Americans have been retiring abroad for years, but going abroad for long-term care is relatively new. One of the pioneers was Bob Preston, a retired CPA and actuary in Sarasota, Fla.
For $3,500 a month, Preston rented a home in Costa Rica for his ailing father a decade ago, shared with two other patients. The price included a supervising nurse, three aides, a care coordinator and a chauffeur.
"We had tried everything in this country," Preston says, such as an assisted-living facility that cost $8,000 a month, including private help. He was frustrated by the lack of attention being paid to his father, the retired chief financial officer of a large pharmaceutical company.
For less than half that amount, his father was able to live in relative luxury in Costa Rica. He attended church on Sundays, took a group to brunch afterward and went out to dinner several times a week.
The arrangement lasted for three years, until Preston's father died in 2001. Preston says that even including his monthly visits, the costs were much lower than long-term care would have cost in Florida. The flight from Connecticut, where he lived, took four hours and 20 minutes, just an hour and 20 minutes more than flying to Florida.
Preston concedes that he had qualms at first. For the first month, he hired a bilingual caregiver from the United States to be on the scene. He checked every reference he could. He contracted with a local secretary to pop in unannounced.
It worked so well that he was making plans for his mother, long divorced from his father, to go there after she suffered a broken hip last year. "We tried a nursing home for six weeks in a five-star place," he says. "But she disliked it." His mother died in February, at age 92, while he was planning the move.
One of Preston's friends followed his lead, moving her mother to Costa Rica, where she lived until she died.
Yes, in my backyard
Many older people want to be with their families when they start to need help with daily living. But disagreements about where to set the thermostat, TV volumes and curfews for teenage grandchildren can make life difficult.
For such families, several companies are developing cottages that either an older adult or an adult child could use as separate living quarters in the other's backyard. Ken Dupin, a minister in Salem, Va., developed so-called MedCottages with help from Virginia Tech researchers after studying family-managed care in other countries.
A MedCottage, which costs about $85,000, has a 12-by-24-foot living area with a handicapped-accessible bathroom, kitchen, hospital bed and living area, and is outfitted so that the person living there can be monitored online.
One of the bigger challenges: getting building permits. Dupin's company, N2Care, and its distributor worked to get a Virginia law passed two years ago that stops local governments from keeping out the structures as long as the family has a doctor's prescription and meets lot requirements, he says. Now, several more states have approved or are considering similar statutes.
Socorrito Baez-Page, a doctor who has spent a number of years caring for her elderly parents in Fairfax County, Va., has been working through the permit process to install a MedCottage for her 86-year-old mother. Her mother has been living in her home since January, but has trouble getting up stairs to bathe.
"Having a cottage in the backyard will help," Dr. Baez-Page says. "There will be a little bit of definition between here and there."
These arrangements, which originated in Denmark decades ago, were designed for anybody interested in living communally. In a cohousing development, residents live in private homes but share a central "common house" with a kitchen and other facilities.
Now, "senior" cohousing is starting to catch on as well, with four such projects already built in the United States and many more expected to follow. (You can find them at seniorcohousing.com). By 2020, there should be at least one cohousing community in every metro area, or 235 developments, and about one-third are expected to serve older adults specifically, says Charles Durrett, a Nevada City, Calif., architect who is promoting the concept.
ElderSpirit Community in Abingdon, Va., one such community, was built in 2005 and features 29 cluster homes and apartments with prices in the $160,000 range. Founded by former nuns, it is nestled in a high valley between two mountain ranges and along the Virginia Creeper Trail, a 34-mile-long path that offers a place to walk or bike.
Richard and Linda Brumleve, a retired English teacher and a research analyst, moved in five years ago, drawn by the focus on spirituality and the beautiful scenery. After Brumleve, 73, was diagnosed three years ago with Parkinson's disease, they decided to stay. He can still go fly-fishing along the shore, and he paints in an artist's studio on the common house's second floor, reachable by elevator.
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