Transportation-Disadvantaged Seniors: Efforts to Enhance Senior
Mobility Could Benefit from Additional Guidance and Information
(30-AUG-04, GAO-04-971).
The U.S. population is aging, and access to transportation, via
automobile or other modes, is critical to helping individuals
remain independent as they age. Various federal programs provide
funding for transportation services for
"transportation-disadvantaged" seniors--those who cannot drive or
have limited their driving and who have an income constraint,
disability, or medical condition that limits their ability to
travel. For those transportation-disadvantaged seniors, GAO was
asked to identify (1) federal programs that address their
mobility issues, (2) the extent to which these programs meet
their mobility needs, (3) program practices that enhance their
mobility and the cost-effectiveness of service delivery, and (4)
obstacles to addressing their mobility needs and strategies for
overcoming those obstacles.
-------------------------Indexing Terms-------------------------
REPORTNUM: GAO-04-971
ACCNO: A11981
TITLE: Transportation-Disadvantaged Seniors: Efforts to Enhance
Senior Mobility Could Benefit from Additional Guidance and
Information
DATE: 08/30/2004
SUBJECT: Cost effectiveness analysis
Disadvantaged persons
Elderly persons
Federal aid for transportation
Federal/state relations
Locally administered programs
Persons with disabilities
Public assistance programs
Transportation statistics
DOT Capital Assistance Program for
Elderly Persons and Persons with
Disabilities
HHS Rural Health Care Services Outreach
Program
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GAO-04-971
Report to the Chairman, Special Committee on Aging, U.S. Senate
August 2004
TRANSPORTATION- DISADVANTAGED SENIORS
Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance
and Information
Contents
Tables
Figures
August 30, 2004Letter
The Honorable Larry E. Craig Chairman, Special Committee on Aging United
States Senate
Dear Mr. Chairman:
The U.S. population is aging, and transportation is critical to helping
individuals stay independent as they age. Access to transportation,
whether by automobile or some other mode, is considered essential to
independent living, allowing individuals to gain access to the goods,
services, and social contacts that support their day-to-day existence and
quality of life. Both the number of older people and their share of the
U.S. population are growing rapidly. Although many seniors continue to
drive for most of their lives, the growing size of the senior population
will increase demand for alternative transportation services. For example,
one study found that more than 600,000 people aged 70 and older stop
driving each year and become dependent on others for transportation.1 The
increase in the potential pool of seniors needing mobility assistance will
challenge federal, state, and local government agencies' ability to
provide such assistance.
In 2000, 35 million Americans, or 12.4 percent of the total U.S.
population, were aged 65 and over, according to the U.S. Bureau of the
Census. The Census Bureau projects that this group will double to 70
million people by 2030, representing 20 percent of the total population. A
national travel survey found that seniors take most of their daily trips
(about 90 percent) by automobile, either as drivers or passengers. For the
remainder, approximately 8 percent of trips are by walking, and 2 percent
by other modes (including public transportation and bicycles).2 As seniors
age, their ability to drive, walk, or use public transportation may become
limited by reduced reaction time; deteriorating night vision; lessening
ability to climb, reach, or stand; or other physical limitations. To help
ensure that
transportation-disadvantaged seniors3 have access to health and medical
care, employment, and other basic services, various federal programs
provide funds for a range of senior transportation services to state,
local, and nonprofit agencies that actually provide the services and, in
some cases, also provide their own funds to support those services.
This report responds to your request for information about the mobility
needs of transportation-disadvantaged seniors. As agreed with your office,
we identified (1) federal programs that address mobility issues for
transportation-disadvantaged seniors, (2) the extent to which federally
supported programs are meeting the mobility needs of transportation-
disadvantaged seniors, (3) program practices that can enhance mobility and
the cost-effective delivery of transportation services to
transportation-disadvantaged seniors and the extent to which federal
programs support the implementation of such practices, and (4) obstacles
to addressing transportation-disadvantaged seniors' mobility needs and
potential strategies for overcoming those obstacles.
To identify federal programs that address mobility issues for
transportation-disadvantaged seniors, we interviewed federal program
officials and senior mobility experts and reviewed pertinent GAO reports.
To assess the extent to which transportation-disadvantaged seniors'
mobility needs are being met, we analyzed data collected by federal
agencies and local agencies on aging; reviewed studies conducted by
research organizations; and obtained the perspectives of experts in the
fields of aging, disability, and transportation. We also conducted
semistructured interviews with officials from a nonprobability sample of
16
area agencies on aging (AAA)4 from urban, suburban, and rural areas in six
states,5 selected to represent different regions of the country. To
identify program practices that can enhance mobility and the
cost-effective delivery of transportation services, we reviewed the
literature on such practices and conducted semistructured interviews with
officials from 10 local transportation providers highlighted in the
literature to determine the extent to which federal programs support
practices that enhance senior mobility. These 10 providers were chosen to
include a diversity of geographic areas (i.e., they were from different
regions of the country and from both urban and nonurban areas), types of
practices, and federal funding sources. To identify obstacles to
addressing transportation-disadvantaged seniors' mobility needs and
strategies for overcoming those obstacles, we reviewed the relevant
literature and interviewed the AAA officials and transportation service
providers previously mentioned. We also interviewed 14 senior mobility
experts and representatives of pertinent professional associations and
advocacy groups. To ensure the reliability of data used in this report, we
reviewed and identified limitations associated with national statistical
research methodologies and documented the quality assurance procedures
that AAAs use to ensure the reliability of the data they collect. We
concluded that the data were sufficiently reliable for our purposes,
although we identified several limitations that we discuss throughout the
report. We also corroborated much of the testimonial information provided
by AAAs, local service providers, experts, professional associations, and
advocacy groups by comparing it with the literature and with other
interviews. We sent draft copies of this report to the five pertinent
federal agencies-the Departments of Education, Health and Human Services
(HHS), Labor, Transportation (DOT), and Veterans Affairs-for their review
and comment. We conducted our work from November 2003 through August 2004
in accordance with generally accepted government auditing standards.
Appendix I contains more information about our scope and methodology.
Results in Brief
Working with experts on aging and federal agency officials, we identified
15 key federal programs that address mobility issues for
transportation-disadvantaged seniors. These programs, which are
administered by five federal departments, distribute funds through state
agencies or make them available directly to local service providers. For
example, some programs-such as DOT's Capital Assistance Program for
Elderly Persons and Persons with Disabilities (Section 5310)-allot funds
by formula to state agencies, which then distribute the funds to local
nonprofit organizations to purchase vehicles, while other programs-such as
HHS's Rural Health Care Services Outreach Program-bypass state agencies
altogether and go directly to local service providers. The 15 federal
programs help make transportation services senior-friendly, mainly by
making them more available, accessible, and affordable (e.g., by providing
rides to seniors at reduced fares). In addition to administering the 15
programs, federal agencies also address transportation-disadvantaged
seniors' mobility less directly. For example, the Department of Justice
has published rules governing the design of transportation facilities,
such as bus stops, to make them accessible to people with disabilities.
Seniors with disabilities can benefit from the implementation of such
designs.
Data on the nature of transportation-disadvantaged seniors' mobility needs
indicate that federally supported programs are not meeting certain types
of needs, but there is little data on the extent of unmet needs. Needs
that are less likely to be met include (1) transportation to multiple
destinations or for purposes that involve carrying packages, such as
shopping, for which the automobile is better suited than other
alternatives; (2) life-enhancing trips, such as visits to spouses in
nursing homes or cultural events; and (3) trips in nonurban areas,
especially for seniors in rural communities, where alternatives to the
automobile are less likely to be available and special transportation
services are limited. However, federal programs generally do not collect
data on the extent to which seniors' mobility needs are being met because
there are few federal requirements to assess such needs. HHS's
Administration on Aging is required by law to provide guidance to states
on how to assess seniors' unmet needs, which could include transportation,
but officials told us that the administration has not done so because
state and local agencies on aging have indicated a greater desire for
guidance on other aspects of providing services for seniors. However,
without guidance on assessing unmet needs, local aging agencies have used
a variety of methods to collect data, many of which produce information on
the nature of needs rather than on the extent to which needs are being
met. Officials from the Administration on Aging said that they are
developing an evaluation plan to examine, among other things, (1) the
extent to which one of the administration's major senior programs6 is
meeting the needs and preferences of seniors for supportive
services-including transportation-and (2) how needs assessments are
performed by state and local entities.
According to literature on senior mobility and our own work,
transportation service providers have implemented a variety of practices
that enhance transportation-disadvantaged seniors' mobility and the
cost-effective delivery of these services; however, the providers we
interviewed indicated that implementation of such practices was sometimes
impeded by multiple reporting requirements and limited federal guidance.
We grouped these practices into three categories: (1) increasing service
efficiency, (2) improving customer service, and (3) leveraging available
funds. For example, one service provider we interviewed plans to improve
service efficiency by using Global Positioning System technology to track
its vehicles and automatically schedule trips, allowing seniors to obtain
same-day service rather than having to reserve rides 48 hours in advance.
Another provider addresses customer service by putting its drivers through
a sensitivity training program that helps drivers understand seniors'
mobility challenges. Several other providers have entered into contracts
with public and private entities to leverage available funds and generate
additional revenue for senior transportation services. According to these
providers, their practices have resulted in more senior-friendly
transportation and more cost-effective service delivery. Our review also
showed that the 10 local service providers we interviewed were using funds
from some of the key federal programs we identified (e.g., DOT's Capital
Assistance Program for Elderly Persons and Persons with Disabilities
(Section 5310) and HHS's Medicaid Program) to deliver transportation
services to seniors, and that the federal program funding supported the
implementation of such practices to some extent. For example, some
providers said that they received technical assistance while implementing
such practices, either directly from federal agencies or indirectly
through federally supported professional organizations. However, many of
the providers we interviewed said that certain characteristics of federal
programs, such as what the providers view as burdensome reporting
requirements and limited program guidance, can impede the implementation
of practices that enhance senior mobility. For example, one provider told
us that it had not received technical guidance from one of the DOT
programs indicating how the funding process works and that, as a result,
it had to seek such assistance from other local organizations.
Experts, advocacy groups, professional organizations, local officials, and
transportation service providers have identified a number of obstacles to
addressing transportation-disadvantaged seniors' mobility needs. They also
have identified potential strategies that the federal government, and
other government levels, as appropriate, can take to better address
transportation-disadvantaged seniors' mobility needs and enhance the
cost-effectiveness of the services delivered. These obstacles and
strategies are centered around three major themes, as follows:
o Planning for alternatives to driving as seniors age. Several experts
have reported that the federal government and other government levels do
not do enough to encourage seniors and their caregivers to identify and
use multiple transportation modes for their routine trips. As a
consequence, seniors may perceive that driving is their only option and
may become isolated or drive even when it is unsafe for them to do so.
Experts and other stakeholders have suggested that helping seniors plan
for alternatives to driving-such as by providing information about the
transportation services available in their community-would extend the
lifespan of their mobility, and that the federal government could provide
a central forum for state and local agencies to provide such information.
o Accommodating seniors' varied mobility needs. The growing senior
population could benefit from policies that accommodate its varied needs,
including differing physical limitations and diverse trip purposes (such
as for work, volunteer activities, medical appointments, and recreation),
and address the particular challenges that transportation- disadvantaged
seniors face in nonurban areas. For example, according to senior mobility
experts and others, some federally funded programs are intended for
seniors who do not drive and need assistance all the time; yet some
seniors need transportation assistance only under certain circumstances,
such as in bad weather or when a medical condition worsens. As a result,
these seniors do not qualify for these federally funded transportation
services. Experts and other stakeholders have suggested that the federal
government require or encourage state and local agencies to focus on
seniors' immediate and future mobility needs by including seniors in the
transportation-planning process. For example, seniors could advocate for
safe walking routes to transit stops and for the use of low-floor buses
(which are accessible to both wheelchair users and people with other
mobility impairments).
o Addressing federal and other governmental funding constraints. Experts
and other stakeholders suggested that although public funding resources
are limited, strategies exist to leverage them, including increasing
funding flexibility among programs and improving the coordination of
transportation services at all levels of government. For example, federal
programs tend to specify that funds from an individual program can be used
only to provide transportation to and from that program's services.
Additional funding flexibility and coordination among programs could
expand seniors' access to transportation services.
Seniors benefit when the obstacles to their mobility are addressed, but
trade-offs also result from implementing the identified strategies. For
instance, according to experts and local aging officials, helping seniors
plan for alternatives to driving could enable more seniors to maintain
mobility while refraining from unsafe driving, but increased demand for
services would likely stress already stretched transportation programs.
Offering additional transportation services or modifying existing public
transit also could help seniors meet their varied needs, but such efforts
can be expensive, and additional funds would have to come from new
revenues or other programs.
Given the expected growth in the senior population, it will be important
for seniors and those who support them to have as much information as
possible to plan for the future. Accordingly, our report contains four
recommendations to the Secretary of Health and Human Services to improve
the guidance and information available to seniors about transportation
options and to local agencies about assessments of the need for senior
transportation services and successful practices for addressing this need.
In commenting on a draft of this report, the Departments of Health and
Human Services, Transportation, and Veterans Affairs concurred with the
findings, and the Department of Health and Human Services concurred with
the recommendations. The Department of Transportation also provided
technical clarifications, which were incorporated as appropriate to ensure
accuracy. The Departments of Education and Labor said that they did not
have any comments on the draft.
Background
Seniors are a heterogeneous group-many do not require assistance with
transportation, and, in fact, most drive automobiles. However, according
to data from the 2001 National Household Travel Survey conducted by DOT's
Bureau of Transportation Statistics, Federal Highway Administration, and
National Highway Traffic Safety Administration, approximately 21 percent
(6.8 million) of seniors aged 65 and older do not drive. The percentages
are higher among minority populations aged 65 and older: approximately 42
to 45 percent of African-Americans and Asian-Americans do not drive,
compared with 16 percent of Caucasians. Approximately 40 percent of
Hispanics also do not drive.7 A person's driving status is correlated with
travel behavior. For example, one study found that drivers aged 75 and
older made an average of six trips per week, compared with two trips per
week for nondrivers.8 While some of this difference may be due to
individual preferences or to other circumstances, such as an illness that
prevents travel, some of the difference may be due to a lack of
transportation alternatives.
Those seniors with poor health or a disability, or who have a limited
income, may face more difficulty finding and accessing transportation.
According to data from the 2000 Census, about 37 percent of persons aged
65 and older reported having at least one disability, and about 10 percent
were below the federal poverty line. Although not all of these seniors
need assistance with transportation, a sizable number are likely to need
such assistance. According to senior transportation experts, the "oldest
of the old" (those aged 85 and older) are especially likely to be
dependent on others for rides, particularly if they are also in poor
health. Figure 1 shows some of the factors that affect seniors'
transportation needs. The more of these factors that seniors have, such as
a network of family and friends who can drive them and an available public
transportation system, the more likely it is that their mobility needs
will be met.
Figure 1: Diagram of the Overlapping Factors Affecting Seniors' Mobility
Needs
Transportation assistance is an important issue for all seniors. In 2001,
approximately 26 percent of state units on aging surveyed by the Aging
States Project identified transportation as a top health issue for older
adults, and 38 percent identified inadequate transportation as a barrier
to promoting health among older adults.9 Furthermore, transportation was
among the top five information requests to the Eldercare Locator Service
in
2001, 2002, and 2003.10 There is, however, a significant gender gap in the
amount of time that seniors can expect to be dependent on alternative
sources of transportation. A study published in August 2002 in the
American Journal of Public Health estimated that men aged 70 to 74 who
stopped driving would be dependent on alternative transportation for an
average of 6 years, while women in the same age group can expect to have
an average of 10 years' dependence on alternative transportation modes.11
Although there is no clear-cut definition of mobility need, the literature
and the experts we consulted indicate that there are two main categories
of mobility need, both of which are important to seniors: (1) "essential"
or "life-sustaining" trips, which include medical trips and trips for
employment, shopping, banking, and other necessary errands, and (2)
"quality of life" or "life-enhancing" trips, which include recreational or
social trips that enable a senior to fully participate and engage in the
community, such as trips to concerts, theatre, visits with family members
in nursing homes or with friends, religious activities, and volunteer
activities. For the purposes of this report, we will use this two-fold
definition of types of trips as our working definition of mobility need.
