a

GAO

United States Government Accountability Office

Report to the Chairman, Special 

Committee on Aging, U.S. Senate

August 2004 TRANSPORTATIONDISADVANTAGED 

SENIORS

Efforts to Enhance 

Senior Mobility Could 

Benefit from 

Additional Guidance 

and Information

GAO-04-971
www.gao.gov/cgi-bin/getrpt?GAO-04-971.

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and methodology, click on the link above. 

For more information, contact Katherine 

Siggerud at (202) 512-2834 or 

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Highlights of GAO-04-971, a report to the 

Chairman, Special Committee on Aging, 

U.S. Senate 

August 2004

TRANSPORTATION-DISADVANTAGED 

SENIORS 

Efforts to Enhance Senior Mobility Could 

Benefit from Additional Guidance and 

Information 

Five federal departments—including the Department of Health and Human 

Services (HHS)—administer 15 programs that are key to addressing the 

mobility issues of transportation-disadvantaged seniors. These programs 

help make transportation available, affordable, and accessible to seniors, 

such as by providing transit passes or reimbursement for mileage. 

National data indicate that some types of needs are not being met, including 

those for trips (1) to multiple destinations or for purposes that involve 

carrying packages; (2) to life-enhancing activities, such as cultural events; 

and (3) in rural and suburban areas. However, there are limited data 

available to assess the extent of unmet needs. HHS’s Administration on 

Aging is required by law to provide guidance to states on how to assess 

seniors’ need for services, but officials said the administration has not done 

so because it has focused on providing other types of guidance. As a result, 

the local agencies on aging we interviewed—which are ultimately 

responsible for performing such needs assessments—used inconsistent 

methods to assess seniors’ mobility needs. The Administration on Aging 

plans to conduct an evaluation of one of its major programs and thus has an 

opportunity to improve its understanding of seniors’ needs and provide 

guidance to local agencies on performing needs assessments. 

Local transportation service providers have implemented a variety of 

practices—including increasing service efficiency, improving customer 

service, and leveraging available funds—that enhance mobility and the costeffective delivery of services. Federal programs provide funding and some 

technical assistance for these practices, but several service providers we 

interviewed said that the implementation of such practices was impeded by 

limited federal guidance and information on successful practices. 

Senior mobility experts and stakeholders identified several obstacles to 

addressing transportation-disadvantaged seniors’ mobility needs, potential 

strategies that federal and other government entities can consider taking to 

better meet these needs, and trade-offs associated with those strategies. 

Obstacles, Strategies, and Trade-offs Associated with Meeting TransportationDisadvantaged Seniors’ Mobility Needs, as Identified by Experts and Stakeholders 

Obstacles Strategies Trade-offs 

Seniors are not sufficiently 

encouraged to plan for 

driving alternatives 

Facilitate a gradual transition 

from driver to nondriver 

Can increase demand for 

services and, therefore, 

increase costs 

Government policies do not 

always address seniors’ 

varied needs 

Improve alternatives and 

include seniors in 

transportation-planning 

process 

Can be expensive and timeconsuming 

Funding constraints limit 

local agencies’ ability to 

address needs 

Increase funding and funding 

flexibility and improve 

coordination 

Takes funds away from other 

uses, flexibility can decrease 

accountability, and 

coordination requires 

sustained effort 

Source: GAO. 

The U.S. population is aging, and 

access to transportation, via 

automobile or other modes, is 

critical to helping individuals 

remain independent as they age. 

Various federal programs provide 

funding for transportation services 

for “transportation-disadvantaged” 

seniors—those who cannot drive or 

have limited their driving and who 

have an income constraint, 

disability, or medical condition that 

limits their ability to travel. For 

those transportation-disadvantaged 

seniors, GAO was asked to identify 

(1) federal programs that address 

their mobility issues, (2) the extent 

to which these programs meet their 

mobility needs, (3) program 

practices that enhance their 

mobility and the cost-effectiveness 

of service delivery, and (4) 

obstacles to addressing their 

mobility needs and strategies for 

overcoming those obstacles. 

GAO is recommending that HHS’s 

Administration on Aging take 

several actions to improve 

guidance and information on 

transportation-disadvantaged 

seniors’ mobility, including 

developing guidance on assessing 

mobility needs and publicizing 

available information on alternative 

transportation services and on 

practices service providers can 

implement to enhance senior 

mobility. 

HHS agreed with the findings and 

recommendations in this report. 
Page i GAO-04-971 Transportation-Disadvantaged Seniors

Contents

Letter 1

Results in Brief 4

Background 8

Federal Agencies Address Mobility Issues Mainly through 15 

Programs That Help Make Transportation Available, Accessible, 

and Affordable 12

Data Indicate That Some Types of Mobility Needs Are Not Being Met, 

but Information on the Extent of Unmet Needs Is Limited 20

Transportation Service Providers Implement Practices That 

Enhance Senior Mobility with Some Federal Support, but 

Implementation Difficulties Remain 33

Experts and Stakeholders Suggested Strategies for Overcoming 

Mobility Obstacles 47

Conclusions 61

Recommendations for Executive Action 62

Agency Comments 64

Appendixes

Appendix I: Scope and Methodology 65

Appendix II: Information on Transportation Provided by 16 Area Agencies 

on Aging 74

Appendix III: Local Service Providers and Practices That Can Enhance 

Transportation-Disadvantaged Seniors’ Mobility 77

Appendix IV: Comments from the Department of Health and Human 

Services 82

Appendix V: GAO Contacts and Staff Acknowledgments 88

GAO Contacts 88

Staff Acknowledgments 88

Tables Table 1: Characteristics of 15 Key Federal Programs That Fund 

Transportation for Seniors 13

Table 2: Attributes of Senior-Friendly Transportation Service 

Addressed by the 15 Key Federal Programs That Fund 

Transportation Services for Seniors 18

Table 3: Practices Implemented and Funding Sources Associated 

with Selected Local Transportation Service Providers 40

Table 4: Limitations of Data Sources Used 67
Contents

Page ii GAO-04-971 Transportation-Disadvantaged Seniors

Table 5: Academics, Advocacy Groups, Professional Associations, 

and Federal Agencies GAO Interviewed about Information 

on Seniors’ Mobility Needs 71

Table 6: Academics, Advocacy Groups, and Professional 

Associations GAO Interviewed about Obstacles, 

Strategies, and Trade-offs in Addressing 

Transportation-Disadvantaged Seniors’ Mobility Needs 73

Figures Figure 1: Diagram of the Overlapping Factors Affecting Seniors’ 

Mobility Needs 9

Figure 2: Flow of Transportation Funds from Federal Programs to 

Seniors 16

Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and 

Older 23

Figure 4: Percentage of Respondents Aged 75 and Older Who Have 

Public Transportation Available to Them, by Area 27

Figure 5: First Set of Obstacles, Strategies, and Trade-Offs 

Associated with Meeting Transportation-Disadvantaged 

Seniors’ Mobility Needs, as Identified by Experts and 

Stakeholders 48

Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs 

Associated with Meeting Transportation-Disadvantaged 

Seniors’ Mobility Needs, as Identified by Experts and 

Stakeholders 52

Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs 

Associated with Meeting Transportation-Disadvantaged 

Seniors’ Mobility Needs, as Identified by Experts and 

Stakeholders 55
Contents

Page iii GAO-04-971 Transportation-Disadvantaged Seniors

Abbreviations

AAA area agency on aging

ADA Americans with Disabilities Act of 1990

AOA Administration on Aging

DOT Department of Transportation

GPS Global Positioning Systems

HHS Department of Health and Human Services

ITS Intelligent Transportation Systems

MEOC Mountain Empire Older Citizens

MPO metropolitan planning organization

NHTSA National Highway Traffic Safety Administration

TCRP Transit Cooperative Research Program

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Page 1 GAO-04-971 Transportation-Disadvantaged Seniors

United States Government Accountability Office

Washington, D.C. 20548

A

August 30, 2004 Letr

The Honorable Larry E. Craig

Chairman, Special Committee on Aging

United States Senate

Dear Mr. Chairman:

The U.S. population is aging, and transportation is critical to helping 

individuals stay independent as they age. Access to transportation, whether 

by automobile or some other mode, is considered essential to independent 

living, allowing individuals to gain access to the goods, services, and social 

contacts that support their day-to-day existence and quality of life. Both the 

number of older people and their share of the U.S. population are growing 

rapidly. Although many seniors continue to drive for most of their lives, the 

growing size of the senior population will increase demand for alternative 

transportation services. For example, one study found that more than 

600,000 people aged 70 and older stop driving each year and become 

dependent on others for transportation.1

 The increase in the potential pool 

of seniors needing mobility assistance will challenge federal, state, and 

local government agencies’ ability to provide such assistance.

In 2000, 35 million Americans, or 12.4 percent of the total U.S. population, 

were aged 65 and over, according to the U.S. Bureau of the Census. The 

Census Bureau projects that this group will double to 70 million people by 

2030, representing 20 percent of the total population. A national travel 

survey found that seniors take most of their daily trips (about 90 percent) 

by automobile, either as drivers or passengers. For the remainder, 

approximately 8 percent of trips are by walking, and 2 percent by other 

modes (including public transportation and bicycles).2

 As seniors age, their 

ability to drive, walk, or use public transportation may become limited by 

reduced reaction time; deteriorating night vision; lessening ability to climb, 

reach, or stand; or other physical limitations. To help ensure that

1

Daniel J. Foley, MS, Harley K. Heimovitz, PhD, Jack M. Guralnik, MD, PhD, and Dwight B. 

Brock, PhD, “Driving Life Expectancy of Persons Aged 70 Years and Older in the United 

States,” American Journal of Public Health, vol. 92, no. 8 (2002).

2

U.S. Department of Transportation, Bureau of Transportation Statistics, Federal Highway 

Administration, and National Highway Traffic Safety Administration, 2001 National 

Household Travel Survey. See appendix I for a discussion of data limitations.
Page 2 GAO-04-971 Transportation-Disadvantaged Seniors

transportation-disadvantaged seniors3 have access to health and medical 

care, employment, and other basic services, various federal programs 

provide funds for a range of senior transportation services to state, local, 

and nonprofit agencies that actually provide the services and, in some 

cases, also provide their own funds to support those services.

This report responds to your request for information about the mobility 

needs of transportation-disadvantaged seniors. As agreed with your office, 

we identified (1) federal programs that address mobility issues for 

transportation-disadvantaged seniors, (2) the extent to which federally 

supported programs are meeting the mobility needs of transportationdisadvantaged seniors, (3) program practices that can enhance mobility 

and the cost-effective delivery of transportation services to 

transportation-disadvantaged seniors and the extent to which federal 

programs support the implementation of such practices, and (4) obstacles 

to addressing transportation-disadvantaged seniors’ mobility needs and 

potential strategies for overcoming those obstacles.

To identify federal programs that address mobility issues for 

transportation-disadvantaged seniors, we interviewed federal program 

officials and senior mobility experts and reviewed pertinent GAO reports. 

To assess the extent to which transportation-disadvantaged seniors’ 

mobility needs are being met, we analyzed data collected by federal 

agencies and local agencies on aging; reviewed studies conducted by 

research organizations; and obtained the perspectives of experts in the 

fields of aging, disability, and transportation. We also conducted 

semistructured interviews with officials from a nonprobability sample of 16

3

We define transportation-disadvantaged seniors as those who cannot drive or have limited 

their driving and who have an income constraint, disability, or medical condition that limits 

their ability to travel. Because federal, state, and local programs have different age ranges 

for seniors (e.g., aged 55 and over, aged 65 and over), we do not use the term “senior” in this 

report to mean any specific age.
Page 3 GAO-04-971 Transportation-Disadvantaged Seniors

area agencies on aging (AAA)4 from urban, suburban, and rural areas in six 

states,5 selected to represent different regions of the country. To identify 

program practices that can enhance mobility and the cost-effective delivery 

of transportation services, we reviewed the literature on such practices and 

conducted semistructured interviews with officials from 10 local 

transportation providers highlighted in the literature to determine the 

extent to which federal programs support practices that enhance senior 

mobility. These 10 providers were chosen to include a diversity of 

geographic areas (i.e., they were from different regions of the country and 

from both urban and nonurban areas), types of practices, and federal 

funding sources. To identify obstacles to addressing 

transportation-disadvantaged seniors’ mobility needs and strategies for 

overcoming those obstacles, we reviewed the relevant literature and 

interviewed the AAA officials and transportation service providers 

previously mentioned. We also interviewed 14 senior mobility experts and 

representatives of pertinent professional associations and advocacy 

groups. To ensure the reliability of data used in this report, we reviewed 

and identified limitations associated with national statistical research 

methodologies and documented the quality assurance procedures that 

AAAs use to ensure the reliability of the data they collect. We concluded 

that the data were sufficiently reliable for our purposes, although we 

identified several limitations that we discuss throughout the report. We 

also corroborated much of the testimonial information provided by AAAs, 

local service providers, experts, professional associations, and advocacy 

groups by comparing it with the literature and with other interviews. We 

sent draft copies of this report to the five pertinent federal agencies—the 

Departments of Education, Health and Human Services (HHS), Labor, 

Transportation (DOT), and Veterans Affairs—for their review and 

comment. We conducted our work from November 2003 through August 

4

AAAs were established, following a 1973 amendment of the Older Americans Act of 1965, to 

respond to the needs of seniors in local communities. There are 655 of these agencies 

nationwide that use various federal, state, and local funds to provide and oversee the 

delivery of supportive home and community-based services to older persons and their 

caregivers. These services include congregate and home delivered meals, senior center 

activities, legal assistance, family caregiver services, disease prevention and health 

promotion activities, transportation and outreach to enable seniors to access other services, 

and other services at the local level. AAAs plan, coordinate, and offer services that help 

seniors remain in their homes and also act as advocates for improved services for seniors 

and their families.

5

This included one semistructured interview with officials from the state unit on aging in 

South Dakota, which has no AAAs. For the sake of simplicity, we refer to that state agency 

as 1 of the 16 AAAs in this report.
Page 4 GAO-04-971 Transportation-Disadvantaged Seniors

2004 in accordance with generally accepted government auditing 

standards. Appendix I contains more information about our scope and 

methodology.

Results in Brief Working with experts on aging and federal agency officials, we identified 15 

key federal programs that address mobility issues for 

transportation-disadvantaged seniors. These programs, which are 

administered by five federal departments, distribute funds through state 

agencies or make them available directly to local service providers. For 

example, some programs—such as DOT’s Capital Assistance Program for 

Elderly Persons and Persons with Disabilities (Section 5310)—allot funds 

by formula to state agencies, which then distribute the funds to local 

nonprofit organizations to purchase vehicles, while other programs—such 

as HHS’s Rural Health Care Services Outreach Program—bypass state 

agencies altogether and go directly to local service providers. The 15 

federal programs help make transportation services senior-friendly, mainly 

by making them more available, accessible, and affordable (e.g., by 

providing rides to seniors at reduced fares). In addition to administering 

the 15 programs, federal agencies also address 

transportation-disadvantaged seniors’ mobility less directly. For example, 

the Department of Justice has published rules governing the design of 

transportation facilities, such as bus stops, to make them accessible to 

people with disabilities. Seniors with disabilities can benefit from the 

implementation of such designs.

Data on the nature of transportation-disadvantaged seniors’ mobility needs 

indicate that federally supported programs are not meeting certain types of 

needs, but there is little data on the extent of unmet needs. Needs that are 

less likely to be met include (1) transportation to multiple destinations or 

for purposes that involve carrying packages, such as shopping, for which 

the automobile is better suited than other alternatives; (2) life-enhancing 

trips, such as visits to spouses in nursing homes or cultural events; and (3) 

trips in nonurban areas, especially for seniors in rural communities, where 

alternatives to the automobile are less likely to be available and special 

transportation services are limited. However, federal programs generally 

do not collect data on the extent to which seniors’ mobility needs are being 

met because there are few federal requirements to assess such needs. 

HHS’s Administration on Aging is required by law to provide guidance to 

states on how to assess seniors’ unmet needs, which could include 

transportation, but officials told us that the administration has not done so 

because state and local agencies on aging have indicated a greater desire 
Page 5 GAO-04-971 Transportation-Disadvantaged Seniors

for guidance on other aspects of providing services for seniors. However, 

without guidance on assessing unmet needs, local aging agencies have used 

a variety of methods to collect data, many of which produce information on 

the nature of needs rather than on the extent to which needs are being met. 

Officials from the Administration on Aging said that they are developing an 

evaluation plan to examine, among other things, (1) the extent to which 

one of the administration’s major senior programs6

 is meeting the needs 

and preferences of seniors for supportive services—including 

transportation—and (2) how needs assessments are performed by state 

and local entities. 

According to literature on senior mobility and our own work, 

transportation service providers have implemented a variety of practices 

that enhance transportation-disadvantaged seniors’ mobility and the 

cost-effective delivery of these services; however, the providers we 

interviewed indicated that implementation of such practices was 

sometimes impeded by multiple reporting requirements and limited federal 

guidance. We grouped these practices into three categories: (1) increasing 

service efficiency, (2) improving customer service, and (3) leveraging 

available funds. For example, one service provider we interviewed plans to 

improve service efficiency by using Global Positioning System technology 

to track its vehicles and automatically schedule trips, allowing seniors to 

obtain same-day service rather than having to reserve rides 48 hours in 

advance. Another provider addresses customer service by putting its 

drivers through a sensitivity training program that helps drivers understand 

seniors’ mobility challenges. Several other providers have entered into 

contracts with public and private entities to leverage available funds and 

generate additional revenue for senior transportation services. According 

to these providers, their practices have resulted in more senior-friendly 

transportation and more cost-effective service delivery. Our review also 

showed that the 10 local service providers we interviewed were using funds 

from some of the key federal programs we identified (e.g., DOT’s Capital 

Assistance Program for Elderly Persons and Persons with Disabilities 

(Section 5310) and HHS’s Medicaid Program) to deliver transportation 

services to seniors, and that the federal program funding supported the 

implementation of such practices to some extent. For example, some 

providers said that they received technical assistance while implementing 

such practices, either directly from federal agencies or indirectly through 

federally supported professional organizations. However, many of the 

6

Grants for Supportive Services and Senior Centers (Title III-B).
Page 6 GAO-04-971 Transportation-Disadvantaged Seniors

providers we interviewed said that certain characteristics of federal 

programs, such as what the providers view as burdensome reporting 

requirements and limited program guidance, can impede the 

implementation of practices that enhance senior mobility. For example, 

one provider told us that it had not received technical guidance from one of 

the DOT programs indicating how the funding process works and that, as a 

result, it had to seek such assistance from other local organizations.

Experts, advocacy groups, professional organizations, local officials, and 

transportation service providers have identified a number of obstacles to 

addressing transportation-disadvantaged seniors’ mobility needs. They also 

have identified potential strategies that the federal government, and other 

government levels, as appropriate, can take to better address 

transportation-disadvantaged seniors’ mobility needs and enhance the 

cost-effectiveness of the services delivered. These obstacles and strategies 

are centered around three major themes, as follows:

• Planning for alternatives to driving as seniors age. Several experts 

have reported that the federal government and other government levels 

do not do enough to encourage seniors and their caregivers to identify 

and use multiple transportation modes for their routine trips. As a 

consequence, seniors may perceive that driving is their only option and 

may become isolated or drive even when it is unsafe for them to do so. 

Experts and other stakeholders have suggested that helping seniors plan 

for alternatives to driving—such as by providing information about the 

transportation services available in their community—would extend the 

lifespan of their mobility, and that the federal government could provide 

a central forum for state and local agencies to provide such information.

• Accommodating seniors’ varied mobility needs. The growing senior 

population could benefit from policies that accommodate its varied 

needs, including differing physical limitations and diverse trip purposes 

(such as for work, volunteer activities, medical appointments, and 

recreation), and address the particular challenges that transportationdisadvantaged seniors face in nonurban areas. For example, according 

to senior mobility experts and others, some federally funded programs 

are intended for seniors who do not drive and need assistance all the 

time; yet some seniors need transportation assistance only under certain 

circumstances, such as in bad weather or when a medical condition 

worsens. As a result, these seniors do not qualify for these federally 

funded transportation services. Experts and other stakeholders have 

suggested that the federal government require or encourage state and 
Page 7 GAO-04-971 Transportation-Disadvantaged Seniors

local agencies to focus on seniors’ immediate and future mobility needs 

by including seniors in the transportation-planning process. For 

example, seniors could advocate for safe walking routes to transit stops 

and for the use of low-floor buses (which are accessible to both 

wheelchair users and people with other mobility impairments).

• Addressing federal and other governmental funding constraints.

Experts and other stakeholders suggested that although public funding 

resources are limited, strategies exist to leverage them, including 

increasing funding flexibility among programs and improving the 

coordination of transportation services at all levels of government. For 

example, federal programs tend to specify that funds from an individual 

program can be used only to provide transportation to and from that 

program’s services. Additional funding flexibility and coordination 

among programs could expand seniors’ access to transportation 

services.

Seniors benefit when the obstacles to their mobility are addressed, but 

trade-offs also result from implementing the identified strategies. For 

instance, according to experts and local aging officials, helping seniors plan 

for alternatives to driving could enable more seniors to maintain mobility 

while refraining from unsafe driving, but increased demand for services 

would likely stress already stretched transportation programs. Offering 

additional transportation services or modifying existing public transit also 

could help seniors meet their varied needs, but such efforts can be 

expensive, and additional funds would have to come from new revenues or 

other programs.

