Residents of long-term care facilities and independent living centers can benefit from home- and community-based senior transportation services – not just their peers who stay at home and age in place, three Washington, D.C.-based advocates say.

Advocates of senior care and transit with B’nai B’rith International and Community Transportation Association of America (CTAA) encourage long-term care and independent living facilities to take advantage of the variety, low cost, flexibility and quality of community services to their aging residents if they cannot afford to outsource transit to other private companies.

One organization funded by the Federal Transit Administration (FTA) with the U.S. Department of Transportation (DOT) can assist communities in the development of additional transportation options for older adults – the National Center on Senior Transportation (NCST). The NCST is hosted by Easter Seals in partnership with the National Association of Area Agencies on Aging.

There are a number of transportation options that both seniors who live at home and seniors who reside in long-term care and independent living facilities can use. These options include public transportation, private transportation such as taxis, volunteer driver programs staffed by local nonprofits, caregiver transportation programs, shuttles, specialized transportation services from local human services agencies, motorcoach services and medical transportation services.

Deciding what transportation options are most appropriate for each individual requires learning about with is available in the community and which service is acceptable to the person who needs the service. Transportation experts and researchers say long-term care and independent living facilities consider several factors when deciding to offer transit services to their customers, especially those without financial capital.

Factors include:

• whether they want to offer necessary trips like both non-emergency and emergency medical services or grocery shopping or recreational trips to museums, symphonies or shopping malls;
• what kinds of vehicles will be used;
• the costs and what kind of training to employees or volunteers should be given;
• how much gasoline or fuel will be used;
• what hours under which to operate;
• what level of assistance or service their residents need based on the specific category of senior care the program provides;
• the functional abilities and preferences of the person who needs the service;
• whether transit is needed to travel to a private home or office;
• whether a facility or nonprofit’s own vehicles will be used;
• what types of insurance will be bought and how much;
• whether paid and/or volunteer drivers will be used, and;
• what type of management and operational style will be used.

Above all, the facilities must think about the services they offer seniors and what those residents actually need when determining the kind of transportation options they can provide, experts say. Whether their customers need assistance with activities of daily living (ADLs) or they can function independently, every aspect of the transit services, including the very design of the vehicles used, ought to reflect this.

As more and more communities see growth in their older adult population, community leaders are working to develop information that is readily available on their transportation options and striving to increase transportation services. Long-term care organizations can connect to these efforts. There are a number of national organizations with programs and resources that can assist in this process. These organizations range from national nonprofits, national associations, private sector companies and federal government agencies.

One national association that has a mission around community transportation is the Community Transportation Association of America, one of three major transportation associations – the other two being the American Public Transportation Association (APTA) and the Taxi Limousine and Paratransit Association.

Jane Hardin, coordinator of Senior Transportation Programs of CTAA, says a fine distinction should be made between senior care facilities in general, which can offer short-term service, and long-term care centers. Nursing homes, assisted living facilities and continuing care retirement communities (CCRCs) are long-term care facilities for the most fragile with the average age of residents or patients being 85. For CCRCs, the average age of patients or residents is 60 years, Hardin says.

A skilled nursing facility or acute rehabilitative care center or post-surgical center can be examples of short-term care facilities.

The difference in the nature of care will correspond with the level of assistance offered to seniors by transit services.

“People can move from those levels of care,” she says, explaining about CCRCs and separating long-term care from short-term care. “You can be independent and have a home. You can go to assisted living or a medical center. You can move back and forth.”

However, she says, because of the capital needed and the high cost of gasoline and other types of fuel, insurance, fees, labor, training, management and construction, facilities could improve services to take advantage of more affordable home- and community-based transit.

“There is no good coordination between transportation and land use because of the cost,” Hardin says. “They will build [long-term care] facilities way out of the major way of transportation. As people age, they cannot drive their cars everywhere. People will use public transit. It would be good for these facilities to look at [home- and community-based] transportation. Transportation is a great cost.

“Coordination is less expensive. If they work on coordination, they don’t have to pay insurance or for buses. All of that cost shifts. This is a source of revenue for the [home- and community-based] bus services. When their buses are not in service and they would be idle, they [facilities] can contract with community [transit].”

