Exporting Grandma to care homes abroad
Sending elderly relatives to a care home can be a tough and emotional decision. But is booking a one-way flight to a destination 8,000 miles away a step too far?
Sybille Wiedmer lives in Zurich and is packing her suitcase for a trip to Thailand.
But this is no ordinary holiday.
She is off to visit her mother who lives in a care home in the Thai city of Chiang Mai.
"A lot of people were shocked in the beginning and said, 'How can you do this? How dare you do this? You can't visit her,'" says Wiedmer.
"And I said if I visited her here, half an hour later she didn't know any more. She had forgotten."
Sybille's mother Elisabeth is 91 and has dementia.
She has been living in a care home in Thailand with a dozen other Swiss and German residents for the past four years but struggles to remember anything from the present.
Lost in space?
- The word 'dementia' covers a wide range of illnesses - the most common being Alzheimer's and vascular dementia.
- It's often assumed that people with dementia don't know where they are - but dementia affects every person differently.
- Although dementia progresses differently from person to person, it is often factual memories rather than emotional ones which are lost first.
- This means that although people might not remember the precise facts of where they are or who has come to visit, they are more likely to remember the emotional feelings that come with those visits or locations.
- There is evidence that for some people with dementia, visiting familiar places and talking about the past can be very beneficial.
Source: Alzheimer's Society
"I'm not long here up to now. But it is very nice and they are very kind. How long do I stay here?" she asks.
Elisabeth is told she's been a resident for four years.
"I'm here how long already? Four and a half years? Oh! I grow old."Care in crisis
A quick look at the figures and it's easy to see why some families are starting to look for care further afield.
The staff costs for nursing are significantly lower in Thailand, but the reputation for quality is still very high.
In Elisabeth's case, her family chose Thailand partly because she had spent time living in Asia with her late husband - so it wasn't completely unfamiliar.
But Sybille says a key factor was the type of care her mother would receive.
"The treatment is so much more individual, and, how shall I say, with love. So I wouldn't hesitate to put anyone like that there," she says.
Sending relatives to care homes abroad might be a choice that many more Europeans find themselves considering, as the gulf between cost and quality continues to widen.
The problem is partly fuelled by demand. People are simply living longer and to ages where chronic health problems are more likely.
The World Health Organization states that by 2050, the number of people who make it past their 80th birthday is expected to almost quadruple to 395 million - the age after which one in six people are estimated to have developed dementia.
Add this to the findings of a report by the Alzheimer's Society showing that around 80% of current care home residents have dementia or significant memory problems, and it's clear that the need for care is only going to increase.
But with people tightening their belts like never before, paying the bills for a good residential home is out of the question for many.
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In Switzerland, people are expected to contribute to costs amounting to anything between US$5,000 (£3,036) and $10,000 (£6,073) a month, In Thailand the figure is closer to US$3,000 (£1,821) a month - and that for a care package that is likely to be more comprehensive.
In the UK average costs range from US$3,600 (£2,186) for basic residential care to over US$5,000 (£3,036) a month with nursing care.
And while life savings are depleted, the UK care system has been beset by shocking revelations about abuse of the elderly and people being left to die of hunger and thirst.
"There's often a strong aversion to having family members go into care," says Chris Quince, a senior policy advisor at the Alzheimer's Society.
"Our research has found that abuse is the biggest fear among the public."A matter of culture
In contrast, Thailand has a strong culture of looking after its elderly.
Martin Woodtli, the Swiss director of a Chang Mai care home, says his residents enjoy a quality of care and value for money that is missing back home.
End Quote Sybille Wiedmer Daughter of parent in Thai care home
The treatment is so much more individual and, how shall I say, with love.”
"You can have three or four caretakers for one person and you can organise that this is possible 24 hours. This wouldn't be possible in Europe," he says.
Even so, Thai caregiver La, who lovingly looks after Elisabeth day after day, doesn't see the home as a solution for her own family.
"I think we don't need to come here. If we have to come, then I think we have a problem with a daughter," says La.
"If you have a daughter then you don't have to come here because your daughter can take care of you at home, we can take care together, living together."A moral dilemma
Sybille Wiedmer did try caring for her mother herself but, like many relatives of people with dementia, it eventually became impossible.
"Most of the time I looked after her every day," she says.
"But if you're so close to somebody... she got very aggressive. That made the situation very very difficult, very bad."
Although many relatives experience immense guilt for going down the care home route, Chris Quince of the Alzheimer's Society says that decisions about care are often out of their hands.
"Many people would like to continue caring at home but really can't," he told the BBC. "That choice to go to a home is often not really a choice, but happens because people can't cope in the community or have an accident or illness."
Despite the distance, Sybille speaks to Elisabeth via Skype almost every day and visits Thailand at least twice a year.
However, Markus Leser of the Association of Care Homes for the Elderly in Switzerland is not convinced that sending relatives to foreign climes is the right way to go.
"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," he says.
"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."
Even so, as a generation of 40- and 50-year-olds find themselves living through a financial crisis while simultaneously supporting both their children and elderly parents, it may mean that many more people like Elisabeth are being cared for a very long way from home.