Given the expected growth in the senior population, it will be important for 

seniors and those who support them to have as much information as 

possible to plan for the future. Accordingly, our report contains four 

recommendations to the Secretary of Health and Human Services to 

improve the guidance and information available to seniors about 

transportation options and to local agencies about assessments of the need 

for senior transportation services and successful practices for addressing 

this need. In commenting on a draft of this report, the Departments of 

Health and Human Services, Transportation, and Veterans Affairs 

concurred with the findings, and the Department of Health and Human 

Services concurred with the recommendations. The Department of 

Transportation also provided technical clarifications, which were 

incorporated as appropriate to ensure accuracy. The Departments of 
Page 8 GAO-04-971 Transportation-Disadvantaged Seniors

Education and Labor said that they did not have any comments on the 

draft.

Background Seniors are a heterogeneous group—many do not require assistance with 

transportation, and, in fact, most drive automobiles. However, according to 

data from the 2001 National Household Travel Survey conducted by DOT’s 

Bureau of Transportation Statistics, Federal Highway Administration, and 

National Highway Traffic Safety Administration, approximately 21 percent 

(6.8 million) of seniors aged 65 and older do not drive. The percentages are 

higher among minority populations aged 65 and older: approximately 42 to 

45 percent of African-Americans and Asian-Americans do not drive, 

compared with 16 percent of Caucasians. Approximately 40 percent of 

Hispanics also do not drive.7

 A person’s driving status is correlated with 

travel behavior. For example, one study found that drivers aged 75 and 

older made an average of six trips per week, compared with two trips per 

week for nondrivers.8

 While some of this difference may be due to 

individual preferences or to other circumstances, such as an illness that 

prevents travel, some of the difference may be due to a lack of 

transportation alternatives.

Those seniors with poor health or a disability, or who have a limited 

income, may face more difficulty finding and accessing transportation. 

According to data from the 2000 Census, about 37 percent of persons aged 

65 and older reported having at least one disability, and about 10 percent 

were below the federal poverty line. Although not all of these seniors need 

assistance with transportation, a sizable number are likely to need such 

assistance. According to senior transportation experts, the “oldest of the 

old” (those aged 85 and older) are especially likely to be dependent on 

others for rides, particularly if they are also in poor health. Figure 1 shows 

some of the factors that affect seniors’ transportation needs. The more of 

these factors that seniors have, such as a network of family and friends 

who can drive them and an available public transportation system, the 

more likely it is that their mobility needs will be met.

7

Surface Transportation Policy Project, Aging Americans: Stranded Without Options

(Washington, D.C.: April 2004). This study uses data from the National Household Travel 

Survey, the limitations of which are discussed in appendix I.

8

AARP, Community Transportation Survey (Washington, D.C.: 1997).
Page 9 GAO-04-971 Transportation-Disadvantaged Seniors

Figure 1: Diagram of the Overlapping Factors Affecting Seniors’ Mobility Needs 

Transportation assistance is an important issue for all seniors. In 2001, 

approximately 26 percent of state units on aging surveyed by the Aging 

States Project identified transportation as a top health issue for older 

adults, and 38 percent identified inadequate transportation as a barrier to 

promoting health among older adults.9

 Furthermore, transportation was 

among the top five information requests to the Eldercare Locator Service in

9

The Aging States Project is a collaborative effort of the Association of State and Territorial 

Chronic Disease Program Directors and the National Association of State Units on Aging, 

with support from the Centers for Disease Control and Prevention and HHS’s 

Administration on Aging.

Ability to drive Informal network of 

 family, friends to drive

Good health

Access to transportation

provided by nonprofit

community institutions

Source: GAO.

Needs

met

Needs

unmet

Sufficient income Access to 

public transportation 

Federal transportation programs are 

designed to target seniors most at risk 

for having transportation needs unmet
Page 10 GAO-04-971 Transportation-Disadvantaged Seniors

2001, 2002, and 2003.10 There is, however, a significant gender gap in the 

amount of time that seniors can expect to be dependent on alternative 

sources of transportation. A study published in August 2002 in the 

American Journal of Public Health estimated that men aged 70 to 74 who 

stopped driving would be dependent on alternative transportation for an 

average of 6 years, while women in the same age group can expect to have 

an average of 10 years’ dependence on alternative transportation modes.11

Although there is no clear-cut definition of mobility need, the literature and 

the experts we consulted indicate that there are two main categories of 

mobility need, both of which are important to seniors: (1) “essential” or 

“life-sustaining” trips, which include medical trips and trips for 

employment, shopping, banking, and other necessary errands, and (2) 

“quality of life” or “life-enhancing” trips, which include recreational or 

social trips that enable a senior to fully participate and engage in the 

community, such as trips to concerts, theatre, visits with family members in 

nursing homes or with friends, religious activities, and volunteer activities. 

For the purposes of this report, we will use this two-fold definition of types 

of trips as our working definition of mobility need. Unmet need occurs 

when assistance from others is needed but is not provided or is inadequate. 

However, according to the experts we contacted, there is no agreed-upon 

standard or benchmark for the number of trips that an individual requires 

to take care of essential activities for living (for both life-sustaining and 

life-enhancing activities),12 although experts generally agree that 

government should be concerned with meeting both types of needs for 

transportation-disadvantaged seniors. The lack of a standard or benchmark 

makes it difficult to determine an appropriate way to measure the extent to 

which mobility needs are being met. Researchers have begun to identify 

10The Eldercare Locator Service is a nationwide toll-free service and Web site designed to 

help older adults and their caregivers find services for seniors. It is funded by the 

Administration on Aging and administered by the National Association of Area Agencies on 

Aging.

11Foley, Heimovitz, Guralnik, and Brock, “Driving Life Expectancy.”

12In addition, the Federal Interagency Forum on Aging-Related Statistics—an organization 

comprised of representatives from the Administration on Aging, the Census Bureau, the 

Department of Veterans Affairs, and other agencies—identified several areas where more 

data are needed to support research and policy efforts, such as obtaining more information 

on the effects of transportation on the quality of life, including the number of trips seniors 

take and the types of transportation they use. See Federal Interagency Forum on 

Aging-Related Statistics, Older Americans 2000: Key Indicators of Well-Being

(Washington, D.C.: U.S. Government Printing Office, August 2000).
Page 11 GAO-04-971 Transportation-Disadvantaged Seniors

and evaluate transportation-disadvantaged seniors’ unmet mobility needs 

by comparing the number of trips they make with those of 

nondisadvantaged populations.13 In addition, some researchers have used 

satisfaction ratings to measure seniors’ unmet mobility needs. In the 

absence of a standard measure of need, we will discuss need and unmet 

need by comparing the travel of disadvantaged seniors with the travel of 

nondisadvantaged seniors and by using other measures that federal and 

local officials have developed.

The federal government has traditionally provided some assistance in 

mobility, mostly for the purpose of accessing other federal program 

services. Federal agencies partner with local agencies, nonprofit 

organizations, and others that actually provide transportation services and 

also contribute their own funds. The federal agency that has a central role 

in providing all types of services to seniors is HHS’s Administration on 

Aging (AOA). With a total discretionary budget of more than $1.3 billion, 

AOA is the official federal agency dedicated to policy development, 

planning, and the delivery of supportive home and community-based 

services to older persons and their caregivers. AOA works through a 

national aging network of 56 state units on aging; 655 AAAs; 241 tribal and 

native organizations representing 300 American Indian and Alaskan Native 

tribal organizations, and 2 organizations serving Native Hawaiians; and 

thousands of service providers, adult day care centers, caregivers, and 

volunteers.

13One problem with this measure is that it assumes that transportation-disadvantaged 

populations want to take as many trips as nondisadvantaged populations, an assumption 

that may be reasonable in some, but not all, cases.
Page 12 GAO-04-971 Transportation-Disadvantaged Seniors

Federal Agencies 

Address Mobility 

Issues Mainly through 

15 Programs That Help 

Make Transportation 

Available, Accessible, 

and Affordable

Five federal departments administer 15 programs that are key in addressing 

mobility issues of transportation-disadvantaged seniors. The programs are 

“senior-friendly” in that they help make transportation available, 

accessible, and affordable to seniors.

Fifteen Key Federal 

Programs Fund Services to 

Enhance TransportationDisadvantaged Seniors’ 

Mobility

Working with experts and federal agency officials, we identified 15 key 

programs in five departments that provide senior transportation (see table 

1) out of the many federal programs that are used to provide transportation 

services. Some of these programs specifically target seniors, such as HHS’s 

Grants for Supportive Services and Senior Centers (Title III-B). Other 

programs—including DOT’s Nonurbanized Area Formula Program (Section 

5311)—target other groups, such as rural populations, of which seniors can 

be a part. About half of the 15 programs fund transportation for specific 

types of trips, including for medical services, employment-related 

activities, and other services (such as nutrition) that the programs provide. 

The other half of the programs can be used to provide general 

transportation for any trip purpose. The programs fund a variety of types of 

services, ranging from transit passes and training in the use of public 

transit to vehicle purchases or expansion of public transit service.
Page 13 GAO-04-971 Transportation-Disadvantaged Seniors

Table 1: Characteristics of 15 Key Federal Programs That Fund Transportation for Seniors

Agency Program Target population Type of trip allowed

Type of service 

provided

Department of Education, 

Office of Special 

Education and 

Rehabilitative Services

Independent Living 

Services for Older 

Individuals Who Are Blind

Persons aged 55 and 

older who have significant 

visual impairment

To access program and 

related services, or for 

general trips

Referral, assistance, and 

training in the use of 

public transportation

Department of Health and 

Human Services, 

Administration for 

Children and Families

Community Services 

Block Grant Programs

Low-income persons 

(including seniors)

General trips Taxicab vouchers, bus 

tokens

Social Services Block 

Grants

Target population 

identified by states

To access medical or 

social services

Any 

transportation-related use

Department of Health and 

Human Services, 

Administration on Aging

Grants for Supportive 

Services and Senior 

Centers (Title III-B)

Seniors (aged 60 and 

older)

To access program 

services or medical 

services, or for general 

trips

Contract for service with 

existing transportation 

provider, or directly 

purchase vehicles (such 

as vans)

Program for American 

Indian, Alaskan Native, 

and Native Hawaiian 

Elders (Title VI)

American Indian, Alaskan 

Native, and Native 

Hawaiian seniors

To access program 

services or medical 

services, or for general 

trips

Purchase and operation 

of vehicles (such as vans)

Department of Health and 

Human Services, Centers 

for Medicare and 

Medicaid Services

Medicaid Generally low-income 

persons (including 

seniors), although states 

determine eligibility

Medicaid medical 

services (emergency and 

nonemergency)

Reimbursement for 

services with existing 

transportation providers 

(e.g., transit passes)

Department of Health and 

Human Services, Health 

Resources and Services 

Administration

Rural Health Care 

Services Outreach 

Program

Medically underserved 

populations (including 

seniors) in rural areas

To access healthcare 

services

Transit passes, purchase 

vehicles (such as vans)

Department of Labor, 

Employment and Training 

Administration

Senior Community 

Service Employment 

Program

Low-income seniors 

(aged 55 and older)

To access employment 

opportunities

Reimbursement for 

mileage
Page 14 GAO-04-971 Transportation-Disadvantaged Seniors

Source: GAO. 

Note: As we previously reported, we were unable to determine the amount spent on transportation 

services through many of these federal programs. See GAO, Transportation-Disadvantaged 

Populations: Some Coordination Efforts Among Programs Providing Transportation Services, but 

Obstacles Persist, GAO-03-697 (Washington, D.C.: June 30, 2003).

Funds from the 15 programs follow various paths in providing 

transportation services to seniors (see fig. 2). Many of the programs are 

block grants or formula programs through which funds are distributed to 

states on the basis of certain criteria, such as population. State agencies 

then provide services directly or distribute the funds to local agencies, 

nonprofit organizations, transit providers, and other organizations. For 

example, funds from DOT’s Capital Assistance Program for Elderly Persons 

and Persons with Disabilities (Section 5310) are allotted by formula to state 

agencies, which then distribute the funds to private nonprofit organizations 

or local public entities (such as transit providers) to purchase vehicles or 

other equipment. In another example, funds from HHS’s Grants for 

Agency Program Target population Type of trip allowed

Type of service 

provided

Department of 

Transportation, Federal 

Transit Administration

Capital and Training 

Assistance Program for 

Over-the-Road Bus 

Accessibility

Persons with disabilities 

(including seniors)

General trips Assistance in purchasing 

lift equipment and 

providing driver training

Capital Assistance 

Program for Elderly 

Persons and Persons with 

Disabilities (Section 

5310)

Seniors and persons with 

disabilities

General trips Assistance in purchasing 

vehicles, contract for 

services with existing 

transportation providers

Capital Investment Grants 

(Section 5309)

General public, although 

some projects are for the 

special needs of elderly 

persons and persons with 

disabilities

General trips Assistance for bus and 

bus-related capital 

projects

Job Access and Reverse 

Commute

Low-income persons 

(including seniors)

To access employment 

and related services

Expansion of existing 

public transportation or 

initiation of new service

Nonurbanized Area 

Formula Program 

(Section 5311)

General public in rural 

areas (including seniors)

General trips Capital and operating 

assistance for public 

transportation

Urbanized Area Formula 

Program (Section 5307)

General public in urban 

areas (including seniors)

General trips Capital assistance, and 

some operating 

assistance, for public 

transportation

Department of Veterans 

Affairs, Veterans Health 

Administration

Veterans Medical Care 

Benefits

Veterans (including 

seniors) with disabilities 

or low incomes

To access healthcare 

services

Mileage reimbursement 

or contract for service 

with existing 

transportation providers

(Continued From Previous Page)
Page 15 GAO-04-971 Transportation-Disadvantaged Seniors

Supportive Services and Senior Centers (Title III-B) are distributed first to 

state units on aging according to the number of seniors residing in the 

state, and then to local AAAs, which generally contract for services with 

local transportation providers.14 In other programs, such as the Department 

of Labor’s Senior Community Service Employment Program, some funds go 

through the state while other funds go directly to nonprofit organizations 

or local service providers. Finally, other programs—such as HHS’s Rural 

Health Care Outreach Services Program—bypass state agencies altogether 

and go directly to local entities. Local entities can use funds from a variety 

of federal programs to provide transportation services to seniors. For 

example, AAAs can receive funds from the Title III-B program, DOT’s 

Capital Assistance Program for Elderly Persons and Persons with 

Disabilities (Section 5310), and other federal programs. 

14The exceptions are the states that do not have AAAs, in which case the state unit on aging 

provides services directly or through contracts with providers.
Page 16 GAO-04-971 Transportation-Disadvantaged Seniors

Figure 2: Flow of Transportation Funds from Federal Programs to Seniors

Seniors

Programs that 

must go through 

state/tribe

Programs that can go through 

states/tribes or can go directly 

to local agencies or other entities

Programs that go directly 

to local agencies or 

other entities

States/Tribes

Community 

Services 

Block Grant 

Programs

Grants for 

Supportive 

Services 

and Senior 

Centers

Social 

Services 

Block

Grants

Job 

Access 

and 

Reverse 

Commute

Urbanized 

Area 

Formula 

Program 

Program 

for 

American 

Indian, 

Alaskan 

Native, 

and 

Native 

Hawaiian 

Elders

Senior 

Community 

Service 

Employment 

Program

Capital 

Investment 

Grants

Independent 

Living 

Services 

for Older 

Individuals 

Who Are 

Blind 

Capital 

Assistance 

Program for

Elderly 

Persons 

and 

Persons 

with 

Disabilities 

Nonurbanized 

Area 

Formula 

Program 

Medicaid

Capital and 

Training 

Assistance 

Program for 

Over-theRoad Bus 

Accessibility

Veterans 

Medical

Care 

Benefits

Rural 

Health 

Care

Services 

Outreach 

Program

Local agencies or other entities

Community 

action 

agencies

Local 

transit 

providers

Area 

agencies 

on aging

Nonprofit 

organizations

Local public 

or nonprofit 

health or 

social 

service 

providers

Veterans 

medical 

centers

Private bus 

operators

Source: GAO.

Funds going through states/tribes

Funds going directly to local entities
Page 17 GAO-04-971 Transportation-Disadvantaged Seniors

Federal Programs Enhance 

Senior Mobility by 

Addressing Certain 

Attributes of 

Senior-Friendly 

Transportation

The Beverly Foundation, a leading independent research organization on 

senior transportation issues, has identified the following “5 A’s” of 

senior-friendly transportation service:15

• availability (service is provided to places seniors want to go at times 

they want to travel);

• accessibility (e.g., door-to-door or door-through-door service16 is 

provided if needed, vehicles are accessible to people with disabilities, 

and stops are pedestrian-friendly);

• acceptability (service is clean, safe, and user-friendly);

• affordability (financial assistance is provided to those who need it); and

• adaptability (service is flexible enough to accommodate multiple trip 

types or specialized equipment).

However, there are trade-offs involved in addressing any of the “5 A’s.” For 

example, improving the acceptability of service can increase the costs of 

providing service.

Our review of federal programs’ authorizing legislation and guidance, as 

well as interviews with federal program officials, indicates that most of the 

15 key federal programs we identified in table 1 are generally designed to 

make transportation more available, accessible, and affordable to 

transportation-disadvantaged populations, such as seniors (see table 2). 

For example, HHS’s Medicaid Program provides transportation that is free 

or low-cost for seniors. Some of the programs address other attributes of 

senior-friendly transportation, such as acceptability. For example, the 

Department of Education’s Independent Living Services for Older 

15Beverly Foundation in partnership with the AAA Foundation for Traffic Safety, 

Supplemental Transportation Programs for Seniors (Pasadena, CA, and Washington, D.C.: 

June 2001).

16Door-through-door service involves picking up passengers at the door of their place of 

origin and delivering them to the door of their destination. The driver walks to the 

passenger’s point of origin, enters that building, and then often provides physical assistance 

to the passengers to exit the building and board the vehicle. This service offers the 

maximum level of assistance and is generally reserved for passengers with severe physical 

impairments or disabilities.
Page 18 GAO-04-971 Transportation-Disadvantaged Seniors

Individuals Who Are Blind program can be used to train seniors in the use 

of the public transit system, making it both more accessible and acceptable 

to them.

Table 2: Attributes of Senior-Friendly Transportation Service Addressed by the 15 Key Federal Programs That Fund 

Transportation Services for Seniors

Source: GAO.

Attribute

Agency Program Availability Accessibility Acceptability Affordability Adaptability

Department of 

Education

Independent Living Services 

for Older Individuals Who Are 

Blind ✔ ✔

Department of 

Health and Human 

Services

Community Services Block 

Grant Programs ✔ ✔ ✔ ✔

Social Services Block Grants ✔ ✔ ✔

Grants for Supportive Services 

and Senior Centers (Title III-B) ✔ ✔ ✔

Program for American Indian, 

Alaskan Native, and Native 

Hawaiian Elders (Title VI) ✔ ✔

Medicaid ✔ ✔

Rural Health Care Services 

Outreach Program ✔ ✔

Department of Labor Senior Community Service 

Employment Program ✔

Department of 

Transportation

Capital and Training 

Assistance Program for 

Over-the-Road Bus 

Accessibility ✔ ✔ ✔ ✔

Capital Assistance Program for 

Elderly Persons and Persons 

with Disabilities (Section 5310) ✔ ✔ ✔ ✔ ✔

Capital Investment Grants 

(Section 5309) ✔ ✔ ✔

Job Access and Reverse 

Commute ✔ ✔ ✔ ✔

Nonurbanized Area Formula 

Program (Section 5311) ✔ ✔ ✔

Urbanized Area Formula 

Program (Section 5307) ✔ ✔ ✔

Department of 

Veterans Affairs

Veterans Medical Care 

Benefits ✔ ✔ ✔ ✔
Page 19 GAO-04-971 Transportation-Disadvantaged Seniors

Note: This table focuses on the senior-friendly attributes addressed by the intent of the federal program 

as identified in federal program legislation and guidance and in interviews with federal officials. 

Grantees may actually address more of the five A’s when delivering transportation services to seniors 

at the local level.

In addition to the 15 key programs identified in tables 1 and 2, the federal 

government helps to make transportation more senior-friendly through 

other programs and policies that provide or ensure access to transportation 

services for all disadvantaged populations (including seniors). Although 

seniors are not the target population of these other programs and policies, 

they often benefit from them. For example, seniors are eligible for many of 

the programs we identified in a previous report on the coordination of 

services for the transportation-disadvantaged.17 In that report, we identified 

62 federal programs that can be used to provide transportation services, 

including the 15 programs identified above. For instance, seniors can 

benefit from the Department of Housing and Urban Development’s 

Community Development Block Grant Program, which can be used to 

purchase and operate vehicles in low-income areas, and the Department of 

Labor’s Workforce Investment Act Adult Services Program, which can be 

used to provide bus tokens or reimbursement for mileage to access training 

opportunities.

Another federal program that does target seniors—Medicare, the federal 

health financing program covering almost all persons aged 65 and older and 

certain persons with disabilities—was not included in our list of 15 key 

programs because it funds only a very specific type of transportation 

service for seniors. Medicare covers medically necessary ambulance 

services when other means of transportation, such as a wheelchair van or a 

taxicab, are inadvisable, given the beneficiary’s medical condition at the 

time. Medically necessary ambulance trips include both emergency care, 

such as responses to 911 calls, and nonemergency care, such as transfers 

from one hospital to another. Medicare covers nonemergency 

transports—both scheduled and nonscheduled—if the beneficiary is

17GAO, Transportation-Disadvantaged Populations: Some Coordination Efforts Among 

Programs Providing Transportation Services, but Obstacles Persist, GAO-03-697

(Washington, D.C.: June 30, 2003).
Page 20 GAO-04-971 Transportation-Disadvantaged Seniors

bed-confined18 or meets other medical necessity criteria, such as requiring 

oxygen on the way to the destination.19

Many programs and policies that address the mobility needs of persons 

with disabilities also benefit seniors. For example, the Americans with 

Disabilities Act (ADA) has resulted in changes to many 

transportation-related facilities, including transit vehicles and bus stops, 

that make transportation more accessible to seniors with disabilities as 

well as others. Other federal ADA-related activities can also benefit seniors. 

