The “lifestyle” surgeries in Canada (knee/hip replacement) don’t happen so fast. Long waitlists. Most of that seems to be covered here by company health plans, albeit with hefty copays
Breast cancer care in urban Ontario, from all accounts, is very good.
Thanks @dragonmom. We did look at possibly moving there about 10 years ago – ShawWife had said she would like to retire in Canada. I love the Rockies. I assume that we would need to move to Canada for me to begin the process of becoming a permanent resident, but I don’t know that for a fact.
From a tax standpoint, the US and Canada have a tax treaty, so in principle, there is no double taxation. The US gives a credit for taxes paid to other countries (although the foreign tax credit does not usually give you back 100% of what you paid to other countries). Canadian tax rates are generally higher but health care is covered (though long term care is not). If healthcare costs go up a lot in the US (Fidelity Releases 2022 Retiree Health Care Cost Estimate: 65-Year-Old Couple Retiring Today Will Need an Average of $315,000 for Medical Expenses), moving to Canada might be a smart financial move.
I don’t recall researching permanent residency. I will look. Becoming a citizen wasn’t actually that hard. You have to stay within the country for most of three years (I think, it was a while since I looked at it). However, if I moved the company that employs me to Canada, then all of my travel outside of Canada for work would be considered time in Canada. I think I would qualify for health insurance after six months. There are supplemental insurance plans that can expedite certain surgeries. [I was on the board of a health care company in Canada for a few years so have a good feeling for the health care system there, which in many dimensions is a lot better than most US citizens think. But, elective surgeries, including knee replacements can have a several year waiting period and there may be a delay of a year to several years in getting government approval of expensive new tests and drugs.]
If I recall correctly, there were meaningful differences between provinces regarding requirements in some of the policies.
We now have a house in such an extraordinary location that it is hard to imagine moving, but it is entirely possible for the country to continue on its path of self-induced decline, for climate change to be faster than expected, and/or medical costs to rise dramatically that might cause us to think again.
When I worked for a physician group, we had a guy in one of the clinical trials that lived in retirement in Costa Rica. He found it cheaper to live there and flew back fairly regularly. A single guy.
Brother lived in Costa Rica for a while and had hernia surgery there - instead of laparoscopic and small incisions, he had a big mid-line incision, with the MD ‘fixing’ anything he saw needed repair before closing him up. Long time to heal. he was the second surgery case out of 9 that day with the one surgeon in the hospital. His next hernia surgery was in Switzerland as a dual-US citizen. He cannot return to the US. I doubt that he will return to CR but one doesn’t know. He may find he can continue to work enough to live OK in Switzerland and work enough years there to be on their pension system – all Swiss buy into their health care or have it provided with disability. He worked and paid in with their health care.
Many people look to buy into a facility where there are levels of care, and 90% of their pay in is returned at death – but one has to qualify with health status going in.
One can find out in looking at skilled care facilities if they accept Medicaid once the resident runs out of resources – and determine what facility has the best match for your loved one that needs skilled care. Often going outside of metro areas can find better prices. Sometimes it is surprising, but it also depends on the network of facility providers.
My in-laws took the buy-in route with different levels of care. This quote is important to note. Many have unrealistic expectations that when one is ready to move to a senior community, all that’s necessary is a check and the necessary funds.
However, there’s often (if not always) a cognitive test that must be passed. When we were looking at communities, if the prospective resident failed the cognitive test, they did NOT allow a do-over and a passing grade had an “expiration date”…this can come into play if a house/property has to be sold for the buy-in. If the prospective resident did not pass the cognitive test, he/she could not move into independent living.
Also, moving directly into AL was quite a bit more expensive than if a current independent living resident were to move to AL. Current residents were also prioritized over people looking to move in. There are so many things to consider.
It gets more complicated when there are two people involved. What we learned was if one spouse physically and mentally qualified for independent living, but the other spouse did not, the move-in could be quite costly. We just barely got my in-laws situated in their senior community before one of them needed assisted living. If they had waited much longer, they wouldn’t have been able to live together for as long as they did and the financial hit would’ve been substantial. It was stressful for everyone.
