Dying At Home In Chiang Mai

[steven100]

Thanks for the report. It is nice to know what is going to happen to me in about 5 years.

Ajarn, just wondering how your doing ? all is well ?

[maewang99]

I'm really glad that it works out like this. I recently had read something that was kind of scary and this is very reassuring. thank you thank you thank you.

Edited October 27, 2015 by maewang99

[ThaiPauly]

A much belated thank you for that TP. While it , no doubt, is one of the more important threads on the forum, it is not one to which I tend to visit very often. Just the topic I guess. But is there any further information on the passing of Ajarn, or is it posted in the Page of Remembrance thread. I try and not visit that one too often also, fearful maybe, of seeing my own name.

Ajarn took his own life about 5 years after he said "that will be me in 5 years". I knew him quite well he had a lot of personal problems towards the end of his life. There was a long thread running about it as he posted on T V that he was intending to take his own life...and he did!!

RIP Larry, a guy who spent 20 years in CM after sticking a pin in the map of the world and the pin stuck in Chiang Mai

[NancyL]

Chiang Mai Christian Community Classifieds recently added an excellent reference document to their on-line publication called "Funeral Assistance for Foreigners in Chiang Mai"  Very comprehensive:

 

https://docs.google.com/document/d/1IihzPd3B00Wkwo2eo-jb0flO35z36GaKsd6UQ3xmjr0/pub#h.jzcdypudf1r3

[Thailand]

Download for free/editable Living Will accepted in Thailand

 

http://en.nationalhealth.or.th/sites/default/files/Living_Will_Samples%202_Final.doc

[NancyL]

19 hours ago, Thailand said:

Download for free/editable Living Will accepted in Thailand

 

http://en.nationalhealth.or.th/sites/default/files/Living_Will_Samples%202_Final.doc

 

I like the simplicity of this document however, someone using it should add that they wish to be kept comfortable and free of all pain and discomfort if they refuse other treatment.  That can sometimes be difficult to secure in a Thai hospital, especially if the cause of the pain is not diagnosed.  For example, it may be evident that someone is dying of cancer, but if the extend of spread or stage isn't know, Thai doctors may be loathe to prescribe morphine because it is addictive, even if it's evident that someone is within a few weeks of death, just in looking at the person.

 

Also, people using this form should be aware of the burden it places on their loved ones to check the box that they wish to die at home.  Often death can take several weeks and be incredibility messy.  People near death often have no strength and are totally unable to cooperate in bathing, changing diaper, even moving around a little bit to help make themselves more comfortable.  Beds at home can't be adjusted.  Often, in a Thai home, a terminally ill person ends up staying on a piece of plastic on the floor for the ease of dragging them into the shower for cleaning.  Once clean, they're brought back into the bedroom and if too heavy for the others in the household to move, they're made as comfortable as possible on that mat.

 

Be aware, also, that higher level pain killers won't be dispensed for home use.

 

Thai people don't like the idea of someone dying at home.  It can make your condo or home difficult to sell and landlords don't like tenants dying in their properties.  Ghosts, you know.  

 

Consider spending final days at McKean Rehabilitation Center where they will respect final wishes for non-intervention and keep a patient clean, comfortable and as pain-free and possible.  Family members can go there with the patient and stay in the same room or have an adjoining room.  It's quiet and tranquil.  The staff will tend to the dying person while the family can spend quality time with their loved ones.  People who come to die are in a section removed from the hustle and bustle and the rest of the hospital, with a beautiful view of nature and little interruption from the staff, yet they're steps away if help is needed.  It's a very peaceful and caring place. 

 

And when the end comes, they can handle the arrangements, including cremation on-site.  If you die at home, local authorities will enter you home and cause immediate disruption.  At McKean, your family and friends will be able to spend time with you after passing in a dignified fashion and not have to answer intrusive questions.

[noise]

There are many expats with Thai families that have/may have members in a terminal state that can not afford McKean.   What are some other resources in Chiangmai?  

