Alzheimer's Resource Center

Helpful Hints for Caregivers in the Home

Caring for a loved one with Alzheimer's is hard work. When you don't have time to consult all of the information in the Alzheimer's Survival Kit, use this as a quick Reference.

You know your loved one best. Try to accept their behavior for what it is and do the best you can to respond in a loving way. You are already doing a job that most people cannot do. Take one day at a time and take care of you -- give some loving care to yourself. Ask for help from others. You may think it’s a burden to them, but so many friends and neighbors would be glad to stay over for a few hours and let you get out for a while or just take a nap. And at the end of each day, understand -- no matter the frustrations or small failures -- that you are doing your best. No one can ask for more than that.

Safe Driving

Driving and Alzheimer’s Disease

      Even though Carmen had been diagnosed with Alzheimer’s disease, she prided herself in her continuing ability to do all her own grocery shopping.  She also drove to her beauty parlor appointment every Saturday morning. Her husband, Jim, had noticed that Carmen sometimes seemed confused when driving, taking an occasional wrong turn. Increasingly, she had trouble with her depth perception, which caused her to hit the brakes too early before a traffic light. At other times she would forget to stop at all.

      One Saturday afternoon, a police officer knocked on the door of their home, and Carmen answered.   “I’m investigating a motor vehicle accident,” he said. “Someone ran into the car parked across the street from your driveway. Do you know anything about that?”    Carmen shook her head. “No, I didn’t see anything,” she said. “But I’ve been gone all morning. I went to my hair appointment about 10:30.”

      The police officer asked Carmen to accompany him outside. Together, they looked at the rear bumper of her car. The police officer pointed to a large area where the bumper had been scraped. Red paint clung to the scraped area. Across the street, a red Ford Taurus sat, its door panel crumpled by a deep dent.    “Has anyone else driven this car today?” the police officer asked.   “Why, no,” Carmen said. “But I don’t remember hitting anything.”

      Jim stood on the doorstep with his hands in his pockets. He was grateful no one had been hurt in the accident. He knew he could no longer postpone the difficult decision to keep Carmen from driving. Even though Carmen treasured the independence her automobile symbolized, Jim knew he had to take away Carmen’s car keys for good.

     If you have Alzheimer’s disease, you may someday be faced with a recommendation that you restrict your driving privileges. If you have recently been diagnosed in the disease’s early stage, you may be able to continue to drive. However, at some point, you or your family members may begin to notice effects the disease has on your memory, judgment and attention. Your depth perception may fail and your reaction time may increase. You may find yourself disoriented in once-familiar areas, misjudge the speed of oncoming traffic or fail to notice stop signs.

     You may be driving legally that is, you have a valid driver’s license. But, you might not be driving responsibly. The last thing you’d want to do is cause an accident, which could harm someone else and cause legal problems and financial burdens for you and your family. The independence that driving allows isn’t easy to give up. Some people even feel lowered self-esteem when they can no longer drive. We have all grown up in a culture where driving is important to us. And, no one wants to be a burden on others for transportation. So it’s common for Alzheimer’s patients not to admit difficulty behind the wheel.

      However, people with Alzheimer’s disease and their families and doctors have a responsibility to balance a person’s convenience with his or her safety and the safety of passengers and other drivers. Studies have found that, particularly in later stages, a person with Alzheimer’s disease is twice as likely to cause or be involved in motor vehicle accidents as a driver of the same age without the condition.

      Recently published American Psychiatric Association guidelines for restricting driving privileges of persons with Alzheimer’s disease say that all severely impaired Alzheimer’s patients pose unacceptable risks on the road. So do some people with moderate impairment. In the early stage of the disease, some people can drive safely for a while. Others, however, cannot drive even short distances without endangering themselves or others. Discuss this issue openly with your family members and doctor. Trust them to tell you when to turn over your car keys.

