Assisted Living Mexico, Ex-pats in Mexico, Mexico Senior Living, Nursing Homes Mexico, Senior Care Mexico

Assisted Living Homes at Lake Chapala, Mexico Brace for COVID-19

Taking care of frail or gently infirm older adults, even in “good” times, is a challenging job. For many of us in senior care it is also a satisfying way to serve, and offers rewarding engagement.

But how does one rally to protect and defend older adults living in senior communities from COVID-19, the newest corona respiratory virus with multiple symptoms and possibly an unmerciful death, perhaps alone?

Precious American senior at a Lake Chapala assisted living home offering love to a little crab

Medical experts and tragic statistics share that older adults are more vulnerable than others to this borderless virus. A recent New York Times article reports an estimated one-fifth of U.S. deaths are linked to nursing facilities often due to inadequate protection and/or compensation for staff who sometimes work in more than one building to financially survive.

COVID-19 is now in Mexico. It flowed from Asia to Europe and the U.S. first. As of April 18, 958 Mexicans over age 60 have been hospitalized and 160 have required intensive care, representing 37% of the population. (No number is known from senior homes if any, but most patients had underlying health conditions).

Inspired by the response of healthcare workers around the world and despite distressing international and local news, all hands are on deck at approximately 25 assisted living/”nursing” homes at Lake Chapala, Mexico, one hour south of Mexico’s second largest city Guadalajara.  Residents are ex-pat and Mexican retirees and do not represent typical populations in other parts of the country.

Garden area, assisted living, Riberas del Pilar, Lake Chapala, Mexico

Important note: In Mexico, there are no nursing homes as they are defined north of the border. Acute care is in hospitals only. Assisted living homes offer some nursing care and rehab. There is more or less a one size fits all approach to senior care in Jalisco state and the rest of Mexico, with exceptions.

Shelter-in-place began March 19, the date of the first confirmed case in Guadalajara. Since then I’ve been engaged by phone and e-mail with home owners and staff where I have found appropriate care for “gringos”.  I am also in touch with precious residents via phone, e-mail, and sometimes Skype.

The virus has probably been present at Lake Chapala far longer than April 22, the date of the first reported but yet to be confirmed COVID-19 case locally.  Why? Because the lake is a major destination for American, Canadian, and European retirees and/or residents who travel extensively.

What protocols have been in place at assisting living/”nursing homes” since mid-March?

First, no visitors allowed, until further notice.

Each lakeside home (4 to 20 residents, owned by Mexicans or ex-pats) is doing what it can to adhere to guidelines from Jalisco Governor Enrique Alfaro and his Ministry of Health, as well as to those of the World Health Organization (WHO). In a land not known for high health standards and cleanliness, and where compliance for the greater good is not the norm, it is impressive what this virus has prompted at assisted living/”nursing homes”.

Restful Assisted Living grounds in San Juan Cosala overlooking Lake Chapala

Hand washing for all, several times. Hand sanitizers at all entry ways.

Hand sanitizer on mini-tables outside every room for doctors, nurses, caregivers, and residents.

Personal Protective Equipment (PPE) such as masks and gloves are provided for staff and residents, including masks for sitting in outside garden areas. These items are in regular supply. This is unusual as hospitals countrywide do not have enough PPE. Outside China, Mexico is the largest manufacturer of PPE. Mexico, ironically, sent a majority of its supplies to help China months ago. There is a cottage industry in every lakeside village making cotton double fabric washable masks at reasonable cost. Not the same as N-95 masks which are intended to be disposed after each use in clinical settings and are a challenge to clean. Home-made masks are, however, a helpful alternative.

Staff has stopped wearing scrubs on their way to work.

Rooms for staff to change from street clothes to scrubs have been created. Some places had these areas before with private lockers included.

Washing machines are going all day with resident clothing and staff clothing.

Staff stopped wearing scrubs to work based on hospital doctors and nurses being assaulted with bleach, hot coffee, eggs, or beatings because scrubs identify them with the virus. From Guadalajara to Merida healthcare worker abuse incidents have been markedly on the rise. Some essential workers have been prevented from entering their apartments or evicted by landlords who fear contagion. In one city, hospital workers now live in a hotel. See The Guardian article at end for more details.

Daily disinfection multiple times of door handles, railings, ground walkways

Double the work keeping dementia care residents safe

Food for kitchens now delivered to entry gates, fewer trips out

Meals served in rooms. Disposable utensils instead of flatware.

So far, no staff shortages and no cases as of this writing. Staff is showing up, fear or not. This could change if the infection takes hold. The majority of healthcare workers are young and have families.

One building picks up all staff for work so they do not travel by bus. The ideal situation, though not possible in most places, is having staff live on campus for the duration of the outbreak. Hogar Miguel Leon, a senior home housing 30 residents in Cuenca, Ecuador, for example, has outside staff living with the nurse nuns who are in charge.

