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entitled 'Transportation-Disadvantaged Seniors: Efforts to Enhance 
Senior Mobility Could Benefit from Additional Guidance and Information' 
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GAO Highlights: 

Highlights of GAO-04-971, a report to the Chairman, Special Committee 
on Aging, U.S. Senate: 

Why GAO Did This Study: 

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.

What GAO Found: 

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. 

Obstacles, Strategies, and Trade-offs Associated with Meeting 
Transportation-Disadvantaged Seniors’ Mobility Needs, as Identified by 
Experts and Stakeholders: 

[See PDF for table]

Source: GAO.

[End of table]

What GAO Recommends: 

GAO is recommending that HHS’s Administration on Aging take several 
actions to improve guidance and information on transportation-
disadvantaged seniors’ mobility, including developing guidance on 
assessing mobility needs and publicizing available information on 
alternative transportation services and on practices service providers 
can implement to enhance senior mobility. 

HHS agreed with the findings and recommendations in this report.


www.gao.gov/cgi-bin/getrpt?GAO-04-971.

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Katherine Siggerud at 
(202) 512-2834 or siggerudk@gao.gov.

[End of section]

Report to the Chairman, Special Committee on Aging, U.S. Senate: 

August 2004: 

TRANSPORTATION-DISADVANTAGED SENIORS: 

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

GAO-04-971: 

Contents: 

Letter: 

Results in Brief: 

Background: 

Federal Agencies Address Mobility Issues Mainly through 15 Programs 
That Help Make Transportation Available, Accessible, and Affordable: 

Data Indicate That Some Types of Mobility Needs Are Not Being Met, but 
Information on the Extent of Unmet Needs Is Limited: 

Transportation Service Providers Implement Practices That Enhance 
Senior Mobility with Some Federal Support, but Implementation 
Difficulties Remain: 

Experts and Stakeholders Suggested Strategies for Overcoming Mobility 
Obstacles: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments: 

Appendixes: 

Appendix I: Scope and Methodology: 

Appendix II: Information on Transportation Provided by 16 Area Agencies 
on Aging: 

Appendix III: Local Service Providers and Practices That Can Enhance 
Transportation-Disadvantaged Seniors' Mobility: 

Appendix IV: Comments from the Department of Health and Human Services: 

Appendix V: GAO Contacts and Staff Acknowledgments: 

GAO Contacts: 

Staff Acknowledgments: 

Tables: 

Table 1: Characteristics of 15 Key Federal Programs That Fund 
Transportation for Seniors: 

Table 2: Attributes of Senior-Friendly Transportation Service Addressed 
by the 15 Key Federal Programs That Fund Transportation Services for 
Seniors: 

Table 3: Practices Implemented and Funding Sources Associated with 
Selected Local Transportation Service Providers: 

Table 4: Limitations of Data Sources Used: 

Table 5: Academics, Advocacy Groups, Professional Associations, and 
Federal Agencies GAO Interviewed about Information on Seniors' Mobility 
Needs: 

Table 6: Academics, Advocacy Groups, and Professional Associations GAO 
Interviewed about Obstacles, Strategies, and Trade-offs in Addressing 
Transportation-Disadvantaged Seniors' Mobility Needs: 

Figures: 

Figure 1: Diagram of the Overlapping Factors Affecting Seniors' 
Mobility Needs: 

Figure 2: Flow of Transportation Funds from Federal Programs to 
Seniors: 

Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and Older: 

Figure 4: Percentage of Respondents Aged 75 and Older Who Have Public 
Transportation Available to Them, by Area: 

Figure 5: First Set of Obstacles, Strategies, and Trade-Offs Associated 
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as 
Identified by Experts and Stakeholders: 

Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs 
Associated with Meeting Transportation-Disadvantaged Seniors' Mobility 
Needs, as Identified by Experts and Stakeholders: 

Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs Associated 
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as 
Identified by Experts and Stakeholders: 

Abbreviations: 

AAA: area agency on aging: 

ADA: Americans with Disabilities Act of 1990: 

AOA: Administration on Aging: 

DOT: Department of Transportation: 

GPS: Global Positioning Systems: 

HHS: Department of Health and Human Services: 

ITS: Intelligent Transportation Systems: 

MEOC: Mountain Empire Older Citizens: 

MPO: metropolitan planning organization: 

NHTSA: National Highway Traffic Safety Administration: 

TCRP: Transit Cooperative Research Program: 

Letter August 30, 2004: 

The Honorable Larry E. Craig:
Chairman, Special Committee on Aging: 
United States Senate: 

Dear Mr. Chairman: 

The U.S. population is aging, and transportation is critical to helping 
individuals stay independent as they age. Access to transportation, 
whether by automobile or some other mode, is considered essential to 
independent living, allowing individuals to gain access to the goods, 
services, and social contacts that support their day-to-day existence 
and quality of life. Both the number of older people and their share of 
the U.S. population are growing rapidly. Although many seniors continue 
to drive for most of their lives, the growing size of the senior 
population will increase demand for alternative transportation 
services. For example, one study found that more than 600,000 people 
aged 70 and older stop driving each year and become dependent on others 
for transportation.[Footnote 1] The increase in the potential pool of 
seniors needing mobility assistance will challenge federal, state, and 
local government agencies' ability to provide such assistance.

In 2000, 35 million Americans, or 12.4 percent of the total U.S. 
population, were aged 65 and over, according to the U.S. Bureau of the 
Census. The Census Bureau projects that this group will double to 70 
million people by 2030, representing 20 percent of the total 
population. A national travel survey found that seniors take most of 
their daily trips (about 90 percent) by automobile, either as drivers 
or passengers. For the remainder, approximately 8 percent of trips are 
by walking, and 2 percent by other modes (including public 
transportation and bicycles).[Footnote 2] As seniors age, their ability 
to drive, walk, or use public transportation may become limited by 
reduced reaction time; deteriorating night vision; lessening ability to 
climb, reach, or stand; or other physical limitations. To help ensure 
that transportation-disadvantaged seniors[Footnote 3] have access to 
health and medical care, employment, and other basic services, various 
federal programs provide funds for a range of senior transportation 
services to state, local, and nonprofit agencies that actually provide 
the services and, in some cases, also provide their own funds to 
support those services.

This report responds to your request for information about the mobility 
needs of transportation-disadvantaged seniors. As agreed with your 
office, we identified (1) federal programs that address mobility issues 
for transportation-disadvantaged seniors, (2) the extent to which 
federally supported programs are meeting the mobility needs of 
transportation-disadvantaged seniors, (3) program practices that can 
enhance mobility and the cost-effective delivery of transportation 
services to transportation-disadvantaged seniors and the extent to 
which federal programs support the implementation of such practices, 
and (4) obstacles to addressing transportation-disadvantaged seniors' 
mobility needs and potential strategies for overcoming those obstacles.

