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Pay for elderly to live in care homes in lower income countries, rich nations advised

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Pay for elderly to live in care homes in lower income countries, rich nations advised

Providing local people aren’t disadvantaged, it’s a practical solution to the elder care crisis, says the author

Rich nations should consider paying for elderly people to live in care homes in lower income countries in a bid to ease the pressure on domestic residential and nursing care provision, argues an ethicist in the Journal of Medical Ethics.

Providing such a move wouldn’t disadvantage local residents, and that appropriate quality checks could be made, this policy would enable older citizens to access affordable and decent care when they need it, contends Dr Bouke de Vries, University of Umeå, Sweden.

The reality is that many higher-income countries are struggling to provide affordable and decent care for their relatively old and ageing populations, says De Vries. 

Something has to be done, and there are already examples of German and Swiss citizens who have opted to live in care homes in Eastern Europe and South East Asia, he points out.

Paying for provision in lower income countries would be morally acceptable if five criteria are met he suggests:

  • a significant proportion of citizens don’t currently have access to adequate residential or nursing care
  • the care in homes abroad isn’t worse than that provided in domestic care homes
  • sending states conduct regular quality checks or delegate this to reliable local monitoring bodies
  • appropriate steps are taken to ensure that this type of migration doesn’t disadvantage local residents in the receiving countries
  • the public money allocated for this isn’t better spent on other ways of easing the pressure on domestic care/nursing homes 

How much a richer nation should pay will depend on several factors, he suggests. These include its wealth; the magnitude of the strain on domestic provision; and how much the public purse will save, as well as the amount of taxpayers’ money needed to convince citizens to make the move, to monitor the quality of those care homes, and to offset any disadvantage to local citizens.

This disadvantage might include fierce competition for care home places that would otherwise be available to locals and/or increasing the costs of residential care, because of the ability of migrants from richer countries to afford higher prices. 

But this could be overcome by the sending countries subsidising the construction of affordable care homes for local people or building care homes within the receiving countries that partly if not wholly accommodate their own citizens, suggests De Vries.

In a linked blog, De Vries acknowledges that this migration policy is not the only solution to the crisis facing elderly care. 

Others include paying formal caregivers more; providing better support to informal caregivers; and investing in robot caregivers and other forms of assistive technology. But he nevertheless believes his solution shows “great promise.”

Some people might object on the grounds that the policy might put undue pressure on people on lower incomes to migrate while others might simply feel that it is unpalatable.

“My proposal for higher-income countries to pay their residents to move to care homes within lower-income countries will undoubtedly prove controversial,” he accepts.

But should it, if the eligibility criteria are strictly adhered to? he asks. 

“The proposal could have significant benefits for lower-income countries. “By incentivising comparatively wealthy foreigners to live in care homes within these countries, it might indirectly stimulate their economies. In addition, it might reduce the need for local clinicians and care workers to move to higher income countries to earn higher wages, meaning that fewer of them would be separated from their family and friends,” he writes. 



Notes for editors
Should higher-income countries pay their citizens to move to foreign care homes? Doi 10.1136/medethics-2020-106380
Journal: Journal of Medical Ethics

Funding: Swedish Research Council

Link to Academy of Medical Sciences press release labelling system:

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

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