For example, the Department of Justice’s Civil Rights Division is 

responsible for enforcing federal statutes, including the ADA, that prohibit 

discrimination on the basis of race, sex, handicap, religion, and national 

origin. In addition, Justice has published rules governing the design of 

transportation facilities, such as bus stops, to make them accessible to 

people with disabilities. Finally, the U.S. Architectural and Transportation 

Barriers Compliance Board—an independent entity within the federal 

government devoted to accessibility for people with disabilities—develops 

and maintains accessibility standards for transit vehicles, provides 

technical assistance and training on these standards, and ensures 

compliance with accessibility standards for federally funded facilities.

Data Indicate That 

Some Types of Mobility 

Needs Are Not Being 

Met, but Information 

on the Extent of Unmet 

Needs Is Limited

The data on the nature of mobility needs that we obtained from research 

publications and interviews with federal officials, experts, and officials 

from 16 local AAAs indicate that federally supported programs are not 

meeting some of the mobility needs of transportation-disadvantaged

18Bed confinement is defined as when the beneficiary is unable to get up from bed without 

assistance, to walk, or to sit in a chair or wheelchair.

19GAO, Rural Ambulances: Medicare Fee Schedule Payments Could Be Better Targeted, 

GAO/HEHS-00-115 (Washington, D.C.: July 17, 2000), and Ambulance Services: Medicare 

Payments Can Be Better Targeted to Trips in Less Densely Populated Rural Areas, 

GAO-03-986 (Washington, D.C.: Sept. 19, 2003).
Page 21 GAO-04-971 Transportation-Disadvantaged Seniors

seniors.20 In particular, (1) seniors who rely on alternative transportation 

have difficulty making trips for which the automobile is better suited, such 

as trips that involve carrying packages; (2) life-enhancing needs are less 

likely to be met than life-sustaining needs; and (3) mobility needs are less 

likely to be met in nonurban communities (especially rural communities) 

than in urban communities. However, there are few current or planned 

efforts to collect data for assessing the extent to which federally supported 

programs are meeting transportation-disadvantaged seniors’ mobility 

needs. In addition, AAAs’ methods for collecting and reporting data make it 

difficult to determine the extent to which transportation-disadvantaged 

seniors’ needs are being met, in part because of a lack of federal guidance 

on how to assess needs. According to experts and local officials, barriers to 

assessing the extent of unmet needs include the lack of consensus on how 

to define or measure needs, a lack of federal guidance, and the difficulties 

of measuring the unmet needs of seniors who are not attempting to access 

publicly funded services.

Federally Supported 

Programs Are Not Meeting 

Some Types of Mobility 

Needs of TransportationDisadvantaged Seniors

Federally supported transportation services are meeting some, but not all, 

types of mobility needs of transportation-disadvantaged seniors. Although 

up to 75 percent of nondrivers aged 75 and older have reported being at 

least somewhat satisfied with their mobility,21 evidence from nationally 

published research and from interviews we conducted with federal 

officials, experts, and local aging professionals indicates that many of those 

seniors who are able to meet life-sustaining and life-enhancing needs are 

doing so because they have access to supportive family and friends who 

drive them or because they live in transit-rich cities. For those seniors who 

do not have access to these support structures or who live in nonurban 

areas, some mobility needs—especially those related to life-enhancing 

activities—may not be met.

20Our review indicates that these data have limitations, including limited generalizability of 

focus group findings; lack of documentation to assess the potential for nonresponse bias 

(the difference between those who responded or participated and those who did not); and 

lack of objective, quantifiable data on which to base perspectives. See appendix I for a more 

detailed discussion of the limitations associated with these data.

21As compared with the nearly 90 percent of drivers aged 75 and older who reported being at 

least somewhat satisfied with their mobility. See AARP, Understanding Senior 

Transportation: Report and Analysis of a Survey of Consumers Age 50+ (Washington, 

D.C.: 2002). According to AARP’s calculations, all of the estimates we cite from this study 

have sampling errors that do not exceed + or – 4.5 percent at the 95 percent confidence 

level. 
Page 22 GAO-04-971 Transportation-Disadvantaged Seniors

Transportation-Disadvantaged 

Seniors Lack Alternatives to the 

Automobile That Provide 

Comparable Benefits 

Data from nationally published research indicate that 

transportation-disadvantaged seniors prefer the automobile to other modes 

of transportation because it is readily available, can reach multiple 

destinations in the course of one trip, and can be used to access 

destinations that require carrying packages (such as shopping). In focus 

groups conducted by AARP,22 the general consensus among participants 

was that access to ready transportation provided by the private automobile 

is critical to overall life satisfaction. In comparison, seniors perceived other 

modes such as public transit, specialized transportation (such as senior 

vans), and walking as having inherent negative attributes—including time 

spent waiting, waits in bad weather, difficulty carrying items, scheduling 

requirements, infrequent service, and concerns about personal security and 

accessibility—that made them less attractive than driving or being driven. 

Consistent with this, a survey conducted by AARP found that senior 

nondrivers use automobile rides from family or friends more than other 

modes of transportation to get where they need to go (see fig. 3).23

22AARP, Transportation and Older Persons: Perceptions and Preferences (Washington, 

D.C.: 2001).

23AARP, Community Transportation Survey.
Page 23 GAO-04-971 Transportation-Disadvantaged Seniors

Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and Older

Note: Other modes include public transportation, senior vans, walking, and taxicabs.

Even if seniors could overcome some of these negative perceptions of 

alternatives to the automobile, they may not be able to use the alternatives 

because the alternatives might be unavailable in their community or are 

inaccessible to seniors. In a survey by AARP, about 33 percent of senior 

nondrivers who reported that they did not use public transportation said 

that it was because public transportation was not available.24 In focus 

groups conducted for the Coordinating Council on Access and Mobility, 

HHS, and the National Highway Traffic Safety Administration, participants 

reported having trouble walking long distances, getting to the bus stop, 

getting on and off buses, and seeing street signs from the bus so that they

24AARP, Community Transportation Survey.

33

Percentage of nondrivers

0

10

20

30

40

50

60

70

80

90

67

Source: GAO analysis of AARP data.

Rides from 

family 

or friends

Other modes 

Mode of transportation
Page 24 GAO-04-971 Transportation-Disadvantaged Seniors

knew where and when they should disembark.25 Similarly, more than 

one-third of the respondents in one study’s focus groups reported that they 

would be unable to walk one-quarter mile to a bus stop.26

Transportation-Disadvantaged 

Seniors’ Life-Enhancing Needs 

Are Less Likely to Be Met Than 

Life-Sustaining Needs 

Data from nationally published research indicate that difficulty in getting 

the transportation they needed interfered with 

transportation-disadvantaged seniors’ activities and trip-making, especially 

for life-enhancing needs such as social or recreational activities. For 

example, a report analyzing data from the 2001 National Household Travel 

Survey found that seniors who do not drive made 15 percent fewer trips to 

the doctor than drivers, but made 65 percent fewer trips for social, family, 

religious, and other life-enhancing purposes.27 In addition, although few 

seniors in an AARP survey28 reported that a lack of transportation 

interfered with their activities—such as getting to the doctor, their place of 

worship, the grocery store or drug store, or entertainment; shopping for 

clothes or household items; or visiting with friends—nondrivers were two 

to three times as likely as drivers to report that a lack of transportation 

interfered with such activities.29 Furthermore, a study that analyzed 

responses from seniors in focus groups reported that older adults who have 

stopped driving significantly curtailed their recreational activities. One 

participant who had stopped driving reported, “What I do now, my daughter 

tries to take me shopping once a week for heavy items, which is very 

helpful. But I’m accustomed to going from mall to mall and store to store to 

see things, you know, and I don’t get around like that. I’m very limited.” 30

25Jon E. Burkhardt, Arlene M. Berger, Michael Creedon, and Adam T. McGavock, Mobility 

and Independence: Changes and Challenges for Older Drivers, a report prepared by 

Ecosometrics, Incorporated, for the Coordinating Council on Access and Mobility, the 

Department of Health and Human Services, and the National Highway Traffic Safety 

Administration (July 4, 1998).

26The study included perspectives from the transit industry, including that walking a 

one-quarter mile distance to a bus stop was a reasonable expectation for a healthy senior. 

See U.S. Department of Transportation, Transit Cooperative Research Program, 

Transportation Research Board, TCRP Report 82, Improving Public Transit Options for 

Older Persons, Volume I: Handbook and Volume II: Final Report (Washington, D.C.: 2002).

27Surface Transportation Policy Project, Aging Americans.

28AARP, Understanding Senior Transportation.

29Other causes of interference with activities may include health limitations or other 

personal reasons.

30Burkhardt, Berger, Creedon, and McGavock, Mobility and Independence.
Page 25 GAO-04-971 Transportation-Disadvantaged Seniors

Federal officials and experts we interviewed also said that the available 

transportation options are not meeting seniors’ mobility needs, especially 

for life-enhancing trips. Several experts said that, while mobility needs are 

being met for the majority of seniors who drive—and even for some 

transportation-disadvantaged seniors who live in transit-rich environments, 

who have access to supportive family and friends, or who have knowledge 

of and access to nonprofit or other organizations that provide 

transportation—the mobility needs generally are not being met for 

transportation-disadvantaged seniors without these options. Although a 

few officials and experts said that for most seniors, trips for life-sustaining 

needs (e.g., medical appointments) are likely being met, others said that 

such needs are not being met. 

Finally, the majority of AAA officials we interviewed said that 

transportation-disadvantaged seniors’ needs were not being met. (Although 

3 of the 16 AAAs said that needs were being met with the limited funding 

available, they also cited gaps in service.) Furthermore, although the AAA 

officials we interviewed were split in their perspectives on whether needs 

for travel to critical, life-sustaining activities were being met, nearly all said 

that needs for travel to life-enhancing activities such as church and 

shopping at the mall were not being met. In addition, all of the AAAs we 

interviewed imposed restrictions that limited or prioritized transportation 

services for life-sustaining activities. For example, many AAAs require 

advance notification (e.g., 24-hour notification) for service and most 

restrict service to approximately 9 a.m. to 5 p.m. on weekdays, which limits 

spontaneous travel and travel in the evenings when many cultural and 

social events take place. Furthermore, most AAAs offer transportation only 

within the counties or towns they serve, which limits access to activities. 

Finally, when we asked AAA officials about the destinations to which they 

provide transportation, most identified essential, life-sustaining sites, such 

as nutrition sites, medical facilities, grocery stores, pharmacies, public 

service agencies, and banks. Only a few AAAs offered transportation for 

life-enhancing activities, such as for recreational or cultural events, or for 

visits to spouses or other family or friends in long-term-care facilities, and 

some explicitly stated that they were unable to provide service for personal 

or life-enhancing activities. The AAA officials told us that all of these 

constraints were due to limited funding availability.31

31See appendix II for information on transportation services provided by the 16 AAAs we 

interviewed.
Page 26 GAO-04-971 Transportation-Disadvantaged Seniors

Transportation-Disadvantaged 

Seniors’ Needs Are Less Likely to 

Be Met in Nonurban Areas Than 

in Urban Areas

The travel of transportation-disadvantaged seniors living in nonurban 

communities is more restricted than the travel of 

transportation-disadvantaged seniors living in urban communities. A study 

analyzing 2001 National Household Travel Survey data indicated that older 

Americans living in small towns and rural areas who do not drive were 

more likely to stay home on a given day than their urban and suburban 

counterparts—63 percent of nondrivers in small towns and 60 percent of 

nondrivers in rural areas reported that they stayed home on a given day, 

compared with 51 percent of nondrivers living in urban and suburban 

areas.32 Alone, these data do not indicate that mobility needs are less likely 

to be met because of limited transportation options rather than other 

aspects that distinguish rural communities from urban ones, such as fewer 

activities and longer distances between destinations. However, data we 

obtained from other sources support the idea that the lack of 

transportation is a significant reason for these travel patterns. For example, 

in focus groups and interviews that AARP conducted in 2001 with seniors 

aged 75 and older, nondrivers living in the suburbs were less satisfied that 

their mobility needs were met than urban nondrivers. In addition to 

identifying feelings of lost freedom, diminished control, and altered 

self-image, several suburban participants noted that they make fewer trips 

and pursue fewer activities as nondrivers, whereas the urban nondrivers 

expressed more satisfaction with their ability to get around.33 In addition, in 

a survey by AARP, respondents living in cities reported that they were more 

likely to have public transportation available to them than respondents 

living in rural areas (see fig. 4).34

32Surface Transportation Policy Project, Aging Americans.

33AARP, Transportation and Older Persons.

34AARP, Understanding Senior Transportation.
Page 27 GAO-04-971 Transportation-Disadvantaged Seniors

Figure 4: Percentage of Respondents Aged 75 and Older Who Have Public 

Transportation Available to Them, by Area

Note: Respondents were asked how they would describe their current residence: as a city, a suburban 

area around a city, a small town, or in the country. According to AARP’s calculations, all of the 

estimates we cite from this study have sampling errors that do not exceed + or - 4.5 percent at the 95 

percent confidence level.

In addition, several federal officials and experts we interviewed said that 

the needs of transportation-disadvantaged seniors are not being met with 

available transportation options, especially for those seniors living in rural 

communities. Similarly, when we asked AAA officials whether 

transportation-disadvantaged seniors’ needs were being met, nearly half 

offered the view that needs were not being met for those living in rural 

communities because of the long distances required to travel to facilities 

and the resulting need for the driver to wait to bring the senior back. In 

addition, some said there are geographic regions in rural areas that are not 

served at all by public transportation, taxicab, or other transportation 

providers. 

0

10

20

30

40

50

60

70

80

90

Cities

Residency

Source: GAO presentation of AARP data.

Suburbs Small towns Rural areas

Percentage of respondents

84

69

23

45
Page 28 GAO-04-971 Transportation-Disadvantaged Seniors

Data Are Limited on the 

Extent to Which Mobility 

Needs Are Being Met

Because most of the federal programs that fund transportation for 

transportation-disadvantaged seniors do not focus specifically on seniors 

or transportation (instead, seniors may be one of several target 

populations, and transportation may be one of several supportive services 

provided by the program), federal agencies have minimal program data 

about the extent of seniors’ unmet transportation needs. Five of the 15 key 

federal programs that provide transportation to seniors—the Department 

of Education’s Independent Living Services for Older Individuals Who Are 

Blind program and HHS’s Social Services Block Grants, Community 

Services Block Grant Programs, Grants for Supportive Services and Senior 

Centers (Title III-B), and Program for American Indian, Alaskan Native, and 

Native Hawaiian Elders (Title VI)—collect some nonfinancial performance 

data related to senior transportation.35 Most of the data collected for these 

5 programs provide only information on usage, such as the number of 

seniors receiving transportation services or the number of one-way trips 

provided to seniors. In addition, for transit programs that serve the general 

public, the Federal Transit Administration collects data on the number of 

rides and the number of people served, but these data are not broken out 

by federal program or by age. However, AOA officials told us that they are 

beginning to measure performance outcomes related to transportation 

services under the Title III-B program. On the basis of a national survey it 

conducted in 2004, AOA estimated that state and area agencies on aging 

provided transportation services to approximately 440,000 seniors in fiscal 

year 2003. AOA officials told us that most of the respondents rated the 

transportation services as good or excellent, and that many respondents 

reported that they relied on these services for all or nearly all of their local 

transportation needs. Although this information is useful in assessing the 

satisfaction of seniors who receive transportation services, it does not 

measure the extent of unmet needs. Officials from AOA and the Federal 

Transit Administration currently are assessing the state of data on seniors’ 

mobility needs to identify baseline data on needs and available resources.

Similarly, few AAAs use, or plan to use, data collection methods that enable 

them to determine the extent of seniors’ unmet mobility needs—that is, 

information on both the extent of need in the community and the capacity 

35In a prior report (GAO-03-697), we found that there were no reliable national program data 

on federal, state, and local spending for transportation services for the 

transportation-disadvantaged, including seniors. There were no such data because many 

federal funding recipients are not required to distinguish transportation spending from other 

spending when reporting information to federal agencies.
Page 29 GAO-04-971 Transportation-Disadvantaged Seniors

of services, including their own, to provide transportation to seniors to 

meet those needs. AAAs are required to determine the extent of need for 

supportive services (which could include transportation) provided through 

HHS’s Title III-B program and to evaluate how effectively resources are 

used to meet such need.36 However, several AAAs we interviewed reported 

that they do not collect this type of data at all. Of those AAAs reporting that 

they do collect data on the extent of unmet needs, most collect data on the 

number of seniors who called the AAA to request transportation services 

that the agency was unable to provide (including data such as the number 

of trip denials and the number of seniors on a waiting list). There are a 

number of limitations to this type of data. For example, a few AAAs 

reported that waiting list data were not reliable in measuring the unmet 

needs of seniors because the data allowed multiple-counting of seniors 

who are wait-listed by more than one transportation provider or who 

periodically call for rides and are added to the waiting list each time they 

call. In addition, AAAs reported that waiting list data were not entirely 

representative of unmet needs because these data include information only 

on seniors who call for service and not on seniors who do not call (because 

no services are available, because they do not know what services are 

available, because they are tired of being turned down, because they moved 

to an assisted living facility since they had difficulty obtaining 

transportation, or because of some other reason) but who may still need 

rides. Furthermore, the waiting list data do not allow for calculating the 

number of seniors who were referred to other transportation services and 

were able to get rides through these other services. Only 2 of the 16 AAAs 

(the Salt Lake County Aging Services and the Bear River Association of 

Governments, both in Utah) have a method for determining the gap in 

transportation service by calculating the difference between the number of 

seniors who are in need of transportation and the number of seniors who 

are receiving service through other providers, or through family and 

friends. 

Finally, there is little information from national surveys and studies that 

addresses the extent to which transportation-disadvantaged seniors’ needs 

are being met; rather, those surveys and studies focus on the nature of 

needs, as discussed in the previous section of this report. For example, one 

report prepared by DOT’s Bureau of Transportation Statistics analyzes 2002 

data from the Transportation Availability and Use Survey on the travel 

behavior of persons with disabilities, but the findings are not broken down 

3642 U.S.C. § 3026(a)(1).
Page 30 GAO-04-971 Transportation-Disadvantaged Seniors

by age.37 Another Bureau of Transportation Statistics report analyzing the 

same data source provides some insights on the types of travel problems 

encountered by seniors with disabilities, but it does not provide data that 

can be used to measure the extent of those seniors’ transportation needs or 

to determine whether those needs are being met.38

There Are Several Barriers 

to Assessing the Extent of 

Unmet Need

Senior mobility experts told us that there is no clear-cut definition of 

mobility needs, making it difficult to determine the extent to which such 

needs are being met. Although many of the experts we contacted 

mentioned the distinction between life-sustaining and life-enhancing needs, 

they did not provide a more concrete definition. Many of these experts also 

said that they were not aware of an agreed-upon standard or benchmark for 

assessing seniors’ unmet mobility needs. One researcher said that the topic 

of seniors’ mobility needs is just beginning to be discussed in the literature, 

so a standard has not yet been developed.

In addition to the lack of consensus on definitions or measures of need, 

there is also little guidance on assessing mobility needs. Although some of 

the 15 key federal programs we identified require state or local agencies to 

assess the need for services, federal agencies provide little guidance on 

how to do this. As previously noted, HHS’s Title III-B and Title VI 

programs—through which AOA provides grants to states and Native 

American tribes for senior services—require AAAs to prepare a plan that 

includes an assessment of the needs of disadvantaged seniors, which could 

include transportation needs.39 Furthermore, the Older Americans Act, as 

amended, requires AOA to provide guidance to states on assessing needs, 

specifically “to design and implement [for program monitoring 

purposes]...procedures for collecting information on gaps in services 

needed by older individuals” and “procedures for the assessment of unmet 

needs for services....”40 Although AOA has developed general guidance for 

Native American tribes on conducting needs assessments for its Title VI 

37U.S. Department of Transportation, Bureau of Transportation Statistics, Freedom to 

Travel, BTS03-08 (Washington, D.C.: 2003).

38U.S. Department of Transportation, Bureau of Transportation Statistics, Travel Patterns of 

Older Americans with Disabilities, Working Paper 2004-001-OAS (Washington, D.C.: July 

2004).

3942 U.S.C. § 3026(a)(1) and 42 U.S.C. § 3057d.

4042 U.S.C. § 3012(a)(26)(D) and (E).
Page 31 GAO-04-971 Transportation-Disadvantaged Seniors

program, the program guidance that the agency provides to states for its 

Title III-B program does not include guidance on how to assess and 

measure needs or on specific data collection methods. As a result of the 

lack of guidance on assessing need, most of the AAAs that we interviewed 

reported assessing seniors’ unmet mobility needs using a range of data 

collection methods that resulted in data not specific enough for planning 

purposes, and not indicative of the precise extent to which seniors’ 

mobility needs are being met. While some AAAs said they did not need 

additional data, other AAAs we spoke with said that more precise 

information on the extent of unmet need would be useful in designing 

services and getting political support and funding for services, but some do 

not have the staff, funds, or expertise to develop methodologies to do this. 

They said that guidance from the federal government in this regard would 

be very useful.

