Care overseas

[Davidb1973]

3 years since my Mums diagnosis I am exhausted, Mum has me and a carer 4 days a week for 4 hours. She can't make a cup of tea, eat properly, switching on the tv and changing channel is a chore, she can't bathe herself and the toilet is now becoming an issue, she spends the evening watching tv and often gets up and opens the front door looks out and then closies it (sometimes). She has no understanding of time and sometimes will be up at 8am, sometimes I get there from work and she is still in bed at 6pm

I have looked an a number of care homes overseas (Thailand) who have daily activities including 10am easy exercise (when I was there there were 15 residents and 10 carers), trips to the zoo, shopping trips, art classes,Tai, chi..... every day at least 3 activities daily. She used to swim daily and they can facilitate that, and food is essentially what I choose for her. Breakfast is served from 8am and can be anything from porridge to bacon and eggs, all residents are also served with a selection of fresh fruits.

I am looking at the pros and cons of the option, as I can see the options are

1. Stay as is, until she has an accident and social services get involved and force my hand
2. Get another carer or two to ensure she is safe- the money will run out and then its a state run home
3. uk care home
4. Thai care home with fabulous facilities, it used to be a resort

She has no friends that visit, she has 4 sisters 1 of whom has visited twice in 3 years, and by the way we are in the UK (not sure if this site is international). 3 years ago Mum went to the gym and swam daily and having worked overseas and been to Thailand many times and being able to swim again and enjoy the good weather I think that is best. I have spoken to her sisters who initially agreed, but 2 are now questioning it (to be frank, their involvement would be more relevant if they had bothered visiting), my one brother overseas who I pleaded with to call more often when Mum was not right 3 years ago and he barely called was offended by the idea and advised it would make it more difficult for him to visit, so that tells you about him

Has anyone any experience of overseas homes, that can offer advice. In absolute honesty I am struggling to cope, having regular panic attacks and have gone from full time to part time work. I have just visited Thailand and seen 10 different homes in 3 provinces and if this is the option I choose I know where which one I would choose. When I say visited, I had a 2hour initial visit and then returned from 7am to 1pm a few days later, I was invited to attend during breakfast and be present int eh exercise area and was given the freedom to walk around which I did and indeed spoke to a number of residents. Mum had a replacement carer a few weeks back as the usual one was ill, and she took to her within minutes, so I can't see settling in to be an issue
Am not sure what sort of reply I am expecting, ideally people with experience of an overseas home or maybe to be called a monster. I do think I have considered all options but welcome your thoughts. By the way, if she didn't settle we would come back,
Thanks

 

[canary]

Hello @Davidb1973

Well, on paper it sounds lovely, doesnt it and I can see why the facilities have dazzled you. I wonder what the reality is for people with advanced dementia?

I remember when mum moved into a care home. I had been looking at lots of care homes and some at the top end of the scale seemed wonderful. However, mum was taken into hospital with a TIA and afterwards was placed in a care home for 6 weeks reablement. It was a complete eye opener. The home she was in was one I had previously rejected because it was scruffy, old fashioned and had no facilities. However, I discovered that the care was wonderful. It was exactly what mum needed and she was happy there.

There are lots of things to think about and I want to throw out some questions

Are the carers trained in dementia care? A dementia home in UK has carers who are trained in dementia care and have experience.
How do they deal with incontinence, aggression, resistance to personal care and mobility problems? Many of the more upmarket homes in UK cannot deal with this and will give notice. Will this home in Thailand do the same, or will they resort to a "chemical cosh" (high doses of sedatives) to keep them docile?
What medical facilities are available? Mum was taken to hospital quite a lot during the time she was in her care home - she had a stroke, pneumonia requiring IV antibiotics, had a cataract removed and fractured her hip. All of these needed hospital treatment. Would they be available and how would this be paid for? Do they have mobility equipment available or would you be expected to provide zimmer frames, wheelchairs, hoists and other equipment? What happens about incontinence supplies?
Is the care home secure? How easy would it be to escape?
Would she really use all these wonderful facilities? Just because she would have once enjoyed them doesnt mean that she still will. Dementia changes things.
How do they deal with End of Life? Do they have a protocol for making sure that she would be kept pain free and comfortable?

