Specially since I am well into my “Golden Years” (I’ll be 69 in September of this year, Good Lord willing and the creek don’t rise), many people ask me about growing old and the provisions for elder care here in the Philippines.
Some of their questions seem to be general concerns about my plans, and how I will be cared for in my old age, and many folks want to know what would be in store for them if they move to the Philippines and retire.
Well, The Real Answer Is Nobody Knows
If you’re like me you have probably read a thousand articles about aging, elder care, government programs .. and especially these days, hordes of salesmen try to flog Extended Care Insurance to cover prolonged stays in nursing homes. A big push from government employees, like the folks who work for the Civil Service retirement system taking care of retired government employees (that would be me).
I really think the US government should NOT be in the business of promoting commercial insurance, but given the huge numbers of us “more elderly” folks coming along every day, those who don’t have LTC are going to have to be cared for by “someone” and if the “someone” is only Uncle Sam, I truly think the USA economy will crumble.
The US is for all intents and purposes insolvent right now, today, as I write this, because the amount of money coming in via taxes and the amount of money going out to pay interest on US debts owed to others is virtually equal.
It’s like having a salary of $4,000 a month and credit card bills with total minimum monthly payments adding up to $4,000. Your long-term prognosis is not good … and neither is Uncle Sam’s.
Some Of The Facts:
- Statistics tell us that roughly 80% of us are going to need Long Term care (primarily a nursing home) for at least part of our latter years.
- Those depressing, odiferous places are damn expensive … easily $80,000 a year or more.
- Regular commercial Health Insurance either doesn’t pay for nursing homes at all, or only pays a limited amount.
- Social Security, which virtually all of us have after age 65, only pays for nursing homes for very short periods of time. It won’t take care of LTC needs
Thus it’s pretty easy to see why commercial insurance companies are going crazy to capture this huge and lucrative market. Out of everyone alive in the USA who is lucky enough to reach “old age”, about 80% are going to need Long Term care. Currently there are something like 100,000 of you out there reaching Social Security age every month … so that’s one huge market.
If You Do Stay in the USA Until You Need Care
It will not ONLY be the payment of the huge costs that will be your problem. Even if you have the resources to pay thousands and thousands of dollars a month, What kind of care will you get? Time will tell, and you’ll then be too old (and out of it) to really make any change.
Here’s an excerpt from a cheerful little news item that crossed my desk a few days back:
An army of robots may soon be deployed to care for the elderly
… A conference in San Francisco last week on innovation and aging featured a keynote address by Cynthia Breazeal, founder and director of the Personal Robots Group at MIT’s Media Lab. Breazeal’s research focuses on robots that can make social and emotional connections with people. Her lab has developed a range of robots ranging from small six-legged devices to small stationary machines that mimic human expression and communication.
Breazeal’s lab has designed a robot called Nexi that can blink, shrug, and make facial expressions; another, called Autom, is designed to help people lose or maintain weight. And telepresence robots can gesture and pick up non-verbal cues. (ed comment, will it recognize (or know how to give the “one digit salute”? 😉
No doubt, the demand for caregiving help will be there. …
You may be interested in reading the whole article. It’s not very long, but BOY is it scary to me. Indeed the demand will surely be there. But not for me, no thanks, Mr. Roboto, thank you very much.
What If You Make Your Own Plan Instead of “Submitting”
However “cute” and attentive such little gremlins like “Nexi” and “Autom” and their ilk may be, I’m afraid I won’t be submitting myself to their tender mercies. The fact that US Medicare and other government entitlement programs don’t cover me while living in the Philippines is an object of great concern to many folks I talk with. Perhaps it even worries my family back in the USA as well.
But NOT dealing with US Medicare, Medicaid, ACA (Obamacare) and all the rest of the “Alphabet Soup” that advertises that they care for you, while actually jamming you into the “mold” of submission (and in the case of Medicaid, actually divesting you of your entire estate in order to offer you limited care) to me is actually a relief.
