Nursing homes expenses burden families

“The additional expenses come from medicines, massages, and acupressure sessions,” Phuong explained.

The 42-year-old Hanoi resident said that after her father passed away in 2015, her septuagenarian mother chose to live on her own. But her Alzheimer’s got worse over time, and at the end of last year she had a heart attack and caught a severe fever.

Treatment for the elderly woman lasted over two months. Phuong’s family realized they couldn’t rely on their domestic help to take care of their mother anymore. They did their research on four different nursing homes before choosing a high-end nursing home in their Dong Da District neighborhood.

The home charges VND18 million ($766.45) per month to live in a six-person dormitory room with nurse assistance. To complete the enrollment process, Phuong and her siblings had to pay a total over VND140 million for six months of fees and another two months as a deposit.

A week after arriving at the nursing home, Phuong’s mother became more active. However, she experienced a decreased appetite and was ordered to take five bottles of plasma a month, which cost an additional VND7.5 million in total. She was also prescribed 14 acupuncture sessions, each of which cost VND300,000. On top of that, she was also prescribed pills and supplements for dementia, blood pressure, and other issues.

This month, Phuong had to pay VND6 million more for those additional services and products. Prior to this, she already spent a similar amount on diapers and milk for her mother.

Friends visit an elderly woman at a nursing home in Thanh Tri District, Hanoi, winter 2021. Photo by VnExpress/Phan Duong

There has not been any detailed research in Vietnam on the financial pressures that families with elderly members in nursing homes have to face. But seniors enrolled in nursing homes are frequently elderly people who receive monthly retirement pensions or who come from well-off families.

However, even when that is the case, many seniors still find themselves financially struggling to pay their nursing homes’ fees.

A VnExpress survey of 10 middle-end nursing homes in Hanoi revealed that monthly expenses range between VND8-20 million, depending on room types and other costs, including diapers and milk. Meanwhile, the average retirement pension in Vietnam is around VND5.4 million per month.

Nguyen Thi Kim Thanh, who has operated a nursing home in Hanoi for 17 years, admitted that high costs are the biggest obstacle for elderly who want to be taken care of by professional nursing homes.

This observation aligns with the results of another VnExpress survey that questioned some 400 respondents.

About 43% of people surveyed said that they didn’t think they’d be able to afford nursing home expenses. About 33% thought they could pay between VND8-10 million, 14% thought they could pay between VND10-15 million, and the remaining 10% thought they could pay a higher amount.

This elderly woman has lived in her 20-meter-square “studio” at a nursing home in Tay Ho District, Hanoi, ever since her husband passed away 9 years ago. She pays VND14 million a month. Photo taken on May 5, 2023, by VnExpress/Phan Duong

According to Thanh, the majority of Vietnamese are not well prepared for old age, neither theirs nor their family members’. As a result, many families struggle financially if an elderly member of theirs requires long-term medical treatment.

Thanh’s nursing facility is home to over 100 seniors. However, after Covid, many families encountered financial hardships and had to apply for discounts on monthly fees. Some even wanted to terminate their contracts and bring their elderly parents home.

Tung Anh, 37, a resident of Hoai Duc District, Hanoi, came to this decision after his business was affected by the pandemic. The VND13 million monthly fee he had been paying Thanh’s nursing home since 2019 became too much pressure for him.

“I contemplated for several months. I didn’t want to change my mom’s life, however, I decided to take her home and take care of her myself,” he said.

When informed of Tung’s decision, his mother cried and told him: “I will die if you take me away from here.”

Thanh and other members of the management board decided to help the mother-and-son by moving the senior to another cheaper room, as well as cutting down on costs of several optional services, so that Tung and his family could feel comfortable leaving his mother here.

Many families have simply stopped paying monthly fees after sending their family members to nursing homes. Nguyen Tuan Ngoc, founder of the first nursing home in Vietnam, said that his nursing home has been taking care of several seniors whose families have “disappeared” on payment.

Phan Thi Do, from Thanh Hoa, has enrolled in a nursing home in Bac Tu Liem District, Hanoi since April 2023. Photo taken on May 5, 2023, by VnExpress/Minh Ngoc

In order for nursing homes to become reliable and affordable, Ngoc said that taking care of seniors has to be considered a social welfare service supported by the state or local authorities. Once that is achieved, these institutions would be able to serve more people’s needs, according to Ngoc.

“We have wanted to access the public land treasury in order to reduce our investments,” he said.

Thanh added that Vietnamese people have to adapt their financial habits as well.

“People should plan for a savings to be spent on their parents’ caretaking services, instead of treating it as an unexpected cost. Old age is a long journey which requires a lot of investments,” she said.

Data collected by the General Office for Population and Family Planning showed that Vietnamese people’s average life expectancy is 73.6, which is higher than the world average. However, people’s health reportedly deteriorates after age 64, which means on average, a lot of people have to deal with sickness for around a decade.

A survey about the “level of willingness to live alone after getting old” done by Prudential Vietnam in 2021 showed that 85% of the participants wanted to live on their own in their old age. However, only 40% of them were confident that they were well-prepared to do so.

To solve this problem, many countries in the world have employed policies to improve senior caretaking services and retirement pension systems. In 2022, the Chinese government announced plans to spend CNY35 billion (around $5 billion) on new nursing homes for elderly people, as part of an initiative to improve the quality of senior care.

In Japan, nursing homes’ monthly fees can be as much $3,000, but citizens only have to pay between 10 and 30% of the amount as the remaining amount is paid by social insurance agencies. In exchange for this support, Japanese people have to participate in long-term care insurance programs starting at age 40.

Phuong and her two sisters came to a decision that the oldest among them, who has the best financial capacity, pays half of their mother’s caretaking expenses. The other half is divided between the other two sisters. Unplanned expenses are paid using their mother’s VND7 million monthly pension.

“I hope my mom’s health improves in the future,” said Phuong, “otherwise, we will struggle enduring these expenses in the long term.”