To identify federal programs that address mobility issues for 
transportation-disadvantaged seniors, we interviewed federal program 
officials and senior mobility experts and reviewed pertinent GAO 
reports. To assess the extent to which transportation-disadvantaged 
seniors' mobility needs are being met, we analyzed data collected by 
federal agencies and local agencies on aging; reviewed studies 
conducted by research organizations; and obtained the perspectives of 
experts in the fields of aging, disability, and transportation. We also 
conducted semistructured interviews with officials from a 
nonprobability sample of 16 area agencies on aging (AAA)[Footnote 4] 
from urban, suburban, and rural areas in six states,[Footnote 5] 
selected to represent different regions of the country. To identify 
program practices that can enhance mobility and the cost-effective 
delivery of transportation services, we reviewed the literature on 
such practices and conducted semistructured interviews with officials 
from 10 local transportation providers highlighted in the literature 
to determine the extent to which federal programs support practices 
that enhance senior mobility. These 10 providers were chosen to 
include a diversity of geographic areas (i.e., they were from different 
regions of the country and from both urban and nonurban areas), types 
of practices, and federal funding sources. To identify obstacles to 
addressing transportation-disadvantaged seniors' mobility needs and 
strategies for overcoming those obstacles, we reviewed the relevant 
literature and interviewed the AAA officials and transportation 
service providers previously mentioned. We also interviewed 14 senior 
mobility experts and representatives of pertinent professional 
associations and advocacy groups. To ensure the reliability of data 
used in this report, we reviewed and identified limitations associated 
with national statistical research methodologies and documented the 
quality assurance procedures that AAAs use to ensure the reliability 
of the data they collect. We concluded that the data were sufficiently 
reliable for our purposes, although we identified several limitations 
that we discuss throughout the report. We also corroborated much of 
the testimonial information provided by AAAs, local service providers, 
experts, professional associations, and advocacy groups by comparing 
it with the literature and with other interviews. We sent draft copies 
of this report to the five pertinent federal agencies--the Departments 
of Education, Health and Human Services (HHS), Labor, Transportation 
(DOT), and Veterans Affairs--for their review and comment. We conducted 
our work from November 2003 through August 2004 in accordance with 
generally accepted government auditing standards. Appendix I contains 
more information about our scope and methodology.

Results in Brief: 

Working with experts on aging and federal agency officials, we 
identified 15 key federal programs that address mobility issues for 
transportation-disadvantaged seniors. These programs, which are 
administered by five federal departments, distribute funds through 
state agencies or make them available directly to local service 
providers. For example, some programs--such as DOT's Capital Assistance 
Program for Elderly Persons and Persons with Disabilities (Section 
5310)--allot funds by formula to state agencies, which then distribute 
the funds to local nonprofit organizations to purchase vehicles, while 
other programs--such as HHS's Rural Health Care Services Outreach 
Program--bypass state agencies altogether and go directly to local 
service providers. The 15 federal programs help make transportation 
services senior-friendly, mainly by making them more available, 
accessible, and affordable (e.g., by providing rides to seniors at 
reduced fares). In addition to administering the 15 programs, federal 
agencies also address transportation-disadvantaged seniors' mobility 
less directly. For example, the Department of Justice has published 
rules governing the design of transportation facilities, such as bus 
stops, to make them accessible to people with disabilities. Seniors 
with disabilities can benefit from the implementation of such designs.

Data on the nature of transportation-disadvantaged seniors' mobility 
needs indicate that federally supported programs are not meeting 
certain types of needs, but there is little data on the extent of unmet 
needs. Needs that are less likely to be met include (1) transportation 
to multiple destinations or for purposes that involve carrying 
packages, such as shopping, for which the automobile is better suited 
than other alternatives; (2) life-enhancing trips, such as visits to 
spouses in nursing homes or cultural events; and (3) trips in nonurban 
areas, especially for seniors in rural communities, where alternatives 
to the automobile are less likely to be available and special 
transportation services are limited. However, federal programs 
generally do not collect data on the extent to which seniors' mobility 
needs are being met because there are few federal requirements to 
assess such needs. HHS's Administration on Aging is required by law to 
provide guidance to states on how to assess seniors' unmet needs, which 
could include transportation, but officials told us that the 
administration has not done so because state and local agencies on 
aging have indicated a greater desire for guidance on other aspects of 
providing services for seniors. However, without guidance on assessing 
unmet needs, local aging agencies have used a variety of methods to 
collect data, many of which produce information on the nature of needs 
rather than on the extent to which needs are being met. Officials from 
the Administration on Aging said that they are developing an evaluation 
plan to examine, among other things, (1) the extent to which one of the 
administration's major senior programs[Footnote 6] is meeting the needs 
and preferences of seniors for supportive services--including 
transportation--and (2) how needs assessments are performed by state 
and local entities.

According to literature on senior mobility and our own work, 
transportation service providers have implemented a variety of 
practices that enhance transportation-disadvantaged seniors' mobility 
and the cost-effective delivery of these services; however, the 
providers we interviewed indicated that implementation of such 
practices was sometimes impeded by multiple reporting requirements and 
limited federal guidance. We grouped these practices into three 
categories: (1) increasing service efficiency, (2) improving customer 
service, and (3) leveraging available funds. For example, one service 
provider we interviewed plans to improve service efficiency by using 
Global Positioning System technology to track its vehicles and 
automatically schedule trips, allowing seniors to obtain same-day 
service rather than having to reserve rides 48 hours in advance. 
Another provider addresses customer service by putting its drivers 
through a sensitivity training program that helps drivers understand 
seniors' mobility challenges. Several other providers have entered into 
contracts with public and private entities to leverage available funds 
and generate additional revenue for senior transportation services. 
According to these providers, their practices have resulted in more 
senior-friendly transportation and more cost-effective service 
delivery. Our review also showed that the 10 local service providers we 
interviewed were using funds from some of the key federal programs we 
identified (e.g., DOT's Capital Assistance Program for Elderly Persons 
and Persons with Disabilities (Section 5310) and HHS's Medicaid 
Program) to deliver transportation services to seniors, and that the 
federal program funding supported the implementation of such practices 
to some extent. For example, some providers said that they received 
technical assistance while implementing such practices, either directly 
from federal agencies or indirectly through federally supported 
professional organizations. However, many of the providers we 
interviewed said that certain characteristics of federal programs, such 
as what the providers view as burdensome reporting requirements and 
limited program guidance, can impede the implementation of practices 
that enhance senior mobility. For example, one provider told us that it 
had not received technical guidance from one of the DOT programs 
indicating how the funding process works and that, as a result, it had 
to seek such assistance from other local organizations.

