Hasta La Vista Gran!

Carol Dimon c

Looking for somewhere for  a relative in a nursing home? Peruse the web http://www.careresortchiangmai.com/index.php?viewID=3. This is just one example.

Glossy images, and lower fees attract many from countries such as Switzerland, UK, and Germany. Buchdahl  (2013) comments “Germany is in the throes of a ‘grandma export’ as one in five Germans say they are considering sending their elderly relatives to a care home abroad.” More than 7146 people from Germany are said to live in retirement homes in Hungary (ibid).There are many positive tales of patients there with dementia- recollected by relatives who are unable to visit often. Many have never been to the country before. Some may actually have distant relatives there, more so with migration to the home country. People in America also send old people to nursing homes abroad (Foxnews 2013). This article describes a positive situation involving swimming, massage and personal attention from some carers who have had “no formal training”. “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.”

Some relatives were said to have been disappointed in the standards of care in their own country (ibid). Other reasons for dissatisfaction  include cost. Political reasons for overseas care include the rising number of old people compared to the young, with few people available to care for them. However, this is unsupported by statistics of newly qualified nurses without jobs in the UK and other countries (Dimon 2014).

Beware, some of the adverts are false, asking for money for nursing homes that do not exist  “One place called Pensjonat Ania in Tomislaw near the German border, which offered delights such as mushroom hunting excursions for its residents as well as an on-site nurse and ultra-cheap rooms at €400 (£340) a month, was exposed in April to be entirely non-functioning” (Buchdahl 2013). Innes (2014) discusses older people being sent to Thailand , with an example of  a lady sent there  from Zurich. It is stated that the quality of care in Thailand is of  a higher quality with evidence of more nurses and better facilities. There are also concerns of moving people who suffer from dementia from their home country to Thailand. Indeed, is it possible that older people who have no relatives may be more likely to be sent to nursing homes overseas? -especially if suffering from dementia.

A web search for reports of  quality of care overseas, yields few results- why is this? Is care suddenly perfect? There can be no perfect care because care depends on a relationship between people who have different beliefs and expectations. Italy provides one example  regarding freezing residents kept  in an attic (upi.com 2013).

We hear of 3 or 4 nurses per resident, unlike the UK level  of about one or two  per 30, but, what is  a nurse? What training has the nurse had? Dimon (2013) reports of overseas nurse education being unequal in content and duration to the UK. Culture also differs which does affect attitudes and acceptability of standards. Not to mention fake certificates, which may easily be bought . Many countries discourage the questioning of doctors or more senior staff (Duell 2013), thus staff may be reluctant to raise issues. There are also differences regarding such aspects as pain control (RCN 2003 ).  Another difficulty may be bringing the person back from overseas or visiting quickly  if problems occur such as sudden illness (Kresge 2013).

Poland  may query whether there will be enough high quality homes to care for people who live in Poland as many cannot afford the home used by people from Germany (Kresge 2013). Will care home companies react by commencing to build nursing homes overseas instead of in the more expensive home countries? There may also be less regulations to meet in certain countries.

“Sorry- no room at the inn, or in the country”.  Is this considering people as COMMODITIES to the extreme?  This approach could well be fuelled by neoliberal approaches of politicians in many countries; individuals are responsible for themselves, and make their own choices of where they wish to be cared for, or, in the case of lack of mental capacity, this choice is  made by relatives.  Does “empowerment” mean you have the choice – but we are not responsible? Horton (2007) claims neoliberals view of the world is  as a “vast supermarket”. Yet, as Horton describes, the disadvantaged cannot “shop” at this supermarket. This reflects the preoccupation of neoliberalism with consumerism and the acquisition of goods, and neglects to address society’s caring role. Horton describes the resulting control held by the ruling class, who have “approval and consent of members of society”, as “hegemony”. As a consequence, those on welfare benefits may be regarded with less compassion, as they are viewed as not contributing towards the wealth of society.

This approach of discarding old people mirrors historical ones within some countries -Eskimos were said to have been killed when they reached  a certain age “Historical data exists that in the past some Eskimos did kill old people when circumstances were sufficiently desperate ( capefrasers 2010 ) . Yet, in Eastern countries, families have been very loyal to their older relatives- this is not without reports of abuse from the family  (Holder 2013). Of course families do need help and support. The present overriding culture fuelled by politics, particularly in Western countries, seems to be to value people who are regarded as directly contributing, such as workers, rather than  old people.

The approach to old people, and other vulnerable people, reflects the culture that exists within society ; “The True Measure of Any Society can be found in how it treats its most vulnerable members” – Ghandi” (seventhvoice 2012).

What is to be said of  sending old people abroad – even with skype and a couple of visits  a year ?

Ask yourself, would you send grandma or mother abroad? Mother, would you like to be sent to Thailand?

Is this ever more likely to occur in the UK, as arguments continue regarding quality of care and payment for care?



