National Strategic Plan for Human Services Person-Directed Mobility Management. Easter Seals

Transcription

1 National Strategic Plan for Human Services Easter Seals R

2 NATIONAL STRATEGIC PLAN FOR HUMAN SERVICES PERSON-DIRECTED MOBILITY MANAGEMENT Prepared for: Prepared by: Easter Seals Project ACTION 1425 K Street NW, Suite 200 Washington, DC Phone: / TDD: Easter Seals Project ACTION for the Federal Transit Administration December 2009 Easter Seals Project ACTION is funded through a cooperative agreement with the U.S. Department of Transportation, Federal Transit Administration. This document is disseminated under the sponsorship of Easter Seals Project ACTION in the interest of information exchange. Neither Easter Seals, Easter Seals Project ACTION, nor the U.S. Department of Transportation, Federal Transit Administration assumes liability for its contents or use thereof. Easter Seals R

3 ACKNOWLEDGMENTS This strategic plan was developed from the proceedings of several conferences Easter Seals Project ACTION convened with assistance from the Community Transportation Association of America (CTAA). Easter Seals Project ACTION is the sponsoring training and technical assistance center for the Easter Seals Person- Directed Mobility Management project. Easter Seals Project ACTION is grateful to Doug Birnie of the Federal Transit Administration (FTA), James McLary of McLary Consulting, Carolyn Jeskey of CTAA, and Kylah Hynes of the American Public Transportation Association (APTA) for their ideas and collaboration on the project. Many of the definitions on mobility management come from discussions with Mr. Birnie and Mr. McLary. The opinions expressed in this document do not necessarily reflect the opinions of the FTA, CTAA, APTA or Easter Seals, Inc. Prepared by: Mary A. Leary, Ph.D. and Rachel Beyerle of Easter Seals Project ACTION ii

4 National Strategic Plan for Human Services TABLE OF CONTENTS Section Executive Summary... 4 Introduction Why Develop a National Strategic Plan?... 9 Background The Need for PDMM Why is a National Plan Needed? Existing Resources...19 Mobility Management Across the Country...20 National Strategic Plan...23 PDMM Goals...25 Goals...26 Objectives and Tasks...27 Creating Access and Meeting Consumer Needs through the Goals and Objectives...32 Outcome Measurement...35 PDMM Outcome/Impact Final Deliverables Conclusion Next Steps References and Appendices...40 References and Works Consulted...40 Appendix A Team Recommendations...43 Appendix B Team Recommendations by Category...45 Appendix C United We Ride Logic Model...47 Appendix D Life Space Mobility Measure...53 TABLES Table 1 Goals, Objectives, and Tasks...30 FIGURES Figure 1 People-Directed Mobility Management Plan Diagram...13 Figure 2 National Spending on Nursing Home Care...17 Figure 3 - September 2008 Team Presentation Examples...24 Figure 4 Human Service Network slides...36 Figure 5 United We Ride Logic Model

5 EXECUTIVE SUMMARY (PDMM) supports the concept that improving mobility and transportation options for those accessing community services, workforce development centers, education, and health services ultimately improves mobility options for everyone. As part of a national initiative to encourage transportation improvements at the community level, Easter Seals Project ACTION has developed a National Strategic Plan for Human Services. This plan is designed ultimately to increase access to community services for people with differing mobility abilities who rely on both formal and informal public and private transportation systems. The plan identifies goals, objectives, and tasks that will guide national organizations as they work with local agencies to increase access to services and community activities. The primary audience for this plan is national organizations that will have a role in furthering the PDMM movement. The primary beneficiaries of the plan are the community service providers who will implement mobility management concepts and the customers they serve. PDMM includes identifying needed services, identifying needed transportation to access services, assessing community transportation resources, assessing an individual s ability to use transportation services, filling service gaps, and providing agencies and individuals with access to and training on how to use local transportation. The Need for The PDMM strategic plan includes recommendations that can benefit individuals, providers, and the community. Access to transportation is critical at a time when states are experiencing fiscal challenges and programs that serve those with limited incomes or older adults, particularly Medicaid and Medicare, are stressed to meet demand. The PDMM strategic plan will help community agencies get information about services to the people who need it and provide training so that those who need transportation learn how to use the service and have means to pay for transportation services, if so required. While many people know about public transit bus service, many may not know about alternative options, such as paratransit, volunteer driver programs or accessible taxis. In frontier, rural or small urban areas, residents may be even less aware of how to get around their region, as the options are fewer. Developing the Plan This strategic plan is based on feedback received during two conferences held in Fall Community services (aging, healthcare, workforce development, education, and 4

