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The Equities of Accessible Travel

Friends 🙂

My brother generously inquired of me recently, “what would it take for you to travel?”

I expect, at worst, he anticipated one of my lengthy emails to parse through looking for the detail he hoped to find. Little did he know, he would get this lengthy monstrosity instead. 😉

So here you are, this is a one-off draft. I do hope it’s worth it’s ink, or at least its electrons, and would appreciate any insight around content, continuity, or value for others.

Was this just an amusing exercise, or is it a good first draft?

To be more broadly useful, where does it need to go from here?

Thank you and I hope you find this at least amusing. 🙂



The Economics of Travel

From any perspective, a robust economics constitutes an awareness of and accounting for the full spectrum of give-and-take arising in a particular environment. When that dynamic is in harmony, we have a wellbeing of homeostasis and growth; when it is out of balance, we find excess and decay.

This document is meant to provide insight into concerns we might face when we, or someone we care about (and for) is met with the invitation, desire, or need for travel. It is written from the perspective of a highly motivated and engaged quadriplegic. The points offered should provide a starting point for anyone, “able-bodied,” “severely disabled,” or anywhere in between, to contemplate the economics of travel from an omnidirectional care awareness point of view.

To consider:

  • Appreciation of opportunity.
  • Presence and portability of care.
  • Means of movement and presence of care in route.
  • Residential accommodations on location.
  • Accessibility and structure of precipitating engagement.
  • Influences on existing care community/structure.
  • Influences on destination value.
  • Financial cost.
  • ESG Considerations.
  • Overall cost/benefit evaluation.

Appreciation of the opportunity.

To begin a reasonable assessment of the economics (read: values, risks, and opportunities at play) of any situation we are wise to first assess what we may regarding the nature of the opportunity. In other words, it is good to know in broad strokes exactly what is the object we are considering.

What is the essential gem of this possibility? Do we expect to learn something, to share something specific, to have a certain experience, or make a certain connection? Appreciation of the opportunity is just that; to make good on what truly precious thing is in potential to be born.

Of course, the details of this and the risks involved, either peripherally, or centrally will be considered as we go, but the starting point is truly to ask what and if we should be excited enough about to pursue.

Presence and portability of care.

The first questions we must ask enable us to recognize whether the current state of affairs reflects a basic sufficiency of care required for the individual (or system at any scale) to sustain its wellbeing in the dynamic environment of travel.

The degree of required care will vary of course for each of us. Some consider nothing more than the invitation and a toothbrush to be care enough and easily portable as well. Others may in fact require extensive specialized equipment and support personnel simply to travel beyond the front door. The “care” to which we are referring can be considered in three dimensions: awareness care (such as the insights in a document like this), person care (at minimum the one caring enough to respond to invitation, all the way through to “support personnel”), and material care (ie. the toothbrush or specialized equipment.)

For the sake of simplicity and clarity we will consider these matters from the point of view of our aforementioned “motivated and engaged quadriplegic.”

The first consideration in this territory is the actual primary and fundamental presence of care necessary to function, not just from bed, but in the world at large. While this may seem obvious, or trivial, this is unfortunately not always the case. Certainly not for all, and often not all of the time.

Awareness care, though not to be overlooked, is simply the presence and portability of the necessary awareness required to fundamentally manage the entirety of the endeavor. This care is found throughout the system, in the individuals/individuals invited to travel and their community, the place, opportunity and/or persons extending the invitation, even within those they may encounter along the way. To what degree and with what sophistication are we aware of the vitality and harmony in these flowing currents of care?

Person care…

In the case of the quadriplegic, this fundamental presence of care begins with the persons who provide the actual hands-on experience of care. These Care Partners act skillfully in the role of comprehensive facilitation. To exist in a state of wellbeing at home, let alone at large in the world, one substantially limited in the use of their arms and legs (to say nothing impolite of bowel and bladder 😉 is quite dependent on the reliable presence of such partners for many, if not most of the hours and activities of the waking day.

