Made in India: Low-cost care for ailing parents
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American facing unpleasant alternatives finds novel solution with outsourcing

By Laurie Goering | Tribune foreign correspondent
July 29, 2007

After three years of caring for his increasingly frail mother and father in their Florida retirement home, Steve Herzfeld was exhausted and faced with spending his family's last resources to put the couple in a cheap nursing home.

So he made what he saw as the only sensible decision: He outsourced his parents to India.

Today his 89-year-old mother, Frances, who suffers from advanced Parkinson's disease, gets daily massages, physical therapy and 24-hour help getting to the bathroom, all for about $15 a day. His father, Ernest, 93, an Alzheimer's patient, has a full-time personal assistant and a cook who has won him over to a vegetarian diet healthy enough that he no longer needs his cholesterol medication.


Best of all, the plentiful drugs the couple require cost less than 20 percent of what they do in the U.S., and salaries for their six-person staff are so cheap that the pair now bank $1,000 a month of their $3,000 Social Security payment. They aim to use the savings as an emergency fund, or to pay for airline tickets if family members want to visit.

"I wouldn't say it's a solution for everybody, but I consider it the best solution to our problem," said Herzfeld, 56, a management expert who moved to India with his parents and now, as "care manager rather than the actual worker," has time for such things as bike rides to the grocery and strolls in the botanical gardens with his father.

With the cost of nursing homes, home nurses and medications painfully high in the United States, the elderly and their caregivers have long looked abroad for solutions. Many families drive to Mexico or Canada to buy cheaper drugs, or hire immigrants -- some of them undocumented -- to help them look after frail parents.

A growing number of aging couples are buying retirement homes in Mexico, where help is cheap and Medicare-funded health care is just across the border.

Herzfeld never thought he'd be headed abroad. When his mother broke a hip in 2004, he drove to their home in Pompano Beach from his home in North Carolina, figuring he'd stay a while to help his parents get back on their feet. But three years later, he found himself still on the couch in his parents' spare bedroom, wondering where his life had gone.

"I started to see him breaking down after three years working 24 hours a day," remembers longtime friend Eric Shaffer, who runs a software design firm with offices around the world, including one in Pondicherry, a former French colony on India's southern coast. "He was in a chess game with no move."



Nursing homes costly

At wit's end, Herzfeld began investigating nursing homes but found that the $6,600-a-month cost at the cheapest one he could find near family members would quickly bankrupt his parents. An uncle offered financial help, but Herzfeld's father refused to take what he called "welfare" from his family or from the government, which would have assumed the cost of his nursing home care when his own money ran out.

Herzfeld also was hesitant. "I've seen nursing homes, and it's a hell of a way to end your life," he said. "I wouldn't want someone to do that to me."

So when Shaffer suggested Herzfeld consider a move to India, "I said right away, 'There's an idea!'" he remembers.

Herzfeld, who is single and a longtime follower of Transcendental Meditation, had previously spent five years in India, studying and later teaching courses on management at an MBA program in Hyderabad. He admired India's renowned respect for the elderly, despite some evidence that it has slipped in recent years, and he quickly realized that Pondicherry -- a haven for aging hippies from around the world -- might just work.

The graceful old town, with its coconut palms and orange-blooming flamboyant trees, was foreigner-friendly and on the ocean, a big attraction for his father. The weather was much like Florida's, and many people spoke French, a language his Swiss-born father was fluent in. Best of all, nursing care and rent were cheap, and Shaffer was already there, promising to help rent a house and hire staff. Herzfeld decided to move.

Just hours after arriving in India, Herzfeld's jet-lagged father tried to chase his new Indian personal aide out of the bathroom -- the youth had been instructed to help him with the toilet -- and fell, cracking his head on the bathtub. The family spent the first night in the hospital as Ernest was stitched up.

The three also had a few bouts with India's infamous intestinal bugs as they adjusted to a new diet, and Ernest broke his nose when he tripped over his aide -- diligently sleeping just outside the bedroom door -- on a midnight refrigerator raid.

"It was pretty intense those first weeks," Steve Herzfeld said. "It was chaos."

Eight months later, however, the family is settled in.

Herzfeld's mother has a daily hourlong session with a physical therapist, who flexes her stiff legs and gets her up walking with a walker. A nurse, on duty all day, braids flowers into her hair, massages her legs and arms, holds her hand while she watches TV and feeds her. A massage therapist gives the couple a daily massage, and a cook fixes them simple Indian meals.

Ernest spends much of the day watching cable television in an overstuffed chair, reading local English-language papers or catching a rickshaw to the beach or botanical gardens with his aide or his son.



Adjusting to India

Asked how he likes India, he says he has seen enough and is "ready for a change." But he admits to liking the food and speaking French, not to mention the pretty young sari-clad attendants around him.

The three have long-term visas that will allow them to stay in India through 2011.

Other things are still being figured out. The family has put up screens to keep out mosquitoes carrying the dreaded Chikungunya virus and bought a battery system to cope with power outages.

But India, where life expectancy still hovers around 60 years, lacks many physicians experienced in gerontology. And while the family keeps in touch with relatives and friends back home, they haven't yet persuaded anybody to visit.

"They still think of India as being on another planet," Herzfeld said of family and friends.

Still, every time he looks at the bills -- less than $2,000 a month for food, rent, utilities, medications, phones and 24-hour staffing -- he thinks he's done the right thing for his parents and himself.

"It can be done," he said. "This is working."