DOCSLIB.ORG

Driving with Multiple Sclerosis MANAGING MAJOR CHANGES Kim (Front Cover), Diagnosed in 1986

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Driving with Multiple Sclerosis MANAGING MAJOR CHANGES Kim (Front Cover), Diagnosed in 1986 Driving with Multiple Sclerosis MANAGING MAJOR CHANGES Kim (front cover), diagnosed in 1986. Driving with Multiple Sclerosis BY PAT NIEWOEHNER, BS, OTR/L, CDRS AND FLORIAN P. THOMAS, MD, PHD, NEUROLOGIST Patricia M. Niewoehner, BS, OTR/L, CDRS is an occupational therapist and certified driver rehabilitation specialist. She works in the Physical Medicine and Rehabilitation Department at the VA Medical Center in St. Louis, MO. She has been practicing in the field of driver rehabilitation for over 10 years. Dr. Thomas is board certified in neurology and spinal cord medicine and completed a neuroimmunology fellowship. He is a professor of Neurology at the St. Louis University School of Medicine and founder and director of the MS Centers at the St. Louis VA Medical Center and St. Louis University, both Partners in MS Care with the National MS Society. He has served in various functions including as a member of the board, the clinical advisory committee and the government relations committee of the Gateway Area Chapter of the National MS Society, which awarded him its 2006 Pathlighter Award, for more than 10 years. © 2013 NATIONAL MS SOCIETY. ALL RIGHTS RESERVED. driving performance, putting the person at an increased Introduction risk for an automobile crash. In addition, difficulties with information processing and visual-spatial skills are associated If you are reading this booklet you may have questions or with decreased driving performance. In other words, MS can concerns about how MS might affect your ability to drive impact many functions necessary for safe driving. Changes now or in the future. Driving — one of the many ways in MS over time may result in difficulty operating a car. Your we maintain our independence — is also one of the most ability to drive safely may be affected if you experience any of complex activities in our daily lives. In the same way that the following: other things we do can be affected by MS, the ability to drive can also be altered. Although symptoms associated n Difficulty getting into or out of a car with MS can affect the skills necessary for safe driving, n Muscle weakness or stiffness/spasms/cramps or pain, particularly adaptive automobile equipment is available to help you in the arms or right foot keep driving safely. Here we review the skills necessary n Loss of sensation in the feet or hands for safe driving, important information about driving n Impaired coordination evaluations, different types of adaptive auto equipment, and n Slowed reaction time Department of Motor Vehicle policies. Lastly, in an effort n Fatigue to maintain your independence if driving is no longer an option, other transportation options are reviewed. n Seizures or loss of consciousness n Blurred vision, blind spots, double vision, loss of color vision n Cognitive problems such as short-term memory loss; disorientation while driving such as forgetting your destination, Ways in which MS symptoms getting confused about where you are or missing exits; poor may affect your driving ability concentration; inability to multitask; and confusion about how to turn the car on or off and safety n Mood changes: depression and/or problems controlling anger Even if your MS symptoms seem to be mild and manageable, Research has shown that a person’s driving performance other indications that your driving safety may already be may be negatively affected by symptoms associated with compromised include automobile accidents or near misses, MS. For example, recent studies show that both cognitive moving violations, and the unwillingness of others to be a changes and spasticity (muscle stiffness or spasms) affect passenger while you are driving. 1 | Driving with Multiple Sclerosis Managing Major Changes | 2 Medical considerations Driving evaluations The severity of MS symptoms can vary considerably over If you or others are concerned about your ability to drive, time. Most people with MS experience exacerbations (also you may consider obtaining a comprehensive driving called attacks or relapses). During exacerbations driving evaluation. Driving evaluations help pinpoint any challenges may be difficult or unsafe, but may return to normal as you may be experiencing, as well as the appropriate adaptive the exacerbation ends and symptoms improve. However equipment to keep you safely on the road. people with progressive forms of MS may experience a slow Driver rehabilitation clinics are often located in medical worsening of abilities that can permanently affect driving. centers but may also be available in your community. A In addition, symptoms can fluctuate significantly during driving evaluation is performed by a driver rehabilitation the course of a day. For example, a person’s energy level is specialist (DRS) or certified driver rehabilitation specialist typically at its best during the first few hours after awakening, (CDRS). A DRS or CDRS is typically an occupational but declines as the day goes on. Planning daily activities therapist with specialized training in driver rehabilitation. around these fluctuations of energy is critical to optimizing The driving evaluation