Officials at AOA said that, in the past, they have not provided guidance to 

state and local aging agencies on how to assess needs for the Title III-B 

program because they received feedback that state and local aging 

agencies had a more immediate desire for guidance on assessing the quality 

of service and collecting information on client characteristics. To this end, 

AOA is currently developing a plan for evaluating the various supportive 

services, including transportation, provided through its Title III-B 

programs. The evaluation effort will address the needs of states and 

communities for supportive services and the extent to which the Title III-B 

program is meeting the needs and preferences of the elderly for those 

services. As part of the evaluation, AOA plans to address questions about 

the role of AAAs in providing supportive services, how needs assessments 

are performed by state and local entities, and how the results of those 

assessments are used by states in implementing the Title III-B program. On 

the basis of the results of our interviews with AAA representatives, the 

AOA official responsible for the planned evaluation said that it would be 

useful to obtain some additional information during the evaluation to 

determine the need for services under the Title III-B program, including (1) 

identifying how needs should be defined and measured; (2) determining the 

range of methodologies that AAAs use for assessing seniors’ need for 

services, including transportation, and unmet needs; and (3) identifying the 

kinds of guidance that AAAs want from AOA and states to help them 

perform their required needs assessments. AOA plans to complete its 

evaluation of this program by January 2006.

Other federal program regulations also require or encourage local agencies 

to assess need to be eligible for funding. For example, DOT’s Capital and 
Page 32 GAO-04-971 Transportation-Disadvantaged Seniors

Training Assistance Program for Over-the-Road Bus Accessibility (which 

provides funds to bus operators to help make their services more 

accessible to persons with disabilities) lists “identified need” as one of the 

criteria for selecting grantees, and HHS’s Community Services Block Grant 

Program (which provides funds for services to address the needs of 

low-income individuals) requires grantees to assess need for services and 

report this information to the state. However, these agencies do not provide 

guidance for assessing need for most of these programs. DOT officials said 

that they allow local applicants for the Capital and Training Assistance 

Program for Over-the-Road Bus Accessibility to decide what measures to 

use to demonstrate need, and the measures vary accordingly. For example, 

some of these applicants have provided information on the number of trips 

that were denied for lack of an accessible vehicle, while other applicants 

demonstrate need on the basis of the number of trips provided using an 

existing lift-equipped vehicle. For its Job Access and Reverse Commute 

Program, DOT asks applicants to provide data on the percentage of 

low-income persons in the area as well as on transportation gaps between 

existing services and employment opportunities for these persons, and the 

agency provides some guidance on how to identify such gaps.41 HHS 

provides some guidance for assessing the need for services under the 

Community Services Block Grant Programs, but the guidance is for 

assessing a wide range of services, of which transportation is only one.

Federal officials report that it is difficult to measure unmet mobility needs 

largely because of difficulties in measuring the unmet needs of those 

transportation-disadvantaged seniors who are not trying to access 

transportation services (such as those who do not call for service because 

they have given up trying to get transportation or are not aware of 

services). Some AAA officials and federal officials said that collecting this 

type of data is time-consuming and expensive. In addition, there may be 

other difficulties in reaching these seniors. For example, they may have 

difficulty hearing questions posed over the telephone, may be wary of 

providing personal information, or may be reluctant to admit that they need 

assistance or that they can no longer safely drive themselves to activities 

they need or want to attend. 

41This program has transitioned from one in which DOT competitively selected grantees to 

one in which the Congress designates the grantees. See GAO, Job Access and Reverse 

Commute: Program Status and Potential Effects of Proposed Legislative Changes, 

GAO-04-490R (Washington, D.C.: Aug. 20, 2004).
Page 33 GAO-04-971 Transportation-Disadvantaged Seniors

Transportation Service 

Providers Implement 

Practices That 

Enhance Senior 

Mobility with Some 

Federal Support, but 

Implementation 

Difficulties Remain 

Transportation providers use a variety of practices—which we have 

grouped into three categories—to enhance the mobility of 

transportation-disadvantaged seniors and promote the cost-effective 

delivery of transportation services. These include practices that (1) 

improve service efficiency through increasing the use of technology and by 

coordinating services with other providers in the community; (2) improve 

customer service by providing training sessions for service staff and 

seniors, using vehicles that can accommodate seniors’ mobility challenges, 

and increasing the level of service provided; and (3) leverage existing 

resources by increasing volunteer involvement and forging financial 

partnerships with public and private entities in the community. According 

to the local service providers we interviewed, these practices, which were 

implemented with some federal support, resulted in more senior-friendly 

transportation services and more cost-effective service delivery. All 10 local 

transportation service providers we interviewed indicated that they had 

been able to use funds from 1 or more of the 15 key federal programs in 

implementing practices that enhance senior mobility. The most commonly 

used programs were DOT’s Capital Assistance Program for Elderly Persons 

and Persons with Disabilities (Section 5310) and HHS’s Title III-B and 

Medicaid Programs, followed by DOT’s Nonurbanized Area Formula 

Program (Section 5311), and HHS’s Community Services Block Grant 

Programs. However, according to the providers we interviewed, certain 

characteristics of federal programs may impede the implementation of 

practices that enhance transportation-disadvantaged-seniors’ mobility. 
Page 34 GAO-04-971 Transportation-Disadvantaged Seniors

Certain Practices Enhance 

TransportationDisadvantaged Seniors’ 

Mobility and Promote 

Cost-effective Delivery of 

Services 

According to a 2002 report prepared by DOT’s Transit Cooperative 

Research Program (hereafter referred to as the TCRP report),42 local 

transportation providers have implemented a number of program practices 

to improve public transportation services for seniors. The 10 local service 

providers we interviewed in urban and rural areas have implemented some 

of these practices, as discussed below. 

Improvements to Service 

Efficiency 

Increasing the use of technology: According to the TCRP report, using 

advanced technology can improve efficiency, productivity, and 

cost-effectiveness. Global Positioning Systems (GPS) and other advanced 

technologies can provide real-time information about where vehicles are 

located, when they will arrive to pick up a senior, and how long the trip 

may take. Two of the 10 local service providers we interviewed are using 

advanced technology to improve their trip scheduling. For example, 

Sweetwater Transportation Authority in Rock Spring, Wyoming, is using 

GPS technology on board each bus, connecting the bus to software that 

will automatically schedule rides and provide an accurate estimated time of 

arrival to passengers. The Friendship Center, which offers 

door-through-door transportation services in Conroe City, Texas, is 

involved in the early stages of implementing a computerized dispatching 

and mapping system that will allow same-day scheduling to transport 

seniors to their destinations. In the past, all scheduling was done manually 

and seniors often had to call 48 hours in advance to schedule a ride. 

According to Friendship Center officials, the implementation of the 

computerized mapping system will increase efficiency and coordination of 

their transportation service, which will also improve the level of service 

provided to seniors. 

42U.S. Department of Transportation, Transit Cooperative Research Program, Transportation 

Research Board, TCRP Report 82. For more information on the service providers discussed 

in this section, as well as other providers that experts have identified as having implemented 

practices that enhance senior mobility, also see Community Transportation Association of 

America, Senior Transportation: Toolkit and Best Practices (Washington, D.C.: May 2003) 

and Beverly Foundation in partnership with the AAA Foundation for Traffic Safety, 

Supplemental Transportation Programs. In addition, the Beverly Foundation released a 

report in July 2004 that identifies additional service providers. (See Beverly Foundation in 

partnership with the AAA Foundation for Traffic Safety, Supplemental Transportation 

Programs for Seniors: A Report on STPs in America (Pasadena, CA, and Washington, D.C.: 

July 2004).)
Page 35 GAO-04-971 Transportation-Disadvantaged Seniors

Coordinating transportation services: According to the TCRP report and 

our previous work, coordination of transportation services can improve the 

overall efficiency of operations, increase the productivity of services, 

reduce service costs, and increase mobility.43 Our previous work indicated 

that the extent of coordination of transportation services varies. Several 

service providers we interviewed have implemented a coordinated 

transportation service, including Mountain Empire Older Citizens (MEOC), 

which is located in central Virginia.44 MEOC recognized that coordination 

was needed because each human service agency in the area was 

transporting its own clients exclusively, while other vehicles from other 

agencies were picking up passengers in the same area. Under its 

coordination contract, MEOC leases vehicles from other specialized 

transportation service providers and coordinates all aspects of transporting 

their clients (including other transportation-disadvantaged groups, such as 

people with developmental disabilities). As a result, MEOC has maximized 

the efficient use of vehicle fleet and realized cost savings in service 

delivery, according to an agency official. Another service provider, the 

Friendship Center, coordinates its transportation services with medical 

facility staff to schedule medical appointments for seniors. The dispatchers 

at the center work directly with the medical providers to schedule medical 

appointments for seniors when the center’s transportation services are 

available. In addition, the center’s hours for transportation services reflect 

those of the medical centers. By coordinating their services, the center 

helps ensure that seniors do not encounter transportation scheduling 

problems. Lastly, Medical Motor Service, which provides transportation 

and brokerage45 services to seniors in Monroe County, New York, 

coordinates with other nonprofit agencies to provide volunteers who serve 

as “shopping buddies” to help seniors carry packages or assist them with 

their groceries.

43See GAO-03-697 and GAO, Transportation-Disadvantaged Populations: Many Federal 

Programs Fund Transportation Services, but Obstacles to Coordination Persist, 

GAO-03-698T (Washington, D.C.: May 1, 2003). 

44Coordinated transportation services may include the following activities: joint planning 

among several private or public agencies, brokerage, or the shared use of vehicles among 

multiple programs. 

45The Community Transportation Association of America defines brokerage as a method of 

providing transportation where riders are matched with appropriate transportation 

providers through a central trip-request and administration facility. The transportation 

broker may centralize vehicle dispatch, record keeping, vehicle maintenance, and other 

functions under contractual arrangements with agencies, municipalities, and other 

organizations. Actual trips are provided by a number of different vendors.
Page 36 GAO-04-971 Transportation-Disadvantaged Seniors

Improvements to Customer 

Service

Providing training to staff and seniors: According to the TCRP report and 

a brochure on innovative transit services for seniors developed by the 

Beverly Foundation and the Community Transportation Association of 

America (hereafter, Innovations Brochure),46 training for service 

staff—particularly drivers—and for senior riders is important in improving 

transportation services. The TCRP report states that staff training should 

address customer service issues, such as the need for polite and courteous 

interactions by drivers with passengers and the physical constraints 

seniors encounter while using public transportation. The TCRP report also 

indicates that customer service training should be part of an overall change 

in organizational focus, from just operating vehicles to serving customers. 

Several service providers we interviewed were implementing training to 

improve customer service by helping seniors feel more comfortable while 

being transported. For example, Altoona Metro Transportation, which 

provides public transit service to the general public in central Blair County 

in Pennsylvania, developed a driver-training sensitivity program through 

which drivers receive specialized training to recognize the diverse needs of 

seniors. In what is considered a “hands-on” session, drivers wear special 

glasses to distort their vision so that they can temporarily experience the 

physical limitations that some seniors face while riding public 

transportation. An Altoona Metro official also told us that drivers are 

encouraged to socialize with senior passengers and foster relationships to 

make seniors feel comfortable and welcomed. In addition to training for 

staff, providers are also implementing travel-training programs to teach 

seniors who are not accustomed to using transit services how to use public 

transportation. One service provider, North County Lifeline, Inc. (a 

curb-to-curb47 transit service located in the northern San Diego area), 

developed a travel-training program for seniors to learn about public transit 

and reduce any concerns they may have about personal safety when using 

transit. The program includes instruction in how to problem-solve, map out 

a trip, make transfers, and understand the rights and responsibilities they 

have while riding public transportation. 

46Beverly Foundation and Community Transportation Association of America, Innovations 

for Seniors: Public and Community Transit Services Respond to Special Needs (Pasadena, 

CA, and Washington, D.C.: February 2004).

47Curb-to-curb service is a common designation for the paratransit service that involves a 

transit vehicle that picks up and discharges passengers at the curb or driveway in front of 

their home or destination. In curb-to-curb service, the driver does not assist the passenger 

along walks or steps to the door of the home or other destination.
Page 37 GAO-04-971 Transportation-Disadvantaged Seniors

Using vehicles that can accommodate seniors’ mobility challenges: Using 

vehicles that accommodate the mobility challenges of seniors—such as 

purchasing low-floor buses,48 equipping vehicles with lifts, or modifying 

vehicles to make them identifiable and visually appealing (by using buses 

with distinctive colors to designate specific routes or with large 

see-through windows)—may help address some of the physical challenges 

(such as difficulties boarding a bus or van) and emotional challenges (such 

as concerns about boarding the wrong bus or personal safety) that seniors 

may face while using public transportation. For example, the TCRP report 

states that low-floor buses provide advantages over conventional buses 

because they shorten the distance between the first step on the bus and the 

curb (e.g., the first step on a conventional bus is approximately 9 to 12 

inches above the curb, whereas the first step on the latest low-floor buses 

is less than 3 inches above the curb). However, there may be constraints in 

using such buses—one service provider we interviewed found them 

impractical for the provider’s service area, which contains hilly terrain49

and many narrow streets. The majority of service providers we interviewed 

use lift-equipped50 vehicles to transport seniors who use wheelchairs. 

Several of the service providers are also using vehicles that are easily 

identifiable and visually appealing to further address concerns seniors may 

have about using public transportation. For example, several of the service 

providers we interviewed said that they transport seniors in vehicles that 

are color-coded to designate specific routes or that have large, nontinted 

windows to limit the confusion that seniors face while trying to determine 

which bus to board, to provide a sense of personal security, and to 

“demystify” public transportation for seniors.

Increasing level of service: According to the TCRP report, increasing 

overall service levels is vital to meeting the mobility needs of a growing 

senior population. Some of the local service providers we interviewed said 

that the practices they implemented allowed them to improve their services 

48Low-floor buses are public transit vehicles designed to ensure that passengers can board 

the vehicle using one step relatively low to the ground or sidewalk. Most of the floor space 

within the vehicle will be at the level of the initial entry.

49Ramps on low-floor buses are manufactured for deployment on level ground.

50Lift-equipped vehicles are public transit or agency vehicles that incorporate retractable 

mechanical platforms that are capable of lifting individuals who need a means of access into 

the vehicle other than the use of stairs from the ground to the level of the floor of the 

vehicle. Such individuals may include people who use wheelchairs or have other mobility 

limitations.
Page 38 GAO-04-971 Transportation-Disadvantaged Seniors

by expanding service hours for life-sustaining trips (as much as their 

funding allows), accommodating all requests as they arise (even if that 

means temporarily modifying a route), and expanding services to include 

life-enhancing trips (e.g., field trips sponsored by senior centers and trips 

to a therapeutic warm-water pool program). For example, a MEOC official 

told us that the provider expanded its service from 8 hours to 12 hours per 

day on weekdays to provide transportation for life-sustaining trips (e.g., 

medical appointments), and that the agency plans to modify an existing 

route to provide service regardless of how little notice is given. MEOC’s 

computer scheduling system enables dispatchers to radio the nearest 

driver and ask him or her to modify the current route to fit in an extra 

pick-up or drop-off. In another example, Gold Country Telecare, a 

nonprofit agency that provides accessible specialized transportation in 

rural northern California, learned through interviews with others in the 

local community involved in senior transportation that seniors were often 

isolated on weekends, when transportation services were rarely available 

for them. To address this need, the agency increased its service level by 

implementing an all-day Sunday transportation service for seniors to get to 

church or other activities, such as grocery shopping. 

Improvements to Leverage 

Available Funds

Increasing volunteer involvement: According to the TCRP report and the 

Innovations Brochure, volunteer involvement may lead to cost savings in 

delivering transportation services to seniors by reducing the need for paid 

staff. The local service providers we interviewed used volunteers in a 

variety of ways. For example, Gold Country Telecare implemented a 

volunteer driving program under which volunteers are reimbursed for 

mileage expenses incurred in using their personal vehicles to transport 

seniors to medical and health treatment facilities located in a nearby urban 

center. According to a Gold Country Telecare official, this program allows 

seniors to participate in health therapies or medical services not found in 

their rural community. OATS, Inc., a transportation service provider in 

Missouri, uses volunteers who act as dispatchers, taking calls in their 

homes from people in the community who need trips. The volunteers 

transfer requests to the driver, who then schedules the trips. The use of 

volunteers allows OATS to provide more cost-effective and more frequent 

service by avoiding the administrative expense of having an office in each 

of the 87 counties it serves. Furthermore, according to an OATS official, the 

value of the volunteer hours (including the in-kind allowance for the use of
Page 39 GAO-04-971 Transportation-Disadvantaged Seniors

their personal telephones and space in their home) translates into 

approximately $1.6 million in cost savings per year.51

Forging partnerships with private and public entities: The TCRP report

suggests forging financial partnerships with public and private entities in 

the community to address funding concerns and to diversify funding 

sources. Several of the local service providers we interviewed developed 

private/public partnerships such as (1) contracts with private entities to 

engage in revenue-enhancing activities, such as using the service providers’ 

vehicles to transport other groups when the vehicles were not being used 

for senior transportation or transporting seniors to specific locations, such 

as shopping sites, or (2) joint agreements with human service agencies to 

provide specialized services for clients who need additional assistance. For 

example, the Friendship Center contracts with private entities to provide 

shuttle services from employee parking to employment sites, from 

overflow parking lots to special event venues, to community churches on 

Sunday mornings, and other similar transportation services. According to 

center officials, these additional contracts for shuttle services bring in 

approximately $140,000 in additional annual revenue, which is being used 

to provide additional senior transportation services and represents 

approximately 15 percent of the center’s annual budget for senior 

transportation. Another local service provider that diversified its funding 

sources, Medical Motor Service, developed a partnership with a regional 

private supermarket to supplement its fund-raising efforts. Under this 

arrangement, Medical Motor Service receives approximately $300,000 in 

annual funding from the supermarket to transport seniors to and from the 

grocery store. This sum represents 18 percent of the provider’s annual 

senior transportation budget. As a result of this arrangement, seniors 

residing in 55 housing complexes have transportation for grocery shopping 

or for renewing medical prescriptions at any of the 14 supermarkets 

located in Monroe County. However, one trade-off in having an exclusive 

partnership with one grocery store chain is that, unlike seniors (and 

others) who can drive, seniors who rely on such a service do not have a 

choice of where to shop. In that regard, Special Transit, a local service 

provider in Boulder, Colorado, identified a need to diversify its funding 

sources to reduce dependence on any one source of funds, helping to 

ensure continuity of service for all of its clients, including seniors. To do so, 

it hired an outreach coordinator to identify other service providers in the 

community (such as senior day care programs, senior centers, and local 

51We did not verify this information.
Page 40 GAO-04-971 Transportation-Disadvantaged Seniors

hospitals) that were interested in having Special Transit provide 

transportation services. In addition, the coordinator was tasked with 

identifying opportunities for generating private donations. Through its 

partnerships, Special Transit reduced its dependence on public funding 

(including federal and local government grants and matching funds) from 

more than 80 percent of its total revenue sources in the mid-1980s to 

approximately 65 percent in 2004. Presently, Special Transit’s service 

contracts and private donations account for approximately 30 percent of its 

total revenues. 

Summary of Practices and 

Funding Sources

Table 3 provides examples of some of the practices and federal funding 

sources used by the local service providers we interviewed.52

Table 3: Practices Implemented and Funding Sources Associated with Selected Local Transportation Service Providers 

52See appendix III for additional information on the local service providers we interviewed, 

as well as information on some of the other service providers identified by the Beverly 

Foundation, Community Transportation Association of America, and TRCP report as having 

implemented practices to enhance senior mobility.

Practices

Provider name 

and associated 

federal funding 

sources Technology

Coordination 

of services

Training and 

safety

Vehicle 

modification

Service 

delivery

Volunteer 

involvement

Financial 

partnerships

Altoona Metro 

Transportation

• Section 5307 

• Section 5309

Driver 

sensitivity 

training 

program

Low-floor 

buses

Markets its 

services 

specifically to 

seniors

Senior 

companion 

volunteers 

promote 

“Bus-Buddy” 

program 

Friendship 

Center

• CSBG

• Section 5310 

• Title III-B

Computerized 

mapping 

system to 

schedule 

same-day 

service

Coordinates 

with medical 

facility staff to 

schedule 

medical 

appointments 

for seniors

Lift-equipped 

vehicles

Customerfocused 

organization

Uses vehicles 

after hours to 

increase 

revenue 

through 

contracted 

services 
Page 41 GAO-04-971 Transportation-Disadvantaged Seniors

Practices

Provider name 

and associated 

federal funding 

sources Technology

Coordination 

of services

Training and 

safety

Vehicle 

modification

Service 

delivery

Volunteer 

involvement

Financial 

partnerships

Gold Country 

Telecare, Inc.

• SCSEP

• Section 5310 

• Title III-B

Lift-equipped 

vehicles

Sunday 

transportation 

service and 

follow-up and 

preventive 

healthcare 

transportation 

services

Neighbor-toneighbor 

volunteer driver 

program

Medical Motor 

Service

• Medicaid

• Section 5310 

• Title III-B

Coordinates 

with other 

nonprofit 

agencies to 

provide senior 

shopping 

buddies

Wheelchairaccessible 

vehicles

Provides 

door-to-door 

escort service

Contracts with 

regional 

grocery chain 

to transport 

seniors for 

grocery 

shopping

Mountain 

Empire Older 

Citizens, Inc.

• Medicaid

• SCSEP

• Section 5310

• Section 5311 

• Title III-B

Coordinates 

transit system 

that provides 

door-throughdoor, 

one-on-one 

services to 

special needs 

populations

Lift-equipped 

vehicles

Customerfriendly and 

flexible service 

to meet the 

needs of a 

multicounty 

rural community

North County 

Lifeline

• Section 5307 

• Section 5310

Collaborates 

to establish a 

Web-based 

referral system 

to highlight 

transportation 

options for 

seniors and 

assist social 

service 

providers

Travel-Training 

Program 

teaches 

seniors how to 

use fixed-route 

transportation

Lift-equipped 

vehicles

OATS, Inc.

