US Alzheimer's patient: Goodbye Thailand - it was nice knowing you

[rexall]

12 minutes ago, donnacha said:

A. I have sympathy for their situation.

B. I understand the financial decision to leave her mother in Manila.

C. I have no patience for the blatant dishonesty of pretending that the decision was forced upon her by a fairly standard retirement requirement.

All these things can be true at once. They are not at all opposites, as contradiction would require.

"Forced on her" is just a figure of speech.  Her meaning is pretty clear, I think.  

[rexall]

5 minutes ago, donnacha said:

That is clearly the hope here, that public opinion can be whipped up into a frenzy against the government, but it simply does not stand up to scrutiny.

Their problem here is the cost of Alzheimer's care, which is being privately purchased. It has nothing to do with the government.

The government have given her entry to their country on a retirement visa. She is welcome to stay, she merely has to meet the standard requirement to have a reasonable amount of money set aside for emergencies. Given her age and condition, she is actually more likely to need that emergency fund than most other retirees.

There is zero chance that this attempt to spark a social media backlash will gain momentum. They simply don't have a case that stands up. 

Dude, if you were an I/O with discretionary authority, would you refuse an exception or some kind of accommodation?

[dcnx]

4 hours ago, MRToMRT said:

Makes me want to leave Thailand. Not because of the story (I sympathize greatly) but because of the sad reflection most of the posts so far in this thread are on the expats of Thailand.

Thailand has the ugliest expat community I’ve ever seen. 

[donnacha]

11 minutes ago, Thaidream said:

You make a good point and while I agree with 75% of your narrative, you have failed to understand that it's just possible that this family had reached the end and that Thai Immigration refusal was the 'straw that broke the camel's back' and a useful excuse to change the situation.

No, I agree that this is exactly what is happening: for some reason the daughter felt the need to find an excuse and to blow it up with publicity. I accept that the word excuse is better and less controversial than words such as scapegoat etc.

Worth noting that there was no actual refusal on the part of Thai immigration, they currently have the money deposited in the bank and the mother's retirement visa is currently valid, but the daughter states that they need to withdraw the deposit.

[ousaou]

20 hours ago, Kasane said:

The patient needs to be on Medicaid. She paid all her life for Medicare, now that she is ill US don't want to care for its citizen who is now terminally ill. Reminds me of unscrupulous insurance companies who drop coverage when the patient really needs them. 

My mother had Alzheimer and passed on at 86. She lived in California and was not US Citizen. My father took care of her all the way to the end. My sister and I help my father, but my mother stayed home, she saw the doctor for her medications only. We paid for the medications.

The cost of living in an old age facility is very expensive. This lady family was not able to take care of her at home and preferred to place her in a retirement home. This is where the Thai emigration required the earning or the caution of 800K. She could go back to the US, she would come under “Medicaid” not “Medicare”, her living conditions may not be what they wanted.

[dcnx]

My god. Some of you are so unbelievably ignorant and cold. It’s no wonder you’re here. Probably stuck and married to a local with an 8th grade education.

[donnacha]

8 minutes ago, rexall said:

"Forced on her" is just a figure of speech.  Her meaning is pretty clear, I think. 

"Force" was her choice of word. It figures prominently in her statements. The impression is clearly intended. The whole thrust of her publicity drive is that the entire family is being compelled, against their wishes, to leave Thailand due to unreasonable retirement requirements.

She was clearly aware that the expat community in Thailand would be highly receptive to this characterization. She is quite clever but, apart from expressing her anger, I do not see that she have much to gain from this. If anything, her anger endangers her and her husband's own retirement visas.
 

[micmichd]

59 minutes ago, shy coconut said:

It seems odd to me that in the original thread on this topic it was suggested that the

mother could piggy back the daughter's visa.

 

Perhaps the real reason they are shipping out to Manila is that the daughter is having 

trouble meeting the requirements as well as paying for the care.

 

As usual there seems to be a few key elements missing from the sad story.

Maybe a question of heritage. 

I'm German, and I can only speculate that if this old lady had to be repatriated she would immediately be a welfare case with the welfare office on the back of her daughter. 

[rexall]

6 minutes ago, donnacha said:

"Force" was her choice of word. It figures prominently in her statements. The impression is clearly intended. The whole thrust of her publicity drive is that the entire family is being compelled, against their wishes, to leave Thailand due to unreasonable retirement requirements.

She was clearly aware that the expat community in Thailand would be highly receptive to this characterization. She is quite clever but, apart from expressing her anger, I do not see that she have much to gain from this. If anything, her anger endangers her and her husband's own retirement visas.
 

