CODE - Certified Older Driver Evaluations
The Older Driver Problem
According to the Centers for Disease Control and Prevention, every day in America there are 16 older adults killed and 648 injured in traffic collisions. That brought the total in 2014 to more than 5,700 older adults who were killed and more than 236,000 who were treated in emergency rooms in hospitals all over America. In 2012, in the state of Georgia, more than 200 were killed and over 500 hospitalized due to vehicle collisions.
In 2015, America had more than 40 million licensed drivers 65 years of age and up, which is a 50% increase from 1999, and the numbers are expected to increase over time as our citizens are living longer https://www.cdc.gov/motorvehiclesafety/older_adult_drivers/
Even though the trends for serious injury and death for all drivers, including older drivers, have been declining for the last decade, the number of collisions producing serious injury and death is still alarmingly high for older drivers as a percentage of the total drivers and miles driven.
The older driver most at risk is not necessarily individually a legal, mental, physical, spiritual, financial, social, or planning problem, but rather a problem that could encompass one or several if not all of these areas for our older drivers most at risk. There are many problems associated with educating stakeholders and older drivers who are most at risk when operating a motor vehicle. In addition, many other problems have been identified, which I will address in this proposal.
- Lack of central leadership in bringing stakeholders together
- Lack of established triggers, which should generate referrals from stakeholders to the appropriate driver licensing authorities, (DDS, DMV) calling for medical evaluations and driver evaluations, or referrals directly to driver evaluators.
- Lack of well-trained driver evaluators to perform both Clinical and Functional Driver Evaluations
- Driver evaluation scoring is often subjective and makes training of new evaluators difficult
- Driver evaluation and training cost
- Driver evaluation not covered by insurance nor Medicare
- Drivers’ fear of failing driver evaluation and losing their driver’s license
- Drivers unaware of program availability
- Drivers unaware of program benefits
- Healthcare providers unaware of program availability
- Program location (too far away)
- Program location (different environment for driver)
- Waiting time for appointments
- Lack of affordable public or private transportation
Problems Associated with Leadership and Driver Evaluation Triggers for Referrals
The first problem identified is the lack of established triggers, which would generate a referral for older drivers who are at risk to seek a professional driver evaluation, education, training or an immediate intervention from law enforcement.
“January 12, 2016 (WTVM) Channel 9 News in Columbus Georgia reports—A woman driving a Chevrolet Cruz crashed her car into The Egg and I restaurant located on Weems Road on Tuesday.
According to police, the driver was an 89-year-old woman from Fortson, GA who accidentally hit the gas pedal when she was trying to park her car. The woman’s foot apparently slipped, hitting the accelerator instead of the brake.
The woman says she is not sure what happened, but she was cited for the improper start of a vehicle, a misdemeanor. Her car received moderate damage.”
This type of collision happens all over America and many times law enforcement, media, and other stakeholders miss the opportunity to trigger a referral and simply categorized incorrectly the cause of the collision.
The case of the 89-year-old woman is a prime example of the problem we face in America as our population of drivers continues to get older. The law enforcement officer simply cited her for improper start of a vehicle. Sec. 15-88.—Improper starting of parked vehicle, (No person shall start a vehicle, which is stopped, standing or parked unless and until such movement can be made with reasonable safety.) which is a simple misdemeanor charge with a possible three-point count added to her Motor Vehicle Record. Meaning, no judge could hear the facts and the Georgia Department of Driver Services (DDS) could not suspend or move to revoke her driving privilege.
In addition, no mental health referral was made to determine her mental competence to operate a motor vehicle, nor was a driver evaluation suggested or ordered. However, she did visit her family doctor of her own accord and he told her it was simply because she was getting older. The insurance company wrote it off as an accident and re-insured her new vehicle. This was a total breakdown among the stakeholders who should have been on high alert and making a referral.
Instead, the 89-year-old woman hit the road again, as if the pedal misapplication, which caused her to run through the side of the restaurant, never happened.
Problems Associated with the Shortage of Professionals Performing Driver Evaluations
Another big problem is the shortage of professionals performing driver evaluations, such as professional driving instructors, occupational therapists, physical therapists, and driver rehabilitation specialists in Georgia and throughout America.
According to ADED, the Association for Driver Rehabilitation Specialists, currently there are about 360 active CDRS in the U.S. and Canada, hardly enough to begin to address the problem in the U.S. In Georgia, only 10 providers were found to have a driver rehabilitation specialist.
Number of driver rehabilitation programs (DRPs) per 100,000 older adults
In an article titled Driving Rehabilitation Programs for Older Drivers in the United States written by Marian E. Betz, MD, MPH, Anne Dickerson, PhD, OTR/L, FAOTA, Tyler Coolman, MPH, Elin Schold Davis, OTR/L, CDRS, Jacqueline Jones, RN, PhD, and Robert Schwartz, MD, The authors explain the objective of their study was to describe the services, referral and reporting practices, and barriers to utilization of DRPs for older drivers. Identified through two national association databases, 204 DRPs completed an online survey. DRP availability varies, with a median of one program per 64,151 older adults (range: 1,006–676,981). The median cost for a complete evaluation was $400; 36% of DRPs reported no third-party reimbursement. Participants thought barriers to DRP use include cost/reimbursement, lack of program awareness, and issues with evaluator training. Models for insurance reimbursement and increased awareness of program benefits by healthcare providers and older drivers are needed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347878/
The Cost of Professional Driver Evaluation is currently not covered by insurance companies or Medicare, and this is a concern to many who simply cannot afford the high cost of the evaluations.
