Reducing Social Isolation Among Older Adults
Case Study

Community & Public Partnership:
Trip Subsidy Program in San Francisco Helps Older Adults
and People with Disabilities Maintain Health andConnections

6/30/22

Community Living Campaign
Submitted to National Center for Mobility Management

1663 Mission Street, Suite 525
San Francisco, CA 94013
www.sfcommunityliving.org
415-821-1003
info@sfcommunityliving.org

Community & Public Partnership:
Trip Subsidy Program in San Francisco Helps Older Adults
and People with Disabilities Maintain Health andConnections
The ETC program permitted me to get medical care. [CLC staff] explained much tome & repeatedly if I misunderstood or forget. The CLC is remarkably patient &consistent with info. The paratransit program helps me access healthcare,essential shopping & I had no idea how I was going to do it. I like how SF
ParaTransit & CLC work together and enables me to do better self-care.
– Program participant
The Essential Trip Card has enabled me to go places such as physical therapy anddoctor's appointments. It has saved me time and has made it very convenient to
get around. Also, it has decreased my stress level in HUGE ways. Since I was laid
off I am now dependent on unemployment benefits for food, clothing, rent,
medical expenses, etc. There is not much left over in my budget for things liketaxis. CLC’s help makes a huge difference in my life.
– Program participant

Summary
In 2020, Community Living Campaign, a San Francisco nonprofit, launched a first-of-itskind partnership with the San Francisco Municipal Transportation Agency (SFMTA) to
fully subsidize taxi rides for seniors and adults with disabilities. By paying the rider
contribution of a new low-cost taxi program offered by the SFMTA, Community Living
Campaign has been able to leverage the SFMTA’s contribution to deliver FREE taxi rides
to seniors and people with disabilities, who are often on a fixed income. CLC’s
Transportation Subsidy Program has grown to include subsidies for Paratransit taxi andvan users. Since the program began, CLC has awarded almost 900 subsidies to 165
residents, giving them free rides to medical appointments, grocery stores, and othervital services.
Most participants reported that CLC’s Transportation Program has helped them
maintain or increase their physical and mental health, made them more independent,
and has allowed them more opportunities for social connection.

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Community Living Campaign
Since 2007, Community Living Campaign (“CLC”) has been working with San Francisco
seniors and adults with disabilities to increase the connections, resources, and support
they need to age and thrive in their own homes and neighborhoods. In 2021, CLC staff
and 120 volunteers brought practical support and connections to 2,300 neighbors.
CLC’s Community Connector Network program supports neighbors in coordinating local
activities for seniors and people with disabilities, from exercise classes and walking
groups to volunteer projects. Whatever the activity, neighbors get to know each other –often for the first time despite years of living close by – allowing them to build thefriendships and support they need to age in their community. CLC’s Food Delivery
Networks bring groceries and human connection to seniors and people with disabilities
who can’t get to food pantries on their own. This program coordinates neighbors to call,stop by with groceries, and check in. Other CLC programs include the Neighborhood
Tech Connect program, the SF ReServe jobs program, and the Transportation Program.
Creating connections and reducing social isolation is at the heart of CLC’s work. Eightyfour percent (84%) of participants in CLC’s Community Connector Networks report theyknow one or more neighbors to ask for help. Ninety-three percent (93%) of participantsin the Food Delivery Networks report feeling less isolated since being in the program.

CLC’s Transportation Program
Access to reliable and affordable transportation is a critical component of promoting
wellness and reducing isolation. According to AARP, nearly 90% of older adults choose
to age in place. To thrive in their homes and communities, older adults and people withdisabilities need the ability to access jobs, medical care and other services, as well as
find opportunities for social interaction.
Transportation can be a challenge for all San Franciscans, but older adults and adults
with disabilities face increased barriers to travel. Taking transit can be difficult, due to alack of seating at bus stops, steep hills between bus stops and destinations, onerous
transfers, and inaccessible transit stations and stops. In addition, rising transportation
costs can seriously strain the budget of those on a fixed income.
Knowing that transportation was a major challenge for participants in its Community
Connector Networks and Food Delivery Program, CLC launched a formal Transportation
Program in the spring of 2020. The program has two overarching goals: 1) Connect
residents to free and low-cost transportation options, and 2) Teach residents how to
advocate for the transportation services they need. This case study focuses on the firstprogram goal.
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Connecting Residents to Free and Low-Cost
Transportation
CLC’s Transportation staff conducts regular outreach
within CLC’s Networks, both virtually and in person. Staff
share information about free and low-costtransportation options in San Francisco, including the
Senior Clipper Card, Free Muni for Seniors and People
with Disabilities, and San Francisco Paratransit services.