Caregiving is an intensive activity (read as: emotionally, psychologically, and physically demanding) in a well appointed home circumstance. A Care Partner is attentive to basic nutritional and hydration needs, any ongoing body care concerns (hygiene and “waste management”) as well as any necessary attendance to mobility, agility, and environmental matters. In short, acting in this capacity calls one to stand in a state of heightened attention, mindful not just of these elements for themselves, but for another as well.

Care in this regard is not a static resource, but must be rested regularly and maintained even in its “off” state. At home, eight hours of this activity is considered quite substantial for a given individual, slightly longer can be managed for a time, but even doing so one evening, and returning the following morning is a level of intensity that is frowned upon.

For our featured quadriplegic, breaking this activity out one week at a time, a team of five is necessary to provide an adequate balance of respite and professional capacity in attendance to the matters. This goes to presence of care, portability is another matter.

Taking these affairs “on the road,” requires us as Care Partners to manage the usual concerns, but in contrast to a stable and established “home” environment, the context becomes increasingly VUCA. The intensity of the demands for resilience and agility on the inner state of the individual rise substantially.

Similarly, with the shifts in environment and often “full schedule” of travel destinations (yes, even vacation) the sheer volume of “hands-on” activity is often notably greater as the resource of the familiar home environment must be re-created and maintained dynamically and on the move.

All of this translates to the consideration that eight hours of caregiving on the road is wisely considered to be the equivalent of a much longer day at home. Where “at home,” a team of five is necessary to keep things in balance over the course of a week and longer, the duration of a travel event lasting greater than part of the day requires its own calculus to determine the number of partners to maintain the health and wellbeing of the mobile cohort.

As a rule of thumb, one caregiver (with good support at home, and on the road) can manage a 24 hour excursion within a few hours driving distance (assuming an appropriate vehicle.) For longer durations, or 24 hour affair requiring some form of navigating commercial travel, at least two partners are necessary, with international and/or durations greater than 72 hours requiring 3 or more.

Finally, we must also consider the explicit care for the caregivers on the road. Again due to the nature of the “foreign” environment and the intense requirements to be “on” when acting in the capacity of formal care, the container and facilities of “downtime” for these individuals cannot be undervalued.

In some cases, the formal activities of the invited travel may resonate closely with these individuals, and in other circumstances, and to varying degrees, simply having personal time to introspect and refresh may be the very real priority. Regardless of the fluency of this spectrum, care must be taken to ensure that these Partners find sufficient accommodation and facility for the pursuit of their own state of day-to-day happiness and wellbeing.

This may require some formal “travel allowance,” depending on the general availability of food and opportunities for engagement, or simply a map of nearby trails and a friendly reminder of mealtimes. The importance of ensuring a nurturing atmosphere of care for these partners in care, cannot be overstated.

Material care is familiar to most of us, “wallet, keys, lipstick, purse…” or variations on that mantra echoes in common colloquialism. When it comes to traveling with “disability,” the packing list takes on a distinctly more complex air.

As a quadriplegic I travel with a 35-pound wheelchair in tow and, for any event lasting overnight, will pack an additional commode/shower chair. The latter of which takes up its own large bag and weighs approximately twice as much as the former. Some medical supplies can be useful for short day trips out of the house. The requirements for such supplies accumulate to essential additional packing space for something as brief as an overnight. Longer trips add gradually more to this equation. Travel materials for overnight include a foam mattress topper for skin protection, and a 1500 W space heater/fan for specialized purposes.

This “material care” is essential. By way of illustration, I once traveled to Brazil for 18 days (with 3 care partners rounding out our little collective.) After the first 16 hours of our travel, — drive north to LA from San Diego, flight from LAX to Rio de Janeiro — we found ourselves waiting for bags at the airport turnstile. Emerging from the portal in the wall, along the conveyor comes first the big rectangular black bag with shower/commode chair. Along with that and naturally interspersed with the bags of other travelers, we collect our remaining items… Except one.

