Going Home, For The Last Time

November 27, 2022November 27, 2022

Submitted by Rudy de Kort
Jet Companion Canada Ltd.

For the expat with dementia, home might indeed be where the heart is.

Among families with first generation immigrants to the USA and Canada, it is not uncommon to find elderly parents and grandparents who cherish a strong desire to go back and spend the last years of their lives in their native country. More so when dementia is a factor, going back to the town where you grew up can mean a better quality of life and reconnecting with others in an otherwise foggy world.

When it’s time to go back home, families turn to medical travel companion companies like ours to plan these so called “end of life repatriation” missions from A to Z.

The Case of a Dutch Gentleman

A Dutch potato farmer had emigrated in the late ’80s to Alberta, Canada.

As he established and grew his new farming business, not too far from Calgary, he never slowed down and life just happened. His children and grandchildren did not share his history though. They did not feel any strong ties with Friesland, the rural region in the Netherlands where the gentleman grew up.

He spoke English and French fluently, and he was as much of a Canadian as all his neighbors, but in his heart he was Friesch in the first place, and a member of the Dutch Reformed Church in the second place.

Friesland Jet Companion on Dementia Map — Photo by Frank Eiffert on Unsplash

Alzheimer’s Alters Aspirations

When he retired, he started talking more and more about going back to Wolvega, the town where he was born and raised. At first his family didn’t think much of it. But when the uninvited guest called Alzheimer’s started sneaking in, everything turned upside down.

Decisions on how he would spend the last few years of his life now became a dilemma: would a care home in Calgary be the obvious choice? Or was this the last opportunity to give in to his long cherished desire to go back to Friesland, at the cost of being away from immediate family?

“Our presence didn’t seem to make the difference any more. It didn’t give him any comfort, and often we would question if he even noticed us being there for him.”

As one daughter described the situation: “Our presence didn’t seem to make the difference any more. It didn’t give him any comfort, and often we would question if he even noticed us being there for him.”

At the same time, he became louder and more emotional about his memories. It was difficult to ignore the thought that he might just be happier in a care home in Friesland, speaking his mother tongue, eating local dishes and sharing commonalities that would put him in touch with his younger self.

With his mind failing, would a radical change of his environment be the last opportunity to make a difference for him?

An Expert’s Perspective

Because this type of request is not uncommon for us, I discussed the subject with an expert. Her name is Alie van den Brink. She is a nurse manager at Korian, a group of 30 small-scale care homes, spread over the Netherlands. Through the years, she specialized in dementia care and welcomed many Dutch expats who returned to their roots in the evening of their lives. She shared some interesting thoughts.

Alie: “Whether it’s a good idea to organize such a large move for an 80+ year old, is a very intimate decision. What I can say is that someone with dementia can experience conflicting needs over time.”

Living close to family can be the most important support system for a while, but as the disease progresses, memories from the past sometimes bring more solace than family ties. Sadly, family ties can even fade away, making it hard to know for sure what would really make the person happy in his last years.

Why a Midnight Snack Made Perfect Sense

Private care homes in Europe aren’t necessarily better than those in the US or Canada. But many elderly expats, who emigrated as an adult, have one emotional conflict in common: they don’t forget where they came from.

They are home in two countries. The wish to return to Europe can have deep roots that go back far beyond the last decades, spent in North America. That’s why planned repatriation of expats is common, even when dementia has struck, and the end of life is near.

It can be the ultimate attempt to add joy and meaning to someone’s life. In the case of dementia, it can be the one move that makes someone “reconnect”, despite the long list of cognitive challenges.

Alie describes the most current foundation of dementia care in the Netherlands: “We are increasingly deepening our approach to dementia care. We use knowledge of someone’s past to better understand behavior that was previously considered problematic. Our strategy is carefully adapted to the psychological profile of the person in front of us.

“As an example, a gentleman arrived at one of our homes. He would attempt to order a kroket (a deep-fried snack), for take out in the middle of the night. Every single night. We soon learned that he had spent many years of his life living in hotels, ordering food at odd times.

“In the privatized setting, we are in the position to dedicate time to this type of individual needs, instead of a more corrective approach. We try our best to give our clients reasons to enjoy their stay with us.”

A Sense of Belonging

A sense of belonging is important. Care homes for specific ethnic groups, cater to a variety of expats from different parts of the world.

In the case of the potato farmer from Wolvega, he could of course be relocated to a Dutch Reformed care home in Ontario. He would enjoy the presence of Dutch-speaking staff, who would do their best to simulate a Dutch ambience by cooking authentic meals and playing music from back home. But even then, being Dutch is only a small part of being Friesch.

If the man is brought back to live in a care home in Friesland instead, he is now exposed to his own dialect that he spoke in his younger years and he is likely to have more in common with his peers and his caregivers. It also does wonders when clients with dementia are placed in a group of people with a similar level of intelligence, and similar interests.

Finding the right care home takes time, but pays off at the end, as there is plenty of choice, ranging from historic buildings in the peaceful forest to vibrant city locations with lots of human interaction. There is a fair chance of not only finding a spot but actually finding a care home where the client will feel at ease.

For the potato farmer, the options in his region would have a monthly cost of anywhere between 1,700 and 3,500 euros all-in. Organizing the travel mission, with a medical escort adds a one time cost that starts at 7,000 dollars and can go up to several thousands.

This sort of support includes airline tickets, a dedicated flight nurse who is trained to deal with all challenges related to dementia in the context of international travel, and adequate transfers to and from the airport. If needed, it would also include advanced care setups that involving medication, in-flight oxygen, or a stretcher onboard the aircraft.

What Moves Him?

It is emotionally draining to make end of life decisions in the wake of a dementia diagnosis. It can be hard to gauge if being close to adult children takes precedence over moving closer to for example an elderly sibling or a dear friend who was left behind in the past and whose special connection could make a difference now.

What personality traits are at stake?
Is the person very attached to traditions and his identity and culture?
What occupies his mind?
Is it his life at present or is it his previous life, before emigrating

It takes time to find the answers to such complex questions. My advise is not to wait until the elderly parent needs to move out to a care home imminently because of an incident. If relocation to the country of origin is a possible scenario, the discussion at the kitchen table should start in the early stages of dementia, when the elderly parent can still participate in the decision-making, assimilate the preparations, and live towards the day that the big step is made.

It would be devastating for someone with dementia to find himself in a plane to the other side of the world, and be totally confused about what is happening.