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You're misunderstanding the term self-insure. Self-insure does not mean taking out an insurance policy for yourself. It means you choose to bear the risks and associated costs yourself rather than getting an insurance policy. It's a simple way of saying I'll just pay out of pocket
As projectmaximus and elnrgby have their own versions of defining self-insure, I will also add my own version. Self-insure = Basketball! The concept is play basketball to get healthy and active ----> leads to less cost medically. I just started playing basketball pick-up games and will do so weekly from hereon.
On topic, the filing of tax annually in Thailand is a bummer. Even if there is zero or minimal tax (say $100) to pay, I can see it turning off folks planning to retire in the Land of Smiles.
I'm still continuing on my dream to retire beachfront so still retiring there for 25 years. Then back to US for my home and community based care.
Most people that can’t afford it end up on Medicaid and then their families and friends can visit them. They don’t go overseas. In fact I don’t know one person that has done that. By the time you need that level of care the only meaningful thing left is your connections to other people.
There are a couple people on C-D that seem to deny that sentiment. I could not agree with you more. Whether people acknowledge it or not it is the only thing that matters (but, I would add yourself and your pets into the mix as they get to be people too).
Some of this have to do with the sample set of your acquaintance circle. There are immigrants who move to the US without any family. If they partner up with another immigrant with the same situation (or not) and don't have children, there is no 'family' in the US. They, of course, have friends and so on - but are a lot less rooted in a particular community - sometime even to a country. That can be good and bad - good because one has a lot less inertia and attachments and can relocate more easily to fit whatever makes sense at that time of life. Bad is that one must be self-reliant, irrespective of the stage of life.
We fall in this category. My wife and I are from two different continents and have lived most of our adult lives on a third continent in the USA. We have lived and/or worked in European countries as well as in Asia and Africa. [So, we have friends in and are otherwise familiar with several different countries on different continents. ] Sure we have families in different countries - but they are generally clueless about how things work in the US. So, there is little of East or West, Home is Best sentiment as the home is and has been much more movable.
My best friend who's family has been in mid-West (OH, TN) is totally clear where he and his wife will be located. His advice to me is that you don't have any particular place to which you are rooted in (have family and children in). So, you might as well turn that into an advantage and move to new place(s), have new learnings, explorations and adventures. That's sort of how we see it.
We have yet to settle on a plan. [Were set on Bellingham but the developer flaked out on us.] We will likely travel / live overseas for extended periods upon retirement and see how it goes. Currently France is something we are thinking about. Whether we move there or just do long stays depend upon how much progress we can make with our respective French
Some of this have to do with the sample set of your acquaintance circle. There are immigrants who move to the US without any family. If they partner up with another immigrant with the same situation (or not) and don't have children, there is no 'family' in the US. They, of course, have friends and so on - but are a lot less rooted in a particular community - sometime even to a country. That can be good and bad - good because one has a lot less inertia and attachments and can relocate more easily to fit whatever makes sense at that time of life. Bad is that one must be self-reliant, irrespective of the stage of life.
We fall in this category. My wife and I are from two different continents and have lived most of our adult lives on a third continent in the USA. We have lived and/or worked in European countries as well as in Asia and Africa. [So, we have friends in and are otherwise familiar with several different countries on different continents. ] Sure we have families in different countries - but they are generally clueless about how things work in the US. So, there is little of East or West, Home is Best sentiment as the home is and has been much more movable.
My best friend who's family has been in mid-West (OH, TN) is totally clear where he and his wife will be located. His advice to me is that you don't have any particular place to which you are rooted in (have family and children in). So, you might as well turn that into an advantage and move to new place(s), have new learnings, explorations and adventures. That's sort of how we see it.
We have yet to settle on a plan. [Were set on Bellingham but the developer flaked out on us.] We will likely travel / live overseas for extended periods upon retirement and see how it goes. Currently France is something we are thinking about. Whether we move there or just do long stays depend upon how much progress we can make with our respective French
Yes, when you are orphaned at 13 family is also hard to come by. You do not need to be from a different country to be isolated here in the US.
What you describe above is why I ended up divorced. I wanted a home base and he wanted to keep moving to advance his career. We both got what we wanted (separately). It's why I won't move in retirement either because I have built a home base and a few close friends of all ages (to add to my friends that are out of town). He has his 3rd wife (and his ex career and cancer diagnosis).
There are a couple people on C-D that seem to deny that sentiment. I could not agree with you more. Whether people acknowledge it or not it is the only thing that matters (but, I would add yourself and your pets into the mix as they get to be people too).
Yes my dogs are people too). I don’t want to live without at least one dog ever.
Yes, when you are orphaned at 13 family is also hard to come by. You do not need to be from a different country to be isolated here in the US.
What you describe above is why I ended up divorced. I wanted a home base and he wanted to keep moving to advance his career. We both got what we wanted (separately). It's why I won't move in retirement either because I have built a home base and a few close friends of all ages (to add to my friends that are out of town). He has his 3rd wife (and his ex career and cancer diagnosis).
Understand.