• CSBG

• JARC

• Rural Health

• Section 5310 

• Section 5311

• SSBG

• Title III-B

Use volunteers 

to fulfill 

functions such 

as dispatching 

calls to drivers, 

fund-raising, 

and serving as 

liaisons to the 

community

(Continued From Previous Page)
Page 42 GAO-04-971 Transportation-Disadvantaged Seniors

Legend: 

CSBG Community Services Block Grant Programs

JARC Job Access and Reverse Commute 

Rural Health Rural Health Care Services Outreach Program 

SCSEP Senior Community Service Employment Program

Section 5307 Urbanized Area Formula Program

Section 5309 Capital Investment Grants 

Section 5310 Capital Assistance Program for Elderly Persons and Persons with Disabilities

Section 5311 Nonurbanized Area Formula Program

SSBG Social Services Block Grants 

Title III-B Grants for Supportive Services and Senior Centers

Source: GAO analysis of interviews with local service providers and a review of the senior mobility literature.

Practices

Provider name 

and associated 

federal funding 

sources Technology

Coordination 

of services

Training and 

safety

Vehicle 

modification

Service 

delivery

Volunteer 

involvement

Financial 

partnerships

Special Transit

• Medicaid

• Section 5310

• Section 5311 

• Title III-B

Easy Rider 

Program 

teaches 

seniors how to 

use fixed-route 

transportation

Vehicles have 

large, 

nontinted 

windows to 

alleviate 

seniors’ safety 

concerns

“Friends and 

Family” mileage 

reimbursement 

program

St. John’s 

County Council 

on Aging

• JARC

• Medicaid

• Section 5310

• Section 5311

• Title III-B

Coordinates 

services with 

local transit 

authority and 

taxicab 

services 

Driver-training 

program that 

emphasizes 

safety and 

customer 

service

Vehicles are 

brightly 

decorated to 

attract senior 

ridership

Customerfocused 

organization

Sweetwater 

Transportation 

Authority

• CSBG

• Medicaid

• Section 5310

• Section 5311

Global 

Positioning 

Systems 

technology on 

vehicles to aid 

in accurate 

and automatic 

trip scheduling 

Coordinates 

transportation 

software with 

city and county 

emergency 

response 

transportation 

systems 

(Continued From Previous Page)
Page 43 GAO-04-971 Transportation-Disadvantaged Seniors

Local Practices Have 

Enhanced the 

Senior-Friendliness and 

Cost-effectiveness of 

Services

The implementation of these practices contributed to the improvement of 

senior transportation services by making them more senior-friendly, 

according to the 10 local service providers we interviewed. In particular, 

these practices collectively addressed the five A’s of senior-friendly 

transportation previously discussed—availability, accessibility, 

acceptability, affordability, and adaptability—as follows:

• The majority of service providers told us that they made transportation 

services readily available for seniors to get to needed medical locations.

• The 10 providers said that their services are tailored to ensure that 

seniors can access the vehicles: that is, pick-up locations are easy for 

seniors to walk to, one-on-one escort service is available to seniors who 

need special assistance, or lift equipment is installed in the vehicles.

• Several service providers stated that they use vehicles that are 

identifiable and visually pleasing to make sure their vehicles are 

acceptable to seniors. 

• Most of the service providers also indicated that their services are 

affordable because they are free to seniors or minimal donations are 

requested at the time of service.

• More than half of the service providers said that their services are 

adaptable and flexible enough to accommodate the service requests and 

the mobility limitations some seniors may have. 

In addition, the majority of the service providers we interviewed said that 

their organizations realized cost savings and increased the quality and 

quantity of service by implementing the practices. For example, as 

previously noted, the coordinated transportation service implemented by 

MEOC allowed lower per-unit costs, which also resulted in cost savings for 

all the agencies involved. According to a MEOC official, the cost savings 

allowed MEOC to increase the number of trips provided, increase the hours 

of operation, continue to afford dispatchers, hire more transportation 

managers, and provide adequate training for drivers—all of which 

translated into improvements in the quantity and quality of service to 

MEOC’s clients. 
Page 44 GAO-04-971 Transportation-Disadvantaged Seniors

Federal Programs Support 

the Implementation of 

Practices That Enhance 

TransportationDisadvantaged Seniors’ 

Mobility to Some Extent

According to the service providers we interviewed, the most common way 

in which federal programs support the implementation of practices that 

enhance transportation-disadvantaged seniors’ mobility is by providing 

funding. As previously noted, the 10 providers we interviewed use funds 

from at least 1 of the 15 key federal programs in implementing practices 

that enhance transportation-disadvantaged seniors’ mobility.53 (See table 3 

for the federal funding sources associated with each service provider.) We 

found that DOT’s Capital Assistance Program for Elderly Persons and 

Persons with Disabilities (Section 5310) and HHS’s Grants for Supportive 

Services and Senior Centers (Title III-B) and Medicaid Programs are the 

federal programs most often used by the 10 providers we interviewed, 

followed by DOT’s Nonurbanized Area Formula Program (Section 5311) 

and HHS’s Community Services Block Grant Programs. 

According to some of the service providers, the federal programs had both 

a direct and an indirect role in providing technical assistance for the 

implementation of practices to enhance transportation-disadvantaged 

seniors’ mobility. In some cases, federal programs provided direct technical 

assistance (by providing information on how to apply for program funding 

or how to implement the service or by providing contact information for 

other resources) through program representatives or through the 

program’s Web site. Several providers stated that, as grantees, they 

obtained technical assistance from DOT’s Intelligent Transportation 

Systems (ITS) program,54 which assigned consultants to their organizations 

to provide assistance in selecting software and hardware and developing 

requests for proposals. One service provider further added that he found 

DOT’s ITS program Web site to be useful in obtaining information on best 

practices and on other technology-related resources. Another service 

provider received technical assistance through both Federal Transit 

Administration representatives and the state’s transit association on how to 

obtain funding through the Job Access and Reverse Commute Program. In 

53The service providers said that in addition to federal funds, they also use other government 

funding sources (e.g., from state, county, transit districts, and municipalities) to fully fund 

all the services provided.

54DOT’s ITS program offers technology-based systems intended to improve the safety, 

efficiency, and effectiveness of the surface transportation system. One objective of the ITS 

program is to promote the implementation of a technically integrated and coordinated 

transportation system across the country. The service provider in this example received ITS 

program funding to coordinate its transportation software with city and county emergency 

response transportation systems.
Page 45 GAO-04-971 Transportation-Disadvantaged Seniors

other cases, some providers stated that the federal government indirectly 

provided guidance or technical assistance. For example, guidance on 

implementing practices and marketing services to the senior community 

was provided through federally funded professional organizations, such as 

the Community Transportation Association of America and the National 

Academy of Sciences’ Transportation Research Board.

Other service providers we interviewed told us that the federal programs 

did not provide assistance (other than funding) or guidance on 

implementing practices to enhance transportation-disadvantaged seniors’ 

mobility, so they had to look to other state and regional transit agencies or 

other local transportation service providers to provide guidance or 

technical assistance. One service provider said that it researched and 

sought out other mobility management programs and travel-training 

programs to learn how to implement such programs, because this 

information was not available from federal or state agencies. Several 

providers told us that finding information on successful practices for 

enhancing transportation-disadvantaged seniors’ mobility required 

considerable staff time and other resources, and that a centralized 

source—particularly a Web-based source—for such information would be 

useful. Many of the providers suggested that providing such a Web site 

would be an appropriate role for the federal government. AOA, the lead 

federal agency for coordinating programs for seniors and the dissemination 

of information relevant to seniors, has some transportation information 

available on its Web site, but there are some limitations to this information, 

as discussed in more detail in the section below on senior mobility 

obstacles and strategies.

Local Transportation 

Service Providers Continue 

to Face Difficulties in 

Implementing Practices 

That Enhance 

TransportationDisadvantaged Seniors’ 

Mobility

According to the local providers we interviewed, certain characteristics of 

federal programs can impede the implementation of practices that enhance 

transportation-disadvantaged seniors’ mobility. Although federal programs 

provide financial support for practices that enhance senior mobility, an 

expert in senior mobility and several service providers stated that receiving 

federal funds entails burdensome reporting requirements. Often, the local 

service providers receive funding from several federal programs with 

different reporting requirements and therefore have to submit several 

different reports calling for different data. One provider stated that 

submitting all of the required documentation for DOT’s Capital Assistance 

Program for Elderly Persons and Persons with Disabilities (Section 5310) 

and HHS’ Grants for Supportive Services and Senior Centers (Title III-B) 

Program necessitated the dedication of 720 administrative hours each year 
Page 46 GAO-04-971 Transportation-Disadvantaged Seniors

(equivalent to over $10,000), costing the provider more in administrative 

costs than the actual funding received through the federal programs.55

Another service provider we interviewed said it has designated about 1,690 

administrative hours annually to complying with the reporting 

requirements of the Title III-B program, Medicaid, and DOT’s Congestion 

Mitigation and Air Quality Improvement Program,56 including doing such 

tasks as tracking the different data requested by each program, organizing 

documents, and following up on required information. 57 The provider 

noted that the 1,690 hours (equivalent to about $60,000 in costs) 

represented a significant portion (14 percent) of the total federal program 

funding received under those programs.58 Federal officials have told us that 

the Coordinating Council on Access and Mobility—a federal body, 

consisting of representatives from 10 federal agencies, including the 

Departments of Education, Labor, Health and Human Services, 

Transportation, and Veterans Affairs, that is charged with coordinating 

transportation services provided by federal programs and promoting the 

maximum feasible coordination at the state and local levels—is examining 

possible ways to streamline reporting requirements of the various federal 

programs that fund transportation for disadvantaged populations. Council 

officials said that a paper addressing this issue will be developed and 

presented in 2004 or early 2005.

Some of the local providers said that federal guidance on how to apply for 

funding and comply with reporting procedures is limited. For example, one 

service provider stated that it has not received technical guidance from 

DOT that explains the funding process for the Urbanized Area Formula 

55We did not verify this information.

56The service provider told us that it uses Congestion Mitigation and Air Quality 

Improvement Program funds for a senior travel-training program, designed to reduce the 

amount of single-occupancy vehicle emissions by helping seniors use public transportation 

(fixed routes). The Congestion Mitigation and Air Quality Improvement Program, authorized 

by the Transportation Equity Act for the 21st Century, is designed to reduce motor vehicle air 

pollution. It is a flexible funding source for state and local governments for transportation 

projects and programs to help meet the requirements of the Clean Air Act. Eligible activities 

include transit improvements and travel demand management strategies, among others. 

57The service provider told us that this estimate includes the administrative (management 

and clerical) time spent on gathering, checking, and reporting data for federal programs. 

The estimate does not include time spent writing grants or any time spent directing, 

providing, or supporting the services funded by these programs. We did not verify this 

information.

58We did not verify this information.
Page 47 GAO-04-971 Transportation-Disadvantaged Seniors

Program (Section 5307). Instead, the provider contacted other local 

nonprofit organizations to seek their technical assistance in understanding 

the funding process, but the funds were delayed in the meantime. The 

provider said that it contacted local DOT representatives but was unable to 

determine the cause of the delay in funds. As a result, the provider said that 

it had to convince its nonprofit board of directors to continue to provide 

services without the promised federal funds so that seniors would still have 

transportation services available. 

Lastly, several of the service providers perceive that program guidelines are 

rigid and lack flexibility, although the federal officials we contacted 

disagreed with the providers’ interpretations. For example, one provider 

stated that the program guidelines for DOT’s Nonurbanized Area Formula 

Program (Section 5311) are very rigid in that the funds may only be used for 

transportation for the general public. The service provider stated that the 

Section 5311 guidelines require it to track the type of passenger who 

requests demand-response service and the trip destination. If a senior 

requests transportation to a senior center or any other human service 

program destination, the service provider told us it must find another 

funding source (e.g., Title III-B) for that trip because Section 5311 funding 

is designated for general rural transportation services and not specialized 

services. However, a DOT official told us that rural transit providers 

receiving Section 5311 assistance may transport a senior to a senior center 

if the service is also made available to the general public. 

Experts and 

Stakeholders 

Suggested Strategies 

for Overcoming 

Mobility Obstacles

Through a review of the literature and interviews with experts on senior 

transportation and aging, representatives of pertinent professional 

associations and advocacy groups, local officials, and transportation 

service providers, we identified several obstacles to addressing 

transportation-disadvantaged seniors’ mobility needs and potential 

strategies that the federal government and other government levels, as 

appropriate, can consider taking to better address those needs and 

enhance the cost-effectiveness of the services delivered. We grouped these 

obstacles and strategies around three themes: (1) planning for alternatives 

to driving as seniors age to extend the lifespan of their mobility, (2) 

accommodating seniors’ varied mobility needs, and (3) leveraging federal 

and other government funding to better use limited resources. The 

suggested strategies for addressing obstacles to senior mobility involve 

certain trade-offs, and these obstacles, strategies, and trade-offs are 

discussed in each of the following sections.
Page 48 GAO-04-971 Transportation-Disadvantaged Seniors

Helping Seniors Plan for 

Alternatives to Driving 

Could Increase the Lifespan 

of Their Mobility Figure 5: First Set of Obstacles, Strategies, and Trade-Offs Associated with Meeting 

Transportation-Disadvantaged Seniors’ Mobility Needs, as Identified by Experts and 

Stakeholders

Seniors who have relied on driving as their primary mode of transportation 

may experience a sharp decline in mobility if their driving becomes limited 

or ceases. In addition, some seniors may continue to drive even when it is 

no longer safe for them to do so because they do not have, or do not know 

about, alternative transportation options. In focus groups conducted by 

AARP, few participants indicated that they had ever thought about giving 

up driving in advance of doing so. Sixty percent of the seniors surveyed in 

another study thought they would get a ride from family members or 

friends when they could no longer drive themselves. Several experts have 

reported that seniors and their caregivers are not sufficiently 

encouraged—by federal and other government entities, family members 

and other caregivers, the medical profession, and others—to identify and 

use multiple transportation modes for their routine trips. As a 

consequence, seniors may perceive that driving is their only viable option, 

and they may become isolated or risk driving when it is unsafe for them to 

do so. 

Source: GAO.

OBSTACLE

Seniors and their caregivers are 

not sufficiently encouraged to 

plan for driving alternatives.

STRATEGY

Facilitate a gradual transition 

from driver to nondriver and 

incorporate additional modes 

into seniors' daily travel 

routines.

TRADE-OFF

More seniors would be able to maintain mobility while 

refraining from unsafe driving, but increased demand would 

likely stress the already stretched transportation programs.
Page 49 GAO-04-971 Transportation-Disadvantaged Seniors

For the large number of seniors who routinely drive, experts and local 

service providers have suggested ways to facilitate a gradual transition 

from driver to nondriver and to incorporate additional transportation 

modes into seniors’ daily travel. Advocacy groups, such as AARP, have 

found that seniors have a strong preference for driving as their primary 

mode of transportation, and the transition from driver to nondriver may be 

particularly challenging for seniors as they age. While some types of 

driver-screening programs are currently available in some communities,59

the federal government could make them more widely and consistently 

available by supporting or encouraging state governments to implement 

such programs to help seniors and their caregivers assess their driving 

abilities. Seniors could also be offered—through new and existing 

programs—additional training, physical therapy, or adaptive equipment to 

address weaknesses identified in the screening (e.g., larger rear-view 

mirrors and pedal extenders can help seniors who have difficulty turning 

their heads or reaching the pedals). AOA officials told us that they have 

historically worked with AARP’s Mature Driving Program, the American 

Automobile Association, and others to provide support to seniors in 

addressing their driving abilities, but that sustaining an effort in this area 

would likely require new funding. DOT’s National Highway Traffic Safety 

Administration (NHTSA), in partnership with other federal agencies, the 

American Occupational Therapy Association, the American Society on 

Aging, and others, has begun promoting some programs to help seniors 

extend the lifespan of their mobility by making driving choices that 

maximize their personal and community safety and using transit before it is 

their only transportation option. For example, NHTSA is pilot testing a 

social marketing program to increase awareness of senior transportation 

challenges and options. In each of the test sites, community groups have 

surveyed people aged 65 and older regarding their perceptions about safer 

driving behaviors, other modes of transportation, and how easy or difficult 

it is for them to get around in their communities. The groups then 

publicized the survey results and initiated a community discussion about 

how to help people remain safely mobile and active as they age. According 

to a NHTSA official, a final report with a prioritized set of 

recommendations and a booklet containing materials tested by the 

community groups will be prepared later this year.

59U.S. Department of Transportation, Transportation Research Board, Transportation in an 

Aging Society: A Decade of Experience (Washington, D.C.: 2004).
Page 50 GAO-04-971 Transportation-Disadvantaged Seniors

Experts, advocacy groups, and local officials have also suggested providing 

a continuum of services to accommodate different trip purposes and 

different levels of need. Such services could include safety programs for 

older drivers; ridesharing information; and public transportation and 

paratransit options,60 including escorts and financial assistance. The 

federal government is currently developing ways to support informed 

driving choices and encourage state and local agencies to provide 

information on the alternative transportation options available to seniors 

who can no longer safely drive or are not comfortable driving in certain 

conditions, such as at night or in poor weather. For example, NHTSA (in 

conjunction with the American Society on Aging) has developed Web-based 

seminars to help seniors and their families make appropriate driving 

choices that maximize their personal and community safety. These 

seminars can also help communities maximize seniors’ mobility options. In 

addition, the Easter Seals Caregiver Project (funded by the Federal Transit 

Administration and AOA) has developed a template for identifying all of the 

transportation options that are available to seniors in a typical community. 

The template is designed to help seniors and their caregivers know what 

services are available to them and to help service providers, caseworkers, 

and city and county planners assess transportation options and identify 

gaps in transportation services. Experts also suggested a publicity 

campaign to raise awareness about the importance of planning for seniors’ 

future mobility needs, as well as training programs for seniors on how to 

access the transportation modes available in their communities. 

Local service providers and an expert suggested that the Internet could be 

a valuable resource in disseminating information. For example, one local 

service provider collaborated to develop a Web-based database of 

transportation options for seniors in its service area, which reduced 

duplication in referral services and provided comprehensive and current 

information on transportation options to stakeholders and seniors. The 

service provider stated that the result was an interactive, user-friendly Web 

site that provided seniors with appropriate, individualized information on 

transportation and referral services and enabled social service 

organizations, healthcare agencies, community groups, and caregivers to 

locate information on transportation options. Such information could also 

be available in document format for those seniors and organizations that 

60Paratransit often refers to wheelchair-accessible, demand-response van service. The ADA 

requires that transit operators provide accessible paratransit service for persons with 

disabilities that is comparable to their regular service.
Page 51 GAO-04-971 Transportation-Disadvantaged Seniors

prefer not to use the Internet or do not have access to it, although experts 

suggest that future generations of seniors will be progressively more 

familiar and comfortable with technology, especially as the “baby boomers” 

join the senior population.

The trade-off in encouraging driver-screening programs and publicizing 

alternative transportation options is that these strategies would increase 

their use. Such an increase would have both positive and negative results. 

According to experts and local aging officials, more demand would put 

additional pressure on already stretched transportation programs, but also 

would mean that more seniors are able to access the services available to 

them or are not driving when it is unsafe for them to do so.
Page 52 GAO-04-971 Transportation-Disadvantaged Seniors

Growing Senior Population 

Could Benefit from Policies 

That Accommodate Its 

Varied Needs Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs Associated with 

Meeting Transportation-Disadvantaged Seniors’ Mobility Needs, as Identified by 

Experts and Stakeholders

The mobility needs of seniors vary, depending on differing mobility 

limitations they may experience and the reasons they may need 

transportation (such as for work, volunteer activities, medical 

appointments, and recreation). However, according to experts, advocacy 

groups, and local officials, traditional transportation services are not 

always designed to meet those varied needs of seniors, particularly 

transportation-disadvantaged seniors. The health and mobility limitations 

that prevent seniors (particularly seniors aged 85 and older) from driving 

may also present obstacles when they use public transit, paratransit,

Source: GAO.

OBSTACLE 

Many policies do not address seniors' 

varied needs, including differing 

mobility limitations and diverse trip 

purposes.

STRATEGY 

Focus on seniors' range of 

needs to improve alternatives 

to driving.

STRATEGY 

Include seniors in planning for 

their immediate and future 

mobility needs.

TRADE-OFF

Providing additional services or modifying vehicles can be 

expensive, but may cost less than the alternatives, such as 

paratransit services.

TRADE-OFF

Including more stakeholders in transportation planning could 

slow the process, but doing so may be worth the time if it 

results in seniors' enhanced mobility.
Page 53 GAO-04-971 Transportation-Disadvantaged Seniors

taxicabs, and other transportation options.61 Many seniors also live in 

suburban and rural areas that are not easily served by traditional 

fixed-route transit. In addition, approximately half of the key federal 

programs for senior transportation fund services only for specific 

destinations, such as medical appointments (rather than for life-enhancing 

needs), which tend to occur during normal business hours. Life-enhancing 

trips are often needed on evenings (e.g., to a concert) or weekends (e.g., to 

religious services) when many paratransit and other specialized 

transportation services for seniors are not available. According to one 

professional association, the limited amount of funding provided through 

HHS’s Title III-B program, which senior centers use to provide 

transportation, has meant that providers are often unable to provide 

life-enhancing trips and restrict service to only medically necessary trips. 

Finally, as indicated by the data previously discussed, most seniors prefer 

to travel in private automobiles, which offer greater comfort and flexibility 

than conventional vans and buses, but many federally funded services for 

transportation-disadvantaged seniors provide only bus or van travel. 

Experts suggested that if conventional vans and buses are modified to offer 

greater comfort and flexibility, they may appeal to seniors in much the 

same way as private automobiles.

