How To Know When Your Loved One Needs To Take A Dementia Driving Test?
When is it time to take the car keys away?
As a caregiver for a loved one with dementia, have you ever wondered when it’s no longer safe for them to drive? This question, though tough, is essential. This episode will cover the signs and strategies for managing this challenging situation, ensuring both safety and independence.
Recognizing the Signs
Driving safety is a significant concern for those with dementia. Here are some signs that it might be time to reconsider your loved one’s driving abilities:
1. Getting Lost on Familiar Roads:
If they struggle to navigate places they’ve known for years, it’s a red flag.
2. Fender Benders:
Unexplained dents and scratches on the car could indicate declining driving skills.
3. Close Calls:
Frequent near-accidents or confusion in traffic are worrying signs.
4. Difficulty with Everyday Tasks:
Struggling with simple tasks like filling out forms or paying bills might also reflect their driving safety.
5. Physical Limitations:
Trouble getting in and out of the car or poor coordination can impact driving ability.
Taking Action
Once you notice these signs, it’s crucial to act. Here are some practical steps to help:
Consult with a Doctor:
Get a professional opinion. Some doctors can recommend driving rehabilitation assessments.
Driving Rehabilitation Programs:
These programs evaluate both physical and cognitive abilities necessary for safe driving. Insurance might cover part of this assessment.
Formal Evaluation:
If recommended by a doctor, this evaluation can help decide if driving is still safe.
Balancing Safety and Independence
Taking away driving privileges is a significant change. It’s vital to balance safety with maintaining some level of independence for your loved one.
Alternative Transportation: Look into services like GoGo Grandparent, a simplified version of Uber or Lyft for seniors.
Community Resources: Church groups, community volunteer drivers, and senior centers often offer rides.
Family Support: Organize a network of family and friends to assist with transportation needs.
Legal and Emotional Considerations
Driving with dementia isn’t just a safety issue; it’s also a legal one. If an accident happens, the consequences can be severe, including civil suits. It’s essential to act before a tragic event occurs.
Acknowledge the emotional aspect. Losing the ability to drive is a loss of independence, which can be distressing. Compassion and understanding are key during this transition.
Support and Resources
You are not alone in this journey. Many caregivers face the same challenges. Support groups and meetups can provide valuable advice and emotional backing.
Our monthly “Ask the Dementia Coach” meetup is an excellent resource. Here, you can get personalized guidance and connect with others in similar situations.
Register here:
Conclusion
Deciding when to take away the car keys is difficult, but it’s necessary for safety. Recognize the signs, consult professionals, and use available resources to navigate this challenging time.
By balancing safety and independence, you can ensure your loved one’s well-being while maintaining their dignity.
Remember, you are not alone, and there are many resources to support you through this journey.
Read More:
Talking About Caregiver Burnout With Michelle Gordon
Check the other podcast: https://dignicarebydesign.com/category/podcast/
Email me: lizette@dignicarebydesign.com
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Listen to the Podcast
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When to Stop Driving with Dementia?
[0:02] When is a person living with dementia not safe to drive a car anymore? more? That is the big question that we are going to explore today, as well as giving you practical steps and actionable signs to look for in a person with dementia to know whether or not it’s time to take the car keys away. This is not a popular subject for a lot of people to consider, but bear with me today because I do this with love and compassion because ultimately we as Christians bear a responsibility for the safety of other people if we know that the person we love of living with dementia is not safe to drive a vehicle anymore. Today is Wednesday, the 24th of July, and tomorrow night at 6 p.m., so Thursday the 25th, we have our next free monthly meetup where you can co-create with me an episode of this podcast called Ask the Dementia Coach.
[1:26] Where you can come on and you can ask me specific individualized questions related to you and your journey as a Christian dementia caregiver.
[1:39] So if you haven’t signed up for our monthly meetup, the link is in the show notes to join the Ask the Dementia Coach monthly meetup.
[1:51] My biggest ask is that you show up live. You do not need to be on camera. We can change your name in the Zoom room and you can be entirely anonymous, but get the support that you need. So join me tomorrow night. It’s not too late to register and listen to today’s episode where we unpack how to know when your loved one needs to take a driving test as someone living with dementia.
