The ability to travel around town, going where we want or need to go whenever we need or choose to, is a freedom that most of us enjoy. We take for granted that we can hop on a bus, hail a taxi, or slip behind the wheel of a car to drive whenever we please. But for a growing portion of the elderly population, once routine outings such as going to the grocery store, the library, or even to the mall for shopping or a movie now present daily challenges. As we age, driving is not an option for many of us, and we need to find other methods for getting to and from our daily activities.
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.
Many older people are reluctant to stop driving, even though CTAA statistics predict that elderly traffic fatalities will triple by the year 2030. For most seniors, the ability to drive not only signals their level of independence, but also serves as an essential means of preserving identity and life-long routines. In most locales, 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.
Deciding Not to Drive—A Big Moment for Seniors
Despite these concerns among older drivers, physical conditions associated with the aging process may make safe driving impossible. Drivers noticing a decline in their vision or finding that they have restricted physical mobility need to reconsider the decision to continue driving. In addition, friends and family of elderly drivers should be alert to signs of confusion or other sensory impairment that might make their loved ones unsafe on the road. Although some elderly drivers will recognize that their skills have declined, others might not notice the changes or may be reluctant to admit to them.
Friends and family also need understand that, even though older relatives grasp that they should no longer sit behind the wheel of a car, they might continue to do so because they are unaware of other travel options. Many do not want to burden their families by asking for rides, yet, relying on others for rides (ridesharing) is a common alternative used by the elderly. Family members should try to find simple ways to make their older passengers feel at ease about asking for rides.
Making the decision not to drive definitely alters an older person's daily routine and habits, but need not signal an end to independence. Senior citizens should be made aware of the many options that exist for them in their own communities since available alternatives may differ tremendously depending on where the older person lives.
Finding and Paying for Senior Transportation
When selecting a system of transportation, you must take into account a variety of factors. Do you live in a rural or urban community? Do you have medical needs that require consideration when providing transportation? What economic resources can be allocated to fulfill your transportation needs? Transportation does not have to be expensive, and 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 are likely to be the most costly.
As required by law, Medicaid will cover 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 911 service. In certain chronic and debilitating cases, Medicare will pay for non-emergency trips, but these need to be worked out on a case by case basis. Other insurance companies have only recently begun to consider transportation as an insurable cost. Savvy consumers can find hidden opportunities in their plans, such as worker's compensation, as a means to obtain coverage. The options are so varied among insurance carriers that it's best to consult with your individual company to see what it provides.
A good transportation system will not just take a passenger from point A to point B. Rather, a top system will provide senior citizens with a similar feeling of control over the timing of and route to their final destination to that they felt in their own vehicles. In addition to providing independence, seniors should expect a transportation system to enable them to maintain their sense of security and dignity.
Legal Support for Senior Transportation
Seniors who are contemplating no longer driving and their family members should be aware that federal law under the Americans With Disabilities Act (ADA) guarantees a basic level of transportation service for many older citizens. The ADA says that a city or town providing a public transportation service to the community at large also must provide a complementary or paratransit service for persons with disabilities and, under the practical definition of disability, many senior citizens will find themselves eligible for this system. Since the goal of the ADA is to guarantee disabled citizens the same rights as the general public, the paratransit system must be comparable to the regular public transportation system in response time and days and hours of service. The local community generally serves as the watchdog for the locality to make sure it operates a paratransit system. If you are investigating alternative means of transportation and find that your community has a public bus or rail system, but does not have an alternative system to assist less mobile citizens, speak up! It's the law, and it's your right!
Another important law that will help you in your search for the best senior transportation options is the Older Americans Act (OAA). The OAA allocates funds to state and territorial units to ensure that each supports an Area Agency on Aging. These agencies serve as invaluable resources to elderly persons looking for alternative means of transportation. Your Area Agency on Aging is required by law to provide access to support systems such as nutritional services. Many times, the agencies will meet this requirement by providing transportation to seniors as a means of granting them access to such services. In addition, the agencies must provide referrals for their elderly clients to other transportation agencies. The government allocates funds to the area agencies for use in matters benefiting elderly citizens and most agencies make transportation one of their priorities. Every state has one of these agencies, so make sure to give your local agency a call.
