Feeling excited to be included on two panels at a Mexican government Pueblos Magicos/AMAR event in Los Angeles, Friday September 22, 2023, at the Shrine Auditorium to talk about Moving to Mexico. My focus will be senior housing and healthcare options, among other subjects.
Pueblos Magicos are “magical pueblos”, 177 small towns in 31 Mexican states. For the most part they are charming Mexican villages that represent Mexico’s cultural heritage and traditions, some with historical relevance.
As a lovely synchronicity, I have enjoyed one pueblo magico on and off for several years, Ajijic at Lake Chapala, one hour south of Guadalajara in Jalisco state.
Javier Govi, Founder and CEO of AMAR (Asociacion Mexicana de Asistencia en el Retiro), the Mexican Association of Retirement Communities, is producing and moderating the panels.
Here is the AMAR marketing for two of the invitees, do not know who else will be present. Looking forward to participating!
AMAR, founded in 2007, is a national Mexican non-profit organization committed to educate and collaborate with Mexican government regulatory agencies and business executives in Mexico and North America on the potential of the senior housing industry in Mexico.
The Shrine Auditorium is at Figueroa and Jefferson Blvd in downtown Los Angeles near the campus of USC. https://www.shrineauditorium.com/ The event is free.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care advocate from California. She has travelled Mexico for 20+ years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She is a speaker and published author on subjects related to senior well-being. Wendy’s web site is https://www.WellnessShepherd.com
If you live in Mexico or Latin America, have you created a plan for what to do in case of an accident, natural disaster, or healthcare emergency?
Who is going to show up for you?! What if you are no longer able to speak and make decisions for yourself?
If you wish to save your family, other loved ones, and neighbors considerable grief and time, it is important to understand what is involved when a foreigner becomes ill or dies in Mexico or other Latin American nation.
Last month I had the pleasure of joining patient advocate and educator colleague Deborah Bickel of Be Well San Miguel to share with expats in San Miguel de Allende why it is wise to create a Mexican documentacion jurada (living will) or voluntad anticipada (advance healthcare directive). My role in the meeting was to give an overview of palliative care and hospice.
Deborah Bickel of Be Well San Miguel, Wendy Jane Carrel of Wellness Shepherd
We have each invested 11 years or more sharing with expats (Deborah in Mexico, Guatemala, and Nicaragua – me in Mexico and Ecuador) why planning is important no matter your age but especially if you are 55+.
Short list of reasons:
Mexican law is civil law. British, Canadian, and U.S. law is common law. There are major differences.
If you arrive with an Advance Health Care Directive or Five Wishes or other document legal in your native country, it will not be legal in Latin America unless you get lucky. In Mexico, you must create a documentacion jurada and/or voluntad anticipada if you want your wishes honored. These documents must be notarized.
Notaries in Mexico are experienced attorneys appointed by the Governor of State. Some will incorporate your home country wishes for you. These documents must be created BEFORE any accident, illness, or demise. In some instances documents are created by an attorney who is not a notary and then signed in front of a notary.
Regarding the voluntad anticipada, as of this date only 14 of Mexico’s 32 states offer a voluntad anticipada. The purpose of the voluntad, sometimes referred to as a directriz, is to avoid legal, medical, and bioethical problems that could complicate the situation for you the patient or your family.
Mexico is a country with predominantly Catholic traditions. These traditions influence choices. If you are Catholic, the system may seem familiar, such as burial over cremation. If you had chosen to live in Buddhist or Hindu Asia, cremation would be a relatively easy matter involving fewer steps as cremation is common practice. Or, you could have opted for a Tibetan sky burial. If you wish to be cremated, you will need a notarized document stating this wish.
Latin Americans have large family systems. If something happens to you as a Latin American, a family member will show up and know what to do. Most expats live in Latin America alone or as a couple, sometimes with children, often without a plan for emergency support.
The Mexican culture, language, and way of thinking are unique. Most of all, procedures may be unfamiliarand complex. Attitudes and response to accidents, illness, and death are different.
Non-Spanish speaking expats often need bilingual advocates to negotiate the system. At least three people are recommended to advocate for your wishes, and/or serve as your healthcare proxies. If one is not available when needed, perhaps another will be.
April 16 is National Healthcare Decisions Day in the U.S. and a reminder that if you do not yet have a plan, every day is a good day to work on one no matter where you live.
Aileen Gerhardt, a fellow patient advocate and educator in Boston writes “decide, document, designate, and discuss!!” Good advice.