Unmet need occurs when assistance from others is needed but is not
provided or is inadequate. However, according to the experts we contacted,
there is no agreed-upon standard or benchmark for the number of trips that
an individual requires to take care of essential activities for living
(for both life-sustaining and life-enhancing activities),12 although
experts generally agree that government should be concerned with meeting
both types of needs for transportation-disadvantaged seniors. The lack of
a standard or benchmark makes it difficult to determine an appropriate way
to measure the extent to which mobility needs are being met. Researchers
have begun to identify and evaluate transportation-disadvantaged seniors'
unmet mobility needs by comparing the number of trips they make with those
of nondisadvantaged populations.13 In addition, some researchers have used
satisfaction ratings to measure seniors' unmet mobility needs. In the
absence of a standard measure of need, we will discuss need and unmet need
by comparing the travel of disadvantaged seniors with the travel of
nondisadvantaged seniors and by using other measures that federal and
local officials have developed.
The federal government has traditionally provided some assistance in
mobility, mostly for the purpose of accessing other federal program
services. Federal agencies partner with local agencies, nonprofit
organizations, and others that actually provide transportation services
and also contribute their own funds. The federal agency that has a central
role in providing all types of services to seniors is HHS's Administration
on Aging (AOA). With a total discretionary budget of more than $1.3
billion, AOA is the official federal agency dedicated to policy
development, planning, and the delivery of supportive home and
community-based services to older persons and their caregivers. AOA works
through a national aging network of 56 state units on aging; 655 AAAs; 241
tribal and native organizations representing 300 American Indian and
Alaskan Native tribal organizations, and 2 organizations serving Native
Hawaiians; and thousands of service providers, adult day care centers,
caregivers, and volunteers.
Federal Agencies Address Mobility Issues Mainly through 15 Programs That
Help Make Transportation Available, Accessible, and Affordable
Five federal departments administer 15 programs that are key in addressing
mobility issues of transportation-disadvantaged seniors. The programs are
"senior-friendly" in that they help make transportation available,
accessible, and affordable to seniors.
Fifteen Key Federal Programs Fund Services to Enhance Transportation-
Disadvantaged Seniors' Mobility
Working with experts and federal agency officials, we identified 15 key
programs in five departments that provide senior transportation (see table
1) out of the many federal programs that are used to provide
transportation services. Some of these programs specifically target
seniors, such as HHS's Grants for Supportive Services and Senior Centers
(Title III-B). Other programs-including DOT's Nonurbanized Area Formula
Program (Section 5311)-target other groups, such as rural populations, of
which seniors can be a part. About half of the 15 programs fund
transportation for specific types of trips, including for medical
services, employment-related activities, and other services (such as
nutrition) that the programs provide. The other half of the programs can
be used to provide general transportation for any trip purpose. The
programs fund a variety of types of services, ranging from transit passes
and training in the use of public transit to vehicle purchases or
expansion of public transit service.
Table 1: Characteristics of 15 Key Federal Programs That Fund
Transportation for Seniors
Agency Program Target Type of trip Type of service
population allowed provided
Department of Independent Persons aged To access
Education, Living 55 and older program and Referral, assistance,
Office of Services for who have related and training in the
Special Older significant services, or use of public
Education and Individuals visual for general transportation
Rehabilitative Who Are Blind impairment trips
Services
Community Low-income
Department of Services persons General trips Taxicab vouchers, bus
Health and Block Grant (including tokens
Human Services, Programs seniors)
Administration Social Target To access Any
for Children Services population medical or transportation-related
and Families Block Grants identified social use
by states services
Grants for To access Contract for service
Supportive program with existing
Services and Seniors services or transportation
Senior (aged 60 and medical provider, or directly
Centers older) services, or purchase vehicles
Department of (Title III-B) for general (such as vans)
Health and trips
Human Services, Program for
Administration American American To access
on Aging Indian, Indian, program
Alaskan Alaskan services or Purchase and operation
Native, and Native, and medical of vehicles (such as
Native Native services, or vans)
Hawaiian Hawaiian for general
Elders (Title seniors trips
VI)
Generally
Department of low-income Medicaid
Health and persons medical Reimbursement for
Human Services, (including services services with existing
Centers for Medicaid seniors), (emergency transportation
Medicare and although and providers (e.g.,
Medicaid states nonemergency) transit passes)
Services determine
eligibility
Department of Medically
Health and Rural Health underserved
Human Services, Care Services populations To access Transit passes,
Health Outreach (including healthcare purchase vehicles
Resources and Program seniors) in services (such as vans)
Services rural areas
Administration
Department of Senior Low-income
Labor, Community seniors To access Reimbursement for
Employment and Service (aged 55 and employment mileage
Training Employment older) opportunities
Administration Program
Agency Program Target Type of trip Type of service
population allowed provided
Capital and
Training Persons with Assistance in
Assistance disabilities purchasing lift
Program for (including General trips equipment and
Over-the-Road seniors) providing driver
Bus training
Accessibility
Capital
Assistance Assistance in
Program for purchasing vehicles,
Elderly Seniors and contract for services
Persons and persons with General trips with existing
Persons with disabilities transportation
Disabilities providers
(Section
5310)
General
public,
although
Department of Capital some
Transportation, Investment projects are Assistance for bus and
Federal Transit Grants for the General trips bus-related capital
Administration (Section special projects
5309) needs of
elderly
persons and
persons with
disabilities
Job Access Low-income To access Expansion of existing
and Reverse persons employment public transportation
Commute (including and related or initiation of new
seniors) services service
Nonurbanized General
Area Formula public in Capital and operating
Program rural areas General trips assistance for public
(Section (including transportation
5311) seniors)
Urbanized General Capital assistance,
Area Formula public in and some operating
Program urban areas General trips assistance, for public
(Section (including transportation
5307) seniors)
Veterans
Department of (including Mileage reimbursement
Veterans Veterans seniors) To access or contract for
Affairs, Medical Care with healthcare service with existing
Veterans Health Benefits disabilities services transportation
Administration or low providers
incomes
Source: GAO.
Note: As we previously reported, we were unable to determine the amount
spent on transportation services through many of these federal programs.
See GAO, Transportation-Disadvantaged Populations: Some Coordination
Efforts Among Programs Providing Transportation Services, but Obstacles
Persist, GAO-03-697 (Washington, D.C.: June 30, 2003).
Funds from the 15 programs follow various paths in providing
transportation services to seniors (see fig. 2). Many of the programs are
block grants or formula programs through which funds are distributed to
states on the basis of certain criteria, such as population. State
agencies then provide services directly or distribute the funds to local
agencies, nonprofit organizations, transit providers, and other
organizations. For example, funds from DOT's Capital Assistance Program
for Elderly Persons and Persons with Disabilities (Section 5310) are
allotted by formula to state agencies, which then distribute the funds to
private nonprofit organizations or local public entities (such as transit
providers) to purchase vehicles or other equipment. In another example,
funds from HHS's Grants for Supportive Services and Senior Centers (Title
III-B) are distributed first to state units on aging according to the
number of seniors residing in the state, and then to local AAAs, which
generally contract for services with local transportation providers.14 In
other programs, such as the Department of Labor's Senior Community Service
Employment Program, some funds go through the state while other funds go
directly to nonprofit organizations or local service providers. Finally,
other programs-such as HHS's Rural Health Care Outreach Services
Program-bypass state agencies altogether and go directly to local
entities. Local entities can use funds from a variety of federal programs
to provide transportation services to seniors. For example, AAAs can
receive funds from the Title III-B program, DOT's Capital Assistance
Program for Elderly Persons and Persons with Disabilities (Section 5310),
and other federal programs.
Figure 2: Flow of Transportation Funds from Federal Programs to Seniors
Federal Programs Enhance Senior Mobility by Addressing Certain Attributes
of Senior-Friendly Transportation
The Beverly Foundation, a leading independent research organization on
senior transportation issues, has identified the following "5 A's" of
senior-friendly transportation service:15
o availability (service is provided to places seniors want to go at times
they want to travel);
o accessibility (e.g., door-to-door or door-through-door service16 is
provided if needed, vehicles are accessible to people with disabilities,
and stops are pedestrian-friendly);
o acceptability (service is clean, safe, and user-friendly);
o affordability (financial assistance is provided to those who need it);
and
o adaptability (service is flexible enough to accommodate multiple trip
types or specialized equipment).
However, there are trade-offs involved in addressing any of the "5 A's."
For example, improving the acceptability of service can increase the costs
of providing service.
Our review of federal programs' authorizing legislation and guidance, as
well as interviews with federal program officials, indicates that most of
the 15 key federal programs we identified in table 1 are generally
designed to make transportation more available, accessible, and affordable
to transportation-disadvantaged populations, such as seniors (see table
2). For example, HHS's Medicaid Program provides transportation that is
free or low-cost for seniors. Some of the programs address other
attributes of senior-friendly transportation, such as acceptability. For
example, the Department of Education's Independent Living Services for
Older Individuals Who Are Blind program can be used to train seniors in
the use of the public transit system, making it both more accessible and
acceptable to them.
Table 2: Attributes of Senior-Friendly Transportation Service Addressed by
the 15 Key Federal Programs That Fund Transportation Services for Seniors
Attribute
Agency Program Availability Accessibility Acceptability Affordability Adaptability
Independent
Living
Department of Services for ✔ ✔
Education Older
Individuals
Who Are Blind
Community
Services ✔ ✔ ✔ ✔
Block Grant
Programs
Social
Services ✔ ✔ ✔
Block Grants
Grants for
Supportive
Services and ✔ ✔ ✔
Senior
Centers
Department of (Title III-B)
Health and Program for
Human Services American
Indian,
Alaskan
Native, and ✔ ✔
Native
Hawaiian
Elders (Title
VI)
Medicaid ✔ ✔
Rural Health
Care Services ✔ ✔
Outreach
Program
Senior
Department of Community
Labor Service ✔
Employment
Program
Capital and
Training
Assistance
Program for ✔ ✔ ✔ ✔
Over-the-Road
Bus
Accessibility
Capital
Assistance
Program for
Elderly
Persons and ✔ ✔ ✔ ✔ ✔
Persons with
Disabilities
(Section
5310)
Department of Capital
Transportation Investment
Grants ✔ ✔ ✔
(Section
5309)
Job Access
and Reverse ✔ ✔ ✔ ✔
Commute
Nonurbanized
Area Formula
Program ✔ ✔ ✔
(Section
5311)
Urbanized
Area Formula
Program ✔ ✔ ✔
(Section
5307)
Department of Veterans
Veterans Medical Care ✔ ✔ ✔ ✔
Affairs Benefits
Source: GAO.
Note: This table focuses on the senior-friendly attributes addressed by
the intent of the federal program as identified in federal program
legislation and guidance and in interviews with federal officials.
Grantees may actually address more of the five A's when delivering
transportation services to seniors at the local level.
In addition to the 15 key programs identified in tables 1 and 2, the
federal government helps to make transportation more senior-friendly
through other programs and policies that provide or ensure access to
transportation services for all disadvantaged populations (including
seniors). Although seniors are not the target population of these other
programs and policies, they often benefit from them. For example, seniors
are eligible for many of the programs we identified in a previous report
on the coordination of services for the transportation-disadvantaged.17 In
that report, we identified 62 federal programs that can be used to provide
transportation services, including the 15 programs identified above. For
instance, seniors can benefit from the Department of Housing and Urban
Development's Community Development Block Grant Program, which can be used
to purchase and operate vehicles in low-income areas, and the Department
of Labor's Workforce Investment Act Adult Services Program, which can be
used to provide bus tokens or reimbursement for mileage to access training
opportunities.
Another federal program that does target seniors-Medicare, the federal
health financing program covering almost all persons aged 65 and older and
certain persons with disabilities-was not included in our list of 15 key
programs because it funds only a very specific type of transportation
service for seniors. Medicare covers medically necessary ambulance
services when other means of transportation, such as a wheelchair van or a
taxicab, are inadvisable, given the beneficiary's medical condition at the
time. Medically necessary ambulance trips include both emergency care,
such as responses to 911 calls, and nonemergency care, such as transfers
from one hospital to another. Medicare covers nonemergency transports-both
scheduled and nonscheduled-if the beneficiary is
bed-confined18 or meets other medical necessity criteria, such as
requiring oxygen on the way to the destination.19
Many programs and policies that address the mobility needs of persons with
disabilities also benefit seniors. For example, the Americans with
Disabilities Act (ADA) has resulted in changes to many
transportation-related facilities, including transit vehicles and bus
stops, that make transportation more accessible to seniors with
disabilities as well as others. Other federal ADA-related activities can
also benefit seniors. For example, the Department of Justice's Civil
Rights Division is responsible for enforcing federal statutes, including
the ADA, that prohibit discrimination on the basis of race, sex, handicap,
religion, and national origin. In addition, Justice has published rules
governing the design of transportation facilities, such as bus stops, to
make them accessible to people with disabilities. Finally, the U.S.
Architectural and Transportation Barriers Compliance Board-an independent
entity within the federal government devoted to accessibility for people
with disabilities-develops and maintains accessibility standards for
transit vehicles, provides technical assistance and training on these
standards, and ensures compliance with accessibility standards for
federally funded facilities.
Data Indicate That Some Types of Mobility Needs Are Not Being Met, but
Information on the Extent of Unmet Needs Is Limited
The data on the nature of mobility needs that we obtained from research
publications and interviews with federal officials, experts, and officials
from 16 local AAAs indicate that federally supported programs are not
meeting some of the mobility needs of transportation-disadvantaged
seniors.20 In particular, (1) seniors who rely on alternative
transportation have difficulty making trips for which the automobile is
better suited, such as trips that involve carrying packages; (2)
life-enhancing needs are less likely to be met than life-sustaining needs;
and (3) mobility needs are less likely to be met in nonurban communities
(especially rural communities) than in urban communities. However, there
are few current or planned efforts to collect data for assessing the
extent to which federally supported programs are meeting
transportation-disadvantaged seniors' mobility needs. In addition, AAAs'
methods for collecting and reporting data make it difficult to determine
the extent to which transportation-disadvantaged seniors' needs are being
met, in part because of a lack of federal guidance on how to assess needs.
According to experts and local officials, barriers to assessing the extent
of unmet needs include the lack of consensus on how to define or measure
needs, a lack of federal guidance, and the difficulties of measuring the
unmet needs of seniors who are not attempting to access publicly funded
services.
Federally Supported Programs Are Not Meeting Some Types of Mobility Needs
of Transportation- Disadvantaged Seniors
Federally supported transportation services are meeting some, but not all,
types of mobility needs of transportation-disadvantaged seniors. Although
up to 75 percent of nondrivers aged 75 and older have reported being at
least somewhat satisfied with their mobility,21 evidence from nationally
published research and from interviews we conducted with federal
officials, experts, and local aging professionals indicates that many of
those seniors who are able to meet life-sustaining and life-enhancing
needs are doing so because they have access to supportive family and
friends who drive them or because they live in transit-rich cities. For
those seniors who do not have access to these support structures or who
live in nonurban areas, some mobility needs-especially those related to
life-enhancing activities-may not be met.
