Senior Citizens- the downward spiral and when to step in

Parent Cafe
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<p>HImom – watchful waiting? Those increasing dings mean that they aren’t fully aware of what’s going on around their car and/or they can’t respond quickly enough to what’s happening on the road. It’s only a matter of time until there’s a serious accident, and there’s no way of knowing when that day will be. I think you’re wise to be thinking about assessing their driving skills, at least to get a baseline.</p>

<p>Do they ever say, “That car/pedestrian came out of nowhere”? Do other drivers honk at them on a regular basis? Are they reluctant to get the dings fixed? You can take them (separately) for a test drive. Some red flags to watch for: failure to maintain speed, drifting within the lane, failure to notice pedestrians or cars entering from side streets, slow response times to changing situations, confusion/frustration. Especially notice their judgment when making left turns against oncoming traffic; this is the most common and deadly type of accident which they have.</p>

<p>wharfrat – despite what the PCP may think, after a certain point seniors actually do better in Assisted Living than they do in their own homes. Unfortunately, they generally can’t be convinced of this beforehand, but I wanted you to know. My parents are MUCH better off than they were a year ago, and much happier too.</p>

<p>My family had to take a crash course in the various types of facilities for seniors. Before we began our journey, we thought there were only 2 choices – staying in their house which was becoming increasingly hazardous, or “putting them in a home” which we envisioned as some kind of dreary warehouse for the demented. In reality, there is a range of options:</p>

<p>Independent Living – A community for seniors who simply don’t want the responsibilities of maintaining a home any more. Combines the best features of an apartment building and a dormitory. Residents have their own apartment and share the common areas (dining room, living areas, exercise room, library, TV room). Meals are provided, as well as light housekeeping and sometimes laundry, some transportation, social outings, and organized activities in the facility. The IL facilities we visited were very cheerful; the staff makes a great effort to keep the place vibrant and stimulating. There is a great deal of social interaction among residents, and between residents and staff.</p>

<p>Assisted Living – All the features of Independent Living, plus assistance with some of the tasks of daily living. My parents get help with putting on their compression socks; Mom can’t reach her lower legs, so an attendant helps her apply lotion after she showers. Their medication is dispensed to them, as I mentioned earlier. My parents’ AL includes a Memory Care wing; these residents get much more assistance and supervision, and are largely segregated from the rest of the population. </p>

<p>Skilled Nursing/Rehab – Must be ordered by a doctor. This is the place for a senior who needs medical care or therapy which can’t be administered at home. There are RNs on staff around the clock, and a doctor does regular rounds. The stay can be for a day or two, or semi-permanent. Skilled nursing is far less cheerful – it’s basically one level below a hospital.</p>

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<p>I guess none of us are willing to fight our folks who both insist they can continue to drive (& both have valid licenses). I have offered to drive them as much as I can, but only my sister has helped with getting season tickets with them to basketball our other 5 sibs have ignored it as as all have active lives. Both parents are used to driving wherever they want. They do get the dings repaired. Dad is still working 5 days/week, from about 6:30 until he leaves for home about 3ish, plus going out to golf several times/week. No one is free to be his driver and he doesn’t see the need for one. (He got upset last time I offered to drive but does allow us to drive them to the opera and season football games, plus some dinner parties that we are all attending.)</p>

<p>It’s a very touchy situation and my sibs all prefer to look the other way. I have more flexibility than many, as I largely make my own hours and officially work part-time for the non-profit I run & can do a lot from my home. My other sibs all have full-time jobs, as do their spouses.</p>

