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Get your motor running

Rehab Private Practice Alert, September 7, 2005

Driver screenings are an OT specialty

As patients age, their families or physicians may want to reevaluate their driving skills to ensure they are still capable of safely operating a motor vehicle. This is where you come in.

If you're interested in expanding your business, here's what you need to know about driver screening programs and why you should consider adding one to your facility's offerings.

In most cases, patients will walk through your door with a physician's referral for a driver screening. A driver screening might be necessary for any of the following reasons:

Often, therapists who conduct driver screenings see elderly patients who are either recovering from an injury or adjusting to age-related driving difficulties. But some OTs also see young patients who are learning to drive with modifications because of long-term conditions.

Aren't physicians aren't the only ones who can request driver screenings. Those who can request a screening for an individual include the following:

While screening, remember that driving is a key to being independent in areas where public transportation is not readily available. If you serve an area that is rural or suburban, there may be more need for a driver rehabilitation program than if you practice in an urban area.

After patients receive a referral from a physician, they'll be headed to a rehab facility. When a patient walks through the door, the evaluation begins immediately, according to Kimber Glick, OTR, CDRS, therapist at Kaweah Delta Rehabilitation Hospital in Visalia, CA.

"When I greet them in the waiting room, I'm already assessing them," says Glick. "And the front desk [staff] is observing whether they have trouble filling out the paperwork." This helps the OT get an accurate picture of what patients' driving deficits might be.

The pre-driving assessment, also considered an OT evaluation, can take from 30-90 minutes and varies by clinic. Assessment areas include the following:

"If they meet the basic physical, vision, and cognitive requirements, they can do the behind-the-wheel assessment the same day," says Evan Detweiler, OTR, clinical leader of occupational therapy at the Rehabilitation Hospital of Ft. Wayne (IN).

Like at Detweiler's facility, some clinics chose to do both parts the same day, while others allow patients to return at a later date. Either way, many patients who perform marginally during the clinical evaluation perform well once they actually drive because they have adapted to compensate for certain weaknesses. For this reason, most OTs will always take a patient for the behind-the-wheel test, unless it would be unsafe to do so.

"The only [reason] I wouldn't take them behind the wheel would be if their vision didn't meet North Carolina state guidelines," says Page Riggs, OTR/L, a therapist with the InRoads Driving Program at Pitt County Memorial Hospital in Greenville, NC.

Riggs, who is also a licensed driving instructor, takes her patients out for their behind-the-wheel assessments on a 22-mile course that begins in a parking lot and quiet neighborhood and progresses to suburban and urban traffic. At her facility, there are four recommendation options:

Patients must know that you are assessing their abilities, but will not make the final determination as to whether they can resume driving.

Family's don't want to hurt a loved one's feelings, and doctors don't want to insult their patients, says Glick. "It's easier to send [the patient] to a neutral party."

But even if you're not making the final decision, patients must understand that you are making a recommendation to either the physician or the DMV, depending on the circumstance and the state in which you practice.

"I try to explain to patients that [the screening] is something the doctor is requesting," says Steve Molinari, OTR/L, driving program coordinator at Walnut Creek (CA) Therapy Center at the John Muir/Mt. Diablo Health System. "I explain the process to them and tell them to just do their best."

The individual or group to whom you report varies depending on the state in which you practice, says Maria Klamm, OTR/L, a therapist in the outpatient therapy department of Sioux Valley Hospital in Sioux Falls, SD. For patients living in South Dakota and Iowa, she reports her recommendation directly to the DMV. But for Minnesota residents, state regulations require her to pass along her recommendation to the physician, who then reports to the DMV.

If you want to begin a driver screening program at your facility, decide whether you want to conduct the on-the-road assessment in-house or subcontract out to a driver training school.

Riggs and Glick are licensed driver's education instructors, so they can conduct both the clinic and road parts of the screening. According to Glick, if you're an OT, you've already mastered the hard stuff.

"As OTs, we can get a good idea of what a person's deficits are," says Glick. "It's much easier to learn the rules of the road."

If you want to do it all, consider start-up costs such as purchasing a vehicle and having it adapted for impaired drivers, as well as ongoing costs such as insurance. Because Glick works for a nonprofit facility, she had a vehicle and some of the necessary adaptive equipment donated, an opportunity your facility may want to explore.

Molinari and Detweiler, suggest the following adaptive equipment:

Most facilities bill Medicare or private insurance for the initial OT evaluation. But the behind-the-wheel assessment is almost always paid for out-of-pocket by the patient.

"A lot of folks want the opportunity to try [the behind-the-wheel assessment]," says Molinari. "It's worth their money to get out there."

The cost varies by area, but many patients are willing to pay because it gives them a chance to prove their driving skills and earn a positive recommendation from the OT.

There is a tremendous focus on driving in our society, says Glick. "It really is an aspect of independence in small communities."

Editor's note: Go to the Driver Rehabilitation Specialists Web site, www.aded.net, to learn more about driver screenings.

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