Models to Improve Transportation for Veterans, Patients and People with Disabilities

Community Transportation Association of America
CTAA's National Resource Center for Human Service Transportation Coordination released NRC Report: Transportation for America's Veterans and Their Families, which discusses improving transportation for our nation's veterans through partnerships and coordination. Examples of the work of regional ambassadors are given. The NRC also maintains a webpage "bookshelf" with veterans transportation resources.

Life-Saving Transportation

CTAA also distributed the Dialysis Report, which discusses the dire, complicated transportation demands that dialysis patients present.

The crux of the transportation challenge is that the majority of dialysis patients are covered by Medicare, which — unlike Medicaid — does not offer non-emergency transportation as a benefit. Three out of four dialysis patients in the U.S., are Medicare primary, meaning that Medicare sets the reimbursement rate and pays 80 percent of that amount ...

Indeed, in background discussions with community and public transit officials around the country for this article, a common refrain was the difficult position in which many transit operators find themselves — how to continuously add new dialysis patients to the transit schedule with no means of payment.

The situation places transportation providers between the proverbial rock and a hard place. CTAA is advocating for a funding mechanism within Medicare and for increased kidney organ donation. "Transplants can add decades to people’s lives and significantly forestall the need for dialysis, but only when the needed organs are available."

Solutions Possible to Realize Decades-Old Commitments

Association of Programs for Rural Independent Living
APRIL's Executive Director, Billy Altom, testified before the Senate Health, Education, Labor and Pensions Committee about the need for affordable, accessible and available rural transportation. Forty years after the Urban Mass Transportation Act and 20 years after the passing of the ADA, Altom argues, "minimal or nonexistent transit services in rural areas still create serious barriers to employment, accessible health care, and full participation in society for people with disabilities."

Altom sees some solutions that are working - mobility management and voucher programs. Altom praised the Easter Seals Project ACTION Mobility Management Independent Living Coaches program and he cited as an example the Center for Independent Living for Western Wisconsin Regional Mobility Management/New Freedom Program, which provided 12,000 rides last year and coordinates in seven counties with public and private transportation providers. More than 140 volunteer drivers provide the rides and the program is expanding into an 18-county area. Already weekly rides are being supplied to 130 veterans.

Partnership for Mobility Management member Denise Larson is the mobility manager for the program. She also serves on the Partnership's advisory committee.

Another Type of Coordination

American Public Human Services Association
Bridging the Divide: Leveraging New Opportunities to Integrate Health and Human Services is APHSA's new report about the value added of coordinating and aligning health and human services for clients beyond eligibility and enrollment for a "customer‐focused, one‐stop shop, 'service home'." Such coordination makes sense, according to the report, because:

Many of the same people who qualify for Medicaid, CHIP or some level of premium subsidy identified through the Exchanges also qualify for one or more human service assistance programs.

The positive impact of coordinated care and integrated case management on improving the overall health and well‐being of individuals and populations— strengthening families, achieving employment and independence, improving the well‐being of children, youth, people with disabilities, seniors and other vulnerable populations—is well documented. Better outcomes mean healthier, safer, stabilized individuals and families with a better chance of sustainable independence from government services and long‐term personal success.

The report contains case studies of what several states are doing and the impending impact of the new healthcare law.

Not Just Vehicles: Access to Long-Term Care, Food Assistance & Mobility

American Public Human Services Association
APHSA's concerns about Food and Nutrition Service (FNS) closure of Supplemental Nutrition Assistance Program (SNAP) offices include transportation barriers. It sees technology as a solution. "[I]implementation of office closures that are accompanied by the appropriate alternative methods and technology could not only avoid negative effects but can very likely on balance improve access and integrity." APSHA is also objecting to an FNS requirement for the SNAP that allows deduction from income of transportation costs for dependent care, which requires documentation of actual transportation expenses. "[T]he great variety of possible arrangements opens the door to errors, and requires an unwarranted amount of effort by the worker." APSHA would prefer either a federal standard or a state-by-state standard amount. Both of these documents are available on APSHA's homepage.

Long-Term Care Report Card

AARP
AARP issues its State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers. The report asserts that quality of life, including engagement in the community, requires a long-term care support system where:

there is effective coordination or integration between health-related services (such as clinician services, medications, home health, and physical therapy) and supportive services (such as personal care, adult day, homemaker, transportation, and other services).