Experts, advocacy groups, professional organizations, local officials, 
and transportation service providers have identified a number of 
obstacles to addressing transportation-disadvantaged seniors' mobility 
needs. They also have identified potential strategies that the federal 
government, and other government levels, as appropriate, can take to 
better address transportation-disadvantaged seniors' mobility needs 
and enhance the cost-effectiveness of the services delivered. These 
obstacles and strategies are centered around three major themes, as 
follows: 

* Planning for alternatives to driving as seniors age. Several experts 
have reported that the federal government and other government levels 
do not do enough to encourage seniors and their caregivers to identify 
and use multiple transportation modes for their routine trips. As a 
consequence, seniors may perceive that driving is their only option and 
may become isolated or drive even when it is unsafe for them to do so. 
Experts and other stakeholders have suggested that helping seniors plan 
for alternatives to driving--such as by providing information about the 
transportation services available in their community--would extend the 
lifespan of their mobility, and that the federal government could 
provide a central forum for state and local agencies to provide such 
information.

* Accommodating seniors' varied mobility needs. The growing senior 
population could benefit from policies that accommodate its varied 
needs, including differing physical limitations and diverse trip 
purposes (such as for work, volunteer activities, medical appointments, 
and recreation), and address the particular challenges that 
transportation-disadvantaged seniors face in nonurban areas. For 
example, according to senior mobility experts and others, some 
federally funded programs are intended for seniors who do not drive and 
need assistance all the time; yet some seniors need transportation 
assistance only under certain circumstances, such as in bad weather or 
when a medical condition worsens. As a result, these seniors do not 
qualify for these federally funded transportation services. Experts and 
other stakeholders have suggested that the federal government require 
or encourage state and local agencies to focus on seniors' immediate 
and future mobility needs by including seniors in the transportation-
planning process. For example, seniors could advocate for safe walking 
routes to transit stops and for the use of low-floor buses (which are 
accessible to both wheelchair users and people with other mobility 
impairments).

* Addressing federal and other governmental funding constraints. 
Experts and other stakeholders suggested that although public funding 
resources are limited, strategies exist to leverage them, including 
increasing funding flexibility among programs and improving the 
coordination of transportation services at all levels of government. 
For example, federal programs tend to specify that funds from an 
individual program can be used only to provide transportation to and 
from that program's services. Additional funding flexibility and 
coordination among programs could expand seniors' access to 
transportation services.

Seniors benefit when the obstacles to their mobility are addressed, but 
trade-offs also result from implementing the identified strategies. For 
instance, according to experts and local aging officials, helping 
seniors plan for alternatives to driving could enable more seniors to 
maintain mobility while refraining from unsafe driving, but increased 
demand for services would likely stress already stretched 
transportation programs. Offering additional transportation services 
or modifying existing public transit also could help seniors meet their 
varied needs, but such efforts can be expensive, and additional funds 
would have to come from new revenues or other programs.

Given the expected growth in the senior population, it will be 
important for seniors and those who support them to have as much 
information as possible to plan for the future. Accordingly, our report 
contains four recommendations to the Secretary of Health and Human 
Services to improve the guidance and information available to seniors 
about transportation options and to local agencies about assessments of 
the need for senior transportation services and successful practices 
for addressing this need. In commenting on a draft of this report, the 
Departments of Health and Human Services, Transportation, and Veterans 
Affairs concurred with the findings, and the Department of Health and 
Human Services concurred with the recommendations. The Department of 
Transportation also provided technical clarifications, which were 
incorporated as appropriate to ensure accuracy. The Departments of 
Education and Labor said that they did not have any comments on the 
draft.

Background: 

Seniors are a heterogeneous group--many do not require assistance with 
transportation, and, in fact, most drive automobiles. However, 
according to data from the 2001 National Household Travel Survey 
conducted by DOT's Bureau of Transportation Statistics, Federal Highway 
Administration, and National Highway Traffic Safety Administration, 
approximately 21 percent (6.8 million) of seniors aged 65 and older do 
not drive. The percentages are higher among minority populations aged 
65 and older: approximately 42 to 45 percent of African-Americans and 
Asian-Americans do not drive, compared with 16 percent of Caucasians. 
Approximately 40 percent of Hispanics also do not drive.[Footnote 7] A 
person's driving status is correlated with travel behavior. For 
example, one study found that drivers aged 75 and older made an average 
of six trips per week, compared with two trips per week for 
nondrivers.[Footnote 8] While some of this difference may be due to 
individual preferences or to other circumstances, such as an illness 
that prevents travel, some of the difference may be due to a lack of 
transportation alternatives.

Those seniors with poor health or a disability, or who have a limited 
income, may face more difficulty finding and accessing transportation. 
According to data from the 2000 Census, about 37 percent of persons 
aged 65 and older reported having at least one disability, and about 10 
percent were below the federal poverty line. Although not all of these 
seniors need assistance with transportation, a sizable number are 
likely to need such assistance. According to senior transportation 
experts, the "oldest of the old" (those aged 85 and older) are 
especially likely to be dependent on others for rides, particularly if 
they are also in poor health. Figure 1 shows some of the factors that 
affect seniors' transportation needs. The more of these factors that 
seniors have, such as a network of family and friends who can drive 
them and an available public transportation system, the more likely it 
is that their mobility needs will be met.

Figure 1: Diagram of the Overlapping Factors Affecting Seniors' 
Mobility Needs: 

[See PDF for image] 

[End of figure] 

Transportation assistance is an important issue for all seniors. In 
2001, approximately 26 percent of state units on aging surveyed by the 
Aging States Project identified transportation as a top health issue 
for older adults, and 38 percent identified inadequate transportation 
as a barrier to promoting health among older adults.[Footnote 9] 
Furthermore, transportation was among the top five information requests 
to the Eldercare Locator Service in 2001, 2002, and 2003.[Footnote 10] 
There is, however, a significant gender gap in the amount of time that 
seniors can expect to be dependent on alternative sources of 
transportation. A study published in August 2002 in the American 
Journal of Public Health estimated that men aged 70 to 74 who stopped 
driving would be dependent on alternative transportation for an 
average of 6 years, while women in the same age group can expect to 
have an average of 10 years' dependence on alternative transportation 
modes.[Footnote 11]

