Highlights

• SNAP Community Service Report Form
• Sober Homes Certified
• Proposed HSN Restrictions
• Cancer Survivor Wellness Guide
• Health Insurance & Taxes
• Bereavement Support for College Students
• Remote Notarization App
• Older Drivers Tips

Sections

• Program Highlights
• Health Care Coverage
• Of Clinical Interest

Questions, comments about the newsletter? Contact Ellen Forman, x6-5807.

CMS Now Provides Star Ratings for Home Health Care Agencies

People who need home health care can now look up star ratings for home health care agencies using the new Home Health Compare tool from the Centers for Medicare & Medicaid Services (CMS). The tool, launched January 28, 2016,  is part of a suite of tools to compare other aspects of health care, including hospitals, physicians, nursing homes, Medicare plans, and suppliers.

Just like other compare tools, Home Health Compare rates agencies using the standard scale of one star to five stars, with five being the best rating. Agencies are rated on a variety of areas, including care of patients, communication between providers and patients, specific care issues, and the overall rating of the care provided. The tool contains over 11,000 agencies. To date, about 6,000 agencies have ratings. CMS is still collecting data on the other agencies and will continue to update the tool with new ratings.

See the press release for more information.

-From New Star Ratings for Patient Experience with Home Health Care, Medicare Watch, Volume 7, Issue 5, The Medicare Rights Center, February 04, 2016.

As reported previously (SNAP Work Requirement and Time Limit Update, MGH Community News, December 2015), as of January 1, 2016, able-bodied adults without children (ABAWDs) from most areas of the state are now subject to a 3-month SNAP time limit unless they comply with, or are exempt from, work requirements.  In January we reported on a new Homeless Exemption Form. Now DTA has released a form that can be used to document that one has complied with the work requirement by completing community service hours or volunteer work. The form must be completed by the agency overseeing the work. It must be completed monthly and the client must be working 19 hours a week, possibly less if they are getting partial SNAP benefits (the hours are the SNAP grant divided by the $10/hour minimum wage). 

• DTA's DTA ABAWD Work Participation Report form (must be filled out by community service site). Note: at this writing this form is not posted on DTA website.

Federal Poverty Level Changes 

There has been a slight increase in the 200% FPL that mainly impacts the SNAP 200% FPL gross income test. DTA has posted the new 200% FPL figures effective February 1, 2016:  http://www.mass.gov/eohhs/docs/dta/eligibility-charts/c-snap-364-976.pdf. There is NO increase in the SNAP benefit amounts, the standard deduction, shelter deduction, etc. 

The Mass Legal Service SNAP calculator has been updated with the new figures: http://www.masslegalservices.org/SNAPCalculator.

-Adapted from Three Month SNAP Time Limit in the News, Action Alert to Call CONGRESS, More SNAP Advocacy Tools to help 18-49 Year Old "ABAWDs", e-mail from Pat Baker, Mass Law Reform Institute, February 01, 2016.

The Baker administration unveiled a new drug treatment unit for women at Taunton State Hospital this month, marking a shift from what one official called “the Dark Ages” of sending female addicts to a state prison in Framingham for detox services.

The Women’s Recovery from Addictions Program, or WRAP, was scheduled to open 15 beds on February 9th for women who are ordered by a judge under a law known as Section 35 to undergo treatment for drug or alcohol dependency. An additional 30 beds are scheduled to be available at the hospital this summer.

For three decades, women committed under Section 35 have been sent to MCI-Framingham, the state prison for female inmates. Officials said Thursday that the new Taunton unit signals a shift from incarcerating addicts to offering them treatment in a secure medical setting.

“Addictions are a disease,” said Marylou Sudders, the state secretary for Health and Human Services, during a news conference at the hospital. “They are chronically relapsing illnesses, and we need to ensure that we treat individuals with the dignity and respect and access to treatment that they need.” The initiative stems from a landmark bill that Governor Charlie Baker signed last month to ensure that women who are civilly committed for treatment receive care in a therapeutic setting instead of a prison, Sudders’ office said in a statement.

