By Anna De La Cruz for Better Life Lab at New America and Slate.
Broadcast version by Isobel Charle for Washington News Service reporting for the Slate-Better Life Lab at New America-Public News Service Collaboration
My stepfather and I walked up a cobblestone street in the town of Chapala, Mexico, to an inconspicuous iron door built into a concrete wall. As we entered an enclosed garden, a winding path led us past a small office and into a communal courtyard surrounded by bright yellow buildings divided into apartments. We were there to visit my dad, who had recently and abruptly moved into a nursing home whose costs could be covered by his monthly Social Security check. His dementia and poor physical health had become too much for his husband to handle at their home in Washington state, and insurance would no longer cover his care at a medicalized facility outside Seattle. They feared that if he continued living in a nursing home stateside, it would bankrupt them.
Arriving at the 21-person nursing home in Chapala was a stark difference from the towering hospital-like building my dad had moved from back home. The residents who gathered on the sunny patio for meals, socializing, and mobility classes were not so different, however. They were mostly English-speaking Americans and Canadians who knew little if any Spanish.
Over 700,000 Americans collect billions in Social Security benefits abroad, where these dollars often go further; according to 2023 data from the Social Security Administration, nearly 60,000 of those beneficiaries live in Mexico. This number is artificially low: My father and his expat friends, like many others, have their Social Security checks sent to their American bank accounts—technically, they receive benefits in the U.S., but they spend them largely elsewhere.
Although the government does not track the proportion of the funds being used specifically for eldercare, my father is part of a growing group of seniors being pushed to look for creative solutions to the widening gaps between eldercare demand, supply, and affordability in the U.S. The decision to move him to Mexico had been fast and furious after insurance cited lack of sufficient physical therapy progress and refused to pay for ongoing care even as the nursing home deemed him unfit to go home. The out-of-pocket cost at the facility near Seattle was over $500 a day, while in Mexico, his care cost closer to $150 a day—a difference that would amount to over $125,000 per year.
This stark contrast was highlighted when I returned home from Mexico to a bill for my mother’s first four months in a nursing home in Seattle—an unbelievable $58,000. Her Social Security did not come close to covering the expenses, and like many older adults in need of higher-level support, she was forced to go on Medicaid and spend down her savings to pay for her ongoing care.
Not only has the skyrocketing cost of eldercare in the U.S. become out of reach for many whose retirement strategies did not plan for such exorbitant expenditures, but with a record proportion of Americans over age 65, supply is also insufficient to meet growing demand. Medicaid has long been the fallback for older Americans who need more intensive care but cannot afford it, with two-thirds of nursing home residents supported by the program. But with over $900 billion in proposed Medicaid cuts underway, nursing homes across the country are already closing in some of the places they are most needed, such as rural, low-income communities. Between 2020 and 2025, 770 nursing homes in the U.S. shuttered.
In response, various care consultants have emerged to work specifically with families like mine who need help finding the best care solution for their circumstances and budget. Arthur Bretschneider is a third-generation senior housing operator and chief product officer at CareScout, a company that provides eldercare services such as need assessment and planning. He highlights that in addition to the quickly rising year-over-year care costs, providers are finding that “more and more folks are having higher care needs in general.” He added, “Twenty or 30 years ago, it was very much retirement living, and now assisted-living communities tend to look a lot more like a skilled nursing facility.”
Other consultants work with families specifically looking to relocate elders to assisted-living facilities abroad. For Americans, they most often suggest Mexico, but those I spoke with also send elderly clients to Costa Rica, Panama, Ecuador, and other parts of the world. They scout locations, match clients to an appropriate home, and help families budget and tackle the logistics of the move.
John Kelly, who founded Eldercare Global in 2025, is part of this new wave. His father suffers Lewy body dementia, and Kelly was not satisfied with the memory care facility they first tried in Minnesota. Although the facility had the standard 8-to-1 caregiver ratio for a U.S. nursing home, he felt this was insufficient for his dad and others with neurodegenerative diseases. Now in Chapala (in a different facility from my dad’s), his father has one-to-one care at a fraction of the cost. Kelly describes more time with doctors and the appeal of generally smaller “boutique” centers that feel more like homes than medical facilities. He says Mexico offers “options for 24-hour one-on-one care at the cost of nearly a Social Security check, that allow people to conserve their nest egg, sit in the sun, and eat better food and save their money while doing it.” He now supports other families who are exploring similar options.