6 tribal programs) and transportation professionals from across the country representing stakeholder organizations, state government, regional agencies, and local providers participated. Conference participants discussed a series of questions and offered their thoughts on types of mobility solutions and the process of implementing mobility solutions in their communities. Common themes discussed include: Inventorying existing transportation options and identifying gaps in service or physical infrastructure Providing information and education opportunities, training or tools so that community services providers learn about the importance of transportation Helping recipients of community services learn about the transportation options that exist Helping recipients of community services use the transportation services that are available in the community With these themes in mind, Easter Seals Project ACTION developed a set of goals, tasks, and objectives that takes into account the needs of individuals as well as the needs of the community. This person-directed approach also takes into account that community services interests are often not involved in transportation decision-making, and community services professionals may simply be unaware of the role that transportation has in the community. Goals 1. Build capacity for mobility managers across the United States Educate community leaders on the importance of mobility management by illustrating how implementing mobility management affects economic characteristics, the environment, and the overall quality of life for a community through promotion of independent living. 2. Assess Existing Mobility Options Assess the mobility services available in communities by inventorying existing transportation options and identifying where gaps in service or physical infrastructure exist. 3. Ensure Access to Mobility Services for All Citizens Ensure access to mobility services for all citizens, especially older adults, individuals with low incomes, veterans, people with disabilities, and students through public policy, information, education, and training. 4. Expand Community Awareness Expand awareness of the relationship between transportation and community services through awareness campaigns, mobility professionals, and integration of mobility into local planning processes. 5

7 5. Ensure Sustainable and Efficient Transportation Options Ensure sustainable and efficient transportation options that meet customer needs and improve connections to the community services network. Objectives & Tasks A series of tasks will be finalized to support the following objectives: Goal 1 Objectives: Develop an outreach campaign on the purpose of mobility management for countylevel agencies administering community services, workforce, education, transportation, and healthcare programs. Create a network for mobility manager information exchange Conduct an outreach campaign for community services advocacy groups and direct service providers Goal 2 Objectives: Develop a mobility preparedness assessment survey to measure individuals awareness of available resources and evaluate willingness to consider and adopt new modes of travel. Develop a tool to assist agency-to-agency dialogue so that all can learn about other agencies resources and needs. Make a resources packet of mobility management assessment tools and templates available to city and county agencies. Goal 3 Objectives: Promote infrastructure enhancements that enable physical access to transportation services. Provide educational resources for individuals, family members, and caregivers. Provide a means for individuals to utilize a transportation plan that meets their travel needs. Goal 4 Objectives: Increase the number of access points for mobility information. Create one integrated certification program covering policy, transportation services, and community services, and cultural and institutional awareness in conjunction with the American Public Transportation Association and the Community Transportation Association of America. Goal 5 Objectives: Identify ways that quality of life improvements can be attributed to mobility management. Increase use of healthcare, workforce, education, general community services, and recreation/leisure programs through use of transportation services. 6

8 Maintain on-going communication with national stakeholders and community partners. Establish a national mobility management technical assistance certification program. A series of tasks related to community outreach, professional development, and survey assessment tools have been identified for each of the goals and objectives. The tasks are outlined in the full strategic plan. Outcome Measurement The ESPA Plan recommends measurements that can be used to analyze whether the plan s goals are being met particularly Goals 3-5. The outcome measures take into consideration that each community implements mobility management in its own way. The plan recommends five measures. Three measurements are federal United We Ride logic model measures of cost containment, access, and customer satisfaction. Two additional measures included in the plan are person-centered: Social Network Expansion This is a measure of growth in access to community services through an increase in personal connections to those services. The measurement is the percentage increase in the number of access points per person requiring human services transportation. Examples include taking on employment, attending classes or accessing leisure and recreation activities that may improve one s health, mental outlook or civic involvement. Quality of Life This measure is also referred to as Life Space Mobility in the strategic plan. Life Space Mobility is measured by the percentage of human services transportation riders noting an increase in their perceived quality of life. The strategic plan suggests development of two tools for measuring outcome of the tasks in the plan. The first tool is a revised United We Ride Logic Model that incorporates the three original UWR model measures and the Social Network Expansion and Quality of Life measures. The second tool is a Community Transportation Infrastructure Assessment that will enable local leaders to customize a measurement tool to assess human services transportation infrastructure expansion. Infrastructure expansion can be measured by the number of mobility manager positions created and filled, new levels of service or gaps addressed, and relative awareness of transportation by human service providers. Executing the Plan The objectives and tasks of the Strategic Plan will be executed in cooperation with the Federal Transit Administration and through a partnership of national associations. The organizations include Easter Seals Project ACTION, the American Public Transportation Association, the Community 7

