Category Archives: Health

Relocation & Expat Resources – Health. Information, Inspiration, How-To Guides and Tools for Trailing Spouses, Accompanying Partners, and Families in Transition.

Expat Essentials: Safeguarding your longterm health, finances and family. Defining Moves - The Art of Successful Relocation. Information, Inspiration and Resources for the Expat Trailing Spouse / Accompanying Partner

Not Just For Expats: 3 Ways to Safeguard Your Life, Health and Family at home and abroad.

Not Just for Expats - 3 steps to safeguard your longterm health, family and finances. Defining Moves The art of successful relocation
My version of long term care

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.


Expat Essentials: Safeguarding your longterm health, finances and family. Defining Moves - The Art of Successful Relocation. Information, Inspiration and Resources for the Expat Trailing Spouse / Accompanying Partner
How my children see it..

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.”


Relocating? 9 Essential questions every expat should ask. (Part 2)

It’s the second part of our guide to avoiding relocation disaster – and the same rules apply for domestic moves, diplomatic postings and international assignments. So before you sign on the dotted line, here’s numbers 4 and 5 of the essential questions that every relocating expat should ask.. If you missed the first part, you can catch it here.

4. What support is available? If you answered the first three questions, you already have an idea of what support you’ll need – so here’s where you have a clear conversation with HR about what support services are in place to meet those needs. Many packages seem lavish to the casual observer, but when you scratch the surface, the services included are not always right for your family needs.

Schools, for instance. While the local schools may be excellent, if you are on a 2-3 year contract with a high school age child. you need a curriculum that accepted by their target college rather than a host location one. If the relocation package doesn’t include funding for private schooling, your salary has effectively been reduced by anything up to $30,000 per child, per year.

Increasing numbers of assignments are to developing markets – India, China and Africa – all of which need considerable amounts of cultural orientation and language training. Does the package include enough for you to be able to function effectively and meet your personal goals outside the home or workplace? Shopping, medical visits, dealing with bureaucracy – all are a very real part of the transition, and all involve interpersonal communication.

These examples are gleaned from experience, and the best way to understand what support is needed is to see it firsthand. Hence number 5.

5. Do we get a family pre-visit? In my mind, the pre-visit is vital to a successful relocation – there is no substitute for seeing firsthand the challenges that you all will be facing. Throughout the assignment process, your life transition is facilitated by people whom you have never met, and who are deciding your needs for you. The pre-visit is your chance to see what they got right, and what they have wrong.

The biggest mistake people make is to use the pre-visit purely to find housing. This is wrong for two reasons:

  1. it means you agreed to the assignment based on a very small amount of information and
  2. the time is better spent identifying the challenges you face, not choosing floor plans.

So what should you be doing? Sadly, not staying in the hotel enjoying room service, or visiting the local tourist sights. Your goal is to recreate daily life, in all it’s glory, using the information that you put together in the previous steps. Look at neighborhoods, visit schools, experience traffic and commute times, do some grocery shopping, and most of all, talk to other expat residents.

Listen carefully to what they are telling you about the good, the bad and the plain ugly of your new home. Not all  of their concerns will be problems for you, but you can count complaints about the weather, issues with utilities, security, traffic and schools being pretty universal.

Once everyone has given you the low down and dirty, listen carefully to the concerns of your own family. The work environment will be more familiar and (usually) more supportive, whereas everyone outside of work is flying solo, and your package needs to acknowledge and make allowances for that. With “62% of all refusals to accept an international posting .. family related” and “34% of expatriates return from assignment prematurely because of family concerns”, this pre-visit is a time for the whole family to identify the potential pitfalls and possible ‘deal breakers’ while you still have time and negotiation on your side.


Tales of woe from the roaming professionals

Brookfield Global Relocation Trends Survey


Deer tick

Expat Adventures..Tick Bite Fever

Know Your Ticks

I like to think of myself as calm in the face of a crisis, so my own hysteria took me a little by surprise. Through 10 years of expat relocating, I have faced rogue elephants, stampeding rhino, a head-on with a hippo, floods, train derailment and a police inquiry, all of which have been endured with relative calm and a cup of tea / stiff gin and tonic depending on the time of day. But here in the bucolic calm of Lafayette, my previous calm has been shattered forever.

It started with an itch, which I attributed to a label inside my T shirt. It continued to gently irritate through the day, until by 7pm, it had upgraded to ‘sore’ status. I lifted my shirt and peered at my rib cage, only to discover a set of legs gently waving back at me. The rest of the head and body of a huge tick were firmly rooted in my flesh, and judging by the size of it’s abdomen, it had hit the mother lode.

There then ensued a frantic phone to Safety Staci, who can be relied upon to have the latest health updates on these matters. The token glance that I could manage without fainting to the floor confirmed that the creature was too far embedded for standard removal, so I was duly delivered to the Urgent Care Clinic for professional attention. By now the legs were no longer visible, I could hear a funny buzzing noise on the inside of my skull, and the casual observer could be forgiven for assuming from my overall demeanor that I was inches from death.

