Community and Public Transportation: Viable Transportation Options for Older Persons

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1 Community and Public Transportation: Viable Transportation Options for Older Persons Jane Hardin Community Transportation Association of America 1341 G Street, N.W. 10 th Floor Washington, D.C Tel: FAX:

2 Issue Statement Two issues: Non-emergency medical transportation and Public transportation as a mobility option for older persons and Non-Emergency Medical Transportation Medical transportation is usually given as the first transportation need of older people. Medicare, the Federal program that provides health care cover for 35 million persons 65 and older, however, provides no coverage for non-emergency medical transportation. It presently authorizes reimbursement for trips made only in ambulances. The results of this policy are both nonsensical and cruel. The nonsensical results are that ambulances are often used for medical trips that can be provided by less expensive transportation options: By conservative estimates, Medicare could save $265 million dollars annually in transportation costs to hospitals and $37 million dollars annually in medical services provided in other than emergency department facilities if current procedures that reimburse only ambulance transportation were altered. Benefits of Transportation Services to Health Programs, by Jon E. Burkhardt, Community Transportation Magazine, pp at p. 32. September/October i These annual savings estimates are based on studies conducted in1999 and 2000; as the 65 and older population increases, we can expect savings estimates for later years to be even higher. ii The cruel result of Medicare s policy of not reimbursing for non-emergency medical transportation is that older Americans are denied access to preventive health and health improvement services. A local alliance of North Carolina community leaders prepared the consequences of a lack of mobility and access to services: A delay in receiving medical attention and/or obtaining necessary medications, resulting in illness that is more serious; reduced quality of life; and increased cost of care to the patient, medical providers and the community. A significant use of the emergency room for non-emergency care, resulting in increased cost and less efficient use of emergency services. Decreased use of preventative care opportunities, health improvement programs and public and private human services. Isolation from the community, particularly for those who are economically disadvantaged, on fixed incomes or who are part the growing population of elderly. iii Lack of access to preventive health services is likely to lead to more severe illnesses that result in institutionalization and shortened lives.

3 Public Transportation as a Mobility Option Older people use public transit for about 3 per cent of their trips. iv This figure is probably the most widely known statistic about older people and public transportation. It is usually used as proof of the futility of offering public transportation as an option for older non-drivers and people cutting back on their driving. The accompanying explanations for the only 3 per cent figure often are: By time an older person stops driving, he or she is too frail to use public transportation to board the high steps, to walk the long distance to the bus stop, and then to stand in extreme weather until the bus comes. These statements are valid descriptions of some public transportation systems and of the needs of many frail older people especially those generally in the 85 and older age range, who require specialized transportation service and an escort. These statements, however, are only partial explanations of the 3 per cent figure. One leading reason that older people don t use public transportation is that there isn t any to use. Slightly more than thirty-four per cent of older people live where there is no public transportation system. v In urban areas, older people account for 10 per cent of all trips. The Community Transportation Association s data show that older people account for more than 30 per cent of transportation use in rural areas and in cities of less than 50,000. vi Even when public transportation is available, however, significant numbers of older people don t use it. When queried in focus groups, formal surveys, and personal conversations -- they say they don t use public transportation because it is inconvenient it does not go where they want to go, it is not accessible, and it is hard to figure out. Two common themes emerge from their answers whether in focus groups, formal surveys, or personal conversations: First, a significant portion say that if public transportation became easier to use (to get to the bus and to board it) and service improved (on-time arrivals, comfortable vehicles, weekend and evening service, helpful and courteous drivers), they would use it or seriously consider using it. Second, their preferences and needs are quite similar to people of other ages. The first theme is important because it indicates that if public transportation systems provide improved services, older persons will consider using public transportation. The second that most people over 65 want transit improvements similar to those of the general adult population makes it more practicable for public transportation providers to make the improvements older people want because the improvements are likely to attract more riders of all ages. Examples of Senior-Friendly Transportation Today a number of community and public transportation providers are adding services features that make their systems more comfortable and attractive to all passengers, but that are particularly helpful to older passengers. Buses with low floors and low-platform

