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Our family was blindsided by the rapid onset of my Grandmother's Alzheimer's' disease. Then we were shocked to discover how expensive quality care actually is. She has no long-term care insurance and now we are faced with the whole spend-down notion, Selling her house is an option, but it is rented and providing her income.


If I can find a more affordable Nursing Home, how far away is too far away?

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Just my opinion.
If someone retires to Florida, moving away from family and ends up alone in a NH, with visitors only a couple of times a year, I cannot feel sorry for them....they broke the family bond when they were younger and more able.

If someone lives family style all their lives and suddenly is sent away and cannot be visited by family frequently, i feel sorry for them.

If needed I would seek a NH for my mom, but I would find one I could visit al least once a week.....that would at least be my plan. That is not feasible for all, no judgement.

Your moral obligation is to have her safe and to do what you can to show her your love.
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Well, Dave a/k/a Angels Respite, I was blindsided by the title of your post. "Interstate" means between states, not between countries.

I'm going to be very blunt in my answer, with no apologies.

First, the term "immoral" has no relevance to finding a good place for your grandmother.

Second, the issue of how far away is too far is a relative one. Some families might think 50 miles is too far; others will drive 100 miles.

Third, I think the question is more of whether it's appropriate to find a good, suitable, place for Granny, within driving distance of your various relatives and family members, using HER assets for her care if necessary.

I don't deny that asset preservation is a major and relevant consideration in any placement decision, but they are her assets, not the would-be beneficiaries. And they should be used for her care.

Fourth, I think you want validate what's already been done. That's not a criticism; others face the same dilemma. It's not an easy decision to make.


But there is this conundrum.

Your "On your Mind" comment is:

"Is it unethical to send my Granny to an affordable Nursing Home in Europe to protect her assets here in the States? " Putting it bluntly, hell, yes! It's not only unethical, it's irresponsible, selfish, and cruel.

And I'm guessing that someone in the family already has made arrangements to take over management of her assets.

Your description of the situation also states that Granny has been in a home in Romania for 6 months, so the question of whether it's "immoral" is a moot one. Granny's already out of the country.

In your post you write that she has no long term care insurance; you're faced with the whole spend-down notion, which infers she has some assets to spend down before she can get Medicaid.

You're in California, sometimes working in Eastern Europe. Where are the rest of the relatives? In Romania as well?

And who takes care of the assets she has here, including the home that's rented?

What's this really all about? The post is written in such a way as to raise questions of your real intent, and putting together your "on my mind" thoughts with the selection of words in your post makes me wonder whether someone has their eye on Granny's assets (and their inheritance) and just wanted to send her packing.

Honestly, I'm so appalled by the thought of worrying about her assets rather than her best interests, and shipping her off to another continent that I find this very disturbing, if not outright disgusting.

Then I read the full background in your post, and came upon this enlightening tidbit:

"Granny has been there nearly six months now. She has a healthy appetite and is very strong. I have independent people who check on her twice weekly and report directly to me.

Our situation has turned out better that I anticipated, so well in fact that I am starting a service to help other families who are in a similar situation. Come Check us out at Angels Respite Program website.

So, are you soliciting? Is that what this is all about?


If so, you're a real "piece of work".

You must have a high level job to be commuting from California to Romania, so I suspect the choice of words referenced above doesn't reflect your intellect or profession. Frankly, I think you were searching for ways to encourage people to read, and perhaps check out your website.

And to be even more blunt, I wouldn't even consider checking out your website, or your company, especially if your idea of care is to send someone packing up to an Eastern Europe country half way around the globe.
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BTW, and to other posters:

DO NOT check out Angels Respite; McAfee hasn't green flagged it, which means that the safety and security of the site are questionable.

I Googled it because I wanted to see if it really existed. Given the extent of fabrication in the post, it could be a site for other purposes.
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Garden Artist, Thank you for your brutal honesty and sharing your views.

My intent is to open dialogue and honest discourse as to barometer of what is acceptable with regards to how far is too far. Maybe I crossed that line. Honestly, thank you for your comments. Not sure what you are referring to as "fabricated" but i'll not take offense to that. When you share such personal information one should expect to be scrutinized.