From her base in Lake Chapala, self-described “wellness shepherd” Wendy Jane Carrel also consults North Americans who are looking to move abroad for care. Carrel says that the writing has been on the wall since the early 2000s, when assisted living and nursing care in the U.S. was already becoming unaffordable for the average older adult in need. She has since experienced increasing demand for her services and has helped over 200 people move from the U.S. to care facilities in Mexico and Ecuador.
Carrel tries to make sure her clients understand the drawbacks as well as the benefits, noting that people underestimate costs and make assumptions that certain benefits will travel with them, when often they do not. But relocations aren’t about just the price difference—there’s also a value gap. “Unlike the formal, clinical feel of some American assisted-living homes, Mexican care is rooted in apapacho—a unique blend of cuddling, pampering, and deep societal respect that provides a level of emotional security many seniors feel is missing at home,” she told me.
Despite the benefits, moving abroad is an adjustment for anyone and comes with its own unique challenges. The North Americans in my dad’s care home got by communicating the basics with nurses and had longer conversations with the management-level staff and doctors who spoke English. As a Spanish speaker, I quickly picked up on how much was lost in translation—a specific meal request that was met with a smile but no verbal response, a joke from a staffer that went unacknowledged. I found myself translating details that would otherwise have been misunderstood.
True to his nature, my dad was a good sport about the transition. For better or for worse, it could not have been more different from the hospitalized nursing home he had lived in back in the U.S. There, he was monitored extensively to minimize safety risks but barely left his room or talked to anyone beyond nurses and visitors. In Chapala, there was open space and an informal feel that encouraged socialization and time outside.
Still, even having previously spent time living in Mexico, my father struggled with aspects of the move; he didn’t like living apart from his husband, he was frustrated with his physical limitations, and he had complaints about the training of those who cared for him. He experienced apapacho, along with what felt like a lack of boundaries and consent when it came to physical space. A big guy, he needed a male staff member to help him transfer from a chair to the bed, or to use the bathroom. In some cases, the staffer who did the job was the handyman. The system was neither graceful nor perfected by lawsuit-driven fear, but the employees did what they needed to get the job done. There was less precision, and more warmth.
While I understood the appeal of paying less for care and being able to enjoy sitting outside in the sun, I struggled and grieved my dad being hastily moved so far away. I knew it was quite possible he would not again see his grandchildren or my brother (who has Down syndrome), given his frail state and the challenges and cost for all of us to travel to Mexico. Unfortunately, I was right. My father died less than a month after my visit, following a 45-minute ambulance ride to the nearest Level 3 hospital, in Guadalajara. He had suffered small strokes and an internal infection that had gone undetected. I couldn’t help but wonder if the outcome would have been different at home.
My research uncovered other stories of older adults moving to Mexico and elsewhere to stretch their retirement funds, only to suffer major health issues without local knowledge, in-country insurance, or the language to navigate it all. Legal infrastructure differences and estate and inheritance disputes can also become a tricky part of the equation for elders abroad, as well as their families.
As Bretschneider puts it: “I’ve realized over the years there’s no one-size-fits-all. It’s not like the aging journey is linear. … Some people are going to be super healthy all the way. Others are going to have twists and turns early on, and that’s what makes it so hard. You need to plan for it in advance, but people don’t want to when they are healthy.”
By 2030, for the first time in history, the U.S. population will be made up of more older Americans than people 18 and under. And by 2060, people 65 and up will account for a quarter of the population. Instead of planning for the care that will be needed with these demographic shifts, the federal government is cutting funding to an already strapped eldercare system.
Moving my dad to Mexico felt like the only viable work-around for my family at the time. But the lack of affordable options meant it was rushed and emotional, and it made it difficult for him to see his children and grandchildren in the final months of his life. The United States could help families avoid such painful situations by investing in innovative care infrastructure: expanding home-based services, bolstering the caregiving workforce, and creating a durable way to finance long-term care. In the meantime, every single one of us is getting older.
Anna De La Cruz wrote this story for Better Life Lab at New America and Slate.
Source: Public News Service
