I am on my way to Mexico City to speak at a Senior Living Summit being held at the Hotel Marquis Reforma September 3-4, 2025 about the growing need to create evolved, affordable, holistic enclaves of well-being for older adults to age in place, age in community, and more, a subject on my mind since 2003.
Quick history:
In 2003, when serving as nighttime administrator and day time admissions and marketing officer at an exemplary (still is) memory care campus in Rancho Mirage, California, (thank you owner and mentor Floyd), the writing was on the wall.
Unless you are blessed with excellent health your entire life and have experienced no accidents, in the U.S. the cost of adequate long-term care at home or in a residence, could easily require up to $1 million per person with 2025 fees and pricing. With long-term care insurance at several hundred dollars a month, only 80% of costs would be covered.
This awakening was the impetus to look internationally for more affordable options with quality care and medical infrastructure. Mexico and Ecuador, by virtue of proximity, were places I conducted due diligence and developed hands-on experience with locals and expats, as well as other nations farther away.
Thankfully, as a trusted older adult advocate and consultant I have met like-minded souls on my path including Mexico’s Javier Govi, the « nearretiring » proselytizer and real estate entrepreneur behind CIAMAR’s 9th edition Wellness and Senior Living Summit for 50+ to 80.
About 100 to 150 persons are expected to attend the gathering gently modelled after NIC (National Investment Center conferences in the U.S. with 1500 to 3,000 participants).
The concept to develop and expand senior living options is growing in Latin America as the silver tsunami is not just an American/Canadian/European phenomenon, it is worldwide.
Attendees will be real estate developers, venture capitalists, architects, brokers, folks from the tourism industry, and senior living operators who will meet, greet, and assess future potential for collaboration.
I will be on the Bucket List panel with two others to talk about expats who migrate to Mexico and other countries in Latin America and what their expectations are.
If you are unable to access it, here is how my bio reads:
Wendy Jane Carrel
Founder, Wellness Shepherd
A trusted older adult advocate and consultant who has hands-on experience with healthcare systems, retirement options, senior living residences, and wellness programs in Mexico, Ecuador, and other countries. She provides informed and thoughtful transition guidance and curated options for families and elders moving to Latin America.
Looking forward to this adventure!
I hope to report about the experience and my findings after the summit.
Nestled in Mexico’s highlands, Aguascalientes charms visitors with colonial architecture, clean streets, wide sidewalks, shade trees, and a warm community spirit. About 1.5 million residents live at 6,194 feet above sea level, an easy drive on the highway from Jalisco (three hours from Guadalajara). Known for its safety and relative tranquility, Aguascalientes surprised this newcomer. During my three-day stay persistent winds became an unexpected part of the city’s personality.
Founded in 1575 by royal decree of King Phillip II of Spain, the city’s original name was Villa de Nuestra Señora de la Asunción de las Aguas Calientes (Village of Our Lady of the Assumption of the Hot Waters). Citizens are amusingly referred to as hidrocalidos or hydrothermal people.
Mini-park in central Aguascalientes:
Immaculate street with residences and shops in central Aguascalientes:
Aguascalientes is an industrial city. Major companies present are GM, Honda, Mazda and Nissan. Other notable companies manufacture medical equipment, electronics, car parts, and textiles. Years ago, Aguascalientes built trains. The original station still stands as a museum and there are restored train cars to see.
Not surprisingly, among the expat population estimated around 1,000, there are several Japanese. Trip Advisor lists 34 Japanese restaurants (not all Japanese owned).
A glimpse of what I experienced related to older adult activities, care, hospitals, and end of life:
Older Adult Socialization in Community
Club de la Tercera Edad is a public center for older adults run by CONACYT, the national counsel studying science and technology. When I arrived, there was a danzon class. Danzon is a Cuban music and slow dance tradition, immensely popular in Mexico and other parts of Latin America.
DIF and INAPAM Older Adult Activity Centers Both DIF (Desarrollo Integral de la Familia) and INAPAM (Instituto Nacional de las Personas Adultas Mayores) are government run centers offering activities. They are separate entities but sometimes collaborate. DIF addresses entire family needs and is more about social protection of vulnerable populations. It offers adult daycare centers, psychosocial support, food programs, medical attention, recreational activities, and more. INAPAM is focused on older adult legal rights, transportation discounts, medical and cultural services.
