Transportation-Disadvantaged Seniors
Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance and Information Gao ID: GAO-04-971 August 30, 2004The U.S. population is aging, and access to transportation, via automobile or other modes, is critical to helping individuals remain independent as they age. Various federal programs provide funding for transportation services for "transportation-disadvantaged" seniors--those who cannot drive or have limited their driving and who have an income constraint, disability, or medical condition that limits their ability to travel. For those transportation-disadvantaged seniors, GAO was asked to identify (1) federal programs that address their mobility issues, (2) the extent to which these programs meet their mobility needs, (3) program practices that enhance their mobility and the cost-effectiveness of service delivery, and (4) obstacles to addressing their mobility needs and strategies for overcoming those obstacles.
Five federal departments--including the Department of Health and Human Services (HHS)--administer 15 programs that are key to addressing the mobility issues of transportation-disadvantaged seniors. These programs help make transportation available, affordable, and accessible to seniors, such as by providing transit passes or reimbursement for mileage. National data indicate that some types of needs are not being met, including those for trips (1) to multiple destinations or for purposes that involve carrying packages; (2) to life-enhancing activities, such as cultural events; and (3) in rural and suburban areas. However, there are limited data available to assess the extent of unmet needs. HHS's Administration on Aging is required by law to provide guidance to states on how to assess seniors' need for services, but officials said the administration has not done so because it has focused on providing other types of guidance. As a result, the local agencies on aging we interviewed--which are ultimately responsible for performing such needs assessments--used inconsistent methods to assess seniors' mobility needs. The Administration on Aging plans to conduct an evaluation of one of its major programs and thus has an opportunity to improve its understanding of seniors' needs and provide guidance to local agencies on performing needs assessments. Local transportation service providers have implemented a variety of practices--including increasing service efficiency, improving customer service, and leveraging available funds--that enhance mobility and the cost-effective delivery of services. Federal programs provide funding and some technical assistance for these practices, but several service providers we interviewed said that the implementation of such practices was impeded by limited federal guidance and information on successful practices. Senior mobility experts and stakeholders identified several obstacles to addressing transportation-disadvantaged seniors' mobility needs, potential strategies that federal and other government entities can consider taking to better meet these needs, and trade-offs associated with those strategies.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-04-971, Transportation-Disadvantaged Seniors: Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance and Information
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GAO Highlights:
Highlights of GAO-04-971, a report to the Chairman, Special Committee
on Aging, U.S. Senate:
Why GAO Did This Study:
The U.S. population is aging, and access to transportation, via
automobile or other modes, is critical to helping individuals remain
independent as they age. Various federal programs provide funding for
transportation services for ’transportation-disadvantaged“ seniors”
those who cannot drive or have limited their driving and who have an
income constraint, disability, or medical condition that limits their
ability to travel. For those transportation-disadvantaged seniors, GAO
was asked to identify (1) federal programs that address their mobility
issues, (2) the extent to which these programs meet their mobility
needs, (3) program practices that enhance their mobility and the cost-
effectiveness of service delivery, and (4) obstacles to addressing
their mobility needs and strategies for overcoming those obstacles.
What GAO Found:
Five federal departments”including the Department of Health and Human
Services (HHS)”administer 15 programs that are key to addressing the
mobility issues of transportation-disadvantaged seniors. These programs
help make transportation available, affordable, and accessible to
seniors, such as by providing transit passes or reimbursement for
mileage.
National data indicate that some types of needs are not being met,
including those for trips (1) to multiple destinations or for purposes
that involve carrying packages; (2) to life-enhancing activities, such
as cultural events; and (3) in rural and suburban areas. However,
there are limited data available to assess the extent of unmet needs.
HHS‘s Administration on Aging is required by law to provide guidance
to states on how to assess seniors‘ need for services, but officials
said the administration has not done so because it has focused on
providing other types of guidance. As a result, the local agencies on
aging we interviewed”which are ultimately responsible for performing
such needs assessments”used inconsistent methods to assess seniors‘
mobility needs. The Administration on Aging plans to conduct an
evaluation of one of its major programs and thus has an opportunity to
improve its understanding of seniors‘ needs and provide guidance to
local agencies on performing needs assessments.
Local transportation service providers have implemented a variety of
practices”including increasing service efficiency, improving customer
service, and leveraging available funds”that enhance mobility and the
cost-effective delivery of services. Federal programs provide funding
and some technical assistance for these practices, but several service
providers we interviewed said that the implementation of such
practices was impeded by limited federal guidance and information on
successful practices.
Senior mobility experts and stakeholders identified several obstacles
to addressing transportation-disadvantaged seniors‘ mobility needs,
potential strategies that federal and other government entities can
consider taking to better meet these needs, and trade-offs associated
with those strategies.
Obstacles, Strategies, and Trade-offs Associated with Meeting
Transportation-Disadvantaged Seniors‘ Mobility Needs, as Identified by
Experts and Stakeholders:
[See PDF for table]
Source: GAO.
[End of table]
What GAO Recommends:
GAO is recommending that HHS‘s Administration on Aging take several
actions to improve guidance and information on transportation-
disadvantaged seniors‘ mobility, including developing guidance on
assessing mobility needs and publicizing available information on
alternative transportation services and on practices service providers
can implement to enhance senior mobility.
HHS agreed with the findings and recommendations in this report.
www.gao.gov/cgi-bin/getrpt?GAO-04-971.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Katherine Siggerud at
(202) 512-2834 or siggerudk@gao.gov.
[End of section]
Report to the Chairman, Special Committee on Aging, U.S. Senate:
August 2004:
TRANSPORTATION-DISADVANTAGED SENIORS:
Efforts to Enhance Senior Mobility Could Benefit from Additional
Guidance and Information:
GAO-04-971:
Contents:
Letter:
Results in Brief:
Background:
Federal Agencies Address Mobility Issues Mainly through 15 Programs
That Help Make Transportation Available, Accessible, and Affordable:
Data Indicate That Some Types of Mobility Needs Are Not Being Met, but
Information on the Extent of Unmet Needs Is Limited:
Transportation Service Providers Implement Practices That Enhance
Senior Mobility with Some Federal Support, but Implementation
Difficulties Remain:
Experts and Stakeholders Suggested Strategies for Overcoming Mobility
Obstacles:
Conclusions:
Recommendations for Executive Action:
Agency Comments:
Appendixes:
Appendix I: Scope and Methodology:
Appendix II: Information on Transportation Provided by 16 Area Agencies
on Aging:
Appendix III: Local Service Providers and Practices That Can Enhance
Transportation-Disadvantaged Seniors' Mobility:
Appendix IV: Comments from the Department of Health and Human Services:
Appendix V: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Staff Acknowledgments:
Tables:
Table 1: Characteristics of 15 Key Federal Programs That Fund
Transportation for Seniors:
Table 2: Attributes of Senior-Friendly Transportation Service Addressed
by the 15 Key Federal Programs That Fund Transportation Services for
Seniors:
Table 3: Practices Implemented and Funding Sources Associated with
Selected Local Transportation Service Providers:
Table 4: Limitations of Data Sources Used:
Table 5: Academics, Advocacy Groups, Professional Associations, and
Federal Agencies GAO Interviewed about Information on Seniors' Mobility
Needs:
Table 6: Academics, Advocacy Groups, and Professional Associations GAO
Interviewed about Obstacles, Strategies, and Trade-offs in Addressing
Transportation-Disadvantaged Seniors' Mobility Needs:
Figures:
Figure 1: Diagram of the Overlapping Factors Affecting Seniors'
Mobility Needs:
Figure 2: Flow of Transportation Funds from Federal Programs to
Seniors:
Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and Older:
Figure 4: Percentage of Respondents Aged 75 and Older Who Have Public
Transportation Available to Them, by Area:
Figure 5: First Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders:
Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs
Associated with Meeting Transportation-Disadvantaged Seniors' Mobility
Needs, as Identified by Experts and Stakeholders:
Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders:
Abbreviations:
AAA: area agency on aging:
ADA: Americans with Disabilities Act of 1990:
AOA: Administration on Aging:
DOT: Department of Transportation:
GPS: Global Positioning Systems:
HHS: Department of Health and Human Services:
ITS: Intelligent Transportation Systems:
MEOC: Mountain Empire Older Citizens:
MPO: metropolitan planning organization:
NHTSA: National Highway Traffic Safety Administration:
TCRP: Transit Cooperative Research Program:
Letter August 30, 2004:
The Honorable Larry E. Craig:
Chairman, Special Committee on Aging:
United States Senate:
Dear Mr. Chairman:
The U.S. population is aging, and transportation is critical to helping
individuals stay independent as they age. Access to transportation,
whether by automobile or some other mode, is considered essential to
independent living, allowing individuals to gain access to the goods,
services, and social contacts that support their day-to-day existence
and quality of life. Both the number of older people and their share of
the U.S. population are growing rapidly. Although many seniors continue
to drive for most of their lives, the growing size of the senior
population will increase demand for alternative transportation
services. For example, one study found that more than 600,000 people
aged 70 and older stop driving each year and become dependent on others
for transportation.[Footnote 1] The increase in the potential pool of
seniors needing mobility assistance will challenge federal, state, and
local government agencies' ability to provide such assistance.
In 2000, 35 million Americans, or 12.4 percent of the total U.S.
population, were aged 65 and over, according to the U.S. Bureau of the
Census. The Census Bureau projects that this group will double to 70
million people by 2030, representing 20 percent of the total
population. A national travel survey found that seniors take most of
their daily trips (about 90 percent) by automobile, either as drivers
or passengers. For the remainder, approximately 8 percent of trips are
by walking, and 2 percent by other modes (including public
transportation and bicycles).[Footnote 2] As seniors age, their ability
to drive, walk, or use public transportation may become limited by
reduced reaction time; deteriorating night vision; lessening ability to
climb, reach, or stand; or other physical limitations. To help ensure
that transportation-disadvantaged seniors[Footnote 3] have access to
health and medical care, employment, and other basic services, various
federal programs provide funds for a range of senior transportation
services to state, local, and nonprofit agencies that actually provide
the services and, in some cases, also provide their own funds to
support those services.
This report responds to your request for information about the mobility
needs of transportation-disadvantaged seniors. As agreed with your
office, we identified (1) federal programs that address mobility issues
for transportation-disadvantaged seniors, (2) the extent to which
federally supported programs are meeting the mobility needs of
transportation-disadvantaged seniors, (3) program practices that can
enhance mobility and the cost-effective delivery of transportation
services to transportation-disadvantaged seniors and the extent to
which federal programs support the implementation of such practices,
and (4) obstacles to addressing transportation-disadvantaged seniors'
mobility needs and potential strategies for overcoming those obstacles.
To identify federal programs that address mobility issues for
transportation-disadvantaged seniors, we interviewed federal program
officials and senior mobility experts and reviewed pertinent GAO
reports. To assess the extent to which transportation-disadvantaged
seniors' mobility needs are being met, we analyzed data collected by
federal agencies and local agencies on aging; reviewed studies
conducted by research organizations; and obtained the perspectives of
experts in the fields of aging, disability, and transportation. We also
conducted semistructured interviews with officials from a
nonprobability sample of 16 area agencies on aging (AAA)[Footnote 4]
from urban, suburban, and rural areas in six states,[Footnote 5]
selected to represent different regions of the country. To identify
program practices that can enhance mobility and the cost-effective
delivery of transportation services, we reviewed the literature on
such practices and conducted semistructured interviews with officials
from 10 local transportation providers highlighted in the literature
to determine the extent to which federal programs support practices
that enhance senior mobility. These 10 providers were chosen to
include a diversity of geographic areas (i.e., they were from different
regions of the country and from both urban and nonurban areas), types
of practices, and federal funding sources. To identify obstacles to
addressing transportation-disadvantaged seniors' mobility needs and
strategies for overcoming those obstacles, we reviewed the relevant
literature and interviewed the AAA officials and transportation
service providers previously mentioned. We also interviewed 14 senior
mobility experts and representatives of pertinent professional
associations and advocacy groups. To ensure the reliability of data
used in this report, we reviewed and identified limitations associated
with national statistical research methodologies and documented the
quality assurance procedures that AAAs use to ensure the reliability
of the data they collect. We concluded that the data were sufficiently
reliable for our purposes, although we identified several limitations
that we discuss throughout the report. We also corroborated much of
the testimonial information provided by AAAs, local service providers,
experts, professional associations, and advocacy groups by comparing
it with the literature and with other interviews. We sent draft copies
of this report to the five pertinent federal agencies--the Departments
of Education, Health and Human Services (HHS), Labor, Transportation
(DOT), and Veterans Affairs--for their review and comment. We conducted
our work from November 2003 through August 2004 in accordance with
generally accepted government auditing standards. Appendix I contains
more information about our scope and methodology.
Results in Brief:
Working with experts on aging and federal agency officials, we
identified 15 key federal programs that address mobility issues for
transportation-disadvantaged seniors. These programs, which are
administered by five federal departments, distribute funds through
state agencies or make them available directly to local service
providers. For example, some programs--such as DOT's Capital Assistance
Program for Elderly Persons and Persons with Disabilities (Section
5310)--allot funds by formula to state agencies, which then distribute
the funds to local nonprofit organizations to purchase vehicles, while
other programs--such as HHS's Rural Health Care Services Outreach
Program--bypass state agencies altogether and go directly to local
service providers. The 15 federal programs help make transportation
services senior-friendly, mainly by making them more available,
accessible, and affordable (e.g., by providing rides to seniors at
reduced fares). In addition to administering the 15 programs, federal
agencies also address transportation-disadvantaged seniors' mobility
less directly. For example, the Department of Justice has published
rules governing the design of transportation facilities, such as bus
stops, to make them accessible to people with disabilities. Seniors
with disabilities can benefit from the implementation of such designs.
Data on the nature of transportation-disadvantaged seniors' mobility
needs indicate that federally supported programs are not meeting
certain types of needs, but there is little data on the extent of unmet
needs. Needs that are less likely to be met include (1) transportation
to multiple destinations or for purposes that involve carrying
packages, such as shopping, for which the automobile is better suited
than other alternatives; (2) life-enhancing trips, such as visits to
spouses in nursing homes or cultural events; and (3) trips in nonurban
areas, especially for seniors in rural communities, where alternatives
to the automobile are less likely to be available and special
transportation services are limited. However, federal programs
generally do not collect data on the extent to which seniors' mobility
needs are being met because there are few federal requirements to
assess such needs. HHS's Administration on Aging is required by law to
provide guidance to states on how to assess seniors' unmet needs, which
could include transportation, but officials told us that the
administration has not done so because state and local agencies on
aging have indicated a greater desire for guidance on other aspects of
providing services for seniors. However, without guidance on assessing
unmet needs, local aging agencies have used a variety of methods to
collect data, many of which produce information on the nature of needs
rather than on the extent to which needs are being met. Officials from
the Administration on Aging said that they are developing an evaluation
plan to examine, among other things, (1) the extent to which one of the
administration's major senior programs[Footnote 6] is meeting the needs
and preferences of seniors for supportive services--including
transportation--and (2) how needs assessments are performed by state
and local entities.
According to literature on senior mobility and our own work,
transportation service providers have implemented a variety of
practices that enhance transportation-disadvantaged seniors' mobility
and the cost-effective delivery of these services; however, the
providers we interviewed indicated that implementation of such
practices was sometimes impeded by multiple reporting requirements and
limited federal guidance. We grouped these practices into three
categories: (1) increasing service efficiency, (2) improving customer
service, and (3) leveraging available funds. For example, one service
provider we interviewed plans to improve service efficiency by using
Global Positioning System technology to track its vehicles and
automatically schedule trips, allowing seniors to obtain same-day
service rather than having to reserve rides 48 hours in advance.
Another provider addresses customer service by putting its drivers
through a sensitivity training program that helps drivers understand
seniors' mobility challenges. Several other providers have entered into
contracts with public and private entities to leverage available funds
and generate additional revenue for senior transportation services.
According to these providers, their practices have resulted in more
senior-friendly transportation and more cost-effective service
delivery. Our review also showed that the 10 local service providers we
interviewed were using funds from some of the key federal programs we
identified (e.g., DOT's Capital Assistance Program for Elderly Persons
and Persons with Disabilities (Section 5310) and HHS's Medicaid
Program) to deliver transportation services to seniors, and that the
federal program funding supported the implementation of such practices
to some extent. For example, some providers said that they received
technical assistance while implementing such practices, either directly
from federal agencies or indirectly through federally supported
professional organizations. However, many of the providers we
interviewed said that certain characteristics of federal programs, such
as what the providers view as burdensome reporting requirements and
limited program guidance, can impede the implementation of practices
that enhance senior mobility. For example, one provider told us that it
had not received technical guidance from one of the DOT programs
indicating how the funding process works and that, as a result, it had
to seek such assistance from other local organizations.
Experts, advocacy groups, professional organizations, local officials,
and transportation service providers have identified a number of
obstacles to addressing transportation-disadvantaged seniors' mobility
needs. They also have identified potential strategies that the federal
government, and other government levels, as appropriate, can take to
better address transportation-disadvantaged seniors' mobility needs
and enhance the cost-effectiveness of the services delivered. These
obstacles and strategies are centered around three major themes, as
follows:
* Planning for alternatives to driving as seniors age. Several experts
have reported that the federal government and other government levels
do not do enough to encourage seniors and their caregivers to identify
and use multiple transportation modes for their routine trips. As a
consequence, seniors may perceive that driving is their only option and
may become isolated or drive even when it is unsafe for them to do so.
Experts and other stakeholders have suggested that helping seniors plan
for alternatives to driving--such as by providing information about the
transportation services available in their community--would extend the
lifespan of their mobility, and that the federal government could
provide a central forum for state and local agencies to provide such
information.
* Accommodating seniors' varied mobility needs. The growing senior
population could benefit from policies that accommodate its varied
needs, including differing physical limitations and diverse trip
purposes (such as for work, volunteer activities, medical appointments,
and recreation), and address the particular challenges that
transportation-disadvantaged seniors face in nonurban areas. For
example, according to senior mobility experts and others, some
federally funded programs are intended for seniors who do not drive and
need assistance all the time; yet some seniors need transportation
assistance only under certain circumstances, such as in bad weather or
when a medical condition worsens. As a result, these seniors do not
qualify for these federally funded transportation services. Experts and
other stakeholders have suggested that the federal government require
or encourage state and local agencies to focus on seniors' immediate
and future mobility needs by including seniors in the transportation-
planning process. For example, seniors could advocate for safe walking
routes to transit stops and for the use of low-floor buses (which are
accessible to both wheelchair users and people with other mobility
impairments).
* Addressing federal and other governmental funding constraints.
Experts and other stakeholders suggested that although public funding
resources are limited, strategies exist to leverage them, including
increasing funding flexibility among programs and improving the
coordination of transportation services at all levels of government.
For example, federal programs tend to specify that funds from an
individual program can be used only to provide transportation to and
from that program's services. Additional funding flexibility and
coordination among programs could expand seniors' access to
transportation services.
Seniors benefit when the obstacles to their mobility are addressed, but
trade-offs also result from implementing the identified strategies. For
instance, according to experts and local aging officials, helping
seniors plan for alternatives to driving could enable more seniors to
maintain mobility while refraining from unsafe driving, but increased
demand for services would likely stress already stretched
transportation programs. Offering additional transportation services
or modifying existing public transit also could help seniors meet their
varied needs, but such efforts can be expensive, and additional funds
would have to come from new revenues or other programs.
Given the expected growth in the senior population, it will be
important for seniors and those who support them to have as much
information as possible to plan for the future. Accordingly, our report
contains four recommendations to the Secretary of Health and Human
Services to improve the guidance and information available to seniors
about transportation options and to local agencies about assessments of
the need for senior transportation services and successful practices
for addressing this need. In commenting on a draft of this report, the
Departments of Health and Human Services, Transportation, and Veterans
Affairs concurred with the findings, and the Department of Health and
Human Services concurred with the recommendations. The Department of
Transportation also provided technical clarifications, which were
incorporated as appropriate to ensure accuracy. The Departments of
Education and Labor said that they did not have any comments on the
draft.
Background:
Seniors are a heterogeneous group--many do not require assistance with
transportation, and, in fact, most drive automobiles. However,
according to data from the 2001 National Household Travel Survey
conducted by DOT's Bureau of Transportation Statistics, Federal Highway
Administration, and National Highway Traffic Safety Administration,
approximately 21 percent (6.8 million) of seniors aged 65 and older do
not drive. The percentages are higher among minority populations aged
65 and older: approximately 42 to 45 percent of African-Americans and
Asian-Americans do not drive, compared with 16 percent of Caucasians.
Approximately 40 percent of Hispanics also do not drive.[Footnote 7] A
person's driving status is correlated with travel behavior. For
example, one study found that drivers aged 75 and older made an average
of six trips per week, compared with two trips per week for
nondrivers.[Footnote 8] While some of this difference may be due to
individual preferences or to other circumstances, such as an illness
that prevents travel, some of the difference may be due to a lack of
transportation alternatives.
Those seniors with poor health or a disability, or who have a limited
income, may face more difficulty finding and accessing transportation.
According to data from the 2000 Census, about 37 percent of persons
aged 65 and older reported having at least one disability, and about 10
percent were below the federal poverty line. Although not all of these
seniors need assistance with transportation, a sizable number are
likely to need such assistance. According to senior transportation
experts, the "oldest of the old" (those aged 85 and older) are
especially likely to be dependent on others for rides, particularly if
they are also in poor health. Figure 1 shows some of the factors that
affect seniors' transportation needs. The more of these factors that
seniors have, such as a network of family and friends who can drive
them and an available public transportation system, the more likely it
is that their mobility needs will be met.
