Transportation for Older Adults: Measuring Results Could Help Determine If Coordination Efforts Improve Mobility
Published: 2014-12-10T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: As the U.S. population ages, access to safe and reliable transportation alternatives is critical to helping older adults remain in their homes as long as possible. HHS, DOT, VA, and other federal agencies may provide funds to state and local entities to help older adults access transportation. GAO was asked to review access to transportation services for older adults. This report examines (1) the federal programs that provide funding for transportation services for older adults and the extent to which the programs that fund these services are coordinated, and (2) how state and local transportation agencies and aging network organizations in selected states coordinate transportation for older adults and the challenges they face in coordinating or providing these services. GAO reviewed past work on programs for transportation-disadvantaged populations, reviewed federal program information, and conducted interviews with HHS, DOT, and VA, as well as, state and local transportation agencies and aging organizations in selected states. GAO selected four states based on populations of older adults, federal funding received for transportation, and geography, among other factors.
section_title: What GAO Found
paragraphs: Two key federal programs and several other programs identified by GAO provide funding for transportation services for older adults. The Administration on Aging (AoA) within the Department of Health and Human Services (HHS) provides funding for supportive services—including transportation—to state and local agencies exclusively for older adults. Within the Department of Transportation (DOT), the Federal Transit Administration's (FTA) Enhanced Mobility of Seniors and Individuals with Disabilities program is focused on improving the mobility of older adults as one of its two primary populations. Other federal agency programs, including some within the Department of Veterans Affairs (VA), can fund access to transportation services for eligible older adults, among other beneficiaries. The Interagency Coordinating Council on Access and Mobility (Coordinating Council) is responsible for leading federal efforts to improve the efficiency and effectiveness of human service transportation by coordinating related programs. Federal agencies' involvement in the council and its activities varies, with coordination on older adult transportation primarily occurring between AoA and FTA through working groups, initiatives, and technical assistance efforts. While some federal coordination activities are ongoing, current efforts do not identify desired outcomes, a key feature GAO has identified to consider when implementing interagency collaborative mechanisms. Specifically, the Coordinating Council's latest strategic plan, which covers the period 2011 to 2013, lacks clearly defined outcomes and measures to track progress toward those outcomes. Without defined outcomes and a clear method to collect data to monitor progress, it is difficult to determine whether current efforts of the council are achieving their intended results and providing the benefits of coordination, such as improved access to transportation, for older adults. In a concurrent report ( GAO-15-110 ), GAO is recommending that the council update its plan.
State and local transportation agencies and aging organizations in the four states GAO visited used a variety of mechanisms to coordinate transportation services for older adults. For example, many state and local activities are currently focused on mobility management approaches—such as travel training programs—to help older adults identify and access the various transportation resources available. Some organizations GAO interviewed have also implemented more extensive approaches to coordination that are intended to help older adults access transportation services, such as offering a wide range of volunteer transportation. For example, Ride Connection—a transportation provider operating in Oregon—relies heavily on volunteers and service partners to provide over 400,000 rides a year to older adults and others, through travel training, community shuttles, and other programs. However, funding eligibility and reporting requirements for different programs , geographic boundaries , and limited data on the extent of need were identified as challenges that, at the state and local level, may inhibit coordination in the selected states. For example, officials in all four of the selected states noted that rural areas often have very few transportation options available to serve older adults and other residents, particularly for social and recreational outings. Examples from the selected states also suggest that funding for these types of life-enhancing activities may be limited as states prioritize their funding to ensure life-sustaining trips, such as medical and nutrition services, are provided.
section_title: What GAO Recommends
paragraphs: GAO recommends that DOT define and report on desired outcomes and collect related data to track and measure progress in achieving results, including the extent of coordination efforts under way. DOT partially concurred with the recommendation and plans to consider what information may be needed to measure and evaluate ongoing coordination efforts.

section_title: Letter
paragraphs: As the U.S. population ages, transportation is a service that is critical to  helping older adults remain in their homes as long as possible. Although  many older adults continue to rely on personal vehicles as their primary  mode of travel, older adults are also increasingly using public and private  transportation options to access a range of services. Older adults who are  no longer able to drive rely on these transportation options for health and  medical appointments, grocery shopping, social events, and other life- sustaining and life-enhancing activities. In addition, as people age, their  physical, visual, and cognitive abilities may decline, making it more  difficult for them to drive safely. A decline in mobility can severely  decrease an older person’s quality of life, leading to issues such as fewer  out-of-home activities, increases in health and nutrition problems, and  isolation. With the older adult population projected to increase from 40  million in 2010 to 72 million in 2030, having access to safe and reliable  transportation alternatives can help this growing population age in place,  particularly for those older adults who may face additional mobility  challenges.
Federal agencies, including the Departments of Health and Human  Services (HHS), Transportation (DOT), and Veterans Affairs (VA) play an  important role in helping older adults access transportation services and  increase their mobility options. In particular, these agencies administer  programs that provide funds for a range of transportation services to state  and local grantees that, in turn, offer transportation services either directly  or through private or public transportation providers. State and local  governments also provide substantial funding for programs providing  transportation for older adults, and these entities, along with public or  private providers, administer services at the local level. For example,  federal program grantees may include state units on aging and local area  agencies on aging (AAA), commonly referred to as the aging services  network. Transportation services may be provided by contracting with  private transportation providers or providing transit passes, taxi vouchers,  or mileage reimbursement to program participants, or some combination  of these methods. However, fiscal constraints at the national, state, and  local levels may limit the funds that are available to provide transportation  services to the growing population of older adults. We have previously  found that people in need of transportation often benefit from greater and  higher quality of services when transportation providers coordinate their  operations.benefits, such as funding flexibility, reduced costs, or greater efficiency.
Additionally, federal coordination can lead to economic  You asked us to review access to transportation services for older adults.  This report examines (1) the federal programs that provide funding for  transportation services for older adults and the extent to which the  programs that fund these services are coordinated, and (2) how state and  local transportation agencies and aging network organizations in selected  states coordinate transportation for older adults and the challenges they  face in coordinating or providing these services.
