Is Care Migration the Next Frontier?

Or another bandaid for our broken care system?

Hello friends and fellow carers. I recently returned from a trip to Jalisco, Mexico, where I was visiting my father who has made the 2,600 mile move into a Mexican nursing home. As I shared last month, it was an abrupt and difficult transition for him - and for those of us who love him. My mindset going into the visit was marked by temptation to meticulously plan out the questions I would ask, how I might frame and voice my concerns, and how I would navigate difficult conversations. I was feeling guarded and skeptical, struggling to move beyond the black and white thoughts about this massive change. In the end (and to my own surprise), those thoughts softened into shades of gray, and the mindset that ultimately prevailed was, fortunately, one of presence and openness to the unknown. By the end of my time there, I felt the relief and peace of acceptance. The trip also brought up many conflicting thoughts and questions about different care communities, and particularly the roles and care relationships between migrants/expats¹ here in the US, in Mexico and elsewhere.

My step father Jackson, me, and my dad at his nursing home in Mexico

The nursing home is inconspicuous, behind concrete walls on a quiet street above the main road connecting two lakeside towns south of Guadalajara on Lake Chapala. Once buzzed in, the metal doors open to a pathway that leads to a lush and sunny courtyard where residents gather to chat, participate in exercise classes and eat comida when the weather permits - which it usually does. There is a large flowering tree in the courtyard, surrounded by one story bright yellow buildings with patio entrances to each residents’ apartment. It is a stark contrast to the hospital-like nursing environment my father moved from here in the US.

The first day I arrived, my dad was thrilled not only to see me, but to share his progress from the day before: he walked for the first time since his fall last October! And it was the talk of the courtyard, his new friends as excited to share the news as he was. The sense of community and care for each other was palpable and genuine. Similarly, many of the staff radiated a warmth and affection for the residents that is noticeably different from the professional but detached approach in the US.

Of course it’s not all sunshine and roses either. Perhaps the flip side of the warmer, more family-like attitude of staff is that the bedside manner also tends to be more… informal. Staff often jump right into what they are there to do to the resident (changing a diaper, taking vitals, etc), at times without an explanation or request for consent beforehand. It’s nothing concerning, just a cultural difference that is further hindered by language barrier; but it has been a difficult adjustment for my dad, as I imagine it has for many of the primarily American and Canadian residents. Sometimes he brushes his shock off with a joke, other times it clearly pisses him off! All in all, I saw that he was being well cared for in an environment that is much more social and sunny than the one he moved from. And I got to spend quality time with my dad, including listening to him share stories about his time living in Iran, as college student body president, and the challenges when his first child was born with Downs Syndrome.

Retirement Migration & Living the Mexican Dream

After spending most of the day with my dad, I spent evenings with his husband Jackson, who has an apartment in Chapala, and a crew of new fast friends - American expats in their 80s who had moved to Chapala for nursing care for their partners, and the quality of retired life they can afford there.

An estimated 20,000 retired Americans and Canadians live in the enclaves around Lake Chapala, making up between 20-40% of the population in Ajijic - the most popular town for expats. Nearby Guadalajara has some of the best medical facilities in the country, and is also a hotspot for medical tourism. I can see the appeal for retirees: most of us are trying to maximize the quality of our lives with the resources we have, and for those who love travel and sunshine, retirement in Mexico sounds like a dream. Yet its hard to ignore the vast disparities: similar to the situation in US nursing homes, lower class Mexicans are caring for privileged, white north Americans. I would guess that many of the staff are also caring for relatives of their own when they clock out of work.

Over dinner one night the group of retirees who have maintained good health tell stories about their life at my age. One recalls purchasing a home in Seattle in the 1970s for $30k that last sold for $800,000. Another was able to support a family of three on only a graduate school stipend. Here in Mexico they are living the dream, in houses with pools, maids and frequent travel. And they know that at some point they may also end up with my dad in nursing care.

Beyond the financial side, Jackson shared just how challenging and lonely life had become in their rural island home in the pacific northwest. He has been living the Long Goodbye more intimately than I for the past couple of years, slowly taking over more and more (and eventually all) of the household tasks, and missing the deeper conversations and interests he once shared with my dad, with fewer and fewer social interactions. In Chapala, like my dad, Jackson has found a community that looks out for each other, offers companionship and in some cases has led to DIY communal living arrangements.

A mix of residents and visitors in the nursing home courtyard

Expats from the Bay area and Portland getting ready to play a jazz set in Ajijic

Upon my return home, I had a further wake up call to the absolute shocking price differential of care. Despite my requests, it took months to get the first bill from my mother’s new nursing home here in Seattle, but it was waiting for me when I arrived home from Mexico. A whopping $58,000 for four months.² Yes, you read that right. The nursing home in Mexico is closer to $3,000 a month, which is still expensive for Mexico but which can almost be covered by my father’s social security check. Even the majority of relatively privileged Americans living their best lives in Chapala would be wiped out by US nursing expenses.

The reality is, many people with the privilege to do so are fleeing and doing whatever they can to escape the disaster that is our caregiving (and healthcare) system in the United States. This ‘silver migration’³ is not unlike the post-pandemic nomadic Gen Z remote worker lifestyle that involves banking US salaries from cafes around the world, or millennials who have decided to move their families permanently to a lower-cost, higher happiness country of choice (with subsidized health and child care).

While these are all feasible option for the privileged, it certainly isn’t a solution for the vast majority, and it is yet another reminder of the inequities that prevail on the individual, societal and global levels and which shape our experiences. It may also become less attainable for Americans. When I describe my life as a working sandwich caregiver and the exponential costs in Seattle to the table of retired expats, I’m met with the familiar “I don’t know how you do it.” Generally speaking, Gen Xers and Millennials have been saddled with college debt and recessions, and we are on track to have a much harder time in retirement. While there has been buzz about a “great wealth transfer,” in reality this doesn’t account for longer life expectancies, skyrocketing eldercare costs and greater inequality.

How will post-covid migration impact the future of retirement, care and social security in the US? Will the US start to crack down on expats cashing and spending social security checks abroad - assuming social security still exists? Will the gentrification of popular expat locales help those economies or just exacerbate inequality and resentments? In fact, we’re already hearing about the backlashes in popular remote work locations like Portugal. Will the US eventually realize that care is a public good that that should be subsidized like other infrastructure? What other responses to the care crisis can we expect to see over the next generation? Perhaps my friend David - a recent migrant to Mexico himself - has some predictions.

View of Lake Chapala from the town of Chapala

Thanks for reading, and for being part of this community. I love to hear from you! If you enjoyed this and/or have something to say about it, leave me a comment or a ❤️ or simply reply to this email.

📚 Reads

Meet the Elderly Britons Swapping the NHS for Luxury Care Homes in Thailand

When a Spouse Goes to the Nursing Home

What the Childcare Crisis Does to Parents

1. I can’t use these terms without cringing at the biases they represent. While technically the term “migrant” suggests a more permanent move, in reality the term “expat” is usually given to privileged white people while “migrants” are non-white, lower class laborers.

2. More to say about this, but in our case my mother will spend down her retirement savings and go on Medicaid, which fortunately (and unusually) is accepted by this home.

3. “Silver Migration” is apparently a term in electrochemistry, but I’m hereby appropriating it to describe migration abroad for nursing/elder care.