Who needs a "case" you have got "face."  Not that I understand face very well, not nearly at gut level as does any 10 year old Thai child. Compassion sometimes springs from one's one internal values, and sometimes it is imposed on the outside by shame, particularly in Asia. But it is tricky. Which produces more loss of face, appearing to knuckle under to the demands of the greasy infidels or appearing to kick out a 77 year old Alzheimer's patient?  That is a tough one. I guess it depends upon how far the story spreads outside of ThaiVisa.

[terje johnsen]

27 minutes ago, Jingthing said:

Your assumption is not based on evidence. You clearly don't understand the U.S. system. As I said and you can easily verify the average U.S. social security check is about 45K per month. Many under, many over, but a significant majority will be less than 65K. Your mentions of non-U.S. nations irrelevant to the situation in the U.S. 

there is many untold points in this story that you need 800k in bank or 65k of income is nothing new. she have been there 4 years and Thailand have not change the law. The news is that many embassys  not state prove of income and Thailand have new rules how to state the income by put 800k in bank or show that you have income by prove money come regulary to the thai bank for 1 year.

[Jingthing]

Just now, terje johnsen said:

there is many untold points in this story that you need 800k in bank or 65k of income is nothing new. she have been there 4 years and Thailand have not change the law. The news is that many embassys  not state prove of income and Thailand have new rules how to state the income by put 800k in bank or show that you have income by prove money come regulary to the thai bank for 1 year.

Don't get your point. Actually there is a LOT that is new but won't bother going over the details of that on this thread. You can find that info elsewhere.

You asserted she has over 65K monthly income. I replied most likely she does not. Now you want to deflect. It's OK to just admit you were wrong. 

[donnacha]

37 minutes ago, rexall said:

Dude, if you were an I/O with discretionary authority, would you refuse an exception or some kind of accommodation?

What sort of exception are you suggesting?

Asking retirees to set aside $25K for medical emergencies, or possible medical repatriation to their own country, is intended for precisely this sort of situation. You have a woman in her 70's, whose body has been ravaged by the knock-on effects of Alzheimer's for 12 years, and who is now approaching the final stages of her life.

From the I/O's perspective, a farang with no pension suggests a super-flakey situation, one in which it is highly unlikely that any relatives will step forward to pay, say, $40K of hospital costs if she spends a few month in ICU or requires cardiac operations before she dies. I have to keep stressing, as so few people here seem to be aware, such costs are not at all unusual in the final stages of life.

If, instead of a lowly-paid I/O whose own parents, wife and children all receive extremely basic public health treatment, you made me a kindly billionaire, sure, keep this lady in Thailand where she is comfortable and can keep hugging elephants.

The I/O's job, however, is to prevent his developing nation getting stuck with the end-of-life costs of retirees from rich countries who have never paid taxes in Thailand. His DUTY is to protect those resources so that poor Thai people can receive some level of care.

If you can seriously put forth some grounds whereby people in the most need of medical care should no longer have to meet the requirement to put aside a fraction of what that will cost, fine, please do so. Please also explain how a developing nation can pay for all this and, please, don't suggest that what elderly retirees spend in Thailand comes anywhere close to paying the cost of private end-of-life medical care.

 

[Jingthing]

Just now, donnacha said:

What sort of exception are you suggesting?

Asking retirees to set aside $25K for medical emergencies, or possible medical repatriation to their own country, is intended for precisely this sort of situation. You have a woman in her 70's, whose body has been ravaged by the knock-on effects of Alzheimer's for 12 years, and who is now approaching the final stages of her life.

The lack of any pension suggests a super-flakey situation, one in which it is highly unlikely that any relatives will step forward to pay, say, $40K of hospital costs if she spends a few month in ICU or requires cardiac operations before she dies. I have to keep stressing, as so few people here seem to be aware, such costs are not at all unusual in the final stages of life.

If, instead of a lowly-paid I/O whose own parents, wife and children all receive extremely basic public health treatment, you made me a kindly billionaire, sure, keep this lady in Thailand where she is comfortable and can keep hugging elephants.

The I/O's job, however, is to prevent his developing nation getting stuck with the end-of-life costs of retirees from rich countries who have never paid taxes in Thailand. His DUTY is to protect those resources so that poor Thai people can receive some level of care.

If you can seriously put forth some grounds whereby people in the most need of medical care should no longer have to meet the requirement to put aside a fraction of what that will cost, fine, please do so. Please also explain how a developing nation can pay for all this and, please, don't suggest that what we spend in Thailand comes anywhere close to paying the cost of private end-of-life medical care.

OMG, this family wasn't asking anyone else to pay. They were paying the care facility. 

