Keys to putting the brakes on drivers with Alzheimer's

Q: My husband was diagnosed with Alzheimer's a year ago. He still drives. However, I'm quite concerned about his abilities. I've pointed out errors to him, which he denies or brushes off as nothing to worry about. People in my Alzheimer's support group recommend I ask his doctor for a letter of diagnosis to take to the police department.

I wonder if there's a better way. He doesn't drive much, only short distances and only to places he's familiar with. He's comfortable with my driving — but there are times I'm not home, and he'll take off on his own.

A: You've described one of the toughest issues in the entire field of aging — taking the car keys from someone who can no longer drive safely. It's also one of the saddest side effects of dementia because it means a perfectly healthy (physically, at least) person can be quite dangerous behind the wheel — yet have no clue.

Because your husband is demented, it's useless to point out his mistakes to him — by definition, he no longer has good judgment or understands the consequences of what he does. Thus, he'll never fathom why he should stop driving. You must take more forceful action, behind the scenes.

In Washington state, anyone — you, your doctor, or a friend — can contact the nearest drivers'- licensing office and file a written report (called "Recommendation for Driver Re-examination"), giving specifics about a person's poor driving. After assessing the situation, the Department of Licensing may call the person in for retesting. This form is available at any licensing office or on the department's Web site, http://www.dol.wa.gov/forms/520005.html).

Other ideas from the Alzheimer's Association:

• Reduce the person's need to drive by having prescription drugs, groceries and meals delivered.

• Get others to drive or arrange for a taxi or special transit for disabled adults.

• Ask the demented person's doctor to tell him to stop driving and write a prescription that says, "No driving." Show it to him often.

• Ask your insurance company to write a letter saying the demented person's coverage will end.

• Control access to the car keys. Provide substitute keys that look the same but don't work.

• Disable the car — mechanics can install a "kill wire" that will prevent the car from starting unless the switch is thrown.

You can obtain more information from the Alzheimer's Association in Seattle at 800-848-7097 or go online to www.alzwa.org. Ask for the "Driving Fact Sheet" and "Who Says When It's Time to Turn in the Keys?"

Update: A few months after my reader's first e-mail, she wrote again, saying, "My husband received a letter from the Department of Licensing advising him to stop driving. I take it the letter from his doctor worked. The best part: My husband grumbled a bit but complied. Now he seems quite content letting me drive while commenting on all the other bad drivers!"

Q: I'm thinking about returning to the small town I grew up in when I retire. I've bought land and intend to build a house, with space in the basement for a spare bedroom. This is where a live-in could stay if I ever need care, in exchange for free rent and board. Sound reasonable?

A: No, it's pie-in-the-sky wishful thinking. If I had a dime for every person who's told me they intend to offer "free room and board" in exchange for free eldercare, I'd be wealthy.

Consider several realities.

Most people including caregivers love their homes and prefer to sleep in their own beds at night, not live with someone else. As a result, the universe of people willing to "sleep over," especially if they have to provide care at night, is small.

It gets even smaller if you expect the person to work on-call, 24 hours a day. And no, this is not the time to assume there are homeless people who'll jump at your offer. You want a caregiver — it's a profession that requires special training, experience, and a passion for providing care.

Finding quality, reliable caregivers in major cities is tough enough, but it's much harder in small towns with limited workforces. When it works, it's usually because of high unemployment, a temporary solution that may disappear once the job market improves.

Eldercare is like everything else we buy — there's no free lunch. Someone has to pay, and often its price reflects its value. A friend once told me she'd hired a caregiver for her dad at a very low rate of pay. Later she learned the caregiver had been "borrowing" significant sums from her dad, adding up to just about what the family would have paid if they'd started with a fair wage.

In planning for care, think about what you would want if you were caring for an older person you didn't know and had no ties to. What would it take? There are exceptions to this rule — I've known a few wonderful caregivers willing to work for practically nothing — but that's rare.

Liz Taylor's column runs Mondays in the Northwest Life section. With 30 years experience in the aging field, she writes and conducts workshops. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.