Figure 1: Diagram of the Overlapping Factors Affecting Seniors'
Mobility Needs:
[See PDF for image]
[End of figure]
Transportation assistance is an important issue for all seniors. In
2001, approximately 26 percent of state units on aging surveyed by the
Aging States Project identified transportation as a top health issue
for older adults, and 38 percent identified inadequate transportation
as a barrier to promoting health among older adults.[Footnote 9]
Furthermore, transportation was among the top five information requests
to the Eldercare Locator Service in 2001, 2002, and 2003.[Footnote 10]
There is, however, a significant gender gap in the amount of time that
seniors can expect to be dependent on alternative sources of
transportation. A study published in August 2002 in the American
Journal of Public Health estimated that men aged 70 to 74 who stopped
driving would be dependent on alternative transportation for an
average of 6 years, while women in the same age group can expect to
have an average of 10 years' dependence on alternative transportation
modes.[Footnote 11]
Although there is no clear-cut definition of mobility need, the
literature and the experts we consulted indicate that there are two
main categories of mobility need, both of which are important to
seniors: (1) "essential" or "life-sustaining" trips, which include
medical trips and trips for employment, shopping, banking, and other
necessary errands, and (2) "quality of life" or "life-enhancing" trips,
which include recreational or social trips that enable a senior to
fully participate and engage in the community, such as trips to
concerts, theatre, visits with family members in nursing homes or with
friends, religious activities, and volunteer activities. For the
purposes of this report, we will use this two-fold definition of types
of trips as our working definition of mobility need. Unmet need occurs
when assistance from others is needed but is not provided or is
inadequate. However, according to the experts we contacted, there is no
agreed-upon standard or benchmark for the number of trips that an
individual requires to take care of essential activities for living
(for both life-sustaining and life-enhancing activities),[Footnote 12]
although experts generally agree that government should be concerned
with meeting both types of needs for transportation-disadvantaged
seniors. The lack of a standard or benchmark makes it difficult to
determine an appropriate way to measure the extent to which mobility
needs are being met. Researchers have begun to identify and evaluate
transportation-disadvantaged seniors' unmet mobility needs by
comparing the number of trips they make with those of nondisadvantaged
populations.[Footnote 13] In addition, some researchers have used
satisfaction ratings to measure seniors' unmet mobility needs. In the
absence of a standard measure of need, we will discuss need and unmet
need by comparing the travel of disadvantaged seniors with the travel
of nondisadvantaged seniors and by using other measures that federal
and local officials have developed.
The federal government has traditionally provided some assistance in
mobility, mostly for the purpose of accessing other federal program
services. Federal agencies partner with local agencies, nonprofit
organizations, and others that actually provide transportation services
and also contribute their own funds. The federal agency that has a
central role in providing all types of services to seniors is HHS's
Administration on Aging (AOA). With a total discretionary budget of
more than $1.3 billion, AOA is the official federal agency dedicated to
policy development, planning, and the delivery of supportive home and
community-based services to older persons and their caregivers. AOA
works through a national aging network of 56 state units on aging; 655
AAAs; 241 tribal and native organizations representing 300 American
Indian and Alaskan Native tribal organizations, and 2 organizations
serving Native Hawaiians; and thousands of service providers, adult day
care centers, caregivers, and volunteers.
Federal Agencies Address Mobility Issues Mainly through 15 Programs
That Help Make Transportation Available, Accessible, and Affordable:
Five federal departments administer 15 programs that are key in
addressing mobility issues of transportation-disadvantaged seniors.
The programs are "senior-friendly" in that they help make
transportation available, accessible, and affordable to seniors.
Fifteen Key Federal Programs Fund Services to Enhance Transportation-
Disadvantaged Seniors' Mobility:
Working with experts and federal agency officials, we identified 15 key
programs in five departments that provide senior transportation (see
table 1) out of the many federal programs that are used to provide
transportation services. Some of these programs specifically target
seniors, such as HHS's Grants for Supportive Services and Senior
Centers (Title III-B). Other programs--including DOT's Nonurbanized
Area Formula Program (Section 5311)--target other groups, such as rural
populations, of which seniors can be a part. About half of the 15
programs fund transportation for specific types of trips, including for
medical services, employment-related activities, and other services
(such as nutrition) that the programs provide. The other half of the
programs can be used to provide general transportation for any trip
purpose. The programs fund a variety of types of services, ranging from
transit passes and training in the use of public transit to vehicle
purchases or expansion of public transit service.
Table 1: Characteristics of 15 Key Federal Programs That Fund
Transportation for Seniors:
Agency: Department of Education, Office of Special Education and
Rehabilitative Services;
Program: Independent Living Services for Older Individuals Who Are
Blind;
Target population: Persons aged 55 and older who have significant
visual impairment;
Type of trip allowed: To access program and related services, or for
general trips;
Type of service provided: Referral, assistance, and training in the
use of public transportation.
Agency: Department of Health and Human Services, Administration for
Children and Families;
Program: Community Services Block Grant Programs;
Target population: Low-income persons (including seniors);
Type of trip allowed: General trips;
Type of service provided: Taxicab vouchers, bus tokens.
Agency: Department of Health and Human Services, Administration for
Children and Families;
Program: Social Services Block Grants;
Target population: Target population identified by states;
Type of trip allowed: To access medical or social services;
Type of service provided: Any transportation-related use.
Agency: Department of Health and Human Services, Administration on
Aging;
Program: Grants for Supportive Services and Senior Centers (Title
III-B);
Target population: Seniors (aged 60 and older);
Type of trip allowed: To access program services or medical services,
or for general trips;
Type of service provided: Contract for service with existing
transportation provider, or directly purchase vehicles (such as vans).
Agency: Department of Health and Human Services, Administration on
Aging;
Program: Program for American Indian, Alaskan Native, and Native
Hawaiian Elders (Title VI);
Target population: American Indian, Alaskan Native, and Native
Hawaiian seniors;
Type of trip allowed: To access program services or medical services,
or for general trips;
Type of service provided: Purchase and operation of vehicles (such as
vans).
Agency: Department of Health and Human Services, Centers for Medicare
and Medicaid Services;
Program: Medicaid;
Target population: Generally low-income persons (including seniors),
although states determine eligibility;
Type of trip allowed: Medicaid medical services (emergency and
nonemergency);
Type of service provided: Reimbursement for services with existing
transportation providers (e.g., transit passes).
Agency: Department of Health and Human Services, Health Resources and
Services Administration;
Program: Rural Health Care Services Outreach Program;
Target population: Medically underserved populations (including
seniors) in rural areas;
Type of trip allowed: To access healthcare services;
Type of service provided: Transit passes, purchase vehicles (such as
vans).
Agency: Department of Labor, Employment and Training Administration;
Program: Senior Community Service Employment Program;
Target population: Low-income seniors (aged 55 and older);
Type of trip allowed: To access employment opportunities;
Type of service provided: Reimbursement for mileage.
Agency: Department of Transportation, Federal Transit Administration;
Program: Capital and Training Assistance Program for Over-the-Road Bus
Accessibility;
Target population: Persons with disabilities (including seniors);
Type of trip allowed: General trips;
Type of service provided: Assistance in purchasing lift equipment and
providing driver training.
Agency: Department of Transportation, Federal Transit Administration;
Program: Capital Assistance Program for Elderly Persons and Persons
with Disabilities (Section 5310);
Target population: Seniors and persons with disabilities;
Type of trip allowed: General trips;
Type of service provided: Assistance in purchasing vehicles, contract
for services with existing transportation providers.
Agency: Department of Transportation, Federal Transit Administration;
Program: Capital Investment Grants (Section 5309);
Target population: General public, although some projects are for the
special needs of elderly persons and persons with disabilities;
Type of trip allowed: General trips;
Type of service provided: Assistance for bus and bus- related capital
projects.
Agency: Department of Transportation, Federal Transit Administration;
Program: Job Access and Reverse Commute;
Target population: Low-income persons (including seniors);
Type of trip allowed: To access employment and related services;
Type of service provided: Expansion of existing public transportation
or initiation of new service.
Agency: Department of Transportation, Federal Transit Administration;
Program: Nonurbanized Area Formula Program (Section 5311);
Target population: General public in rural areas (including seniors);
Type of trip allowed: General trips;
Type of service provided: Capital and operating assistance for public
transportation.
Agency: Department of Transportation, Federal Transit Administration;
Program: Urbanized Area Formula Program (Section 5307);
Target population: General public in urban areas (including seniors);
Type of trip allowed: General trips;
Type of service provided: Capital assistance, and some operating
assistance, for public transportation.
Agency: Department of Veterans Affairs, Veterans Health Administration;
Program: Veterans Medical Care Benefits;
Target population: Veterans (including seniors) with disabilities or
low incomes;
Type of trip allowed: To access healthcare services;
Type of service provided: Mileage reimbursement or contract for
service with existing transportation providers.
Source: GAO.
Note: As we previously reported, we were unable to determine the amount
spent on transportation services through many of these federal
programs. See GAO, Transportation-Disadvantaged Populations: Some
Coordination Efforts Among Programs Providing Transportation Services,
but Obstacles Persist,
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-03-697]
(Washington, D.C.: June 30, 2003).
[End of table]
Funds from the 15 programs follow various paths in providing
transportation services to seniors (see fig. 2). Many of the programs
are block grants or formula programs through which funds are
distributed to states on the basis of certain criteria, such as
population. State agencies then provide services directly or distribute
the funds to local agencies, nonprofit organizations, transit
providers, and other organizations. For example, funds from DOT's
Capital Assistance Program for Elderly Persons and Persons with
Disabilities (Section 5310) are allotted by formula to state agencies,
which then distribute the funds to private nonprofit organizations or
local public entities (such as transit providers) to purchase vehicles
or other equipment. In another example, funds from HHS's Grants for
Supportive Services and Senior Centers (Title III-B) are distributed
first to state units on aging according to the number of seniors
residing in the state, and then to local AAAs, which generally contract
for services with local transportation providers.[Footnote 14] In other
programs, such as the Department of Labor's Senior Community Service
Employment Program, some funds go through the state while other funds
go directly to nonprofit organizations or local service providers.
Finally, other programs--such as HHS's Rural Health Care Outreach
Services Program--bypass state agencies altogether and go directly to
local entities. Local entities can use funds from a variety of federal
programs to provide transportation services to seniors. For example,
AAAs can receive funds from the Title III-B program, DOT's Capital
Assistance Program for Elderly Persons and Persons with Disabilities
(Section 5310), and other federal programs.
Figure 2: Flow of Transportation Funds from Federal Programs to
Seniors:
[See PDF for image]
[End of figure]
Federal Programs Enhance Senior Mobility by Addressing Certain
Attributes of Senior-Friendly Transportation:
The Beverly Foundation, a leading independent research organization on
senior transportation issues, has identified the following "5 A's" of
senior-friendly transportation service: [Footnote 15]
* availability (service is provided to places seniors want to go at
times they want to travel);
* accessibility (e.g., door-to-door or door-through-door
service[Footnote 16] is provided if needed, vehicles are accessible to
people with disabilities, and stops are pedestrian-friendly);
* acceptability (service is clean, safe, and user-friendly);
* affordability (financial assistance is provided to those who need
it); and:
* adaptability (service is flexible enough to accommodate multiple trip
types or specialized equipment).
However, there are trade-offs involved in addressing any of the "5
A's." For example, improving the acceptability of service can increase
the costs of providing service.
Our review of federal programs' authorizing legislation and guidance,
as well as interviews with federal program officials, indicates that
most of the 15 key federal programs we identified in table 1 are
generally designed to make transportation more available, accessible,
and affordable to transportation-disadvantaged populations, such as
seniors (see table 2). For example, HHS's Medicaid Program provides
transportation that is free or low-cost for seniors. Some of the
programs address other attributes of senior-friendly transportation,
such as acceptability. For example, the Department of Education's
Independent Living Services for Older Individuals Who Are Blind program
can be used to train seniors in the use of the public transit system,
making it both more accessible and acceptable to them.
Table 2: Attributes of Senior-Friendly Transportation Service Addressed
by the 15 Key Federal Programs That Fund Transportation Services for
Seniors:
Agency: Department of Education;
Program: Independent Living Services for Older Individuals Who Are
Blind;
Attribute: Availability: No;
Attribute: Accessibility: Yes;
Attribute: Acceptability: Yes;
Attribute: Affordability: No;
Attribute: Adaptability: No.
Agency: Department of Health and Human Services;
Program: Community Services Block Grant Programs;
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: Yes.
Agency: Department of Health and Human Services;
Program: Social Services Block Grants;
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: No.
Agency: Department of Health and Human Services;
Program: Grants for Supportive Services and Senior Centers (Title III-
B);
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: No.
Agency: Department of Health and Human Services;
Program: Program for American Indian, Alaskan Native, and Native
Hawaiian Elders (Title VI);
Attribute: Availability: Yes;
Attribute: Accessibility: No;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: No.
Agency: Department of Health and Human Services;
Program: Medicaid;
Attribute: Availability: No;
Attribute: Accessibility: No;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: Yes.
Agency: Department of Health and Human Services;
Program: Rural Health Care Services Outreach Program;
Attribute: Availability: Yes;
Attribute: Accessibility: No;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: No.
Agency: Department of Labor;
Program: Senior Community Service Employment Program;
Attribute: Availability: No;
Attribute: Accessibility: No;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: No.
Agency: Department of Transportation;
Program: Capital and Training Assistance Program for Over-the-Road Bus
Accessibility;
Attribute: Availability: No;
Attribute: Accessibility: Yes;
Attribute: Acceptability: Yes;
Attribute: Affordability: Yes;
Attribute: Adaptability: Yes.
Agency: Department of Transportation;
Program: Capital Assistance Program for Elderly Persons and Persons
with Disabilities (Section 5310);
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: Yes;
Attribute: Affordability: Yes;
Attribute: Adaptability: Yes.
Agency: Department of Transportation;
Program: Capital Investment Grants (Section 5309);
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: Yes;
Attribute: Affordability: No;
Attribute: Adaptability: No.
Agency: Department of Transportation;
Program: Job Access and Reverse Commute;
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: Yes.
Agency: Department of Transportation;
Program: Nonurbanized Area Formula Program (Section 5311);
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: No;
Attribute: Adaptability: Yes.
Agency: Department of Transportation;
Program: Urbanized Area Formula Program (Section 5307);
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: No.
Agency: Department of Veterans Affairs;
Program: Veterans Medical Care Benefits;
Attribute: Availability: Yes;
Attribute: Accessibility: Yes;
Attribute: Acceptability: No;
Attribute: Affordability: Yes;
Attribute: Adaptability: Yes.
Source: GAO.
Note: This table focuses on the senior-friendly attributes addressed by
the intent of the federal program as identified in federal program
legislation and guidance and in interviews with federal officials.
Grantees may actually address more of the five A's when delivering
transportation services to seniors at the local level.
[End of table]
In addition to the 15 key programs identified in tables 1 and 2, the
federal government helps to make transportation more senior-friendly
through other programs and policies that provide or ensure access to
transportation services for all disadvantaged populations (including
seniors). Although seniors are not the target population of these other
programs and policies, they often benefit from them. For example,
seniors are eligible for many of the programs we identified in a
previous report on the coordination of services for the transportation-
disadvantaged.[Footnote 17] In that report, we identified 62 federal
programs that can be used to provide transportation services, including
the 15 programs identified above. For instance, seniors can benefit
from the Department of Housing and Urban Development's Community
Development Block Grant Program, which can be used to purchase and
operate vehicles in low-income areas, and the Department of Labor's
Workforce Investment Act Adult Services Program, which can be used to
provide bus tokens or reimbursement for mileage to access training
opportunities.
Another federal program that does target seniors--Medicare, the federal
health financing program covering almost all persons aged 65 and older
and certain persons with disabilities--was not included in our list of
15 key programs because it funds only a very specific type of
transportation service for seniors. Medicare covers medically necessary
ambulance services when other means of transportation, such as a
wheelchair van or a taxicab, are inadvisable, given the beneficiary's
medical condition at the time. Medically necessary ambulance trips
include both emergency care, such as responses to 911 calls, and
nonemergency care, such as transfers from one hospital to another.
Medicare covers nonemergency transports--both scheduled and
nonscheduled--if the beneficiary is bed-confined[Footnote 18] or meets
other medical necessity criteria, such as requiring oxygen on the way
to the destination.[Footnote 19]
Many programs and policies that address the mobility needs of persons
with disabilities also benefit seniors. For example, the Americans with
Disabilities Act (ADA) has resulted in changes to many transportation-
related facilities, including transit vehicles and bus stops, that make
transportation more accessible to seniors with disabilities as well as
others. Other federal ADA-related activities can also benefit seniors.
For example, the Department of Justice's Civil Rights Division is
responsible for enforcing federal statutes, including the ADA, that
prohibit discrimination on the basis of race, sex, handicap, religion,
and national origin. In addition, Justice has published rules governing
the design of transportation facilities, such as bus stops, to make
them accessible to people with disabilities. Finally, the U.S.
Architectural and Transportation Barriers Compliance Board--an
independent entity within the federal government devoted to
accessibility for people with disabilities--develops and maintains
accessibility standards for transit vehicles, provides technical
assistance and training on these standards, and ensures compliance with
accessibility standards for federally funded facilities.
Data Indicate That Some Types of Mobility Needs Are Not Being Met, but
Information on the Extent of Unmet Needs Is Limited:
The data on the nature of mobility needs that we obtained from research
publications and interviews with federal officials, experts, and
officials from 16 local AAAs indicate that federally supported programs
are not meeting some of the mobility needs of transportation-
disadvantaged seniors.[Footnote 20] In particular, (1) seniors who rely
on alternative transportation have difficulty making trips for which
the automobile is better suited, such as trips that involve carrying
packages; (2) life-enhancing needs are less likely to be met than life-
sustaining needs; and (3) mobility needs are less likely to be met in
nonurban communities (especially rural communities) than in urban
communities. However, there are few current or planned efforts to
collect data for assessing the extent to which federally supported
programs are meeting transportation-disadvantaged seniors' mobility
needs. In addition, AAAs' methods for collecting and reporting data
make it difficult to determine the extent to which transportation-
disadvantaged seniors' needs are being met, in part because of a lack
of federal guidance on how to assess needs. According to experts and
local officials, barriers to assessing the extent of unmet needs
include the lack of consensus on how to define or measure needs, a lack
of federal guidance, and the difficulties of measuring the unmet needs
of seniors who are not attempting to access publicly funded services.
Federally Supported Programs Are Not Meeting Some Types of Mobility
Needs of Transportation-Disadvantaged Seniors:
Federally supported transportation services are meeting some, but not
all, types of mobility needs of transportation-disadvantaged seniors.
Although up to 75 percent of nondrivers aged 75 and older have reported
being at least somewhat satisfied with their mobility,[Footnote 21]
evidence from nationally published research and from interviews we
conducted with federal officials, experts, and local aging
professionals indicates that many of those seniors who are able to meet
life-sustaining and life-enhancing needs are doing so because they have
access to supportive family and friends who drive them or because they
live in transit-rich cities. For those seniors who do not have access
to these support structures or who live in nonurban areas, some
mobility needs--especially those related to life-enhancing activities-
-may not be met.
Transportation-Disadvantaged Seniors Lack Alternatives to the
Automobile That Provide Comparable Benefits:
Data from nationally published research indicate that transportation-
disadvantaged seniors prefer the automobile to other modes of
transportation because it is readily available, can reach multiple
destinations in the course of one trip, and can be used to access
destinations that require carrying packages (such as shopping). In
focus groups conducted by AARP,[Footnote 22] the general consensus
among participants was that access to ready transportation provided by
the private automobile is critical to overall life satisfaction. In
comparison, seniors perceived other modes such as public transit,
specialized transportation (such as senior vans), and walking as having
inherent negative attributes--including time spent waiting, waits in
bad weather, difficulty carrying items, scheduling requirements,
infrequent service, and concerns about personal security and
accessibility--that made them less attractive than driving or being
driven. Consistent with this, a survey conducted by AARP found that
senior nondrivers use automobile rides from family or friends more than
other modes of transportation to get where they need to go (see fig.
3).[Footnote 23]
Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and Older:
[See PDF for image]
Note: Other modes include public transportation, senior vans, walking,
and taxicabs.
[End of figure]
Even if seniors could overcome some of these negative perceptions of
alternatives to the automobile, they may not be able to use the
alternatives because the alternatives might be unavailable in their
community or are inaccessible to seniors. In a survey by AARP, about 33
percent of senior nondrivers who reported that they did not use public
transportation said that it was because public transportation was not
available.[Footnote 24] In focus groups conducted for the Coordinating
Council on Access and Mobility, HHS, and the National Highway Traffic
Safety Administration, participants reported having trouble walking
long distances, getting to the bus stop, getting on and off buses, and
seeing street signs from the bus so that they knew where and when they
should disembark.[Footnote 25] Similarly, more than one-third of the
respondents in one study's focus groups reported that they would be
unable to walk one-quarter mile to a bus stop.[Footnote 26]
Transportation-Disadvantaged Seniors' Life-Enhancing Needs Are Less
Likely to Be Met Than Life-Sustaining Needs:
Data from nationally published research indicate that difficulty in
getting the transportation they needed interfered with transportation-
disadvantaged seniors' activities and trip-making, especially for life-
enhancing needs such as social or recreational activities. For example,
a report analyzing data from the 2001 National Household Travel Survey
found that seniors who do not drive made 15 percent fewer trips to the
doctor than drivers, but made 65 percent fewer trips for social,
family, religious, and other life-enhancing purposes.[Footnote 27] In
addition, although few seniors in an AARP survey[Footnote 28] reported
that a lack of transportation interfered with their activities--such as
getting to the doctor, their place of worship, the grocery store or
drug store, or entertainment; shopping for clothes or household items;
or visiting with friends--nondrivers were two to three times as likely
as drivers to report that a lack of transportation interfered with such
activities.[Footnote 29] Furthermore, a study that analyzed responses
from seniors in focus groups reported that older adults who have
stopped driving significantly curtailed their recreational activities.
