Exporting the elderly – retirement in Chiang Mai

Adrian Fleur looks at the retirement care options in Chiang Mai and why for many foreigners Chiang Mai offers better quality living in their twilight years.

By | Wed 30 Apr 2014

“All the baby boomers have grown up, grown old, and lived longer lives than their parents did before them. Populations are ageing, everywhere in the world, and there are more Alzheimer’s sufferers than ever before.” Marc Dumur’s gaze wanders over the nearly-finished elder care resort beyond the window. “In rich, developed countries, there are so many Alzheimer’s sufferers being taken care of by their families at home. But eventually, they will need professional care, and nobody wants to send their loved ones somewhere cold and clinical. This is where Vivo Bene comes in.”

We’re sitting in the makeshift office of Vivo Bene, a sprawling 36,000 square metre property with six buildings designed to house foreign “guests” (“patients” is too impersonal a term for Dumur, the facility’s general manager). When completed, Vivo Bene will house up to 60 people in six residences with 12 rooms each, all with private bathrooms and wheelchair-friendly access to the gardens. While Dumur says that the private Vivo Bene is totally Swiss-run and marketed mainly to Swiss and Germans in their respective countries, he also stresses how Thais and other nationalities are more than welcome to stay there too. The staff will be made up of a small Swiss team qualified in nursing, medicine, neuropsychology and psychiatry, while the larger Thai team will comprise of qualified nurses and assistants, meaning staff to guest ratio will easily be one-to-one. Although 24-hour care is afforded to all guests at the resort, more serious emergencies or surgeries will be attended to at Vivo Bene’s partner, Chiang Mai Ram Hospital. “In Switzerland, patients can pay around 10,000 francs (364,000 baht) a month to be taken care of, and while the healthcare is very good, patients can’t be entertained,” says Dumur.

Guests at Vivo Bene will fork out a more affordable sum, starting at 214,000 baht a month for a small villa. As Dumur points out, “The staff [in the West] just don’t have enough time to pay anyone special attention, or there are not enough staff to do so. Alzheimer’s sufferers need to be occupied and stimulated, or else they will get anxious, nervous and depressed.” Many Alzheimer’s sufferers are likely to experience other health problems due to their age, such as back pain, diabetes, arthritis, and increasingly common mental health issues like anxiety and stress. It’s not surprising that families fear the image of frosty, pill-pushing care centres, often perpetuated by tear-jerking movies where loved ones are sent to wither away on their lonesome.

Other people are afraid of more than just loneliness: the abuse and maltreatment of elders has been increasingly highlighted in the media in the last decade, although statistics are still murky at best. The American Psychological Association estimates that four million elderly Americans are victims of some form of abuse, whether they are living in private homes or retirement facilities. The World Health Organisation, which has been drawing international attention to the issue since 2002, predicts that worldwide elder maltreatment will increase as populations continue ageing. By 2025, the amount of people aged 60 and over is expected to reach a staggering 1.2 billion.

Dumur muses over the increasing cases of dementia in his home country of Switzerland, where over 20 percent of the eight million residents are over 61 years old. Switzerland’s life expectancy stands at an average of 82, meaning dementia among the elderly is extremely expensive for sufferers and their families (in the United States, it’s set to cost 203 billion dollars this year alone). This is where a niche presents itself in Thailand – affordable yet personalised adult-care retirement homes set in the North’s idyllic mountainous regions. Yet, despite the development of retirement homes in Thailand in recent years, elder care around the world still largely takes place in private homes, and most of that work goes unpaid. Even though many modern families are geographically dispersed, and decreasing in size, home-based care is still the most common form of elder care. The Alzheimer’s Association released a report in 2012 revealing that 26.5 percent of American adults are family caregivers, and three-quarters of all family caregivers are women. As our societies develop, and especially as more women work outside the home and children spend more time gaining education, a glaring need for outside elder care will emerge.