For facilities that can afford them, transportation services are offered to individual senior residents as part of a housing and service contract. A contract will specify the services it will provide seniors such as laundry, hair care, dining out, transportation and fees.

“Purchasing of vehicles is most hard,” Hardin says of the challenges facilities face in offering transportation. “It is expensive. They [the facilities] are not aware of the benefits of coordination. They have genuine concerns for their residents. They have to overcome this. They say, ‘We are trying to help seniors in our facilities. If we have them in vehicles, we have to know how they are being treated.’ That’s understandable. In fact, that is noble.”

Hardin explains that CTAA provides transit company members, senior care facilities and related businesses with technical assistance and training that explores a wide range of physical mobility and transportation options for seniors that take into account a lack of transit in rural areas and tribal areas, among low-income populations and sometimes with area employee-commuters. Trainees are taught the medical aspect of transit. Training is geared, ultimately, toward benefitting seniors, their friends and family caregivers and senior care service providers.

For employment, CTAA offers local senior care businesses a Transportation Toolkit for the Business Community at http://www.ctaa.org/transportation-to-walk to help them serve their commuting employees and cut costs – with funding from the Department of Labor and a partnership with the FTA.

CTAA’s technical assistance takes the form of site visits, phone calls, e-mail exchanges and the provision of information via magazines, websites and electronic newsletters.

“Technical assistance can be as simple as a phone call or a series of calls,” she says. “It can be a site visit. One of our experts sees the site and provides assistance.” Several national nonprofit organizations were selected and funded by the FTA to provide training and technical assistance on senior transportation – Easter Seals and the National Association of Area Agencies on Aging. This program is called the NCST. CTAA is one of a number of key partners who work with the NCST.

In further discussing CTAA’s suggestions, Hardin adds that facilities can use a peer-to-peer aspect of the program as she often does. “A senior facility can call me and ask if it is profitable to purchase a fleet of buses or to contract out for this service,” she says. “I give general information on buses and I’d have them contact other senior facilities. I find peer [interaction] is best. One student can work with a teacher.”

CTAA, Hardin notes, develops issues of transportation, performs advocacy among non-profit, private-sector and government entities, and offers transportation, lending services and training and professional development.

She attends conferences to share ideas about coordination of transit between senior care facilities and home- and community-based services, works with issues-based consortiums and often serves as a panelist on professional conferences, conventions or events.

Easter Seals and n4a units, outside of their work on the NCST, also provide significant national and state advocacy leadership in policy discussions on what is needed to further inclusive, community-based independent living for seniors. Many organizations’ leaders share perspectives at major national conferences to educate and inform others on seniors’ transportation needs.

For example, at the invitation of the NCST, Hardin joined former NCST Director Jed Johnson and both organizations presented on their technical assistance programs.

Hardin noted transit coordination and CTAA’s technical assistance and organizing at a conference of Leading Age (formerly known as the professional long-term care advocacy group the American Association of Homes and Services for the Aging (AAHSA).

Johnson discussed the essential role of homes and services for the aged in coordinating their services, becoming a part of local coordination efforts, and suggested ways these organizations can provide more transportation options for their communities’ residents.

A fellow presenter was a transit service from Denver. She also heard about the relationship between a home- and community-based group and senior care facilities in Portland, Ore.

“They had a tough time providing transportation,” Hardin says of the local transit group and the facility. “It gives you a headache or a heartache or both. They made an arrangement with an assisted living facility when it was being built. There was a purchase by the federal government and [the vehicle] was sitting idle.”

CTAA also assists nonprofit and commercial providers, public agencies, local and state governments and community and human service organizations by giving money through its technical assistance and low cost. Through its stand-alone subsidiary, Community Development Transportation Lending Services Corporation (CDTLS), recipients must qualify for loans by offering transportation programs to people who are transit-disadvantaged, such as frail older adults and people with disabilities.

“We will purchase 80 percent [of the value of transit vehicle or vehicles and supplies] and, if you come up with a 20 percent match, we will leave it on your property,” Hardin says. “The assisted living center is free to use that van when they need it and they are with Ride Connection.”