One participant who had stopped driving reported, "What I do now, my
daughter tries to take me shopping once a week for heavy items, which
is very helpful. But I'm accustomed to going from mall to mall and
store to store to see things, you know, and I don't get around like
that. I'm very limited."[Footnote 30]
Federal officials and experts we interviewed also said that the
available transportation options are not meeting seniors' mobility
needs, especially for life-enhancing trips. Several experts said that,
while mobility needs are being met for the majority of seniors who
drive--and even for some transportation-disadvantaged seniors who live
in transit-rich environments, who have access to supportive family and
friends, or who have knowledge of and access to nonprofit or other
organizations that provide transportation--the mobility needs
generally are not being met for transportation-disadvantaged seniors
without these options. Although a few officials and experts said that
for most seniors, trips for life-sustaining needs (e.g., medical
appointments) are likely being met, others said that such needs are not
being met.
Finally, the majority of AAA officials we interviewed said that
transportation-disadvantaged seniors' needs were not being met.
(Although 3 of the 16 AAAs said that needs were being met with the
limited funding available, they also cited gaps in service.)
Furthermore, although the AAA officials we interviewed were split in
their perspectives on whether needs for travel to critical, life-
sustaining activities were being met, nearly all said that needs for
travel to life-enhancing activities such as church and shopping at the
mall were not being met. In addition, all of the AAAs we interviewed
imposed restrictions that limited or prioritized transportation
services for life-sustaining activities. For example, many AAAs require
advance notification (e.g., 24-hour notification) for service and most
restrict service to approximately 9 a.m. to 5 p.m. on weekdays, which
limits spontaneous travel and travel in the evenings when many cultural
and social events take place. Furthermore, most AAAs offer
transportation only within the counties or towns they serve, which
limits access to activities. Finally, when we asked AAA officials about
the destinations to which they provide transportation, most identified
essential, life-sustaining sites, such as nutrition sites, medical
facilities, grocery stores, pharmacies, public service agencies, and
banks. Only a few AAAs offered transportation for life-enhancing
activities, such as for recreational or cultural events, or for visits
to spouses or other family or friends in long-term-care facilities, and
some explicitly stated that they were unable to provide service for
personal or life-enhancing activities. The AAA officials told us that
all of these constraints were due to limited funding
availability.[Footnote 31]
Transportation-Disadvantaged Seniors' Needs Are Less Likely to Be Met
in Nonurban Areas Than in Urban Areas:
The travel of transportation-disadvantaged seniors living in nonurban
communities is more restricted than the travel of transportation-
disadvantaged seniors living in urban communities. A study analyzing
2001 National Household Travel Survey data indicated that older
Americans living in small towns and rural areas who do not drive were
more likely to stay home on a given day than their urban and suburban
counterparts--63 percent of nondrivers in small towns and 60 percent of
nondrivers in rural areas reported that they stayed home on a given
day, compared with 51 percent of nondrivers living in urban and
suburban areas.[Footnote 32] Alone, these data do not indicate that
mobility needs are less likely to be met because of limited
transportation options rather than other aspects that distinguish rural
communities from urban ones, such as fewer activities and longer
distances between destinations. However, data we obtained from other
sources support the idea that the lack of transportation is a
significant reason for these travel patterns. For example, in focus
groups and interviews that AARP conducted in 2001 with seniors aged 75
and older, nondrivers living in the suburbs were less satisfied that
their mobility needs were met than urban nondrivers. In addition to
identifying feelings of lost freedom, diminished control, and altered
self-image, several suburban participants noted that they make fewer
trips and pursue fewer activities as nondrivers, whereas the urban
nondrivers expressed more satisfaction with their ability to get
around.[Footnote 33] In addition, in a survey by AARP, respondents
living in cities reported that they were more likely to have public
transportation available to them than respondents living in rural areas
(see fig. 4).[Footnote 34]
Figure 4: Percentage of Respondents Aged 75 and Older Who Have Public
Transportation Available to Them, by Area:
[See PDF for image]
Note: Respondents were asked how they would describe their current
residence: as a city, a suburban area around a city, a small town, or
in the country. According to AARP's calculations, all of the estimates
we cite from this study have sampling errors that do not exceed + or -
4.5 percent at the 95 percent confidence level.
[End of figure]
In addition, several federal officials and experts we interviewed said
that the needs of transportation-disadvantaged seniors are not being
met with available transportation options, especially for those seniors
living in rural communities. Similarly, when we asked AAA officials
whether transportation-disadvantaged seniors' needs were being met,
nearly half offered the view that needs were not being met for those
living in rural communities because of the long distances required to
travel to facilities and the resulting need for the driver to wait to
bring the senior back. In addition, some said there are geographic
regions in rural areas that are not served at all by public
transportation, taxicab, or other transportation providers.
Data Are Limited on the Extent to Which Mobility Needs Are Being Met:
Because most of the federal programs that fund transportation for
transportation-disadvantaged seniors do not focus specifically on
seniors or transportation (instead, seniors may be one of several
target populations, and transportation may be one of several supportive
services provided by the program), federal agencies have minimal
program data about the extent of seniors' unmet transportation needs.
Five of the 15 key federal programs that provide transportation to
seniors--the Department of Education's Independent Living Services for
Older Individuals Who Are Blind program and HHS's Social Services Block
Grants, Community Services Block Grant Programs, Grants for Supportive
Services and Senior Centers (Title III-B), and Program for American
Indian, Alaskan Native, and Native Hawaiian Elders (Title VI)--collect
some nonfinancial performance data related to senior
transportation.[Footnote 35] Most of the data collected for these 5
programs provide only information on usage, such as the number of
seniors receiving transportation services or the number of one-way
trips provided to seniors. In addition, for transit programs that serve
the general public, the Federal Transit Administration collects data on
the number of rides and the number of people served, but these data are
not broken out by federal program or by age. However, AOA officials
told us that they are beginning to measure performance outcomes related
to transportation services under the Title III-B program. On the basis
of a national survey it conducted in 2004, AOA estimated that state and
area agencies on aging provided transportation services to
approximately 440,000 seniors in fiscal year 2003. AOA officials told
us that most of the respondents rated the transportation services as
good or excellent, and that many respondents reported that they relied
on these services for all or nearly all of their local transportation
needs. Although this information is useful in assessing the
satisfaction of seniors who receive transportation services, it does
not measure the extent of unmet needs. Officials from AOA and the
Federal Transit Administration currently are assessing the state of
data on seniors' mobility needs to identify baseline data on needs and
available resources.
Similarly, few AAAs use, or plan to use, data collection methods that
enable them to determine the extent of seniors' unmet mobility needs--
that is, information on both the extent of need in the community and
the capacity of services, including their own, to provide
transportation to seniors to meet those needs. AAAs are required to
determine the extent of need for supportive services (which could
include transportation) provided through HHS's Title III-B program and
to evaluate how effectively resources are used to meet such
need.[Footnote 36] However, several AAAs we interviewed reported that
they do not collect this type of data at all. Of those AAAs reporting
that they do collect data on the extent of unmet needs, most collect
data on the number of seniors who called the AAA to request
transportation services that the agency was unable to provide
(including data such as the number of trip denials and the number of
seniors on a waiting list). There are a number of limitations to this
type of data. For example, a few AAAs reported that waiting list data
were not reliable in measuring the unmet needs of seniors because the
data allowed multiple-counting of seniors who are wait-listed by more
than one transportation provider or who periodically call for rides and
are added to the waiting list each time they call. In addition, AAAs
reported that waiting list data were not entirely representative of
unmet needs because these data include information only on seniors who
call for service and not on seniors who do not call (because no
services are available, because they do not know what services are
available, because they are tired of being turned down, because they
moved to an assisted living facility since they had difficulty
obtaining transportation, or because of some other reason) but who may
still need rides. Furthermore, the waiting list data do not allow for
calculating the number of seniors who were referred to other
transportation services and were able to get rides through these other
services. Only 2 of the 16 AAAs (the Salt Lake County Aging Services
and the Bear River Association of Governments, both in Utah) have a
method for determining the gap in transportation service by calculating
the difference between the number of seniors who are in need of
transportation and the number of seniors who are receiving service
through other providers, or through family and friends.
Finally, there is little information from national surveys and studies
that addresses the extent to which transportation-disadvantaged
seniors' needs are being met; rather, those surveys and studies focus
on the nature of needs, as discussed in the previous section of this
report. For example, one report prepared by DOT's Bureau of
Transportation Statistics analyzes 2002 data from the Transportation
Availability and Use Survey on the travel behavior of persons with
disabilities, but the findings are not broken down by age.[Footnote 37]
Another Bureau of Transportation Statistics report analyzing the same
data source provides some insights on the types of travel problems
encountered by seniors with disabilities, but it does not provide data
that can be used to measure the extent of those seniors' transportation
needs or to determine whether those needs are being met.[Footnote 38]
There Are Several Barriers to Assessing the Extent of Unmet Need:
Senior mobility experts told us that there is no clear-cut definition
of mobility needs, making it difficult to determine the extent to which
such needs are being met. Although many of the experts we contacted
mentioned the distinction between life-sustaining and life-enhancing
needs, they did not provide a more concrete definition. Many of these
experts also said that they were not aware of an agreed-upon standard
or benchmark for assessing seniors' unmet mobility needs. One
researcher said that the topic of seniors' mobility needs is just
beginning to be discussed in the literature, so a standard has not yet
been developed.
In addition to the lack of consensus on definitions or measures of
need, there is also little guidance on assessing mobility needs.
Although some of the 15 key federal programs we identified require
state or local agencies to assess the need for services, federal
agencies provide little guidance on how to do this. As previously
noted, HHS's Title III-B and Title VI programs--through which AOA
provides grants to states and Native American tribes for senior
services--require AAAs to prepare a plan that includes an assessment of
the needs of disadvantaged seniors, which could include transportation
needs.[Footnote 39] Furthermore, the Older Americans Act, as amended,
requires AOA to provide guidance to states on assessing needs,
specifically "to design and implement [for program monitoring
purposes]—procedures for collecting information on gaps in services
needed by older individuals" and "procedures for the assessment of
unmet needs for services."[Footnote 40] Although AOA has developed
general guidance for Native American tribes on conducting needs
assessments for its Title VI program, the program guidance that the
agency provides to states for its Title III-B program does not include
guidance on how to assess and measure needs or on specific data
collection methods. As a result of the lack of guidance on assessing
need, most of the AAAs that we interviewed reported assessing seniors'
unmet mobility needs using a range of data collection methods that
resulted in data not specific enough for planning purposes, and not
indicative of the precise extent to which seniors' mobility needs are
being met. While some AAAs said they did not need additional data,
other AAAs we spoke with said that more precise information on the
extent of unmet need would be useful in designing services and getting
political support and funding for services, but some do not have the
staff, funds, or expertise to develop methodologies to do this. They
said that guidance from the federal government in this regard would be
very useful.
Officials at AOA said that, in the past, they have not provided
guidance to state and local aging agencies on how to assess needs for
the Title III-B program because they received feedback that state and
local aging agencies had a more immediate desire for guidance on
assessing the quality of service and collecting information on client
characteristics. To this end, AOA is currently developing a plan for
evaluating the various supportive services, including transportation,
provided through its Title III-B programs. The evaluation effort will
address the needs of states and communities for supportive services and
the extent to which the Title III-B program is meeting the needs and
preferences of the elderly for those services. As part of the
evaluation, AOA plans to address questions about the role of AAAs in
providing supportive services, how needs assessments are performed by
state and local entities, and how the results of those assessments are
used by states in implementing the Title III-B program. On the basis of
the results of our interviews with AAA representatives, the AOA
official responsible for the planned evaluation said that it would be
useful to obtain some additional information during the evaluation to
determine the need for services under the Title III-B program,
including (1) identifying how needs should be defined and measured; (2)
determining the range of methodologies that AAAs use for assessing
seniors' need for services, including transportation, and unmet needs;
and (3) identifying the kinds of guidance that AAAs want from AOA and
states to help them perform their required needs assessments. AOA plans
to complete its evaluation of this program by January 2006.
Other federal program regulations also require or encourage local
agencies to assess need to be eligible for funding. For example, DOT's
Capital and Training Assistance Program for Over-the-Road Bus
Accessibility (which provides funds to bus operators to help make their
services more accessible to persons with disabilities) lists
"identified need" as one of the criteria for selecting grantees, and
HHS's Community Services Block Grant Program (which provides funds for
services to address the needs of low-income individuals) requires
grantees to assess need for services and report this information to the
state. However, these agencies do not provide guidance for assessing
need for most of these programs. DOT officials said that they allow
local applicants for the Capital and Training Assistance Program for
Over-the-Road Bus Accessibility to decide what measures to use to
demonstrate need, and the measures vary accordingly. For example, some
of these applicants have provided information on the number of trips
that were denied for lack of an accessible vehicle, while other
applicants demonstrate need on the basis of the number of trips
provided using an existing lift-equipped vehicle. For its Job Access
and Reverse Commute Program, DOT asks applicants to provide data on the
percentage of low-income persons in the area as well as on
transportation gaps between existing services and employment
opportunities for these persons, and the agency provides some guidance
on how to identify such gaps.[Footnote 41] HHS provides some guidance
for assessing the need for services under the Community Services Block
Grant Programs, but the guidance is for assessing a wide range of
services, of which transportation is only one.
Federal officials report that it is difficult to measure unmet mobility
needs largely because of difficulties in measuring the unmet needs of
those transportation-disadvantaged seniors who are not trying to access
transportation services (such as those who do not call for service
because they have given up trying to get transportation or are not
aware of services). Some AAA officials and federal officials said that
collecting this type of data is time-consuming and expensive. In
addition, there may be other difficulties in reaching these seniors.
For example, they may have difficulty hearing questions posed over the
telephone, may be wary of providing personal information, or may be
reluctant to admit that they need assistance or that they can no longer
safely drive themselves to activities they need or want to attend.
Transportation Service Providers Implement Practices That Enhance
Senior Mobility with Some Federal Support, but Implementation
Difficulties Remain:
Transportation providers use a variety of practices--which we have
grouped into three categories--to enhance the mobility of
transportation-disadvantaged seniors and promote the cost-effective
delivery of transportation services. These include practices that (1)
improve service efficiency through increasing the use of technology and
by coordinating services with other providers in the community; (2)
improve customer service by providing training sessions for service
staff and seniors, using vehicles that can accommodate seniors'
mobility challenges, and increasing the level of service provided; and
(3) leverage existing resources by increasing volunteer involvement and
forging financial partnerships with public and private entities in the
community. According to the local service providers we interviewed,
these practices, which were implemented with some federal support,
resulted in more senior-friendly transportation services and more cost-
effective service delivery. All 10 local transportation service
providers we interviewed indicated that they had been able to use funds
from 1 or more of the 15 key federal programs in implementing practices
that enhance senior mobility. The most commonly used programs were
DOT's Capital Assistance Program for Elderly Persons and Persons with
Disabilities (Section 5310) and HHS's Title III-B and Medicaid
Programs, followed by DOT's Nonurbanized Area Formula Program (Section
5311), and HHS's Community Services Block Grant Programs. However,
according to the providers we interviewed, certain characteristics of
federal programs may impede the implementation of practices that
enhance transportation-disadvantaged-seniors' mobility.
Certain Practices Enhance Transportation-Disadvantaged Seniors'
Mobility and Promote Cost-effective Delivery of Services:
According to a 2002 report prepared by DOT's Transit Cooperative
Research Program (hereafter referred to as the TCRP report),[Footnote
42] local transportation providers have implemented a number of program
practices to improve public transportation services for seniors. The 10
local service providers we interviewed in urban and rural areas have
implemented some of these practices, as discussed below.
Improvements to Service Efficiency:
Increasing the use of technology: According to the TCRP report, using
advanced technology can improve efficiency, productivity, and cost-
effectiveness. Global Positioning Systems (GPS) and other advanced
technologies can provide real-time information about where vehicles are
located, when they will arrive to pick up a senior, and how long the
trip may take. Two of the 10 local service providers we interviewed are
using advanced technology to improve their trip scheduling. For
example, Sweetwater Transportation Authority in Rock Spring, Wyoming,
is using GPS technology on board each bus, connecting the bus to
software that will automatically schedule rides and provide an accurate
estimated time of arrival to passengers. The Friendship Center, which
offers door-through-door transportation services in Conroe City, Texas,
is involved in the early stages of implementing a computerized
dispatching and mapping system that will allow same-day scheduling to
transport seniors to their destinations. In the past, all scheduling
was done manually and seniors often had to call 48 hours in advance to
schedule a ride. According to Friendship Center officials, the
implementation of the computerized mapping system will increase
efficiency and coordination of their transportation service, which will
also improve the level of service provided to seniors.
Coordinating transportation services: According to the TCRP report and
our previous work, coordination of transportation services can improve
the overall efficiency of operations, increase the productivity of
services, reduce service costs, and increase mobility.[Footnote 43] Our
previous work indicated that the extent of coordination of
transportation services varies. Several service providers we
interviewed have implemented a coordinated transportation service,
including Mountain Empire Older Citizens (MEOC), which is located in
central Virginia.[Footnote 44] MEOC recognized that coordination was
needed because each human service agency in the area was transporting
its own clients exclusively, while other vehicles from other agencies
were picking up passengers in the same area. Under its coordination
contract, MEOC leases vehicles from other specialized transportation
service providers and coordinates all aspects of transporting their
clients (including other transportation-disadvantaged groups, such as
people with developmental disabilities). As a result, MEOC has
maximized the efficient use of vehicle fleet and realized cost savings
in service delivery, according to an agency official. Another service
provider, the Friendship Center, coordinates its transportation
services with medical facility staff to schedule medical appointments
for seniors. The dispatchers at the center work directly with the
medical providers to schedule medical appointments for seniors when the
center's transportation services are available. In addition, the
center's hours for transportation services reflect those of the medical
centers. By coordinating their services, the center helps ensure that
seniors do not encounter transportation scheduling problems. Lastly,
Medical Motor Service, which provides transportation and
brokerage[Footnote 45] services to seniors in Monroe County, New York,
coordinates with other nonprofit agencies to provide volunteers who
serve as "shopping buddies" to help seniors carry packages or assist
them with their groceries.
Improvements to Customer Service:
Providing training to staff and seniors: According to the TCRP report
and a brochure on innovative transit services for seniors developed by
the Beverly Foundation and the Community Transportation Association of
America (hereafter, Innovations Brochure),[Footnote 46] training for
service staff--particularly drivers--and for senior riders is important
in improving transportation services. The TCRP report states that staff
training should address customer service issues, such as the need for
polite and courteous interactions by drivers with passengers and the
physical constraints seniors encounter while using public
transportation. The TCRP report also indicates that customer service
training should be part of an overall change in organizational focus,
from just operating vehicles to serving customers. Several service
providers we interviewed were implementing training to improve customer
service by helping seniors feel more comfortable while being
transported. For example, Altoona Metro Transportation, which provides
public transit service to the general public in central Blair County in
Pennsylvania, developed a driver-training sensitivity program through
which drivers receive specialized training to recognize the diverse
needs of seniors. In what is considered a "hands-on" session, drivers
wear special glasses to distort their vision so that they can
temporarily experience the physical limitations that some seniors face
while riding public transportation. An Altoona Metro official also told
us that drivers are encouraged to socialize with senior passengers and
foster relationships to make seniors feel comfortable and welcomed. In
addition to training for staff, providers are also implementing travel-
training programs to teach seniors who are not accustomed to using
transit services how to use public transportation. One service
provider, North County Lifeline, Inc. (a curb-to-curb[Footnote 47]
transit service located in the northern San Diego area), developed a
travel-training program for seniors to learn about public transit and
reduce any concerns they may have about personal safety when using
transit. The program includes instruction in how to problem-solve, map
out a trip, make transfers, and understand the rights and
responsibilities they have while riding public transportation.
Using vehicles that can accommodate seniors' mobility challenges: Using
vehicles that accommodate the mobility challenges of seniors--such as
purchasing low-floor buses,[Footnote 48] equipping vehicles with lifts,
or modifying vehicles to make them identifiable and visually appealing
(by using buses with distinctive colors to designate specific routes or
with large see-through windows)--may help address some of the physical
challenges (such as difficulties boarding a bus or van) and emotional
challenges (such as concerns about boarding the wrong bus or personal
safety) that seniors may face while using public transportation. For
example, the TCRP report states that low-floor buses provide advantages
over conventional buses because they shorten the distance between the
first step on the bus and the curb (e.g., the first step on a
conventional bus is approximately 9 to 12 inches above the curb,
whereas the first step on the latest low-floor buses is less than 3
inches above the curb). However, there may be constraints in using such
buses--one service provider we interviewed found them impractical for
the provider's service area, which contains hilly terrain[Footnote 49]
and many narrow streets. The majority of service providers we
interviewed use lift-equipped[Footnote 50] vehicles to transport
seniors who use wheelchairs. Several of the service providers are also
using vehicles that are easily identifiable and visually appealing to
further address concerns seniors may have about using public
transportation. For example, several of the service providers we
interviewed said that they transport seniors in vehicles that are
color-coded to designate specific routes or that have large, nontinted
windows to limit the confusion that seniors face while trying to
determine which bus to board, to provide a sense of personal security,
and to "demystify" public transportation for seniors.