Although there is no clear-cut definition of mobility need, the 
literature and the experts we consulted indicate that there are two 
main categories of mobility need, both of which are important to 
seniors: (1) "essential" or "life-sustaining" trips, which include 
medical trips and trips for employment, shopping, banking, and other 
necessary errands, and (2) "quality of life" or "life-enhancing" trips, 
which include recreational or social trips that enable a senior to 
fully participate and engage in the community, such as trips to 
concerts, theatre, visits with family members in nursing homes or with 
friends, religious activities, and volunteer activities. For the 
purposes of this report, we will use this two-fold definition of types 
of trips as our working definition of mobility need. Unmet need occurs 
when assistance from others is needed but is not provided or is 
inadequate. However, according to the experts we contacted, there is no 
agreed-upon standard or benchmark for the number of trips that an 
individual requires to take care of essential activities for living 
(for both life-sustaining and life-enhancing activities),[Footnote 12] 
although experts generally agree that government should be concerned 
with meeting both types of needs for transportation-disadvantaged 
seniors. The lack of a standard or benchmark makes it difficult to 
determine an appropriate way to measure the extent to which mobility 
needs are being met. Researchers have begun to identify and evaluate 
transportation-disadvantaged seniors' unmet mobility needs by 
comparing the number of trips they make with those of nondisadvantaged 
populations.[Footnote 13] In addition, some researchers have used 
satisfaction ratings to measure seniors' unmet mobility needs. In the 
absence of a standard measure of need, we will discuss need and unmet 
need by comparing the travel of disadvantaged seniors with the travel 
of nondisadvantaged seniors and by using other measures that federal 
and local officials have developed.

The federal government has traditionally provided some assistance in 
mobility, mostly for the purpose of accessing other federal program 
services. Federal agencies partner with local agencies, nonprofit 
organizations, and others that actually provide transportation services 
and also contribute their own funds. The federal agency that has a 
central role in providing all types of services to seniors is HHS's 
Administration on Aging (AOA). With a total discretionary budget of 
more than $1.3 billion, AOA is the official federal agency dedicated to 
policy development, planning, and the delivery of supportive home and 
community-based services to older persons and their caregivers. AOA 
works through a national aging network of 56 state units on aging; 655 
AAAs; 241 tribal and native organizations representing 300 American 
Indian and Alaskan Native tribal organizations, and 2 organizations 
serving Native Hawaiians; and thousands of service providers, adult day 
care centers, caregivers, and volunteers.

Federal Agencies Address Mobility Issues Mainly through 15 Programs 
That Help Make Transportation Available, Accessible, and Affordable: 

Five federal departments administer 15 programs that are key in 
addressing mobility issues of transportation-disadvantaged seniors. 
The programs are "senior-friendly" in that they help make 
transportation available, accessible, and affordable to seniors.

Fifteen Key Federal Programs Fund Services to Enhance Transportation-
Disadvantaged Seniors' Mobility: 

Working with experts and federal agency officials, we identified 15 key 
programs in five departments that provide senior transportation (see 
table 1) out of the many federal programs that are used to provide 
transportation services. Some of these programs specifically target 
seniors, such as HHS's Grants for Supportive Services and Senior 
Centers (Title III-B). Other programs--including DOT's Nonurbanized 
Area Formula Program (Section 5311)--target other groups, such as rural 
populations, of which seniors can be a part. About half of the 15 
programs fund transportation for specific types of trips, including for 
medical services, employment-related activities, and other services 
(such as nutrition) that the programs provide. The other half of the 
programs can be used to provide general transportation for any trip 
purpose. The programs fund a variety of types of services, ranging from 
transit passes and training in the use of public transit to vehicle 
purchases or expansion of public transit service.

Table 1: Characteristics of 15 Key Federal Programs That Fund 
Transportation for Seniors: 

Agency: Department of Education, Office of Special Education and 
Rehabilitative Services; 
Program: Independent Living Services for Older Individuals Who Are 
Blind; 
Target population: Persons aged 55 and older who have significant 
visual impairment; 
Type of trip allowed: To access program and related services, or for 
general trips; 
Type of service provided: Referral, assistance, and training in the 
use of public transportation.

Agency: Department of Health and Human Services, Administration for 
Children and Families; 
Program: Community Services Block Grant Programs; 
Target population: Low-income persons (including seniors); 
Type of trip allowed: General trips; 
Type of service provided: Taxicab vouchers, bus tokens.

Agency: Department of Health and Human Services, Administration for 
Children and Families; 
Program: Social Services Block Grants; 
Target population: Target population identified by states; 
Type of trip allowed: To access medical or social services; 
Type of service provided: Any transportation-related use.

Agency: Department of Health and Human Services, Administration on 
Aging; 
Program: Grants for Supportive Services and Senior Centers (Title 
III-B); 
Target population: Seniors (aged 60 and older); 
Type of trip allowed: To access program services or medical services, 
or for general trips; 
Type of service provided: Contract for service with existing 
transportation provider, or directly purchase vehicles (such as vans).

Agency: Department of Health and Human Services, Administration on 
Aging; 
Program: Program for American Indian, Alaskan Native, and Native 
Hawaiian Elders (Title VI); 
Target population: American Indian, Alaskan Native, and Native 
Hawaiian seniors; 
Type of trip allowed: To access program services or medical services, 
or for general trips; 
Type of service provided: Purchase and operation of vehicles (such as 
vans).

Agency: Department of Health and Human Services, Centers for Medicare 
and Medicaid Services; 
Program: Medicaid; 
Target population: Generally low-income persons (including seniors), 
although states determine eligibility; 
Type of trip allowed: Medicaid medical services (emergency and 
nonemergency); 
Type of service provided: Reimbursement for services with existing 
transportation providers (e.g., transit passes).

Agency: Department of Health and Human Services, Health Resources and 
Services Administration; 
Program: Rural Health Care Services Outreach Program; 
Target population: Medically underserved populations (including 
seniors) in rural areas; 
Type of trip allowed: To access healthcare services; 
Type of service provided: Transit passes, purchase vehicles (such as 
vans).

Agency: Department of Labor, Employment and Training Administration; 
Program: Senior Community Service Employment Program; 
Target population: Low-income seniors (aged 55 and older); 
Type of trip allowed: To access employment opportunities; 
Type of service provided: Reimbursement for mileage.

Agency: Department of Transportation, Federal Transit Administration; 
Program: Capital and Training Assistance Program for Over-the-Road Bus 
Accessibility; 
Target population: Persons with disabilities (including seniors); 
Type of trip allowed: General trips; 
Type of service provided: Assistance in purchasing lift equipment and 
providing driver training.

Agency: Department of Transportation, Federal Transit Administration; 
Program: Capital Assistance Program for Elderly Persons and Persons 
with Disabilities (Section 5310); 
Target population: Seniors and persons with disabilities; 
Type of trip allowed: General trips; 
Type of service provided: Assistance in purchasing vehicles, contract 
for services with existing transportation providers.

Agency: Department of Transportation, Federal Transit Administration; 
Program: Capital Investment Grants (Section 5309); 
Target population: General public, although some projects are for the 
special needs of elderly persons and persons with disabilities; 
Type of trip allowed: General trips; 
Type of service provided: Assistance for bus and bus- related capital 
projects.