To identify federal programs that provide funding for transportation  services for older adults, we reviewed our 2012 report on transportation- disadvantaged populations, which identified federal programs that provide  funding for older adults, among other transportation services, and a 2013  AARP report that identified federal programs that provide funding for older  adults. In addition, we conducted a search of the Catalog of Federal  Domestic Assistance. We limited our scope to member agencies of the  Interagency Coordinating Council on Access and Mobility (Coordinating  Council). Through these reviews, we identified three primary federal  agencies (HHS, DOT, and VA) that administer programs that provide  funds to older adults where transportation is an eligible expense or that  target older adults among the eligible recipients for transportation funds.  Other federal agencies may also have programs that provide funding for  transportation for older adults. However, we did not systematically identify  every program government-wide that could provide such funding as part   We also asked federal program officials from the three  of this review.agencies to review and verify the programs identified and the program  information collected, including if transportation for older adults was an  allowable use of program funds, and program spending or obligations for  fiscal year 2013. Agency officials provided requested spending and  obligation data when available, but we did not independently verify the  data provided. To determine the extent to which these programs are  coordinated, we reviewed policy and other guidance established to  promote coordination of transportation services at the federal level and  interviewed officials from HHS, DOT, and VA about the level of  interagency coordination on transportation for older adults. We also  reviewed Coordinating Council documents, such as its 2011 to 2013  strategic plan and progress report on recommended actions for human  service transportation coordination. We interviewed staff from federal  technical assistance centers, university researchers, and stakeholder  groups involved in transportation coordination efforts about federal  coordination of services to meet the transportation needs of older adults.  We also compared coordination efforts against leading practices GAO  has identified for successful interagency collaboration and collaborative  mechanisms, such as interagency groups and councils.
To determine how selected state and local transportation agencies and  aging network organizations coordinate transportation for older adults and  the challenges they face in coordinating or providing these services, we  conducted site visits in four states—Florida, Oregon, Pennsylvania, and  Texas—to discuss the coordination of transportation services between  transportation and aging network organizations. In particular, we  interviewed officials from state and area agencies on aging, state  transportation departments, metropolitan planning organizations, VA  medical centers, and local transit providers about how they coordinate  transportation services for older adults, challenges to providing and  coordinating services, and any gaps in the current services provided. We  selected these four states as they were among those with the greatest  overall population of and the largest proportion of older adults and  received the largest amounts of DOT funding for transportation services  that can be used for older adults; within those states, we identified and  visited metropolitan areas that provided transportation services to older  adults in both urban and rural portions of the states. Information obtained  in the site visits is not generalizable to other states that coordinate  transportation services for older adults. In addition, we interviewed federal  agency officials within HHS, DOT, and VA as well as staff from the federal  technical assistance centers about the challenges to coordination at the  state and local levels. See appendix I for additional details on our scope  and methodology.
We conducted this performance audit from March 2014 to December  2014 in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: Older adults are considered among the transportation-disadvantaged  population, or those millions of Americans who are unable to provide their  own transportation or have difficulty accessing public transportation  because of age, disability, or income. The total number of transportation- disadvantaged older adults is unknown, and groups of transit dependent  riders can overlap because some older adults may also be disabled or  low income, or both. However, the older adult population is growing more  rapidly than any other age group in the United States. Specifically,  according to 2010 U.S. Census data, the population aged 65 and older  grew 15 percent from 2000 to 2010, compared to about a 10 percent  growth in the overall population, and by 2030, older adults are expected  to comprise about 20 percent of the overall population. In 2012, the  estimated population of veterans 65 and older was 9.6 million. Although  about 83 percent of older adults are licensed drivers, approximately 20  percent of older adults no longer drive, according to the Federal Highway  Administration’s 2009 National Household Travel Survey.
A range of mobility options can allow older adults to maintain their  independence and age in place in their communities. For example, for  those older adults who no longer drive, some may walk, bike, or use  public transportation to meet their mobility needs. Others, including those  with disabilities, may require more specialized transportation, such as  paratransit in order to access services. According to 2010 U.S. Census  data, 50 percent of adults 65 and older had a disability. Paratransit  service, broadly defined, is accessible, origin-to-destination transportation  service that operates in response to calls or requests from riders. It is an  alternative to fixed-route transit service, which operates according to  regular schedules along prescribed routes with designated stops.
The Older Americans Act of 1965 (OAA) was enacted to provide services  to older adults to help them remain in their homes and communities for as  long as possible. authorizes federal funding for a variety of home- and community-based  supportive services that allow older adults to maintain independence. For  example, Part B of Title III provides funding for a variety of supportive  services, including transportation for older adults with and without mobility  impairments. In fiscal year 2014, about $1.2 billion in Title III grants  were provided to states, of which $344 million were grants for supportive  services. The OAA, as amended, established the Administration on Aging  (AoA) within HHS as the chief federal advocate for older Americans and  assigned responsibility for home- and community-based services to AoA.  In 2012, HHS established the Administration for Community Living (ACL),  which brought together AoA, the Office on Disability, and the  Administration on Developmental Disabilities—within HHS—to better  align the federal programs that address the community living service and  support needs of both the aging and disability populations, among other  things. AoA distributes funding through grants to state units on aging,  which allocate these funds to AAAs that either directly provide services,  or contract with local service providers.
42 U.S.C. §§ 3001 and 3003. include private nonprofit and government organizations; 244 tribal and  Native American organizations; and 2 organizations serving Native  Hawaiians. Nearly 20,000 local organizations provide services through  this network. The state units on aging and AAAs are responsible for the  planning, development, and coordination of an array of home- and  community-based services within each state. In particular, the OAA  requires state units on aging to submit plans to the AoA for 2, 3, or 4  years. Among other types of information, the plans must evaluate older  adults’ needs for home- and community-based services, which may  include transportation. In addition, the OAA requires that state units on  aging develop a standardized process to determine the extent to which  public or private resources (including volunteers and programs and  services of voluntary organizations) are capable of meeting needs.
MAP-21, Pub. L. No. 112-141, § 20028, 126 Stat. 405, 726, codified at 49 U.S.C. § 5338  (a)(2)(D). include activities previously eligible under the New Freedom program and  to public transportation projects that improve access to fixed-route service  and decrease reliance by individuals with disabilities on complementary  paratransit. In particular, Enhanced Mobility program funds can be used  for capital planning and operations: 55 percent of all allocations for each  grant recipient must be used for public transportation projects where  traditional services are unavailable, inappropriate, or insufficient, while the  remaining 45 percent can be used for other eligible services, including  capital and operating expenses and projects previously eligible under the  New Freedom program. States typically distribute these funds to local  nonprofit human service agencies to buy vehicles that transport older  adults and people with disabilities, and the agencies funded may provide  transportation to support a range of activities, such as visiting friends.
