Why are Westerners moving to Thai care homes?
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Don't miss the Thomas Rhett Veteran Boots Tour this summer. Fueled by Marathon. Now participate in locations. Terms and conditions apply. Hello, welcome to Business Daily from the BBC World Service. I'm Gideon Long with a question for you. Where will you retire and live out your old age? Increasingly, older people in wealthier Western countries are choosing to move abroad, fed up with what they see as poor quality, expensive care in their own countries.

One of the places they're heading for is Thailand, which has established itself as a hub for Western pensioners. There is definitely a growing demand. I remember when we started, we had one new guest per year. Now, on average, we get a new guest every three to four weeks. So it has dramatically accelerated. In part, this is due to the spiralling cost of care in Europe and North America. But it's also about the culture in Thailand, religion even.

The Buddhist culture is very interesting. People do not lose their temper. People are extremely gentle and kind, and particularly to the elderly. But what does all this mean for care for local people, particularly for those who can't afford to go private?

One of the big critiques is that this infrastructure, all these private hospitals, facilities, they are draining resources away, investment, nurses, doctors, from the public and private clinics and hospitals that are desperately needed by the national population. That is a real concern. We're all generally living longer and spending more years in retirement. The demand for care homes is only likely to grow.

So is Thailand offering a workable business model for care? And if so, could it work elsewhere? That's coming up on this edition of Business Daily. It's Saturday morning at the care resort Chiang Mai in northern Thailand and a group of Thai carers are running an exercise class for the residents. Seven, three more.

Ten elderly people are sitting, lifting their arms, stretching their legs, following the instructor's routine. A couple of them are in wheelchairs. Some look very frail. Others less so. After the class, I wander around the resort. Well, there's no denying it is a beautiful place. I'm standing in front of the lake here with fountains playing in it. There are tropical plants everywhere, palm trees and some incredible flowers.

The accommodation here consists of bungalows. Some of them are overlooking the lake with lovely verandas on them. And all of it nestled in the lush, green hills that surround Chiang Mai. Hi. I meet Lynn Stewart, one of the residents. Did you go to the exercise class this morning? I didn't. No? It's no problem. It's tomorrow. It's every day. Every day. Every day. 10 to 11. Thank you.

Lynn's 81 years old. She's from the US and lived there and in Northern Europe for many years before moving to Thailand. There was a time when I just got fed up with the weather and I looked for sunshine, butterflies and flowers and year-round beauty. I came here and I thought I'd give it six months. Five years later and I'm still here.

It's so much more reasonable than the United States, and you get the most exchange for your dollar. And there's a lot of activities here on the resort. I'm always called it on campus because it feels more like a college campus than a retirement home. It's so exciting and so vibrant.

Do you go back to the US at all now? I don't. There are so many wonderful places to go in Thailand and so many places around Chiang Mai that are just delightful. Everything I need is here. I really have nothing that I absolutely can't find in Thailand. It's a sentiment echoed by other residents.

Liz has been here for a year. I really, really do.

You know, when you get out of the taxi and you see this place, you think, gosh, this is heaven. And tell me about the process of moving out here. How easy or difficult was it? Because it's quite a big thing to pick up your life and move to the other side of the world. I know, I know. Everybody said to me, gosh, aren't you brave? But honestly, when I had seen this place, I thought, I want to die there. It couldn't be a better place to go to.

For many retirees, cost is a big factor in the decision to move to Thailand. Liz tells me she pays US$1,800 a month for her care, a quarter of what she was paying in the UK. And that's your food, your cleaning, your laundry. Everything is done for you. None of the residents I speak to has health insurance. They can't get it because of their age or it's prohibitively expensive. Instead, when they have health problems, they pay...

they pay for treatment up front at local private clinics in Chiang Mai, which are much cheaper than back home.

This is not all about money, though. It is financial, but it's also the care that I feel is so good here. You know, they've all got time for you and you know them all, you get to know them all. The Buddhist culture is very interesting. People are extremely kind and gentle. Peter Millard is another British pensioner at the resort. There's very little anger. You never hear people shouting.