“Since 1987, the Commonwealth has been saying that they were going to stop the practice of civilly committing women to MCI-Framingham,” Sudders said, adding that addicts who are serving prison terms there can receive “tremendously good” treatment. However, she said, women who are civilly committed under Section 35 “do not have access to those treatment services. You are literally held in the infirmary and detoxed. . . . This is about really ending a historic discrimination around not providing treatment to women who need that treatment.”

Thousands of Section 35 petitions come before the courts each year, and judges can send addicts to a licensed treatment facility or, if none is available, separate units at state prisons for men and women in Bridgewater and Framingham, respectively.

Other options include the Women’s Addiction Treatment Center in New Bedford and the Men’s Addiction Treatment Center in Brockton, according to the Health and Human Services website.
-See the full Boston Globe article.

As reported last month (New Certification for Sober Homes, MGH Community News, January 2016), in January the state Public Health Council approved regulations that establish voluntary certification of sober homes according to standards set by the National Alliance for Recovery Residences, or NARR. Sober homes are group housing that promises an alcohol- and drug-free environment for those in recovery.

While certification is voluntary, the amended substance-abuse treatment program regulations require that starting later this year, state agencies, including treatment programs and courts, refer only to certified sober homes.

The first two sober homes to be inspected, one in Dorchester and one in Lynn, were certified Jan. 20.

"Most of the Massachusetts sober houses are anything but sober. That's the reality," said Richard Winant, owner of a sober house in Wakefield and president of the Massachusetts Association for Sober Housing, or MASH. "But this is aiming to make a difference."

Since the new regulations were passed, he said, "I've been talking to people from all over the state. The people I've talked to have been above and beyond (the standards) - they're all in. It's a breath of fresh air."

He said he hoped the certification rule would weed out the bad ones.

The inspection application, standards, list of certified sober homes and process for complaints are on the MASH website (www.mashsoberhousing.org).

The two new certified programs:

A New Beginning 
Services Provided: For Women
Dorchester MA 02124
Diana Cadiz
857-526-2689
dianacadiz@gmail.com

Chelsea’s House
Services Provided: For Men
Lynn, MA 01902
http://chelseashouse.com/
Matthew Powers
(857) 251-5047
mattypowers1979@yahoo.com

(From http://mashsoberhousing.org/certified-residences/)

Certification standards are available at: http://mashsoberhousing.org/standards-ethics/narr-quality/.

-See the full Telegram article.

The Baker Administration has issued draft regulations which dramatically cut back the Health Safety Net (HSN) which enables free care for people with low-income. The proposed regulation is planned to go into effect no sooner than April 1, 2016. Public comment was due by February 26.

Changes may be forthcoming in response to public comment, but under the current proposal:

1. Retroactive coverage- the start date for covered services is cut from 6 months retroactive from date of application to 10 days.
2. FULL HSN income limit decreases from 200% of the Federal Poverty Level (FPL) ($23,544 for one person in 2016) to 150% FPL ($17,664 for one person).
3. The maximum income for PARTIAL HSN declines from 400% of the federal poverty level (FPL) to 300%. (Partial HSN spans 150% FPL to 300% FPL instead of the historic 200% to 400% FPL.) While this is in line with ConnectorCare eligibility, Affordable Care Act federal premium tax credit subsidies are available up to 400% FPL. Keep in mind though that those with high medical expenses may still qualify under “medical hardship” based on medical bills in excess of a certain percentage of income.
4. The partial HSN deductible begins after 150% FPL instead of the historic 200%. The proposed rules would charge people with income over 150% FPL an annual deductible of $516 (in 2016 for one person) before a hospital can be reimbursed from HSN, and lower the Community Health Center (CHC) reimbursement by 20% per visit (to be collected from the patient as a co-payment) until the deductible is met. 

• Mass Law Reform notes that the $516 amount is based on the annual premium for insurance through ConnectorCare (with no deductible) for someone with income between 150-200% FPL. But people who pay $516 for HSN, unlike those in ConnectorCare, will still be uninsured. HSN cannot be used for example for services provided by ambulance companies, chronic/rehab hospitals or nursing facilities, commercial pharmacies or specialists or any other provider who is not directly employed by a hospital or CHC.