9 Transportation Association of America, the Taxi, Limousine, and Paratransit Association, and the American Bus Association. These organizations will create outreach programs, training opportunities, assessment tools, education resources, and a certification program for mobility managers, local transportation and community service agencies, local policy makers and advocates. A list of specific tasks will be prioritized, and it is expected to take 2 to 5 years to fully implement the plan. Although the plan s audience is national organizations, the target area for implementation is the city and county level. Conclusion The National Strategic Plan for Human Services sets the foundation for a comprehensive program to identify best practices in mobility management, fills gaps in tools and resources, and identifies outcome assessments that can be used to understand the cross-cutting elements of transportation access for human services users. The goals of the plan are designed to reduce costs across community services and transportation systems; improve access to transportation for people with disabilities, older adults and people of limited income; improve customer satisfaction for human service transportation; increase human service networks that enable people of all ages to live more fulfilled and community-based lives; and improve their overall quality of life. Transportation is an integral part of independent living, and access to transportation is vital for older adults with mobility impairments. In addition, the plan will aid in the expansion of community infrastructure needed to help fuel economic expansion through increased access to jobs. Finally, and perhaps most importantly, the plan will ultimately have a role in helping professionals and families create communities where more people can participate in jobs, schools, civic roles, social networks, recreation and leisure, and have access to health and community services--access that not only allows individuals to live independently but also allows them to experience a higher quality of life. 8

10 National Strategic Plan for Human Services Person- Directed Mobility Management I know that we can I know that we shall begin here the fuller and richer realization of that hope that promise of a land where all men are free and equal, and each man uses his freedom and equality wisely and well. Hubert H. Humphrey, 1948 INTRODUCTION WHY DEVELOP A NATIONAL STRATEGIC PLAN FOR HUMAN SERVICES PERSON-DIRECTED MOBILITY MANAGEMENT? The basic American tenets of freedom, equality, and civil rights for all cannot be achieved without equal access to transportation. Like the information superhighway and the national highway systems that preceded it, the Federal Government has led the investment of national networks that enable everyone to be connected and facilitated equal opportunity and access to the American dream. It is now time to turn that same federal attention to the development of greater public transportation systems that support mobility for everyone, everywhere and at anytime their lives require it whether or not they can drive. Yet, often, transportation services and access to them in a community intersect across a bewildering array of regulations, planning and local ordinances. A host of movements today help people who especially need those services people with disabilities, older adults and people with limited income find and use them to gain access to the systems they require to live in their communities. One set of systems everyone needs for independent living, including people with mobility impairments, is commonly referred to as human services. Human services include those related to health, employment, education, civic engagement, community services, nutrition, and recreation. For over four years, a federal program in the United States, the United We Ride federal interagency initiative, has been striving to increase human service transportation for people with mobility limitations. United We Ride addresses a key goal of the Federal Transit Administration (FTA) to increase transit ridership by: Identifying best practices and technologies to increase transit ridership, Identifying and overcoming barriers to the adoption of ridershipenhancement techniques, Identifying solutions to provide public transportation for targeted populations, such as people with disabilities, older adults and people with limited income, and Identifying cost-effective solutions to provide rural public transportation services. 9

