Wheels of fortune: Long term care facilities help fill senior transportation gap.

Long term care facilities help fill senior transportation gap

Anyone who has been stuck for a ride knows the frustration of not being able to get where you need to go. Many older and disabled people feel that way much of the time.

Being unable to get to a doctor appointment, the grocery store, church, or a friend diminishes independence and quality of life. To address the need, some providers have begun providing transportation services to people outside their facilities.

Mission-oriented not-for-profits are leading the way. A report from the American Association of Homes and Services for the Aging profiling providers offering home and community-based services found that about half provide some type of transportation.

But they're not doing it purely out of the goodness of their hearts. Offering transportation services, says Edgar Rivas, director of home and community-based services for AAHSA, is a way for providers to diversify services, increase marketability, enhance revenue stream, and improve social accountability.

Scott Burpee, CEO for valley Vista Care Services in St. Maries, Idaho, a not-for-profit CCRC that will net more than $16,000 this year from its community transportation services, believes that many providers are missing an opportunity. "The ability to do [transportation] is there," says Burpee. "If ALFs would schedule their vehicles better, they could be serving other people in the community and making money, instead of having their vehicles sitting around waiting for one person."

Besides that, it's excellent marketing. "The intangible PR piece of it is hard to quantify for people," Burpee notes.

Don't expect to make a killing, cautions Burpee. Because transportation is a high-cost item, it's hard to realize large profit margins. "There are lots of expenses that go with this business," he says.

But the potential is definitely there. As the aging population continues to grow, so will the need for senior transportation. What's more, the fastest-growing segment of the aging population--those age 85 and older--are also those least likely to drive, according to Scott Bogren, communications director for the Community Transportation Association of America in Washington, D.C.

Also, in many parts of the country, particularly suburbs and rural areas, driving is a necessity. About 38 percent of rural residents live without any public transit service and 28 percent live in areas where the service level is negligible, according to the U.S. Administration on Aging. Almost three quarters of people over age 65 live in suburban or rural areas of the country, the AOA reports. And rural areas have a high concentration of seniors 85 and older.

Yet the frail or disabled don't have to live in remote areas to feel the isolation and dependence that a lack of transportation can inflict. "A bus stop across the street can seem like miles and miles away to some older people," says Christie Case, who coordinates services for St. Mary's Court Housing Development Corporation, a 150-resident independent living facility in downtown Washington, D.C.

While the facility doesn't charge extra for its transportation services, it's a value-added service its residents appreciate. "It's definitely something applicants ask about," says Case.

With no van of its own--St. Mary's is a HUD Section 8 facility with limited funds--the facility relies on the city's metro and taxi systems, as well as on some local senior service organizations, to help coordinate, subsidize, and provide rides to its residents. For residents needing financial assistance, St. Mary's established a fund with a private donation to supplement transportation subsidies.

No one recognizes the importance of transportation to older persons more than the people who work at community service agencies. "When you're actively providing a number of services in the community, you recognize that a great need among elders is transportation," says Elaine Taggart, administrator of Rockynol Community Services in Akron, Ohio.

Rockynol provides transportation services, including specialized door-to-door service, to the elderly and handicapped. With five vehicles ranging in size from a station wagon to a 23-passenger bus, 3 full-time drivers, and couple of on-call drivers, Rockynol serves hundreds of county residents each month, helping them get to doctor's offices, grocery stores, the airport, or social outings. If they need assistance when they arrive at their destination--for instance, buying groceries or clothes--a home health aide might accompany them.

Members of the community who use the service, which operates on a first-come, first-served basis, pay $1.50 per mile. Drivers receive special training in working with people who are confused, visually impaired, and handicapped. They are also trained in emergency care and hospitality.

A division of Ohio Presbyterian Retirement Services, a continuing care retirement community, Rockynol also provides transportation services to assisted living and skilled nursing facilities in the area that don't offer such services, either because they are too small or because not enough of their residents expressed an interest in getting out and about.

The challenges in developing a transportation program, says Taggart, are three-fold: "developing a system that allows successful scheduling, dedicating adequate man hours to the program, and getting insurance coverage."

According to Taggart, "you have to dedicate part of your staff to the program. You need someone to take transportation requests, set up a schedule, make sure rides are billed correctly. You also need a system to deal with the vehicles and drivers--training, drug screening, routine vehicle maintenance, methods of communicating with drivers. You become something of a mini-transportation system."

Before getting started, you need to check out local transportation requirements (such as commercial drivers' licenses), identify potential funding sources, and have a well-planned system ready to go.

On the insurance issue, AAHSA's Rivas suggests exploring pooled insurance options. He also says to check out whether your state has a Good Samaritan law. Such laws, which shield from liability those who come to the aid of people in distress, have been extended to volunteer drivers.