The Enhanced Mobility program requires grantees to develop coordinated  public transit-human services plans. development and approval process that includes seniors, people with  disabilities, and transportation providers, among others, and is  coordinated to the maximum extent possible with transportation services  assisted by other federal departments and agencies. The program also  allows other federal non-DOT funds, such as Title III Part B funds, to be  used as matching funds in order to better meet the transportation needs  of older adults and promote federal coordination.
Human-service transportation refers to transportation services provided by or on behalf  of a human service agency to provide access to agency services and to meet the basic,  day-to-day mobility needs of transportation-disadvantaged populations, especially  individuals with disabilities, seniors, and people with low incomes. income individuals. Medicaid programs, which are administered by each  state subject to the oversight of CMS, are required to assure that program  beneficiaries—such as low-income children, people with disabilities, and  older adults, among others—have access to necessary Medicaid  providers when the beneficiaries cannot transport themselves to these  providers. Under federal regulations, VA also provides transportation to  medical services for those veterans who have service connected injuries  or disabilities and meet certain eligibility criteria.
Our past work on transportation-disadvantaged populations has found  that federal coordination has the potential to reduce federal transportation  program costs by clustering passengers; using fewer one-way trips; and  sharing the use of personnel, equipment, and facilities. Federal efforts  to coordinate transportation for the disadvantaged, including older adults,  began in 1986 when DOT and HHS formed what is now known as the  Coordinating Council. The Coordinating Council is chaired by the  Secretary of Transportation and is charged with improving the efficiency  and effectiveness of human service transportation by coordinating related  programs at the federal level and promoting the maximum feasible  coordination at the state and local levels. In 2003, the Coordinating  Council launched the “United We Ride” initiative to act as a forum for  interagency communication and to help states and communities  overcome obstacles to coordination. The Coordinating Council’s actions  have included issuing publications such as policy statements and  progress reports on efforts taken. However, our June 2012 report on  transportation-disadvantaged populations concluded that insufficient  federal leadership and a lack of guidance for furthering collaborative  efforts might hinder coordination efforts among state and local  providers. To promote and enhance federal coordination efforts, we  therefore recommended in 2012 that the Secretary of Transportation, as  the Chair of the Coordinating Council, along with the council’s 11 member  agencies, should meet and complete and publish a strategic plan  outlining agency roles and responsibilities and articulate a strategy to help  strengthen interagency collaboration and communication. In response to  our recommendations, the Coordinating Council’s member agencies  issued a strategic plan for 2011 to 2013, which established agency roles  and responsibilities and identified a shared strategy to reinforce  cooperation.
Our prior work has shown that coordination can lead to improved quality  and cost-effectiveness of transportation-disadvantaged services. In  addition, we have previously identified key features and issues to  consider when federal agencies collaborate and implement collaborative  mechanisms, such as an interagency group or council. These key  features include defining outcomes; monitoring progress to show  accountability; establishing clear leadership; and determining key  resources, such as funding. For example, various approaches can help  enhance and sustain collaboration among federal agencies, such as  developing a plan to identify short- and long-term outcomes and tracking  progress toward those outcomes.
section_title: Transportation Funding Flows to Older Adults through Key Federal Programs, but Outcomes of Coordination Efforts Are Not Measured
subsections: section_title: Transportation Funding Can Flow to Older Adults through Two Targeted Federal Programs and Several Other Federal Programs That Serve Broader Populations
paragraphs: We identified two key federal agency programs, AoA’s Title III Part B  Supportive Services and FTA’s Enhanced Mobility program, and six other  federal agency programs that can provide funding or transportation  services for older adults. These eight identified programs are not an  exhaustive list of all existing programs, but rather we focused on  programs administered by the three primary Coordinating Council  member agencies that provide transportation funding or services that may  benefit older adults. Not all of the programs we identified focus solely on  the older adult population. (For additional information on how we  identified these, see appendix I. Also, see appendix II for the complete  program list, including program descriptions.) In addition, as we reported  in 2012, total federal spending on transportation services for  transportation-disadvantaged populations is unknown because in many  cases federal agencies do not separately track spending for these  services. As such, transportation spending for older adults is also  unknown because the funds are used to provide transportation services  for a broader population.
Of the eight federal programs we identified, the only programs that  specifically provide funding exclusively for older adults were established  in the OAA, which includes Title III Part B Supportive Services.  Specifically, Title III Part B provides funds to 11 categories of supportive  services for older adults, including transportation and assisted   According to HHS officials, transportation can include a  transportation.range of services such as shared rides and public transportation access,  while assisted transportation serves eligible older adults who have  difficulties using regular vehicular transportation and involves providing  assistance, such as an escort, to those adults. Because this program  targets services for older adults—including transportation—spending  information for that population is available, as states are required to  annually report their Title III Part B spending across the different  supportive services. In fiscal year 2012, states reported spending a total  of $68.8 million on transportation and $3.3 million on assisted  transportation. Overall, states reported spending a total of $330 million  on supportive services in 2012, making transportation and assisted  transportation about 22 percent of total reported expenditures. This is  similar to what states have previously reported spending on these two  supportive service categories from 2010 and 2011 (see table 1). In  addition, AoA collects information on the number of transportation service  rides provided through Title III Part B, as well as both the number of rides  and people receiving assisted transportation services through their  programs.
