Susan Cuzic knew she needed 24-hour assisted living for her mother, and quickly.
"She was doing crazy things like wrapping up the phone in sheets and putting it in the closet and going down to breakfast at 3 a.m. and stuff like that," said Cuzic, a nurse in San Diego. "I would lay awake all night terrified."
Her mom, Adrianne Hanson, is 94 years old and has Alzheimer's. Cuzic started looking for options but found most places in California were unaffordable, and government health programs like Medicare didn't cover the costs. The average cost of assisted living in California is $5,000 a month for people paying without government assistance, according to the group California Advocates for Nursing Home Reform.
"So I was stuck," Cuzic said. "I have to keep working. I'm the only child. And so I couldn't take care of her."
Then Cuzic found another option: Serena Senior Care, where she pays $1,800 a month.
The only catch: it is located in Mexico.
To visit her mom, she has to drive across the U.S.-Mexico border, then wind her way through Tijuana traffic and finally go down a long dirt road in Rosarito that hosts the occasional stray dog.
But when she arrives, she finds a quiet and clean assisted living center with private rooms, a small gym and a garden.
Serena is one of many elder care facilities in Mexico set up to cater to Americans looking for cheaper retirement options — about half of Serena's residents are from the U.S.
KPBS drove down to Rosarito where the facility is located, about 30 miles south of San Diego.
When you are inside, it is easy to forget you are in Mexico. The signs are in English and Spanish, and most of the staff speaks English.
As Marisa Molina, Serena's operations manager, walked through the center's small dining area, she stopped to chat with residents, switching seamlessly between English and Spanish.
"Since we have an interesting mix between Mexicans and Americans, sometimes it's Mexican food, sometimes it's American food. I think they did mole today," she said, referring to the Mexican sauce being served.
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Still, there are reminders that the center is in a foreign country. Reminders like the TV that is always on in Spanish. And when residents go out on trips it is "noisy and dirty," said Pauline Adams, who had never been to Mexico before moving to Serena.
But, she said, she likes her new home.
"They have very good food, and if I need help and no one's within listening distance, I just push this button and they come no matter what time of day or night it is," she said, lifting up a call button she wears around her neck.
For the 14 Serena residents, there are three caregivers trained to work with people with dementia during the day and two at night, plus nurses and nursing assistants on staff. That caregiver-to-resident ratio is similar to many California assisted living facilities, said Brenda Shorkend, an elder care consultant.
But, she pointed out, there are not the same regulations on assisted living centers in Mexico as in the U.S. And there are other obstacles to moving an elderly person to Mexico, especially someone with dementia, she said.
"It's another country. A lot of Americans are not used to going to another country," she said. "The language is different, the food is different. It's hard enough moving from home to assisted living, so to do that in another country can be very confusing for people."
Most U.S. seniors have Medicare, which covers their health care costs, but not in Mexico, she said. So they have to cross the border to see a doctor, get prescriptions and go to the hospital.
"What if there's an emergency? Do you pay for a private hospital flight, do you pay for an RN to accompany you to a hospital?" Shorkend asked.
That scary scenario happened for Mary Lopez, a Serena resident, when she fell and hit her head. But her close friend and caretaker Ivette Perez said it was not a problem — she drove Lopez across the border to the hospital in a special lane for medical emergencies. The drive from Serena to the San Ysidro border crossing is about 30 minutes.
Peter Fowler also crossed the border when his appendix burst. The 93-year-old World War II veteran has been getting care from Serena since it first opened 10 years ago. He has only positive things to say about retiring to Mexico.
"I used to run out of money before I run out of month, and then here the cost of living is so good that I now run out of month before I run out of money," he said.
He said he does not mind the added hassle of living in a different country. His caregiver drives him back to the U.S. once a month to get his prescriptions and visit doctors, and he enjoys the outings.
"On the way I stop at a place called El Yogurt Place in Tijuana," he said. "Beautiful Eggs Benedict, oh my goodness, I look forward to that every month."
The only challenge to living in Mexico, he said, is that he does not speak enough Spanish, but hopes to be fluent by the end of the year.
Susan Cuzic's mom Adrianne was raised in the U.S. and also doesn't speak Spanish — "doesn't even know the word taco," Cuzic said — but likes Serena and tells her daughter she does not want to leave.
"The whole attitude of the Mexican culture is much different than that of American culture," Cuzic said. "They practically revere their senior citizens and they take very good care of them."
In fact, Cuzic is so pleased with the care her mom receives that she also hopes to retire to Mexico.
