My husband and I are in Florida, in July of all times. Spending the week on Anna Maria Island, where the Gulf coddles our toes in warm bath water, makes it tolerable. But the real reason we come to Florida this time of year is for no other reason than to visit his parents – Eve 84, Tom 89. I like to believe that when we come here all other worries will instantly wash away with the outgoing Gulf tide. Yet, that’s not possible. I can’t help but worry about Tom’s driving (Eve does not drive due to her macula degeneration). More specifically, I worry because Tom still believes he ‘s capable of driving, even though his legs hurt and he can barely rise from his recliner, the one he sits in for endless hours each day.  I ask him if he still drives, especially when he takes the medicine that makes him see double.

“Drive,” he says. “They won’t let me drive.” When he says “they,” he means his four adult children who followed him and Eve to Florida some six years ago. They take turns driving Tom to the grocery store, pharmacy, doctor, casino, and to his favorite deli. He has a sparkling new Lexus, so why wouldn’t they want to be in the driver’s seat. But I know that it’s more than the smooth ride, the broad seats, the dual- zone automatic climate control, and the surround sound audio system that lures them into driving. I know his children drive Tom to here-and-there because they harbor the desire.

But what happens when someone who should not be driving drives because there is no one who cares enough to drive him to the doctor, the pharmacy, or his favorite restaurant? That man drives.

While in Florida, my sister-in-law’s good friend tells me her husband has Alzheimer’s. She asked him to cook an egg the other day; he cracked the egg directly onto the flat top stove. Then she asked him to shut the light off; he looked at her with utter confusion. Yet, he still drives. “If I wasn’t with him,” she says, “he’d turn left on a red arrow.”

I ask her if there is anyone else that can do the driving. There isn’t. She doesn’t drive and there is no family in the area. I ask her if she and her husband would be willing to take public transportation.

“I suppose we could,” she says. “But he’s so stubborn. I can’t tell him what to do.”

I left it at that, at a loss for other options to offer. What will it take to stop him from driving? A car accident? Loss of life?

Second to Maine, Vermont is the most rural state in the nation, posing a challenge for the non-driving elderly to get to the doctor, the grocery store, the bank, or simply to enjoy lunch with a friend. Fortunately, the non-profit organization, Vermont’s Area Agencies on Aging, provides transportation services to help meet the needs of our elders. Depending on the county in which a Vermont resident who is 60 or older lives, a specific agency under the umbrella of Vermont’s Area Agencies on Aging are available: Champlain Valley Agency on Aging, Central Vermont Council on Aging, Southwest Vermont Council on Aging, Senior Solutions, Area Agency on Aging for Northeast Kingdom.

The caveat is that these agencies require 24 to 48 hours notice. Understandably, the drivers are busy (some help out of the goodness of their hearts and volunteer). But what happens if your elderly mother wakes up with a fever or cut to the leg that needs medical attention, but doesn’t require calling an ambulance? You can’t leave the critical meeting your boss has attended and are leading. Or maybe your five-year-old is home with a fever and you can’t leave him home alone (you’re a single parent and no one is available, or willing to babysit a sick kid). Then what? You could call a cab to pick up your mother, or just tell your boss you must leave.

Of course, no system is full-proof. But what else can we do to ensure the availability of transportation for our elders, even on a moment’s notice?

After the Santa Monica Farmers’ Market tragedy, I felt sad for Russell Weller, as he had to live and sleep burdened by horrific deaths. In 2006, he was convicted of ten counts of manslaughter. Though he did not serve prison time, he lived in a personal prison for the remainder of his life as a recluse, hunkered in is home with the venetian blinds permanently closed. He died in December 2010 at the age of ninety-three, more than seven years after the accident.

My family was angry with Russell Weller while I was angry with his family – they did not take the keys away from him despite the fact that he had a history of auto accidents (fortunately none involved any fatalities or serious injuries) I found myself asking time and time again, Why did Russell Weller fail to see that he was no longer capable of driving?

The answer: independence.

As Ironic as this statement may sound, and it has taken me almost nine years to come to this realization, it isn’t so easy to take the keys away. I’ve come to this conclusion through my work as a wellness nurse with the aging population.

Inevitably, the topic of driving is central to the conversations I have with   the residents of the independent facilities in which I visit. During my assessments, I ask them if they still drive, if they have any concerns about their driving, if they have a history of auto accidents, and if they are taking any narcotics or other medications that could impair their ability to concentrate.

Even after I shared the tragic story of the Santa Monica Farmers’ Market accident with a particularly worrisome resident, who happened to be taking narcotics for chronic pain, she said, “I’m fine. In the sixty-years I’ve been driving, I’ve never been in an accident. My doctor says it’s okay to drive.”

I shared my concerns with the manager of the property and with other wellness nurses. But my role is to strongly encourage rather than prescribe. I’m not supposed to call physicians or family members without permission from the residents. I must trust that their physicians will speak with their patients, and advise them that they should have a thorough medical exam to assess their ability to continue driving. I must trust that family members will act on the best interest of their parents or grandparents, if need be, and take the keys away.

I’d exhale a sigh of much needed relief when I arrived each Tuesday to visit this resident, seeing that she indeed made it another week without either injuring or killing herself, or someone else.

You can breathe now – she no longer drives. Her family stepped in, took the car. Sold it.

But what happens once we take the keys away? How will the no-longer-able-to-drive get to the grocery store or to medical appointments? What do they do if they simply want to get out of the house to visit with a friend for lunch or do volunteer work? Do we simply take the keys then drive away in our own cars, indulging in selfish freedom? If we insist on taking the keys away from our elders, shouldn’t we also have in place a workable transportation plan?