[NancyL]

2 hours ago, noise said:

There are many expats with Thai families that have/may have members in a terminal state that can not afford McKean.   What are some other resources in Chiangmai?  

I'm not familiar with resources and services available for Thai people who are covered by various Thai gov't programs, agencies, care homes, etc.  There are indeed resources.  They could start by contacting the well-regarded Chiang Mai based Foundation for the Development of Older Persons  http://fopdev.or.th/ for referrals to local Thai resources.

[maewang99]

I'm afraid to find out.... what if it is a US citizen, any more strict?  i.e. US consulate must be informed and what they will request from police... but especially..... where there are no legal Thai relatives..... i.e. the deceased's spouse is his or her spouse in real life but not the legal one of record because of complications such as multiple jurisdictions for divorce plus things on top of that as well... had a post a few years ago and was too scared to look at the posts. 

 

the law for the USA is to look for a relative in the last state the deceased lived in.... which for most of us Americans means where we most recently were hanging onto some job... they will be looking for mine quite a long while if that is what they are required to do, and they are... and of course another US law prohibits ANY public funds to be used to transport or do anything maybe with the dead body until they do that (US law nothing to do with Brits)......   plus the autopsy is required unless... don't know the real answer to that one... or a firm one.  in the mean time I am waiting for next visit to US Consulate to ask there... gulp.

 

when we're dead there are still things that matter to us....quite a bit.... especially if we don't believe we even get to hang around a little while as a ghost or anything else.

Edited November 16, 2016 by maewang99

[CMBob]

Maewang, sorry but a few of your comments are confusing to me.  I'd note:

(1)  If a US citizen wonders what involvement (not all that significant) the consulate/embassy has upon the death of the US citizen, go to the consulate/embassy website and read about it. 

(2)  Upon death of a US citizen here in CM, the consulate is notified and will start the process of looking for what they call the next-of-kin; however, if you have a  Will which names an executor, the consulate will indeed honor that choice and deal with that person (of course, they'll need to see the Will to determine that...and it's possible they'll ask for a translated version if your Will is in Thai).  A US passport has a page where one fills in info for an emergency contact and, absent seeing an apparently valid Will that says otherwise, that's who the consulate will contact first.  One can also enroll online with what's called the STEP program and include your emergency contact info there.  In other words, it's rather easy to help the consulate figure out who to contact should the US citizen die here.

(3)  The consulate does not have anything to do with requesting an autopsy.  The Thai police or medical officer on scene will often request one if a foreigner dies outside a hospital and/or if there are suspicious circumstances surrounding the death.  The next-of-kin, of course, can also request that an autopsy be done.

(4) Normally a hospital having possession of a deceased US citizen will request a release letter from the consulate before allowing the body to leave the hospital morgue. The consulate will give that okay as soon as they have identified the person with authority noted in #2 above and then the person with authority can take care of cremation or whatever after (typically) paying all the hospital bills to date.  

 

It's not all that complicated and one can sometimes save the consulate and others some hassle by simply filling in the emergency contact info in your passport, enrolling in the STEP program, and/or making and keeping a Will. 

Edited November 16, 2016 by CMBob

[NancyL]

MaeWang99, CMBob is correct in what he says.  I suggest you download the document I referenced in post Number 34, above and read it carefully.  As Bob said, there are a few simple things you can do to make sure your Next-of-Kin is notified of your death.  If you download and read the document in Post no. 34 you'll learn the circumstances when an autopsy requested.  

 

And, let me read between the lines of your post a little bit.  Forgive me if I'm wrong.  If you have a "common law" wife in Thailand but didn't bother to divorce your previous wife in the U.S., then I suggest you hire a Thai lawyer to write a Final Will that protects the interests of your "common law" Thai "wife" or your Thai "wife" may discover that your lawful U.S. wife is coming here to rightfully claim her estate, which may include your condo, vehicles, bank accounts, etc.  There is no such thing as a "common law" wife in Thai law and the U.S. Consulate AND the Thai authorities will be fully cooperative in helping your long-lost U.S. wife claim her assets.  You can prevent all this by leaving them to your "common law" Thai partner via a properly executed Final Will.