11 Based on a 2004 executive order, United We Ride addresses the development, implementation, and maintenance of responsive, comprehensive, coordinated community transportation systems that are essential for people referred to as human services disadvantaged who rely on such transportation to fully participate in their communities (Executive Order 13330, 2004). Now, with United We Ride in place, this type of collaboration is sought between all groups that transportation services in the U.S. have historically underserved (i.e., human services disadvantaged including people with disabilities, people with low incomes, and older adults). Over 62 different federal programs, from which states derive over $2.4 billion in grants/contracts, serve the special transportation needs of people with low-income, people with disabilities, and older adults (GAO, 2003). The U.S. Government Accountability Office (GAO) outlined many challenges states face as they strive to understand and use these programs, each with different funding cycles, different reporting requirements, and different regulations (GAO, 2003). GAO estimates that $2.4 billion is being spent in just 50% of these programs for human services transportation (2003). The Department of Health and Human Services, Department of Labor, Department of Transportation, and Department of Education are the major sponsoring agencies for these programs. Human services transportation access challenges for inclusive living differ depending upon such factors as public and private transportation resources; human services agency knowledge of these transportation resources; whether a community is urban, rural, suburban or frontier; and the various mobility skills of people using local human services. One program FTA s United We Ride initiative currently champions to address these needs is person-directed mobility management (PDMM). PDMM supports the concept that improving mobility and transportation options for those accessing human services, workforce development centers, education, and medical services ultimately improves mobility options for everyone. This can happen through potential changes such as expanded service hours, more accessible vehicles, information dissemination, and stronger political emphasis on the importance of transportation to the community. PDMM is part of a broader mobility management effort being undertaken at the national level. This strategic plan is designed to supplement and support the mobility management initiatives of national partners like the Community Transportation Association of America (CTAA), the American Public Transportation Association (APTA), and the Taxicab, Limousine, and Paratransit Association (TLPA), and the American Bus Association (ABA). Easter Seals, through its Easter Seals Project ACTION FTA training and technical assistance cooperative agreement, has a twentyone year history of outreach and providing tools, such as its Mobility Planning Services, for community leaders to gather together to discuss regional issues, collaborate, and plan for locally-based projects. Easter Seals, in partnership with the National Association of Area Agencies on Aging, manages the National Center on Senior Transportation providing training, technical assistance, outreach and applied research 10

12 to expand transportation options for older adults in communities across the United States. CTAA has placed emphasis on training and certification, and has established communication for sharing industry practices and policy. CTAA also hosts the National Joblinks Employment Transportation Initiative. Joblinks provides training and resources for overcoming transportation barriers that face current and prospective workers, especially those with specialized transportation needs (people with disabilities, older adults, youth, low-income, late night and early shift workers). CTAA also manages the CTAP (Community Transportation Assistance Program) for the Department of Health and Human Services with a primary focus on medical transportation and other human services transportation for people served by DHHS programs such as TANF and Medicaid. CTAP includes a peer to peer network in support of these initiatives. Another CTAA program that ties to the development of mobility options at the state and local levels is the National Resource Center on Human Services Transportation Coordination (NRC). The NRC provides technical assistance and advice on public transportation and coordination with medical care, employment, education, and services for people with disabilities, and senior adults. APTA supports certification and standards setting for direct transit service provision and emphasizes the importance of transportation as an economic driver, particularly in regards to job creation. In this vein, APTA s own mobility management plan recommends establishing mobility manager positions, encourages transit systems to create partnerships with private service providers, recommends greater use of information technology for real-time information, encourages development and implementation of one-stop travel information centers, traffic management strategies, and coordination of public transportation with land use and infrastructure. APTA is also making the business case for cost savings associated with mobility management through shared rides to cut paratransit costs, coordinated dispatching, and vanpool and taxi services that serve as alternatives to some ADA paratransit trips. TLPA s mobility management-related activities range from member participation in policy decision-making at the local level to driver sensitivity training. This includes ensuring that local inventories and information materials include information on private providers, operating brokerage or call centers, and advocating for demand response service that may be able to be provided through a private provider. ABA bolsters mobility management concepts through its support of a modally-integrated and passenger-focused network. ABA members provide tour, travel, and charter opportunities for communities and individuals nationwide. The association s services connect rural communities to transportation and service hubs as well as provide accessible transportation for travel and leisure. ABA is committed to working with local transportation connecting communities with rail, air, and bus stations and by sharing information to help customers in an area travel in and through the region with access to points beyond. Through using private match and working with DOTs, consultants, local operators and governments, ABA members seek to build connections and relationships 11

13 to support a national network of intercity services. These services can help customers use the public and private transportation systems more seamlessly. Each association, in addition to affiliated national stakeholders, brings strengths to the table that will support creating information tools and training materials for human service program providers, their customers, and their families. In addition, the programs and technical assistance centers housed as these national associations can provide outreach opportunities and strategies to connect federal, state, and local entities. This strategic plan presents best practices and concepts gleaned from local, state and national leaders that can be used to implement PDMM in cities and counties, states, regions, and communities across the U.S. The vision for PDMM is to increase access to human services for people with mobility limitations who rely on both formal and informal public and private systems for transportation to the human services of their choice. PDMM is defined best by the steps required to implement it: Identify needed services, Identify the transportation required to access them, Assess community transportation resources, Assess the functional ability of client to use available transportation services, Fill service gaps, and Provide agencies and individuals access to and training on how to use local transportation services. Since the executive order was released, United We Ride has been developing tools and resources to help states and local communities expand transportation options for older adults, people with disabilities, and people with limited incomes. United We Ride refers to these needed transportation options as a family of services that include public transportation services, such as fixed route, ADA complementary paratransit, flex-route, service routes and other publicly funded transit; volunteer-driver programs; ride sharing options; voucher programs; driver-safety programs for older adults to help them drive safely longer; social-services transportation programs, such as those funded by the Older Americans Act; faith-based transportation; caregiver transportation; creative approaches to public/private partnerships, such as Intelligent Transportation Network of America; and the use of enabling technology and one call systems through intelligent transportation systems, such as those being fielded by the Department of Transportation Mobility Services for All Americans Program. FTA funds a number of technical assistance programs as part of United We Ride. Three of these programs are pertinent to a discussion of PDMM and the organizations 12