The bag with my clothing and medical supplies was taking a long time and it was apparent we were down to the final bags. Without the specialized equipment, relevant contacts, or fluency with the local language, remedying the absence of those supplies in route would be a nonstarter. It struck me, a sudden realization, if that bag had gone missing on the international flight (or any other of that trip for that matter), it would not so much impair, as urgently and abruptly cancel the whole affair.

How we found the bag and what happened next is a story for another time. The bag did arrive and we were on our way to continue what was a priceless journey. But to the point, as the material care required increases in its specialized nature and volume, so too does its impact on the calculus of the possible.

Means of movement and presence of care in route.

Not necessarily so “mission-critical” as the presence and portability of care, but no less material to the calculations of the practical are the means of travel and the presence of a variety of care in route.

Taking these one at a time, the means of movement bear a particular significance when faced from the point of view of a quadriplegic (and care partners). Hills, stairs, uneven surfaces, narrow or broken pathways, heat, cold, rain, long periods of stasis, and other environmental factors come into play in ways often overlooked and entirely unimagined for the otherwise able-bodied.

Even something so simple as a car service takes on new dimension when faced with the requirement to transport, in addition to individuals and luggage, a wheelchair with its awkwardness in shape and size and needs for exceptional care in handling.

Routes and timing must be considered in detail, with accommodations for potential deviation. Delays or absence of adequate transport resources create new orders of complexity when they demand a new overnight, changing travel mode, or anything else that might change the calculus of supplies on hand and infrastructure needed for environmental, to say nothing of, bowel, bladder, or skin care.

Concerns of various modes:

Travel by “foot.” — This can be terrain between housing and conference centers, pathways around and within retreat facilities, “about town” for accommodations such as restaurant, grocery, etc. These are best considered from the point of view of the Partners in Care who will be tasked with pushing what essentially amounts to a 150 pound wheeled cart over whatever terrain may be encountered. Of course exposure to the elements must be considered as well, as internal temperature regulation can often be severely disrupted in the quadriplegic body.

Travel by “car.” — As the transfer from wheelchair to vehicle and back is a single person lift and transfer affair, again this is largely considered from the point of view of the Care Partner. Given the mechanics of such a transfer, it is impractical to do so into, or out of a sedan style (height) automobile. The demands of the low seating situation compounded by the need to “duck under” the roof level creates excessive strain on the lower back of the individual doing the lifting and almost inevitably results in injury.

As a result, any travel by car necessitates not only adequate storage space for the wheelchair and any additional luggage concerns, but also a vehicle of an adequate height that the transfer lift can be a strictly lateral move with no downward bend required to either place or retrieve the quadriplegic occupant. As a general rule of thumb this means automobile transport requires an SUV (full-size or compact,) van, or truck (the latter of these being a special case as it would be inappropriate to transport the wheelchair In an exposed bed during inclement weather.

Travel by commercial buses, trains, or airplanes. — Travel by these modes is measured and considered first in terms of time. One of the concerns of transporting a quadriplegic body is that of managing the health of the skin which can breakdown rapidly in situations of longer-term stasis (greater than a few hours) causing injury that can disrupt or even cancel further travel.

In explicit terms, the quadriplegic body needs to be repositioned periodically. If sitting, this means laying down (or reclining substantially) every few hours, or vacating the seat entirely for an adequate break of some kind.

When traveling a longer distance (stasis duration of greater than four hours,) this often necessitates “class” upgrades in order to allow adequate space for body movement and Care Partner’s ability to maneuver around the person. When traveling with one or more care partners, this generally necessitates an additional class upgrade for at least one of them.

Of additional concern when traveling by air is the impact of altitude on the body. In short, this kind of travel is often physically uncomfortable taxing the body above and beyond the ordinary impacts of air travel on an otherwise healthy traveler. While this can be mitigated pharmaceutically through pain medications, it does incur the prudence of longer recovery times available before further activity.

Timing of travel is also important. Due to the more complicated nature of rising and going to bed, there are additional layers of work on travel days, both in terms of packing up last minute supplies, or unpacking and setting up necessary infrastructure for evening programs.

