Why can’t we do a better job providing safe, cost-effective, and reliable transportation to older adults?
For decades, we’ve known about the consequences of poor transportation. It is a major reason why people miss medical appointments, struggle to shop for food and medicine, and become more socially isolated. It can contribute to malnutrition and falls, result in more emergency department visits and hospital admissions, and even push older adults to leave their homes and move to residential care.
All for want of a simple ride.
Yet, government, local non-profits, and businesses still are taking only small steps to fill this critical need. Often programs struggle to get beyond lip-service, or provide only half measures that look good on paper but do little to help older adults remain independent and as healthy as possible at home.
Like so much else in the world of senior services, transportation for older adults suffers from a lack of both coordination and resources. Technology can help. Payment systems can be modernized.
Jana Lynott of the AARP Public Policy Institute describes a model where consumers use universal scheduling software to better coordinate “door-to-door transportation services such as senior shuttles, paratransit busses, taxicabs, and even ride-hailing platforms like Uber and Lyft.”
She describes the concept, called Universal mobility as a service (UMaaS), as Expedia for paratransit—a simple way for consumers to choose the most appropriate and cost-effective ride. But this, and other solutions, must navigate a swamp of regulations and payment systems that are less-then-friendly.
Traditional Medicare: Medicare generally pays only for ambulance trips to hospitals or skilled nursing facilities. Last week, the federal Centers for Medicare and Medicaid Services announced a new demonstration program that takes a modest step towards a more sensible model. Medicare would pay for ambulance rides to lower-cost and more accessible urgent care clinics or doctor’s offices.
That’s fine, but seniors rarely need an ambulance to take them to the doctor. Ride-sharing or similar services would be far less costly and more convenient. Even better: Medicare could cover transportation to social services such as adult day programs, senior centers, and the like.
Medicare Advantage: Unlike fee-for-service Medicare, MA managed care plans may provide non-emergency transportation to healthcare providers. And they can use less-costly alternatives than ambulances. Under new rules, the plans will be able to expand these services in the coming years and, for example, provide rides to adult day programs or other non-medical services. Even better: If they could provide rides to the grocery store.
Medicaid: Non-emergency medical transportation is a required Medicaid benefit. However, because funding is short, many states limit this service. According to one study, 3.6 million beneficiaries “miss or delay” medical care because they cannot get to the doctor.
Public transportation: Those living in cities and some suburbs may be able to rely on the bus or other mass transit. And buses increasingly are accessible for those who use wheelchairs or otherwise need assistance. But public transportation suffers from the “last mile” problem. How does a senior who has trouble walking get from his home to the bus stop?
Some public transit agencies provide paratransit or other options for older adults. But they often are expensive and inefficient. Limited service often means long waits. A growing number of cities and counties are winning designations as “age-friendly” by improving transit options, at least on paper. But many still fall far short in reality.
Private market options: Ride sharing is a growing option for older adults, just as it is for everyone else. Uber and, especially, Lyft, are aggressively raising their profile in both the senior and medical markets. Lyft, for instance, is partnering with health systems to provide rides to medical appointments and even has begun adapting services to older customers who do not have smartphones. However, ride-sharing has its challenges: For example, most drivers are untrained in assisting customers who may have functional or cognitive limitations.
Community organizations. Volunteer rides are a core service of many community organizations. Neighborhood-based senior villages link volunteers with those who need assistance. The most common request? Rides.
Faith communities and circles of friends do much the same informally, sometimes with the help of online calendar software such as lotsa helping hands. And community-based organizations are non-profits that often provide rides or information about third-party transportation (full disclosure: I am on the board of such a non-profit).
This really isn’t that hard, and the payoff in improved quality of life and potential cost savings could be significant. Government, business, the health system, and non-profits need to get on board this train.