I have a younger brother, Ed, who has had many physical and psychological difficulties throughout his life. In his early 20s he had a serious car accident driving home from a job as a night watchman while he was putting himself through a local college. Although only a few credits from graduation he was never able to finish. He survived driving his car head on into a tree and the cause of the accident was determined to have been that Ed had an epileptic seizure, an illness no one knew he had before the accident. Although controlled by medication, in New York State Ed was never able to get a driver’s license. Unable to drive, having experienced some brain damage in the accident, and with what we now know is Asperger Syndrome, Ed ended up mainly mowing lawns, doing odd jobs, and living with my parents. By the time both of my parents had died, Ed also developed diabetes. He tried living alone in Pennsylvania where my parents had lived and thankfully I we had some wonderful cousins who looked after him. Eventually we concluded he could no longer live a lone and four years ago brought him to Panama. We bought a nice little Panamanian house for him in town outside Valle Escondido which worked well when we lived in Valle Escondido. But getting him to live on a schedule, take his medication and insulin on schedule, and eat regularly was always a challenge.
When we moved from Valle Escondido to Palmira we converted a caretaker cottage on our farm into a cute little cottage for Ed. It was right at the entrance to our farm so we could keep closer watch on him. Our Indian farm worker woke him up every morning, tried to make sure he ate and took his medicine, and we tried to have him improve his diet. Things went fairly well for about two years, but Ed would suffer from bouts of dementia. He would forget to take his medication or not eat, or just take medication at random. We came up with a monthly calendar with little plastic bags of morning and evening pills, which worked for a while, but then Ed started to forget what day it was, so he’d just grab a couple of bags of pills at random to consume. He was always pretty good with his insulin, until he started forgetting if he’d taken it, so would give himself a second injection. Then we noticed instead of 30 cc he would sometimes give himself 20 cc or 60 cc. Several times our Indian worker who lived next door to Ed would find him going into a diabetic coma. We knew we were getting to the point where we had to do something.
On this past contract, when I was gone for three months on RUBY PRINCESS, Ed really crashed and burned. The first month Nikki was on the ship with me and our Indian worker Sabino came and got Stan, a friend who was house sitting for us. Ed was on the floor and couldn’t move. Stan managed to get him to our local doctor where they kept him overnight and managed to bring him around. Nikki came back and Ed seemed OK, if very forgetful. Then he really did crash and burn and for several weeks was totally out of it. He couldn’t stand up, control himself, or at one point even lift his arms to eat. It now turns out that he had a type of stroke and epilepsy as well. So it was definitely time.
At one time I had written about a couple who were attempting to start an assisted care facility in Boquete called Angels Wings. They made a valiant effort but in the end were done in by all the local red tape and regulations. It is not unusual in Panama to find that there are often more regulations and enforcement for Gringos than for locals. We knew of nothing in or close to Boquete. For a while it looked like we might have to return Ed to the States.
We found what we thought would be a good home for Ed about an hour from Boquete. It was run by a church group. There was a little hurch next to the home. The administrator and pastor has been a missionary all over the world.. Ed had a nice little apartment with a living area and leeping room and private bath. It seemed like an ideal situation for him and he was very happy to be moving . . . probably to escape our nagging to eat and take his medicine on schedule.
So we thought things were good. They had a care giver for every two patients. We were paying $750 a month which we thought was very good. Later we would find out that this was the “gringo” rate and Ed’s doctor told us that for Panama it really was excessive. But we were happy to have what we thought was a good situation. The care giver was excellent, very caring and saw this as her Christian mission. Ed complained a lot about the food … and it was Panamanian food and no way did we expect anything different just because he was agringo. Everyone spoke Spanish and Ed knew only a smattering of Spanish, but this is Panama. Ed could be very critical, as is typical of someAsberger patients, and he complained a lot, mostly about food. I tended to dismiss these complaints, or his statements that they were doing everything “cheap.” Then Ed started dramatically losing weight … down 70 pounds in ten months. We bought him a new wardrobe and put him through a lot of tests at the hospital to figure out the problem. The doctor couldn’t find any reason for the weight loss. Then I started arriving unexpectedly around meal times. Typical Panama food is chicken, rice and beans, only the chicken on his plate were parts of the chicken I never knew existed. And I would see the overweight administrator of the home chowing down on fried chicken breasts. In the evening they served pretty much the same thing ever night. A small bread roll with a slice of cheese or a single slice of cheap luncheon meat. Never any fruit or juices or vegetables, all of which are available in abundance in Panama. I started doing a calorie count and discovered that evening meals were generally 300 to 350 calories. We were bringing him cereal for breakfast and aheavy duty nutritional drink which the doctor ordered before bed. When they were putting in a new water pipe in front of the home, a process which took weeks, I discovered that frequently there was no water … NO water! No back up supply. Nothing. And this was a home where some of the residents wore diapers. No water!
