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Innovative transportation program serves more residents and clients than before- more cost-effectively

Two years ago, Senior Independence (a home- and communitybased service organization) and Lianfair Retirement Community (a CCRC), two entities of Ohio Presbyterian Retirement Services (OPRS) that share a campus in the Cincinnati area, had two separate transportation programs. Each had its own vehicles to maintain, and each employed its own staff of drivers. That changed in July 2000 when, in response to the ever-growing need for transportation services, Senior Independence and Lianfair joined forces to create one transportation program with which to serve all their residents and clients.

Purchasing vehicles, hiring drivers and keeping up with the high costs of maintenance and gasoline are daunting challenges for today's long-term care facilities, but transportation is one of the essential services they provide. According to Joan Punch-Fleming, RN, BSN, who is the director of community services for Senior Independence-Cincinnati, which administers the combined program, "Transportation is always a hot issue. More and more people are dependent on transportation services as they age in place. By combining our programs into one, we eliminated some duplication of efforts and improved our staffing efficiency. We also now have one director of transportation instead of two, which enables us to be better stewards of the dollars our residents and clients pay for our services."

Besides providing transportation for Lianfair's residents, skilled nursing, assisted and independent living residents on the campus, and Senior Independence clients, the combined program also serves residents of other long-term care facilities that are not part of OPRS, as well as clients from the Cincinnati (Hamilton County) area. In addition, Senior Independence-Cincinnati is a transportation provider for the Hamilton County Elderly Services Program (ESP), which is supported with local tax levy funds, and is a PASSPORT (an Ohio Medicaid waivers program) transport provider serving communitybased clients. The program also provides back-up transportation services to a local senior center. This last year, the program has served 370 clients in all.

For residents and clients of the campus, transportation to medical appointments, activities, shopping and church services are provided at no extra charge; they can also request special transportation (e.g., a ride to the airport or a hair appointment) for a small charge, based on zone-to-zone (ZIP code-to-ZIP code) distance. These charges are adjusted annually to make sure they cover actual costs of maintenance, salary and gasoline; it is not a moneymaking service, but an extension of OPRS's mission in the community.

Payment for community-based seniors comes from state and county sources, such as PASSPORT and Hamilton County ESP. For these, the program has to submit bids to the local area or agency, with cost justification for salaries, overhead, gasoline and maintenance. The charge to these clients is, again, based on zone-to-zone mileage, plus a dispatch fee.

Serving this broad base of elderly and disabled populations has enabled Senior Independence/Llanfair to take advantage of an Ohio Department of Transportation grant, which will pay 80% of the cost of purchasing an additional vehicle in 2002. Currently, the transportation program operates with four vehicles: a Mercury Sable, used for simple transports; a Dodge Caravan equipped with a wheelchair-lift (seats 3); a lift-equipped paratransit bus that seats up to 15; and a 30-passenger bus for transporting residents to activities. The program has a staff of two full-time and three "as-needed" drivers.

The Mercury Sable came to the organization as a result of the OPRS Foundation's "Cars for Caring," an in-kind contribution program through which people can make tax-deductible donations of vehicles. OPRS can either sell them to raise money or, if the vehicles are usable or repairable, put them into service.

When asked if scheduling transportation for multiple facilities and populations has been problematic, Punch-Fleming says, "We have one scheduler, our program coordinator Sharon Jones, who works 30 hours per week. She handles calls from Llanfair residents and

Senior Independence clients who are requesting transportation. She does a good job of being flexible, which is important since scheduling needs to be very fluid and very accommodating. For example, when someone calls for a ride to a physician's office during a time when no one is available to pick him or her up, she will look for open slots on the schedule and then call the physician's office to see if the appointment can be changed to coordinate with transportation availability.

"Another thing that makes scheduling work is communication: Ms. Jones stays in contact with the drivers via cellular phones. This is especially helpful for medical appointments, since we never know for sure when someone will be ready for pick-up after an appointment, and we don't like to keep them waiting any longer than necessary.

The first year of the combined transportation program has been successful, according to Punch-Fleming. She says, "Our goal is to provide services to as many elderly in need as possible-from those receiving home care and skilled nursing, to those residing in independent living and assisted living, to those in adult day care programs, to those living in the community."

To ensure that the program remains successful, Senior Independence and Llanfair regularly conduct resident/client surveys. They ask clients to rate their satisfaction with such things as scheduling, drivers and timing. According to Punch-Fleming, the responses have been quite positive. "This helps us to stay on top of any issues that might arise," she explains. "It also enables us to be aware of our clients' needs and gives us a good indicator of changes in those needs. We also seek their input through resident forum meetings."

The philosophy of this transportation program is simple, Punch-Fleming says: "We work hard to be a member of the community, and be supportive. We are committed to bringing the mission of Senior Independence to as many seniors as possible, which is 'to provide older adults with caring and quality services toward the enhancement of physical, mental and spiritual well-being, consistent with the Christian Gospel."' NH

Joan Punch-Fleming, RN, BSN, is director of community services for Senior Independence-Cincinnati, a home- and community-based service organization of Ohio Presbyterian Retirement Services.