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Even if you need full-time attention, you needn't give up traveling by air. Starting this month, American Airlines will offer Skycaare service for travelers who need medical assistance while flying. The line will provide a skilled medical companion -- usually a registered nurse -- to provide full-time care, airport to airport. American will initially provide Skycaare on selected flights to and from its Chicago and Dallas-Fort Worth hubs, but the program will eventually be expanded to other domestic and international flights.

American bills Skycaare as a lower-cost replacement for air ambulance service, but it won't always fill the bill. Skycaare will be limited to travelers who are stable for air travel, do not need intensive or emergency care in flight, and pose no risks to other travelers. A traveler who doesn't pass those tests will still need an air ambulance.

To arrange Skycaare, start with American reservations, where an agent will connect you with a special Skycaare coordinator. Before you leave, the coordinator will check with your physician and provide specific instructions to the companion. During the flight, the nurse will do whatever is called for -- administer medications, monitor oxygen supply, even help in the restroom.

Skycaare may be less expensive than an air ambulance but it's expensive by ordinary travel standards. To use the service, you must buy two tickets -- one for you, another for the companion -- at 30 percent below full-fare Coach or First Class, plus you pay an (unspecified) hourly fee.

If your requirements fall short of a full-time registered nurse, you can arrange your own companion for a lot less than the price of Skycaare. For example, a round-trip Skycaare trip from Chicago to San Francisco would cost $3,508 in airfare alone, plus companion charges (that's 30 percent off the regular full-fare Coach rate of $2,506 each, for two seats). If you arranged for your own companion, you could buy two excursion round-trips for as little as $218 each, or a total of $436. If the companion didn't want to stay at the destination as long as you did, you could buy a third ticket for your companion to make a separate round-trip for your return and still pay a lot less. Of course, you'd have to comply with the restrictions on the cheap tickets -- advance purchase, minimum stay and maximum stay.

Most of the time, I suppose, travelers who need companions can find them among family members or friends. I performed that function for my parents on several trips, when they were in their early 90s, and I know others who have undertaken that duty. Seniors who don't have available family members might offer the job to an attendant in a senior center as a way to make a few extra dollars on days off or vacation days. Or check with a nearby university or college, where a pre-med or nursing student might be happy to be paid for taking a trip.

Recognizing that some senior travelers might have difficulty finding a companion, Carol Hendrick, a nurse living in Eugene, Ore., recently started to provide travel-companion service as A Nanny for Granny. Her charges are modest, starting at $10 an hour or $250 a day, plus airfare and expenses, for simple assignments, increasing if special care is required. It sounds like a good idea to me; Carol says she hopes to add additional companions and expand into other areas. (Hendrick is in the process of developing a Web site but it wasn't up when I spoke with her in early February.) I would expect to see more market initiatives along the same lines.

All too often, physical or mental problems make travel difficult for senior travelers. If you're seriously incapacitated, Skycaare sounds like a great idea. But if you just need a little help, some family member or friend -- or A Nanny for Granny -- can help you along at far lower cost.

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