It's a sign that you've lost control of yourself in a Buddhist country if you start shouting. So people are very calm, and that has an effect on you as well. People are extremely gentle and kind, and particularly to the elderly. So how easy is it to move to Thailand? Arun Paslo lives in Bangkok and works for a company called Offshore in Asia. He advises Westerners who are thinking of making the move.

So basically if you're 50 years of age, you can come out here, get a retirement visa. You have to have $25,000 that you put in a Thai bank account. It is a one-year visa, but it is renewable indefinitely and

You can basically keep this going as long as you keep satisfying the financial requirements and also provide proof of a lease if you rent an apartment or something like that. And apart from the $25,000 in a Thai bank account, are there any other financial considerations that people need to consider?

I suppose just having enough money to support yourself here, whether that comes down to having enough money to take care of medical issues or having insurance. You might also want to look at any taxation implications. For most people, that won't be an issue. As the rules stand at the moment, you might have to be a little bit careful about bringing large sums of money into Thailand. But everything said, it is a very easy country to retire in. It's a big market. They're very welcoming. You can live a very good life

Sounds pretty straightforward. But, of course, not all elderly people are as healthy as Lin, Liz and Peter. The decision to move can be complex, involving relatives too. And some pensioners, sadly, are no longer able to make an informed decision about where they receive care. I visit another care facility, also in Chiang Mai.

Here too, the young Thai staff are coaxing the residents through a class. But it's a calming meditation class. There are eight patients in it and some are clearly very ill. This is the VivoCare dementia facility.

All of the guests here have dementia, and in many cases, it's severe. I don't know what time is it. It's probably about half past twelve. Half past twelve. Sybil Davis is 90. Her son, Gary, lives in Chiang Mai and helped her move to Thailand when her mind started to fail her. I think you've got mixed up between the coffee and the milk. Oh. And you take the coffee in the saucer rather than milk in the coffee. Oh.

Gary says the move has worked out.

She's in absolutely the right place here, getting exactly the care that she needs, a level of care that she couldn't possibly hope to receive in the UK. She's surrounded by lovely people.

Beautiful people that look after her. She's getting 24-hour one-to-one care. She's never cold. The weather's fantastic. And she knows she's getting the best life she could possibly have in her condition, and she's comfortable with that. The family's comfortable with that. I'm comfortable with that. This is Business Daily from the BBC World Service.

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I'm Gideon Long, looking at the growing business of retirement care homes in Thailand, catering to elderly, mostly Western guests.

I spoke to one of Vivocare's Swiss owners, Roger Holzer. He's been in Thailand for over a decade and has seen the market for retirees expand. Attitudes have changed too.

When we started, there was always this negative comments about deporting the sick relatives abroad. But that has completely changed since they now realise that providing care for dementia people is not possible anymore in many European countries because it's just lack of staff or too high costs. And tell me about the staff that you have here. Are they locals from the local area? What kind of qualifications do they have?

All our caregivers are from the area here and they are all holding a certificate for care. We prefer to hire young, certified caregivers fresh from the university. But they all have qualifications. They have to have qualifications to work here. They have. We have many nurses here, certified registered nurses, and every single caregiver holds at least appropriate certificate for caregiving.

Labour costs are much cheaper in Thailand than they are in Europe or the United States. Can you give me an idea of what your carers earn? Well, their base salary is around US$350 a month, plus overtime, plus night shifts. So, on average, a caregiver receives roughly about US$600.

About $600 a month. That's more than double the Thai minimum wage, which is around $250 a month. But that's a huge difference from Europe and the United States, so I imagine that that's a big reason why people are coming to places like yours, because your costs are inevitably going to be lower. Yeah, definitely. In Thailand, the wages are much lower compared to other countries. At the end, it's also a question of affordability, and that's why Thailand comes into the game.

Occupational therapist? And is it seen as a good job to have working in care in Thailand? Is it a well-paid job?