The Essential Trip Card: A New Low-Cost Taxi
ProgramWhen the COVID pandemic began in the spring of 2020,
the San Francisco Municipal Transportation Agency
CLC Transportation Program staff sharing(SFMTA), the city’s transit and Paratransit provider,
information about the Essential Trip Cardat an outreach event
suspended the majority of their transit service. To help
fill the gaps for seniors aged 65 and older and people
with disabilities, the agency created a new low-cost taxi program called the Essential
Trip Card, which was fashioned after their existing Paratransit taxi program. Riders pay
only 20% of the fare, through the use of a debit card. Riders can put up to $12 on thecard a month, which the City adds $48 to, for a total of $60 of taxi credit each month.
Riders can use any taxi company in San Francisco, since the SFMTA regulates the taxi
industry. Riders do not have to contribute each month, and any balance remaining on
their card at the end of each month rolls over into the next month. For more
information about the Essential Trip Card program, visit http://www.sfmta.com/etc.
This low-cost program was not only vital to helping seniors and people with disabilities
on fixed incomes access medical services and get food when transit was limited, but it
allowed these populations to use a transportation option that limited their exposure toothers during a pandemic. The residents we serve shared:[The Essential Trip Card] allows me to not be exposed and around too many
people. It's comforting to be in a cab. The plastic barrier helps you not worry. It
helps with piece [sic] of mind that I won't be exposed.
The ETC program has been extremely helpful in allowing me to move around more
freely and confidently during the pandemic in the past two years in SF and feelsafe and less stressed out overall in doing so.
Since the Essential Trip Card program launched, CLC has focused most of its outreach on
informing participants about the program and helping them sign up.
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Launch of CLC’s Transportation Subsidy Program: Leveraging an Existing
City Program
Many residents in CLC’s Community Connector and Food Networks live on fixed incomesand might not be able to afford the $12 monthly rider contribution for the Essential Trip
Card. To help these residents access this new transportation option, CLC launched afirst-of-its-kind partnership with the SFMTA in the fall of 2020 to fully subsidize Essential
Trip Card taxi rides for CLC participants.
By paying the $12 rider contribution, CLC has been able to leverage the City’scontribution ($48), allowing the organization to deliver free taxi rides to participants in
the Community Connector and Food Network Programs. CLC later expanded theprogram to include similar subsidies for CLC participants signed up for Paratransit vans
and taxis.

Running the Subsidy Program
To set up the partnership with the SFMTA, CLC signed a basic Memorandum ofUnderstanding with SFMTA’s Paratransit broker, Transdev. Then, CLC set up an accountwith Transdev and regularly sends funding. Several times a week, CLC staff emails
Transdev staff a request to transfer funding from CLC’s account into specific riders’accounts.
CLC offers a monthly subsidy of $12 for Essential Trip Card and Paratransit taxi users.
This gives them $60 of taxi credit. CLC will subsidize riders each month if they regularly
take rides using the program. If a rider’s Essential Trip Card or Paratransit taxi cardbalance gets above $200, CLC pauses its subsidy until the balance drops below $200, tokeep funds free for other riders.
For CLC participants who use the SFMTA’s ADA van service, called SF Access, CLC’s pays
for free SF Access van tickets each month, as needed. Transdev mails these tickets
directly to the rider.
To determine whether the subsidy program participants need additional funding after
the first month, CLC staff contacts participants regularly.

