The ability to travel around town, going wherever we want whenever we want, is a freedom that most of us enjoy. We take for granted that we can slip behind the wheel of a vehicle and drive off without giving it much thought. But for a growing portion of the elderly population, once routine outings like going to the grocery store, the library, social gatherings or doctor’s appointments have become monumental challenges. As we age, health conditions may impact driving and we must find other methods for getting to and from our daily activities.
Many older people are reluctant to stop driving, even though they may be putting themselves and their communities in danger by continuing to get behind the wheel. In fact, the Community Transportation Association of America (CTAA) predicts that elderly traffic fatalities will triple by the year 2030. For most seniors, the ability to drive not only represents their level of independence, but also serves as an essential means of preserving one’s identity and life-long routines. A driver’s license is the most widely accepted form of identification. Therefore, to give up one’s driver’s license is akin not only to relinquishing independence and freedom of mobility, but also to a loss of self-esteem and power.
Furthermore, research indicates that older individuals who are no longer able to drive attend fewer medical appointments, go shopping and out for meals less often, and reduce the frequency of their visits to friends and family compared to drivers of the same age. While taking away a senior’s car keys can be a serious blow, this change doesn’t have to render them housebound and deprive them of engaging activities and a social life.
Many elders look to their family members to fill this gap but driving back and forth takes a great deal of time and money and causes significant wear and tear on a vehicle. Family caregivers seldom have the resources and ability to meet all an aging loved one’s transportation needs. Fortunately, there are many transportation and driving services available for elders who can no longer drive themselves.
Finding and Paying for Senior Transportation
When helping a senior select alternative modes of transportation, you must consider a variety of factors. Does the elder live in a rural or urban community? Do they have medical needs that require consideration when arranging transportation? What economic resources can be allocated to fulfill their transportation needs? Transportation does not have to be expensive, and health insurance will sometimes cover the cost, especially if the trip is for medical purposes. Nonetheless, like many things in America, the best and most convenient alternatives to driving are likely to be the costliest.
As required by law, Medicaid covers non-emergency medical transportation, such as trips to the doctor for a scheduled appointment. Medicare, however, will only cover emergency medical trips, like those that require ambulance service. In certain chronic and debilitating cases, Medicare will pay for non-emergency trips, but these must be arranged on a case by case basis. Other health insurance companies have only recently begun to consider transportation as an insurable cost. The options are so varied among insurance carriers that it’s best to consult with a senior’s individual company to see what their policy covers.
Another important resource for finding senior transportation options is a local Area Agency on Aging (AAA). The Older Americans Act (OAA) allocates funds to support more than 600 AAAs in communities across the country. These offices are an invaluable source of information on local, state and federal benefits and supportive programs for the elderly and people with disabilities. The goal of AAAs is to provide and connect seniors with home and community-based services that enable them to age in place and avoid placement in long-term care for as long as possible. Because access to transportation has a huge impact on seniors’ ability to live independently, many AAAs provide transportation services or can at least refer seniors to other free and low-cost providers in the community. You use the AgingCare.com Area Agency on Aging Directory to search for your local office.
Ideally, a good transportation system will not just take a passenger from point A to point B. A service should help a senior feel as much control over their travel as possible, but it’s important to understand that switching from driving oneself to using other resources for rides is a huge change that often requires a shift in mindset and routine. Rather than focusing on the new challenges that arise with this transition, help remind your aging loved one that navigating these minor inconveniences is worth maintaining their independence, security and dignity.
Public Transportation Options for Seniors
Public transportation is the most obvious choice for seniors in good health who decide they no longer want to risk driving. It is one of the most affordable modes of transportation and can provide non-drivers with a relative sense of independence. Public transportation includes bus and rail systems with fixed routes, stops and schedules. Bigger cities usually have sophisticated public transportation systems that can take travelers to almost any location.
Public transportation, however, does have limitations for seniors. To use public transit, most people must walk to and from bus or train stops, adhere to strict schedules, wait outside for pickup and be able to navigate stairs. Therefore, this is not always appropriate for older people, especially those who have limited mobility and/or have difficulty planning and following a schedule.
Senior citizens relying on walking aids or wheelchairs for assistance can use most public transit systems. Every public bus is required by law to have a wheelchair lift on it, and every train must have one wheelchair accessible railcar. However, it is advisable to inquire about the safety of the stops and stations to be used and ensure that they have good lighting, an elevator if necessary, and working telephones if help is needed. Seniors relying on public transportation may also want to adjust their schedules to avoid daily rush hours when large, jostling crowds may make it more difficult to get around.