[terje johnsen]

2 minutes ago, Jingthing said:

Don't get your point. Actually there is a LOT that is new but won't bother going over the details of that on this thread. You can find that info elsewhere.

You asserted she has over 65K monthly income. I replied most likely she does not. Now you want to deflect. It's OK to just admit you were wrong. 

she have been in Thailand for the last 4 years and met the requirments and have visa so she have 800k in bank or 65k in income for month that is the facts this requierments have been for some years now. it was the us embassy that stop to give statements of income and many embassys follow that make problems for people. it was not Thailand that make this problems.

[Jingthing]

1 minute ago, terje johnsen said:

she have been in Thailand for the last 4 years and met the requirments and have visa so she have 800k in bank or 65k in income for month that is the facts this requierments have been for some years now. it was the us embassy that stop to give statements of income and many embassys follow that make problems for people. it was not Thailand that make this problems.

Again you posted she had the 65K income. She probably didn't. Obviously the 65K income is not the only method. I never said that it was. 

[newnative]

2 minutes ago, Jingthing said:

Don't get your point. Actually there is a LOT that is new but won't bother going over the details of that on this thread. You can find that info elsewhere.

You asserted she has over 65K monthly income. I replied most likely she does not. Now you want to deflect. It's OK to just admit you were wrong. 

      I'm getting ready to do my 1 year extension in June and starting to prepare my documents.  I use the 800,000 in the bank method and, frankly, I am not seeing a lot that is new.  The form is the same, the documents required to be photocopied seem to be the same, bank documentation the same, cost the same, and so on.  The only change I can see is I will need to go back to Immigration in 3 months after my renewal and show my updated bank book again.  But, maybe I've missed something. You're right about SS--the average check is less than $1500, as is mine.

[donnacha]

24 minutes ago, Jingthing said:

OMG, this family wasn't asking anyone else to pay. They were paying the care facility. 

Do you seriously not understand, after all these posts, that they were paying for special residential care for Alzheimer's?

That does not cover you for ANY of the hundreds of other things that can go wrong in a septuagenarian body. If you have a heart attack, the hospital does not give you a free surgeon on the basis that you are already paying for bed and board somewhere else.

If you catch the flu and have to stay in an ICU for 3 months, they don't write off the cost against what you are paying elsewhere. If you develop diabetes, they don't include your insulin as part of your breakfast.

This sort of woolly thinking is why people are heading towards a cliff in old age. I don't know if this is because many of you come from countries in which health care is supposedly free, but you all need to wake up and understand that paying for one service, or one procedure does not then get you everything else for free.

If you have an old body, at some point it will start to fail, and it won't just be one problem, you are likely to experience a whole range of bad shit in quick succession, all of it expensive.

All that Thai immigration require is that you have $25k, or equivalent income, available to you so that you can pay for that stuff. Not money you have already committed to treating a long term pre-existing condition, but additional money that you can use to pay all the other bills which will inevitably arise.

By throwing this tantrum and insisting that they, alone, among all retirees should not have to set aside this money for their own bills, this family are suggesting that someone else should have to pick up the eventual tab. That is precisely what they are doing.


 

[Knee Jerk Reaction]

The daughter seems like a decent enough person. She helps dog and cat rescue organisations in Thailand and the Philippines.

[Billy The Kid]

1 in 3 Expat will have Alzheimer’s in later years .... Best of luck to this family . 

[donnacha]

2 minutes ago, Knee Jerk Reaction said:

The daughter seems like a decent enough person. She helps dog and cat rescue organisations in Thailand and the Philippines.

Ah. A "good" person.

That probably explains why she is going to such lengths to obscure the fact that she is essentially dumping her mother in the Philippines while she continues to live in Thailand.

It wouldn't do to sully the fine reputation she has built up.

[rabas]

20 minutes ago, terje johnsen said:

there is many untold points in this story that you need 800k in bank or 65k of income is nothing new. she have been there 4 years and Thailand have not change the law. The news is that many embassys  not state prove of income and Thailand have new rules how to state the income by put 800k in bank or show that you have income by prove money come regulary to the thai bank for 1 year.

"Thailand have not change the law"

 

In the last several months, Thai authorities changed many rules regarding long stay foreigners, making life more difficult for many. In some cases people may be forced to leave or provide less support for the Thai families, etc.

[Thaidream]

19 minutes ago, donnacha said:

you can seriously put forth some grounds whereby people in the most need of medical care should no longer have to meet the requirement to put aside a fraction of what that will cost, fine, please do so. Please also explain how a developing nation can pay for all this and, please, don't suggest that what elderly retirees spend in Thailand comes anywhere close to paying the cost of private end-of-life medical care.