5. Households determined eligible for Connector Care lose HSN eligibility after 90 days of HSN eligibility except for dental coverage. Or put another way, those eligible for both have 90 days to select and enroll in a ConnectorCare plan. At the end of the 90 days, these individuals are eligible to use the HSN for HSN-eligible dental services only.

MassHealth was scheduled to mail notices during the first two weeks in February to individuals who have been eligible for the HSN and ConnectorCare for more than 90 days (but who are not yet enrolled in a ConnectorCare plan) to let them know their HSN eligibility will change as of April 1, 2016. At that time, HSN will cease paying for services, other than eligible dental services, for individuals whose period of temporary HSN eligibility has ended. It is important that those eligible for ConnectorCare enroll in a ConnectorCare plan as soon as possible so they do not experience a gap in coverage.

Individuals can enroll in a ConnectorCare plan by going to www.MAhealthconnector.org. Individuals will need to select a plan and make their first month's premium payment, if they have one.  Questions about the Health Safety Net may be directed Patient Financial Services or to the HSN Help Desk at 1-877-910-2100. 

Sources and for more information

• Draft regulations – redlined to highlight changes.   
• Notice of Public Hearing
• Health Safety Net Cutbacks Effective April 1st, e-mail correspondence, Neil Cronin, Massachusetts Law Reform Institute, January 29, 2016.
• Important Updates from MassHealth - 02/12/16, MA Health Care Training Forum, February 12, 2016.

Massachusetts health regulators moved this month to significantly strengthen oversight of nursing homes, creating a unit that will conduct unannounced inspections and promising to impose fines on problem-plagued facilities.

The overhaul, unveiled by the state’s public health commissioner, also calls for intensified scrutiny of companies and executives seeking licenses to run nursing homes.

The actions follow revelations about serious gaps in state supervision of nursing homes at a time when dozens of facilities have been sold or closed.

Dr. Monica Bharel, the health commissioner, also revealed that the state has a backlog of consumer complaints about nursing homes. Bharel said that her department will hire and train more staff but did not detail how the agency will pay for the hires.

As part of the changes Bharel announced, consumers will have access to a new online system to file complaints and find more detailed information about nursing homes.

Families with relatives in nursing homes have long expressed frustration with the state’s system for filing complaints. Last year alone, the Department of Public Health was flooded with about 11,000 complaints from consumers and reports of problems filed by nursing homes, Bharel said.

Governor Charlie Baker’s proposed state budget includes money for two additional nursing home inspectors.

Officials said the department may consider using money collected from the stepped-up fines to pay for a new unit, the Supportive Planning and Operations Team, which will be launched this spring and conduct surprise inspections that target problem facilities. That unit, dubbed the SPOT team, will be a one-year experiment, Bharel said, and will focus on retraining management and staff at struggling nursing homes.The state will start imposing fines in March.

Bharel acknowledged her agency already had the authority to impose penalties but had not used it. State law allows fines of up to $50 per day — far less than federally imposed sanctions of up to $10,000 per day.

Nursing home advocates have lamented that the health department has not been more aggressive in using its longstanding ability to strip operators of their licenses or freeze admissions to problem nursing homes. “These sanctions are clear in state and federal law,” said Wynn Gerhard, a senior attorney at Greater Boston Legal Services. “The question is, why don’t they utilize these powers in specific cases?”

Bharel said the department would consider raising the $50 fine, but that would require a change in state law. She did not address whether her agency would more aggressively go after the licenses of problem facilities.

-See the full Boston Globe article.

The investigative arm of State Auditor Suzanne Bump's office completed more than 10,000 investigations in fiscal year 2015, identifying welfare fraud in around 1,100 of them, according to a recent report.

