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.

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