While you have a point- be aware that this lady has been living in Thailand for years and IOs well aware of her illness.  She is living in a hospice which takes care of  people with diseases such as has.

 

As I have mentioned previously- I do not hold Thai Immigration completely at fault  although I believe much has been lost in translation.

 

If this would have been my decision- I would have met with the family and worked out a suitable solution which benefited all.  I am well aware that the Immigration Officer can make any extension by waiving the  rules and regulations. Part of the problem is the  new rules in which 800K has to be kept in a Thai bank for seasoning 3 months after the extension and then 400K  only is available for use. 

 

The purpose of the 800K system was to be used monthly for one's support.  The Thai Immigration rules on this are way too stringent and represent a challenge to  people who were told the money was for living expenses.  It would have been much fairer to allow current retirees in Thailand to use the old system and new retirees to use the new system.

 

In regard to your question as how to handle medical issues in the future, one has to start with the fact that Healthcare is a human right. People have a right to life and is enshrined in almost every Constitution in existence as well as the United Nations.

 

All countries face this issue simply because  the Medical Industry to include Big Pharma wants to make profits off people's illness; This has to end because for it to continue costs will continue to rise;  and the cost will become so great that people will die needlessly in great numbers. Insurance per se is not the answer because Insurance is in an unholy union with the medical establishment in making medicine a profit earner.

 

However, the current issue is to how to solve the medical issues confronting Thailand.  One proposal being floated is to charge a flat $10 on every person purchasing an airline ticket to Thailand.  A good proposal as it will generate $380 million per year 

Now for the long term stayers, why not allow them to buy into the Thai Social Security system at 1,000 Baht ($38) per month  or $456 per year.  If there are 200K long stayers- this would raise around $90 million per year.  A long stayer could use the Thai Government Hospital or any private  hospital that accepts Government rates.

 

This is a win-win for everyone- The Thai Medical system and long stay people without adequate private insurance.

 

I am convinced that at some point-if nothing is done- the cost of healthcare will cost so much that only the wealthy will be able to afford it and the rest of the population will be forced to die.

 

[micmichd]

36 minutes ago, Allen1967 said:

Who  cares    

My Thai family and I care. And I'm more and more happy to be an orphan with no heirs in the West. 

[TallGuyJohninBKK]

7 hours ago, donnacha said:

That is a tough decision for any family, and the sudden enforcing of the income rules has caused problems for many who were circumventing them. That has no doubt contributed to the hysteria around this story, but let's stop pretending that their mother has been "forced out" by the Thais.

 

The way I understood the prior reporting on this episode is that the daughter and her husband couldn't come up with enough money to satisfy Immigration's financial requirements for their Mom to remain -- after dealing with their own Immigration financial requirements and paying for the mother's medical care in Chiang Mai.... 

 

In the past, the mother could have been/was covered by an income affidavit, because she/they could count the income they had coming in before it went to pay for her nursing care. But with the loss of the income affidavit and its replacement by the required and expanded Thai bank deposit or monthly income import requirement, apparently, they weren't able to make that work.

 

[flbkk]

US Medicaid is only good in the USA, if you’re poor (often one’s USA social security income (government pension, not health insurance as in Thailand) make you too rich for Medicaid. Eventually you will get it if you are in an American nursing home. I’d hope to be cared for in Thailand when I get older and disabled, not sure it will be possible. 

[justin case]

1) do not expect thai immigration to help with anything

 

2) at least manilla have people who speak actually some/descend English compared to TIT, no need to learn anything even it is being thought at schools

[SheungWan]

2 hours ago, rexall said:

Why "should" any country be the "dumping ground" for any demographic from another country?  Why should the U.S. be the "dumping ground" for nurses from the Philippines who cannot obtain employment in their home country? 

The UK NHS would probably collapse without the employment of overseas nurses. These are jobs which locals are either unable or unwilling to do. A side issue to the thread but worth noting.

[donnacha]

1 hour ago, Thaidream said:

In regard to your question as how to handle medical issues in the future, one has to start with the fact that Healthcare is a human right. People have a right to life and is enshrined in almost every Constitution in existence as well as the United Nations.

I accept that you are arguing in good faith but, look, we don't need to get lost in the philosophical issues. Let's forget about concepts such as big pharma, or an aspirational right to healthcare, etc.

Let's keep this at the most basic level, and directly relevant to the case under discussion.

As populations all over the world live longer, more and more people will present with Alzheimer's, Parkinson's, and a range of other deteriorating conditions. Many of them will require intensive, specialized care.