We have only moved to support my wife's career choices. Even though I am the bigger earner - I have a lot of locational flexibility. As a humanities scholar, my wife had little. So, we moved where she had the best options. As a result, I have rarely lived where I worked (since leaving academia). Remote work helps you make many friends that are, well, remote
Maybe it won't matter if OP's in a nursing home though..? In my mom's facility, residents were never ever taken outside. Only the ones that smoked for daily smoke breaks.
This is a topic of high interest to me. Those that know my story know I'm a caregiver to a parent that had a stroke and became disabled/wheelchair bound. I moved her in with me from her nursing home and we took a month long trip to Portugal the end of last year. I thought Portugal would be the place I planned to move to, to retire in and also to receive long term care for my mom now and for me if I needed it down the line. However, that trip has me questioning things now (I won't go into all of the details but I do still love PT, just not sure I'd want to move my parent/myself there). With that said, we had excellent, and I do mean excellent care from the "CNA" that cared for my mom in-home (in-hotel, really) while we were there.
OP, have you lived in Thailand before previously?
What is the specific criteria you are looking for in a place to move to for LTC purposes? Are you sure you want to focus on facility care only over live-in care?
All you can do is plan for the worst case scenario and expect changes, so having a Plan B and C would seem wise. Both the primary and the backup plans might just change over time though depending upon how close your timelines are to moving. Just how soon are you planning to go? Only when you need LTC? Within the next year or 2? Further down the road?
My personal experience with LTC having taken my mom out of a facility is that having someone who can advocate for you is most important. It sounds like you have that person but I'm not sure how they'd be able to advocate for you from abroad. That is essential in case facility staff is found to be incompetent and/or negligent/abusive (very common in the US and many other countries) - in facilities staff turnover can be high* and even if it is low there's still a chance you're dealing with multiple people all of the time which raises the risk of a bad apple being in there somewhere. In my mom's facility many (the majority?) of the staff were not people you'd want caring for you. But part of that IMO is just based on how our culture treats the elderly, invalid, etc. I do believe you are smart to plan to relocate for LTC in a place where there is a higher level of quality of care/respect for the aging/disabled which 'might' lower the risk of being in a place where you end up mistreated/not cared for properly/etc. Of course, bad things happen everywhere though so there's that.
*Not sure how turnover is in facilities outside of the US - maybe in some other countries it's not like it is here.
Sorry for delayed response; I was immersed in traveling and not checking the forum. Answers to your questions:
Yes, nursing homes (and practically all other indoor spaces) in Thailand are air-conditioned. I have not lived in Thailand, but have spent there blocks of about 2 weeks multiple times.
My specific criteria are comfortable private room, relaxed but responsible caretakers who won't hassle me at 6 am with "scheduled activities" but will be appropriately responsive whenever I need them (part of it is the cultural respect for old people, which you mentioned), hopefully location in a cosmopolitan city (there is something about a large city vibe that matters to me even though I'd never be leaving my room), an acceptable price, and minimal (preferably none) administrative hassle including visas and taxes.
I would need a nursing home rather than home care because I'd want to care for myself til the end unless I am paralyzed or stone-demented. In two latter cases I would need either a nursing home or a live-in caretaker. I do not have any space at home for a live-in caretaker. But renting an apartment and a caretaker in Bangkok could be an alternative to the nursing home; thank you for that idea!
My extended family would communicate with me and the nursing home via Skype or something similar, and would know if I had complaints. How soon am I planning to go? Hopefully never :-). Yes, only if I need LTC.
A rental apartment with a live-in caretaker in an inexpensive country (maybe still Thailand, depending upon the evolution of tax etc. immigration rules) is a real thought, though. I will think more about it .
Here the emphasis is on the economic issue as a priority. But I ask... and the emotional factor? You'd be on the other side of the world, thousands of miles away from your loved ones. No one is going to visit you; at least regularly.
I am already on the other side of the world from my loved ones (I assume you mean my family), have been for about 2/3 of my life :-). I don't have a problem with that; in fact I prefer it that way :-).
I enjoyed living in Germany for 3 of the past 6 years. There were 2 big reasons that prevented me from staying there as a US citizen retiree. These 2 reasons were why I returned to the US last October.
First, the monthly cost of private health insurance was high, about $1000 per month. On top of that, I was paying for my USA Medicare part B because I did not want to lose my coverage for that if I decided to return to the USA.
My second big reason for not staying in Germany was the tax system. I am a US retiree with annual taxable income from pension, SS and investments over $100K. In Germany, dividends and interest are taxed at a flat 25 percent and any income over about $50K USD is taxed at 42 percent (ouch). If I stayed any longer than I did I would have been dragged into the tax system. I did not want to pay that level of taxes forever.
Yes, those are the two major concerns for expatriation in retirement: health insurance and tax rules. I don't understand why Medicare, or at least providers of Medicare supplements, don't cover healthcare abroad. It would be cheaper for them than coverage in the US.
Most people that can’t afford it end up on Medicaid and then their families and friends can visit them. They don’t go overseas. In fact I don’t know one person that has done that. By the time you need that level of care the only meaningful thing left is your connections to other people.
Not for me. It is not a particularly meaningful thing for me even now.
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The concept is play basketball to get healthy and active ----> leads to less cost medically. I just started playing basketball pick-up games and will do so weekly from hereon. 
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