My Father moved from the UK to the US along with my sister thirty years ago, apparently my Dad never gave up his British citizenship, recently his has been diagnosed with dementia/ alzheimers and although he currently lives independently my sister says he will need twenty four hour care very soon.
My sister now proposes moving my dad back to the UK for elderly care , my dad probably has the finances to pay for the care for a period of time but when the money runs out my sister says that the UK state/ NHS will provide him with free care.
I totally disagree with what she is proposing and think it is so wrong in so many ways, it could even be illegal, does anyone have any advise or opinions on this as it would be greatly appreciated.

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You also need to find out what their philosophy of care is for elders--one of my SIL's lived in the UK and when she was in the late stage of cancer, the care was similar to hospice--she was on morphine and had the fluid in her lungs that is a typical side effect of morphine, and they wouldn't aspirate the fluid. Her daughter called her aunt her in the States, who flew over there and pushed them until they
did treat her.
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I know a lot of dial citizenship persons. I do not think it would be illegal, as long as it meets UK requirements. I just think it is sad to ps hip him away to a place ge has not been in for 30 yrs
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One thing that should be remembered is that there is a fairly new US law--the Foreign Accounts Tax Compliance Act (FATCA)--which can make it very difficult for US taxpayers who are US citizens or green card holders and are expatriating. Make sure you look through the tax implications of his move as they have gotten very draconian--especially if he transfers significant assets out of the country. Many US expats are renouncing their US citizenship but he might not be allowed to with his dementia (is he a dual citizen?)

Beyond that, most Western countries (except the USA) do provide medical care to their citizens, and basic medical care is usually not dependent on having paid into a country's social security system. So assuming you are right that he never gave up British citizenship, yes, he could likely get medical care there. Also if he is eligible for US social security benefits (not the same thing as Medicare) he could still get US social security in the UK (but not Medicare). With the exception of a few very unfriendly countries (Cuba, North Korea, ...) social security benefits can be received outside the US. What your sister is suggesting is unlikely to be illegal but whether it is a good idea is another matter.

Beyond that, of course, it comes down to what other social support networks he would have in one country versus the other. As others have said uprooting him to go to live in what is now a foreign country might be very difficult at this stage of his life.

And do look into the tax implications especially with regard to FATCA. Moving abroad has gotten to have some very nasty tax implications at any age--but it will be especially difficult with someone with dementia.
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In the US, Medicare is an insurance coverage that you have to pay into. Medicaid is not based on paying in. Your dad is a lawful permanent resident -- is that correct? In that case he is apparently eligible for Medicaid. See this chart of eligibility for federal programs:

Rather than rely on the interpretation of a chart, I hope you and/or your sister will verify this information.

It is not clear to me what elder care/long-term care a UK citizen who has not been a resident is entitled to. I am sure you or your sister can determine this, with professional help if necessary.

Let us say that Dad would be eligible for financial assistance with the care he needs whichever country he is in.

Which care is "better"?

Where will he feel more "at home" and in familiar surroundings?

Where will he have the most contact with people he knows and who love him?

Since he has dementia is it fairly safe to predict that he will need 24 hour supervision. Exactly the path his decline will take is harder to predict. He may have years where, with supervision, he can shop, attend ball games, play bingo, enjoy entertainment, etc. Where would he be most comfortable doing these things?

Or he may quickly decline to a point where he stays in the care center and doesn't much interact with others.

My one piece of advice is this: IF he is to move out of the country he has lived in for 30 years, doing it sooner rather than later makes sense. The further into dementia he goes the harder a "simple" plane trip becomes, let alone a drastic move.
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Well, if he goes back to the UK, will he get free care because he is still a UK citizen or because he paid into the system? Does it matter? Or does he pay for care In the USA and then go on Medicaid because he paid into the system? Which is the best situation for him? Which gives the best care and outcome?

It doesn't really matter if he lived here for 30 years and now will go back to,the UK for care. He has paid intoSocial Security right? He is a citizen of the United Kingdom right? So if he goes to the United Kingdom and receives care as a citizen then that is one less person taking from the Social Security System in this country. BUT, we must understand the difference. Does he receive care in American because he paid for it or does he receive care in the UK because he is a Citizen of the United Kingdom. The philosophy of these two countries are very different and that is the root of the problem.

We as Americans have been raised to believe that we only deserve care if we PAY for it. Not if we are part of a whole. So the problem lies in how you view this.

Basically, does your father deserve care from the UK even though he lived in the USA for 30 years? Only the UK can tell you that and what the country's philosophy is concerning It's citizens even if they live in a different country.
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Gary, are you in the US or the UK (or somewhere else)?

Does Dad have a lot of friends where he is now? Does he have lots of relatives or friends back in the UK? Has he gone back often? Will the UK be "foreign" to him after all these years? Or would he have a sense of "going home"?

One part of the answer is legal/financial. You and your sister will have to research that thoroughly, to be sure you know what would happen if he stayed here, and what would happen if he goes to the UK.

Another part of the answer is what would be best for Dad. Changes can be very difficult for persons with dementia.
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You would have to ask the NHS, but I do know that if you are on Medicare and leave the USA, you have no Medicare coverage in a foreign country.
Did he pay in to FICA, the USA social security system for the last 30 years?
Have you asked your nearest consulate for assistance?
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