Three Case Studies on Affordable Long-Term Care in Mexico - IL

Long-term/assisted living healthcare isn’t anyone’s favorite topic… But whether you live in North America or overseas, it’s a critical issue that all retirees should address.

My husband and I were in our 50s when we first moved abroad—to Ambergris Caye, Belize. We were healthy, energetic, and ready for adventure. Back then, we had no major health concerns. Fast forward 10 years and four surgeries later. As we neared Medicare age, access to quality healthcare became our top priority.

We’re still healthy and active. But we’ve watched a few of our expat friends struggle with serious health issues. These experiences spurred us to seriously consider all of our healthcare concerns and options.

During our discussions, Mike and I concluded that moving back to the U.S. full-time for long-term care is not a realistic option for us. We didn’t invest in long-term care policies while we were in our 50s. At our current age, the policy costs are prohibitive, as are the annual costs to stay in U.S. assisted-living facilities. And while living in Belize was rewarding, we found no long-term care options there that would work for us.

So, it was time to choose a different overseas location…one that would meet our future healthcare needs.

While living in Belize, we’d often traveled to Mérida, Mexico for yearly examinations, medical tests, and surgeries. Each time, we were impressed with the medical care in Mexico, the quality of the hospitals and doctors, as well as the caring approach of medical practitioners. What’s more, in healthcare facilities in Mexico, we noticed that older people were treated with respect and affection.Older people are treated with respect and affection.So, I began researching long-term care facilities in Mexico. Several of the most well-known are located in the vicinity of San Miguel de Allende, given that many expats live in the Colonial Highlands city. The two largest local assisted-living facilities are Casa Cieneguita and Ceilito Lindo at Los Labradores. Both are located outside of town. But there are smaller private-care facilities in the town proper, some of which are mentioned in the following personal stories.

In May 2018, my husband and I moved to San Miguel de Allende. Within a few months, we’d obtained our permanent residencies and Seguro Popular Mexican health coverage. But we’ve also retained our U.S.-based Medicare. In the future, we plan to obtain our primary healthcare in Mexico.

Soon after arriving in San Miguel, we met with Deborah Bickel, one of the owners of Be Well San Miguel, a patient-advocacy service provider. If we ever need assistance making medical decisions, or dealing with hospitals, we will be able to rely upon her for as-needed assistance.

Early in our tenure in San Miguel, I met several expats who moved here mainly to take advantage of its long-term care options.

Each of these expats has a spouse, or parent, with healthcare issues that require 24/7 care. They had each evaluated putting their loved one into long-term care in the U.S. But in every case, the cost was beyond their respective budgets.

Many retirees find themselves in this situation. The expats profiled in this article worked hard during their earning years. But their retirement savings and health insurance in the U.S. are inadequate to cover long-term care there.

Each of these expats has dealt with the decline of a loved one while struggling with an overwhelming financial burden… and has come to the conclusion that their best option is to move to a foreign country.

In San Miguel de Allende, they’ve been able to obtain affordable, quality longterm medical care for their loved ones. As a result, they’ve not only had the relief of seeing their loved ones properly cared for, but they have themselves also been able to find community and friendship and lead satisfying lives of their own. Here are their stories…

Community spirit and respect for the elderly are intrinsic parts of San Miguel life. ©Jason Holland.
Community spirit and respect for the elderly are intrinsic parts of San Miguel life. ©Jason Holland.

Joan, 68, and Jon Wolf, 70.

From Ann Arbor, Michigan

For 41 years, Joan and Jon Wolf lived and worked in the Ann Arbor region of Michigan. They were starting to think about where they’d spend their retirement winters, in a warmer climate. But, in 2014, a year before they planned to retire, Jon began having early symptoms of Lewy Body Dementia (LBD), the second-most common form of dementia (after Alzheimer’s).

Within a year, he could no longer fulfill the obligations of his job. Since then, he’s been gradually losing his executive functions. (With LBD, he may retain his ability to recognize loved ones, and some memories.)