So we decided to bite the bullet and take him back to the States. With the help of the good people of Washington we found him a wonderful assisted living home with only four residents. It happens to be in an exclusive, gated community of huge houses. The mother of the guy who owns it, and is a builder, had diabetes so they had remodeled the bottom floor for her. When she died they decided mostly as a Christian mission to run an assisted living home. When we took Ed to Washington his sugar numbers were fluctuating wildly, sometimes dropping to 31 and Ed was confused and almost going into a diabetic comma. He has been taking insulin for almost ten years. New doctors. US medicine. Another viewpoint. He is now totally OFF insulin, eating well, walking daily, and his numbers are staying on target. Everyone speaks English. He can watch US TV and best of all for him, NFL football. His roommate is a nice guy, also in his 60s who had a slight stroke and he is a football fan. Ed is still a Dallas Cowboy fan but his roommate is working hard to convert him to being a Seahawk fan.
There may, may be something similar to a US-style assisted living center in Panama City, but there is nothing in Chriqui where we live. I know that uniformed logic says that it must be just as cheap in Panama to hire a full-time care giver, but finding someone qualified, capable and dependable isn’t as easy as it sounds.
I recently received this email, from Steve …
Richard, I am coming to Panama this November to begin my research into opening what would be called in the States an “Adult Foster/Family Home”, in Panama! I have long believed that there are ex-pats in Panama that have no desire to return to the States and would prefer to spend their final days in Panama. My hope is to offer “American care infrastructure” for ex-pats in Panama. My model is to purchase a home and have up to 6 residents that need 24 hour care, whether the care is limited to dementia or they are bed bound. I have the experience and ability to do this. Am I an idiot to think of this, or is there a real need? Do you have any insights or comments? Anxiously awaiting your reply, Steve B
And here’s my response …
Steve, there is a HUGE NEED for this type of assisted living in Panama! Many of us come down to Panama to enjoy retirement in paradise, but … things change. Life grows on, which means we are all getting older. Our bodies change and although we all see ourselves as “forty something” the fact is that bodies start to wear out. Growing older and needing assisted living is not something that we find appealing, especially for folks who are active and adventurous enough to move to Panama and experience a new and different culture. Family is ALL important in Panama. Multi-generations live in the same town, and often under the same roof. When you get older and need assistance your family takes care of you. Most North Americans and Europeans come from cultures where the family is strung out across states and countries, the so-called “nuclear” family. So, as we discovered with my younger brother whom we had to take back to the States for care, there is no North American style assisted living concept in Panama. And it is definitely one of those things that you need to keep in mind when you move to Panama. It’s the reason why I included a chapter in the NEW ESCAPE TO PARADISE entitled “Exit Strategy.” My wife, Nikki, is involved in the Hospice program in Boquete, created in part to assist folks who come to Panama and end up terminally ill, alone and without a support structure. Just this week she met with folks who are forming a support group for care givers … people struggling with incredible challenges of caring for infirm spouses, alone, in a foreign country without local family support. So, yes, there is a need.
Are you crazy? Well … We knew some folks who tried to do this. Mom had Alzheimer’s and needed round-the-clock care and so they bought a little house, hired a staff, and set up an “Adult Foster/Family Home” intended for Mom and four others. It was a great idea and these folks came with experience doing the same thing in the States. Then they ran into Panama and a different way of doing everything, a host of red tape and regulations … and gave up. This doesn’t mean it can’t be done, but you’ll need incredible patience and deep pockets. I’d suggest that you work with a local partner, maybe a Panamanian church or existing non-profit care group who understand the Panamanian way of doing things. I know from a distance it seems like you could easily hire care givers and hire them more cheaply than in the US. But wages, like everything else, have gone up in Panama, and finding people who are qualified and willing to work as care givers is a challenge and if you hire anyone in Panama you immediately have the Labor Board as a partner and tons of regulations and red tape, to say nothing of the regulations and red tape of the Health Department. There is a crying need, but Panama doesn’t make it easy to meet the need.
We’re all getting older … and it’s something to think about when you’re considering moving outside the comfort zone of where you live right now. But then, if you need to and if you don’t wait too long, you can always move back to wherever you call home. Is it better to sit in the rocking chair, stay put, just in case … or knowing and anticipating that the time will come …? Or is it better to go off to a new adventure and enjoy your life to the fullest while you may?