As millions of baby boomers reach retirement age and U.S. health care costs soar, Mexican nursing home managers expect more American seniors to head south in coming years.

Mexico’s proximity to the USA, low labor costs and warm climate make it attractive, although residents caution that quality of care varies greatly in an industry that is just getting off the ground there.

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After Jean Douglas turned 70, she realized she couldn’t take care of herself anymore. Her knees were giving out, and winters in Bandon, Oregon, were getting harder to bear alone.  Douglas was shocked by the high cost and impersonal care at assisted living facilities near her home. After searching the Internet for other options, she joined a small but steadily growing number of Americans who are moving across the border to nursing homes in Mexico, where the sun is bright and the living is cheap.

For $1,300 a month–a quarter of what an average nursing home costs in Oregon–Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.  "It is paradise," says Douglas, 74. "If you need help living or coping, this is the place to be. I don’t know that there is such a thing back (in the USA), and certainly not for this amount of money."

An estimated 40,000 to 80,000 American retirees already live in Mexico, many of them in enclaves such as San Miguel de Allende or the Chapala area, says David Warner, a University of Texas public affairs professor who has studied the phenomenon. There are no reliable data on how many are living in nursing homes, but at least five such facilities are on Lake Chapala.

"You can barely afford to live in the United States anymore," said Harry Kislevitz, 78, of New York City. A stroke victim, he moved to a convalescent home on the lake’s shore two years ago and credits the staff with helping him recover his speech and ability to walk.  "Here you see the birds, you smell the air, and it’s delicious," Kislevitz said. "You feel like living."

Many expatriates are Americans or Europeans who retired here years ago and are now becoming more frail. Others are not quite ready for a nursing home but are exploring options such as in-home health care services, which can provide Mexican nurses at a fraction of U.S. prices.

Retirement homes are relatively new in Mexico, where the aging seniors usually live with family. There is little government regulation. Some places have suddenly gone bankrupt, forcing American residents to move. Some Mexican homes have rough edges, such as peeling paint or frayed sofas, that would turn off many Americans.

"I don’t think they’re for everyone," said Thomas Kessler, whose mother suffers from manic depression and lives at a home in Ajijic. "But basically, they’ve kept our family finances from falling off a cliff."

Residents such as Richard Slater say they are happy in Mexico. Slater came to Lake Chapala four years ago and now lives in his own cottage at the Casa de Ancianos, surrounded by purple bougainvillea and pomegranate trees.

He has plenty of room for his two dogs and has a little patio that he shares with three other American residents. He gets 24-hour nursing care and three meals a day, cooked in a homey kitchen and served in a sun-washed dining room. His cottage has a living room, bedroom, kitchenette, bathroom and a walk-in closet.

For this Slater pays $550 a month, less than one-tenth of the going rate back home in Las Vegas. For another $140 a year, he gets full medical coverage from the Mexican government, including all his medicine and insulin for diabetes.

"This would all cost me a fortune in the United States," said Slater, a 65-year-old retired headwaiter.

On a recent afternoon, lunch at the Casa de Ancianos consisted of vegetable soup, beet salad, Spanish rice, baked dogfish stuffed with peppers, garlic bread and a choice of four cakes and two Jell-O salads. Slater’s neighbor doesn’t like Mexican food, so a nursing home employee cooks whatever she wants on a stove beside her bed.

Like many retirees, Slater has satellite television, so he doesn’t miss any American news or programs. When he wants to see a movie or go shopping downtown, the taxi ride is only $2 or $3. Guadalajara, a culturally rich city of four million people, is just 30 miles away.

For medical care, Slater relies on the Mexican Social Security Institute, or IMSS, which runs clinics and hospitals nationwide and allows foreigners to enroll in its program even if they never worked in Mexico or paid taxes to support the system. He recently had gallbladder surgery in an IMSS hospital in Guadalajara, and he paid nothing.

Many of the nursing home employees speak English, and so does Slater’s doctor.

The Casa de Ancianos began accepting foreigners in 2000 as part of an effort to raise extra money, director Marlene Dunham said. It built the cottages especially for the Americans and uses the income received from them to subsidize the costs of the 20 Mexican residents at the home.