My Plan, Will It Work?
Well as I said above, nobody knows for sure. Anyone who wants to challenge my assumptions is welcome but you have to keep quiet for 30 more years, which is how long I plan to live. We won’t know for sure how well that will work until then .. so mark the date on your calendar.
I am currently in good health. So is everyone until they get sick. When I do get sick, I first pay from my pocket … I know that’s a strange thought for most Americans. But I typically pay much less for a doctor’s visit than you pay back in the US for just your co-pay.
When, it’s not “if” it is “when” something happens that I can’t pay for out of pocket, I’ll get part of my money back from PhilHealth, the very inexpensive Philippine government health plan (and yes, foreigners who are not married to Filipinos may avail of PhilHealth as well.)
I also have (free) TRICARE insurance which comes to me as a retired US serviceman.
Next I maintain three different US credit cards, zero balance, which together would fund several million pesos of Philippine medical care. If I run up big bills on my cards, well I’ll just pay them my monthly payments, same as most other Americans are doing. Or, if things get too bad, I’ll just stop paying. They can’t garnish my Federal Pension and that “credit rating’ thing you all worry so much about? It has nothing to do with me here in the Philippines.
I actually have yet another level of health care support I could activate if I needed it, but that’s not important to our discussion here.
Long Term Care in the Philippines
That’s the main subject I started writing this article about, so let’s get to the point and wrap it up, shall we? I have no need of Long Term Care insurance, or of nursing homes for that matter. My sons will NEVER have to face the burden of deciding on a home for dad and even worse the burden of deciding how to pay for it.
My wife and I are completing the total renovation of the little house we bought some years ago here in Marilao, Bulacan. We added a second story, added bathrooms and most importantly made sure there were no steps from the street up to the main floor, and there’s a den/guest room on the first floor with an adjoining, handicapped accessible bath.
Not wishing bad luck on ourselves, but if either of us is stricken with something immobilizing, we could be looked after quite comfortably in out own home.
We can hire a registered nurse for as little as P4,000 or P5,000 a month, so round the clock nursing if needed won’t break out budget.
We can also hire ancillary care, say a physical therapist for even cheaper than a nurse.
And if the end is near and I have to go to hospital because I need more care than can be provided at home … just as would likely occur if I were back in the States, a hospital like the one pictured above, situated on the shore of Subic Bay, will run less than $900USD a _month_ for an air conditioned private room. That’s way less than any hotel in that area would charge, and TRICARE will pay 75%. Any wonder why I am not in any hurry to rush back to the USA and place myself under Medicare’s tender care?
So Do I Have a Solution?
I am not so arrogant or ignorant to think I have all the answers, but I must say I’m really open to discussing why on earth I would want to stay in the USA (37th best ranked health care in the world, according to the WHO) in order to get only the level of care which our “Nanny Government” says I am allowed, instead of making my own way, deciding on my own level if care and being happy along that way.
America was founded and most Americans used to be free and independent. Today? I’m not so sure. It seems so many Americans, especially those who have attained my age or greater, just sit around in fear and apprehension, waiting to be told just what the government says they can have this year or next.
Seems a shame I have to live outside my own country in order to feel like a free American.
Dave, you bring out some good points and information for those trying to decide if they can be taken care of in their later years in the Philippines. I think your plan is very workable and affordable; and I also would agree with you regarding America’s future if we continue down the path we are currently headed.
since I just turned 64 it seems many health issues have come up that makes me think about this issue of care ( mainly like in home nursing care ) if needed…its a bit worry some to say the least! it is good to know that to get an in home nurse is relatively inexpensive..was happy to find out this week that at Brokenshire hospital in Davao they will remove cataracts from both eyes for 13,700p if one has Phil-Health ins. without ins. its 25,700 so it is quite a savings to have Phil-Health. thats for each eye I should mention and they have 4 levels to choose from my is the least expensive it will mean I will still need to wear glasses, some of the other levels will allow you to not need glasses anymore
Hi Scott, thanks for contributing.