14 supporting these centers: Easter Seals Project ACTION (ESPA), the National Center on Senior Transportation (NCST), and the National Resource Center (NRC). All three programs are operated through cooperative agreements between FTA and national non-profit organizations. ESPA is led by Easter Seals, Inc., the NCST is a joint program between Easter Seals, Inc. and the National Association of Area Agencies on Aging, and the NRC is led by the Community Transportation Association of America (CTAA). Easter Seals and CTAA are collaborating on the development and deployment of tools and best practices for human services people-directed mobility management. In addition, the FTA has funded the American Public Transportation Association (APTA) to construct a national strategic plan for transportation mobility management that addresses both system and service management for transit agencies. ESPA was charged with preparing a strategic plan that focuses on the connection between human services providers and their customers who require access to transportation resources. ESPA developed the diagram in Figure 1 to illustrate the integration of human-services systems and transportation systems through persondirected mobility management: FIGURE 1 United We Ride espouses three overarching goals for coordinated communities that also relate to PDMM: increasing efficiency through more rides for the same or lower cost; increasing effectiveness through easier access to transportation resources; and; increasing customer satisfaction through higher quality services (2007). As the diagram shows, PDMM achieves these goals by coordination between two systems human services and transportation to enable inclusive community living for people with disabilities, older adults, and people with limited income. 13

15 Mobility Management At its essence, mobility management is about managing resources, not managing people by identifying transportation resources and making them available to agencies and individuals, mobility managers are connectors of transportation services on behalf of people who need those services. Mobility management can be viewed as having four levels of application: (a) policy adoption or development of institutional standards; (b) agency-to-agency coordination; (c) development of the coordination manager or navigator role; and (d) direct customer service to individuals and their families. National, state, regional or community-based coordinated planning and partnership initiatives take place at a policy and institutional level. This includes establishment of mobility or coordination councils, planning forums, and memoranda of understanding. Day-to-day coordination that places transportation on the road takes place at the next level. This may include funding, establishing brokerages, or sharing vehicles. Coordination also includes partnership development and collaboration. Mobility managers, transportation navigator or coordinators make up the third level. These professionals may perform community outreach, identify transportation services, serve as mobility advocates, participate in mobility planning or advisory committees, and meet with employers or operators of major destinations to encourage their involvement in mobility planning. Those who use transportation services and the staff who work directly with the passengers make up the fourth level. This may include vocational rehabilitation workers, one-stop labor-center employees, transit employees, travel trainers, healthcare or education professionals. State and local governments across the country are in different stages of managing mobility and involving human services agencies in transportation decision-making or applying human services funding to mobility services. Some jurisdictions have projects incorporating all four levels of mobility management; others are beginning conversations about policy or institutional structures to incorporate human services perspectives into transportation planning. Others have created and funded mobility management positions or held transportation awareness training for workforce development center staff. The pace and extent to which mobility management practices are being implemented across the country, as well as the varying types of activities, signifies that each community has a different focus. Mobility management succeeds when it reflects the travel patterns, land use, and values of a community. BACKGROUND THE NEED FOR PDMM Programs and systems supporting the family of services go across many different state agencies and present significant challenges to state leadership in order to catalog, leverage, and provide integrated access to such services. This crossing of organizational boundaries makes collaboration and coordination essential. Many states increased progress in transportation coordination over the last 20 years by establishing 14

