Friday, August 31, 2007

A new front in outsourcing

Families in the developed countries struggling to pay the spiralling costs of care for their elderly relatives could soon have a new cheaper option: outsourcing to India.

Extreme though the idea may sound, one man has already made the move successfully with his parents, and the concept is being regarded with interest by care charities.

Steve Herzfeld, a 56-year-old American, was caring for his elderly parents for three years when, at his wit’s end over finances, he decided to relocate them to India in November 2006.

The three of them rented a house in Puducherry. With the help of a friend, Mr. Herzfeld organised a team of six to nurse, massage and care for his parents.

They pay £1,000 a month for the house, bills and medication — leaving them with money to put aside for a rainy day. Had they stayed in the U.S., they would have faced nursing-home fees three times that amount. Mr. Herzfeld’s parents would not have been able to afford such charges — and, anyway, he could not face the prospect of putting them in a home.

Frances Herzfeld, 89, was suffering from advanced Parkinson’s disease and Ernest Herzfeld, 93, has Alzheimer’s. Mr. (Steve) Herzfeld had retrained as a nursing assistant, not so much to nurse them himself but to know enough to manage their care. However, by late 2006, he knew they were so fragile they could not continue as they were. In the Florida nursing home he found for his mother, he knew she would spend her time “in a wheelchair, with four or five others in a room, while a nurse read the paper all day.”

Mr. Herzfeld is a disciple of Maharishi Mahesh Yogi, founder of the Transcendental Meditation programme, and since 1982 has been taking part in a long-term research project using advanced yoga techniques. The Maharishi encourages disciples to care for their family, so Mr. Herzfeld has taken time out to do this.

When a friend suggested the idea of relocating to India — for its far lower nursing costs and the promise of some quality of life for his parents — Mr. Herzfeld could see a lot of merit in the apparently outlandish idea. He had spent five years in India before, knew the country well and also could count on considerable help from his friend. So they moved to Puducherry.

Frances died in May, but Mr. Herzfeld still feels the move was worthwhile. “The big benefit was seeing my parents still had some dignity in their life,” he says.

However, he would only recommend that others took the same route if they had family or friends there or had lived in India before. “I don’t want to encourage people to do it when they could be very unhappy,” he says. “This is an environment that some Westerners thrive in and others don’t like particularly.”

Finding English-speaking staff has been difficult, as most of them can get better-paid jobs abroad.

Nonetheless, wages for a nurse amount to about £125 a month and drugs cost a fifth of what they do in the U.S. Instead of using every cent to pay for care, the father and son are now actually able to put some away.

Despite his own reservations, Mr. Herzfeld is clearly a pioneer and others — potentially millions — may want to follow him to warmer climes and more affordable care.

Nevertheless, there may be more pressure soon from a demanding baby-boomer generation of pensioners that is prepared to question authority and traditional stances.

U.K. property consultant King Sturge advises on the nursing home sector and senior associate Anthony Oldfield says: “There is scope in the next five years or so for British nursing home companies whose names are well-known in the U.K. to expand abroad.”

When the issue starts being debated, it will have to be an international discussion, not a national one. Within Europe, pensioners are tending to move from northern countries — such as the U.K. and Germany — to the south, to Spain, Greece and Italy.

The Norwegian Ministry of Health already organises “health trips” for people with rheumatism and skin problems to Spain, Turkey and Montenegro. Sooner or later, this will need to be addressed on a European or global level. The world population of 80-plus-year-olds is set to soar from 90 million now to 400 million by 2050, according to the World Demographic Association.

In Puducherry, Mr. Herzfeld has been surprised to receive e-mails from people who want to pack their ageing spouses off to India on their own.

But while there is no infrastructure for that now, Mr. Steve (who has studied accountancy) says: “It appears to me that there is a potential industry here — in areas that are nice and quiet, with less pollution. You could staff them, even build rooms for family members to live in and provide Western comfort levels.”