The Battle of Taking the Car Keys
[2:28] Welcome back to Christian Dementia Caregiving, the podcast where I teach Bible-believing Christians where they can find help as well as hope in their dementia caregiving journey, and where you can learn to still create moments of joy as well as gain peace of mind during this challenging time in your life. Today’s episode is a little bit different and unique because this is something most people who are navigating a dementia caregiving journey dread to do. This is the battle of the car. This is the battle of taking the keys away and knowing when your loved one is not safe to drive a car anymore. more.
[3:32] So let me back up. About probably 10 years ago or so, I was still working in Spartanburg Regional in South Carolina as an occupational therapist in the acute care hospital, which meant that I would see eight to 10 new patients every single day. And of those, at least half of them had some form of cognitive loss. I’ll never forget this particular day because it was in the summer, it was hot as all Hades, kind of like we have right now when it is super, super hot here in South Carolina and unusually dry. I have lived in South Carolina on and off for about 16, 17 years, and I don’t recall it ever being this hot or this dry.
[4:27] But anyway, back to this particular day, I had a new patient and as I was doing the chart review, going through what was going on with her, the story that came out in the chart was that this particular patient was found in her car at a gas station about two hours away from her home because she had gotten into the car and started driving. She had mild dementia and she had started driving and got turned around either because there was road construction or something had happened and she got herself turned around and kept driving until she ran out of gas two hours away from home. The only reason it didn’t have a worse outcome than it already had was because she had enough ability remaining to recognize that the gas tank light had come on and she pulled into a gas station.
[5:52] The gentleman who was at the cash register in the gas station, in conversing with her, recognized that she was very confused.
[6:05] And he called the police. And the police found her, they identified who she was, and they were able to get her the help she needed by admitting her to the hospital, and the whole process took off from there. So driving with dementia, even though it is a touchy subject and nobody wants to talk about it, It is a very important conversation for us to have as family caregivers of somebody living with dementia.
[6:43] And today’s topic, today’s conversation really has to do with when is it time to take away the car keys of somebody driving with dementia and what kind of options or techniques or or strategies, or ideas are there to help you navigate this extremely emotional and difficult part of a dementia caregiving journey. But it’s one of those conversations, and there are several of these conversations that we need to have earlier and more often than what we do because one of them is if you live long enough with dementia, you will need 24-hour supervision. The other one is if you have dementia and you have guns, at some point, those need to be taken away. And I have not even touched on that topic yet. But the third one is driving in dementia. So today we’re going to have the hard conversation about driving with dementia.
[7:59] Did you know that normal human adults, normal people who do not actually have cognitive loss, who are aging, normal aging, but have changes in their physical abilities like the ability to turn their head or the ability to see in the dark or the ability to get in and out of the car, normal aging populations, because there is nothing wrong with their thinking processes, when they start to self-identify that they are having difficulty with driving, will spontaneously self-restrict and stop driving because they recognize that driving with lack of vision or inability to respond fast enough or to turn and see other vehicles coming.
[9:03] They recognize because there’s nothing wrong with their thinking processes that they are not safe to drive anymore. The problem we have is that people with dementia often have no awareness that they are having these issues and therefore will not self-restrict. They will not stop driving unless somebody takes the keys or the car or goes through the steps themselves.
[9:36] Enforce them in not driving. Expecting somebody living with dementia to understand, the reasoning that you and I can have related to not being safe to drive anymore is unrealistic. For us as the caregiver of the family member of somebody living with dementia, to expect them to have the insight and the judgment that they are not safe anymore is not a realistic expectation.
[10:13] So what I need you to hear me saying clearly today is that if you have a loved one living with dementia that is still driving at some point or another, it becomes our responsibility as the person who can think through the consequences of driving to take the keys away, to go through the difficult steps of implementing a plan related to driving with cognitive impairment. So, I know this is a sensitive topic. I know this is something most people do not want to think about because I recognize that the moment we have and open up this particular can of worms related to caregiving is the moment that our life as a family caregiver changes overnight because now we have somebody who has no other way to get places other than if somebody helps them get there.