Be a good neighbor

Rockynol offers transportation services as part of its mission, but it's also good PR, says Taggart. It "makes us a good neighbor in many ways. It fills a niche in our community for those who choose to live in their own homes but need some support."

For Breckenridge Village Community Services in Willoughby, Ohio, a suburb of Cleveland, providing transportation services to nonresidents brings in additional income and increases public exposure, says Ken Weidig, transportation coordinator. And coordinating its transportation efforts with other agencies qualifies Breckinridge to obtain transportation grant funding.

Florida also requires its community transportation providers to coordinate services to avoid duplication and maximize limited resources. Specifically, the state's Commission for the Transportation Disadvantaged is charged with ensuring that transportation programs operating with the help of state, federal, or local government funds--such as the Older Americans Act, federal transportation dollars, Medicaid, mental health and mental retardation funds, and county coffers and grants--are coordinated.

Neighboring Georgia recently began coordinating transportation services among social services agencies as well. "It takes a lot of money to operate and maintain vehicles," says Maureen Kelly, special projects coordinator for the aging division of the Atlanta Regional Commission. "Hopefully a coordinated system will improve that."

Breckenridge, which provides independent assisted, and skilled nursing to 600 residents, has a fleet of 6 vehicles, including 10-passenger, 12-passenger and 18-passenger vehicles, all equipped with lifts, wheelchair security, and other requirements specified in the Americans With Disabilities Act. It also has a 25-passenger bus, which is not equipped with a lift, All vehicles are equipped with cell phones. Breckenridge uses the vehicles to transport residents, for whom the services are included in their monthly rent, and non-residents, who pay 50 cents a mile, which includes assistance at their destinations, if needed.

Before calling Breckenridge for a ride, users must fill out an application that has to be co-signed by a family member. Although there are no restrictions on where passengers are transported, Breckenridge tries to limit destinations to within a half-hour drive each way.

Breckenridge also has contracts to provide transportation for an hourly rate to three small assisted living facilities. This generates income during times when their vehicles would be idle. Last year, this business generated between $10,000 and $12,000, half of which was profit. What's more, with seven ALFs under construction or development in the area, Weidig sees a growing need for his services.

Although Breckenridge doesn't advertise its transportation services, local agencies on aging list it as a transportation provider and its vehicles are marked with the facility's address and telephone number.

Offering community transportation is not cheap, Weidig cautions. Maintaining and fueling vehicles is costly, as are drivers' salaries, particularly when you have to compete with school systems and the like. Wages and benefits accounts for three-quarters of the program's $175,000 annual operating costs.

Revenue from passengers covers the labor costs, and a federal grant awarded through the local transit authority provides another $80,000. But the transportation service is currently losing money, which Weidig attributes to wage increases and a spike in the price of fuel. But he says it has made money in the past and is confident it will do so in the future, especially as the contract business picks up.

Anyway, says Weidig, it's a good marketing tool. By offering transportation to non-residents, he says, "we were able to avoid having to make our residents pay more money for expanded transportation. The cost would become prohibitive and they wouldn't want to live here."

Overcoming feelings of dependence

Not having easy access to transportation not only thwarts independence but raises psychological issues for some seniors. "It's very difficult, as you age, to become dependent," says Tern Barton, executive director of the community services division for the Cathedral Foundation of Jacksonville (Florida). "Many older people look at arranged transportation as a dependency kind of thing. People want transportation freedom."

One of the biggest complaints users have, says Barton, is having to arrange their schedules to fit someone else's. With their children and grandchildren working longer hours and living further away, it's never been more difficult for seniors who can no longer drive or who cannot afford a car to line up rides. Yet, with taxi cabs cost-prohibitive and public transportation unavailable in many areas, older people often remain dependent on busy or distant family members, or on church groups with limited resources.

To make transportation more convenient, the Cathedral Foundation contracts with Intellitran Comsis Mobility Services Inc., a for-profit transportation management company, to give Jacksonville residents age 60 and older rides to medical appointments. Eligible seniors pay $2 for a round-trip van ride. Cathedral collects all ride requests and forwards them to Intellitran for scheduling.

With up to 90 vehicles on the road each day, all equipped to accommodate people with disabilities, Intellitran provides about 2,600 trips daily, not just for Cathedral but for other community programs, including all state agency programs and organizations for the blind and for multiple sclerosis and cerebral palsy. Drivers are required to have commercial driver's licenses and passenger endorsements on their licenses. They also undergo criminal background checks, drug testing, and physical examinations. Once they clear those hurdles, they get on-the-road training and sensitivity training in how to work with special-needs groups.

The growing transportation needs of seniors and the disabled are more than small agencies can handle. As a provider, you can help--and help yourself in the process.

Anne Wright is a freelance writer based in Falls Church, Virginia.