Learning How Not to Drive: Clinical Driving Assessments, Driving Skills Evaluations, and What Comes Next

The scenario is all too familiar – you have an older family member and they've had a couple of minor at-fault accidents. Perhaps you feel unsafe as a passenger in their car or you'd never let them drive your children anywhere. Learning to drive is a rite of passage when we are teenagers and learning how not to drive is just as significant a rite of passage as we age.

Clinical Driving Assessments and Driving Skills Evaluations

Some physicians are "prescribing" clinical driving assessments or driving skills evaluations to patients. This can be a relief to caregivers who don't want the duty of convincing a relative or loved one that they should stop driving. These services are also useful in terms of providing a structured, quantifiable way of evaluating a driver's capabilities.

Clinical driving assessments and driving skills evaluations are similar, but not identical. AAA defines them in the following ways:

Clinical driving assessments. These are conducted by individuals who are medically trained occupational therapists. The assessments include a review of the individual's medical history, a cognitive assessment, an on-road driving test, and recommendations for next steps. These may include specialized training, vehicle adaptations, or cessation of driving altogether.
Driving skills evaluations. These are conducted by organizations that are licensed and certified by states to offer driver training. The objective of a driving skills evaluation is to capture information about an individual's driving abilities at a point in time. It does not identify medical causes for reductions in a person's driving ability.

Every state has different rules and regulations related to older drivers. Some issue informal recommendations, while others have formal license restrictions. For instance, drivers may only be allowed to drive a certain distance from home or they may not be allowed to drive at night or on freeways. In some states, physicians are legally responsible for reporting drivers they believe to be "unsafe" to the licensing agency.

The National Highway Transportation Safety Administration's (NHTSA) Clinician's Guide to Assessing and Counseling Older Drivers offers six questions to consider if you or a family member is selecting a driver evaluation program:

How many years have they been offering these services and what types of clients do they serve?
Do they offer comprehensive evaluations that include both clinical and on-road assessments?
Do they offer driver rehabilitation and training?
How much do assessments cost? If rehabilitation or adaptive equipment for a vehicle is recommended, how much do those typically cost?
Who will receive a copy of the assessment report? If reports are sent to the state licensing agency, that should be clearly stated upfront. Even if reporting is not legally mandated, some organizations voluntarily send assessments to the state in the interest of public safety.
If the evaluator recommends that the individual stop driving, what counseling is provided to identify alternative transportation services?

When the Assessment Says Driving is No Longer Safe…

Caregivers may have a sense of relief if a family member takes a driving assessment and does not pass. However, the task of developing a transportation plan remains. Ridesharing services like Uber and Lyft are one alternative, but a potential obstacle is that some older adults don't have smartphones due to a lack of "tech savviness."

Some caregivers elect to schedule Uber or Lyft rides for family members themselves. This is certainly an option, but it may take away a person's sense of independence. Also, it may not always be practical for caregivers to take time away from work or personal responsibilities to schedule rides.

Another possibility is GoGoGrandparent which is a concierge "middle man" between riders and rideshare drivers which removes the need for a smartphone. After registering with the service, the rider calls an 800 number and use key prompts to schedule a pickup. Once the driver arrives, text message updates can be sent to an emergency contact like a family member. GoGoGrandparent charges a "concierge fee" of $0.27 for each minute of the ride. A friend's mother recently started using this service and has liked it thus far. Online reviews at Yelp and Better Business Bureau, however, reveal mixed experiences. Some users have reported billing issues. Since riders have no way to communicate directly with drivers, problems can arise if drivers can't find the pickup point (e.g., at a large mall) and "no show fees" may result.

Another similar "middleman" ridesharing service is GreatCall Rides which works with Lyft. GreatCall Rides requires riders to have a Jitterbug mobile phone (sold by GreatCall). Riders dial zero and request a ride from a live operator. The operator provides an estimate for the ride cost prior to booking. Once the ride is complete, the fare is added to the rider's GreatCall bill. It appears that the GreatCall Rides service requires riders to subscribe to a Health and Safety plan ($34.99 per month) which includes a personal operator. In addition, a surcharge is levied on each ride scheduled through GreatCall.

Outside of ridesharing services and concierge "middlemen," the market for senior transportation services is quite fragmented and varies based on region. Local Councils on Aging may be good resources to learn about community-based transportation options, such as Senior Center paratransit services, volunteer drivers, and more.

Starting the conversation about transportation alternatives early (i.e., before family members and loved ones can no longer drive safely) makes sense. Consider, for example, using a ridesharing service to go out to eat with an older family member even when you both can drive. Treat it as a fun experience which also generates familiarity with the process. Just as learning how to drive takes time, so does learning how not to drive.