Agency: Department of Transportation, Federal Transit Administration; 
Program: Job Access and Reverse Commute; 
Target population: Low-income persons (including seniors); 
Type of trip allowed: To access employment and related services; 
Type of service provided: Expansion of existing public transportation 
or initiation of new service.

Agency: Department of Transportation, Federal Transit Administration; 
Program: Nonurbanized Area Formula Program (Section 5311); 
Target population: General public in rural areas (including seniors); 
Type of trip allowed: General trips; 
Type of service provided: Capital and operating assistance for public 
transportation.

Agency: Department of Transportation, Federal Transit Administration; 
Program: Urbanized Area Formula Program (Section 5307); 
Target population: General public in urban areas (including seniors); 
Type of trip allowed: General trips; 
Type of service provided: Capital assistance, and some operating 
assistance, for public transportation.

Agency: Department of Veterans Affairs, Veterans Health Administration; 
Program: Veterans Medical Care Benefits; 
Target population: Veterans (including seniors) with disabilities or 
low incomes; 
Type of trip allowed: To access healthcare services; 
Type of service provided: Mileage reimbursement or contract for 
service with existing transportation providers.

Source: GAO.

Note: As we previously reported, we were unable to determine the amount 
spent on transportation services through many of these federal 
programs. See GAO, Transportation-Disadvantaged Populations: Some 
Coordination Efforts Among Programs Providing Transportation Services, 
but Obstacles Persist, 
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-03-697]
(Washington, D.C.: June 30, 2003).

[End of table]

Funds from the 15 programs follow various paths in providing 
transportation services to seniors (see fig. 2). Many of the programs 
are block grants or formula programs through which funds are 
distributed to states on the basis of certain criteria, such as 
population. State agencies then provide services directly or distribute 
the funds to local agencies, nonprofit organizations, transit 
providers, and other organizations. For example, funds from DOT's 
Capital Assistance Program for Elderly Persons and Persons with 
Disabilities (Section 5310) are allotted by formula to state agencies, 
which then distribute the funds to private nonprofit organizations or 
local public entities (such as transit providers) to purchase vehicles 
or other equipment. In another example, funds from HHS's Grants for 
Supportive Services and Senior Centers (Title III-B) are distributed 
first to state units on aging according to the number of seniors 
residing in the state, and then to local AAAs, which generally contract 
for services with local transportation providers.[Footnote 14] In other 
programs, such as the Department of Labor's Senior Community Service 
Employment Program, some funds go through the state while other funds 
go directly to nonprofit organizations or local service providers. 
Finally, other programs--such as HHS's Rural Health Care Outreach 
Services Program--bypass state agencies altogether and go directly to 
local entities. Local entities can use funds from a variety of federal 
programs to provide transportation services to seniors. For example, 
AAAs can receive funds from the Title III-B program, DOT's Capital 
Assistance Program for Elderly Persons and Persons with Disabilities 
(Section 5310), and other federal programs.

Figure 2: Flow of Transportation Funds from Federal Programs to 
Seniors: 

[See PDF for image] 

[End of figure] 

Federal Programs Enhance Senior Mobility by Addressing Certain 
Attributes of Senior-Friendly Transportation: 

The Beverly Foundation, a leading independent research organization on 
senior transportation issues, has identified the following "5 A's" of 
senior-friendly transportation service: [Footnote 15]

* availability (service is provided to places seniors want to go at 
times they want to travel);

* accessibility (e.g., door-to-door or door-through-door 
service[Footnote 16] is provided if needed, vehicles are accessible to 
people with disabilities, and stops are pedestrian-friendly);

* acceptability (service is clean, safe, and user-friendly);

* affordability (financial assistance is provided to those who need 
it); and: 

* adaptability (service is flexible enough to accommodate multiple trip 
types or specialized equipment).

However, there are trade-offs involved in addressing any of the "5 
A's." For example, improving the acceptability of service can increase 
the costs of providing service.

Our review of federal programs' authorizing legislation and guidance, 
as well as interviews with federal program officials, indicates that 
most of the 15 key federal programs we identified in table 1 are 
generally designed to make transportation more available, accessible, 
and affordable to transportation-disadvantaged populations, such as 
seniors (see table 2). For example, HHS's Medicaid Program provides 
transportation that is free or low-cost for seniors. Some of the 
programs address other attributes of senior-friendly transportation, 
such as acceptability. For example, the Department of Education's 
Independent Living Services for Older Individuals Who Are Blind program 
can be used to train seniors in the use of the public transit system, 
making it both more accessible and acceptable to them.

Table 2: Attributes of Senior-Friendly Transportation Service Addressed 
by the 15 Key Federal Programs That Fund Transportation Services for 
Seniors: 

Agency: Department of Education; 
Program: Independent Living Services for Older Individuals Who Are 
Blind; 
Attribute: Availability: No; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: Yes; 
Attribute: Affordability: No; 
Attribute: Adaptability: No.

Agency: Department of Health and Human Services; 
Program: Community Services Block Grant Programs; 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: Yes.

Agency: Department of Health and Human Services; 
Program: Social Services Block Grants; 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: No.

Agency: Department of Health and Human Services; 
Program: Grants for Supportive Services and Senior Centers (Title III-
B); 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: No.

Agency: Department of Health and Human Services; 
Program: Program for American Indian, Alaskan Native, and Native 
Hawaiian Elders (Title VI); 
Attribute: Availability: Yes; 
Attribute: Accessibility: No; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: No.

Agency: Department of Health and Human Services; 
Program: Medicaid; 
Attribute: Availability: No; 
Attribute: Accessibility: No; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: Yes.

Agency: Department of Health and Human Services; 
Program: Rural Health Care Services Outreach Program; 
Attribute: Availability: Yes; 
Attribute: Accessibility: No; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: No.

Agency: Department of Labor; 
Program: Senior Community Service Employment Program; 
Attribute: Availability: No; 
Attribute: Accessibility: No; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: No.

Agency: Department of Transportation; 
Program: Capital and Training Assistance Program for Over-the-Road Bus 
Accessibility; 
Attribute: Availability: No; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: Yes; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: Yes.

Agency: Department of Transportation; 
Program: Capital Assistance Program for Elderly Persons and Persons 
with Disabilities (Section 5310); 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: Yes; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: Yes.

Agency: Department of Transportation; 
Program: Capital Investment Grants (Section 5309); 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: Yes; 
Attribute: Affordability: No; 
Attribute: Adaptability: No.

Agency: Department of Transportation; 
Program: Job Access and Reverse Commute; 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: Yes.

Agency: Department of Transportation; 
Program: Nonurbanized Area Formula Program (Section 5311); 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: No; 
Attribute: Adaptability: Yes.

