[Senate Hearing 113-866]
[From the U.S. Government Publishing Office]
S. Hrg 113-866
TRANSPORTATION: A CHALLENGE TO INDEPENDENCE FOR SENIORS
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED THIRTEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
NOVEMBER 6, 2013
__________
Serial No. 113-12
Printed for the use of the Special Committee on Aging
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SPECIAL COMMITTEE ON AGING
BILL NELSON, Florida, Chairman
RON WYDEN, Oregon SUSAN M. COLLINS, Maine
ROBERT P. CASEY JR, Pennsylvania BOB CORKER, Tennessee
CLAIRE McCASKILL, Missouri ORRIN HATCH, Utah
SHELDON WHITEHOUSE, Rhode Island MARK KIRK, Illinois
KIRSTEN E. GILLIBRAND, New York DEAN HELLER, Nevada
JOE MANCHIN III, West Virginia JEFF FLAKE, Arizona
RICHARD BLUMENTHAL, Connecticut KELLY AYOTTE, New Hampshire
TAMMY BALDWIN, Wisconsin TIM SCOTT, Scott Carolina
JOE DONNELLY, Indiana TED CRUZ, Texas
ELIZABETH WARREN, Massachusetts
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Kim Lipsky, Majority Staff Director
Priscilla Hanley, Minority Staff Director
CONTENTS
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Page
Opening Statement of Chairman Senator Bill Nelson................ 1
Statement of Ranking Member Susan M. Collins..................... 2
PANEL OF WITNESSES
Therese W. McMillan, Deputy Administrator, Federal Transit
Administration, U.S. Department of Transportation.............. 4
Grant Baldwin, Ph.D., Director, Division of Unintentional Injury
Prevention, National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services...................................... 6
Virginia Dize, Co-Director, National Center on Senior
Transportation, National Association of Area Agencies on Aging. 8
Katherine Freund, Founder and President, ITNAmerica.............. 9
APPENDIX
Prepared Witness Statements
Therese W. McMillan, Deputy Administrator, Federal Transit
Administration, U.S. Department of Transportation.............. 26
Grant Baldwin, Ph.D., Director, Division of Unintentional Injury
Prevention, National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services...................................... 33
Virginia Dize, Co-Director, National Center on Senior
Transportation, National Association of Area Agencies on Aging. 45
Katherine Freund, Founder and President, ITNAmerica.............. 54
Additional Statements for the Record
Dave Wise, Director, Physical Infrastructure Issues, U.S.
Government Accountability Office............................... 68
Norman Y. Mineta, former Secretary, U.S. Department of
Transportation, North American Chairman of the Make Roads Safe
Campaign, and Member, Commission for Global Road Safety........ 78
TRANSPORTATION: A CHALLENGE TO INDEPENDENCE FOR SENIORS
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WEDNESDAY, NOVEMBER 6, 2013
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 2:18 p.m., in
Room SD-562, Dirksen Senate Office Building, Hon. Bill Nelson,
Chairman of the Committee, presiding.
Present: Senators Nelson and Collins.
OPENING STATEMENT OF SENATOR BILL NELSON, CHAIRMAN
The Chairman. Good afternoon. I want to thank my dear
friend, Senator Collins, for suggesting this hearing today on
the need for safe and reliable transportation options for
seniors. It is obviously a crucial topic to seniors in order to
be able to get around and enhance their quality of life.
The lack of dependable transportation clearly affects a
senior's quality of their lives. If they do not have it, they
cannot go to the grocery store. They cannot get to the doctor's
appointment. They cannot connect with their friends. Having
access to transportation helps many older Americans remain
independent and self-sufficient, two very important things.
And it is also a cost issue. With transportation
representing 20 percent of consumer spending, second only to
housing, obviously, that is a big chunk out of a senior's
income.
Florida has a few examples that we can learn from. Miami-
Dade County helps defray the cost of transportation for seniors
through the Golden Passport program, and it allows residents of
that South Florida county who are 65 years or older to ride on
all the transit system buses and rail for free. Urban,
suburban, and rural communities face different transportation
challenges, and thus, a variety of options are needed to
provide seniors with safe and reliable transportation.
Greater mobility also has a very real impact on health care
costs when you consider that elders with available
transportation are more likely to use office-based care rather
than emergency care with obviously the greater impact on cost
to the overall health care system. And, access to
transportation has been linked to even reduced hospital
readmissions.
But, we have to do a better job with coordinating Federal
dollars and working with private partners to ensure that we get
the most out of the dollars that we have available. If we stay
on our current path, estimates are that the national cost of
alternative transportation for seniors will range anywhere
between $572 billion and $2.2 trillion by the end of this
decade--correction, by the end of the next decade, by the end
of 2030.
The GAO found that while 80 Federal programs fund
transportation services for the disadvantaged, the total
spending is unknown. Well, we have to find out. The GAO
recommended that improved coordination has the potential to
improve both the quality and cost effectiveness of these
services.
In my State of Florida, the Safe Mobility for Life
Coalition has brought together over 20 organizations, agencies,
and the universities to improve transportation safety,
mobility, and access for our seniors. In addition to promoting
safety for all road users, including drivers, pedestrians, and
transit users, the Coalition serves as a resource on the
options for seniors in each community, connecting those seniors
with a range of public and private services. Now, we need
coordination like this.
And so it is fairly simple. We need to ensure that those
who can drive are able to continue. But if a senior should not
be driving, then they ought to have an alternative, and we do
not want a senior getting behind the wheel who should not be
driving, even though the pressure is there on them to get to
where they need to get for whatever the reason is. And so our
seniors deserve nothing less.
Now, we are going to do something different here today.
Since Senator Collins was so gracious and insightful to suggest
this hearing today, what I want to do is I want to turn the
gavel over to her. Senator Collins.
OPENING STATEMENT OF SENATOR SUSAN M. COLLINS
Senator Collins. Thank you very much, Mr. Chairman, and
this is typically gracious of you and I must say it feels so
good to have the gavel back in my hand.
[Laughter.]
Senator Collins. But, I will pledge right now that should
there ever be a change, that I will be as wonderful to you as
you have been to me.
And I want to start by thanking you for holding this
important hearing. Throughout our committee's recent hearings,
we have focused on a number of the great challenges facing our
nation as our population ages, and much of that discussion has
revolved around health care, Social Security, financial
security, scams directed at our seniors, but there is another
daunting challenge that has rarely been discussed at a public
hearing, and I refer to the challenge of senior transportation.
We Americans love our automobiles. From the time that most
of us were old enough to drive, we have been behind the wheel.
Cars mean freedom, not in some grand philosophical sense, but
in a very real practical sense that matters to us in our
everyday lives. Having a car and being able to drive it means
the freedom to go where we want, when we want.
But as we age, we find it harder and harder to use that
freedom given to us by automobiles. As our abilities decline,
driving becomes more and more complicated. Finally, the day
comes when we wonder whether we should keep driving at all. And
yet, if we do not, how will we go about our daily lives? And
many of us struggle with how to tell our parents or our
grandparents that it is time to give up the keys to the car.