Increasing level of service: According to the TCRP report, increasing
overall service levels is vital to meeting the mobility needs of a
growing senior population. Some of the local service providers we
interviewed said that the practices they implemented allowed them to
improve their services by expanding service hours for life-sustaining
trips (as much as their funding allows), accommodating all requests as
they arise (even if that means temporarily modifying a route), and
expanding services to include life-enhancing trips (e.g., field trips
sponsored by senior centers and trips to a therapeutic warm-water pool
program). For example, a MEOC official told us that the provider
expanded its service from 8 hours to 12 hours per day on weekdays to
provide transportation for life-sustaining trips (e.g., medical
appointments), and that the agency plans to modify an existing route to
provide service regardless of how little notice is given. MEOC's
computer scheduling system enables dispatchers to radio the nearest
driver and ask him or her to modify the current route to fit in an
extra pick-up or drop-off. In another example, Gold Country Telecare, a
nonprofit agency that provides accessible specialized transportation in
rural northern California, learned through interviews with others in
the local community involved in senior transportation that seniors were
often isolated on weekends, when transportation services were rarely
available for them. To address this need, the agency increased its
service level by implementing an all-day Sunday transportation service
for seniors to get to church or other activities, such as grocery
shopping.
Improvements to Leverage Available Funds:
Increasing volunteer involvement: According to the TCRP report and the
Innovations Brochure, volunteer involvement may lead to cost savings in
delivering transportation services to seniors by reducing the need for
paid staff. The local service providers we interviewed used volunteers
in a variety of ways. For example, Gold Country Telecare implemented a
volunteer driving program under which volunteers are reimbursed for
mileage expenses incurred in using their personal vehicles to transport
seniors to medical and health treatment facilities located in a nearby
urban center. According to a Gold Country Telecare official, this
program allows seniors to participate in health therapies or medical
services not found in their rural community. OATS, Inc., a
transportation service provider in Missouri, uses volunteers who act as
dispatchers, taking calls in their homes from people in the community
who need trips. The volunteers transfer requests to the driver, who
then schedules the trips. The use of volunteers allows OATS to provide
more cost-effective and more frequent service by avoiding the
administrative expense of having an office in each of the 87 counties
it serves. Furthermore, according to an OATS official, the value of the
volunteer hours (including the in-kind allowance for the use of their
personal telephones and space in their home) translates into
approximately $1.6 million in cost savings per year.[Footnote 51]
Forging partnerships with private and public entities: The TCRP report
suggests forging financial partnerships with public and private
entities in the community to address funding concerns and to diversify
funding sources. Several of the local service providers we interviewed
developed private/public partnerships such as (1) contracts with
private entities to engage in revenue-enhancing activities, such as
using the service providers' vehicles to transport other groups when
the vehicles were not being used for senior transportation or
transporting seniors to specific locations, such as shopping sites, or
(2) joint agreements with human service agencies to provide specialized
services for clients who need additional assistance. For example, the
Friendship Center contracts with private entities to provide shuttle
services from employee parking to employment sites, from overflow
parking lots to special event venues, to community churches on Sunday
mornings, and other similar transportation services. According to
center officials, these additional contracts for shuttle services bring
in approximately $140,000 in additional annual revenue, which is being
used to provide additional senior transportation services and
represents approximately 15 percent of the center's annual budget for
senior transportation. Another local service provider that diversified
its funding sources, Medical Motor Service, developed a partnership
with a regional private supermarket to supplement its fund-raising
efforts. Under this arrangement, Medical Motor Service receives
approximately $300,000 in annual funding from the supermarket to
transport seniors to and from the grocery store. This sum represents 18
percent of the provider's annual senior transportation budget. As a
result of this arrangement, seniors residing in 55 housing complexes
have transportation for grocery shopping or for renewing medical
prescriptions at any of the 14 supermarkets located in Monroe County.
However, one trade-off in having an exclusive partnership with one
grocery store chain is that, unlike seniors (and others) who can drive,
seniors who rely on such a service do not have a choice of where to
shop. In that regard, Special Transit, a local service provider in
Boulder, Colorado, identified a need to diversify its funding sources
to reduce dependence on any one source of funds, helping to ensure
continuity of service for all of its clients, including seniors. To do
so, it hired an outreach coordinator to identify other service
providers in the community (such as senior day care programs, senior
centers, and local hospitals) that were interested in having Special
Transit provide transportation services. In addition, the coordinator
was tasked with identifying opportunities for generating private
donations. Through its partnerships, Special Transit reduced its
dependence on public funding (including federal and local government
grants and matching funds) from more than 80 percent of its total
revenue sources in the mid-1980s to approximately 65 percent in 2004.
Presently, Special Transit's service contracts and private donations
account for approximately 30 percent of its total revenues.
Summary of Practices and Funding Sources:
Table 3 provides examples of some of the practices and federal funding
sources used by the local service providers we interviewed.[Footnote
52]
Table 3: Practices Implemented and Funding Sources Associated with
Selected Local Transportation Service Providers:
Provider name and associated federal funding sources: Altoona Metro
Transportation;
* Section 5307;
* Section 5309;
Practices: Training and safety: Driver sensitivity training program;
Practices: Vehicle modification: Low-floor buses;
Practices: Service delivery: Markets its services specifically to
seniors;
Practices: Volunteer involvement: Senior companion volunteers promote
"Bus-Buddy" program.
Provider name and associated federal funding sources: Friendship
Center;
* CSBG;
* Section 5310;
* Title III-B;
Practices: Technology: Computerized mapping system to schedule same-
day service;
Practices: Coordination of services: Coordinates with medical facility
staff to schedule medical appointments for seniors;
Practices: Vehicle modification: Lift-equipped vehicles;
Practices: Service delivery: Customer-focused organization;
Practices: Financial partnerships: Uses vehicles after hours to
increase revenue through contracted services.
Provider name and associated federal funding sources: Gold Country
Telecare, Inc;
* SCSEP;
* Section 5310;
* Title III-B;
Practices: Vehicle modification: Lift-equipped vehicles;
Practices: Service delivery: Sunday transportation service and
follow-up and preventive healthcare transportation services;
Practices: Volunteer involvement: Neighbor- to-neighbor volunteer
driver program.
Provider name and associated federal funding sources: Medical Motor
Service;
* Medicaid;
* Section 5310;
* Title III-B;
Practices: Coordination of services: Coordinates with other nonprofit
agencies to provide senior shopping buddies;
Practices: Vehicle modification: Wheelchair-accessible vehicles;
Practices: Service delivery: Provides door-to-door escort service;
Practices: Financial partnerships: Contracts with regional grocery
chain to transport seniors for grocery shopping.
Provider name and associated federal funding sources: Mountain Empire
Older Citizens, Inc;
* Medicaid;
* SCSEP;
* Section 5310;
* Section 5311;
* Title III-B;
Practices: Coordination of services: Coordinates transit system that
provides door-through-door, one-on-one services to special needs
populations;
Practices: Vehicle modification: Lift-equipped vehicles;
Practices: Service delivery: Customer-friendly and flexible service to
meet the needs of a multicounty rural community;
Provider name and associated federal funding sources: North County
Lifeline;
* Section 5307;
* Section 5310;
Practices: Coordination of services: Collaborates to establish a Web-
based referral system to highlight transportation options for seniors
and assist social service providers;
Practices: Training and safety: Travel-Training Program teaches seniors
how to use fixed-route transportation;
Practices: Vehicle modification: Lift-equipped vehicles.
Provider name and associated federal funding sources: OATS, Inc;
* CSBG;
* JARC;
* Rural Health;
* Section 5310;
* Section 5311;
* SSBG;
* Title III-B;
Practices: Volunteer involvement: Use volunteers to fulfill functions
such as dispatching calls to drivers, fund-raising, and serving as
liaisons to the community.
Provider name and associated federal funding sources: Special Transit;
* Medicaid;
* Section 5310;
* Section 5311;
* Title III-B;
Practices: Training and safety: Easy Rider Program teaches seniors how
to use fixed-route transportation;
Practices: Vehicle modification: Vehicles have large, nontinted
windows to alleviate seniors' safety concerns.
Practices: Volunteer involvement: "Friends and Family" mileage
reimbursement program.
Provider name and associated federal funding sources: St. John's
County Council on Aging;
* JARC;
* Medicaid;
* Section 5310;
* Section 5311;
* Title III-B;
Practices: Coordination of services: Coordinates services with local
transit authority and taxicab services;
Practices: Training and safety: Driver-training program that emphasizes
safety and customer service;
Practices: Vehicle modification: Vehicles are brightly decorated to
attract senior ridership;
Practices: Service delivery: Customer-focused organization.
Provider name and associated federal funding sources: Sweetwater
Transportation Authority;
* CSBG;
* Medicaid;
* Section 5310;
* Section 5311;
Practices: Technology: Global Positioning Systems technology on
vehicles to aid in accurate and automatic trip scheduling;
Practices: Coordination of services: Coordinates transportation
software with city and county emergency response transportation
systems.
Legend:
CSBG: Community Services Block Grant Programs:
JARC: Job Access and Reverse Commute:
Rural Health: Rural Health Care Services Outreach Program:
SCSEP: Senior Community Service Employment Program:
Section 5307: Urbanized Area Formula Program:
Section 5309: Capital Investment Grants:
Section 5310: Capital Assistance Program for Elderly Persons and
Persons with Disabilities:
Section 5311: Nonurbanized Area Formula Program:
SSBG: Social Services Block Grants:
Title III-B Grants for Supportive Services and Senior Centers:
Source: GAO analysis of interviews with local service providers and a
review of the senior mobility literature.
[End of table]
Local Practices Have Enhanced the Senior-Friendliness and Cost-
effectiveness of Services:
The implementation of these practices contributed to the improvement of
senior transportation services by making them more senior-friendly,
according to the 10 local service providers we interviewed. In
particular, these practices collectively addressed the five A's of
senior-friendly transportation previously discussed--availability,
accessibility, acceptability, affordability, and adaptability--as
follows:
* The majority of service providers told us that they made
transportation services readily available for seniors to get to needed
medical locations.
* The 10 providers said that their services are tailored to ensure that
seniors can access the vehicles: that is, pick-up locations are easy
for seniors to walk to, one-on-one escort service is available to
seniors who need special assistance, or lift equipment is installed in
the vehicles.
* Several service providers stated that they use vehicles that are
identifiable and visually pleasing to make sure their vehicles are
acceptable to seniors.
* Most of the service providers also indicated that their services are
affordable because they are free to seniors or minimal donations are
requested at the time of service.
* More than half of the service providers said that their services are
adaptable and flexible enough to accommodate the service requests and
the mobility limitations some seniors may have.
In addition, the majority of the service providers we interviewed said
that their organizations realized cost savings and increased the
quality and quantity of service by implementing the practices. For
example, as previously noted, the coordinated transportation service
implemented by MEOC allowed lower per-unit costs, which also resulted
in cost savings for all the agencies involved. According to a MEOC
official, the cost savings allowed MEOC to increase the number of trips
provided, increase the hours of operation, continue to afford
dispatchers, hire more transportation managers, and provide adequate
training for drivers--all of which translated into improvements in the
quantity and quality of service to MEOC's clients.
Federal Programs Support the Implementation of Practices That Enhance
Transportation-Disadvantaged Seniors' Mobility to Some Extent:
According to the service providers we interviewed, the most common way
in which federal programs support the implementation of practices that
enhance transportation-disadvantaged seniors' mobility is by providing
funding. As previously noted, the 10 providers we interviewed use funds
from at least 1 of the 15 key federal programs in implementing
practices that enhance transportation-disadvantaged seniors'
mobility.[Footnote 53] (See table 3 for the federal funding sources
associated with each service provider.) We found that DOT's Capital
Assistance Program for Elderly Persons and Persons with Disabilities
(Section 5310) and HHS's Grants for Supportive Services and Senior
Centers (Title III-B) and Medicaid Programs are the federal programs
most often used by the 10 providers we interviewed, followed by DOT's
Nonurbanized Area Formula Program (Section 5311) and HHS's Community
Services Block Grant Programs.
According to some of the service providers, the federal programs had
both a direct and an indirect role in providing technical assistance
for the implementation of practices to enhance transportation-
disadvantaged seniors' mobility. In some cases, federal programs
provided direct technical assistance (by providing information on how
to apply for program funding or how to implement the service or by
providing contact information for other resources) through program
representatives or through the program's Web site. Several providers
stated that, as grantees, they obtained technical assistance from DOT's
Intelligent Transportation Systems (ITS) program,[Footnote 54] which
assigned consultants to their organizations to provide assistance in
selecting software and hardware and developing requests for proposals.
One service provider further added that he found DOT's ITS program Web
site to be useful in obtaining information on best practices and on
other technology-related resources. Another service provider received
technical assistance through both Federal Transit Administration
representatives and the state's transit association on how to obtain
funding through the Job Access and Reverse Commute Program. In other
cases, some providers stated that the federal government indirectly
provided guidance or technical assistance. For example, guidance on
implementing practices and marketing services to the senior community
was provided through federally funded professional organizations, such
as the Community Transportation Association of America and the National
Academy of Sciences' Transportation Research Board.
Other service providers we interviewed told us that the federal
programs did not provide assistance (other than funding) or guidance on
implementing practices to enhance transportation-disadvantaged
seniors' mobility, so they had to look to other state and regional
transit agencies or other local transportation service providers to
provide guidance or technical assistance. One service provider said
that it researched and sought out other mobility management programs
and travel-training programs to learn how to implement such programs,
because this information was not available from federal or state
agencies. Several providers told us that finding information on
successful practices for enhancing transportation-disadvantaged
seniors' mobility required considerable staff time and other resources,
and that a centralized source--particularly a Web-based source--for
such information would be useful. Many of the providers suggested that
providing such a Web site would be an appropriate role for the federal
government. AOA, the lead federal agency for coordinating programs for
seniors and the dissemination of information relevant to seniors, has
some transportation information available on its Web site, but there
are some limitations to this information, as discussed in more detail
in the section below on senior mobility obstacles and strategies.
Local Transportation Service Providers Continue to Face Difficulties in
Implementing Practices That Enhance Transportation-Disadvantaged
Seniors' Mobility:
According to the local providers we interviewed, certain
characteristics of federal programs can impede the implementation of
practices that enhance transportation-disadvantaged seniors' mobility.
Although federal programs provide financial support for practices that
enhance senior mobility, an expert in senior mobility and several
service providers stated that receiving federal funds entails
burdensome reporting requirements. Often, the local service providers
receive funding from several federal programs with different reporting
requirements and therefore have to submit several different reports
calling for different data. One provider stated that submitting all of
the required documentation for DOT's Capital Assistance Program for
Elderly Persons and Persons with Disabilities (Section 5310) and HHS'
Grants for Supportive Services and Senior Centers (Title III-B) Program
necessitated the dedication of 720 administrative hours each year
(equivalent to over $10,000), costing the provider more in
administrative costs than the actual funding received through the
federal programs.[Footnote 55] Another service provider we interviewed
said it has designated about 1,690 administrative hours annually to
complying with the reporting requirements of the Title III-B program,
Medicaid, and DOT's Congestion Mitigation and Air Quality Improvement
Program,[Footnote 56] including doing such tasks as tracking the
different data requested by each program, organizing documents, and
following up on required information.[Footnote 57] The provider noted
that the 1,690 hours (equivalent to about $60,000 in costs) represented
a significant portion (14 percent) of the total federal program funding
received under those programs.[Footnote 58] Federal officials have told
us that the Coordinating Council on Access and Mobility--a federal
body, consisting of representatives from 10 federal agencies, including
the Departments of Education, Labor, Health and Human Services,
Transportation, and Veterans Affairs, that is charged with coordinating
transportation services provided by federal programs and promoting the
maximum feasible coordination at the state and local levels--is
examining possible ways to streamline reporting requirements of the
various federal programs that fund transportation for disadvantaged
populations. Council officials said that a paper addressing this issue
will be developed and presented in 2004 or early 2005.
Some of the local providers said that federal guidance on how to apply
for funding and comply with reporting procedures is limited. For
example, one service provider stated that it has not received technical
guidance from DOT that explains the funding process for the Urbanized
Area Formula Program (Section 5307). Instead, the provider contacted
other local nonprofit organizations to seek their technical assistance
in understanding the funding process, but the funds were delayed in the
meantime. The provider said that it contacted local DOT representatives
but was unable to determine the cause of the delay in funds. As a
result, the provider said that it had to convince its nonprofit board
of directors to continue to provide services without the promised
federal funds so that seniors would still have transportation services
available.
Lastly, several of the service providers perceive that program
guidelines are rigid and lack flexibility, although the federal
officials we contacted disagreed with the providers' interpretations.
For example, one provider stated that the program guidelines for DOT's
Nonurbanized Area Formula Program (Section 5311) are very rigid in that
the funds may only be used for transportation for the general public.
The service provider stated that the Section 5311 guidelines require it
to track the type of passenger who requests demand-response service and
the trip destination. If a senior requests transportation to a senior
center or any other human service program destination, the service
provider told us it must find another funding source (e.g., Title III-
B) for that trip because Section 5311 funding is designated for general
rural transportation services and not specialized services. However, a
DOT official told us that rural transit providers receiving Section
5311 assistance may transport a senior to a senior center if the
service is also made available to the general public.
Experts and Stakeholders Suggested Strategies for Overcoming Mobility
Obstacles:
Through a review of the literature and interviews with experts on
senior transportation and aging, representatives of pertinent
professional associations and advocacy groups, local officials, and
transportation service providers, we identified several obstacles to
addressing transportation-disadvantaged seniors' mobility needs and
potential strategies that the federal government and other government
levels, as appropriate, can consider taking to better address those
needs and enhance the cost-effectiveness of the services delivered. We
grouped these obstacles and strategies around three themes: (1)
planning for alternatives to driving as seniors age to extend the
lifespan of their mobility, (2) accommodating seniors' varied mobility
needs, and (3) leveraging federal and other government funding to
better use limited resources. The suggested strategies for addressing
obstacles to senior mobility involve certain trade-offs, and these
obstacles, strategies, and trade-offs are discussed in each of the
following sections.
Helping Seniors Plan for Alternatives to Driving Could Increase the
Lifespan of Their Mobility:
Figure 5: First Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders:
[See PDF for image]
[End of figure]
Seniors who have relied on driving as their primary mode of
transportation may experience a sharp decline in mobility if their
driving becomes limited or ceases. In addition, some seniors may
continue to drive even when it is no longer safe for them to do so
because they do not have, or do not know about, alternative
transportation options. In focus groups conducted by AARP, few
participants indicated that they had ever thought about giving up
driving in advance of doing so. Sixty percent of the seniors surveyed
in another study thought they would get a ride from family members or
friends when they could no longer drive themselves. Several experts
have reported that seniors and their caregivers are not sufficiently
encouraged--by federal and other government entities, family members
and other caregivers, the medical profession, and others--to identify
and use multiple transportation modes for their routine trips. As a
consequence, seniors may perceive that driving is their only viable
option, and they may become isolated or risk driving when it is unsafe
for them to do so.
For the large number of seniors who routinely drive, experts and local
service providers have suggested ways to facilitate a gradual
transition from driver to nondriver and to incorporate additional
transportation modes into seniors' daily travel. Advocacy groups, such
as AARP, have found that seniors have a strong preference for driving
as their primary mode of transportation, and the transition from driver
to nondriver may be particularly challenging for seniors as they age.
While some types of driver-screening programs are currently available
in some communities,[Footnote 59] the federal government could make
them more widely and consistently available by supporting or
encouraging state governments to implement such programs to help
seniors and their caregivers assess their driving abilities. Seniors
could also be offered--through new and existing programs--additional
training, physical therapy, or adaptive equipment to address weaknesses
identified in the screening (e.g., larger rear-view mirrors and pedal
extenders can help seniors who have difficulty turning their heads or
reaching the pedals). AOA officials told us that they have historically
worked with AARP's Mature Driving Program, the American Automobile
Association, and others to provide support to seniors in addressing
their driving abilities, but that sustaining an effort in this area
would likely require new funding. DOT's National Highway Traffic Safety
Administration (NHTSA), in partnership with other federal agencies, the
American Occupational Therapy Association, the American Society on
Aging, and others, has begun promoting some programs to help seniors
extend the lifespan of their mobility by making driving choices that
maximize their personal and community safety and using transit before
it is their only transportation option. For example, NHTSA is pilot
testing a social marketing program to increase awareness of senior
transportation challenges and options. In each of the test sites,
community groups have surveyed people aged 65 and older regarding their
perceptions about safer driving behaviors, other modes of
transportation, and how easy or difficult it is for them to get around
in their communities. The groups then publicized the survey results and
initiated a community discussion about how to help people remain safely
mobile and active as they age. According to a NHTSA official, a final
report with a prioritized set of recommendations and a booklet
containing materials tested by the community groups will be prepared
later this year.
Experts, advocacy groups, and local officials have also suggested
providing a continuum of services to accommodate different trip
purposes and different levels of need. Such services could include
safety programs for older drivers; ridesharing information; and public
transportation and paratransit options,[Footnote 60] including escorts
and financial assistance. The federal government is currently
developing ways to support informed driving choices and encourage state
and local agencies to provide information on the alternative
transportation options available to seniors who can no longer safely
drive or are not comfortable driving in certain conditions, such as at
night or in poor weather. For example, NHTSA (in conjunction with the
American Society on Aging) has developed Web-based seminars to help
seniors and their families make appropriate driving choices that
maximize their personal and community safety. These seminars can also
help communities maximize seniors' mobility options. In addition, the
Easter Seals Caregiver Project (funded by the Federal Transit
Administration and AOA) has developed a template for identifying all of
the transportation options that are available to seniors in a typical
community. The template is designed to help seniors and their
caregivers know what services are available to them and to help service
providers, caseworkers, and city and county planners assess
transportation options and identify gaps in transportation services.