"... immoral" has no relevance to finding a good place for your grandmother.

I'm not asking about a "good" place, there are many, but the morality of sending someone so far away for the same level care, for less. (and yes, my Granny is in Transylvania for 9 months now, but that is a different post.)

"... 50 miles is too far; others will drive 100 miles"

How often? 50 miles in LA could be 2 hrs? What about 5 miles from Detroit to Windsor Canada eh? Or from France to England via the Chunnel?

"..just wanted to send her packing"

I don't think there is a caregiver in the world that hasn't muttered those exact same words, especially after giving 24/7 care. Yes, I have guilt, but her care is better there than here, and it's my loss that I can't hug her via skype. Everyones situation is unique, including our family's. We found a creative solution something that worked for us, so I thought I'd share. (once again, another post).

We send our kids to college, we participate in medical tourism and many family members live in other states. But when it comes to relocating loved ones, I think the real objection is based from inside oneself. It seems to raise fears, like where will my kids send me when it's my turn?

Judge me as you may, but when it's my time to go I hope to preserve a financial legacy for my kids and their kids instead of hemorrhaging money for 24/7 care. Don't get me wrong, caregivers earn every penny, but I;d rather see my grandkids go to college.

All the best,

Dave
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I wholeheartedly agree with Everything GardenArtist posted, as her questions were the same as mine!
But as to your response to her, plan your financial future on your own dime, not on the monies your Grandparent's earned for their own future, that is money they themselves earned, and if in their right minds, probably would have preferred to be spent right HERE, RIGHT NOW, and certainly not be packed off to some foreign country, just so that you could save her money for your own financial gains! That's just sickening! How selfish can you possibly be! Let your kids earn their own way through college, like most every kid does these days, they end up appreciating their respective educations more this way anyhow! It isn't always best to have things given to you on a silver platter, most times, we appreciate things more, when we've worked hard for them! Skype, you Skyping your Love and respect through a computer monitor, how Loving! Not!
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"We send our kids to college, we participate in medical tourism and many family members live in other states. But when it comes to relocating loved ones, I think the real objection is based from inside oneself. It seems to raise fears, like where will my kids send me when it's my turn?"

No, no and no! Younger, more mobile family members may jet around the country or the world, or relocate to the other side of the planet, but that's their choice, based on what they want for their own lives. You can't compare that to moving an incapacitated, homebound individual to a distant country without their voluntary consent and for no purpose other than the benefit it would bring to others to "preserve" their assets. You may think Romania is lovely, but from granny's point of view, they only distinction between a quality nursing home in one place and a quality nursing home somewhere else is probably the proximity to family members and other loved ones.

How far is too far? If it's too far for family member to easily visit (and by family members I mean not just one person but all those who would normally visit and interact with the elder), then it's too far.

"Judge me as you may, but when it's my time to go I hope to preserve a financial legacy for my kids and their kids instead of hemorrhaging money for 24/7 care. Don't get me wrong, caregivers earn every penny, but I;d rather see my grandkids go to college."

That would be your choice to make when it's your money, but it's not your choice to make with your grandmother's money. You can't assume your grandmother would rather benefit future generations than live in her own country where all her family member are able to come visit her and keep an eye on the care she's receiving. What you describe as "hemorrhaging" money may simply be spending one's own money for one's own care in old age, which may very likely be the reason granny saved that money to begin with.
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This is advertising, not a caregiver's post. Admins, please delete this thread.
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Tacy, thanks for the insightful information. I knew Dave had an ulterior motive, but who would have guessed that he was a movie producer?

Unbelievable!

Good point on the Hotmail address; that's a real clue, including as to whether this alleged care home even exists, which I suspect it doesn't. I still think Dave has some ulterior motives that have nothing to do with elder care - it's just the carrot he's dangling to entrap or ensnare unwitting and naïve people.

Who knows - maybe he's even involved in the nefarious dirty market slave trade!

Babalou, BTW, he's pitched AngelsRespite on some of his other posts as well.

