Can Thailand provide better dementia care than the UK?
In your report (Families sending relatives with dementia to Thailand for care, 13 January), the statement that “local authority residential care costs up to £700 per week with private care costing around £1,000” is misleading. It implies that local authorities run their own care homes, when in fact few do, since most councils closed down their care homes or transferred them to the profit-driven private sector a decade or two ago.
Now, they pay fees to private care homes for people living in their areas who qualify under the means test (having assets of less than £23,250). At the same time those same private care homes charge customers with assets above the £23,250 threshold about £1,000 a week – who thus, in effect, subsidise councils where the latter have managed to negotiate a lower rate.
This mix creates huge problems in the residential care “market”. Provision is patchy – private providers prefer to open homes in wealthier areas where custom is more assured and payments higher. Strategic, demographically driven, planning for care – especially its distribution – is impossible.
Your report also says there are no prescribed patient-staff ratios in the UK, with the outcome currently being around one member of staff to six residents – compared, according to the report, with one on one in Thailand. It is widely acknowledged that poor staffing ratios have a severe impact on quality of care, and yet we are only too familiar with serious cases of understaffing and poor care appearing frequently on the news.
While the idea of exporting citizens with dementia sounds bizarre, if the quality of care is better – why not? But I think most people would prefer a high-quality national care service, free at the point of use, funded out of general taxation, and available to all who need it.
Gillian Dalley
London
• While it is easy to understand why people living with dementia and their families would consider moving to Thailand given the crippling costs of paying for care in the UK, doing so is no panacea for the individuals involved; nor is it a solution to the political issue of paying for care.
Anyone considering this course of action should be aware that people relocating to Thailand will see their state pension and other benefits frozen, but will have to meet the potentially high cost of medical care in full. They will also no longer benefit from the UK’s stringent safeguarding requirements and Care Quality Commission inspection regime.
Moreover, where someone has lost the capacity to take their own decisions, approval from the court of protection or a clearly evidenced decision from someone with lasting power of attorney would be needed in order to move them abroad.
As a solicitor specialising in matters relating to paying for care, this is a course of action I would struggle to recommend to my clients. In my experience, too many people are advised wrongly that they need to sell the family home when in fact their circumstances mean they do not have to.
Dianne Steene
Steene Law Ltd, Elstree, Hertfordshire
• As someone who has recently lost both parents to dementia, if I were diagnosed with it, I would warmly welcome my family sending me to Thailand for care.
Having lived in Bangkok, I have experienced first-hand the hospitality of Thai people, the respect and love for the elderly in Thai culture, and the high level of compassionate holistic medical care available in Thai hospitals, not to mention great healthy food and therapeutic sunshine.
Contrast this with the postcode lottery of social care in the UK, the lack of integration between social services and NHS care, hurried home visits, repeated nursing home scandals, a culture that fears rather than respects old age and death, and exorbitant nursing home fees.
James Hope-Thompson
Liverpool
• Arranging care for people with dementia in Thailand strikes me as a very sensible idea, given the state of the sector in this country. Why stop there? Elderly care with or without a terminal illness in a warm country with lower costs could provide a win-win all round. This could give us some early post-Brexit trade deals.
Personally, I would prefer Cuba. Many Cubans speak some English, medical care is of a very high quality, and there’s no chlorinated chicken at meal times.
Patrick Cosgrove
Chapel Lawn, Shropshire
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