On another trip I hope to meet Aguascalientes DIF director Aurora Jimenez Esquivel, known for her innovative initiatives including a popular travel program to visit nearby states known as “Gigantes Viajeros”. If you have access to Facebook, there are charming photos with older adults from Aguascalientes enjoying a trip at the FB page of Aurora Jimenez Esquivel. The link would not post when I loaded it here.
Señor Sebastian As I made my way to the Panteón de los Ángeles y La Cruz, thirst led me to a sunlit corner store not far from the cemetery gates. There I met the venerable octogenarian you see in the photo whose warmth seemed to animate the whole neighborhood. With his son by his side, he presides over the store like a sage, sharing stories about local elders and aging in place. He graciously pointed me to the entrance of the cemetery. After wandering the peaceful grounds among small and large gravestones, I returned to thank him —feeling, in that moment, not just like a visitor, but welcomed to Aguascalientes. Memorable encounter.
According to INEGI (the Mexican government statistics bureau) and Google, there are about 14 long-term care residences. (In Mexico long-term care is, with some exceptions, all in one – assisted living/memory care/nursing).
I focused on homes in the city center and visited seven to get a feeling for environment, providers, residents, and care.
Three assisted living/memory care homes had closed, one during COVID. Most places were basic, clean, modest, and dark, yet each with devoted caregivers. Residents in some homes seemed thrilled to have a visitor.
I was warmly welcomed at clean, efficient, light-filled Residencia de la Roble which houses 33 older adults including Mexican-Americans who prefer to age in their native Aguascalientes. Care costs are about $700/month USD (13,000 pesos/month) for shared rooms (there were two single rooms). Included in the fee: nutrition with customized diets, television and activities, laundry, medical care by the owner, a geriatrician, and most of all what appeared to be loving, energetic care by devoted nursing assistants. Note: Many Mexicans are accustomed to sharing space. The concept of privacy and your own room is often found with families who are well-off.
Here are photos showing a shared room with pristine, well-organized clothing and linen storage:
There is no website for Residencia de la Roble but you may find several photos of its high energy, activities, and sweet residents and caregivers on Facebook at Residencia para adulto mayor “El Roble”. https://www.facebook.com/profile.php?id=100064126566555
On my next visit I wish to tour Estancia Geriatrica Villas Juan Pablo as I had originally planned. It is a privileged residence in a park-like setting, also with lots of light, a few miles north of the city center. You will find photos at https://estanciageriatricavjp.com/ The environment reminds me of countryside care homes outside Quito, Ecuador – wood cabinetry, vistas of green meadows, tranquility. Under “instalaciones” there are photos of private rooms. The monthly prices at Villas Juan Pablo would be double, or more than double, the costs at Residencia de la Roble.
Note: prices for long-term care in the state of Aguascalientes are less than in the state of Jalisco (home to Guadalajara, Lake Chapala, and Puerto Vallarta). The Aguascalientes homes cater to local Mexican families.
Hospitalsand Dental Care
Aguascalientes has an impressive medical infrastructure with hospitals both public and private. Hospital MAC (there are two, one in the north the other in city center), Centro Hospitalario de Aguascalientes, Star Medica, Centro Medico la Salud, Hospital Cardiologica de Aguascalientes, Medica San Juan de Aguascalientes, Hospital Fundación Medica México Franco Brasileña plus a plethora of other options for specialized medical care as well as dentistry.
Emergency Care at Hospital MAC
The third night of my visit I awakened around 10-10:30 p.m. feeling tingling down my right side and leg. My first thought, oh no, not a TIA/stroke!! But I was able to speak. The sweet elderly man on night duty at the hotel suggested a taxi to the Red Cross. I wished for a hospital. I was super weak and dizzy yet decided to slowly walk to a nearby hotel. The night duty clerk there suggested Hospital MAC, a few blocks away.