Elders Using Public Transportation
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 least costly means of transportation (most single rides cost under $2.00) and can provide non-drivers with a relative sense of independence. Public transportation includes a bus or rail system with a fixed route, meaning a standard path and time that the bus or train takes. Bigger cities usually have highly functioning public transportation systems that take travelers to almost any location.
Public transportation, however, does have limitations for seniors that might include walking to and from bus or train stops, adhering to schedules, waiting for buses outdoors in bad weather and climbing or descending flights of stairs. Therefore, it is not always appropriate for older people and especially not for those in need of medical attention or those who are not reasonably mobile.
Even senior citizens relying on walking aids or wheelchairs for assistance can use the public system. Every public bus is required by law to have a wheelchair lift on it, and every train must have one wheelchair accessible railcar. A high-quality service also makes large-print schedules available and designates priority seats for the elderly or disabled which other riders are asked to relinquish. You also are entitled to ride with drivers who have experience with positioning wheelchairs on and off buses. However, it is advisable to inquire about the safety of the stops and stations to be used and assure that they have good lighting and working telephones in the event that help is needed. Some people may want to adjust their schedules to avoid daily rush hours when large, jostling crowds may unnerve or confuse frail older people.
Despite the efforts of public transportation systems to accommodate elderly citizens with disabilities, some systems 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 ADA may be a better alternative.
Paratransit service provides a more specialized and personalized level of service to people who cannot get around using the fixed route public transportation system. Paratransit vehicles usually include vans that are easily wheelchair and handicapped accessible. The breadth of the paratransit service must extend to a three-quarter mile corridor on each side of the normal fixed route. 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 because they are too far away. It is important to note that curbside service differs from door-to-door-service. Unlike door-to-door service, paratransit drivers will not enter people's homes 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) to help them. PCAs are allowed to ride the paratransit system for free. In addition, under the ADA the cost for the complementary system can never be more than twice the fare for the normal public transportation. For example, if public bus service costs $1.50 per ride, then the paratransit system cannot cost more than $3.00 for the same ride.
The high demand on paratransit systems means that users must exercise patience and flexibility when using this alternative arrangement. It is not a response on demand system. However, a certain level of service can be expected including the following:
- You 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. (e.g., if the trip takes one hour on the fixed route system, then it should take no more than one and one-half hours with the paratransit system).
- A quality system will have a maximum 30-minute window of waiting time for you to be picked up by the driver (15 minutes before your requested time plus 15 minutes after your requested time). However, the law permits a one-hour window of waiting time.
Security of paratransit passengers and confidentiality are a must and many public paratransit systems perform background checks on their drivers. Passengers using welfare/charitable services to pay for their trips, or whose particular health conditions make them eligible for services, will feel reassured if they know that their medical and financial information remain private.
Qualifying for the paratransit system can be difficult in some localities but easier in others, depending on the ridership load. Some systems automatically accept riders after they reach a certain age, while others apply very stringent criteria.
Applying for eligibility can involve a lot of paperwork as well as a meeting with a rehabilitation specialist to determine precise needs. A visit to an eligibility determination center may be required before eligibility can be obtained. The center should provide someone to transport the senior to and from the center, if needed. In theory, there is a 21-day turnaround time from the time you apply for eligibility until the time that a decision is received. However, most paratransit services have such large backlogs of requests that they provide temporary eligibility until a case can be reviewed.
Don't be discouraged if you do 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 system is the service route, which operates as a hybrid between fixed-route and paratransit service. 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.
Other Transportation Options for Seniors
Other transportation systems have developed training programs that work with elderly persons to make them feel more comfortable using public transportation. These programs provide trainers who spend up to a few weeks with each older person practicing getting on and off buses and working out appropriate routes and schedules. In addition, they also can supply an elderly person with a mentor to travel along until the person feels secure enough to go it alone. In less frequent cases, paratransit systems will let elderly citizens who do not officially qualify for rides use the system on a space-available basis.