That is one of the hardest conversations.
That day has already come for millions of our senior
citizens. According to the Census Bureau, roughly 19 percent of
our population, or 13.9 million people, will need alternative
transportation options to continue living independently. The
last White House Conference on Aging identified transportation
as the third most important issue for seniors out of literally
hundreds of options for priorities.
And this issue is particularly a critical concern in rural
States like my State of Maine. Not being able to drive takes a
particular toll on seniors living in rural, low-density
population areas. In 2004, the GAO found that 60 percent of
non-drivers in rural areas reported that they had stayed home
on a given day because they lacked transportation. In addition,
non-drivers over the age of 75 and living in the suburbs
reported significant dissatisfaction with how their
transportation needs are being met compared to those living in
cities. Since three out of four older individuals live in low-
density areas, these concerns raise very real policy questions.
Public transportation, which is often hailed as the primary
solution, simply does not meet the needs of many seniors. I
think of my State. It is only the very largest communities that
have any public transportation at all. More than a third of
those over age 69 have no public transportation in their
communities. And even those who do have to plan around route
restrictions, uneven trip frequencies, hours of operations, or
advanced notice reservations. In rural areas, the options may
not exist at all, but even in cities, if, for example, you have
problems with your sight or mobility, transportation on mass
transit can be truly daunting.
According to the Maine Office of Aging and Disability
Services, of people using State-funded home care services, just
65 percent of those over age 65 reported that they could always
get to the doctor when they need it, and only 36 percent could
always get to the grocery store. Most of them rely--90
percent--on family and friends to drive them. It is not
surprising, since one in five Americans age 65 and older does
not drive. So, without driving, seniors must find some other
way to get to the places they need to go.
You know, we talk a lot about doctors' appointments and
grocery stores, but there is also an issue with social
isolation, not being able to drive to go see your friends, to
keep up with family members, and that matters, too, and gets
even less attention.
The challenge of providing transportation alternatives to
our seniors is literally growing by the day as the ``Silver
Tsunami'' starts to hit our country. To meet the challenge, we
must find reasonable, practical transportation models that
allow seniors to stay active and mobile even after they stop
driving. And one such model is ITNAmerica, which has been
operating in my home State of Maine since the mid-1990s and has
since branched out to other communities across the nation.
ITNAmerica, which we will hear more about today, uses private
automobiles to provide rides to seniors whenever they want,
almost like a taxi service. And Katherine Freund, who is the
founder of ITNAmerica, is here with us today. I am delighted
that she is able to join us as well as the rest of our
outstanding panel of witnesses.
This is an issue that is only going to grow as people are
living longer and as the baby boomers, 10,000 of us every day,
turn 65. This is a challenge that has not received the
attention, in my view, that it has deserved, and that is why I
am so delighted that our Chairman has agreed to shine a
spotlight on this issue today.
Now, Mr. Chairman, I understand you are even going to allow
me to introduce the witnesses, which is----
The Chairman. Run the meeting.
Senator Collins. [continuing]. Given what a great panel we
have, is truly an honor.
First, we are going to hear from Therese McMillan, who is
the Deputy Administrator of the Federal Transit Administration,
who will talk about the administration's efforts to address the
transportation and mobility needs of our nation.
We will then hear from Dr. Grant Baldwin, the Director of
the Division of Unintentional Injury Prevention at the Centers
for Disease Control and Prevention.
We will then hear from Virginia Dize, the Co-Director of
the National Center on Senior Transportation administered by
the Easter Seals in partnership with the National Association
of Area Agencies on Aging.
And, finally, as I mentioned, we will hear from Katherine
Freund, the founder and President of ITNAmerica, who will talk
about the innovative transportation model that she developed,
and Katherine, I hope you will also tell the story of how you
became interested in this issue, and you have done so much over
so many years.
We will start with Ms. McMillan. Thank you. Thank you all
for being here.
STATEMENT OF THERESE W. McMILLAN, DEPUTY ADMINISTRATOR, FEDERAL
TRANSIT ADMINISTRATION, U.S. DEPARTMENT OF TRANSPORTATION
Ms. McMillan. Chairman Nelson, Ranking Member Collins, I am
so excited to be able to be here with you today. I am Therese
McMillan, Deputy Administrator for the Federal Transit
Administration, and I want to thank you for the opportunity to
highlight the administration's efforts to address
transportation and mobility needs of America's seniors.
Our nation is undergoing a significant demographic shift
that will profoundly affect our policies and priorities for
years to come. By 2050, the number of Americans age 65 and
older is projected to more than double, and the number of men
and women 85 years and older could increase fivefold during
that period. This population, as you observed, can face
significant challenges, including increased poverty, isolation,
and the struggle to access medical services.
The Department of Transportation is committed to helping
older Americans to age in place and live with dignity in urban
and rural communities alike. A key point of collaboration is
the Federal Interagency Coordinating Council on Access and
Mobility, or CCAM, chaired by the Transportation Secretary. In
recent years, working with several Federal CCAM partners, the
FTA awarded competitive grants in more than three dozen States
and Territories to help install one-call, one-click access to
transportation, with a special focus on military veterans and
their families. Through this program, patients at the VA clinic
in Lee County, Florida, just to cite one example, will be able
to arrange rides on the spot using a computer kiosk installed
on site. Importantly, many of these veterans are seniors.
My agency, the FTA, has entered into many other innovative
cooperative agreements to improve locally coordinated access to
public transportation for older individuals. For example,
working with Easter Seals and other industry partners, we have
launched a new National Center for Mobility Management. The
Center will, among other things, develop a database to identify
best practices for delivering transportation to seniors as
efficiently as possible.
Mobility Management is a responsible and innovative use of
taxpayer dollars that will extend FTA's assistance into
communities. This approach improves customer service to
individuals by encouraging partnerships among transportation
providers, both public and private, at the local level. There
is no one-size-fits-all. Those who know their communities best
will serve them the best.
In fiscal year 2012, FTA provided over $40 million for
Mobility Management projects, a four percent increase over
fiscal year 2011. Thanks to ongoing investments in this area,
today, there are over 400 Mobility Managers nationwide and over
half the States are planning one-call centers.
The funding picture is decidedly mixed, however. On the one
hand, MAP-21, our current authorization, enhances funding and
services for seniors and others. For example, our program to
enhance mobility for seniors and people with disabilities is
authorized to receive $28 million more in fiscal year 2012 than
under the prior authorization. This includes, for example,
providing rides on accessible taxicabs, which is working well
in Houston, Texas, Madison, Wisconsin, and elsewhere. MAP-21
also increase spending by 25 percent for rural transportation.
Rural States are home to many of the nation's lowest-income and
most transit-dependent seniors. And, importantly, MAP-21
enables the Federal Transit Administration to leverage its own
investments in coordinated transportation activities with
matching funds drawn from a variety of other Federal programs,
ranging from Medicaid to Head Start.