This is simply an accounting matter, but must include considerations for duration of energy requirements for caregivers, infrastructure resources, and basic health and physical maintenance concerns. The windows for departures and arrivals must be carefully considered as these elements can reliably add an additional 30 to 60 minutes to the scheduling requirements.

Taking these factors in hand can often effect timing and considerations for the day prior and the day after such travel.

Residential accommodations on location.

Residential accommodations generally reflect the same basic requirements as an able-bodied traveler.

Lodging overall: Housing must of course be wheelchair accessible within a reasonable margin (1-3 stairs can be manageable in the right circumstance, for example). As mentioned above, temperature regulation is also a concern and therefore central AC and/or the presence of an effective space heater/fan (our featured quadriplegic will usually bring this device as a standard part of the luggage as its service is absolutely critical, even in otherwise balmy climates.)

Resting: due to the daily medical and hygiene care requirements, there should be a private bedroom available for the disabled traveler. Given the unfamiliarity of the territory, it is often helpful for the quadriplegic to have a Care Partner in the same resting space overnight for the purpose of on hand assistance as needed.

Available bed for the quadriplegic should be at least 24 inches in height (to top of mattress), and no more than 35 inches in height. These dimensions represent an important care factor for the ergonomics of the Care Partner(S) assisting with the transfer. Mattress should be reasonably firm to allow movement and repositioning of the body by a second party. Presence of a quality pillow top or memory foam mattress can mitigate some of the above luggage requirements as well.

Appropriate accommodations are of course needed for each additional Care Partner in the troop.

Bathing: in the bathroom, fully wheelchair accessible, “roll in” shower accommodations are obviously the ideal. Alternately, a bathtub with hose showerhead and outer wall height under 15 inches can be of service. Though not ideal, a duration of three or fewer successive days may be endured without access to formal bathing facilities. (Access to hot water would nonetheless be required.)

Dining: diet is an important aspect in the fragile chemical balance of the quadriplegic body. The availability of fresh vegetables, organic vegetarian fare and fresh clean drinking water are a fundamental necessity. Dietary “roughing it,” is not really an option as consequences in terms of both elimination and susceptibility to infection (exacerbated by sugars) can be swift and severe.

As a general rule, allowances will be made in luggage for any specialized dietary concerns beyond the generalities above.

Accessibility and structure of precipitating engagement.

This section has to do with the physical location and nature of the Private Home, Retreat Center, Conference Center, or other venue, as well as the structure of any scheduling or process that may be a part of the formal engagement.

The accessibility of these contexts represent a matter of some range of adaptability in terms of navigating this environment. This adaptability depends in large part on the nature of the community of the engagement. For example, while 1-3 stairs can be (suboptimally) managed in residential accommodation, with enough willing and capable hands, much longer flights and even substantially uneven terrain can be managed on behalf of a wheeled participant.

By way of example, our intrepid wheeled adventurer has enjoyed the privilege of an overnight dirt floor lodge ceremony in the Navajo nation, and journeyed over a steep singletrack into the ravine of the sacred waterfall in rural Brazil. Both of these required and were made possible by the EXTREME generosity of able-bodied co-participants. Joining the ceremony group in the morning sweat lodge, and the fellow seekers showering in the waterfall, however remained respectively out of reach.

Less forgiving, though also not a dealbreaker, is the scheduling of events.

The process undergone by the quadriplegic and Care Partner of getting from pillow to bedroom door takes responsibly at minimum, an hour in the morning and similarly the reverse in the evening. It’s generally appropriate to allow for an additional 50% time on both ends for any unexpected concerns which may arise.

This often makes early morning meditation appointments inaccessible, and hurried breakfast windows in order to “get on with the important work of the day,” can lead to either having to miss food or engagement. Extracurricular evening festivities remain also often off-limits as it’s not so simple to simply wander off the dance floor and collapse happily in a heap of sleep till morning. As long as there is some forgiveness in the morning schedule by the collective, and understanding in the evening, these eventualities are easily managed should they arise.

