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‘Grandma export’ exposes Germany’s struggle with care

by Naomi Kresge

Bloomberg

Sonja Miskulin has forgotten her beloved cat, Pooki. She can’t remember whether she has grandchildren and has no memory of her nine-hour journey one recent Sunday to forever leave behind her home in Germany.

Suffering from dementia, the wheelchair-bound former translator celebrated her 94th birthday in a Polish nursing home in August. Her daughter sent her there in a bid for a better life and more affordable care.

Miskulin has joined the vanguard of a controversial movement: emigrant nursing home residents. The “Grandma export” trend has set hands wringing in Germany, where Munich’s leading newspaper denounced it as “gerontologic colonialism” and compared it to nations exporting their trash. Yet more families like Miskulin’s say it’s their best option to provide a dignified old age for elderly parents — and save money — amid a lack of affordable quality care at home. One in five Germans would now consider going abroad for a nursing home, according to a March survey by TNS Emnid, one of Germany’s biggest pollsters.

“I can only say, children, when your parents get older, send them to Poland,” said Miskulin’s 66-year-old daughter, Ilona von Haldenwang.

Germany’s migrating seniors are an early warning sign of a challenge of global proportions. As birth rates drop, life expectancies increase and the baby boomer generation heads into old age, the United Nations estimates the world’s population of people older than 60 will more than triple to almost 2 billion by 2050. Meanwhile, even for seniors cushioned by government aid in countries like Germany, the cost of nursing home care is rapidly becoming prohibitive. German spending on long-term care for seniors is expected to increase from 1.4 percent of gross domestic product to 3.3 percent of GDP by 2060, the European Commission said in a report last year.

Miskulin’s new home is in a picturesque Polish ski resort called Szklarska Poreba, which roughly translates to Glassmaking Clearing, named for the many glassworks that once defined the area. Her daughter chose the nursing home sight unseen after studying its website and meeting with a nursing-home placement broker. What began as an act of desperation — exporting her own mother — quickly began to make sense.

For four years, Von Haldenwang watched with increasing despair as her mother’s health deteriorated in what she says was a poorly run German facility, even as it strained the women’s finances. Now, at about a third the price for the care she received in Germany, Sonja lives in a restored century-old luxury villa where she enjoys fine meals, around-the-clock nursing and extensive physical therapy.

Miskulin is adjusting to her new surroundings. Still, the trade-off for both mother and daughter is the 560 km separating them. The two women used to live only a two-minute walk apart. Von Haldenwang recalls the friend who helped move her mother protesting in disbelief as they climbed into the fir-covered Karkonosze Mountains that mark Poland’s border with the Czech Republic.

“Oh God, oh God, where are we going? It’s the end of the Earth,” she remembered her friend saying. “Then we drove up the hill and she said, ‘Oh! It’s a palace!’ And I said, ‘See, I told you, everything will be good.’ ”

The owners say half the residents will soon be Germans, who have state-mandated long-term care insurance through a nearly 20-year-old program, a benefit out of the reach of most people beyond Europe, including the United States.

Spare cash

The insurance pays out €1,550 ($2,060) a month to German citizens who, like Miskulin, need the highest level of care. That’s less than half of the €3,250 average monthly bill for such care inside Germany. Nursing homes in Poland are marketing care that in some cases may be similar or better for about €1,200 per month. The German government will pay as much as €700 toward nursing care outside the country. Though less than half the amount provided for in-country homes, it’s enough, together with most retirees’ pensions, to pay for monthly care costs — with cash to spare.

The arithmetic is compelling for older Germans and their grown children. And costs in Germany are only likely to go higher: The country’s population is expected to be among the world’s oldest by 2050, on par with Japan, South Korea and Italy, with about 15 percent of residents over the age of 80, according to an Organization for Economic Co-operation and Development report.

Ingrid Fetz, 74, did the math after four back operations got her thinking about her financial vulnerability.

“I worked so hard for what I have,” said Fetz.

She fears her savings won’t last if she has to pay for a nursing home near her 52-year-old daughter’s Munich home, Fetz said. And she worries she’ll eventually have to sell the apartment she had hoped to leave to her family. In Poland, Fetz said she figures she would have money left over each month after paying for her care costs.

She began her search at a German-language website that promises affordable homes in the Czech Republic, Slovakia, Hungary and the country that piqued her interest most of all: Poland. Like many of the German seniors searching there, Fetz has roots in the country: her mother grew up speaking a Polish dialect in an ethnic German family near Warsaw, and she spent her own childhood in what is now Poland before the end of World War II.

“It would break my heart to give my apartment to a nursing home someday,” she said. “I thought to myself, why would I have to stay in Germany at all?”

Little Germany

The lure of elderly Germans with money in the bank has caught the attention of Polish entrepreneurs and owners of resorts that have seen better days.

One new facility has sought to transplant a piece of Germany into the Polish town of Zabelkow. Like Szklarska Poreba, Zabelkow is in Silesia, a region that had long been part of the German-speaking world. It was once ruled by Austria’s Habsburg Empire and by Prussia, eventually becoming part of Poland after World War II.