But the fiscal year 2013 appropriations, the sequester, and
continuing resolutions have left the Federal Transit
Administration unable to fund even modest technical assistance
to help grantees strengthen service delivery and innovation.
This reduces FTA's ability to invest in transportation
coordination at a time when it is needed most.
Despite these and other challenges, however, we must
continue helping communities to identify and fill the gaps in
transportation for seniors and others. Oftentimes, seniors
simply may not know what services and transportation options
are available to them or how to connect with them. Therefore,
we need to support Mobility Managers and similar initiatives
across the country to foster even greater connectivity.
Mr. Chairman, Ranking Member Collins, this concludes my
testimony and I would be happy to answer any questions.
Senator Collins. Thank you.
Dr. Baldwin.
STATEMENT OF GRANT BALDWIN, PH.D., DIRECTOR, DIVISION OF
UNINTENTIONAL INJURY PREVENTION, NATIONAL CENTER FOR INJURY
PREVENTION AND CONTROL, CENTERS FOR DISEASE CONTROL AND
PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Mr. Baldwin. Good afternoon, Chairman Nelson and Ranking
Member Collins. Thank you for the opportunity to testify today.
I am pleased to join my fellow panelists and speak about
the intersection of transportation and public health and how it
affects the health of older adults. I will also discuss what
can be done to help older adults remain safe, active, mobile,
independent, and healthy as they age.
As the committee is aware, the U.S. population continues to
age. In 2012, 14 percent of the U.S. population was 65 years or
older, and by 2030, it is projected to reach 20 percent. This
is approximately 72 million older Americans. The fastest-
growing segment of older adults is those aged 85 and older.
This group is at the greatest risk for experiencing frailty and
requiring assistance with mobility. Taken together, the
upcoming growth in the size and life expectancy of the older
adult population will create new challenges for older Americans
to get around.
Many older adults are dependent on cars. This is
particularly true in suburban and rural areas, where public
transportation is often limited. In fact, nine out of ten trips
by older adults are made in personal vehicles. As the baby
boomers continue turning 65 between now and 2020, the suburbs
will see a 50 percent increase in people aged 65 to 74.
But, it is more than the roads that we drive on that can
make a difference. More broadly, the built environment, the
human made physical characteristics of a community, can present
challenges, too. If a community has an abundance of streets
with fast and high-volume traffic or lacks infrastructure like
sidewalks and safe street crossings, it will be harder and more
dangerous to walk, bike, or use other forms of active
transportation. But, it is more than safety, though. The built
environment can enable, facilitate, and encourage older adults
to be physically active, reducing their risk of obesity,
diabetes, heart disease, and other chronic conditions.
Mobility, whether by car, public transit, or another form
of transportation, are critical for an older adult to remain
independent. Ride sharing, shuttles, or volunteer driver
services, like those provided by ITNAmerica, offer innovative
transportation options for American seniors. Beyond keeping an
older adult connected with family and friends, mobility also
enables older adults to receive vital health and preventive
services. Ease of mobility may also enable older adults to
pursue volunteer or paid work opportunities, bringing
additional meaning and a sense of fulfillment to their lives
and benefiting their communities, as well.
The benefits of mobility underscore the need to improve our
understanding of the factors that enable older adults to
successfully and safely manage the transition from driving to
non-driving. In an upcoming CDC study, we find many older
adults anticipate driving for years to come and do not plan for
when they will be unable to drive. Some older adults will face
limitations in their ability to drive at night, when the
weather is bad, or due to age-related declines in vision,
cognitive functioning, or physical capacity. Therefore, we are
researching older adults' views about having to limit or stop
driving. In addition, CDC is developing a tool to help older
adults quickly assess their own mobility.
Changes to the built environment can also improve
transportation options for older adults. Affordable,
accessible, and suitable housing options can allow older adults
and others living with disabilities to age in place and remain
in their communities. The availability of public transit and
the proximity of grocery stores, parks, places of worship, and
medical offices, just to name a few places, have an impact,
too. These features are even more important when driving is no
longer an option.
CDC works to save lives, protect people, and save money
through prevention. As America's leading health protection
agency, we work with many different partners to identify,
develop, and test programs that can make a difference in
communities across the country.
One of the strongest and longest standing collaborations is
with the U.S. Department of Transportation. We are partners
with shared interests. This includes a Memorandum of
Understanding with the National Highway Traffic Safety
Administration anchored to a mutually agreed upon annual action
plan. We work together to reduce the number of motor vehicle
injuries by improving data, strengthening policy, synergizing
research, and translating evidence-based interventions into
real world settings. We are currently discussing ways to
include older mobility in our plans.
For those older adults who are able to drive, we must
continue to find ways to improve motor vehicle safety and
reduce the disproportionate number of fatalities and injuries
suffered by older adults, whether they are drivers, passengers,
or pedestrians. We understand that more progress can be made
through coordinated, sustained, and complementary actions,
including by partnerships with organizations like AARP and
others.
In summary, at the intersection of transportation and
public health are solutions that can help people get where they
want to go and keep them safe across the lifespan. By helping
older adults remain safe, active, mobile, and independent as
they age, we also have an opportunity to help them remain
healthier longer. Transportation's impact on health and safety
is why these collaborations are a priority for CDC. Good
transportation is good for public health.
Thank you.
Senator Collins. Thank you very much.
Ms. Dize.
STATEMENT OF VIRGINIA DIZE, CO-DIRECTOR, NATIONAL CENTER ON
SENIOR TRANSPORTATION, NATIONAL ASSOCIATION OF AREA AGENCIES ON
AGING
Ms. Dize. Thank you, Chairman Nelson, Ranking Member
Collins. It is indeed an honor to be here today to address the
importance of transportation to older adults and the pivotal
role of coordination in increasing the availability of public
and private transportation options in local communities.
My name is Virginia Dize and I am Co-Director of the
National Center on Senior Transportation. In our work with
communities, we have seen firsthand the importance of
coordinating transportation resources across modes and payment
resources and the value of making connections between
transportation and health and human services. As our country
ages, it is increasingly important that we get this right.
The National Center on Senior Transportation was created by
Congress in 2005. It is funded by FTA and is cooperatively
administered by Easter Seals and the National Association of
Area Agencies on Aging. Our mission to increase transportation
options for older adults and enhance their ability to live more
independently within their communities is achieved by gathering
and sharing best practices, providing information, technical
assistance and training, facilitating partnerships and
community engagement, and administering demonstration grants.
Our work addresses the full range of transportation options, no
matter the funding source.
Since 2006, NCST has reached hundreds of communities and
provided $1.3 million in grant funding. Let me provide just a
few examples of NCST grantees' work.
In Dane County, Wisconsin, they created a time bank system
to help provide transportation to dialysis patients. In
Knoxville, Tennessee, an NCST grantee combined several funding
streams to create a new volunteer force and purchase specially-
equipped vehicles to provide older adults the personal travel
assistance they needed. In Florida, a small grant to the United
We Guide Project developed a one-call system for information
about transportation options, safety, and mobility. And,
finally, in Wichita, Kansas, outreach to encourage the Hispanic
community to use transit resulted in creation by the transit
agency of a bilingual Mobility Manager.
