An Alzheimer patient from Switzerland, walks with a Thai caretaker
during a tour at a Buddhist temple in Chiang Mai province, northern Thailand.
Pic: AP.
CHIANG MAI, Thailand (AP) — Residents of this facility for people with Alzheimer’s disease toss
around a yellow ball and laugh under a cascade of water with their caregivers,
in a swimming pool ringed by palm trees and wind chimes. Susanna Kuratli, once
a painter of delicate oils, swims a lap and smiles.
Watching is her husband, Ulrich, who has a
heart-rending decision: to leave his wife of 41 years in this facility 9,000
kilometers (5,600 miles) from home, or to bring her back to Switzerland.
Their homeland treats the elderly as well as any
nation on Earth, but Ulrich Kuratli says the care here in northern Thailand is
not only less expensive but more personal. In Switzerland, “You have a cold,
old lady who gives you pills and tells you to go to bed,” he says.
Kuratli and his three grown children have given
themselves six months to decide while the retired software developer lives
alongside his 65-year-old wife in Baan Kamlangchay — “Home for Care from the Heart.”
Patients live in individual houses within a Thai community, are taken to local
markets, temples and restaurants, each with three caretakers working in
rotation to provide personal around-the-clock care. The monthly $3,800 cost is
a third of what basic institutional care would come to in Switzerland.
Kuratli is not yet sure how he’ll care for Susanna,
who used to produce a popular annual calendar of her paintings. But he’s
leaning toward keeping her in Thailand, possibly for the rest of her life.
“Sometimes I am jealous. My wife won’t take my hand
but when her Thai carer takes it, she is calm. She seems to be happy,” he says.
“When she sees me she starts to cry. Maybe she remembers how we were and
understands, but can no longer find the words.”
Spouses and relatives in Western nations are
increasingly confronting Kuratli’s dilemma as the number of Alzheimer’s
patients and costs rise, and the supply of qualified nurses and facilities
struggles to keep up. Faraway countries are offering cheaper, and to some minds
better, care for those suffering from the irreversible loss of memory.
The nascent trend is unnerving to some experts who say
uprooting people with Alzheimer’s will add to their sense of displacement and
anxiety, though others say quality of care is more important than location.
There’s also some general uneasiness over the idea of sending ailing elderly
people abroad: The German press has branded it “gerontological colonialism.”
Germany is already sending several thousand sufferers,
as well as the aged and otherwise ill, to Eastern Europe, Spain, Greece and
Ukraine. Patients are even moving from Switzerland, which was ranked No. 1 in
health care for the elderly this year in an index compiled by the elderly
advocacy group HelpAge International and the U.N. Population Fund.
The Philippines is offering Americans care for $1,500
to $3,500 a month — as compared to $6,900 the American Elder Care Research
Organization says is the average monthly bill for a private room in a skilled
nursing U.S. facility. About 100 Americans are currently seeking care in the
Philippines but more facilities are being built and a marketing campaign will
be launched in 2014, says J.J. Reyes, who is planning a retirement community
near Manila.
Facilities in Thailand also are preparing to attract
more Alzheimer’s sufferers. In Chiang Mai, a pleasant city ringed by mountains,
Baan Kamlangchay will be followed by a $10 million, holiday-like home scheduled
to open before mid-2014. Also on the way is a small Alzheimer’s unit within a
retirement community set on the grounds of a former four-star resort. With
Thailand seeking to strengthen its already leading position as a medical
tourism and retirement destination, similar projects are likely.
The number of people over 60 worldwide is set to more
than triple between 2000 and 2050 to 2 billion, according to the World Health
Organization. And more are opting for retirement in lower-cost countries.
“Medical tourism” has become a booming industry, with
roughly 8 million people of all ages seeking treatment abroad annually,
according to the group Patients Without Borders.
The U.K.-based Alzheimer’s Disease International says
there are more than 44 million Alzheimer’s patients globally, and the figure is
projected to triple to 135 million by 2050. The Alzheimer’s Association
estimates that in the U.S. alone, the disease will cost $203 billion this year
and soar to $1.2 trillion by 2050.
The pioneering Baan Kamlangchay was established by
Martin Woodtli, a Swiss who spent four years in Thailand with the aid group
Doctors Without Borders before returning home to care for his Alzheimer’s
diagnosed mother.
Wanting to return to Thailand and knowing that Thais
traditionally regard the elderly with great respect, he brought his mother to
Chiang Mai, where she became the home’s first “guest.” Woodtli never uses the
word “patient.”
Over the next 10 years, the 52-year-old psychologist
and social worker purchased or rented eight two-story houses where 13 Swiss and
German patients now reside. Two people normally share the modest but well-kept,
fully furnished houses, each sleeping in a separate bedroom along with their
caretaker.
Breakfast and lunch are eaten together at another
residence where Woodtli, his wife and son live. On most afternoons, the group
gathers at a private, walled park to swim, snack and relax on deck chairs.
Regular outside activities are organized because he believes these stimuli may
help delay degeneration.
“Movement is important. Tensions are also relieved if
they have freedom to move. Our carers allow our guests a lot of space as long
as it does not pose a danger to them,” he says. “In Switzerland we don’t have
opportunity for such care.”