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To find new participants for thetransportation subsidy program, CLC
staff continually conducts outreach inits neighborhood networks. In thesecond year of the subsidy program,
word of the program spread so muchthat many residents proactively
reached out to CLC after hearing about
it from a friend or neighbor. In thisway, outreach conducted by CLC’s
Transportation Program staff has
dramatically increased the reach of
the SFMTA’s Essential Trip Card
program.

CLC staff telling participants of the Inner Sunset Community
Connector Network about the Essential Trip Card and CLC’s subsidy
program.

Program Reach & Recipient
Demographics
CLC began its transportation subsidy program in October 2020 with residents in its
Potrero Hill Community Connector Network. This was a new network in a neighborhoodthat had many steep hills that participants would have to navigate to reach ouractivities. In early 2021, CLC expanded the program to include residents in all its
Connector Networks and Food Network programs. This includes older adults and people
with disabilities in the following San Francisco neighborhoods / communities:
•
•
•
•
•
•
•

Bayview/Hunters Point
CayugaCrocker Amazon
Inner Sunset
Merced Extension Triangle
Midtown Terrace
Miraloma Park

• OMI
• Outer Sunset (through a groupcalled Senior Power)• Park Merced/University Park
• Potrero Hill
• Saint Francis Square• Sunnyside

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Food Networks
Community Connector
Networks
Other Neighborhood
Networks

CLC’s Neighborhood Networks

Between October 2020 and May 2022, CLC awarded 893 taxi and Paratransit subsidies
to 165 residents (most received repeat subsidies). The dollar value of these subsidies torecipients equaled approximately $55,690.
Subsidies Awarded between October 2020 and May 2022
Number of Taxi and Paratransit Subsidies Awarded

893

Number of Residents Awarded Subsidies

165

Dollar Value of Subsidies Awarded$55,690

The majority of subsidy recipients (52%) were between 70 and 79 years old. Fifty-nine
percent (59%) of subsidy recipients reported having a disability.

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Age of Subsidy Recipients
60%
50%
40%
30%
20%
10%
0%

52%

2%

7%

Under 50 50-59

21%

15%

2%

60-69

70-79

80-89

90+

Age

Disability Status(Reported by Recipients)
No
Disability
39%
Disability
59%

Unknown2%

The majority of subsidy recipients used the Essential Trip Card.

SFMTA Trip Program
Used by Subsidy Recipients

Essential
Trip Card
88%

ADA
Paratransit
22%

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Program Impact
Throughout this subsidy program, CLC has sent out
surveys to get feedback from participants. In April of2022, CLC sent out an extensive survey to 99
participants to understand how the transportation
subsidy impacted their health and feelings of social
isolation / connection. Surveys were sent to subsidy
recipients who had received a subsidy within the past
year and had taken at least one trip after they received
the subsidy. CLC offered gift cards to everyone who
filled out the survey by the deadline, resulting in a
return rate of 75% (75 surveys returned out of 99 sent).
Survey results show that CLC’s Transportation Subsidy
Program had a positive influence on participants’finances, physical and mental health, social
connectedness, and their feelings of independence.

CLC Transportation Subsidy recipient
holding her Essential Trip Card

Financial Impact
The $12 monthly rider contribution for San Francisco’s Essential Trip Card program andParatransit taxi program can be burdensome for residents on a fixed income. When
asked how CLC’s financial support impacted their lives, subsidy recipients shared:
Since I was laid off I am now dependent on unemployment benefits for food,clothing, rent, medical expenses, etc. There is not much left over in my budget forthings like taxis. This help makes a huge difference in my life.
I consider [CLC’s support] a wonderful gift. It helps me a great deal, because
otherwise I would probably not be able to use the program.
The financial support provides a stable and trusted amount every month. It's one
less thing to worry about and the payment makes a difference in my finances.
Impact on Physical and Mental Health
According to the US Office of Disease Prevention and Health Promotion, having regularand reliable access to health services can prevent disease and disability and increase life
expectancy and quality of life (https://www.healthypeople.gov/2020/leading-healthindicators/2020-lhi-topics/Access-to-Health-Services).