One concrete result of high quality home and community support is the cost-saving reduction of hospital readmissions. The report emphasizes that limited data to measure services such as transportation and assistance in the home means that currently the performance of programs cannot be effectively measured. A state-by-state scorecard website looks at several measures, but does not examine anything directly related to transportation.

Events

Easter Seals Project ACTION
Public Involvement in the Transportation Planning Process - webinar - October 12, 2011. This webinar will provide a guide to taking and utilizing a seat at the table for transportation planning and implementation. This event will prepare transportation advocates to offer effective input that will be heard, understood and incorporated into the over-all plan.

Transcripts from ESPA's summer webinars can now be found at its website.

Praise for Transit and Improving the Experience for People with Disabilities

Always a good day when you read about people and organizations you personally know. Today it is the American Public Transportation Association. I read many of Secretary LaHood's blog posts on the Fastlane. (Yes, I skip stuff related to airlines and anything on the water except for taxis and ferries.) Today, I find the Secretary praising APTA for its mission to "strengthen and improve public transportation,":

a goal this Department deeply believes in. This Administration has made transportation a priority--and affirmed that commitment, not just with words, but also with actions. President Obama’s 2012 budget proposal invests $129 billion in transportation. We’re talking about a 127% increase in support aimed at improving safety, service, and reliability.

After reviewing the proposed budget's transit priorities, Secretary LaHood spoke generally about the contributions of public transit, saying that "[p]ublic transportation connects Americans," takes them to airports, downtowns, jobs, essential services, education and shopping, while relieving congestion.

Every day in our cities and towns, transit workers are planning, building, maintaining, repairing and operating these vital systems. Here at DOT, we think that’s incredibly important.

The Secretary quoted from his speech at the APTA Legislative Conference.

People with Disabilities Invited to Rate Service

Speaking of public transit service, a former colleague, Judy Shanley, pointed me to a survey on the website of the Center for Inclusive Design and Environmental Access that requests people with disabilities to share their public transit experiences. Of course, I can never stop with the one recommended feature and explored the website further. There is information about and links to resources involving rural aging in place, naturally occurring retirement communities (NORCS), and universal design for housing.

Easter Seals Project ACTION points out that IDEA also has published a wheelchair users mobility report that includes new data on wheeled mobility devices people with disabilities use, including data about ease of use and navigating spaces. The report recommends that standards be revised to reflect body size and functional abilities of current wheelchair users.

Great Minds Think Alike

Two national parters, Easter Seals Project ACTION and the Taxi, Limousine and Paratransit Association pointed me to the big news that the Department of Energy (DOE) is loaning $50 million to develop a "six-passenger MV-1, a purpose-built wheelchair accessible vehicle that will run on compressed natural gas." According to DOE,

[The] MV-1 is the only factory-built light-duty vehicle to date that meets or exceeds the guidelines of the Americans with Disabilities Act. The vehicle features a deployable access ramp with a 1,200-pound weight capacity, a 36-inch entryway and an interior that accommodates up to six occupants with the optional jump seat, including one or two wheelchair passengers and the driver.

Getting to and Navigating Transit

Easter Seals Proejct ACTION
Webinar series - The Cutting Edge of Wayfinding Technology - Apr. 4 and 11 at 2 ET. The webinars will cover wayfinding technologies that help customers with disabilities navigate transit systems. The two sessions will discuss new technologies that are either available to the public or currently being researched. Visit ESPA's homepage for information about the organization's many events about accessibility, transportation, and improving transportation options for people with disabilities.

Transit a Priority for People with Disabilities, Commuters and Capitol Hill

American Public Human Services Association (APHSA)
APSHA's Working for Tomorrow newsletter recommended a Minnesota policy brief. Following the link, I found a series devoted to employment of people with disabilities and the concrete changes needed to increase their employment rates. Particularly interesting is the brief about people with visual impairments and the brief about people who are deaf and blind, probably because of the prominent position of the recommendation for improved public transportation. For more information, visit the Minnesota Employment Policy Initiative.