And second BTW, has anyone noticed that the order of posts has been rearranged? Check it out. First post was by Ismiami, mine was second; now they're reversed. Look at the hourly stamps. What's with that?
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Oh, I see; the posts have automatically been rearranged into the most helpful answer mode.
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I've never been able to figure out why some threads get shortened to the best helpful answers and others don't, it can get really annoying to follow some of the longer threads that have nothing to do with the original question if you don't want it added to your news feed.

Has anyone contacted the admins about this shyster? Maybe it is time for this post to disappear.
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CWillie, I have a suspicion this isn't the first post by whoever's behind this scam. I noticed a similarity to the BidetSprayerMan's style. This shyster is more sophisticated in presentation, but the similarities are there.

There was another scammer who posted here bragging about his skills as a presenter on aging care issues. I don't remember what his handle is, but his approach was also to create website, then compliment himself. This was several months ago, and if I remember correctly, the thread was started around the time of a particular holiday.

Maybe it's the same guy just trying out different personae?
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Tacy, Thanks for insight on the website. The place sounds like a dump, and very pathetic.

I had been wondering about that b/c at one time Romania was experiencing difficulty managing care for the number of orphans, and wasn't able to provide proper care for them. I recall seeing a documentary that was so depressing I couldn't watch it.

To think that someone could put a relative there is more than sad. However, I don't believe that Dave is necessarily who or what he claims to be. I wonder if it really was his GM in the photo. His GM may not even be alive but rather a figment of his marketing campaign. One never knows with these scammers.

Perhaps when the Admins return tomorrow this thread will be deleted. I've found it curious that some of the marketing campaigns, scams and posts deliberately inciting controversy are posted just before or during weekends.
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You just have to click the link to see all answers versus most helpful.

And, I'm surprising myself a little. I went to the website and there are no red flags about any malware or anything else. It does not seem dishonest. The place is not posh or luxurious but it is clean, and people are up and about, not restrained and not just sitting around bored to tears. Low rent is not always bad care.

I think his situation is unique in that he can visit in person more than most of us could. My question would be the disorientation and confusion being worse because of only a few other English speakers there.
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Please help stay on topic.

I am more than happy to answer any question, but the comments like “Shyster” and “sounds like a dump” among others, seem to be more personal than constructive criticism or advice to me.

Stacyb with the Union Jack flag. I appreciate your comments. Where is here? My Granny lived in no less than a dozen houses and half as many states, she traveled internationally and was not a xenophobe. “..some foreign country”. Have you seen some of the Nursing Homes in the U.S.? I have.

Carlab thank you for your comments “You can't assume your grandmother would rather benefit future generations than live in her own country where all her family member are able to come visit her and keep an eye on the care she's receiving.”
No assumption necessary here, I’ve known her my whole life, and no she didn’t save for when she would get dementia or she would have purchased a ltc insurance. When she was with me for a year no family came to see her.

Tacy022 Thanks very much for your objectivity. Point taken on the review, I will remedy. Hotmail point also, thx. (different subject).

Garden Artist, More facts would be helpful. You just need a big hug, or a strong drink. Maybe both.

I posted this question specifically about morals, but under the finance heading.

Perhaps I should have rephrased the question.

If you could get better care for the same price further away, how far is too far?

All the Best Dave.
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vstefans,
Yes, that was my main concern also, the language barrier for her. The nurses/doctor and admin all speak english. Her biweekly visitors are fluent in 3 or 4 languages and help her skype us. (she also has the deluxe cable package).
If you are worried about english as a second language that rules out many caregivers in the u.s. Additionally, as her condition progresses, the staff have told me they rely heavily on visual cues and just knowing her.
Best regards Dave.
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Dave, you are SO predictable. I just won a bet that by the end of Sunday you would make some kind of snide remark directed toward me b/c I was so critical of your actions.
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I tell you what GA having looked at the pictures of angels respite I wouldn't put my dog in there let alone my mother. Jings. Bare walls compared to our own home and I know how important plainness is for people with Lewy Body Dementia but my Mother doesn't have that. Mother's socialising is something she enjoys so that would be gone completely as she might have staff to talk to - when they had time - but outside that mealtimes would be awful for her and tv?

