Elder Law Library

 

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The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families.
Elizabeth Dugan. New York, NY: Collins, 2006. 283  pages.

For the past 80 years or so, most U.S. communities have been built around the assumption that adults will drive to obtain the essentials of life, including the proverbial quart of milk. But as people age, driving can become more difficult and more dangerous. Given the essential role driving plays in our culture, questioning a loved one's ability to operate a car can be a hot-button issue.

In this book, Elizabeth Dugan, a researcher on geriatric issues, offers a comprehensive resource on improving the safety of an older driver or persuading one to relinquish the wheel, if need be.

As Dugan notes, driving requires healthy functioning in three key areas: vision, thinking and movement. A large section of the book is devoted to how to discuss the issues of driving with a loved one who may be showing deficits in one or more of these areas -- and how to discuss it without triggering an emotional crack-up that can be as devastating to a family as an actual accident. Dugan walks readers through the "motivational interviewing" approach, which has been used successfully to help many people change behavior.  Useful sample dialogue scripts accompany the discussion.

Elsewhere, Dugan explains how to assess driving fitness, the medical conditions and prescription drugs that can affect driving, and how to report an unsafe driver (including a sample letter).

The book's second half is devoted to resources for further help. For example, you'll find each state's driving regulations, including the state's age-based renewal procedures, information on state driver rehabilitation and assessment programs, and national transportation resources.

Soon one in four drivers will be over age 65, and studies suggest that we'll outlive our ability to drive by nearly 10 years. This looming crisis would be far less acute - and this book far less necessary - if more communities offered realistic alternatives to driving. As things stand now, taking away a driver's license usually imposes a sentence of immobility or dependency on others. While this book will be helpful in the interim, the underlying solution to the "driving dilemma" is to find alternatives to the atumobile and to locate the off-ramp from our car-centered culture.

 

Always on Call: When Illness Turns Families into Caregivers.
Carol Levine, ed. New York: United Hospital Fund of New York. 2000. 213 pages.

 Are you providing care for a loved one? If so, you're not alone (although it may sometimes feel that way). As this timely bookrelates, about 26 million Americans are looking after an ill or disabled relative or friend. These "informal caregivers" are providing an average of 18 hours of care a week, often while holding down full-time jobs or raising families, or both. If these caregivers were paid for their work, their economic value would total $200 billion a year—one-fifth of national health care expenditures. This is far more than we spend on home health care and nursing home care--combined.

Always on Call, a collection of essays by different authors, looks at why the demands on family caregivers are growing and how the health care system can better meet their needs. The book combines the personal stories of caregivers, often movingly told, with professional insights on the impact of caregiving on workers and families. What comes through all the chapters is the lack of social support for caregivers under our current system. The cost constraints of managed care have shifted costs and caregiving responsibilities to families. Often family caregivers are required to provide high-tech assistance and perform the work that nurses or physical therapists used to perform. In trying to cope, caregivers are going it alone for the most part, and the stresses are sometimes unimaginable. In one particularly heart-wrenching chapter, Gladys Gonzalez-Ramos describes how her father finally buckled under the isolation of years of caring for his wife, who had advanced Parkinson's disease. With his wife's apparent consent, he shot her and then killed himself.

Such dramatic action, of course, is not the norm. Most caregivers struggle on in silence, internalizing the stress and pain they feel. Many could benefit from psychotherapist Barry Jacobs' brief but extraordinarily helpful chapter, "From Sadness to Pride: Seven Common Emotional Experiences of Caregiving." But caregivers need more than emotional support. As Rabbi Gerald I. Wolpe puts it in his account of caring for his wife, most caregivers "are in an almost constant state of caregiving." They need breaks, they need more help from a medical system that off-loads patients onto families as quickly as possible, and they need relief from insurance companies and HMOs that are reluctant to pay for home health care.

Always on Callis a much-needed step in the right direction. It is written for a broad audience—family caregivers, health care professionals, administrators, policymakers and advocates. Through its powerful first-person accounts and resources section, the book offers solace to caregivers struggling under our current system. Through its concrete suggestions for improving that system, Always on Call also offers them hope for a better future.

For more on family caregiving, go to the National Family Caregivers Association Web site at www.nfcacares.org

 

Baby Boomer's Guide to Estate & Medicaid Planning.
Jon A. Iverson, JD. Medford, OR. Stonemark Publishing. 2005. 238 pages.

If they aren't concerned with issues involving their parents' possible incapacity and eventual deaths, Baby Boomers will soon be facing questions related to their own demise. This book is a highly readable survey of the estate planning and long-term care choices that could spell the difference between financial stability and ruin for families as one generation gives way to the next.

Author Jon Iverson, an elder law specialist who has been practicing law for more than 30 years, writes in a straightforward style that renders comprehensible even the most confusing tax or Medicaid concepts. The book is also filled with helpful, real-world examples that illustrate the concepts presented.

Readers will learn, for example, what a will can and cannot accomplish, why joint tenancy is not a substitute for estate planning, how trusts and estates are taxed, the role of guardians and conservators, how a credit shelter trust works, and what to look for in a long-term care insurance policy. Two important topics -- living trusts and Medicaid planning – receive their own sections. The book is also particularly useful for those who may serve as an executor, trustee, guardian or conservator of someone else's estate.

Iverson is refreshingly candid in reminding readers that there are no easy answers – each estate planning choice involves some sort of tradeoff. He also stresses that his book is not a "do-it-yourself" substitute for retaining professional advice. But reading it will help Boomers – or anyone else -- work more confidently with the legal or financial professionals they retain.

 

Pointers for Picking an Assisted Living Facility

This new booklet provides a step-by-step guide for gathering information about the features of assisted living facilities that will affect a resident''s quality of life.  Choosing an Assisted Living Facility: Strategies for Making the Right Decision will help consumers choose facilities that will provide the highest level of service for themselves or a loved one.  The publisher is the Consumer Consortium on Assisted Living, a national nonprofit organization that includes consumers, health care and legal professionals.

To obtain a copy, send $5 to CCAL, P.O. Box 3375, Arlington VA 22203, or download a free copy from their web site, www.ccal.org.