At the Zabelkow home, nurses speak German, the elevator announcement is in German and the kitchen comes from Robert Bosch GmbH. Residents dine on classic German meals, such as a cold supper of bread, cured meats and cheese, while German Bundesliga soccer stalwarts like Wolfsburg and Mönchengladbach face off on the large flat-screen television. The linens, the emergency-call system and the hospital gloves all come from Germany. Even the teaspoons are made by German brand BSF.

Since its Easter opening, the home has filled its 34 beds and is finishing six more single rooms in the attic, which are already reserved for this November, said Fabrice Gerdes, who managed it at its opening. A management consultant, German-born Gerdes built the home together with his Polish father-in-law across the street from the farmhouse where his mother-in-law was born.

“We have significantly beaten the goals we set for ourselves,” Gerdes said in September.

Not every Polish nursing home advertising in German on the Web is necessarily what it seems. One, Pensjonat Ania, a small residence in Tomislaw near the German border, promises rooms that sleep four for an unusually low price of €400 per month, complete with an on-site nurse and excursions including mushroom hunting. The only sign of life during a visit in April, however, was a skinny dog barking behind a metal fence.

Owner Lidia Straszak said she decided to convert her bed-and-breakfast in part because, unlike tourists, seniors will stay through the winter. The first Polish residents were due to arrive that weekend, and Germans had also expressed interest, she said.

On two subsequent visits, Straszak would not allow access to the home’s interior. Straszak declined to comment by phone on Sept. 9.

Another ad on the website Fetz promises a “very well-equipped senior home in a delightfully scenic setting,” in a renovated three-star spa hotel called Piastow Grod. The website features photos of happy seniors at play and uniformed young nurses and doctors looking on. That nursing home, in Duszniki-Zdroj about 120 km along the hilly Czech border from Szklarska Poreba, has yet to open.

Though the would-be senior home found some interested customers, there weren’t enough to cover the cost of opening. Only a faded set of brochures tacked under the glass of the defunct hotel’s old sign remind passers-by that inside there’s a “spa grotto for harmony of mind and body.”

“This is a tough business,” owner Andrzej Pietrucha said.

Sleepless nights

The home Von Haldenwang eventually chose for her mother had initially been conceived as a nursing residence for wealthy Poles. After it opened in September 2012, the owners, who also run a medical center in nearby Karpacz, found most of their customers were Germans as well as Polish people living abroad.

Von Haldenwang said her mother pays €1,200 a month for 24-hour care, physical therapy, a double room, board and medical care. The interior decorating is in natural wood and stone; the care philosophy is to avoid sedatives and help residents regain mobility using physical therapy. Like Miskulin, most of the other residents have dementia.

“For Polish people, this is expensive, but for German people, this is an attractive price,” said director Helena Grab, who also headed the facility in its previous incarnation as a children’s respiratory clinic.

Von Haldenwang said the decision to send her mother to Poland was not an easy one. She lay awake at night weighing practical considerations and a sense of duty colored by a lifetime of strained and sometimes distant relations with her mother. As a young mother, Miskulin left her daughter behind to pursue a career as a theater translator in the tumultuous post-World War II Soviet Union where they then lived.

Miskulin shuttled between Leningrad, now St. Petersburg, and Moscow, leaving her daughter with her mother in Riga, more than 480 km away. The two saw each other about four times a year until they were able to emigrate to West Germany in 1962.

“She was a woman I barely knew,” Von Haldenwang said. She remembered her mother’s fear during their first night in a German holding facility for Soviet bloc immigrants, waiting for U.S. officials who were due to question the new arrivals from Russia the next morning.

“My mother was crying the night before, and I — who was sad to leave my beloved grandma, my friends, my school — I had to comfort her,” Von Haldenwang said. “The camp was a real barracks. In Riga, I lived in a beautiful Art Nouveau apartment. I thought, ‘My god, where has this woman brought me?’”

She soon moved out on her own, gaining a scholarship at age 16 to a residential arts school and eventually making a modest living performing Russian folk music.

In 2007, Miskulin’s husband of 38 years, a Croatian man 16 years her junior, became ill. Von Haldenwang moved her mother, already suffering from dementia, to her own home in the Bavarian spa town of Bad Brueckenau.

“When she got sick I thought, it doesn’t matter if she didn’t raise me, I have to take care of her,” Von Haldenwang said. “No question about it.”

The pitfalls of caring for an aging parent in a fourth-floor apartment with no elevator quickly became apparent. The home health aides Von Haldenwang hired often quit. Miskulin would wake up at night and call her cat, Pooki, from the balcony at 3 a.m. — forgetting that she had let the pet in before she went to bed.

Von Haldenwang moved Miskulin into a shared assisted-living apartment a few doors down from her own home, and then, when the assisted-living project closed in 2009, into the nursing home next door.

