I often get asked about how our various senior living models here in the U.S., including continuing care retirement communities (CCRCs or life plan communities), compare to the options abroad. The impetus for this query is typically from one of two angles: Some people are pondering if they would like to move to another country during their retirement years; others are curious about how the quality of our domestic senior living communities stacks up against those abroad.
What senior living looks like in the U.S.
In the U.S., as the baby boomers grow older and people are having fewer children than they did in previous generations, demographics are markedly shifting. Our aging population requires us to consider how we as a society will care for people as they age.
As in many developed, industrial counties, it used to be that multiple generations of families in the U.S. lived together in the same home or at least in close proximity to one another in small towns. But now, as our population relocates to larger cities, where jobs are more abundant, different generations of a family are often separated by many miles.
This is one of the reasons the senior living community model has become an increasingly popular option in the United States. In a CCRC, for example, residents are provided with an array of on-site services and amenities that can keep them healthy and living independently for longer, but that also can address health issues if and when they arise.
But despite the growing numbers of CCRCs and other senior living options in the U.S., for both personal and financial reasons, a majority of seniors still opt to remain in their own home, receiving any necessary care services from unpaid loved ones or professional home health workers.
So, let’s examine how some different countries and cultures care for their elders, as compared to the United States.
Our neighbors to the north
In Canada, where they have single-payer healthcare (what some would term “socialized medicine”), many senior services are covered, at least in part, by the government; private pay options are also available.
Canada’s national and provincial governments offer services for seniors who need assistance to age in their own home, as well as what they call “supportive housing” for seniors who need assisted living and “subsidized nursing home care” for long-term care (LTC) services. The cost of LTC is usually shared between the senior and the country’s health ministry, with formulas in place to determine the amount each party contributes.
Canada also has private-pay senior living communities, some of which have a “continuity of care model,” which is much like a CCRC in the U.S. In these communities, seniors start out in an independent living residence but can move into an assisted living or memory care unit later if needed.
Caring for seniors in Asia
Much of Asia has a big problem when it comes to their population size and age demographics. For example, because of their past restrictions on how many children people could have, China has a large population of seniors, but too few younger people to support them, both financially and with caregiving needs. In fact, China is projected to have a whopping 636 million people over age 50 by 2050—almost half of its population—up from a quarter of the population in 2010. That’s more than the total population of the United States!
Dealing with this huge number of seniors is an ongoing challenge for China. While elderly parents in China can sue their adult children for both emotional and financial support, the country is looking for more tangible solutions for caring for their aging population. For example, according to a Forbes article, China’s largest real estate and insurance companies are joining forces to build large-scale CCRCs, often in partnership with U.S.-based senior care providers. India is another enormous market that is being pursued by these same CCRC providers.
In Japan, it is a common custom to have multiple generations of a family living together in one home. Elders are revered, and grandparents frequently assist with tasks such as childcare and meal preparation. This tradition is thought to be one of the many reasons that seniors in Japan live longer than in any other country.
Senior care in Europe
Turning to Europe, they don’t have the same lopsided ratios of older citizens to younger ones that are found in Asia. And many European countries have some form of socialized medicine, which in certain cases can aid in the care of their elderly population.
In England, for example, the National Health Service (NHS) is their publicly-funded national healthcare system. The NHS pays for some long-term care for seniors, such as skilled nursing services, but government reimbursement rates have been substantially reduced in recent years, frequently leaving the balance to be paid out-of-pocket by the senior or by their co-insurance.
In Italy, they also have a universal healthcare system, but one of the things that it does not cover is long-term care for seniors. As a result, the responsibility for caring for seniors most often falls on family members. If their family cannot or will not care for them, seniors will be put into an acute hospital.
The CCRC concept for senior living is being embraced in many European countries like England, Germany, and the Netherlands—a private-pay housing model that they call “extra care housing.” With the aim of allowing seniors to maintain a level of independence for as long as possible, extra care housing offers residents a continuum of care based on the senior’s needs—from independent living bungalows to assisted living apartments. Many but not all extra care communities offer amenities similar to a CCRC such as laundry services, an on-site hair salon, guest suites, and community dining rooms.
Aging down under
The Commonwealth Government of Australia subsidizes much of the cost associated with “residential aged care,” including assisted living services and full-time nursing care for older people who can no longer live independently, though eligibility must be determined by a regional “aged care assessment team” (ACAT). Once a senior moves into a residential aged care facility, their needs will get a classification, which determines what the senior will pay for and what will be included as part of their government-subsidized care.
In Australia, they refer to private-pay retirement communities as “retirement villages.” They have independent living villages, but they also have a model referred to as “co-located villages,” which is a retirement village with an adjacent assisted living community (an “aged care home” as they call it). They also have a model called “home care villages,” which is a similar concept to the CCRCs we have in the U.S., offering residents various onsite amenities and a continuum of care services.
Is retiring abroad right for you?
An international retirement can be a great way to continue exploring the world, while potentially taking advantage of other country’s lower costs of living too. International Living even publishes a list of their top countries for retirement each year. The motives for retirement in another country consist of many of the same reasons why seniors choose certain U.S. states over others—factors like climate and cost of living—but also include things like cultural and educational experiences.
But don’t discount the fact that the United States has some of the best healthcare in the world, as well as a vast number of senior living and care options to meet the nuanced needs of seniors as they grow older. CCRCs, in particular, offer seniors tailored care in a setting that is custom-designed to keep them safe, happy, and healthy for longer.
If you’re considering a move overseas for your retirement years, you’ll want to do a lot of research in advance. Be certain you understand things like what is required to establish residency, how the other country’s healthcare system operates, and the quality of the care it provides. Other questions to consider: Do you need to be a permanent resident in order to take full advantage of a country’s government-funded healthcare system? What are the options available for assisted living and/or skilled nursing care, should you ever need those services?
Doing this type of homework prior to retiring to another country will ensure you are making an informed decision, factoring in how the move will impact both your pocketbook and your quality of life.