 

And let me add, that if you're U.S. military veteran, even one who served for as little as a few years, during a wartime period like Vietnam or the Gulf war, you could be cheating your Thai partner out of a widows pension for life of over $700 per month by not legally marrying her.  Few U.S. widows know about, much less claim this pension, because they earn more than $700 per month, but Thai widows don't.  NOTE:  The VA will find out if you're still married in the U.S. when you married her in Thailand if you go that route.  I've seen some poor Thai widows learn their marriage was a sham from a VA letter, when they applied for the widow's pension after the death of their "husband".  Talk about devastating.  

 

 

[songhklasid]

Did she inform her embassy about her death wishes beforehand ? i was thinking that if you did not leave prior instructions, would the body be returned to native country ? at great expense for family, 

cheers songhklasid.

[NancyL]

The Next-of-Kin will give instructions to the Embassy about the disposition of the final remains.  In general, Embassies encourage cremation here and repatriation of the cremated remains.

[Will Power]

Thanks to everyone, especially TRAZ57, for this important information.

[r136dg]

Have often wondered about dying here. Been to many funerals but never put one together. Thanks much for the invaluable information! 

[gk10002000]

On 5/29/2009 at 5:57 AM, caznshaz said:

This sort of post is very helpful - thank you very much and please accept my condolences.

yes, thank you for posting real world details. 

[MalandLee]

Firstly I must echo Nancy's comments on the McKean Centre. Prices start at (around) 32,000 Baht per month. Of course everyone's  needs are different AND prices vary accordingly, BUT, if one is cognizant and able to express their wishes - many will know (Certainly my friend did), that remaining at home was an unacceptable burden on the person  who cared & loved the person.

 

We have a Thai friend in a "San Sai" palliative care centre - His family pay 34,000 Baht per month for his care. Being Thai and "local", they hunted for a cost effective solution to home care - hiring nurses 24/7 did not work for them.

 

Note, that in both cases - (Thai, Non Thai) drugs are not included in the prices quoted. MANY enterprising partners of terminally ill persons can "source" expensive drugs, from the families of recently deceased persons. I know from experience, it can save considerable sums of money. Whilst it may seem distasteful, to some doing this, it is often a "win - win" situation for the terminally ill person AND the partner of a deceased person - FINANCIALLY.

 

Other things happen after death and can be quite draining on the "bereaved" - but need to be done.

 

<SNIP>I had to go to immigration to cancel <deceased> visa. Speak to British Embassy to get <deceased> passport cancelled. Apparently these are urgent items to get sorted.

 

I am in the process of getting Thai & English death certificates certified. I went to City Hall this morning (Twice) for them to finish off the process. I go back Monday to collect the papers.

 

Yesterday I posted off <deceased> UK driving license to get that cancelled. There are a few things like that, that I still need to do - need to look at my list of actions. <END>

 

These last weeks have been draining saying our final goodbye's - If I am to go, whilst here in Thailand, I hope the McLean centre has room for me in my final days..

 

One last thought, re drugs to keep terminally ill patients comfortable - "it may exist but I have never heard of it" IT WOULD BE NICE, if expat's had an acceptable repository, where drugs could be "donated" by the families of the deceased - to assist those less fortunate. Given the potential for abuse and legalities, something like this could be difficult - but would not be impossible?

 

 

[CMBob]

All good points, MalandLee, but I think the use of others' prescription drugs (unless handled through a pharmacist who knew exactly which drug was what) would be problematic and impossible.  And it could be illegal here (as it is in the US) for anybody to have possession of a controlled substance without a prescription in that person's name.