[11:27] Do you feel alone and isolated and need a little bit more help and support in this journey? Sign up for our next Ask the Dementor monthly meetup where we will come together. Less than 10 people are allowed to sign up at a time so we can have fellowship where we can answer questions, where you can get some Christian guidance and just an awareness that you are not alone on this journey. I really want you to be able to connect with me. I want to be able to answer your specific questions. So if you’re struggling, if you’re tired, if you’re overwhelmed, if you’re stressed, if you just need a little bit of help, sign up for the next Ask the Dementor monthly meetup. The link is in the show notes below.
Signs It’s Time for the Driving Conversation
[12:29] Let us start today off with the first point, which is, what are some signs of the times? What are some signs of the times that it is time to start to have the dementia-driving, conversation, to start to have the conversation related to, is this person still safe to drive a car? So what are some signs? And they are signs that you see likely a lot earlier in a person’s dementia caregiving journey than what we want to recognize. Because like I said, it impacts my life if I have to take the keys away of somebody that I love because if I’m a husband or a wife, now I’m 100% responsible for all of the driving, for all of the grocery shopping, driving.
[13:39] Or appointments, or whatever it is. If it is a husband-wife combination and it’s the husband who you have to take the keys away from, then the wife may not have had as much of a ability to convict her husband to let her drive and it can change the dynamic. If you are the child of somebody living with dementia and you have to take the car keys away, now you have a reasonable expectation that the driving and all of the responsibilities related to chores or errands or things like that fall upon you as the family caregiver to now arrange or facilitate or be able to include. So I understand this is not a conversation anybody wants to be having, but what are the signs of the times? Here are a few very, very clear indicators that it is time to take the next steps related to the keys. One is that the person is getting lost on familiar roads.
[15:01] Another one is that there are signs of fender benders on the car or on the garage or on the mailbox or on anything close by related to things that the person can be accidentally bumping into. to. I had the opportunity to be that child who had to take my father’s driver’s license away. And it was a knockdown drag out fight. But as we were navigating this process ourselves, when we actually got the car, both my husband and I were surprised about how many dents and dings there were in my dad’s car, that he had ready excuses related to how they got there, why they were there, and they were always someone else’s fault. He was never to blame for the incident that caused the fender bender. You may be noticing close calls. falls. The person might be having confusion in filling out forms.
[16:21] That can be a sign, a subtle sign, that they are no longer safe to drive. They might not be paying their bills, or they may be overpaying the same bill over and over again. That can be a sign that it’s time for a driving test. The person might be making medication errors, or if you are helping somebody with their medication because they are not remembering or they’re unable to set it up in the right way, that that may be a subtle sign that it is time to change.
[17:00] Do a driving assessment, or to have the conversation about taking away the keys. If the person that you are helping is having trouble with a checkbook, managing their checkbook, or even getting in and out of the car, if they are struggling to get in and out of the car because of physical components, they may not be safe to drive anymore. Or if they’re really having difficulty with coordination, buttoning things or opening up bottles and other items where you need to have both eye and hand coordination. The fact of the matter is somebody with dementia frequently loses their ability to judge safely themselves. And one of the early signs, which is even before a person starts to have trouble remembering is the changes in what we call the fancy word executive functions, the things like planning and organizing and anticipating consequences, and judgment. So any of those or combinations of those are a big, big sign of the times.
[18:24] Did you know that in a survey of 3,450 doctors, that’s close to 3,500 doctors, physicians.
[18:41] Only 59% of those physicians believed it was their responsibility to report somebody who is unsafe to drive. That statistic floored me because one of the practical steps for helping somebody with taking their car keys away or going through this process of changing their ability to drive is often left up to doctors. Families want the doctor to be the bad guy and recommend that the person actually stop driving. And I believe it is a good and solid strategy and a good and practical step.
The Responsibility to Take Away the Keys
[19:32] But the reality is that you as the family caregiver might first have to have that battle with the doctor related to the person not being safe to drive again. anymore.
[19:48] There was a benchmark study that shows that from time of diagnosis to the point when a person is not at all safe to drive a vehicle anymore is approximately three years.