The program was so successful that the nursing home has plans for 12 more cottages, a swimming pool, a Jacuzzi and a gazebo with picnic area. The nursing home now advertises on the Internet and through pamphlets distributed in town. Some U.S. companies have also begun investing in assisted living facilities in Mexico, said Larry Minnix, president of the American Association of Homes and Services for the Aging, which represents 5,800 nursing homes and related services.

However, Minnix cautioned that lax government regulation poses dangers at smaller homes.

"It’s the same danger you have of going across the border looking for cheap medications," Minnix said. "If you don’t know what you’re getting, and you’re not getting it from people you trust, then you’ve got an accident waiting to happen."

Since many nursing homes are run out of private homes, regulation by state health departments is often spotty. Managers such as Beverly Ward of Casa Nostra and Maura Funes of El Paraiso, both in Ajijic, said that Mexican officials inspect them only once a year, unlike U.S. inspectors, who may visit a home several times a year.

The U.S. Embassy said it had no record of complaints against Mexican nursing homes, but some residents in the Lake Chapala area reported bad experiences at now-defunct homes.

The first home that Jean Douglas lived in after she moved from Oregon was staffed by "gossips and thieves," she said. It went out of business.  Irene Chiara of Los Angeles also lived in a home that was shut down by Jalisco state authorities.

"It was filthy, and the food was very bad. It was all made in the microwave," she said.

Some Mexican managers also underestimate the costs and difficulty of running a retirement home. Two hotels turned into assisted living facilities, The Spa in San Miguel de Allende and The Melville in the Pacific Coast city of Mazatlán, recently abandoned the business, their managers said.

"It was very expensive to run it," said Luis Terán, manager of The Melville.  Some managers said they were especially selective when admitting foreign residents, to make sure they’ll be able to pay. Medicare, Medicaid, the Department of Veterans Affairs and most U.S. insurance companies will not cover care or medicine as long as patients are outside the USA.

Some American residents said they had doubts about the quality of Mexican medical facilities and would go back to the USA if they became seriously ill. Jim May, 74, a resident of the Casa de Ancianos, said he recently decided to move to Texas to be closer to Veterans Affairs hospitals.

The language barrier can be daunting, and Mexican food can be very different, some residents said.

Some residents said they miss home and find it hard to make friends with Mexican residents. "It’s a very nice place, but it’s lonesome," said Polly Coull, 99, of Seminole, Fla., a resident at Alicia’s Convalescent Nursing Home in Ajijic.

Mexican entrepreneurs are doing their best to prepare for a tide of Americans.  In the Baja Peninsula town of Ensenada, the Residencia Lourdes opened in 2003, offering care for patients with Alzheimer’s disease and senile dementia. The towns around Lake Chapala have at least five small retirement homes. Most of them opened in the last five years and house from one to 25 foreigners.  The largest, Alicia’s Convalescent Nursing Home, consists of four renovated homes, one of them specializing in stroke victims and another for Alzheimer’s patients. Prices range from $1,000 to $1,500 a month and include everything except medicine and adult diapers. The rooms are outfitted in Mexican style, with murals, hand-carved beds, arched ceilings lined with brick and individual patios.

In other American enclaves, in-home healthcare services have sprung up to serve the retirees. In Rosarito, just south of the U.S. border, INCARE provides nursing aides to retirees starting at $8.33 an hour, less than half the cost of the same service in nearby San Diego.

Developers of independent living facilities for seniors are also beginning to look to Mexico. A Spanish-U.S. venture is building Sensara Vallarta, a 250-unit condominium complex aimed at Americans age 50 and older in the Pacific Coast resort of Puerto Vallarta. And in the northern city of Monterrey, El Legado is marketing itself as a "home resort" for seniors.

Academics and government officials are beginning to take notice. In March, the University of Texas at Austin held a forum for developers, hospital officials, insurance companies and policymakers to discuss health care for retirees in Mexico.

"With the right facilities in place, Mexico could give (American retirees) a better quality of life at a better price than they could find in the United States," says Flavio Olivieri, a member of Tijuana’s Economic Development Council, which is seeking funding from Mexico’s federal government to build more retirement homes, including senior apartments. "We think this could be a very good business as these baby boomers reach retirement age," he says.

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