4 boarding are becoming standard. Communities are using innovative routing: circulator buses; combinations of demand-responsive and fixed routes; and fixed/deviation routes -- buses that follow a route, but stop at any corner when a person waves. Transportation providers are adding features that make their systems more generally attractive and comfortable: In New York City, the MTA has purchased new bus seating designed with higher seats and back cushions to support a person s lower back. In Tempe, Arizona, Valley Transit has bus stop shelters with cooling mechanisms in theirs ceiling that release drifts of mist to cool the air. The Upper Great Plains Transportation Institute in Fargo, North Dakota sponsored an architectural competition to design bus shelters heated bus shelters. Through a federal grant for bus facilities, at least one of the new shelters will be built. These examples are not yet typical, but they are successful and realistic indicators that public and community transportation can be a viable transportation option for older nondrivers. Current Federal Role: Programs and Activities Related to Senior Transportation The Federal Transit Administration Since 1964 the federal government has invested to support public transit services. This investment comes from the U.S. Department of Transportation through the Federal Transit Administration (FTA). The 10 regional FTA offices and designated officials in each state Department of Transportation provides localized technical assistance, outreach and guidance on the use of these funds. The primary FTA investment in general public transportation comes through two formula grant programs: one to Urbanized Areas, (Section 5307); and one to non-urbanized areas, populations less than 50,000 (Section 5311). In addition, the Rural Transit Assistance Program (RTAP) provides $5.3 million in formula spending to states for rural transit training and technical assistance. The Transit Capital Assistance Programs for Elderly Persons and Persons (Section 5310) is the FTA program that focuses on senior transportation. The 5310 program provides formula funding to states for the purpose of assisting private nonprofit groups and certain public bodies meeting the transportation needs of elders and persons with disabilities. The Americans with Disability Act The Americans with Disability Act requires public transportation agencies that provide fixed-route public transportation to provide paratransit services for persons who cannot use accessible fixed-route services due to a disability, but provides no funding. It is estimated that approximately one-half of all ADA passengers are older persons.

5 Medicaid, a state-federal program for low-income persons, provides transportation to medical appointments, but not trips to the pharmacy. Medicare reimburses only for ambulance trips, and does not cover non-emergency medical trips. Transportation Funding and the Older Americans Act (OAA) Area Agencies on Aging (AAAs) receive funds from their respective State Unit on Aging to plan and develop services. Title III-B of the OAA is the primary funding source for transportation. Recipients of III-B funds for transportation are also often recipients of FTA 5310 funds that can be used for capital investment, e.g., vehicle purchase. Memorandum of Understanding between the Federal Transit Administration and the Administration on Aging The two agencies have agreed to foster coordination of transportation services. Policy Opportunity The White House Conference on Aging is itself a policy opportunity for the Federal Government to act as a catalyst for building consensus and to energize the delegates to return to their home communities to mobilize older people to advocate for aging programs and services, and to engage in their planning and creation. Recommendations Medicare should fund non-emergency medical transportation. Over fifty percent of all ambulance trips are estimated to be non-emergency that could be handled by local community and public transportation providers. Even shifting limited trips, e.g., kidney dialysis and chemotherapy, to community and public transportation operators could save millions of dollars. Policymakers should also look into innovative approaches to providing quality non-emergency transportation including a program of Medicare transit passes similar to the Medicaid pass program. There should be increased federal and state investment in public transportation and there should be policies that encourage customer-oriented approach to public transportation. One percent of 5307 (urbanized areas) funding allocations must be spent on transit enhancements. The federal government should provide information and technical assistance to urban transit providers on enhancements that will benefit all passengers, but especially older passengers, e.g., comfortable bus stops and bus shelters that protect passengers from weather extremes.

6 AmeriCorps or a similar government agency should create a program of fulltime volunteers who will be assigned to public and community transportation providers to develop programs and services for older people. Successful precedent: Annapolis (Maryland) Transit obtained an AmeriCorps volunteer to develop transportation services for older persons who were too frail to use public transportation or ADA paratransit. The volunteer worked with a local nonprofit aging services agency to create a volunteer driver program to provide recurrent transportation for frail elders.