Deborah’s extensive medical directive service for Guanajuato state Mexico may be found at:
Wendy Jane Carrel, MA, is a Spanish-speaking senior care advocate from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She is a compassionate companion and palliative care liaison, legacy writer, co-founder of Café Mortality Ajijic/now Death Café Ajijic and founding member/speaker of the Beautiful Dying Expo (USA). She is a trauma-informed, gentle End-of-Life Doula (National End-of-Life Doula Alliance proficient), and a speaker and published author on subjects related to senior well-being. Wendy’s web site is https://www.WellnessShepherd.com
Looking forward to another trip to beautiful San Miguel de Allende in March 2023. If it were not so cold at night in that expat haven of 10,000 or more retirees, I’d travel there more often!!
In any event, pleased to be joining talented patient advocate Deborah Bickelof Be Well San Miguel for a talk about end-of-life planning, palliative care, and hospice in Mexico titled “Planning for the Third Stage of Life.”
Deborah will share the wisdom of preparing for your care, how she first learned to plan when she worked with AIDS in Africa, and how creating your Mexican Advance Healthcare Directive aka your “documentacion jurada” may assist in creating quality of life to the end of life. The ultimate message: there are good reasons for all foreigners in Mexico to obtain these notarized documents.
I will provide a brief history of palliative care and hospice in Mexico, the Mexican Palliative Care Law of 2009, what care is present now, where to find support, what the future may hold. My talk is based oneight years of research, conferences, studies for a Mexican palliative care diploma, volunteer years with a Jalisco palliative care hospital, site visits, and relationships with palliative care organizations and hospice providers in Jalisco (Guadalajara, Lake Chapala, Lagos de Moreno, Puerto Vallarta, Tepatitlan), Mazatlan, Merida, Mexico City, Morelia, San Miguel de Allende, and Tijuana.
The event is scheduled for 11:00 a.m., Wednesday, March 15, 2023, at the Kubo Hotel Cafe, Stirling Dickinson 28, San Miguel de Allende, Mexico.
Deborah holds an MA in Public Health from UC Berkeley. She is also a graduate of Stanford University’s Physician Assistant program where she later taught. She has been dedicated to healthcare advocacy in Mexico, Nicaragua, Guatemala, Cuba, and Africa. She is a fluent Spanish speaker. See https://bewellsanmiguel.com
My bio for this subject is as follows:
Wendy Jane Carrel, MA, is a Spanish-speaking senior care advocate from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She is a compassionate companion and palliative care liaison, legacy writer, co-founder of Café Mortality Ajijic/now Death Café Ajijic, and founding member/speaker of the Beautiful Dying Expo (USA). She is a trauma-informed, gentle End-of-Life Doula (National End-of-Life Doula Alliance proficient), and a speaker and published author on subjects related to senior well-being. Wendy’s web site is https://www.WellnessShepherd.com
One hour south of Guadalajara, Mexico’s second largest city, is the quaint village of Ajijic, a Pueblo Magico. For those of you who have visited or lived there, you have may have heard or read that the village is also known as the “City of Fallen Women.”
The Fallen Women are foreigners. Foreigners who have tripped on river rock, rough cobblestone, or lone pieces of steel rebar. They have broken hips, femur bones, wrists, or sadly lost their lives with complications from falls. Fewer men fall. As I write it is reported that one older adult male was walking in Chapala Centro, three miles from Ajijic, at 8:19 a.m. Sunday, September 26. According to a witness, he fell, hit his head, and died.
A few years ago, I felt just as sorrowful when I learned a similar story. I think of it often. A 60-year-old male fell in Ajijic, impaled his head on river rock, and died. Someone reported he was fit and had no health conditions. That may be true or not. No matter what, surviving a fall or dying from a fall is sad and painful, an event to be avoided no matter where you live. But if you are in Mexico it’s good to have a plan if you do fall and to walk with awareness even though it is easy to get distracted.
The worst-case scenario is falling and dying alone. In Mexico your body will be transported to the closest SEMEFO (Servicio Medico Forense or Medical Forensic Service) for an autopsy and your family and friends will have quite a challenge retrieving your corpse. Even if your government makes a call to assist, your government does not interfere or have influence with the Mexican government SEMEFO unless you get lucky.
Several ladies I’ve met at Lake Chapala have fallen on the street or at home. Fortunately, they were in company or had cell phones to call for help. They also had immediate access to doctors. They or companions had pre-organized for such an event, just in case. Recovery was rarely easy but thankfulness for rescue is the continued message.