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<p>After we put my mom in the nursing home, one of us needed POA. My brother had medical POA and was on her checking account, but it was obvious she was not going to get any better, so we needed to look to selling her car. We didn’t know how long she would end up in the nursing home, and we were looking at having to do something with her house–at least rent it. We spoke to an attorney who drew up the papers, but he said that he would have to be convinced that she knew what she was signing or we would have to go to court and prove her incompetent to handle her own affairs. I lived several hours away, but B&S went with the attorney for her to sign the papers. They said it was scary. She was almost her old self for those few minutes he was there, but she agreed that she needed help with her affairs and signed the papers. That was really the last time any of us saw her seemingly normal. The last time H & I and 2 kids visited, she obviously knew who we were, but when she wanted to introduce us to the staff she couldn’t come up with any of our names.</p>

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<p>Glad you mom at least remembered who you were when you visited. It’s tough watching our loved ones drift from the vital folks we knew when they were in their prime. My folks are doing pretty well, but not as well as they were only a few years back.</p>

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<p>If and when folks want to step in (especially regarding driving), how does one go about it? When I broached the subject with my sibs, I was firmly rebuffed by all of those I spoke to. :frowning: They all don’t want to “get involved.” We all live within a very short distance of mom & dad (the furthest lives about 30 minutes drive).</p>

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<p>My FIL (age 78) recently decided to stop driving. He had a couple of small dings, and has hit the back wall of his garage a few times, but after going the wrong way down a one-way street (and getting stopped by the police) a couple of times, it did not take much convincing to get him to surrender the license. Thank goodness.</p>

<p>When my FIL moved out of the Bronx to NJ to be closer to my BIL (thereby saving the BIL 2-3 trips a week), my FIL had to set up new bank accounts, utilities, etc. FIL can’t handle this stuff solo, so BIL took him, and the timing was excellent to get things set up so BIL has access to view bills, is on the checking account and can view transactions online, etc. We trust BIL implicitly, and since DH won’t touch any of this with a ten-foot pole, I am personally tremendously grateful.</p>

<p>My parents have made some arrangements (I have a copy of my mom’s medical directive). Mom is 71 and bedridden, but is mentally competent and handles all the money. My dad does all the nursing care (much to our consternation) and is wearing himself out. He’s starting to get a bit forgetful and is not able to do as much for my mom as she needs. He refuses to sell the house and move to a single-level which would be safer and better meet their needs. One of my sisters lives three minutes away, which is a godsend.</p>

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<p>It’s so tough when our parents have been so fiercely independent for so long. I know of other couples where the “healthy” one wears himself/herself out caring for the spouse, refusing any help. It is painful for everyone involved. Is it possible financially & practically to have someone come in a few hours/day or week to provide some respite? Maybe as a trial at first but increasing?</p>

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<p>I can only tell you how it happened in our family. It happened in stages, not all at once. </p>

<p>For a year or two, there had been increasing signs that Dad’s driving ability was deteriorating – scrapes on the car, a near-collision making a left turn, getting confused about where he was. I finally got concerned enough to bring it up with my brothers.</p>

<p>Brother #1 (single & childless) was adamant that we could probably wait another year or so. When asked, he admitted that Dad wasn’t safe and probably couldn’t pass a DMV test. But his main concern, I think, was the blow to Dad’s pride if we took away the keys. Brother #2 (married, 2 school-age kids) shared my concerns and thought it was time to at least consider getting him off the road. We were at an impasse for several months.</p>

<p>Then we were having a conference call about an unrelated issue and the driving came up again. I said to Brother #1, “We all agree that Dad is unsafe to drive. If he kills someone and gets sued, and it comes out that we kids believed him to be unsafe and did nothing – WE could be in jeopardy.” That gave him pause. Later in the conversation, I mentioned that I had told my D that she was never to get into a car that Granddad was driving. Brother #2 instantly chimed in, “I’ve told my boys the same thing.” That’s when Brother #1 changed his mind.</p>

<p>Once we were on the same page, that left the question of how to tell him. We decided against a family meeting; we just thought it would be even more humiliating for him if the whole gang was arrayed against him. I was elected spokeschild and flew up soon after. I first told Mom about our decision. Later, I asked her to make an excuse to leave the room, but had her to listen in from around the corner so she would know what had been said. </p>

