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Rehabilitation programs can keep older adults safely in the driver's seat

Freedom. That's how Kathleen Slove describes the ability to begin driving again.

The 66-year-old Hoffman Estates resident voluntarily gave up her place behind the wheel in March when she no longer felt comfortable on the road.

A progressive muscle weakening disease  was making it hard for her to turn the wheel and too weak to properly brake.

While people were more than willing to help get her where she needed to go, Slove says she didn't like being at the mercy of others or asking for help.

"I didn't like not having my freedom to go when I wanted to go," she explains.

She was able to restore her independence after driver rehabilitation through Marianjoy Rehabilitation Hospital in Wheaton, as well as adapting her vehicle with special equipment such as hand controls and low effort steering. And not a moment too soon. The day after she completed her driving program her husband had a stroke.

"So now it's up to me to do the driving," she says.

While Slove's circumstances may be unique, the fear of losing independence and the ability to get around is common among older adults.

There are several programs in the area, including Marianjoy and Rush University Medical Center, that offer driver rehabilitation evaluations and courses to help hang on to independence.

The idea behind the programs is to pair safety and prolonged independence, according to Karen Lukaszewski, Licensed Clinical Social Worker and coordinator, Adult Day Rehabilitation and Driving Rehabilitation Programs at Rush University Medical Center.

"Because driving holds such significance for many people, we strongly encourage our clients to practice safe driving as long as possible, says Lukaszewski. "Often we can work with someone to maintain this independence through adaptations to the vehicle and/or driving behaviors."

The first step

Anne Hegberg, an occupational therapist and certified driver rehabilitation specialist, has been a driving instructor at Marianjoy for more than 25 years. She says it is not uncommon for an older adult to voluntarily give up driving when they no longer feel safe or to stop driving at night or during heavy traffic times.

Sometimes there are red flags like an adult child not allowing the grandparent to drive their grandchildren. For others, disability due to a diagnosis, low vision or an injury or post stroke situation might compel them to seek out driving assistance.

Whatever the hesitation with driving, the first step is to seek a doctor's order for an evaluation.

Both Marianjoy and Rush start with the evaluation process, which can take several hours to complete. It includes a basic history, driving history as well as extensive testing related to areas such as perceptual skills, cognitive skills and processing time. Hegberg says they take everybody out driving as well.

"We are fortunate that we have 50-60 acres (at Marianjoy in Wheaton). People can drive around in a controlled environment," Hegberg says.

If they are comfortable there they move on to heavier traffic areas.

The evaluation and classes are done at Marianjoy and Rush by registered occupational therapists trained in accessing driver safety and certified driving rehabilitation specialists. Rush also includes a social worker coordinator who supports the team providing resources and education.

The separate behind the wheel evaluation usually takes 45 minutes to an hour, Hegberg says. While the Secretary of State driving exam is usually 10 to 15 minutes and is looking at a person taking right and left turns properly and obeying speed limits, driver rehabilitation specialists want to make sure drivers are equipped with defensive driving capabilities, problem solving abilities and other important skills. Hegberg says most people can hold it together for 10 to 15 minutes, but a longer drive really shows the driver's range.

"Many people do not realize the level of responsibility and complexity involved in driving safely; many different body systems need to work together, and a person needs to be able to adapt to changes very quickly. Given that a person is moving at an increased rate of speed in a vehicle, ensuring that the driver is safe is our paramount concern. This is what we aim to assess during the driving evaluation," says Lukaszewski.

Following the evaluation the OT goes over strengths and weaknesses. At the evaluation they can determine if someone is clear to drive, could benefit from behind the wheel instruction, could use some specialized equipment to help with driving or should consider "driving retirement," says Hegberg.

"Most people outlive their ability to drive now by about seven to 10 years," she says.

The evaluation also offers an opportunity to educate the patient and family about alternative transportation options. A client might begin using the resources while they still are able to drive so the transition won't be so difficult when they should no longer drive, Hegberg says.

The goal, however, is to help people continue driving if that is a safe option.

What the instruction looks like and involves depends on the client.

"A lot of elderly people never had driver's ed," Hegberg says. "They didn't have it when they were young and learning to drive."

In those cases they spend time going over defensive driving, use of mirrors and other areas in which they may not have been instructed.

Available adaptations

Many people aren't aware of safe adaptations that can be made to vehicles to help people continue driving, Hegberg says. It might be something like additional mirrors or bioptic lenses that magnify vision or more extensive modifications like adding hand controls and wheelchair access.

In addition to the driving instruction, Hegberg and the driver rehabilitation staff typically assist the patient at the dealership to make sure the right modifications are made to their vehicle. They also will accompany a client on their vehicle pick up to make sure that the driver feels completely comfortable and all the proper adjustments have been made.

Back on the road

How long it takes to get back on the road varies depending on the person's situation.

For Slove it took four lessons before she felt comfortable going more than 20 mph on the Marianjoy campus.

"It took me six lessons to completely get to the point where I felt comfortable that I was doing well enough to drive on my own," she says.

Drivers need to meet the State of Illinois vision requirements, be able to use primary and secondary motor vehicle controls independently with or without modifications, have adequate physical and visual speed of reaction, and demonstrate the cognitive ability to make appropriate judgments while driving, explains Lukaszewski.

Through the program Marianjoy staff will often accompany the client to the Secretary of State's office for their license testing, allowing them to use the adaptive driving vehicle they are accustomed to.

What is covered?Most insurance companies will cover the OT clinical evaluation portion, Hegberg says, but many do not cover the behind the wheel evaluation. The cost can vary from $272 for a car to $544 for use of an adaptive van. Medicare does cover behind the wheel training while most insurance does not.

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