16 formal coordination organizations through legislative mandates, executive orders, or memorandums of understanding. Coordinated transportation through formal planning systems interweaves the perspectives of key stakeholders and integrates the spectrum of policy approaches to increasing transportation access to a family of community transportation services. The Coordinating Council on Access and Mobility, established by the 2004 Executive Order, is the executive group approving key steps in the United We Ride initiative. They have made a number of policy recommendations to expand coordinated transportation. These polices encourage coordination of programs and states that there is nothing in Federal law that prohibits trip and vehicle sharing. The specific polices are: 1. That coordinated transportation planning be promoted which is now codified in SAFETEA-LU (Safe, Accountable, Flexible, Efficient Transportation Equity Act: Legacy for Users). This Federal Transportation reauthorizing legislation passed in 2005 requires state DOTs [Department of Transportation] to develop coordinated human service transportation plans across stakeholders, including nonprofit, private, state, and community organizations. 2. That federal agencies review and revise their transportation programs to allow for vehicle sharing. 3. That federal agencies find ways to address cost allocation to encourage economies of scale and resource sharing. 4. That a model for reporting and evaluation be developed, which is now completed with the 2007 publication of the United We Ride Logic Model for Coordinated Communities. 5. That a consolidated-access demonstration program be initiated to show how a single program could meet the needs of all transportationdisadvantaged populations. (United We Ride, 2005) At the local level, PDMM implements many of these recommendations. The need is compelling for PDMM today with the financial crisis facing families and communities alike. As in the early years of the 20th century, local news abounds with stories of how states are experiencing serious fiscal challenges and critical programs that serve people with limited incomes, such as Medicaid, are particularly stressed. Additionally, Medicare, our national health insurance system for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant), is also financially challenged while the groups served by these programs are growing. Though the U.S. Census found that the average household income rate of $50,233 was slightly higher than the previous year (August 2008), 2008 witnessed the 15

17 beginning of a fiscal crisis with falling housing prices, volatile gas prices, and rising unemployment rates that many believe is dwarfed only by the Great Depression. Official estimates of the fiscal effects of 2008 are not yet available; however, the most recent U.S. Census report notes some troubling trends. In particular, poverty rates increased for Hispanics and stood at 21.5 percent in The poverty rate for children under 18 years old increased 0.6 percent between 2006 and 2007 to a rate of 18 percent. (U.S. Census, August 2008, p. 12) Among those living below the poverty line, people with disabilities are disproportionately represented. In the U.S., there are 41M people estimated as having some level of disability. Poverty rates among people 25 to 64 with a non-severe disability are 11 percent compared to 26 percent of those with a severe disability, and 8 percent of those without a disability (U.S Census, May 2008). By 2030 the over-65 adult population is expected to reach in excess of 70 million, over twice today s over-65 population, and with the over-85 population expected to double from the 5.3 million in 2006 to 8.9 million (Administration on Aging, 2008). If the high disability rates among older adults and the high poverty rates among people with disabilities remain similar to the 2008 rates and the current fiscal challenges intensify, the needs for human services transportation are also expected to intensify. The largest funder of human services transportation is the federal Medicaid program. Currently, Medicaid non-emergency transportation represents the largest state and federal investment in human service transportation. It dwarfs social service transportation efforts.... (Koffman, Raphael, & Weiner, 2004, p. 33). Other local transportation services are funded by federal, state, or private sources, including Older American s Act programs, FTA programs, Department of Education programs, Department of Labor programs, FTA, matching funds from states and localities, nonprofit contributions, and fee-for-service transportation, such as taxis, privately run shuttle services, and charter service. People with mobility limitations rely on both formal transportation such as public transportation and Medicaid, as well as informal transportation such as that provided by volunteers and caregivers older adults are especially represented in this latter group. Many caregivers are family members. Metlife estimates the lost productivity costs to businesses for the estimated 7M working caregivers to be between $17.1B and $33.6B (Metlife, 2006). AARP shows even larger costs for caregiving and strong growth in those costs: 34M family caregivers provided care at an unpaid cost of $375B in 2007 up from $350B in 2008 (2008). Loss of productivity is one area of concern for businesses and government agencies investing in human resources. In a similar vein, state and local governments take an interest in measuring the benefits from public investment in transportation. The Florida State University College of Business conducted a return on investment study for the Florida Transportation Disadvantaged Program to assess the return on investment the state of Florida receives when state funding is spent on transportation to get individuals to jobs, healthcare, schools, and shopping. Florida has five common types of 16

