Transportation-Disadvantaged Seniors: Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance and Information
Published: 2004-08-30T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: 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.
section_title: What GAO Found
paragraphs: 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 cost-effective 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.

section_title: Letter
paragraphs: 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. 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). 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 transportation-disadvantaged seniors 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 transportation-  disadvantaged 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 area agencies on aging (AAA) from urban, suburban, and rural areas in six  states, 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  2004 in accordance with generally accepted government auditing  standards. Appendix I contains more information about our scope and  methodology.
subsections: section_title: Background
paragraphs: 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. 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. 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.
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. Furthermore, transportation was  among the top five information requests to the Eldercare Locator Service in 2001, 2002, and 2003. 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.
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), 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  and evaluate transportation-disadvantaged seniors’ unmet mobility needs  by comparing the number of trips they make with those of  nondisadvantaged populations. 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.
section_title: Federal Agencies Address Mobility Issues Mainly through 15 Programs That Help Make Transportation Available, Accessible, and Affordable
paragraphs: 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.
subsections: section_title: Fifteen Key Federal Programs Fund Services to Enhance Transportation- Disadvantaged Seniors’ Mobility
paragraphs: 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.
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  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. 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.
section_title: Federal Programs Enhance Senior Mobility by Addressing Certain Attributes of Senior-Friendly Transportation
paragraphs: The Beverly Foundation, a leading independent research organization on  senior transportation issues, has identified the following “5 A’s” of  senior-friendly transportation service: 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 service 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  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.
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. 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 bed-confined or meets other medical necessity criteria, such as requiring  oxygen on the way to the destination.
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.
section_title: Data Indicate That Some Types of Mobility Needs Are Not Being Met, but Information on the Extent of Unmet Needs Is Limited
paragraphs: 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 seniors. 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.
subsections: section_title: Federally Supported Programs Are Not Meeting Some Types of Mobility Needs of Transportation- Disadvantaged Seniors
paragraphs: 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, 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.
subsections: section_title: Transportation-Disadvantaged Seniors Lack Alternatives to the Automobile That Provide Comparable Benefits
paragraphs: 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, 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).
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. 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 knew where and when they should disembark. 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.
section_title: Transportation-Disadvantaged Seniors’ Life-Enhancing Needs Are Less Likely to Be Met Than Life-Sustaining Needs
paragraphs: 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. In addition, although few  seniors in an AARP survey 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. 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.”
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.
section_title: Transportation-Disadvantaged Seniors’ Needs Are Less Likely to Be Met in Nonurban Areas Than in Urban Areas
paragraphs: 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. 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. 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).
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.
section_title: Data Are Limited on the Extent to Which Mobility Needs Are Being Met
paragraphs: 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. 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  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. 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  by age. 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.
section_title: There Are Several Barriers to Assessing the Extent of Unmet Need
paragraphs: 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. 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....” Although AOA has developed general guidance for  Native American tribes on conducting needs assessments for its Title VI  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  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. 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.
section_title: Transportation Service Providers Implement Practices That Enhance Senior Mobility with Some Federal Support, but Implementation Difficulties Remain
paragraphs: 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.
subsections: section_title: Certain Practices Enhance Transportation- Disadvantaged Seniors’ Mobility and Promote Cost-effective Delivery of Services
paragraphs: According to a 2002 report prepared by DOT’s Transit Cooperative  Research Program (hereafter referred to as the TCRP report), 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.
subsections: section_title: Improvements to Service Efficiency
paragraphs: 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.
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. 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. 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 brokerage 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.
section_title: Improvements to Customer Service
paragraphs: 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), 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-curb 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.
Using vehicles that can accommodate seniors’ mobility challenges: Using  vehicles that accommodate the mobility challenges of seniors—such as  purchasing low-floor buses, 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 terrain  and many narrow streets. The majority of service providers we interviewed  use lift-equipped 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  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.
section_title: Improvements to Leverage Available Funds
paragraphs: 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 their personal telephones and space in their home) translates into  approximately $1.6 million in cost savings per year.
