Transportation can present a barrier to care delivery, regardless of a person’s age, their condition or where they live.
While this care barrier may arise often in rural and remote areas where health care services are most challenged, caregivers can take comfort in 1) the new partnerships helping move clients from point A to point B—and 2) the equipment making it safer and easier to do so.
Transportation needs evolve along the care continuum. Part of developing a patient-centered plan revolves around an overhead view of the client’s support network. The nurse, case manager or social worker may have assessed the client’s resources early on, but needs may change as time passes and chronic conditions progress. Much depends on the client’s individual needs and his or her ability at the time of service, so consider the condition first.
When clients contract for in-home, non-medical care, transportation may be included in the care plan and included in a flat, contracted rate. Such is the case with Comfort Keepers in Perrysburg, Ohio, according to Ashley Kohlman, who manages the service there, as well as Synergy HomeCare in northern New Jersey, where director of client services Casey Holstein says the transportation option is determined by individual agencies.
“Each agency determines their own comfort level with driving their clients. For some clients, it’s an active part of the service plan or an occasional need. Some agencies do not allow caregivers to drive their clients at all,” Holstein said. Transportation is a benefit of the overall care plan option through Synergy.
Generally, as needs change, primary caregivers and family members sometimes don’t know where to turn as they try to help. Since services can vary by state, region and homecare program, the homecare nurse or social worker may be prepared to help by suggesting a range of options that involve a combination of covered, reimbursable and private-pay fee-for-service options, dependent or independent of the care program.
The best programs optimize routing and scheduling to spare clients from long waits, strain and worry, for a range of needs from dialysis and cancer treatments to doctors’ appointments, physical therapy, errands and other activities.
Who’s Stepping Up to the Plate?
With non-emergency medical transportation needs rising, consumer-focused ride-hailing services Uber and Lyft now offer business platforms that allow health care providers, homecare providers, nonprofit and faith-based organizations to manage rides—in some cases without the need for a rider’s individual account through a smartphone.
Uber Central presented a meaningful use case where the Atlanta-based national nonprofit organization Common Courtesy piloted Uber to help expand mobility, freedom and independence for hundreds of seniors who previously had to rely on rides through public transportation, friends and family, just to complete daily tasks such as grocery shopping or making it to an appointment.
Common Courtesy and its chapter-affiliate program is one of the first of its kind, according to Bob and Anne Carr, the couple who founded the organization, which works with home health agencies, Grady Memorial Hospital in Atlanta and other organizations. Riders pay a nominal expense, and the program has been replicated during the last 18 months to create five similar need-based ride programs along the East Coast. “We conceptualized a neighborhood volunteer services,” says Bob Carr, “but we found that volunteer transportation is hard to manage and keep funded, and the need is huge. What started with the older adult population morphed into other groups—people with Parkinson’s, cancer or heart failure.”
Common Courtesy is not intended to replace other transportation programs, Carr says, but it seems to be serving patients well where it has been established.
The ride program starts when someone develops a chapter. At Grady Hospital, for example, six departments each host a chapter. Funds are then acquired from various sources—examples include community grants, foundations and pharmaceutical companies—and light assistance is factored in when needed.
In another example, caregiver marketplace platform CareLinx partnered with Lyft in late 2016 to add CareRides, a service that allows family members and authorized caregivers to order and track car trips for clients.
“We have three core solutions that we provide our partners,” says Dan Trigub of Lyft Healthcare Partnerships. “We work with large national caregiver agencies to small mom-and-pop operators. Each of our customers has different needs, but fundamentally they all see that transportation is such a key barrier to effective health care delivery and that a solution such as Lyft can drastically improve the lives of their caregivers, patients, employees and all those they serve. At the core of what we look to do is improve the lives of people with the world's best transportation and especially for our elder population. We look to increase the independence of our elders and reduce isolation, and the feedback we have received is that the service is doing just that.”
Trigub added that passengers who use wheelchairs or walkers—that can safely and securely fit in the car’s trunk or backseat without obstructing the driver’s view—should be reasonably accommodated by drivers on the Lyft platform. If seniors require a wheelchair accessible vehicle, Lyft can provide this in certain markets where the company has partners who specialize in this level of transport.
According to the National Aging and Disability Transportation Center (NADTC), in 2016, almost every week a new partnership was formed, primarily for the purpose of either maintaining service or assisting with paratransit or demand-response service. Many partnerships, the NADTC says, are pilot projects.
Services Vary from Community to Community
The Department of Health and Human Services offers guidance through the U.S. Administration on Aging (AoA) at eldercare.gov and the combined efforts of Easter Seals, Inc., the National Association of Area Agencies on Aging and the Federal Transit Administration. In Janesville, Wisconsin, the Beloit Transit System (BTS) in conjunction with the Dementia Friendly Initiatives of Rock County (Wisconsin) completed criteria to earn the designation of being dementia friendly. For BTS, this means that staff received training to help them recognize the condition and better communicate with those who may have it, as well as direct people toward community resources.
Dementia care specialist Cori Marsh says unraveling transportation systems for need-based riders is ongoing. “The problem is that it really varies by area, by state and by county. Parkinson’s, stroke and memory loss are probably the three big changes where people are no longer able to drive. Some have never used public transportation in their lives, they do not use public transportation, and they end up isolated. For us, our focus is really to make sure that people can be independent for as long as possible,” Marsh said of Rock County’s approach, adding that the county has a mobility manager on staff to teach people how to use the system.
