Mid-size buses: what's the value?

Long-term care managers comment on their "real world" assessments

It's been only a few years since the mid-size bus - a vehicle seating anywhere from 12 to 30 residents with wheelchair accommodations of various types - began appearing with any frequency at long-term care facilities and campuses. In theory, this vehicle should be an advance over high-top vans and, most certainly, over the public transportation that facilities typically used (and often still use). Has it worked out that way? Recently Nursing Homes asked several purchasers of these vehicles for their assessments and evaluations, and their comments are summarized:

Kenneth Posey, Administrator, Jasper County Nursing Home, Bay Springs, MO: "We purchased a mid-size bus about two years ago to give our residents the opportunity to get out and leave the facility from time to time. We might just go out riding the country roads, but this has been very important. On our first trip we had a woman who had been wheelchair-bound and had never left the facility for six years, through no one's particular fault, and her experiencing this trip in itself made it all worthwhile. We also use the bus for one-day outings about four times a year; about 90% of the residents are wheelchair-bound and we hook up a trailer behind the bus for the wheelchairs the bus can't accommodate. The bus cost about $50,000 and, for all that is has done for the residents, it's a purchase we would highly recommend."

Marsha Doctor, Operations Administrator, Seven Acres Jewish Center, Houston, TX: "We have two of these buses - a 16-passenger, 8-wheelchair vehicle and a 9-passenger, 2- wheelchair vehicle - and the quality of our residents' lives has come to depend on these vehicles. We have a 290-bed nursing home and an adult day care center with about 100 participants, and the buses are working from 7:30 a.m. to 5:30 p.m. transporting residents to facilities and programs and taking them shopping and to movies, parks, art museums and fishing trips. We even take residents from our certified Alzheimer's unit on 'joy rides' - they love to get out and ride. Our goal is for the vehicles to never be on our property.

"It is very important, though, when purchasing these to have a clear idea of your specifications; good specifications are the key. We spent hours developing ours - door size, air conditioning, engine size, floor strength, safety accommodations, where the hatch should be located, accommodations for people using walkers and canes - it's really a customizing situation. The best approach is to spend some time with someone who has purchased one of these and knows what the needs are. It's like purchasing a $30,000-70,000 piece of high-tech equipment.

"I should mention that, as a not-for-profit, we were able to get a Federal grant through our state Department of Transportation covering 80% of the cost of our first vehicle" (see "Grants for Nonprofits," p. 75).

Peggy Breneman, Resident Acitivities, Conestoga View, Lancaster, PA: "We purchased a 16-passenger bus with lockins for two wheelchairs about eight years ago to enable our residents to get out more in the community. We had used public transportation, but it wasn't very reliable or convenient for our purposes. Now we're going out about 15 times a month and average about 600 miles a month. Lancaster County is a very picturesque area, and we go on a lot of scenic rides, as well as outings to restaurants, nurseries, bowling, shopping malls and, in the summer, lots of trips for ice cream. The residents really enjoy this and it's been very successful. I'd say the only problem we've had is the lack of storage for more than two wheelchairs. We deal with this by taking fewer residents on trips but scheduling more trips so that everyone has a chance to get out fairly regularly."

David Ross, Vice-President, Levindale Hebrew Geriatric Center, Baltimore, MD: "We have 10 mid-size buses, seating 12 to 18 and handicapped-accessible, that we use for our complex, which includes a 288-bed nursing facility, a 23-bed specialty hospital, a partial psychiatric hospitalization program, three adult day care centers and several senior apartment complexes we manage. One of the buses, actually a 25- passenger, two-wheelchair vehicle, is used for transportation of community-dwelling elderly throughout northwest Baltimore - a very successful, well-accepted community service. Nine of the buses are used primarily for adult day care, taking participants to doctors' appointments and on various trips, and the nursing facility uses them for activities like its 'Ride in the Country.' They are much more comfortable than the high- top van we used to use, where the residents sometimes seemed 'jammed in.'

"We also think that the mid-size bus has a cost advantage over the high-top van. We anticipate at least a couple of years more life expectancy from the bus, and when you spread out capital costs over that period, along with pretty much the same costs for maintenance, the mid-size bus becomes more cost- effective. But you have to make very sure of what you're buying. These buses run in price from the mid-30s to the mid-50s at least, and they're a major expense. A key factor is the quality of the company you're dealing with."

Sidney Roberts, Executive Director, Woodland Terrace, Deland, FL: "We purchased a 25-passenger, two-wheelchair bus about eight years ago and just purchased another one. We made the initial purchase because the residents of our independent living complex at the time - we have 70 independent units, 124 assisted living units and a 120-bed skilled nursing facility - were reaching their early 80s in age and needed more than a van could provide them. We had several complaints about this. Though we urge residents to use outside services or family members as much as possible, schedules and personal cost can be problems, and it turns out we use the bus frequently for doctors' appointments and shopping activities. Our recent addition of skilled nursing beds and independent living units led to our purchase of the second bus.

"My advice would be to recognize that more and more residents are aging these days, and it's wise to get as big a bus and as many options as you can afford - wheelchair lifts, air conditioning (certainly in our area), arm rests along the aisles, and even mid-rise seat backs so that seat backs don't block residents' view. An independent living complex nearby recently purchased a van without any handicapped accommodations and that really surprised me. I don't think that's a good idea these days."

Charles Beatty, Administrator, Friendship Home, Audubon, IA: "We purchased a 12-passenger, two-wheelchair with lift vehicle a year or so ago to give the more ambulatory residents of our 150-bed facility a chance to get out of the facility now and then. We had no service previously other than public transportation, and that had resulted in residents' spending long periods of time at doctors' offices waiting to be picked up. That has been resolved, and now we also get out at least once a week for various outings, including shopping, picnics and taking our facility choir to church services on Sunday. I don't think of this in terms of cost-effectiveness; it's an important service that we provide. We did have a community fund-raising for the bus that lasted about 16 months.

"The only problem we've had was the issue of drivers needing a commercial driver's license (CDL). Though we have only 12 seats, the department of transportation counted our back seat and space for wheelchairs as five seats, bringing our total up to 17, which is one over the limit for a CDL. We had a lot of back-and-forth with government agencies over this, but we now have three on our staff who have CDLs, including myself. I've driven on a few occasions - it 'goes with the territory.'"

Grants for Nonprofits

Not-for-profit facilities planning to purchase vehicles for use by the elderly and disabled should contact the department of transportation in their states regarding their eligibility for a Federal Transit Administration Section 5310 grant. The Federal grant covers up to 80% of the cost of the vehicle purchase. Funds are available each Federal fiscal year.