7 Appendix I CURRENT FEDERAL ROLE IN PLANNING by Chris Zeilinger Under current Federal law, states and metropolitan areas are required to prepare shortand long-range transportation plans. These plans are to be developed with varying levels of stakeholder participation, and with public involvement. Among other factors, these transportation plans must consider the following factors (codified at 49 USC 5303, among other places; emphasis added): (A) support the economic vitality of the metropolitan area, especially by enabling global competitiveness, productivity, and efficiency; (B) increase the safety and security of the transportation system for motorized and nonmotorized users; (C) increase the accessibility and mobility options available to people and for freight; (D) protect and enhance the environment, promote energy conservation, and improve quality of life; (E) enhance the integration and connectivity of the transportation system, across and between modes, for people and freight; (F) promote efficient system management and operation; and (G) emphasize the preservation of the existing transportation system. Furthermore, Federal transportation law (at 49 USC 5303(e)(4)) requires states and metropolitan planning organizations to coordinate, to the maximum extent practicable, the design and delivery of transportation services within the metropolitan planning area that are provided-- (A) by recipients of assistance under this chapter; and (B) by governmental agencies and non-profit organizations (including representatives of the agencies and organizations) that receive Governmental assistance from a source other than the Department of Transportation to provide non-emergency transportation services. Meanwhile, the Older Americans Act, in which one of the stated objectives is to secure for older persons the opportunity of access to low-cost transportation (Sec. 101, item (8)), has specific planning requirements for state and area agencies on aging. For area agencies, these include plans for providing a comprehensive and coordinated system for supportive services (Sec. 306(a)(1)), and for effective and efficient procedures for coordination of entities conducting other Federal programs for older individuals at the local level (both at Sec. 306(a)(6)(E) and at Sec. 306(a)(12)). In addition, state units on aging have a specific requirement that their plans shall provide assurances that the State will coordinate public services within the State to assist older individuals to obtain transportation services associated with access to services provided under this title, to services under Title VI, to comprehensive counseling services, and to legal assistance (Sec. 307(a)(24)). POLICY OPPORTUNITY

8 Pending reauthorization of federal highway and transit programs is expected to increase the obligation of state and metropolitan transportation planning organizations to coordinate their plans and programs with related activities and stakeholders. For example, a pending revision to 49 USC 5303(e)(4) in the U.S. Senate would have the metropolitan planning process develop transportation plans with due consideration of, and in coordination with, other related activities within the metropolitan area (emphasis added). Comparable language is found in other pending versions of this legislation, and thus may be expected to become enacted in the nation s next surface transportation act. In addition, all pending versions of the transit reauthorization include proposed provisions for states and localities to make funding decisions in the transit programs for elders and persons with disabilities ( Section 5310 ), job access and reverse commute, and similar programs based on locally developed, coordinated public transit-human services transportation plans, to borrow the pending House language as an illustration. Given these directions toward increased coordination of transportation planning processes in surface transportation law, there is a tremendous opportunity to harmonize this effort with planning for transportation and related supportive services within the soon-to-be-reauthorized Older Americans Act. POLICY RECOMMENDATIONS Renew the Federal transit laws at 49 USC Chapter 53 to include the language now passed by the House of Representatives and before the Senate that is cited above to enhance the coordination of planning between public transportation and services for older persons. Amend Sections 306 and 307 of the Older Americans Act to provide that state and area agencies on aging develop the transportation aspects of their respective plans for aging services in consultation with the appropriate statewide and metropolitan transportation planning agencies. In recognition of the importance of transportation access to older Americans, and in recognition of the recent Executive Order 13330, concerning Human Service Transportation Coordination, amend the citation now found at Sec. 203(b)(9) of the Older Americans Act to include all the Federal public transportation programs authorized under title 49, United States Code, chapter 53. Ensure greater consistency between planning and service delivery for older persons, and planning and service delivery of transportation services, by amending Sec. 306(c)(1) and Sec. 306(c)(2) to include the Federal public transportation programs authorized under title 49, United States Code, chapter 53 along with the existing references to programs under the Rehabilitation Act of 1973 and titles XIX and XX of the Social Security Act as legally allowable partners for the planning and purchase of transportation services for older persons.

9 i Benefits of Transportation Services to Health Programs, by Jon E. Burkhardt, Community Transportation Magazine, pp at p. 32. September/October ii Ibid. iii Ibid. iv Improving Public Transit Options for Older Persons, Executive Summary of TCRP Report 82, reproduced in Community Transportation Magazine, pp at p. 47. September/October v. Ibid vi Federal Express by Chris Zeilinger, How We Assure Senior Mobility, pp at p. 10. Community Transportation Magazine, September/October 2003 vii Conversation with vendor, TRB/Rural/Intercity Transportation Conference, Roanoke, Va., October 26, 2004 viii Conversation with Chris Zeilinger, April 7, 2005 ix Sheltering Passengers, From Young Riders to Young Designers: Students Design Shelters that Invite Passengers to Ride, by Tom Jirik, pp ; 47 Community Transportation Magazine, Fall 2004

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