The bedrooms are vile - 2 people to a room neither of which speaks the other's language hmm sounds ideal - NOT

Urinals? Really? Is it my lack of knowledge or and I right in thinking that no-one has urinals in their homes?

Where is the interaction? Where are the nutrition guides - cola for people over 90 ? really?

Let me tell you for just a tiny amount more they could stay in beautiful surrounds in a UK rest home and you would have the safety net of knowing that all the homes MUST conform to specific guidelines and oh yes they speak english. If you don't believe me go google care homes in Hampshire UK and click on images. THAT is the norm for over here and we are by no means the best in the world and you will always get staff who are bad eggs.

How do you deal with that in a rest home on the other side of the world in a language you don't speak. Who checks your loved one for bruises? Who checks them to see they don't have urea associated dermatitis/bed sores.

I'm sorry I couldn't agree at all to sending someone that far UNLESS I had relatives there who were going to monitor the care. I wouldn't allow my mother to go to a care home in USA (I live in UK) let alone a country whose language she doesn't speak. It's utter madness to even consider it and once the dementia declines its actually quite cruel to put them in a place whose surround and culture they don't understand, where the interaction is so poor that they are confined to a room which they share with someone else who also doesn't speak their language. NO NO NO NO NO
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This sounds like an ugly version of "The Best Exotic Marigold Hotel". Feh.
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"Carlab thank you for your comments 'You can't assume your grandmother would rather benefit future generations than live in her own country where all her family member are able to come visit her and keep an eye on the care she's receiving.'

"No assumption necessary here, I’ve known her my whole life, and no she didn’t save for when she would get dementia or she would have purchased a ltc insurance. When she was with me for a year no family came to see her."

Dave, I think you ARE assuming, in spite of your denials. Just because she didn't buy LTC insurance doesn't mean she would rather pass her assets down to future generations than use her assets to pay for nursing home care in her own country. You've known her all your life - did she ever say "Don't spend my money on me when I'm old - I'd rather have the younger generation goes to college, or gets a down payment on a house. Get me the cheapest care you can find, even if it's on the other side of the world?" I doubt it.

And it doesn't help to rephrase it to say "If you could get better care for the same price further away, how far is too far?" That's not your situation. You're not getting better care for the same price. Paying a lesser price is the whole motive behind moving her.

I also don't think it matters that family didn't come to see her when she lived with you. You are a family member, not a nursing home. That's not an excuse to send her to a foreign country where family can't visit her and where she doesn't even speak the language.

I feel like you're using every excuse and argument you can come up like trying to put lipstick on a pig. And sorry, but it's still a pig, lipstick or not.
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Just to answer the question: Is it immoral to send a loved one interstate for the sake of more affordable nursing home costs?

It really depends on the underlying rationale for so doing. Nursing costs vary and are totally dependent on the person being cared for and how much 'nursing' they need. However you are not dealing with JUST nursing costs or JUST nursing home costs. When the decision is made to put a loved one into care it is really important that people consider the person being put into the care of others.

This isn't a matter of ' that one is much cheaper so we will choose that one' Yes nursing care in large cities or resorts maybe more expensive because that is the cost of owning in the first place and running a home where wages might be higher etc.

Perhaps with that in mind you may choose one a little further away for costs and no that isn't immoral in my opinion - it actually makes more sense. But that decision is that last one you make once you know you are comparing like for like...and I do mean like for like

Ask yourselves some questions

Is Mum religious and if so how religious and does that require dietary provision. What do their menus look like and the timing of them

Yes to any of those means you must check to see that she can access spiritual wellbeing and that includes food - this is particularly important if we are talking Halal or Kosher food. Do they observe the religious days be they Christmas Pesach Eide Diwali or something else (no offence to any religion I missed)

Does mum like to be in a room on her own or would she prefer to share.
Can they provide for this and will the match be monitored for the well-being of both parties? Is the room well lit does it have views - preferably not of a brick wall or the waste bins

Is there a GP attached to the home?

What activities do they have scheduled, Music to movement, singing,painting, drawing, trips out, community inclusion.