Experts also suggested a publicity campaign to raise awareness about
the importance of planning for seniors' future mobility needs, as well
as training programs for seniors on how to access the transportation
modes available in their communities.
Local service providers and an expert suggested that the Internet could
be a valuable resource in disseminating information. For example, one
local service provider collaborated to develop a Web-based database of
transportation options for seniors in its service area, which reduced
duplication in referral services and provided comprehensive and current
information on transportation options to stakeholders and seniors. The
service provider stated that the result was an interactive, user-
friendly Web site that provided seniors with appropriate,
individualized information on transportation and referral services and
enabled social service organizations, healthcare agencies, community
groups, and caregivers to locate information on transportation options.
Such information could also be available in document format for those
seniors and organizations that prefer not to use the Internet or do not
have access to it, although experts suggest that future generations of
seniors will be progressively more familiar and comfortable with
technology, especially as the "baby boomers" join the senior
population.
The trade-off in encouraging driver-screening programs and publicizing
alternative transportation options is that these strategies would
increase their use. Such an increase would have both positive and
negative results. According to experts and local aging officials, more
demand would put additional pressure on already stretched
transportation programs, but also would mean that more seniors are able
to access the services available to them or are not driving when it is
unsafe for them to do so.
Growing Senior Population Could Benefit from Policies That Accommodate
Its Varied Needs:
Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs
Associated with Meeting Transportation-Disadvantaged Seniors' Mobility
Needs, as Identified by Experts and Stakeholders:
[See PDF for image]
[End of figure]
The mobility needs of seniors vary, depending on differing mobility
limitations they may experience and the reasons they may need
transportation (such as for work, volunteer activities, medical
appointments, and recreation). However, according to experts, advocacy
groups, and local officials, traditional transportation services are
not always designed to meet those varied needs of seniors, particularly
transportation-disadvantaged seniors. The health and mobility
limitations that prevent seniors (particularly seniors aged 85 and
older) from driving may also present obstacles when they use public
transit, paratransit, taxicabs, and other transportation options.
[Footnote 61] Many seniors also live in suburban and rural areas that
are not easily served by traditional fixed-route transit. In addition,
approximately half of the key federal programs for senior
transportation fund services only for specific destinations, such as
medical appointments (rather than for life-enhancing needs), which
tend to occur during normal business hours. Life-enhancing trips are
often needed on evenings (e.g., to a concert) or weekends (e.g., to
religious services) when many paratransit and other specialized
transportation services for seniors are not available. According to
one professional association, the limited amount of funding provided
through HHS's Title III-B program, which senior centers use to provide
transportation, has meant that providers are often unable to provide
life-enhancing trips and restrict service to only medically necessary
trips. Finally, as indicated by the data previously discussed, most
seniors prefer to travel in private automobiles, which offer greater
comfort and flexibility than conventional vans and buses, but many
federally funded services for transportation-disadvantaged seniors
provide only bus or van travel. Experts suggested that if conventional
vans and buses are modified to offer greater comfort and flexibility,
they may appeal to seniors in much the same way as private automobiles.
According to federal officials and experts, many federally funded
programs are intended for seniors who do not drive at all and need
assistance all of the time. However, many seniors do not qualify for
the federally funded transportation programs in their communities
because they require transportation assistance only under certain
circumstances, such as in bad weather or when a medical condition is
aggravated. Experts, advocacy groups, and local officials proposed (1)
improving conventional public transit services to better accommodate
transportation-disadvantaged seniors' needs and (2) familiarizing
seniors with transit options while their health is favorable so they
feel more comfortable using transit as they age and require the
adaptability that transit can provide. To accomplish this, several
suggested that the federal government, or other government levels as
appropriate, provide incentives for transit agencies to restructure
routes to encompass areas where seniors travel or live and improve the
safety and security of waiting areas and vehicles. Additionally,
several proposed that government agencies encourage service providers
to provide training for transit operators on how to better serve
seniors, as well as training for seniors on how to use transit and the
other transportation options available to them. Although such changes
could be expensive, several experts countered that they might be less
expensive than the alternatives (i.e., providing individual paratransit
service or providing emergency medical care or nursing home care).
To accommodate both the immediate and long-term mobility needs of the
aging population, experts and advocacy groups suggested that seniors'
needs be considered in the transportation-planning process. They
suggested that the federal government encourage or require metropolitan
planning organizations (MPO) to evaluate the impact of transportation
systems on seniors' mobility; include seniors when developing the
transportation improvement plan (currently, interested parties are
given opportunities to comment on transportation plans, but they are
not necessarily included in the planning process); and consider the
accessibility of transit facilities to pedestrians. For example,
seniors could advocate for safe walking routes to transit stops and for
the use of low-floor buses (which are accessible to both wheelchair
users and people with other mobility impairments). Currently, AOA is
working with the Community Transportation Association of America and
the Federal Transit Administration to develop guidance for AAAs and
MPOs on considering seniors' mobility needs in the transportation-
planning process. Additionally, a local government official proposed
that DOT should hold MPOs accountable by ensuring that senior mobility
needs are considered in their transportation plans. One senior mobility
expert acknowledged that including more groups in the planning process
can slow that process down, but she said that it would be worth taking
additional time if the planning ultimately results in enhanced mobility
for seniors.
Resources Are Limited, but Strategies Exist to Leverage Them:
Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders:
[See PDF for image]
[End of figure]
The conflict between meeting the mobility needs of transportation-
disadvantaged seniors and addressing the financial burden of providing
services to meet these needs was evident in the literature and
interviews. Officials and experts reported that funding constraints
inhibit local agencies' abilities to address transportation-
disadvantaged seniors' needs. Some suggested increasing funding for
senior transportation programs and improving funding flexibility.
Others said the government could facilitate the sharing of information
between providers, sponsor demonstration projects, and improve the
coordination of transportation services.
Increasing Funding and Using Volunteer Drivers:
Experts, advocacy groups, and local providers suggested increasing
funding for public transit and paratransit as well as for
transportation services specifically designated for seniors, persons
with disabilities, and rural areas. Additional funding for public
transit and paratransit could enable the expansion or improvement of
services to benefit both the general public and seniors who depend on
those services. Experts and advocacy groups have reported that
operators of paratransit demand-responsive, curb-to-curb services have
been adhering more tightly to ADA eligibility criteria in the face of
financial constraints, leading to a decrease in paratransit services
for non-ADA-eligible seniors. One DOT official said that very few urban
transit providers can provide specialized transportation to non-ADA-
eligible seniors because of the high operating costs for ADA-
complementary paratransit. An increase in federal funds would allow
providers to expand their level of service; however, any funds for such
programs would likely have to come either from new revenues or from
other federal programs.
Federal and local officials and advocacy groups have also suggested the
use of volunteer drivers to expand transportation options for
transportation-disadvantaged seniors. However, local service providers
report that finding insurance to cover community-based transportation
or volunteer driver programs is difficult, and the cost of such
insurance is rising. Several service providers told us that they had
difficulty recruiting volunteer drivers because of liability issues,
such as concern over being responsible for expenses that were beyond
their personal insurance limits in the event of an accident. One
provider overcame these liability concerns by obtaining insurance
coverage through a nonprofit insurance organization that would provide
liability coverage for volunteers to drive seniors to their medically
related destinations. Several experts and advocacy groups suggested
that the federal government could establish insurance pools for
volunteer drivers or provide other incentives for volunteer programs.
Increasing Funding Flexibility:
Local officials and advocacy groups have proposed allowing greater
flexibility in the use of federal funds. According to several experts-
-as well local providers and agencies on aging--federal programs tend
to specify that their funds can be used only to provide transportation
to and from that program's services, making it difficult to make
effective use of transportation resources and coordinate with other
service providers. Additionally, some federal programs require
transportation providers to seek two separate sources of funding--one
for capital and one for operating costs--which can be burdensome,
especially for small nonprofits, according to one national senior
advocacy organization. For example, funds from DOT's Capital Assistance
Program for Elderly Persons and Persons with Disabilities (Section
5310) generally cannot be used for operating costs, such as driver
salaries, gas, insurance, and maintenance, and these costs can be
considerable.[Footnote 62] With operating costs more burdensome than
they have been in the past (i.e., higher prices for gas and liability
insurance), a local provider and several advocacy groups have suggested
allowing DOT's Section 5310 funds to be used for operating
expenses.[Footnote 63] However, DOT officials cautioned that such a
change could decrease coordination among local providers because the
current need to seek operating funds from different sources results in
increased communication among local agencies. Another trade-off is that
increasing funding flexibility can decrease accountability because
there is less assurance that the funds will be used for their intended
population. However, another way that an official from a national
transportation association and a local service provider suggested the
federal government can increase flexibility is by allowing in-kind
services, such as the use of volunteers, to count as part of the
required state/local contribution for federal programs. Some federal
programs, such as the Department of Education's Independent Living
Services for Older Individuals Who Are Blind program and HHS's Title
III-B program, currently allow this, while others do not. Several
advocacy groups and experts also suggested encouraging or allowing
federal funds to be used for vouchers for informal volunteer driver
programs or taxicabs. (DOT's Capital Assistance Program for Elderly
Persons and Persons with Disabilities (Section 5310) and Nonurbanized
Area Formula Program (Section 5311) funds can be used for vouchers,
although one expert says they rarely are.) One study found that voucher
programs were less expensive than the direct provision of
transportation services. This strategy would also address the obstacle
about policies that do not address transportation-disadvantaged
seniors' mobility needs, previously discussed, because seniors could be
transported in private automobiles rather than in buses or vans.
Sponsoring Demonstration Programs and Identifying Best Practices:
According to experts, advocacy groups, and local officials, no
coordinated senior transportation policy exists at the national level,
so there is no federal funding stream for local demonstration projects,
no lead agency or resource for information on best practices, and
limited coordination among federal programs. In response, the experts
and officials suggested that the federal government sponsor
demonstration programs, perhaps through the Federal Transit
Administration, or share information about innovative programs targeted
to meet seniors' needs and use creative local partnerships. For
example, AOA officials told us that they have an ongoing project to
identify best practices in implementing each of the elements in the
Framework for Action (a coordination self-assessment tool for states
and communities),[Footnote 64] such as identifying cost-sharing
arrangements and determining technology needs for coordination of
services for transportation-disadvantaged populations, including
seniors. In addition, the Senate bill for reauthorization of surface
transportation contains a provision creating a national technical
assistance center for senior transportation to be run by a national
nonprofit organization.[Footnote 65] Among other activities, the
technical assistance center would gather and distribute information on
best practices in senior transportation, create a Web site and central
clearinghouse for information on senior mobility, and award
demonstration grants.
Providing an Information Clearinghouse:
Experts, advocacy groups, and local officials said that the federal
government could use its prominence and visibility to provide a central
clearinghouse for information on successful practices to enhance senior
mobility and improve the cost-effectiveness of services. They said that
such a clearinghouse could serve as a national technical assistance
center where local aging officials, service providers, and others can
exchange effective program models for senior transportation. They also
suggested that the Internet could be a valuable tool in establishing a
clearinghouse to store and share information, including information
about successful practices and about efforts that federal agencies are
taking to enhance senior mobility. For example, both the Beverly
Foundation and the American Automobile Association's Foundation for
Traffic Safety use their Web sites to distribute information related to
programs of excellence and leading practices in providing
transportation for seniors, but the audiences for these Web sites may
not be as broad as for federal Web sites.
Although AOA's Web site contains transportation information, most of
the information is for providers rather than for seniors. For service
providers and other professionals, there is a transportation page
containing links to other organizations' Web sites (such as the Beverly
Foundation and the Community Transportation Association of America) for
information on promising practices for improving senior transportation,
research and data on senior transportation, and other topics. For
seniors and their families, there is a senior transportation "fact
sheet" containing some statistical information on senior demographics
and travel patterns as well as information on AOA's ongoing
coordination activities with the Federal Transit Administration. The
site directs seniors and their caregivers to contact their local AAAs
or AOA's Eldercare Locator Service for more information on
transportation services available. However, our interviews with experts
and local service providers suggest that people may not know about
AOA's transportation information page or think of the AOA's Web site as
a central forum for senior transportation-related information. Federal
Transit Administration officials told us that the Coordinating Council
on Access and Mobility is working to ensure that there is a "one-stop"
federal Web site on programs, policies, and resources available to
assist communities and states in implementing and enhancing human
service transportation services for seniors, persons with disabilities,
and lower income populations. The site would include links to specific
federal programs addressing the needs of these specific populations.
Facilitating Coordination:
Experts, advocacy groups, and local officials suggested facilitating
the coordination of services at all levels of government. The federal
government could encourage states to coordinate the transportation
components of senior programs with other highway and public transit
planning processes. For example, DOT's Capital Assistance Program for
Elderly Persons and Persons with Disabilities (Section 5310) and
Urbanized and Nonurbanized Area Formula Programs (Section 5307 and
Section 5311) require that projects be the result of "maximum feasible
coordination" with other federally funded transportation services. The
federal government could also encourage or require the creation of a
central coordinated planning entity in metropolitan areas that would
allow nonprofit organizations and government agencies to collaborate
and maximize routes for senior vans and buses. As previously noted,
experts have suggested that seniors should be represented in such
transportation-planning bodies so that their mobility needs are
considered in the decision-making process.
Although we found in the past that federal efforts to coordinate
services for transportation-disadvantaged populations were
limited,[Footnote 66] we recently reported that the Coordinating
Council on Access and Mobility had taken significant steps to improve
coordination among federal agencies.[Footnote 67] These steps included
developing a tool to help states and communities assess their
coordination efforts and providing information on best practices in
coordinating medical transportation services. The council expanded its
original membership--DOT and HHS--to include additional federal
agencies, such as the Departments of Labor and Education, that
administer significant programs for seniors.[Footnote 68]
The council used to have a work group--headed by AOA and the Federal
Transit Administration--for coordinating senior mobility issues, but
council members told us that the council has recently changed its
approach, integrating the population-specific work groups (seniors,
persons with disabilities, etc.) into cross-cutting groups that will
address specific obstacles to coordination. For example, in our
previous and current work, experts and advocacy groups suggested that
legislating uniform cross-program reporting requirements could be a
means to both facilitate coordination and make it easier for small
local providers to access federal funds. As previously mentioned, the
council's work group will address the issue of simplifying federal
grant reporting requirements and administration procedures and propose
some potential solutions. Other work groups will address education and
outreach for coordination, allocation of costs among coordinating
agencies, coordinated planning of human service transportation, and
other issues. In addition, the Departments of Education, Health and
Human Services, Labor, and Transportation recently launched a five-part
coordination initiative--"United We Ride"--that is designed to help
states and communities overcome obstacles to coordination. This
initiative is designed to provide financial incentives for coordination
and establish an interagency forum for communication. As we have
mentioned in previous reports, coordination at all levels of government
requires sustained commitment and leadership but can result in improved
services for seniors and others.
Conclusions:
As the senior population doubles over the next 25 years, it will become
increasingly important to target resources to the areas of greatest
need and to know whether current methods and programs are working to
reduce transportation-disadvantaged seniors' unmet needs and improve
their mobility and access to services. The 655 local area agencies on
aging that are required to gather data to assess seniors' needs for
services could serve as valuable sources of information for federal
agencies to use in program planning, evaluation, and resource
allocation. However, without guidance from the Department of Health and
Human Services' Administration on Aging on assessing needs for
services, including transportation, these local agencies are using a
variety of methods--some less comprehensive than others--to assess
seniors' mobility needs. As a result, it is not possible to determine
whether current programs are reducing unmet needs and improving
transportation-disadvantaged seniors' mobility and access to services.
The Administration on Aging is now embarking on a comprehensive
assessment of seniors' needs for services that affords a good
opportunity for the administration to help state and local agencies
conduct and use the results of improved needs assessments.
The experiences of other federal agencies, such as the Department of
Transportation, that have developed guidance for assessing or
demonstrating needs for some of the programs they administer, such as
the Job Access and Reverse Commute Program, could be useful in
designing guidance for area agencies on aging to assess needs. The
Coordinating Council on Access and Mobility is uniquely positioned to
provide a forum for such a coordinated effort because all of the
federal agencies that administer the key programs we identified are
members, and many of these agencies are involved in the council's
efforts to improve mobility for all transportation-disadvantaged
populations. As the agency designated by the Older Americans Act as the
lead for gathering information on seniors' needs for services, and as
one of the original members of the council, the Administration on Aging
is well-situated to lead a coordinated effort to design guidance for
assessing seniors' needs.
Not having information on alternatives to driving is an obstacle to
both seniors and service providers. Without such information, seniors
do not plan for a time when they can no longer drive, and providers
waste time and money "reinventing the wheel" and become frustrated with
federal programs. Some federal efforts, such as the community awareness
pilot project implemented by the Department of Transportation's
National Highway Traffic Safety Administration, have already begun to
address this obstacle, but the expected growth in the senior population
will require broader efforts. As service providers and representatives
from the advocacy groups and professional associations we interviewed
said, an important role for the federal government would be to provide
a central forum for comprehensive information on transportation
services, perhaps through a centralized Web site that could enhance
seniors' awareness of available services and improve providers' ability
to serve them. Such a Web site would also be useful for publicizing
activities the various federal agencies are undertaking to improve
transportation-disadvantaged seniors' mobility. Although the
Administration on Aging (the federal focal point and advocacy agency
for seniors) has a Web site with information on transportation
services, most of this information is aimed at service providers rather
than at seniors or their caregivers. Furthermore, many of the service
providers and representatives from advocacy groups and professional
organizations we interviewed did not seem to be aware of the presence
of such information on the administration's Web site. In addition,
although seniors are increasingly comfortable using the Internet, there
are still many who do not have access to, or are not at ease with, such
technology.
Recommendations for Executive Action:
To help enhance transportation-disadvantaged seniors' mobility by
improving available information and guidance, we recommend that the
Secretary of Health and Human Services direct the Administrator,
Administration on Aging, to take the following four actions:
* To improve the value and consistency of information obtained from
area agencies on aging on the extent to which transportation-
disadvantaged seniors' mobility needs are being met, the Administrator
should develop guidance for assessing such needs by doing the
following:
* Expand the scope of work in the administration's planned evaluation
of the Grants for Supportive Services and Senior Centers (Title III-B)
program to include gathering and analyzing information on (1)
definitions and measures of need; (2) the range of methodologies that
area agencies on aging use for assessing seniors' need for services,
including transportation, and unmet needs; (3) leading practices
identified in the needs assessments methodologies used by area agencies
on aging; and (4) the kinds of guidance that area agencies on aging
want from the administration and the states to help them perform their
required needs assessments.
* Use the results of the administration's evaluation of the Title III-
B program, and input from the Coordinating Council on Access and
Mobility of other federal agencies that fund transportation services
for seniors, to develop and disseminate guidance to assist state and
local agencies on (1) methods of assessing seniors' mobility needs and
(2) the suggested or preferred method for collecting information on
gaps in transportation services.
* To help address the obstacles that seniors, their caregivers, and
service providers face in locating information on available services
and promising practices, the Administrator should do the following:
* Take the lead in developing a plan--in consultation with members of
the Coordinating Council on Access and Mobility--for publicizing the
administration's Web site and Eldercare Locator Service as central
forums for sharing information on senior transportation through
workshops, annual meetings, and other outreach opportunities with
seniors, their caregivers, and service providers. The plan should
include steps for reaching out to seniors and providers who do not use
or have access to the Internet to increase awareness of information
available in hard copy or other format.
* Work with members of the Coordinating Council on Access and Mobility
to consolidate information about services provided through the
participating agencies' programs and to establish links from their
programs' Web sites to the administration's transportation Web site to
help ensure that other agencies (such as local transit agencies) are
aware of, and have access to, such information.
Agency Comments:
We provided the Departments of Education, Health and Human Services,
Labor, Transportation, and Veterans Affairs with draft copies of this
report for their review and comment. The Departments of Health and
Human Services, Transportation, and Veterans Affairs agreed with the
findings and conclusions in the report. The Department of
Transportation also provided technical clarifications, which were
incorporated as appropriate. The Department of Health and Human
Services provided written comments on the draft of this report, which
are presented in appendix IV. The department concurred with our
recommendations. The Departments of Education and Labor said that they
did not have any comments on the draft.
As arranged with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days
after the date of this letter. At that time, we will send copies of
this report to the appropriate congressional committees and to the
Secretaries and other appropriate officials of the Departments of
Education, Health and Human Services, Labor, Transportation, and
Veterans Affairs. We will also make copies available to others upon
request. In addition, the report will be available at no charge on the
GAO Web site at [Hyperlink, http://www.gao.gov].
If you have any questions about this report, please contact me at
[Hyperlink, siggerudk@gao.gov] or at (202) 512-2834. Additional GAO
contacts and staff acknowledgments are listed in appendix V.
Sincerely yours,
Signed by:
Katherine Siggerud:
Director, Physical Infrastructure Issues:
[End of section]
Appendixes:
Appendix I: Scope and Methodology:
The scope of this report is limited to a review of the mobility needs
of transportation-disadvantaged seniors, who we define as those who
cannot drive or have limited their driving and who have an income
constraint, disability, or medical condition that limits their ability
to travel. In addition, because federal, state, and local programs have
different age ranges for seniors (e.g., aged 55 and over, aged 65 and
over), we do not use the term "senior" in this report to mean any
specific age. We obtained statistics presented in the introduction and
background of this report about seniors and their mobility from an
article published in the American Journal of Public Health, the 2000
Census, the Aging States Project, and the Eldercare Locator Service;
because this information is included as background only, we did not
assess its reliability.
