Is Driving Cessation a Risk Factor for Long-Term Care?

Olivia has always enjoyed driving. She loves the wind in her hair as she drives on Main Street with the top down on her convertible, a retirement present she bought for herself. She enjoys the independence she feels when she gets behind the wheel and can go where ever she wants, whenever she wants. Unfortunately, as she is approaching 80, her vision, hearing, and motor skills aren’t what they used to be, and her doctor told her she should no longer be driving. Olivia feels saddened by the impact this will have on her life. Independence means everything to her, and the thought of no longer being able to drive in a car-dependent area, such as the DC Metro area, is depressing.

Driving a car is a symbol of independence and competence and is closely tied to an individual’s identity. For seniors, similar to Olivia in our example, it also represents freedom and control and enables easy access to social connections, health care, shopping, volunteering, and activities.

Understandably, dealing with impaired older drivers is a delicate issue. This is especially true in areas such as the DC Metro area, which are car dependent. In the suburbs of DC, for the most part, seniors can’t simply switch to walking to the grocery store on the corner — because in car-dependent suburbs, there are no corner grocery stores (only supermarkets on busy, traffic-filled roads). Keeping the current coronavirus pandemic in mind, a recent article in StreetsBlog discusses how car-dependent neighborhoods have made it “virtually impossible for seniors to age in place when they lose the ability to drive” and how many of these seniors must move into long-term care facilities sooner rather than later. The article described also provides a very interesting history lesson about how assisted living facilities and nursing homes care to be.

Are Those Who Are No Longer Driving More Likely to Enter a Long-Term Care Facility Sooner?

Driving cessation was reported to be associated with declines in general health and physical, social, and cognitive functions, and with increased risks of admission to long-term care facilities and mortality. Researchers at Columbia University’s Mailman School of Public Health examined the health and well-being of older adults after they stopped driving and found that their health worsened in a variety of ways. In particular, driving cessation nearly doubled the risk of depressive symptoms, while also contributing to diminished cognitive abilities and physical functioning. Findings are published online in the Journal of the American Geriatrics Society.

A study titled, “Driving Status and Risk of Entry into Long-Term Care in Older Adults” examines the impact of driving cessation on older adults and whether or not driving is a risk factor for entering long-term care (LTC). Data was collected for over 8 years from a random sample of 2,520 older adults (between 65-84) living in Salisbury, Maryland.

The study found that former drivers were nearly five times as likely as current drivers to be admitted to long-term care (LTC) facilities (e.g., nursing home, assisted living community, and retirement home). Having no other driver in the house was independently associated with increased LTC entry. The study also shows that senior non-drivers aren’t using the public transportation options that are available to them.

Seniors Rarely Use Public Transportation Options

As you can see, given the importance of driving in American society and in our area in particular, older non-drivers may be unable to meet basic needs while living independently. Inadequate access to transportation is recognized as a significant barrier to older adults’ social participation, utilization of services in the community, well-being, and quality of life. Even with the transportation options available, two national studies estimate that older people use public transportation for only 2% to 3% of their trips. Many seniors instead rely on informal transportation support from friends and family, but at the same time may feel concerned about being a burden to others and thus, limit their activities.

Resources for Non-Drivers During the Coronavirus Pandemic and Beyond

Many older adults have been urged to stay home because the risk of serious illness from COVID-19 increases with age and with co-existing conditions. Many of these individuals often do not drive, yet they still need food and possibly medication and transportation to medical appointments, and will continue to have these needs after the pandemic is over. Here are some resources that can help:

• According to Forbes, Walgreens and CVS are waiving delivery fees on prescription medicine(s) in support of older adults during the COVID-19 crisis.
• Rite Aid: Home delivery is available upon request and the company will waive delivery fees. Customers should contact their local Rite Aid pharmacist for details. Controlled substances or refrigerated medications are not eligible.
• Home Delivered Meals/Meals on Wheels in Virginia
• Mom’s Meals— Ready-made meal delivery plan designed specifically for seniors.
• HelloFresh— Farm-to-table sourcing of high-quality ingredients.
• Fresh n’ Lean— Ready-made meals, just heat and eat.
• Grubhub, Uber Eats, DoorDash, and Postmates all deliver food from restaurants.
• Services such as FreshDirect, Amazon Fresh and FoodKick let you add items like fresh produce, organic proteins and healthy snacks to your cart, and have them delivered to your doorstep at a designated time.
• Instacart offers same-day grocery delivery. With Instacart, a personal shopper goes to your favorite local grocery store and delivers your shopping list to you within the hour.
• Peapod from Giant Food offers next-day and same-day grocery delivery in select areas
• Target delivers groceries through its own shipping service called Shipt, which offers same-day delivery to your doorstep during your selected delivery window
• Walmart Grocery allows you to shop online or through their app, with the option of in-store pick up or delivery with a designated time slot
• Thrive Market is a membership-based grocery and household website offering natural and organic products at reduced costs, delivered right to your doorstep.
• Washington, DC offers a variety of transportation options to help residents who are elderly or disabled get around the District.
• In Northern Virginia, Fairfax County, Arlington County, Alexandria, and the Fredericksburg area offer a variety of transportation options for seniors.
• Montgomery County, Maryland has several options for transportation services for seniors.

You Can Still Age-in-Place if You Aren’t Driving, But You Should Plan Ahead for the Future

With all the options for delivery and transportation, it is still possible to age-in-place even if you are no longer driving. However, there may come a time when you will need more care and support than you or a caregiver can provide in your home. If you have a loved one who needs nursing home care or even if your loved one is already in a nursing home, if you haven’t done so already, the time to plan is now!

For anyone who does not have their planning in place, now is an ideal time to do so, as the Farr Law Firm is offering discounts to get your planning done (20% off all levels of planning for everyone until the end of May, and 50% off of incapacity planning documents for healthcare professionals and first responders until the end of May).

At the Farr Law Firm, we assist clients and family members of those who need long-term care through the process of Life Care Planning and Medicaid Planning (also called Medicaid Asset Protection Planning). Our goal is to help protect a family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance.

If you or a loved one needs nursing home care or even if your loved one is already in a nursing home, please contact us as soon as possible to make an appointment for an initial consultation. For those who feel safer in their homes, we offer phone appointments or video conference appointments in lieu of in-person meetings (but we are still open for in-person meetings, of course using social distancing, safe sanitation, and face masks):

Medicaid Planning Fairfax, VA: 703-691-1888
Medicaid Planning Fredericksburg, VA: 540-479-1435
Medicaid Planning Rockville, MD: 301-519-8041
Medicaid Planning Washington, DC: 202-587-2797