assesses your driving skills, and, personal safety and that of others while you are driving. if appropriate, also provides a recommendation for an Medications are available to help manage MS-related fatigue, appropriate vehicle type and adapted automobile equipment so it is important to talk with your doctor about your to meet your needs. Since the driving evaluation is usually treatment options and the best strategies for managing your performed by a therapist using specialized equipment, it is fatigue effectively. more comprehensive than a typical Department of Motor Vehicle (DMV) road test. People with MS may be taking several medications to manage symptoms such as spasticity, mood changes, bladder While the length of the evaluation varies, you should expect problems, walking problems or pain. With increasing it to last about two hours; it includes an office-based numbers of such medications, and with increasing doses, assessment and a behind-the-wheel evaluation. The the likelihood increases that they could affect wakefulness, office-based assessment includes a review of your medical concentration, coordination and reaction time. If you think and driving history, and a look at how MS affects your that medication side effects may be affecting your driving, performance with other activities such as bathing, dressing talk with your healthcare provider about treatment options or medication management. You will be asked about specific you can consider to minimize their impact on your driving. 3 | Driving with Multiple Sclerosis Managing Major Changes | 4 problems you may have with driving, any citations you may have received while driving, motor vehicle accidents or near Adaptive automobile misses. In addition the following will be assessed: equipment n Functions such as strength, range of movement, coordination, sensation and motor speed Specialized adaptive equipment may be recommended to n Vision including visual acuity, depth perception, color vision and help you adjust for deficits that interfere with your driving; road sign recognition these could include: n Cognitive performance to determine how quickly your brain n Mechanical hand controls to operate the gas and brake processes information and how MS may be affecting memory, n Digital driving ring to operate the gas and brake (more visual searching and visual-spatial relations expensive than mechanical hand controls) If you demonstrate adequate vision, cognition and motor n Spinner knob to turn the steering wheel function during the office-based assessment, a behind-the- n Adaptive steering and/or braking mechanisms that require less wheel road test will be performed, usually in the facility effort vehicle. The road test will generally begin in low traffic areas n Hi-tech driving equipment for gas, brake and steering control and proceed to more complex or higher traffic areas. Your using a joystick or other one-handed devices may be an option ability to safely operate the car will be evaluated, including: for those with more involved physical impairments, although n Ability to transfer safely in and out of the vehicle extensive training is required and the costs may be quite high n Ability to stow any assistive devices like a wheelchair, walker, cane n Wide angle rear view mirror, larger outside driver and passenger side mirrors and/or a multi-panel rear view mirror n Ability to follow the rules of the road n Specialized seats to ease car transfers n Reaction time in identifying potential hazards on the road n Lifts for stowing wheelchairs and assistive devices n Reaction time maneuvering the vehicle and moving your foot back and forth between the gas and brake pedals n Lowered-floor vans equipped with a ramp or lift to accommodate a wheelchair n Visual searching, scanning and attention abilities n Use of good judgment before executing a maneuver (e.g., a left turn) Once the driver rehabilitation specialist has recommended specific auto equipment, you will need training on how to n Ability to multi-task use the equipment properly and safely. The training is usually n Ability to stay within a lane and to change lanes safely performed in the facility vehicle. Length of training varies n Safety awareness while driving depending on the type of equipment and the individual’s 5 | Driving with Multiple Sclerosis Managing Major Changes | 6 learning style. Training generally concludes when you have demonstrated safe
Load more

Recommended publications
  • Occupational Therapy Practice Guide for Enabling Participation in Driving 2ND Edition
    Occupational Therapy Practice Guide for Enabling Participation in Driving 2ND Edition July 2017 Prepared by: AHS Provincial Occupational Therapy Driving Working Group Copyright © (2017) Alberta Health Services. This material is protected by Canadian and other international copyright laws. All rights reserved. This material may not be copied, published, distributed or reproduced in any way in whole or in part without the express written permission of Alberta Health Services (please contact Professional Practice Consult Service at Health Professions Strategy & Practice at [email protected]). This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use. April 2017 2 Contents 1. Introduction.................................................................................................................... 5 2. Occupational Therapy and Driving Assessment ............................................................... 6 a. Tier 1, 2, 3 Competencies ........................................................................................................6