Ride Connection is a local nonprofit home- and community-based transportation services provider based in Portland, Oregon that serves communities in need, including seniors and people with disabilities in Clackamus, Multnomah and Washington counties. Using a community partnership, they offer door-to-door rides, carpooling and training for residents on how to use mass transit. About 400 volunteer drivers provide rides and 42 advocates and interns are involved in organizing and recruiting drivers for the program.

CTAA trains its own drivers through ([cm1]CTAA does not have its own vehicles as it is an association.  It provides the PASS program for the employees of other organizations, programs, companies, etc. that provide the transportation services) its own Passenger Service and Safety (PASS) Driver Certification Program. The training program is meant to ensure that drivers are skilled and certified in passenger assistance and sensitivity towards people with disabilities.

Training takes two days by CTAA-recruited PASS instructors. There is also a three-day Train-the-Trainer program to certify trainers who, in turn, can train other prospective drivers.
The principles of training drivers stem from a 2009 study co-authored by the CTAA and the Beverly Foundation, another national transportation advocacy group, titled “Delivering Community Transportation Services: Report on the Roles, Responsibilities and Contribution of Paid Drivers.” The study appears on CTAA’s website at http://www.ctaa.org or http://www.seniortransportation.net.

“Most drivers are good about treating seniors well,” Hardin says of CTAA’s certification training program. “When the driver takes the course, agencies will take this. It appears on their resumes and application forms. It is respected. It assures people that they have trained drivers and good service.”

In her work with consortiums and professional transit conferences, Hardin encountered or heard anecdotes of senior care and transit that highlight the need for coordination. One example involved a transit impediment posed by the manner in which a senior care facility was constructed.

A different type of coordination challenge is presented by limited support from Medicare and even Medicaid for senior transportation.

Medicare offers emergency ambulance services but does not cover non-emergency medical transportation, with an exception for Medicare Part C/Advantage programs, which limit service to bedridden patients.

By contrast, Medicaid is one of the largest providers of medical transportation for Medicaid covered services. These services include both emergency and non-emergency transportation, from a nursing home or a senior’s home for medical appointments, significantly assisting low-income disabled seniors.

Additionally, with the increased emphasis on community based living and long-term care, Medicaid is providing more and more funding for Home and Community-Based Services (HCBS), including providing a number of waivers to assist states in offering federal programs’ to beneficiaries who are nursing-home eligible for a wide variety of non-medical transit reasons such as grocery shopping. Still, with Medicaid, income guidelines are low enough to disqualify hundreds of thousands of seniors who are too poor to pay for medical care in general.

Most affected by the restrictions on Medicare and Medicaid funding and assistance for elderly transit care are severely ill seniors or victims of such long-term conditions as leukemia and multiple sclerosis. Such patients must regularly visit dialysis treatment centers for kidney dysfunction, and cancer therapy facilities.

Hardin says Medicare may support a senior’s emergency trips to the hospital but it does not cover a return trip home or to that senior’s care facility. When seniors cease to be patients, social workers at hospitals are often not able to arrange for trips home. Geography augments this gap as seniors living in rural areas face greater difficulties in medical care, socialization and non-medical care than their urban peers.

Additionally, if a senior’s nursing home or medical care facility cannot or will not intervene, the task of planning transportation back home is left to his or her family, often to a family caregiver. She explains that this leads to problems as family transit alternatives are too ill-equipped to deal with the special needs of their aging relatives.

“There are heartbreaking stories,” Hardin says, citing one anecdote in which an elderly woman had to return home from the hospital physically sandwiched between relatives in a pickup truck.

“A woman was being released [from a hospital]. They did a probe. Her relatives only had a pickup truck. She had an oxygen machine. The trip was not an emergency one so the senior and her family had to pay for it. There’s a disconnect between the social worker, the head nurse and the medical care provider.”

Aside from emergency medical transit coverage by Medicare and both emergency and non-emergency healthcare funding by Medicaid, Hardin says senior care facilities as well as nonprofit transit services can coordinate home- and community-based transit with general transportation private companies, paratransit services under the Americans with Disabilities Act (ADA), rural services under the U.S. Department of Transportation’s (DOT)-FTA’s Section 5310 program, senior-specific rural private transit services under the U.S. Department of Transportation’s Federal Transit Administration (DOT-FTA)’s Section 5311 program and the Older Americans Act Title III (State and Community Programs), Title VI (Grants to American Indian Tribes) and Home- and Community-Based Services (HCBS) programs to buy vehicles and equipment to serve seniors.