To identify federal programs that address transportation-disadvantaged
seniors' mobility issues, we asked experts who had participated in a
senior mobility forum we moderated in July 2003[Footnote 69] to
identify those federal programs that they consider key for providing
transportation services to seniors who cannot drive or have limited
their driving. We verified the resulting list of 15 programs with
federal program officials. To assess the extent to which the 15 federal
programs address each of the five A's of senior-friendly transportation
(as identified by the Beverly Foundation), we reviewed program
legislation and guidance and interviewed federal officials and senior
mobility experts. We also reviewed prior GAO reports on the
coordination of transportation services for disadvantaged
populations[Footnote 70] and interviewed federal officials, senior
mobility experts, and other stakeholders to identify additional ways in
which the federal government addresses transportation-disadvantaged
seniors' mobility challenges.
To identify data that could tell us anything about the extent to which
transportation-disadvantaged seniors' needs are being met, we reviewed
the literature on transportation, disability, and aging found in
statistical databases and on agency, academic, and advocacy Web sites.
In addition, we asked experts--including academics conducting research
in the fields of aging, disability, and transportation; advocacy policy
analysts knowledgeable about senior transportation; and federal
officials responsible for senior transportation programs--to identify
sources of data and relevant studies. We included in our review only
nationwide surveys or focus groups (1) that were conducted in multiple
states or types of communities, (2) that were conducted after 1995,
(3) that had variables that analyzed transportation behavior of
individuals aged 65 and older, and (4) that were reported in published
or soon-to-be-published journals or reports. Also, we identified
federal agency performance indicators and other data collected by
federal agencies that have key transportation programs for seniors.
For the performance indicators and data sources we identified, we
assessed the extent to which they provided meaningful information
about the extent to which seniors' mobility needs are being met. To
assess the reliability of research publications, we reviewed the
studies' overall designs and methodologies, including the selection
processes for any participants, response rates, and measures used. A
social science analyst at GAO was involved in each review of
methodological soundness. Table 4 summarizes the limitations of the
data sources we used in assessing the extent to which seniors'
mobility needs were being met.
Table 4: Limitations of Data Sources Used:
Data sources and descriptions: Research and statistical publications:
Surveys:
* Bureau of Transportation Statistics, 2001 National Household Travel
Survey. This is a nationwide telephone survey of approximately 60,000
individuals (including seniors) about travel behavior. It documents
approximately 250,000 daily trips. Data were collected between March
2001 and March 2002;
*AARP, Understanding Senior Transportation: Report and Analysis of a
Survey of Consumers Age 50+, 2002. This is a nationwide telephone
survey of 2,422 individuals aged 50 and older, designed to obtain
information on problems with transportation and overall satisfaction
with transportation, among other things. Data were collected between
October 1998 and January 1999;
*AARP, Community Transportation Survey, 1997. This is a nationwide
telephone survey of 710 individuals aged 75 and older, designed to
provide a greater understanding of older persons' mobility, as
measured by the number of trips they take. Data were collected between
October and November 1996;
Limitations:
Although the surveys provide some perspective on the extent of the
problem, information is not available to determine how representative
the responses are, and therefore we are relying on the surveys
primarily to provide information about the nature of unmet needs.
Limitations include the following:
* By their nature, telephone surveys are likely to miss some
individuals living in a community, including those who are oldest and
have the most severe health problems and disabilities, two factors
also related to mobility. For example, for AARP's Understanding Senior
Transportation: Report and Analysis of a Survey of Consumers Age 50+,
AARP estimates that about 16 percent of persons aged 75+ were missed
by the survey, and that those missed were more likely to have physical
impairments and suffer from activity limitations than those in the 75+
population who were captured by the telephone survey;
* For AARP's Community Transportation Survey, the response rate was
not presented in the report. However, this survey relied on an omnibus
survey--omnibus surveys typically lack a thematic structure and
involve minimal callback procedures, which can suppress the response
rate. For example, comparisons with prior research suggest that AARP's
Community Transportation Survey may overestimate the mobility of the
75+ population. Also, those 85+ were underrepresented in this survey;
* For the National Household Travel Survey and the AARP survey that was
reported in Understanding Senior Transportation, the response rates
were somewhat low (40 percent and 59 percent, respectively). Low
response rate could result in nonresponse bias, depending on how the
obtained responses were weighted to make the results representative of
the populations aged 75 and older, particularly since some weighting
factors are themselves correlated with mobility;
* For the National Household Travel Survey and AARP's Community
Transportation Survey, a complete list of the weighting factors was
not available;
* For the National Household Travel Survey and AARP's Community
Transportation Survey, the methodologies used to calculate the
estimates were not fully disclosed, nor were the standard errors
reported for the estimates. Without this information, and without
further information on the potential for nonresponse bias, we were
unable to assess the reliability of the estimates;
* For all three surveys, a full description of procedures used to
estimate missing values for specific items was not available, so it is
unclear whether results are representative;
* In addition to possible nonresponse bias, the practical difficulties
of conducting any survey may introduce other types of errors. For
example, differences in how a particular question is interpreted can
introduce unwanted variability into the survey results.
Data sources and descriptions: Research and statistical publications:
Focus groups:
* AARP, Transportation and Older Persons: Perceptions and Preferences,
2001. This report includes data from focus groups with 28 individuals
and in- person interviews with 17 individuals aged 75 and older in
urban and suburban communities in Massachusetts. Questions were
designed to obtain information on the value and role of transportation,
trip-making decisions, and transportation alternatives when customary
transportation is unavailable. Data were collected in April 1997;
*Ecosometrics, Inc., prepared for the Coordinating Council on Access
and Mobility, the Department of Health and Human Services, and the
National Highway Traffic Safety Administration, Mobility and
Independence: Changes and Challenges for Older Drivers, 1998. This
report includes data from focus groups with 86 people aged 70 and
older and was designed to better define the mobility consequences of
reducing or stopping driving. Focus groups were conducted in Florida,
Maine, and Maryland between August and December 1996;
*Transportation Research Board, TCRP Report 82, Improving Public
Transit Options for Older Persons, Volume I Handbook and Volume II:
Final Report, 2002. This report includes data from focus groups with
88 individuals aged 70 and older, from urban, suburban, and rural
communities that have good transit services (New York City; a Maryland
suburb of Washington, D.C; a suburban area outside Akron, Ohio; and a
rural county east of Cleveland, Ohio). Focus groups were designed to
obtain information on mobility preferences;
Limitations:
Focus groups are adequate in providing qualitative data on the nature,
but not the extent, of unmet needs. Limitations include the following:
* Focus groups are not statistically representative samples of their
communities. Responses from focus groups cannot be used to generalize
to the broader population of which they are a part; 1. For example, in
Transportation and Older Persons: Perceptions and Preferences, the
focus group respondents were from a single geographic area--that is,
in-person interviews were conducted only among residents of the Boston
metropolitan area, and the focus groups were only among residents of
Boston and Framingham; 2. For TCRP Report 82, Improving Public Transit
Options for Older Persons, Volume I: Handbook and Volume II: Final
Report, the focus groups were conducted only in environments that were
considered transit-friendly.
Data sources and descriptions: Research and statistical publications:
Expert perspectives:
Interviews with experts and officials; in the fields of aging,
disability, and transportation research and policy;
Limitations:
Interviews are based largely on the experts' familiarity with these
national data sources, which have known limitations, and on
conversations with local officials, who may rely primarily on anecdotal
data, personal experience, and testing of services.
Data sources and descriptions: Area agencies on aging:
Interviews with agency officials from 16 local area agencies on aging
(AAA) that described obtaining information on transportation from
seniors, caregivers, transportation providers, local aging network
professionals, and senior center directors through focus groups,
surveys, listening sessions, public forums, interviews, waiting lists,
and population data;
Limitations:
We were unable to determine if the data were sufficiently reliable to
assess the extent of unmet need, but determined that they were
sufficiently reliable to describe the nature of unmet need. While
several of the AAA officials we interviewed said that they felt fairly
comfortable with the data they obtained through these methods, others
acknowledged that the data were opinion-driven, anecdotal, and
representative only of the seniors who contacted the AAA. As a result,
the data tended to focus on concerns identified by clients, caregivers,
or transportation providers, rather than on the consensus of all
seniors in the community (including those who do not receive services
from the AAA).
Source: GAO.
Note: Data from the National Household Travel Survey were obtained from
the Surface Transportation Policy Project, Aging Americans: Stranded
Without Options (Washington, D.C.: April 2004).
[End of table]
To better understand the variety of methodologies that area agencies on
aging (AAA) used to assess seniors' unmet mobility needs, the
reliability of data collected using these methodologies, the barriers
to quantifying unmet mobility needs, and the perspectives of local
officials on the extent to which seniors' mobility needs are being met,
we conducted semistructured interviews with officials from 15 of the
655 AAAs nationwide and 1 state unit on aging. To select the
nonprobability sample of 15 AAAs that we interviewed, we asked the 42
state units on aging that have AAAs in their states (8 states--Alaska,
Delaware, Nevada, New Hampshire, North Dakota, Rhode Island, South
Dakota, and Wyoming--and the District of Columbia do not have AAAs and
instead the state unit on aging is the single planning and service area
under the Older Americans Act) to identify 1 urban, 1 rural, and 1
suburban AAA in their state, and for each, to identify the method by
which the AAA collects data on seniors' unmet mobility needs. Of the 42
states that have AAAs, 30 responded to our request. From these
responses, we selected AAAs to ensure geographic dispersion (West,
South, Northeast, and Midwest); representation of AAAs with different
population density (urban, rural, and suburban); representation of
different data collection methods (survey, focus group, census, or
other); representation of input from community stakeholders (service
providers, caregivers, seniors, and professionals); and representation
of states with higher-than-average and lower-than-average percentages
of seniors in their population. In addition to selecting 3 AAAs from
each of 4 states--1 in the West, 1 in the South, 1 in the Midwest, and
1 in the Northeast--we also selected 3 AAAs in New York State because
it had recently completed an audit of transportation for seniors that
included an evaluation of AAAs' procedures for conducting needs
assessments. We also interviewed the state unit on aging from 1 of the
8 states that do not have AAAs (South Dakota). Using a semistructured
interview, we asked senior-level management and staff that had
responsibilities for assessing seniors' unmet mobility needs at each of
the AAAs (and 1 state unit on aging) to provide information on
transportation services offered and restrictions to service; on their
processes for collecting data on seniors' unmet mobility needs,
including information about how they ensure the reliability of the data
they collect and their methodology for reporting and maintaining the
data; on their perspectives on the extent to which seniors' mobility
needs are being met; and on the additional data that should be
collected, if any. To assess the reliability of the data obtained from
AAAs, we reviewed the data for obvious errors in accuracy and
completeness and interviewed agency officials knowledgeable about the
data. Specifically, we asked whether any tests were conducted to ensure
that data were entered accurately and whether the quality of the
collected data had been reviewed. In addition, we asked AAAs to
identify limitations of the data and actions taken to correct any
limitations. (See table 4 for information about limitations of the AAA
data.)
To obtain the perspectives of experts on the extent to which needs are
being met, possible barriers to determining the extent of unmet
mobility needs, and their knowledge of any standards or benchmarks
developed for assessing seniors' unmet mobility needs, we interviewed
federal agency officials that have responsibilities for senior
transportation programs in the Departments of Education, Health and
Human Services, Labor, Transportation, and Veterans Affairs, as well as
representatives from research organizations, advocacy organizations,
and academic institutions in the fields of aging, disability, and
transportation (see table 5). We asked these experts to identify
potential sources for data and information on seniors' mobility needs
as well as for their perspectives on the extent to which such needs are
being met.
Table 5: Academics, Advocacy Groups, Professional Associations, and
Federal Agencies GAO Interviewed about Information on Seniors' Mobility
Needs:
Type of affiliation: Academic/Research;
Organization: University of Alabama, Birmingham;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Academic/Research;
Organization: University of Arizona;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Academic/Research;
Organization: University of California, San Francisco;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Academic/Research;
Organization: University of Florida;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Academic/Research;
Organization: University of Iowa;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Academic/Research;
Organization: University of Massachusetts, Boston;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Academic/Research;
Organization: University of North Dakota;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Academic/Research;
Organization: Westat;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Advocacy;
Organization: AARP;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Advocacy;
Organization: Beverly Foundation;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Association;
Organization: American Public Health Services Association;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Association;
Organization: American Society on Aging;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Association;
Organization: American Medical Association;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Association;
Organization: American Occupational Therapy Association;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Association;
Organization: Community Transportation Association of America;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Association;
Organization: National Association for State Units on Aging;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Association;
Organization: National Association of Area Agencies on Aging;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Committee;
Organization: Transportation Research Board, Committee on Accessible
Transportation and Mobility;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Committee;
Organization: Transportation Research Board, Committee on the Safe
Mobility of Older Persons;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Education, Office of Special Education and
Rehabilitative Services;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Health and Human Services, Administration
on Aging;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Health and Human Services, Administration
for Children and Families;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Health and Human Services, Centers for
Medicare and Medicaid Services;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Health and Human Services, Health Resources
and Services Administration;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Labor, Employment and Training
Administration;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Transportation, Bureau of Transportation
Statistics;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Transportation, Federal Transit
Administration;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Transportation, National Highway Traffic
Safety Administration;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Department of Veterans Affairs, Veterans Health
Administration;
Information provided: Data and information sources: No;
Information provided: Perspective on mobility needs: Yes.
Type of affiliation: Federal government;
Organization: Federal Interagency Forum on Aging-Related Statistics;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Federal government;
Organization: National Center for Health Statistics;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: No.
Type of affiliation: Federal government;
Organization: National Institute on Aging;
Information provided: Data and information sources: Yes;
Information provided: Perspective on mobility needs: Yes.
Source: GAO.
[End of table]
To identify practices that can enhance transportation-disadvantaged
seniors' mobility and local service providers that have implemented
such practices, we interviewed experts and federal officials and
reviewed the literature on senior mobility. We then contacted these
local service providers and requested further information about the
practices they employed and the funding sources they used to implement
the practices. To learn about the practices and their results,
obstacles to implementing the practices, and the role of federal
programs in supporting them, we conducted semistructured interviews
with officials from 10 of the 29 local transportation service
providers that responded to our initial request for information. These
10 providers represented a nonprobability sample, chosen to include a
diversity of geographic areas (i.e., 5 were in urban areas and 5 were
in nonurban areas, from different regions of the country); types of
practices (such as use of technology and coordination); and federal
funding sources (to get representation of as many of the 15 key federal
programs as possible and to include both providers that used many
federal funding sources and those that used only one or two). To
determine the extent to which federal programs support practices that
enhance transportation-disadvantaged seniors' mobility, we interviewed
federal program officials, senior mobility experts, and local service
providers and reviewed pertinent GAO reports.
To identify examples of obstacles to addressing transportation-
disadvantaged seniors' mobility needs and strategies the federal
government could consider taking to improve the ability of federal
programs to meet these seniors' mobility needs and enhance the cost-
effectiveness of the services delivered, we reviewed literature on
transportation, disability, and aging and interviewed experts,
professional associations, and advocacy groups (see table 6). We also
interviewed federal officials and officials from the 16 AAAs and 10
local transportation service providers previously mentioned. We
organized the obstacles and strategies identified in the literature
and through our interviews into three categories: planning for
alternatives to driving as seniors age, accommodating seniors' varied
mobility needs, and addressing federal and other governmental funding
constraints. We presented the proposed strategies to federal program
officials to obtain their comments on the potential trade-offs
associated with implementing them. The trade-offs were included in the
discussion on obstacles and suggested strategies.
Table 6: Academics, Advocacy Groups, and Professional Associations GAO
Interviewed about Obstacles, Strategies, and Trade-offs in Addressing
Transportation-Disadvantaged Seniors' Mobility Needs:
Type of affiliation: Academic/Research;
Organization: Mobility for Life.
Type of affiliation: Academic/Research;
Organization: Westat.
Type of affiliation: Advocacy;
Organization: AARP.
Type of affiliation: Advocacy;
Organization: Beverly Foundation.
Type of affiliation: Advocacy;
Organization: B'nai B'rith.
Type of affiliation: Advocacy;
Organization: Easter Seals.
Type of affiliation: Advocacy;
Organization: Gray Panthers.
Type of affiliation: Advocacy;
Organization: Independent Transportation Network.
Type of affiliation: Advocacy;
Organization: National Caucus and Center for Black Aged, Inc.
Type of affiliation: Advocacy;
Organization: Surface Transportation Policy Project.
Type of affiliation: Association;
Organization: American Society on Aging.
Type of affiliation: Association;
Organization: American Medical Association.
Type of affiliation: Association;
Organization: American Occupational Therapy Association.
Type of affiliation: Association;
Organization: Community Transportation Association of America.
Source: GAO.
[End of table]
We conducted our work from November 2003 through August 2004 in
accordance with generally accepted government auditing standards.
[End of section]
Appendix II: Information on Transportation Provided by 16 Area
Agencies on Aging:
State/City/Location: Connecticut;
Southwestern Connecticut Agency on Aging; (Urban);
Type of service provided and destinations served:
* Curb-to-curb demand response and some escort service to senior
centers, nutrition meal sites, shopping, and medical appointments;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Most are Monday through Friday, normal business hours;
some providers may offer services on weekends;
* Majority of providers restrict service to within the geographical
limits of the town they serve. Some may provide transportation to an
adjacent town for medical appointments;
* Most providers restrict service to no more than two roundtrip rides
per week;
the number of rides a senior can receive is generally dependent on the
number of requests received.
State/City/Location: Connecticut;
Western Connecticut Area Agency on Aging; (Suburban);
Type of service provided and destinations served:
* Escort, fixed-route, and demand-responsive transportation is provided
to grocery stores, medical appointments, nursing homes for spousal
visits, congregate meal sites, senior centers for general nonmeal
activities, hospitals for spousal visits, and provider agencies (such
as the Social Security Administration);
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older and adults with disabilities;
* Normal business hours on weekdays; most require 24-hour advance
reservation notice;
* Transportation is provided only within the town in which the service
provider operates;
* Generally, there are no restrictions on how often individuals can
receive transportation service.
State/City/Location: Connecticut;
Senior Resources Agency; (Rural);
Type of service provided and destinations served:
* Fixed route, demand response, and escort for trips to nutrition
sites, shopping, senior centers, medical/healthcare, libraries, beauty
salons;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Generally Monday through Friday, 8 a.m. to 5 p.m; often providers
require at least 24-hour notice; some providers offer some limited
weekend coverage but this is not publicized;
* Transportation provider will drop off rider at the border of a
region - usually trips stay within the town;
* No restrictions on the number of trips allowed.
State/City/Location: New York;
Westchester County Office for the Aging; (Urban);
Type of service provided and destinations served:
* Curb-to-curb paratransit primarily for medical appointments;
* Escort to medical appointments;
* Shared rides for seniors volunteering; buses for group activities,
such as going to museums, theatres, educational, or cultural
activities; transportation also provided to nutrition centers, for
work, health screenings, grocery and other types of shopping, and
senior centers;
* Discounts for taxicab rides and fixed route;
* Registered driver program;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Must schedule most trips in advance; paratransit does not run on
weekends or after 4 p.m. on weekdays; however, buses and vans do run
on weekends and during evenings for special events;
* Most municipalities restrict service to within the boundaries of the
municipalities;
* No restrictions on how often individuals can receive transportation
service.
State/City/Location: New York;
Onondaga County Department for Aging and Youth; (Suburban);
Type of service provided and destinations served:
* Demand response, fixed route, and escort to senior centers for
nutrition and socialization, to medical appointments, and to grocery
stores, but not for recreation;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Most operate between 9 a.m. and 2 p.m. on weekdays; very limited
service on weekends; required to request service 2 to 3 days in
advance;
* No programs extend beyond the county line, except the call-a-bus;
* Limited to two roundtrip rides a month on the call-a-bus, but no
restrictions on other programs.
State/City/Location: New York;
Chemung County Office for the Aging; (Rural);
Type of service provided and destinations served:
* Demand response and escort for trips to medical appointments,
congregate meals, senior centers, and public agencies; Service
restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* No restrictions on time of day or day of week since AAA contracts
with a taxicab service that operates 24 hours a day; usually requires
24-hour advance notification;
* Provider does not transport out of the county or state;
* No restrictions on how often individuals can receive transportation
service.
State/City/Location: North Carolina;
Centralina Council of Governments; (Urban);
Type of service provided and destinations served:
* Fixed route, demand response, paratransit, and mass transit for
trips to medical care facilities, congregate nutrition sites, senior
centers, necessary grocery shopping, banking, bill paying, and other
essential trips;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older; some disability requirements because of funding
eligibility requirements;
* Restrictions on when service may be available, depending on distance;
medical destinations are prioritized; may have to wait for trips other
than medical;
* Services for fixed route and demand response have restrictions on
distance--for the most part within county boundaries (except for some
medical services);
* No restriction on number of trips, although some counties may
restrict if funding is short.
State/City/Location: North Carolina;
Upper Coastal Plain Council of Governments; (Suburban);
Type of service provided and destinations served:
* Fixed route for trips to congregate meal sites;
adult day care centers;
most counties to senior centers, farmers market once a month when in
season;
* Demand response and bus system for trips for personal care needs,
such as medical appointments and grocery stores;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Weekdays in the more rural counties; public transit is available on
weekends and evenings; fixed route is restricted to business hours
weekdays, except for special events;
* Funding may limit number of days service is available in rural areas;
* Some medical trips (e.g., for dialysis) take priority;
no restrictions on how often individuals can receive service.
State/City/Location: North Carolina;
Southwestern Planning and Economic Development Commission; (Rural);
Type of service provided and destinations served:
* Demand response in rural areas, mostly for medical appointments;
* Fixed route in more densely populated areas for nutrition programs,
shopping centers, community college, and places of employment;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Weekdays during normal business hours;
* Medical trips are first priority; currently, a service recipient can
use up to 100 one-way trips per month for both demand-response and
fixed-route services;
* Counties may set their own priorities due to funding limitations.