[20:05] So if a person is diagnosed, from the time that you start to see these changes that a person has until they truly are not safe to drive anymore, the benchmark time per the study is approximately three years. That doesn’t mean that everybody is at that three-year mark. It just means that that is the benchmark that the study was actually able to show.
[20:32] And that the same study showed that after the three-year mark of knowing that somebody is having these changes and a diagnosis, So sometimes we know changes come before a diagnosis, so sometimes that timeline may be a little closer, correct? But after three years, the crash rate significantly increases for a person driving with dementia. So a practical solution, a practical first step, if we take together the fact that we know that if a person is showing these signs of the times in any one of those factors, and we marry together with that, that most doctors don’t believe that it’s their responsibility to report an unsafe driver. And we put together the fact that we have a three-year window maximum before that person definitely is not safe to drive anymore.
[21:38] What do we do? So here are some practical solutions.
[21:43] And these are actual things that I had to do with my own father. So my father was fighting me related to taking the car away. Now, an interesting thing that I learned as I was preparing for this episode today is that women more likely are willing to self-limit driving with dementia before men. Men will not easily rescind their privilege to drive. Please understand and please remember that driving, we believe, a lot of people believe, driving is a right. We have a right to drive a car. If you are a person who believes that people have a right to drive a car, I’m sorry to upset your apple cart, but driving is wrong.
[22:42] A privilege. We have a privilege to drive a car, just like we have a privilege to vote. We have a privilege to drive a car. We have a privilege to own a gun, right? You have to have, there are certain restrictions that we have to have, and these are not rights. A child who is 16 years old has to demonstrate that they are safe to drive a car, and then they get the privilege of driving a car by passing the driver’s test and getting a driver’s license. There is ample, ample research that shows that a person over the age of 75 is not as safe to drive a vehicle anymore, but we do not have good effective strategies in place to capture that these people are not safe drivers anymore. So conversations like this are going to likely start to become more prevalent as people are getting older and living longer. It is a privilege to drive a car. So back to the practical steps.
[24:03] What steps did I have to take? Well, first of all, the very first battle that I had, other than my father, was with the doctor. Because of my background as a trained occupational I am full aware and extremely aware that there are driving rehabilitation programs and that the people who are the driving rehabilitation certified therapists that do this, they look at the physical components. Can the person respond fast enough? Do they have the range of motion in their neck, in their arms, in their legs? Do they have the strength? But more than that, they look at the thinking processes that are needed and necessary to actually be able to safely drive a car. But before you can get to a driving rehabilitation program.
[25:06] You have to get through the gatekeeper, and the gatekeeper is the doctor. So I had to convince the doctor first that my dad was not safe to drive the car, and then we were able to get him scheduled to go to a driving rehabilitation program where an occupational therapist did a full assessment and came up with the results. And the way it is structured, most driving rehabilitation programs, if the doctor orders it as part of their therapy, insurance should pay for the assessment part. So the sitting there with the therapist, getting the physical assessment, getting the cognitive assessment, all of that is covered under their insurance.
[25:57] What is not typically covered under their insurance is if a on-the-road test is actually required in order to assess whether or not the person is safe to drive. So there are two components to it. My father only got through the first part, which was the physical and cognitive evaluation to be able to determine whether he was safe to drive. And so we did that. And the plan that the therapist came back to my father with was, okay, we can do a course of skilled therapy. Here are your problems. These are the things that you’re having a hard time with. One solution that we have to offer is let us do a course of skilled occupational therapy and work on these underlying impairments, these underlying skill sets, and see if they improve over a month. And if they improve over a month and we retest you, if you have done better, then maybe we can do the on the road assessment. So that is what we did. So step one is talk to the physician.
[27:16] Convince the physician, possibly. And step two is get an order for a driving rehabilitation evaluation.