There are about 30 MAC hospitals in the country. I had visited others and felt confident. I was especially encouraged because I could see the hospital tower from the front door of the hotel. I walked slowly but surely about four short blocks and made it to the emergency room. A nurse promptly greeted me, took my name, invited me to a room, took my vitals. I was then escorted to meet Dra Nancy originally from Mexico City and a graduate of UNAM. She was amazing – attentive, kind, professional. A thorough assessment of eyes, strength in arms and legs, heart, walking etc. Thankfully I was going to be okay. I was dehydrated (first time ever and quite a lesson) and had a bit of heat stroke from walking in the sun from early morning to sundown. The hospital experience was a gift, and I remain grateful to all who assisted and cared for me at the hotel as well.
Palliative Care and End-of-Life Care
Pain relief for life-limiting illness is offered by 14 anesthesiologists with palliative care credentials at hospitals and clinics. Two of the physicians drive from Guadalajara. According to a list of medical providers, there are 20 geriatricians. In-home pain relief for end-of-life is offered by at least two geriatricians.
All assisted living/nursing homes attend to end-of-life.
One residence, Hogar del Abuelo Maty, was founded with supportive end-of-life care in mind. It is in the countryside one hour to the northeast of Aguascalientes.
The home, opened in 1981, is named in remembrance of Matilde (Maty) Dubroy de Villanueva who was accompanied at end of life by her daughter Carolina Villanueva de Garcia. The profound experience inspired Señora Carolina to build the hogar where every elder could have a dignified death with compassionate, personalized care.
The current administrator of the non-profit is the founder’s son, Carlos Garcia Villanueva. Care is provided by nurse nuns of St. Vincent de Paul. The nuns have a long and rich history of companioning the infirm and those at end-of-life. The website with photos and videos reveals more: https://www.hogardelabuelomaty.org/
While I did not encounter any modern-day end-of-life doulas in Aguascalientes, Mexico, non-medical, psychosocial spiritual support has been a community tradition for centuries. Local women known as “parteras” assist not only with birth but have a significant role supporting families and individuals during the dying process.
Funeral Home Arriaga
Toward the end of each day, I passed Funeraria Arriaga on the way to my hotel. Families waited inside where there are four viewing rooms and a place to sit and sip coffee or tea. Or, they waited in front of the building. There is a florist across the street.
Most Mexicans choose burial in a coffin. For those who choose cremation, the cost with this funeral home is between 9,000 and 20,000 pesos ($470 to $1000 USD) depending on whether there is a memorial service. According to Funeraria Arriaga there is no refrigeration in Aguascalientes but there is embalming. (Refrigeration is possible in Jalisco to create time for family members arriving from far away to view the deceased). The Boinita Group advertises green spaces for cremains (ashes) in Aguascalientes as well as Cancun, Hermosillo, Merida, and San Luis Potosi. https://boinita.com/en/green-niches-of-funerary-forests-in-mexico/
National Museum of Death
The museum, which opened in 2007, exhibits death-related artifacts from pre-Hispanic times to the present from the personal collection of Octavio Bajonero Gil. The 2,000 or so items include sacred religious paintings, sculptures, objects d’arte, and more. They are displayed in three connected buildings of a restored 17th century convent that once housed Franciscan monks. The property is now owned by the University of Aguascalientes.
My experience was not of the macabre. Some items show the unique Mexican sense of humor.
At the entrance of the museum is a gift shop where you pay an entrance fee of 20 pesos ($1 USD). It takes 45 minutes to an hour for a self-guided tour. If you are lucky you will have university student Antonio accompany you to the basement to see reconstructed gravesite remains. The photo below was taken in the basement:
Later, multi-lingual Jesus from Mexico City who delighted me with his Italian might lead you through the floors and buildings.
The museum produces 200 or so events per year including the October/November Day of the Dead Celebrations. At the writing of this post the calendar of events for the 2025 Annual Festival de Calaveras (skeletons) has yet to be posted.
