The Myths of Senior Driving

There have been numerous articles written about senior driving, however most of them have one thing in common —  the overzealous desire to ensure that the independence of the senior citizen is preserved at any price. Many of these articles favor preserving the rights of senior who may be compromised in their ability to drive. They are written by extremely caring geriatric care managers with degrees in social service, writing from their heart, but not necessarily weighing the risks involved.  I call this the “bleeding heart” analysis, and frankly it’s dangerous.

Here are a few simple facts. In our mobile society, it is certainly critical for seniors to be able to leave their homes to commute to shop, go to supermarkets, senior activities,  church, etc.   Mass transit is not always readily available, and due to budget constraints, bus services have been severely curtailed in many communities. Senior transportation services exist, but are often inconvenient or inaccessible and seniors do not necessarily have the disposable income to take taxis.

As for family members, some may not live close by to their parents but may not be available to help and family members who do live close by may not want their lives disrupted by constantly having to drive relatives around.

Although the issues are a problem for senior mobility, they fail to address the one reality that  cannot be denied.  Seniors “do not want to admit that they are no longer able to drive safely” when their vision deteriorates or their reflexes are no longer adequate due to  physical limitations.  Seniors often do not recognize when early stage dementia has set in or choose not to admit it and do not want to give up their independence and be forced to rely on other people or services for transportion.  Underlying all of these reasons is their fragile egos, where they focus solely on their needs and don’t see the risk they present to others.

The harsh reality is that every time that a senior with early stage dementia or severe disability sets foot in a vehicle,  he or she is putting his or her life in danger and more importantly, putting the life of innocent people at risk. And stated very simply, putting others lives in danger to preserve the fragile ego of the elderly is too high a price.

Two recent episodes with clients demonstrate the critical nature of this issue.

Example 1:  A senior citizen was whose only other family was an elderly sister, was driving down to the Jersey Shore to visit a friend.  She exited the highway at the correct exit, but then had an episode.  She could not remember where she was going. She become highly agitated and crashed the vehicle into the side of a retail building. An ambulance arrived and she was taken to a local hospital. Her car was towed to the police lot. In the end, she was transferred to a nursing home, where she remained for approximately one year until her passing a few months ago.

Example 2:  We had been working with a family for years.  The mother had been in decline for some time with advanced dementia.   On several occasions, she had left her home to go shopping and called a family member to tell them that she had gotten lost and could not remember the way home.  We advised the family to “take away her keys” before she got into a serious accident or worse.  The mother refused to relinquish her keys. She would not accept her dementia, insisted that she was fine and was not going to stop driving.   The family lacked the fortitude to deal with the situation.  Several weeks later, she was driving a few blocks from her house, lost control of the vehicle and crashed into a neighbor’s home, totaling the car. After this episode, she finally gave up driving!

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We could cite numerous other similar cases.   The Division of Motor Vehicles is reluctant to revoke the license of a senior citizen because of the concern about age discrimination complaints from senior advocacy groups.   The police may issue summons to senior citizens if laws are violated, but it has been my experience that police officers also feel uncomfortable in these situations.  Even judges are lax in forcing senior citizens to retake a driver’s test.  All of this is well and good, until there is a major accident involving a senior and a life is lost unnecessarily, a tragedy that could have been prevented.

Children of seniors are reluctant advocates because they do not want to upset their parents for a variety of reasons.  For one, they sensitive to the loss of independence their parents are experiencing.  They also may not want to jeopardize any possible inheritance, not pleasant but it’s a variable.   They don’t want to alienate a parent, to incur their rath, and risk damaging a wonderful, loving relationship.  Children are also concerned that the burden will fall on them.  So the children sit by and let nature take its course.   And maybe after mom or dad has three accidents in a six -month period, the children will finally act.  Or maybe they won’t.

I know that this blog is not going to win any popularity contests with senior citizens.   The truth often hurts, but it is still the truth!   Yes, we need to improve the availability of alternative transportation in our communities for seniors.  But in the meantime, we have to be cognizant of the problems with senior driving and be vigilant about protecting the lives of the innocent victims that may be on the other side of the road.

 

REINCARNATING THE “MILLER TRUST”

Having professionally assisted families to navigate through the Medicaid application process for over 25 years, new regulations are considered an annual event.  Private experts like CARENET, Inc. roll with the punches, analyzing the new rules and adjusting our approach to ensure that every application is processed until final approval is received.

On December 1, 2014, private case managers were hit with a new “old” rule.  Medicaid decided to bring back what many years ago was denoted as a “Miller Trust”, but is, in essence, a “QIT or Qualified Income Trust”.   The original purpose of this trust was to protect assets for families, i.e. to preserve assets legally, while still qualifying for Medicaid.  Not surprisingly, the new regulations are “not designed” to help families protect assets.  Rather, these rules are designed to eliminate one of the Medicaid programs, i.e. Medically Needy.

The average individual has generally believed all these years that Institutional Medicaid was one singular program, financing individuals in nursing homes, and as of 1996, in assisted living facilities.  That has never been the case since the 1970’s.  There have always been three programs, Jersey Care for low income applicants (below $ 973 in 2015), Medicaid for average income, and Medically Needy for high income individuals ( $ 2197 or more in 2015).    However, the Medically Needy program has always had a major defect in the program.  High income individuals could not qualify for “Assisted Living Medicaid”.  The new regulations will now allow individuals with incomes over the income cap ($2197), to finally qualify for Medicaid as long as their income does not exceed Medicaid reimbursement to assisted living facilities.

For new Medicaid applicants who require skilled nursing care, this new regulation is an undue burden. There is no benefit that is recognizable at all.  Applicants will forced to set up a new account, arrange with the Social Security Administration and various pension plan administrators to transfer these direct deposits from current personal accounts to the new QIT.

With every new regulation, there are going to be problems with implementation.    In order to set up a QIT, which is essentially a bank account with a trustee, local banks have to be on board.   In 2014, the State of New Jersey held a webinar for Eldercare attorneys, banks, and other Medicaid experts,  in order to disseminate information on the proper procedures to be used to establish a QIT.  They also sent out information packets to banks, explaining the procedures.  Unfortunately, the average bank manager and/or platform person apparently was too busy soliciting customers to pay attention.  We have yet to encounter one banker who was up to speed on the procedure to establish a QIT.

A second issue is that one of the new parameters is in direct conflict with banking procedures.  A QIT must be an “irrevocable” trust.  Under banking protocols, irrevocable trusts must have a federal tax ID number.  However, the new regulations clearly state that the State of New Jersey mandates banks to set up the trust with the applicant’s Social Security number.   In trying to set up a trust, each banker with whom we worked had to first obtain clearance from their in-house legal department to set up this trust with the Social Security number.

When trying to explain this new regulation to clients, we have an extremely difficult time explaining the process and a more difficult time convincing them why it is necessary.  Our fallback position is always the same: “We don’t make the regulations; we just assist you with complying with them”.

The bottom line is as follows. If an individual’s total monthly income exceeds $2197, a QIT  (Qualified Income Trust) must be established in order to qualify for Medicaid benefits in a health care facility.   A professional case manager or Eldercare attorney should be able to assist with the process and solicit cooperation from the local banks.   This regulation is mandatory; i.e. all new applicants must comply.   For current Medicaid recipients, there is no retroactivity, i.e. no necessity to set up a QIT at this time.