Beside from its Section 5310 (Formula Grants for the Elderly & Persons with Disabilities) program and Section 5311 (Formula Grants for Other Than Urbanized Areas) program, DOT also supervises the compliance of transit-related rules under the ADA and other civil rights laws that ensure equity and accommodations for public transportation services for people with disabilities. The ADA is a civil rights law designed to ensure that public services and facilities are designed and operated with accessibility features that ensure their use by people with disabilities.

In localities with public transit services, there are both fixed-route and, for those who cannot use fixed route, paratransit services for people with disabilities. Additionally, in order to fulfill requirements of the ADA, some jurisdictions provide assistive technologies and accessible vehicle features such as low-floor buses, elevators, large-print or Braille signage, calling out of bus stops and accommodations at train stations.

Overtime, since the passage of the ADA in 1990, the number of paratransit services offered by nonprofits and public transportation companies has expanded and their use has increased dramatically. Easter Seals has hosted a training and technical assistance cooperative agreement funded by the FTA for over 22 years that has assisted communities to develop accessible transportation called Easter Seals Project ACTION.

Another U.S. Department of Health and Human Services (HHS) sub-agency that often partners with the Centers for Medicare and Medicaid Services (CMS) is the Administration on Aging (AoA) that administers the Older Americans Act (OAA). The OAA provides significant funding for transportation services can be used as match for some FTA programs such as 5310. Federal and State OAA transportation services are the second-highest funded service.

The main drawback, however, is that often communities still find that there is a lack of sufficient resources to keep up with the growing number of older adults who need transportation and other services.

“Another value of public transportation is that it is required to offer paratransit services,” Hardin says. “They provide door-to-door or curb-to-curb services, wheelchair lifts and vans for people who cannot use public transit. That can get residents to medical appointments. The fare is low – a few dollars.”

Again, category of senior care weighs in heavily on the nature and level of assistance provided by a transit service.

“There are issues of disability,” says Mark D. Olshan, associate executive vice president of B’nai B’rith International and director of the Center for Senior Services, the largest Jewish sponsor of government-supported housing for seniors in the nation. “In nursing homes, patients are bedridden. It’s difficult [for them] to get out. A person in an assisted living facility needs care. It depends on the level of mobility.”

Olshan explains that B’nai B’rith works with the U.S. Department of Housing and Urban Development (HUD) to provide independent living housing to over 6,000 seniors through 38 apartment buildings in 25 communities nationwide. The buildings are located in Arizona, Arkansas, California, Connecticut, Delaware, Florida, Illinois, Maryland, Massachusetts, Missouri, New Jersey, Pennsylvania and Texas and abroad in Australia, Britain, Ontario and British Columbia in Canada, Israel and New Zealand.

He says B’nai B’rith receives funding and technical assistance from Section 202 of the Federal Housing Act to maintain its senior housing properties and to build new ones.

The organization participates in HUD’s yearly competition for housing funds for seniors. It retains a community sponsor and submits an application to seek funds. After winning funds, B’nai B’rith organizes a development team to preserve, build or operate housing for senior residents aged 62 and over.

Eligibility requirements include proximity to mass transit. “One of the main criteria is the closeness of a facility to hospitals and public transit,” he says. “The closer, the more points a facility scores. It is easier to receive federal funds if you are on a bus line or near a train station.”

Olshan says that the senior apartment residents are physically and mentally healthy and independent and primarily don’t need transportation assistance as many of them own their own cars. The B’nai B’rith housing network has a service coordinator who is responsible for arranging transportation, including home- and community-based transit, if the need arises.

The B’nai B’rith apartment buildings have 30 to 35 passenger vans available. Olshan says the local campuses determine if they need transportation and B’nai B’rith makes it available.