Most homes, despite the added work load for prevention and preparation, are addressing isolation and possible loneliness issues of their residents. Volunteer visitors, outside entertainment, and chair yoga teachers on campus are no longer present. There is instead accelerated collaboration with faith communities, the Lake Chapala Society, other service groups, and individuals providing phone trees and Zoom chats. Adopt-a-Senior is happening. Facebook provides various resource guides for COVID-19 and delivery services on lakeside group pages. Example: one home orders to-go lunches which are delivered by a restaurant every Friday.

Assisted living for abandoned Mexican women near Jocotopec, Lake Chapala. An extraordinary volunteer service is offered by ex-pats.

Technology. There is a sudden rise in Facetime and Skype use. Zoom conferencing has been implemented and used for daily or weekly news and events. For those who are cogent, this technology is happily received.  For the most part, there are not so many innovations for dementia residents. No one has mentioned the use of telemedicine which is on the rise in the U.S.

Culture.  In Mexico, life works depending on who you know. Owners and staff network for support with family, friends, and colleagues for solutions – Facebook reigns.

As mentioned, the majority of homes at Lake Chapala implemented public health advice promptly and with uncommon vigor.

But will the rest of the community outside these homes rally for COVID-19 and honor quarantine and face mask measures?

Is there a way to prevent unprecedented loss of life in assisted living at Lake Chapala?

Senior living homes may not be able to prevent outbreaks, but they are working on delaying them. They are taking known measures to protect vulnerable populations and staff. But the variables are many and luck is required. As in the U.S., testing is slow to arrive.

And, the virus is invisible, so prevention may be an impossible task. Staff could unwittingly be silent carriers. Local quarantines are suggested and are not enforced. Mexicans enjoy gathering in large groups, no matter what, even when they’ve been asked not to.

The song Ay Yay, Yay Yay… Canta, No Llores comes to mind for Mexico in the time of COVID-19. Sing, Don’t Cry, continue on. The words represent a mindset for suffering and profoundly sad situations which the majority of the population has endured for five centuries. The country is rich in resources. Few are well-to-do. The rest struggle to put food on the table. Singing is a way to continue every day.

In closing, gratitude to all Mexican healthcare and essential workers, unsung heroes and heroines. Thank you for your presence. You demonstrate tremendous strength and courage. May you and those you care for be protected in the days ahead.

Final note: The majority of older adults in Mexico cannot afford healthcare, let alone assisted living or in-home care. The majority of assisted living/”nursing home” residents at Lake Chapala are ex-pats, even though there are a number of Mexican residents. Each home has private rooms and baths, few have shared rooms, What’s available at the lake is not typical of the rest of Mexico where almost 900 senior homes are generally more crowded and contagion more likely.

 

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.

 

You have permission to re-post the article when you include author’s name, biography, and contact information as above.

© Wendy Jane Carrel, 2020

Resources:

https://www.theguardian.com/world/2020/apr/23/mexico-health-workers-attacked-covid-19-fears  Mexican healthcare workers being attacked throughout the country

https://medium.com/@richardensor_50805/a-chat-with-mexicos-coronavirus-czar-e2117a3a4757  Economist reporter interviews Mexican Deputy Minister of Health Hugo López-Gatell April 5, 2020, excellent overview of the public health situation

https://mexiconewsdaily.com/news/coronavirus/40-of-seniors-have-survived-covid-19-without-hospitalization/  Mexican seniors who have survived

https://www.bestoflakechapala.com/lake-chapala-steps-up-a-covid-19-resource-guide/

https://www.seniorlivingforesight.net/life-after-covid-19-technologys-starring-role-in-affordable-senior-housing/   technology is making a positive difference for quality of life and care in places where it is affordable and can be implemented

www.reuters.com/article/us-health-coronavirus-canada-seniors/we-are-failing-our-grandparents-canadas-trudeau-says-as-covid-19-hammers-nursing-homes-idUSKCN2253I6  Canadian nursing home situation

https://www.nytimes.com/2020/04/17/us/coronavirus-nursing-homes.html  about a fifth of U.S. virus deaths are linked to nursing facilities

https://ktla.com/news/california/socal-nursing-homes-among-hardest-hit-in-covid-19-outbreak/  list of CA nursing homes affected by virus…. 70%% of deaths in Long Beach.    April 20, 2020

https://www.helpage.org/guidelines-for-care-homes-for-older-people-in-the-context-of-coronavirus-covid19/  Help Age International guidelines for care homes

Aging, Alzheimer's, Assisted Living, Assisted Living Mexico, CCRC's in Mexico, Health & Wellness, Life Planning Communities Mexico, Living Abroad, Mexico, Mexico Senior Living, Senior Care Mexico

Guidelines for Choosing Assisted Living/Nursing Care in Mexico

Gardens at Casa de las Lunas in Puerto Vallarta with independent living, assisted living and respite care, private pay

According to realtors at Lake Chapala, Mexico, and the information desk at the Lake Chapala Society in Ajijic, the popular ex-pat retirement destination has received more than double the no. of potential renters, buyers, and information hungry folks from Canada and the U.S. than in years before. (Other popular retirement destinations are also seeing an increase in activity – see no. 3 below).