The Family’s Role

      Julianne had watched her widowed father’s mental condition deteriorate in the three years since he’d been diagnosed with Alzheimer’s disease. Despite his illness, he remained relatively independent, doing his own laundry and preparing his own meals. He drove to his Rotary Club meetings and church and ran occasional errands to the hardware store to get supplies for tinkering around the house.

      Lately, though, Julianne noticed he’d been having trouble. Several times when she stopped by, she found wet laundry that had sat for several days in the washing machine. And the last time he made beef stew, he had added one-fourth cup of salt rather than one-fourth teaspoon, making it inedible.

      Her father had driven the night before when they went out for dinner at a new restaurant in town. They enjoyed roast chicken and simple conversation. (Julianne had become accustomed to his repetitive questions and hardly noticed.) What she did notice, however, was his erratic driving when he took her home. He changed lanes without looking, nearly sideswiping a van. Then he swore at another driver who honked at him for running a red light.
     Julianne resolved to keep her father from driving, but she knew from past discussions that he would ignore a plea from her to turn over the keys. Instead, she phoned her father’s doctor and asked him to write “Do Not Drive” on a prescription form and hand it to him at his next appointment.

      If you are a family member of someone with Alzheimer’s disease, keeping an impaired driver off the road is your moral responsibility. Because of the independence an automobile represents, many people with Alzheimer’s disease resist giving up their driving privilege. If family members are providing care for the patient, this issue can be divisive. If you try to takeaway your loved one’s car keys, you may face his or her frustration and anger. Helping a frustrated, angry person bathe, dress or perform other activities of daily life adds tension to an already stressful situation. For these reasons, many families turn to their loved one’s doctor or the state motor vehicle department for help.

  ACTION POINT!

How do you know when the time has come to stop your loved one’s driving? A good rule of thumb is when you no longer feel comfortable riding with him or her or letting your child go along. Another sign is when you notice your loved one can no longer follow recipes or perform simple household tasks. Mental abilities required for these activities are critical for driving.

      Once you decide the time has arrived, you may find several actions helpful. First, consult your loved one’s doctor. An older person may find it easier to hear advice not to drive from a health care professional he or she trusts rather than from a family member. Understanding this role, many doctors are willing to comply with such a request from the patient’s family. In some states, doctors can also file a request for re-examination with the agency responsible for licensing drivers. People authorized to file such a request depend on laws in each state. Those who can ask the state to re-examine a driver’s ability to operate a motor vehicle may include police officers, family members, neighbors or others.

      For example, both Kansas and Missouri laws and practices provide for retesting of drivers whose mental or physical impairments may prevent them from driving safely. In Missouri, the law authorizes the director of revenue (who oversees driver’s licensing) to require a road test, medical evaluation or both if there is cause to believe a driver is incompetent or unqualified to keep his or her driver’s license. Under the law, the Department of Revenue can order an examination of driving skills after receiving a written medical report from a physician or a letter from a law enforcement officer, family member or licensed health care worker who presents personal observation or physical evidence of unsafe driving. Reports must be in writing (no action is taken on telephone calls). The report must include the name, address, telephone number and signature of the person making the report.

      Kansas law provides for additional tests to determine whether a person with mental or physical disability can keep a driver’s license. Another law authorizes the Division of Motor Vehicles to revoke driving privileges of people who are incompetent to drive.

      A doctor, police officer, family member, employer, neighbor or anyone else who questions a driver’s ability can send a letter of concern to the state director of vehicles. Such letter must state a specific reason for the concern. It must also be signed. The letter is kept confidential; the writer’s name can be revealed only by court order.

      When the director receives a letter of concern, the driver is contacted and asked to have a doctor complete a medical form. If the doctor says the driver may continue to drive, the state requires the driver to take a road test. If the doctor says the driver may not drive, the state revokes the driver’s license. (Revoked drivers may appeal the decision.)

      Other states have different rules and practices. In New Mexico, for instance, drivers 75 and older must get a new driver’s license each year. In addition, the state Motor Vehicle Division can require an individual to complete all testing phases if it receives information concerning the driver’s inability to operate a motor vehicle safely. Most often, information comes from a member of the driver’s family.