As a consequence I encourage all my friends, who are dealing with aging parent(s) issues, to research senior communities in advance of any conversations with said parent(s). Knowledge is power.
My in laws had no issues when they moved into AL. However, there is a facility in their town where many of their friends live. It requires a VERY expensive buy-in, but they are then guaranteed to be able to stay in their various levels of care should they need them down the road. But “down the road” is key … their friends moved there within the past 6 months, and the man has had a sudden illness that requires a higher level of care. There is a caveat that if you require care within a certain time period, you can’t stay. The man got sick too soon. Last I heard, they were appealing & hoping for the best.
The scenario you describe can certainly happen with buy-ins and levels of care. It’s important to ask the “what if” questions.
In the case with my in-laws they were able to squeak in as independent living even though we saw obvious signs of decline in my FIL. That was the first hurdle. The second hurdle was trying to keep him safe and good enough to reach the milestone needed to transfer him to a different level of care. We were able to limp along with most of the burden falling on my MIL. We supplemented the care he needed by hiring part time assistance for several hours a day, several times a week, with the assistance of a coordinator affiliated with the senior community. Yes, it was expensive but fortunately my in-laws had LTC insurance and it was only for a few months.
Something to keep in mind with levels of care is that even though they made it through the necessary timeframe, an open bed in the desired level of care must also be available. We count our blessings it worked out with perseverance. And I will add that the level of care my FIL eventually received was truly outstanding.
Article from the Atlantic on Wills including how few people have them, how most who have a will are higher income, and how non-traditional families can be at risk given existing laws, if they don’t have a will.
Absolutely agree with everything you said!
Dementia can be very drawn out and costly. BIL’s mother was in skilled care over 12 years bedridden with dementia. These communities are utilizing the best screening information so that they can operate their overall complex at a profit.
An interesting article tied to emmigration as discussed above
https://www.yahoo.com/news/portuguese-angered-influx-californians-import-143950897.html
That page says that there was a program (now suspended) in Portugal to give residency to people who bought homes for at least 500000€. Who would have thought that it could result in immigrants with money buying expensive homes and driving up real estate prices?
I wonder if wealthy criminals were taking up Portugal on their offer, and the country decided this was not a good move for the country.
How are people feeling about the stock market downturn? Any thought of changing plans, delaying retirement, cutting back on spending?
Here in Silicon Valley it feels very gloomy. Lots of references to spring 2000 in the tech community. Here’s one example from a VC firm:
(From https://twitter.com/refsrc/status/1527238287471292417)
If it is as bad as 2001-2003 for the computing industry, that could “solve” colleges’ problems with overflowing CS enrollment for some years afterward. It wouldn’t be pretty for current CS majors in colleges graduating in the next few years, though.
A more general recession may result in forced retirement for some people.
And forced “unretirement” for others…
When NFTs and metaverse became a staple topic on CNBC, I said we were in a bubble. 
Does not smell like Y2K Dot Bomb yet, but there are some similarities. The smart heads sold their imaginary treasures and bought tangible stuff. Like real estate. When all hell breaks loose, at least one can have a roof above their head.
I’m 8-10 years out from retirement so riding the wave. I won’t check my portfolio until things turn around. I don’t need to obsess about the losses yet. And I’m still putting my usual amount in every month for my broker to buy cheap stocks.
Someone please remember the 1987 crash. I was a young whipper-snapper. 
I started to nibble a little today in the hope that I timed the bottom. 
I remember it well. We bought a house in ‘83 for $105,000 and sold it in ‘87 for $79,000.
Hoping this will be a shorter recovery. We have cash to carry us three or four years, but after that it won’t be fun.
I reduced investment of my $27k 401(k) allowance to a trickle just before the war. Will be bumping up my contributions to make up for the slow go during the first half of the year.