Transportation-Disadvantaged Seniors Lack Alternatives to the Automobile
That Provide Comparable Benefits
Data from nationally published research indicate that
transportation-disadvantaged seniors prefer the automobile to other modes
of transportation because it is readily available, can reach multiple
destinations in the course of one trip, and can be used to access
destinations that require carrying packages (such as shopping). In focus
groups conducted by AARP,22 the general consensus among participants was
that access to ready transportation provided by the private automobile is
critical to overall life satisfaction. In comparison, seniors perceived
other modes such as public transit, specialized transportation (such as
senior vans), and walking as having inherent negative attributes-including
time spent waiting, waits in bad weather, difficulty carrying items,
scheduling requirements, infrequent service, and concerns about personal
security and accessibility-that made them less attractive than driving or
being driven. Consistent with this, a survey conducted by AARP found that
senior nondrivers use automobile rides from family or friends more than
other modes of transportation to get where they need to go (see fig. 3).23
Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and Older
Note: Other modes include public transportation, senior vans, walking, and
taxicabs.
Even if seniors could overcome some of these negative perceptions of
alternatives to the automobile, they may not be able to use the
alternatives because the alternatives might be unavailable in their
community or are inaccessible to seniors. In a survey by AARP, about 33
percent of senior nondrivers who reported that they did not use public
transportation said that it was because public transportation was not
available.24 In focus groups conducted for the Coordinating Council on
Access and Mobility, HHS, and the National Highway Traffic Safety
Administration, participants reported having trouble walking long
distances, getting to the bus stop, getting on and off buses, and seeing
street signs from the bus so that they
knew where and when they should disembark.25 Similarly, more than
one-third of the respondents in one study's focus groups reported that
they would be unable to walk one-quarter mile to a bus stop.26
Transportation-Disadvantaged Seniors' Life-Enhancing Needs Are Less Likely
to Be Met Than Life-Sustaining Needs
Data from nationally published research indicate that difficulty in
getting the transportation they needed interfered with
transportation-disadvantaged seniors' activities and trip-making,
especially for life-enhancing needs such as social or recreational
activities. For example, a report analyzing data from the 2001 National
Household Travel Survey found that seniors who do not drive made 15
percent fewer trips to the doctor than drivers, but made 65 percent fewer
trips for social, family, religious, and other life-enhancing purposes.27
In addition, although few seniors in an AARP survey28 reported that a lack
of transportation interfered with their activities-such as getting to the
doctor, their place of worship, the grocery store or drug store, or
entertainment; shopping for clothes or household items; or visiting with
friends-nondrivers were two to three times as likely as drivers to report
that a lack of transportation interfered with such activities.29
Furthermore, a study that analyzed responses from seniors in focus groups
reported that older adults who have stopped driving significantly
curtailed their recreational activities. One participant who had stopped
driving reported, "What I do now, my daughter tries to take me shopping
once a week for heavy items, which is very helpful. But I'm accustomed to
going from mall to mall and store to store to see things, you know, and I
don't get around like that. I'm very limited." 30
Federal officials and experts we interviewed also said that the available
transportation options are not meeting seniors' mobility needs, especially
for life-enhancing trips. Several experts said that, while mobility needs
are being met for the majority of seniors who drive-and even for some
transportation-disadvantaged seniors who live in transit-rich
environments, who have access to supportive family and friends, or who
have knowledge of and access to nonprofit or other organizations that
provide transportation-the mobility needs generally are not being met for
transportation-disadvantaged seniors without these options. Although a few
officials and experts said that for most seniors, trips for
life-sustaining needs (e.g., medical appointments) are likely being met,
others said that such needs are not being met.
Finally, the majority of AAA officials we interviewed said that
transportation-disadvantaged seniors' needs were not being met. (Although
3 of the 16 AAAs said that needs were being met with the limited funding
available, they also cited gaps in service.) Furthermore, although the AAA
officials we interviewed were split in their perspectives on whether needs
for travel to critical, life-sustaining activities were being met, nearly
all said that needs for travel to life-enhancing activities such as church
and shopping at the mall were not being met. In addition, all of the AAAs
we interviewed imposed restrictions that limited or prioritized
transportation services for life-sustaining activities. For example, many
AAAs require advance notification (e.g., 24-hour notification) for service
and most restrict service to approximately 9 a.m. to 5 p.m. on weekdays,
which limits spontaneous travel and travel in the evenings when many
cultural and social events take place. Furthermore, most AAAs offer
transportation only within the counties or towns they serve, which limits
access to activities. Finally, when we asked AAA officials about the
destinations to which they provide transportation, most identified
essential, life-sustaining sites, such as nutrition sites, medical
facilities, grocery stores, pharmacies, public service agencies, and
banks. Only a few AAAs offered transportation for life-enhancing
activities, such as for recreational or cultural events, or for visits to
spouses or other family or friends in long-term-care facilities, and some
explicitly stated that they were unable to provide service for personal or
life-enhancing activities. The AAA officials told us that all of these
constraints were due to limited funding availability.31
Transportation-Disadvantaged Seniors' Needs Are Less Likely to Be Met in
Nonurban Areas Than in Urban Areas
The travel of transportation-disadvantaged seniors living in nonurban
communities is more restricted than the travel of
transportation-disadvantaged seniors living in urban communities. A study
analyzing 2001 National Household Travel Survey data indicated that older
Americans living in small towns and rural areas who do not drive were more
likely to stay home on a given day than their urban and suburban
counterparts-63 percent of nondrivers in small towns and 60 percent of
nondrivers in rural areas reported that they stayed home on a given day,
compared with 51 percent of nondrivers living in urban and suburban
areas.32 Alone, these data do not indicate that mobility needs are less
likely to be met because of limited transportation options rather than
other aspects that distinguish rural communities from urban ones, such as
fewer activities and longer distances between destinations. However, data
we obtained from other sources support the idea that the lack of
transportation is a significant reason for these travel patterns. For
example, in focus groups and interviews that AARP conducted in 2001 with
seniors aged 75 and older, nondrivers living in the suburbs were less
satisfied that their mobility needs were met than urban nondrivers. In
addition to identifying feelings of lost freedom, diminished control, and
altered self-image, several suburban participants noted that they make
fewer trips and pursue fewer activities as nondrivers, whereas the urban
nondrivers expressed more satisfaction with their ability to get around.33
In addition, in a survey by AARP, respondents living in cities reported
that they were more likely to have public transportation available to them
than respondents living in rural areas (see fig. 4).34
Figure 4: Percentage of Respondents Aged 75 and Older Who Have Public
Transportation Available to Them, by Area
Note: Respondents were asked how they would describe their current
residence: as a city, a suburban area around a city, a small town, or in
the country. According to AARP's calculations, all of the estimates we
cite from this study have sampling errors that do not exceed + or - 4.5
percent at the 95 percent confidence level.
In addition, several federal officials and experts we interviewed said
that the needs of transportation-disadvantaged seniors are not being met
with available transportation options, especially for those seniors living
in rural communities. Similarly, when we asked AAA officials whether
transportation-disadvantaged seniors' needs were being met, nearly half
offered the view that needs were not being met for those living in rural
communities because of the long distances required to travel to facilities
and the resulting need for the driver to wait to bring the senior back. In
addition, some said there are geographic regions in rural areas that are
not served at all by public transportation, taxicab, or other
transportation providers.
Data Are Limited on the Extent to Which Mobility Needs Are Being Met
Because most of the federal programs that fund transportation for
transportation-disadvantaged seniors do not focus specifically on seniors
or transportation (instead, seniors may be one of several target
populations, and transportation may be one of several supportive services
provided by the program), federal agencies have minimal program data about
the extent of seniors' unmet transportation needs. Five of the 15 key
federal programs that provide transportation to seniors-the Department of
Education's Independent Living Services for Older Individuals Who Are
Blind program and HHS's Social Services Block Grants, Community Services
Block Grant Programs, Grants for Supportive Services and Senior Centers
(Title III-B), and Program for American Indian, Alaskan Native, and Native
Hawaiian Elders (Title VI)-collect some nonfinancial performance data
related to senior transportation.35 Most of the data collected for these 5
programs provide only information on usage, such as the number of seniors
receiving transportation services or the number of one-way trips provided
to seniors. In addition, for transit programs that serve the general
public, the Federal Transit Administration collects data on the number of
rides and the number of people served, but these data are not broken out
by federal program or by age. However, AOA officials told us that they are
beginning to measure performance outcomes related to transportation
services under the Title III-B program. On the basis of a national survey
it conducted in 2004, AOA estimated that state and area agencies on aging
provided transportation services to approximately 440,000 seniors in
fiscal year 2003. AOA officials told us that most of the respondents rated
the transportation services as good or excellent, and that many
respondents reported that they relied on these services for all or nearly
all of their local transportation needs. Although this information is
useful in assessing the satisfaction of seniors who receive transportation
services, it does not measure the extent of unmet needs. Officials from
AOA and the Federal Transit Administration currently are assessing the
state of data on seniors' mobility needs to identify baseline data on
needs and available resources.
Similarly, few AAAs use, or plan to use, data collection methods that
enable them to determine the extent of seniors' unmet mobility needs-that
is, information on both the extent of need in the community and the
capacity of services, including their own, to provide transportation to
seniors to meet those needs. AAAs are required to determine the extent of
need for supportive services (which could include transportation) provided
through HHS's Title III-B program and to evaluate how effectively
resources are used to meet such need.36 However, several AAAs we
interviewed reported that they do not collect this type of data at all. Of
those AAAs reporting that they do collect data on the extent of unmet
needs, most collect data on the number of seniors who called the AAA to
request transportation services that the agency was unable to provide
(including data such as the number of trip denials and the number of
seniors on a waiting list). There are a number of limitations to this type
of data. For example, a few AAAs reported that waiting list data were not
reliable in measuring the unmet needs of seniors because the data allowed
multiple-counting of seniors who are wait-listed by more than one
transportation provider or who periodically call for rides and are added
to the waiting list each time they call. In addition, AAAs reported that
waiting list data were not entirely representative of unmet needs because
these data include information only on seniors who call for service and
not on seniors who do not call (because no services are available, because
they do not know what services are available, because they are tired of
being turned down, because they moved to an assisted living facility since
they had difficulty obtaining transportation, or because of some other
reason) but who may still need rides. Furthermore, the waiting list data
do not allow for calculating the number of seniors who were referred to
other transportation services and were able to get rides through these
other services. Only 2 of the 16 AAAs (the Salt Lake County Aging Services
and the Bear River Association of Governments, both in Utah) have a method
for determining the gap in transportation service by calculating the
difference between the number of seniors who are in need of transportation
and the number of seniors who are receiving service through other
providers, or through family and friends.
Finally, there is little information from national surveys and studies
that addresses the extent to which transportation-disadvantaged seniors'
needs are being met; rather, those surveys and studies focus on the nature
of needs, as discussed in the previous section of this report. For
example, one report prepared by DOT's Bureau of Transportation Statistics
analyzes 2002 data from the Transportation Availability and Use Survey on
the travel behavior of persons with disabilities, but the findings are not
broken down by age.37 Another Bureau of Transportation Statistics report
analyzing the same data source provides some insights on the types of
travel problems encountered by seniors with disabilities, but it does not
provide data that can be used to measure the extent of those seniors'
transportation needs or to determine whether those needs are being met.38
There Are Several Barriers to Assessing the Extent of Unmet Need
Senior mobility experts told us that there is no clear-cut definition of
mobility needs, making it difficult to determine the extent to which such
needs are being met. Although many of the experts we contacted mentioned
the distinction between life-sustaining and life-enhancing needs, they did
not provide a more concrete definition. Many of these experts also said
that they were not aware of an agreed-upon standard or benchmark for
assessing seniors' unmet mobility needs. One researcher said that the
topic of seniors' mobility needs is just beginning to be discussed in the
literature, so a standard has not yet been developed.
In addition to the lack of consensus on definitions or measures of need,
there is also little guidance on assessing mobility needs. Although some
of the 15 key federal programs we identified require state or local
agencies to assess the need for services, federal agencies provide little
guidance on how to do this. As previously noted, HHS's Title III-B and
Title VI programs-through which AOA provides grants to states and Native
American tribes for senior services-require AAAs to prepare a plan that
includes an assessment of the needs of disadvantaged seniors, which could
include transportation needs.39 Furthermore, the Older Americans Act, as
amended, requires AOA to provide guidance to states on assessing needs,
specifically "to design and implement [for program monitoring
purposes]...procedures for collecting information on gaps in services
needed by older individuals" and "procedures for the assessment of unmet
needs for services...."40 Although AOA has developed general guidance for
Native American tribes on conducting needs assessments for its Title VI
program, the program guidance that the agency provides to states for its
Title III-B program does not include guidance on how to assess and measure
needs or on specific data collection methods. As a result of the lack of
guidance on assessing need, most of the AAAs that we interviewed reported
assessing seniors' unmet mobility needs using a range of data collection
methods that resulted in data not specific enough for planning purposes,
and not indicative of the precise extent to which seniors' mobility needs
are being met. While some AAAs said they did not need additional data,
other AAAs we spoke with said that more precise information on the extent
of unmet need would be useful in designing services and getting political
support and funding for services, but some do not have the staff, funds,
or expertise to develop methodologies to do this. They said that guidance
from the federal government in this regard would be very useful.
Officials at AOA said that, in the past, they have not provided guidance
to state and local aging agencies on how to assess needs for the Title
III-B program because they received feedback that state and local aging
agencies had a more immediate desire for guidance on assessing the quality
of service and collecting information on client characteristics. To this
end, AOA is currently developing a plan for evaluating the various
supportive services, including transportation, provided through its Title
III-B programs. The evaluation effort will address the needs of states and
communities for supportive services and the extent to which the Title
III-B program is meeting the needs and preferences of the elderly for
those services. As part of the evaluation, AOA plans to address questions
about the role of AAAs in providing supportive services, how needs
assessments are performed by state and local entities, and how the results
of those assessments are used by states in implementing the Title III-B
program. On the basis of the results of our interviews with AAA
representatives, the AOA official responsible for the planned evaluation
said that it would be useful to obtain some additional information during
the evaluation to determine the need for services under the Title III-B
program, including (1) identifying how needs should be defined and
measured; (2) determining the range of methodologies that AAAs use for
assessing seniors' need for services, including transportation, and unmet
needs; and (3) identifying the kinds of guidance that AAAs want from AOA
and states to help them perform their required needs assessments. AOA
plans to complete its evaluation of this program by January 2006.
Other federal program regulations also require or encourage local agencies
to assess need to be eligible for funding. For example, DOT's Capital and
Training Assistance Program for Over-the-Road Bus Accessibility (which
provides funds to bus operators to help make their services more
accessible to persons with disabilities) lists "identified need" as one of
the criteria for selecting grantees, and HHS's Community Services Block
Grant Program (which provides funds for services to address the needs of
low-income individuals) requires grantees to assess need for services and
report this information to the state. However, these agencies do not
provide guidance for assessing need for most of these programs. DOT
officials said that they allow local applicants for the Capital and
Training Assistance Program for Over-the-Road Bus Accessibility to decide
what measures to use to demonstrate need, and the measures vary
accordingly. For example, some of these applicants have provided
information on the number of trips that were denied for lack of an
accessible vehicle, while other applicants demonstrate need on the basis
of the number of trips provided using an existing lift-equipped vehicle.
For its Job Access and Reverse Commute Program, DOT asks applicants to
provide data on the percentage of low-income persons in the area as well
as on transportation gaps between existing services and employment
opportunities for these persons, and the agency provides some guidance on
how to identify such gaps.41 HHS provides some guidance for assessing the
need for services under the Community Services Block Grant Programs, but
the guidance is for assessing a wide range of services, of which
transportation is only one.