A reminder for why I do not wish to fall anywhere, I wish to keep dancing. This lovely mural may be found at the base of Colon Street in the Pueblo Magico of Ajijic.
Fall Awareness Week was commemorated September 18-24 in the U.S.
Throughout the coming fall/autumn weeks fall prevention workshops are being held at senior centers in the U.S. Fortunately, in Mexico, most expat communities offer balance and exercise classes as well as services with local physical therapists.
Current statistics related to older adults falling in the U.S. (and Mexico):
The U.S. Center for Disease Control (CDC) and innumerable other studies report the following:
1 in 4 older adults fall each year
1 in 4 falls result in an increased level of care
Every 19 minutes an older adult dies from a fall (in the U.S.)
Persons with Alzheimer’s and other forms of dementia fall more, and person-centered care is critical for them
Falls are the leading cause of both fatal and non-fatal injuries for older adults
The cost of falls is $50 billion per year across the U.S. health system – emergency rooms, hospitals, rehab, and more.
Mexico’s INEGI (National Institute of Statistics and Geography) has population stats, aging stats, and mortality figures (but not by cause). On the Instituto Nacional de Geriatria Mexico City website I was unable to discover statistics related to falls. Studies of the last three years have focused on poverty, nutrition, care of chronic illness, and COVID. Nonetheless, falls happen in Mexico, and not just to expats.
With care and attention most falls can be prevented. When they are prevented, they save you and healthcare systems high costs financially, physically, and emotionally.
What should anyone of any age, especially an older adult, pay attention to now? Preventive measures?
1. Assess your fall risk. Protect your bones. Many older adults are not aware they may be walking around with osteoporosis, also known as the “silent disease”. The cost of a bone density test in Mexico is reasonable (for most). Discuss the results with your physician, chiropractor, or naturopath. Read about diet, exercise, supplements and more.
2. Join an exercise program focused on building balance and strength. Expat communities throughout Mexico offer pilates, yoga, training at gyms, and specialized classes for older adults at senior centers known as “centros geriatricos.” As mentioned, physical therapy may also be helpful.
3. Dress sensibly. Wear clothing you will not trip on. Wear sensible shoes that support and cushion your feet. Flip flops, for example, are not the best choice of sandal at a certain age, easy to twist an ankle.
3. Check your vision, hearing, and medications. Some medications may cause weakness, fogginess, forgetfulness. Be aware.
4. If you do fall, yes, there could be an emotional toll. You may feel shame or anxiety. Even if the fall is unwitnessed, best to share the information with chosen healthcare professionals and friends. It is fine to self-recover but letting someone know what happened will create a history to refer to and will assist healthcare professionals should you fall again (hopefully not).
5. Consider using a cane or walking stick. No need to stay inside. Movement is more important than no movement. Walk in safe places without skateboards, bicycles, and other moving forces that could harm you.
6. Consider making where you live safe and barrier free by following universal living design standards. Wood floors and linoleum are preferred as the materials cushion falls to some degree. No slippery or wet floors. Well-lit rooms and corridors. Grab bars. See links below in Resources for ways to create an environment friendly to falls and most disabilities.
7. Companions or buddies to keep an eye on you. Whether you are a solo ager, married, or with a significant other, it is wise to have at least two persons you can call for rescue. Make that three, with your doctor. As the National Council on Aging suggests, “make fall prevention a team effort.”
Wishes for your wellness and no falls! Please be careful.
Safely You is a San Francisco-based company focused on preventing falls in senior living and skilled nursing. Their well-documented report “The 2022 State of Falls” is available for download on their website. https://www.safely-you.com/
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She has assessed hundreds of senior housing choices in 16 Mexican states. Her web site is https://www.WellnessShepherd.com.
Last month Steve Moran, senior housing veteran and colleague, kindly invited me to talk with him about senior living in Mexico. (Steve has experience in Mexico leading humanitarian missions).
We spoke about what I’ve learned and experienced researching healthcare, housing, and hospice in 16 Mexican states, mainly places where expats live.
He asked if there are any Belmont Village or Brookdale style developments. (There is a Belmont Village in Mexico City).
Belmont Village, Santa Fe section, Mexico City
When we finished the chat, I sent Steve an article to post on Senior Living Foresight that outlines what we discussed – current models for senior living and/or senior care in Mexico and what is up and coming.
Not surprisingly American, Canadian, Mexican, and Spanish senior care providers have been looking to expand or initiate development in Mexico.