[27:25] Now, what the driving rehabilitation person is, they work in collaboration with the DMV. So they work with each state’s driving license program where you get your driver’s license. And if the assessment comes back that the person is not safe to drive their vehicle anymore, the therapist will send that report to the Department of Motor Vehicles, who will then send a letter to rescind the person’s license. That is what is supposed to occur. It is not a perfect system. They do sometimes make errors. In our specific case, the Department of Motor Vehicles never actually closed the loop, but I was able to get the car away because I now had the documentation and I was able to get the title from my dad. I retitled it in my name so that he could not get it insured or have any contact with the vehicle anymore. And so therefore, my father kept his driver’s license. I did not force him to take it back to the DMV. Thank you. But the final step is that the DMV actually take the license back. You can get an identification card. You do not need a driver’s license for identification purposes. So those are the practical steps that you can take. There are other practical steps.
[28:55] Like I said earlier on, there are people who will self-restrict. Uh, they, they typically are females who will stop driving a vehicle before somebody who is a male. Um, some other strategies that people will do is they will disable the car. They will do other things like that to immobilize the vehicle. Physical, but the real biggest challenge is if the person that you are helping is at that fighting stage related to the car, this is the formal process that I would encourage you to take. It is not fun. Been there, done that. Have the t-shirt. My sister, when she comes to visit, my dad tells her all the time how terrible it is that I took the car away. So this is a burden that I carry. I gladly carry it because I believe that it is our responsibility as the people around the person who is not making good decisions anymore to take away the
Balancing Safety and Independence
[30:02] car keys or to come up with a plan to keep them safe. Which brings us to the third point today. The third point today is we do need to balance safety and independence. I understand that we’re privileged to drive.
[30:21] Equals our independence. If you think back to being 16 or 17 years old and getting your driving privileges and getting your driver’s license, it equated our freedom. It allowed us to now go places without somebody taking us. We were free. It became our freedom. Driving equals people’s independence. But the balance has to be with safety as well as independence because legitimately, one of the big considerations that we need to talk about is the legal consequences and that’ll be the next point that we look at. But how do we now balance safety? We have been able to take the car keys away. We’ve balanced that safety, but now we need to continue to maintain independence.
[31:23] What are some practical strategies related to that? Number one is there is a platform called GoGo Grandparent. It is a Lyft or an Uber light for people with cognitive impairment. It is a a much easier platform. You can set it up for the person. There are ways that we can do Uber and Lyft in certain communities using GoGo Grandparent.
[31:54] We can look at rides, rides with friends, with family, with church members. We have a gentleman in our church. He does not have dementia, but he is legally blind. He has a network of people that he will call and ask for a ride when he needs a ride. So you can tap into your church, but you have to be proactive about it. You have to put into place a plan. There are community volunteer driving programs in certain communities, and some local senior centers do offer some limited rides.
[32:32] You can consider those as strategies, but I know that if you are the family caregiver of somebody who is needing transportation, I know that changes your life. Because you do have to help them maintain their social interaction. You have to maintain them related to doctor’s appointments, related to going out for fun, all of those kinds of things. And this, I believe, is one of the biggest reasons family caregivers do not take on the battle of the car, because they inherently know that if I do this now, my life has changed. I would encourage you, based on the legal implications that we’re going to talk about next in the fourth point, I beg you to not wait until too late to start this process. So what are the legal considerations or what are the legal ramifications of allowing somebody to drive a car when they are no longer safe to drive?
Legal Ramifications of Allowing Driving
[33:40] When we were going through this process, I had a long conversation with our insurance agent, the car insurance agent, who told me a terrible story.
[33:52] And we don’t make up these stories just to scare people. These are real situations that happen with real people that have real consequences on everybody’s lives. The insurance agent told me that because the person has a valid driver’s license and an in-place policy that is enforced, if the person with dementia drives the car and accidentally kills somebody in an accident, Whether it be turning across the median, whether it be not stopping at a light, whatever the case may be, the insurance company is obligated because of the policy to pay out the policy. However, immediately after that, if there is any indication, and it will come out, that this person has a diagnosis of dementia.
[34:57] The estate of that person is now opened up for a civil suit. And the example that he gave me was a criminal who was who he didn’t mention who was driving his vehicle and killed somebody I believe he killed two people in the accident his family his estate sued by the family afterwards and he was left destitute there are legal ratifications above and beyond the emotional.