Agency: Department of Transportation; 
Program: Urbanized Area Formula Program (Section 5307); 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: No.

Agency: Department of Veterans Affairs; 
Program: Veterans Medical Care Benefits; 
Attribute: Availability: Yes; 
Attribute: Accessibility: Yes; 
Attribute: Acceptability: No; 
Attribute: Affordability: Yes; 
Attribute: Adaptability: Yes. 

Source: GAO.

Note: This table focuses on the senior-friendly attributes addressed by 
the intent of the federal program as identified in federal program 
legislation and guidance and in interviews with federal officials. 
Grantees may actually address more of the five A's when delivering 
transportation services to seniors at the local level.

[End of table]

In addition to the 15 key programs identified in tables 1 and 2, the 
federal government helps to make transportation more senior-friendly 
through other programs and policies that provide or ensure access to 
transportation services for all disadvantaged populations (including 
seniors). Although seniors are not the target population of these other 
programs and policies, they often benefit from them. For example, 
seniors are eligible for many of the programs we identified in a 
previous report on the coordination of services for the transportation-
disadvantaged.[Footnote 17] In that report, we identified 62 federal 
programs that can be used to provide transportation services, including 
the 15 programs identified above. For instance, seniors can benefit 
from the Department of Housing and Urban Development's Community 
Development Block Grant Program, which can be used to purchase and 
operate vehicles in low-income areas, and the Department of Labor's 
Workforce Investment Act Adult Services Program, which can be used to 
provide bus tokens or reimbursement for mileage to access training 
opportunities.

Another federal program that does target seniors--Medicare, the federal 
health financing program covering almost all persons aged 65 and older 
and certain persons with disabilities--was not included in our list of 
15 key programs because it funds only a very specific type of 
transportation service for seniors. Medicare covers medically necessary 
ambulance services when other means of transportation, such as a 
wheelchair van or a taxicab, are inadvisable, given the beneficiary's 
medical condition at the time. Medically necessary ambulance trips 
include both emergency care, such as responses to 911 calls, and 
nonemergency care, such as transfers from one hospital to another. 
Medicare covers nonemergency transports--both scheduled and 
nonscheduled--if the beneficiary is bed-confined[Footnote 18] or meets 
other medical necessity criteria, such as requiring oxygen on the way 
to the destination.[Footnote 19]

Many programs and policies that address the mobility needs of persons 
with disabilities also benefit seniors. For example, the Americans with 
Disabilities Act (ADA) has resulted in changes to many transportation-
related facilities, including transit vehicles and bus stops, that make 
transportation more accessible to seniors with disabilities as well as 
others. Other federal ADA-related activities can also benefit seniors. 
For example, the Department of Justice's Civil Rights Division is 
responsible for enforcing federal statutes, including the ADA, that 
prohibit discrimination on the basis of race, sex, handicap, religion, 
and national origin. In addition, Justice has published rules governing 
the design of transportation facilities, such as bus stops, to make 
them accessible to people with disabilities. Finally, the U.S. 
Architectural and Transportation Barriers Compliance Board--an 
independent entity within the federal government devoted to 
accessibility for people with disabilities--develops and maintains 
accessibility standards for transit vehicles, provides technical 
assistance and training on these standards, and ensures compliance with 
accessibility standards for federally funded facilities.

Data Indicate That Some Types of Mobility Needs Are Not Being Met, but 
Information on the Extent of Unmet Needs Is Limited: 

The data on the nature of mobility needs that we obtained from research 
publications and interviews with federal officials, experts, and 
officials from 16 local AAAs indicate that federally supported programs 
are not meeting some of the mobility needs of transportation-
disadvantaged seniors.[Footnote 20] In particular, (1) seniors who rely 
on alternative transportation have difficulty making trips for which 
the automobile is better suited, such as trips that involve carrying 
packages; (2) life-enhancing needs are less likely to be met than life-
sustaining needs; and (3) mobility needs are less likely to be met in 
nonurban communities (especially rural communities) than in urban 
communities. However, there are few current or planned efforts to 
collect data for assessing the extent to which federally supported 
programs are meeting transportation-disadvantaged seniors' mobility 
needs. In addition, AAAs' methods for collecting and reporting data 
make it difficult to determine the extent to which transportation-
disadvantaged seniors' needs are being met, in part because of a lack 
of federal guidance on how to assess needs. According to experts and 
local officials, barriers to assessing the extent of unmet needs 
include the lack of consensus on how to define or measure needs, a lack 
of federal guidance, and the difficulties of measuring the unmet needs 
of seniors who are not attempting to access publicly funded services.

Federally Supported Programs Are Not Meeting Some Types of Mobility 
Needs of Transportation-Disadvantaged Seniors: 

Federally supported transportation services are meeting some, but not 
all, types of mobility needs of transportation-disadvantaged seniors. 
Although up to 75 percent of nondrivers aged 75 and older have reported 
being at least somewhat satisfied with their mobility,[Footnote 21] 
evidence from nationally published research and from interviews we 
conducted with federal officials, experts, and local aging 
professionals indicates that many of those seniors who are able to meet 
life-sustaining and life-enhancing needs are doing so because they have 
access to supportive family and friends who drive them or because they 
live in transit-rich cities. For those seniors who do not have access 
to these support structures or who live in nonurban areas, some 
mobility needs--especially those related to life-enhancing activities-
-may not be met.

Transportation-Disadvantaged Seniors Lack Alternatives to the 
Automobile That Provide Comparable Benefits: 

Data from nationally published research indicate that transportation-
disadvantaged seniors prefer the automobile to other modes of 
transportation because it is readily available, can reach multiple 
destinations in the course of one trip, and can be used to access 
destinations that require carrying packages (such as shopping). In 
focus groups conducted by AARP,[Footnote 22] the general consensus 
among participants was that access to ready transportation provided by 
the private automobile is critical to overall life satisfaction. In 
comparison, seniors perceived other modes such as public transit, 
specialized transportation (such as senior vans), and walking as having 
inherent negative attributes--including time spent waiting, waits in 
bad weather, difficulty carrying items, scheduling requirements, 
infrequent service, and concerns about personal security and 
accessibility--that made them less attractive than driving or being 
driven. Consistent with this, a survey conducted by AARP found that 
senior nondrivers use automobile rides from family or friends more than 
other modes of transportation to get where they need to go (see fig. 
3).[Footnote 23]

Figure 3: Modes of Transportation Used by Nondrivers Aged 75 and Older: 

[See PDF for image] 

Note: Other modes include public transportation, senior vans, walking, 
and taxicabs.

