Planning for Assisted Care

[chris49]

17 hours ago, bows00 said:

I have a mother that is turning 80 this year who will eventually be needing assisted living.  Unfortunately, we live in Hawaii and the cost of care will eventually bankrupt her hard earned savings.  And yes, this is a very difficult subject to discuss, and the rest of the family are in a state of denial, including me, and there is currently no plan in place.

But I have been pondering the idea of taking her with me to the Philippines once I have secured my retirement in October 2017.  She will not be needing the care yet, I estimate for at least another 3 years.  

So this thread peaked my interest, but it does not discuss the actual costs involved.  So how much is the going rate for decent live in professional care?  With my current budget, I was hoping it would cost no more than $68,000P per month.  Is this a feasible price?  Would I need more? 

 

Professional level nurse or caregiver. About minimum wage, approximately 400 ++ pesos a day, 12, 000 a month. But it might be tricky finding someone in that many such qualified persons will look to go abroad.

For less qualified. 4000-5000/month plus room and board.

It is actually a reasonable idea to bring her if she's receiving SS. He monthly check would cover everything and might accumulate until she actually needs the care.

[JJReyes]

6 hours ago, bows00 said:

I have a mother that is turning 80 this year who will eventually be needing assisted living.  Unfortunately, we live in Hawaii and the cost of care will eventually bankrupt her hard earned savings.  And yes, this is a very difficult subject to discuss, and the rest of the family are in a state of denial, including me, and there is currently no plan in place.

But I have been pondering the idea of taking her with me to the Philippines once I have secured my retirement in October 2017.  She will not be needing the care yet, I estimate for at least another 3 years.  

So this thread peaked my interest, but it does not discuss the actual costs involved.  So how much is the going rate for decent live in professional care?  With my current budget, I was hoping it would cost no more than $68,000P per month.  Is this a feasible price?  Would I need more? 

My research dates back to 2011, the year two brothers passed away and the family had ask me to return and take over the family farm. One possibility was to convert it into a Continuing Care Retirement Community targeted to the international market. My numbers maybe off a bit, but still accurate.

Php 68,000 should be more than sufficient to provide a caregiver at home. Depending on your Mother's needs, the caregiver could remain awake at night attending to her. You could help by providing care during daylight hours. The important thing is the companionship and assurance someone is always available. The Philippine nursing schools graduate about 90,000 every year. They need another year of studies before taking the national exam to become a Registered Nurse. This group is ideal to care for the elderly one-on-one. They remain awake studying or helping. Good pay is Php 10,000 to 20,000 plus room and board. If it is a hospital or clinic that provides the practical training, the labor is free. Some hospitals even charged the nurses, but the government ruled this is illegal. A medical doctor certifies that the nurse has completed training under his supervision.

On the high side, as a business, the cost at a Philippine facility for someone with Alzheimer ranged from $1,500 to $3,500 a month. This is for a team of RNs one-on-one 24 hours per day. Usually in the United States, it's a ward with one person caring for six and up depending on the laws of the state. There is only one RN for the entire facility and most of the workers are minimum wage earners. The RN does the medications and signs the paperwork.

It would be best to discuss the situation with other family members and to ask for financial commitments if the amount available from her pension is insufficient. Don't forget to include your Mother as part of the decision making process. 

 

 

 

 

 

[bows00]

3 minutes ago, JJReyes said:

Don't forget to include your Mother as part of the decision making process. 

Yeah, and that is the hard part.  My mother and the rest of my family want nothing to do with the Philippines.  But she is willing to visit me once I settle down there, and I am hoping to persuade her otherwise.

[Dave Hounddriver]

9 hours ago, bows00 said:

So how much is the going rate for decent live in professional care? 

I have only known, personally, 2 expats who hired live-in caregivers due to medical necessity (as opposed to calling their GF a caregiver).  Let me relate my observations of each.

First case was terminal cancer, Bill could not get out of bed unassisted and he had chosen to die at home, in Philippines.  He hired one of those 5,000 a month caregivers and the first thing she did was demand a second caregiver to help as she could not do everything by herself (she said foreigners are too big and heavy for a filipina to handle alone.  Bill was about 6 foot and 180 pounds.)  So she got another nurse to come there and help, cost became 10K a month, plus food for them.  The level of care went down as they appeared to spend most of the day socializing with each other.  Eventually they started stealing his things.  When we expat friends went to visit old Bill he told us these things.  Some things we could see for ourselves.  Bottom line is we had to run off the caregivers and another expat sat with old Bill day and night until he passed.  (We did try to hire a different care-giver but she ran off in the first couple of days, too much work I guess.)  My opinion is that this kind of care-giving is absolutely useless when the caregivers are not well supervised, something the sick person could not do.

In the second case, it was a very big guy (perhaps 300 pounds?) who had an agile mind but was wheelchair bound.  I cannot remember his name but played poker with him in Mactan on Sundays.  Anyway, he had to hire 3 female caregivers (due to his size) to push him around and take care of him and I think it cost him between 25 and 30,000 pesos a month for their salary plus their food and other expenses.  That one seemed to work out as he was able to supervise them and they just did what he told them.  He may have done better with one strong man as caregiver but many older expats are not comfortable with a male nurse taking care of them.