Census Data for Transit and Transportation

National Association of Development Organizations (NADO)
NADO's current Rural Transportation newsletter includes information helpful to anyone analyzing commuter patterns. It highlights the Census Transportation Planning Products release of the 2006 - 2008 3-year American Community Survey (ACS) Data. This release shows where people are commuting to and from and how they get there, and the data is organized by where workers live, where they work, and by the flow between those places. For more information, visit http://ctpp.transportation.org/Pages/3yrdas.aspx.

National Resource Center for Human Service Transportation Coordination (NRC)
The NRC has a Census 2010 page, which links to a wonderful resource, the Transportation Research Board's Census Data for Transportation Planning.

Happenings on the Hill

National Association of Regional Councils (NARC)
NARC has updated information about the fast-moving developments on Capitol Hill and Pennsylvania Avenue regarding earmarks, the federal budget and transportation.

High Demand for Intercity Bus Service and Insights into Quality Concerns of the Transportation Challenged

A few years ago, intercity bus companies took notice of successful routes that had sprung up to serve Chinatown in New York. Those companies and a few new ones changed the traditional model of station-to-station service and started curbside departures and arrivals, Internet-supplied tickets, free wifi, comfortable seating and very cheap prices compared to the airlines and Amtrak - prices competitive with driving.

Now a report highlighted by the American Bus Association, from DePaul University, The Intercity Bus: America’s Fastest Growing Transportation Mode - 2010 Update on Scheduled Bus Service, examines the numbers, the phenomenal increase in demand, though generally limited to major cities with good public transportation, that outstrips growth for air and long-distance train travel. Megabus alone boasts a one-year growth in ridership of almost 50 percent, with "33% ... a conservative middle-ground estimate of the growth in curbside traffic between the 4th quarter of 2009 and 2010."

Good Service Brings Alternative to Car Use and Ownership

Though Amtrak pointed to much more modest ridership increases this past year, Amtrak does not have the luxury of adding service and destinations very easily. The bus phenomenon of the last few years demonstrates the potential demand for long-distance service even in places where that demand has not been addressed. Indeed, the bus phenomenon also shows that for "discretionary riders" a nice atmosphere goes a long way, even without the guarantee of on-time arrival that a train generally delivers.

The report makes the rather large claim that:

curbside buses encourage “transit lifestyles” that place comparatively little emphasis on single-occupant automobile travel (and more emphasis on common-carrier providers) and thus apparently lower carbon footprints per mile traveled.

I think that intercity buses are a piece of the mobility puzzle for many people, a piece that means a car is not a necessity for everyone. The buses also provide a cost-effective way for families to reduce car use, which the train and air travel do not provide, a fact in evidence on the highways during the Thanksgiving weekend and the winter holidays every year.

Sea of Buses

In contrast to even a few years ago, now when you are entering the Lincoln Tunnel to head into the city for Thanksgiving, you see a sea of buses, a good percentage of which are these intercity carriers. And to what do we owe this recent change in the mobility landscape? A flexible private sector that has the ability to make changes without the delay of regulatory changes, infrastructure building and repair, and the other factors that slow down public endeavors. Not saying the private sector can do it all, just that this is a good example of its role in publicly-available transportation as well as the insights into markets that the private sector provides and that other public and private modes can learn from.

Deviating from Private Car Ownership

And intercity buses are not the only part of the private market that is seeing increases, creative car sharing businesses are being developed and spreading. Still an urban phenomenon, companies like Flex Car are branching out into more cities. RelayRides adds a new type of business model to the mix. The company, backed by Google, enables people to rent out their cars to friends or strangers for a nominal fee with a standard agreement that includes an insurance arrangement. Read about one person's experience in the Cambridge area. It started in Cambridge and is commencing service in San Francisco.

Different Picture in the Heartland

In the heartland of South Dakota, the availability of mobility options is a very different situation than in the urban centers on the East and West coasts. This is not a transit-rich area; in fact, for people with disabilities, the need is all too real. Assessing Existing and Needed Community Transportation for People with Disabilities in North Dakota outlines the challenges - "Adequate shelter from the weather while waiting, inconvenient schedules, and having a place to sit while waiting were most often cited as a major problem for people with disabilities." Added to the list a little more into the report is difficulty of boarding.