[End of figure] 

Even if seniors could overcome some of these negative perceptions of 
alternatives to the automobile, they may not be able to use the 
alternatives because the alternatives might be unavailable in their 
community or are inaccessible to seniors. In a survey by AARP, about 33 
percent of senior nondrivers who reported that they did not use public 
transportation said that it was because public transportation was not 
available.[Footnote 24] In focus groups conducted for the Coordinating 
Council on Access and Mobility, HHS, and the National Highway Traffic 
Safety Administration, participants reported having trouble walking 
long distances, getting to the bus stop, getting on and off buses, and 
seeing street signs from the bus so that they knew where and when they 
should disembark.[Footnote 25] Similarly, more than one-third of the 
respondents in one study's focus groups reported that they would be 
unable to walk one-quarter mile to a bus stop.[Footnote 26]

Transportation-Disadvantaged Seniors' Life-Enhancing Needs Are Less 
Likely to Be Met Than Life-Sustaining Needs: 

Data from nationally published research indicate that difficulty in 
getting the transportation they needed interfered with transportation-
disadvantaged seniors' activities and trip-making, especially for life-
enhancing needs such as social or recreational activities. For example, 
a report analyzing data from the 2001 National Household Travel Survey 
found that seniors who do not drive made 15 percent fewer trips to the 
doctor than drivers, but made 65 percent fewer trips for social, 
family, religious, and other life-enhancing purposes.[Footnote 27] In 
addition, although few seniors in an AARP survey[Footnote 28] reported 
that a lack of transportation interfered with their activities--such as 
getting to the doctor, their place of worship, the grocery store or 
drug store, or entertainment; shopping for clothes or household items; 
or visiting with friends--nondrivers were two to three times as likely 
as drivers to report that a lack of transportation interfered with such 
activities.[Footnote 29] Furthermore, a study that analyzed responses 
from seniors in focus groups reported that older adults who have 
stopped driving significantly curtailed their recreational activities. 
One participant who had stopped driving reported, "What I do now, my 
daughter tries to take me shopping once a week for heavy items, which 
is very helpful. But I'm accustomed to going from mall to mall and 
store to store to see things, you know, and I don't get around like 
that. I'm very limited."[Footnote 30]

Federal officials and experts we interviewed also said that the 
available transportation options are not meeting seniors' mobility 
needs, especially for life-enhancing trips. Several experts said that, 
while mobility needs are being met for the majority of seniors who 
drive--and even for some transportation-disadvantaged seniors who live 
in transit-rich environments, who have access to supportive family and 
friends, or who have knowledge of and access to nonprofit or other 
organizations that provide transportation--the mobility needs 
generally are not being met for transportation-disadvantaged seniors 
without these options. Although a few officials and experts said that 
for most seniors, trips for life-sustaining needs (e.g., medical 
appointments) are likely being met, others said that such needs are not 
being met.

Finally, the majority of AAA officials we interviewed said that 
transportation-disadvantaged seniors' needs were not being met. 
(Although 3 of the 16 AAAs said that needs were being met with the 
limited funding available, they also cited gaps in service.) 
Furthermore, although the AAA officials we interviewed were split in 
their perspectives on whether needs for travel to critical, life-
sustaining activities were being met, nearly all said that needs for 
travel to life-enhancing activities such as church and shopping at the 
mall were not being met. In addition, all of the AAAs we interviewed 
imposed restrictions that limited or prioritized transportation 
services for life-sustaining activities. For example, many AAAs require 
advance notification (e.g., 24-hour notification) for service and most 
restrict service to approximately 9 a.m. to 5 p.m. on weekdays, which 
limits spontaneous travel and travel in the evenings when many cultural 
and social events take place. Furthermore, most AAAs offer 
transportation only within the counties or towns they serve, which 
limits access to activities. Finally, when we asked AAA officials about 
the destinations to which they provide transportation, most identified 
essential, life-sustaining sites, such as nutrition sites, medical 
facilities, grocery stores, pharmacies, public service agencies, and 
banks. Only a few AAAs offered transportation for life-enhancing 
activities, such as for recreational or cultural events, or for visits 
to spouses or other family or friends in long-term-care facilities, and 
some explicitly stated that they were unable to provide service for 
personal or life-enhancing activities. The AAA officials told us that 
all of these constraints were due to limited funding 
availability.[Footnote 31]

Transportation-Disadvantaged Seniors' Needs Are Less Likely to Be Met 
in Nonurban Areas Than in Urban Areas: 

The travel of transportation-disadvantaged seniors living in nonurban 
communities is more restricted than the travel of transportation-
disadvantaged seniors living in urban communities. A study analyzing 
2001 National Household Travel Survey data indicated that older 
Americans living in small towns and rural areas who do not drive were 
more likely to stay home on a given day than their urban and suburban 
counterparts--63 percent of nondrivers in small towns and 60 percent of 
nondrivers in rural areas reported that they stayed home on a given 
day, compared with 51 percent of nondrivers living in urban and 
suburban areas.[Footnote 32] Alone, these data do not indicate that 
mobility needs are less likely to be met because of limited 
transportation options rather than other aspects that distinguish rural 
communities from urban ones, such as fewer activities and longer 
distances between destinations. However, data we obtained from other 
sources support the idea that the lack of transportation is a 
significant reason for these travel patterns. For example, in focus 
groups and interviews that AARP conducted in 2001 with seniors aged 75 
and older, nondrivers living in the suburbs were less satisfied that 
their mobility needs were met than urban nondrivers. In addition to 
identifying feelings of lost freedom, diminished control, and altered 
self-image, several suburban participants noted that they make fewer 
trips and pursue fewer activities as nondrivers, whereas the urban 
nondrivers expressed more satisfaction with their ability to get 
around.[Footnote 33] In addition, in a survey by AARP, respondents 
living in cities reported that they were more likely to have public 
transportation available to them than respondents living in rural areas 
(see fig. 4).[Footnote 34]

Figure 4: Percentage of Respondents Aged 75 and Older Who Have Public 
Transportation Available to Them, by Area: 

[See PDF for image] 

Note: Respondents were asked how they would describe their current 
residence: as a city, a suburban area around a city, a small town, or 
in the country. According to AARP's calculations, all of the estimates 
we cite from this study have sampling errors that do not exceed + or - 
4.5 percent at the 95 percent confidence level.

[End of figure]

In addition, several federal officials and experts we interviewed said 
that the needs of transportation-disadvantaged seniors are not being 
met with available transportation options, especially for those seniors 
living in rural communities. Similarly, when we asked AAA officials 
whether transportation-disadvantaged seniors' needs were being met, 
nearly half offered the view that needs were not being met for those 
living in rural communities because of the long distances required to 
travel to facilities and the resulting need for the driver to wait to 
bring the senior back. In addition, some said there are geographic 
regions in rural areas that are not served at all by public 
transportation, taxicab, or other transportation providers.