In fiscal year 2015, which ended in June, the Bureau of Special Investigations(BSI) identified $13.7 million in fraud, a 44 percent increase from the previous year

As The Republican / MassLive reported  this month, the high numbers do not necessarily mean that there was a large increase in the amount of fraud, but rather that the state is using new technology and doing a better job catching it.

"BSI has made strategic investments in technology that increase the organization's capacity to view and analyze tremendous amounts of data, allowing investigators to proactively discern potential patterns of fraud more quickly across multiple programs rather than relying strictly on referrals," the report states.
For example, MassHealth has begun working with a data analytics unit of the auditor's office to identify whether personal care attendants are double-billing both the state and federal governments.

The largest portion of the fraud – $7.7 million – came from MassHealth. This is because MassHealth cases involve more money since the cost of health care and health benefits is higher than the costs associated with other welfare programs. So although only 1,000 MassHealth investigations were completed, compared to close to 10,000 investigations of the Department of Transitional Assistance, which provides welfare benefits, the dollar amount of the fraud was higher.

Michelle Hillman, a spokeswoman for the Executive Office of Health and Human Services, said the office "has a strong partnership" with Bump to identify and prevent fraud in public assistance programs. “ DTA and MassHealth are constantly reviewing and revising internal controls to increase the program integrity of all of its programs."

For example, the Department of Transitional Assistance signed an agreement with local law enforcement that allows them to work together to prosecute people who traffic in food stamps. The department monitors benefit usage to determine if a person has moved out of state.

MassHealth has begun auditing programs, such as a home health program, that have usually high costs. It put in place new technology to avoid paying duplicate claims. MassHealth has also been improving its system for ensuring that a person is eligible for subsidized health insurance by using federal data to verify a person's income and residency.
See the full report: 020316 - BSI FY15 Annual Report

-See the full MassLive.com article.

The Massachusetts Department of Public Health’s The Massachusetts Comprehensive Cancer Prevention and Control Network’s Survivorship Workgroup has created a “Wellness Guide for Cancer Survivors”.  Available to read online or download as an e-book or printed copy, the guide addresses the multiple spheres of life cancer may impact- physical, emotional, social, spiritual, thinking and working.

Sections may include tips from survivors, expert advice, questions to ask oneself or one’s care team and additional resources.

Wellness Guide for Cancer Survivors

-Thanks to Lauren DeMarco and Paula Gauthier for sharing this resource.

Helping the environment while saving money is a laudable goal, but deciding whether to add solar panels to one’s home may be a more complex decision than it initially appears.

vivintsolar.com is one company reportedly approaching fuel assistance agencies seeking help in advocating for fuel assistance clients to “go solar”. The company listed the following benefits in an e-mail:

• No cost to the homeowner.
• The existing electric utility remains and participates in the program.
• The billing rate for electricity is about ½ of what they are now paying.
• A check is sent to the homeowner for $1,000 (federal and state money) or split between the homeowner and [the fuel assistance agency] in two checks. This is in addition to the savings.
• The annual savings range is typically $500 to $1,300. The average is $800 to begin with. It is estimated that the savings will be double in the 8th year.
• Annual electricity overproduction would be credited to your organization. 

All the homeowner has to do is allow us to add solar power to their home at no cost for panels, installation, or maintenance. They just pay a rate that's about half of what they are now paying. The utility even credits them on their bill for over-production – usually from May through August.

Sounds like a win-win right?

Members of a local utility advocate’s listserv recently reported that some solar companies may be making overly-aggressive sales pitches. The list’s moderator, Charlie Harak, attorney with the National Consumer Law Center, advises caution. In a listserv post he said “these solar deals are more complicated than they first appear.  It is important to read every word of any contract very carefully, and if you don't understand the contract terms, ask for advice from someone experienced in reading contracts.  There are potential pitfalls.”  In a related post he added that the “asserted benefits are not guaranteed.  They depend on so many factors: the future price of electricity...how much electricity the consumer actually uses; the size and orientation of the person's roof; future changes in net metering rules; and other factors.” 

Additionally he noted that “under some of the solar lease contracts, the solar company has the right to reject a potential buyer of your home!  The leases are long-term, and the solar company may have the right to consider the credit score of the potential buyer, since the solar company wants to make sure the buyer can make the lease payments.”

