Homemaker/Home Health Needs

4theloveofsun wrote:

Hi All!  I've been reading/researching/considering a move to CR for approximately 10 years.  Recent life events are quickly turning my "dream" of moving into a potential immediate necessity.  My mom passed away and she was my 85 yo father's primary caregiver.  Moreover, my 68 yo husband has a multitude of health problems.  Both men have "DNR's" so 99%  of their healthcare is provided by me i.e., comfort at home and let nature take its course. 

We are not "rich" by any means but money isn't necessarily the problem.  My husband and I own our own home, and so does my father; neither home is mortgaged.  A reverse mortgage so I can pay someone to help me, and/or paying for institutionalized care is insane (IMHO).  The vast majority of the medical expenses incurred is for medication (of course health insurance pays most of that).  I'm not concerned about doctors and hospitals any longer, we are past that.  The primary focus is quality of life and in-home care. I'll be 60 yo next year and in fairly good health, comparatively speaking.  Health insurance for me in CR is not a huge concern, and obviously my husband and father are well past the need for ICU's.

I can't take care of them alone (physical and mental exhaustion is in my future if I don't get help) and I can't put them in an assisted living facility/nursing home.  I know what institutionalized care is;  "care" is an oxymoron.  Time is not on my side.  If I'm going to do this I need to do it now while both are physically able to move and travel or circumstances will dictate our future.  FWIW: I'm a world traveler; I've lived and worked in various places around the globe.  The inevitable cultural and societal challenges are the very least of my concerns.  How this situation plays out in CR is anyone's guess but the people like you, who live there, can provide much needed insight. 

Can you fine folks here please give me your 2 cents worth?  Any thoughts?  Thanks in advance!!!

Hola 4thelove,

The person who moved me down here came down with her mother who was in the advanced stages of Alzheimer's disease.  She needed a lot of care or watching over.  Because of the low cost of labor here, she was able to hire a neighbor girl who watched and cared for her during the day, I think for 5-6 days per week.  Labor for something like this would be less than ¢3,000 per hour ($5.30).  If you did something similar it would give you some freedom and the peace of mind to know that they are being cared for "at home."

The challenging part that I foresee is how would you be able to come down to figure out where to relocate to?  Do you have anyone that can help temporarily in your absence?  Do you have an idea of what community or area you want to live in?  Keep in mind the closer to the beach you are the hotter it is.  It does not sound like the heat and humidity of beach living would benefit either your husband or father.  So you might want to consider higher elevation areas.

I would suggest looking in communities that have University classes in nursing so that you might have someone with the need for home health care experience.  If you have an idea of what area you are considering, let us know and maybe someone will know if nursing classes are available in that area. 

Hope this helps.  Let us know any specific question you might have.

- Expat Dave

I'm strongly considering Chris Howard's combo tour in April.  I do have someone to provide care while I'm gone.  I (scuba diver) LOVE the ocean but I'm not sure I can afford an ocean community within my price range; around $350,000.  Ideally the home will have 2 separate living areas with approximately 3,000+ sq ft, or approx 280+ sq meters.  For health reasons my dad will need the gringo conveniences of ac/heat etc.  The type of home and the availability of help is my priority at the moment.  At some point in the future it will be just me and I can move closer to the ocean.  An expat community would be great if I can find one.

Have you read the residency requirements?

You  will not be covered by the CAJA healthcare system here, until a legal resident which can take a year or more. Your US insurance will not cover you here, and you can't have Rx's or any supplements shipped.

You may find 'help' cheaper, but you will be legally required to pay their CAJA & INS which will be more than the labor.

I wish you good luck...

kohlerias wrote:

Have you read the residency requirements?

You  will not be covered by the CAJA healthcare system here, until a legal resident which can take a year or more. Your US insurance will not cover you here, and you can't have Rx's or any supplements shipped.

You may find 'help' cheaper, but you will be legally required to pay their CAJA & INS which will be more than the labor.

I wish you good luck...

True; however, if she shows that her father and her husband are physically and financially dependent on her, their CAJA will be almost nothing.  My daughter's is set up this way.  Because she is disabled and dependent on me, (has to be confirmed by a U.S. physician), her CAJA is only ¢20,000 per month.

If her husband does have an income, it will be based on that income just the same as if he were healthy.

Based on the fact that she is saying that they both have DNR's, there shouldn't really be the concern of huge hospital bills.  Yes, a lot of variables here.  I'm just basing this on the small amount of information she provided.

As far as health insurance for herself, she can always obtain international health insurance until she obtains residency.  We had it for a while through Cigna and it was about $360 per month, I think, for full coverage.  Covered us in any country except the U.S.

...just other options to look in to.   

- Expat Dave

I was referring more towards the time taken towards being covered by CAJA, after their residency application, more than the cost involved.

kohlerias wrote:

I was referring more towards the time taken towards being covered by CAJA, after their residency application, more than the cost involved.

👍

I can private pay until I get health insurance.  The meds the men take are generic and they no longer need constant medical/hospital visits.  Doctors?  Hospitals?  As I said, we are well past that -- been there, done that.  The "co-pay" for meds in the US vs private pay or out-of-pocket in CR isn't much different in terms of $$$. 

I understand the lack of understanding by the general public because I've been in their shoes.  If you have never personally experienced the "caregiver" role, end-of-life decisions, and the expense associated with in-home care you cannot appreciate or comprehend the costs associated with it; financially, physically, and mentally.  Unless your loved one is on Medicaid, has long-term care insurance, or millions of dollars, you are forced to make some very hard decisions regarding their end-of-life care.  My options are:

1.  Estate planning -- meaning all assets are protected through trusts and the person needing care has less than $2,000 in the bank.  The person can then qualify for Medicaid.  Medicaid will not pay more for in-home care than the cheapest, rat infested nursing home costs.  Again "care" is an oxymoron in this scenario.  Furthermore, Medicaid will ask for reimbursement after the person dies so you had better make sure the estate planning is done very well, by a very good and experienced "elder care" attorney in the state you live in.