[35:35] Complexity of knowing that you have accidentally killed someone. And if you are the family caregiver and you knew that this person was not safe to drive, I would gently like to exhort you that you bear responsibility if somebody is killed in an accident. Because if you don’t want your child getting into the car with your parent or a spouse and that they drive, or if you don’t want to be in the car with them driving, then you should not be allowing them to drive anymore. And I know this is not a popular opinion and I apologize if I sound a little harsh about this, but the reality is that we bear a responsibility to other people to keep them safe as well.
Acknowledging the Loss and Arranging Alternatives
[36:31] So what are some steps, practical steps that I want you to consider today? The first one is, the very first thing is we do have to acknowledge that this is a loss.
[36:43] I know that my dad is still upset and angry with me about the loss of the vehicle. And I feel for him. But at the same time, I bear responsibility to other people to keep other people safe on the road. I would not get in a car with him and let him drive. I don’t want him accidentally killing somebody else and then losing all of the assets that they have. But we have to acknowledge it’s a loss.
[37:10] The second step is we do need to arrange alternative transportation. We have to. We cannot let that person just.
[37:19] Be on their own. They have trouble thinking. So therefore we have to help them think through how to get rides. And there are lots of things that we can do. The third thing is you really do need to get the support of the family and your friends around you to help you with this process as you’re navigating this, or you need to make, and this is not the best solution, make the car less accessible. But if it’s a female, maybe you can, especially if they’re not mechanically inclined, maybe you can make the car less accessible. But the fifth thing is a driving rehab assessment and then being firm, being firm in the decision afterwards.
[38:08] You cannot waffle. You cannot. It’s like a child who has two parents that they pit against one another. I’ll go to mom and I’ll ask her. She says, no, I’ll go to dad and dad will get it.
[38:22] You have to be firm. You have to be on the same page. And as difficult as this is, this is a conversation that you have to have sooner rather than later. I have a private client whose husband has mild dementia. Adventure and what we did is we actually had him go take a driving a private driving rehab assessment and he still has the ability to drive a car because he hasn’t advanced to the point where he’s not safe anymore but now we have a benchmark now we have an assessment and six months from now or a year from now we can retake the assessment and we can see what has changed and so i would encourage you to follow these steps if you are struggling with a family member that needs to have their license taken away or the car driving privileges taken away. I hope this helps you because it is a very super practical and extremely valuable episode with actionable steps that you can take and to know some of the data behind why it is dangerous for somebody living with dementia to drive a car. So a quick recap is some signs of the times, some symptoms that you can be looking for that indicate the person isn’t safe to drive a vehicle anymore. We talked about practical steps in getting the physician on board.
[39:50] We want to make the physician the bad guy, but 59% of physicians believe it’s their, only 59% of physicians believe it’s their responsibility, which means that we need to take responsibility.
[40:04] The third point was that we have to balance safety and independence. And we talked extensively today that driving is a privilege. It is not a right. We looked at the legal considerations of what potentially could happen if there is an accident that causes a death. And so I would encourage you today to just really sit in this for a couple of minutes and understand that as Christians, we do bear responsibility if we know somebody has dementia in whether or not they’re safe to drive. So dear friend, dear Christian caregiver, do not shy away from this conversation. It can be hard. It can be challenging, but it is well worth you being able to go through this process. If you haven’t yet signed up for my Ask the Dementia Coach monthly meetup, the next one is actually tomorrow, Thursday, July the 25th at 6 p.m. The link is in the show notes. I would love for you to just go register. It becomes co-creation on this podcast. But at the same time, the value that you get is you actually get to ask me specific individualized questions.
[41:33] We can change your name. You can be anonymous. You do not need to even come on camera. I just need to be able to speak with you. I would love to be able to serve you in this manner. Like I said, the next Ask the Dementia Coach segment is this coming Thursday. It is at 6 p.m. Eastern Time. The link is in the show notes, and you can sign up to come to this particular monthly meetup, and I hope to see you there. Like I end all of my episodes, if I remember, which I’m human, so I don’t always remember. member. But do know, Christian caregiver, I do pray for you every single day. And I walk this walk with you, both as a daughter of somebody living with dementia, but as a professional with 31 years of helping people just like you and me navigate this journey in an easier way. And may the Lord bless you and keep you and I will see you on Friday.