Seniors use the vans for personal use or group trips for grocery shopping or visits to the doctor. Olshan says the most common reasons for using transit are medical appointments or health-related needs. However, the apartment buildings have medical facilities and enable their aging tenants to hold appointments in the properties.

For example, the apartment buildings in Silver Spring, Maryland, worked with a nearby community with greater resources. It set up valet parking in the community. Vans are used regularly for group outings by seniors. The community allowed B’nai B’rith’s housing in Silver Spring the use of a large van but would not permit individual use. For this, the Silver Spring community could book the van and incur an additional cost.

Olshan says one of the advantages of senior shopping from the apartments is that a group can be served at one time if they are visiting the same shopping center.

“You can put 30 or 40 people in a van at once,” he says. “It’s difficult but you can do the doctors’ appointment. The vans are available. Family visits are less likely and it would be difficult to get a van [to their homes or elsewhere off campus]. You should prioritize use and determine what is it for and how important is it. The most important is medical need or institutional care.”

A main concern for B’nai B’rith is the proposed federal cuts and possible phase out of Medicare and the state-block-grant fate of Medicaid. With rising Medicaid costs and declining federal and state tax income, the national and state deficits have resulted in a federal atmosphere indicative of budget cuts, threatening decreases in Medicaid and Medicare transportation funding.

Through its Center for Senior Services and Senior Advocacy Institute, B’nai B’rith supports a range of issues affecting the aging such as senior housing, comprehensive health care coverage for seniors under Medicare, a livable minimum wage and strengthening and maintaining Social Security, stem cell research and universal health care.

The organization has an Aging in Place program to authorize expertise to teach seniors about such a stay-at-home issues as home improvement and modification or tapping social service agencies for general assistance. Through its Center for Human Rights and Public Policy, it promotes its views on issues before Congress, local and state government, experts and company executives.

“There is a mentality that there is a need to cut everything [that assists low-income and disadvantaged communities in the federal budget in this current fiscal year],” Olshan says. “These [programs] are helpful. You look at entitlements and programs under the Older American Act. It is the low-income persons who are affected. Balancing the budget on the backs of low-income people and without raising taxes [makes maintaining] transportation [and other services] difficult.”

The National Center on Senior Transportation (NCST), too, supports an alliance between senior care facilities and home- and community-based transportation. According to Jed Johnson, the former Director of the Center, there is much value in leveraging transportation resources between senior care facilities and other community-based services.

Mary Leary, principle investigator for the NCST, suggests that “a method many embrace is one that focuses on the abilities and preferences of the individual – what is commonly referred to as a ‘person-centered’ approach. This approach connects a person and, in some cases, their family’s preferences to those transportation services that exist in the community.

Leary notes that the United We Ride Program, the federal government inter-agency initiative that has sought to breakdown barriers to states’ for leveraging transportation-oriented federal funds and promotes coordination, calls the various services a “family of services.” Seniors who live independently in older adult communities and facilities may have a host of options in this family of services. Johnson suggests that “senior care facilities can assist in this process of providing information or access to transportation choices to their residents including:

• driving and safe driving continuation programs for those who own a car and are able to drive;
• developing relationships with and subcontracting with transit providers;
• providing or working with organizations that do travel training and orientation for individuals who might be able to access public transportation;
• for residents who may be eligible, exploring paratransit availability;
• providing taxi vouchers as a growing option;
• developing partnerships with local ‘supplemental transportation’ programs, also known as volunteer driver programs;
• contracting for or providing accessible shuttle or vanpool services;
• creating their own volunteer-based program (for example, drivers and accompanied transportation);
• and, exploring relationships with car-sharing organizations (for example, ‘Zipcar’ locations accessible to retirement communities).”

Leary states that “providers can become part of broader mobility and livability activities, including working closely with public transportation, Area Agencies on Aging, local nonprofits, private sector transportation resources such as taxis, mobility management projects and land-use planning,  to contribute to and be included in local coalition and capacity building through transportation coordination plans.”

A growing area of promise, Leary says, is ensuring that hospital discharge planners, community health organizations, medical and public health professionals are also part of the network of outreach and partnership. Older adults who have access to transportation that can get them to healthcare and preventative services, are able to stay healthier and able to more effectively manage their chronic conditions that are often a reality of living a longer life, she says.