Federal officials report that it is difficult to measure unmet mobility
needs largely because of difficulties in measuring the unmet needs of
those transportation-disadvantaged seniors who are not trying to access
transportation services (such as those who do not call for service because
they have given up trying to get transportation or are not aware of
services). Some AAA officials and federal officials said that collecting
this type of data is time-consuming and expensive. In addition, there may
be other difficulties in reaching these seniors. For example, they may
have difficulty hearing questions posed over the telephone, may be wary of
providing personal information, or may be reluctant to admit that they
need assistance or that they can no longer safely drive themselves to
activities they need or want to attend.
Transportation Service Providers Implement Practices That Enhance Senior
Mobility with Some Federal Support, but Implementation Difficulties Remain
Transportation providers use a variety of practices-which we have grouped
into three categories-to enhance the mobility of
transportation-disadvantaged seniors and promote the cost-effective
delivery of transportation services. These include practices that (1)
improve service efficiency through increasing the use of technology and by
coordinating services with other providers in the community; (2) improve
customer service by providing training sessions for service staff and
seniors, using vehicles that can accommodate seniors' mobility challenges,
and increasing the level of service provided; and (3) leverage existing
resources by increasing volunteer involvement and forging financial
partnerships with public and private entities in the community. According
to the local service providers we interviewed, these practices, which were
implemented with some federal support, resulted in more senior-friendly
transportation services and more cost-effective service delivery. All 10
local transportation service providers we interviewed indicated that they
had been able to use funds from 1 or more of the 15 key federal programs
in implementing practices that enhance senior mobility. The most commonly
used programs were DOT's Capital Assistance Program for Elderly Persons
and Persons with Disabilities (Section 5310) and HHS's Title III-B and
Medicaid Programs, followed by DOT's Nonurbanized Area Formula Program
(Section 5311), and HHS's Community Services Block Grant Programs.
However, according to the providers we interviewed, certain
characteristics of federal programs may impede the implementation of
practices that enhance transportation-disadvantaged-seniors' mobility.
Certain Practices Enhance Transportation- Disadvantaged Seniors' Mobility
and Promote Cost-effective Delivery of Services
According to a 2002 report prepared by DOT's Transit Cooperative Research
Program (hereafter referred to as the TCRP report),42 local transportation
providers have implemented a number of program practices to improve public
transportation services for seniors. The 10 local service providers we
interviewed in urban and rural areas have implemented some of these
practices, as discussed below.
Improvements to Service Efficiency
Increasing the use of technology: According to the TCRP report, using
advanced technology can improve efficiency, productivity, and
cost-effectiveness. Global Positioning Systems (GPS) and other advanced
technologies can provide real-time information about where vehicles are
located, when they will arrive to pick up a senior, and how long the trip
may take. Two of the 10 local service providers we interviewed are using
advanced technology to improve their trip scheduling. For example,
Sweetwater Transportation Authority in Rock Spring, Wyoming, is using GPS
technology on board each bus, connecting the bus to software that will
automatically schedule rides and provide an accurate estimated time of
arrival to passengers. The Friendship Center, which offers
door-through-door transportation services in Conroe City, Texas, is
involved in the early stages of implementing a computerized dispatching
and mapping system that will allow same-day scheduling to transport
seniors to their destinations. In the past, all scheduling was done
manually and seniors often had to call 48 hours in advance to schedule a
ride. According to Friendship Center officials, the implementation of the
computerized mapping system will increase efficiency and coordination of
their transportation service, which will also improve the level of service
provided to seniors.
Coordinating transportation services: According to the TCRP report and our
previous work, coordination of transportation services can improve the
overall efficiency of operations, increase the productivity of services,
reduce service costs, and increase mobility.43 Our previous work indicated
that the extent of coordination of transportation services varies. Several
service providers we interviewed have implemented a coordinated
transportation service, including Mountain Empire Older Citizens (MEOC),
which is located in central Virginia.44 MEOC recognized that coordination
was needed because each human service agency in the area was transporting
its own clients exclusively, while other vehicles from other agencies were
picking up passengers in the same area. Under its coordination contract,
MEOC leases vehicles from other specialized transportation service
providers and coordinates all aspects of transporting their clients
(including other transportation-disadvantaged groups, such as people with
developmental disabilities). As a result, MEOC has maximized the efficient
use of vehicle fleet and realized cost savings in service delivery,
according to an agency official. Another service provider, the Friendship
Center, coordinates its transportation services with medical facility
staff to schedule medical appointments for seniors. The dispatchers at the
center work directly with the medical providers to schedule medical
appointments for seniors when the center's transportation services are
available. In addition, the center's hours for transportation services
reflect those of the medical centers. By coordinating their services, the
center helps ensure that seniors do not encounter transportation
scheduling problems. Lastly, Medical Motor Service, which provides
transportation and brokerage45 services to seniors in Monroe County, New
York, coordinates with other nonprofit agencies to provide volunteers who
serve as "shopping buddies" to help seniors carry packages or assist them
with their groceries.
Improvements to Customer Service
Providing training to staff and seniors: According to the TCRP report and
a brochure on innovative transit services for seniors developed by the
Beverly Foundation and the Community Transportation Association of America
(hereafter, Innovations Brochure),46 training for service
staff-particularly drivers-and for senior riders is important in improving
transportation services. The TCRP report states that staff training should
address customer service issues, such as the need for polite and courteous
interactions by drivers with passengers and the physical constraints
seniors encounter while using public transportation. The TCRP report also
indicates that customer service training should be part of an overall
change in organizational focus, from just operating vehicles to serving
customers. Several service providers we interviewed were implementing
training to improve customer service by helping seniors feel more
comfortable while being transported. For example, Altoona Metro
Transportation, which provides public transit service to the general
public in central Blair County in Pennsylvania, developed a
driver-training sensitivity program through which drivers receive
specialized training to recognize the diverse needs of seniors. In what is
considered a "hands-on" session, drivers wear special glasses to distort
their vision so that they can temporarily experience the physical
limitations that some seniors face while riding public transportation. An
Altoona Metro official also told us that drivers are encouraged to
socialize with senior passengers and foster relationships to make seniors
feel comfortable and welcomed. In addition to training for staff,
providers are also implementing travel-training programs to teach seniors
who are not accustomed to using transit services how to use public
transportation. One service provider, North County Lifeline, Inc. (a
curb-to-curb47 transit service located in the northern San Diego area),
developed a travel-training program for seniors to learn about public
transit and reduce any concerns they may have about personal safety when
using transit. The program includes instruction in how to problem-solve,
map out a trip, make transfers, and understand the rights and
responsibilities they have while riding public transportation.
Using vehicles that can accommodate seniors' mobility challenges: Using
vehicles that accommodate the mobility challenges of seniors-such as
purchasing low-floor buses,48 equipping vehicles with lifts, or modifying
vehicles to make them identifiable and visually appealing (by using buses
with distinctive colors to designate specific routes or with large
see-through windows)-may help address some of the physical challenges
(such as difficulties boarding a bus or van) and emotional challenges
(such as concerns about boarding the wrong bus or personal safety) that
seniors may face while using public transportation. For example, the TCRP
report states that low-floor buses provide advantages over conventional
buses because they shorten the distance between the first step on the bus
and the curb (e.g., the first step on a conventional bus is approximately
9 to 12 inches above the curb, whereas the first step on the latest
low-floor buses is less than 3 inches above the curb). However, there may
be constraints in using such buses-one service provider we interviewed
found them impractical for the provider's service area, which contains
hilly terrain49 and many narrow streets. The majority of service providers
we interviewed use lift-equipped50 vehicles to transport seniors who use
wheelchairs. Several of the service providers are also using vehicles that
are easily identifiable and visually appealing to further address concerns
seniors may have about using public transportation. For example, several
of the service providers we interviewed said that they transport seniors
in vehicles that are color-coded to designate specific routes or that have
large, nontinted windows to limit the confusion that seniors face while
trying to determine which bus to board, to provide a sense of personal
security, and to "demystify" public transportation for seniors.
Increasing level of service: According to the TCRP report, increasing
overall service levels is vital to meeting the mobility needs of a growing
senior population. Some of the local service providers we interviewed said
that the practices they implemented allowed them to improve their services
by expanding service hours for life-sustaining trips (as much as their
funding allows), accommodating all requests as they arise (even if that
means temporarily modifying a route), and expanding services to include
life-enhancing trips (e.g., field trips sponsored by senior centers and
trips to a therapeutic warm-water pool program). For example, a MEOC
official told us that the provider expanded its service from 8 hours to 12
hours per day on weekdays to provide transportation for life-sustaining
trips (e.g., medical appointments), and that the agency plans to modify an
existing route to provide service regardless of how little notice is
given. MEOC's computer scheduling system enables dispatchers to radio the
nearest driver and ask him or her to modify the current route to fit in an
extra pick-up or drop-off. In another example, Gold Country Telecare, a
nonprofit agency that provides accessible specialized transportation in
rural northern California, learned through interviews with others in the
local community involved in senior transportation that seniors were often
isolated on weekends, when transportation services were rarely available
for them. To address this need, the agency increased its service level by
implementing an all-day Sunday transportation service for seniors to get
to church or other activities, such as grocery shopping.
Improvements to Leverage Available Funds
Increasing volunteer involvement: According to the TCRP report and the
Innovations Brochure, volunteer involvement may lead to cost savings in
delivering transportation services to seniors by reducing the need for
paid staff. The local service providers we interviewed used volunteers in
a variety of ways. For example, Gold Country Telecare implemented a
volunteer driving program under which volunteers are reimbursed for
mileage expenses incurred in using their personal vehicles to transport
seniors to medical and health treatment facilities located in a nearby
urban center. According to a Gold Country Telecare official, this program
allows seniors to participate in health therapies or medical services not
found in their rural community. OATS, Inc., a transportation service
provider in Missouri, uses volunteers who act as dispatchers, taking calls
in their homes from people in the community who need trips. The volunteers
transfer requests to the driver, who then schedules the trips. The use of
volunteers allows OATS to provide more cost-effective and more frequent
service by avoiding the administrative expense of having an office in each
of the 87 counties it serves. Furthermore, according to an OATS official,
the value of the volunteer hours (including the in-kind allowance for the
use of
their personal telephones and space in their home) translates into
approximately $1.6 million in cost savings per year.51
Forging partnerships with private and public entities: The TCRP report
suggests forging financial partnerships with public and private entities
in the community to address funding concerns and to diversify funding
sources. Several of the local service providers we interviewed developed
private/public partnerships such as (1) contracts with private entities to
engage in revenue-enhancing activities, such as using the service
providers' vehicles to transport other groups when the vehicles were not
being used for senior transportation or transporting seniors to specific
locations, such as shopping sites, or (2) joint agreements with human
service agencies to provide specialized services for clients who need
additional assistance. For example, the Friendship Center contracts with
private entities to provide shuttle services from employee parking to
employment sites, from overflow parking lots to special event venues, to
community churches on Sunday mornings, and other similar transportation
services. According to center officials, these additional contracts for
shuttle services bring in approximately $140,000 in additional annual
revenue, which is being used to provide additional senior transportation
services and represents approximately 15 percent of the center's annual
budget for senior transportation. Another local service provider that
diversified its funding sources, Medical Motor Service, developed a
partnership with a regional private supermarket to supplement its
fund-raising efforts. Under this arrangement, Medical Motor Service
receives approximately $300,000 in annual funding from the supermarket to
transport seniors to and from the grocery store. This sum represents 18
percent of the provider's annual senior transportation budget. As a result
of this arrangement, seniors residing in 55 housing complexes have
transportation for grocery shopping or for renewing medical prescriptions
at any of the 14 supermarkets located in Monroe County. However, one
trade-off in having an exclusive partnership with one grocery store chain
is that, unlike seniors (and others) who can drive, seniors who rely on
such a service do not have a choice of where to shop. In that regard,
Special Transit, a local service provider in Boulder, Colorado, identified
a need to diversify its funding sources to reduce dependence on any one
source of funds, helping to ensure continuity of service for all of its
clients, including seniors. To do so, it hired an outreach coordinator to
identify other service providers in the community (such as senior day care
programs, senior centers, and local hospitals) that were interested in
having Special Transit provide transportation services. In addition, the
coordinator was tasked with identifying opportunities for generating
private donations. Through its partnerships, Special Transit reduced its
dependence on public funding (including federal and local government
grants and matching funds) from more than 80 percent of its total revenue
sources in the mid-1980s to approximately 65 percent in 2004. Presently,
Special Transit's service contracts and private donations account for
approximately 30 percent of its total revenues.
Summary of Practices and Funding Sources
Table 3 provides examples of some of the practices and federal funding
sources used by the local service providers we interviewed.52
Table 3: Practices Implemented and Funding Sources Associated with
Selected Local Transportation Service Providers
Practices
Provider name
and associated Coordination Training and Vehicle Service Volunteer Financial
federal Technology of services safety modification delivery involvement partner-
funding ships
sources
Altoona Metro Senior
Transportation Driver Markets its companion
sensitivity Low-floor services volunteers
o Section 5307 training buses specifically promote
program to seniors "Bus-Buddy"
o Section 5309 program
Friendship Uses
Center Computerized Coordinates vehicles
mapping with medical after
o CSBG system to facility staff Lift-equipped Customer- hours to
schedule to schedule vehicles focused increase
o Section 5310 same-day medical organization revenue
service appointments through
o Title III-B for seniors contracted
services
Practices
Provider name
and associated Coordination Training and Vehicle Service Volunteer Financial
federal Technology of services safety modification delivery involvement partner-
funding ships
sources
Gold Country Sunday
Telecare, Inc. transportation Neighbor-to-
service and neighbor
o SCSEP Lift-equipped follow-up and volunteer
vehicles preventive driver
o Section 5310 healthcare program
transportation
o Title III-B services
Contracts
Medical Motor Coordinates with
Service with other regional
nonprofit Wheelchair- Provides grocery
o Medicaid agencies to accessible door-to-door chain to
provide senior vehicles escort service transport
o Section 5310 shopping seniors
buddies for
o Title III-B grocery
shopping
Mountain
Empire Older
Citizens, Inc. Coordinates Customer-
transit system friendly and
o Medicaid that provides flexible
door-through- Lift-equipped service to
o SCSEP door, vehicles meet the needs
one-on-one of a
o Section 5310 services to multicounty
special needs rural
o Section 5311 populations community
o Title III-B
Collaborates
to establish a
Web-based
North County referral Travel-Training
Lifeline system to Program teaches
highlight seniors how to Lift-equipped
o Section 5307 transportation use fixed-route vehicles
options for transportation
o Section 5310 seniors and
assist social
service
providers
OATS, Inc.
Use
o CSBG volunteers to
fulfill
o JARC functions
such as
o Rural Health dispatching
calls to
o Section 5310 drivers,
fund-raising,
o Section 5311 and serving
as liaisons
o SSBG to the
community
o Title III-B
Practices
Provider name
and associated Coordination Training and Vehicle Service Volunteer Financial
federal Technology of services safety modification delivery involvement partner-
funding ships
sources
Special
Transit Vehicles have
Easy Rider large, "Friends and
o Medicaid Program teaches nontinted Family"
seniors how to windows to mileage
o Section 5310 use fixed-route alleviate reimbursement
transportation seniors' program
o Section 5311 safety
concerns
o Title III-B
St. John's
County Council
on Aging
Coordinates Driver-training Vehicles are
o JARC services with program that brightly
local transit emphasizes decorated to Customer-
o Medicaid authority and safety and attract focused
taxicab customer senior organization
o Section 5310 services service ridership
o Section 5311
o Title III-B
Sweetwater Global
Transportation Positioning Coordinates
Authority Systems transportation
technology software with
o CSBG on vehicles city and
to aid in county
o Medicaid accurate and emergency
automatic response
o Section 5310 trip transportation
scheduling systems
o Section 5311
Legend:
CSBG Community Services Block Grant Programs JARC Job Access and Reverse
Commute Rural Health Rural Health Care Services Outreach Program SCSEP
Senior Community Service Employment Program Section 5307 Urbanized Area
Formula Program Section 5309 Capital Investment Grants Section 5310
Capital Assistance Program for Elderly Persons and Persons with
Disabilities Section 5311 Nonurbanized Area Formula Program SSBG Social
Services Block Grants Title III-B Grants for Supportive Services and
Senior Centers
Source: GAO analysis of interviews with local service providers and a
review of the senior mobility literature.