Miskulin was lucky. She had spent part of her life in public service and thus had a relatively generous pension of €1,500 a month. That was almost enough to cover her share of the bill for the nursing home next door to her daughter. Even so, bills flowed in for such extras as haircuts, manicures and pedicures, sometimes as much as €250 a month, “just to make money,” Von Haldenwang said.

Von Haldenwang said she also became dissatisfied with the nursing care. She disliked the sedatives the staff used to manage her mother’s sometimes imperious behavior, believing they made Miskulin more confused and lethargic. Her mother had lost weight, and Von Haldenwang suspected it was because the staff failed to ensure her mother ate properly. She began supplementing Miskulin’s diet with powdered nutritional drinks.

Von Haldenwang asked that the German nursing home not be identified. Its director said his staff only use sedatives when doctors prescribe them. Von Haldenwang and the nursing home both say they are disputing a bill.

In the meantime, she had started looking for a new nursing home, first close by, and then, put off by the price of top-quality care, farther afield.

She heard about Germans sending elderly relatives to Poland. For Von Haldenwang, the prospect of care in Poland was more blessing than parental exile. The state’s €700 stipend plus her mother’s pension would be more than enough to pay for a Polish nursing home. The rest she sets aside for future medical bills. And she said she believed that Polish people, who put their own relatives into nursing homes at rates lower than much of the rest of Europe, would be respectful caregivers for her mother.

To find a Polish home, Von Haldenwang turned to a fixer: businessman Günter Stobrawe. A retired traveling salesman, Stobrawe started a placement service for Germans in Polish nursing homes last year with his wife, who is Polish and a former nursing home administrator in Germany, and a friend.

Far away

Business has picked up in the past few months, Stobrawe said. The company has advised more than 100 families, placed eight seniors and signed contracts for seven more to move to Poland in coming months. It has partnerships with eight nursing homes in Poland.

“Our clients aren’t on welfare,” Stobrawe said over cappuccino and mineral water at the train station in Wiesbaden, an upscale city outside Frankfurt famous for its baths. “They’re people who have saved something.”

Some have come to regret sending relatives so far away. Joerg-Christian Henningsen, 67, brought his 63-year-old wife, Annegret, to the Zabelkow home for a month’s trial in late March, saying that he needed help after Alzheimer’s disease had left her unrecognizable from her former self. He soon discovered one of the biggest drawbacks of distant nursing homes: it’s difficult to bring a spouse or parent back home when things go wrong.

A late night phone call about a sudden turn for the worse four weeks after his wife moved into the home led him to make a panicked eight-hour drive from their home near Hamburg to Zabelkow the next day. He arrived, his 93-year-old mother in tow, to find his wife could no longer communicate.

Henningsen said he desperately wanted to bring her home. In order to do so, he had to get a letter attesting to her condition from her Polish doctor.

He spoke to the doctor over a mobile phone set on loudspeaker while one of the Polish nurses helped translate. It was 9 p.m. on a Saturday; he wanted the letter that evening so he could take his wife back to Germany the following day.

Believing they could return to Germany by air, Henningsen argued that the trip would be quick. The doctor was skeptical his wife could travel at all.

“It’ll only take an hour and a half,” Henningsen argued. “That’s nothing. I want to have her in a hospital in Germany.”

The nursing home instead proposed sending her to a Polish hospital, but Henningsen refused, said Gerdes, the Zabelkow home’s founder.

Henningsen eventually got his way, and arranged for a German ambulance to pick up his wife. She spent 10 days in a German hospital and two more months in a German nursing home before moving back to where she began: at home with Henningsen, cared for four days of the week by a day care 20 minutes away.

While Henningsen says his wife got worse during her stay in Poland, Von Haldenwang maintains that her mother is in better health now than while she was living right next door. She isn’t given sedatives and is more awake and aware of what’s going on around her, Von Haldenwang said. She has remembered her Polish — one of the many languages she spoke as a translator — in conversations with Grab, the director, who in turn is taking German lessons from another resident.

“Nationality doesn’t seem to make the slightest difference,” said Grab. “We’d been a little nervous about anniversaries of wartime events, but it turned out that one of our residents, a Polish woman who’d fought in the Warsaw Uprising, sat right down at the same table with two Germans and made friends.”

Nice cake

One Saturday in late August, about eight weeks after she dropped off her mother, Von Haldenwang made the long trek back to the nursing home to help celebrate Miskulin’s 94th birthday. Staffers spent a diligent hour singing songs, dancing and dishing up cream cake and sparkling wine.

“Are you happy that your daughter is here, that I’m here for your birthday?” Von Haldenwang asked her mother. “What did you like about your birthday? The nice cake? The many flowers? Did you hear how beautifully they sang? And the many guests, you liked those too?”

Miskulin told her daughter she was happily surprised by the visit.

“But I didn’t really understand what was going on,” she said.

Her daughter reassured her that it didn’t matter. Grab, the nursing home director, hugged Miskulin. Then Von Haldenwang headed off for a look at the mountains. Her mother went to bed.