A national travel survey referenced in a 2004 report (U.S. General Accounting Office, 2004) concerning the community mobility of older people found that 90 percent of trips taken by older people are by automobile, either as passengers or drivers. For the remaining trips, 8 percent were walking and 2 percent were on public transportation. For most individuals, however, driving expectancy is significantly less than life expectancy. On average, men outlive their ability to drive by 6 years; women outlive their driving ability by 10 years ( Foley, Heimovitz, Guralnik, and Brock, 2002). Research suggests that more than 600,000 people 70 and older stop driving each year and become dependent on others to meet their transportation needs. Poor vision, memory impairment, and an inability to perform one or more activities of daily living are common reasons for older people to stop driving. This section examines transportation options for seniors, and discusses the specialized community mobility needs of the individual with dementia. This section is not meant to be exhaustive. Readers who wish to read more about community transportation options are referred to the Transit Cooperative Research Program (TCRP) at www.tcrponline.org.
According to a 2001 report from the National Household Travel Survey conducted by the U.S. Department of Transportation’s Bureau of Transportation Statistics, and the Federal Highway Administration, 21 percent of seniors 65 and older do not drive. Moreover, people 85 and older are especially likely to be nondrivers (U.S. General Accounting Office, 2004).
Currently, 15 Federal programs contain provisions for the mobility needs of disadvantaged seniors (see list in Appendix A). These programs are considered senior accessible if they are designed specifically for seniors, if seniors are included in the eligible population, or if they offer reduced fares for the elderly (U.S. General Accounting Office, 2004). These programs are generally overseen by Area Agencies on Aging (AAAs), which can also guide States in assessing seniors’ transportation needs. However, most AAAs only modestly address senior mobility on the statewide level, citing their perception that local agencies make a higher priority of other programs for seniors.
On February 24, 2004, President George W. Bush signed Executive Order 13330 (Bush, 2004). This executive order established the new Interagency Transportation Coordinating Council on Access and Mobility, which was charged with coordinating 62 separate Federal programs in nine departments that provide funding for human services transportation. The latter is defined in the order as any of the broad range of programs designed to meet the needs of transportation-disadvantaged populations, including the elderly, individuals with disabilities, and those with low incomes. The coordinating council established the United We Ride initiative to implement the executive order. .This initiative is intended to eliminate duplication and ultimately to lower operating costs for transportation providers. People in need of transportation are also expected to benefit from enhanced transportation options and higher quality of services. The United We Ride initiative is also in the process of developing a Transportation Technical Assistance Clearinghouse, which will offer resources for transportation providers to improve their accessibility and staff training.
According to the U.S. General Accounting Office (GAO) (2004), the needs of older people who depend on public transportation are not being met, but there is little information about the extent of these unmet needs. Though 75 percent of nondrivers 75 and older reported satisfaction with their community mobility resources, it is believed that these seniors obtain transportation largely from family members and friends. Seniors without access to family members or those living in nonurban areas are likely to have unmet needs that are greater than those of older people who live near family members. A 2001 AARP report referenced by the GAO (2004) found that senior nondrivers accepted rides from other people more than any other transportation option.
Community Mobility for the Nondriving Older Person with Disabilities
Two Federal departments are primarily responsible for addressing mobility needs among older individuals with disabilities: the Department of Transportation (DOT) and the Department of Health and Human Services (HHS). The DOT offers targeted funding to State and local jurisdictions to develop and run transportation programs via Formula Grants for the Elderly and Persons with Disabilities, Formula Grants for Other Than Urbanized Areas, Urbanized Area Formula Grants, and Capital Investment Grants. The DOT also oversees the enforcement of the Americans with Disabilities Act (ADA) as it relates to transportation., Under the civil rights legislation, public transportation must accommodate people with disabilities. Where fixed-route bus service exists, for example, public transportation operators must also provide paratransit services. However, this applies only to areas already served by fixed-route transit and does not affect areas that have no or limited public transportation. Initiatives like United We Ride are attempting to address these shortcomings.
Medicaid provides health care benefits that include transportation to medical appointments. Approximately $1.8 billion are spent annually to provide about 110 million trips, costing about $16 per trip, according to the AARP study previously mentioned (GAO, 2004). Because Federal law permits them to do so, the States have adopted many different approaches to Medicaid access requirements. These range from comprehensive programs to those that rely on local private services. In addition, due to the new program of Medicaid waivers intended to encourage home and community-based services, two thirds of the States have implemented programs that provide for essential trips (such as for grocery shopping) to be paid for with Medicaid dollars.
It should be noted that Medicare does not provide transportation help for individuals with disabilities except for emergency transportation in an ambulance. This restriction is a source of controversy among transportation advocates, who argue that many emergency trips to the hospital could be avoided through increased access to preventive care at the doctor’s office. Similarly, emergency trips may be used inappropriately for nonemergency episodes.
The Department of Transportation has published rules regarding the scope of public transportation services in an effort to make them more accessible to people with disabilities. Nevertheless, some still cannot use these facilities or the ADA paratransit system currently in place. Because it is limited to “curb-to-curb” service, ADA paratransit rules do not necessarily specify provision of support to would-be users who have cognitive impairments. These rules do not require the availability of a responsible person to assist the disabled individual at their destination. More comprehensive services are commonly referred to as “door-through-door” services and are not generally offered directly by Federal programs. The U.S. Administration on Aging is currently conducting a study of the benefits and costs of door-through-door services.
Federal transportation programs are designed to target seniors most at risk of having unmet transportation needs related to deficiencies in six major areas: ability to drive; availability of an informal network of family or friends who drive; access to transportation provided by nonprofit community institutions; access to public transportation; adequate income; and good health. Seniors who are transportation disadvantaged are likely to have particular difficulty with transportation to multiple destinations, life-enhancing trips (e.g., visits to spouses in nursing homes or cultural events), and trips to nonurban areas (U.S. General Accounting Office, 2004).
The growth of the 85-and-older population is projected to occur largely outside of centralized areas that have public transportation already in place (Koffman, Raphael, and Weiner, 2004). The majority of the growth is expected to occur in rural areas and in recently established suburbs that have yet to set up reliable and easy-to-use public transportation. Some organizations have also begun to consider the mobility and service needs of residents of “frontier communities,” so-called because they are completely removed from such direct services as respite care and adult day care. They are classified as being at least 60 miles and/or 60 minutes from the nearest market center and, thus, many critical health and social services. The Alzheimer’s Association is one organization attempting to identify and provide services for remote populations with the convening of the first “Frontier Conference” in 2005.