To try and get my Dad back to the UK so he can die here

[Ataloss23]

I am looking for a bit of support with this, as I don't really know where to start!

My Dad lives in the USA, born in Scotland but moved over in 2019 when he married his wife who he met whilst traveling over there.

18 months ago he was diagnosed with stage 4 pancreatic cancer. He tolerated treatment well, and we have been lucky to get more time with him.

He decided he wanted to move back to Scotland, so he could live out his days here. He sought advice from lawyers and they began the immigration process for his wife, which has been long winded. She has paid all of her fees, including NHS fees and had her embassy interview 9 weeks ago. We have been told it takes up to 12 weeks to get a response.

His treatment over the past few months hasn't gone as well as it has been, and he has taken a real decline this week. I've ended up flying over to America to be with him as we don't know how much time he has left. We are discussing hospice options, and he has said that he would much rather find a way to get back to Scotland, because he still wants to die back home. So I am trying to do everything I can to get him home, but would really appreciate some guidance.

His Dr here has said that he may be able to discharge him for flying, if he feels he would be able to manage the whole flight and we can manage his pain. My concern is how quickly could we access services in the UK? We live quite rurally, so not the same issues for getting access to GP as people in larger populated areas experience. I'm more concerned about how we would access District Nurses, pain relief, stuff like that rather than home support/hospice/care home, as we will be providing his care at home and should manage it all between us.

And regarding the Immigration process - his wife is unable to travel to the UK while immigration clearance is ongoing. Is there a way to expedite this to get him home this week does anyone think? As much as he wants to be here to die, he doesn't want to be here without her. I have plans to phone Immigration in the morning from over here to see what we can do, as I feel this is the biggest challenge we are going to face.

I know this isn't a very common situation, but does anyone have anything similar that they could share with me, or have any professional insight regarding accessing District Nurses or Immigration?

I'm also trying to suss out what services we will need to get him home - private ambulance from the hospital to my house, a hospital bed (can I even get one of these in the house if I don't have access to OTs? Pain management in the community etc. Is there anything else I haven' considered that I need to look into?

I know we are probably chasing something that isn't possible, but I want to make sure I'm doing everything I can to meet his wishes.

Any thoughts or advice would be great please!

There’s so much in this, but as far as his wife is concerned, can’t she just come on a tourist visa (at least to start with)?

This. Trying to get a residence permit, despite the extenuating circumstances, can only bring more stress and heartache, and i am not quite sure it would be easy to get at all considering her sponsor would be so ill and unable to suport her in the long run.

in terms of medical support, I really don’t know how things work in Scotland but if in England I would be worried about the likelihood of getting carers willing to travel regularly to a remote location and it may be quite taxing to drive your dad to hospital regularly or problematic in case of emergencies.

The life expectancy for pancreatic cancer has improved very considerably in the last decade so if I were in your shoes, I would try to convince him to stay were he is receiving adequate treatment to prolong his life as you never know, things can change for the better. If he is only receiving palliative care it woukd be different but again, it is impossible to predict if he would be able to get the same level of care he is getting where he is.

Best thing you can do OP is talk to the local doctors surgery re that side of things.

Sending hugs OP x

Much of Scotland is very rural we have a population of approx 5.5 million of which 4 million of those live in the central belt so most people outside of this area bar a few exceptions are likely to live at best in a small town at worst literally in the middle of nowhere. NHS Scotland is not perfect but it is very aware of the problems of rural remote living including problems of getting carers to visit patients in very remote locations. So in most rural areas HCSWs are employed by the NHS to provide personal care to EOL patients in very remote locations so getting carers to visit is not usually an issue.

I'm very thankful to everyone who has shared their experiences. I'm especially thankful to @BurnoutGP and @tiredwardsister for letting me know it could be possible if we get everything in order prior to leaving.

When I say I live rurally, I mean away from the few major cities in Scotland, we are 15 minutes away from two community hospitals that have wards where EOL care is possible should we not be able to manage his pain at home.

Due to my own experiences, I would feel comfortable managing his medications as required for the course of the flight. I am also looking into a private ambulance to get him from the airport to my house.

Thank you to the poster who pointed out a out the airline, I will need to contact them to confirm if they would accept him.

I am in the process of writing to MP/MSP to see if they can offer support/advice around the immigration process. It will be 3am local time for me when the immigration line will open, so I am going to phone then for advice to see what we can do for his wife.

I understand some people may not agree that we want to support his wishes, however I would hope that my family would support me in my final days/weeks. Selfishly, I cannot stay I the US indefinitely until he passes due to my commitments at home, so if I can bring him home with me, I would get to be with him. I wasn't with my Mum when she died because I was a young and couldn't handle it. It's been one of my biggest regrets in life. I feel I need to do everything I can to be with him in his last moments.

That's good to know.

Pain meds are extremely tightly controlled here now but hospice care makes access easier.