These seem like universal design issues. Though adequate shelter, for example, might allow a person with a disability to ride transit, it also makes transit more welcoming to the parent with a toddler and the guy who is considering taking the bus during the winter. Aspects of street accessibility to transit were listed as problems for more than half of the survey respondents, as was safety and travel information.

[T]hose who do not use transit were significantly more likely to say service is not available, transit users were less likely to think they are not capable of riding, and those who used transit in the past but do not anymore were more likely to say they do not have enough information.

The results indicate it is not lack of need that keep people with disabilities from using public transportation. Rather, lack of service, lack of information, thinking they are not capable of riding (whether true or not), and fear of riding can likely explain many of the differences between those who use public transportation and those who do not.

Insights into Quality of Paratransit Service

The report also addresses the challenges of using paratransit and the unique situation of people with cognitive impairments.

Two-thirds of respondents said that service not being available when they need it was a problem; 35% said it was a major problem. Other significant problems were unkept schedules for pickups and drop-offs or long waits, the need for scheduling trips too far in advance, and trip times that are too variable or unpredictable. Respondents were least concerned about the vehicles, in terms of their mechanical condition, accessibility, and seating availability.

This is an insightful and detailed study that would be helpful to anyone in transit or those serving people with disabilities. Really, it shows the opportunities in terms of demand and advances in quality of life that mobility options, sometimes the synergy of pedestrian-friendly streets and transit, sometimes other options, can provide.

Spreading the Seedlings of Creativity

I think that the innovations of the private market in cities, the willingness of Americans all over the country to vote for more public transportation funding, and the increasing unattractiveness of a fuel-intensive lifestyle will spur changes in places like South Dakota. Maybe different models of volunteer driver programs and vanpooling are just around the corner for rural areas and other places where people do not wish to or are unable to drive.

Here's to allowing Americans all over the country to have more and better mobility options. Next year, I want to hear about how you picture mobility; I want to learn from you about places where good transportation choices (be they taxis or shared rides), good street networks and good transit are working. Let's learn from the success stories, build upon them, and adapt them to the amazing quilt of places of we live in.

Distinct Transportation-Challenged Populations and their Particular Needs

These reports discussed below are listed in Tappy Grams, a monthly roundup of research papers about transportation and human services. Subscribe at the Tappy page.

A new report on senior services discusses cutbacks and increased requests for assistance, with older adults in great need of transportation. Older Americans Act: Preliminary Observations on Services Requested by Seniors and Challenges in Providing Assistance also identified home-delivered meals and information and referral as very much in demand.

The Government Accountability Office (GAO) report also examines cutbacks in service due to the economic downturn and lack of funding. "Some state and local officials said they provided less service to individuals so that more could get some amount of assistance."

The need for transportation services was found all along the urban to rural spectrum, with urban older adults preferring specialized service to public transit. Though the report does not examine why this is the case, perhaps for frail individuals the issue might or might not involve the ride on public transit, but rather the daunting task of quickly crossing streets and navigating crowded stations and locations along the way to a bus or rail stop. GAO's "past work has found that mass transit options may pose scheduling and accessibility challenges for seniors" the report notes.

GAO states that the increase in demand for services is due to higher numbers of eligible older adults and people aging in place. According to the report, anecdotal information suggests that the needs are greater than the demand for services.

Travel Assistance Technology for People with Cognitive Disabilities

For those who are interested in user-friendly and individualized technology to support the use of transit by people with cognitive disabilities, the Travel Assistance Device (TAD) Deployment to Transit Agencies, a report of the National Center for Transit Research offers a detailed examination of TAD for individual users who ride transit in different places. Technological potential and glitches were discussed.

The study assessed three individuals with moderate mental retardation and whether TAD supported those individuals sufficiently to allow them to travel independently. The answer is yes, given the parameters of the study. The report is frank in its analysis of the limitations of the study's conclusions, among other issues the problem of extrapolating the applicability of a study done with people with a specific disability who had previously received travel training to people with other types of cognitive disabilities who had not received similar training.

CLASS Act

AARP has produced a fact sheet with details about the new legislation known as the CLASS Act. CLASS stands for Community Living Assistance Services and Supports. The Act was a piece of the health care law passed recently.