 

The only thing you mention that I wouldn't do is bother with any driving licenses....at least ones issued here or in the US.  While it might be smart to destroy same so nobody else could use them (I'd probably retain a photo of any licenses just in case the information is ever needed), the licenses will expire on their own eventually and probably not worth the time to deal with them.  I've never heard of any requirement to deal with those licenses after death although perhaps the UK has different regulations about that.

 

 

[MalandLee]

You are probably correct Bob on the drug front. However, the "trade" does exist. Sadly because I am not sure of the legalities, I prefer not to expand what I know. I can say, there is a myriad of checks and ALL drugs are dispensed to the patient, on the order of a doctor and in the case of my friend, "FULL Doctor supervised pain management" was top notch. THERE WAS NO, (nor was there EVER) any SELF MEDICATION. I prefer not to say more.

 

My guess is members of each "tribe" that chooses to call Thailand their home, will have different requirements after a tribal member is deceased. I am an Aussie, would not have a clue what is needed after I depart this world, however, my (deeply bereaved) friends partner, has reminded me I must try and make the transition for my beautiful wife as seamless as possible - I will endeavour to do that.

 

We NEVER dwell on death, but, some practical steps have been taken. We have a will, plus an encrypted document, password protected, containing ALL known passwords, banking, insurance, etc... PLUS as much info as could possibly be needed to smooth out the bumps. Minimal but practical, I know.

 

[happyas]

I am looking for advice please regarding an elderly guy whom i have recently befriended who is terminally ill and most likely will not see this year out.

He has absolutely no one who will help out after he passes, which leaves me to enquire.

Basically he is a pauper,lives month to month on a pension,has no savings, no family, no friends in his birth country.

When he does finally expire i'm just wondering would would happen with his body.

I read on here that most countries prefer a cremation in order to take remains back as cheap as possible.

He has no thoughts or cares about what happens to his remains, so what are the options for me?

Do i call the police here and let them deal with it,or not?

Would they cremate him and just throw his ashes away somewhere?

Is there an established course for me to take in any way,shape or form?

Sorry for such a lot of questions, but i am at a loss here,and would like to know what can be done for him.

Thanks for any advice in this delicate matter.

[Tarteso]

Thanks for share... Many thanks.


Sent from my iPhone using Thaivisa Connect

[maewang99]

US has a new law on this, so my only 2 cents on this is that you check what his home country's policy is. right? it can vary quite a lot. what country is it, I didn't see you mention it.
   

Edited May 17, 2017 by maewang99

[happyas]

2 hours ago, maewang99 said:

US has a new law on this, so my only 2 cents on this is that you check what his home country's policy is. right? it can vary quite a lot. what country is it, I didn't see you mention it.
   

I believe that he is a NZ citizen .

Edit..he is indeed NZer.

 

Edited May 17, 2017 by happyas

[Sheryl]

6 hours ago, happyas said:

I am looking for advice please regarding an elderly guy whom i have recently befriended who is terminally ill and most likely will not see this year out.

He has absolutely no one who will help out after he passes, which leaves me to enquire.

Basically he is a pauper,lives month to month on a pension,has no savings, no family, no friends in his birth country.

When he does finally expire i'm just wondering would would happen with his body.

I read on here that most countries prefer a cremation in order to take remains back as cheap as possible.

He has no thoughts or cares about what happens to his remains, so what are the options for me?

Do i call the police here and let them deal with it,or not?

Would they cremate him and just throw his ashes away somewhere?

Is there an established course for me to take in any way,shape or form?

Sorry for such a lot of questions, but i am at a loss here,and would like to know what can be done for him.

Thanks for any advice in this delicate matter.

 

When he dies, police will be notified and will have his body taken to a nearby hospital morgue. They will notify his Embassy, assuming they locate hius passport. The Embassy will try to find "next of kin" for instructions about what to do with the body and it will remain in the hospital morgue until they do and issue permission to the hospital to release the body.