Simply put, being able to get around your community is
vital to being able to age successfully in place. Missed
medical appointments can exacerbate chronic conditions and
increase the risk of hospitalization. Social isolation due to
lack of transportation can have an equally dire effect on
health and mental health and may result in placement in long-
term care facilities. Improvements in transit and roadways that
address the needs of older adults may benefit the community as
a whole by making it easier, safer, and more comfortable for
everyone to get where they need and want to go.
As older adults make up an increasing proportion of the
overall population in most U.S. communities, their economic and
social contributions cannot be ignored. An increasing number of
older adults continue working in their 60s and 70s, and we must
not forget that, often, it is older adults themselves who are
the volunteer drivers and escorts who give rides to other older
people.
But, there are challenges. Our communities need to do a
better job coordinating programs and funding streams and use
public and private mobility resources more efficiently to help
older people travel. This is both financially and
programmatically sound.
Communities also need support to find unique local
solutions that work. Even in urban areas where transit is
robust, we know that many more older adults than currently use
the system could benefit from the service with interventions
such as travel training and safe and secure walking routes to
transit.
However, we know that most older adults live in suburban or
rural environments with fewer accessible transit options, so
creative solutions, such as volunteer driver programs and
assisted transportation, funded with a combination of Federal,
State, local, and private funds, can help fill the need.
There are several things that Congress can do within exist
frameworks to help support communities looking to enhance
mobility for older adults. First, there needs to be continued
attention to breaking down the Federal and State barriers to
local-public-private coordination of mobility assets. The
United We Ride Initiative at the FTA provides an excellent
framework for interagency coordination.
Second, this hearing can serve as a starting point to
explore the following, perhaps forming a small working group of
advocates and key decision makers to help to develop
recommendations in support of consistent coordination guidance
to recipients of Federal transportation funding, adoption of
consistent legislative language on transportation coordination
in the Older Americans Act, MAP-21, and other upcoming
authorizations. As coordination across Federal funding streams
is multi-jurisdictional, this committee might seize the
opportunity to act on behalf of older adults.
Finally, and perhaps most importantly, we all need to work
together to drive systems change to assure that community
transportation responds to the needs and preferences of older
adults. One option is to infuse the concept of person-centered
mobility management, which includes both individual education
and counseling on transportation options plus community-wide
transportation coordination. That could be infused in all
Federal transportation programs.
On behalf of NCST, I truly appreciate the opportunity
provided by this hearing to spread understanding of the
importance of mobility for all older Americans and the concept
of person-centered mobility management as an effective model to
better serve those needs that Federal, State, local officials,
and communities can embrace. I look forward to your questions
and the opportunity to work with you.
Thank you.
Senator Collins. Thank you very much for your testimony.
Ms. Freund.
STATEMENT OF KATHERINE FREUND, FOUNDER AND PRESIDENT,
ITNAMERICA
Ms. Freund. Chairman Nelson, Senator Collins, on behalf of
the older people we serve, their families, and their
communities, I thank you for the opportunity to be here today.
My name is Katherine Freund and I am the founder of the
Independent Transportation Network and founder and President of
ITNAmerica, the first and only national nonprofit
transportation service for America's aging population.
I want to begin by thanking Senator Collins for her
longstanding support for sustainable senior transportation, and
I would like to emphasize how much the Independent
Transportation Network and ITNAmerica are a product of public-
private collaboration.
I came to senior transportation through a personal
experience. In 1988, my three-year-old son was run over by an
84-year-old driver. Ryan survived and is today a healthy young
man, but others are less fortunate. In 2011 alone, more than
5,000 older people were killed and 185,000 were injured in
vehicle crashes.
With support from AARP, the Transit IDEA program, the
Federal Transit Administration, National Highway Traffic
Safety, the Southern Maine Agency on Aging, private
philanthropy, and the people of Portland, Maine, we created a
social enterprise that uses efficient business practices to
build transportation that will scale with the aging population.
We call our enterprise the Independent Transportation Network,
or ITN, and we built it as a replicable model with a goal to
connect ITNs into one national system.
Today, ITNAmerica has 25 affiliates in 20 States. We have
delivered 600,000 rides. We are serving more than 5,000 people.
And we are growing at a rate of 100,000 rides a year. These
numbers are small when you look at the aging population, with
10,000 boomers turning 65 every day.
What is important about ITN is that it does not depend on
taxpayer dollars for sustainability. A new ITN affiliate may
use up to 50 percent public money to launch, but after five to
eight years, it must be sustainable through reasonable fares
and a diversified base of private local support.
From a policy perspective, it is easy to justify public
resources for senior mobility. The classic justifications for
policy intervention, public safety and market failure, are
clearly present. But the problem of insufficient public
resources is a fiscal reality, unlikely to change.
ITN affiliates are nonprofit membership organizations that
use automobiles and a combination of paid and volunteer drivers
to provide service 24 hours a day, seven days a week. The core
business innovations are the Personal Transportation Account
and a flexible approach to resources managed through ITNRides,
enterprise software that connects ITN affiliates across the
country.
The Personal Transportation Account is a mobility portfolio
that holds assets in many forms. Older people may trade their
cars they no longer drive to pay for rides. Volunteer drivers
may save transportation credits to plan for their own
transportation future. Volunteers in one ITN community may send
their credits to another ITN to pay for rides for a loved one.
Merchants and health care providers may help to pay for rides
through Ride and Shop and Healthy Miles programs.
The result is an average fare of about $11, with the most
common fare $6, which might seem expensive, but with 30 to 40
percent of our members at an income of less than $25,000 a
year, our last five years of customer satisfaction surveys tell
us that ITN members, by about ten-to-one, feel the fare is
inexpensive for the service they receive. There is dignity and
independence in paying for one's self.
More than 40 percent of ITN rides are for health care.
About 20 percent are for personal needs and shopping. About
eight percent are to work or volunteer. Almost 40 percent of
volunteers save their credits for their own future needs. A
similar amount donate their credits to the Road Scholarship
Fund for low-income seniors.
To assure these innovative practices comply with public
policy, ITNAmerica has worked with State and local policy
makers in many States, including Florida, Maine, Illinois, New
York, Kentucky, Missouri, Ohio, and Tennessee. ITNAmerica has
completed a 50 State inventory of policies that create
incentives or remove barriers to the use of private resources,
and with the National Conference of State Legislatures, we are
disseminating the results to 10,000 policy makers.
Our research database is designed to study mobility for
seniors. With the Centers for Disease Control and Prevention,
we are studying driving transition for seniors in 17
communities across the country, and we have just completed six
years of research to expand ITN to rural communities through
ITNEverywhere, a suite of software programs that brings
together ride share, car share, volunteer transport, and
community transport. ITNEverywhere is to community mobility
what eBay is to flea markets.
Senator Nelson, Senator Collins, public resources may be
scarce, but through the use of information technology and
policies that remove barriers to the voluntary use of private
resources, the future for community mobility is bright and
exciting.