You know one thing I forgot to mention when I was talking about decent, affordable hospitals here in the Philippines is this.
If a guy had almost everything go wrong and he found himself alone with no family to help with his care, it is totally possible to just check in do a decent under $1000 USD per month hospital and use that as his home, ’til he either got better or got worse. In most cases, back in the USA, the co-pays and cost shares and all the non-covered items would add up to far, far more than full-time 24/7 trained nursing care (and don’t forget that includes food, utilities and everything else) in a Philippine hospital … so to me, staying in the USA in order to take advantage of whatever care you are going to get from Medicare’s “tenser mercies” is a really bad deal.
It’s not politics in any way, guys, it’s practical dollars and cents.
Thanks for contributing, RJ,
I did not want this to be about politics in any way, although it is hard to talk about Medicare and such without trending in that direction. All I’m trying to do is point out that we, as a free people, can take action on our own to solve our own dilemmas and let the folks whose chief hobby is making everything a political dissuasion just sit in the corner and bitch. I prefer “doing” rather than complaining.
Hi Dave – Good article
The American financial system will take further serious beatings over time, but people have to keep moving forward, so they will get by. It’s best not to trust in any Government for looking after you, because they just mightn’t be capable depending on circumstance.
They are also building a state of the art resort hospital in Dumaguete – http://www.buglas.com/?p=2150
Also health care is often reasonable in the Philippines if you can pay. If you can’t pay then it’s disastrous even fatal.
Brenton,
Thanks for that. I had my cataracts in both eyes removes and replaced with new lenses several years back. Price was similar to what you quoted above and it was a GREAT investment.
My US eye doctor said my cataracts weren’t “ripe” enough to operate on, yet by the time I moved to the Philippines I really couldn’t drive safely at night. The US doc was following standard Medicare protocols that dictate when money will be spent on seniors.
My Philippine doctor said this … the ethical medical standard is this, if the cataracts are interfering with you enjoyment of life, then they should be dealt with .. what a great deal to be “liberated”. Again I had to come to the Philippines in order to feel like an American.
David;
TriCare is accepted at the Bay Point Hospital shown in your photo as well as PhilHealth and others and treat us very well.
The Sheeple who bought into the “Affordable Health Care Act” will soon wake up to find that it’s a mis-name scam, it has nothing to do with health care and all to do with free insurance for the non-working percentage of society. Uncle Sam will sell the working folk overpriced insurance and then give free insurance to the poor, and exempt its friends and themselves
If people really think the government is there to help them, look to how the government runs the VA, and the hoops we must jump through with TriCare, our so called “free” health Insurance.
People forget the same US government took over a brothel in Nevada for non-payment of taxes, and bankrupted it within six months.
As I age in the Philippine, I know my family will watch over me at home.
Paul, Without a doubt the extended family is already being groomed by my wife of 38 + years for any possible situation involving my health taking a nose dive. For now I am healthy and very fortunate. I trust the family a lot more than any United States Government Agency believes I may or may not need. Plus the family will do the most important thing to me, and for me. . . . Allow me to live my final days with DIGNITY!
Terry, I think you made the most important point in the whole comment chain so far. Dignity. When I go to a doctor here I am treated with dignity, not sorted out by age to go sit in the Medicare category with the other “washed up” oldies.
Or worse yet, be told that the doctor is not accepting new Medicare patients. I mean how degrading is that. I may not have a lot of money, but I am never asked to “prostitute” myself by some clerk who looks at my birth year and then tells me what I am or am not entitled to.
Paul,
You really nailed it. Our family health insurance here in the US has almost doubled in the last year and I’m sure it’s mostly due to Obamacare. The money to cover all the non contributors has to come from somewhere. My wife and I hope to retire and move to the Philippines but it seems the more we work the more they take from us.
