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Our Experts' Blog

Summer feature: Our top holiday tips for clients with additional needs

by Alex Hitchcock, OT at The OT Practice

Introduction

Holidays can be a logistical challenge, the location, the flight, the culture and climate, the list is endless of the considerations we all need to make when booking a break. For client’s with additional needs, whatever they may be, that list grows further. The aim of this article is to highlight some of the important areas of consideration whether for the client directly or for a professional, friend or family member who is booking on their behalf.

Budget

As much as each person’s needs are different, so is their idea of what constitutes a holiday. For some it is a luxury spa in a small town, where others want an action-packed week abroad. So first things first, know what your client considers as a holiday. What they want, where they want to go, how long for and the available budget. Budgeting for carers time and travel, equipment hire or transport will add costs and can change considerably depending on the location and a client’s needs so must be taken into consideration from the first stage of planning.

Location

Location plays a close role in the budget and the level of planning required. Cities such as Berlin, Dubai and Singapore are known for being accessible, but getting additional care or hiring equipment locally can be costly. Contrastingly, developing countries may not have good infrastructure, but travel and hiring additional support can be relatively cheap. Older cities without retrograde developments can also be troublesome. Paris for example is known for its difficult public transport and vast number of steps without alternate access options.

Amsterdam offers wheelchair caddies with lots of attractions having retrofitted lifts to improve accessibility although the cobblestones will require some additional navigation. Berlin is renowned for being wheelchair accessible but does not have very accessible public transport. Many of the Scandinavian cities have become very accessible, and many offer the ability to fly or cruise into town with ease. Vancouver and Seattle are notorious for being accessible with consistently good public transport links for wheelchair users.

Modern Olympic cities such as Sydney, London and Beijing are also likely to be more accessible, especially around central attractions and Olympic villages due to the influence of the Paralympics .

Insurance

Pre-existing medical conditions must be registered prior to travel on most insurance policies and it is beneficial to use an insurance agency that specialises in disability travel. Adequate insurance to cover medical conditions and equipment is required and should be carefully calculated. It is worth noting that most insurance policies will not cover wheelchairs if lost or stolen. Even wheelchairs lost at airports are not always compensated for in full.

Items to consider when selecting travel insurance include carer illness/injury, loss of medication, loss or malfunctioning mobility equipment, cancellation due to illness, carers insurance if paid while travelling, provision for replacement of personal items and medical equipment/aids (http://sath.org/how-to-travel-by-air-with-a-wheelchair). Generic insurance comparison websites generally have options to add medical needs or pre-existing conditions. (www.holidayextras.co.uk/travel-insurance/medical-conditions/disabled.html)

Airport travel

Each airport has a variety of regulations and services related to traveling with a disability. The Civil Aviation Authorities’ role is to ensure everyone is able to access overseas travel. Their website has useful information to outline what can be expected from the airport and airline within the European Union (https://www.caa.co.uk/Passengers/PRM/Passengers-with-disabilities-and-reduced-mobility/). If travelling outside the EU it is recommended that you investigate the regulatory body for that country and the specific regulations for the airport your client is travelling to. Please note that some services will come at a fee and may not be available for pre-booking.

The airline clients are travelling with may be able to provide further support on the ground so it is recommended clients needs are discussed specifically with their access team. Airlines will not provide a support seat or toilet transfers on planes or in airports, so if the client is unable to complete this independently, they will require carers who can support for each transfer. Toileting should be considered on a client-by-client basis, with neighbouring passenger’s comfort taken into consideration.

Bladder and bowel care

Prior to flying it is worth considering bladder and bowel care, with some clients preferring to have enemas the day prior or have a catheter to negate the need for multiple transfers whilst upon the plane. Access to bathrooms while completing stopovers, also needs to be a consideration.

Pressure management

Pressure management is a concern for clients with altered sensation, with total time on the plane, delays and stopovers to be considered. Clients with significant needs may require a multi-hour or day stopover to allow them time to change position prior to continuing their journey.

Possible delays

It is essential to plan for delays that can occur both before and after boarding. Some clients will not be able to wait once boarded, as other passengers will be expected to. However, airline regulations may not allow them to disembark once they have boarded or the doors have been shut. Behavioural, pressure care, pain, fatigue and medication needs will need to be considered in this event. It is also worth discussing carer expectations in this situation, especially if they are working in a shift or team and may not be able to contact case managers or other external support.