The Chairman. Ms. Freund, do we get any credit, Susan and
I----
[Laughter.]
The Chairman. [continuing]. For having this hearing, that
we could then transfer on?
Senator Collins. Or bank for when we need them.
Ms. Freund. Senator Nelson, you may have all of my credit.
[Laughter.]
Senator Collins. Thank you very much for your testimony.
Senator Nelson, would you like to go first on questions,
or----
The Chairman. No, it should be you.
Senator Collins. Okay. Thank you.
First of all, Katherine, I am very glad you talked about
the personal experience that stimulated your getting involved
because so many people would have reacted to that terrible
accident with anger, and instead, you looked at the problem of
the 84-year-old driver, who clearly should not have been
driving, and came up with a solution, and I think that is just
so commendable and I wanted you to share that and appreciate
that you did.
I am going to start with you, Ms. McMillan. In 2006, so
seven years ago, I sponsored legislation that became part of
the Older Americans Act that created a five-year demonstration
project to be overseen by the Administration on Aging to
establish a national nonprofit Senior Transportation Network to
help provide some transportation alternatives to our aging
population, and I am sad to report that the Administration on
Aging really has done nothing with the program that I created.
So, my question to you is would we have better success if we
transferred this program to do this pilot project from the
Administration on Aging to the Department of Transportation?
There seems to be more interest at DOT in the program, oddly
enough, than at the Administration on Aging.
Ms. McMillan. Thank you, Senator, for that question. I
guess the first thing I would say is that one of the important
concepts that I think all of us on the panel have stressed is
that dealing with the challenge of transportation for seniors
really involves work on a number of levels, and we need to be
careful about siloing, any of us, to holes that we have full
jurisdiction over this issue, that it is going to be extremely
important that the Federal agencies continue to work together.
I mentioned the Coordinating Council on Access and
Mobility, and the whole point of setting that up was to make
sure that all of the Federal agencies could bring our resources
and talents to bear to deliver the program. So, while there may
be a lead administrating agency, and certainly we could look at
that, I think the important point is that we all need to
continue working together to make sure that we are addressing
these very complex issues on various levels, and I think that
has been one of the major factors that has made the programs,
for example, the National Center for Senior Transportation,
successful, is this recognition that we need coordination on a
number of different levels. And so we would be happy to work
with your staff and talk about next steps further, definitely.
Senator Collins. Although the GAO has been quite critical
on the lack of coordination, I guess I am going to ask you, and
I do not mean to put you on the spot, but since the
Administration on Aging has yet to provide funding for this
program, which has existed for a long time now, I am going to
ask, were you aware of this program?
Ms. McMillan. I personally was not, but I do not want to
claim that folks in my Department were not.
Senator Collins. Fair enough.
Ms. McMillan. Yes.
Senator Collins. Fair enough.
Ms. Freund, you talked about how you have been able to
transform this program into one that relies on donations, on
people who participate paying their way. I think it is
important, and I am not trying to take credit for this, but for
us to note that there was some Federal funding in the beginning
that served as a catalyst. Would it have been--and then you
were able to transform it into a self-sustaining program, which
is ideally what we always want to see when we are successful in
securing some Federal funding.
Do you think you could have gotten off the ground without
having that initial Federal funding as a catalyst for your
program? Would it have been harder to get it off the ground?
Ms. Freund. Yes, it would have been much, much, much harder
to get it off the ground. The Federal funding came from a
number of different places. The FTA funds the Transit IDEA
program, which sponsored some of the initial research. And it
was, in fact, the Transit IDEA program that directed us to look
at technology to create efficiency.
And then, in addition to that, the FTA funded it, I think,
three or four different times, first to test some of the ideas,
then to deploy the ideas. There was a $1.2 million FTA grant to
develop ITN as a sustainable model. And then there was a grant
to plan the national rollout. So the government, I mean, it
really has been a public-private partnership.
I think one of the difficulties, though, is that there is a
tendency to think that if Federal money goes in, that it stays
in.
Senator Collins. Exactly.
Ms. Freund. This was almost, you know, venture philanthropy
or venture funding on the part of the FTA to create an
incentive for private resources and then to be willing to step
away and let the private sector do it.
Senator Collins. And, to me, that is what is so impressive
in your program, is you did have some Federal funding
initially, but you used it to establish the program and you are
not dependent on the Federal funding today, and other
communities have been able to replicate that.
Let me ask you, Dr. Baldwin, and you, Ms. Dize, the same
question, and that is if the Federal Government could do one
thing to help address the transportation needs of our seniors,
what would it be? Ms. Dize, we will start with you.
Ms. Dize. I think I may have already answered that in my
testimony, because I believe that encouraging coordination and
recognizing that creating a new program in the community is a
very important thing. It can make a difference in some people's
lives. By pulling together all the transportation resources and
all of the players, including older adults and caregivers and
advocates, to look at the whole system, identify where there
are gaps, and identify the best way to fill those gaps so that
the whole community benefits, I think that benefits older
adults. I think that benefits everyone.
Senator Collins. Thank you.
Dr. Baldwin.
Mr. Baldwin. Sure. Thank you for the question. I am not
sure I can identify one specific thing, but one thing I did
want to highlight is, in my view, there are sort of three sort
of goals or touchpoints that we have to be sensitive to that I
think many of us have talked about.
The first is making older drivers safer and understanding
and managing the transition between driving and non-driving.
The second is making sure that older adults who are in a
non-driving mode, and it is my understanding that most of us
will live six to ten years after we finish driving, that there
are transportation options available to those older adults, and
I think some of the innovative solutions have been identified
today.
And, lastly, I spoke in my testimony a little bit about the
built environment, these sort of community-level solutions that
help all of us from a design perspective. I think there are
touchpoints in each of those sort of major issues that need
attention over time.
Senator Collins. Thank you.
Mr. Chairman.
The Chairman. You may be surprised to know that in my
State, there are 325,000 drivers over the age of 85. Now, of
course, I know plenty of 85-year-olds that are quite capable of
driving, but it underscores, as the population ages, more and
more why this is an important topic.
You all have testified as to a number of ways to go about
this coordination. For example, in Florida, there is a
coalition, as I mentioned, of 20 organizations, agencies, and
universities that try to improve the transportation for
seniors. For example, one of them is called Find A Ride,
developed by the University of Florida, and the senior goes and
identifies the type of visit they need to make, such as it is a
medical visit, it is they need help because they are disabled,
where they need the ride, and then it is presented with
various--the senior is presented with various public and
private options.
So, why don't you all share, with Susan and me, some other
kinds of innovative efforts other than what you have testified
that might stimulate our thinking.
Ms. Dize. I would like to suggest a couple of things. One
is that a couple of years ago, the NCST provided some support
to researchers in Missouri, Dr. Tom Meuser, and he developed,
along with his colleague, a tool called the Assessment of
Readiness for Mobility Transition, and it is a tool that can be
used to have a conversation with older adults to help them
identify how ready they are to transition, how important
driving is to their sense of self and independence, and that
way, interventions can be designed to help people become more
ready and be prepared for driving transition, because I believe
that, unfortunately, so many people are faced with transition
as a threat. They have had a fender-bender or a much more
serious situation, or family members hide the keys from them.