One advocate contributed an additional caution-  if the home is sold and the new owner chooses not to use solar power, they are responsible for paying for the removal of the panels.

-Adapted from thread on utilitynetwork@lists.nclc.org, February 19, 2016.

This is the second year that everyone who files taxes must indicate whether they have health insurance.  Depending on their coverage status, some people may also need to supply additional information. These relatively new steps in the tax filing process are the result of the Affordable Care Act’s individual mandate, the requirement that most Americans have health insurance.

Here’s what assisters and individuals should know this tax season to ensure households are accurately completing all health insurance tax requirements.

Everyone is required to report their health insurance status on their taxes

The good news is that this process is straightforward for most people. The majority of Americans have health coverage and many will simply have to check a box to indicate that they have it. Those who do not have health insurance must either pay a fine or claim an exemption from the requirement. This is all done through the tax filing process.

The new health insurance tax requirements are a bit more complex for those who received financial assistance (premium tax credits) to help them pay for their marketplace health plans. These individuals must take additional steps when filing their taxes. See Families USA’s infographic for an overview of the steps each type of tax filer must take this year.

More detailed information can be found on their Health Insurance and 2015 Taxes: A Quick Guide webpage.

Actively Moving Forward supports young adults grieving the illness or death of a loved one. Actively Moving Forward has chapters on college campuses nationwide that connect and empower grieving college students to support one another and participate in community service in memory of deceased loved ones, raising awareness about the needs of grieving young adults, including through the annual National College Student Grief Awareness Week, and hosting national grief support programs, such as the “We Get It” Supportive Blog, and events, such as the National Conference on College Student Grief. They also support non-collegiate young adults by creating virtual information, programming, and community.

Campus Chapters are student-led, faculty/staff-advised, and university-recognized student organizations that consist of a peer-led grief support group for students coping with the illness or death of a loved one, and a service group open to the entire campus community.

Learn more: http://activelymovingforward.org/

-Thanks to Lynn Mazur for sharing this resource.

We’re often called upon to help find a notary public for inpatients who want to complete a health proxy prior to surgery or get their affairs in order at end of life. When a hospital notary isn’t available patients may contact a traveling notary who will come to the hospital for a fee. Now there’s another option as well. While not for everyone, for certain tech savvy folks who have an iPhone, Notarize may save time and money. Inpatients will also likely need help from a friend or family member to scan/upload the document(s) to be notarized.

Notarize for iPhone uses photo IDs, computer imaging technology, forensics software, electronic certificates, live video, and a 24-hour team of Virginia notary agents to notarize documents remotely. The site claims these remote/online notarizations are valid in all 50 states and the District of Columbia.

From the Notarize website:

The service functions like traditional notary, but takes place entirely online. For example, clients must verify their identity with a government issued photo ID. With Notarize, IDs are authenticated using computer imaging technology and a software-based forensic analysis. Once the client’s ID has been validated and the document is uploaded to the service, the client’s identity is verified using knowledge-based authentication. Clients are then connected with a commissioned Virginia Electronic Notary Public agent via live video call. The notary verifies the identity of the individual visually and then witnesses as the client signs the document. Similar to how a standard notary agent operates, the Notarize agent signs, stamps, and completes the electronic notarization process using digital tools. Once complete, the client may print and deliver the notarized document or send it electronically. In accordance with the Virginia statutes governing electronic notarization, all video calls are recorded so that the institution receiving the documents may verify your electronic notarization.

-See the full Boston Globe article.

I am going still working and covered by my employer plan. I qualify for premium-free Part A, but do not want to take Part B yet. Should I enroll in Part B when I become eligible?

Generally speaking, you can delay enrolling in Part B (and not enroll during your Initial Enrollment Period (IEP)) without incurring a late-enrollment penalty if you are still working or your spouse is still working and you have insurance from that work. Before delaying Part B enrollment, however, there are a few things you should consider.