Robert, to my mind a great many people make big mistake by waiting too long in order to have “all their ducks in a row”, to maximize their retirement and such. Nothing in life is more useless that years wasted an left behind. For sure the biggest mistake I made in my planning was waiting years after I could have retired in order to have a bigger pension. The difference between what I would have made and what I make now can not come close to compensating for the years I gave up.
Sigh…
I’m so TIRED of the back and forth arguments about the state of healthcare in the US. Full of political BS and misinformation. Why not take a positive solution-oriented approach and look to the countries that are doing it right (e.g. who is #1 in the world and why?). I think if we objectively look to those examples, we’ll see what it takes to get it right and what the proper role of our government might be in that mix.
The problem with the US is the endless pursuit of self interest. Everyone is out for money and the money invested in the status quo will keep us solidly on the path towards ruin. They profit from it and have a vested interest in keeping the public confused about the facts, while catering to our prejudice. Let’s not fool ourselves into thinking that “government is bad” as a matter of principle. It’s just that ours has been bought-and-paid-for a long time ago by those who seek to keep its influence weak.
It’s an old tried-and-true tactic: Weaken the government’s influence by cutting taxes, de-funding programs and shackling it with debt (and then spending that money on profiteering private enterprise), then point out the ineptitude when the public sector inevitably fails to do the job! How more cynical can things get?
Government is the only entity that has the public/common interest as its reason for existing. I’m also willing to bet, it’s also the only entity making healthcare WORK in those countries at the top of the list. Maybe I’m too pessimistic (and I’m happy to be proved wrong), but I feel the US is too far gone when it comes to embracing the concept of shared sacrifice and investing for the sake of the common good.
We’re going to have to look after ourselves for now, so Dave’s article today is very relevant. Sorry for the rant, folks. I like and respect you all, but this sort of thing is a BIG reason why I’m here with my family today.
Please refrain from steering this toward US politics. Dave’s article did a good job of avoiding that topic for the most part and focusing on what is available in the Philippines. This site is about life in the Philippines, not about US politics.
Bob – The main thrust of my comment was to point out that we would be well served to learn from the positive examples of well-run healthcare in the world and avoid the all-too easy conclusion that government can’t play a legitimate role in crafting a solution for us all – both in the US and here. Like it or not, that’s a political stance in and of itself – even if it’s a popular one among your readers and contributors.
Both the article and some comments that preceded mine expressed a certain “biased view” of healthcare options for US citizens – both in the US and abroad. So if you don’t want any discussion about such things, that’s your prerogative; it’s your site. But please make an effort to be fair and address such requests to the group as a whole. I felt unduly singled out on this one.
I’ve taken my high horse and put him in the stable. Will walk like a mortal for the rest of the day. 🙂
All “main thrusts aside, I did include a little “soap boxing” in my comments – no disrespect intended to anyone.
Sorry Bob. Not another word from me.
Dave,
I agree with you on healthcare for retirees. Don’t want to rely on Medicare for care. I know when my father was in a rehab center after hip replacement, Medicare would not cover his entire stay. I like my chances here.
Indeed, Papaduck. You hit on another important issue I didn’t mention in my article. It;’s very common for some to suffer,say a stroke, and then find that after they make what ever recovery they will be able to make, Medicare will no longer cover things like Physical Therapy, once the is no longer a medical opinion that there will be an improvement.
I have a friend here who had this happen. His wife had a stroke in her ’40’s. She recovered but with some paralysis and speech impediment. Medicare said, no more PT because you are not expected to recover any further.
Wow. But this woman has perhaps 40 or 50 more years to live .. and regular physical therapy greatly enhances her life. Is she to be discarded and not attended to for her remaining life because she most likely will never make a “full recovery”. Disgusting.
Instead they moved to the Philippines, hired a live-in therapist (for less than their previous Medicare co-pays and she can enjoy ever bit of the time she has left,
Dave I really liked your article and agree with your thinking. I can see Baypoint hospital from my house but unlike you, I did not build for the future. My 4 flights of steps may be a little hard to negotiate later on but then on the other hand they may keep me healthy longer. I am saving for an elevator and a generator to run it.
