Long-Term Care Planning for Expats and International Retirees

Long-term care is one of the most significant — and most widely ignored — financial risks in retirement planning. For internationally mobile retirees, it carries a dimension of complexity that domestic planning simply does not address: the question is not just how to fund care, but where care will be provided, under which healthcare system, at what cost, and by whom.

This guide examines the long-term care planning challenge for international retirees, including the costs involved, the funding options available, and the critical decisions that should be made — ideally well before they become urgent.

Defining the Long-Term Care Risk

Long-term care (LTC) refers to assistance with activities of daily living (ADLs) — dressing, bathing, eating, mobility, continence, and cognitive orientation — over an extended period, typically as a result of physical frailty, chronic illness, or cognitive decline such as dementia.

Unlike acute medical care (which international private medical insurance typically covers), long-term care is ongoing, social as much as medical in character, and extremely expensive over time. It is not a risk that a single episode addresses and resolves.

Key statistics (indicative as of 2026, sourced from publicly available data):

• Approximately one in four people over 65 will require care costing over £100,000 during their lifetime
• Care home costs in the UK currently range from approximately £800–£1,500 per week depending on region and care level
• In Southern Europe, residential care costs are broadly 30–60% lower than the UK; in Southeast Asia, high-quality care can be 60–80% lower
• The average duration of care home residency is approximately 2–3 years, but a significant minority require care for 5+ years

For internationally mobile retirees, the cost profile is fundamentally different depending on where they end up receiving care — which may not be where they plan to retire.

The "Where Will I Receive Care?" Question

This is the critical and often unasked question for international retirees. Your chosen retirement location is not necessarily where you will spend the final years of your life. Care needs, family location, linguistic preferences and practical realities often cause retirees to move — sometimes urgently — when significant care needs arise.

Common patterns include:

• Retiring to Southern Europe, then returning to the UK or moving to be near adult children when cognitive or physical care needs develop
• Planning to remain in Southeast Asia for care because of lower costs, but finding that language barriers, family distance, or specific medical needs make this impractical
• Discovering that the country of retirement has no appropriate specialist care facilities (e.g., memory care units for dementia)

The financial implications are significant. Planning on the basis of low Thai care costs and then actually needing to pay UK care home fees is a planning failure with potentially severe consequences.

A prudent approach plans for care costs in at least two scenarios:

1. Receiving care in the chosen retirement location — what is available, at what cost, and what quality?
2. Receiving care in the home country or a high-cost alternative — what are the likely costs, and are they funded?

Funding Long-Term Care: The Available Options

1. Self-Funding from Accumulated Wealth

The most common approach — particularly for HNW individuals — is simply to self-fund care costs from existing retirement savings and assets. This is viable if:

• Retirement savings are sufficient to absorb multi-year care costs without jeopardising the surviving spouse's financial security
• Assets are liquid or can be readily converted
• There is a clear framework for decision-making if cognitive capacity is impaired (see our separate guide on cognitive decline planning)

For HNW retirees with portfolios of £2m+, self-funding from savings is often realistic. For those with more modest estates, or where a large proportion of wealth is in illiquid property, self-funding may be insufficient.

One commonly overlooked self-funding mechanism is property — both releasing equity from a property held in retirement and, in the UK context, the potential to use the family home (if retained) as a care-cost reserve. UK rules provide some limited protection for a spouse's right to remain in the family home even where one partner enters residential care.

2. Long-Term Care Insurance

Dedicated long-term care insurance provides a benefit (typically a weekly sum or reimbursement of care costs) if the insured person becomes unable to perform a specified number of ADLs or develops a defined level of cognitive impairment.

UK LTC insurance market: The standalone UK LTC insurance market is limited and has contracted significantly in recent years, with most insurers withdrawing from writing new policies. The options typically available in the UK are:

• Pre-funded LTC policies: bought before care is needed, pay a benefit when care criteria are met
• Immediate needs annuities (also called care annuities): purchased when care is already needed, provide a guaranteed income to meet ongoing care costs

International LTC insurance: Some international insurers offer long-term care riders within broader health insurance products. These are typically limited in coverage and should be read carefully.