Documentation

For all airline travel a Medical Clearance Travel Form or Frequent Travellers Medical Form will be required. Each airline will have their own form which will need to be completed, with most requiring specific medical clearance. It is worth organizing this early as possible, as some practitioners will charge a fee or require a separate appointment to complete a pre-flight check.

Medication

If traveling with medication, a supply sufficient to your trip and in consideration of possible delays should be carried in their hand luggage. All medicines should also be carried in their original packaging at all times. Clients should always carry a letter from their doctor with a list of the medications, dosage and frequencies with the medication. Having this letter translated into the local language, with local medicine names provided, will also support efficient transfer through security as well as any other times that luggage may be searched. Having digital copies of all letters is also beneficial in case of damage or if duplicates are required. Checking up-to-date security and baggage restrictions is recommended, as generally medical devices and medications will be considered as sanctioned additional hand luggage.

Traveling with equipment

Mobility aides will be treated differently at each airport, with some allowing personal wheelchairs as far as the plane door, with others required to transfer into aisle wheelchairs in the terminal. Wheelchairs will have to be assessed by security personnel which may require the client to transfer in and out of their wheelchair, you can of course request for a private space in this situation. Mobility dimensions and weight also need to be considered for access onto the plane and stowage. Wheelchair batteries will need to be disconnected and put into a special box, as leaking batteries can present a hazard on the plane. To minimize the potential for lost items, all removable pieces should be removed from the wheelchair and each piece named with the client’s contact details, destination, flight number and home address.

Similar security preparations and equipment strategies should be used for other mobility aids, including scooters, crutches, walking sticks and prosthetic limbs. Clients should also be prepared to be patted down by security guards, including removing wigs, limbs or weight shifting in wheelchairs to allow bottoms to be cleared. Oxygen bottles will require special consideration and should be discussed with specific airport and airline prior to departure.

Timings

Due to the additional checks and potential pre-boarding requirements, clients are advised to get to airports at least three hours before their departure time to ensure they are ready to travel. Additional support from case managers may be valuable at the airport to ensure the beginning of their trip goes as smoothly as possible.

Working animals

Airlines must allow service animals to travel with owners, however they will be subjected to quarantine at your destination and upon return. The destination countries’ view on service animals should be taken into consideration as not all countries have equal rights for service animal users, with some countries not allowing them in hotels, public transport or taxis. Further information can be found at the following link, however country-specific research should be completed prior to departure: https://www.pettravel.com/blog/index.php/emotional-support-service-animals-airline-policies-and-how-they-are-changing/

Climates to consider

Climate impacts all travellers whether it be rain, temperature, humidity or freezing conditions. Anything different to what travellers are used to or prepared for can cause disruption to travel plans and needs to be accommodated for when planning a trip. Heat will require clients to consider additional hydration, fatigue and the effects of sweat on pressure management. Other considerations include the effect of heat absorption on black wheelchair cushions or metal push rims, thermoplastic splints melting in sunlight due to windows or their placement within a vehicle, as well as the necessity of air conditioning in accommodation and transport.

Cold/freezing weather will often require additional clothing layers, wind shields and increased indoor/respite breaks. This is especially important for clients with decreased sensation such as following a nerve injury.

Major weather events also require consideration, for example flooding in Venice (Italy) or Hoi An (Vietnam) can restrict access, block bridges and constrain transport links for days at a time. Monsoonal storms in China will ground planes and bush fires in Australia or Portugal can present immediate evacuation dangers for clients. Although some of these situations can be rare, travelling out of particular seasons can make planning much easier.

Additional equipment needs

Additional care and mobility equipment will be difficult to source when travelling, especially specialist pieces or specific brands. Therefore, if your client is planning to hire or buy something oversees rather than taking their own, it is strongly recommended to do prior research and book early. Knowing brand names and model numbers will assist in requesting the specific equipment needed, but do inform your client to expect some level of variety and differences. More generic equipment such as blood pressure monitors, crutches, walking sticks, oxygen tanks and dressings are fairly easy to find in most places. However, if there are specific requirements or a preference not to rely on local availability, then advise the client to pack accordingly and therefore remove some of the stress of sourcing these materials.