Go over the airline regs for flying with his meds. They might have to be in the original containers. Liquids might need hand checking.

Another vote for bring him home, and do so as soon as possible.

I have medically repatriated terminal cancer patients on commercial flights; it's absolutely possible and there are ways to make it easier. You can request wheelchair assistance when you book your flights, so that he won't have to walk long distances or carry bags. I would inform the airline of the situation, but if you do this you must get a fit-to-fly certificate from the doctor before you go. Cabin crew are brilliant, and they have medical training if he deteriorates in-flight.

Have you spoken to his insurers about it? I don't know what they'd cover but it's worth asking. The insurance company I work for would send a medic (e.g. me!) out to repatriate him and they'd fly him in business class. A flat bed and lounge access makes it much less exhausting. They'd also arrange an ambulance to take him home from the airport, and the medic would give him IV pain relief if he needed it during the journey. He might need an anticoagulant injection before the flight to prevent blood clots; ask the doc!

My dh had eol care on the nhs and hospice at home. Wouldn’t recommend it to anyone.

Good luck OP I hope you manage to get your father and his wife to Scotland ASAP.
Im not sure if technically you can register with a GP before he arrives here but you should be able to register with a GP on the day of his arrival and get referred to your GP practices community nurses on the same day. We would come out and see your father either that day or the following day and start putting support in place immediately.

That’s good to hear, the problems you can face in not so remote areas in England is that although the carers are employed by the local authority, I have heard elderly people saying the care is unreliable at times, I can count at least 5 times in a year when an elderly lady I knew was not visited for days due to ice in th ex roads (I suppose they have that under control in Scotland) and someone told me they struggled to get carers as they were paid for the visit time plus travel expenses but if they could only do one visit in the morning due to distance they wouldn’t have enough income to survive on.

i agree.

I wish you all lots of luck with this, Ataloss.

I dont know if this had already been said but hospice space is not always easy. I think if your dad’s wife has a plan for somewhere to stay he may well be there with her at the end. If he would rather that than a hospital. I think if you are coming back act quickly. Otherwise it may be better to stay in the us. As tough as that is a long flight could be uncomfortable. Thinking of you op.

You can normally withdraw a visa application and then she can come as a visitor. There’s a chance the border officer will then stop her as not a genuine visitor when the withdrawn spouse application comes up on the system. So I would just make sure the wife has letters from doctors etc explaining the situation and her husband’s prognosis

The MP might be able to speed up the Home Office if you contact them.

Don’t you have to have been back in the U.K. for a certain period before being eligible for NHS care, as being resident is the criteria for free NHS care?

Thank you for this point of view and great to know these options.

While I do not have the means to support with a business class flight, we do have family friends who may be willing to support, so it is something we had considered. He has dual citizenship as British/American citizen, and is entitled to Medicaid, so I don't think they would cover that aspect, but also good to investigate.

@ChocHotolate he worked every day of his life prior to retiring in the UK paying taxes, and has continued to pay UK taxes on his state pension and his work pension. I don't believe that plays into it as some others have said, but he has paid the same taxes he would've paid if he had continued to live in the UK.

Often once you’ve started the visa process you can’t leave the country as the embassy
may have your passport/you aren’t allowed to.

Or they may deny you entry if they suspect you want to live here etc
It may be tomorrow the wife gets all her paperwork etc but if not she may need to see if there is a way to cancel it asap.

Nope. As long as it is a permanent move home.

I’m sorry to hear this we don’t have hospice at home in the part of Scotland I work in or in many other rural areas you may see it in some of the bigger cities.
I care daily for people who are dying at home and their loved ones. The very positive feedback I get from bereaved when I visit the families them after the person has died to offer my condolences is that they had no idea dying at home could be “like this”. Bar a very few exceptions they have found the experience to be very positive for them and their loved one who is dying. All feel very supported and cared for.
In my very extensive experience providing symptoms can be managed the person who is dying and their families are much more relaxed and settled in their own home/environment.

he won’t be registered with one, so he would be struggling with pain

He only left in 2019 so he may well be registered with his old GP.

I live in France. My English pension is paid into an English bank but I have to declare it in France and pay French taxes on it. I don’t pay taxes on my English pension in the uk. Wish I could as the English taxes are cheaper.

Thank you so much for your support. I have emailed and asked if there is an option to register via a Near Me consultation. They are aware of his situation already as I had reached out to see about continuing his oncology care when they first started the process to move back home. I will see what is said when they open in the morning as my experience is that their team are very supportive and accomodating - I know I'm one of the lucky ones but I can't fault my GP surgery

My first thought when reading your post was that he’s too far gone at this point. The long flight will be difficult and do him no favours. But it is up to him, if he wants to try it then it is up to him. I’m not sure I would be encouraging it really.

Different situation. Local carers are provided by the local authority, under council adult social care budget. These people are not at end of life and requiring sedation, midazolam via a syringe driver or other palliative comfort measures provided at home by the NHS.