      In some states, such as Illinois, the driver’s license authority cannot act on information that comes from a driver’s family members. Under Illinois law, the state agency must receive official notification from one of four authorized sources: the motorist’s physician, a law enforcement agency, a judge or a state’s attorney. The information must be firsthand knowledge of the condition that may impair driving ability and the reason the authorized source believes the state should take action. Family members who wish to keep a driver from behind the wheel must turn to one of the four authorized sources for a professional analysis of driving skills.

ACTION POINT!

Check with your state’s drivers’ licensing agency to see what provisions exist for revoking an impaired driver’s license.

Protecting Insurance Coverage

      Unfortunately, even with a doctor’s order not to drive, or a license revocation, no guarantee exists that your loved one won’t drive. He or she may simply forget the admonition not to drive or forget that driving privileges have been revoked. Frustration or stubbornness may also help put an impaired driver behind the wheel.

      In short, despite loss of driving privileges, a person with Alzheimer’s disease may drive anyway. Should that person be involved in a motor vehicle accident, serious consequences may result. Depending on the state, these consequences may include a challenged insurance claim or cancellation or denial of motor vehicle insurance.

      In some states, for example, state law requires insurance companies to honor claims from a motor vehicle accident that involves an insured vehicle driven by a driver without a license. The insurance company would pay the claim, but may subsequently cancel the insurance policy.

      If the state revokes a driver’s license, the insurance company may cancel the policy even if no accident has occurred. That’s because the revocation becomes part of the driver’s driving record. Many insurance companies routinely run periodic driving record checks on their insured drivers. Once the insurance company learns its insured has no driver’s license, especially if no other drivers reside in the home, the company would likely terminate the policy. If that happens,an impaired person who drives without insurance coverage would be at risk. In the event of an accident, the canceled insurance policy would not cover his or her assets from claims of accident victims for property damage or personal injury.

      Insurance cancellation would also jeopardize the insurability of an unimpaired spouse, who, because of his or her older age, would likely have trouble obtaining another policy without paying rates far higher than the couple had been paying. Some states do, however, provide a remedy for this kind of situation.

      For example, sometimes an impaired driver can submit a letter to the insurance company excluding himself or herself from an insurance policy so the unimpaired spouse can get auto insurance. If a loss results because the excluded driver drives anyway, the insurance company may pay liability claims for property damage or injuries to others. However, it might not pay the full amount of the policy’s limits for personal injury to the driver or damage to the insured’s vehicle. Again, the company would likely then cancel the insurance policy.

WARNING!

State laws concerning motor vehicle insurance vary. If revocation of a driver’s license becomes an issue, consult the insurance department of your state government for information concerning your situation. You may also want to consult an attorney to find out what your responsibilities are.

       If the person with Alzheimer’s disease lives alone and should no longer be driving, the best course of action may be to sell his or her car. If the idea of selling the impaired driver’s car meets with objection, families can and should take other steps. For example, you could remove the car’s tires or otherwise disable the car. One way to disable a car is to disconnect the battery. Another is to disconnect the coil wire that leads from the coil to the distributor, which is as easy as unplugging an electrical cord from a wall socket.

      The effect of disconnecting the coil wire is similar to the effect of removing the flint from a cigarette lighter. You can flick the lighter all you want, but it won’t fire up. With a car, you can turn the key, but the spark created by the coil cannot reach the distributor to start the car. Replacing the wire when an unimpaired driver wants to use the car is easy, too. Ask an auto mechanic to show you how.

      Alternatively, the unimpaired spouse could give the loved one with Alzheimer’s disease a “new” set of car keys that look like the old ones but don’t fit the car. Parking the car out of sight, perhaps down the street, around the corner or in a neighbor’s garage is also a good idea.

ACTION POINT!

If you have a loved one who should no longer drive, for his or her own safety as well as for the safety of others, take action to keep him or her off the road.