<p>I told Dad that I knew he was having some problems with his balance and other issues, and that we kids were concerned for his safety on the road. Out of an abundance of caution, I said, we would like it if he didn’t drive until he could get checked out. I had been in touch with his doctor, and discovered a local occupational therapy program that checks not driving per se, but the skills involved in driving: concentration, mental response time, physical reflexes, agility (like being able to look over the shoulder properly), ability to handle multiple incoming events at the same time. I told him that if they gave him a green light to drive – knowing very well that there was no way he could pass most of the tests – then we were fine with it too. I stressed that we all loved him and that we didn’t want him to get hurt or to hurt someone else. I expressed the hope that he’d pass his tests with flying colors and prove us wrong.</p>

<p>His pride was very hurt, and he insisted that he had no impairment, but he agreed to the deal. The appointment was made, but he was in the hospital on the day (with an accidental sleeping pill overdose). Soon after, they moved down here to California, and there was quite a bit of discussion about whether to bring their car down. I told them that it was up to them, but they’d be required to get licensed within 10 days of arrival, and that they would have to take a driving test (technically true, although the driving test is often waived). That ended the entire topic of conversation once and for all, which tells me they knew very well they couldn’t drive safely. </p>

<p>Like I’ve said before, to me, safety trumps pride and hurt feelings. No matter how hard, no matter how awkward, no matter how painful, it had to be done. During the most difficult moments of this process, I always came back to one thing – What if my D was killed by a senior driver whose kids believed him to be unsafe, but did nothing? That thought always gave me the strength to keep going.</p>

<p>ETA – sorry for the length of some of these posts I’m making. Alot of us are going through this, and I’m hoping that someone will be able to pick some nugget out of one of my posts that will help with this very tough transition.</p>

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<p>Thanks so much for your thoughtful insights and honesty. This is really so hard and represents giving up so much independence for them. Thanks so much for your candor. Much wisdom and love shine through your posts. As many of us are around our 25th anniversary & may of us have folks who are starting to have challenges with driving, it seems many of us are dealing with such similar issues.</p>

<p>Will try conferring with the family doc, who treats all of us, including our folks.</p>

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<p>Fortunately, everyone in my family is on the same page regarding Dad’s condition. We attempted to have a family meeting to convince him to investigate other living arrangements but he became very verbally abusive, cursing us and threw us all out of his house.</p>

<p>He is 100% convinced of his ability to care for himself even when presented with clear evidence that the opposite is the case. </p>

<p>It is becoming increasingly difficult to not be resentful of his stubborness. I realize it’s the illness but the fact is that this has drained way too much of my time and energy. Last week I spent hours as well as my own money in an attempt to get duplicate copies of documents he needs for his taxes because he lost the originals.</p>

<p>It has affected my own home life as well as my professional life. Fortunately my administration (I’m a teacher) has been supportive and understanding.</p>

<p>I have begun attending Alzheimer’s support group meetings and they have helped.</p>

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<p>LasMa … great post</p>

<p>With my FIL we got lucky … he was adament that he still was fine driving … even after a couple fender benders with a mailbox and the garage … then one day after leaving a stop sign at about 5-10 mph he hit a van full of kids (no one was hurt) … and that was it for him … on his own he saw he was a threat to others and never drove again. In this case all the sibs agreed he should not be driving before the van accident and talked to him about it but when he resisted they did not push back.</p>

<p>My Mom was driving longer than she should have … my Dad thought she was Ok … my sister didn’t think she should be driving but didn’t want to confront her … I thought we should force the issue. This is my regret … I let the two votes to let her keep driving win … if she had killed someone in an accident I would be destroyed right now and more importantly someone would be dead because I didn’t have the guts to step up when I should have. I should have intervened … one positive of the Alzheimers is we slinked into the solution … we took away Mom’s keys and eventually she stopped asking about them.</p>

<p>What should I have done? If I could go back I would can the DMV to find out the rules that require older drivers to be tested … and I would have made that happen even if it involved my calling in numerous bogus issues to the DMV. </p>