According to federal officials and experts, many federally funded programs 

are intended for seniors who do not drive at all and need assistance all of 

the time. However, many seniors do not qualify for the federally funded 

transportation programs in their communities because they require 

transportation assistance only under certain circumstances, such as in bad 

weather or when a medical condition is aggravated. Experts, advocacy 

groups, and local officials proposed (1) improving conventional public 

transit services to better accommodate transportation-disadvantaged 

seniors’ needs and (2) familiarizing seniors with transit options while their 

health is favorable so they feel more comfortable using transit as they age 

and require the adaptability that transit can provide. To accomplish this, 

several suggested that the federal government, or other government levels 

as appropriate, provide incentives for transit agencies to restructure routes 

to encompass areas where seniors travel or live and improve the safety and 

security of waiting areas and vehicles. Additionally, several proposed that 

61However, to improve services for all citizens, including seniors, public transportation 

systems often provide special programs, such as a half-fare policy for seniors, low-floor or 

lift-equipped buses for anyone who requests this service, and ADA-complementary 

paratransit for those who are eligible.
Page 54 GAO-04-971 Transportation-Disadvantaged Seniors

government agencies encourage service providers to provide training for 

transit operators on how to better serve seniors, as well as training for 

seniors on how to use transit and the other transportation options available 

to them. Although such changes could be expensive, several experts 

countered that they might be less expensive than the alternatives (i.e., 

providing individual paratransit service or providing emergency medical 

care or nursing home care).

To accommodate both the immediate and long-term mobility needs of the 

aging population, experts and advocacy groups suggested that seniors’ 

needs be considered in the transportation-planning process. They 

suggested that the federal government encourage or require metropolitan 

planning organizations (MPO) to evaluate the impact of transportation 

systems on seniors’ mobility; include seniors when developing the 

transportation improvement plan (currently, interested parties are given 

opportunities to comment on transportation plans, but they are not 

necessarily included in the planning process); and consider the 

accessibility of transit facilities to pedestrians. For example, seniors could 

advocate for safe walking routes to transit stops and for the use of 

low-floor buses (which are accessible to both wheelchair users and people 

with other mobility impairments). Currently, AOA is working with the 

Community Transportation Association of America and the Federal Transit 

Administration to develop guidance for AAAs and MPOs on considering 

seniors’ mobility needs in the transportation-planning process. 

Additionally, a local government official proposed that DOT should hold 

MPOs accountable by ensuring that senior mobility needs are considered in 

their transportation plans. One senior mobility expert acknowledged that 

including more groups in the planning process can slow that process down, 

but she said that it would be worth taking additional time if the planning 

ultimately results in enhanced mobility for seniors.
Page 55 GAO-04-971 Transportation-Disadvantaged Seniors

Resources Are Limited, but 

Strategies Exist to Leverage 

Them

Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs Associated with Meeting 

Transportation-Disadvantaged Seniors’ Mobility Needs, as Identified by Experts and 

Stakeholders

The conflict between meeting the mobility needs of 

transportation-disadvantaged seniors and addressing the financial burden 

of providing services to meet these needs was evident in the literature and 

interviews. Officials and experts reported that funding constraints inhibit 

local agencies’ abilities to address transportation-disadvantaged seniors’ 

Source: GAO.

OBSTACLE

Funding constraints inhibit local 

agencies' abilities to address 

seniors' needs.

STRATEGY

Increase funding for senior 

transportation programs and 

improve funding flexibility.

STRATEGY 

Share information and sponsor 

demonstration projects.

STRATEGY 

Improve coordination of 

transportation services.

TRADE-OFF

Increased funding would expand services, but funds would 

have to come from new revenues or other programs.

TRADE-OFF

Increasing funding flexibility can decrease program 

accountability and decrease coordination and 

communication among local agencies.

TRADE-OFF

Coordination requires sustained commitment and 

leadership, but can lead to improved cost-effectiveness.
Page 56 GAO-04-971 Transportation-Disadvantaged Seniors

needs. Some suggested increasing funding for senior transportation 

programs and improving funding flexibility. Others said the government 

could facilitate the sharing of information between providers, sponsor 

demonstration projects, and improve the coordination of transportation 

services.

Increasing Funding and Using 

Volunteer Drivers

Experts, advocacy groups, and local providers suggested increasing 

funding for public transit and paratransit as well as for transportation 

services specifically designated for seniors, persons with disabilities, and 

rural areas. Additional funding for public transit and paratransit could 

enable the expansion or improvement of services to benefit both the 

general public and seniors who depend on those services. Experts and 

advocacy groups have reported that operators of paratransit 

demand-responsive, curb-to-curb services have been adhering more tightly 

to ADA eligibility criteria in the face of financial constraints, leading to a 

decrease in paratransit services for non-ADA-eligible seniors. One DOT 

official said that very few urban transit providers can provide specialized 

transportation to non-ADA-eligible seniors because of the high operating 

costs for ADA-complementary paratransit. An increase in federal funds 

would allow providers to expand their level of service; however, any funds 

for such programs would likely have to come either from new revenues or 

from other federal programs.

Federal and local officials and advocacy groups have also suggested the 

use of volunteer drivers to expand transportation options for 

transportation-disadvantaged seniors. However, local service providers 

report that finding insurance to cover community-based transportation or 

volunteer driver programs is difficult, and the cost of such insurance is 

rising. Several service providers told us that they had difficulty recruiting 

volunteer drivers because of liability issues, such as concern over being 

responsible for expenses that were beyond their personal insurance limits 

in the event of an accident. One provider overcame these liability concerns 

by obtaining insurance coverage through a nonprofit insurance 

organization that would provide liability coverage for volunteers to drive 

seniors to their medically related destinations. Several experts and 

advocacy groups suggested that the federal government could establish 

insurance pools for volunteer drivers or provide other incentives for 

volunteer programs. 
Page 57 GAO-04-971 Transportation-Disadvantaged Seniors

Increasing Funding Flexibility Local officials and advocacy groups have proposed allowing greater 

flexibility in the use of federal funds. According to several experts—as well 

local providers and agencies on aging—federal programs tend to specify 

that their funds can be used only to provide transportation to and from that 

program’s services, making it difficult to make effective use of 

transportation resources and coordinate with other service providers. 

Additionally, some federal programs require transportation providers to 

seek two separate sources of funding—one for capital and one for 

operating costs—which can be burdensome, especially for small 

nonprofits, according to one national senior advocacy organization. For 

example, funds from DOT’s Capital Assistance Program for Elderly Persons 

and Persons with Disabilities (Section 5310) generally cannot be used for 

operating costs, such as driver salaries, gas, insurance, and maintenance, 

and these costs can be considerable.62 With operating costs more 

burdensome than they have been in the past (i.e., higher prices for gas and 

liability insurance), a local provider and several advocacy groups have 

suggested allowing DOT’s Section 5310 funds to be used for operating 

expenses.63 However, DOT officials cautioned that such a change could 

decrease coordination among local providers because the current need to 

seek operating funds from different sources results in increased 

communication among local agencies. Another trade-off is that increasing 

funding flexibility can decrease accountability because there is less 

assurance that the funds will be used for their intended population. 

However, another way that an official from a national transportation 

association and a local service provider suggested the federal government 

can increase flexibility is by allowing in-kind services, such as the use of 

volunteers, to count as part of the required state/local contribution for 

federal programs. Some federal programs, such as the Department of 

Education’s Independent Living Services for Older Individuals Who Are 

Blind program and HHS’s Title III-B program, currently allow this, while 

others do not. Several advocacy groups and experts also suggested 

encouraging or allowing federal funds to be used for vouchers for informal 

volunteer driver programs or taxicabs. (DOT’s Capital Assistance Program 

for Elderly Persons and Persons with Disabilities (Section 5310) and 

Nonurbanized Area Formula Program (Section 5311) funds can be used for 

vouchers, although one expert says they rarely are.) One study found that 

62According to DOT officials, Section 5310 funds can be used for operating expenses when 

an agency contracts for services.

63A provision allowing this is in the House’s bill for reauthorization of surface transportation 

legislation (H.R. 3550), though not the Senate’s (S. 1072).
Page 58 GAO-04-971 Transportation-Disadvantaged Seniors

voucher programs were less expensive than the direct provision of 

transportation services. This strategy would also address the obstacle 

about policies that do not address transportation-disadvantaged seniors’ 

mobility needs, previously discussed, because seniors could be transported 

in private automobiles rather than in buses or vans.

Sponsoring Demonstration 

Programs and Identifying Best 

Practices

According to experts, advocacy groups, and local officials, no coordinated 

senior transportation policy exists at the national level, so there is no 

federal funding stream for local demonstration projects, no lead agency or 

resource for information on best practices, and limited coordination among 

federal programs. In response, the experts and officials suggested that the 

federal government sponsor demonstration programs, perhaps through the 

Federal Transit Administration, or share information about innovative 

programs targeted to meet seniors’ needs and use creative local 

partnerships. For example, AOA officials told us that they have an ongoing 

project to identify best practices in implementing each of the elements in 

the Framework for Action (a coordination self-assessment tool for states 

and communities),64 such as identifying cost-sharing arrangements and 

determining technology needs for coordination of services for 

transportation-disadvantaged populations, including seniors. In addition, 

the Senate bill for reauthorization of surface transportation contains a 

provision creating a national technical assistance center for senior 

transportation to be run by a national nonprofit organization.65 Among 

other activities, the technical assistance center would gather and distribute 

information on best practices in senior transportation, create a Web site 

and central clearinghouse for information on senior mobility, and award 

demonstration grants.

Providing an Information 

Clearinghouse

Experts, advocacy groups, and local officials said that the federal 

government could use its prominence and visibility to provide a central 

clearinghouse for information on successful practices to enhance senior 

mobility and improve the cost-effectiveness of services. They said that such 

a clearinghouse could serve as a national technical assistance center where 

local aging officials, service providers, and others can exchange effective 

64The Framework for Action was developed by the Departments of Health and Human 

Services, Labor, and Transportation as a tool for states and communities to identify areas of 

success and highlight the actions still needed to improve the coordination of human services 

transportation.

65The House bill for reauthorization of surface transportation does not contain such a 

provision.
Page 59 GAO-04-971 Transportation-Disadvantaged Seniors

program models for senior transportation. They also suggested that the 

Internet could be a valuable tool in establishing a clearinghouse to store 

and share information, including information about successful practices 

and about efforts that federal agencies are taking to enhance senior 

mobility. For example, both the Beverly Foundation and the American 

Automobile Association’s Foundation for Traffic Safety use their Web sites 

to distribute information related to programs of excellence and leading 

practices in providing transportation for seniors, but the audiences for 

these Web sites may not be as broad as for federal Web sites. 

Although AOA’s Web site contains transportation information, most of the 

information is for providers rather than for seniors. For service providers 

and other professionals, there is a transportation page containing links to 

other organizations’ Web sites (such as the Beverly Foundation and the 

Community Transportation Association of America) for information on 

promising practices for improving senior transportation, research and data 

on senior transportation, and other topics. For seniors and their families, 

there is a senior transportation “fact sheet” containing some statistical 

information on senior demographics and travel patterns as well as 

information on AOA’s ongoing coordination activities with the Federal 

Transit Administration. The site directs seniors and their caregivers to 

contact their local AAAs or AOA’s Eldercare Locator Service for more 

information on transportation services available. However, our interviews 

with experts and local service providers suggest that people may not know 

about AOA’s transportation information page or think of the AOA’s Web site 

as a central forum for senior transportation-related information. Federal 

Transit Administration officials told us that the Coordinating Council on 

Access and Mobility is working to ensure that there is a “one-stop” federal 

Web site on programs, policies, and resources available to assist 

communities and states in implementing and enhancing human service 

transportation services for seniors, persons with disabilities, and lower 

income populations. The site would include links to specific federal 

programs addressing the needs of these specific populations. 

Facilitating Coordination Experts, advocacy groups, and local officials suggested facilitating the 

coordination of services at all levels of government. The federal 

government could encourage states to coordinate the transportation 

components of senior programs with other highway and public transit 

planning processes. For example, DOT’s Capital Assistance Program for 

Elderly Persons and Persons with Disabilities (Section 5310) and 

Urbanized and Nonurbanized Area Formula Programs (Section 5307 and 

Section 5311) require that projects be the result of “maximum feasible 
Page 60 GAO-04-971 Transportation-Disadvantaged Seniors

coordination” with other federally funded transportation services. The 

federal government could also encourage or require the creation of a 

central coordinated planning entity in metropolitan areas that would allow 

nonprofit organizations and government agencies to collaborate and 

maximize routes for senior vans and buses. As previously noted, experts 

have suggested that seniors should be represented in such 

transportation-planning bodies so that their mobility needs are considered 

in the decision-making process.

Although we found in the past that federal efforts to coordinate services for 

transportation-disadvantaged populations were limited,66 we recently 

reported that the Coordinating Council on Access and Mobility had taken 

significant steps to improve coordination among federal agencies.67 These 

steps included developing a tool to help states and communities assess 

their coordination efforts and providing information on best practices in 

coordinating medical transportation services. The council expanded its 

original membership—DOT and HHS—to include additional federal 

agencies, such as the Departments of Labor and Education, that administer 

significant programs for seniors.68

The council used to have a work group—headed by AOA and the Federal 

Transit Administration—for coordinating senior mobility issues, but 

council members told us that the council has recently changed its 

approach, integrating the population-specific work groups (seniors, 

persons with disabilities, etc.) into cross-cutting groups that will address 

specific obstacles to coordination. For example, in our previous and 

current work, experts and advocacy groups suggested that legislating 

uniform cross-program reporting requirements could be a means to both 

facilitate coordination and make it easier for small local providers to 

access federal funds. As previously mentioned, the council’s work group 

will address the issue of simplifying federal grant reporting requirements 

and administration procedures and propose some potential solutions. 

Other work groups will address education and outreach for coordination, 

66GAO-03-697.

67GAO, Transportation-Disadvantaged Populations: Federal Agencies Are Taking Steps to 

Assist States and Local Agencies in Coordinating Transportation Services, GAO-04-420R

(Washington, D.C.: Feb. 24, 2004).

68An executive order, issued in February 2004, expanded the membership of the council to 

include an additional six agencies (the Social Security Administration and the Departments 

of Agriculture, Housing and Urban Development, the Interior, Justice, and Veterans Affairs).
Page 61 GAO-04-971 Transportation-Disadvantaged Seniors

allocation of costs among coordinating agencies, coordinated planning of 

human service transportation, and other issues. In addition, the 

Departments of Education, Health and Human Services, Labor, and 

Transportation recently launched a five-part coordination 

initiative—“United We Ride”—that is designed to help states and 

communities overcome obstacles to coordination. This initiative is 

designed to provide financial incentives for coordination and establish an 

interagency forum for communication. As we have mentioned in previous 

reports, coordination at all levels of government requires sustained 

commitment and leadership but can result in improved services for seniors 

and others.

Conclusions As the senior population doubles over the next 25 years, it will become 

increasingly important to target resources to the areas of greatest need and 

to know whether current methods and programs are working to reduce 

transportation-disadvantaged seniors’ unmet needs and improve their 

mobility and access to services. The 655 local area agencies on aging that 

are required to gather data to assess seniors’ needs for services could serve 

as valuable sources of information for federal agencies to use in program 

planning, evaluation, and resource allocation. However, without guidance 

from the Department of Health and Human Services’ Administration on 

Aging on assessing needs for services, including transportation, these local 

agencies are using a variety of methods—some less comprehensive than 

others—to assess seniors’ mobility needs. As a result, it is not possible to 

determine whether current programs are reducing unmet needs and 

improving transportation-disadvantaged seniors’ mobility and access to 

services. The Administration on Aging is now embarking on a 

comprehensive assessment of seniors’ needs for services that affords a 

good opportunity for the administration to help state and local agencies 

conduct and use the results of improved needs assessments.

The experiences of other federal agencies, such as the Department of 

Transportation, that have developed guidance for assessing or 

demonstrating needs for some of the programs they administer, such as the 

Job Access and Reverse Commute Program, could be useful in designing 

guidance for area agencies on aging to assess needs. The Coordinating 

Council on Access and Mobility is uniquely positioned to provide a forum 

for such a coordinated effort because all of the federal agencies that 

administer the key programs we identified are members, and many of these 

agencies are involved in the council’s efforts to improve mobility for all 

transportation-disadvantaged populations. As the agency designated by the 
Page 62 GAO-04-971 Transportation-Disadvantaged Seniors

Older Americans Act as the lead for gathering information on seniors’ 

needs for services, and as one of the original members of the council, the 

Administration on Aging is well-situated to lead a coordinated effort to 

design guidance for assessing seniors’ needs.

Not having information on alternatives to driving is an obstacle to both 

seniors and service providers. Without such information, seniors do not 

plan for a time when they can no longer drive, and providers waste time 

and money “reinventing the wheel” and become frustrated with federal 

programs. Some federal efforts, such as the community awareness pilot 

project implemented by the Department of Transportation’s National 

Highway Traffic Safety Administration, have already begun to address this 

obstacle, but the expected growth in the senior population will require 

broader efforts. As service providers and representatives from the 

advocacy groups and professional associations we interviewed said, an 

important role for the federal government would be to provide a central 

forum for comprehensive information on transportation services, perhaps 

through a centralized Web site that could enhance seniors’ awareness of 

available services and improve providers’ ability to serve them. Such a Web 

site would also be useful for publicizing activities the various federal 

agencies are undertaking to improve transportation-disadvantaged seniors’ 

mobility. Although the Administration on Aging (the federal focal point and 

advocacy agency for seniors) has a Web site with information on 

transportation services, most of this information is aimed at service 

providers rather than at seniors or their caregivers. Furthermore, many of 

the service providers and representatives from advocacy groups and 

professional organizations we interviewed did not seem to be aware of the 

presence of such information on the administration’s Web site. In addition, 

although seniors are increasingly comfortable using the Internet, there are 

still many who do not have access to, or are not at ease with, such 

technology. 

Recommendations for 

Executive Action

To help enhance transportation-disadvantaged seniors’ mobility by 

improving available information and guidance, we recommend that the 

Secretary of Health and Human Services direct the Administrator, 

Administration on Aging, to take the following four actions:

• To improve the value and consistency of information obtained from area 

agencies on aging on the extent to which transportation-disadvantaged 

seniors’ mobility needs are being met, the Administrator should develop 

guidance for assessing such needs by doing the following:
Page 63 GAO-04-971 Transportation-Disadvantaged Seniors

• Expand the scope of work in the administration’s planned evaluation 

of the Grants for Supportive Services and Senior Centers (Title III-B) 

program to include gathering and analyzing information on (1) 

definitions and measures of need; (2) the range of methodologies that 

area agencies on aging use for assessing seniors’ need for services, 

including transportation, and unmet needs; (3) leading practices 

identified in the needs assessments methodologies used by area 

agencies on aging; and (4) the kinds of guidance that area agencies 

on aging want from the administration and the states to help them 

perform their required needs assessments.

• Use the results of the administration’s evaluation of the Title III-B 

program, and input from the Coordinating Council on Access and 

Mobility of other federal agencies that fund transportation services 

for seniors, to develop and disseminate guidance to assist state and 

local agencies on (1) methods of assessing seniors’ mobility needs 

and (2) the suggested or preferred method for collecting information 

on gaps in transportation services.

• To help address the obstacles that seniors, their caregivers, and service 

providers face in locating information on available services and 

promising practices, the Administrator should do the following:

• Take the lead in developing a plan—in consultation with members of 

the Coordinating Council on Access and Mobility—for publicizing the 

administration’s Web site and Eldercare Locator Service as central 

forums for sharing information on senior transportation through 

workshops, annual meetings, and other outreach opportunities with 

seniors, their caregivers, and service providers. The plan should 

include steps for reaching out to seniors and providers who do not 

use or have access to the Internet to increase awareness of 

information available in hard copy or other format. 

• Work with members of the Coordinating Council on Access and 

Mobility to consolidate information about services provided through 

the participating agencies’ programs and to establish links from their 

programs’ Web sites to the administration’s transportation Web site 

to help ensure that other agencies (such as local transit agencies) are 

aware of, and have access to, such information. 
Page 64 GAO-04-971 Transportation-Disadvantaged Seniors

Agency Comments We provided the Departments of Education, Health and Human Services, 

Labor, Transportation, and Veterans Affairs with draft copies of this report 

for their review and comment. The Departments of Health and Human 

Services, Transportation, and Veterans Affairs agreed with the findings and 

conclusions in the report. The Department of Transportation also provided 

technical clarifications, which were incorporated as appropriate. The 

Department of Health and Human Services provided written comments on 

the draft of this report, which are presented in appendix IV. The 

department concurred with our recommendations. The Departments of 

Education and Labor said that they did not have any comments on the 

draft.

As arranged with your office, unless you publicly announce its contents 

earlier, we plan no further distribution of this report until 30 days after the 

date of this letter. At that time, we will send copies of this report to the 

appropriate congressional committees and to the Secretaries and other 

appropriate officials of the Departments of Education, Health and Human 

Services, Labor, Transportation, and Veterans Affairs. We will also make 

copies available to others upon request. In addition, the report will be 

available at no charge on the GAO Web site at http://www.gao.gov.

If you have any questions about this report, please contact me at 

siggerudk@gao.gov or at (202) 512-2834. Additional GAO contacts and staff 

acknowledgments are listed in appendix V.

Sincerely yours,

Katherine Siggerud

Director, Physical Infrastructure Issues
Page 65 GAO-04-971 Transportation-Disadvantaged Seniors

Appendix I

Scope and Methodology ApApenednxidexiIs

The scope of this report is limited to a review of the mobility needs of 

transportation-disadvantaged seniors, who we define as those who cannot 

drive or have limited their driving and who have an income constraint, 

disability, or medical condition that limits their ability to travel. In addition, 

because federal, state, and local programs have different age ranges for 

seniors (e.g., aged 55 and over, aged 65 and over), we do not use the term 

“senior” in this report to mean any specific age. We obtained statistics 

presented in the introduction and background of this report about seniors 

and their mobility from an article published in the American Journal of 

Public Health, the 2000 Census, the Aging States Project, and the Eldercare 

Locator Service; because this information is included as background only, 

we did not assess its reliability.