One such place to fill this need is nestled in the peaceful Mae Rim Valley: Care Resort, a retirement facility that describes itself as basically being a four-star hotel, except with required care at the press of a button. Their website proclaims, “We do not represent the view of an institutionalised nursing home,” which seems to be a common selling point for elder care homes in Thailand. The monthly cost of a stay at Care Resort begins at 37,000 baht a month, where fully-furnished studio or two-bedroom villas are offered to suit various budgets. The resort accommodates all levels of care including Alzheimer’s and dementia, with nurses and carers trained to allow guests as much independence as possible. Another local elder care facility is the Dok Kaew Gardens, on the McKean Rehabilitation Centre grounds, with rates starting as low as 30,000 baht a month for a room, along with a selection of different living facilities which cater to a range of people, from those who are semi-independent and healthy to those suffering from disabilities and debilitating diseases (including Alzheimer’s).

Couples are welcome to stay together, and exercise and regular activities are encouraged, such as trips to the mega-malls in the city or some light gardening work on their small organic vegetable farm. An attitude shared by Vivo Bene is that guests should fill their days with stimulating activities to give them not only enjoyment and a mental workout, but also a sense of purpose and a will to live (sadly, global suicide rates are highest among the elderly). At Vivo Bene, guests can make music, cook, paint, play golf, walk their pets, have a massage, or even get a haircut at the on-site barber shop. Filling their lives with the little, conventional things go a long way in reassuring older people that everything is in its right place, despite the fact that they might be living halfway across the world from their relatives.

While Thailand has been classified as “an ageing society” since 2005, Thai people still have a ways to go before their demand rises above the few privately-run elder care homes, especially since symptoms of Alzheimer’s are often viewed as normal behaviour for the elderly, such as forgetfulness, frailty or difficulty performing tasks. Also, Thailand’s overall death rate for those with Alzheimer’s and dementia is quite low (about 3.2 deaths per 100,000 people), whereas countries with highly developed economies, infrastructures and standards of living are seeing a rise in deaths from dementia-related diseases, therefore increasing demand for care.

Finland’s death rate is the highest at 34.9 per 100,000 people, followed by Iceland, United States, Sweden, Netherlands and Switzerland. The bigger picture shows that the global average mortality rate jumped from 59 years old to 70 between the years 1990 and 2010, but, ironically, living longer isn’t entirely positive for us as individuals or as societies. It means we suffer through disease, depression and disabilities for many more years than ever before, and the financial, emotional and environmental costs are beginning to soar. Today, only 25 state-sponsored retirement or elder care homes exist in Thailand, yet the UN-backed AgeWatch Index 2013 (which ranks countries based on factors regarding the elderly, namely: income security, health status, employment/education and enabling environment) ranked Thailand an encouraging 42 out of 91 countries, beating fellow ASEAN members including the Philippines and Vietnam, as well as other more developed countries like South Korea.

The elderly of Thailand aren’t scrambling to check into nursing homes, but it’s not just the Kingdom that lacks an interest. Most of Asia tends to follow the more traditional methods of elder care, such as having young relatives take care of their elders, or grandparents living with wedded couples and their children. Dumur, who himself is part of a Thai family and has helped take care of his parents-in-law, says he has found Thailand to be more respectful of the elderly compared to other countries where they are shunned from the public eye, regarded as an annoyance, or simply not taken seriously because they’re viewed as “useless.” “Here, it’s instilled in the children to respect their elderly. They cook and clean for their gran and grandpa and always trust what their elders say,” Dumur observes. “Families take care of one another here, just because that’s how it’s always been; that’s what’s expected of you. That’s probably why so many people can’t fathom sending a relative away – they are imagining sending someone away to go and die alone.” Dumur ends our conversation with a bit of self-reflection about ageing: “As you become older yourself, and your parents get ill or die, you begin to look at your own mortality. I was a hotelier all my life, and as fun and rewarding as that was, it didn’t leave me any time for myself – it consumed me. That’s why I’m running Vivo Bene; I want my guests to feel happy with their lives here. My father is 94 years old, and happy. Isn’t that the goal at the end of it all?”