State/City/Location: Ohio;
Western Reserve Area Agency on Aging; (Urban);
Type of service provided and destinations served:
* Demand response for shopping, medical appointments, pharmacies, and
senior centers; escort provided for frail seniors;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Most transportation is limited to 5 days per week, 8 a.m. to 5 p.m;
* One county is more rural and limits transportation to three cities;
* Varies by county (senior centers cannot accommodate everyone due to
limited funds); providers tend to prioritize trips (medical
appointments/pharmacy and food shopping are higher priorities).
State/City/Location: Ohio;
Central Ohio Area Agency on Aging; (Suburban);
Type of service provided and destinations served:
* Shared rides to senior center, shopping, and beauty parlor;
* Demand transportation for medical appointments and pharmacy;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Most do not provide weekend service; some do not provide service in
evenings; and others require advance reservations for trips;
* Each provider determines its own service area;
* Most providers do not restrict the number of trips allowed.
State/City/Location: Ohio;
Buckeye Hills-Hocking Valley Regional Development District; (Rural);
Type of service provided and destinations served:
* Demand response for congregate meals at senior centers, grocery
stores if on the route the provider serves, in-county medical
appointments, and social service agencies;
* Escort for medical appointments out of county;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* Mostly restricted to Monday through Friday, 8: 30 a.m. to 5 p.m;
must call 24 to 48 hours in advance;
* Most providers restrict service at least within the county;
* Number of trips depends only on scheduling and availability (most
providers operate on a first-come, first-served basis).
State/City/Location: South Dakota;
South Dakota Department of Social Services, Office of Adult Services
and Aging; (State unit on aging);
Type of service provided and destinations served:
* Demand response and volunteer escorts for essential transportation
to congregate meals, senior centers, grocery stores, medical
appointments, pharmacies, and banking;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 65 and older;
* Weekdays; 6 to 8 hours a day and very limited service on weekends;
* For long-distance travel, the service provider would usually
consolidate all the rides for that destination for a particular day;
* No restrictions on number of rides that an individual can receive.
State/City/Location: Utah;
Five County Government Association of Governments; (Suburban);
Type of service provided and destinations served:
* Demand-response services, shared rides, and fixed route in two
counties supported through city for congregate meals, shopping,
medical appointments, and some recreational activities;
* Emergency service using ambulances or other vehicles;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older;
* For medical appointments, must call in advance; shopping scheduled
for specific days of the week, typically twice a week; and services on
the weekends and evenings are not available;
* No restrictions on distance because most services are found within
the county;
* First come, first served; not all can be served.
State/City/Location: Utah;
Bear River Association of Governments; (Rural);
Type of service provided and destinations served:
* Fixed route to senior centers;
* Assisted door to door for trips to doctor appointments, grocery
stores, and recreational activities (funded by seniors);
Service restrictions: (age, day/hours, distance, number of trips):
* Seniors and adults with disabilities;
* Generally weekdays; business hours only;
* Most providers offer transportation only within the county; outside
metropolitan area, offered three times a week; and paratransit offered
once per week in one county;
* No restrictions on how often, but individuals have to call in
advance to reserve space.
State/City/Location: Utah;
Salt Lake County Aging Services; (Urban);
Type of service provided and destinations served:
* Demand response for life-sustaining activities, such as trips to the
doctor, dentist, physical therapy, chemotherapy, visits to see loved
ones in a hospital or healthcare facility, trips to the housing
authority, and essential banking;
* Fixed route for less urgent activities, such as trips to the grocery
store or senior center;
* No service for recreational activities;
Service restrictions: (age, day/hours, distance, number of trips):
* Aged 60 and older, must be residents of the county and have no other
means of transportation;
* Generally weekdays, business hours; limited night and weekend
service provided by volunteers;
* Within Salt Lake County only;
* Allows three roundtrip rides per individual per week.
Source: GAO.
Note: The AAAs were designated as "urban," "suburban," and "rural" in
responses we received from state units on aging and therefore may not
conform to definitions provided in the U.S. Census or elsewhere.
[End of table]
[End of section]
Appendix III: Local Service Providers and Practices That Can Enhance
Transportation-Disadvantaged Seniors' Mobility:
Name of provider: ACCESS Transportation Systems;
Location: Pittsburg, PA;
Contact information: Karen Hoesch, Executive Director, (412) 562-5380,
khoesch@accesstransys.com;
Type of practice (as described by the providers and in the literature)
[A]: Coordinates transportation service with "zero trip denial" policy
and uses dedicated funding through state lottery program.
Name of provider: Altoona Metro Transportation;
Location: Altoona, PA;
Contact information: Tom Klevan, Director of Business Development,
(814) 944-4074, tom.klevan@amtran.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides fixed-route service using dedicated funding from the
state lottery program, targets marketing efforts to increase senior
ridership, offers a driver sensitivity training program, and uses
senior volunteers to promote and teach seniors how to ride fixed-route
service through the "bus-buddy" program.
Name of provider: Area IV Agency on Aging (College of Southern Idaho);
Location: Twin Falls, ID;
Contact information: Jim Fields, Administrator, (208) 736-2122,
jfields@rmci.net;
Type of practice (as described by the providers and in the literature)
[A]: Provides free rides for seniors throughout an eight-rural-county
service area with a 48-hour call ahead using volunteers from the
Retired Senior Volunteer Program. Provides senior volunteer companions
for homebound seniors through Senior Companions Program.
Name of provider: Butler County Transit (Busy Wheels);
Location: David City, NE;
Contact information: Judy Polacek, Program Administrator, (402) 367-
6131, is31540@navix.net;
Type of practice (as described by the providers and in the literature)
[A]: Provides demand-response transportation service with volunteer
drivers to transport seniors to medical appointments, grocery stores,
pharmacies, senior centers, or other errands.
Name of provider: Capital Metro Transportation Authority;
Location: Austin, TX;
Contact information: Nancy Crowther, Specialist, (512) 389-7400,
nancy.crowther@capmetro.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides free fixed-route service to seniors. Also provides free
transportation to groups of 20 or more seniors during off-peak hours
(late evening or weekends) to destinations within the service area
(e.g., Senior Games, Senior Proms, Senior Nursing Home Games, Retired
Senior Service Volunteer Program luncheons, and AARP events).
Name of provider: City of Napa;
Location: Napa, CA;
Contact information: Adrian Cardoso, Transportation Planner, (707) 259-
8635, acardoso@nctpa.net;
Type of practice (as described by the providers and in the literature)
[A]: Implemented a volunteer-based transit ambassador program that
allows a volunteer, who knows the local transit systems, to assist and
provide information to other passengers or people using public transit
for the first time. The ambassador program is available to all
passengers. However, seniors often take advantage of the program to
learn how to ride fixed-route services in Napa, CA.
Name of provider: Council on Aging and Human Services;
Location: Colfax, WA;
Contact information: Karl Johanson, Executive Director, (509) 397-4611,
coadirector@stjohncable.com;
Type of practice (as described by the providers and in the literature)
[A]: Provides specialized coordinated transportation services for
medically fragile, disabled, and elderly to locations such as medical
offices, hospitals, and other key destinations. Coordinates
transportation services with consumer advocates, social service
agencies, government offices, and transportation providers to best
meet their clients' needs. Secures transportation funding, takes
telephone calls, schedules and assigns trips with subcontractors,
provides rides, and reimburses providers.
Name of provider: Elder Services of Merrimack Valley;
Location: Merrimack Valley, MA;
Contact information: Rosanne DiStefano, Executive Director, (800)
892-0890, ro@esmv.org;
Type of practice (as described by the providers and in the literature)
[A]: Implemented a medical advocacy program that uses local volunteers
to assist elders with medical transportation and advocacy. Program is
targeted to all elders and spouses and to working and long-distance
caregivers.
Name of provider: Enabling Transportation;
Location: Mesa, AZ;
Contact information: Marty Hadley, Coordinator, (480) 218-2221,
martyforet@mindspring.com;
Type of practice (as described by the providers and in the literature)
[A]: Implemented a mileage reimbursement program through which seniors
find volunteer drivers who use their private vehicles to transport
seniors to medical appointments, grocery shopping, church, or other
recreational activities. The program was modeled after the
Transportation Reimbursement and Information Program, which is listed
below.
Name of provider: Friendship Center;
Location: Conroe, TX;
Contact information: Gary Louie, Executive Director, (936) 756-5828,
glouie@thefriendshipcenter.com;
Type of practice (as described by the providers and in the literature)
[A]: Coordinates with medical facility staff to schedule senior medical
appointments to match with transportation availability and is involved
in business enterprises with others in the community to generate
additional program revenue. The implementation of a computerized
mapping system to schedule same-day services is slated for the near
future.
Name of provider: Gold Country Telecare, Inc;
Location: Grass Valley, CA;
Contact information: Susan Healy-Harman, Development Director, (530)
272-9958, healy49@hotmail.com;
Type of practice (as described by the providers and in the literature)
[A]: Provides low-or no-cost transportation to low-income seniors and
persons with disabilities located in rural communities to healthcare
services, provides all-day Sunday service for seniors to go to church
and other activities, and offers a volunteer driver program through
which volunteers who use their own vehicles to transport seniors are
reimbursed for mileage.
Name of provider: Great Falls Transit District;
Location: Great Falls, MT;
Contact information: Jim Helgeson, General Manager, (406) 727-0382,
gm@gftransit.com;
Type of practice (as described by the providers and in the literature)
[A]: Implemented a travel-training program through which volunteers
teach seniors how to use public transportation.
Name of provider: Independent Transportation Network;
Location: Westbrook, ME;
Contact information: Katherine Freund, Director, (207) 854-0505,
kfreund@itninc.org;
Type of practice (as described by the providers and in the literature)
[A]: Offers a range of demand-responsive services (door-to-door, door-
through-door, and hands-on assistance) to a broad spectrum of older
riders using automobiles driven by both paid staff and volunteer
drivers. Operates exclusively on a combination of fares and donations
and does not depend on public subsidies. Customers (seniors) become
"members" of Independent Transportation Network and prepay (through a
variety of payment plans) into their own account in advance of travel.
Name of provider: Lauderhill Transportation Program;
Location: Lauderhill, FL;
Contact information: Kurt Blades, Transportation Coordinator, (954)
717-1525, kblaides@lauderhill-fl.gov;
Type of practice (as described by the providers and in the literature)
[A]: Provides demand-response transportation services to seniors for
grocery shopping, medical appointments, banking, daily nutrition,
senior center activities, and other general travel trips.
Name of provider: Medical Motor Service;
Location: Monroe County, NY;
Contact information: William McDonald, Director, (585) 654-7030,
w_mcdonald@medicalmotors.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides transportation and brokerage services by coordinating
with other nonprofit agencies. Services are customized to meet the
needs of seniors, using wheelchair accessible vehicles and providing
shuttle services to rural areas of the county. Contracts with a
private, regional grocery chain to supplement its fund-raising
efforts. The grocery store contributes to Medical Motors in exchange
for Medical Motors transporting seniors to the grocery store.
Name of provider: Mountain Empire Older Citizens, Inc;
Location: Big Stone Gap, VA;
Contact information: Dennis Horton, Deputy Director, (276) 523-4202,
dhorton@meoc.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides transit services to the general public and door-through-
door, one-on-one services to special-needs populations in a multicounty
region through a coordinated system that is also consumer friendly and
flexible to meet the needs of the community.
Name of provider: North County Lifeline, Inc;
Location: Vista, CA;
Contact information: Stacy Zwagers, Director of Transportation, (760)
726-3961, szwagers@nclifeline.org;
Type of practice (as described by the providers and in the literature)
[A]: Targets a travel-training program to the senior population to
encourage seniors to use the public transit system by teaching (one-on-
one or through groups) and showing seniors how to use the system.
Helped establish the Strides Web site, designed as a distribution
center for other public transportation service providers as well as a
referral service for seniors to learn about transit services in the
San Diego area.
Name of provider: OATS, Inc;
Location: Columbia, MO;
Contact information: Linda Yaeger, Executive Director, (573) 443-4516,
lyaeger@oatstransit.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides transportation service for the general public,
prioritizing its services on senior citizens and persons with
disabilities within 87 rural counties in the state of Missouri. Uses
volunteers to fulfill a number of functions, such as dispatching calls
to drivers, fund-raising, and serving as liaisons to the community.
Name of provider: Rensselaer County;
Location: Troy, NY;
Contact information: Mike Angley, Deputy Commissioner, (518) 270-2732,
mangley@rensco.com;
Type of practice (as described by the providers and in the literature)
[A]: Provides flexible transportation services for trips to senior
centers, shopping, banking, and medical appointments. Drivers use
pagers for efficient pick-up service. Night and weekend trips are
available.
Name of provider: Seniors' Resource Center;
Location: Denver, CO;
Contact information: Jane Yeager, Director, (303) 238-8151,
jyeager@sraging.org;
Type of practice (as described by the providers and in the literature)
[A]: Transports older adults and persons with disabilities to medical
facilities, grocery stores, meal sites, and adult day centers and for
other personal needs.
Name of provider: Shepherd's Center of America (Northland);
Location: Kansas City, MO;
Contact information: Rebecca Gordon, Executive Director, (816)
452-4536, rgordscn@crn.org;
Type of practice (as described by the providers and in the literature)
[A]: Uses volunteers to provide door-through-door medical
transportation services to seniors. Services are free to seniors.
Name of provider: Special Transit;
Location: Boulder, CO;
Contact information: Lenna Kottke, Executive Director, (303) 447-2848,
lenna@specialtransit.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides a variety of services, including demand-response, curb-to
-curb transportation service offered to the general public;
a circular shuttle route serving the entire community that is also
senior friendly;
a "family and friends" mileage reimbursement program;
and a comprehensive, one-on-one training program developed to teach
seniors how to use their community transit alternatives.
Name of provider: St. Johns County Council on Aging;
Location: St. Augustine, FL;
Contact information: Cathy Brown, Executive Director, (904) 823-4810,
ckbrown@aug.com;
Type of practice (as described by the providers and in the literature)
[A]: Coordinates its services with local transit authority and taxicab
services. Provides a driver-training program that emphasizes safety
and customer service. Uses brightly-decorated vehicles to attract
senior ridership.
Name of provider: Suburban Mobility Authority for Regional
Transportation;
Location: Detroit, MI;
Contact information: Ron Ristau, Director of Service Development, (313)
223-2100, rristau@smartbus.org;
Type of practice (as described by the providers and in the literature)
[A]: Helps provide vehicles and funding to local communities in the
service area. Local communities that receive the vehicles and funding
design and operate services independently according to local needs.
Name of provider: Sweetwater Transportation Authority;
Location: Rock Springs, WY;
Contact information: Judy Wilkinson, Director, (307) 382-7827,
starbus@fascination.com;
Type of practice (as described by the providers and in the literature)
[A]: Provides coordinated demand-response transportation services using
computerized scheduling. The computerized scheduling software will
allow accurate and on-time scheduling through the use of Global
Positioning Systems technology that tracks the location of vehicles.
Name of provider: Transportation Options, Broward County Transit;
Location: Pompano Beach, FL;
Contact information: Ed Wisniewski, Paratransit;
Manager, (954) 357-8321, ewisniewski@broward.org;
Type of practice (as described by the providers and in the literature)
[A]: Provides senior transportation services 7 days a week and serves
approximately 40 designated senior nutrition and social center sites.
Also implemented a community bus program that circulates within a
specific community to encompass shopping areas, senior residences, and
senior day programs.
Name of provider: Transportation Reimbursement and Information Program;
Location: Riverside, CA;
Contact information: Richard Smith, Executive Director, (909) 697-4697,
richard.smith@pe.net;
Type of practice (as described by the providers and in the literature)
[A]: Reimburses volunteer drivers to transport individuals where no
transit service exists or when the individual is too frail to use other
transportation.
Name of provider: Treasure Valley Transit;
Location: Canyon County, ID;
Contact information: Terri Lindenburg, Executive Administrator, (208)
465-6472, peggy@treasurevalleytransit.com;
Type of practice (as described by the providers and in the literature)
[A]: Operates a demand-response service for seniors who need
transportation services to medical facilities. Also works with local
senior centers to provide transportation services.
Name of provider: West Austin Caregivers;
Location: Austin, TX;
Contact information: Jeanie Teel, Executive Director, (512) 472-6339,
wacaregivers@juno.com;
Type of practice (as described by the providers and in the literature)
[A]: Provides free transportation using volunteers, who use their
private vehicles to transport seniors to medical appointments,
shopping, and errands.
Source: GAO analysis of information obtained through interviews with
service providers and reports by the Beverly Foundation, the Community
Transportation Association of America, and the National Academy of
Sciences' Transportation Research Board.
Note: This appendix includes only those service providers who
responded to our request for information, and is therefore not a
comprehensive list of providers identified by the Beverly Foundation,
the Community Transportation Association of America, and the
Transportation Research Board as having implemented practices that
enhance transportation-disadvantaged seniors' mobility. For more
information, see Beverly Foundation in partnership with the AAA
Foundation for Traffic Safety, Supplemental Transportation Programs
for Seniors (Pasadena, CA, and Washington, D.C.: June 2001) and
Supplemental Transportation Programs for Seniors: A Report on STPs in
America (Pasadena, CA, and Washington, D.C.: July 2004);
Community Transportation Association of America, Senior
Transportation: Toolkit and Best Practices (Washington, D.C.: May
2003); and U.S. Department of Transportation, Transit Cooperative
Research Program, Transportation Research Board, TCRP Report 82,
Improving Public Transit Options for Older Persons, Volume I: Handbook
and Volume II: Final Report (Washington, D.C.: 2002).
[A] The practices listed above focus on efforts targeted to seniors
and are not intended to represent a complete list of services provided
by each local service provider.
[End of table]
[End of section]
Appendix IV: Comments from the Department of Health and Human Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES:
Office of Inspector General:
AUG 16 2004:
Ms. Kate Siggerud:
Director, Physical Infrastructure Issues:
United States Government Accountability Office:
Washington, D.C. 20548:
Dear Ms. Siggerud:
Enclosed are the Department's comments on your draft report entitled,
"Transportation-Disadvantaged Seniors - Efforts to Enhance Senior
Mobility Could Benefit from Additional Guidance and Information" (GAO-
04-971). The comments represent the tentative position of the
Department and are subject to reevaluation when the final version of
this report is received.
The Department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Dara Corrigan:
Acting Principal Deputy Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the Department's
response to this draft report in our capacity as the Department's
designated focal point and coordinator for Government Accountability
Office reports. OIG has not conducted an independent assessment of
these comments and therefore expresses no opinion on them.
COMMENTS AND RESPONSES ON THE GOVERNMENT ACCOUNTABILITY OFFICE (GAO)
DRAFT REPORT "TRANSPORTATION-DISADVANTAGED SENIORS: EFFORTS TO ENHANCE
SENIOR MOBILITY COULD BENEFIT FROM ADDITIONAL GUIDANCE AND INFORMATION"
(GAO-04-971):
The Department of Health and Human Services (HHS) recognizes the
critical link transportation plays in connecting older adults to vital
services, to their friends/family and to essential daily activities. As
identified in the GAO report, the majority of the supportive services
for older persons funded through HHS are managed through the
Administration on Aging (AoA) under the Older Americans Act (OAA). The
OAA includes transportation as one of the community services that may
be funded under the Act, depending on local needs and resources. In
addition, AoA advocates across the Department on behalf of older
adults, including on transportation issues.
Since 1986, HHS has worked with the Department of Transportation (DOT)
to identify opportunities to improve the availability and quality of
community transportation for all recipients of HHS-funded programs. As
indicated in previous GAO reports, these efforts have met with some
frustration and impatience in the transportation and human services
fields. However, the commitment to address transportation issues as
represented by a memorandum of understanding signed in 1986 by the
Secretaries of HHS and DOT, served to highlight the issues and
encourage communication through the original Coordinating Council on
Access and Mobility (CCAM). A new CCAM will soon be initiated to
include more Federal agencies.
Recently, Assistant Secretary on Aging Josefina G. Carbonell signed a
new memorandum of understanding with the Federal Transit Administration
(FTA) of DOT on January 9, 2003 that continues the focus on
transportation issues. This memorandum of understanding (MOU) outlines
activities in five areas: (1) public awareness and outreach; (2) data
collection and promising practices, (3) technical assistance; (4)
stakeholder input; and, (5) local and State transportation plan
development. The overarching goal for the MOU is to improve the
availability of local transportation service for older adults to keep
elders active and aging in place in their communities.
The AoA/FTA MOU has helped to stimulate a significant amount of
interagency work. Focusing on coordinating transportation planning and
resources, the United We Ride (UWR) Initiative was originated by DOT,
Departments of Education, Labor and HHS and now is managed under the
auspices of the new Interagency Coordinating Council on Access and
Mobility. The goals of UWR are to: (1) provide a benchmark for progress
to States and communities; (2) promote a nationwide dialogue among
States and communities; (3) recognize and encourage progress; (4)
secure specific State commitments for continued progress; and (5)
provide resources to help through funding and technical assistance. The
UWR initiative was developed in response to the obstacles to
coordination noted in a previous GAO report and highlighted during the
Congressional hearing on May 1, 2003. Success in the UWR effort will no
doubt result in improved transportation services for all transportation
disadvantaged individuals including older adults.
There are two new tools to assist States and communities to achieve
improved mobility. Within the UWR Initiative, A Framework for Action
(FA) has been developed; a self-assessment tool that States and
communities can use to identify areas of success and highlight the
actions still needed to improve the coordination of human service
transportation. The complete FA and facilitator's guide are available
on the CCAM website at http://www.fta.dot.gov/CCAM/www/index.html.