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According to the survey results, CLC’s transportation subsidy recipients overwhelmingly
used their trips to access health services:• 100% reported that CLC’s transportation program “helps me get to medical
appointments and procedures.”• 58% reported that health care services were their most frequent trip
designation.
Along with regular access to health care, other indicators of health include regularexercise and access to healthy food. CLC’s trip subsidy program helped participants withboth of these health indicators:• 100% reported that CLC’s transportation program helped them “maintain or
increase my physical activity level.”• 97% reported that CLC’s transportation program helped them “get healthy
food.”
Finally, when asked directly whether they believed that CLC’s Transportation Program
benefited their health:• 100% of subsidy recipients reported that the program helped them maintain or
improve their health and their emotional well-being.
Considering that 51% of subsidy recipients reported that they would take fewer trips
without the Essential Trip Card program and CLC’s support, it is likely that their accessto health services, exercise, and healthy food – and potentially their health – would
decline if they were not participating in the program.
Impact on Social Isolation and LonelinessAccording to the National Institute on Aging, older adults are more likely to experiencesocial isolation and loneliness, both of which are associated with negative healthoutcomes, including depression, dementia, and ultimately death(https://www.nia.nih.gov/health/loneliness-and-social-isolation-tips-stayingconnected).
Fifty percent (50%) of survey respondents reported living alone. For many of theseresidents, leaving their house is the main way to get social contact. Thirty-eight percent(38%) of survey respondents lived with just one other person.

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Subsidy recipients reported that participating in CLC’s Transportation Program
substantially increased their opportunities for social contact:• 100% of survey respondents reported that the program “helps me get out of
the house.” As one participant said:
Thank you so much for helping me get the [Essential Trip] card . . . This isreally going to be a boon for my claustrophobic life.
• 91% of survey respondents reported that the program “helps me interact withothers more often.”
CLC’s Transportation Program also helped participants spend time with family andfriends, which is an important component of social connection and well-being.
• 87% of survey respondents stated that the program “helps me see my friends
and family more often.”• Many survey respondents reported that the card enabled them to visit loved
ones who were in facilities:[The program] helped ease the expense of visiting my husband in a nursing
home located across the city from where I live.
Very good program - helped me keep in touch with other friends who were
physically unable to leave residence/care facilities, enabling for me to visit
them easily.
My wife got sick and had to be admitted to the hospital . . . Because of yoursystem, I could visit my wife every day.
CLC Plays a Major Role in Strengthening Connectedness
In addition to the social connection that the Essential Trip Card enables, the personal
contact provided by CLC’s Transportation Program staff contributes greatly to theprogram’s impact on social isolation. Transportation Program staff checks in withsubsidy recipients every one to two months, asking how they’ve been, how thetransportation service is working for them, and providing general social contact. In
addition, staff regularly connects subsidy recipients to other CLC programs, such as our
Neighborhood Tech Connect Program and our virtual and in-person activities.
Furthermore, when residents have questions about services outside of CLC’s scope,
Transportation Program staff refer them to outside resources, such as the Department
of Disability and Aging Services, Legal Assistance to the Elderly, and In-Home Supportive
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Services. All these actions by CLC’s Transportation program staff increase theconnection in subsidy recipients’ lives beyond the impact of a simple financial subsidy.
Program participants reported:
I'm very thankful for the phone calls I receive from [CLC staff].
[CLC staff] has been wonderful for keeping things going! Checks in to see ifanything else is needed.
Staff helped me to reach out to best agencies to find caregiver for my husband.
Impact on Independence
For older adults and people with disabilities, traveling independently can be a challenge.
Transit can be hard to navigate, with limited bus stop seating, limited seating on the bus,
multiple transfers, and inaccessible transit stations and stops. Maintaining a car can bedifficult on a fixed income, and parking and night driving are regular concerns for older
adults. Despite these challenges, maintaining independence is important, since
independence is associated with better health and well-being(https://web.stanford.edu/~hazelm/publications/2010%20Kitayama%20et%20al%20Independence%20and%20interdependence%20pre
dict%20health%20and%20wellbeing ).
Survey results show that CLC’s Transportation Program did help subsidy recipients travel
independently:• 99% of survey respondents stated that since they started participating in CLC’s
program, they were able to get around San Francisco without relying on family,
friends, and neighbors. As one subsidy recipient shared:
The program is very helpful, makes me feel independent because I don't
have to ask for ride from someone in the family.
Another participant summed it up perfectly:This program supports my independence thereby promoting my emotional andphysical health.