There need to be improved referral and reporting systems. Shorter evaluation times, possible tiered sessions, and more trained evaluators are needed.
Perceived needs, at national level, to address older driver safety
The Communication, Location, and Timing Problem
One of the biggest problems is the older driver’s perception of taking a driver evaluation. Their fear is the loss of their driver’s license; they believe they will not be able to pass the test. For this reason, self-referrals from our older drivers rarely occur. In fact, most referrals come from pressure being place on the older driver by law enforcement, family or doctors, or a combination of many partners in the referral.
Many drivers are unaware of programs being offered to evaluate and even sharpen their driving skills. Not only are drivers unaware but healthcare providers are also unaware in many cases.
Program locations may prohibit potential users from using the service because they are too far from home to travel to, and they will be tested in unfamiliar territory.
Even when we have willing candidates for the driver evaluations, the limited number of evaluators creates lengthy waiting periods.
Figure 3 barriers
The problems discussed in this proposal are occurring all over the United States, Georgia, and more specifically in two major regions of Georgia, which is our focus and target area. EMS Region 7 (Columbus Georgia area) and EMS Region 3 (Metro Atlanta Area) had the highest crash rates in 2012. Geographically, these are two diverse areas, with Region 3 having urban roadways and Region 7 having more rural roadways.
Fatalities in crashes involving drivers 65 and older, 2008–2013
|# of Crashes involving older drivers||217||227||208||226||248||198|
Fars Data 2015 Governor’s Strategic Highway Safety Plan page 25
CODE Certified Older Driver Evaluation
Currently, fragmented resources are being used ineffectively to address the problems in and around our state and country when it comes to at-risk older drivers.
CODE consist of all the components needed to address the problem from a holistic approach, from leadership, to standardization in evaluations, expansion of the distribution of evaluations, training, software solutions, and future transportation needs of the older driver. CODE-The System and Training will be distributed through Commercial Driving Schools like our Columbus Ga. Partner Barber’s Driving School. Code will also be available to Occupation Therapist, Physical Therapist and Driver Rehabilitation specialist throughout the United States.
Unfortunately, only recently have doctors been referring older drivers to Barber’s Driving School to complete clinical and functional driver evaluations. Until Barber’s began evaluating older drivers 18 months ago, there was no place to send drivers except Warm Springs Georgia, almost one hour away from Columbus. In reality, very few would make the trip for all the reasons we have already pointed out.
To have a meaningful and large impact on reducing older drivers’ crash, injury, and death rates, several resources must be created or enhanced.
First and foremost, leadership must be present to remove the stakeholders from a fragmented approach to an approach of consolidation and unity in addressing the problems. This unity must be brought between individuals, institutions, associations, governments, businesses, organizations, and foundations who are considered stakeholders and vested in the problem of older drivers’ safety. Barber has taken the leadership position in this effort in Columbus and the surrounding area, and will assume the role throughout the State of Georgia and the nation.
Second, there must be triggers established that will generate referrals from all stakeholders to have older drivers evaluated when they are most at risk. There must be a communication software system to allow partners easy access to referrals and outcomes of driver evaluations being performed. Currently, there are few triggers that generate needed referrals for older drivers most at risk. There is no software being used to open communications and track referrals and outcomes of evaluations among stakeholders. UMI has partnered with ADE to develop the software program needed to help stakeholders be informed.
Third, the evaluation needs to be holistic and standardized among evaluators. Barber has created a driver’s evaluation that is holistic in its approach and hopes it will be the future standard for evaluations.
Fourth, the driver evaluation must be affordable and convenient. Currently, Barber’s is convenient and affordable at a cost of $250.00–$300.00 per evaluation in the Columbus market, but throughout Georgia and the nation, this is not the case. In addition the distribution of services-trained evaluators can be accomplished by larger distribution channels such as commercial driver training schools.
Fifth, scoring of the evaluation must move from mostly subjective to being mostly an objective process, which in contrast to subjective, relies on quantitative scales that could apply to the description of the older driver’s performance. Barber’s is developing standardized scoring, which we believe will set the standard.
Sixth, the problem and solutions must be clearly communicated to all stakeholders and older drivers. This will require a process of education on the benefits to all parties concerned. Barber’s currently has multiple educational tools, which can be given to stakeholders and older drivers.
Lastly, there must be a plan in place for the older drivers to remain mobile past the point of not being able to drive themselves. There are several, but very limited, resources in our community and around the state, that provide dependable ongoing transportation for our older population. Barber’s has joined ranks with the Columbus Area Agency on Aging and is providing free transportation when possible through our STARS community outreach program.
This is a community outreach initiative to provide transportation for our senior citizens to and from healthcare appointments, grocery stores, pharmacies, shopping centers, religious events, social events, and more. Our volunteers are hands-on and stay with the senior during the appointment. This creates the opportunity for companionship and availability for assistance if any is needed.
All volunteers must carry their own personal automobile liability insurance and have completed a thorough background investigation as well as an approved caregiver and driver education course. UMI will have several automobiles as well as continue to partner with companies like Barber’s Driving School who uses its vehicles and instructors to help fill in the gaps of our volunteers in special circumstances. This program has been operational since April 2017 and has already helped many our seniors.