Additionally, in Chicago on May 11, 2004, Assistant Secretary Carbonell
announced the "Options Template" developed by the Beverly Foundation
(BF) and funded by AoA's National Family Caregiver Support Program, to
help communities assess existing transportation options, gaps and
needs. These are only a few of the technical assistance tools available
to help communities to assess older adult transportation needs and
develop plans to meet those needs. More information on these tools may
be obtained through the Community Transportation Assistance Project
(CTAP) funded by HHS. CTAP provides access to the Information Station
at the Community Transportation Association at http://www.ctaa.org.
Effective community planning is essential to improving transportation
services. The OAA requires a bottoms up grassroots planning process
that gathers data at the community level through numerous forums
including town halls, consumer surveys, focus groups and other senior
outreach efforts. This planning process results in an aging services
strategic plan for how each State will follow OAA guidelines and what
programs they will implement. There is, by design, a lot of variation
on the `how' of this process in order to give each State and their
commensurate area agencies on aging the freedom to choose the best
methods to collect information and prioritize need. Many of these State
plans explicitly mention transportation services and do formal needs
analysis for older adult transportation services as part of this
planning process. At this time, there is no prescription for how States
or local area agencies on aging are required to do transportation
planning.
AoA is currently in the process of outlining major outcome areas to
study transportation coordination results as a part of a promising
practices study funded by AoA due to be released in September 2004. In
addition, AoA will soon announce an assisted transportation study for
door through door transportation. Both studies seek to compile specific
and practical information to help community service providers and area
agencies on aging meet the critical need for older adult
transportation. As mentioned previously, the CTAP project funded by HHS
provides hands-on assistance to States and communities in the
development and delivery of coordinated human service transportation
programs for older adults persons with disabilities and in need
children and families.
The President's February 2004 Executive Order for Human Service
Transportation Coordination (EO), which includes services for older
adults, has provided additional emphasis on developing planning
processes and tools. HHS is actively participating in the
implementation of the EO, serving on all six of the implementation
workgroups.
Among other efforts, AoA is reviewing planning processes and detailed
transportation surveys from the area agencies on aging for a project
funded by the Community Transportation Association of America and
conducted by the National Association of Area Agencies on Aging.
HHS is appreciative of this GAO report "Efforts to Enhance Senior
Mobility Could Benefit from Additional Guidance and Information." The
report provides a useful summary of major research and the major
Federal programs to date providing funding for older adult
transportation. This report reinforces AoA's findings and focus to
develop more detailed best practices and to disseminate planning
guidance to communities for older adult transportation.
In addition, the obstacles to coordination of Federal programs, as
noted in a prior GAO report, are extensive. More flexibility is needed
for local communities to pool resources to meet their specific needs.
HHS advocates the use of information technology, such as intelligent
transportation systems. These systems create an integrative
infrastructure for resource efficiency and a mechanism for agencies'
outcome reporting-so information required to continue to assess the
efficacy of their specific programs is available.
HHS accepts the recommendations of this GAO report to enhance senior
mobility through the proposed four actions. This reinforcement of our
current direction and that of UWR, we hope will further encourage the
inter-agency commitment for the President's EO. Our strategy is to
leverage the inter-agency efforts for collective strength and
consistency for communities dealing with Federal agencies while at the
same time staying true to the AoA mission to ensure older adults get
the services they require. The suggested actions to increase focus on
needs assessment technical assistance, best practices and education/
outreach, underscore the importance these initiatives hold in creating
bold systems change for both the human services and transportation
areas.
GAO Recommendation #1:
Expand the scope of work in the Administration's planned evaluation of
the Title III-B program to include gathering and analyzing information
on: (1) definitions and measures of need, (2) the range of
methodologies that area agencies on aging use for assessing seniors'
need for services, including transportation, and unmet needs, (3)
leading practices identified in the needs assessments methodologies
used by area agencies on aging, and (4) the kinds of guidance that area
agencies on aging want from the Administration and the States to help
then: perform their required needs assessments.
HHS Response:
AoA recently completed a statement of work for this project to evaluate
the Title IIIB program. In further development of this project, AoA
will explore ways to address the four above-mentioned points in
contract discussions.
GAO Recommendation #2:
Use the results of the American's evaluation of the Title III-B
program, and input from the Coordinating Council on Access and Mobility
of other Federal agencies that fund transportation services for
seniors, to develop and disseminate guidance to assist State and local
agencies on: (1) methods of assessing seniors' mobility needs; and (2)
the suggested or preferred method for collecting information on gaps in
transportation services.
HHS Response:
AoA, working with the UWR effort along with other Federal agencies, is
involved in these actions. AoA continues to promote the transportation
template developed by the BF and Easter Seals to help communities
assess existing transportation options, gaps and needs at the local
level. Other tools are in process and, as they are available, will be
disseminated. AoA will continue a collaborative and guidance based
approach to States and communities in this regard to reinforce their
unique needs, processes and assets.
GAO Recommendation #3:
Take the lead in developing a plan-in consultation with members of the
Coordinating Council on Access and Mobility-for publicizing the
Administration's Web site and Eldercare Locator Service as central
forums for sharing information on senior transportation through
workshops, annual meetings, and other outreach opportunities with
seniors, their caregivers, and service providers. The plan should
include steps for reaching out to seniors and providers who do not use
or do not have access to the Internet to increase awareness of
information available in hard copy or other format.
HHS Response:
HHS, and specifically AoA, agrees that continued access to information
on transportation in numerous venues, web, print media, telephone-
consolidated access, is important. It will be important to ensure that
the AoA efforts are coordinated with the new CCAM website.
The President's EO emphasizes the types of coordinated effort that are
encouraged by the GAO report. The EO calls on 10 Federal departments to
work together to improve the coordination of transportation services
for the human service disadvantaged population. HHS is very active on
committees addressing education/outreach and consolidated access -
including the Mobility for All Americans project. AoA recommends that
any effort for education/outreach, both web and print, should integrate
with the UWR activities to ensure States and local communities are not
further confused by multiple efforts by multiple agencies to address
the needs of one targeted group.
GAO Recommendation #4:
Work with members of the Coordinating Council on Access and Mobility to
consolidate information about services provided through the
participating agencies' programs and to establish links from their
programs' Web sites to the Administration's transportation Web site to
help ensure that other agencies (such as local transit agencies) are
aware of, and have access to, such information.
HHS Response:
The creation of a consolidated transportation website, the UWR
Education and Outreach workgroup has already discussed the development
of a fully operational web site. A contract to discuss the strategy and
conceptual approach for the development of this web site is imminent.
As a member of UWR, HHS, including AoA, is actively participating in
this consolidated effort.
In summary, HHS thanks GAO for this compelling, thorough effort and
again applauds the recommendations. HHS, through AoA, is committed to
providing technical assistance and information to the aging network to
support their work in increasing understanding of older adult
transportation needs. We look forward to working with the GAO as we
continue to develop and implement projects for collecting and
disseminating older adult transportation information. Better guidance
and information for States and communities stand to enhance already
existing programs, projects and initiatives.
[End of section]
Appendix V: GAO Contacts and Staff Acknowledgments:
GAO Contacts:
Katherine Siggerud (202) 512-2834 or [Hyperlink, siggerudk@gao.gov]
Rita Grieco (202) 512-2834 or [Hyperlink, griecor@gao.gov]
Staff Acknowledgments:
In addition to the individuals above, Bert Japikse, Jessica Lucas-Judy,
Kristen Sullivan Massey, Sara Ann Moessbauer, Elizabeth Roberto, and
Maria Romero made key contributions to this report.
(542029):
FOOTNOTES
[1] Daniel J. Foley, MS, Harley K. Heimovitz, PhD, Jack M. Guralnik,
MD, PhD, and Dwight B. Brock, PhD, "Driving Life Expectancy of Persons
Aged 70 Years and Older in the United States," American Journal of
Public Health, vol. 92, no. 8 (2002).
[2] U.S. Department of Transportation, Bureau of Transportation
Statistics, Federal Highway Administration, and National Highway
Traffic Safety Administration, 2001 National Household Travel Survey.
See appendix I for a discussion of data limitations.
[3] We define transportation-disadvantaged seniors as those who cannot
drive or have limited their driving and who have an income constraint,
disability, or medical condition that limits their ability to travel.
Because federal, state, and local programs have different age ranges
for seniors (e.g., aged 55 and over, aged 65 and over), we do not use
the term "senior" in this report to mean any specific age.
[4] AAAs were established, following a 1973 amendment of the Older
Americans Act of 1965, to respond to the needs of seniors in local
communities. There are 655 of these agencies nationwide that use
various federal, state, and local funds to provide and oversee the
delivery of supportive home and community-based services to older
persons and their caregivers. These services include congregate and
home delivered meals, senior center activities, legal assistance,
family caregiver services, disease prevention and health promotion
activities, transportation and outreach to enable seniors to access
other services, and other services at the local level. AAAs plan,
coordinate, and offer services that help seniors remain in their homes
and also act as advocates for improved services for seniors and their
families.
[5] This included one semistructured interview with officials from the
state unit on aging in South Dakota, which has no AAAs. For the sake of
simplicity, we refer to that state agency as 1 of the 16 AAAs in this
report.
[6] Grants for Supportive Services and Senior Centers (Title III-B).
[7] Surface Transportation Policy Project, Aging Americans: Stranded
Without Options (Washington, D.C.: April 2004). This study uses data
from the National Household Travel Survey, the limitations of which are
discussed in appendix I.
[8] AARP, Community Transportation Survey (Washington, D.C.: 1997).
[9] The Aging States Project is a collaborative effort of the
Association of State and Territorial Chronic Disease Program Directors
and the National Association of State Units on Aging, with support from
the Centers for Disease Control and Prevention and HHS's Administration
on Aging.
[10] The Eldercare Locator Service is a nationwide toll-free service
and Web site designed to help older adults and their caregivers find
services for seniors. It is funded by the Administration on Aging and
administered by the National Association of Area Agencies on Aging.
[11] Foley, Heimovitz, Guralnik, and Brock, "Driving Life Expectancy."
[12] In addition, the Federal Interagency Forum on Aging-Related
Statistics--an organization comprised of representatives from the
Administration on Aging, the Census Bureau, the Department of Veterans
Affairs, and other agencies--identified several areas where more data
are needed to support research and policy efforts, such as obtaining
more information on the effects of transportation on the quality of
life, including the number of trips seniors take and the types of
transportation they use. See Federal Interagency Forum on Aging-Related
Statistics, Older Americans 2000: Key Indicators of Well-Being
(Washington, D.C.: U.S. Government Printing Office, August 2000).
[13] One problem with this measure is that it assumes that
transportation-disadvantaged populations want to take as many trips as
nondisadvantaged populations, an assumption that may be reasonable in
some, but not all, cases.
[14] The exceptions are the states that do not have AAAs, in which case
the state unit on aging provides services directly or through contracts
with providers.
[15] Beverly Foundation in partnership with the AAA Foundation for
Traffic Safety, Supplemental Transportation Programs for Seniors
(Pasadena, CA, and Washington, D.C.: June 2001).
[16] Door-through-door service involves picking up passengers at the
door of their place of origin and delivering them to the door of their
destination. The driver walks to the passenger's point of origin,
enters that building, and then often provides physical assistance to
the passengers to exit the building and board the vehicle. This service
offers the maximum level of assistance and is generally reserved for
passengers with severe physical impairments or disabilities.
[17] GAO, Transportation-Disadvantaged Populations: Some Coordination
Efforts Among Programs Providing Transportation Services, but Obstacles
Persist, GAO-03-697 (Washington, D.C.: June 30, 2003).
[18] Bed confinement is defined as when the beneficiary is unable to
get up from bed without assistance, to walk, or to sit in a chair or
wheelchair.
[19] GAO, Rural Ambulances: Medicare Fee Schedule Payments Could Be
Better Targeted, GAO/HEHS-00-115 (Washington, D.C.: July 17, 2000), and
Ambulance Services: Medicare Payments Can Be Better Targeted to Trips
in Less Densely Populated Rural Areas, GAO-03-986 (Washington, D.C.:
Sept. 19, 2003).
[20] Our review indicates that these data have limitations, including
limited generalizability of focus group findings; lack of documentation
to assess the potential for nonresponse bias (the difference between
those who responded or participated and those who did not); and lack of
objective, quantifiable data on which to base perspectives. See
appendix I for a more detailed discussion of the limitations associated
with these data.
[21] As compared with the nearly 90 percent of drivers aged 75 and
older who reported being at least somewhat satisfied with their
mobility. See AARP, Understanding Senior Transportation: Report and
Analysis of a Survey of Consumers Age 50+ (Washington, D.C.: 2002).
According to AARP's calculations, all of the estimates we cite from
this study have sampling errors that do not exceed + or -4.5 percent
at the 95 percent confidence level.
[22] AARP, Transportation and Older Persons: Perceptions and
Preferences (Washington, D.C.: 2001).
[23] AARP, Community Transportation Survey.
[24] AARP, Community Transportation Survey.
[25] Jon E. Burkhardt, Arlene M. Berger, Michael Creedon, and Adam T.
McGavock, Mobility and Independence: Changes and Challenges for Older
Drivers, a report prepared by Ecosometrics, Incorporated, for the
Coordinating Council on Access and Mobility, the Department of Health
and Human Services, and the National Highway Traffic Safety
Administration (July 4, 1998).
[26] The study included perspectives from the transit industry,
including that walking a one-quarter mile distance to a bus stop was a
reasonable expectation for a healthy senior. See U.S. Department of
Transportation, Transit Cooperative Research Program, Transportation
Research Board, TCRP Report 82, Improving Public Transit Options for
Older Persons, Volume I: Handbook and Volume II: Final Report
(Washington, D.C.: 2002).
[27] Surface Transportation Policy Project, Aging Americans.
[28] AARP, Understanding Senior Transportation.
[29] Other causes of interference with activities may include health
limitations or other personal reasons.
[30] Burkhardt, Berger, Creedon, and McGavock, Mobility and
Independence.
[31] See appendix II for information on transportation services
provided by the 16 AAAs we interviewed.
[32] Surface Transportation Policy Project, Aging Americans.
[33] AARP, Transportation and Older Persons.
[34] AARP, Understanding Senior Transportation.
[35] In a prior report (GAO-03-697), we found that there were no
reliable national program data on federal, state, and local spending
for transportation services for the transportation-disadvantaged,
including seniors. There were no such data because many federal funding
recipients are not required to distinguish transportation spending from
other spending when reporting information to federal agencies.
[36] 42 U.S.C. § 3026(a)(1).
[37] U.S. Department of Transportation, Bureau of Transportation
Statistics, Freedom to Travel, BTS03-08 (Washington, D.C.: 2003).
[38] U.S. Department of Transportation, Bureau of Transportation
Statistics, Travel Patterns of Older Americans with Disabilities,
Working Paper 2004-001-OAS (Washington, D.C.: July 2004).
[39] 42 U.S.C. § 3026(a)(1) and 42 U.S.C. § 3057d.
[40] 42 U.S.C. § 3012(a)(26)(D) and (E).
[41] This program has transitioned from one in which DOT competitively
selected grantees to one in which the Congress designates the grantees.
See GAO, Job Access and Reverse Commute: Program Status and Potential
Effects of Proposed Legislative Changes, GAO-04-490R (Washington, D.C.:
Aug. 20, 2004).
[42] U.S. Department of Transportation, Transit Cooperative Research
Program, Transportation Research Board, TCRP Report 82. For more
information on the service providers discussed in this section, as well
as other providers that experts have identified as having implemented
practices that enhance senior mobility, also see Community
Transportation Association of America, Senior Transportation: Toolkit
and Best Practices (Washington, D.C.: May 2003) and Beverly Foundation
in partnership with the AAA Foundation for Traffic Safety, Supplemental
Transportation Programs. In addition, the Beverly Foundation released a
report in July 2004 that identifies additional service providers. (See
Beverly Foundation in partnership with the AAA Foundation for Traffic
Safety, Supplemental Transportation Programs for Seniors: A Report on
STPs in America (Pasadena, CA, and Washington, D.C.: July 2004).)
[43] See GAO-03-697 and GAO, Transportation-Disadvantaged Populations:
Many Federal Programs Fund Transportation Services, but Obstacles to
Coordination Persist, GAO-03-698T (Washington, D.C.: May 1, 2003).
[44] Coordinated transportation services may include the following
activities: joint planning among several private or public agencies,
brokerage, or the shared use of vehicles among multiple programs.
[45] The Community Transportation Association of America defines
brokerage as a method of providing transportation where riders are
matched with appropriate transportation providers through a central
trip-request and administration facility. The transportation broker may
centralize vehicle dispatch, record keeping, vehicle maintenance, and
other functions under contractual arrangements with agencies,
municipalities, and other organizations. Actual trips are provided by a
number of different vendors.
[46] Beverly Foundation and Community Transportation Association of
America, Innovations for Seniors: Public and Community Transit Services
Respond to Special Needs (Pasadena, CA, and Washington, D.C.: February
2004).
[47] Curb-to-curb service is a common designation for the paratransit
service that involves a transit vehicle that picks up and discharges
passengers at the curb or driveway in front of their home or
destination. In curb-to-curb service, the driver does not assist the
passenger along walks or steps to the door of the home or other
destination.
[48] Low-floor buses are public transit vehicles designed to ensure
that passengers can board the vehicle using one step relatively low to
the ground or sidewalk. Most of the floor space within the vehicle will
be at the level of the initial entry.
[49] Ramps on low-floor buses are manufactured for deployment on level
ground.
[50] Lift-equipped vehicles are public transit or agency vehicles that
incorporate retractable mechanical platforms that are capable of
lifting individuals who need a means of access into the vehicle other
than the use of stairs from the ground to the level of the floor of the
vehicle. Such individuals may include people who use wheelchairs or
have other mobility limitations.
[51] We did not verify this information.
[52] See appendix III for additional information on the local service
providers we interviewed, as well as information on some of the other
service providers identified by the Beverly Foundation, Community
Transportation Association of America, and TRCP report as having
implemented practices to enhance senior mobility.
[53] The service providers said that in addition to federal funds, they
also use other government funding sources (e.g., from state, county,
transit districts, and municipalities) to fully fund all the services
provided.
[54] DOT's ITS program offers technology-based systems intended to
improve the safety, efficiency, and effectiveness of the surface
transportation system. One objective of the ITS program is to promote
the implementation of a technically integrated and coordinated
transportation system across the country. The service provider in this
example received ITS program funding to coordinate its transportation
software with city and county emergency response transportation
systems.
[55] We did not verify this information.
[56] The service provider told us that it uses Congestion Mitigation
and Air Quality Improvement Program funds for a senior travel-training
program, designed to reduce the amount of single-occupancy vehicle
emissions by helping seniors use public transportation (fixed routes).
The Congestion Mitigation and Air Quality Improvement Program,
authorized by the Transportation Equity Act for the 21ST Century, is
designed to reduce motor vehicle air pollution. It is a flexible
funding source for state and local governments for transportation
projects and programs to help meet the requirements of the Clean Air
Act. Eligible activities include transit improvements and travel demand
management strategies, among others.
[57] The service provider told us that this estimate includes the
administrative (management and clerical) time spent on gathering,
checking, and reporting data for federal programs. The estimate does
not include time spent writing grants or any time spent directing,
providing, or supporting the services funded by these programs. We did
not verify this information.
[58] We did not verify this information.
[59] U.S. Department of Transportation, Transportation Research Board,
Transportation in an Aging Society: A Decade of Experience (Washington,
D.C.: 2004).
[60] Paratransit often refers to wheelchair-accessible, demand-
response van service. The ADA requires that transit operators provide
accessible paratransit service for persons with disabilities that is
comparable to their regular service.
[61] However, to improve services for all citizens, including seniors,
public transportation systems often provide special programs, such as a
half-fare policy for seniors, low-floor or lift-equipped buses for
anyone who requests this service, and ADA-complementary paratransit for
those who are eligible.
[62] According to DOT officials, Section 5310 funds can be used for
operating expenses when an agency contracts for services.
[63] A provision allowing this is in the House's bill for
reauthorization of surface transportation legislation (H.R. 3550),
though not the Senate's (S. 1072).
[64] The Framework for Action was developed by the Departments of
Health and Human Services, Labor, and Transportation as a tool for
states and communities to identify areas of success and highlight the
actions still needed to improve the coordination of human services
transportation.
[65] The House bill for reauthorization of surface transportation does
not contain such a provision.
[66] GAO-03-697.
[67] GAO, Transportation-Disadvantaged Populations: Federal Agencies
Are Taking Steps to Assist States and Local Agencies in Coordinating
Transportation Services, GAO-04-420R (Washington, D.C.: Feb. 24, 2004).
[68] An executive order, issued in February 2004, expanded the
membership of the council to include an additional six agencies (the
Social Security Administration and the Departments of Agriculture,
Housing and Urban Development, the Interior, Justice, and Veterans
Affairs).
[69] U.S. Senate Special Committee on Aging, "Forum: Keeping America's
Seniors Moving: Examining Ways to Improve Senior Transportation"
(Washington, D.C.: July 21, 2003).
[70] GAO, Transportation-Disadvantaged Populations: Federal Agencies
Are Taking Steps to Assist States and Local Agencies in Coordinating
Transportation Services, GAO-04-420R (Washington, D.C.: Feb. 24, 2004),
and Transportation-Disadvantaged Populations: Some Coordination
Efforts Among Programs Providing Transportation Services, but Obstacles
Persist, GAO-03-697 (Washington, D.C.: June 30, 2003).
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