Once the formal activities of the engagement are underway, the daily matter of Person Care (described above) comes into play in the lightest of ways (hydration concerns, snacks and short distance mobility, bathroom, etc.) Assuming alignment with the interests of attending Care Partners and process intent (i.e. is it a private cohort, or is part-time participation allowed) all necessary support activities remain easily accessible and provided. Additionally, it is not uncommon to find relations in the participating cohort who may even desire to step in as “helping hands.” Care is, after all, at the heart of who we are.

Influences on existing care community/structure.

As in any design endeavor, it is often appropriate to account for “negative space.” In our context here, this refers to the enduring care environment that does not participate in the active process of the travel journey.

In simple terms, this is houseplants, pets, family members or other dependents and responsibilities, and members of the Care Team who stay behind.

Surrounding any travel engagement, there is a time in advance, a time during, and a time after in which the ordinary patterns of Care Flow will be modified by care concerns specific to the event.

Preparation for the journey. In addition to obvious elements such as organization of materials, plans, and packing (notable portions of which often must occur “day of” travel), it is important to consider the affair as a whole in the context of overall flow. This means recognizing the addition of travel related stress as it will manifest throughout the various dimensions of the system and community in preparation.

While “stress” is often considered a negative that is undesirable and should be avoided, it is also appropriate to recognize that stress and tension are natural elements of any fluid or living process. Recognizing these without aversion allows us to modulate conscientiously to facilitate not just resilience, but also potential growth and learning in response to these emergent conditions in our otherwise familiar territory. Meeting these conditions with anticipatory awareness grants us the greatest opportunity to respond and evolve in a positive way.

In a care system where, for example, 5 Care Partners share a balance of tending to the concerns of the quadriplegic and environment at the core, a few things come into view. In addition to ongoing maintenance and management, everyone has a role in “seeing” and planning for the overall dynamic of the engagement in context. These elements include tending to the coming additional stresses on Care Partners who will be traveling who, may for example need to take some personal time in advance to properly prepare their energy for the travel dynamic. Other Partners may need to pick up some additional responsibility to allow for this flex to occur.

Depending on the scope of travel, there will be a window of hours, days, or weeks where the otherwise ordinary activities of the care system will adapt to incorporate more event specific attentions.

During the journey. While not pretty, it is practical to recognize that individuals engaged in formal caregiving roles, often depend on the income from these “jobs” for monthly hand to mouth subsistence. When taking a whole systems Care approach, we must consider this dynamic as a critical element to the health of the Care Collective. Often some minor flexibility in this regular synergy is absorbed as a matter of course, however it is inappropriate to take this for granted and/or simply overlook it by privileging the view of the individual, in our case, quadriplegic who centers it. Changes to the familiar ongoing dynamic of more than a few days may take additional attention to maintain adequate community well-being.

Again, standard concerns such as houseplants, pets, dependents, or other responsibilities may be managed with a simple arithmetic of friends, family, and community, but additional attention must be paid to the state of the Care Field such that it is in good form and good health on the other side of travel.

Post journey. Hopefully, along the journey and at home, all has gone well and everyone and everything is in good shape, well rested, or at the very least deeply nourished for the experience. If not, the post journey concerns go to mending, repair, and recovery. Nonetheless, even in the best of circumstances, the return home is not so much the end of the journey, but just the beginning of the end.

As mentioned above, extending the duration of a Care Partner’s focus on actively caring for self and other and context beyond the scope of an eight hour shift (long already) and/or a familiar environment, is a tax that will require additional care to maintain balance. For something even so slight as an eight hour journey outside the home, some tending will be in order. In such a case, this might just be a good meal and early to bed, the usual reward after a meaningful day’s work.

In anything greater than this ordeal, we must start thinking terms of “days off,” and the like. As mentioned above, a usual well-functioning care system involves a balanced flow of action and repose between the members. While not unmanageable, it is appropriate to maintain awareness and care around the community as it holds space for the recovery and rebalancing of its traveling members once they have returned home.