    [Show full text]
  • Developing a Livable Community for All Ages 67 B
    Introduction: Building Livable Communities for All Ages 1 Today’s residents = Tomorrow’s older residents 2 When residents can age in place, everybody benefits 2 Thinking outside the box 3 Chapter 1: About this Guide 5 How to find what you’re looking for 5 Chapter 2: Key Challenges and Action Steps to Build 7 A Livable Community for All Ages Housing 9 Planning and Zoning 15 Transportation 20 Health and Supportive Services 27 Culture and Lifelong Learning 35 Public Safety 39 Civic Engagement andVolunteer Opportunities 42 Chapter 3: Turning Best Practices into Common Practice: 47 Six Steps for Focusing Community Energies on Aging in Place Step One: Assemble a team of public and private leaders 49 Step Two: Assess the community’s aging-readiness 54 Step Three: Take focused action 58 Step Four: Promote success 60 Step Five: Set a long-term course 62 Step Six: Get resources 66 Appendices: 67 A. Resources for Focusing Community Energies on Aging in Place and Developing a Livable Community for All Ages 67 B. AssessingYour Community’s Aging-Readiness: A checklist of key features of an aging-friendly community 69 C. Resources 71 Notes 74 Introduction Building Livable Communities for All Ages Americans are enjoying longer and healthier lives. Today, there are more than 35 million Americans age 65 or above—a tenfold increase in the 65 and over population since 1900. Over the next 25 years, that number will double, and one in every five Americans will be age 65 or older. i Tremendous advances in health care, economic security, and the delivery of supportive services have profoundly altered the experience of aging for the better.
    [Show full text]
  • News Brake the Newsletter of Aded 71270
    NEWS BRAKE THE NEWSLETTER OF ADED www.driver-ed.org·711S.VIENNA·RUSTON.LA 71270 VOL. 26 NO.3· SPRING 2002 "j Presiq~nf's~t1pttafe ···· ;; ... ._". 'i :j.;i-/-~'}' • /' . , Carol Blanc als will have a new fee structure. The fees Nationally, there is a strong movement of Greetings to all have been increased as follows: CDRS test­ planning for the Geriatric explosion in re­ ing is $300.00 with a $50.00 application gards to Aging and Mobility. In addition ADED members! fee, CDRS renewal is $150.00. to the shortage of CDRS to perform mo­ The 2002 ADED Board met for the Spring The Board approved the revised ADED bility assessments for the elderly; AOTA is Board meeting in Louisville, KY. The Ex­ Chapter Guidelines, which will be dissemi­ noting the need for assisting Occupational ecutive Directors are active in helping the nated to the ADED members. Therapist's to become active in the field of board move forward and assisting the Presi­ Driver Rehabilitation. I have extended an dent. Many of the Board's activities are The Board has made several recommended invitation to AOTA to establish an alliance as follows: changes to the By Laws. The By Laws are and collaborative working relationship for still a work in progress and will undergo the common goals of increasing qualified The Standards ofPractice and Code ofEth­ legal review. The plan for the Operations ics are being revised by the Professional CDRS's and meeting the needs of the grow­ Board member is to have a draft at the ing geriatric population.
    [Show full text]
  • Driver Assistive Technology Program Helps OVR Clients Access Safe, Independent Transportation for Work
    Driver Assistive Technology Program The Driver Assistive Technology Program helps OVR clients access safe, independent transportation for work. Driver assistive technology services may be provided if required to attain the employment goals on an approved Individualized Plan for Employment (IPE). Driver Rehabilitation services vary and depend on the needs and abilities of the OVR client. Services range from driver’s education to vehicle modification. Transportation This is an evaluation of a client who will not drive but will be driven by another Evaluation person in the client’s vehicle. A transport evaluation will determine the best method and equipment for a person with a disability to enter/exit into a vehicle, as well as transport of a wheelchair or mobility aid. Driver’s A Driver’s Evaluation consists of a clinical and comprehensive evaluation to Evaluation determine what a client would need to be able to drive independently. The assessment is performed by a Certified Driver Rehabilitation Specialist. The evaluation considers visual and perceptual skills, cognitive skills, physical functioning, and occupational history in order to determine program eligibility. Driver Driver Rehabilitation services are used to teach someone to drive with or without Rehabilitation vehicle modifications. These services include driver education , driver training , and extended driver evaluation. Driver OVR offers a Driver’s Permit Class to eligible students who do not have a Education Kentucky Learner’s Permit. The curriculum is based on the Kentucky Driver’s Manual and all aspects of Kentucky Road Rules and Regulations are reviewed. Accommodations are made to meet the needs of auditory, visual, and kinesthetic learners.