18 transportation disadvantaged programs for medical, employment, education, nutrition, and life-sustaining trips. For medical trips alone, it was found that if one percent of medical trips resulted in a hospital stay, then the payback to the state is about $11 for each dollar the state invests in the program (Cronin, 2008). It is important to address the need for Medicaid and caregiver costs containment because these costs are a growing need and access to transportation resources in the community will help facilitate this cost containment through both cost avoidance and actual cost reductions that can be achieved by less costly forms of care such as community based care. Often, the workers who assist to provide personal care and home health care in the community also require transportation services. The Kaiser Foundation helps underscore this comparison of nursing home care costs with home health care costs in the long-term care system. Healthcare spending distribution for those people with disabilities or advanced age who require assistance with activities of daily living is shown in the charts below (Figure 2). As illustrated, nursing home care costs surpassed home healthcare costs by over $60 billion in FIGURE 2 (Kaiser, 2006) Access to healthcare, whether to enable a patient to visit a doctor or enable a personal care assistant to reach a patient s home, is not the only human services function with a connection to the transportation system. Human services transportation spans the health, social services, education, employment and disability sectors of states, local agencies, and services providers. Often, policy initiatives, such as state legislative acts or executive orders, create a venue for such joint planning through coordination councils. A 2005 National 17

19 Conference of State Legislators (NCSL) study provided a compendium for state transportation coordination models and their associated legislative approaches suggesting that: The large number, diversity and dispersion of specialized transportation programs across many agencies potentially can create ineffective and inefficient service and problems.... To combat these problems, government agencies, human service organizations and transportation plans have advocated improved program coordination. (Sundeen, Reed, & Savage, 2005, p. ix) Thus, when we assess the demographic imperatives of our time, mobility management services facilitated by PDMM may hold the key to addressing both economic issues and quality-of-life needs for communities, families and people with disabilities. Furthermore, to ensure that mobility and access to human services is a reality for people with disabilities, older adults and people with limited income, the development of PDMM and the creation and dissemination of tools, resources, and guides that communities can use is essential. This is the reason FTA commissioned this PDMM strategic plan. Why is a National Strategic Plan needed? The statistics for poverty rates, healthcare needs for people with low incomes, people with disabilities, and the projected increase in the number of elderly adults indicate that transportation access will continue to be a necessary, integral link to community agencies, healthcare, and education. In general, transportation agencies are aware of the various types of services available in their community whether public transportation, private transportation, taxi services or other forms of transport. Community services providers, caseworkers, educators, medical providers, and workforce centers may not have all the information that is available on the variety of transportation options available or may not know what resources are available to help train clients to use transportation services or what programs can be used to pay for trips. This strategic plan is designed to fill those gaps. The mobility management (PDMM) strategic plan is needed to help community agencies get information about services to the people who need it, provide training so that those who need transportation learn how to comfortably use the service, and have means to pay for transportation services, if so required. While many people know about transit bus service, many may not know about alternative options such as paratransit, volunteer driver programs or accessible taxis. In frontier, rural or small urban areas, consumers may be even less aware of how to get around their region, as the options are fewer. 18

20 Existing Resources The national associations will not be starting from scratch when it comes to developing training tools. As mentioned previously, the CTAP, Joblinks, and NRC programs are examples of existing technical assistance centers that provide networking, information resources, and training. Easter Seals, APTA, and the National Transit Institute also offer several existing training opportunities that focus on mobility management or include elements of mobility management such as connecting to human services agencies through community collaboration, raising opportunity awareness, and working with customers to create an individualized transportation plan. These resources are highlighted below: CTAA-Easter Seals Transportation Solutions Curriculum Developed by Easter Seals and CTAA, this curriculum is targeted toward mobility managers, workforce development, and human services professionals who may be unfamiliar with the range of transportation options available or the resources that could help them connect to the community. Curriculum for the course includes strategies for gathering information on transportation services, information on funding sources, how to develop an individualized transportation plan based on a template developed by the Beverly Foundation, and support services that assist people to use transportation. In addition, there is information on steps to take to affect the community s efforts to improve transportation options. The course also comes in a condensed version that can be used by direct-service providers whose customers need transportation. Easter Seals Mobility Planning Services Easter Seals Project ACTION and the National Center on Senior Transportation both host Mobility Planning Services team leadership institutes for community leaders in transportation, transit customers who have disabilities, and leaders in the area of accessibility decision-making. The ESPA event is called the Accessible Transportation Coalitions Initiative and enables community leaders to participate in a facilitated discussion that will enable them to identify an accessibility goal and develop an action plan for implementing that goal in their community or region. The NCST training event is targeted toward senior transportation issues and is called the Senior Transportation Institute (STI). STI runs parallel to the Accessible Community Transportation Services Institute; the senior training is for community teams encompassing older adults, area agency on aging representatives, local personnel and officials, private providers and volunteer transportation programs. CTAA Institute for Transportation Coordination The ITC is a three-day planning and training forum to help communities learn about coordination, local coordination practices, community outreach, partnerships, and funding. Team members are traditionally representatives from the community's transit, 19