BigP, thanks for contributing. Being in sight of Baypointe is a really good place to be. Here’s my secret plan to deal with stairs, in case I want to use both floors in my house and I should became “Chair bound”.
Front of my house is a pretty much standard garage (car port really). There are no steps between the car port and the main floor. Above the carport is a concrete deck/terrace, with no steps into the “bedroom/computer room/blog central” floor.
Think of a 4 x 4 steel plate with railing, 4 1/4 inch steel cables hooked to each corner, all connecting to the cable of a standard 12 volt pickup truck bumper winch, mounted on a bracket 6 or 7 feet up above the terrace level, and a 4 x 4 hole cut into the terrace floor. And one 12 volt gold cart battery to power the winch. (and a tiny solar panel to keep the winch battery charged if you really want to do the whole think up “green”. I just looked up a suitable winch on Overstocked dot com , P5900 with 45 feet of cable. They sell winches like this in the Philippines too.
My wife doesn’t like the idea but I’m keeping it in the back of my mind … I can have a guy with a concrete saw cut the hi-ole in my terrace in one afternoon and my local welding guy do the mounting brackets and my local electrician install switches at top and bottom, and voila, “Bob’s Your Uncle”.
Maybe next week we’ll talk about how to modify a standard Philippine trike to make the rear of the side car a roll-on roll-off wheel chair ramp for going to the mall without the hassle of transferring from a chair to a car and back again four times per round trip.
And the great part about living here is, ain’t nobody to tell me what I can and can’t do 😉
Timely article Dave, Just yesterday we received our first co-payment from Tri-Care, so the system works (for those who might be concerned). The payment was processed with-in 30 days as promised, and sent to us via registered letter (2 weeks) and now we will have to wait 30 days for checks to clear. But all in all I am happy with it.
When we designed our house we purposely made our downstairs “family” room a little large so that when the wife and I are a bit old to climb stairs we will move downstairs. We should be able to afford live in care, not only that we have enough nurses in the family I feel confident we will be taken care of.
The care here might not be completely top notch as compared to other places in the world, but frankly I feel more confident here than I would back in the states.
First of all, let me say, I am 100% in favor of taking care of the truly needy in the U.S. As far as the health care in the U.S. goes, no question there could be improvements and the cost is excessive for many procedures. There is definitely improvements that can be made in U.S. healthcare. The question is how you achieve that. According to the most recently published WHO dated in 2000, France and Italy were rated #1 and #2 in world health care. The 2010 WHO study was so controversial it was not published. We all know of the financial situation France and Italy are now encountering due to their socialist policies.
Share sacrifice…hmmm. Based on the most recent IRS data available (2011 tax year) 50% of the top wage earners in the U.S. paid 97% of the taxes. The top 5% paid 57%, the top 1% paid 35%. Our problem is spending not revenue.
I’m not anti-government. I worked for a small agency of the U.S Treasury Department (OCC) for 34 years and it was a very challenging and rewarding career. I had the pleasure of working with many dedicated and talented professionals. There are critical and important functions our government performs extremely well, however when it gets involved with trying to replace private enterprise, it is extremely inefficient and wasteful. Government regulations, to a point, are definitely needed for we all know there can be some bad actors and abuses in the private sector as well.
Sorry Bob, I did not read your comment about the U.S. politics until i already posted…will refrain from further comments regarding that.
Thank you for that, RJ. It just is a topic that will only turn into a flame war, and really has no place on this site.
Great article Dave, so very true what you said! I’m a little older than you (74) and thank God in good health except arthritis attacks at times.
I’ve already decited to cancel my Medicare since Uncle Sam would will deduct about a hundred bucks from my SS as soon as I leave the States. Of course Medicaid and Medicare would not pay for anything in the Philippines, so why not?