Please note: I do not receive any referral fees or funds from any senior living homes in Mexico.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
When recovering from dental surgery and in an altered state, I was interviewed by colleague and dedicated senior care advocate Steve Moran. For more than 10 years Steve has published an on-line magazine reaching thousands of U.S. senior housing executives and their teams – Senior Living Foresight.
Below is a link to our overview chat about Senior Living in Mexico which may be located on Steve’s web site, LinkedIn, and You Tube. (Please scroll to bottom of copy to find link if you are interested).
Part of the 36 minute video is out of sync; it also skips and flip-flops in places.
Toward the end Steve talks about a phone number. If you stay through that one minute, there is a brief mention of Medicare. One of the most asked questions by Americans looking to Mexico is: ” will Medicare be accepted”?
The video is not required viewing. 😉 The intention is to offer helpful information.
I am accustomed to researching, interviewing, listening, and participating in private one-on-ones. I am unaccustomed to being the center of attention. I have much to learn about being on camera.
Thank you Steve for including me in the discussion!!!!
On November 2 the newspaper San Diego Union-Tribune hosted a free event that attracted a 50+ crowd interested in subjects related to aging. Main speakers were Patricia Schultz (author of 1000 Places to See Before You Die) and Captain Dale Dye, USMC retired (author, filmmaker) focused on veterans and others.
November 2, 2019
Most of the activity at the San Diego Convention Center was at booths. Among the participants offering information were AARP, Leading Age, healthcare service providers, a cancer awareness initiative group, estate planners, Medicare Advantage Plan insurers such as Humana and SCAN, retirement counselors, senior movers, senior living placement consultants, a sleep therapy advisor, and others.
The highlight for me, related to some of my work as a senior placement consultant for Mexico, was to meet up with Miguel Angel Torres and Marisa Molina of Serena Senior Care in Baja California. I toured their Rosarito assisted living home last year and am eager to return to see their latest developments. I appreciate their dedication, enthusiasm, and focus on quality care. See www.serenacare.net plus links to videos found on their web site.
As an aside, Serena offers residents and visitors to Baja a Full Assistance Card for $99/year ($198 per couple). The Full Assistance Card offers ambulance services, roadside assistance, a 24-hour bi-lingual call center, discounts, and access to online medical records. Have not seen this service in action so am not in a position to comment on it. Information on this is at the web site listed above.
Miguel Angel Torres, one of his supporters, and Wendy Jane Carrel Assisted Living Consultant for Mexico at Serena Care booth
Corey Avala of www.RetireBaja55.com was also present to encourage folks to retire early and “affordably” to one of three developments he is involved with. Have not seen them.
Jane Garcia, a realtor from Dream Home Mexico was also there to espouse the benefits of retiring to Mexico.
One of the advantages of Baja California for assisted living and retirement, aside from the lower cost of living, is its close proximity to San Diego for health care through the Veteran’s Administration, and U.S. healthcare for American ex-pats who wish to return in case of need.
Many thanks for the warm reception by the San Diego Union-Tribune sponsor team! Many thanks to the San Diego Union-Tribune for producing the San DiegoEldercare Directory 2020 available in print at the expo, and also available on-line at http://www.sandiegoeldercare.com. The directory includes listings of independent living and long-term care throughout San Diego County.
I am a Spanish-speaking senior care specialist for Mexico, serving Americans, Canadians, and Europeans who are discovering they may not be in a position to retire, or, may outlive their savings. They are looking for more affordable aging options at home or abroad.
Where are these retirees choosing to move if going abroad?
Mexico … for the most part, because of its proximity to Canada and the U.S., milder weather, opportunities for new life adventures, and most of all, access to medical and senior care at one-third to one-half less than at home – a major concern, just in case, even for those who are super fit and who follow a healthy lifestyle.
This boom is no surprise to developers from Canada, Mexico, Spain, and the U.S. who have anticipated the rise in the number of retirees from Canada and the U.Sfor over 10 years – to Baja California, Mazatlan, Oaxaca, Puerto Vallarta, San Miguel Allende, and the Quintana Roo/Yucatan states where Merida and Cancun reign. Large numbers of ex-pats continue to arrive.
Many new retirees – boomers, boomers bringing parents, and some Gen-Xers – love technology, travel, and learning. They like to drive, to explore. Some will continue to work on-line. More than anything they enjoy their independence. They seek ways to live more economically, and, use Mexico as a home base for more travel.
They have unique interpretations of what independent living means. Generally, the vision is of a person 50 or older, usually but not always retired. The overriding lifestyle goal is AGING IN PLACE either within a community where one is self-sufficient, or in a community providing services such as meals, laundry, cleaning, and transportation.
