Tackling Transportation Challenges in Old Age – Issue Brief


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Functional decline often disrupts transportation routines in old age: driving becomes unsafe and walking is hard or impossible. Tax-funded and private services can transport seniors to their medical appointments, errands, and community meetings, but the low availability, cost, and complexity of these programs reduces their use. With a growing number of seniors in America and higher rates of disability among the elderly expected, transit offerings must quickly equip for disability and coordinate their activities to help the elderly get the most from the services.

Remaining mobile in the community is possible during functional and cognitive decline in old age, though transportation needs become difficult and costly. Each of us should be able to envision a future rich with visits to family, community centers, and medical appointments. However, this will require door-to-door transportation for those of us who will have impaired mobility.

A decade ago, municipal leaders identified transportation as the second biggest issue for the elderly. Yet little action has been taken. Without correcting deficits in coordination and access, the largest elderly cohort in American history will be mostly marooned at home.

Expanding affordability supports for seniors, efficient medical transportation, and flexibility for local transit planning can help but will require new investments and initiatives. Growing ranks of elders with disability and serious illness face increasing challenges to remaining at home and they will require costly institutional care if infrastructure systems fail to help them live in the community.

To address the COVID-19 pandemic, the U.S. Congress authorized a $25 billion package for public transportation operations and capital in the CARES Act, intended as a stopgap for temporary lost ridership. However, the continuous need for infrastructure investments and inclusive planning remains evident as COVID presents lasting challenges to the elderly and their mental and physical health.

Throughout the emergence from the COVID-19 crisis, seniors’ need for these services will grow apace due to demographics and pent-up demand for services. Likely, several subpopulations will instead be best served by shifting their medical and social services – and perhaps even their socializing – to the home. For many seniors, travel options will be crucial to enriching and protecting the social, emotional and physical health of the elderly.

Key Facts

Policy Issues

  • In addition to funding local public transit fleets and their operation, the Federal Transit Administration (FTA) funds an Enhanced Mobility for Seniors and Individuals with Disabilities program, called Section 5310 grants, providing affordability vouchers, purchases of vehicles and equipment, and other programming for seniors and those with disabilities.
  • Non-Emergency Medical Transportation (NEMT) services drive patients to their medical appointments and are a necessity to many who live in the community with disability. Medicaid, but not Medicare, covers NEMT. States administer Medicaid NEMT with state and federal dollars, providing impoverished older adults with access to medical appointments.
  • Paratransit describes services with flexible routes and times. It is needed most by those with disabilities and in rural areas, for whom getting to a fixed transit stop or station is impossible. Paratransit for the elderly includes Medicaid NEMT, Area Agencies on Aging services under the Older Americans Act, and Veteran Affairs’ Veteran Transportation Service. Funding for paratransit helps localities access other funds that require a funding match (like the FTA’s Section 5310 grants). And paratransit programs can fund volunteer services, which coordinate drivers and compensate them for mileage costs.
  • While the FTA convenes the Coordinating Council for Access and Mobility, and local agencies do well by using a mix of federal funding sources, 16 states lacked a state or regional transit coordinating council in 2015. Existing councils reported the most success when funded and legislatively authorized, with a state agency participating, and with representation by their served communities. In particular, the GAO and Transportation Research Board have cited NEMT as requiring better coordination.


Use inclusive planning to prioritize and improve access.

  • In an inclusive planning process, transit agencies create forums to learn what trade-offs are encountered by various groups of persons with disabilities and/or serious illnesses. During our emergence from the COVID-19 crisis and its economic fallout, these key groups’ needs and risks will shift – inclusive planning can remove guesswork about their priorities and concerns.
  • Include the frail elderly and their caregivers in planning transportation investment and routes and plan to meet their needs. A series of “inclusive planning” projects funded by the Administration for Community Living (ACL) have demonstrated valuable contributions by frail elders and individuals with disabilities, identifying service gaps and resolving inefficiencies in several communities. The elderly and their caregivers have special insights on service offerings needed, financial affordability, education and marketing, and investment decisions.
  • Under the most recent federal laws, municipalities must spend at least 55% of Section 5310 funds on capital projects rather than on programs and operating funds. Congress should remove these requirements to defer to local priorities. The right investment mix for a community’s elders will shift year by year, as prioritized through inclusive planning.

Expand public transportation infrastructure and target the greatest needs.

  • Expand fleets by investing in new public transit equipment, especially to increase access for rural riders and riders with disability. Infrastructure legislation should boost the federal transit programs’ capital project funding. Today’s capital investments will determine system capacity for the subsequent decade. Most fleets have aged, causing large backlogs for new equipment. In preparation for growing use by the elderly and their caregivers, more funds should be set aside for specialized equipment and inclusive planning projects.

Build platforms – with the frail elderly in mind – for planning trips with available transportation options.

  • Frail elders need travel planning support, due to lack of information about services and frequent need for timely arrival at health care appointments. This need is enhanced when elders require special equipment or physical assistance. For instance, taxis are often subsidized for seniors lacking alternatives, but seniors may not be aware of this opportunity without individualized planning.
  • Universal mobility service platforms provide a single planning, scheduling, and payment interface that lets users plan trips with all available options — requiring public and private collaboration. The HCBS Infrastructure Improvement bill before the 116th Congress (S. 3277) would fund state projects to develop a universal mobility service platform and make it accessible across any income, age, ability, and geographic groups. Any platform should integrate private options with public programs and voucher payments, and should be usable by those without internet access. Many communities have piloted similar programs called “mobility management,” hiring in-person case workers, or establishing an online or telephone trip-planning system. Programs targeting persons with disability and rural persons can receive specialized federal and philanthropic funds.

Coordinate transportation across health and human services programs.

Enable volunteer and private-sector supports.

  • State laws can empower nonprofits to offer volunteer services, often hindered by insurance rules. Vermont set up a statewide insurance policy to cover volunteer driving organizations and has many volunteer driver services that are integrated in its communities’ transit systems. Other states support their volunteer driver services with grant funding. Volunteer services should integrate with universal mobility services to make payment and ride hailing easy for seniors, as accomplished by the Ride@50+ volunteer-driver program sponsored by AARP in two states.

Original posting date: July 28, 2020

Date of last update: July 28, 2020

Author attribution: Nils Franco, Analyst, Program to Improve Eldercare, Altarum Institute

Copyright by Joanne Lynn, MD ([email protected]).

Content is provided with a Creative Commons Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) license. Learn more at https://creativecommons.org/licenses/by-sa/4.0/

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Requested citation: Nils Franco. “Tackling Transportation Challenges in Old Age.” MediCaring.org, July 28, 2020. https://www.medicaring.org/faq/transportation

We welcome comments and suggested improvements. Please send them to [email protected]


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