Many of us dream of escaping a Canadian winter, especially this year, with the repeated snowfalls and freezing temperatures. As our population ages, the annual migration of Canadian ‘snowbirds’ to warmer climates continues to grow. Travelling with a person who has cognitive impairments can be challenging, yet it is possible with adequate planning. As your International Estate Plan changes to reflect cognitive impairment, so should your International Lifestyle Plan.

A few years ago, one of my fellow bloggers, Derek Hambly from Scotiatrust, wrote about the necessity of an International Estate Plan and the strategy of using separate wills for property or assets in another country. As part of a holistic Estate Plan, it is equally important to consider your lifestyle and care plans or an International Lifestyle Plan if you spend considerable time outside of Canada.

With the rising incidence of dementia in our population, the question invariably arises: Can I travel with my partner who has been diagnosed with dementia and cognitive impairment? Many families struggle with this question and are worried about older parents travelling. If older people are used to travelling and can manage their changing abilities, then travel can enrich their quality of life.

To assess how to proceed, the following framework helps identify potential challenges and strategies for addressing them.

Mild Impairment Versus Challenging Warning Signs

Be realistic when gauging a person’s cognitive and functional abilities. Mild cognitive impairment, especially in the early stages, may be manageable.

However, the following warning signs can signal significant challenges:

• Person becomes agitated and anxious in new settings and disoriented to time, person and place,
• Becomes withdrawn or visibly upset in noisy settings such as airports,
• Agitation and sundowning behaviours at the end of the day,
• Demonstrates aggressive behaviours or personal expressions in various ways, with loss of social filters when interacting with others,
• Increasing incontinence, and
• Wanders off.

Careful planning in advance is critical for successful travels. Here are some strategies to consider.

1. What To Know Before You Go

1. 1. Consult your medical professional who coordinates care. Depending on medical coordination needs and how long you are away, it may be wise to get a referral to a local clinic.
   2. Update the current medications list and take both e-copies and a hard copy. Some medications are not available in other countries such as Australia, so discuss alternatives. Take enough prescription and over-the-counter medications to last the trip and any extra days, if possible.
   3. Most medications for Ontario residents aged 65 and older are covered under the Ontario Drug Benefit Plan (ODBP). For travelling outside the country, a pharmacist can issue a 3-month supply for certain chronic conditions such as diabetes, hypertension, and high cholesterol. For other medications, if you have less than a 30-day supply, you can request up to 200 days of medication once per year between August 1^st and July 31^st. ODBP does not cover prescriptions filled outside Canada. [1]
   4. Take key documents such as a Power of Attorney for Personal Care and create a contact list of key people with phone numbers and email addresses.
   5. Have an emergency plan if you, as the travelling companion, become ill. Are you travelling in a group? Should you take a companion with you to help out?
   6. Consider printing up cards that you can discreetly use with airline staff, hotel staff, etc. “The person travelling with me has cognitive impairments, and we may need extra time. Please be patient.”
   7. Notify airlines, hotel staff, tour staff, and others in advance that your travelling companion may need extra time and assistance. People can be very understanding if they know what to expect.
   8. Time your travel for less busy days of the week, and the best time of day for the individual. Do not travel during peak seasons, if possible.
   9. Consider travel to destinations and locations you know well.
   10. Explore and investigate the best travel, cancellation, trip interruption, and medical insurance before you go. Note the pre-existing conditions.
   11. Review the health insurance coverage for each location to which you are travelling. An Ontario resident can leave the country for up to 212 days each year without losing their coverage under the Ontario Health Insurance Plan (OHIP). OHIP will pay for out-of-country health services for emergency medical services or previously approved out-of-country services if specific conditions are met. For example, to be eligible for reimbursement for emergency medical services, the condition must be acute, unexpected, and not pre-existing before you left Canada. If you plan to be away for more than 7 months, different rules apply.[2]

2. Preparations Before the Trip

1. 1. Consider an out-of-town trial trip in a hotel or similar accommodation. It’s a good test.
   2. Identify the person’s luggage, clothing and travelling items with both their name and your name and cell number.
   3. Consider using AirTags™, or similar tracking devices, for luggage and to slip into the pocket of your travelling partner just in case they wander off.
   4. Plan one activity per day and build in rests and meals.
   5. Bring ‘easy to put on and care for’ clothing and shoes. Add a change of clothing for excursions and travel.

3. Travel Day

1. 1. Leave lots of extra time for each travel segment.
   2. Bring items that are familiar and calming to the person, such as familiar books or music, drinks, or snacks.
   3. Use accessibility offerings such as early boarding.
   4. On boarding flights or trains, alert the attendants that you may need assistance with the washroom, etc. Choose seats nearby.
   5. Try to maintain a daily routine of meals, naps, and sleep.
   6. Slow down and enjoy the trip.

With careful planning, electronic health records and technology-supported monitoring, older people should be able to continue their travels even if they have mild cognitive impairment. As your International Estate Plan changes to reflect cognitive impairment, so should your International Lifestyle Plan. Happy travels!

[1] https://www.ontario.ca/page/get-coverage-prescription-drugs#section-8

[2] https://www.ontario.ca/page/ohip-coverage-while-outside-canada#section-5