Transportation-Disadvantaged Seniors:

Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance and Information

GAO-04-971: Published: Aug 30, 2004. Publicly Released: Sep 16, 2004.

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The U.S. population is aging, and access to transportation, via automobile or other modes, is critical to helping individuals remain independent as they age. Various federal programs provide funding for transportation services for "transportation-disadvantaged" seniors--those who cannot drive or have limited their driving and who have an income constraint, disability, or medical condition that limits their ability to travel. For those transportation-disadvantaged seniors, GAO was asked to identify (1) federal programs that address their mobility issues, (2) the extent to which these programs meet their mobility needs, (3) program practices that enhance their mobility and the cost-effectiveness of service delivery, and (4) obstacles to addressing their mobility needs and strategies for overcoming those obstacles.

Five federal departments--including the Department of Health and Human Services (HHS)--administer 15 programs that are key to addressing the mobility issues of transportation-disadvantaged seniors. These programs help make transportation available, affordable, and accessible to seniors, such as by providing transit passes or reimbursement for mileage. National data indicate that some types of needs are not being met, including those for trips (1) to multiple destinations or for purposes that involve carrying packages; (2) to life-enhancing activities, such as cultural events; and (3) in rural and suburban areas. However, there are limited data available to assess the extent of unmet needs. HHS's Administration on Aging is required by law to provide guidance to states on how to assess seniors' need for services, but officials said the administration has not done so because it has focused on providing other types of guidance. As a result, the local agencies on aging we interviewed--which are ultimately responsible for performing such needs assessments--used inconsistent methods to assess seniors' mobility needs. The Administration on Aging plans to conduct an evaluation of one of its major programs and thus has an opportunity to improve its understanding of seniors' needs and provide guidance to local agencies on performing needs assessments. Local transportation service providers have implemented a variety of practices--including increasing service efficiency, improving customer service, and leveraging available funds--that enhance mobility and the cost-effective delivery of services. Federal programs provide funding and some technical assistance for these practices, but several service providers we interviewed said that the implementation of such practices was impeded by limited federal guidance and information on successful practices. Senior mobility experts and stakeholders identified several obstacles to addressing transportation-disadvantaged seniors' mobility needs, potential strategies that federal and other government entities can consider taking to better meet these needs, and trade-offs associated with those strategies.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The Administration on Aging (AoA) developed a multi-faceted marketing campaign to broaden awareness and visibility of the Eldercare Locator Service, with emphasis on outreach to special target populations, including minority, low-income, and limited-English speaking elders. Newspaper articles targeted to local media are distributed several times a year to over 7000 daily, weekly, and monthly periodicals. Promotional materials, including an informational brochure, posters, and media kits are distributed to increase awareness. In addition, staff at the Eldercare Locator is working to increase public awareness of the Locator through strategic partnerships with a myriad of groups, including community and faith-based organizations, the business community, and minority and special interest groups. Finally, the Coordinating Council for Access and Mobility, of which AoA is a member, plans to use its Web site as a one-stop shop for information on transportation for disadvantaged populations, including seniors. All Coordinating Council members are expected to link their agency's transportation Web pages to the Coordinating Council's site and conduct outreach to advertise the site.

    Recommendation: To help enhance transportation-disadvantaged seniors' mobility by improving available information and guidance, the Secretary of Health and Human Services should direct the Administrator, Administration on Aging, in order to help address the obstacles that seniors, their caregivers, and service providers face in locating information on available services and promising practices, to take the lead in developing a plan--in consultation with members of the Coordinating Council on Access and Mobility--for publicizing the administration's Web site and Eldercare Locator Service as central forums for sharing information on senior transportation through workshops, annual meetings, and other outreach opportunities with seniors, their caregivers, and service providers. The plan should include steps for reaching out to seniors and providers who do not use or have access to the Internet to increase awareness of information available in hard copy or other format.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: Administration on Aging (AoA) officials have taken numerous steps to address this recommendation. According to these officials, the Title III-B evaluation was finalized in February 2008 and received final clearance for dissemination. The knowledge gained from this report may be used to develop transportation-related questions for future national surveys to evaluate consumer perceptions of services, unmet needs, and perceived gaps in transportation services. Meanwhile, AoA will post the final report on its web site and provide technical assistance to those implementing its findings. Between 2006 and 2008, AoA also issued a number of guidance and other documents designed to help state and local agencies assess needs. For example, AoA issued guidance requiring state plans prepared under the Older Americans Act to address how the state will assess the needs of the elderly for transportation services and coordinate transportation services to assist elderly individuals in communities and across the state. AoA also developed two transportation technical assistance tools for the aging network: (1) a Door-through-Door How-to Guide that features successful models of assisted transportation and how to replicate them and (2) a transportation coordination toolbox--developed in cooperation with the Federal Transit Administration--that is designed to help state and local planners assess seniors' transportation needs and coordinate transportation services. The toolbox includes a PowerPoint presentation that summarizes the project and findings, a summary of best practices from the 14 transportation coordination case studies that AoA conducted (including those for conducting needs assessments), a more in-depth discussion of the case studies, and a resource guide with other suggested readings and links. To highlight the importance of the planning process and to be consistent with other interagency efforts, the best practices and case studies in AoA's toolbox are organized around the Framework for Action planning process (the Framework for Action is an evaluation and planning tool to help state and community leaders and agencies improve or start coordinated transportation systems). According to AoA, this planning process is a primary way of addressing needs analysis for seniors and all transportation-disadvantaged individuals in local communities. As of March 2008, there had been four printings of this resource by AoA, the Federal Transit Administration, and the National Senior Technical Assistance Center. AoA estimates that over 4,000 print copies of this information and CD have been distributed, including a mailing to the aging network and a mailing to the American Public Transportation Association's members. In addition, AoA funded the development of a Community Transportation Options Template that identifies all transportation options available to people in a typical community by providing a framework for communities to inventory and assess existing transportation options, gaps, and needs. It also includes a customized template (a formatted electronic file), which is designed to allow easy data entry. Following these steps, the program generates a brochure with all of the transportation options available for individuals with disabilities, older adults, and individuals with lower incomes. AoA also contributed to the launch of the National Center for Senior Transportation, a congressionally-mandated center designed to assist local communities in the expansion of senior transportation services. The center recently conducted a comprehensive needs assessment survey to guide the direction of its efforts to provide technical assistance. Finally, as part of United We Ride, AoA officials assisted in developing suggested performance indicators for local communities to use in assessing their level of coordination and success in the provision of transportation services for seniors, including indicators for efficiency, effectiveness, and quality.