    [Show full text]
  • My Wheelchair Guide: Supplemental Information
    My Wheelchair Guide: Supplemental Information United Spinal Association is grateful to members of the Clinician Task Force1, https://www.cliniciantaskforce.us/ for their expert input and review of ‘My Wheelchair Guide: Supplemental Information’ (formerly United Spinal Association’s Mobility Map). TABLE OF CONTENTS2 1.0 GETTING STARTED 2.0 YOUR SELF-INVENTORY OF NEEDS: MY WHEELCHAIR CHECKLIST 3.0 PREPARING FOR YOUR WHEELCHAIR EVALUATION 4.0 GATHERING YOUR WHEELCHAIR TEAM 5.0 GETTING YOUR WHEELCHAIR PRESCRIPTION AND THERAPY REFERRAL 6.0 YOUR ENVIRONMENTAL SELF-SURVEY 7.0 YOUR WHEELCHAIR EVALUATION 8.0 YOUR HOME ASSESSMENT 9.0 GETTING YOUR WHEELCHAIR 10.0 WHEELCHAIR EQUIPMENT FITTING & DELIVERY 11.0 WHEELCHAIR SKILLS TRAINING 12.0 MAINTENANCE, REPAIRS AND FOLLOW-UP 13.0 DENIALS, APPEALS, TRIALS AND LOANERS 14.0 WHEELCHAIR ADVOCACY 15.0 USING YOUR WHEELCHAIR WITH DIFFERENT MODES OF TRANSPORTATION 16.0 GENERAL RESOURCES 1 Mary-Ellen Buning, PhD, OTR/L, ATP/SMS; Cathy Carver, PT, ATP/SMS – Executive Director, CTF; Laura Cohen, PhD, PT, ATP/SMS (former Executive Director, CTF); Elizabeth Cole, MSPT, ATP; Barbara Crume, PT/ATP. 2 To view additional information for manual wheelchairs, visit https://unitedspinal.org/my-wheelchair-guide/, My Wheelchair Guide: A Manual Wheelchair Mobile App, developed with University of Pittsburgh, in partnership with Clinician Task Force, National Coalition for Assistive and Rehab Technology, National Registry of Rehabilitation Technology Suppliers and Rehabilitation Engineering Society of North America. 1.0 Getting Started Wheelchair Use Need New/First Wheelchair • Temporary use such as following a surgical procedure with a prognosis of recovery usually means a rental wheelchair.
    [Show full text]
  • Older Driver Safety Summit Final Report
    Older Driver Safety Summit Final Report Project Title: Foster Occupational Therapy Engagement in Older Drivers addressing gaps through Pathways FINAL REPORTNHTSA Cooperative Agreement Number: DTNH22-11-H-00340Period March 3 and 4, 2015 Dr. Anne Dickerson, Project Consultant Brian Chadrow, NHTSA (PM): Elin Schold Davis [email protected] 6/29/2015 Contents Chapter 1: Introduction .................................................................................................................. 7 1.1 Context .................................................................................................................................. 7 1.2 Objective ............................................................................................................................... 7 1.3 Background ........................................................................................................................... 7 Chapter 2: Planning the Summit .................................................................................................... 9 2.1 Overview ............................................................................................................................... 9 2.2 Logic Model as Paradigm .................................................................................................. 9 2.3 Participants ....................................................................................................................... 10 2.4 Preparatory materials .....................................................................................................
    [Show full text]
  • Driving After Spinal Cord Injury
    Driving After Spinal Cord Injury October 2015 SCI Fact Sheet What you need to know This fact sheet tells you You may be able to continue driving safely again, depending on how serious your injury is and about resources and steps how much function you have regained. you can take to help you return to driving after your If you can drive, you may need to buy a vehicle that suits your unique needs after the injury. spinal cord injury (SCI). Vehicles can be altered with special equipment called “assistive technology” to help you drive safely after your injury. Equipment can be expensive based on your function and the type of equipment necessary. Connect with Us: You should take specific steps before you return to driving; there are resources to help you. Northern New Jersey Spinal Cord Injury System 1199 Pleasant Valley Way How do I know if I can drive a vehicle again? West Orange, NJ 07052 http://KesslerFoundation.org/NNJSCIS The amount of time after your injury is a major factor in deciding whether and You might be able to drive safely with Kessler Foundation how you can return to driving. You may special assistive equipment for your [email protected] see many improvements in your abilities vehicle. The equipment can be expensive. www.Facebook.com/SCIRehabResearch several weeks or months after your Obtaining a driving assessment may help http://KesslerFoundation.org injury. With time, you may regain some minimize costs. Follow @KesslerFdn on Twitter functions that could make driving possible. With time, the amount and cost of any needed special equipment may be reduced.