Mexico is preparing to offer a variety of such choices in beach environments or the colonial highlands.
However, unlike the U.S., retirees must not expect choices as diverse as an all Hindu, laughing yoga, retired postal worker, artist, Japanese, or Presbyterian senior community, nor any development as large as a Sun City.
The most aggressive housing expansion has been at Lake Chapala, one hour south of Guadalajara, Mexico’s second largest city, which also boasts an international airport.
Ajijic malecon, Lake Chapala, Mexico
What kind of housing are retirees finding at the lake?
If not stand-alone private homes, most retirees are on the look-out for living akin to 55+ communities near golf courses, shopping, gyms, spas, and the company of other ex-pats.
What’s in the offing at Lake Chapala?
Three large construction projects – two Life Plan Communities with independent living (with moves to assisted living or nursing care as part of a long-term plan), and one “luxury” development of condos and casitas not unlike already existing communities known as El Dorado, El Parque, or The Raquet Club replete with tennis courts, pools, a club house, gym equipment, and gardens. The new projects may open by 2021.
The two newest additions for independent living at Lake Chapala are:
Namaste Lake Chapala Community tiny houses, a co-housing enclave in the village of Ajijic. Its founder is American James F. Twyman, a body/mind/spirit author and musician who travels the globe as a “peace troubadour.” The Namaste community opens its doors to the public for morning meetings to discuss or review A Course in Miracles.
Namaste Community Patio, Lake Chapala
Namaste offers 12 brightly painted homes providing 300 SF to 600 SF of living space, each with kitchen, bath, and living areas. The Namaste concept is to age in place affordably, bringing healthcare in should it be needed. Meals are communal, or taken to your residence if you wish silence.
Namaste Co-Housing Community, Lake Chapala, Mexico
Namaste Co-Housing Communty, Lake Chapala, Mexico
First Completed Namaste Tiny House Kitchen
As of this writing, all but one of the homes have been purchased and/or rented. For more information see www.NamasteLakeChapala.com or call Kerri Moon, Head of Sales, at (510)250-3002, a U.S. phone number.
Ohana Independent Living in San JuanCosala, 20 minutes west of Ajijic, is the other newbie. The owners are bi-lingual geriatric nurses. Even though there is no assisted living or nursing care at their two story independent living home on the lake, folks with walkers who can take care of themselves are welcome. An elevator is currently being installed.
Ohana Independent Living main gate entrance, Lake Chapala
Ohana Independent Living is located on a large lakefront estate with sprawling lawns, close to nature. There are 12 rooms. Each residence has mountain or lake views. There is a balcony on the second floor facing the lake. Rooms are partially furnished or decorated to one’s preferences. Dogs are welcome. Meals are included, as well as laundry, maid service, and parking. There is no web site. For more information call Alonzo Garcia at 52 331 495-6167.
Alonzo, Ana, and Adam bi-lingual owners of Ohana
Patio at Ohana Independent Living, Lake Chapala
Cloudy day view of Lake Chapala from Ohana Independent Living
Dining room, newly opened Ohana Independent Living, Lake Chapala, Mexico
Summation:
There are currently three independent living residences with meals, laundry, maid service, and parking for your car at Lake Chapala. There is a fourth residence, owned by a physician, with no parking. If you became seriously infirm at any of these places, you would be required to move somewhere else. Monthly fees range from $1200 to $1800/month USD, the average cost of Mexican assisted living with no frills.
There are another four communities designed as individual apartments for older adults. Stretching the interpretation, there are about seven more that have a community feel but are exclusively rentals; the renters happen to be older adults. There are also four hotel apartments, some with kitchens, rented long-term by older adult ex-pats.
There are two intentional co-housing communities. Other than Namaste there is Rancho La Salud Village in West Ajijic. It consists of a group of larger homes created for aging in place and green, sustainable living. There are no communal meals, each resident is on his or her own. RLSV was founded in 2010 by Jaime Navarro and his wife Sara Villalobos, together with “green” architect Rick Cowlishaw. See www.ranchollasaludvillage.com
As of this writing, other “independent living” and/or senior living projects for ex-pat retirees are in the works throughout Mexico awaiting, for the most part, American and Canadian boomers.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. Over a period of several years she has traveled state to state in Mexico researching health systems, senior care options, end-of-life care, and disposition of remains. She volunteers at the only 24/7 palliative care hospital/hospice in Jalisco that also has a community outreach service. http://www.WellnessShepherd.com or contact her at wellnessshepherd@aol.com.
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