Local Practices Have Enhanced the Senior-Friendliness and
Cost-effectiveness of Services
The implementation of these practices contributed to the improvement of
senior transportation services by making them more senior-friendly,
according to the 10 local service providers we interviewed. In particular,
these practices collectively addressed the five A's of senior-friendly
transportation previously discussed-availability, accessibility,
acceptability, affordability, and adaptability-as follows:
o The majority of service providers told us that they made transportation
services readily available for seniors to get to needed medical locations.
o The 10 providers said that their services are tailored to ensure that
seniors can access the vehicles: that is, pick-up locations are easy for
seniors to walk to, one-on-one escort service is available to seniors who
need special assistance, or lift equipment is installed in the vehicles.
o Several service providers stated that they use vehicles that are
identifiable and visually pleasing to make sure their vehicles are
acceptable to seniors.
o Most of the service providers also indicated that their services are
affordable because they are free to seniors or minimal donations are
requested at the time of service.
o More than half of the service providers said that their services are
adaptable and flexible enough to accommodate the service requests and the
mobility limitations some seniors may have.
In addition, the majority of the service providers we interviewed said
that their organizations realized cost savings and increased the quality
and quantity of service by implementing the practices. For example, as
previously noted, the coordinated transportation service implemented by
MEOC allowed lower per-unit costs, which also resulted in cost savings for
all the agencies involved. According to a MEOC official, the cost savings
allowed MEOC to increase the number of trips provided, increase the hours
of operation, continue to afford dispatchers, hire more transportation
managers, and provide adequate training for drivers-all of which
translated into improvements in the quantity and quality of service to
MEOC's clients.
Federal Programs Support the Implementation of Practices That Enhance
Transportation- Disadvantaged Seniors' Mobility to Some Extent
According to the service providers we interviewed, the most common way in
which federal programs support the implementation of practices that
enhance transportation-disadvantaged seniors' mobility is by providing
funding. As previously noted, the 10 providers we interviewed use funds
from at least 1 of the 15 key federal programs in implementing practices
that enhance transportation-disadvantaged seniors' mobility.53 (See table
3 for the federal funding sources associated with each service provider.)
We found that DOT's Capital Assistance Program for Elderly Persons and
Persons with Disabilities (Section 5310) and HHS's Grants for Supportive
Services and Senior Centers (Title III-B) and Medicaid Programs are the
federal programs most often used by the 10 providers we interviewed,
followed by DOT's Nonurbanized Area Formula Program (Section 5311) and
HHS's Community Services Block Grant Programs.
According to some of the service providers, the federal programs had both
a direct and an indirect role in providing technical assistance for the
implementation of practices to enhance transportation-disadvantaged
seniors' mobility. In some cases, federal programs provided direct
technical assistance (by providing information on how to apply for program
funding or how to implement the service or by providing contact
information for other resources) through program representatives or
through the program's Web site. Several providers stated that, as
grantees, they obtained technical assistance from DOT's Intelligent
Transportation Systems (ITS) program,54 which assigned consultants to
their organizations to provide assistance in selecting software and
hardware and developing requests for proposals. One service provider
further added that he found DOT's ITS program Web site to be useful in
obtaining information on best practices and on other technology-related
resources. Another service provider received technical assistance through
both Federal Transit Administration representatives and the state's
transit association on how to obtain funding through the Job Access and
Reverse Commute Program. In other cases, some providers stated that the
federal government indirectly provided guidance or technical assistance.
For example, guidance on implementing practices and marketing services to
the senior community was provided through federally funded professional
organizations, such as the Community Transportation Association of America
and the National Academy of Sciences' Transportation Research Board.
Other service providers we interviewed told us that the federal programs
did not provide assistance (other than funding) or guidance on
implementing practices to enhance transportation-disadvantaged seniors'
mobility, so they had to look to other state and regional transit agencies
or other local transportation service providers to provide guidance or
technical assistance. One service provider said that it researched and
sought out other mobility management programs and travel-training programs
to learn how to implement such programs, because this information was not
available from federal or state agencies. Several providers told us that
finding information on successful practices for enhancing
transportation-disadvantaged seniors' mobility required considerable staff
time and other resources, and that a centralized source-particularly a
Web-based source-for such information would be useful. Many of the
providers suggested that providing such a Web site would be an appropriate
role for the federal government. AOA, the lead federal agency for
coordinating programs for seniors and the dissemination of information
relevant to seniors, has some transportation information available on its
Web site, but there are some limitations to this information, as discussed
in more detail in the section below on senior mobility obstacles and
strategies.
Local Transportation Service Providers Continue to Face Difficulties in
Implementing Practices That Enhance Transportation- Disadvantaged Seniors'
Mobility
According to the local providers we interviewed, certain characteristics
of federal programs can impede the implementation of practices that
enhance transportation-disadvantaged seniors' mobility. Although federal
programs provide financial support for practices that enhance senior
mobility, an expert in senior mobility and several service providers
stated that receiving federal funds entails burdensome reporting
requirements. Often, the local service providers receive funding from
several federal programs with different reporting requirements and
therefore have to submit several different reports calling for different
data. One provider stated that submitting all of the required
documentation for DOT's Capital Assistance Program for Elderly Persons and
Persons with Disabilities (Section 5310) and HHS' Grants for Supportive
Services and Senior Centers (Title III-B) Program necessitated the
dedication of 720 administrative hours each year (equivalent to over
$10,000), costing the provider more in administrative costs than the
actual funding received through the federal programs.55 Another service
provider we interviewed said it has designated about 1,690 administrative
hours annually to complying with the reporting requirements of the Title
III-B program, Medicaid, and DOT's Congestion Mitigation and Air Quality
Improvement Program,56 including doing such tasks as tracking the
different data requested by each program, organizing documents, and
following up on required information. 57 The provider noted that the
1,690 hours (equivalent to about $60,000 in costs) represented a
significant portion (14 percent) of the total federal program funding
received under those programs.58 Federal officials have told us that the
Coordinating Council on Access and Mobility-a federal body, consisting of
representatives from 10 federal agencies, including the Departments of
Education, Labor, Health and Human Services, Transportation, and Veterans
Affairs, that is charged with coordinating transportation services
provided by federal programs and promoting the maximum feasible
coordination at the state and local levels-is examining possible ways to
streamline reporting requirements of the various federal programs that
fund transportation for disadvantaged populations. Council officials said
that a paper addressing this issue will be developed and presented in 2004
or early 2005.
Some of the local providers said that federal guidance on how to apply for
funding and comply with reporting procedures is limited. For example, one
service provider stated that it has not received technical guidance from
DOT that explains the funding process for the Urbanized Area Formula
Program (Section 5307). Instead, the provider contacted other local
nonprofit organizations to seek their technical assistance in
understanding the funding process, but the funds were delayed in the
meantime. The provider said that it contacted local DOT representatives
but was unable to determine the cause of the delay in funds. As a result,
the provider said that it had to convince its nonprofit board of directors
to continue to provide services without the promised federal funds so that
seniors would still have transportation services available.
Lastly, several of the service providers perceive that program guidelines
are rigid and lack flexibility, although the federal officials we
contacted disagreed with the providers' interpretations. For example, one
provider stated that the program guidelines for DOT's Nonurbanized Area
Formula Program (Section 5311) are very rigid in that the funds may only
be used for transportation for the general public. The service provider
stated that the Section 5311 guidelines require it to track the type of
passenger who requests demand-response service and the trip destination.
If a senior requests transportation to a senior center or any other human
service program destination, the service provider told us it must find
another funding source (e.g., Title III-B) for that trip because Section
5311 funding is designated for general rural transportation services and
not specialized services. However, a DOT official told us that rural
transit providers receiving Section 5311 assistance may transport a senior
to a senior center if the service is also made available to the general
public.
Experts and Stakeholders Suggested Strategies for Overcoming Mobility
Obstacles
Through a review of the literature and interviews with experts on senior
transportation and aging, representatives of pertinent professional
associations and advocacy groups, local officials, and transportation
service providers, we identified several obstacles to addressing
transportation-disadvantaged seniors' mobility needs and potential
strategies that the federal government and other government levels, as
appropriate, can consider taking to better address those needs and enhance
the cost-effectiveness of the services delivered. We grouped these
obstacles and strategies around three themes: (1) planning for
alternatives to driving as seniors age to extend the lifespan of their
mobility, (2) accommodating seniors' varied mobility needs, and (3)
leveraging federal and other government funding to better use limited
resources. The suggested strategies for addressing obstacles to senior
mobility involve certain trade-offs, and these obstacles, strategies, and
trade-offs are discussed in each of the following sections.
Helping Seniors Plan for Alternatives to Driving Could Increase the
Lifespan of Their Mobility
Figure 5: First Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders
Seniors who have relied on driving as their primary mode of transportation
may experience a sharp decline in mobility if their driving becomes
limited or ceases. In addition, some seniors may continue to drive even
when it is no longer safe for them to do so because they do not have, or
do not know about, alternative transportation options. In focus groups
conducted by AARP, few participants indicated that they had ever thought
about giving up driving in advance of doing so. Sixty percent of the
seniors surveyed in another study thought they would get a ride from
family members or friends when they could no longer drive themselves.
Several experts have reported that seniors and their caregivers are not
sufficiently encouraged-by federal and other government entities, family
members and other caregivers, the medical profession, and others-to
identify and use multiple transportation modes for their routine trips. As
a consequence, seniors may perceive that driving is their only viable
option, and they may become isolated or risk driving when it is unsafe for
them to do so.
For the large number of seniors who routinely drive, experts and local
service providers have suggested ways to facilitate a gradual transition
from driver to nondriver and to incorporate additional transportation
modes into seniors' daily travel. Advocacy groups, such as AARP, have
found that seniors have a strong preference for driving as their primary
mode of transportation, and the transition from driver to nondriver may be
particularly challenging for seniors as they age. While some types of
driver-screening programs are currently available in some communities,59
the federal government could make them more widely and consistently
available by supporting or encouraging state governments to implement such
programs to help seniors and their caregivers assess their driving
abilities. Seniors could also be offered-through new and existing
programs-additional training, physical therapy, or adaptive equipment to
address weaknesses identified in the screening (e.g., larger rear-view
mirrors and pedal extenders can help seniors who have difficulty turning
their heads or reaching the pedals). AOA officials told us that they have
historically worked with AARP's Mature Driving Program, the American
Automobile Association, and others to provide support to seniors in
addressing their driving abilities, but that sustaining an effort in this
area would likely require new funding. DOT's National Highway Traffic
Safety Administration (NHTSA), in partnership with other federal agencies,
the American Occupational Therapy Association, the American Society on
Aging, and others, has begun promoting some programs to help seniors
extend the lifespan of their mobility by making driving choices that
maximize their personal and community safety and using transit before it
is their only transportation option. For example, NHTSA is pilot testing a
social marketing program to increase awareness of senior transportation
challenges and options. In each of the test sites, community groups have
surveyed people aged 65 and older regarding their perceptions about safer
driving behaviors, other modes of transportation, and how easy or
difficult it is for them to get around in their communities. The groups
then publicized the survey results and initiated a community discussion
about how to help people remain safely mobile and active as they age.
According to a NHTSA official, a final report with a prioritized set of
recommendations and a booklet containing materials tested by the community
groups will be prepared later this year.
Experts, advocacy groups, and local officials have also suggested
providing a continuum of services to accommodate different trip purposes
and different levels of need. Such services could include safety programs
for older drivers; ridesharing information; and public transportation and
paratransit options,60 including escorts and financial assistance. The
federal government is currently developing ways to support informed
driving choices and encourage state and local agencies to provide
information on the alternative transportation options available to seniors
who can no longer safely drive or are not comfortable driving in certain
conditions, such as at night or in poor weather. For example, NHTSA (in
conjunction with the American Society on Aging) has developed Web-based
seminars to help seniors and their families make appropriate driving
choices that maximize their personal and community safety. These seminars
can also help communities maximize seniors' mobility options. In addition,
the Easter Seals Caregiver Project (funded by the Federal Transit
Administration and AOA) has developed a template for identifying all of
the transportation options that are available to seniors in a typical
community. The template is designed to help seniors and their caregivers
know what services are available to them and to help service providers,
caseworkers, and city and county planners assess transportation options
and identify gaps in transportation services. Experts also suggested a
publicity campaign to raise awareness about the importance of planning for
seniors' future mobility needs, as well as training programs for seniors
on how to access the transportation modes available in their communities.
Local service providers and an expert suggested that the Internet could be
a valuable resource in disseminating information. For example, one local
service provider collaborated to develop a Web-based database of
transportation options for seniors in its service area, which reduced
duplication in referral services and provided comprehensive and current
information on transportation options to stakeholders and seniors. The
service provider stated that the result was an interactive, user-friendly
Web site that provided seniors with appropriate, individualized
information on transportation and referral services and enabled social
service organizations, healthcare agencies, community groups, and
caregivers to locate information on transportation options. Such
information could also be available in document format for those seniors
and organizations that prefer not to use the Internet or do not have
access to it, although experts suggest that future generations of seniors
will be progressively more familiar and comfortable with technology,
especially as the "baby boomers" join the senior population.
The trade-off in encouraging driver-screening programs and publicizing
alternative transportation options is that these strategies would increase
their use. Such an increase would have both positive and negative results.
According to experts and local aging officials, more demand would put
additional pressure on already stretched transportation programs, but also
would mean that more seniors are able to access the services available to
them or are not driving when it is unsafe for them to do so.
Growing Senior Population Could Benefit from Policies That Accommodate Its
Varied Needs
Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders
The mobility needs of seniors vary, depending on differing mobility
limitations they may experience and the reasons they may need
transportation (such as for work, volunteer activities, medical
appointments, and recreation). However, according to experts, advocacy
groups, and local officials, traditional transportation services are not
always designed to meet those varied needs of seniors, particularly
transportation-disadvantaged seniors. The health and mobility limitations
that prevent seniors (particularly seniors aged 85 and older) from driving
may also present obstacles when they use public transit, paratransit,
taxicabs, and other transportation options.61 Many seniors also live in
suburban and rural areas that are not easily served by traditional
fixed-route transit. In addition, approximately half of the key federal
programs for senior transportation fund services only for specific
destinations, such as medical appointments (rather than for life-enhancing
needs), which tend to occur during normal business hours. Life-enhancing
trips are often needed on evenings (e.g., to a concert) or weekends (e.g.,
to religious services) when many paratransit and other specialized
transportation services for seniors are not available. According to one
professional association, the limited amount of funding provided through
HHS's Title III-B program, which senior centers use to provide
transportation, has meant that providers are often unable to provide
life-enhancing trips and restrict service to only medically necessary
trips. Finally, as indicated by the data previously discussed, most
seniors prefer to travel in private automobiles, which offer greater
comfort and flexibility than conventional vans and buses, but many
federally funded services for transportation-disadvantaged seniors provide
only bus or van travel. Experts suggested that if conventional vans and
buses are modified to offer greater comfort and flexibility, they may
appeal to seniors in much the same way as private automobiles.