And most importantly of all - how often will you be able to visit? Im getting the impression that visits will be very few and far between. Visits are important. They are important for the person with dementia, but they are also important for the family. One of the reasons for visiting is to make sure that your relative is being cared for properly. In UK, care homes are regulated and are regularly inspected by the CQC and you can read their reports. Are there similar regulations in Thailand? Here you can talk to the staff and make sure that there are no problems. If problems do arise (and believe me, they do) you can draw them to the managers attention and can make sure that they are properly resolved. You cannot just leave them there and trust that all is well.

If you cannot get there easily what will happen if there is an emergency or when she reaches end of life? You may well find that you need to go backwards and forwards there quite a lot.

Sorry about the length of this reply, but there is far far more than just the facilities to think about. I dont think you will get many replies from other people who have actually done this - I dont actually know of any other member who has.

 

[Jessbow]

Why? Why go so far?
Why do you attach so very importance on doing such as swimming? Seems an unusual'want' for a person with dementia- most of us struggle to get our loved ones into a bath! Does she even rememberhow to swim? How old is she?

In most dementia cases, the surroundings and 'what is on offer' become irrelevent - its the actual physical caring that matters- how will your mother cope with the native language?
its all very well to say ''we'll come back if it doesnt work out''- You then hve to settle her all over again

 

[Davidb1973]

Firstly, thanks for your reply
Are the carers trained in dementia care? A dementia home in UK has carers who are trained in dementia care and have experience.
They are experienced, they have other dementia residents, and the owner actually set it up for his mother to attend. They also have an advanced dementia block, which consists of 6 residences and a 24 hour nurse station alongside the main nurses station.

How do they deal with incontinence, aggression, resistance to personal care and mobility problems? Many of the more upmarket homes in UK cannot deal with this and will give notice. Will this home in Thailand do the same, or will they resort to a "chemical cosh" (high doses of sedatives) to keep them docile?
I really do not know about aggression and resistance to personal care. Mums regular carer was of for a while and she was fine with the new one. On my second trip some people walked to the breakfast area, some on frames where escorted, a gentleman in a wheelchair was brought there in what is best described as a 6 seater electric golf buggy..

What medical facilities are available? Mum was taken to hospital quite a lot during the time she was in her care home - she had a stroke, pneumonia requiring IV antibiotics, had a cataract removed and fractured her hip.
The Hospitals there are world class and they have already given indicative costing for common incidents

Do they have mobility equipment available or would you be expected to provide zimmer frames, wheelchairs, hoists and other equipment? What happens about incontinence supplies?
Equipment provided, consumables are chargeable and are a standard supermarket line in Thailand

Is the care home secure? How easy would it be to escape?
It is in effect a resort with a secure entrance.

Would she really use all these wonderful facilities? Just because she would have once enjoyed them doesnt mean that she still will. Dementia changes things.
Who knows? How can anyone know I asked her about swimming and she said she misses it. She did say she gets bored in a big house on her own

How do they deal with End of Life? Do they have a protocol for making sure that she would be kept pain free and comfortable?
Another question for me to ask, thank you for your thoughts and time you have clearly put into this. I want to ensure her last years are enjoyable, and will never know unless we try. I spoke to an English guy there (90% of residents are from the UK or other English speaking countries). he advised me his neighbours wife had dementia, he had tried a home in the UK and Portugal but was dissatisfied, he told me they had been there for 2 0r 4 weeks (want recall) and after 4 days his wife was in the pool with 4 carers and the change in her was immeasurable.
Thanks once again

 

[Davidb1973]

Why? Why go so far?
Why do you attach so very importance on doing such as swimming? Seems an unusual'want' for a person with dementia- most of us struggle to get our loved ones into a bath! Does she even rememberhow to swim? How old is she?