 

What happens if the Embassy cannot locate any next of kin, I don't know, but I'm sure it has happened not a few times.

 

In any case, nothing that you can or should do except call the police if you happen to be the first to find him.

[happyas]

51 minutes ago, Sheryl said:

 

When he dies, police will be notified and will have his body taken to a nearby hospital morgue. They will notify his Embassy, assuming they locate hius passport. The Embassy will try to find "next of kin" for instructions about what to do with the body and it will remain in the hospital morgue until they do and issue permission to the hospital to release the body.

 

What happens if the Embassy cannot locate any next of kin, I don't know, but I'm sure it has happened not a few times.

 

In any case, nothing that you can or should do except call the police if you happen to be the first to find him.

Thank you Sheryl..i feel that it will be me who does find him,as there is really no one else who cares if he is not seen for a couple of days.

Quite sad , but he is a nice enough guy,who i sort of took pity on initially,and helped him out when he needed things.

Now, i'm in this position and want to do as much as i can to send him off as dignified as is possible.

I feel that no next of kin will even care,let alone want to be involved at the end.

As i said, quite sad, but i guess not so uncommon here.

When the inevitable does happen, i will notify the police as you suggest and let them deal with it.

Thanks.

[NancyL]

Assuming the terminally ill man in question is in Muang Chiang Mai, he will probably be taken to Suan Dok (CMU) hospital upon passing.  There will be an autopsy to determine cause of death, something done for most deaths at home, unless the deceased was under the care of a physician for a diagnosed disease.  

 

Then, as Sheryl said, the man's Embassy will work very diligently to notify next-of-kin to assume responsibility for paying for his cremation at Suan Dok.  It can be quite economical.  Different Embassies have different policies about how they handle someone's personal effects.  The Americans will have someone from the Embassy/Consulate go to a person's condo gather all valuable items and documents and hold them in storage.  Most other countries don't do this and simply instruct the the building management to put items in storage or lock the room.  

 

If no one comes forward assume responsibility for the cost of his cremation (quite economical at Suan Dok) then eventually a Buddhist charity will make arrangements for a proper ceremony.  No one will be told about the place or time or be able to claim the remains, because if they want to come to pay final respects, well then, they should be prepared to pay for the service, shouldn't they?

[happyas]

4 hours ago, NancyL said:

Assuming the terminally ill man in question is in Muang Chiang Mai, he will probably be taken to Suan Dok (CMU) hospital upon passing.  There will be an autopsy to determine cause of death, something done for most deaths at home, unless the deceased was under the care of a physician for a diagnosed disease.  

 

Then, as Sheryl said, the man's Embassy will work very diligently to notify next-of-kin to assume responsibility for paying for his cremation at Suan Dok.  It can be quite economical.  Different Embassies have different policies about how they handle someone's personal effects.  The Americans will have someone from the Embassy/Consulate go to a person's condo gather all valuable items and documents and hold them in storage.  Most other countries don't do this and simply instruct the the building management to put items in storage or lock the room.  

 

If no one comes forward assume responsibility for the cost of his cremation (quite economical at Suan Dok) then eventually a Buddhist charity will make arrangements for a proper ceremony.  No one will be told about the place or time or be able to claim the remains, because if they want to come to pay final respects, well then, they should be prepared to pay for the service, shouldn't they?

Thanks NancyL.

This and Sheryls post have given me all i need to know.

I may foot the bill for the cremation at least,and i guess i'll be the only one there to see him off.

Hopefully later than sooner.

 

PS Do you know roughly the cost of the cremation at Suan Dok please?

[YetAnother]

lot of steps at a time of great stress

[NancyL]

Someone with direct knowledge may chime in, but I believe it's around 5000 baht for a cremation at Suan Dok hospital.  

[Sheryl]

If it is possible to get him to register with his embassy naming you as emergency contact itmay save delay and hassle when the time comes.