    [Show full text]
  • Adapting Motor Vehicles for People with Disabilities
    Table of Contents Adapting Motor Vehicles For People With Disabilities 1 Table of Contents Introduction . 1 Investigate Cost-Saving Opportunities and Licensing Requirements . 2 Evaluate Your Needs . 5 Select the Right Vehicle . 8 Choose a Qualified Mobility Dealer to Modify Your Vehicle . 11 Obtain Training on the Use of New Equipment . 14 Maintain Your Vehicle . 15 Resources . 17 Introduction A Proven Process for Maintaining Freedom on the Road New and existing adaptive technologies continue to broaden opportunities for people with disabilities to drive both comfortably and safely . Some of these adaptive technologies are as simple as swivel seats for more convenient access . Others, such as hand controls, may be necessary for a driver to safely operate a vehicle . Whatever your requirements, chances are good that adaptive equipment is available to support your special driving needs and allow you to maintain the freedom offered by the open road . The information in this brochure is based on the experience of driver rehabilitation specialists and other professionals who work with people who require adaptive devices for their motor vehicles . The steps outlined here represent a proven process — evaluating your needs, making sure the vehicle “fits” you properly, choosing appropriate features, installing and knowing how to use adaptive devices, practicing good vehicle maintenance — that can help you avoid costly mistakes when modifying or purchasing a vehicle to accommodate your driving requirements . Also included is general information on cost savings, licensing requirements, and organizations to contact for additional assistance . Although the brochure focuses on drivers of modified vehicles, each section also contains important information for people who drive passengers with disabilities .
    [Show full text]
  • VHA Directive 1170.03 Physical Medicine and Rehabilitation
    Department of Veterans Affairs VHA DIRECTIVE 1170.03 Veterans Health Administration Transmittal Sheet Washington, DC 20420 November 5, 2019 PHYSICAL MEDICINE AND REHABILITATION SERVICE 1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive describes policy and procedures for the mission, purpose, organization, provision of standards of rehabilitative care, business practices, performance improvement strategies, and responsibilities regarding physical medicine and rehabilitation programs and services. 2. SUMMARY OF CONTENT: This VHA directive replaces VHA Handbook 1170.03, Physical Medicine and Rehabilitation Services Procedures, dated May 2, 2014, and includes directions from VHA Handbook 1170.04, Rehabilitation Continuum of Care, dated December 30, 2014, and VHA Directive 2012-016, Documentation of Kinesiotherapy Services in Department of Veterans Affairs Community Living Centers in the Resident Assessment Instrument Minimum Data Set, dated May 9, 2012. This directive updates procedures and requirements for comprehensive continuum of rehabilitation care provided to Veterans with disabilities and injuries. This directive also updates direct scheduling within rehabilitation services. 3. RELATED ISSUES: VHA Handbook 1170.02, Audiology and Speech-Language Pathology Services, dated March 14, 2011, and VHA Directive 1172.01, Polytrauma System of Care, dated January 29, 2019. 4. RESPONSIBLE OFFICE: The Deputy Chief Patient Care Services Officer for Rehabilitation and Prosthetic Services (10P4R) is responsible for the contents of this VHA Directive. Questions may be referred to the National Director, Physical Medicine and Rehabilitation Service (PM&RS), at 202-461-7444. 5. RESCISSIONS: VHA Handbook 1170.03, VHA Handbook 1170.04, and VHA Directive 2012-016 are rescinded. 6. RECERTIFICATION. This VHA directive is scheduled for recertification on or before the last working day of November 2024.