Other thing is that if you have Phil family you don’t have to worry about care anyway, it’s a given that they will take care of you, you take care of them, they take care of you, kind of a tradition? also the honorable thing to do! best Elder Care there is, FAMILY!
Amen to that, Heinz. It’s not really about the money, it’s about spending one’s latter years shunted aside like you are nothing but a nuisance and a burden. Am I arrogant? I don’t think of myself that way, although if others do. so be it. But I feel a huge number of folks are age have the problem that they think TOO LITTLE of themselves. We aren’t worthless just because we’re old.
You’re right. I completely understand. Sorry again.
Definitely something I have factored in to spending more of my retirement time in the Philippines. Not just the affordability of care, but the general respect for elders. Great points, great article.
Yep, I may die without a lot of money in the bank, but I won’t die shunted into a corner at the whim of some bureaucrat.
Sounds like you have a very well thought out plan Dave and thanks for sharing it here. It is very encouraging that Philhealth is now available for foreign residents. I think a few years ago it was not. I would think residents on a SRRV, 13A and other popular resident visa would qualify. What about those that stay by extending tourist visas, making a visa run at the appropriate time and then returning to repeat the process over again. My understanding would be that they are still a tourist, not a resident and therefore would not qualify for any Philhealth Policy ?
Hello Bob NY,
So far a I know PhilHealth is now available to all and it has never had any citizenship requirements. World you happen to have any reference on foreigner restrictions, from someone who knows? I note that many Filipinos have little or no knowledge of their own system. My suggestion? (to all who have this question, actually) Go direct to PhilHealth, in your own and find out, directly.
Hi Dave,
I learned about Philhealth a few years ago from their website, things may have changed a bit since then. I was not at the time reading it for myself but wanted to recommend it to a Filipino friend. who has since subscribed to it. At the time I went thru the website I either read or was under the impression it was for Filipino citizens only and maybe spouse regardless of the nationality of the spouse.
Hello Dave!
Once again a great article. I really like your no-nonsense approach. I am in the same boat as you, i.e. retired military, soon to be retired civil service. I will be living in the Philippines next May 2015.
I really would like to meet you and many others who post to this site.. And gain from all your experience in regard to health care use via tri-care. Its one of the few benefits that come from retiring from the military.
Personally I am trusting God to not go thru all the suffering, but to just check out (smile)!
Looking forward to meeting many of you guys who post to thios site. I have learn so much from all the articles. I am listening and learning from all your experience. Thanks to all of you!!!! Because of you I am well prepare to come live in the Philippines.
PhilHealth is likely worth the limited expense that it costs, for some benefit is better than nothing, but I’d be hesitant to rely on it exclusively. For example, my wife’s sister had an extremely complicated child-birth and when the final bill was tallied, less than 20-percent of the bill was covered and guess who had to chip in for the rest. So, while I was able and willing to kick in the extra 200,000-pesos, someone might not have that disposable income while in “retirement” in the Philippines.
Another good thought provoking article Dave. It took some time to convince Marlyn that we shouldn’t build a multi-story home. She loves the designs, but my lifestyle has not been kind to my knees and hips. I reminded her of that, as well as the problems her aged mother has with the stairs in her own house. I mentioned that we were going to grow old in this house, and she finally consented to building a ground level house.
Between Tricare, Philhealth, and an emergency savings account, I think we’ll be better off than in the States.
Take care,
Pete
I understand there is a VA Hospital in Manila. Q. Can I as a disabled 30% Veteran use this Hospital, if move to the Phillipines??
Thanks ,
Hank
@ Hank
There is NOT a US VA Hospital in the Manila Philippines, Hank. There is a US VA Clinic (outpatient only) in Manila. To use it your VA disability must be must have Service Connected (SC) only. Contact info here:
http://www.va.gov/directory/guide/facility.asp?ID=682
All very interesting but what about the heat. Has anybody dealt with a contractor that knows insulation and such so I can a have central a/c if I decide to retire in the Philippines.