The first is how and when you will sign up for Part B when your employer insurance ends. Because you are still working, you will be eligible for a Part B Special Enrollment Period (SEP). This enrollment period allows beneficiaries who delay Medicare enrollment while they are covered by their or their spouse’s current employer insurance to enroll later. You will not have to wait for the General Enrollment Period (GEP) that runs from January through March, and you will not have a penalty for delaying enrollment. Your SEP runs from now through eight months after the month in which you stop working, or your insurance ends, whichever comes first.

The next thing you should consider is how Medicare will work with your current employer insurance. When someone has Medicare and an employer group health plan, Medicare either pays first or second in coordination with the employer plan. 

1. Medicare pays secondary to your current employer insurance if your company has 20 or more employees. This means that your employer insurance will pay first on health care claims, and then Medicare may pick up some or all of the remaining costs. If this is the case, you can delay Part B without creating a gap in coverage.  
2. Medicare pays primary to your current employer insurance if your company has fewer than 20 employees. In this case, should sign up for Part B. If you delay Part B enrollment and continue to use your employer coverage as your primary insurance, you may run into problems. For example, your employer insurance may take back payments it made mistakenly as the primary insurance while you were Medicare-eligible.

If you decide to delay Part B enrollment you should call the Social Security Administration at 800-772-1213 or visit a local office to let them know. You should ensure you fully understand the consequences of delaying enrollment. Keep a record of your conversation with the Social Security staff. You should also keep record of your employer coverage for the time you are covered because you will need this information when you sign up for Part B at a later time.

Delaying Part B enrollment involves making sure you can enroll in Part B later without  a penalty or gap in coverage. You should also make sure your current insurance will continue to provide adequate coverage. It is important to consider your situation carefully before delaying enrollment in Part B.

If your Medicare Advantage plan (Medicare private health plan) or Medicare prescription drug plan makes any changes during the plan year they must notify you.

Network Provider Changes

Most Medicare Advantage plans have networks of doctors, hospitals and other providers. You typically pay less if you see providers that are in your plan’s network. Most people can only change their plan once a year during the Fall Open Enrollment Period, but providers can leave a plan’s network at anytime.

When a provider is leaving a plan’s network, the plan must try and send all the plan members who use that provider a written notice at least 30 days before the provider leaves the network.

Mid-Year Formulary Changes

If your drug plan makes changes to its formulary during the year, you have certain rights depending on why the plan made the change.

If the plan is making maintenance changes, they must give you 60 days notice or provide you with a 60 day transition fill. Maintenance changes include covering a generic drug instead of a brand-name drug or adding quantity limits for drugs that the FDA adds warnings to, and making formulary changes based on clinical best practices and safety concerns.

If your plan is making non-maintenance changes, which is any other change, and you are already taking the drug you must be allowed to continuing taking that drug for the rest of the year as long as it is medically necessary. Your plan must also send you a notification in the mail stating that the drug is no longer on their formulary but it will be covered for you for the rest of the year.

Learn more at www.medicareinteractive.org.

There is a lack of information for nonveterans with posttraumatic stress disorder (PTSD) on the effectiveness of various treatments and how to access them, warn researchers, who call for more studies of this issue.

In the civilian population, the estimated lifetime prevalence of PTSD is 5.7%, which is equivalent to 18 million people in the United States alone. The per-case annual direct cost of PTSD is $19,407 for Medicaid patients and $11,287 for privately insured patients, researchers write.

The team found that, compared with the services available to veterans, there is a lack of information and resources for nonveterans with PTSD and that the services that are available are less cohesive. This partly reflects a dearth of studies into the delivery of care to civilians with PTSD.

"For the other people affected by PTSD — victims of sexual assault, child abuse, and natural disasters — there really isn't an organized body of research that generates guidance for how they and their caregivers should deal with their PTSD," said lead researcher Judith D. Bentkover, PhD, from the School of Public Health at Brown University, Providence, Rhode Island, in a release.

In response, the authors, writing in the November/December issue of the Harvard Review of Psychiatry, propose a series of recommendations to improve the provision of and access to optimal care.

