Last updated October, 2023

At 63, an expat friend of mine in Mexico is one of the most beautiful women I know. Flowing waist-length auburn hair, and huge deep-set eyes and a figure that evokes Elton’s John’s song “Tiny Dancer.” Her attitude and thinking are just as youthful, so it was surprising to hear her talking about getting old in Mexico, and in particular about her and her husband’s plans for home health care should they ever need it.  

My expat friends in Mexico have a rather brilliant plan. The two guest casitas that they built and presently rent out would be converted into apartments for home-health care providers to live in. Or maybe they would live in them and give the caregivers the bigger house in case its stairs become a problem for them later. The casitas and house are separated by a colorful and expansive courtyard, full of plants and flowers, with small pool to dip into on hot days, and an outdoor kitchen and dining area.

Costs of home health care in the U.S.

The cost of home health care in the U.S. averages  $19 an hour ($10 to $36 an hour depending on your state) and is still by far cheaper than the facility alternatives. Having someone around to prevent falls and monitor medication can help avoid more expensive hospital stays. Assistance and its cost depends on whether the client needs simply help with daily living or requires actual medical care.

In the United States, a six-hour visit by a home health aide (not a professional nurse) five days a week costs an average of $114 per day, or $29,640 per year. If billed by the hour, the costs can quickly add up, sometimes to even more than an assisted living facility.

Contrary to what many people believe, Medicare does not pay for home health care past what is medically necessary. For example, it will pay for care after a surgery and to those who are home bound, meaning they can’t leave their homes without assistance. It doesn’t pay for personal assistance for daily needs later. The visits that are covered are short and procedural. The gap between needing some daily help and actual medical assistance is wide and expensive.

My friend’s attitude about the future and leaving their care to homecare professionals rather than one another recalled in me memories of watching the dynamics of my own parents’ relationship in their final years. They loved each other very much, but being a loving wife or husband doesn’t necessarily translate to being a good caregiver.  

When eventually someone was hired to help my father, who was going blind, Sharon, a care-provider, was much better at it than my mother was. A wife plays many roles in a marriage. It’s unfair to expect her to be perfect at all of them, especially when the roles can be so wildly disparate.

My own mother was the principal breadwinner in a demanding job, raised two children with little assistance and worked to maintain her attractiveness to my father to the end. The fact that she wasn’t Mother Teresa to a very difficult spouse was easy to forgive.

I for one would rather pay a kind stranger who is predisposed to this type of work to assist me than leave it any of a number of people I love dearly but likely to not notice for quite some time when I wander off the property naked.

Nearly 10 million people in the United States, mostly over 50, have to manage the care of parents or grandparents even as they try to formulate plans and save money for their own retirement. Mexico gives couples like my friends an attractive option of live-in assistance that they could never afford in the US.

In the U.S. the cost of putting a relative into assisted care averages about $42,000 a year. A private room averages more than $87,000. Not only are assisted-living facilities more expensive than staying in at home, they are often detrimental to the emotional health of the family member.  

The cost of home healthcare in Mexico

What are the costs of having at-home care in Mexico? Always Mexico [Siempremexico.com.mx] is an agency of nurses that offers the services of caregivers. It charges 7,158 pesos ($360) per month for 8 hours from Monday to Friday, 10,500 pesos ($525) for 12 hours, and 21,500 pesos ($1,075) for 24 hours, five days a week. (If you can’t find it online in the US, make sure to do a search using a VPN. I find foreign websites can be hard to access without a VPN).

Based on the average $114 a day for only six hour visits (as compared to eight hours quoted by Always Mexico), the same home care in the U.S. would cost $3,420 a month, more than 3x the cost of care in Mexico.  The cost of a registered nurse during the day could cost $2,000 dollars a month in the U.S.

The cost of nursing assistants trained to do injections, handle oxygen and check vital signs ranges from 8,200 pesos ($410) per month for an 8-hour day from Monday to Friday, 12,300 pesos ($675) for 12 hours a day or 24,000 pesos and ($1,200) for 24 hours.   

Even a clumsy Google-translated quote by the director of a company providing assisted living care reflected the compassion of Mexican culture often missing in the U.S. “Hiring a caregiver improves the health of the elderly, because the client stops being a sedentary and sad person to become active. Usually when the 'grandmothers' are taken to an asylum they fall into depression.”

Could Mexico be the answer to home healthcare needs?