To identify federal programs that address transportation-disadvantaged 

seniors’ mobility issues, we asked experts who had participated in a senior 

mobility forum we moderated in July 20031

 to identify those federal 

programs that they consider key for providing transportation services to 

seniors who cannot drive or have limited their driving. We verified the 

resulting list of 15 programs with federal program officials. To assess the 

extent to which the 15 federal programs address each of the five A’s of 

senior-friendly transportation (as identified by the Beverly Foundation), we 

reviewed program legislation and guidance and interviewed federal 

officials and senior mobility experts. We also reviewed prior GAO reports 

on the coordination of transportation services for disadvantaged 

populations2

 and interviewed federal officials, senior mobility experts, and 

other stakeholders to identify additional ways in which the federal 

government addresses transportation-disadvantaged seniors’ mobility 

challenges.

To identify data that could tell us anything about the extent to which 

transportation-disadvantaged seniors’ needs are being met, we reviewed 

the literature on transportation, disability, and aging found in statistical

1

U.S. Senate Special Committee on Aging, “Forum: Keeping America’s Seniors Moving: 

Examining Ways to Improve Senior Transportation” (Washington, D.C.: July 21, 2003).

2

GAO, Transportation-Disadvantaged Populations: Federal Agencies Are Taking Steps to 

Assist States and Local Agencies in Coordinating Transportation Services, GAO-04-420R

(Washington, D.C.: Feb. 24, 2004), and Transportation-Disadvantaged Populations: Some 

Coordination Efforts Among Programs Providing Transportation Services, but Obstacles 

Persist, GAO-03-697 (Washington, D.C.: June 30, 2003).
Appendix I

Scope and Methodology

Page 66 GAO-04-971 Transportation-Disadvantaged Seniors

databases and on agency, academic, and advocacy Web sites. In addition, 

we asked experts—including academics conducting research in the fields 

of aging, disability, and transportation; advocacy policy analysts 

knowledgeable about senior transportation; and federal officials 

responsible for senior transportation programs—to identify sources of data 

and relevant studies. We included in our review only nationwide surveys or 

focus groups (1) that were conducted in multiple states or types of 

communities, (2) that were conducted after 1995, (3) that had variables that 

analyzed transportation behavior of individuals aged 65 and older, and (4) 

that were reported in published or soon-to-be-published journals or 

reports. Also, we identified federal agency performance indicators and 

other data collected by federal agencies that have key transportation 

programs for seniors. For the performance indicators and data sources we 

identified, we assessed the extent to which they provided meaningful 

information about the extent to which seniors’ mobility needs are being 

met. To assess the reliability of research publications, we reviewed the 

studies’ overall designs and methodologies, including the selection 

processes for any participants, response rates, and measures used. A social 

science analyst at GAO was involved in each review of methodological 

soundness. Table 4 summarizes the limitations of the data sources we used 

in assessing the extent to which seniors’ mobility needs were being met.
Appendix I

Scope and Methodology

Page 67 GAO-04-971 Transportation-Disadvantaged Seniors

Table 4: Limitations of Data Sources Used 

Data sources and descriptions Limitations

Research and statistical publications

Surveys

Bureau of Transportation Statistics, 2001 

National Household Travel Survey. This is 

a nationwide telephone survey of 

approximately 60,000 individuals 

(including seniors) about travel behavior. 

It documents approximately 250,000 daily 

trips. Data were collected between March 

2001 and March 2002.

AARP, Understanding Senior 

Transportation: Report and Analysis of a 

Survey of Consumers Age 50+, 

2002. This is a nationwide telephone 

survey of 2,422 individuals aged 50 and 

older, designed to obtain information on 

problems with transportation and overall 

satisfaction with transportation, among 

other things. Data were collected between 

October 1998 and January 1999. 

AARP, Community Transportation Survey,

1997. This is a nationwide telephone 

survey of 710 individuals aged 75 and 

older, designed to provide a greater 

understanding of older persons’ mobility, 

as measured by the number of trips they 

take. Data were collected between 

October and November 1996. 

Although the surveys provide some perspective on the extent of the problem, information is 

not available to determine how representative the responses are, and therefore we are 

relying on the surveys primarily to provide information about the nature of unmet needs. 

Limitations include the following:

• By their nature, telephone surveys are likely to miss some individuals living in a 

community, including those who are oldest and have the most severe health problems and 

disabilities, two factors also related to mobility. For example, for AARP’s Understanding 

Senior Transportation: Report and Analysis of a Survey of Consumers Age 50+, AARP 

estimates that about 16 percent of persons aged 75+ were missed by the survey, and that 

those missed were more likely to have physical impairments and suffer from activity 

limitations than those in the 75+ population who were captured by the telephone survey. 

• For AARP’s Community Transportation Survey, the response rate was not presented in the 

report. However, this survey relied on an omnibus survey—omnibus surveys typically lack 

a thematic structure and involve minimal callback procedures, which can suppress the 

response rate. For example, comparisons with prior research suggest that AARP’s 

Community Transportation Survey may overestimate the mobility of the 75+ population. 

Also, those 85+ were underrepresented in this survey. 

• For the National Household Travel Survey and the AARP survey that was reported in 

Understanding Senior Transportation, the response rates were somewhat low (40 percent 

and 59 percent, respectively). Low response rate could result in nonresponse bias, 

depending on how the obtained responses were weighted to make the results 

representative of the populations aged 75 and older, particularly since some weighting 

factors are themselves correlated with mobility. 

• For the National Household Travel Survey and AARP’s Community Transportation Survey, 

a complete list of the weighting factors was not available. 

• For the National Household Travel Survey and AARP’s Community Transportation Survey,

the methodologies used to calculate the estimates were not fully disclosed, nor were the 

standard errors reported for the estimates. Without this information, and without further 

information on the potential for nonresponse bias, we were unable to assess the reliability 

of the estimates.

• For all three surveys, a full description of procedures used to estimate missing values for 

specific items was not available, so it is unclear whether results are representative. 

• In addition to possible nonresponse bias, the practical difficulties of conducting any survey 

may introduce other types of errors. For example, differences in how a particular question 

is interpreted can introduce unwanted variability into the survey results. 
Appendix I

Scope and Methodology

Page 68 GAO-04-971 Transportation-Disadvantaged Seniors

Data sources and descriptions Limitations

Focus groups

AARP, Transportation and Older Persons: 

Perceptions and Preferences, 2001. This 

report includes data from focus groups 

with 28 individuals and in-person 

interviews with 17 individuals aged 75 and 

older in urban and suburban communities 

in Massachusetts. Questions were 

designed to obtain information on the 

value and role of transportation, tripmaking decisions, and transportation 

alternatives when customary 

transportation is unavailable. Data were 

collected in April 1997.

Ecosometrics, Inc., prepared for the 

Coordinating Council on Access and 

Mobility, the Department of Health and 

Human Services, and the National 

Highway Traffic Safety Administration, 

Mobility and Independence: Changes and 

Challenges for Older Drivers, 1998. This 

report includes data from focus groups 

with 86 people aged 70 and older and was 

designed to better define the mobility 

consequences of reducing or stopping 

driving. Focus groups were conducted in 

Florida, Maine, and Maryland between 

August and December 1996. 

Transportation Research Board, TCRP 

Report 82, Improving Public Transit 

Options for Older Persons, Volume I 

Handbook and Volume II: Final Report, 

2002. This report includes data from focus 

groups with 88 individuals aged 70 and 

older, from urban, suburban, and rural 

communities that have good transit 

services (New York City; a Maryland 

suburb of Washington, D.C.; a suburban 

area outside Akron, Ohio; and a rural 

county east of Cleveland, Ohio). Focus 

groups were designed to obtain 

information on mobility preferences. 

Focus groups are adequate in providing qualitative data on the nature, but not the extent, of 

unmet needs. Limitations include the following:

• Focus groups are not statistically representative samples of their communities. Responses 

from focus groups cannot be used to generalize to the broader population of which they 

are a part. 

1. For example, in Transportation and Older Persons: Perceptions and Preferences, the 

focus group respondents were from a single geographic area—that is, in-person 

interviews were conducted only among residents of the Boston metropolitan area, and 

the focus groups were only among residents of Boston and Framingham.

2. For TCRP Report 82, Improving Public Transit Options for Older Persons, Volume I: 

Handbook and Volume II: Final Report, the focus groups were conducted only in 

environments that were considered transit-friendly. 

Expert perspectives

Interviews with experts and officials 

in the fields of aging, disability, and 

transportation research and policy.

Interviews are based largely on the experts’ familiarity with these national data sources, 

which have known limitations, and on conversations with local officials, who may rely 

primarily on anecdotal data, personal experience, and testing of services.

(Continued From Previous Page)
Appendix I

Scope and Methodology

Page 69 GAO-04-971 Transportation-Disadvantaged Seniors

Source: GAO.

Note: Data from the National Household Travel Survey were obtained from the Surface Transportation 

Policy Project, Aging Americans: Stranded Without Options (Washington, D.C.: April 2004).

To better understand the variety of methodologies that area agencies on 

aging (AAA) used to assess seniors’ unmet mobility needs, the reliability of 

data collected using these methodologies, the barriers to quantifying unmet 

mobility needs, and the perspectives of local officials on the extent to 

which seniors’ mobility needs are being met, we conducted semistructured 

interviews with officials from 15 of the 655 AAAs nationwide and 1 state 

unit on aging. To select the nonprobability sample of 15 AAAs that we 

interviewed, we asked the 42 state units on aging that have AAAs in their 

states (8 states—Alaska, Delaware, Nevada, New Hampshire, North 

Dakota, Rhode Island, South Dakota, and Wyoming—and the District of 

Columbia do not have AAAs and instead the state unit on aging is the single 

planning and service area under the Older Americans Act) to identify 1 

urban, 1 rural, and 1 suburban AAA in their state, and for each, to identify 

the method by which the AAA collects data on seniors’ unmet mobility 

needs. Of the 42 states that have AAAs, 30 responded to our request. From 

these responses, we selected AAAs to ensure geographic dispersion (West, 

South, Northeast, and Midwest); representation of AAAs with different 

population density (urban, rural, and suburban); representation of different 

data collection methods (survey, focus group, census, or other); 

representation of input from community stakeholders (service providers, 

caregivers, seniors, and professionals); and representation of states with 

higher-than-average and lower-than-average percentages of seniors in their 

population. In addition to selecting 3 AAAs from each of 4 states—1 in the 

West, 1 in the South, 1 in the Midwest, and 1 in the Northeast—we also 

selected 3 AAAs in New York State because it had recently completed an 

audit of transportation for seniors that included an evaluation of AAAs’ 

procedures for conducting needs assessments. We also interviewed the 

Data sources and descriptions Limitations

Area agencies on aging

Interviews with agency officials from 

16 local area agencies on aging (AAA) 

that described obtaining information on 

transportation from seniors, caregivers, 

transportation providers, local aging 

network professionals, and senior center 

directors through focus groups, surveys, 

listening sessions, public forums, 

interviews, waiting lists, and population 

data.

We were unable to determine if the data were sufficiently reliable to assess the extent of 

unmet need, but determined that they were sufficiently reliable to describe the nature of 

unmet need. While several of the AAA officials we interviewed said that they felt fairly 

comfortable with the data they obtained through these methods, others acknowledged that 

the data were opinion-driven, anecdotal, and representative only of the seniors who 

contacted the AAA. As a result, the data tended to focus on concerns identified by clients, 

caregivers, or transportation providers, rather than on the consensus of all seniors in the 

community (including those who do not receive services from the AAA). 

(Continued From Previous Page)
Appendix I

Scope and Methodology

Page 70 GAO-04-971 Transportation-Disadvantaged Seniors

state unit on aging from 1 of the 8 states that do not have AAAs (South 

Dakota). Using a semistructured interview, we asked senior-level 

management and staff that had responsibilities for assessing seniors’ unmet 

mobility needs at each of the AAAs (and 1 state unit on aging) to provide 

information on transportation services offered and restrictions to service; 

on their processes for collecting data on seniors’ unmet mobility needs, 

including information about how they ensure the reliability of the data they 

collect and their methodology for reporting and maintaining the data; on 

their perspectives on the extent to which seniors’ mobility needs are being 

met; and on the additional data that should be collected, if any. To assess 

the reliability of the data obtained from AAAs, we reviewed the data for 

obvious errors in accuracy and completeness and interviewed agency 

officials knowledgeable about the data. Specifically, we asked whether any 

tests were conducted to ensure that data were entered accurately and 

whether the quality of the collected data had been reviewed. In addition, 

we asked AAAs to identify limitations of the data and actions taken to 

correct any limitations. (See table 4 for information about limitations of the 

AAA data.) 

To obtain the perspectives of experts on the extent to which needs are 

being met, possible barriers to determining the extent of unmet mobility 

needs, and their knowledge of any standards or benchmarks developed for 

assessing seniors’ unmet mobility needs, we interviewed federal agency 

officials that have responsibilities for senior transportation programs in the 

Departments of Education, Health and Human Services, Labor, 

Transportation, and Veterans Affairs, as well as representatives from 

research organizations, advocacy organizations, and academic institutions 

in the fields of aging, disability, and transportation (see table 5). We asked 

these experts to identify potential sources for data and information on 

seniors’ mobility needs as well as for their perspectives on the extent to 

which such needs are being met.
Appendix I

Scope and Methodology

Page 71 GAO-04-971 Transportation-Disadvantaged Seniors

Table 5: Academics, Advocacy Groups, Professional Associations, and Federal Agencies GAO Interviewed about Information on 

Seniors’ Mobility Needs 

Information provided

Type of affiliation Organization

Data and 

information 

sources

Perspective 

on mobility 

needs

Academic/Research University of Alabama, Birmingham ✔ ✔

Academic/Research University of Arizona ✔ ✔

Academic/Research University of California, San Francisco ✔

Academic/Research University of Florida ✔

Academic/Research University of Iowa ✔ ✔

Academic/Research University of Massachusetts, Boston ✔

Academic/Research University of North Dakota ✔ ✔

Academic/Research Westat ✔ ✔

Advocacy AARP ✔ ✔

Advocacy Beverly Foundation ✔ ✔

Association American Public Health Services Association ✔

Association American Society on Aging ✔

Association American Medical Association ✔

Association American Occupational Therapy Association ✔ ✔

Association Community Transportation Association of America ✔ ✔

Association National Association for State Units on Aging ✔

Association National Association of Area Agencies on Aging ✔ ✔

Committee Transportation Research Board, Committee on Accessible Transportation 

and Mobility ✔

Committee Transportation Research Board, Committee on the Safe Mobility of Older 

Persons ✔ ✔

Federal government Department of Education, Office of Special Education and Rehabilitative 

Services ✔

Federal government Department of Health and Human Services, Administration on Aging ✔ ✔

Federal government Department of Health and Human Services, Administration for Children and 

Families ✔

Federal government Department of Health and Human Services, Centers for Medicare and 

Medicaid Services ✔

Federal government Department of Health and Human Services, Health Resources and Services 

Administration ✔
Appendix I

Scope and Methodology

Page 72 GAO-04-971 Transportation-Disadvantaged Seniors

Source: GAO.

To identify practices that can enhance transportation-disadvantaged 

seniors’ mobility and local service providers that have implemented such 

practices, we interviewed experts and federal officials and reviewed the 

literature on senior mobility. We then contacted these local service 

providers and requested further information about the practices they 

employed and the funding sources they used to implement the practices. To 

learn about the practices and their results, obstacles to implementing the 

practices, and the role of federal programs in supporting them, we 

conducted semistructured interviews with officials from 10 of the 29 local 

transportation service providers that responded to our initial request for 

information. These 10 providers represented a nonprobability sample, 

chosen to include a diversity of geographic areas (i.e., 5 were in urban 

areas and 5 were in nonurban areas, from different regions of the country); 

types of practices (such as use of technology and coordination); and 

federal funding sources (to get representation of as many of the 15 key 

federal programs as possible and to include both providers that used many 

federal funding sources and those that used only one or two). To determine 

the extent to which federal programs support practices that enhance 

transportation-disadvantaged seniors’ mobility, we interviewed federal 

program officials, senior mobility experts, and local service providers and 

reviewed pertinent GAO reports.

To identify examples of obstacles to addressing transportationdisadvantaged seniors’ mobility needs and strategies the federal 

government could consider taking to improve the ability of federal 

Information provided

Type of affiliation Organization

Data and 

information 

sources

Perspective 

on mobility 

needs

Federal government Department of Labor, Employment and Training Administration ✔

Federal government Department of Transportation, Bureau of Transportation Statistics ✔ ✔

Federal government Department of Transportation, Federal Transit Administration ✔ ✔

Federal government Department of Transportation, National Highway Traffic Safety Administration ✔ ✔

Federal government Department of Veterans Affairs, Veterans Health Administration ✔

Federal government Federal Interagency Forum on Aging-Related Statistics ✔

Federal government National Center for Health Statistics ✔

Federal government National Institute on Aging ✔ ✔

(Continued From Previous Page)
Appendix I

Scope and Methodology

Page 73 GAO-04-971 Transportation-Disadvantaged Seniors

programs to meet these seniors’ mobility needs and enhance the costeffectiveness of the services delivered, we reviewed literature on 

transportation, disability, and aging and interviewed experts, professional 

associations, and advocacy groups (see table 6). We also interviewed 

federal officials and officials from the 16 AAAs and 10 local transportation 

service providers previously mentioned. We organized the obstacles and 

strategies identified in the literature and through our interviews into three 

categories: planning for alternatives to driving as seniors age, 

accommodating seniors’ varied mobility needs, and addressing federal and 

other governmental funding constraints. We presented the proposed 

strategies to federal program officials to obtain their comments on the 

potential trade-offs associated with implementing them. The trade-offs 

were included in the discussion on obstacles and suggested strategies.

Table 6: Academics, Advocacy Groups, and Professional Associations GAO 

Interviewed about Obstacles, Strategies, and Trade-offs in Addressing 

Transportation-Disadvantaged Seniors’ Mobility Needs

Source: GAO.

We conducted our work from November 2003 through August 2004 in 

accordance with generally accepted government auditing standards.

Type of affiliation Organization

Academic/Research Mobility for Life 

Academic/Research Westat

Advocacy AARP

Advocacy Beverly Foundation

Advocacy B’nai B’rith

Advocacy Easter Seals

Advocacy Gray Panthers

Advocacy Independent Transportation Network

Advocacy National Caucus and Center for Black Aged, Inc.

Advocacy Surface Transportation Policy Project

Association American Society on Aging

Association American Medical Association

Association American Occupational Therapy Association

Association Community Transportation Association of America
Page 74 GAO-04-971 Transportation-Disadvantaged Seniors

Appendix II

Information on Transportation Provided by 16 

Area Agencies on Aging ApendxiI

State/City/ 

Location

Type of service provided and destinations 

served

Service restrictions

(age, day/hours, distance, number of trips)

Connecticut

Southwestern 

Connecticut 

Agency on Aging 

(Urban)

• Curb-to-curb demand response and some 

escort service to senior centers, nutrition meal 

sites, shopping, and medical appointments

• Aged 60 and older

• Most are Monday through Friday, normal business hours; some 

providers may offer services on weekends

• Majority of providers restrict service to within the geographical 

limits of the town they serve. Some may provide transportation 

to an adjacent town for medical appointments

• Most providers restrict service to no more than two roundtrip 

rides per week; the number of rides a senior can receive is 

generally dependent on the number of requests received

Connecticut

Western 

Connecticut Area 

Agency on Aging

(Suburban)

• Escort, fixed-route, and demand-responsive 

transportation is provided to grocery stores, 

medical appointments, nursing homes for 

spousal visits, congregate meal sites, senior 

centers for general nonmeal activities, hospitals 

for spousal visits, and provider agencies (such 

as the Social Security Administration)

• Aged 60 and older and adults with disabilities

• Normal business hours on weekdays; most require 24-hour 

advance reservation notice

• Transportation is provided only within the town in which the 

service provider operates

• Generally, there are no restrictions on how often individuals can 

receive transportation service

Connecticut

Senior Resources 

Agency

(Rural)

• Fixed route, demand response, and escort for 

trips to nutrition sites, shopping, senior centers, 

medical/healthcare, libraries, beauty salons

• Aged 60 and older

• Generally Monday through Friday, 8 a.m. to 5 p.m.; often 

providers require at least 24-hour notice; some providers offer 

some limited weekend coverage but this is not publicized

• Transportation provider will drop off rider at the border of a 

region - usually trips stay within the town

• No restrictions on the number of trips allowed

New York

Westchester 

County Office for 

the Aging

(Urban)

• Curb-to-curb paratransit primarily for medical 

appointments

• Escort to medical appointments

• Shared rides for seniors volunteering; buses for 

group activities, such as going to museums, 

theatres, educational, or cultural activities; 

transportation also provided to nutrition centers, 

for work, health screenings, grocery and other 

types of shopping, and senior centers

• Discounts for taxicab rides and fixed route

• Registered driver program

• Aged 60 and older

• Must schedule most trips in advance; paratransit does not run 

on weekends or after 4 p.m. on weekdays; however, buses and 

vans do run on weekends and during evenings for special events

• Most municipalities restrict service to within the boundaries of 

the municipalities

• No restrictions on how often individuals can receive 

transportation service

New York

Onondaga 

County 

Department for 

Aging and Youth

(Suburban)

• Demand response, fixed route, and escort to 

senior centers for nutrition and socialization, to 

medical appointments, and to grocery stores,

but not for recreation

• Aged 60 and older

• Most operate between 9 a.m. and 2 p.m. on weekdays; very 

limited service on weekends; required to request service 2 to 3 

days in advance

• No programs extend beyond the county line, except the call-abus

• Limited to two roundtrip rides a month on the call-a-bus, but no 

restrictions on other programs
Appendix II

Information on Transportation Provided by 

16 Area Agencies on Aging

Page 75 GAO-04-971 Transportation-Disadvantaged Seniors

New York

Chemung County 

Office for the 

Aging

(Rural)

• Demand response and escort for trips to 

medical appointments, congregate meals, 

senior centers, and public agencies

• Aged 60 and older

• No restrictions on time of day or day of week since AAA 

contracts with a taxicab service that operates 24 hours a day; 

usually requires 24-hour advance notification

• Provider does not transport out of the county or state

• No restrictions on how often individuals can receive 

transportation service

North Carolina

Centralina 

Council of 

Governments

(Urban)

• Fixed route, demand response, paratransit, 

and mass transit for trips to medical care 

facilities, congregate nutrition sites, senior 

centers, necessary grocery shopping, banking, 

bill paying, and other essential trips

• Aged 60 and older; some disability requirements because of 

funding eligibility requirements

• Restrictions on when service may be available, depending on 

distance; medical destinations are prioritized; may have to wait 

for trips other than medical

• Services for fixed route and demand response have restrictions 

on distance—for the most part within county boundaries (except 

for some medical services)

• No restriction on number of trips, although some counties may 

restrict if funding is short

North Carolina

Upper Coastal 

Plain Council of 

Governments

(Suburban)

• Fixed route for trips to congregate meal sites; 

adult day care centers; most counties to senior 

centers, farmers market once a month when in 

season

• Demand response and bus system for trips for 

personal care needs, such as medical 

appointments and grocery stores

• Aged 60 and older

• Weekdays in the more rural counties; public transit is available 

on weekends and evenings; fixed route is restricted to business 

hours weekdays, except for special events 

• Funding may limit number of days service is available in rural 

areas

• Some medical trips (e.g., for dialysis) take priority; no 

restrictions on how often individuals can receive service

North Carolina

Southwestern 

Planning and 

Economic 

Development 

Commission

(Rural)

• Demand response in rural areas, mostly for 

medical appointments

• Fixed route in more densely populated areas 

for nutrition programs, shopping centers, 

community college, and places of employment

• Aged 60 and older 

• Weekdays during normal business hours 

• Medical trips are first priority; currently, a service recipient can 

use up to 100 one-way trips per month for both demandresponse and fixed-route services

• Counties may set their own priorities due to funding limitations

Ohio

Western Reserve 

Area Agency on 

Aging 

(Urban)

• Demand response for shopping, medical 

appointments, pharmacies, and senior centers; 

escort provided for frail seniors

• Aged 60 and older

• Most transportation is limited to 5 days per week, 8 a.m. to 5 

p.m.

