as the expats get older or retiries head south

KeithF

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Just out of curiosity, what plans do the existing ex-pats have for when they reach a point in time where they need more support due to their age? Are there any 'first world' quality nursing/residential homes available or will you be heading back to Europe, Canada or the US? Is there a sizeable group of people for whom this is becoming a reality yet? My guess is that most of the 'first wave' of ex-pats are in their 50's & 60's so probably too healthy to be worried right now?

Secondly, for people who are considering retiring to DR, especially from the US & Canada, do you have insurance that covers you for nursing home fees when you need it and would that cover you if you chose to stay in DR for the rest of your days or would you have to return to make use of it?

I'm just trying to 'second guess' how the demographic is heading for the 'silver surfer' brigade.
 

Caren M.

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Jan 27, 2006
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Good question. I'm curious too. Most of the people I know are still maintaining residences and insurance in the states or Canada or Europe. But that may not be financially possible for everyone. And I honestly don't know if traditional long term care insurance covers you out of the country.
 

Don Juan

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Dec 5, 2003
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"Golden" opportunity.

For an enterprising person to cash in on the many retirees who will eventually be in need of nursing-home care.
My understanding is that there are few, if any, quality providers in DR. I'm guessing that most or all expats who reach that point in life, reluctantly return to their countries of origin for lack of these facilities there.

If insurance from their home countries were to cover their care, the expenses involved for such in DR may be much less and therefore very attractive to many who'd want to live out their golden years in paradise.

For this type of business, (there are so many, here in Maryland), to become a reality, quality medical care, to mention just one aspect, must become available at all times and facilities must resemble resort hotels.

There are big bucks to be made in this field. I'm surprise no one has made the effort to get one going. Por que sera eso?
 

jaguarbob

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Mar 2, 2004
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as xpats get older

my dominican family will take care of me until the end...no need to go back anywhere,
bob
 

Lambada

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I'm guessing that most or all expats who reach that point in life, reluctantly return to their countries of origin for lack of these facilities there.

I've known of some who got really unwell, were almost forcibly repatriated by their concerned children & died very soon afterwards. I'm lucky in that I don't have any children who will do this...............:)

I have a UK medical policy but it does not cover for long term care only long term hospitalisation. In any event our plans are to care for each other as long as we can & when we become unable to do so we will employ live-in Dominican assistance from a family we have known for years. The house has been built with that in mind. I have also asked my doctor not to resuscitate should I have a stroke leading to the type of brain damage which would render me mentally incapable. Physical deterioration I (& my other half) will cope with. Mental deterioration I would rather not experience.

There are old peoples homes here but they are vastly under resourced despite having caring staff. I would agree that there is a business opportunity for the enterprising in providing quality care for the elderly. I'm just none too sure that I would want to spend my final days in a 'gringo' old folks home :ermm: - if it had Dominican residents as well, then maybe......... but the plan is to be cared for in my own home & to be taken out of it in a wooden box. Haven't designed the box yet though...............:)
 

Don Juan

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Dec 5, 2003
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Fashionable expats.

Haven't designed the box yet though...............

Maybe Oscar De La Renta can begin a new line of designer's caskets for the "downwardly mobile".
 

abe

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Jan 2, 2002
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There has been some political pressure, although not much, to change US government policies about federal medical insurance so ex-pats could use it to pay for services outside of the US. One argument put forth on some of the Central America ex-pat web communities is that it will create health care jobs in those countries and contribute to a reduction in the flight to the US by illegal immigrants. I doubt the numbers are big enough to justify that, but it does seem unfair that Medicaid is not available to Americans who choose to live outside the US in their old age.

As for nursing care with US standards (Canadian, European, etc.), don't hold your breath. I think the posters who have explained that they have created good extended DR families who will care for them have the right idea. However, the reality is that there are plenty of retirees in the DR who have come here for the very reason that they don't have the luxury of extended families. This is the demographic segment that is going to have trouble here or in other ex-pat retirement destinations--their old age is going to be difficult.

What is their fate? As they become more dependent on the kindness of strangers, they will surely become more vulnerable to the darkest impulses of those who would take advantage of them. This is a little scary.
 

Ken

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Jan 1, 2002
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Based on what I have read about nursing home care in the US, unless maybe you have a lot more money than we have, spending my last days in one of those places does not appeal to me.

People in the DR are accustomed to taking care of the elderly at home. Consequently, it is possible to employ people to work in your home who have had experience. This includes registered nurses.

Our present plan is to go that route, and cremation at the end. No designer boxes for us.
 
May 12, 2005
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I certainly think there is an untapped market for aging ex-pats/retirees in the DR. Here in the US senior housing called assisted living is taking off bigtime. Basically it is individual apartments in a nursing home type setting. There are community dining and recreation areas. And of course it has it's own medical facilities and 24 hour nursing available. I can certainly see the potential for that in the DR. I beleive in the future as medical costs and medicare budgets rise, the US gov't will start to allow overseas residents to use their benefits in another country as a way to lessen the cost of these programs due to the lesser cost of medical care inj most other nations. I can also see a development of this type brining in american educated/trained doctors and nurses to staff these facilities.
 

