The Baker Beacon

The Driving Conversation

Posted in The Baker Beacon

Jennifer Milsovic is an Occupational Therapist with Baker Rehab Group, she shares her wisdom on having “The Driving Conversation” with elders.


Perhaps you are a clinician and have a client that you know is driving and probably shouldn’t be. Or, maybe you have a spouse that you aren’t sure should be driving. Maybe the person in question has some problems with memory, or some difficulty seeing, or right leg weakness. You know that you should somehow address this issue, but you don’t know exactly what to say. Driving is such a sensitive issue.  If you are a clinician and you “tell” on the client, you risk destroying the excellent rapport you’ve built. If the driver in question is your spouse, well, you have to live with that person. On the other hand, if you don’t address the issue at all, the person could have a bad accident and kill himself or somebody else. So, what exactly should you do? Maybe you decide to make a vague statement, and the conversation goes something like this:

You: I’m a little concerned about you driving.

Driver: Don’t worry, I’ve been driving for 50 years! And, I’ve never had an accident. I’m fine!

Now you really don’t know what to say or do. No accidents in 50 years? He has a valid point. But you still don’t feel right just letting this go. Luckily, the Maryland Motor Vehicle Administration (MVA) has some guidance for you.

First, let’s look at Maryland’s requirements for driving with a medical condition. The Maryland Motor Vehicle Administration has a branch, Driver Wellness and Safety, which is focused on ensuring that drivers with medical conditions are capable of driving safely. Driver Wellness and Safety considers the following to be medical conditions that could affect driving ability:

  • Cerebral palsy
  • Diabetes requiring insulin
  • Epilepsy
  • Multiple sclerosis
  • Muscular dystrophy
  • Irregular heart rhythm or heart condition
  • Stroke, ministroke, or transient ischemic attack
  • Alcohol dependence or abuse
  • Drug or substance dependence or abuse
  • Loss of limb or limbs
  • Traumatic brain injury
  • Bipolar disorder
  • Parkinson’s disease
  • Disorder which prevents a corrected minimum visual acuity of 20/70 in each eye and a field of vision of at least 110 degrees
  • Dementia, for example, Alzheimer’s disease or multi-infarct dementia
  • Sleep disorders (e.g. narcolepsy or sleep apnea)
  • Autism
  • Panic attack disorder
  • Schizophrenic disorder
  • Impaired loss of consciousness, fainting, blackout, or seizure.

 

The Motor Vehicle Administration requires that a driver with one of the above the medical conditions report the condition to Driver Wellness and Safety at the time of diagnosis or at the time of license renewal.  Let’s say that the person you’re concerned about has had a stroke. Technically, he would not have to notify Driver Wellness and Safety of his stroke until his license is up for renewal. This does not mean that he should, on his own accord, decide to resume driving. To avoid liability in the event of a crash, he (and anyone else with one of the above medical conditions) should have clearance before returning to driving. This clearance could be obtained from his doctor, a driving rehabilitation specialist, or Driver Wellness and Safety. Please note that even if the person decides to obtain clearance from a doctor or a driving rehabilitation specialist before he returns to driving, he will still need to report his stroke to Driver Wellness and Safety upon license renewal.

Let’s return to the above conversation. Now that you have some more information, you can offer a confident response!

Driver: Don’t worry, I’ve been driving for 50 years! And, I’ve never had an accident. I’m fine!

You: Well, I know you’ve been driving for 50 years. But, a stroke can affect your ability to drive safely. Returning to driving without clearance could open you up for a lot of liability. For your safety and protection from liability, before you drive again, you really need to do one of 3 things: talk to your doctor about returning to driving, schedule an appointment for a driving evaluation, or notify the MVA of your stroke.

In an ideal world, the person would do exactly what you recommended. But in the real world, he might just continue driving. If you know that he is continuing to drive despite your recommendation, you can notify either his physician or Driver Wellness and Safety. If you choose to contact Driver Wellness and Safety, you will be able to do so anonymously. You can contact Driver Wellness and Safety by phone at 410-768-7000, by fax at 410-768-7627, or by mail at MVA Driver Wellness and Safety Division, 6601 Ritchie Highway, Glen Burnie, MD 21062.

Let’s enter the ideal world and go over some answers to follow up questions that a highly prudent client, spouse, mom, dad, etc. might have.

Driver: How do I notify the MVA of my stroke?

You: You can notify them by phone, fax, mail, or e-mail. Just be sure that you include your name, date of birth, mailing address, driver’s license number, and medical condition in your correspondence. After you notify Driver Wellness and Safety of your stroke, you can expect to receive a packet in the mail with information for you to fill out as well as information for your doctor to fill out. Once you send that information back in, the MVA will advise you of any next steps and may require that you have a driving evaluation with a driving rehab specialist or take a driving test.

Driver: Okay, so what if I want to start out by having a driving evaluation? What exactly is that?

You: A driving evaluation includes a clinical evaluation, during which the therapist will look at your driving-related vision, cognition and physical function. Then, the therapist will schedule a time to take you behind the wheel to further assess your driving. If you need special equipment to help you steer or operate the pedals, the therapist will prescribe training with that equipment.

Even if the driver in question doesn’t have one of the above-mentioned conditions, like a stroke, but does appear to have visual, cognitive, or physical limitations that could preclude safe driving, you can still follow the above guidelines for approaching the subject and/or anonymously reporting the person. For more information, check out aota.org/olderdriver.

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