In most dementia cases, the surroundings and 'what is on offer' become irrelevent - its the actual physical caring that matters- how will your mother cope with the native language?
its all very well to say ''we'll come back if it doesnt work out''- You then hve to settle her all over again

Why
Why a home? why Thailand? A home for as much stimulation as possible and daily activities which it impossible or perhaps inpracticle to do here, and to have 24 hour support
Why Thailand
She has been many times. I used to live here and plan to return if it all works out., but in the meantime they have agreed a 4 month sabbatical.. Also there is an imbedded respect for the elderly in Thailand, I know ithe country and culture as does/did Mum and can't visit care facilities worldwide. During the exercise session 15 residents attended there where 10 carers also in attendance, on my second visit to the home I watched listened and made extensive note, one thing that surprised me was their attention they gave to the residents, in the 5-6 hours I was there I saw only one member of staff using her phone

Importance of swimming?
She used to swim daily, it is something she found enjoyable and have no reason to assume she wouldn't. She needs support bathing and it has never been an issue or something she resists. I appreciate your reply but does she remember how to swim? I really do not know, I really do not know how anyone can know or otherwise, I don't think you have to know/remember how to swim to enjoy the feeling of being in a warm pool. She is 81

Language
With 90% of residents speaking English you can take it as a given the staff speak English, yes of varying degrees

''we'll come back if it doesnt work out''

I am racking my mind wanting to do the best for Mum. My fear is social services may at some point take the decision away from us. There are lots of what if's but it may work out (of course I hope and expect it to), In my mind I am thinking what if we don't try it and she misses out on the possibility of a better more fulfilled life. What if she falls over today and has to go a home at short notice and this opportunity is taken from her.

I appreciate your reply. I do feel the easy decision would be to go to a home in the UK but I believe I am thinking outside the box and trying to find what I am many others believe are better alternatives.
Thank You

 

[Jessbow]

I really do not know about aggression and resistance to personal care. Mums regular carer was of for a while and she was fine with the new one

that is a question you really do need to ask then. Also ask what constiutes agression and non co-operation - how far will they go? resistance to personal car is somethingso many of us have to deal with - if you have met no resistance so far, you are lucky!

Is the care home secure? How easy would it be to escape?
it might be within a compound type area, but is the gate hut and locked?What would happen if she wandered off, and wandered off towards the sea to swim? Could be ctastrophic.
Many care home residnts are subject to a DOL's order here- if someone goes walk bout, they can be returned to the care home, even undr protest. Can the same be said in Thialand?

How do they deal with incontinence, aggression, resistance to personal care and mobility problems? Many of the more upmarket homes in UK cannot deal with this and will give notice.
A dementia home will have strategies and plans that they will execute long before they give notice.
I agree that many upmarket homes are not dementia suitable....but them dementia often doesnt suit 'upmarket' as a solution. They are more suited to the elderly frail & not the mentally impaired.

you mention carers- what lead you to engage carers in the first place? How far along is your mother?

 

[Davidb1973]

I really do not know about aggression and resistance to personal care. Mums regular carer was of for a while and she was fine with the new one

that is a question you really do need to ask then. Also ask what constiutes agression and non co-operation - how far will they go? resistance to personal car is somethingso many of us have to deal with - if you have met no resistance so far, you are lucky!

Is the care home secure? How easy would it be to escape?
it might be within a compound type area, but is the gate hut and locked?What would happen if she wandered off, and wandered off towards the sea to swim? Could be ctastrophic.
Many care home residnts are subject to a DOL's order here- if someone goes walk bout, they can be returned to the care home, even undr protest. Can the same be said in Thialand?

How do they deal with incontinence, aggression, resistance to personal care and mobility problems? Many of the more upmarket homes in UK cannot deal with this and will give notice.
A dementia home will have strategies and plans that they will execute long before they give notice.
I agree that many upmarket homes are not dementia suitable....but them dementia often doesnt suit 'upmarket' as a solution. They are more suited to the elderly frail & not the mentally impaired.

you mention carers- what lead you to engage carers in the first place? How far along is your mother?

 

[Davidb1973]

A quick reply to your last point the rest I need time to absorb. It started with her having difficulties in reading and progressed to amongst other things forgetting how to make a cup of tea, how to microwave a meal, how to use cutlery, not remembering her address DOB, being unable to use a phone , place the receiver on the phone base, rubbish in the washing machine, clothes in the dishwasher, a burnt plate on the stove.... Thanks again I do appreciate all input

 

[Violet Jane]

Does anyone have powers of attorney for your mother (there are two types)? The health and welfare one only comes into play (I believe) if the donor has lost capacity in relation to a decision of the type covered by the power. With the finance one it depends on what the document says. However, even with a health power if there is a dispute in the family about whether your mother should move abroad it's likely that Social Services would get involved and arrange a Best Interests meeting.