One program the NCST team holds up as an example of success is Luther Manor, a nonprofit, faith-based CCRC in Wauwatosa in southeastern Wisconsin, serving 800 residents on a 29-acre campus. Luther Manor offers independent housing, assisted living and other long-term care options, rehabilitative services, adult day care, hospital, parish nursing, respite care, congregational senior or ministry and other community outreach programs.

The facility worked with the NCST to improve its oversight of its medical transit services, operation and costs. At first, the two entities held a Transportation Task Force to determine costs for service delivery. The CCRC used NCST’s Transportation by the Numbers to calculate its transit costs in staff time, maintenance and insurance. The NCST also surveyed similar CCRCs to evaluate their transit services.

Luther Manor conducted a transportation assessment interviewing residents to examine needs and preferences. The company then created a Transportation Options Matrix that provides an overview of different choices in the area.

Afterward, they found a “preferred provider” for medical transit and kept their own vehicle as back up to save costs, provide training for staff of subcontractors for travel training, transit pass eligibility and senior driver safety, and connected with the Mobility Manager serving the Milwaukee county area.

Luther Manor plans to use Carfit, an educational program to help seniors to learn if their cars fit their needs but the company’s occupational therapy staff will be certified as training for seniors in the community.

When asked if transit companies should partner with senior care facilities on behalf of their aging residents or deal with seniors and their families directly, Leary responded that: “We do see a number of innovative programs with collaborative relationships between long-term-care facilities [and] public transportation.

“Some communities’ transportation professionals help nonprofits maintain their fleets of buses. Others develop mobility mentoring or bus-buddy programs with recreational projects that help interested seniors living in theses facilities learn how to use the transit resources. Others collaborate to develop creative on-demand programs that provide more transportation choices for older adult community residents and some transit providers benefit from the knowledge and experience in aging services of the staff at local facilities.”

Luther Manor staff, for example, provided a sub-contracted transit provider with training and education on dementia and person-centered-care approaches to service delivery.

When asked about the types of trips seniors want to take, Johnson replies: “A number of entities and providers (for example, the Beverly Foundation, TRIP model, ITN America, Ride Connection and Partners in Care) have done studies related to trip purposes. None we are aware of, however, are specific to long-term care communities.”

Johnson said that many variables also impact trip purpose, including:

• the type of community;
• the geographic location (for example, urban, suburban and rural);
• the level of access to transportation options, and;
• the interests and abilities of older adult residents..

Leary says that researchers from the Centers for Disease Control and Prevention (CDC) Funded Healthy Aging Network also note the importance of placing a priority not only on ensuring access to medical-related visits such as for dialysis, cancer treatment, off-site medical providers and adult-day centers, but also to social and recreational activities that help older adults stay connected in their communities and ensures that they do not become isolated.

“We all want to go to a movie, see families and friends, attend a theater or musical performance, visit local destinations, participate in faith-based activities, go to the grocery, and access to transportation resources should include ways older adults can take all the trips they want,” she says.

When approached about whether senior-specific carpooling or donating of cars should occur with senior care facilities, Johnson presented information about ITN America, a community-based nonprofit transit service whose acronym stands for “Independent Transportation Network” as an example.

ITN is open year-round, utilizing cars instead of vans and buses. It relies on private resources and volunteerism and offers arm-to-arm, door-to-door busing and prices based on consumer choice. Factors for use include the purpose of the trips, frequency of use or destination for its service.

Seniors join ITN and pay dues to protect their independence and mobility. Under its Ride & Shop program, it offers seniors transit to their favorite shopping centers. Businesses donate gifts for volunteers, certificates for car washes, oil change and gas.

Under its Healthy Miles program, ITN offers trips to medical appointments. The nonprofit invites members of any community in the country to host a Community Tea to inform their neighbors of its local presence and service.

