind....

Swelters

Edited July 11, 2007 by Swelters