And I think that we really need to start having these
conversations earlier. The ARM tool is one instrument to help
that happen.
Ms. McMillan. Senator, one of the basic requirements for
making a number of the initiatives we have outlined here is you
need to really start with good planning and planning that is
focused at the community that needs to coordinate the services.
And I think the example that you just outlined in Florida is
exactly the type of model we need to make work on a much more
consistent basis throughout the country.
Under current rules to access the major funding source for
enhanced services for seniors and disabled--persons with
disabilities, we require this coordinated--it has got a long
name--Coordinated Public Transit and Human Services Plan, but
the point there is that we require that senior members and
persons with disabilities must participate in the development
of that plan so the users are helping to design the system. And
it might seem a simple thing, but it is incredibly important
that when you are designing services, that the people who are
going to use them are involved very early.
What we would like to see is not only that be a standard
for the transportation planning, but as Dr. Baldwin pointed
out, we need to have planning on such things as housing and
medical care and the other elements, and so having that type of
coordinated planning effort in those sectors, as well, to link
with what were happening at Transportation could just make it
much clearer in terms of what are the services and activities
people need to access and then connect that with how you get
there, which is the transportation end of things.
The Chairman. Yes, ma'am.
Ms. Freund. I think that coordination is very, very
important, but there are some important numbers to remember.
Public transportation for people over 65 accounts for between
two and three percent of the trips they take, and since most of
the resources for transportation, by a ratio of five-to-one,
are private, I think that a major part of the solution is when
you engage the community, do not just engage the demand side of
the problem, which is the consumers. It is a supply side
business problem. There are not enough resources to address
this. So, bring the business community to the table. Bring
corporate America to the table.
And, I think a huge thing that could happen, perhaps as a
result of these hearings or other Federal action, would be to
awaken the American people to the social need that we are
looking for and encourage everybody to look around them and
give an older person a ride. I think the solution is sitting in
driveways from coast to coast, and if people will just open
their eyes and see the--and I think people are really willing
to help each other, but we just do not have a culture of
looking around and realizing that older people have this need.
I mean, and that is right there. That does not cost any public
money at all.
The Chairman. Is it in your experience that a senior will
limit their mobility because they do not want to be a burden on
their family members?
Ms. Freund. Absolutely. Absolutely. I mean, I must have
heard an older person say, ``I do not want to be a burden,''
about a quarter of a million times already.
The Chairman. Right.
Ms. Freund. Nobody wants to be a burden, and I think that
is so at any age.
The Chairman. Dr. Baldwin.
Mr. Baldwin. Yes. One of the innovations that I want to
bring forward is something that we have been charged with at
CDC, that is to think about the connection between clinical
medicine and public health. In early September, Dr. Frieden
sent all of the CDC leadership a note saying, ``How can we
improve prevention and health care,'' and he outlined four
specific areas that I think crosswalk nicely with
transportation.
The first was to reduce practice variability. An
opportunity in this space is as we get better and better about
understanding driver fitness and how to evaluate it, reducing
practice variability across health care settings is going to be
critically important.
The second area was engaging the entire health care team,
so assisting with these screenings, understanding these
transitions, engaging allied health, occupational therapists,
and others, and then, importantly, having those professionals
connect with these transportation services.
The third area was to leverage health IT. As electronic
health records become more and more ubiquitous in this country,
I think there is a real opportunity to leverage those. One of
the issues, as we all know, in older drivers is the issue of
polypharmacy or medication management. Those electronic health
records can sort of help understand what the issues are at
play, and they can help potentially--again, I know there are
some HIPAA issues--with connecting potential individuals who
may be at risk to informing the Department of Motor Vehicles
and others.
And the final is to--you know, I think one of the drumbeats
you are hearing from all of us in this case is remaining
patient-focused, but thinking about the older adult themselves.
So what are their needs? Using some of the older mobility
assessment tools that have been discussed, understanding them,
and then catering services to that end.
So, I think there is a real opportunity in sort of
connecting clinical medicine and public health and I think that
is an untapped innovation.
The Chairman. Dr. Baldwin, how are you all working to
promote health and transportation and reaching out between your
agency, HHS, and DOT?
Mr. Baldwin. Sure. So, injuries are the leading cause of
death for Americans between one and 44 and the fifth leading
cause of death overall. CDC Director Frieden, this is one of
his priority topics because of both the burden, the
availability of evidence-based interventions that can be
readily scaled up.
As part of that, and I spoke briefly in my remarks about
the strengthening of the connection that we have made with DOT
and particularly the National Highway Traffic Safety
Administration, there are some real opportunities there.
Because transportation impacts so much of us in public health
and so broadly, I think that is one of the other reasons why it
is a public health issue.
Earlier this year, the CDC and partners released Aging and
Health in America 2013. One of the issues that was spotlighted
here by our colleagues in the Healthy Aging program at the
Chronic Disease Center was, in fact, mobility. So it both cuts
into motor vehicle injury prevention, which is the expertise
where I reside, as well as our colleagues in chronic disease
and environmental health. So, it is really a cross-cutting
issue.
The Chairman. And I would like the two of you to comment,
is there anything in the Affordable Care Act that is applicable
to stimulate and to fund transportation solutions.
Mr. Baldwin. Sure. From CDC's perspective, the biggest
touchpoint in the Affordable Care Act that impacts us is
through our Community Transformation Grants. It has the
opportunity to impact over 130 million Americans, and we are
currently working to improve community design to encourage
active transportation--walking and biking--for all ages,
including older adults.
In the first round of funding in 2011, $103 million were
distributed to 61 State-local agencies, including Tribes and
non-governmental organizations. And in round two of that
funding, an additional $70 million went to 40 communities--
these are smaller communities.
In fact, impacting your home State of Florida, we support
the Broward Regional Health Planning Council to incorporate
complete street standards and smart growth principles, to
increase access to safe and comfortable transportation for 1.3
million commuters. And, Senator Collins, in your State, in
Portland, Maine, Maine Health is working to improve active
transportation for up to 57,000 people as a result of CTG, the
Community Transformation Grants.
Ms. McMillan. Well, just to maybe complement that from our
perspective, as you know, the Affordable Care Act is
administered by the Centers for Medicaid Services at HHS, and
in talking with our partners there, we understand that under
the Medicaid expansion for household incomes up to 133 percent
of the poverty line, transportation is a required service, and
so older adults would be eligible to receive transportation
access for medical services within that envelope.
Very importantly, though, I would like to also mention how
HHS really has been an incredibly strong partner with FTA on a
number of levels, and very importantly--I mentioned it in my
testimony, I can elaborate--the ability to leverage the funding
sources that we have available for services for seniors for
things such as accessing medical care does require, by law, a
match. But what is made available is the fact that, unlike in
most programs, other Federal funds, such as HHS funds, can be
used by communities to match the transportation fund, and that
is very important, particularly for communities that may be
stretched in terms of their own local sources that might
otherwise need to be brought to bear. So, it enables a number
of the programs that folks might want to pursue with our
transportation dollars, including health access, for that to be
not such a financial burden because they can deploy the HHS
funding to help get those projects on the ground.