What PT do they encourage, is there a specific area for this

Do they have visiting hairdressers, chiropodists, manicurists

Do they have showers AND baths

Does the home smell at all - if it does it means that hygiene isn't as closely monitored as it should be

What laundry provision is there

Can residents bring their own possessions

Is there more than one common room?

Are there tvs in the room or is there just 1 tv room

Is there a library or a quiet room

Are there lifts and if so how often are they serviced and what is the call out protocol should they fail

Is the home close enough for you to visit regularly - this isn't about you this is about them knowing they haven't been abandoned into some strange place where they don't know anyone. Of course if you actually don't care whether they are frightened or upset then I would say morality has already gone out of the window

This is just some of the physical stuff without looking at the audit reports and recommendations of families re the care their loved one received. It isn't about costs until you are quite sure that the homes you are comparing are indeed matched.

As for morals? Your reasoning determines the morality - if it is for your personal gain then it is immoral no question about it. If not then have you done the best you can to make your mum's change of residence safe healthy and secure and that she FEELS HAPPY THERE.....that means she gets visitors...it doesn't have to family but don't strip her of all friends and family and her home her location and her dietary emotional and spiritual needs and expect her to cope....that IMHO is cruel, thoughtless and immoral
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Wow. Wow. I didn't know something like this existed. A business that helps send a loved one overseas for end of life care to save the family money? Wow, is all I can say.
Going through end of life with Mom has been hard, but I can't imagine not being there for her. My children are 1000 miles away and I agonize about where to go. I don't want to live in either of their cities but I won't want to spend my last years totally alone. I will eventually move closer.
To me, its unbelievable that someone would send a loved one away deliberately to protect their inheritance, but then if this company exists, there are people out there like that.
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For myself, I am so glad my Dad is just 5 miles down the road in a wonderful facility which he picked himself.... he said where do I sign as soon as he walk through the front door and saw the lobby being like that of an upscale hotel. Dad can afford this place and if it talks all of his estate, so be it. I want Dad to spend his remaining days in a place where he is happy.

Plus, what about citizenship? I wouldn't be all comfortable living in a foreign country having citizenship elsewhere, unless I was there for the U.S. State Department or for a corporation who has offices in said country.
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North Carolina must have very reasonable rates for long term care. I have noticed that in Assisted Living and in Memory Care Assisted Living, there are many residents from the northern states. Many of them do not have family here, but their family calls and sends gifts. I've seen how the rooms are decorated and the photos of their loved ones who obviously are caring for them long distance.
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Jude, I did take a quick look at some of the UK homes in Hampshire. The Sunrise home in Chorleywood has a lobby which if I remember correctly from a visit several years ago is quite similar to the Sunrise AL configuration in SE Michigan. It wouldn't surprise me if the US and UK Sunrises are held by the same parent company.

Sunrise has 2 beautiful Victorian styled AL facilities as well as a resident pet. Seems like good management.


As to Dave/AngelsRespite, assumptions are still that he actually is involved with this particular home in Romania. There's no proof that he is. He could be trying to act as a middleman, for purposes of soliciting for some other unknown purpose. There are scammers who misrepresent their intents for nefarious purposes.

One of the top DIY forums used to be plagued by spammers pretending to represent major, sometimes Fortune 500, corporations. They were soliciting allegedly on behalf of these companies. I did some background investigation and learned that they weren't connected at all - no surprise here. So I reported them to the companies, which contacted the Admins. Spam was deleted and IP addresses were blocked.

I think Dave's mother would be better off if a guardian/conservator were appointed for her and the state took control, allowing her to remain here, rather than being shipped across the ocean to Transylvania.

I also get the impression he blames her for not having LTC, and considers it his right to make choices for her b/c she didn't make one he felt she should have.

At any rate, he's still soliciting and using the distance issue to generate interest. And we're assuming he really does have a living grandmother. For all we know, this could all be a hoax.

Maybe he should be taking a marketing course if he's the point man for this outfit as his tactics certainly aren't generating results for the Transylvanian care facility.

Interestingly, he has the persistence of the BidetSprayerMan who was stubborn and wouldn't give up. Could they be the same poster?
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