<p>Dealing with parents aging is gut wrenching for them … we’re on our thrid time through and starting on our fourth … and I’ve settled on this. I talk to them about any issues I thnk they are having … but ultimately respect their independnce and decisions even if I totally disagree if the outcome only affects them (and that includes monetary decisions like giving away money I might inherent) as long as I think they are competent. That said as soon as the safety of others becomes involved the long leash goes away … our kids no longer drive with last grandparent and when/if he becomes a threat to others I am not asking for others votes I’m off to the DMV. </p>

<p>BTW the safety issue can show up in many ways other than driving … my Mom has Alzheimers and wanted to stay home as long as possible … fair enough and we wanted to help make that happen. But homes are huge risks for Alzheimer patients … gas ovens, stairs, doors (my Mom wonders), lawn mowers, blenders, etc … there are a ton of things that a person loosing their judgement can hurt themselves with. Getting my Mom to agree to have someone on the house with her was not fun but we got there eventually … and this decision was necessary for both my Mom and my Dad who was watching her 24x7x365 and it was aging him very quickly.</p>

<p>There is nothing fun or good about this situation … your parent is wilting away … it is killing your other parent … it involves conflict about reducing their independence … and it is all gut wrenching … and it will only get worse. I’ve helped/edvised others through this … and I was no way ready for how much of my soul this has consumed … it’s hard but I’m trying to do my best out of love and respect for all my parents did for me.</p>

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<p>HIMom, they paid off the house early so there would be money for a home nurse, but now he refuses to do it. Declines our help when we are down there, too. They got a visiting nurse when he had to go out of town for a funeral, and were not happy with the experience, which just cemented the stubbornness.</p>

<p>My dad was a surgical nurse for over 40 years (21 years of that in the Army), so he knows what to do, and also took care of my grandmother and aunt for many years in tandem with my mom’s care. He knows that if my mom has to go to a nursing home things will go south for her very quickly. Too many co-morbidities and not enough staff to connect the dots. She’s been fully bedridden for seven years now (broken femur that did not heal) and has never had a bedsore. I think that deep down, he is terrified of letting anyone else take care of her.</p>

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<p>Absolutely, HImom. Respite is essential for caregivers. </p>

<p>There are all kinds of in-home services available, everything from just watching to make sure the person doesn’t get into trouble, all the way up to skilled nursing. Contact your doctor and ask for a recommendation for a home-health agency. It ain’t cheap – when we were looking into this, it was $20 and up for the lowest level of care. But for the caregiver, getting to take a few hours off – priceless.</p>

<p>Another thing you could look into: I’m not sure how common this is, but my parents’ Assisted Living facility has a “respite room.” This is one of their apartments, which can be rented by the night for around $80. It’s basically a one-bedroom apartment, nicely furnished, and the guest receives all the same services that a resident does: 3 meals, 24-hour staffing in case of emergency, med dispensing if needed, escorting/transferring/dressing as needed, participation in activites.</p>

<p>Either way, getting some help will also start introducing the concept – to both spouses, and to the family – that the current situation just isn’t working any more.</p>

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<p>Speaking as a cyclist who could be one of those “dings” you guys are talking about- if a driver is hitting things, that driver should not be driving. Please, please, please, take away the car keys. You don’t want to be sitting at the funeral of the jogger, the cyclist, the mother pushing a stroller your parent killed. </p>

<p>It’s not right to risk the lives of innocent bystanders.</p>

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<p>^I would gladly do it, in fact I have tried. When I did, my dad called the police who promptly told me I had to give them back. Now he keeps them in his pocket at all times, puts them under his pillow at night, and takes them in the bathroom with him when he takes a shower.</p>