As Jon’s disease progressed, Joan’s priorities shifted. She made many difficult decisions about how to best tend to his special-care needs. “To simplify our lives,” she says, “in 2017 we moved into assisted living in the Ann Arbor region. After six months, it became clear that Jon needed 24/7 companion care.”

While digging into the details, Joan learned that their long-term care policy could be used internationally. But the policy amount is capped. She calculated that in the U.S., the policy funds would run out within five years. It was time to consider other options. “I researched dementia facilities and home-care options in Mexico. I found that San Miguel de Allende offered good choices for both, at prices of one-third to half of what we’d pay in the U.S. Simple math showed that our policy funds would last twice as long in Mexico.”

Joan chose San Miguel as their next home primarily due to the well-priced quality long-term care. But she was also comfortable that there’s a large expat community. She wouldn’t need to learn Spanish right away, since English is commonly used in town.Neither of us misses the cold Midwest winters.And it’s easy to travel to and from town. The closest airport is only 90 minutes away. “It’s an easy four-hour flight back to Michigan,” says Joan. “And San Miguel is a beautiful, walkable colonial town. We do not need a car. The climate is perfect. It’s very easy to make friends, and there are many interesting things to do here. Neither of us misses the cold, dark, dreary, six-month-long Midwest winters. Our lives are so much better here.”

The Wolfs get much more, in terms of housing and care, in San Miguel. “Before leaving Ann Arbor, we lived in a 600-square-foot, one-bedroom, one-bathroom, assisted living apartment with no kitchen,” says Joan.

“It cost $6,000 per month. Our meals were included, and housekeeping. But Jon received no one-on-one companion care. He wasn’t able to follow along with group activities unless a companion was with him. We paid an additional $12-$24 an hour for a caregiver to come 15-20 hours a week, just so I could have some free time.

“In San Miguel de Allende I work through a home care provider called Be Well San Miguel. We pay the Mexican caregivers much less—$6.25 an hour.”

The Wolfs now live in a popular colonia (neighborhood) in San Miguel. Jon’s Michigan long-term caregiver moved with them. She says, “We rent a three-bedroom, two-story house in Colonia San Antonio for $1,350 per month. Jon has his own bedroom, and a bathroom, on the first floor. His live-in caregiver and I each have our own bedrooms, on the second floor, and a shared upstairs bathroom. Our U.S. live-in caregiver doesn’t work nights. So, I have several different local caregivers who rotate overnight shifts to attend to Jon.

“In the U.S., while in assisted living, we had wonderful caregivers. But they were stretched very thin. They couldn’t spend much time with any one person. Jon now gets excellent one-on-one care 24/7, for a fraction of the cost of home care, or facility care, in the U.S. His needs are constant. He always has a caregiver present and receives loving attention 24/7.

“Jon’s happy in San Miguel. Actually, I think he may be happier now than at any other time in his life. He’s eating healthfully and enjoying meals more than ever before. The stress that caused a lifetime of stomach problems has disappeared…so he no longer needs acid reflux or pre-diabetes medicine.

“Jon does not express himself coherently with words very often… But a while ago he told me ‘I love these guys,’ in reference to his caregivers. And they love him back. It’s so sweet.”

Because Jon is so well taken care of, within their budget, Joan now has time to pursue her personal interests. “I go to yoga classes twice a week, joining my yoga friends for coffee and conversation after class. I meditate with two different groups three times a week. I also belong to the Unitarian Universalist Fellowship church.

“I’ve made many friends in San Miguel. We get together to go out to movies, restaurants, lectures, art openings, concerts, hiking in the botanical gardens, and much more. I am grateful that my life is much better here than it was in the U.S. I now have the time, and peace of mind, to participate in the activities I most enjoy, knowing that my husband is being well cared for.”

Manon, 65, and Roland Mays, 78.