Museo Posada This museum is dedicated to the collected works of Aguascalientes native Jose Guadalupe Posada (2 February 1852 – 20 January 1913), a political satirist/caricaturist, engraver, and printmaker known throughout Mexico as the father of La Calavera Garbancera/La Catrina, a female skeleton dressed to the nines that is seen each year at Dia de los Muertos/Day of the Dead ceremonies. During the presidencies of Portfirio Diaz (1876-1911) Posada introduced skulls and bones as political and cultural critique. La Catrina indicates death comes to all, including politicians and the super wealthy. Here below is a Catrina from the Museum of Death:
Wendy Jane Carrel, MA, is a trusted older adult advocate and consultant who has many years of hands-on experience with healthcare systems, retirement options, senior living and wellness programs in Mexico, Ecuador, Italy, the U.S., and beyond. She provides culturally sensitive transition guidance and curated options for families and elders domestically and internationally. Wendy’s web site is https://www.WellnessShepherd.com
We live in an aging universe, a universe where older adults live longer than ever before and the need for care is growing.
For centuries we have protected and provided for loved ones from cradle to grave. These acts of reverence, respect, and love still exist and are seen in traditions around the world.
But modern life has shifted from relative stability to burden for many – out-of-the-blue expensive healthcare conditions, a growing number of older adults with chronic diseases/co-morbidities requiring long-term care, fewer folks to work as caregivers, multiple stressors for families overwhelmed with work and caregiving, financial loss, climate change, pandemics, war, forced migration.
Sadly, the reality of aging in the U.S. if you are not independently wealthy requires extra effort, planning, and sacrifice. No matter how much exercise, living with a positive attitude, and attention to healthful lifestyles, you may find yourself with difficult choices due to an unanticipated surprise – do you adjust where you are or imagine alternatives? Staying home is understandably preferable.
Older adults around the globe prefer to Age in Place and make their end-of-life transitions in a community they know and love. Quality of life that is comfortable and familiar is the main objective. This is generally translated to, NOT in a foreign country or anywhere else.
If you have exhausted all avenues of community support at home or in adjacent counties, states, or provinces, and realize care may not be affordable or you may outlive your funds, what are your choices? What if you are a solo ager with no family, spouse, or fallback? What if you must continue to work to support a family and are uncomfortable with the idea of sending mom or dad away for care?
Choosing to move could be a disheartening task. It is a leap into the unknown, no matter how adventurous one is.
One option is to seek care in another country.
There are seven continents on our planet. All but one (Antarctica) provide a form of care for older adults. From Albania to Samoa, unless loved ones are cared for by family, there are in-home support services or residences offering various forms of independent living, assisted living, memory care, nursing care, and/or end-of-life support.
According to Grand View Research, “the global long-term care market size was valued at USD 1.11 trillion in 2023 and is expected to grow at a compound annual growth rate (CAGR) of 6.68% from 2024 to 2030.”
The area with the largest anticipated growth is memory care. Alzheimer’s Disease International reports there are more than 44 million Alzheimer’s patients globally. The number is expected to triple to 135 million by 2050. “If ‘dementia’ was a country it would be the world’s 17th largest economy.” Costs for memory care are exorbitant, especially if the anticipated lifetime of care is 12 years or more.
How do you choose where to go?
Somewhere around 2003 it became evident to me as a person dedicated to older adult healthcare that the future for American boomers, Gen-Xers, Millenials, and their parents would be affected by the rising cost of aging care. With the benefit of a lifetime of travel, foreign study, and work on five continents, it became apparent Americans might begin to seek care in another state or abroad if they could not afford the cost of care at home.
In the last 15 years I have witnessed and assisted more and more Americans, as well as Canadians and some Europeans take a leap of faith and choose south of the U.S. border for retirement and care for reasons of proximity (not for Europeans), weather, cost, and a reputation for thoughtful providers.
According to Lottie, a UK research organization and placement advisor, the best countries for senior care named in order are Norway, Sweden, Switzerland, Germany, Canada, and the U.S. You would need to have residency, be a national, or have funds to pay for care. Factors included in the study were pensions, healthcare systems, care services (assisted living, nursing), social support, and government grants.