Among visitors intent on moving are travel aficionados looking for a unique cultural experience, the prospect of meeting stimulating people from all parts of the world, but more importantly, an opportunity to stretch their dollars.

And then there is senior living and healthcare, a subject of interest for most. For “sandwich-generation” boomers who lost savings and/or homes during the American recession of 2007-8, or spent savings for the education of millennial children or grandchildren, many are finding there may be little left for themselves or parents if assisted living or nursing care are ever required.

An added concern is that funding for Medicare and Medicaid in the U.S. are currently being challenged.

Alma, a non-profit home for 40 residents in San Miguel Allende

If the cost of assisted and continuing care in Canada (Canada takes care of its disabled, ill, and older adults through universal care programs but there is also private pay care) or the U.S. is not an option, there are more affordable options in other countries. The closest place to look is Mexico.

Here are guidelines for looking at assisted living and continuing care in Mexico, costing between $600 USD to $3500 USD/month, depending on the value of the American dollar and the Canadian dollar vs. the peso, the location, and the residence you choose:

  1. Take note – in Mexico the terms assisted living and “nursing home” are often one and the same, with exceptions. Care facilities are not known as they are north of the border – assisted living, rehabilitation, nursing home, and hospice. It is often an all-in-one approach. Also, with some exceptions, homes mix physically disabled residents with memory care residents.
  2. Select cities or areas you wish to be in for climate – coastal, desert, mountains. (Coastal tropical places cost a little more because A/C is expensive).
  3. If the future resident does not speak Spanish, seek places with ex-pat communities and English-speaking locals who are often a source of volunteers – Baja California Norte (Ensenada, Rosarito Beach, Tijuana), Cancun, Lake Chapala, Mazatlan, Mexico City, Puerto Vallarta. Or, choose smaller places such as Merida, and San Miguel Allende. Some care homes have all foreigners as residents, others locals and foreigners together. Usually one person on staff speaks English, sometimes more than one.
  4. Do the due diligence. Research places and determine costs. Most assisted living and “nursing homes” catering to foreigners have web sites in English easily found on Google Search.
  5. Consider private pay homes and non-profits, as well as residences run by nuns whether you are Catholic or not. Nuns often (but not always) provide quality care as most are nurses with a mission to serve, plus costs tend to be what Mexicans would pay if price is a consideration. Another level of care is found in government homes, some pleasant others not; some accept foreigners with residency cards. There are differences in every region of the country, and there are no rules.
  6. Note: no two places will be alike – financially, environmentally, socially, and in terms of care. Homes are not regulated with the strict standards one is accustomed to in Canada and the U.S.  However, there are places with quality care and high standards.
  7. Conduct site visits. Assess for yourself what might be an acceptable match in terms of environment and people. Would you or your loved one feel comfortable and safe? Do you like the space, the staff?  How are you welcomed? Do residents seem cared for or are they alone in “God’s waiting room” without attention and activities? Ask residents what they like best and what they don’t like. How clean is the home? Standards differ from place to place. Arrive at meal time… is there enough assistance for each resident? Is food fresh, nutritious, and nicely presented? Is it food you would or could eat? Does the home prepare meals compatible with health challenges? What about care plans and medication management? What about emergencies? How are these matters handled?
Patio at a private pay “nursing” home, Casa Nostra, at Lake Chapala

 

Casa de los Abuelos DIF (government) home for seniors, Morelia – these homes are intended for Mexican nationals but on occasion persons with residency visas who pay are accepted, depends on the place and availability

There are no simple answers for selection.

Ideally, we would all have perfect health to our last days and an abundance of funds which would allow us to receive the best possible care wherever we choose to live.

Note: CCRC’s (Continuing Care Retirement Communities, from independent living to demise), now referred to as Life Plan Communities, have not arrived in Mexico, with one exception. There are plans in the works for Life Plan Communities in Baja California, Cancun, and at Lake Chapala from American, Canadian, Mexican, and Spanish developers.

References:

https://www.youtube.com/watch?time_continue=2&v=6lYA7c1Pnuo   Ajijic, Mexico video 2017

http://www.pbs.org/newshour/bb/foreign-retirees-flocking-mexico/

https://www.seniorhousingforum.net/blog/2016/8/3/will-mexico-solve-senior-living-affordability-problem