Buchdahl E (2013) Germans sending parents To Cheaper Nursing Homes With One in Five Planning to do it  dailymail.co.uk 17.9

Capafrasers (2010) Eskimo Woman Arrives At Cape Dauphin-1820 capefrasers.wordpress.com

Dimon C (2013) The Commodity of Care Cloister House Press

Dimon C (2014) Culture and Care https://nursebloginternational.wordpress.com/2014/02/27/culture-and-care/

Dimon C (2014) Roll Up! Roll Up! By Your Fake Certificates in Anything. https://nursebloginternational.wordpress.com/2014/01/27/roll-up1-roll-up1-buy-your-fake-certificate-in-anything/

Duell M (2013) ‘Full of life’ great-grandmother, 100, ‘died from fractured skull after falling 5ft when foreign carers failed to properly strap her into hoist’ mailonline 8 January

Foxnews (2013) More Alzheimer’s Patients Finding Care Far Overseas 30.12

Holder H (2014) Japan’s solution to providing care for an ageing population? The Guardian 27.3

Horton E .S. (2007). Neoliberalism And The Australian Healthcare System. Conference of The Philosophy of Education Society of Australasia, Wellington, New Zealand. Web: eprints.qut.edu.au.12 February 2013.

Innes E (2014) The Families Sending Relatives to Nursing Homes in THAILAND: Care is ‘Cheaper and Often Better in Asia’  They Say dailymail.co.uk  9.1

Upi.com (2013) Italian Nursing Home Seized After Six Patients Found in Cold Attic 30.12


Kresge N 92013) Germans Export Grandma  To Poland As Costs, Care Converge Bloomberg.com 16.9

RCN(2003) “We Need Respect”: Experiences of Internationally Recruited Nurses  In The UK rcn.org/publications 1st March

This article also published in nursesfyi edition 16 August (2014)







10 thoughts on “Hasta La Vista Gran!

  1. Pingback: Another Look at Freud | NURSE BLOG INTERNATIONAL

  2. CARE HOMES???????
    Deaths waiting rooms is a better description.
    I have worked in may ‘care’ homes in the south and north of England. I actually know 1 (only one) company that I could describe the care as excellent. Im sure there are more somewhere. A family run concern with residential homes in the North East. Helen McCardle homes are 1st class and the rates reasonable..
    Others I have worked in, looked at, checked the CQC reports of, leave a lot to be desired.
    I have said for a long time that for me suicide is a better option than the slow death of a care home.
    In my last post the home as a whole had 71 beds in 3 units and only 1 nurse on duty, and this is where they blur things. On all units, if the emergency buzzer was activated the RGN/RMN had to attend, taking them away from the nursing unt and residents. The general residential unit where some who should have been on nursing or EMI residential, It was the unit downstairs and on show. It was beautifully kept. Meals were adequate, and they had the best and most, none went hungry. As it was residential it was deemed not to need a nurse as district nurses went in daily. However RGN/RMN on duty had to check out any schedule 3 or 4 with restrictions.(CDs) and any dressings.They had 5/6 staff 3 of them ‘senior’ care assistants who had a basic training in medicines. So for 30 residents they had plenty of staff.. Most were continent, most only needed assistance with personal needs, they were able to verbalise their needs, discuss and be involved in their care to some extent. Staff had so much time they were able to sit and have meals with the residents. Staff could sit & paint nails and style hair.
    Move onto the EMI Unit. Again some of these residents should have been on the EMI nursing unit. All had dementia or other neurological illnesses or disorders. Again deemed not needing a nurse in charge and the district nurse visited daily. Most of the units residents were unable to verbalise their wished or needs. Some were incontinent and some needed 1/2 for personal care. The cost is more in this unit. Some were CHC residents. There was 3 staff for 20 resident (1 ‘senior’ HCA) but the RGN had to check out any CDs and do dressings. To an RGN eye most were allowed to wander at will. the staff caring for those who got visitors.The meals were OK they got 2nd best never enough Staff would have meals with the residents
    The nursing unit had 19 residents. These were very advanced dementia cases who were physically fit or had personality disorders or acquired cognitive impairment. These included some who had served prison sentences for assaults & even attempted murder, others had been detained under section 2 or 3. All were violent, all were doubly incontinent and needed 2, 3 or 4 to change them. All needed 2 for personal care. 3 were needed to give baths, some didnt have baths for weeks but the HCA records showed that they had weekly baths. Staff didnt have meals with the residents, there was never enough and staff didnt have time for meals. The RGN/RNM was constantly being called away. There was no privacy or dignity for residents as doors had to be open so staff could listen for fights going on between other residents. Food on this unit, even from the same kitchen, was disgusting and never enough. Many times at week ends staff would go to the chippy for chips to give to the residents.
    Most of the EMI nursing residents were CHC so got 3/4 visits from the authorities a year. About 4 actually got visitors. It was a heartbreaking unit
    As i said rather than face that for me suicide is a better option than deaths waiting rooms

  3. Many people now send relatives abroad for care in nursing homes- cheaper but there can be problems. As reported- some nursng homes advertsed do not exiist– what happens in emergencies also, not to mention vistng but many have skype, Could ths be more used by they with relatives or fundng bodies, who need a place for people with dementia ?? Frightening.

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