The CLASS Act sets up an insurance program that aims to help people remain in their homes once they have a:

functional limitation, certified by a licensed health care practitioner, that is expected to last for at least 90 continuous days. The limitation could be at least two or three activities of daily living (such as eating, bathing, and dressing); a cognitive impairment that requires substantial supervision to protect the person from threats to health or safety; or a similar level of functional limitation.

What will the CLASS Act mean for people who remain in their homes, but who wish to venture out? The benefits will enable people to pay for taxis, buses, vanpools or other transportation to any destination, whether to see a doctor, go to a movie, or have dinner with friends. Of course, the benefits will not be much, up to about $75 per day, depending on the degree of impairment. So, the money will have to also go for whatever supports a person needs - such as help with cooking and bathing.

However, though the funds are clearly inadequate for round-the-clock care, it will assist people who are partially physically or mentally impaired to stay in their homes.

No Age Requirement

Though the CLASS Act seems to be intended mainly for people who are suffering from age-related conditions, it will also provide benefits for people with disabilities, both permanent or temporary. As explained to me at the recent Health Care Colloquium held by the Community Transportation Association of America (CTAA), an insured who has a bad break on the ski slope or a three-month course of chemotherapy would be able to receive temporary benefits for cooking, cleaning and taxi services.

More details are available on the fact sheet.

Put Transportation Options in the American Dream

The National Disability Institute is asking for short videos from people with disabilities that define their concept of the New American Dream. Examples are starting a business, saving money, and buying a home. Getting around towns, cities and regions is an integral tool for realizing those dreams. So, if your organization is promoting participation in the New American Dream project, mention transportation options, such as public transit, pedestrian-friendly streets, vanpools, and more, for the means to achieve the dreams of people with disabilities.

How to Give People with Disabilities More Transportation Options

The Cleveland Plain Dealer has written a good article that explains the benefits of travel training. Transit Agency Travel Trainers Help People Overcome Fears of Riding Regular Buses concentrates on the assistance that people who are disabled can receive to transition from paratransit to conventional transit.

Easter Seals Project ACTION has an Introduction to Travel Training three-day course that provides travel trainers with knowledge in the classroom that is directly applied and practiced on the street, supplying constructive feedback from trainers and colleagues.

In 1999, the Transit Cooperative Research Program, in TCRP Report 49: Using Public Transportation to Reduce the Economic, Social, and Human Costs of Personal Immobility, explained the economic and social benefits of travel training.

Who Needs Sounds of the Road

American Council of the Blind

ACB has been pushing hard to resolve the dilemma of hybrid vehicles and the safety of people who are visually impaired. Hybrids are quieter than their conventional counterparts and in some circumstances fail to supply noises that are sufficiently loud to enable visually-impaired people to navigate streets. ACB supports passage of, the Pedestrian Safety Enhancement Act (H.R. 734, S. 841). This Act would require a Department of Transportation study and establishment of a motor vehicle safety standard for alerting blind and other pedestrians of motor vehicle operation. Both bills have been in committee since early 2009.

Now a National Highway Traffic Safety Report, Quieter Cars and the Safety of Blind Pedestrians: Phase I, posted on ACB’s website, studies the circumstances in which there is a difference between noise levels, whether those differentials impact safety, and the merits of possible countermeasures. Basically, noise levels differ at speeds up to 20 miles per hour. Two approaches for counter measures are discussed, (1) configuring hybrids so that they emit more noise and (2) producing devices that can be carried that warn people who are visually impaired that a quiet vehicle is nearby.

At present, only countermeasures that cause quiet vehicles to emit additional sound come close to meeting the requirements of blind pedestrians. Within this class of countermeasures, there is a fundamental distinction between systems that emit synthetic engine noise at all times when the vehicle is operating at low speeds, and those that emit noise only when triggered by a transmitter carried by blind pedestrians. The former eliminate the need for blind pedestrians to carry special transmitters, and also warn other pedestrians, cyclists and animals of the approach of quiet vehicles, while the latter minimize community noise impact.

The report wisely observes what is true in many circumstances, that universal design measures that assist people with disabilities also help others. The boys and girls who play soccer and street hockey in the middle of the road or who ride bikes without paying too much attention to their surroundings need vehicle noise almost as much as someone who is blind and they are probably less likely to carry a personal noise emitter. The sound must also be recognizable as vehicular noise, the report noted, discussing the disadvantages of personal device sounds.