The Chairman. And, do any of you want to comment on what
this last round of sequestration has done and what you might
expect this next round, if enacted January 15, of sequestration
will do?
Mr. Baldwin. I will comment on that. Sequestration required
CDC to cut about five percent, or more than $285 million, from
its fiscal year 2013 budget, and we applied those cuts evenly
across all programs, projects, and activities. This, frankly,
means that every area at CDC was impacted. In addition, the
Prevention and Public Health Fund allocation in fiscal year
2013 was almost $350 million below the fiscal year 2012 number.
So, in total, CDC programs lost about $1 billion, or ten
percent of the entire CDC budget, below fiscal year 2012
numbers.
Ms. McMillan. Well, sequestration had a very direct impact
on the research money that goes to supporting the work of the
Technical Assistance Centers that we have here. That, combined
with appropriation pressures, really meant that for a number of
our centers, we were able to continue funding them for this
year, but unless the situation changes for next year, it is
going to be very tough to continue providing the technical
assistance that is extremely cost effective in terms of, again,
having folks on the ground be able to advance the programs that
we are administering.
The Chairman. Thank you all.
Senator Collins. According to the Bureau of Labor
Statistics, the average household spends about 20 percent of
its income on transportation. I will say that was higher than I
expected. We tend to think of shelter, food, clothing, when, in
fact, transportation is right up there after housing as a large
part of household income expenditures.
So, Ms. Freund, when you were talking about seniors being
willing to pay the $11, is that because they understand how
much a car costs them to maintain, to insure, to drive?
Ms. Freund. Senator Collins, I am not sure they understand
that on any kind of a sort of conscious or cognitive level, but
I do think that people truly are willing to pay for a service
that they need and that they know will help them remain
independently in their homes. Even our ITN users who use the
service very, very, very often are spending far less than it
costs to support a private automobile.
You know, those numbers are shocking, I know, but numbers
are numbers and reality does not go away. Those are free
consumer choices. People will willingly spend 20 percent of
household income on transportation, and I think that--I mean,
to me, that is a big pot of gold. To me, that is not bad news.
To me, that is good news. All we need to do is provide a
service that they want and they will pay for it.
Senator Collins. Exactly. I think that is why when one
first hears $11 a trip or $6 a trip, you think, oh, is that
going to be a barrier? But when you look at what people are
already spending, it translates into a very reasonable amount,
and certainly the demand for your service proves that.
But, I think it would be helpful for the committee if you
were to describe to us a typical ITN member in the State of
Maine.
Ms. Freund. Sure. I can actually describe a typical ITN
member in 20 States.
[Laughter.]
Senator Collins. Very impressive.
Ms. Freund. Well, the numbers are consistent over many
years. The typical member, the average age is 80, but the most
common age is 85. Eighty percent of our members are women. Most
of those women are living alone in the community and most of
those women have sort of a lower- to middle-income range and
they use their rides most commonly for access to medical care,
but also for shopping and social needs and so forth.
Senator Collins. And, what about income levels? Could you
give us a sense of what the average income level, or what
percentage--you mentioned that you have a significant
percentage below $25,000 annual income.
Ms. Freund. Well, more than half of the people who use the
service have an income of $50,000 or less, and they use the
service between two and four times a week.
The Chairman. Are any of them in rural areas that you go to
pick up?
Ms. Freund. Some are in rural areas, but most are in
suburban areas. The service we are developing for rural areas
is ITNEverywhere. That is the next phase of what we are doing.
I can also tell you that 50 percent, a little over 50 percent
of the people we serve have some kind of a mobility impairment,
either a chair or a walker or a cane, and 30 percent are either
blind or visually impaired. So, we are talking about a frail
population.
Senator Collins. And a very vulnerable population that
really should not be driving and cannot drive.
Ms. Freund. Twenty-five percent of the people who use ITN
are driving at the time that they sign up, and then they
transition voluntarily because they have an alternative. In an
evaluation of the project that we did for the Atlantic
Philanthropies, we were actually able to determine that after
using the service for six months, and again at 12 months, that
the amount of mobility people felt themselves to have was equal
to the amount of mobility they had when they were driving,
which is something that I think nobody thought was possible.
But it is possible.
Senator Collins. That is really a terrific result. That is
great news. I am very eager to see you expand into the rural
areas of the State, as you know.
Ms. Freund. You can have my credits, too, then.
[Laughter.]
Ms. Freund. Thank you.
Senator Collins. Ms. McMillan, Ms. Freund said something I
thought was very profound when she said the answer is in our
driveways across America and that there is a lack of public
awareness that we each could be really helpful by volunteering
to drive an elderly person to an appointment or to see a friend
or to the grocery store. You mentioned in your opening
statement that there are some 400 Mobility Managers. What do
these people do and where are they?
Ms. McMillan. Well, they are all across the country, and
what Mobility Managers do is, again, they are sort of the
master ride match service, you might say, in terms of being
able to identify, first of all, what is the customer
constituency that you are trying to serve, where do they need
to go, and what is the combination of different services that
might get them there, whether that be a ride sharing, volunteer
or otherwise, service provided by a nonprofit, public transit
service, paratransit service, again, a taxi, accessible taxicab
service. Within that community, what are all the various
options that might be there and then serve to assist in what we
hope more and more, through a one-call or one-click web-based
service, of how someone can put together the customized ride
from A to B that they need to have.
And, again, we have been able to fund those under--in 2005,
I believe, one of the important changes in our authorizing law
is that those Mobility Management services can be funded from
our core funding programs both for urban and rural areas. They
are coded Section 5307 and 5311. But the point being that there
is an eligibility that was extended to these Mobility
Management options that then can be funded with Federal
dollars, because we would like to see them more and more.
I think we had 325--let me see, I was trying to think--it
was $325,000 was being spent when that eligibility first
happened in 2005 and now it is over $40 million are being spent
per year on these services. So, we have seen a huge jump in
interest.
Senator Collins. And, I think that reflects the growing
need of our increasingly eligible population, but I am
concerned that there is a lack of public awareness about these
services and about the Mobility Managers. This is an issue
that, because of ITNAmerica, I have followed fairly closely,
and as someone who represents a State that by median age is the
oldest in the nation, I also have a great interest in how we
are going to meet this need. And, prior to this hearing, I was
not aware of these Mobility Managers.
So, I wonder what is being done to increase public
awareness to work more closely with, perhaps, seniors, groups
in the States, whether it is AARP or just senior centers in
various communities. What are you doing to increase the
visibility?
Ms. McMillan. Well, there are a couple of things I would
mention. I had mentioned before this coordinated plan that is
required to access some of our funding. One recommendation that
has been made is that there really needs to be an ongoing
coordinating council that involves on an ongoing basis the very
groups you have just mentioned, whether it is AARP or senior
groups within the community, faith-based organizations, that
can get the word out that these services are available.