According to federal officials and experts, many federally funded programs
are intended for seniors who do not drive at all and need assistance all
of the time. However, many seniors do not qualify for the federally funded
transportation programs in their communities because they require
transportation assistance only under certain circumstances, such as in bad
weather or when a medical condition is aggravated. Experts, advocacy
groups, and local officials proposed (1) improving conventional public
transit services to better accommodate transportation-disadvantaged
seniors' needs and (2) familiarizing seniors with transit options while
their health is favorable so they feel more comfortable using transit as
they age and require the adaptability that transit can provide. To
accomplish this, several suggested that the federal government, or other
government levels as appropriate, provide incentives for transit agencies
to restructure routes to encompass areas where seniors travel or live and
improve the safety and security of waiting areas and vehicles.
Additionally, several proposed that government agencies encourage service
providers to provide training for transit operators on how to better serve
seniors, as well as training for seniors on how to use transit and the
other transportation options available to them. Although such changes
could be expensive, several experts countered that they might be less
expensive than the alternatives (i.e., providing individual paratransit
service or providing emergency medical care or nursing home care).
To accommodate both the immediate and long-term mobility needs of the
aging population, experts and advocacy groups suggested that seniors'
needs be considered in the transportation-planning process. They suggested
that the federal government encourage or require metropolitan planning
organizations (MPO) to evaluate the impact of transportation systems on
seniors' mobility; include seniors when developing the transportation
improvement plan (currently, interested parties are given opportunities to
comment on transportation plans, but they are not necessarily included in
the planning process); and consider the accessibility of transit
facilities to pedestrians. For example, seniors could advocate for safe
walking routes to transit stops and for the use of low-floor buses (which
are accessible to both wheelchair users and people with other mobility
impairments). Currently, AOA is working with the Community Transportation
Association of America and the Federal Transit Administration to develop
guidance for AAAs and MPOs on considering seniors' mobility needs in the
transportation-planning process. Additionally, a local government official
proposed that DOT should hold MPOs accountable by ensuring that senior
mobility needs are considered in their transportation plans. One senior
mobility expert acknowledged that including more groups in the planning
process can slow that process down, but she said that it would be worth
taking additional time if the planning ultimately results in enhanced
mobility for seniors.
Resources Are Limited, but Strategies Exist to Leverage Them
Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs Associated
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as
Identified by Experts and Stakeholders
The conflict between meeting the mobility needs of
transportation-disadvantaged seniors and addressing the financial burden
of providing services to meet these needs was evident in the literature
and interviews. Officials and experts reported that funding constraints
inhibit local agencies' abilities to address transportation-disadvantaged
seniors' needs. Some suggested increasing funding for senior
transportation programs and improving funding flexibility. Others said the
government could facilitate the sharing of information between providers,
sponsor demonstration projects, and improve the coordination of
transportation services.
Increasing Funding and Using Volunteer Drivers
Experts, advocacy groups, and local providers suggested increasing funding
for public transit and paratransit as well as for transportation services
specifically designated for seniors, persons with disabilities, and rural
areas. Additional funding for public transit and paratransit could enable
the expansion or improvement of services to benefit both the general
public and seniors who depend on those services. Experts and advocacy
groups have reported that operators of paratransit demand-responsive,
curb-to-curb services have been adhering more tightly to ADA eligibility
criteria in the face of financial constraints, leading to a decrease in
paratransit services for non-ADA-eligible seniors. One DOT official said
that very few urban transit providers can provide specialized
transportation to non-ADA-eligible seniors because of the high operating
costs for ADA-complementary paratransit. An increase in federal funds
would allow providers to expand their level of service; however, any funds
for such programs would likely have to come either from new revenues or
from other federal programs.
Federal and local officials and advocacy groups have also suggested the
use of volunteer drivers to expand transportation options for
transportation-disadvantaged seniors. However, local service providers
report that finding insurance to cover community-based transportation or
volunteer driver programs is difficult, and the cost of such insurance is
rising. Several service providers told us that they had difficulty
recruiting volunteer drivers because of liability issues, such as concern
over being responsible for expenses that were beyond their personal
insurance limits in the event of an accident. One provider overcame these
liability concerns by obtaining insurance coverage through a nonprofit
insurance organization that would provide liability coverage for
volunteers to drive seniors to their medically related destinations.
Several experts and advocacy groups suggested that the federal government
could establish insurance pools for volunteer drivers or provide other
incentives for volunteer programs.
Increasing Funding Flexibility
Local officials and advocacy groups have proposed allowing greater
flexibility in the use of federal funds. According to several experts-as
well local providers and agencies on aging-federal programs tend to
specify that their funds can be used only to provide transportation to and
from that program's services, making it difficult to make effective use of
transportation resources and coordinate with other service providers.
Additionally, some federal programs require transportation providers to
seek two separate sources of funding-one for capital and one for operating
costs-which can be burdensome, especially for small nonprofits, according
to one national senior advocacy organization. For example, funds from
DOT's Capital Assistance Program for Elderly Persons and Persons with
Disabilities (Section 5310) generally cannot be used for operating costs,
such as driver salaries, gas, insurance, and maintenance, and these costs
can be considerable.62 With operating costs more burdensome than they have
been in the past (i.e., higher prices for gas and liability insurance), a
local provider and several advocacy groups have suggested allowing DOT's
Section 5310 funds to be used for operating expenses.63 However, DOT
officials cautioned that such a change could decrease coordination among
local providers because the current need to seek operating funds from
different sources results in increased communication among local agencies.
Another trade-off is that increasing funding flexibility can decrease
accountability because there is less assurance that the funds will be used
for their intended population. However, another way that an official from
a national transportation association and a local service provider
suggested the federal government can increase flexibility is by allowing
in-kind services, such as the use of volunteers, to count as part of the
required state/local contribution for federal programs. Some federal
programs, such as the Department of Education's Independent Living
Services for Older Individuals Who Are Blind program and HHS's Title III-B
program, currently allow this, while others do not. Several advocacy
groups and experts also suggested encouraging or allowing federal funds to
be used for vouchers for informal volunteer driver programs or taxicabs.
(DOT's Capital Assistance Program for Elderly Persons and Persons with
Disabilities (Section 5310) and Nonurbanized Area Formula Program (Section
5311) funds can be used for vouchers, although one expert says they rarely
are.) One study found that voucher programs were less expensive than the
direct provision of transportation services. This strategy would also
address the obstacle about policies that do not address
transportation-disadvantaged seniors' mobility needs, previously
discussed, because seniors could be transported in private automobiles
rather than in buses or vans.
Sponsoring Demonstration Programs and Identifying Best Practices
According to experts, advocacy groups, and local officials, no coordinated
senior transportation policy exists at the national level, so there is no
federal funding stream for local demonstration projects, no lead agency or
resource for information on best practices, and limited coordination among
federal programs. In response, the experts and officials suggested that
the federal government sponsor demonstration programs, perhaps through the
Federal Transit Administration, or share information about innovative
programs targeted to meet seniors' needs and use creative local
partnerships. For example, AOA officials told us that they have an ongoing
project to identify best practices in implementing each of the elements in
the Framework for Action (a coordination self-assessment tool for states
and communities),64 such as identifying cost-sharing arrangements and
determining technology needs for coordination of services for
transportation-disadvantaged populations, including seniors. In addition,
the Senate bill for reauthorization of surface transportation contains a
provision creating a national technical assistance center for senior
transportation to be run by a national nonprofit organization.65 Among
other activities, the technical assistance center would gather and
distribute information on best practices in senior transportation, create
a Web site and central clearinghouse for information on senior mobility,
and award demonstration grants.
Providing an Information Clearinghouse
Experts, advocacy groups, and local officials said that the federal
government could use its prominence and visibility to provide a central
clearinghouse for information on successful practices to enhance senior
mobility and improve the cost-effectiveness of services. They said that
such a clearinghouse could serve as a national technical assistance center
where local aging officials, service providers, and others can exchange
effective program models for senior transportation. They also suggested
that the Internet could be a valuable tool in establishing a clearinghouse
to store and share information, including information about successful
practices and about efforts that federal agencies are taking to enhance
senior mobility. For example, both the Beverly Foundation and the American
Automobile Association's Foundation for Traffic Safety use their Web sites
to distribute information related to programs of excellence and leading
practices in providing transportation for seniors, but the audiences for
these Web sites may not be as broad as for federal Web sites.
Although AOA's Web site contains transportation information, most of the
information is for providers rather than for seniors. For service
providers and other professionals, there is a transportation page
containing links to other organizations' Web sites (such as the Beverly
Foundation and the Community Transportation Association of America) for
information on promising practices for improving senior transportation,
research and data on senior transportation, and other topics. For seniors
and their families, there is a senior transportation "fact sheet"
containing some statistical information on senior demographics and travel
patterns as well as information on AOA's ongoing coordination activities
with the Federal Transit Administration. The site directs seniors and
their caregivers to contact their local AAAs or AOA's Eldercare Locator
Service for more information on transportation services available.
However, our interviews with experts and local service providers suggest
that people may not know about AOA's transportation information page or
think of the AOA's Web site as a central forum for senior
transportation-related information. Federal Transit Administration
officials told us that the Coordinating Council on Access and Mobility is
working to ensure that there is a "one-stop" federal Web site on programs,
policies, and resources available to assist communities and states in
implementing and enhancing human service transportation services for
seniors, persons with disabilities, and lower income populations. The site
would include links to specific federal programs addressing the needs of
these specific populations.
Facilitating Coordination
Experts, advocacy groups, and local officials suggested facilitating the
coordination of services at all levels of government. The federal
government could encourage states to coordinate the transportation
components of senior programs with other highway and public transit
planning processes. For example, DOT's Capital Assistance Program for
Elderly Persons and Persons with Disabilities (Section 5310) and Urbanized
and Nonurbanized Area Formula Programs (Section 5307 and Section 5311)
require that projects be the result of "maximum feasible coordination"
with other federally funded transportation services. The federal
government could also encourage or require the creation of a central
coordinated planning entity in metropolitan areas that would allow
nonprofit organizations and government agencies to collaborate and
maximize routes for senior vans and buses. As previously noted, experts
have suggested that seniors should be represented in such
transportation-planning bodies so that their mobility needs are considered
in the decision-making process.
Although we found in the past that federal efforts to coordinate services
for transportation-disadvantaged populations were limited,66 we recently
reported that the Coordinating Council on Access and Mobility had taken
significant steps to improve coordination among federal agencies.67 These
steps included developing a tool to help states and communities assess
their coordination efforts and providing information on best practices in
coordinating medical transportation services. The council expanded its
original membership-DOT and HHS-to include additional federal agencies,
such as the Departments of Labor and Education, that administer
significant programs for seniors.68
The council used to have a work group-headed by AOA and the Federal
Transit Administration-for coordinating senior mobility issues, but
council members told us that the council has recently changed its
approach, integrating the population-specific work groups (seniors,
persons with disabilities, etc.) into cross-cutting groups that will
address specific obstacles to coordination. For example, in our previous
and current work, experts and advocacy groups suggested that legislating
uniform cross-program reporting requirements could be a means to both
facilitate coordination and make it easier for small local providers to
access federal funds. As previously mentioned, the council's work group
will address the issue of simplifying federal grant reporting requirements
and administration procedures and propose some potential solutions. Other
work groups will address education and outreach for coordination,
allocation of costs among coordinating agencies, coordinated planning of
human service transportation, and other issues. In addition, the
Departments of Education, Health and Human Services, Labor, and
Transportation recently launched a five-part coordination
initiative-"United We Ride"-that is designed to help states and
communities overcome obstacles to coordination. This initiative is
designed to provide financial incentives for coordination and establish an
interagency forum for communication. As we have mentioned in previous
reports, coordination at all levels of government requires sustained
commitment and leadership but can result in improved services for seniors
and others.
Conclusions
As the senior population doubles over the next 25 years, it will become
increasingly important to target resources to the areas of greatest need
and to know whether current methods and programs are working to reduce
transportation-disadvantaged seniors' unmet needs and improve their
mobility and access to services. The 655 local area agencies on aging that
are required to gather data to assess seniors' needs for services could
serve as valuable sources of information for federal agencies to use in
program planning, evaluation, and resource allocation. However, without
guidance from the Department of Health and Human Services' Administration
on Aging on assessing needs for services, including transportation, these
local agencies are using a variety of methods-some less comprehensive than
others-to assess seniors' mobility needs. As a result, it is not possible
to determine whether current programs are reducing unmet needs and
improving transportation-disadvantaged seniors' mobility and access to
services. The Administration on Aging is now embarking on a comprehensive
assessment of seniors' needs for services that affords a good opportunity
for the administration to help state and local agencies conduct and use
the results of improved needs assessments.
The experiences of other federal agencies, such as the Department of
Transportation, that have developed guidance for assessing or
demonstrating needs for some of the programs they administer, such as the
Job Access and Reverse Commute Program, could be useful in designing
guidance for area agencies on aging to assess needs. The Coordinating
Council on Access and Mobility is uniquely positioned to provide a forum
for such a coordinated effort because all of the federal agencies that
administer the key programs we identified are members, and many of these
agencies are involved in the council's efforts to improve mobility for all
transportation-disadvantaged populations. As the agency designated by the
Older Americans Act as the lead for gathering information on seniors'
needs for services, and as one of the original members of the council, the
Administration on Aging is well-situated to lead a coordinated effort to
design guidance for assessing seniors' needs.
Not having information on alternatives to driving is an obstacle to both
seniors and service providers. Without such information, seniors do not
plan for a time when they can no longer drive, and providers waste time
and money "reinventing the wheel" and become frustrated with federal
programs. Some federal efforts, such as the community awareness pilot
project implemented by the Department of Transportation's National Highway
Traffic Safety Administration, have already begun to address this
obstacle, but the expected growth in the senior population will require
broader efforts. As service providers and representatives from the
advocacy groups and professional associations we interviewed said, an
important role for the federal government would be to provide a central
forum for comprehensive information on transportation services, perhaps
through a centralized Web site that could enhance seniors' awareness of
available services and improve providers' ability to serve them. Such a
Web site would also be useful for publicizing activities the various
federal agencies are undertaking to improve transportation-disadvantaged
seniors' mobility. Although the Administration on Aging (the federal focal
point and advocacy agency for seniors) has a Web site with information on
transportation services, most of this information is aimed at service
providers rather than at seniors or their caregivers. Furthermore, many of
the service providers and representatives from advocacy groups and
professional organizations we interviewed did not seem to be aware of the
presence of such information on the administration's Web site. In
addition, although seniors are increasingly comfortable using the
Internet, there are still many who do not have access to, or are not at
ease with, such technology.
Recommendations for Executive Action
To help enhance transportation-disadvantaged seniors' mobility by
improving available information and guidance, we recommend that the
Secretary of Health and Human Services direct the Administrator,
Administration on Aging, to take the following four actions:
o To improve the value and consistency of information obtained from area
agencies on aging on the extent to which transportation-disadvantaged
seniors' mobility needs are being met, the Administrator should develop
guidance for assessing such needs by doing the following:
o Expand the scope of work in the administration's planned evaluation of
the Grants for Supportive Services and Senior Centers (Title III-B)
program to include gathering and analyzing information on (1) definitions
and measures of need; (2) the range of methodologies that area agencies on
aging use for assessing seniors' need for services, including
transportation, and unmet needs; (3) leading practices identified in the
needs assessments methodologies used by area agencies on aging; and (4)
the kinds of guidance that area agencies on aging want from the
administration and the states to help them perform their required needs
assessments.
o Use the results of the administration's evaluation of the Title III-B
program, and input from the Coordinating Council on Access and Mobility of
other federal agencies that fund transportation services for seniors, to
develop and disseminate guidance to assist state and local agencies on (1)
methods of assessing seniors' mobility needs and (2) the suggested or
preferred method for collecting information on gaps in transportation
services.
o To help address the obstacles that seniors, their caregivers, and
service providers face in locating information on available services and
promising practices, the Administrator should do the following:
o Take the lead in developing a plan-in consultation with members of the
Coordinating Council on Access and Mobility-for publicizing the
administration's Web site and Eldercare Locator Service as central forums
for sharing information on senior transportation through workshops, annual
meetings, and other outreach opportunities with seniors, their caregivers,
and service providers. The plan should include steps for reaching out to
seniors and providers who do not use or have access to the Internet to
increase awareness of information available in hard copy or other format.
o Work with members of the Coordinating Council on Access and Mobility to
consolidate information about services provided through the participating
agencies' programs and to establish links from their programs' Web sites
to the administration's transportation Web site to help ensure that other
agencies (such as local transit agencies) are aware of, and have access
to, such information.