 

[Bod]

A question regarding language.
Your mothers english accent, home counties, Yorkshire, Norfolk, geordie, weak or strong accent?
Bearing in mind the Thai english will be American english(which isn't the Kings english!) will there be misunderstandings as her speech reverts to coquial english, with a strong regional accent. Which will be very "foreign" to the Thai staff.

Bod

 

[Davidb1973]

A question regarding language.
Your mothers english accent, home counties, Yorkshire, Norfolk, geordie, weak or strong accent?
Bearing in mind the Thai english will be American english(which isn't the Kings english!) will there be misunderstandings as her speech reverts to coquial english, with a strong regional accent. Which will be very "foreign" to the Thai staff.

Bod

She speaks clear English with minimal accent, so I can't see that being an issue

Does anyone have powers of attorney for your mother (there are two types)? The health and welfare one only comes into play (I believe) if the donor has lost capacity in relation to a decision of the type covered by the power. With the finance one it depends on what the document says. However, even with a health power if there is a dispute in the family about whether your mother should move abroad it's likely that Social Services would get involved and arrange a Best Interests meeting.

I Have Power of Attorney for health and finance. To be absolutely honest, I can't see anyone in the family formally disputing any decision, I could be wrong but given she has 4 sisters and 1 other Son and has been visited twice by one sister since the diagnosis, I really question if anyone else really cares.
Re Language. She speaks clearly with minimal accent, however I made her a drink last night and asked if she wanted ice with it and she didn't understand, there will be issues, but there are now. I lived in Thailand for 5 years about 10 years ago and from my experience American English is certainly not dominant

 

[Jessbow]

What happens when your money runs out in Thailand?

 

[Lawson58]

Nobody thinks you are a monster for wanting to do the best for your mother.

However, I think you have actually decided that moving her to Thailand is what you are going to do anyway. I think you are trying to rationalise it, perhaps to justify making the decision on your own.

Thailand along with China has a rapidly growing aging population and with the money currently being invested in care homes by international companies, you might find that things may not stay as cheap as they are now. Once the bottom line of profitability comes into play, change is inevitable. That many of the newer homes are going upmarket is a sign of the times.

There also appears to be some resistance by the Thai government about dementia patients and visas with hefty deposits required for people to stay. Of course, there will always be ways around that if you know the right someone who might be helpful. Reviews of care homes in Thailand vary just as much as they do in UK, the good the bad and the downright ugly.

You asked for advice and people on Talking Point have combined hundreds of years of experience about dementia and how it progresses. I am sorry that you don’t seem to be inclined to heed that advice.

 

[Bod]

Would any British Power of Attorney have any validity abroard, or would you need to apply for the Thai version?

Bod

 

[Davidb1973]

What happens when your money runs out in Thailand?

Based on personal finances providing she doesn't need half a million pounds of medical procedures it will not

 

[Violet Jane]

A couple of things concern me. Firstly, will anyone visit your mother? Apart from visits directly benefitting your mother it’s really important that a care home knows that someone is keeping an eye on things. Do you have helpful and trusted friends who could visit your mother at least once a fortnight and report back? Secondly, if, for some reason, you want to bring your mother back to the UK and she’s in a poor state you may find it difficult to persuade a commercial airline to allow her to fly.

I think that you’d probably need to go over to Thailand for a couple of months to settle your mother in and deal with the inevitable teething problems,

 

[Davidb1973]

Would any British Power of Attorney have any validity abroard, or would you need to apply for the Thai version?

Bod

not sure, I will find out thanks

Nobody thinks you are a monster for wanting to do the best for your mother.

However, I think you have actually decided that moving her to Thailand is what you are going to do anyway. I think you are trying to rationalise it, perhaps to justify making the decision on your own.