FTA’s Enhanced Mobility program also targets older adults as one of its  primary populations and is focused on improving the mobility of seniors  and people with disabilities. According to FTA officials, the agency  obligated about $180.6 million in Enhanced Mobility program funds in  fiscal year 2013. FTA officials stated that they do not track the  proportion of funds going to transportation projects and services for older  adults versus those with disabilities, and said that in many cases, the  project to be funded would benefit both populations by responding to the  same functional needs, whether the need is derived from age or a  disability. For example, the cost to ride in taxicabs that meet the  Americans with Disabilities Act (ADA) accessibility requirements are an  eligible expense under the Enhanced Mobility program. Accessible taxis  offer communities flexibility, and cost savings, compared to traditional  ADA paratransit service,disabilities regardless of age.   and can benefit older adults and persons with  The remaining programs within CMS and VA do not specifically target  older adults, but provide funds for transportation services that qualified  older adults could benefit from. These programs are primarily focused on  nonemergency medical transportation (NEMT). Specifically, CMS’s  programs such as Medicaid NEMT and 1915(c) Home and Community  Based Services waiver programs can provide transportation to eligible  older adults. The Medicaid program provided health services to NEMT  eligible populations. For example, it provided service to more than 4.6- million low-income seniors, compared to 11-million non-disabled adults,  8.8-million individuals with disabilities, and more than 31-million  children. In addition, VA programs, including Veteran’s Medical Care Benefits (Beneficiary Travel) and Veteran’s Transportation Program can  benefit eligible older adult veterans. For example, in 2013, VA officials  told us that the Beneficiary Travel program reimbursed approximately 5- million claims for mileage costs totaling about $168 million to veterans  aged 65 or older.
section_title: Federal Coordination Efforts Vary and Outcome Measures Are Not Clearly Identified or Tracked
paragraphs: Federal agency involvement in the Coordinating Council varies, with  coordination on older adult transportation primarily occurring between  FTA and AoA, the two primary agencies involved in human services  transportation planning activities. The Coordinating Council’s Executive  Committee has not met since 2007, but Coordinating Council officials told  us that the lack of meetings is not a sign of inactivity, as working groups  comprised of staff-level program officials from some of the 11 member  agencies have developed initiatives intended to further federal  coordination efforts. According to Coordinating Council officials, working  groups are activated in response to specific needs that arise for  collaboration between partner agencies. For example, current working  group initiatives have focused on mobility management tools, such as  one-call one-click centers, to better connect transportation service  providers and riders. In particular, Coordinating Council officials stated  that the Health, Wellness and Transportation working group, which  includes participation from DOT, VA, HHS, and the Department of Laboris the focal point for current coordination activities and has incorporated  earlier initiatives, such as veterans transportation efforts, into this group.
This research and demonstration program also included contributions from the  Community Transportation Association of America, Easter Seals, and the National  Association of Area Agencies for Aging—industry associations representing transportation  providers, older adults, and people with disabilities, as well as the aging services network,  respectively. as well as new and innovative models for addressing the needs of older  adults and those with disabilities. According to DOT officials, the Small  Grants program was initially funded in fiscal year 2012 for $1 million,  about $950,000 in fiscal year 2013, and $1 million in fiscal year 2014. The  program has finished its first phase and is currently funding its second  phase of grant projects. One such grant was awarded to Montgomery  County, Maryland to help increase participation by older adults in a local  transportation advisory committee, and to train high school and  community college students to assist older adults and persons with  disabilities in accessing and navigating public transportation systems. The  second initiative was the Veterans Transportation and Community Living  Initiative (VTCLI) grant, a coordinated effort by the Departments of  Defense, HHS, Labor, DOT, and VA.help veterans and others identify and access locally available  transportation services that connect them with work, education, health  care, and other vital services in their communities. While the primary goal  was to support veterans and military families, the grants are structured to  fund transportation projects that will potentially benefit anyone living  within the jurisdiction of a grant recipient—including older adults. The  program only awarded grants in fiscal years 2011 and 2012. In that  period, VTCLI awarded approximately $64 million for 119 grant projects  for a wide range of activities and technology improvements, including  mobility management tools, such as one-call or one-click centers.
VTCLI grants were intended to  Mobility management was also identified as an objective in the  Coordinating Council’s 2011 to 2013 strategic plan, with an emphasis on  increasing the use of cost-effective and efficient mobility management  principles, in part by expanding training for state and local officials.  According to Coordinating Council officials, FTA’s Enhanced Mobility  program, which includes allowing mobility management as an eligible  expense, provides opportunities for innovative programs and practices at  the state and local level, such as helping support mobility manager  positions or other mobility management tools. According to these officials,  mobility managers are seen as a key position that can help connect the  various stakeholders in a coordinated transportation system.
In addition to supporting mobility management activities, the Coordinating  Council’s strategic plan highlights the importance of providing technical  assistance to support Coordinating Council coordination goals and  strengthen state- and local-coordination efforts. Coordinating Council  officials highlighted three national technical assistance centers that  receive funding from FTA and are affiliated with other Coordinating  Council agencies, and have been established to share coordination  information and resources with state and local entities.
Easter Seals Project ACTION (Project ACTION) provides technical  assistance related to accessible community transportation for persons  with disabilities and older adults through research, online training, and  outreach efforts to individuals or communities. For example, a Project  ACTION white paper for FTA on access to public transit found that  increased coordination of healthcare and transportation programs can  produce reduced costs, increased accessibility to transportation  options, and more positive health outcomes for older adults and  persons with disabilities.
The National Center for Mobility Management provides support to  FTA grantees, with a focus on direct technical assistance and sharing  information with state and local entities. As a part of its efforts, the  center is collecting data on transportation coordination plans and  mobility management approaches from state and local providers for  inclusion in a database and as case studies published on its  website. For example, the center has developed publications  identifying promising practices in mobility management areas,  including coordinated transportation planning and technology use in  transportation coordination.
The National Center for Senior Transportation facilitates local  partnerships that help provide transportation to older adults,  administers grant programs, and provides information and technical  assistance support to communities. FTA is the primary funding agency, and according to center officials, AoA has been a primary  partner in program development and activities. The center’s technical  assistance activities have included administering a series of grants  intended to encourage aging organizations and public and private  transportation providers to involve older adults and people with  disabilities in the public-transit planning process. For example, the  center implemented a grant program under a cooperative agreement  with FTA that focuses on person-centered mobility management. In  2012, NCST awarded 9 grants totaling about $500,000 to local  communities, which included grants to provide travel training and  counseling on travel options for older adults.
We found that some agencies are more engaged in coordinating  transportation for older adults than others. In particular, AoA and FTA  have shown continuing coordination through Coordinating Council  working groups, initiatives, and technical assistance efforts as described  above. Both agencies also help facilitate coordination through their  respective programs. Specifically, the planning requirements and funding  flexibility in both the Title III Part B and the Enhanced Mobility programs  help involve stakeholders and coordinate federal resources for human  service transportation by, for example, allowing Title III Part B funds to be  used as the non-federal match for Enhanced Mobility program funds.  However other agencies, such as VA and CMS, have not been as active  in federal coordination efforts that affect the transportation- disadvantaged. For example, the Coordinating Council’s activities have  been limited to staff-level working group activities that do not involve all  member agencies, and lack participation by key players, such as those  primarily involved in NEMT. As we previously found, agencies can use  their strategic plans as tools to drive collaboration with other agencies  and partners by ensuring consistent and complementary goals and  strategies. Our concurrent report related to the coordination of NEMT  services recommended that the Council update its strategic plan, which  covered the period from 2011 through 2013. An updated strategic plan  could be used to outline a strategy for coordinating NEMT across all  federal agencies funding this type of service, which could benefit all  transportation-disadvantaged populations, including older adults.