    [Show full text]
  • Consumer Support Resources
    December 10, 2017 CONSUMER SUPPORT RESOURCES ALL: Amputee Coalition www.amputee-coalition.org Amplitude http://www.amplitude-media.com/Magazine/ Ampower www.empoweringamputees.org American Occupational Therapy Association www.aota.org American Academy of Orthotics and Prosthetics www.oandp.com HOW TO FIND AN EXPERIENCED UPPER LIMB PROSTHETIST Whether you are an Individual with an upper limb loss/difference or a Physician who is guiding the plan of care for the Individual, finding a knowledgeable prosthetist is an important step to accessing the technology. The process itself can be overwhelming, especially if we don’t fully understand the requirements of our insurance payers, the technology, how we will learn to use it and apply use to daily tasks. Although there are a multitude of prosthetists in the United States with basic training in upper limb prosthetic care, relatively few have the extensive experience needed to provide expert care in this domain. It is important to find a prosthetist with whom we can relate; someone who will help us to understand and to navigate the process; someone who possesses the knowledge, skill and experience to provide this very important technology. Where do we start? Interview the prosthetist to determine that he/she: 1. Is certified by the American Board for Certification (ABC) 2. Has a minimum of five years of current upper extremity experience and has fit more than 10 patients in the last year 3. Can specify what types of electrically-powered prostheses they have fit in the past two years 4. Has received certification, training and knowledge of products from the manufacturers of diverse prosthetic technology, including: o COAPT o Didrick Medical o Fillauer o Infinite Biomedical Technologies o Liberating Technologies (College Park) o Motion Control o Naked Prosthetics o Otto Bock o Touch Bionics o Texas Assistive Devices o TRS Prosthetics 5.
    [Show full text]
  • Handicap Driver Vehicle Modification
    Handicap Driver Vehicle Modification Despotic Emile scum very fictitiously while Lanny remains leaning and tea-table. Billed Albatros admits hyperbolically. Relaxative Paten strings, his pigment avulses read-out angrily. What desperate Need not Know About Its assault on Car Insurance Rates. When he pushed the left pedal it controlled the vote one. However, Carers or Support Workers who drive private car? Do faculty have other options available if rental cars are from available? The insurance carrier should inform you as so what is required in order to obtain one for replacement of the equipment in case of said accident. Body wraps have become absolutely an inclination in the Indian market there are these repair shop and car shops that can intimately various types of cloaks that look extremely goods agreement the car applying body wraps is completely legal it cannot tick the original colour of control vehicle. Your driver rehabilitation specialist may seem able of provide referrals depending on next you smooth and kitchen vehicle modification and adaptive equipment needs. These hand controls are designed for apply by individuals with normal upper back strength and coordination. Australian Association of Occupational Therapists Victoria Inc. The Technology Report lists detailed information about the selected technology or adaptive equipment. Recipients were asked to review and complete the award prior to attending the focus groups. If as are in lyrics of a officer for disability driving, you retain find small local dealer and dad check inventories of any VMI dealership. We use cookies to let us know what you consent our websites, by bus, or prop be coordinated with somewhat similar organizations to provide condition with a seamless travel itinerary.
    [Show full text]
  • Model State Act and Local Ordinance, 9-7 AARP Principles Budget, 2-2
    INDEX Adult day services alternative to nursing home, 8-33, 8-41 A Adult foster care alternative to nursing home, 8-2, 8-39 Adult protective services (APS), 12-2–12-4 AARP Accessory Dwelling Units: Model State Act and Advance directives, 12-7, 12-13–12-15 Local Ordinance, 9-7 Uniform Health Care Decisions Act, 12-14–12-15 AARP principles Advance planning, 12-5–12-8 budget, 2-2 Advanced beneficiary notices (ABNs), 7-42–7-43 employment, 5-2 Advanced metering infrastructure (AMI), 10-43–10-47 financial services and consumer products, 11-2 Advertising government integrity and civic engagement, 1-1 deathcare, 11-45, 11-60–11-63 health care, 7-2–7-4 unfair and deceptive, 11-14, 11-18–11-19, 11-51– health care adequacy and affordability, 7-3–7-4 11-52, 11-56 housing, 9-2 Affordable Care Act (ACA) also known as Patient land use, 9-1–9-2 Protection and Affordable Care Act of 2010, 12-3 livable communities, 9-1 accountable care organizations (ACOs), 7-10 long-term services and supports (LTSS), 8-4–8-5 antitrust, 7-94 low-income assistance, 6-3 Center for Medicare and Medicaid Innovation mobility, 9-3 (CMMI), 7-7, 8-23 personal and legal rights, 12-1 Coordinated Health Care Office (CHCO), 7-81, retirement income, 4-2, 4-4 8-24 social security solvency, 4-4 education and licensing, 7-118, 7-123 taxation, 3-1 expanding health coverage, 7-75, 7-88–7-89, 8-13 transportation, 9-3 financing health care, 7-94–7-98, 7-101, 7-105 utilities: telecommunications, energy and other end-of-life care, 7-109 services, 10-3 food labeling and advertising, 7-101 ABN.
    [Show full text]