This post was sparked by an episode Mad Men – a series about adverting executives in New York in the 50’s and 60’s. This particular one covered the characters’ responses to the Cuban missile crisis.
Kennedy was had just given his famous television broadcast, highlighting the potential threat to the US from the Soviets, plunging the characters into a frenzy of uncharacteristic behaviors.
In justifying their sudden need to fulfill life dreams and expectations, one of the characters made the comment:
” We might not be here tomorrow”,
to which the reply came;
“Isn’t that always true?”.
We all applaud the idea of living each day as if it were your last, but are incredibly naive about what that actually means. Most of us imagine finally parachuting, walking the Inca Trail or any other number of ambitious, death defying activities listed on our bucket list. It bears little relation to the reality of life and death.
The concept of seizing the day is reliant on good health, or at least mental consciousness, the absence of pain, and a considerable amount of forward planning. If I ask how many of you have checked your medical records, understand your health insurance rights and coverage, or have an advocate who knows your wishes in the event you are unable to make decisions, 97% of the room start twitching nervously and suddenly find their notes fascinating. Sound familiar?
For those of you who are now in a state of panic, let me reassure you. You don’t need to start visiting psychics, ordering crystal balls or trying to predict every eventuality – in fact, the simpler you keep it, the better.
To get you started, here are the three essentials to consider:
Health Insurance for Locals and Expats Living Overseas.
For those of you who don’t live in a country with a National Health Service (and for many of you who do), for any travel abroad or residence overseas, health insurance is essential. While many services and regular care can be contracted more cheaply without going through an insurance service provider, for the expense of chronic, emergency and long term health coverage, you need a safety net.
Sadly, most insurers are for-profit businesses, which means that they are careful (and in some cases, downright difficult) about handing out money, and have many ways of avoiding or limiting it. Not being completely honest about your age, activities, destination and current or previous health is the fastest way to get your claim rejected and end up with a huge bill.
Pre-existing conditions, so-called ‘extreme sports’ and high risk behaviors (i.e. drug taking, using prostitutes) are common exclusions and many policies only cover your host country. They often specify services and providers that you can use, required co-pays and ineligible treatment and procedures. This means that either you personally, or your family, will be liable for any healthcare costs not met by the insurers, and these can stack up really, really quickly.
The basics to consider include:
- What exclusions apply to your policy, and are they relevant to your situation?
- What are the insured maximums, and what does that really mean in terms of local care?
- Are you covered for transport home?
- In the event of your death, will your remains be repatriated or is that the responsibility of your next of kin?
- If you have company insurance, how are your benefits affected if you are no longer able to work or have to terminate your assignment early?
- What happens if care is not available in your host country? Will you be sent home, or to another country, and if so, can family members accompany you?
- If you are taken ill when overseas, are you covered for a family member to join you? Who will look after the children? Who will be your advocate? How do I make my wishes known in a way that is legally binding?
In the event of serious or long term illness, where do you want to be?
Common wisdom dictates that we like to be surrounded by our nearest and dearest, but for some, that qualifies as the one of Dante’s Rings of Hell.
As Greta Garbo is famously uttered “I want to be left alone”.
Most of the time the answer is “wherever I can get the best care”, but the reality is harsher and involves finance, family, support and legal residence issues.
For working expats, the decision is often taken out of their hands – once you are no longer able to work, your visa is invalid, and you are repatriated. For those permanent overseas residents the choices are wider, and many choose to stay where care is cheaper and there is less pressure on family members to be full time caregivers.
Returning ‘home’ is often not as easy as it seems, and may require significant adjustment – repatriation is difficult under the best of circumstances, so expect a period of transition for the whole family, especially if you have been expats for a long period. Consider both mental and physical health needs for all the family – there are many excellent counselors that can deal with adaptation and coping issues, both for you, your partner and your children. x
Before you take the decision to move back, you will also need to check that you are entitled to healthcare benefits – either though the national health service or via your insurance – before you move; many insurance companies will not cover people with certain pre-existing conditions or will demand high premiums, and your expat insurance may only include your host country. Consider also what is included, whether it is just urgent care, inpatient care or ongoing long term care – and also, the standard of care and and waiting lists.
Do you have an Advanced Directive of Health Care?
More commonly known as a Living Will, this document defines who will make decisions for your care in the event that you are unable to do, and sets guidelines for your care. We tend to assume that here only apply if we have a serious debilitating illness, however having a stated person to advocate for you is invaluable for acute and emergency medical conditions too – whether you are simply under anesthetic, unconscious, in severe pain or have temporary amnesia.
Your advocate doesn’t have to be your life partner – I have chosen my sister for four reasons: firstly, we have similar decision making processes; I would rather that my partner was free to concentrate on his own needs and those of the children; she has a great relationship with my partner and I trust her to make the best decisions for both him and I without being burdened with guilt and expectations, and finally she has a great sense of humor, and if anyone can find the laughter in any situation, it’s her.
Many doctor’s offices have ADHC template forms that you can complete, but it’s worth getting legal advice – many terms vary between states and countries. Use simple language to eliminate the chance of misunderstandings, be specific about your intentions, state what treatments you are and are not willing to receive (especially in countries with different health standards and practices), nominate a healthcare proxy (someone who you trust to make decisions for you) and ensure that they understand, agree and that their contact details are accurate and finally, get it witnessed, preferably by someone with legal standing.
Ill health happens, and never when we expect it. When it does happen, it’s a knee jerk, all hand-on-deck approach, dominated by the need to get care quickly, the demands of the medical staff and the fear of the unknown. It is always inconvenient, unexpected and bewildering, and as a former nurse I can tell you that the last thing your partner or loved ones want to be doing is second guessing your choices. They need to know what you would want, and they need it in writing. It needs to be discussed, agreed upon, written down and easy to find. You can change your mind at any point, but we all need somewhere to start.
And as a final piece of advice, bear in mind the words of wisdom from Phyllis Diller:
“Always be nice to your children – they are the ones who will choose your rest home.”