By Anita Kamiel, RN, MPS
Getting seniors to give up the keys to their car is no small task and, frankly, I am quite sympathetic to the seniors. After a lifetime of independence, it is yet another degradation they must endure as they age and their faculties wane. Only with this one, it can feel like a prison sentence, being confined to four walls.
While there are many seniors on the road who should not be (government statistics for those over 75 years old attest to this), sometimes children of senior citizens are overly cautious in their “drive” to strip parents of their car keys. There are professionals out there who can help assess whether or not it is time for that step.
Driving rehabilitation specialists are a subspecialty of occupational therapists (OT-DRS), but they could have a background in physical therapy, kinesiotherapy, driver education, or psychology as well. Their clinical assessments include a review of personal medical history, cognitive ability, and a functional/on-road assessment of visual, cognitive, physical, and behavioral impairments. They can then make recommendations for vehicle modifications or specialized training. Assessments can cost $200–$400, plus $100 an hour for any needed subsequent service. The American Occupational Therapy Society (see https://myaota.aota.org/driver_search/) can help you locate a professional near you.
Driving skills evaluators are also trained, licensed, and certified by the state and perform evaluations based on an in-car evaluation of driving skills and may recommend further testing with an OT-DRS or additional training by the evaluator. Those evaluations run $100–$200 with additional hourly charges ranging from $75 to $150. The Association for Driver Rehabilitation Specialists (see http://www.aded.net/?page=230) can help you understand the different levels of certification as well as how to find a specialist in your area.
Family members must watch for indications of problems that might lead to possible harm to the older adult or others. It would be good to consider evaluations for seniors who have trouble seeing street signs at night or have had an increase in near-miss accidents or fender benders, whose reflexes have slowed, who have a history of falling, or who have been diagnosed with a medical condition such as diminishing vision, seizures, dementia, stroke, or sleep disorders. An informal self-assessment can be found through AAA Roadwise Review (http://www.roadwiseonline.org) or the Fitness-To-Drive Screening Measure Online (http://fitnesstodrive.phhp.ufl.edu).
It is understandable that as children see more physical signs of disability, they feel awkward about broaching the subject with their aging parents. There are many resources for information about how to enter this new phase of life. Seniors and their families should be aware of their many options before giving up the keys, as well as solutions to lessen the negative effects of a total relinquishing.
When seniors don’t drive, most of the burden falls to the caregiver. However, for those who don’t have a “resident driver” or who can’t rely on their caregivers 100% of the time, there are alternatives.
The following are different categories of services available.
- Curb-to-curb or taxi services that pick you up and drop you off curbside but don’t help at all with mobility aids such as walkers or wheelchairs.
- Door-to-door car services that pick you up and drop you off, but don’t get out of the car to assist you with entering and exiting the car. Again, they may not want to help you with any walking aids or wheelchairs.
- “Door-through-door” services that provide a full service of helping you in and out of the car or van and help you with whatever you need, including groceries and packages.
As more and more seniors relinquish their driver’s licenses, they will need more services to fill the gap. Certain companies like the for-profit SilverRide and the not-for-profit Independent Transportation Network of America are available only in specific states. Seniors in New York rely on a mix of private car services, government-subsidized programs, and community and religious organizations to supplement their transportation needs. The New York City Department for the Aging (see http://www.nyc.gov/html/dfta/html/services/transportation.shtml) can provide transportation services through listed senior centers. Information regarding Access-A-Ride (http://web.mta.info/nyct/paratran/guide.htm), a subsidized door-to-door transportation service available 24/7 to those eligible, can also be obtained there. Manhattan residents can take advantage of the Community Arranged Resident Transportation (CART) Project (http://www.nyfsc.org/services/freetrans.html) funded by that department which provides free transportation service to the frail elderly five days a week.
It’s all about keeping everyone safe. According to the AAA, the highest fatal car accidents occur in two distinct age groups—teenagers and those 75 and older. The difference is that seniors are far less likely to survive these car crashes, not to mention the harm that can be inflicted upon others. They are more fragile and don’t bounce back from injuries well at all.
On the other hand, until the age of 65, the accident rates of older adults mirror those who are middle-aged. In order to ensure that seniors continue driving safely for as long as possible, we need to educate them about the warning signs and plan for the various options for maintaining their independence. v
Anita Kamiel, R.N., M.P.S. is the founder and owner of David York Home Healthcare Agency and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.