The energy of travel (and adventure) often brings with it its own vitality to serve these aspects of maintenance prior, during, and after the engagement, so we are certainly not speaking of deficit only conditions. It is just prudent to recognize these flows of energy nonetheless, to avoid getting caught up in the turbulence either coming or going.

Influences on destination value.

“How may I be of service?” — Among the determinants of value driving intent in our full spectrum appreciation of the economics of a given situation must be the recognition of the value we ourselves bring through our engagement.

Certainly we easily venture forth moved by nothing more than the idea that there is something we might gain by doing so. Even so, this gain may be measured in terms of the Hero’s Journey — some Grail or value we will bring back for our community. It also serves in the context of a holistic to consider if and what we may be bringing in service or offering to that which we may meet on the road.

In evaluating the economics of travel, particularly as our thinking involves to encompass more global perspectives, it is useful to lean into a practical accounting for these variables. If there is some event we may attend, will it be better for our presence? How? How much better? This is an occasion for frank realism, not simple self deprecation or egotism. This is not THE metric by which we value the opportunity, but can play an important role in the cost/benefit analysis overall. (See below.)

Financial cost.

Speaking of economics, let us not forget the critical role of finance in the mandala of the world today. Upon evaluating ALL of the above, we can assess the simple financial budget of the trip overall. This will of course include simple things like fuel and fares, lodging and meals, additional costs incurred for accessibility accommodations, Care Partners salaries (if appropriate), and other specialty expenses that may be required.

In financial terms, what will it cost? Where is the money coming from? Against what existing budgets (financial and otherwise) must it be drawn? With the movement of focus, will there be income lost, necessary opportunities for income spent? (Probably for a different section, but do we need to exchange currencies? 😉

Get the numbers. This may be the most black-and-white element of the entire formula for calculation. Appreciation of the full spectrum of this document WILL inform the detail of necessary finance involved.

ESG Considerations.

While there is some debate over the actual value of carbon credits, the construct provides a reasonable metaphor, at least, for this important aspect of a holistic economic intelligence and wisdom.

What will be the externalized costs of the endeavor? Jet fuel? How much? At what impact, and to whom? There are the broad aspects of this category (ESG), and the local.

What communities are we passing through and/or visiting? What will be the impact of our presence there? Positive elements, negative? Probably a mix of both?

What will be the challenges and costs to our own community (the immediate Care Collective, and beyond)? Will the houseplants survive?

This is an area in which I think we don’t have particularly good answers, constructs, or information broadly available and will likely be the most anemic in terms of the sophistication of our analysis. This is just a personal view as of this draft, Q2 2023, but appears an area in which we have much room to improve.

In appreciating the question, “What would it take for you to travel to/for…” there is a calculus of reflection that lends to a wise response; ESG is a part of this.

Overall cost/benefit evaluation.

The final decision to undertake a journey is best served through the incorporation of the widest reasonable survey of stakeholder viewpoints involved.

Who is traveling? Who is going with them? Whom are they visiting, and from whence the invitation or motivation? Whose lives will be impacted one way, or another by the engagement? How visible/transparent are the economic elements of each of the above sections to those whose evaluation may be impacted by the data?

How skillful are we at taking multiple perspectives, the actual view of others, understanding our own biases, preferences, and aversions?

In terms of the proposed engagement, what do we, collectively, understand to be the cost? What do we anticipate in terms of benefit? How do we like the odds? How do we like the opportunity?

As the day dawns, we incur a cost in caloric terms, simply to stretch, rise from bed and approached the breakfast table. As a rule, I like to think that’s generally worth it. Similarly, stepping out the front door and into the world is one of the key ways we engage the gift of life.

I’m reminded of a simple Sufi mealtime prayer…

“All life is one, and everything that lives is holy, plants, animals, and beings.

All must eat to live, and to nourish one another.

Let us eat consciously, resolving by our work to pay the debt of our existence.”

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