Growing numbers of elderly and sick Germans are being sent overseas for long-term care in retirement and rehabilitation centres because of rising costs and falling standards in Germany.
The move, which has seen thousands of retired Germans rehoused in homes in eastern Europe and Asia, has been severely criticised by social welfare organisations, which have called it "inhumane deportation".
But with increasing numbers of Germans unable to afford the rising cost of retirement homes, and an ageing and shrinking population, the number expected to be sent abroad is only likely to rise. Experts describe it as a "time bomb".
The Sozialverband Deutschland (VdK), a German socio-political advisory group, said the fact more Germans were unable to afford a retirement home in their own country sent a huge "alarm signal". It has called for political intervention.
"We simply cannot let those people who built Germany up to be what it is, who put their backbones into it all their lives, be deported," VdK president Ulrike Mascher said. "It is inhumane."
Researchers have estimated 7,146 German pensioners were living in retirement homes in Hungary last year. More than 3,000 had been sent to homes in the Czech Republic, and there were more than 600 in Slovakia. There are also unknown numbers in Spain, Greece and Ukraine. Thailand and the Philippines are also attracting increasing numbers.
According to Germany's bureau of statistics, more than 400,000 senior citizens can't afford a German retirement home, a figure that is growing by about 5 per cent a year. German care homes cost on average between €2,900 (HK$29,700) and €3,400 a month. Costs at comparable facilities in Hungary, Thailand and Greece ranged from one-third to two-thirds of those costs.
As a result, the insurers that make up Germany's state insurance system are discussing how to make care in foreign retirement homes into a long-term workable financial model.
But the financial benefit of overseas care comes with downsides.
Sabine Jansen, head of Germany's Alzheimer Society, said that surroundings and language were often of paramount importance to those with dementia looking to cling to their identity.
"People with dementia find it difficult to orientate themselves in a wholly other culture with a completely different language because they're very much living in an old world consisting of their earlier memories," she said.
With Germany's population expected to shrink from almost 82 million to about 69 million by 2050, one in every 15 - about 4.7 million people - are expected to be in need of care, meaning the problem of provision is only likely to worsen.
Willi Zylajew, an MP with the conservative Christian Democrats and a care service specialist, said it would be increasingly necessary to consider foreign care.
"Considering the imminent crisis, it would be judicious to at least start thinking about alternative forms of care," he said.
Christel Bienstein, a nursing scientist from the University of Witten/Herdecke, said many German care homes had reached breaking point due to lack of staff, and that care standards had dropped as a result.