-See the full Medscape summary article.

The National Institute on Aging recently updated their “Older Drivers” website and handout, which is also available in Spanish. Excerpts follow.
Do You Have Concerns About an Older Driver?<> Are you worried about your parent or other older family member or friend driving? Sometimes it can be hard for an older person to realize that he or she is no longer a safe driver. You might want to observe the person’s driving skills. For example, make sure that the driver:

• Follows the rules of the road, including speed limits, traffic lights, and stop signs
• Yields the right-of-way
• Is aware of other vehicles, motor­cyclists, bicyclists, pedestrians, and road hazards
• Merges and changes lanes safely and stays in the lane when turning and driving straight
• Can easily move the foot between the gas and the brake pedals, and does not confuse the two.

If it’s not possible to observe the older person driving, look out for these signs that he or she is having problems at the wheel: 

• Has multiple vehicle crashes, “near misses,” and/or new dents in the car
• Receives two or more traffic tickets or warnings within the last 2 years; increases in car insurance premiums because of driving issues
• Neighbors or friends observe unsafe driving
• Has anxiety about driving at night
• Develops health issues that might affect driving ability, including problems with vision, hearing, and/ or movement
• Complains about the speed, sudden lane changes, or actions of other drivers
• Shares that doctor recommended he or she modify driving habits or quit driving entirely

Having “The Talk” About Driving

Talking with an older person about his or her driving is often difficult. Here are some things that might help when having the talk.

• Be prepared. Observe the older driver for potential problems. Learn about local services to help someone who can no longer drive. Identify the person’s transportation needs.
• Avoid confrontation. Try having a one-on-one conversation. Use “I” messages rather than “You” messages. For example, say, “I am concerned about your safety when you are driving,” rather than, “You’re no longer a safe driver.”
• Stick to the issue. Discuss the driver’s skills, not his or her age.
• Focus on safety and maintaining independence. Be clear that the goal is for the older driver to continue the activities he or she currently enjoys while staying safe. Offer to help the person stay independent. For example, you might say, “I’ll help you figure out how to get where you want to go if driving isn’t possible.”
• Be positive and supportive. Recognize the importance of a driver’s license to the older person. Understand that he or she may become defensive, angry, hurt, or withdrawn. You might say: “I understand that this may be upsetting,” or “We’ll work together to find a solution.”

Is It Time to Give Up Driving?

We all age differently. For this reason, there is no way to set one age when everyone should stop driving. So, how do you know if you should stop? To help decide, ask yourself:

• Do other drivers often honk at me?
• Have I had some accidents, even if they were only “fender benders”?
• Do I get lost, even on roads I know?
• Do cars or people walking seem to appear out of nowhere?
• Do I get distracted while driving?
• Have family, friends, or my doctor said they’re worried about my driving?
• Am I driving less these days because I’m not as sure about my driving as I used to be?
• Do I have trouble staying in my lane?
• Do I have trouble moving my foot between the gas and the brake pedals, or do I sometimes confuse the two?
• Have I been pulled over by a police officer about my driving?

If you answered “yes” to any of these questions, it may be time to talk with your doctor about driving or have a driving assessment.

How Will You Get Around?

Are you worried you won’t be able to do the things you want and need to do if you stop driving? If so, you’re not alone. Many people have this concern, but there may be more ways to get around than you think. For example, some areas provide free or low-cost bus or taxi services for older people. Some communities offer a carpool service or scheduled trips to the grocery store, mall, or other places of interest. Religious and civic groups sometimes have volunteers who will drive you where you want to go.

Your local Area Agency on Aging can help you find services in your area. Call 1-800-677-1116, or go to www.eldercare.gov to find your nearest Area Agency on Aging.

You can also think about using a car service. Sound pricey? Don’t forget—it costs a lot to own a car. If you don’t have to make car payments or pay for insurance, maintenance, gas, oil, or other car expenses, then you may be able to afford to take taxis or other public transportation. You can also buy gas for friends or family members who give you rides.

-See the full National Institute on Aging publication.