Lessons Learned
It cannot be understated how crucial low-cost or free taxi service has been for older
adults and people with disabilities during a public health crisis. Even if transit service had
not been cut in San Francisco during the pandemic, most of the older adults and people
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with disabilities CLC works with would not have felt safe from infection on public transit.
Without this new taxi program and CLC’s subsidy, many of CLC’s subsidy recipientswould have rarely left their homes, leading to increased social isolation and negative
health outcomes.
Pandemic aside, the program has also shown that there was an unmet need fortransportation options for older adults and people with disabilities in San Francisco.
When asked how they would take the trips if they didn’t have the Essential Trip Cardand CLC’s support, 51% of survey respondents said they would have to take fewer
trips. Subsidy recipients repeatedly shared three needs that the Essential Trip Card taxi
program was meeting that other options clearly were not:1. Personal Safety
Many subsidy recipients mentioned being concerned about their public safety
when traveling, especially at night-time, and how the Essential Trip Card gives
them the freedom to go out:
This is a very good program that makes it possible to . . . come home if it's
dark when I leave my friend's house.
I wouldn't go out or drive at night because of feeling unsafe parking onsome neighborhoods. It was/is really freeing to go out at night when I want(because of ETC).
[The program provides] safety during after-hours appointments.
2. Carrying bags / heavy items
Many program participants described how the Essential Trip Card helped themtransport heavy and large loads:[Without the Essential Trip Card] it will be hard for me to get my groceries
in one trip.
[I use the Essential Trip Card] when I have heavy packages.
3. Taking Onerous Trips
Many subsidy recipients talked about scenarios in which public transit would
have been difficult for them to use, and how grateful they were to have theoption of taking a taxi through the Essential Trip Card and CLC’s program. (Manyof CLC’s subsidy recipients would not qualify for ADA Paratransit.) Subsidy
recipients described how the program was helpful when they weren’t feeling
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well, or when travel by transit was burdensome.
If I didn’t have trip cards I will have to take Muni [the bus]-- not a goodalternative if I am sick or in pain.
On days I felt sick, the card was a life saver.
[I use the Essential Trip Card] when visiting family requires 2 transfers.

Conclusion
When CLC began its Transportation Program, the main goal was to give people ways tonavigate hilly neighborhoods so they could attend the organization’s activities. Twoyears later, the program has not only met this initial goal, but it has helped CLC meet its
overarching organizational goals: to reduce social isolation and improve health and wellbeing.
CLC’s partnership with the SFMTA on the Essential Trip Card program and the ADA
Paratransit program has significantly expanded the impact of these City services. The
transportation services themselves allow residents to access health care, social services,food, and visit family and friends, amongst other things. CLC’s subsidy program provides
much-needed financial support, which allows more residents to utilize this important
program. CLC’s staff also conducts extensive outreach for the program, provides regularsocial contact with subsidy recipients, and connects recipients to other resources that
support health and social connection. Working together, CLC and the SFMTA are
significantly contributing to the health, independence, and social connection of older
adults and people with disabilities in San Francisco.
SFMTA’s Essential Trip Card program was created as a temporary program to fill in thegaps of decreased bus service during the pandemic. Due to its popularity, the program isstill active two years later, even as bus service has slowly been restored. The SFMTA has
secured funding for the program through at least June 2023, with plans to continue theprogram as long as funding allows. Community Living Campaign will work to support thepermanent continuation of this vital program and to continue our successful partnershipwith the SFMTA.

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