In addition, current federal coordination efforts do not identify or  incorporate clear short- and long-term desired outcomes, a key issue to  consider when implementing interagency collaborative mechanisms to  ensure participation from all member agencies. The Coordinating  Council identified high-level strategies, related objectives, and proposed  performance indicators supporting these objectives in the 2011 to 2013  strategic plan as a guide for the council’s activities over the two-year  period. However, the Coordinating Council did not clearly define desired  outcomes, measures to track progress towards achieving its objectives,  or timeframes for implementing its strategies and communicating results.  For example, the strategic plan identifies deploying mobility management  as one of the objectives for implementing the strategy to expand  coordinated human-service transportation infrastructure in order to  improve the capacity of communities to deliver integrated transportation  and improved customer service. The objective identifies action steps and  performance indicators, including tracking the number of mobility  managers and the number of mobility managers receiving training and  technical assistance. However, according to Coordinating Council  officials, no data associated with these indicators are currently being  collected that would help the council determine whether its efforts to  deploy mobility management are resulting in an increased use of cost- effective and efficient mobility management principles in local  communities. Additionally, because Coordinating Council officials said  there are currently no plans to renew or revise the now-expired strategic  plan, it is not clear which, if any, of the proposed objectives are applicable  to current Coordinating Council activities or whether the performance  indicators will be tracked. Coordinating Council officials said the  objectives and performance indicators outlined in the strategic plan were  intended to demonstrate potential outcomes and ways of measuring  progress, and officials plan to explore specific measures and  opportunities for data collection through the technical assistance centers  in the future. However, the Coordinating Council has not yet established a  specific time frame for doing so. We have previously found that  monitoring and evaluating federal collaborative efforts to identify areas of  improvement can help key decision makers within the agencies, as well  as clients and stakeholders obtain feedback for improving both policy and   Without clearly defined outcomes and related  operational effectiveness.performance measures, it is difficult to assess the effectiveness of  activities related to transportation for older adults currently under way in  improving mobility options and access to transportation services or to  make decisions about future coordination efforts. Additionally, without a  clear method to collect and track information and data to demonstrate  progress, it is difficult to show the benefits of coordination, and whether  current Coordinating Council efforts are achieving the outcomes intended  to improve transportation coordination for transportation-disadvantaged  populations, including older adults.
section_title: State and Local Transportation Agencies and Aging Network Organizations Coordinate in Various Ways, but Challenges Continue
subsections: section_title: A Variety of State and Local Coordination Efforts Are Under Way
paragraphs: State and local transportation agencies and aging network organizations  in the four states we selected used a variety of different mechanisms to  coordinate transportation services for older adults. These mechanisms  are similar to those we previously found are being used by a number of  other regions, states, or localities for coordinating transportation. In our  selected states, they were also being used to help older adults access  transportation services (see table 2). For example, state level  coordination councils may be created by statute, executive order, or  governor initiative to oversee coordinated transportation for  transportation-disadvantaged populations within a given state. In addition,  mobility management efforts—which include individual level education  and counseling on transportation options and systems level coordination  among transportation and human service providers—are being promoted  nationwide, including in our selected states.
Building from the efforts described above, some selected transportation  and aging network organizations have implemented or are piloting more  extensive or innovative approaches to coordination intended to help older  adults access transportation services, such as offering a wide range of  volunteer transportation and expanded mobility management services.  For example, Ride Connection—a transportation provider operating in  Oregon—relies heavily on volunteers and a network of service partners  throughout the region to provide over 400,000 rides a year to older adults,  people with disabilities, and those living in rural areas through a range of  programs. These include travel training and coaches, community shuttles,  a shared vehicle program, as well as fare assistance and relief programs.  According to Ride Connection officials, approximately two thirds of the  organization’s 600 drivers are volunteers, and the officials view the  volunteer model as an important component of helping older adults age in  place. Transportation organizations in other areas of the country are also  seeking to leverage volunteer networks. The Independent Transportation  Network America, an organization created to help expand the range of  services available to older adults needing transportation, has explored  innovative approaches and a volunteer network specifically targeted at  serving older adults. Founded in Maine, this organization has 26 affiliate  locations nationwide, offering rides 24 hours a day, 7 days a week, for  any purpose. As members, the individuals also have the option to trade in  their vehicles in exchange for credits that can be used to pay for future  rides. The Independent Transportation Network also provides door- through-door service to better meet the mobility needs of frail older  adults.
All of the states we selected were also pursuing pilot projects to refine  long-standing services or conducting research to better assess unmet  needs and potential additional coordination mechanisms. For example,  the Pennsylvania Department of Transportation and stakeholders,  including AAA officials, have begun a pilot project to explore adjustments  and alternative approaches for the state’s lottery-funded Shared-Ride  program. In part, this is an effort to use stakeholder input to address  issues with many counties’ inability to cover the full cost of the senior  transportation service. Other selected states have engaged in research  and assessments to better identify unmet needs and potential  approaches for furthering coordination efforts among transportation- disadvantaged groups, including older adults. For example, officials at the  Florida Commission for the Transportation Disadvantaged worked with  academic researchers to define the unmet and latent travel demand to  better understand the mobility needs of the transportation-disadvantaged  population in the state. Oregon and Texas have also undertaken  initiatives to further explore opportunities for increased coordination. Both  states completed reports in 2013 that included recommendations for  developing performance metrics and both reports highlighted the need to  collect and share information on gaps in service and unmet need, efforts  that officials in these states continue to pursue. For example, the Texas  coordination report proposed that state and regional stakeholders  collaborate to develop statewide performance indicators for  demonstrating that individuals throughout the state have improved access  to an effective and efficient network of public transportation services,  especially for seniors and people with disabilities.