Yes, I think it's OK because in Chiang Mai we are not paid a lot. I think it's OK. What do you think it is about the Thai culture that makes it a good country for care facilities? The most thing I think, we're smiling. I think body language is the most thing that Thai people, we are like smile and not so like, hmm, something like that. Slow, calm, the way to speaking also.

I wonder what other locals made of all these elderly foreigners descending on their city with their aches, pains, ailments and hospital needs, but also with their western pensions and retirement dollars. Wasana Sitirin grew up in the region and lives in Chiang Mai. She took me to one of the city's fabulous street food markets. It's an amazing market. The food here just looks incredible. Is it well known in Chiang Mai for its food?

Yeah, I'm just hungry now. And what do you think of the foreigners coming to Chiang Mai to live? And what do you think most locals, what's their attitude towards the foreigners who come here to live? They are okay with it and probably happy because these foreigners spend money in our city and...

They bring the money from their country to boost the economy in our city with no issue. Why not? Yes. In general, there's no issue with this at all. So this seems to be a win-win situation. Western pensioners get good affordable care, the owners of the care homes have a thriving business, Thai care workers get employment and the local economy gets a boost too.

could it work elsewhere in the world? Roger Holzer from VivoCare. The next facility we are, I hope, going to open is in Kenya. We just need the final approval by an investor and then we will start. And in Africa, we have two other destinations we are intending to go to. One is Morocco and the other one is Namibia. Very different culture from Thailand. It is completely different.

But I've been to Kenya now several times. I love the way the people are there. They are a little bit more louder compared to Thai people, definitely, but very professional also. But you do not have any, well, I didn't see any dementia care facilities in Kenya.

Would they run on a franchise basis? Yes. We're also setting up an academy here in Chiang Mai where we train these people and then they run our care concept in their countries and we always have people from Thailand working there. I wondered about the standard of care in Thailand.

After all, the young Thai carers that I saw have to deal with difficult cases, severe dementia, as well as the inevitable physical decline that comes with old age. Are they up to the job? The care that's being provided in these facilities is looking pretty good. Dr Caleb Johnston has researched the private sector care system in Thailand. He's been working with the private sector care system for a long time.

who's based at Newcastle University in the UK. These facilities can offer a much higher staff ratio, and I can't really overstate the impact of having an abundance of highly skilled care workers. As you suggested, the business model for these care homes basically works because wages in Thailand are so much lower than they are in countries in Europe or in the United States, for example. So at what point do you think this becomes exploitative?

It is true that many of these facilities are only able to offer what they can offer because of the abundance of cheap care labor, people working at wages which would be considered unacceptable in the U.S. or Canada or the United Kingdom. At the same time, what's a better system? Is it better for care workers to migrate overseas and be separated from their children for five, ten years working in Canada or the U.S. or Australia?

Working conditions in these facilities, by and large, I think are pretty good. Wages are decent comparatively. They're low, but decent. So it's a complicated question. And what is the impact on the local and particularly the public health service in Thailand itself of this influx of foreigners seeking care? Thailand has been at the centre of a global medical tourist or migration industry. This is big business now in Thailand.

The Thai government has seen medical tourism as a key development strategy for decades. But one of the big critiques of medical migration more broadly is that this infrastructure, all these private hospitals, facilities, they are draining resources away, investment, nurses, doctors, care assistants, equipment from the public and private clinics and hospitals that are desperately needed by the national population. That is a real concern. Care is complicated.

Across the world, countries are grappling with how to look after their elderly and their sick and how to pay for that care. Culturally, economically, maybe Thailand has at least some of the answers. This is my home and I'm just here. It's where I am.

90-year-old Sybil Davis certainly seems to be staying put in Thailand. Are we done? I think I'll have to cut it short now. Lovely to talk to you. My thanks to her and to everyone who spoke to me for this edition of Business Daily from the BBC World Service. That brings us to the end of this week of programmes looking at Thailand and Southeast Asia. If you've missed any of them, just search for Business Daily wherever you get your BBC podcasts.

And why not take a listen to World Questions, which this week comes from the Malaysian capital, Kuala Lumpur. For now, that's all from me, Gideon Long. Thanks for listening. Goodbye.

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