Given the growing need for services to transport elderly citizens who do not have serious medical needs, but still need extra assistance during a trip, 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 in various cities. Usually, these systems provide much the same service as paratransit systems, but do not have as strict eligibility requirements 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 such places as 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 you are willing to go to the grocery store on a fixed day at a fixed hour (for example, Wednesday mornings at 10:00 am), you will find that you can go with a group of peers in an environment that is sensitive to your individual needs.
When comparing the characteristics of these systems, it is important to remember that drivers holding commercial driver's licenses must undergo drug and alcohol testing. In addition, be sure to inquire as to whether the drivers have passenger assistance training. Such subtleties can help identify the system that best meets the needs of someone no longer able to drive.
Private Transportation for Seniors
If these options do not work for you, you might need to explore the more costly option of private transportation. The most basic form of private transportation is a taxi service. This option is most appropriate if you require occasional travel and a minimal amount of extra assistance, but cannot access public transportation. It's also a good option if you live in a rural area without extensive public transportation, need to travel late at night or during rush hours, or if you simply do not feel secure when traveling. The cost of a single ride in a taxi varies greatly depending on the location and the distance traveled, but it's safe to assume that the minimum one-way fare will be $5.00 and could be as high as $20.00 to $40.00, including tips and tolls.
A likely scenario that might require a senior to seek private services would involve medical necessity. Many private companies supply vehicles know as "cabulances" or coaches. A cabulance or a coach is appropriate for a senior who can't spend time on public transportation and requires constant assistance during a trip. A senior on kidney dialysis or suffering from Alzheimer's or Parkinson's disease might be an appropriate passenger for this service. A cabulance has wheelchair accessibility and provides door-to-door service with assistance from the driver who will help the passenger out of his/her house and into the cabulance. Some cabulances provide stretcher service for people unable to sit upright. 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 case, Medicare might cover a non-emergency medical trip in a cabulance. In addition, unlike public services, cabulance services must be scheduled far in advance — sometimes up to two weeks. Also, the senior must be prepared to wait for the vehicle to arrive. Unlike public services, the government does not regulate cabulance organizations and the company is free to give a three to six hour spread in possible pick-up time.
In the most extreme cases of medical necessity, you may want to employ a private ambulance for transportation. Many of the same companies that operate cabulances also lease ambulances. Most often, private ambulances contract with nursing homes and hospitals to provide transportation for their clientele. Ambulances are used in cases in which a person is bedridden. Usually this implies a high degree of physical impairment, but it can include temporarily disabling injuries such as a broken hip. Two types of ambulance services exist depending on the needs of the patient. The first comes equipped with basic life support devices. The attendant monitors the person's vital signs throughout the trip, including blood pressure checks. The second type of ambulance service is more advanced and will have a trained staff member on the trip who can start an IV (intravenous transfusion) or administer oxygen to the patient, if necessary.
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, it will increasingly demand a variety of higher-quality services. Future systems may focus on community planning, such as current ones in Florida that allow citizens to drive around in golf carts or operate mini vans that cover a defined route. In addition, imagine how much easier funding these methods would be if transportation accounts, similar to IRA accounts, were available. During the search for feasible transportation, maintain a lookout for such innovations. With creativity and perseverance, a transportation plan can be put together that will ease the hardship of being unable to drive and perhaps even produce an enjoyable experience during the retirement years.
Questions to Ask About Senior Transportation Options
- How long has the company providing the transportation been in business and is it well established in the community?
- Does the company have adequate insurance coverage?
- Does the company have a sufficient number of vehicles? 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, others to assist passengers?
- Do the drivers have defensive driving training, Red Cross certified CPR training and passenger assistance training?
- Do cabulances have air conditioners?
- Where do they place wheelchairs in the cabulance: in the back, the middle or the front? (The middle is preferable because it is the least bumpy location in the van.)
- Will the vehicle be small enough to pull into the driveway of a private residence?
- Does the company employ dispatchers who know how to assess the seriousness of a passenger's situation?