Need Advice - Take Ailing Mother To Thailand Or Not

[flewis25200]

Fellow forum members:

I have an ailing mother who suffers from congestive heart failure disease. Do to her disease she retains water in her body and requires hospitalization and nursing case to remove water from her body. She is placed in a nursing home, however, she does not like it and prefers to live with family. If she stays with us here in the U.S., the cost is prohibitive as she requires 24 hour supervision.

I was wondering if it is good option for me to take her to Chiang Mai, rent a house and hire three or four maids to take care of her at the house. I have just received a retirement visa to Thailand and was planning on living in BKK, however, due to my mother's situation, I am planning on moving to Chaing Mai as it is cheaper then BKK. I am hoping I can get a nurse and a doctor to visit her regularly. Of course I have to pay for it - which would be fine (if it is 3 to 4 thousand U.S. dollars a month). I am paying more than that here in the U.S.

She currently has medicare, which she would not have if she moves to Thailand.

Any ideas or opinions about what I am thinking of doing will be appreciated.

[jimmym40]

I commend you for taking full responsibility for the care of your mother. I did the same for both my parents at their time of need.

I wish I could give you more valuable thoughts to help you decide what to do, but there is so much left out of your situation that it is difficult for anyone to give you any help. Are you married, have other dependents, keeping assets in the US or totally moving out of country, things like that. And above all, you stated your mother has medicare. Doesn't medicare cover most of the costs involved now to treat your mother? Don't they pay for a nurse to at least give home assistance several times a week? What if your mother would require major surgery here in Thailand? Costs invovled here vs in the US with medicare?

As far as 24 hour supervised care here in Thailand, I'm sure that would be no problem. My guess would be it wouldn't cost over $2,000 a month for that. Most hospital doctors here have clinics of their own with night and weekend operating hours. You would have to look around or ask the hospitals if there are any doctors that would do house calls. I believe I've read somewhere on TV that a person was able to have a doctor visit at home, but I remember that it was not a specialist, just a General Practiioner.

Maybe if you supply more detailed information or asked more specific questions, you may get a number of replies.

[Jockstar]

I commend you for taking full responsibility for the care of your mother. I did the same for both my parents at their time of need.

I wish I could give you more valuable thoughts to help you decide what to do, but there is so much left out of your situation that it is difficult for anyone to give you any help. Are you married, have other dependents, keeping assets in the US or totally moving out of country, things like that. And above all, you stated your mother has medicare. Doesn't medicare cover most of the costs involved now to treat your mother? Don't they pay for a nurse to at least give home assistance several times a week? What if your mother would require major surgery here in Thailand? Costs invovled here vs in the US with medicare?

As far as 24 hour supervised care here in Thailand, I'm sure that would be no problem. My guess would be it wouldn't cost over $2,000 a month for that. Most hospital doctors here have clinics of their own with night and weekend operating hours. You would have to look around or ask the hospitals if there are any doctors that would do house calls. I believe I've read somewhere on TV that a person was able to have a doctor visit at home, but I remember that it was not a specialist, just a General Practiioner.

Maybe if you supply more detailed information or asked more specific questions, you may get a number of replies.

This is from the OP as he reported instead of replying.

Thanks for the help.

I want to live in Thailand full time. with my mother in the U.S. I return every month. My cost to keep her at the house will be around $14,000 as she will require two caregivers 24 hours as she cannot move on her own and one person cannot move her by them selves. Medicare/medicaid will only give coverage for 1 person for up to 40 hours. I checked the cost of her medicine in Thailand and it is around $100 per month for a month's supply.

I think that I will need to hire two people to be with her at all times and one can help with other house chores. The reason I am looking at Chaing Mai is because it is cheaper than BKK. I am expecting that her monthly costs will be less than $3000.

Currently I stay in BKK one month and one month in the U.S. Id I can arrange for my mother to be in Thailand, then I don not need to come back to the U.S. as often. I pay around $3000 for my mother in the U.S. now and another $3500 for my stay in Thailand. IF my mother is in Thailand, then it will be easier and cheaper for me.