Agency Comments
We provided the Departments of Education, Health and Human Services,
Labor, Transportation, and Veterans Affairs with draft copies of this
report for their review and comment. The Departments of Health and Human
Services, Transportation, and Veterans Affairs agreed with the findings
and conclusions in the report. The Department of Transportation also
provided technical clarifications, which were incorporated as appropriate.
The Department of Health and Human Services provided written comments on
the draft of this report, which are presented in appendix IV. The
department concurred with our recommendations. The Departments of
Education and Labor said that they did not have any comments on the draft.
As arranged with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days
after the date of this letter. At that time, we will send copies of this
report to the appropriate congressional committees and to the Secretaries
and other appropriate officials of the Departments of Education, Health
and Human Services, Labor, Transportation, and Veterans Affairs. We will
also make copies available to others upon request. In addition, the report
will be available at no charge on the GAO Web site at http://www.gao.gov.
If you have any questions about this report, please contact me at
[email protected] or at (202) 512-2834. Additional GAO contacts and staff
acknowledgments are listed in appendix V.
Sincerely yours,
Katherine Siggerud Director, Physical Infrastructure Issues
Scope and MethodologyAppendix I
The scope of this report is limited to a review of the mobility needs of
transportation-disadvantaged seniors, who we define as those who cannot
drive or have limited their driving and who have an income constraint,
disability, or medical condition that limits their ability to travel. In
addition, because federal, state, and local programs have different age
ranges for seniors (e.g., aged 55 and over, aged 65 and over), we do not
use the term "senior" in this report to mean any specific age. We obtained
statistics presented in the introduction and background of this report
about seniors and their mobility from an article published in the American
Journal of Public Health, the 2000 Census, the Aging States Project, and
the Eldercare Locator Service; because this information is included as
background only, we did not assess its reliability.
To identify federal programs that address transportation-disadvantaged
seniors' mobility issues, we asked experts who had participated in a
senior mobility forum we moderated in July 20031 to identify those federal
programs that they consider key for providing transportation services to
seniors who cannot drive or have limited their driving. We verified the
resulting list of 15 programs with federal program officials. To assess
the extent to which the 15 federal programs address each of the five A's
of senior-friendly transportation (as identified by the Beverly
Foundation), we reviewed program legislation and guidance and interviewed
federal officials and senior mobility experts. We also reviewed prior GAO
reports on the coordination of transportation services for disadvantaged
populations2 and interviewed federal officials, senior mobility experts,
and other stakeholders to identify additional ways in which the federal
government addresses transportation-disadvantaged seniors' mobility
challenges.
To identify data that could tell us anything about the extent to which
transportation-disadvantaged seniors' needs are being met, we reviewed the
literature on transportation, disability, and aging found in statistical
databases and on agency, academic, and advocacy Web sites. In addition, we
asked experts-including academics conducting research in the fields of
aging, disability, and transportation; advocacy policy analysts
knowledgeable about senior transportation; and federal officials
responsible for senior transportation programs-to identify sources of data
and relevant studies. We included in our review only nationwide surveys or
focus groups (1) that were conducted in multiple states or types of
communities, (2) that were conducted after 1995, (3) that had variables
that analyzed transportation behavior of individuals aged 65 and older,
and (4) that were reported in published or soon-to-be-published journals
or reports. Also, we identified federal agency performance indicators and
other data collected by federal agencies that have key transportation
programs for seniors. For the performance indicators and data sources we
identified, we assessed the extent to which they provided meaningful
information about the extent to which seniors' mobility needs are being
met. To assess the reliability of research publications, we reviewed the
studies' overall designs and methodologies, including the selection
processes for any participants, response rates, and measures used. A
social science analyst at GAO was involved in each review of
methodological soundness. Table 4 summarizes the limitations of the data
sources we used in assessing the extent to which seniors' mobility needs
were being met.
Table 4: Limitations of Data Sources Used
Data sources
and Limitations
descriptions
Research and
statistical
publications
Surveys
Although the surveys
provide some
perspective on the
extent of the
problem, information
is not available to
determine how
representative the
responses are, and
therefore we are
relying on the
surveys primarily to
provide information
about the nature of
unmet needs.
Limitations include
the following:
o By their nature,
telephone surveys
are likely to miss
some individuals
living in a
community, including
those who are oldest
and have the most
severe health
problems and
disabilities, two
factors also related
to mobility. For
example, for AARP's
Understanding Senior
Transportation:
Report and Analysis
of a Survey of
Consumers Age 50+,
AARP estimates that
about 16 percent of
persons aged 75+
were missed by the
survey, and that
those missed were
more likely to have
physical impairments
and suffer from
activity limitations
than those in the
75+ population who
were captured by the
telephone survey.
o For AARP's
Community
Transportation
Survey, the response
Bureau of rate was not
Transportation presented in the
Statistics, 2001 report. However,
National Household this survey relied
Travel Survey. This on an omnibus
is a nationwide survey-omnibus
telephone survey of surveys typically
approximately 60,000 lack a thematic
individuals structure and
(including seniors) involve minimal
about travel callback procedures,
behavior. It which can suppress
documents the response rate.
approximately For example,
250,000 daily trips. comparisons with
Data were collected prior research
between March 2001 suggest that AARP's
and March 2002. Community
Transportation
AARP, Understanding Survey may
Senior overestimate the
Transportation: mobility of the 75+
Report and Analysis population. Also,
of a Survey of those 85+ were
Consumers Age 50+, underrepresented in
this survey.
2002. This is a
nationwide telephone o For the National
survey of 2,422 Household Travel
individuals aged 50 Survey and the AARP
and older, designed survey that was
to obtain reported in
information on Understanding Senior
problems with Transportation, the
transportation and response rates were
overall satisfaction somewhat low (40
with transportation, percent and 59
among other things. percent,
Data were collected respectively). Low
between October 1998 response rate could
and January 1999. result in
nonresponse bias,
AARP, Community depending on how the
Transportation obtained responses
Survey, 1997. This were weighted to
is a nationwide make the results
telephone survey of representative of
710 individuals aged the populations aged
75 and older, 75 and older,
designed to provide particularly since
a greater some weighting
understanding of factors are
older persons' themselves
mobility, as correlated with
measured by the mobility.
number of trips they
take. Data were o For the National
collected between Household Travel
October and November Survey and AARP's
1996. Community
Transportation
Survey, a complete
list of the
weighting factors
was not available.
o For the National
Household Travel
Survey and AARP's
Community
Transportation
Survey, the
methodologies used
to calculate the
estimates were not
fully disclosed, nor
were the standard
errors reported for
the estimates.
Without this
information, and
without further
information on the
potential for
nonresponse bias, we
were unable to
assess the
reliability of the
estimates.
o For all three
surveys, a full
description of
procedures used to
estimate missing
values for specific
items was not
available, so it is
unclear whether
results are
representative.
o In addition to
possible nonresponse
bias, the practical
difficulties of
conducting any
survey may introduce
other types of
errors. For example,
differences in how a
particular question
is interpreted can
introduce unwanted
variability into the
survey results.
Data sources
and Limitations
descriptions
Focus groups
AARP, Transportation
and Older Persons:
Perceptions and
Preferences, 2001.
This report includes
data from focus
groups with 28
individuals and
in-person interviews
with 17 individuals
aged 75 and older in
urban and suburban
communities in
Massachusetts.
Questions were
designed to obtain
information on the
value and role of
transportation, Focus groups are
trip-making adequate in
decisions, and providing
transportation qualitative data on
alternatives when the nature, but not
customary the extent, of unmet
transportation is needs. Limitations
unavailable. Data include the
were collected in following:
April 1997.
o Focus groups are
Ecosometrics, Inc., not statistically
prepared for the representative
Coordinating Council samples of their
on Access and communities.
Mobility, the Responses from focus
Department of Health groups cannot be
and Human Services, used to generalize
and the National to the broader
Highway Traffic population of which
Safety they are a part.
Administration,
Mobility and 1. For example, in
Independence: Transportation and
Changes and Older Persons:
Challenges for Older Perceptions and
Drivers, 1998. This Preferences, the
report includes data focus group
from focus groups respondents were
with 86 people aged from a single
70 and older and was geographic area-that
designed to better is, in-person
define the mobility interviews were
consequences of conducted only among
reducing or stopping residents of the
driving. Focus Boston metropolitan
groups were area, and the focus
conducted in groups were only
Florida, Maine, and among residents of
Maryland between Boston and
August and December Framingham.
1996.
2. For TCRP Report
Transportation 82, Improving Public
Research Board, TCRP Transit Options for
Report 82, Improving Older Persons,
Public Transit Volume I: Handbook
Options for Older and Volume II: Final
Persons, Volume I Report, the focus
Handbook and Volume groups were
II: Final Report, conducted only in
2002. This report environments that
includes data from were considered
focus groups with 88 transit-friendly.
individuals aged 70
and older, from
urban, suburban, and
rural communities
that have good
transit services
(New York City; a
Maryland suburb of
Washington, D.C.; a
suburban area
outside Akron, Ohio;
and a rural county
east of Cleveland,
Ohio). Focus groups
were designed to
obtain information
on mobility
preferences.
Expert
perspectives
Interviews are based
largely on the
Interviews with experts' familiarity
experts and with these national
officials data sources, which
have known
in the fields of limitations, and on
aging, conversations with
disability, and local officials, who
transportation may rely primarily
research and on anecdotal data,
policy. personal experience,
and testing of
services.
Data sources
and Limitations
descriptions
Area agencies
on aging
We were unable to
determine if the
data were
sufficiently
reliable to assess
the extent of unmet
Interviews with need, but determined
agency officials that they were
from sufficiently
reliable to describe
16 local area the nature of unmet
agencies on aging need. While several
(AAA) that of the AAA officials
described we interviewed said
obtaining that they felt
information on fairly comfortable
transportation with the data they
from seniors, obtained through
caregivers, these methods,
transportation others acknowledged
providers, local that the data were
aging network opinion-driven,
professionals, anecdotal, and
and senior center representative only
directors through of the seniors who
focus groups, contacted the AAA.
surveys, As a result, the
listening data tended to focus
sessions, public on concerns
forums, identified by
interviews, clients, caregivers,
waiting lists, or transportation
and population providers, rather
data. than on the
consensus of all
seniors in the
community (including
those who do not
receive services
from the AAA).
Source: GAO.
Note: Data from the National Household Travel Survey were obtained from
the Surface Transportation Policy Project, Aging Americans: Stranded
Without Options (Washington, D.C.: April 2004).
To better understand the variety of methodologies that area agencies on
aging (AAA) used to assess seniors' unmet mobility needs, the reliability
of data collected using these methodologies, the barriers to quantifying
unmet mobility needs, and the perspectives of local officials on the
extent to which seniors' mobility needs are being met, we conducted
semistructured interviews with officials from 15 of the 655 AAAs
nationwide and 1 state unit on aging. To select the nonprobability sample
of 15 AAAs that we interviewed, we asked the 42 state units on aging that
have AAAs in their states (8 states-Alaska, Delaware, Nevada, New
Hampshire, North Dakota, Rhode Island, South Dakota, and Wyoming-and the
District of Columbia do not have AAAs and instead the state unit on aging
is the single planning and service area under the Older Americans Act) to
identify 1 urban, 1 rural, and 1 suburban AAA in their state, and for
each, to identify the method by which the AAA collects data on seniors'
unmet mobility needs. Of the 42 states that have AAAs, 30 responded to our
request. From these responses, we selected AAAs to ensure geographic
dispersion (West, South, Northeast, and Midwest); representation of AAAs
with different population density (urban, rural, and suburban);
representation of different data collection methods (survey, focus group,
census, or other); representation of input from community stakeholders
(service providers, caregivers, seniors, and professionals); and
representation of states with higher-than-average and lower-than-average
percentages of seniors in their population. In addition to selecting 3
AAAs from each of 4 states-1 in the West, 1 in the South, 1 in the
Midwest, and 1 in the Northeast-we also selected 3 AAAs in New York State
because it had recently completed an audit of transportation for seniors
that included an evaluation of AAAs' procedures for conducting needs
assessments. We also interviewed the state unit on aging from 1 of the 8
states that do not have AAAs (South Dakota). Using a semistructured
interview, we asked senior-level management and staff that had
responsibilities for assessing seniors' unmet mobility needs at each of
the AAAs (and 1 state unit on aging) to provide information on
transportation services offered and restrictions to service; on their
processes for collecting data on seniors' unmet mobility needs, including
information about how they ensure the reliability of the data they collect
and their methodology for reporting and maintaining the data; on their
perspectives on the extent to which seniors' mobility needs are being met;
and on the additional data that should be collected, if any. To assess the
reliability of the data obtained from AAAs, we reviewed the data for
obvious errors in accuracy and completeness and interviewed agency
officials knowledgeable about the data. Specifically, we asked whether any
tests were conducted to ensure that data were entered accurately and
whether the quality of the collected data had been reviewed. In addition,
we asked AAAs to identify limitations of the data and actions taken to
correct any limitations. (See table 4 for information about limitations of
the AAA data.)
To obtain the perspectives of experts on the extent to which needs are
being met, possible barriers to determining the extent of unmet mobility
needs, and their knowledge of any standards or benchmarks developed for
assessing seniors' unmet mobility needs, we interviewed federal agency
officials that have responsibilities for senior transportation programs in
the Departments of Education, Health and Human Services, Labor,
Transportation, and Veterans Affairs, as well as representatives from
research organizations, advocacy organizations, and academic institutions
in the fields of aging, disability, and transportation (see table 5). We
asked these experts to identify potential sources for data and information
on seniors' mobility needs as well as for their perspectives on the extent
to which such needs are being met.
Table 5: Academics, Advocacy Groups, Professional Associations, and
Federal Agencies GAO Interviewed about Information on Seniors' Mobility
Needs
Information
provided
Data and Perspective on
Type of affiliation Organization information mobility needs
sources
Academic/Research University of Alabama, ✔ ✔
Birmingham
Academic/Research University of Arizona ✔ ✔
Academic/Research University of California, ✔
San Francisco
Academic/Research University of Florida ✔
Academic/Research University of Iowa ✔ ✔
Academic/Research University of ✔
Massachusetts, Boston
Academic/Research University of North Dakota ✔ ✔
Academic/Research Westat ✔ ✔
Advocacy AARP ✔ ✔
Advocacy Beverly Foundation ✔ ✔
Association American Public Health ✔
Services Association
Association American Society on Aging ✔
Association American Medical ✔
Association
Association American Occupational ✔ ✔
Therapy Association
Association Community Transportation ✔ ✔
Association of America
Association National Association for ✔
State Units on Aging
Association National Association of ✔ ✔
Area Agencies on Aging
Transportation Research
Committee Board, Committee on ✔
Accessible Transportation
and Mobility
Transportation Research
Committee Board, Committee on the ✔ ✔
Safe Mobility of Older
Persons
Department of Education,
Federal government Office of Special Education ✔
and Rehabilitative Services
Department of Health and
Federal government Human Services, ✔ ✔
Administration on Aging
Department of Health and
Federal government Human Services, ✔
Administration for Children
and Families
Department of Health and
Federal government Human Services, Centers for ✔
Medicare and Medicaid
Services
Department of Health and
Federal government Human Services, Health ✔
Resources and Services
Administration
Information
provided
Data and Perspective on
Type of affiliation Organization information mobility needs
sources
Department of Labor,
Federal government Employment and Training ✔
Administration
Department of
Federal government Transportation, Bureau of ✔ ✔
Transportation Statistics
Department of
Federal government Transportation, Federal ✔ ✔
Transit Administration
Department of
Federal government Transportation, National ✔ ✔
Highway Traffic Safety
Administration
Department of Veterans
Federal government Affairs, Veterans Health ✔
Administration
Federal government Federal Interagency Forum ✔
on Aging-Related Statistics
Federal government National Center for Health ✔
Statistics
Federal government National Institute on Aging ✔ ✔
Source: GAO.