In the U.S. those who have to leave their jobs entirely to take care of someone means not only losing income. They also stop accruing social security and retirement benefits and have to face the prospect of their work skills being rusty if they return to work.  If the adult child or grandchild could work remote from Mexico and hire a home healthcare aide at this greatly reduced cost, they might be able avoid this scenario.

This solution, moving to Mexico and hiring a home healthcare provider does involve pretty good-sized obstacles, like a language barrier of course. But an adult child could easily learn enough Spanish to train and supervise a home health provider, especially since they’d be there in the house with them.

For those who have to care for an aging parent or loved one. moving to Mexico and having a home health care provider either full or part-time could make a big difference in terms of both cost and sanity. Combined with the overall lower cost of living, the savings could leave survivors in a much better financial situation for their own retirement years, even if they chose to return to the U.S. some day.

While moving to Mexico may seem like an extreme solution for a caregiver, people do it. I have had several inquiries from single people mentioning they are moving to Mexico with elderly parents.

Financial planning articles edge close to admonishing readers not to sacrifice their own retirement security for caring for their elderly parents - as if it’s a choice. Unspoken is the question of morality, not to mention love, at the heart of the decision to leave a job or go into retirement savings to take care of someone who took care of you, perhaps making their own financial sacrifices.  None of these articles mention options like moving to Mexico and the home healthcare options I've described here. They should.

Knowing they can afford to hire a home health care provider, and even one (or two) to live on the premise full-time if warranted, keeps my friends both looking forward to the future. Rather than the prospect of caring for one or the other 24/7, they can look forward to maintaining their enviable love affair to the end.

Important advice on hiring a home health care aide in Mexico by PROFECO, Mexico’s Consumer Affairs Office

PROFECO, Mexico’s Consumer Affairs Office. warns that in Mexico people sometimes post business cards of people offer nursing services at the pharmacy counter. People sometimes call these people for rates without researching if they have professional training, what their specialty is, if they are supported by a company, or asking for a letter of recommendation - all things you need to ask of any prospective healthcare worker.

Having a business card posted does not mean they are not professionals, but two important things have to be confirmed: healthcare training and safety.

PROFECO offers the following excellent advice on hiring home health care aides, and steps you should follow no matter what country you live in.

1. Ask the doctor about the specialty or the degree of training that the healthcare provider needs for the family member to receive the appropriate care.

2. If you go to a company that specializes in nursing services, make sure that you have personal references (address, telephone) and work (letters of recommendation), and previous work experience).

3. Even if someone you trust recommends a someone, you should check their address, phone number, formal training, and request references. In order to provide a quality service, better providers in Mexico make random visits in staff at the patient's home to supervise their work, presentation, punctuality, interrelation with the patient and the family.

4.Consumers have the right to be shown official documents that prove the academic training of the health care aide or nurse before they hire.

5.Do not underestimate the work of a nurse; If your relative is bathed, combed, shaved and dressed in clean clothes, took their medication and ate at the appointed time, it is because the nurse did her job. Do not assign tasks outside their job.

6. Even if they are asleep, the nurse must be attentive to the needs of their patient.  When you hire through a company, if you are not satisfied with the service, or you feel that your loved one is not comfortable with the nurse, you can ask the company to replace that aide.  

I’m not sure if all these points, such as the right to ask for proof of credentials, is the same in the U.S., but it sure should be.

There are many ways to work it in Mexico and obviously many variables, language ability and temperament of the loved one being only a few.  If the general kindness of the Mexican people is any indication, I would venture that the chance of finding a compassionate health care aide is exceptionally good.

Related links:

Cash-strapped seniors look to Mexico for affordable assisted living by NPR.

Disturbing news about quality of Medicare managed care networks by Retirement Revisited.

A guide to medical care in Mexico by Monica Paxon.

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About the author

Kerry Baker is a partner with Ventanas Mexico and author of   “The Lazy Expat: Recipes That Translate in Mexico, a cookbook for travelers, snowbirds and expats in Mexico. In Mexico, you must cook to maintain a healthy diet. This shows you how in a foreign culture.

"If Only I Had a Place" is a guide to renting luxuriously in Mexico. More than a how-to rent, it’s a system that will guide you towards the richest, most holistic expat life.  Her second book is “The Mexico Solution: Saving your money, sanity, and quality of life through part-time life in Mexico.” This how to book is the only one of its genre that won’t leave you numb.