Travel Training for Seniors
Public transportation systems and aging organizations have developed “travel training” programs that work with seniors to make them feel more comfortable using public transportation. These free programs provide trainers who spend time with a senior helping them practice getting on and off public transit, calculate costs, find discounts and work out appropriate routes and schedules to use. They also can supply an elderly person with a mentor to travel with until they feel secure enough to go it alone.
Paratransit Services for Seniors
Despite the efforts of public transportation systems to accommodate elderly citizens with disabilities, some systems are outdated and provide a poorer level of service than others or are unable to transport older citizens with greater needs. In these cases, the complementary paratransit system mandated by the Americans with Disabilities Act (ADA) may be a better alternative.
Federal law under the ADA guarantees a basic level of transportation service for many older citizens. The ADA says that a city or town providing public transportation services to the community at large must provide a complementary or paratransit service for persons with disabilities as well. Under the practical definition of disability, many senior citizens find themselves eligible for this service.
Paratransit service provides a more specialized and personalized level of service to people who cannot get around easily using the fixed route public transportation system. Paratransit vehicles are usually vans that are wheelchair and handicapped accessible. ADA complementary paratransit services must be provided within 3/4 of a mile of a bus route or rail station at the same hours and days for no more than twice the regular fixed route fare. Many paratransit systems provide curb-to-curb service to locations within their designated complementary routes. These features help persons who cannot get to public bus stops or train stations.
It is important to note that curbside service differs from door-to-door service. Unlike door-to-door service, paratransit drivers will not enter a senior’s home to assist them with getting to and from the vehicle. Paratransit users must be able to navigate their way onto the vehicle or have a personal care attendant (PCA), such as a family caregiver or a hired companion to help them. PCAs can ride the paratransit system for free.
Unfortunately, because paratransit systems are in such high demand, it often means that users must exercise patience and flexibility when planning outings. However, a certain level of service can be expected including the following:
- A senior should be able to call and schedule a ride within 24 hours.
- The ride should take only one-half as long more than the regular fixed route ride. (For example, if the trip takes 60 minutes on the fixed route system, then it should take no more than 90 minutes with the paratransit system.)
- A quality system will have a maximum 30-minute window of waiting time for a senior to be picked up by a driver (15 minutes before the requested time plus 15 minutes after the requested time). However, the law permits a one-hour window of waiting time.
The security of paratransit passengers and confidentiality are crucial and many public paratransit systems perform background checks on their drivers. Passengers using welfare/charitable services to pay for their trips, or whose health conditions make them eligible for services, will feel reassured knowing that their medical and financial information will remain private.
Qualifying for the paratransit system can be more difficult in some localities than in others, depending on the ridership load. Some systems automatically accept riders after they reach a certain age, while others apply very stringent eligibility criteria. Applying can involve a lot of paperwork as well as a meeting with a rehabilitation specialist to determine a senior’s precise needs or a visit to an eligibility determination center. Transportation to and from the center should be provided to the senior if needed. Processing time for applications may vary, however, some paratransit services have such large backlogs of requests that they provide temporary eligibility until a case can be reviewed and a determination can be made.
Don’t be discouraged if an aging loved one does not qualify for paratransit service. Many seniors who only have trouble getting to the regular fixed-route stops or who feel uncomfortable traveling at night or during bad weather will find that they do not qualify for the special service under increasingly burdened systems. Therefore, many transportation authorities are working on creative methods to meet the needs of these citizens. One such solution is the service route system, which operates as a hybrid between the fixed-route and paratransit services. Service routes allow elderly persons flexibility within the fixed-route system, such as requesting to be dropped off along the route but not necessarily at a designated stop or hailing the bus somewhere along its route other than at a designated stop. Indeed, some drivers will even go slightly off the regular route to bring elderly passengers closer to their destinations. Accommodations like these are usually most effective during non-rush hour periods.
Another solution transportation authorities are experimenting with is having the paratransit system pick up persons from their homes and taking them to a fixed route bus stop. These services will usually wait with the passenger until the bus comes or even drive the extra mile to catch up to a missed bus.
Faith-Based and Nonprofit Ride Services for Seniors
Communities often have religious groups and charitable organizations that use a network of volunteers to provide free and low-cost ride services to senior citizens. Volunteer ride services vary extensively. Some may require membership in the providing organization or a small donation in exchange for services. Rides may be provided individually or for groups of seniors. However, a common denominator is that services are typically limited, and seniors must make reservations in advance.