The best countries for senior care by continent named by Lottie are:
Africa – South Africa
Asia – Taiwan
Europe – France
Oceania – Australia
North and Central America – Mexico
South America – Ecuador
The Lottie report did not include parameters for the above assessment. France as the best in Europe contradicts the previous Lottie report that Norway leads in senior care.
The below review is based on my research and experience.
What countries do Americans and other nationalities consider for retirement and senior care if looking internationally?
Americans and Canadians favor the Caribbean or Mexico by virtue of proximity, and often for weather. Other places in Latin America are considered, mainly Costa Rica, Ecuador, and Panama. In the last 15 years, the Philippines and Thailand have also been chosen based on cost, weather, and a reputation for attentive care. Malaysia, a new face of senior care in Asia since legislation in 2018, attracts some Americans but mostly Australians, Brits, and folks from other Asian nations. Ireland is sometimes considered when qualifying for Irish citizenship or residency. If you are an EU citizen, you have certain residency rights in Ireland.
Frida mural in expat enclave Ajijic, Jalisco, Mexico
If you have the blessing of universal healthcare (Americans do not) and are a national in Norway or Sweden, you are cared for from birth to burial no matter the level of care you require. Norway, as mentioned above, is considered the best country for older adults by virtue of its healthcare system and life expectancy. I can attest to Sweden based on attending graduate school in Stockholm and experiencing the healthcare system.
If you live in the UK, Portugal or Greece look like warmer options by virtue of proximity and favorable tax breaks, but the situation may be more of a challenge post-Brexit depending on your financial status and language considerations. Many American older adults are finding their way to Portugal, and to Greece if they have Greek heritage. Brits as we know have considered India for retirement and medical care (shades of the film about middle class retirees in The Best Exotic Marigold Hotel), or a British base in the Caribbean.
Since the end of the 19th Century Italians (and some French) looking for affordable options have been traveling to Tunisia, not so far from home. Historically, Tunisia was a Roman imperial colony. Vibrant Italian colonies are found in Tunis, Bizerte, and Sfax. On a recent trip to Italy, I learned some Italians are now traveling to Croatia for lower costs, which is interesting as several “badante” or caregivers in Italy are from Croatia. Here is the post about aging in Italy a favored country for retirement, healthcare, and senior care by Americans of Italian descent and others:
In the Arab world, Kuwait, Oman, and Zanzibar (on the Trucial Coast of Africa but formerly the Sultanate of Oman and an important Arab trading center), countries I know, taking care of your elders is a religious and traditional obligation. Home health caregivers and nurses are de rigueur. There are now palliative care and hospice services.
What countries have dignified elder care at a price point less than that of the U.S.?
As of 2024 more affordable price points may be found in Costa Rica, Cuba (not an option for U.S. citizens), some Caribbean nations, Ecuador, India, Mexico, Panama, the Philippines, and Thailand. Note: prices for care are rising worldwide.
In every country of the world there is quality, supportive elder care and there is sub-standard, disengaged “care”.
Quick overview of points to ponder:
Determine country. Easiest to do when you have travelled to far flung places before. Be advised that dream vacations are not the same as living long periods of time in a new place. A preliminary, exploratory trip is always recommended. In expat destinations there are often introductory seminars for how to navigate the place you have chosen. If your heritage is Irish, Italian, Polish, or other, and you qualify for residency and a second passport, countries of heritage may be in mind.
Healthcare beyond in-home care and assisted living. Access to physicians, hospitals. Learn how the healthcare system works in the country that beckons you. Medical care may cost less and yet be of similar quality or better. Vet your medical team as you would in your own country. What is the role of the assisted living residence if any? Is the residence hands on or does it expect family members to participate in your hospital and rehab care from a distance? If you are a solo ager, consider locating a healthcare coordinator/advocate to keep an eye on your care. Review factors that affect health – weather, elevation, pollution, availability of fresh water and food. Will you be in a flat place safe from falls? What is the standard of care?
Residency requirements. Every country provides information on how to qualify for and achieve residency. Will you be able to live there in the future on your income as prices rise? Embassy and consulate websites plus expat forums on-line provide guidance for navigating residency. Expect a lot of effort on your part. If you do not speak the language, consider hiring a facilitator.
