How our parents cope with aging directly affects how we will function and how much effort we will have to put forth to ensure their safety and comfort. If our parents are accepting of their conditions, and seek help when they need it, it makes for a much easier job for us. "How's my driving?" my dad asked me once during a visit home. "Fine, Dad," I'm was able to reply honestly. But, because he's the one who has broached the subject, it will be a smidgen easier when I have to say, "Well, you know, Dad, I'm kind of nervous when you drive now. You came awfully close to that parked car, and I'm not sure you saw that car coming that you pulled out in front of. Let's go visit the eye doctor and see if there's a problem we can fix." Then I'll be able to research the resources in his small town to see what transportation is available for seniors.
Most of our elders, however, will hang on to that driver's license with their last dying breath. Just last week, a client said to me, "Well, I passed a driving test just recently!" You and I both know that a "driving test", once the license is established, consists of a cursory eye exam. If your parents are stubborn about driving, it will be all the harder for you to step in for their safety.
Another of my favorite excuses is: "But I haven't had any accidents - so why should I give up driving?!" Okay, let's wait for that six-car pileup and three fatalities and then we'll talk.
Americans are so auto-dependent that giving up driving is very likely the hardest loss any of us will face. It's also, I'm finding, one of the hardest interventions to perform legally. A client's daughter came to me recently and asked if I felt her father should still be driving. She had noticed he had dangerously turned in front of oncoming traffic the other day, and knows that he moves very slowly now due to his arthritis. Would he be able to stop in time if a child ran out into the street?
As part of our services, ElderCare Advocates performs a Reality Comprehension Clock Test (R) which is a locally developed, standardized test which can assess over dimensions of: Visual Task Performance, Visual-Spatial integration, Number Awareness, and Orientation/Memory. In the studies that have been done using this test, potential deficits have been discovered such as: Left Side Neglect (many persons afflicted with strokes are unable to use one side, or see as well on one side), Perseveration (repetitive thoughts or motions), Constructional Apraxia (a psychomotor deficit), Sensory Processing Deficit, and infection-induced delirium. For more information on this excellent new tool, go to www.rcctclocktest.com or contact Barbara Brock at Communication Art, Inc., 419-865-6131.
When I performed the test with this client, it was evident that there were many deficits indicating he should most likely not be driving. Then I began the research. How does one go about revoking a citizen's driver's license when, indeed, they have not been pulled over for erratic driving or cited for causing an accident?
A telephone call to the local Bureau of Motor Vehicles revealed that only a physician in the State of Ohio has the authority to contact the BMV requesting a driver's license be revoked. Once this letter is sent to the State office, many different scenarios can occur, including recontacting the physician for further clarification or permission to exchange information. Supposedly, the identified driver is notified by mail that he or she has 30 days within which they must report to the local BMV to repeat the written AND driving portions of the Ohio state exam. If they fail the test, their license is revoked. If they do not show up, their license is also revoked.
When I sent the completed clock test to the physician, he immediately faxed me a prescription slip stating the client should not drive due to: impaired vision, slow reaction times, and cognitive impairment. I then proceeded to go with the daughter to explain to her father that he should no longer be driving. To put it mildly, he did not take it well. Unfortunately, he is very angry at me, his daughter, AND his doctor, and he is still driving. When he gets the letter from the BMV, he may just throw it away. Another telephone call to the State BMV may reveal when the letter was sent, when the 30 days is up, and when we can ask he police to pull him over and check his license status.
This is a drastic method of intervention. Each individual must decide for themselves how to approach the subject with their loved one. If dementia is evident, sometimes a roundabout method might be better than the direct approach. One lady client of mine, who had disappeared for six hours while grocery shopping, also did not take it well when I informed her she should no longer be driving. I had her attorney/trustee disable her vehicle (he unhooked the battery cables and put his business card on the battery with a note). We had lined up neighbors and friends to take care of all of her transportation needs, so the temptation to drive herself was not as strong. The first day she did try to drive, she had blessedly forgotten that we had spoken of the topic, and when her car would not start, she went back into the house and distracted herself with another activity.
An option that Northwest Ohioans have is to contact Flower Hospital's Road to Independence Driving Program at 419-824-1116. This program utilizes the professional Occupational Therapists at Flower Hospital to evaluate and retrain a persons' driving abilities, especially stroke patients and persons with other disabilities or illnesses. They have no authority to take someone's license, but can evaluate a person's ability and give the physician, client, and family a better idea of the client's capabilities and limitations. This program is partially covered under Medicare.
The reluctance of physicians to take the responsibility of having someone's driver's license revoked is understandable. But it is essential that families and physicians begin to realize that the responsibility is a large one. Gwen Neundorfer, Coordinator of the Lucas County Traffic Safety/Safe Communities Program (419-698-1501) says seniors have a higher percentage of involvement in crashes are more likely to die in car crashes than younger persons due to the fragility of their health and recuperative processes.
There also seems to be a reluctance on the part of society as a whole to take responsibility and demand safety over independence in the case of senior drivers. My own mother-in-law (God rest her soul), who was an alcoholic, was pulled over in a small town for driving erratically. Although she reeked of alcohol, the young police officer took her to a nearby cafe, bought her a cup of coffee, and telephoned my sister-in-law to come and pick up her mother. He neither cited her nor took her license away. She was still a legal driver when she died 10 years later, although she had given up driving due to her health.
Denial is not a river in Egypt, my boss is fond of saying. Most older drivers will deny to their dying day that their driving capacity has diminished whatsoever. "Haven't had an accident yet." "Triple-A just sent me a congratulatory letter offering me lower rates." "I only drive to the corner store and back." Are just a few of the excuses I have heard. Over and over and over.
Well, as a professional care manager, and as a daughter, I'm not willing to wait until that fatal accident, that increased insurance notice, or that frantic phone call saying, "I'm lost and can't find my way home." I'm going to continue educating my clients and their physicians regarding the proper way to begin to solve the problem of the American never-ending driving privilege.
Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of Debra J. Sorensen & Associates Inc., a private geriatric care management company serving Northwest Ohio and Southeast Michigan. She can be reached at 419-367-8835 or e-mail Debra@professionalcareforyou.com.