I hope this helps explain more of our situation.

I desperately need the pros and cons. I also feel that the the doctors will prolong her misery unnecessarily (possibly for financial gains) - may be I am wrong in my perception. My mother has stated multiple times that she does not wish to continue on her medications if she is unable to move, but her wishes are not being adhered to. I already know that she has a right to refuse medication, but in actuality it is easier said than done,

[FBN]

One important aspect here not to overlook; is she fit and able to do a commercial flight of this duration?

Congestive cardiac failure patients may need oxygen in flight and are also prone to acute exacerbation of her current condition in flight. It is essential to get a knowledgeable physician's assessment on this.

If she would require wheelchair assistance and/or oxygen, an airline medical clearance may be needed as well.

[Sheryl]

While you will be able to arrange the home care end of it cheaper here than in the US, you will have to pay out of pocket for any hospitalizations and these can be costly. While government hospitals are more affordable than private they are still far from free and there is also the communication and cultural factor i.e. it might be traumatic for her to be in a Thai government hospital where no one speaks English.

Home care in terms of things like intravenous meds and injections is hard to arrange in Thailand, much easier in the US (and if it involves skilled nursing, covered by medicare)

Last and perhaps most important, hospice care of the type known in the west isn't here yet. You are in much more risk of unnecessary prolonging of suffering in a Thai hospital than in the US. In fact, in the US you can absolutely prevent it by signing an Advance Directive and also having her assign a Health Care Power of Attorney to a family member. (State laws vary so be sure to use forms approved for the state she lives in). And, once the time comes, she can go into a hospice program fully covered by Medicare that would provide no life prolonging measures and liberal pain killers to her, either at home or in a facility. Nothing of that type in Thailand. You can't get IV or injectable pain killer at home here, have to be admitted to hospital. Laws alllowing patients to refuse "heroic" measures are still in formative stages here and the idea is new. It is hard for families to influence end of life decisions once a relative is hospitalized.

In recent years several TV members have gone through this challenge and basically they had to do "do it yourself" hospice care at home, minus the needed medical equipment and drugs, or else have the family member hospitalized. I recall one case where even paying a hige rate to a private hospital for 24 nurses in the home did not allow for intaveneous pain killers but DID result in a lot of unnecessary and futile curative treatments, and that the family member was pretty helpless in influencing any of the treatment choices.

I don't know why you think her life would be unncessarily prolonged in the US as in this day and age that rarely happens and can definitely be 100% prevented. in Thailand, though, it is indeed likely. not so much for profit motive but just because thailand is decades behind the times on this issue.

You say that your mother's treatment wishes are not being adhered to. Why on earth is that so? She has an absolute right to refuse any medication or treatment and a court order would be necessary to override that. Has she executed an Advance Directive? Does a family member hold a Health Care POA? The situation you describe is rare in this day and age and easily remedied, in fact you can and should take immediate legal action if your mother is indeed being in any way treated against her will.

A change of facility would probably also be a good idea, to one with a clear hospice program. But do file official complaint, both with Medicare/Medcaid, the State Ombudmans for elder issues and the JCAH or other relevant licensing bureau as you go.

If the problem is ensuring her end of life wishes are honored this can readily be arranged in the US (and there are whole organizations set up just to help with it) but not in Thailand. In Thailand you would basically have to just not let her be hospitalized, which in turn might mean she'd have to do without parenteral pain killers etc at the end.

I don't really have a sense of how close to end stage your mother is, but do take the above under consideration. And take immediate action on the issue of your mother's wishes/rights not being respected in the facility where she currently is.

[jimmym40]

lewis,

google these two sites: McKean Rehab Center and Dok Kaew Gardens both located in Chiang Mai.

both or one might suit your needs if you do decide to bring your mother to thailand. I don't think many people know about these two places, I just came across them by accident.

you probably can email them to get more important information if required.

wish you the best for you and your mom....

[flewis25200]

Dear Fellow Forum Members:

Thank you for your time and insights. They are very much appreciated. God bless you. Fitzgerald