Some of the transportation agencies and aging network organizations we  met with described examples of areas where existing coordination efforts  have been particularly helpful, but data or information quantifying the  effects of coordination are lacking. For example, officials involved in  regional coordination efforts in Texas told us that standard performance  measures may not adequately capture the complexity of successful  transportation coordination efforts, and they are working on developing  performance measures to help identify geographic service gaps, which  they know are issues in the region. Generally, examples of the benefits of  coordination in our selected states, including those below, were limited to  anecdotal examples.
Ride Solution officials in Florida noted their county-level coordinated  system was designed to deliver any type of rider to any location— serving the general public, human service agencies, and  transportation-disadvantaged populations with the same fleet of  vehicles. Ride Solution officials also designed their own vehicle, which  can accommodate 5 wheelchairs, 25 passengers, and has a low floor  feature eliminating the need for stairs, which can be difficult for older  adults to navigate (see fig.1). According to Ride Solution officials, the  overall level of coordination resulting from their deviated-route format  combining different types of riders has enabled them to provide over double the trips than the state paratransit average for many years.
Others noted that coordination can help improve the logistics  necessary for coordination by offering, for example, one shared call  center and scheduling system. One Oregon transportation provider  we met with, Lane Transit District, described operational efficiencies  and benefits to the customer resulting from coordination. For example,  this provider established a one-stop call center for human service  transportation, which handles requests for transportation for a variety  of programs including ADA paratransit, Medicaid NEMT, as well as  senior and disabled services community transportation. According to  officials, this simplified one-stop access to transportation breaks down  what was once a complex administration of programs, putting  individuals in direct contact with resources to help identify  transportation options available to them.
section_title: Challenges May Inhibit Coordination and Make It Difficult to Meet Older Adults’ Needs
paragraphs: We identified funding eligibility and reporting requirements for different  programs, geographic boundaries, and limited data on the extent of need  given the growing population of older adults as challenges at the state  and local levels that may inhibit coordination in our selected states. For  example, a number of state and local officials in each of our four selected  states told us that it is difficult to co-mingle funds from different federal  funding streams because of eligibility requirements, including both  programmatic requirements on how funds can be used (i.e., certain  beneficiaries) as well as perceptions about how funds can be used within  those requirements. We previously found there is a disconnect between  transportation providers and human service agencies. In other words,  transportation providers are generally focused on making transportation  services available for a wide population, including the general public,  older adults, and people with disabilities. In contrast, human service  agencies are often focused on meeting the specific needs of a narrower  population (i.e., an eligible program beneficiary). For example, a  transportation provider we met with in Florida said there is a perception in  Northeast Florida, including the Jacksonville area, that OAA funding can  only be used to provide a specific service, transporting older adults to  congregate meal sites. These officials stressed that these perceptions  need to be overcome so the region can pursue additional opportunities to  coordinate transportation services and share resources. Similarly, in the  locations we visited, VA officials were generally not involved in regional or  local coordination efforts. In Pennsylvania, for example, VA NEMT  programs operate outside the coordinated transportation planning  process. According to VA officials we met with, from the agency’s  perspective, if veterans are not eligible for VA-provided NEMT, they are  essentially on their own in finding transportation. In certain circumstances  for a specific patient, VA officials may reach out to local entities to try to  identify transportation alternatives, but the officials said there is no formal  structure or process in place for this type of activity. Pittsburgh’s VA  Medical Center currently does not participate in any type of coordination  with non-VA transportation planning or human service-transportation  coordination, according to Medical Center officials.
Coordination among providers serving different geographic boundaries  can be challenging in both rural and urban areas. Officials in Oregon and  Florida identified transportation to medical centers in other counties as a  transportation need. For example, transportation officials in Oregon told  us that in areas outside the urban core or in more rural areas, a rider may  need to access more than one transportation provider to make such a trip  and cross county lines in order to access that service. This situation may  be further complicated for older adults, because it can be more difficult to  physically manage transfers or long waits. In addition, available service  days and hours may be limited in rural areas, further affecting older  adults’ ability to access different types of activities. Officials in all four of  our selected states noted that rural areas often have very few  transportation options available to serve older adults and other residents.  For example, an AAA in rural Pennsylvania noted that the lack of  transportation service options on Sundays has a direct impact on older  adults’ ability to get to church, which can be a very important outing for  some riders.
Another challenge that may hinder coordination is limited data on the  extent of older adults’ transportation needs given the growing population  of older adults. While recipients of Enhanced Mobility program funding  are required to develop coordinated public transit-human service plans  and aging network organizations are required to develop plans that  include planned strategies and priorities to address the growing number  of older adults, state and regional transportation and aging plans include  limited systematically-collected data on unmet needs or projected future  needs. For example, one selected state’s aging plan indicated that it does  not have a formal needs-assessment process. According to the plan,  other sources, such as focus groups and interviews with providers,  helped identify transportation as a service need. Another plan we  reviewed stated that satisfaction surveys and focus groups were used to  help determine needs and ways in which services—including  transportation—could be improved. AAA officials in Florida, Pennsylvania,  and Oregon also told us there is very little concrete data identifying the  extent of unmet transportation needs beyond anecdotal information, and  there is no systematic data collection to identify unmet needs at the local  level. As a result, limited data and information are available to help  determine whether the coordination that is occurring is meeting additional  needs or filling gaps in the provision of transportation services for older  adults. For example, officials at an AAA in Florida explained that there is  no repository of information for collecting data to identify the extent of all  older adults’ needs, but noted that transportation is always raised as a  major challenge in needs assessments and outreach conducted by the  AAA.