    Recommendation: To help enhance transportation-disadvantaged seniors' mobility by improving available information and guidance, the Secretary of Health and Human Services should direct the Administrator, Administration on Aging, in order to improve the value and consistency of information obtained from area agencies on aging on the extent to which transportation-disadvantaged seniors' mobility needs are being met, to develop guidance for assessing such needs by using the results of the administration's evaluation of the Title III-B program, and input from the Coordinating Council on Access and Mobility of other federal agencies that fund transportation services for seniors, to develop and disseminate guidance to assist state and local agencies on (1) methods of assessing seniors' mobility needs and (2) the suggested or preferred method for collecting information on gaps in transportation services.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: The Administration on Aging (AoA) took a number of steps to expand the scope of work for their planned evaluation of Title III-B. First, they decided to gather and analyze additional information on needs assessments for transportation, including (1) the extent to which area agencies on aging (AAA) and state units on aging conduct needs assessments to determine what needs elderly participants have for home care and transportation services, (2) best practices in the provision of home care and transportation services to AAA participants, and (3) the extent to which results have been achieved. Secondly, AoA officials said they are also taking a more comprehensive approach to their evaluation that considers the importance of an integrated assessment of Older Americans Act (OAA) supportive services, with transportation as one important component of these services. Their study thus far demonstrates that transportation is one of the top three OAA services in both funding and total service units, second only to meals. The grassroots planning process for OAA supportive services instituted in the aging network through the Older Americans Act includes significant effort associated with gathering information on needs through town meetings and, for many states, through questionnaires. Finally, new AOA planning guidance complements this process and an upcoming transportation toolkit will provide information on best practices that will aid states in coordinating transportation services.

    Recommendation: To help enhance transportation-disadvantaged seniors' mobility by improving available information and guidance, the Secretary of Health and Human Services should direct the Administrator, Administration on Aging, in order to improve the value and consistency of information obtained from area agencies on aging on the extent to which transportation-disadvantaged seniors' mobility needs are being met, to develop guidance for assessing such needs by expanding the scope of work in the administration's planned evaluation of the Grants for Supportive Services and Senior Centers (Title III-B) program to include gathering and analyzing information on (1) definitions and measures of need; (2) the range of methodologies that area agencies on aging use for assessing seniors' need for services, including transportation, and unmet needs; (3) leading practices identified in the needs assessments methodologies used by area agencies on aging; and (4) the kinds of guidance that area agencies on aging want from the administration and the states to help them perform their required needs assessments.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Implemented

    Comments: The Coordinating Council on Access and Mobility, of which the Administration on Aging (AoA) is a member, has inventoried, reviewed, and catalogued current educational materials (fact sheets, FAQ, talking points, videos, etc.) to further identify education and outreach needs and options. Coordinating Council members are also expected to create transportation web pages and link them to the Council's new web site (www.unitedweride.gov), which AoA has done. The Coordinating Council's site contains a link to AoA's main web page. The site also includes descriptions of each federal program that can be used to fund transportation services for disadvantaged populations, including seniors, and Internet links to many of those programs. In addition, to continue to drive greater access to information at the local level through the AoA's Eldercare Locator program and the Aging and Disability Resource Center Program on senior transportation, AoA commissioned a project through the Eldercare Locator to increase community collaboration between aging and transportation service providers. The National Association of Area Agencies on Aging and the American Public Transportation Association are directing this project, and AoA reports that two stakeholder planning sessions were underway over the summer of 2007. At the completion of this project, AoA expects to further the use of its community transportation template as a tool to catalog community transportation services. This template was widely distributed as part of the AoA Transportation toolbox. Finally, AoA updated its own transportation-related Internet links and expanded its online list of transportation partners. In December 2005, AoA updated its Web page on transportation to include links to a transportation coordination "toolbox," a door-through-door how-to guide, and instructions and electronic template for developing a community transportation guide. AoA's updated site includes a link to the National Center for Senior Transportation (NCST), the new technical assistance center that is a partnership between the Federal Transit Administration and AoA for furthering senior transportation at the community level. The center's Web site provides information for communities, transportation providers, state and local governments, aging and human service providers, and older adults and their caregivers. This information includes training resources, brochures, conferences, and other technical assistance, and also provides links to AoA's transportation toolkit and Eldercare Locator.

    Recommendation: To help enhance transportation-disadvantaged seniors' mobility by improving available information and guidance, the Secretary of Health and Human Services should direct the Administrator, Administration on Aging, in order to help address the obstacles that seniors, their caregivers, and service providers face in locating information on available services and promising practices, to work with members of the Coordinating Council on Access and Mobility to consolidate information about services provided through the participating agencies' programs and to establish links from their programs' Web sites to the administration's transportation Web site to help ensure that other agencies (such as local transit agencies) are aware of, and have access to, such information.

    Agency Affected: Department of Health and Human Services

 

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