Role Reversal

Car keys caution sign

Strategies for taking away the keys when mom or dad should no longer drive.

Automobiles transcend other possessions. They are part of our identity, almost like a member of the family. After a lifetime of mobility, the prospect of losing that aspect of independence can be seriously frightening. But, what do you do when your parent is no longer safe on the road? Here are some suggestions.

A familiar story

Mike picked up the ringing phone one day, and was surprised to hear his father, who had poor hearing and didn't like to use the phone:

"Where is the $4,000 from my pick-up truck?"

Momentarily taken aback, Mike struggled to remember the source of the question. Ah, that's right. A few months back, Mike's mother had been gravely worried about his father's driving. Suffering from moderate dementia, Mike's dad was a danger to himself and others on the road. Neighbors sometimes saw him weaving and driving erratically. But when she tried to talk to him about not driving, Mike's dad would become uncharacteristically furious. It was a big problem fraught with danger.

Mike volunteered to be the "excuse." His father would do anything to help the family, and readily agreed to loan the truck to Mike, who lived about 100 miles away. In actuality, his mother simply parked the truck on the next block. With the truck out of sight, his father soon forgot about it. A few months later, his mother used the opportunity to sell the vehicle to the gardener, and banked the money.

Then, in a moment of clarity, Mike's father remembered the truck. His wife, not wanting to spark a rage, simply said, "Mike sold it. Remember?"

Freedom, dignity, and safety: Are They competing interests?

Nothing conjures images of independence more than driving down the highway, unlimited horizons ahead. Teenagers thrive as they gradually acquire new freedoms and responsibilities, none of which are more coveted than their driver license.

Unlike when we're in our teen years, there is usually no "authority" such as a parent or guardian to make the ultimate judgment of who is safe to drive (see the sidebar on the facing page). Family caregivers face the unpleasant prospect of role reversal -- imposing their own opinions on an elder, who maintains a position of respect in the family hierarchy. In addition, practical matters intrude. Who will do the shopping? Or drive to the doctor?

These are legitimate concerns. Ideally, your parent will "self-regulate" as they get older and -- with the help of loved ones -- make good decisions about when to give up the keys. But, if they don't, how do you, as a family, know when the time has come?

The DMV might revoke a senior's license if:

  • There are tickets, accidents, or health problems
  • Police and/or a doctor notify the DMV
  • The DMV issues a notice to appear in person to take the written test and/or the driving test.

Facts:

  • About 5 percent of seniors will give up driving rather than take a DMV test.
  • More than 75 percent of seniors fail the written test one or more times.
  • Nearly 20 percent fail the driving test because they no longer have safe driving skills.

Tips

Every situation is different and calls for an individual approach. When initiating a family caregiver discussion, there are, however, common elements to consider:

Don't wait -- It is never too early to start talking and brainstorming. Waiting makes things more difficult and dangerous.

Combine subjects -- There are many important areas where it's important to plan in advance, including legal, financial, and medical matters. Put it all on the table together.

Consider the situation -- Never blame or point the finger. Describe the circumstance. Given the dangers (to self and others), ask the older driver for input.

Appeal to reason -- Most adults, given declines in physical or mental acuity, will admit they do not want to endanger the lives of others, especially children.

Get help -- Enlist others in the cause. Doctors, neighbors, and friends may all have input that will help in the decision-making.

Consult experts -- Look for a senior driving course. (The list of resources at the end of this article is a good place to start.)

Consider the costs -- How much does it cost to drive? By comparing costs, public transportation, cabs, or even limousines may look more attractive! Total the cost of the car, maintenance, insurance, gas, oil changes, yearly DMV fees, and car washes.

Offer help -- Offer to visit and give your loved one a ride whenever possible. It is a great opportunity to reconnect, spend time together, and may "return the favor" for shuttling you around when you were a kid.

Are you worried about your own driving?

Be honest with yourself. Do you think anyone has reason to be concerned? If so:

Take a test -- There are screening tools available to help you "look in the mirror."

Ask for help -- Loved ones, friends, and neighbors are likely to support you.

Buddy up -- Form a local "support group" of neighbors with like needs. Use the economy of scale to share rides.

Seek volunteer and public services -- See the resource list below.

Consider your location -- Is it time to move? It may be possible to "downsize" or live in a home within walking distance of shops and services.

Keep perspective -- Giving up a bit of independence for safety won't cause you to lose all your independence. A reasonable approach ultimately preserves your independence for as long as possible.

In the case of cognitive decline

Dementia (in the form of Alzheimer's or another related disease) can present special challenges. Although a person's reason and judgment are impaired, a rational approach is a good place to begin.

Don't assume driving is okay -- With dementia, procedural memory is often intact. Although a person may remember "how to" drive a car, other important
abilities (reading signs, stopping at red lights, remembering directions, etc.) can be impaired.

Don't rely on the DMV -- Even if their license is revoked, a person can still drive if they have a car and keys!

Follow through -- Mom might agree to stop driving, but forget the agreement the next day. If the car and keys are there, so is the ability to keep driving.

Present a united front -- Siblings, put your childhood rivalries aside. You can argue later. Consider safety now.

Unexpected details

The person with dementia, if still independent, is vulnerable. It's important that they retain the right to all of their resources for their own care. For example, if you decide to sell the car, the proceeds need to be available to care for that person.

Mike was able to reassure his father over the phone. Fortunately, his dad quickly forgot about the truck and is willing to allow his wife to do the driving. Even with moderate dementia, he realizes his abilities are impaired. Dealing with these issues gave Mike and his siblings the opportunity to consider other important long-term plans with their parents while their father is still able to participate.

Looking back, he wishes he would have started addressing the issue sooner. But, on the positive side, he now has a head-start for planning with his mother, himself, and his own family. If you don't know how else to begin, hand this article to the person who has (or may someday have) concerns about driving. It is a great conversation to have. The right and privilege of driving should never be taken for granted. Bring up the subject today.

Resources

Adult Protective Services

Alzheimer’s Association

National Highway Traffic Safety Administration

American Occupational Therapy Association

American Automobile Association AAA Car Fit Checklist

Association of Driver Rehabilitation Specialists

Senior Driver's Organization

AARP American Association for Retired Persons Driver Safety Program

Pamela Smith loves being active and has two leadership roles within San Diego County. She's the director of Aging & Independence Services, overseeing 30 different programs serving seniors and disabled persons. She is also the general manager of the East Region for the County's Health and Human Services Agency, which provides eight programs to serve children and families in that area. Pamela has received numerous awards for her community service including California Legislature Woman of the Year, Salvation Army Woman of Dedication, YMCA Distinguished Triangle Award, and the Chula Vista Chamber of Commerce Citizen of the year. www2.sdcounty.ca.gov/hhsa