Car hire

When there is a requirement for a wheelchair accessible vehicle (WAV), pre-booking should be done as early as possible. It wont be possible to know how many WAVs are available as part of a supplier’s fleet, and so early contact can both secure a vehicle as well as examine potential cost-savings from different suppliers. If collecting cars from the airport, ensure the hire company is aware that a wheelchair-dependent client will require supportive transport to get to the car depot, as they can often be a short drive from the arrivals terminal. If the company is unable to support, a pre-booked accessible taxi may be required to collect the car.

Larger car hire companies, such as Hertz and Enterprise, offer a variety of accessible vehicle services. Generally, if unable to meet clients’ needs they are able to put you in contact with alternate companies local to the area your client is visiting.

Some companies offer basic driving adaptations, but it is worth contacting them in advance to determine if clients are able to take their own items such as push hand steering wheel aids or alternate pedal levers. Please note that this will often impact upon their insurance and the type of car that is available. Automatic gearboxes might facilitate these adaptations better since they require less handling, just remember to discuss this option with the client and ensure their familiarity this type of vehicle.

A few car rental websites worth exploring:

It is recommended that local laws pertaining to drivers with a disability and those travelling with a person who has a disability, are reviewed prior to travel to ensure your clients are prepared with the correct documentation. Preparation surrounding basic road laws, such as use of seatbelts and accessible wheelchair tie-downs, is also worth investigating to ensure your client and their equipment fully complies.

Tour Companies

Booking through a tour company takes a lot of the hassle out of the booking; there are a lot of companies who specialize in booking holidays for people who have a disability. If travelling internationally, they can reduce the impact of the language barrier and provide support whilst the client is on holiday. This can support case manager and client interactions due to potential time differences between the client’s holiday location and the case manager’s base. Their experience will also bring the benefit of having people using the service previously and reviews of what it is actually like. If booking through a company it is recommended that you request reviews from people with similar needs to your client.

Disability-friendly tour companies can be found specific to destination and many people with disabilities can use generic tour companies provided they advise on additional services required. Choosing the right tour company is imperative, with many associated with a specific target group. Where this is beneficial, is their targeted consideration for carers and support, provided equipment, suitable destinations and appropriate trip lengths.

Example tour companies include:

Booking Independently

Booking independently generally brings the benefit of saving some money, however it does of course require you to contact all providers and outline your specific needs to ensure they can be supported. This then adds the cost of your case management time to the budget, and therefore could outgrow any time and cost savings originally envisioned.

Clients requiring less support may be able to take on some of the research and planning themselves, and there is a lot of information available to those that wish to do so:

Accommodation Considerations

Disability-friendly accommodation comes in many shapes, with most hotels offering ground floor rooms, lifts and accessible bathrooms, with some even coming complete with hoisting equipment and specialty beds. If using a generic hotel however, contact them directly to outline your clients specific requirements and request photos of rooms available to ensure it will have the equipment space you require.

All of the big-name travel websites give you an option to filter for accessible accommodation when searching them, allowing you to easily refine your shortlists. You can of course use keywords in tandem with a generic search engine (such as Google), just ensure the results you come across actually represent what you are looking for.

Some examples for consideration include:

Cruise ships

Travelling on a cruise ship gives the benefit of getting in a lot of scenery and sights, without the hassle of moving regularly and transporting luggage. There are multiple options when discussing cruises, ranging from short-ocean only stays, European river journeys to month-long round the world trips. The benefit of a cruise is the option to go on day trips when in port or watch the world go by from your cabin or the deck. More ships are now accessible to wheelchairs and are able to support a range of dietary needs. Space on ships will always be an issue, so wheelchair turning circles and having space for equipment will need to be considered.

Cruise ships advertising disability access and reviews:

UK Based Holidays:

The UKs diversity offers a lot of opportunities for easy travel. Staying within the UK brings the benefits of familiar language, services, reduced travel distances and ability to use your own transport. The UK also boasts some of the world’s best festivals, with many becoming more accessible for those with additional mobility and/or sensory needs. Although the UK doesn’t necessarily boast the best beach weather, it does have beautiful coastline.

Festivals in the UK

Best disability friendly beaches

  • Boscombe and Bournemouth Beach, Dorset
  • Gyllyngvase Beach, Falmouth, Cornwall
  • Skeness Beach, Skegness
  • Summerleaze Beach, Bude, Cornwall

Additional beach information can be located through:

Disability Grants, website with wide range of grants available for people with disabilities and carers https://www.disability-grants.org/holiday-grants.html

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