Older adults may require certain types of service to meet their specific  mobility and daily living needs as illustrated by examples from the states  and localities we visited. For example, an AAA in Pennsylvania discussed  working with the primary transportation provider in the region to find ways  to better meet older adults’ mobility needs. In this case, door-to-door  transportation assistance is available, but the officials are interested in  exploring opportunities to provide door-through-door service to better  serve the older adult community. In addition, examples from our selected  states suggest that transportation for life-sustaining needs in those states  are being met (e.g., to access medical and nutrition services), but there is  a significant gap in transportation for social and recreational purposes. As  a transportation provider in Florida explained, demand for older adult  rides in its service area always exceeds available funding, and there are  limits on how the existing funds can be used. For example, the  transportation provider prioritizes its state Transportation Disadvantaged  Trust Fund dollars for life-sustaining activities, such as transportation to  congregate meal sites or medical trip appointments. As a result, this  provider stated that very little funding remains for social outings like going  to church or shopping with friends, which officials noted are very  important components to helping older adults age in place and remaining  connected to their community.
section_title: Conclusions
paragraphs: As the population of older adults continues to grow, having access to a  variety of transportation options is critical to ensure older adults’ access to  health care, social and recreational events, and other instrumental  activities of daily living. When flexible transportation services exist and  are accessible, older adults can more comfortably age in place in their  homes and communities for as long as possible. Furthermore, when  these transportation operations are coordinated, older adults may benefit  from improved and more cost-effective services. A number of federal  agencies provide funding that can be used for transportation for older  adults, and FTA and AoA have been coordinating and are involved in  facilitating initiatives, such as technical assistance efforts and community  grants, to help meet older adults’ mobility needs. However, federal  coordination efforts by the Coordinating Council lack clear, desired  outcomes for its current coordination activities. In addition, there are no  efforts under way to collect performance data that could help the  Coordinating Council and its member agencies better plan and execute  coordination strategies to ensure that its efforts are resulting in improved  mobility and access to transportation services for transportation- disadvantaged populations, including older adults. In particular, defining  desired outcomes could help the Coordinating Council determine whether  its current activities are effective in facilitating coordination and help  inform planning and decision-making about future coordination efforts.  Furthermore, tracking performance data on its activities will help the  Coordinating Council demonstrate the benefits of coordination and  encourage more widespread participation.
As we concluded in 2012, a comprehensive strategy that outlines goals  and desired outcomes for federal coordination efforts is needed to ensure  that relevant stakeholders are actively engaged and participating in  coordination efforts. While the Coordinating Council developed a  strategic plan for 2011 to 2013, it is now out of date, and little else is in  place to provide overall strategic guidance for federal efforts to coordinate  transportation for older adults. Coordinating Council officials said that  there are no plans to update or renew the existing strategic plan. We  continue to believe that a current strategic plan, as recommended in our  concurrent report on NEMT, could enhance coordination and  collaboration among the federal agencies that provide funding that can be  used to meet older adults’ transportation needs.
section_title: Recommendation
paragraphs: To promote and enhance federal, state, and local coordination activities,  we recommend that the Secretary of Transportation, as the chair of the  Coordinating Council, convene a meeting of the member agencies of the  Coordinating Council and define and report on desired outcomes and  collect related data to track and measure progress in achieving results,  including the extent of coordination efforts that are under way, such as  improved services for older adults. This effort could be conducted as a  part of the Coordinating Council’s process to update its strategic plan,  which we have also recommended in a concurrent report.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to DOT for review and comment. DOT  partially concurred with our conclusions and recommendation in an email  response. Specifically, DOT stated that the Coordinating Council’s  working groups and affiliated technical assistance centers have ongoing  activities related to coordination. DOT also stated that FTA is developing  a 2-year implementation strategy for the Coordinating Council and will  determine policy objectives and information that may be needed to  measure progress and evaluate coordination efforts that are under way.  While we agree that these are important steps toward improved  coordination, we believe it is important that any framework FTA  establishes for the Coordinating Council articulates clear, desired  outcomes and measures that the Coordinating Council can use to collect  data and assess the effectiveness of its coordination activities in  improving access to and mobility options for transportation-disadvantaged  populations, including older adults.
We also provided a draft of this report to VA and HHS for review and  comment.  VA commented that the agency welcomes opportunities to  participate in additional coordination efforts and supports the  establishment of performance measures among federal, state, and local  agency coordination efforts.  VA also commented that the agency’s  priority for its transportation programs is to ensure timely access to  medical care for veterans. HHS did not have any comments on the draft  report.
We are sending copies of this report to the appropriate congressional  committees and the Administrator of FTA, the Secretaries of the  Department of Transportation, HHS, VA, and interested congressional  committees. In addition, the report is available at no charge on GAO’s  Web site at http://www.gao.gov.
If you or your staff members have any questions about this report, please  contact me at (202) 512-2834 or wised@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on  the last page of this report. GAO staff who made major contributions to  this report are listed in appendix III.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: This report addresses the following questions:  1.  What federal programs provide funding for transportation services for  older adults, and to what extent are the programs that fund these  services coordinated?  2.  How do state and local transportation agencies and aging network  organizations in selected states coordinate transportation for older  adults and what challenges do they face in coordinating or providing  these services?
To identify federal programs that provide funding for transportation  services for older adults, we reviewed our 2012 report on transportation- disadvantaged populations, which identified federal programs that provide  funding and services for transportation-disadvantaged populations, which  includes older adults, a 2013 AARP report that that identified federal  programs that provide funding for older adults, and conducted a search  of the Catalog of Federal Domestic Assistance. These programs may  fund infrastructure-related costs for transportation or transportation  services. We limited our scope to federal agencies that are members of  the Interagency Coordinating Council on Access and Mobility  (Coordinating Council) because these agencies were identified by  executive order to participate in coordination. Through these reviews, we  identified three primary federal agencies—the Departments of Health and  Human Services (HHS), Transportation (DOT), and Veterans Affairs  (VA)—that administer programs that provide funds to older adults where  transportation is an eligible expense or that target older adults among the  eligible recipients for transportation funds. Other federal agencies may  also have programs that provide funding for transportation for older  adults. However, we did not systematically identify every program  government-wide that could provide such funding as part of this review.  We subsequently asked federal program officials from the three agencies  to review and verify the programs identified and the program information  collected, including if transportation for older adults was an allowable use  of program funds, and program spending or obligations for fiscal 2013.  For HHS’s Title III B program we asked for spending data from fiscal year  2010 to 2013. We also asked agency officials to include any relevant  programs we may have missed in our search. Agency officials provided  requested spending and obligation data when available, but we did not  independently verify the data provided.