• One county is more rural and limits transportation to three cities

• Varies by county (senior centers cannot accommodate everyone 

due to limited funds); providers tend to prioritize trips (medical 

appointments/pharmacy and food shopping are higher priorities)

Ohio

Central Ohio Area 

Agency on Aging

(Suburban)

• Shared rides to senior center, shopping, and 

beauty parlor

• Demand transportation for medical 

appointments and pharmacy

• Aged 60 and older

• Most do not provide weekend service; some do not provide 

service in evenings; and others require advance reservations for 

trips

• Each provider determines its own service area

• Most providers do not restrict the number of trips allowed

(Continued From Previous Page)

State/City/ 

Location

Type of service provided and destinations 

served

Service restrictions

(age, day/hours, distance, number of trips)
Appendix II

Information on Transportation Provided by 

16 Area Agencies on Aging

Page 76 GAO-04-971 Transportation-Disadvantaged Seniors

Source: GAO.

Note: The AAAs were designated as “urban,” “suburban,” and “rural” in responses we received from 

state units on aging and therefore may not conform to definitions provided in the U.S. Census or 

elsewhere.

Ohio

Buckeye HillsHocking Valley 

Regional 

Development 

District 

(Rural)

• Demand response for congregate meals at 

senior centers, grocery stores if on the route 

the provider serves, in-county medical 

appointments, and social service agencies

• Escort for medical appointments out of county

• Aged 60 and older

• Mostly restricted to Monday through Friday, 8:30 a.m. to 5 p.m.; 

must call 24 to 48 hours in advance

• Most providers restrict service at least within the county

• Number of trips depends only on scheduling and availability 

(most providers operate on a first-come, first-served basis)

South Dakota 

South Dakota 

Department of 

Social Services, 

Office of Adult 

Services and 

Aging 

(State unit on 

aging)

• Demand response and volunteer escorts for 

essential transportation to congregate meals, 

senior centers, grocery stores, medical 

appointments, pharmacies, and banking

• Aged 65 and older

• Weekdays; 6 to 8 hours a day and very limited service on 

weekends

• For long-distance travel, the service provider would usually 

consolidate all the rides for that destination for a particular day

• No restrictions on number of rides that an individual can receive

Utah

Five County 

Government 

Association of 

Governments

(Suburban)

• Demand-response services, shared rides, and 

fixed route in two counties supported through 

city for congregate meals, shopping, medical 

appointments, and some recreational activities

• Emergency service using ambulances or other 

vehicles

• Aged 60 and older

• For medical appointments, must call in advance; shopping 

scheduled for specific days of the week, typically twice a week; 

and services on the weekends and evenings are not available

• No restrictions on distance because most services are found 

within the county

• First come, first served; not all can be served

Utah

Bear River 

Association of 

Governments

(Rural)

• Fixed route to senior centers

• Assisted door to door for trips to doctor 

appointments, grocery stores, and recreational 

activities (funded by seniors)

• Seniors and adults with disabilities

• Generally weekdays; business hours only

• Most providers offer transportation only within the county; 

outside metropolitan area, offered three times a week; and 

paratransit offered once per week in one county

• No restrictions on how often, but individuals have to call in 

advance to reserve space

Utah

Salt Lake County 

Aging Services

(Urban)

• Demand response for life-sustaining activities, 

such as trips to the doctor, dentist, physical 

therapy, chemotherapy, visits to see loved ones 

n a hospital or healthcare facility, trips to the 

housing authority, and essential banking

• Fixed route for less urgent activities, such as 

trips to the grocery store or senior center

• No service for recreational activities

• Aged 60 and older, must be residents of the county and have no 

other means of transportation

• Generally weekdays, business hours; limited night and weekend 

service provided by volunteers

• Within Salt Lake County only

• Allows three roundtrip rides per individual per week

(Continued From Previous Page)

State/City/ 

Location

Type of service provided and destinations 

served

Service restrictions

(age, day/hours, distance, number of trips)
Page 77 GAO-04-971 Transportation-Disadvantaged Seniors

Appendix III

Local Service Providers and Practices That 

Can Enhance Transportation-Disadvantaged 

Seniors’ Mobility ApendxiI

Name of provider Location Contact information

Type of practice (as described by the 

providers and in the literature)a

ACCESS Transportation 

Systems

Pittsburg, PA Karen Hoesch, Executive 

Director,

(412) 562-5380, 

khoesch@accesstransys.com

Coordinates transportation service with “zero 

trip denial” policy and uses dedicated funding 

through state lottery program.

Altoona Metro 

Transportation

Altoona, PA Tom Klevan, Director of Business 

Development, 

(814) 944-4074, 

tom.klevan@amtran.org

Provides fixed-route service using dedicated 

funding from the state lottery program, targets 

marketing efforts to increase senior ridership, 

offers a driver sensitivity training program, and 

uses senior volunteers to promote and teach 

seniors how to ride fixed-route service through 

the “bus-buddy” program.

Area IV Agency on 

Aging (College of 

Southern Idaho)

Twin Falls, ID Jim Fields, Administrator, 

(208) 736-2122, 

jfields@rmci.net

Provides free rides for seniors throughout an 

eight-rural-county service area with a 48-hour 

call ahead using volunteers from the Retired 

Senior Volunteer Program. Provides senior 

volunteer companions for homebound seniors 

through Senior Companions Program.

Butler County Transit 

(Busy Wheels)

David City, NE Judy Polacek, Program 

Administrator, 

(402) 367-6131, 

is31540@navix.net

Provides demand-response transportation 

service with volunteer drivers to transport 

seniors to medical appointments, grocery stores, 

pharmacies, senior centers, or other errands. 

Capital Metro 

Transportation Authority 

Austin, TX Nancy Crowther, Specialist, 

(512) 389-7400, 

nancy.crowther@capmetro.org

Provides free fixed-route service to seniors. Also 

provides free transportation to groups of 20 or 

more seniors during off-peak hours (late evening 

or weekends) to destinations within the service 

area (e.g., Senior Games, Senior Proms, Senior 

Nursing Home Games, Retired Senior Service 

Volunteer Program luncheons, and AARP 

events).

City of Napa Napa, CA Adrian Cardoso, Transportation 

Planner, 

(707) 259-8635, 

acardoso@nctpa.net

Implemented a volunteer-based transit 

ambassador program that allows a volunteer, 

who knows the local transit systems, to assist 

and provide information to other passengers or 

people using public transit for the first time. The 

ambassador program is available to all 

passengers. However, seniors often take 

advantage of the program to learn how to ride 

fixed-route services in Napa, CA. 
Appendix III

Local Service Providers and Practices That 

Can Enhance Transportation-Disadvantaged 

Seniors’ Mobility

Page 78 GAO-04-971 Transportation-Disadvantaged Seniors

Council on Aging and 

Human Services

Colfax, WA Karl Johanson, Executive 

Director, 

(509) 397-4611, 

coadirector@stjohncable.com

Provides specialized coordinated transportation 

services for medically fragile, disabled, and 

elderly to locations such as medical offices, 

hospitals, and other key destinations. 

Coordinates transportation services with 

consumer advocates, social service agencies, 

government offices, and transportation providers 

to best meet their clients’ needs. Secures 

transportation funding, takes telephone calls, 

schedules and assigns trips with subcontractors, 

provides rides, and reimburses providers.

Elder Services of 

Merrimack Valley

Merrimack Valley, MA Rosanne DiStefano, Executive 

Director, 

(800) 892-0890, 

ro@esmv.org

Implemented a medical advocacy program that 

uses local volunteers to assist elders with 

medical transportation and advocacy. Program 

is targeted to all elders and spouses and to 

working and long-distance caregivers.

Enabling Transportation Mesa, AZ Marty Hadley, Coordinator, 

(480) 218-2221, 

martyforet@mindspring.com

Implemented a mileage reimbursement program 

through which seniors find volunteer drivers who 

use their private vehicles to transport seniors to 

medical appointments, grocery shopping, 

church, or other recreational activities. The 

program was modeled after the Transportation 

Reimbursement and Information Program, which 

is listed below. 

Friendship Center Conroe, TX Gary Louie, Executive Director, 

(936) 756-5828, 

glouie@thefriendshipcenter.com

Coordinates with medical facility staff to 

schedule senior medical appointments to match 

with transportation availability and is involved in 

business enterprises with others in the 

community to generate additional program 

revenue. The implementation of a computerized 

mapping system to schedule same-day services 

is slated for the near future.

Gold Country Telecare, 

Inc.

Grass Valley, CA Susan Healy-Harman, 

Development Director, 

(530) 272-9958, 

healy49@hotmail.com

Provides low- or no-cost transportation to lowincome seniors and persons with disabilities 

located in rural communities to healthcare 

services, provides all-day Sunday service for 

seniors to go to church and other activities, and 

offers a volunteer driver program through which 

volunteers who use their own vehicles to 

transport seniors are reimbursed for mileage.

Great Falls Transit 

District

Great Falls, MT Jim Helgeson, General Manager, 

(406) 727-0382, 

gm@gftransit.com

Implemented a travel-training program through 

which volunteers teach seniors how to use 

public transportation.

(Continued From Previous Page)

Name of provider Location Contact information

Type of practice (as described by the 

providers and in the literature)a
Appendix III

Local Service Providers and Practices That 

Can Enhance Transportation-Disadvantaged 

Seniors’ Mobility

Page 79 GAO-04-971 Transportation-Disadvantaged Seniors

Independent 

Transportation Network

Westbrook, ME Katherine Freund, Director, 

(207) 854-0505, 

kfreund@itninc.org

Offers a range of demand-responsive services 

(door-to-door, door-through-door, and hands-on 

assistance) to a broad spectrum of older riders 

using automobiles driven by both paid staff and 

volunteer drivers. Operates exclusively on a 

combination of fares and donations and does not 

depend on public subsidies. Customers 

(seniors) become “members” of Independent 

Transportation Network and prepay (through a 

variety of payment plans) into their own account 

in advance of travel. 

Lauderhill Transportation 

Program

Lauderhill, FL Kurt Blades, Transportation 

Coordinator, 

(954) 717-1525, 

kblaides@lauderhill-fl.gov

Provides demand-response transportation 

services to seniors for grocery shopping, 

medical appointments, banking, daily nutrition, 

senior center activities, and other general travel 

trips.

Medical Motor Service Monroe County, NY William McDonald, Director, 

(585) 654-7030, 

w_mcdonald@medicalmotors.org

Provides transportation and brokerage services 

by coordinating with other nonprofit agencies. 

Services are customized to meet the needs of 

seniors, using wheelchair accessible vehicles 

and providing shuttle services to rural areas of 

the county. Contracts with a private, regional 

grocery chain to supplement its fund-raising 

efforts. The grocery store contributes to Medical 

Motors in exchange for Medical Motors 

transporting seniors to the grocery store.

Mountain Empire Older 

Citizens, Inc.

Big Stone Gap, VA Dennis Horton, Deputy Director, 

(276) 523-4202, 

dhorton@meoc.org

Provides transit services to the general public 

and door-through-door, one-on-one services to 

special-needs populations in a multicounty 

region through a coordinated system that is also 

consumer friendly and flexible to meet the needs 

of the community.

North County Lifeline, 

Inc.

Vista, CA Stacy Zwagers, Director of 

Transportation, 

(760) 726-3961, 

szwagers@nclifeline.org

Targets a travel-training program to the senior 

population to encourage seniors to use the 

public transit system by teaching (one-on-one or 

through groups) and showing seniors how to use 

the system. Helped establish the Strides Web 

site, designed as a distribution center for other 

public transportation service providers as well as 

a referral service for seniors to learn about 

transit services in the San Diego area.

OATS, Inc. Columbia, MO Linda Yaeger, Executive Director, 

(573) 443-4516, 

lyaeger@oatstransit.org

Provides transportation service for the general 

public, prioritizing its services on senior citizens 

and persons with disabilities within 87 rural 

counties in the state of Missouri. Uses 

volunteers to fulfill a number of functions, such 

as dispatching calls to drivers, fund-raising, and 

serving as liaisons to the community.

(Continued From Previous Page)

Name of provider Location Contact information

Type of practice (as described by the 

providers and in the literature)a
Appendix III

Local Service Providers and Practices That 

Can Enhance Transportation-Disadvantaged 

Seniors’ Mobility

Page 80 GAO-04-971 Transportation-Disadvantaged Seniors

Rensselaer County Troy, NY Mike Angley, Deputy 

Commissioner, 

(518) 270-2732, 

mangley@rensco.com

Provides flexible transportation services for trips 

to senior centers, shopping, banking, and 

medical appointments. Drivers use pagers for 

efficient pick-up service. Night and weekend 

trips are available. 

Seniors’ Resource 

Center

Denver, CO Jane Yeager, Director, 

(303) 238-8151, 

jyeager@sraging.org

Transports older adults and persons with 

disabilities to medical facilities, grocery stores, 

meal sites, and adult day centers and for other 

personal needs. 

Shepherd’s Center of 

America (Northland)

Kansas City, MO Rebecca Gordon, Executive 

Director, 

(816) 452-4536, 

rgordscn@crn.org

Uses volunteers to provide door-through-door 

medical transportation services to seniors. 

Services are free to seniors.

Special Transit Boulder, CO Lenna Kottke, Executive Director, 

(303) 447-2848, 

lenna@specialtransit.org

Provides a variety of services, including 

demand-response, curb-to-curb transportation 

service offered to the general public; a circular 

shuttle route serving the entire community that is 

also senior friendly; a “family and friends” 

mileage reimbursement program; and a 

comprehensive, one-on-one training program 

developed to teach seniors how to use their 

community transit alternatives.

St. Johns County 

Council on Aging

St. Augustine, FL Cathy Brown, Executive Director, 

(904) 823-4810, 

ckbrown@aug.com

Coordinates its services with local transit 

authority and taxicab services. Provides a drivertraining program that emphasizes safety and 

customer service. Uses brightly-decorated 

vehicles to attract senior ridership. 

Suburban Mobility 

Authority for Regional 

Transportation

Detroit, MI Ron Ristau, Director of Service 

Development, 

(313) 223-2100, 

rristau@smartbus.org

Helps provide vehicles and funding to local 

communities in the service area. Local 

communities that receive the vehicles and 

funding design and operate services 

independently according to local needs.

Sweetwater 

Transportation Authority

Rock Springs, WY Judy Wilkinson, Director, 

(307) 382-7827, 

starbus@fascination.com

Provides coordinated demand-response 

transportation services using computerized 

scheduling. The computerized scheduling 

software will allow accurate and on-time 

scheduling through the use of Global Positioning 

Systems technology that tracks the location of 

vehicles.

Transportation Options, 

Broward County Transit

Pompano Beach, FL Ed Wisniewski, Paratransit 

Manager, 

(954) 357-8321, 

ewisniewski@broward.org

Provides senior transportation services 7 days a 

week and serves approximately 40 designated 

senior nutrition and social center sites. Also 

implemented a community bus program that 

circulates within a specific community to 

encompass shopping areas, senior residences, 

and senior day programs.

(Continued From Previous Page)

Name of provider Location Contact information

Type of practice (as described by the 

providers and in the literature)a
Appendix III

Local Service Providers and Practices That 

Can Enhance Transportation-Disadvantaged 

Seniors’ Mobility

Page 81 GAO-04-971 Transportation-Disadvantaged Seniors

Source: GAO analysis of information obtained through interviews with service providers and reports by the Beverly Foundation, the 

Community Transportation Association of America, and the National Academy of Sciences’ Transportation Research Board.

Note: This appendix includes only those service providers who responded to our request for 

information, and is therefore not a comprehensive list of providers identified by the Beverly Foundation, 

the Community Transportation Association of America, and the Transportation Research Board as 

having implemented practices that enhance transportation-disadvantaged seniors’ mobility. For more 

information, see Beverly Foundation in partnership with the AAA Foundation for Traffic Safety, 

Supplemental Transportation Programs for Seniors (Pasadena, CA, and Washington, D.C.: June 2001) 

and Supplemental Transportation Programs for Seniors: A Report on STPs in America (Pasadena, CA, 

and Washington, D.C.: July 2004); Community Transportation Association of America, Senior 

Transportation: Toolkit and Best Practices (Washington, D.C.: May 2003); and U.S. Department of 

Transportation, Transit Cooperative Research Program, Transportation Research Board, TCRP Report 

82, Improving Public Transit Options for Older Persons, Volume I: Handbook and Volume II: Final 

Report (Washington, D.C.: 2002).

a

The practices listed above focus on efforts targeted to seniors and are not intended to represent a 

complete list of services provided by each local service provider.

Transportation 

Reimbursement and 

Information Program

Riverside, CA Richard Smith, Executive 

Director, 

(909) 697-4697, 

richard.smith@pe.net

Reimburses volunteer drivers to transport 

individuals where no transit service exists or 

when the individual is too frail to use other 

transportation.

Treasure Valley Transit Canyon County, ID Terri Lindenburg, Executive 

Administrator, 

(208) 465-6472, 

peggy@treasurevalleytransit.com

Operates a demand-response service for 

seniors who need transportation services to 

medical facilities. Also works with local senior 

centers to provide transportation services.

West Austin Caregivers Austin, TX Jeanie Teel, Executive Director, 

(512) 472-6339, 

wacaregivers@juno.com

Provides free transportation using volunteers, 

who use their private vehicles to transport 

seniors to medical appointments, shopping, and 

errands.

(Continued From Previous Page)

Name of provider Location Contact information

Type of practice (as described by the 

providers and in the literature)a
Page 82 GAO-04-971 Transportation-Disadvantaged Seniors

Appendix IV

Comments from the Department of Health and 

Human Services ApendxiIV
Appendix IV

Comments from the Department of Health 

and Human Services

Page 83 GAO-04-971 Transportation-Disadvantaged Seniors
Appendix IV

Comments from the Department of Health 

and Human Services

Page 84 GAO-04-971 Transportation-Disadvantaged Seniors
Appendix IV

Comments from the Department of Health 

and Human Services

Page 85 GAO-04-971 Transportation-Disadvantaged Seniors
Appendix IV

Comments from the Department of Health 

and Human Services

Page 86 GAO-04-971 Transportation-Disadvantaged Seniors
Appendix IV

Comments from the Department of Health 

and Human Services

Page 87 GAO-04-971 Transportation-Disadvantaged Seniors
Page 88 GAO-04-971 Transportation-Disadvantaged Seniors

Appendix V

GAO Contacts and Staff Acknowledgments ApendxiV

GAO Contacts Katherine Siggerud (202) 512-2834 or siggerudk@gao.gov

Rita Grieco (202) 512-2834 or griecor@gao.gov

Staff 

Acknowledgments

In addition to the individuals above, Bert Japikse, Jessica Lucas-Judy, 

Kristen Sullivan Massey, Sara Ann Moessbauer, Elizabeth Roberto, and 

Maria Romero made key contributions to this report.

(542029)
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