Thailand along with China has a rapidly growing aging population and with the money currently being invested in care homes by international companies, you might find that things may not stay as cheap as they are now. Once the bottom line of profitability comes into play, change is inevitable. That many of the newer homes are going upmarket is a sign of the times.

There also appears to be some resistance by the Thai government about dementia patients and visas with hefty deposits required for people to stay. Of course, there will always be ways around that if you know the right someone who might be helpful. Reviews of care homes in Thailand vary just as much as they do in UK, the good the bad and the downright ugly.

You asked for advice and people on Talking Point have combined hundreds of years of experience about dementia and how it progresses. I am sorry that you don’t seem to be inclined to heed that advice.

Not sure what resistance from the Thai authorities you are referring to. They have in my opinion a correct requirement for anyone retiring (over 50 years old I think) there to have a certain income or to have at least equivalent of around £20,000 in a Thai bank account.
Its not so cheap and after paying for prescription medicines and losing attendance allowance it is only marginally cheaper. Property and indeed land is very cheap in Chiang Mai and plentiful. You can rent an apartment in with pool, gym, a/c.... in Bangkok for under £200 pm, but cheaper in Chiang Mai this has changed very little in the last 10 years or so, so whilst prices will no doubt increase there is a great deal of competition at present, Of the homes I saw one had 20 residents with a capacity of 70, one in Phuket is currently building a new home in Chiang Mai and the preferred one I have seen has 50 residents with a capacity for 70 and are expanding, so more supply than demand as I can see.
I really do not understand your comment regarding not seeming inclined to heed the advice. Points have been raised and I have thanked posters and advised I will find out and am in the process of getting answers for many of the points raised.

In the last hour Mum (I do have cameras in the porch and driveway and rear garden) has opened the porch door looked out and gone back inside 5 times. It would be far far easier to get some additional support to enable her to stay at home, or indeed use a UK care home, that's the easy call, doing something a little different to try to ensure Mum is in what I believe to be the best possible environment, fantastic facilities, daily activities and a lovely climate (she loves the Sunshine) that is the hard decision, and no decision has been made
Thank you

 

[Davidb1973]

A couple of things concern me. Firstly, will anyone visit your mother? Apart from visits directly benefitting your mother it’s really important that a care home knows that someone is keeping an eye on things. Do you have helpful and trusted friends who could visit your mother at least once a fortnight and report back? Secondly, if, for some reason, you want to bring your mother back to the UK and she’s in a poor state you may find it difficult to persuade a commercial airline to allow her to fly.

I think that you’d probably need to go over to Thailand for a couple of months to settle your mother in and deal with the inevitable teething problems,

Thanks,
I do think I have already mentioned that work have agreed a 3-6 month sabbatical in order to do exactly what you state. I do have trusted friends there but nobody Mum knows or remembers, that said there is a particular friend who I would trust with my life and she has experience of care so I will speak to her about this. Reflecting on what you say there would be no reason why I couldn't pop over at least once a month until we move there permanently which will happen within 18 months or so Mum still takes to people very quickly and very easily. I have looked at medical evacuation companies should she need to return and a commercially airline was not suitable and am comfortable with the indicative pricing I have been quoted.
Thanks for your input

 

[canary]

It sounds to me as though you have considered this very carefully and I am considerably heartened to hear that you will be moving there permanently - although a lot can happen in 18 months. I had a horrible feeling that you intended to move her there and simply trust that they would look after her.

If you do go ahead with this please, please can you feed back to let us know how it went and what happened. We have had a couple of people come on here saying that they are thinking of doing this, but then never came back to let us know if they did, and if so, what happened.

 

[Scarlet Lady]

Hi, @Davidb1973. You clearly know more than most of us about life in Thailand. Most of the questions that have been asked of you on the forum have been slanted towards life within the care system in the U.K, because that’s what most of us know. However, perhaps we need to understand that we most certainly do not hold the gold standard for care and it’s utterly presumptuous of us to assume we can do better than other countries. It may well be that the Thai care home you’ve been looking at will fulfil your mum‘s needs far better than the U.K. could.
All you can do is try, if that’s the decision you make. If so, as Canary has said, please let us know how it goes.