Many people who have retired abroad probably haven't thought about the consequences if they needed to go into care.

At the point where you start to need help looking after yourself, or need to consider residential long-term care, you’ll face some difficult decisions. Here's a guide to what you need to consider.

Returning to the UK or staying overseas?

You can return to the UK to seek help, but your position will be uncertain.

When you arrive you will need to prove your intention to settle permanently. Your application must be processed before you’re deemed to have ‘ordinary residence’ – and success is not guaranteed.

Only when you have been classed as being resident, will you be assessed to decide whether you are entitled to state help with social or medical care. It means you may need to pay for a stay in a care home while you wait to be assessed.

Even then, there’s no guarantee you will receive any assistance from the state.

There are also other issues that make returning to UK a difficult choice.

If you’re a long-term expat you face losing your support network. If you are part of a couple and only one requires residential care it can be even more complex, because if you sell up to return, you may not be able to afford to buy in the UK.

Additionally, the half of the couple who is in better health may not want to relocate.

If you stay in your new home country, meanwhile, you need to consider affordability.

The UK government does not have any reciprocal arrangements to cover overseas residential care for Brits living abroad, or any residential nursing care, so you cannot turn to the state.

A study by The British Legion also highlighted that expats are particularly likely to struggle when they have lived within a close expat community and so have not learned the language or adapted to cultural differences. They can have difficulties with even small things like the food on offer in nursing homes.

The provision of private care varies enormously between countries too, so expats may not be able to find the kind of care they want. It’s important, therefore, to get to grips with what’s on offer.

Below we’ve explored the care provision in four popular retirement destinations and how much it will cost you.

A study by Retirement Advantage found that we are drawn to places like France, Spain, Portugal and Australia where the pace of life can be slower, and the weather warmer, so we’ve focused on these countries for this guide.

As a guide for price comparison, a study by Laing & Bisson found that the average cost of residential care in the UK is around £2,400 a month, and nursing care is around £3,100.

Care options and costs in Spain

In Spain historically there hasn’t been much demand for residential care. In the past ten years, things have gradually changed, and the market is growing.

There have even been some homes built specifically with British expats in mind. However, British expats frequently take to online forums to complain at their difficulties in finding anywhere suitable that’s available in their chosen area.

Costa Blanca couple on beach (Image: Artesia Wells, Shutterstock)

Residential services vary dramatically, but most have medically trained staff: a doctor will tend to visit regularly, and there will often be nursing care available 24 hours a day. At the moment the cost of residential care is marginally cheaper than the UK, and nursing care is roughly equivalent.

In Spain, meanwhile a study in 2014 by Knight Frank found the average monthly cost of residential care was around £1,800. The more services required, the higher the costs are, so hands-on nursing care can cost up to £3,000 a month.

The added consideration is that often expats have their assets in pounds, and the bills are in euros, so any further declines in the pound will make care more expensive.

Care options and costs in Portugal

As in Spain, when you get old in Portugal, there’s an emphasis on turning to the family. Here too there is a legal obligation for adult children to care for their parents.

It means that care services have tended to largely consist of organisations providing care within the family home.

The care homes market is growing, but the relatively small number of services, and increasing demand from an ageing population means prices are comparable to the UK.

Residential care costs around £2,200 a month, while more luxury or more nursing can double your bill. The relatively high cost is one reason why illegal care homes is an issue in Portugal, where families take old people into their homes, charging them less, but providing a completely unregulated service.

Care options and costs in France

Residential care is far more developed in France than elsewhere in Europe, and it offers significantly more beds (on a per head basis) than the UK.

There are also more options, because the market for sheltered accommodation offers an interim solution between staying in your own home and moving into a residential care home.

The other benefit of the French system is that if you pass a residence test, need help with daily activities, are over the age of 60 and have income below the threshold, you may be able to receive a payment called the APA to help cover your costs.

You may need this help, because according to Knight Frank, care is not cheap in France. The average monthly cost of care homes is £2,700 a month, and in Paris this rises to £3,100.

Bridge in Lyon France (Image: Shutterstock)

Care options and costs in Australia

In Australia the emphasis is on care in your home, so there is a developed network of private carers that expats can take advantage of to remain in their home for longer.

The network of care homes is less developed, and just 6% of over 65s live in residential care. Expats in rural areas outside of major cities may struggle to find what they are looking for locally, although there is plenty of provision in the major cities where expats tend to settle.

In these homes, the costs are broken down into a daily fee, a care fee and an accommodation fee. Each home varies in price according to the local market, but you can expect to pay £2,200 a month for the basics.

Additional care and services can double this cost.

Australians may get state help with some of this, including Brits who have become Australian citizens, but expats on temporary visas can expect to pay significant sums for care.

New South Wales Australia scene (Image:Shutterstock)

Don’t get caught out on care abroad

The lack of state assistance for expats is striking, and makes it easy to understand why a study by NatWest in 2015 found just one third of Brits living overseas expected to stay there forever.

It’s far more common for people to plan to stay while their health is good, and return to the UK when they need more help. It’s one reason why so many expats do not register as resident in their new home, because they want to be able to turn back to the NHS.

For those who do intend to stay, it’s vital to consider plans for the ‘third stage of life’. Online forums are packed with stressed-out expats who have left it too late, looked into the care and support at the point they needed it, and discovered they don’t have the funds to finance the long-term care they were expecting.  

[Read more: What going into care in the UK might cost and how to pay for it]