What this means is that, around the clock, someone must be available to to clean them up when they shit themselves, or to sedate them when they wake up in utter confusion, or any of a range of other unpleasant and, sometimes, dangerous tasks.

Under the current system, it is illegal to enslave these nurses and care assistants, so, we must pay them. As the work is unpleasant, and as they have invested time, money and effort in their own training, we must pay them more than average worker.

We must also provide doctors who have spent additional years studying geriatric medicine. It is also, unfortunately, illegal to enslave doctors. In fact, generally, we must pay the doctors even more than the nurses and care assistants, in recognition of their scarcity, and the years and money they have invested into becoming doctors.

We must also provide a secure premises for all this caring to happen - having patients with Alzheimer's escaping out the windows and running towards the nearest motorway rarely ends well.

All of this costs money. Quite a lot of money. Around $12K per month in the US, around $3 per month in Thailand, and around $1 per month in the Philippines. The Alzheimers patients in the Philippines may or may not receive Jello.

Now, the reason why, in this case, we have to avoid drifting off into lofty concepts such as universal rights to healthcare, is that you are suggesting that a developing country, that cannot afford to give any sort of Alzheimer's care to the parents of the care assistant wiping the American woman's arse every day, or the parents of Immigration Officer, or the parents of all the other 50 million or so Thais who cannot afford private hospitals, should provide uncapped private healthcare to a woman who spent her entire productive life in her own, rich country and has never paid taxes in Thailand.

You can argue for a communal pot, in which every citizen in a given country contributes taxes while during their productive lives and, then, receives the care they require in the final stages of their life. This is a fine idea. Doesn't really work in practice, but citizens in the UK at least get the warm and fuzzy feeling that the NHS is there for them, right up until the point they actually have a serious problem.

You cannot reasonably argue, however, that citizens who drift off to an exotic country for their retirement, to enjoy the higher buying power of their currency in an impoverished economy, should then expect the same free provision of healthcare from that country when it can barely provide basic healthcare to its own people.

Luckily, we CAN take advantage of the far cheaper healthcare costs in this country, we are very welcome to do that. We can turn up here and, at relatively modest cost, get treatments, procedures and ongoing services that we simply could not afford in our own countries.

The only catch is that we, or our insurance provider, MUST pay for all this healthcare. There is no moral way around this. We are very welcome to avail of services in Thailand, but only on the basis that we will pay our way and NOT become a drain on their limited resources. It is a great deal.

However. Any Westerner heading into their sixties or seventies in Thailand who insists that they don't need insurance, or to have money set aside for medical emergencies, is a scammer. Their rough strategy, when the inevitable happens, is to simply play dumb and say "Oh, I didn't know I would have a stroke", "Goodness, I didn't expect that heart attack", "Who would have imagined my liver would explode after six Changs a days for 20 years", "No, I did not realize that living in Chiang Mai would give me lung cancer" etc.

Their plan is to wait until they are in extremis and, then, depend upon the kindness of strangers - "Well, they can't let me die, can they?".

Whatever care they receive will require resources. More than likely those resources will end up coming out of the national healthcare budget.

It is a shitty, shitty thing to spend your retirement taking advantage of the fact that services are cheaper in a poor country, but then end up raiding the resources of those same poor people.

If you have the good luck to come from a wealthy country, you have no excuse not to accumulate at least enough money to provide for yourself after you retire. If your host country insists that you need to put aside $25K to cover your final year, whenever that may be, just do it. You should probably insure yourself too. If you don't believe in insurance, well, be aware that $100K does not go all that far in medical bills, you should probably try to have at least that much available to you in liquid assets.

Perhaps, one day, the United Nations will announce universal healthcare for all, from sheep herders in the Andes, to missile technicians in Pyongyang but, until that glorious day, we all need to get our shit together and make sure we don't end our lives sponging resources from some of the poorest people in world.

I cannot see how anyone can argue against the clear, simple, undeniable morality of this.

 

[Oww]

13 minutes ago, justin case said:

2) at least manilla have people who speak actually some/descend English compared to TIT, no need to learn anything even it is being thought at schools

Is #2 meant to be critical?

You may need to go back and review elementary English language basics yourself!

[SheungWan]

The public rationale for the action is not the key IMHO. It is rather what might I do faced with a similar situation. It seems to me that with the disparity in costs between PI and Thailand (assuming that is the case) and funds that have to be managed, the move to PI makes sense. Even if the daughter still remains for now based in Thailand, the PI is only a short inexpensive flight away. I would also be attracted by the fact that the mother would likely have staff who can speak English with the mother. That might be a decisive factor on its own.