To identify practices that can enhance transportation-disadvantaged
seniors' mobility and local service providers that have implemented such
practices, we interviewed experts and federal officials and reviewed the
literature on senior mobility. We then contacted these local service
providers and requested further information about the practices they
employed and the funding sources they used to implement the practices. To
learn about the practices and their results, obstacles to implementing the
practices, and the role of federal programs in supporting them, we
conducted semistructured interviews with officials from 10 of the 29 local
transportation service providers that responded to our initial request for
information. These 10 providers represented a nonprobability sample,
chosen to include a diversity of geographic areas (i.e., 5 were in urban
areas and 5 were in nonurban areas, from different regions of the
country); types of practices (such as use of technology and coordination);
and federal funding sources (to get representation of as many of the 15
key federal programs as possible and to include both providers that used
many federal funding sources and those that used only one or two). To
determine the extent to which federal programs support practices that
enhance transportation-disadvantaged seniors' mobility, we interviewed
federal program officials, senior mobility experts, and local service
providers and reviewed pertinent GAO reports.
To identify examples of obstacles to addressing
transportation-disadvantaged seniors' mobility needs and strategies the
federal government could consider taking to improve the ability of federal
programs to meet these seniors' mobility needs and enhance the
cost-effectiveness of the services delivered, we reviewed literature on
transportation, disability, and aging and interviewed experts,
professional associations, and advocacy groups (see table 6). We also
interviewed federal officials and officials from the 16 AAAs and 10 local
transportation service providers previously mentioned. We organized the
obstacles and strategies identified in the literature and through our
interviews into three categories: planning for alternatives to driving as
seniors age, accommodating seniors' varied mobility needs, and addressing
federal and other governmental funding constraints. We presented the
proposed strategies to federal program officials to obtain their comments
on the potential trade-offs associated with implementing them. The
trade-offs were included in the discussion on obstacles and suggested
strategies.
Table 6: Academics, Advocacy Groups, and Professional Associations GAO
Interviewed about Obstacles, Strategies, and Trade-offs in Addressing
Transportation-Disadvantaged Seniors' Mobility Needs
Type of affiliation Organization
Academic/Research Mobility for Life
Academic/Research Westat
Advocacy AARP
Advocacy Beverly Foundation
Advocacy B'nai B'rith
Advocacy Easter Seals
Advocacy Gray Panthers
Advocacy Independent Transportation Network
Advocacy National Caucus and Center for Black Aged, Inc.
Advocacy Surface Transportation Policy Project
Association American Society on Aging
Association American Medical Association
Association American Occupational Therapy Association
Association Community Transportation Association of America
Source: GAO.
We conducted our work from November 2003 through August 2004 in accordance
with generally accepted government auditing standards.
Information on Transportation Provided by 16 Area Agencies on
AgingAppendix II
Source: GAO.
Note: The AAAs were designated as "urban," "suburban," and "rural" in
responses we received from state units on aging and therefore may not
conform to definitions provided in the U.S. Census or elsewhere.
Local Service Providers and Practices That Can Enhance
Transportation-Disadvantaged Seniors' MobilityAppendix III
Type of practice
Name of (as described by
provider Location Contact information the providers and
in the
literature)a
Coordinates
transportation
ACCESS Karen Hoesch, Executive service with "zero
Transportation Pittsburg, Director, (412) 562-5380, trip denial"
Systems PA [email protected] policy and uses
dedicated funding
through state
lottery program.
Provides
fixed-route
service using
dedicated funding
from the state
lottery program,
targets marketing
efforts to
Tom Klevan, Director of increase senior
Altoona Metro Business Development, ridership, offers
Transportation Altoona, PA a driver
(814) 944-4074, sensitivity
[email protected] training program,
and uses senior
volunteers to
promote and teach
seniors how to
ride fixed-route
service through
the "bus-buddy"
program.
Provides free
rides for seniors
throughout an
eight-rural-county
service area with
a 48-hour call
Area IV Agency Jim Fields, Administrator, ahead using
on Aging Twin Falls, volunteers from
(College of ID (208) 736-2122, the Retired Senior
Southern Volunteer Program.
Idaho) [email protected] Provides senior
volunteer
companions for
homebound seniors
through Senior
Companions
Program.
Provides
demand-response
transportation
Judy Polacek, Program service with
Butler County Administrator, volunteer drivers
Transit (Busy David City, to transport
Wheels) NE (402) 367-6131, seniors to medical
[email protected] appointments,
grocery stores,
pharmacies, senior
centers, or other
errands.
Provides free
fixed-route
service to
seniors. Also
provides free
transportation to
groups of 20 or
more seniors
during off-peak
Nancy Crowther, Specialist, hours (late
Capital Metro evening or
Transportation Austin, TX (512) 389-7400, weekends) to
Authority [email protected] destinations
within the service
area (e.g., Senior
Games, Senior
Proms, Senior
Nursing Home
Games, Retired
Senior Service
Volunteer Program
luncheons, and
AARP events).
Implemented a
volunteer-based
transit ambassador
program that
allows a
volunteer, who
knows the local
transit systems,
to assist and
provide
information to
Adrian Cardoso, Transportation other passengers
Planner, or people using
City of Napa Napa, CA public transit for
(707) 259-8635, the first time.
[email protected] The ambassador
program is
available to all
passengers.
However, seniors
often take
advantage of the
program to learn
how to ride
fixed-route
services in Napa,
CA.
Provides
specialized
coordinated
transportation
services for
medically fragile,
disabled, and
elderly to
locations such as
medical offices,
hospitals, and
other key
destinations.
Coordinates
transportation
services with
Council on Karl Johanson, Executive consumer
Aging and Colfax, WA Director, (509) 397-4611, advocates, social
Human Services [email protected] service agencies,
government
offices, and
transportation
providers to best
meet their
clients' needs.
Secures
transportation
funding, takes
telephone calls,
schedules and
assigns trips with
subcontractors,
provides rides,
and reimburses
providers.
Implemented a
medical advocacy
program that uses
Rosanne DiStefano, Executive local volunteers
Director, to assist elders
Elder Services Merrimack with medical
of Merrimack Valley, MA (800) 892-0890, transportation and
Valley advocacy. Program
[email protected] is targeted to all
elders and spouses
and to working and
long-distance
caregivers.
Implemented a
mileage
reimbursement
program through
which seniors find
volunteer drivers
who use their
private vehicles
to transport
Marty Hadley, Coordinator, seniors to medical
Enabling Mesa, AZ appointments,
Transportation (480) 218-2221, grocery shopping,
[email protected] church, or other
recreational
activities. The
program was
modeled after the
Transportation
Reimbursement and
Information
Program, which is
listed below.
Coordinates with
medical facility
staff to schedule
senior medical
appointments to
match with
transportation
availability and
is involved in
business
Friendship Gary Louie, Executive Director, enterprises with
Center Conroe, TX (936) 756-5828, others in the
[email protected] community to
generate
additional program
revenue. The
implementation of
a computerized
mapping system to
schedule same-day
services is slated
for the near
future.
Provides low- or
no-cost
transportation to
low-income seniors
and persons with
disabilities
located in rural
communities to
healthcare
Susan Healy-Harman, Development services, provides
Director, all-day Sunday
Gold Country Grass service for
Telecare, Inc. Valley, CA (530) 272-9958, seniors to go to
[email protected] church and other
activities, and
offers a volunteer
driver program
through which
volunteers who use
their own vehicles
to transport
seniors are
reimbursed for
mileage.
Implemented a
Jim Helgeson, General Manager, travel-training
Great Falls Great (406) 727-0382, program through
Transit Falls, MT which volunteers
District [email protected] teach seniors how
to use public
transportation.
Offers a range of
demand-responsive
services
(door-to-door,
door-through-door,
and hands-on
assistance) to a
broad spectrum of
older riders using
automobiles driven
by both paid staff
and volunteer
Katherine Freund, Director, drivers. Operates
Independent exclusively on a
Transportation Westbrook, (207) 854-0505, combination of
Network ME fares and
[email protected] donations and does
not depend on
public subsidies.
Customers
(seniors) become
"members" of
Independent
Transportation
Network and prepay
(through a variety
of payment plans)
into their own
account in advance
of travel.
Provides
demand-response
transportation
services to
Kurt Blades, Transportation seniors for
Lauderhill Lauderhill, Coordinator, grocery shopping,
Transportation FL medical
Program (954) 717-1525, appointments,
[email protected] banking, daily
nutrition, senior
center activities,
and other general
travel trips.
Provides
transportation and
brokerage services
by coordinating
with other
nonprofit
agencies. Services
are customized to
meet the needs of
seniors, using
wheelchair
accessible
vehicles and
William McDonald, Director, providing shuttle
Medical Motor Monroe services to rural
Service County, NY (585) 654-7030, areas of the
[email protected] county. Contracts
with a private,
regional grocery
chain to
supplement its
fund-raising
efforts. The
grocery store
contributes to
Medical Motors in
exchange for
Medical Motors
transporting
seniors to the
grocery store.
Provides transit
services to the
general public and
door-through-door,
one-on-one
services to
Mountain Dennis Horton, Deputy Director, special-needs
Empire Older Big Stone (276) 523-4202, populations in a
Citizens, Inc. Gap, VA [email protected] multicounty region
through a
coordinated system
that is also
consumer friendly
and flexible to
meet the needs of
the community.
Targets a
travel-training
program to the
senior population
to encourage
seniors to use the
public transit
system by teaching
(one-on-one or
through groups)
and showing
Stacy Zwagers, Director of seniors how to use
Transportation, the system. Helped
North County Vista, CA establish the
Lifeline, Inc. (760) 726-3961, Strides Web site,
[email protected] designed as a
distribution
center for other
public
transportation
service providers
as well as a
referral service
for seniors to
learn about
transit services
in the San Diego
area.
Provides
transportation
service for the
general public,
prioritizing its
services on senior
citizens and
persons with
disabilities
Columbia, Linda Yaeger, Executive within 87 rural
OATS, Inc. MO Director, (573) 443-4516, counties in the
[email protected] state of Missouri.
Uses volunteers to
fulfill a number
of functions, such
as dispatching
calls to drivers,
fund-raising, and
serving as
liaisons to the
community.
Provides flexible
transportation
services for trips
to senior centers,
Mike Angley, Deputy shopping, banking,
Rensselaer Commissioner, and medical
County Troy, NY appointments.
(518) 270-2732, Drivers use pagers
[email protected] for efficient
pick-up service.
Night and weekend
trips are
available.
Transports older
adults and persons
with disabilities
Seniors' Jane Yeager, Director, to medical
Resource Denver, CO facilities,
Center (303) 238-8151, grocery stores,
[email protected] meal sites, and
adult day centers
and for other
personal needs.
Uses volunteers to
Rebecca Gordon, Executive provide
Shepherd's Director, door-through-door
Center of Kansas medical
America City, MO (816) 452-4536, transportation
(Northland) services to
[email protected] seniors. Services
are free to
seniors.
Provides a variety
of services,
including
demand-response,
curb-to-curb
transportation
service offered to
the general
public; a circular
shuttle route
serving the entire
Lenna Kottke, Executive community that is
Special Boulder, CO Director, (303) 447-2848, also senior
Transit [email protected] friendly; a
"family and
friends" mileage
reimbursement
program; and a
comprehensive,
one-on-one
training program
developed to teach
seniors how to use
their community
transit
alternatives.
Coordinates its
services with
local transit
authority and
taxicab services.
Provides a
St. Johns St. Cathy Brown, Executive driver-training
County Council Augustine, Director, (904) 823-4810, program that
on Aging FL [email protected] emphasizes safety
and customer
service. Uses
brightly-decorated
vehicles to
attract senior
ridership.
Helps provide
vehicles and
funding to local
communities in the
Suburban Ron Ristau, Director of Service service area.
Mobility Development, Local communities
Authority for Detroit, MI that receive the
Regional (313) 223-2100, vehicles and
Transportation [email protected] funding design and
operate services
independently
according to local
needs.
Provides
coordinated
demand-response
transportation
services using
computerized
scheduling. The
Sweetwater Judy Wilkinson, Director, computerized
Transportation Rock scheduling
Authority Springs, WY (307) 382-7827, software will
[email protected] allow accurate and
on-time scheduling
through the use of
Global Positioning
Systems technology
that tracks the
location of
vehicles.
Provides senior
transportation
services 7 days a
week and serves
approximately 40
designated senior
nutrition and
Ed Wisniewski, Paratransit social center
Transportation sites. Also
Options, Pompano Manager, implemented a
Broward County Beach, FL community bus
Transit (954) 357-8321, program that
[email protected] circulates within
a specific
community to
encompass shopping
areas, senior
residences, and
senior day
programs.
Reimburses
volunteer drivers
Transportation to transport
Reimbursement Riverside, Richard Smith, Executive individuals where
and CA Director, (909) 697-4697, no transit service
Information [email protected] exists or when the
Program individual is too
frail to use other
transportation.
Operates a
demand-response
service for
seniors who need
Terri Lindenburg, Executive transportation
Treasure Canyon Administrator, services to
Valley Transit County, ID medical
(208) 465-6472, facilities. Also
[email protected] works with local
senior centers to
provide
transportation
services.
Provides free
transportation
using volunteers,
Jeanie Teel, Executive who use their
West Austin Austin, TX Director, (512) 472-6339, private vehicles
Caregivers [email protected] to transport
seniors to medical
appointments,
shopping, and
errands.
Source: GAO analysis of information obtained through interviews with
service providers and reports by the Beverly Foundation, the Community
Transportation Association of America, and the National Academy of
Sciences' Transportation Research Board.
Note: This appendix includes only those service providers who responded to
our request for information, and is therefore not a comprehensive list of
providers identified by the Beverly Foundation, the Community
Transportation Association of America, and the Transportation Research
Board as having implemented practices that enhance
transportation-disadvantaged seniors' mobility. For more information, see
Beverly Foundation in partnership with the AAA Foundation for Traffic
Safety, Supplemental Transportation Programs for Seniors (Pasadena, CA,
and Washington, D.C.: June 2001) and Supplemental Transportation Programs
for Seniors: A Report on STPs in America (Pasadena, CA, and Washington,
D.C.: July 2004); Community Transportation Association of America, Senior
Transportation: Toolkit and Best Practices (Washington, D.C.: May 2003);
and U.S. Department of Transportation, Transit Cooperative Research
Program, Transportation Research Board, TCRP Report 82, Improving Public
Transit Options for Older Persons, Volume I: Handbook and Volume II: Final
Report (Washington, D.C.: 2002).
aThe practices listed above focus on efforts targeted to seniors and are
not intended to represent a complete list of services provided by each
local service provider.
Comments from the Department of Health and Human ServicesAppendix IV
GAO Contacts and Staff AcknowledgmentsAppendix V
GAO Contacts
Katherine Siggerud (202) 512-2834 or [email protected] Rita Grieco (202)
512-2834 or [email protected]
Staff Acknowledgments
In addition to the individuals above, Bert Japikse, Jessica Lucas-Judy,
Kristen Sullivan Massey, Sara Ann Moessbauer, Elizabeth Roberto, and Maria
Romero made key contributions to this report.
(542029)
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