From Mill Valley, California

For over 35 years, Manon and Roland Mays lived in Mill Valley, in the San Fransisco Bay Area of California. Roland was a successful architect, with his own firm. Manon is a registered nurse who directed the infection-control program in a large hospital and out-patient clinical care center. Nearing retirement, they planned to spend more time in their lovely beach home in Bali, Indonesia.My life is much better here than it was in the U.S.In 2003 the Mays’ lives took an unexpected turn when Roland was diagnosed with early onset dementia/Alzheimer’s. At first the disease progressed slowly. For close to 15 years, using her medical training, Manon took care of her husband. Those were very difficult years for her.

“I was very lonely,” she says. “I felt that I’d lost my husband…my partner…my very special friend. I constantly worried about what to do with Roland. Five years ago, he started declining rapidly.”

The stress of caring for Roland took a toll on Manon’s life and health. The cost of care facilities in the Bay Area was excessive at $13,000 to $21,000 a month. So, instead, Manon hired a caregiver for 25 hours a week at a cost of $4,000 a month.

Even with the savings she was making, the costs were challenging for Manon, and she stressed about having to declare bankruptcy.

During this period, Manon felt compelled to retire early from her job to care for her husband. As her income stream evaporated, she considered less costly geographical alternatives. Her focus was to find a place that offers quality, affordable, loving long-term care.

“At first, I thought I’d take Roland to our home in Bali,” says Manon. A wonderful Balinese family works for us there. We’d both be well taken care of. But Bali is too far away for Roland’s daughter and grandchildren to visit.”

In October of 2017 Manon and her best friend visited San Miguel de Allende to look at long-term care facilities. By Christmas she’d decided to admit Roland to Casa de Reposo Santa Sofia, a private facility located in a popular San Miguel colonia.

Money can’t buy health, but relieving the financial burden of quality care can go a long way. ©Jason Holland.
Money can’t buy health, but relieving the financial burden of quality care can go a long way. ©Jason Holland.

Roland was admitted on April 30, 2018. “This was a very difficult transition period for me, going from the role of Roland’s full-time caregiver to no longer living with him,” says Manon. “But Roland’s care at Casa de Reposo is excellent and very affordable. I frequently ask him if he likes it there. His response is different every time, but always positive.”

It’s also a major relief for Manon that she can afford the cost of long-term care for Roland in San Miguel.

“When I’m in San Miguel, I visit my husband at least once a day,” she says. “Several days a week, I visit him twice daily. Roland has adapted well. He likes the stimulation of group living. I used to say that he was much happier than me, since I’ve been caught between two separate lives. But I love San Miguel. I’m lucky to have made many friends here.”

Manon regularly travels back and forth between Mill Valley and San Miguel. She’s in the process of cleaning out a garage full of Roland’s tools and equipment…and grappling with how to proceed with the sale of their Mill Valley home.

Fortunately, from the beginning, she stepped into a great situation in San Miguel. “My friends, Lynn and Peter, allow me to stay in their beautiful, three-bedroom house in Colonia San Antonio for only $300 a month when I’m there. I am so blessed and grateful. It seemed a great portent that everything was falling into place.”

Once Roland was settled and content, Manon was able to transition to her new lifestyle.

“I have much more free time now, since I’m not caring for Roland 24/7, which is truly a major relief. I now have a life of my own. The pace of life here is slower, easier. I walk everywhere. I love the beauty of the town, the art, the culture, and the good, cheap restaurants. I read a lot, and I also like to play the stock market.

“Twice a week I take a water aerobics class. Other days I work out at the gym with a lovely man who needs a work-out partner. I am playing golf again, which I haven’t been able to do for a while. And I hired a Spanish coach, Pedro, who helps me with my Spanish twice a week. I even have time for short siestas. Plus, the holidays here—Christmas, Easter, Día de Muertos—are great fun.”