One thing that we did when we had our Veterans
Transportation and Community Living Initiative that we funded
in fiscal year 2011 and 2012 that I mentioned, we specifically
included as part of that program a marketing program. So, there
was assistance that was allowed for some folks to come in
simply to, as you well observed, be able to get the word out
that once we put the service out there for Mobility Management
serving not only veterans and their families, but also other
community members that needed those same services, that there
was a way, as you say, of getting the word out. And so it is a
very important point that we need to keep in mind going forward
with these programs.
Senator Collins. Ms. Dize.
Ms. Dize. Thank you. I think that one of the issues is that
there is, parallel with the development of Mobility Management,
there is also an increasing amount of effort, I think, within
the aging network and within human services that provide
general information and assistance lines to address
transportation, because very often, transportation arises out
of a panoply of needs. The person may initially call about
health care or home- and community-based services and
transportation is an adjunct to that need. So, it is important
that general information lines are equipped to know about the
transportation resources and to connect with Mobility Managers
where they exist in the community, and I think a lot of that is
happening.
I would say that n4a, which is the association I work for,
administers an AOA-funded service called the Elder Care
Locator. Last year, the number one reason why people called was
about transportation. We got more than 18,000 calls about
transportation between July of 2012 and June 2013, and those
numbers are increasing. And even though people struggle with
financial issues, health care issues, and so forth,
transportation remains number one.
I also think there is a lot going on in communities to
increase the expertise and the connectedness between the human
services programs and transportation so that when people call,
they have the full picture.
Senator Collins. Thank you.
And, finally, Ms. Freund, in Maine recently, as you know,
there have been some problems with contractors who have been
hired to provide rides to individuals who receive services
through the Medicaid program. Do you assess as part of ITN's
evaluation the reliability and quality and customer
satisfaction, if you will, of your program?
Ms. Freund. We have an annual customer satisfaction survey
that we do for ITN in Maine and across the country, and the
customer satisfaction ratings have been consistent over a
number of years. I think 98 percent of the people who use the
service would recommend it. Ninety-six percent are happy with
the service. About two to three percent think that the service
is too expensive for the service they receive. And by about
ten-to-one, people think that it is inexpensive for the service
they receive. So, we do ask those questions.
We also do a survey of all our volunteers every year and
our affiliates every year, because if you are doing something
wrong, you want to know it right away, right?
Senator Collins. Exactly. Well, I think it is such an
impressive program and I have been delighted to see it
replicated through your leadership in so many other States. I
think it is a great model that we can encourage to be spread. I
hope the Federal Department of Transportation, which has been
generous in its support in the early years, will take notice of
the program and the high satisfaction rates, as well, because
this is a problem that is not going to go away, and I think for
rural States, in particular, it poses a tremendous challenge
for seniors living in very rural areas where, frankly, there
simply is no alternative to a car.
That is one of the reasons that I am so grateful to the
Chairman for allowing us to have this hearing today, and I just
want to thank all of you for adding to our knowledge. When I
heard Ms. Freund give those satisfaction rates, I could not
help but think that Congress would be happy to have half those
rating levels.
[Laughter.]
Senator Collins. But, they truly are impressive, so thank
you very much, Mr. Chairman, and thank you all for testifying.
The Chairman. Well, it has been a great discussion and it
is a discussion about an obligation of a society to take care
of not only the very young, but the very old. And so Susan and
I are just very grateful to be a part of this, so thank you
very much.
The meeting is adjourned.
Senator Collins. Thank you.
[Whereupon, at 3:37 p.m., the committee was adjourned.]
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APPENDIX
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Prepared Witness Statements
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Additional Statements for the Record
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Testimony of The Honorable Norman Y. Mineta
Chairman Nelson, Senator Collins, and Members of the Committee,
thank you for the opportunity to submit this testimony. My name is
Norman Y. Mineta, and I served as Secretary of Transportation from
January 25, 2001, until July 7, 2006. My interest in road safety
continues, in our country and globally, as I now serve as the North
American Chairman of the Make Roads Safe Campaign and as a Member of
the Commission for Global Road Safety, which successfully proposed the
establishment of the United Nations Decade of Action for Road Safety
2011-2020.
During my service as Secretary of Transportation, we worked to
address transportation for older Americans by using public resources
more efficiently, and by looking toward private resources as another
opportunity to meet the growing mobility needs of our older population.
A 2003 Memorandum of Understanding between the Administration on Aging
and the Federal Transit Administration sought to develop more efficient
use of scarce public resources through collaboration and coordination
of services. That effort continues with the United We Ride program but
progress has not been easy. Eight years later, a 2011 GAO Report (GAO-
11-318SP) ``Opportunities to Reduce Potential Duplication in Government
Programs, Save Tax Dollars, and Enhance Revenue,'' reports that ``With
limited interagency coordination and direction at the Federal level,
the United We Ride initiative and the Federal Transit Administration
(FTA) have encouraged State and local coordination.''
Another 2004 General Accountability Office Report, Transportation-
Disadvantaged Seniors, prepared for the Chairman of the Senate Special
Committee on Aging, points to another significant issue. The GAO report
evaluates existing Federal programs designed to provide transportation
for the poorest and neediest older Americans. Defining
``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,''
the report concludes, as its subtitle suggests, that ``efforts to
enhance senior mobility could benefit from additional guidance and
information.'' \1\
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\1\ GAO-04-971, Highlights.
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The GAO determined that Federal programs are not meeting certain
types of needs, including ``(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; (3) trips in non-urban areas, especially for seniors
in rural communities, where alternatives to the automobile are less
likely to be available and special transportation services are
limited.'' \2\
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\2\ GAO-04-971, P. 4.
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The report was helpful, but because the GAO was charged to look
only at the mobility needs of transportation-disadvantaged seniors, and
further limited to an evaluation of existing Federal programs, it was
unable to address the safety and mobility needs of the majority of
aging Americans whose health and income status place them beyond the
reach of today's federally funded transportation programs. Keeping in
mind that almost 90 percent of trips by Americans age 65 and older are
taken in the private automobile, either as the driver or the passenger,
and that 8 percent of trips are walking, it is clear that only a small
proportion of trips by older Americans are taken on public
transportation. Moreover, seniors who stop driving outlive their
decision by about 10 years. So while it is certainly important for
government programs to be more efficient, and we know they are trying
hard to do so, it is also important for us to remember that most older
people travel in cars, and they are willing and able to pay their own
way.
There is an array of resources available to address senior mobility
needs. The business community has a keen interest in older people as
consumers of goods and services. A broad look at senior transportation,
beyond marginal improvements to existing policies and programs, has the
potential to improve services for seniors across all socio-economic
groups.
Members of the Committee, I have experienced this transportation
need in my own family. Our country needs many approaches, both public
and private, to address the unmet transportation needs of our aging
population in the years ahead. I encourage you to look openly at both.
Thank you for this opportunity.