Chris

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Oct 21, 2002
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Based on what I have read about nursing home care in the US, unless maybe you have a lot more money than we have, spending my last days in one of those places does not appeal to me.

People in the DR are accustomed to taking care of the elderly at home. Consequently, it is possible to employ people to work in your home who have had experience. This includes registered nurses.

Perhaps our experience will help someone to make plans. We are currently supporting a very old and greatly loved relative who is in an assisted living facility in the US. He did well throughout his life and can afford good care. Even then it is very expensive. Monthly rent is US$3,000, including a main meal per day and the apartment is going back to the assisted living facility after death. Then, utilities .. on top of that the other two meals and on top of that any medication, nursing care or cleaning and laundry required.

The piece of the care that is missing though, is the personal touch. We found that it is not possible to leave stuff like paying bills (medicare stuff is a nightmare to reconcile) and taxes and making daily life decisions to care givers. Although our old relative still has a good mind, he is now blind and cannot see to make decisions about his affairs. Being old, there is also a matter of who to trust to write your checks - and in this case, sign the checks. Simple stuff becomes problematic... like buying a new chair to sit on 'cause the old one is broken, arranging for books on tape, getting the walker adjusted for height and oiled because it squeeks, purchasing some little thing that the assisted living facility does not have on hand, or cleaning out the fridge. Simple things but things that determine quality of life.

This experience is truly teaching me a few lessons and has made us adjust our plans for our old age.

My old relative is still quite with-it but he does wonder why he could still be alive? He did not plan on having such a long life for sure and the physical deterioration is hard to deal with for a proud and highly educated man. The medical care in the US is also very different, for example, he has a pace maker. In my mind, it is almost criminal to fit a very old person with a pace maker. Especially one that is ready to move on and out of this life. There is a feeling of a medical system that functions on taking the life savings of the old person away from them. We've had to deal with a dentist that would like to give him a new set of implanted teeth, an eye doctor that wants to operate on the off chance that 5% of eyesight can be restored, another internist or something that wants to do something about incontinence and so on and so on.

The issues around the 'no resuscitation' paperwork are also complex and legally fraught with difficulty.

We're fortunate that we discuss life and death without a problem and had a good laugh a few days ago... he was talking again that he does not understand why he still is in life and a joke came up ... skip the next pacemaker service call! I think he is going to do just that.

Seems to me that there is very little left of the idea of growing old and dying with some dignity, normally and surrounded by loving people.
 
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RonS

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Oct 18, 2004
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As a very practical matter, does anyone know what the process is that needs to be implemented to change government policy to permit ex-pats to use thier federal medical insurance/Medicad in the DR?
 

sweetdbt

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Sep 17, 2004
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As I understand it, overseas medical facilities and providers who wish to be eligible for Medicare reinbursement must go through an accreditation process. I had read somewhere that the new medical facility in Santiago was going to try for this.

Medicaid is not insurance, but a program for the indigent, which is jointly paid for by the feds and the state you live in. I am not aware of any set of circumstances under which it would pay for expenses of someone living overseas.
 

Ken

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Jan 1, 2002
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This experience is truly teaching me a few lessons and has made us adjust our plans for our old age.

Sounds like the doctors that deal with these patients consider them cash cows. Imagine, wanting to put implants in the mouth of a man near the end of his life.

I would be interested in what you and Richard have decided for yourselves as a result of this experience.
 

whirleybird

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Feb 27, 2006
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Based on what I have read about nursing home care in the US, unless maybe you have a lot more money than we have, spending my last days in one of those places does not appeal to me.

People in the DR are accustomed to taking care of the elderly at home. Consequently, it is possible to employ people to work in your home who have had experience. This includes registered nurses.

Our present plan is to go that route, and cremation at the end. No designer boxes for us.


So, I assume from what you say Ken, that cremation is available here.... I have not heard or seen of any evidence of it yet but would be interested to learn (for future planning of course!)
 
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pyratt

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Jan 14, 2007
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I guess when the times right I'll eat a handful of Lepela(?) and find Dominicana to send me outta here with a smile on my face
 

Hillbilly

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Jan 1, 2002
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There are exceedingly few facilities to provide long term care for the aged, and even fewer that care for the aged and infirm.

Dominicans rely on family.

The idea of such an institution was first brought to my attention over 25 years ago by my step sister, and the more we looked at it the better it looked. It could be a major cash cow without being abusive to anyone's pocketbook.

Might be a good idea, if there are any real investors out there.

And yes, there are ties to US Medicare available, at least that is what is happening with HOMS, in Santiago.

HB
 

Celt202

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May 22, 2004
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Suicide by chopa

If you have an incurable condition get a barrio girlfriend and tell her she's the beneficiary of a hefty life insurance policy. :paranoid: