It has been a given of good practice that people are best cared for at home or near home, whether ill with a physical illness, or a mental illness or dementia. It is shocking to read that some older people with dementia are being placed for their last months of life in care homes at the other side of the world: https://www.theguardian.com/society/2020/jan/12/families-sending-relatives-with-dementia-to-thailand-for-care This revelation comes from a study by researchers from Newcastle upon Tyne and the University of British Columba who found older people from the UK living in eight care homes that they visited. The reasoning behind individual placements no doubt varies with their specifics, but common themes seem to be the cost of care in the UK and its unsatisfactory profile – not enough staff to make people safe and comfortable, stories of rough handling and worse. Correspondence in response to the initial article has been uniformly positive. Can Thailand provide better dementia care than the UK? | Letters It comes from people who are well travelled and often have personal and continuing family involvement with Thailand. Even so one lady was able to visit her husband three times within a year. There are potentially serious and complex ethical and practical issues: freezing of pension and benefits, need to pay for all medical care, not to mention the matter of lost mental capacity and informed consent. I have a memory of being involved in a Panorama ‘expose’ in the 1980s when old people from the South of England were being transferred to cheaper care in the North. It was suggested that the patients knew no difference because they were demented. We countered this by observing that people with dementia are more sensitive than ever to the nuances of shared language, culture, food, dress and ways of moving. The idea of moving people out of their natural territory at the end of their lives, like passive animals simply because this will be less expensive for them, their family or social services, is unpalatable. But it is happening everyday within towns and cities of the UK: the extension of the practice to an international scale is arguably a logical extrapolation of this.
To me all aspects of this are wrong: the premise that home is important to almost everyone, and the place we want to be when we are ill or dying, is sound and undeniable. When matters are too difficult for life in our own private household, a move to a good quality local alternative where our people can visit is the preferred option. We must find a way of making this possible.