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  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.
section_title: Summary of Practices and Funding Sources
paragraphs: Table 3 provides examples of some of the practices and federal funding  sources used by the local service providers we interviewed.
section_title: Local Practices Have Enhanced the Senior-Friendliness and Cost-effectiveness of Services
paragraphs: 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.
section_title: Federal Programs Support the Implementation of Practices That Enhance Transportation- Disadvantaged Seniors’ Mobility to Some Extent
paragraphs: 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. (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, 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  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.
section_title: Local Transportation Service Providers Continue to Face Difficulties in Implementing Practices That Enhance Transportation- Disadvantaged Seniors’ Mobility
paragraphs: 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  (equivalent to over $10,000), costing the provider more in administrative  costs than the actual funding received through the federal programs.  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, including doing such  tasks as tracking the different data requested by each program, organizing  documents, and following up on required information. 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. 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  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.
section_title: Experts and Stakeholders Suggested Strategies for Overcoming Mobility Obstacles
paragraphs: 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.
section_title: Conclusions
paragraphs: 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  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.
section_title: Recommendations for Executive Action
paragraphs: 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:  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.
section_title: Agency Comments
paragraphs: 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.
section_title: Scope and Methodology
paragraphs: 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 2003 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  populations 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 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.
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  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.
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 transportation- disadvantaged seniors’ mobility needs and strategies the federal  government could consider taking to improve the ability of federal  programs to meet these seniors’ mobility needs and enhance the cost- effectiveness 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.
We conducted our work from November 2003 through August 2004 in  accordance with generally accepted government auditing standards.
section_title: Information on Transportation Provided by 16 Area Agencies on Aging
paragraphs: Service restrictions (age, day/hours, distance, number of trips)
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)
Service restrictions (age, day/hours, distance, number of trips)
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)
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)
Service restrictions (age, day/hours, distance, number of trips)
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)
Fixed route to senior centers  Assisted door to door for trips to doctor  appointments, grocery stores, and recreational  activities (funded by seniors)
section_title: Local Service Providers and Practices That Can Enhance Transportation-Disadvantaged Seniors’ Mobility
paragraphs: Type of practice (as described by the  providers and in the literature)
Coordinates transportation service with “zero  trip denial” policy and uses dedicated funding  through state lottery program.
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.
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.
Provides demand-response transportation  service with volunteer drivers to transport  seniors to medical appointments, grocery stores,  pharmacies, senior centers, or other errands.
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).
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.
Type of practice (as described by the  providers and in the literature)
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.
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.
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.
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.
Provides low- or no-cost transportation to low- income 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.
Implemented a travel-training program through  which volunteers teach seniors how to use  public transportation.
Type of practice (as described by the  providers and in the literature)
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.
Provides demand-response transportation  services to seniors for grocery shopping,  medical appointments, banking, daily nutrition,  senior center activities, and other general travel  trips.
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.
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.
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.
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.
Type of practice (as described by the  providers and in the literature)
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.
Transports older adults and persons with  disabilities to medical facilities, grocery stores,  meal sites, and adult day centers and for other  personal needs.
Uses volunteers to provide door-through-door  medical transportation services to seniors.  Services are free to seniors.
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.
Coordinates its services with local transit  authority and taxicab services. Provides a driver- training program that emphasizes safety and  customer service. Uses brightly-decorated  vehicles to attract senior ridership.
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.
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.
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.
Type of practice (as described by the  providers and in the literature)
Reimburses volunteer drivers to transport  individuals where no transit service exists or  when the individual is too frail to use other  transportation.
Operates a demand-response service for  seniors who need transportation services to  medical facilities. Also works with local senior  centers to provide transportation services.
Provides free transportation using volunteers,  who use their private vehicles to transport  seniors to medical appointments, shopping, and  errands.
section_title: Comments from the Department of Health and Human Services
section_title: GAO Contacts and Staff Acknowledgments
subsections: section_title: GAO Contacts
section_title: Staff Acknowledgments
paragraphs: 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.
section_title: GAO’s Mission
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