It’s easy to make friends in San Miguel, as she explains. “I’ve been able to cultivate new friendships here. I spend a lot of time with my San Miguel friends, much more than I ever did with my Mill Valley friends.

“Almost every day since my return, I’ve gone out to dinner, or met up with friends for coffee or a glass of wine. And I’ve had a constant stream of visitors. At times it’s actually too much.”

Given the low cost of living, and affordable long-term care in Mexico, Manon no longer has the dark cloud of money challenges hanging over her head.

“I’ve actually been able to consistently save money when I’m in San Miguel,” she says.

“I only pay $1,800 a month for Roland’s care. When he shares a room, it drops to $1,450 a month. The cost of living in Mexico doesn’t come close to the high costs of the San Francisco Bay Area, which are at least 10 times more than that in San Miguel.”

Fulfilling A Need For Care In Lake Chapala

A significant part of Greg and Jane Custer’s decision to move from Oregon to central Mexico was Greg’s mother, Maureen, who suffered from Alzheimer’s disease. Greg realized that he could get her better care in Mexico than he could in the United States, and at a cost that wasn’t going to land them in bankruptcy.

Now at 87, and with advanced stages of the disease, Maureen has been living at a full-time nursing facility since 2015, located alongside majestic Lake Chapala.

“I have no doubt,” says Greg, “that my mom’s life has been enhanced.”

Greg and Jane did their share of research before finding Casa Nostra—a small, two-story nursing home in one of Mexico’s top expat retirement communities. The facility, founded in 1990 by a Mexican family, includes five upstairs rooms, with views of the gardens and the expansive lake. A section of the property is dedicated to independent-living residents and another is dedicated solely to memory-care residents. Three full-time nurses care for the five memory care patients—one of them being Maureen.

“A major benefit for my mom living at Lakeside,” says Greg, “is that she’s out in the sun literally every day of the year, spending time in the tree-shaded garden, filled with fruit trees and lush foliage.”

Greg and Jane observe just how the staff members demonstrate respect and admiration for elders, which is inherent in the Mexican culture and shines through in the daily care.

“There are plenty of hugs, kisses, and humor to go around,” says Jane. “When we recently visited, we couldn’t help but notice the lovely hair weave and colorful ribbons the staff added to Maureen’s hair. She was glowing!”

What’s more, the owners see to it that every holiday is celebrated. At Christmas the residents enjoy a traditional Posada, which includes a piñata, mariachi band, fresh-made tacos, and tortillas. Greg adds, “Children and laughter are present at every gathering.”

Because Mexican culture values older adults, senior care in Mexico is nothing new. “Where I see needed improvement in a majority of senior care facilities is for more training,” says Greg. “Plus, bilingual caregivers are not commonly found in Mexico, and that’s a growing need. These are some of the trade-offs to consider when thinking about senior care facilities in Mexico.No doubt. My mom’s life has been enhanced.“Americans are facing a longer retirement period with little or no savings or pension, and it gets more complicated when they have to care for aging parents. That means having to factor in a care model for their still-living parents.” Greg and Jane spent their careers touring Mexico for their business, one aspect of which was training travel agents in the country.

They’re now ready to migrate toward a new opportunity—helping U.S. seniors relocate to central Mexico for quality senior care in adult living facilities.

Says Greg, “Our goal for our new business is to create a network of trained ‘Mexico lifestyle’ advisors who would contact U.S. businesses with baby boomer clientele. We want to connect those baby boomers with specialists who can help them make the right senior-living decision.”

Their idea is to address the supply and demand aspects of senior-living obstacles and they have chosen central Mexico for its climate, airline service, culture, and U.S.-style conveniences.

Along with Greg and Jane, Maureen, too, shares a long-time love for Mexico, and has kept albums of her visits through the years. Now that she is beyond talking, Greg and Jane rest assured that she is lovingly cared for in a place that was always dear to her heart, in a setting that they could never have been afforded in the United States.—IL contributor Carol Kaufman.

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