 

[JJReyes]

4 hours ago, bows00 said:

Yeah, and that is the hard part.  My mother and the rest of my family want nothing to do with the Philippines.  But she is willing to visit me once I settle down there, and I am hoping to persuade her otherwise.

The important thing is to initiate a discussion. You propose the Philippines as a possibility. If it is not acceptable, ask someone else to come up with a better idea. Whoever comes up with a good solution becomes the primary caregiver.

[chris49]

15 hours ago, JJReyes said:

The important thing is to initiate a discussion. You propose the Philippines as a possibility. If it is not acceptable, ask someone else to come up with a better idea. Whoever comes up with a good solution becomes the primary caregiver.

Yes well whoever takes over the care also takes over the SS payment and I imagine that is a point of contention.

[JJReyes]

Dave, I hear you.

A Haitian woman in Florida was hired as a caregiver for an elderly woman. When the children came to visit, all the furniture except for a bed and two nightstands were gone. They were all appropriated by the woman's relatives.

A Filipina who cared for an elderly woman in New York for many years received half of her fortune when she died. The children contested the will. The elderly woman had left notes for the judge, notarized by a lawyer, that in the event the will was contested, nothing goes to the children. Her note of explanation to the judge included one line, "Ask my children how many times they visited me during the past ten years."

Best story was from a brother-in-law about his cousin. She worked in Israel as a caregiver (90% of Israeli caregivers are from the Philippines).  Moving to Canada, she went to a recruitment agency for an interview. In walks a Jewish family whose mother was mad as hell because the daughter wanted to hire someone for her. The mother started becoming hysterical and the cousin went over to try and help calm her down. The Filipina started speaking in Yiddish and 30 minutes later, the two were best of friends. Guess who got the job? The Jewish family treats her well and even pays the college tuition of four siblings left in the Philippines.  

With 90,000 new nursing graduates a year, I can't imagine all of them being incompetent, deceitful and just plain bad. It's a matter of being selective and paying a reasonably good salary.

[Dave Hounddriver]

6 hours ago, JJReyes said:

With 90,000 new nursing graduates a year, I can't imagine all of them being incompetent, deceitful and just plain bad. It's a matter of being selective and paying a reasonably good salary.

It is quite likely you are correct.  I was simply relating the only two instances I was personally present to watch and comment on.  The rest of the stories you mention are just stories to me too.

My conclusion from being personally present in those two instances is that it is very difficult for an average expat to filter through 90,00 (or whatever number) of nursing graduates to pick the best ones and to know how much to pay them.  On the other hand, there are scads of listings for nursing homes for the aged on Manila so it may be much more practical for the average ex pat to use one of those facilities.

So I would personally be reluctant to plan for assisted care in-home and trust that I was smart enough to pick  a good caregiver to trust with my life and my personal assets, but I am more optimistic that doctors and investors in Philippines could do well by investing in nursing homes.  I may be somewhat less reluctant to consider in home care as an out-patient of one of those nursing homes where they provide the caregivers and the supervisors to oversee their performance.  Its a big leap of trust to put my remaining life in their hands (when and if it ever comes to that) but the risk gets less with the right infrastructure.  The problem may be that this level of care could quickly get out of reach for the US$1,000 a month pensioners who need it.

Edited July 7, 2016 by Dave Hounddriver

[JJReyes]

6 hours ago, Dave Hounddriver said:

The problem may be that this level of care could quickly get out of reach for the US$1,000 a month pensioners who need it.

The business model we were developing was in-country (Philippines) caregiver services, assisted living and skilled nursing homes. The group in the Philippines owns private hospitals and nursing schools. Financing was already in place with the Development Bank of the Philippines. The problem was the Philippine side wanted a guarantee of payment. There are cases wherein families would place relatives in a home and stop paying after a few months. They would disappear with no forwarding address. I couldn't provide the guarantee.

In the meantime, my wife convinced me to retire and enjoy our current lifestyle, which is full-time travel. You always want more money, but why start another venture requiring personal commitment for 5 to 10 years? We had enough resources so long as we were careful in how we spent our money.

20% of Americans have sufficient assets to pay for care services even if it is $10,000 a month. Senior executives at large corporations may have senior care insurance as part of their compensation package. The bottom 40% is a problem for state and federal government. We would promote the concept of Overseas Retirement Care to the middle bracket defined as $3,000 to $5,000 a month based on retirement income and assets.

 

[Dave Hounddriver]

7 minutes ago, JJReyes said:

We would promote the concept of Overseas Retirement Care to the middle bracket defined as $3,000 to $5,000 a month based on retirement income and assets.

That's the number I was waiting to see.  You and I seem to agree that there are quite a few retirees living in Philippines with income of US$3,000 to US$5,000 and yet that amount of income has been disputed many times by some forum members.  If you can tap that market you will do well.  Those of us "living like kings on US$1,000 a month" will have to find a young lady to take care of us as we age.