What to expect when you hire a medical travel companion for someone with dementia
Rudy de Kort / 27 JUNE 2022
Dementia care for air travelers
Many families don’t know they can access specialized dementia care for air travelers.
Yet, that is what we do as medical travel companions: take care for of that one passenger who would otherwise stay home, to avoid problems onboard or at the airport. What are some of the challenges and learning we face along the way? How do we keep family members in the loop throughout the process of relocating someone with dementia? And what inspired me to start this unique service? Keep on reading!
Planning for a flight with someone with dementia
Over time, I discovered that many planned, low-acuity transfers are treated like a transient phase between two places. Care is provided at point A or point B, but not necessarily in between. Only the unavoidable is dealt with en route, and the care plan is assumed to be temporarily put on hold, until the client reaches the destination.
But the distance that needs to be bridged between point A and point B can be quite long in a world where families are spread across continents. We are still doing domestic relocations from Toronto to Calgary, but the next transfer could easily be from Halifax to Sydney or from Moncton to Milan.
Families often feel that they are on their own when they decide to move their loved one over such a large distance, with little guidance on how to organize the care in transit, especially if the trip is from one country to another. They are left with questions like:
- How do we manage mobility dependency in the plane?
- Incontinence?
- Disorientation?
- Behavior that is not understood by strangers?
- Anxiety?
- Insulin?
And all the other things that they’ve successfully managed for years, but never thought about in the context of an airline cabin. A medical travel companion who has done it before, can be very helpful in these cases!
Preventing simple problems from escalating
The average airline passenger is considered to be either independent or only in need of simple accommodations. For those who depend on others for their wellbeing, there is a limit to what an airline can commit to. Airlines are transport providers in the first place, not care providers. But the reality is, there are now more travelers of 70, 80, even 90+, than ever before!
At the same time, we are witnessing the rise of the ultra-long haul flight: commercial flights that are operated by aircraft capable of staying in the air for more than 16 hours non-stop! How do you prevent all sorts of small challenges from escalating into a problem and possibly an in-flight medical emergency? A flight attendant doesn’t have all the answers. Neither does a wheelchair attendant, or a personal care aid who spends many hours at bedside, but never in an airline cabin at high altitude. And that is how Jet Companion started: an accessible, affordable service, that delivers specialized care in the air, while also taking into account the prevention of less obvious challenges like DVT and pain.
Traveling with Dementia is a Family Event
When a medical travel companion transfers a client with dementia, we are typically embarking on a long, international journey and exposing the client to a very dynamic environment full of cognitive challenges. For someone with dementia this can lead to over-stimulation, stress and anxiety, aggravated by physiological stressors associated to flying. Our flight nurses use their professional training and experience to complete these transfers, not only uneventfully, but also in a way that the client can actually enjoy. But the family can’t see that, unless they are traveling along.
Like in any care setting, family involvement is important, and with that comes the need for clear communication and emotional support while we take the whole family through this new experience of flying with dementia. Among many tools that we use to make sure the family and Jet Companion are on the same page, are our Intake, the Customer Briefing and a post-arrival video call.
How to think in solutions and make the trip happen
The type of service a medical travel companion delivers is very specialized. We combine our health care experience with the aeromedical knowledge of problems and situations that are specific to traveling, and flying at altitude.
People don’t expect that level of expertise when they approach us. They think in terms of wheelchairs and a helping hand to carry luggage and navigate the airport. So we have a good conversation with the family first. We listen and we explain what we do and why.
For example, why someone who doesn’t need oxygen on the ground, might temporarily need some in the air. Or, what can be done to safely transport a bedridden person without the need of a stretcher. Or, how we manage incontinence, medication schedules or sundowning while our plane is crossing time zones.
By all means, it’s not a lecture on how things should be done. It’s rather an exploratory exchange of ideas, as we start planning for the trip. All questions from both sides are answered. The family brings in their expertise about their family member. We bring in the expertise about in-flight care. We discuss the medical and nursing needs. And we learn about the client’s personality, background, and personal preferences.
Passenger, family and Medical Travel Companion as one team
The client with dementia might have his or her own set of questions, expectations, and preferences. So when we have a plan in place, we communicate it in a way that is easily understood. Prior to the trip we send a so called “customer briefing” which is an an overview of all the details of the trip. It summarizes what is going to happen, when, where, how, and why. These crucial pieces of information are highlighted and can be read over and over again by the client, as many times as needed, before, during or after the journey. For the family it also takes a weight off their shoulders when they can confirm that all the smaller details of the trip are also being taken care of. But it doesn’t stop there. When our medical travel companion meets the client with dementia, we chat. We build in time to establish rapport and make sure that everyone involved is on the same page.
Video Call at the Airport
After a long flight, families are anxious to learn how the trip went. They want to see with their own eyes that everything went smoothly and that mom or dad is calm and relaxed. They also know that it’s important to prove that they are still involved, within reach, that they didn’t just leave their loved one behind with a stranger. That’s why we plan for a little break, right after we deplane. As soon as we are in the airport terminal and our nurse can pick up a Wi-Fi-signal, we ask the wheelchair attendant to wait, and we get on a videocall to update the family and allow them to communicate directly with their loved one. It only takes a few minutes, and it is greatly appreciated.
Fit to Fly, if…
What inspired me, was the realization that flying is getting more complex for certain demographics. There is a need out there for services that in many parts of the world, are nobody’s core business.
When families ask their family doctor or the multidisciplinary team at a care facility if their loved one with dementia is fit to fly, too often the answer is a hard “no” but in all honesty, what they mean to say is “with so many factors that we can’t control, we are not prepared to take responsibility for this plan.”
At Jet Companion we’d approach the question from our own angle of expertise and say: “That is exactly why we are here. Let’s have a conversation about what is needed for your loved one to fly. And next we’ll look into how realistic it is to meet those conditions.’’
Don’t get me wrong: every dementia case reaches a point when flying is no longer responsible, whether temporarily or permanently. Healthcare professionals will rightfully consider the evolution of the disease process, recent events, and certain risks factors specific for that client. If red flags are obviously present, we won’t cross that line either.
But what we also see is that care providers tend to err on the side of caution, because they are unfamiliar with patient care in the context of air travel. In that sense, as a specialized service that takes the responsibility for that long-distance transfer, there is certainly a role for us to listen to their concerns, look at the documentation, and explain that we have actually worked out the potential risks, and have a system in place to manage those risks.
Fortunately, for many people out there, we are now often able to say: “Yes, we can make it work, if we plan ahead to manage the care needs that are brought forward, in the degree of detail it takes, and taking into account the challenges that are specific to this setting.’’
Rudy de Kort is based out of Edmonton, Canada, and his team of flight nurses provide in-fligth care, around the world on commercial flights.
This article was previously published on Dementia Map, a global resource for families who are learning about dementia.
EVERY MILE WE FLY IS FOR THE PURPOSE OF REUNITING PEOPLE OR BRINGING THEM TO SAFETY
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