Semi-Private Transportation Services for the Elderly
Given the growing need for services to transport elderly citizens who do not have serious medical needs but still need extra assistance getting around town, public transportation is looking to the private sector to ease the burden. There are many quasi-private organizations that do not charge much for rides but that operate only during limited hours. Sometimes they work in conjunction with the paratransit system. Because private organizations partially run these arrangements, the specific details of these systems differ vastly between cities. Usually, these providers offer services that are similar to the paratransit systems, but their eligibility requirements are less strict and their service capabilities are more limited.
Other highly valuable resources that senior citizens should look to for their transportation needs are local senior and social service centers. These organizations frequently arrange group trips to places like grocery stores, libraries and medical facilities. Although they don’t provide the same flexibility as paratransit and public systems, they can eliminate a significant amount of hassle. If a senior is willing to go to the grocery store on a fixed day at a fixed hour (for example, Wednesday mornings at 10:00), then they can go with a group of peers in an environment that is sensitive to their individual needs.
Private Transportation for Seniors
If the above options are not available or do not work for your aging loved one, you might need to explore the costlier option of private transportation. The most basic form of private transportation is a taxi service. This option is most appropriate for seniors who require occasional travel and a minimal amount of extra assistance but cannot access public transportation. It’s also a good option for those who live in rural areas without extensive public transportation and those who need to travel late at night or during rush hours.
Ride-hailing services are another private transportation option for seniors. There are some barriers to using these services, such as the need for a smartphone and some technological savvy, but companies like Uber and Lyft are making efforts to provide more accessible vehicles and service options tailored to meet the needs of seniors and people with disabilities.
A likely scenario that might require a senior to seek private services would involve medical necessity. Many private companies supply vehicles known as “cabulances” or coaches. A cabulance is appropriate for a senior who can’t spend time on public transportation and requires a higher level of assistance during a trip. Non-emergent medical transport providers use vehicles that are wheelchair accessible and provide door-to-door service with assistance from the driver who will help the passenger in and out of the cabulance. These companies can also accommodate a senior’s medical equipment, such as mobility aids, oxygen tanks and more.
Although Medicaid will cover cabulance rides taken specifically to access medical services, the cost for a non-medical trip can run from $20 to $100 or more roundtrip. As mentioned previously, Medicare usually only covers emergency transportation rides, but if the patient has a particularly chronic illness, Medicare Part B might cover a non-emergency medical trip in a cabulance if a senior’s doctor deems it medically necessary. These services must be scheduled far in advance—sometimes up to two weeks.
In-Home Care Services
In-home care is often associated with assisting a senior with light housekeeping, meal preparation, and activities of daily living (ADLs) like bathing and dressing—services provided inside the home. But in-home care companies can provide substantial assistance to seniors outside of their homes as well. Professional caregivers can be hired to drive your loved one to doctor’s appointments, errands, social engagements and recreational events. Not only do they provide transportation services, they can also help seniors get into and out of the vehicle and can accompany them on their outings if desired. This option is excellent for seniors who want companionship and/or require another person’s assistance with mobility, transfers and other tasks. This service is paid for privately.
Planning for Senior Transportation Needs
Public transportation, private options and social services represent the bulk of choices currently available to senior citizens needing transportation. However, as the baby boomer generation ages, demand will grow for a wider variety of options.
When researching and evaluating transportation services for an aging loved one, be sure to ask the following questions. Such subtleties can help identify the system that best meets the needs of someone who is no longer able to drive.
- How long has the company been in business and is it well established in the community?
- Does the company have adequate insurance coverage?
- How many vehicles does the provider have?
- Are the vehicles clean and comfortable, inspected frequently, and kept in good condition?
- Does the company have a reputation for reliability and courtesy?
- Does the company employ an adequate number of well-trained drivers and, where appropriate, other staff to assist passengers?
- Do the drivers undergo background checks and drug and alcohol testing?
- Do the drivers have defensive driving training, Red Cross certified CPR training and passenger assistance training?
- How are emergencies handled?
- How are mobility aids like wheelchairs and walkers handled at pick-up and drop-off and during the ride?
- What are the wait times like for rides and where does a senior have to wait for pick up?
- Does the provider offer assistance to and from the vehicle?
- On average, how much does the ride service cost? Are there any discounts available?
The article "Finding Transportation Services for Seniors" by Dr. John Connolly originally appeared on AgingCare.com.
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