He says his guests “cannot explain it, but I think
they feel part of a family, a community, and that is very important.”
Yet Woodtli says he has received criticism about “the
Swiss starting to export their social problems.”
The German press has recently described shifting the
aged and ailing abroad as “grandmother export.”
Sabine Jansen, head of Germany’s Alzheimer Society,
says that while some with Alzheimer’s may adjust to an alien place, most find
it difficult because they live in a world of earlier memories.
“People with dementia should stay in their familiar
environment as long as possible. They are better oriented in their own living
places and communities,” she says. “Friends, family members, neighbors can
visit them. Also because of language and cultural reasons, it is best for most
to stay in their home country.”
Angela Lunde of the U.S.-based Mayo Clinic says that
generally the afflicted do better in a familiar environment, but over time,
even those with advanced stages of the disease can adjust well. “I think a
positive transition has less to do with the move itself and more with the way
in which the staff and new environment accommodates the person living with
dementia,” she says.
Woodtli agrees that moving to country like Thailand is
not the answer for everyone with Alzheimer’s, but those who have traveled
widely and are accustomed to change can probably adapt.
“One of our guests sometimes wakes up in the morning
and says, ‘Where am I?’ But she would do the same if she was in a care center
in Switzerland,” he says. “And they take their past with them. One guest thinks
she is in a schoolhouse at Lake Lucerne.”
Those who end up staying at a facility being built in
the outlying Chiang Mai district of Doi Saket will have amenities that would be
tough for its European counterparts to match, including a clubhouse with a
massage room and beauty parlor, a restaurant, Swiss bakery and pavilions with
soaring ceilings and skylights.
“The idea is that this is a resort, not a hospital,”
says Marc H. Dumur, a veteran hotelier who will manage the Swiss-owned,
3.5-hectare (8.7-acre) facility built amid orchards and groves of teak. Going
up are 72 patient rooms in six spacious pavilions, plus villas for visiting
family members. Around-the-clock care will be provided by a staff of 150,
including a Swiss head nurse and at least one licensed Thai nurse for each
pavilion.
These patient-to-carer ratios reflect the costs in a
developing country like Thailand and the West. A licensed Thai nurse earns less
than $700 a month, compared to about $7,000 for one in Switzerland, where care
centers will have one nurse responsible for 10 patients.
Care at the Doi Saket home will cost $6,000 a month,
roughly what a mid-level employee in Switzerland would receive as a pension,
Dumur says.
A number of European countries have generous national
health insurance, but these generally do not cover treatment abroad. Kuratli
says the Swiss government would cover two-thirds of the bill for his wife’s
care if she stays in Switzerland, but since high-end private clinics there can
cost $15,000 or more per month, he could still end up paying more there than he
would in Thailand.
British businessman Peter Brown has turned a bankrupt
resort into the Care Resort Chiang Mai. Residents will live in five-room units,
watched over by nurses 24 hours a day, and walk out into extensive, landscaped
grounds, with a thousand trees and a lake, set in a tranquil area at the foot
of mountains.
“In Europe they tend to follow a lock-up system. They
know what should be done but they just don’t have the staff to do it — to take
patients to visit gardens, to give them some freedom,” Brown says. “And the
carers tend to come from the lower end of the nursing system. They often don’t
have the desire to work with Alzheimer’s patients or an affinity with them.”
Woodtli agrees that it is crucial “for the patients to
be together with their carers, to know and trust.” He says Thai caregivers like
those at Baan Kamlangchay are generally more emotionally and physically engaged
with their charges.
At the swimming pool, Madeleine Buchmeier snaps photos
and laughs as she watches a caregiver take her smiling husband’s hands to twirl
around together in a dance out of childhood.
“It’s a miracle,” she says. Geri used to bang his head
against the walls of a care facility in Switzerland, she says, “as if he wanted
to do something, get somewhere.”
He would sink when entering water. In the three weeks
since they arrived, he has calmed down and can swim again, all while his
medicine is being sharply reduced.
Like Kuratli, Buchmeier is deciding whether her
64-year-old husband should stay or go back to Switzerland. Once a Ford Motor
Co. employee who spoke four languages, he now mutters largely disjointed
sentences but appears to recognize his wife.
Nearby, Manfred Schlaupitz, a former Daimler-Benz
engineer in his 70s, lies back in a deck chair, cradling a stuffed toy lamb.
His caregiver, Kanokkan Tasa, sits on the grass beside him, gently massaging
his legs and tickling his chin. She has been with him for six years, eight
hours a day and earlier cared for Woodtli’s mother.
“If you think of it as a job it’s very difficult,” she
says, “but if it comes from the heart, it is easy.”
She came to the home with no formal nursing training.
“I felt pity for them and asked myself, ‘If I was
stricken with Alzheimer’s, how would I want to be cared for?’” she said.
The 32-year-old woman communicates in Thai, German,
English and her native tribal language but most importantly, she says, through
eye and physical contact and displays of emotion.
Like a number of Alzheimer’s victims, Schlaupitz
responds well to music. Sometimes they sing one of his favorite songs:
“Yesterday.”
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