Paying people to move to care homes within lower-income countries: Daft or desirable?

By Bouke de Vries

Many higher-income countries are struggling to provide adequate and affordable care to their older residents, which is to a large extent due to population ageing. Not only do residents of these countries live longer than ever before, which comes with a reduction in cognitive and physical abilities and an increased susceptibility to dementia and other age-related diseases, there are progressively fewer young people around to provide care to older generations because of declining birth-rates.  For example, the share of Germans aged 60 years and above is projected to rise to 35 percent by 2030,  which is when, according to some estimates, there will be a shortage of nearly half a million care workers within Germany.

What should the governments of higher-income countries do about this? While it is plausible that a variety of measures is needed, including offering higher salaries to formal care-givers; providing better support to informal care-givers; and  investing in robot care-givers and other forms of care-assistive technology, I have recently proposed a novel measure that I believe has a great promise: Paying residents to move to care homes within lower-income countries. Such payments may take different forms. One involves paying people after they have moved to a foreign care home, which might be done by paying them directly or by providing them with in-kind benefits and rental cost-subsidies. The other form involves paying people who do not currently require residential care for waiving their future rights to live in a domestic care home, or simply their future rights to live in a publicly-funded domestic care home.

It is worth noting that these payments would incentivize a type of migration that already exists within countries such as Germany. In recent years, a few thousand Germans are believed to have moved to care homes within lower-income countries in pursuit of better staff-to-resident ratios and lower living costs, including to care homes within Eastern Europe (e.g. Poland, Hungary, Czech Republic) and South-East Asia (e.g. Thailand). At the same time, however, this type of migration has sparked fierce criticism. For example, Sabine Jansen, director of the German Alzheimer’s Association, has referred to it as “inhumane” [Menschenverachtend], before adding that Germany should aim to “include people with dementia within society, not exclude them”. Or consider the German tabloid Bild, whose opening headline on the 12th of November 2012 read: “Increasingly more Germans are being deported [abgeschoben] to care homes abroad”.

Against this background, my proposal for higher-income countries to pay their residents to move to care homes within lower-income countries will undoubtedly prove controversial as well. But should it? As long as certain conditions are satisfied, I argue in a recently published paper that it should not. One of these conditions is that the care in the foreign care homes be no worse than the one that is available in domestic care homes. Another condition is that sending states take measures to ensure that this type of migration does not harm vulnerable local inhabitants by making residential care and health care (even) less affordable for this group. For example, they might do so by subsidizing the construction of affordable care homes within the receiving societies, as well as by subsidizing the training of aspiring local medical experts and care workers on the condition that these individuals commit to working in their country’s public health and aged care sectors for a certain period after they finish their education.

Besides helping to ease the pressure on care facilities within higher-income countries, it should be noted that that the proposed payments can have significant benefits for lower-income countries. By incentivizing comparatively wealthy foreigners to live in care homes within these countries, they might indirectly stimulate their economies. In addition, they might reduce the need for local medical experts and care workers to move to higher income countries in order to earn higher wages, which is desirable as it means that fewer of them may end up living separated from their family, friends, and country.


Paper title: Should higher-income countries pay their citizens to move to foreign care homes?

Author: Bouke de Vries

Affiliations: Department of Historical, Philosophical and Religious Studies, Umeå University, Sweden & Centre for Biomedical Ethics and Law, KU Leuven, Belgium.

Competing interests: None

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