To determine the extent to which these federal programs are coordinated,  we reviewed policy and other guidance established to promote  coordination of transportation services at the federal level and interviewed  officials from HHS, DOT, and VA about the level of interagency  coordination on transportation for older adults. For example, we met with  DOT agency officials involved with Coordinating Council activities. We  also reviewed Coordinating Council documents, such as the 2011 to 2013  strategic plan and the Council’s progress report on recommended actions  for human service transportation coordination. We also interviewed  officials from relevant stakeholder groups, academic researchers, and  technical assistance centers, such as the National Association of Areas  Agencies on Aging, AARP Public Policy Institute, Center for Urban  Transportation Research at the University of South Florida, Easter Seals  Project ACTION, the National Center for Senior Transportation, and the  National Center for Mobility Management. In addition, we reviewed  literature since 2009 on the coordination of transportation services for  older adults, and interviewed staff from federal technical assistance  centers and other stakeholder groups involved in transportation  coordination efforts about federal coordination of services to meet the  transportation needs of older adults. For example, we reviewed National  Center for Senior Transportation grant programs and initiatives. We also  compared coordination efforts against leading practices GAO has  identified for successful interagency collaboration and collaborative  mechanisms, such as interagency groups and councils.
To determine how selected state and local transportation agencies and  aging network organizations coordinate transportation for older adults and  the challenges they face in coordinating or providing these services, we  conducted site visits in four states—Florida, Oregon, Pennsylvania, and  Texas—to discuss the coordination of transportation services between  transportation agencies and aging network organizations. In particular, we  interviewed officials from state and area agencies on aging, state  transportation departments, metropolitan planning organizations, VA  medical centers, and local transit providers about the coordination of  transportation services for older adults, challenges to providing and  coordinating services, and any gaps in the current services provided. We  selected these four states as they were among those with the greatest  overall population of and the largest proportion of older adults and  received the largest amounts of DOT funding for transportation services  that can be used for older adults. We also selected states with a mix of  state coordination mandates and coordinating councils, and identified and  visited metropolitan areas within the states that provided transportation  services to older adults in both urban and rural portions of the states.  Information obtained in the site visits is not generalizable to other states  that coordinate transportation services for older adults. In addition, we  interviewed federal agency officials within HHS, DOT, and VA as well as  staff from the federal technical assistance centers about the challenges to  coordination at the state and local levels. We also reviewed selected state  and local aging plans and local and regional transportation coordination  plans for selected sites. Table 3 provides more detailed information about  the state and local entities we interviewed.
We conducted this performance audit from March 2014 to December  2014 in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions based on our audit objectives.
section_title: Appendix II: Identified Programs from the Department of Health and Human Services, Department of Transportation, and Department of Veterans Affairs That Fund or Provide Transportation for Older Adults
paragraphs: Older  Americans Act  of 1965;   42 U.S.C. §  3030d(a)(2)
Title III Part B is a formula grant program established in the  Older Americans Act of 1965. Its purpose it to encourage  state units on aging and area agencies on aging to  concentrate resources to develop and implement  comprehensive and coordinated community-based systems of  service for older individuals via statewide planning and area  planning and provision of supportive services. The program is  intended to serve those aged 60 or older. There are a number  of supportive services these funds can be applied to, including  providing both transportation and assisted-transportation  services. These funds are flexible and can be used for both  medical and nonmedical transportation.
Older  Americans Act  of 1965;   42 U.S.C. §§  3057, 3030d  (a)(2)
Title VI Part A is a project grants program established in the  Older Americans Act of 1965. Funds are available through  grants to eligible Indian Tribal Organizations for services  comparable to those provided under Title III. Services must  include nutrition services and information and referral, and  may include transportation and other services authorized  under Title III. Grants also are available to private or nonprofit  organizations having the capacity to provide services to older  Native Hawaiians.
Social Security  Act: 42 U.S.C.  §§ 1396a,  1396n(e)(1)(A)
Federal law requires states to ensure that eligible Medicaid  beneficiaries have transportation to and from health care  services. The program is focused on those who cannot  provide their own transportation to and from appointments.  NEMT programs and ride scheduling procedures vary from  state to state. Generally, beneficiaries must contact the  Medicaid transportation provider in their area to arrange for  rides. Medicaid NEMT rides can be provided through a  number of methods such as through mass transit systems as  well as taxis, cars, or vans.
Social Security  Act: 42 U.S.C.  § 1396n(c)(3)
The Medicaid Home and Community Based Services waiver  program was authorized under Section 1915 (c) of the Social  Security Act. Through this program, states can assist  Medicaid beneficiaries by providing a wide array of services  that permit them to live in their homes or community and  avoid institutionalization in a nursing-home facility. Among the  services that can be provided under the waiver are  transportation services approved to help a beneficiary access  a service that may not be a traditional Medicaid plan service.
subsections: section_title: Agency
paragraphs: The Enhanced Mobility program is a formula grant program  established in 1975 to provide financial assistance in meeting  the transportation needs of elderly persons and persons with  disabilities where public transportation services are  unavailable, insufficient, or inappropriate. Funds can be used  for capital planning and operations. The Enhanced Mobility  program is designed to supplement the Federal Transit  Administration’s other capital assistance programs by funding  transportation projects for elderly persons and persons with  disabilities in all areas—urbanized, small urban, and rural.  The program was renamed under the Moving Ahead for  Progress in the 21st Century Act and modified to include New  Freedom Program activities as eligible projects.
VA provides transportation funds and services to qualified  veterans needing to access a VA medical facility. The  program provides transportation through mileage  reimbursement, purchase of transportation service contracts,  or medically necessary specialized transportation.
VA provides grants to eligible recipients to assist veterans in  highly rural counties through innovative transportation  services to travel to VA Medical Centers, and to otherwise  assist in providing transportation services in connection with  the provision of VA medical care to these veterans.
VA provides funding for housing and services in the  community to help veterans out of homelessness.
Medicaid transportation for older adults is provided under the Nonemergency Medical Transportation  program benefit.  The Centers for Medicare and Medicaid Services’ 1915 (c) Home an Community Based Services  waivers is a program within Medicaid. For the purposes of our report, as this is a program focused on  assisting older adults in living independently and provides transportation funding and services, we  have presented it separately from Medicaid NEMT.
The Department of Transportation had other formula funding programs for transportation services,  such as the Urbanized Area Formula program and formula grants for rural areas. These are general  transit program funds that serve a number of populations, but they may also be applied to  transportation for older adults.
section_title: Appendix III: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Staff Acknowledgments
paragraphs: In addition to the individual named above, the following individuals made  important contributions to this report: Lorelei St. James (Director), Nancy  Lueke (Assistant Director), Lorraine Ettaro, Delwen Jones, Maria Wallace,  Betsey Ward-Jenks, Cheryl Peterson, and Sarah Veale.