21 workforce, and disability service organizations, as well as a member from a senior service organization, medical transportation provider, or local elected government. APTA APTA s current mobility implementation plan includes developing a network of mobility managers and eventually developing a mobility management curriculum focused on transit agencies without duplicating existing training programs. National Transit Institute The National Transit Institute (NTI) is housed at Rutgers, the State University of New Jersey, and since 1992 has provided training, education, and clearinghouse services that support public transportation. NTI offers a number of courses pertaining to transit management, planning, safety and security, and the use of technology in the transit field. Regarding mobility management, NTI offers a two-day course titled Coordinated Mobility: A Unified Transportation Management Solution. This course is designed for human services professionals, transit providers, brokerage firms, and transit managers. The objectives include learning about forging partnerships, understanding customer needs, identify and promote benefits of mobility management, awareness of opportunities, elements of mobility management and planning, and identifying funding resources. Mobility Management Across the Country In addition to national-level training opportunities, mobility management is already taking place in various forms across the country at the state or local level. With the implementation of a national strategic plan, all state, county, and city-level agencies will have a structure they can use to assess the mobility needs in their communities and identify the type of projects that will work best for each community. What has worked in California, Washington State, Wisconsin or Michigan may well be adopted in other parts of the country or new ideas may surface! The following examples are provided to demonstrate how states and local agencies have tailored projects to meet the specific needs of their customers, and they illustrate how mobility management is already being implemented in the field. The list is not inclusive, but rather provides a sampling of what is going on around the country: Wisconsin Mobility Managers The state of Wisconsin formed an Interagency Council on Transportation Coordination in 2005 as a first step toward development of coordinated human services public transportation plans and implementation of mobility management. In 2008, 29 mobility managers were hired using New Freedom, JARC, and rural funding. Mobility managers are employed by aging centers, cities, counties, and transit commissions, the United Way, independent living centers, community action coalitions and economic opportunity councils. Projects implemented include regional mobility management projects, car 20

22 loan programs, new service projects, voucher programs, vehicle repair, carpool, rideshare, shuttle, travel training, and volunteer drivers. The state makes available a mobility manager training program that covers the definition of mobility management, resources to assist with coordination, and how to build relationships with a community. Wisconsin mobility managers keep in contact via workshops, monthly teleconferences, and two Google groups. South Carolina Travel Management Coordination Center (TMCC) The Lower Savannah Council of Governments (LSCG), based in Aiken, South Carolina, provides regional services such as the Area Agency on Aging, an Aging and Disability Resource Center (ADRC), transportation coordination, and other development and enhancement programs. LSCG works to make it easier for people to access information and resources and is building a transit network to serve the region. The agency s focus is on older adults, adults with disabilities, caregivers, and people who need transportation. LSCG offers a one-call information center through its ADRC. In addition, there are mobility managers to help people find and schedule transportation. Lower Savannah is the recipient of a USDOT Mobility Services for All Americans Initiative grant. Through this initiative, LSCG is establishing a Travel Management Coordination Center (TMCC). The TMCC will integrate with the ADRC one-call center, and the center will offer mobility management services to help people link to rides and provide coordination to the transportation network. Lower Savannah s structure serves as a solid foundation for the TMCC. LSCG is South Carolina s first ADRC. This has helped with setting up necessary infrastructure for a one-call center, gaining a reputation as a place for reliable information and assistance, and establishing credibility to attract other resources. The travel center project has helped four counties establish new public transit systems using existing human services vehicles and travel patterns. Mobility managers answer calls and match customers with opportunities. The application of technology has facilitated one call capacity, real time ride information, performance tracking, streamlined service, and cost reduction. California DMV program The Older Californian Traffic Safety (OCTS) Task Force is administered by the California Highway Patrol. The taskforce carries out activities through workgroups that address aging services, health services, law enforcement, licensing, mobility, policy and legislation, public information, and transportation safety. The aging services initiative under this program includes a DMV policy where each DMV office has an identified staff member who serves as an in-house resource on older adult safety and mobility. The staff member disseminates information and resources. A licensing workgroup has worked to identify agencies able to assist older adults when they are de-licensed. California DMV has collaborated with Sacramento County Area 21