Combination LTC/life insurance products: Some international markets offer whole-of-life or universal life insurance products with long-term care riders, so that either the LTC benefit or the death benefit is paid depending on which need arises. These are more commonly available in the US market but some international providers offer equivalent products.

For most internationally mobile HNW retirees, dedicated LTC insurance is not widely available or cost-effective in the current market. The primary planning tool is likely to be self-funding combined with structural planning.

3. Care Bonds and Hybrid Products

Some structured investment products combine investment growth with a guaranteed care benefit at a specific age or upon triggering care criteria. These products are relatively specialist and require careful evaluation of terms, provider quality and underlying guarantees.

4. Equity Release

For retirees who own property — including those who own a UK property even while residing abroad — equity release (lifetime mortgage or home reversion) can fund care costs. Equity release products in the UK allow homeowners over 55 to borrow against the value of their property without making repayments; the loan is repaid from the sale of the property upon death or entry into permanent care.

This can be a legitimate care-funding mechanism for internationally mobile retirees who have retained UK property, but involves significant long-term costs (compound interest on the loan) and reduces the estate available to heirs. Specialist regulated advice is required.

Care in Different Retirement Destinations

Southern Europe (Spain, Portugal, Italy, Greece)

All four countries have developed private care home and residential care sectors, particularly in expat-heavy areas. Quality varies but reputable facilities exist. Costs are typically significantly lower than the UK:

• Spain/Portugal: approximately €2,000–€5,000 per month for residential care, higher for specialist memory care
• Italy: broadly similar but varies by region
• Greece: lower average costs; quality of specialist dementia care is more variable

Language can be a barrier for cognitively impaired residents who do not speak the local language — English-language care homes exist in major expat areas but choice is more limited.

Cyprus and Malta

Both countries have small but reasonable private care sectors, with English widely spoken. Costs are broadly in line with Southern Europe. For UK nationals, the familiarity of culture and language is a meaningful advantage.

UAE

The UAE has developing private care home infrastructure, primarily in Dubai and Abu Dhabi. Costs are relatively high. The practical reality is that many expat retirees in the UAE have family elsewhere and may return home for care.

Thailand

Thailand has well-developed private hospitals but a less mature residential care home sector. High-quality care is available in Bangkok and major cities. Costs are significantly lower than Europe — approximately THB 30,000–80,000 per month (approximately £670–£1,800 as of mid-2026) for quality residential care. Family-at-home care is culturally embedded in Thailand but depends on the retiree's family situation.

Indonesia (Bali)

Care home infrastructure in Bali is limited. Retirees with significant care needs in Bali typically face the choice of returning to their home country or moving to Singapore or another regional hub with better facilities.

Practical Planning Steps

1. Assess your care risk honestly. Family health history, your own health trends, and actuarial data suggest care needs are more likely than most people plan for. A planning conversation with your adviser should include an honest assessment.

2. Designate a care reserve within your retirement plan. A dedicated liquid reserve — separate from your investment portfolio — provides accessible funds for care costs without requiring distress-selling of investments.

3. Prepare legal documentation. Powers of attorney, advance care directives, and financial instructions all need to be in place before cognitive capacity is impaired. For internationally mobile retirees, these documents need to be legally effective in the relevant jurisdictions.

4. Discuss with family. Care decisions involve family as much as financial advisers. Conversations about where you would want to receive care, who would make decisions if you cannot, and what family support is available should happen long before they are needed.

5. Review as circumstances change. Care needs planning is not static. A change of health status, a change of retirement location, or a change in family circumstances should trigger a review.

How Global Investments Can Help

Long-term care planning is integrated into our broader retirement income and estate planning work for international clients. We help clients model realistic care cost scenarios, build adequate reserves, and structure their assets to remain accessible for care needs while meeting other planning objectives.

We coordinate with specialist legal advisers in relevant jurisdictions on the power of attorney and advance directive documentation that underpins practical care planning.

Contact us to discuss how long-term care planning fits within your broader retirement and estate plan.

Care costs and care home availability vary significantly by location and are subject to change. Insurance products and terms are subject to change. This guide is for information purposes only and does not constitute regulated financial or insurance advice. Seek qualified regulated advice before making decisions about care cost planning or care insurance products.