AJIJIC, Mexico — After Jean Douglas turned 70, she realized she couldn't take care of herself anymore. Her knees were giving out, and winters in Bandon, Ore., were getting harder to bear alone.
She was shocked by the high cost and impersonal care at assisted-living facilities near her home. After searching the Internet for other options, she joined a small but steadily growing number of Americans who are moving across the border to nursing homes in Mexico, where the sun is bright and the living is cheap.
For $1,300 a month — a quarter of what an average nursing home costs in Oregon — Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.
"It is paradise," says Douglas, 74. "If you need help living or coping, this is the place to be. I don't know that there is such a thing back (in the USA), and certainly not for this amount of money."
As millions of baby boomers reach retirement age and U.S. health care costs soar, Mexican nursing home managers expect more American seniors to head south in coming years. Mexico's proximity to the USA, low labor costs and warm climate make it attractive, although residents caution that quality of care varies greatly in an industry that is just getting off the ground here.
An estimated 40,000 to 80,000 American retirees already live in Mexico, many of them in enclaves like San Miguel de Allende or the Chapala area, says David Warner, a University of Texas public affairs professor who has studied the phenomenon. There are no reliable data on how many are living in nursing homes, but at least five such facilities are on Lake Chapala alone.
"You can barely afford to live in the United States anymore," said Harry Kislevitz, 78, of New York City. A stroke victim, he moved to a convalescent home on the lake's shore two years ago and credits the staff with helping him recover his speech and ability to walk.
"Here you see the birds, you smell the air, and it's delicious," Kislevitz said. "You feel like living."
Many expatriates are Americans or Europeans who retired here years ago and are now becoming more frail. Others are not quite ready for a nursing home but are exploring options such as in-home health care services, which can provide Mexican nurses at a fraction of U.S. prices.
"As long as the economies of the United States and Europe continue to be strong, we're going to see people coming here to Latin America to pass their final days," said Oscar Cano, manager of Apoyo a los Miguelenses Ancianos, a non-profit group that runs a nursing home in San Miguel de Allende.
Cozy cottage, meals, health care
Retirement homes are relatively new in Mexico, where the aging usually live with family. There is little government regulation. Some places have suddenly gone bankrupt, forcing American residents to move. Some Mexican homes have rough edges, such as peeling paint or frayed sofas, that would turn off many Americans.
"I don't think they're for everyone," said Thomas Kessler, whose mother suffers from manic depression and lives at a home in Ajijic. "But basically, they've kept our family finances from falling off a cliff."
Residents such as Richard Slater say they are happy in Mexico. Slater came to Lake Chapala four years ago and now lives in his own cottage at the Casa de Ancianos, surrounded by purple bougainvillea and pomegranate trees.
He has plenty of room for his two dogs and has a little patio that he shares with three other American residents. He gets 24-hour nursing care and three meals a day, cooked in a homey kitchen and served in a sun-washed dining room. His cottage has a living room, bedroom, kitchenette, bathroom and a walk-in closet.
For this Slater pays $550 a month, less than one-tenth of the going rate back home in Las Vegas. For another $140 a year, he gets full medical coverage from the Mexican government, including all his medicine and insulin for diabetes.
"This would all cost me a fortune in the United States," said Slater, a 65-year-old retired headwaiter.
On a recent afternoon, lunch at the Casa de Ancianos consisted of vegetable soup, beet salad, Spanish rice, baked dogfish stuffed with peppers, garlic bread and a choice of four cakes and two Jell-O salads. Slater's neighbor doesn't like Mexican food, so a nursing home employee cooks whatever she wants on a stove beside her bed.
Like many retirees, Slater has satellite television, so he doesn't miss any American news or programs. When he wants to see a movie or go shopping downtown, the taxi ride is only $2-$3. Guadalajara, a culturally rich city of 4 million people, is just 30 miles away.
For medical care, Slater relies on the Mexican Social Security Institute, or IMSS, which runs clinics and hospitals nationwide and allows foreigners to enroll in its program even if they never worked in Mexico or paid taxes to support the system. He recently had gallbladder surgery in an IMSS hospital in Guadalajara, and he paid nothing.
Many of the nursing home employees speak English, and so does Slater's doctor.
The Casa de Ancianos began taking in foreigners in 2000 as part of an effort to raise extra money, director Marlene Dunham said. It built the cottages especially for the Americans and uses the income received from them to subsidize the costs of the 20 Mexican residents at the home.
The program was so successful that the nursing home has plans for 12 more cottages, a swimming pool, a Jacuzzi and a gazebo with picnic area. The nursing home now advertises on the Internet and through pamphlets distributed in town. Some U.S. companies have also begun investing in assisted-living facilities in Mexico, said Larry Minnix, president of the American Association of Homes and Services for the Aging, which represents 5,800 nursing homes and related services.
However, Minnix cautioned that lax government regulation poses dangers at smaller homes.
"It's the same danger you have of going across the border looking for cheap medications," Minnix said. "If you don't know what you're getting, and you're not getting it from people you trust, then you've got an accident waiting to happen."