Consider the distance and cost of travel, keeping in mind cost to return home should life change. The longer the distance the harder it is to travel with elder loved ones. Will family be able to visit? On a recent Viva Aerobus flight between Los Angeles and Guadalajara a precious senior in obvious pain was traveling with her mindful son. The flight was three hours. The son held her close. She never complained but you could feel it was not easy.
Corporate or Home-Like Environments. What would be the most compatible environment and style for you or your loved one? What is the owner/administrator’s philosophy of care? Do they have a mission to care for elders? Is income the only objective? Will the residence remain in existence for the life of the resident? Search the Internet and AI. You will read about places, mostly those that are corporate, and not necessarily discover smaller places with no budget for outreach. Consider smaller places, some are gems.
Garden at small assisted living home in Mexico
Consider family moves. I have had the privilege of assisting families who moved with their loved ones. The sons and daughters work digitally and visit mom or dad. For those who are unable to move with loved ones, most homes provide Face Time, Google Meets, or Zoom visits.
Safety and happiness. Is the residence secure? How will the residence assist with the transition? Any move is stressful, especially for older adults. It takes three to six months to adapt to a new environment. Not everyone transitions well, some not at all. In my experience, a well-traveled person who has an affinity for adventure or a certain culture, has as easier time. If the loved one has dementia, places in nature with gardens, room to walk, the energy of light, and a high level of activity and engagement encourage positive outcomes. What will the level of socialization be? Are there other expats who would be compatible company? Some expat havens and faith communities have volunteers, usually retirees, who visit homes and keep track of brethren. Is the food fresh, does the home offer diets suitable for diabetes or other illnesses? What are the standards of care? How is staff trained, how many staff per resident?
Quality of life and engagement lead to comfort, better health, and general contentedness.
Local culture. How are older adults viewed by the society and government? Is English a second language and is there experienced, trained staff who speak some English? Will you or your loved one be comfortable living among locals or being examined by a doctor who may not speak English? What is the country like compared to what is familiar to you? What might be missing? Some countries group residents who only have physical disabilities with those who have dementia.
Palliative care and hospice. Will the residence and local doctors accept and respect your wishes? What are local procedures/traditions for treating pain? How is end of life treated? Is there 24/7 attention and vigiling? If you feel close to death, will you be able to return to your home country to die if that is your wish?
Expat forums. There are innumerable expat forums on the Internet, some offer basic guidance about what to expect in the country of choice. Be advised, however, that even with good intentions, information may contain other cultural biases and not necessarily be in alignment with your personal needs, perceptions, and standards.
Summary:
If aging and healthcare options at home become limited, or you realize you may outlive your funds, one option is to look abroad.
Seeking eldercare beyond your own borders is a daunting task and may feel painful. If you have had the privilege of international travel, languages, and on-the-ground experiences that provide you with a level of psychological as well as financial safety and comfort, you may do well. There are also many who have chosen care abroad, never travelled far before, who end up feeling pampered and content. Choosing care near an expat retirement community may bring peace of mind and could provide back-up support and socialization.
Exploring and planning ahead make a difference in your outcomes.
Mission based care (not meant to be interpreted as religious) in smaller residences is often appealing, especially when administrators and staff demonstrate compassionate care daily. Large corporate facilities often require an extra layer of vigilance on the part of families in all countries, so providing an advocate/weekly visitor is helpful if affordable.
There is no perfect place, but there is excellent care to be found in every country.
Research well, make lists, assess your needs, and locate a place that aligns with your preferences.
Abundant blessings for whatever journey you or your loved ones choose.
Wendy Jane Carrel, MA, is an older adult health care advocate, advisor, and consultant from California. She has conducted due diligence for senior living and retirement on five continents and is passionate about supporting families and their elders with solutions. She provides informed, attentive, compassionate guidance and curated options for Ecuador, Mexico, and other destinations both domestic and abroad. She is a speaker and published author on subjects related to older adult well-being. Wendy’s web site is https://www.WellnessShepherd.com
Wellness Shepherd 