We Keep Showing Up Too Late

eastcapehomehealth
May 1
3 min read

Updated: May 7

From the desk of Lic. Brittany Helene Baker, RN, BSN, CDCP

I’ve been thinking a lot about the situations we see over and over again.

We get called in to help an older expat living alone — someone with advanced dementia, no local family, no clear plan. Often, their finances are in disarray, and they refuse care. They’re not permanent residents, so DIF (Mexico’s social services) can’t step in.

The burden falls on whoever’s around. Sometimes it’s a kind neighbor, a friend, or even the gardener — who ends up doing his best with no training, no support, and no backup.

One man I’ll never forget had advanced cognitive decline and thought everyone was stealing from him. He pushed away help until only his gardener remained — quietly bringing food, checking in, making sure he wasn’t totally alone… until the end.

This is not rare. It happens all the time. And it breaks my heart.

So I wanted to share a few things I wish more people knew about death and dying in Baja California Sur — especially those of us who weren’t born here.

Things I Wish More Tourists and Immigrants Knew About Death and Dying in Baja California Sur

As a nurse who’s worked in home care and palliative care across the region for over a decade, I’ve supported many families through end-of-life decisions. And while Baja is a beautiful place to live — it's not always easy to die here, especially if you're unprepared.

Here are five things that could make a huge difference:

1. Know What to Do When Death Happens

If a death is expected, "don’t call the police or ambulance unless there’s foul play." This advice is widely circulated among ex-pats, and for good reason—especially in urban areas. However, in rural locations like Los Barriles or Todos Santos, the availability of a physician who is authorized to file a death certificate can be limited. That’s why having a care team in place early matters.

As a home health agency, we call 911 and provide full documentation to the Ministerio Público, including nursing notes and medical orders in Spanish. This helps ensure everything goes smoothly.

2. Understand Autopsy Rules

The U.S. Embassy requires an autopsy for Americans who die abroad, unless the death occurred in a hospital or under clear medical supervision.

To avoid one, you’ll need detailed medical records in Spanish showing diagnosis, treatment, and palliative care. A brief doctor’s note isn’t enough. And even with documents, the authorities still have the final say.

3. Know the Limits of “Voluntad Anticipada” (Advance Directives)

Baja California Sur does not legally recognize advance directives — only 16 states in Mexico do.

But that doesn’t mean your wishes won’t be respected. It just means you need to:

Talk to your doctor and loved ones
Clearly document your preferences
Translate and apostille your U.S. directives if you want them to hold weight

The hospital culture here often defaults to "saving lives at all costs" — so be sure your preferences are clearly known before a crisis hits.

4. Hire Help & Talk About the Hard Stuff Early

Private home care here is 50–60% cheaper than in the U.S., but it’s still an investment. If you have private insurance, a home care agency can often provide facturas (receipts) for partial reimbursement.

More importantly: have the hard conversations now.

Under what circumstances do you want to go to the hospital?
Would you want oxygen or IV fluids at home?
Who do you trust to speak for you if you can’t?

A professional care team doesn’t just provide nursing — they advocate for you and make sure your wishes are honored.

5. Don’t Overthink It — Just Be Ready

Enjoy your life in Baja. Eat the fish tacos. Swim in the sea. Watch the sunsets. But please — take a little time to plan ahead.

Being prepared is the kindest gift you can give to yourself and the people who care about you.

Need support? If you're looking for private nursing, palliative care, or just have questions about end-of-life planning in Baja California Sur, we're here.

📩 Reach out anytime: info@EastCapeHomeHealth.com🌐 www.EastCapeHomeHealth.com

With cariño,

Brittany Helene Baker, RN, CDCP

East Cape Home Health

Owner, Nurse Manager