My reception at the medical facility was a little disappointing, starting with the somewhat dismissive attitude of the receptionist at the Emergency desk, who seemed to underestimate the life-threatening nature of a tick installation. Instead of being strapped to a gurney and raced at speed to the Operating Room, I was despatched outside the doors to await a courtesy shuttle to Urgent Care. And that title too was a misnomer, unless you are paying in cash. Filling in umpteen forms in triplicate while you are being eaten alive by a flesh eating parasite is no easy task, but luckily I have a stoic disposition and blatant disregard for legibility, so I did at least make it to the examination room alive. There I was greeted by a cheery doctor some years younger than myself, who proceeded to douse the offending tick in mineral oil and remove it with nothing more than a pair of tweezers.

With hindsight, I may have over-reacted. On spying a black breadcrumb-sized object rolling around in the specimen jar, my immediate reaction was ” Are you sure that that one wasn’t piggybacking on a bigger one?”, at which he emitted a very unprofessional snigger, and wrote me a prescription for a brand of antibiotics more commonly associated with teenage acne. It was all such an anticlimax that I am thinking of substituting a currant in the specimen jar so at least I have some shred of dignity left. The only saving grace in the whole debacle is that I didn’t take Staci up on her offer to be with me during my ordeal, to bear witness that I am truly a complete and utter twit.

So today, I’m staying in bed. My body needs to heal, and the memories need to fade. Along with my blushes.

Because we’re not immortal..

I’ve had  a wake-up call. Things have happened this week which have prompted me to take a look at the future – the one without me in it. And how my digital life is not very future proofed, and how many records of our life will be lost unless I start to do some digital estate planning. It’s something none of us want to talk  about, but the alternative is unthinkable.

I learned via Facebook that an old school friend had passed away having only reached 40, and his page is covered with tributes from friends he has made throughout his life. It struck me that it is a wonderful way to send thoughts to a family when you have no idea where they are in the world, but want to express your sympathy. But then I realized that they have no way of curating that page or contacting people on it directly, or even choosing how it will continue in the future. And that worried me.

I have religiously followed my own guidelines. I have a will that is valid both in the UK and the US, and details clearly what should happen to my assets when I die. I have an Advanced Directive of Health Care, which states who should make decisions about my care if I am no longer able to make them myself. I can’t remember if I mentioned this to my sister (she of the Sausage Splait, orange trousers and ScottEVest fame) but it’s her.. Ah well, she knows now, and I will be home in November to discuss wardrobe choices, hair colour, and just when she gets to do a semi ‘accidental’ trip over the cable and pull out the plug. I am even in the process of setting up a Living Trust, so that my beneficiaries avoid the lengthy and painful probate process. So on paper, I look like I have it covered.

But what struck me this week was that my online life has not been accounted for, and there is a great deal of it. On the financial front, there are the online bank accounts, which, if undiscovered, would join the hundreds of billions languishing in idle bank accounts worldwide and eventually turned over to the state or government until (if ever)  reclaimed by my executors. As we move around a great deal, all our accounts, including savings, checking and credit cards, are managed online, and the Other Half has no idea of most of the passwords. Yes, he has a checkbook and a debit card, but when you need access to more than that and the nearest branch is 5000 miles away, things become tricky. Any fraud on the accounts would go unnoticed, online payments could not be made, and day-to-day financial management would be hugely disrupted. Other potential accounts that need to be addressed include ones that would continue to have access to your accounts if not dealt with, such as accounting tools (e.g. Mint, Quicken, TurboTax etc), Paypal, and automatic checkout features on sites such as Amazon and iTunes.

But more importantly, in personal terms, all the records of family life are now stored on various hard drives and servers around the world. My computer has all our recent family photos stored on it, but is password protected, my Photobucket account has all the photos since 2003, but is password protected and my emails, my iTunes account, Facebook and Twitter feeds, this website – you’ve guessed it, it’s all password protected. And there is nobody nominated to take care of it once I’m gone, or even able to get access to it at all. I have backed up all our important documents (medical records, bank statements, tax returns) on Dropbox and Evernote, but the Other Half doesn’t even know these exist, and as he has also never read a single page of my website, you now have more information about my online activities than he does.. Whereas once we could pass on our CD or DVD collection just by handing over the boxes, increasingly valuable media collections are stored online or on hard drives and are invisible to those who aren’t aware of their existence. Diaries, blogs, photographic collections, family videos, computer games, software – the list goes on, and will have taken considerable time, effort and expense to accumulate, only to be lost in the shuffle.

So this is my plan this week – I’m doing a digital audit. I am going to spring clean my digital life so that anyone who does happen to be lumbered with the task after I’m gone won’t require therapy for the rest of their life. I’m going to delete everything that isn’t important, back up the essential stuff onto an external hard drive to be kept somewhere safe, and keep a list of just what digital accounts I have (and their passwords) with a copy of my will. I’m going to back up all our photographs and circulate them to various family members, hoping for safety in numbers. And then I’m going to write a message to be put out on Facebook, Twitter etc. in the event of my death, so that someone else doesn’t have to try and come up with the words, and you find out straight from the horse’s mouth. Which just goes to prove that you never will be able to shut me up..