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I know the subject of expatriating in retirement for lower cost of living combined with better quality of life has been beaten to death in many threads on this forum, but it is also nearly impossible to locate old threads in this forum when you need them, so I have to start a new thread on the same subject.
As most regulars on this forum know, my plan in case of needing a nursing home has for a long time been a specific nursing home in Thailand. Well, darn it . In addition to Thailand adding a cumbersome health insurance requirement during recent Covid years, I just found out that the tax reform in Thailand of Jan 1 this year includes taxation of foreign funds brought to Thailand. Since I would obviously have to pay the nursing home, I would obviously have to bring that payment into Thailand. I haven't studied their new tax law in any detail, so don't know exactly how the new taxation scheme will work, but the new changes are super disturbing .
My very vague plan B was Uruguay, but I have not worked out any specifics of it, while the plans for Thailand were worked out really well. Darn it, darn it, dog darn it .
Maybe a care home in Nevada will have to do after all, but I had really hoped to go to a pleasant, relaxed country for nursing home care if I needed it, and not just because of the lower cost.
Do you have long term care insurance? Approximately how many years forward are you thinking this could be needed?
Why a nursing home rather than in home assistance? Sorry, I'm not familiar with your story.
Uruguay, Thailand and other foreign countries might look attractive today, not so much in a few years for a variety of potential reasons.
Once an elder is in such a state that they require placement in a nursing home, I can imagine that a long jet trip could be unfeasible.
Expat has such an exotic ring to it. Sunshine, beaches, coconuts, friendly natives, low prices. It is all great as long as one is relatively healthy, has one's witts about, understands how things work or do not work and the place is somewhat politically stable.
A lot of nursing care destinations such as Thailand, some former East Block states even Namibia have implemented changes for facilities and patients. Part seems to be purely financial but some is oversight and care.
Once you are in a state of existance requiring nursing home care what do you really care about? Staff shift change which means a shower/bath, fresh diapers, food and medication. A couple of minutes of conversation, getting your hair brushed, maybe an open window. Maybe throwing a tantrum, cussing, crying or waiting for visitors.
MIL is 94, can talk some, can use Alexa and has use of some fingers, is at home with 24/7 aids and what seems to be a monthly excursion to ER and then a week of hospital due to what comes down to constipation. Does she know where she is or what time it is? No. Is she able to make any decision regarding her care, finances or anything else? No. Were she to be an expat - who will handle her immediate affairs? Who will make ethical medical decisions based on her preset perimeters? Who will oversee this?
Another factor is medical treatment and medication. Not to mention availability.
Do you have long term care insurance? Approximately how many years forward are you thinking this could be needed?
Why a nursing home rather than in home assistance? Sorry, I'm not familiar with your story.
Uruguay, Thailand and other foreign countries might look attractive today, not so much in a few years for a variety of potential reasons.
Once an elder is in such a state that they require placement in a nursing home, I can imagine that a long jet trip could be unfeasible.
Just for giggles - look into patient transport costs. Start locally with in-seat then move to non-wheelchair. The four blocks MIL has from hospital to home run about 1500. A few years ago we looked into flying FIL from GA to NJ chartering a medically equipped small jet without medical staff and qualified/insurable pilots (We had our own.). Tripple the going rate due to cargo.
Check into standard airline requirements. Not pretty. Mumsy will be flying from GA to OK soon. It is a one hour commuter flight first class with wheel chair drop off/pick up. This will take everything out of her for a day or two. Make that 10-20 hours.
Do you have long term care insurance? Approximately how many years forward are you thinking this could be needed?
Why a nursing home rather than in home assistance? Sorry, I'm not familiar with your story.
Uruguay, Thailand and other foreign countries might look attractive today, not so much in a few years for a variety of potential reasons.
Once an elder is in such a state that they require placement in a nursing home, I can imagine that a long jet trip could be unfeasible.
I will not want any assistance unless I am paralyzed or demented. In all other situations, I can assist myself. But if I can't get out of bed due to paralysis, or due to not knowing on which planet I am, then I will obviously need a nursing home, not just home assistance.
A long jet trip will be feasible for me as long as I can breathe by myself. Medical care is also not my concern in Thailand; they have better medical care than I will ever want. The only problem are unwieldy, contradictory administrative requirements. In Thailand, the administrative aspect of expatriate retirement used to be entirely straight-forward, but now it unexpectedly got complicated.
Okay. Deep breath, no panic on the Titanic... when I took another look at the new Thai tax law, it says that foreign funds brought to Thailand are now taxable, but the US social security income is exempt from taxation. Since my monthly soc security check (as it is projected now, unless something changes with soc security payout) should be substantially higher than the monthly cost of the nursing home which I have in mind, it seems I may not need to file tax returns in Thailand despite the new law. I need to keep an eye on that.
But I need to also start studying Uruguay more closely.
Just for giggles - look into patient transport costs. Start locally with in-seat then move to non-wheelchair. The four blocks MIL has from hospital to home run about 1500. A few years ago we looked into flying FIL from GA to NJ chartering a medically equipped small jet without medical staff and qualified/insurable pilots (We had our own.). Tripple the going rate due to cargo.
Check into standard airline requirements. Not pretty. Mumsy will be flying from GA to OK soon. It is a one hour commuter flight first class with wheel chair drop off/pick up. This will take everything out of her for a day or two. Make that 10-20 hours.
I won't be chartering any jets, or needing medical staff to fly with me. Moving to a nursing home is not a medical emergency that requires an airlift. A youngster in my extended family would put me from the cab into a wheelchair, lift me from the wheelchair into a seat on the airplane, sit next to me on the airplane, and repeat the procedure in reverse on arrival to Bangkok. I would be very portable (106-108 lbs) even if completely paralyzed.
None of that is a concern. I only have administrative concerns about expatriation, ie, the degree of complexity of visa requirements and tax rules.
The issue with planning to retire to Asia is that area is the part of the world developing the fastest. So the economic advantages for westerners are likely to keep diminishing as their economies and standard of living continue to advance.
The issue with planning to retire to Asia is that area is the part of the world developing the fastest. So the economic advantages for westerners are likely to keep diminishing as their economies and standard of living continue to advance.
Anything can happen, but I don't have a major concern that nursing homes in Asia will become comparably priced as those in the US in my lifetime. Even the nursing homes in Western Europe (which is fairly developed) are cheaper than in the US.
OP, is establishing residency now an option? Getting your foot in the door now might work out better for you if the rules change again
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. In addition to Thailand adding a cumbersome health insurance requirement during recent Covid years, I just found out that the tax reform in Thailand of Jan 1 this year includes taxation of foreign funds brought to Thailand. Since I would obviously have to pay the nursing home, I would obviously have to bring that payment into Thailand. I haven't studied their new tax law in any detail, so don't know exactly how the new taxation scheme will work, but the new changes are super disturbing 
.