For carpooling, Johnson also says: “Meadowlink, a well-established provider of commuter services that delivers fixed-route and on-demand shuttle trips within a six-county urban New Jersey community, added transportation to seniors through its EZ Ride Community Cars program. This project demonstrates a unique approach to maximizing senior transportation options during non-commuter hours and implements a neighbor-helping-neighbor approach to recruit volunteer drivers and escorts. It created a new volunteer driver program that uses a fleet of rented vehicles; recruited and trained volunteers to drive hybrid vehicles and accompany seniors on trips, and created sponsorship accounts whereby community residents and businesses contribute to the cost of rides for seniors who cannot afford them.”

Already, Meadowlink supports its AdVANtage program to pay for vanpools for the first three months using funding from the New Jersey Transit Vanpool Sponsorship program, Transitchek for Employers to offer a transit tax benefit to businesses that are named as Commuter Choice Employer, a designation of a business as a supporter of quality commuter services. It also offers taxis and sedans and the emergency Ride Home as a vanpooling program for users of mass transit.

Asked about reduced rates for indigent seniors, Johnson replies: “Many programs offer discounts, sliding scale fees, scholarships, vouchers, no-cost services, or donations-only services. The type of rate structure depends on the local needs and resources available. NCST recognizes the benefits of a variety of rates structures and does not advocate any one in particular.”

When asked about industry, nonprofit or government trends affecting how transit services assist seniors, Leary states: “There are a number of trends that have both positively and negatively affected transportation availability for some seniors and residents of long term care facilities. They include:

• the DOT Sustainability and Livability program is helping communities develop more walkable, safer, environmentally sound, accessible pathways and transit oriented communities that benefit everyone;
• many transit agencies have created innovative programs and promoted them with outreach activities that have increased the ability of everyone to access and use their resources;
• eligibility programs for the use of ADA complementary paratransit often now have travel training and other associated programs to aid riders to use fixed-route services;
• there are challenges as well, many caused by current economic conditions in some communities that have required route cutbacks in both public transit;
• and, program closures are occurring due to financial climate—particularly, cutbacks in state funding and support.”

Hardin also notes the benefits of livable communities. “The idea of a transit-friendly area and livable communities is a new one,” she says. “A WHO (World Health Organization) official once said he was specializing in senior transportation. If it’s senior-friendly, it’s people-friendly. It should help everyone.”

While expressing some concern for the small number of senior care facilities involved in coordination of transit services for their elderly residents, Hardin says CTAA seeks to focus on giving its client-facilities or the transit provider the benefit of the doubt in terms of how much of a good faith effort they are making toward fully utilizing home- and community-based services.

“I recommend cooperation, collaboration and coordination,” she says. “There is a way for people to work on these problems. That is the heart of our technical assistance: respect for the direct service provider. We never underestimate direct service providers. We are not too critical. We help organizations. That is the theme of our organization. It is a good way to operate: assume that they are doing their jobs.”

Leary agrees.

“In partnership with the National Association of Area Agencies on Aging, we are reaching out and working with many providers, researchers, partners, communities, state and federal officials, transit agencies, mobility managers, the medical community and many others to enhance the provision of transportation options for older adults,” she says.

“No matter where someone lives, we must find a way to ensure they can get access to all that enriches them. The easiest way for us to succeed in making this vision a reality is by working together. There is so much to do with a growing demand and time is short to accommodate it but the really good news is that never before have we had so many people who believe in the importance of a strong focus on mobility and access. Let’s get even more people to partner, including professionals and administrators in all places where older adults live, and perhaps we can make even faster progress!”

Vladimire Herard is a freelance writer in Chicago. She was a health writer and online publication freelancer for the Guidance Channel, Longtermcare.com and States News Service for five years. For Community Development Publications, a publication chain in Silver Spring, Md., Ms. Herard wrote and edited newsletter articles about senior health and housing (Housing the Elderly Report and Aging News Alert); substance abuse prevention and treatment funding (Substance Abuse Funding Newsletter); health care financing (Inside HCFA); and food and product safety issues (Inside FDA) for four years. She has written articles about public education reform, county affairs, crime and community development for the Chicago Defender daily newspaper, the Syracuse Post-Standard and Syracuse Herald-American daily newspapers in New York state and the Pride of Syracuse monthly newspaper in New York state for five years. A print journalist for 18 years, Ms. Herard holds a master’s degree in newspaper from Syracuse University and a bachelor degree in liberal arts from Loyola University in Chicago.