2.  DIY as my mom did; that killed her, she's dead, so I don't recommend this option unless your a suicidal    If you have a large, extended family and they  get along well sharing the daily duties can work.  Unfortunately in the US this rarely happens.  We tend to take, not give back to our elders.  Sad, but oh so true.

3.  Spend every last dime I've worked my entire life for; give all my assets to the bank i.e., mortgage everything so I can pay for the help I need to keep me healthy and sane, and my loved one safe and comfortable.  Of course I will be broke and destitute after they die so this option is not ideal.  What about my retirement and end-of-life care?  I need to consider how I will survive.

I can't pay the local babysitter" to do what I do.  Medication administration and personal care is required. The US has very strict elder care laws (at least we got something right), and labor laws.  Where I live hiring one full-time person (meaning 8 hours a day, 40 hours a week, plus providing the employee with vacations, paying employment taxes, workers comp, etc.) is, at minimum, $50,000 annually.  Even if I found someone willing to do the hard work necessary for minimum wage ($11.00 an hour where I am now) and they had the "smarts" to do it after I trained them (I do more than most RN's with a BS degree) the minimum wage and labor laws make it cost prohibitive.

My mother-in-law has been in a private pay nursing home (her choice) for more than 10 years (she will be 100 yo in 2018).  She "had" long-term-care insurance; "had" because long-term care insurance expires after 10 years....  Unreal!!!  That's different story for a different day. Fortunately she has the cash to pay the $70,000 annual out-of-pocket expenses for her care. 

Just wondering, have you ever provided end-of-life care for a loved one, for an extended period of time?  Have you ever been financially responsible for parent who needs care?  Do you know what's involved?  If you have you must know I devote every minute of every day with zero time off. I clean up urine, feces, and vomit; change bandages; launder their sheets and clothes daily; administer meds and injections on a schedule; and if they have dementia as my father does, I keep him happy, and safe in the middle of the night so he doesn't take a bottle of medicine or walk barefoot through the glass he just dropped and broke.  This is the very short, and very abbreviated list of the things I do.  Trust me, institutionalized "care" doesn't have the resources to provide him with the care I provide (this is my field of expertise, I have an MA in Human Services).  Nursing homes are under staffed and the staff is overburdened.  But that's a different and very sad story for a different day.

ExpatDave wrote:

kohlerias wrote:

Have you read the residency requirements?

You  will not be covered by the CAJA healthcare system here, until a legal resident which can take a year or more. Your US insurance will not cover you here, and you can't have Rx's or any supplements shipped.

You may find 'help' cheaper, but you will be legally required to pay their CAJA & INS which will be more than the labor.

I wish you good luck...

True; however, if she shows that her father and her husband are physically and financially dependent on her, their CAJA will be almost nothing.  My daughter's is set up this way.  Because she is disabled and dependent on me, (has to be confirmed by a U.S. physician), her CAJA is only ¢20,000 per month.

If her husband does have an income, it will be based on that income just the same as if he were healthy.

Based on the fact that she is saying that they both have DNR's, there shouldn't really be the concern of huge hospital bills.  Yes, a lot of variables here.  I'm just basing this on the small amount of information she provided.

As far as health insurance for herself, she can always obtain international health insurance until she obtains residency.  We had it for a while through Cigna and it was about $360 per month, I think, for full coverage.  Covered us in any country except the U.S.

...just other options to look in to.   

- Expat Dave

Dave, your understanding of my situation is on target.  A "do not resuscitate" order, or DNR means more than "do not attempt CPR".  It means no life support: feeding tubes, respirator, dialysis, etc. etc.  are procedures that will sustain life with the hope of recovery, a decent quality of life, and independence.  With a DNR in place they will receive morphine for pain or minor procedures to make them comfortable at home (period). All the medical procedures administered by an ER\hospital that cost big $$$ will not be attempted due to the resulting diminished quality of life with no hope of recovery or independence.

Hi, I'm 62 divorced and considering CR for retirement on social security plus 401K. So CR may be an answer...looking for an affordabe and friendly and possible entertaining place to retire. By entertaining mean walking, the beach, hiking, exploring etc.

randee01 wrote:

Hi, I'm 62 divorced and considering CR for retirement on social security plus 401K. So CR may be an answer...looking for an affordabe and friendly and possible entertaining place to retire. By entertaining mean walking, the beach, hiking, exploring etc.

Hi Randee.  I'm not sure but I think your post may get more replies if you create your own topic.  Your post appears under the topic I created:  Homemaker/Home Health Needs.  I'm new here so I'm not certain.  Someone else with more experience on this forum can give you more accurate information about posting than I.

Since your spouse is in bad health, if you decide to apply for residency, I would advise you to do so,  (or anyone else in a similar situation) as an individual rather than his dependent. If he passes on before you have become a Permanent Resident, you would then be required to reapply with your own 'guaranteed for life' pension.

Thanks. I'll do that. do you like living in Costa Rica? Is it boring after awhile?

kohlerias wrote:

Since your spouse is in bad health, if you decide to apply for residency, I would advise you to do so,  (or anyone else in a similar situation) as an individual rather than his dependent. If he passes on before you have become a Permanent Resident, you would then be required to reapply with your own 'guaranteed for life' pension.

I'm not certain but I assume both will be MY dependent.