Creative Movement: Transportation and the Elderly

When Aghavni Davis gave up driving because of failing eyesight, she never imagined the strain it would put on her ability to stay healthy.

“I gave it up voluntarily because I couldn’t see black cars coming up my left side,” said the 86 year-old resident of Auburn, located in the Sierra foothills.

“The number one problem in this town is transportation,” says Davis. “The hardship is to get to doctors… I’ve tried every system there is.”

After a missed Dial-a-Ride threatened to leave her stranded at a doctor’s office for four hours, Davis was at the end of her rope. “They only wait three minutes,” laments Davis. “If you don’t come out you’ve lost your ride.”

Davis’ story illustrates a growing fear among aging adults: finding transportation to medical appointments.

As the population ages and an estimated 10,000 baby boomers reach the age of 65 every day, governments, senior agencies, and non-profits are devising creative solutions to help with “Driving Miss Daisy.”

Today, Davis happily rides Health Express, a non-emergency medical and dental transportation program funded primarily by Kaiser Permanente. Patients must give 48 hours notice, are picked up 30 minutes before their appointment, and are promptly returned home.

Serving cities near Auburn, Health Express also takes patients to metropolitan Sacramento once a month, typically to see specialists. Vans can take wheelchairs and oxygen, escort the elderly, and help the underserved “as a ride of last resort,” according to Amy Bakker, transportation coordinator for Seniors First, which administers the program.

Davis regales the Health Express service as on time, flexible, and friendly.

“If I didn’t have that I’d probably flip out,” she says.

The transportation problem for the aging could reach staggering proportions as older drivers give up their cars.

“In 2003, about 1 in 7 licensed drivers was 65 or older,” reports the American Association of Retired Professionals. “By 2029, when the last of the boomers turn 65, the proportion will be close to 1 in 4.”

Within 20 years, Americans 65 and older will tally 71 million, increasing from 12% to 20% of the total population according to this year’s report “Aging in Place, Stuck without Options: Fixing the Mobility Crisis Threatening the Baby Boom Generation.”

The transportation problem is a result of several factors, reports the Transportation for America study. Americans are living longer. Only a small percentage move after retirement, choosing to age at home. Most live in decentralized suburban or rural neighborhoods. And the country’s transportation system remains largely unchanged since the 1950’s.

Lack of transportation affects far more than just physical health, says Helen Kerschner, president and CEO of the Beverly Foundation, a national association dedicated to providing transportation for the aging. Lack of mobility often produces profound depression among older adults who feel cut off from mainstream society. They feel isolated, are hurt economically, and can’t visit family, join organizations, volunteer or – for women – can’t even visit their hairdresser.

“It may not be important to most people but it sure is important for adult women,” she says.

Kerschner says there is little available data on how transportation affects elderly health, but awareness of the problem is growing rapidly: “This is an emerging issue.”

The Beverly Foundation maintains a national database of more than 1,400 transportation services for the elderly. As budget cuts force cutbacks in public transit statewide, Kerschner sees a powerful new trend emerging.

“What’s happening in California and all over the country now is that communities – whether it be a church or service organization – they’re all beginning to create volunteer driver programs,” says Kerschner. “It’s a wave. And I think it’s the wave of the future.”

One example comes from Riverside county, home to a clever and inexpensive solution.

The TRIP program – Transportation Reimbursement and Information Program – is surprisingly simple. Elderly riders identify their own drivers – typically friends – and the drivers take their elderly passengers to destinations using their own vehicle. TRIP acts only as the program “sponsor” and pays the rider, who then reimburses the driver. Besides providing reimbursement, TRIP simply documents the process. (TRIP also services the disabled.)

In 2009, TRIP program provided nearly 100,000 rides on a budget of $563,000. Drivers traveled 1.6 million miles at a cost of less than $5.66 per ride, which contrasts starkly with the maximum $45 per ride of anADA-accessible van and driver.

“TRIP is different than most transportation services because it does not recruit drivers, schedule rides, own vehicles, or charge fees,” says Richard Smith, executive director of the Independent Living Partnership, which operates TRIP.

The program’s success is dependent almost entirely on volunteers. Staff needed to run the program totals only 3.5.

TRIP riders responding to a survey were wildly appreciative of the program. Nearly all said their quality of life was better, and 64% said their physical health had improved.

“I could never get to Loma Linda and San Bernadino Medical without your wonderful help,” wrote one survey respondent.

“I would be completely lost without this program and could not get around without my wonderful volunteers,” wrote another. “This program allows me to get out with friends and still be independent.”

Smith says he is now helping 30 other communities nationwide implement TRIP.

The Sacramento area has a progressive history of ride-sharing dating back to 1978 when a small yet passionate group met in a midtown gas station and brainstormed Paratransit, Inc. to serve the elderly and disabled.

Last year Paratransit provided over 830,000 trips to older adults and the disabled.

Paratransit also offers simple training that more youthful citizens take for granted. Three staff members work 20-40 hours weekly to help seniors learn how to ride light rail and buses.

In additon, Paratransit contracts with cities like Spokane and Honolulu, as well as nearby Stanislaus County, to provide mobility training.

In Sacramento, Paratransit partners with the elder living community Eskaton, providing service for some of its 29 northern California facilities.

Eskaton has facility-owned vehicles that residents use to access primary care physicians. Their Transporation Plus service, however, takes residents to specialists and is available to some Sacramento neighborhoods outside Eskaton.

“Because Eskaton is a not-for-profit we take a genuine interest in the needs of all older adults living in our region, not just residents of Eskaton properties,” says Terry McPeek, director of Eskaton’s Live Well at Home program.

For many older adults, though, rides are not enough. Kerschner says that dropping off a frail senior isn’t helpful if they can’t get from the sidewalk into the doctor’s office.

This problem indicates another growing trend in senior transportation: door-through-door service.

“We stay with our clients through the duration of the trip,” says McPeek, calling it “escorted transportation.” Simple pickup/drop-off services is also available.

The Transporation Plus service costs $25 an hour, with additional fees for mileage.

Besides Eskaton, Paratransit has 13 other community partners, including the Asian Community Center, which launched its ride program in 2004 using four volunteer drivers – all from its Board of Directors.

Today, the program serves eight zip codes with more than 70 volunteer drivers, aged 60 to 80, who provided 42,000 rides last year.

While riders can travel for any purpose, about half use the service for transportation to nutrition sites and community meals. Another one-third use it for medical appointments. The remainder travel for errands or recreation.

Three full-time and two part-time staff administer the program on a budget of $700,000.

Virginia Campbell-Wieneke, transportation manager for the center, said that the center’s focus has always translated into a largely Asian ridership. But its popularity quickly filled a need for the greater community.

“Our proposal is to serve disadvantaged Asians who are low-income,” says Campbell-Wieneke, citing a 60% Asian clientele. “(But) you don’t have to be Asian to use the service,” she laughs.

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