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<p>I think the state(s) should be a little more proactive in assessing the skills of elderly drivers. You didn’t grant your father a driver’s license and you shouldn’t have to be the one to take it away. As a society, we all know this a problem and one that is going to get worse as the baby-boomers reach this stage in life. It’s one we should be talking about now. Things like making anyone over a certain age take a hands-on driving test every year as well a a short cognitive test/ interview would be wholly appropriate in my opinion.</p>

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<p>In our state, there are A LOT of geriatric drivers, who yes, do kill and main innocent people. There was a bill a while back that would seek to have people over a certain age (I think it may have been 70), take a road test to keep their license. There was a huge outcry & it died never to be revived (many of our legislators are in their “golden years” themselves, as are of course, their parents). The news about senior drivers maiming & killing people has subsided and probably won’t be an issue again until it starts increasing and getting more publicity again.</p>

<p>We know of one woman who stopped driving after she hit & killed a pedestrian on the sidewalk–the woman was only in her 60s or 70s at that time but refused to drive ever after; her license remained valid nonetheless.</p>

<p>Must be very awkward for families and cops in the driving/no driving wrangle. The states need to take a larger role but AARP, AAA & others don’t want to tackle this delicate subject, risking angering seniors & their families.</p>

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^^^ Sounds good. Where will the money come from to pay for it, though? It sounds hugely expensive to administer a driving test every year to every driver over the age of - what? 75? Younger? And as for the short cognitive test - I don’t know how much faith I’d put in one administered by the DMV. (Think about the vision test they do.) Should the seniors themselves have to pay to be re-tested? They’re on fixed incomes - what about the ones who can’t afford it? </p>

<p>I work with seniors every day. We’ve called the police when we’ve been concerned about some of our seniors who have obvious cognitive problems. In several cases, the police have followed them extensively - but only once has the senior committed the kind of infraction for which they could even be pulled over, let alone lose a license. One of our members was well into Alzheimers, and her nearest relative was a daughter who lived 2000 miles away in Canada. If you’d had a conversation with this elderly lady, you’d have been appalled at the notion of her behind the wheel of a car. The cops finally stopped following her, though, because it was taking up too much time and she drove well enough to give lessons, according to one of the guys in the department. </p>

<p>We’re talking about ourselves in 20 or 30 years, of course. So let’s plan carefully for where we want to end up. From what I’ve seen, it’s easier to get a senior to stop driving if it doesn’t mean essentially imprisoning him/her in an apartment (or worse, a house in the middle of nowhere with zero public transportation options). Better to say “Dad, I think it’s time for you to leave the driving to someone else,” and then take steps to insure the senior can still get out for the things he needs to do, or enjoys.</p>

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<p>LasMa, thank you for a very insightful post. Can you tell us the name of the senior driving test that you described? I’d like to see if our state offers anything like it.</p>

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<p>Yea, many of them have trouble with the vision test, so they have their eye doc write a letter that they can give when they go for their renewal.</p>

<p>I also would like more info about the testing LasMa was able to find that her dad agreed to take regarding his driving.</p>

<p>As it is, the DMV in our state is stretched with all the people trying to get new licenses and doesn’t have the personnel or capacity to administer more testing for seniors currently. It’s also tough to set an arbitrary age when the testing should begin and how frequently it should be administered, by whom & who should bear any costs related to it (but don’t we all bear costs by all the unsafe drivers in our communities). </p>

<p>Having more walkable communities and the ability for seniors to get around & stay active is a huge issue. Our city does NOT have this and cars are a really important part of independence around here. There are countless seniors driving on our roads–in their 70s, 80s, 90s and even north of 100! Teens and young drivers are a danger due to their inexperience but some seniors are as well, due to medical issues and slowing reflexes. Actually young parents who are harried are also pretty dangerous & log a lot of miles–I had a LOT more fender-benders when I was hauling my kids all over for their many activities than I have since I no longer have to drive them about.</p>

<p>Yes, those of us who continue living will soon have our kiddos worrying about us, in the not to distant future! Wish there were good & easy answers, but I haven’t seen or heard any yet.</p>