One of the biggest issues we had to tackle in the context of mum’s increasingly erratic behaviour was that of safety. It seems terrifying to consider it now but even with a diagnosis of Mild Cognitive Impairment and an ever decreasing range of coping mechanisms mum was still driving. She also continued to collect my youngest child from preschool, bring her home and make lunch until relatively recently. At some point prior to the MCI diagnosis I must have made the decision that I was not happy for mum to be driving with the kids in the car although that was never explicitly expressed – I just managed to engineer it so that the need didn’t arise – she walked to and from preschool and once back at our house there was no reason for her to leave until dad came along to pick up the older kids from school. The safety issues regarding childcare were, in a way, easiest to mitigate. As it became obvious that mum was less able to cope with basic tasks we found creative ways to adapt. I became concerned about mum using our oven so we ensured that lunches were cold and involved minimal preparation (even so, I’m not convinced that my youngest child wouldn’t have ended up malnourished if it hadn’t been for her overwhelming survival instinct to eat her own body weight in cheese and sausage rolls if required). We substantially reduced the number of times that mum was left in charge of the kids – again this was never explicitly discussed but my mother-in-law tactfully stepped into the breach without complaint and what had been a once fortnightly concern for me became a once a month issue. This of course made things more difficult for mum on the days that she did help with childcare because the routine was less familiar than it had been.
It probably seems incredibly naive and selfish now to have continued to ’employ’ mum in this way. We should perhaps have enlisted the help of a professional but the practical aspects of the situation did not allow it – no childminder would be happy to commit to a solitary half-day a month, it would be disruptive for my child and I genuinely wanted to reinforce the connection between my parents and my children that the current set-up allowed. I repeatedly checked with dad that he was happy to continue with the arrangement and he seemed to welcome it as a distraction for mum, he felt that it gave her ‘something to do’. We carried on in this fashion for a while, increasingly uneasy but unable to see a clear end-point until one day there was the phone call that sealed the deal: I was at work, halfway through morning surgery when my mobile rang. It was preschool. They said that my mum had arrived to pick up my child at 10.30 – two hours early. Because the preschool leader had recognised mum she had been happy to let my child go with her, assuming that there must be some prior engagement that necessitated early collection. If it hadn’t been for the fact that I had briefly mentioned mum’s MCI diagnosis a week previously to one of the other preschool staff who happened to be working that day then my child would have been handed over to granny in the usual fashion. This in itself would not have given significant cause for concern but mum had, on this occasion, driven up to preschool and I knew she did not have a booster seat in the car (usually she drove to my house, parked and walked up to preschool with the pushchair). In all likelihood, had preschool not called me, mum would probably have driven my child back home without a booster seat, or indeed a seatbelt, and no harm would have come to anyone. But there were so many ‘What if?’s rolled into that scenario with results that ranged from minor distress to death and carnage on a massive scale. The simple five minute journey to and from preschool was beset with peril as soon as you added a vehicle into the equation:
Well intentioned but cognitively compromised adult
Tired, small child
2 tonnes of metal on wheels travelling at high speed
My immediate and overwhelming reaction was that the current arrangement could not continue. I had what is sometimes described in medical textbooks as ‘an impending sense of doom’ (a wonderfully evocative phrase). After dealing with immediate situation (preschool had made mum a cup of tea and were happy to keep hold of her until dad arrived to take both grandchild and granny home) plans were put in place to ensure that mum was never left with the sole responsibility for my kids again and we all breathed a collective sigh of relief. It sounds awful, the implication that my mother was an active danger to her own grandchildren and I do want to stress that nothing untoward ever happened to them whilst they were in her care. In fact the only time my children have sustained injuries or had mishaps befall them has been under the watchful eye of me or my husband. It is simply a question of weighing up the probabilities of risk and we felt that collectively we had pushed our luck as far as it could go. Once the childcare issue had been resolved we then had to deal with the driving. It was one thing to say ‘Well, I don’t want her driving the kids anywhere’ – to then go on and say ‘But it’s OK for her to be out on the road unaccompanied’. The implication was that if she was not safe to drive with children in the car then she probably wasn’t safe to drive full-stop. However, as anyone who has driven a car containing three small children will realise, this activity often requires superhuman powers of concentration and could be classed as a much more advanced driving skill akin to helicopter piloting / commandeering a tank / navigating an HGV through a blizzard. Mum not being safe to drive the kids did not necessarily mean that she was no longer capable of driving on familiar roads in daylight hours and normal weather conditions. We had no direct evidence to stop her. We had no clear guidance from the DVLA or the memory clinic as to when to stop her although it had been mentioned as a potential ‘issue for discussion’. There had been a couple of incidents; one prior to any diagnosis where mum had parked the car on a steep slope and the handbrake had ‘failed’ (not been put on?) causing the car to roll back down the slope into the road, taking mum with it and nearly crushing her against the garden wall (as it was she was lucky to walk away with a humeral fracture). There had also been the incident post MCI diagnosis when mum had come to stay at our house and had been about to drive home in the morning as it started to snow. The change in weather had completely thrown her and she sat in the car for almost half an hour, windscreen wipers jolting furiously, hazard lights flashing, radio blaring but unable to operate the ignition until we called her back inside and suggested she wait for dad – interestingly, as soon as dad arrived and the snow had stopped actively falling she happily got back in the car, started it with no problem and pulled off the drive as cheerily and competently as a professional chauffeur. More recently visiting cousins had expressed some concern about being in the car with mum after dark. My sister and I relayed these concerns to dad. He responded with examples of mum’s reliable driving record, the fact that she often knew the directions better than he did, the fact that she routinely managed to drive to our house, the shops, the hairdressers without incident, but he too was concerned, he just didn’t know how to handle the massive confrontation we feared if we physically took away mum’s car keys and thereby any shred of remaining independence. In the end it was an absolute doddle and for anyone reading this who is currently not sure how to negotiate the difficult decision to confront their loved one in this regard, let me assure you that had we known it would be so easy we would have done it much sooner and saved ourselves a great deal of anguish about public responsibility versus individual autonomy. Sorry if it has taken an enormous trawl through the wooly ramblings about childcare to get you to this point but from a practical point of view this is what we did: Dad told mum that the renewal had come up for the car insurance and that because of the diagnosis the premiums would be too high to reinsure her. This was not an outright lie and fitted well with the fact that she knew they had recently had similar issues with travel insurance. He simply said that she wouldn’t be able to drive any more and she has not mentioned it since. There was no wrestling over keys, no emotional scene. It just happened. And now dad drives her here, we drive there, she gets taken to the shops and the hairdressers and we can relax confident in the knowledge that she is safe and that the British public are safe. The take home message must be this – if you are uncomfortable about your parent driving and you feel it is unsafe then stop them. It may be much easier that you anticipated and even if distress is caused surely it is worth any amount of anguish to avoid the death of innocent pedestrians being on your conscience.
Quick addition – Stop Press etc etc – just found this really helpful page from Dementia Today http://www.dementiatoday.com/alzheimers-and-when-to-stop-driving/