Data Are Limited on the Extent to Which Mobility Needs Are Being Met: 

Because most of the federal programs that fund transportation for 
transportation-disadvantaged seniors do not focus specifically on 
seniors or transportation (instead, seniors may be one of several 
target populations, and transportation may be one of several supportive 
services provided by the program), federal agencies have minimal 
program data about the extent of seniors' unmet transportation needs. 
Five of the 15 key federal programs that provide transportation to 
seniors--the Department of Education's Independent Living Services for 
Older Individuals Who Are Blind program and HHS's Social Services Block 
Grants, Community Services Block Grant Programs, Grants for Supportive 
Services and Senior Centers (Title III-B), and Program for American 
Indian, Alaskan Native, and Native Hawaiian Elders (Title VI)--collect 
some nonfinancial performance data related to senior 
transportation.[Footnote 35] Most of the data collected for these 5 
programs provide only information on usage, such as the number of 
seniors receiving transportation services or the number of one-way 
trips provided to seniors. In addition, for transit programs that serve 
the general public, the Federal Transit Administration collects data on 
the number of rides and the number of people served, but these data are 
not broken out by federal program or by age. However, AOA officials 
told us that they are beginning to measure performance outcomes related 
to transportation services under the Title III-B program. On the basis 
of a national survey it conducted in 2004, AOA estimated that state and 
area agencies on aging provided transportation services to 
approximately 440,000 seniors in fiscal year 2003. AOA officials told 
us that most of the respondents rated the transportation services as 
good or excellent, and that many respondents reported that they relied 
on these services for all or nearly all of their local transportation 
needs. Although this information is useful in assessing the 
satisfaction of seniors who receive transportation services, it does 
not measure the extent of unmet needs. Officials from AOA and the 
Federal Transit Administration currently are assessing the state of 
data on seniors' mobility needs to identify baseline data on needs and 
available resources.

Similarly, few AAAs use, or plan to use, data collection methods that 
enable them to determine the extent of seniors' unmet mobility needs--
that is, information on both the extent of need in the community and 
the capacity of services, including their own, to provide 
transportation to seniors to meet those needs. AAAs are required to 
determine the extent of need for supportive services (which could 
include transportation) provided through HHS's Title III-B program and 
to evaluate how effectively resources are used to meet such 
need.[Footnote 36] However, several AAAs we interviewed reported that 
they do not collect this type of data at all. Of those AAAs reporting 
that they do collect data on the extent of unmet needs, most collect 
data on the number of seniors who called the AAA to request 
transportation services that the agency was unable to provide 
(including data such as the number of trip denials and the number of 
seniors on a waiting list). There are a number of limitations to this 
type of data. For example, a few AAAs reported that waiting list data 
were not reliable in measuring the unmet needs of seniors because the 
data allowed multiple-counting of seniors who are wait-listed by more 
than one transportation provider or who periodically call for rides and 
are added to the waiting list each time they call. In addition, AAAs 
reported that waiting list data were not entirely representative of 
unmet needs because these data include information only on seniors who 
call for service and not on seniors who do not call (because no 
services are available, because they do not know what services are 
available, because they are tired of being turned down, because they 
moved to an assisted living facility since they had difficulty 
obtaining transportation, or because of some other reason) but who may 
still need rides. Furthermore, the waiting list data do not allow for 
calculating the number of seniors who were referred to other 
transportation services and were able to get rides through these other 
services. Only 2 of the 16 AAAs (the Salt Lake County Aging Services 
and the Bear River Association of Governments, both in Utah) have a 
method for determining the gap in transportation service by calculating 
the difference between the number of seniors who are in need of 
transportation and the number of seniors who are receiving service 
through other providers, or through family and friends.

Finally, there is little information from national surveys and studies 
that addresses the extent to which transportation-disadvantaged 
seniors' needs are being met; rather, those surveys and studies focus 
on the nature of needs, as discussed in the previous section of this 
report. For example, one report prepared by DOT's Bureau of 
Transportation Statistics analyzes 2002 data from the Transportation 
Availability and Use Survey on the travel behavior of persons with 
disabilities, but the findings are not broken down by age.[Footnote 37] 
Another Bureau of Transportation Statistics report analyzing the same 
data source provides some insights on the types of travel problems 
encountered by seniors with disabilities, but it does not provide data 
that can be used to measure the extent of those seniors' transportation 
needs or to determine whether those needs are being met.[Footnote 38]

There Are Several Barriers to Assessing the Extent of Unmet Need: 

Senior mobility experts told us that there is no clear-cut definition 
of mobility needs, making it difficult to determine the extent to which 
such needs are being met. Although many of the experts we contacted 
mentioned the distinction between life-sustaining and life-enhancing 
needs, they did not provide a more concrete definition. Many of these 
experts also said that they were not aware of an agreed-upon standard 
or benchmark for assessing seniors' unmet mobility needs. One 
researcher said that the topic of seniors' mobility needs is just 
beginning to be discussed in the literature, so a standard has not yet 
been developed.

In addition to the lack of consensus on definitions or measures of 
need, there is also little guidance on assessing mobility needs. 
Although some of the 15 key federal programs we identified require 
state or local agencies to assess the need for services, federal 
agencies provide little guidance on how to do this. As previously 
noted, HHS's Title III-B and Title VI programs--through which AOA 
provides grants to states and Native American tribes for senior 
services--require AAAs to prepare a plan that includes an assessment of 
the needs of disadvantaged seniors, which could include transportation 
needs.[Footnote 39] Furthermore, the Older Americans Act, as amended, 
requires AOA to provide guidance to states on assessing needs, 
specifically "to design and implement [for program monitoring 
purposes]…procedures for collecting information on gaps in services 
needed by older individuals" and "procedures for the assessment of 
unmet needs for services."[Footnote 40] Although AOA has developed 
general guidance for Native American tribes on conducting needs 
assessments for its Title VI program, the program guidance that the 
agency provides to states for its Title III-B program does not include 
guidance on how to assess and measure needs or on specific data 
collection methods. As a result of the lack of guidance on assessing 
need, most of the AAAs that we interviewed reported assessing seniors' 
unmet mobility needs using a range of data collection methods that 
resulted in data not specific enough for planning purposes, and not 
indicative of the precise extent to which seniors' mobility needs are 
being met. While some AAAs said they did not need additional data, 
other AAAs we spoke with said that more precise information on the 
extent of unmet need would be useful in designing services and getting 
political support and funding for services, but some do not have the 
staff, funds, or expertise to develop methodologies to do this. They 
said that guidance from the federal government in this regard would be 
very useful.

Officials at AOA said that, in the past, they have not provided 
guidance to state and local aging agencies on how to assess needs for 
the Title III-B program because they received feedback that state and 
local aging agencies had a more immediate desire for guidance on 
assessing the quality of service and collecting information on client 
characteristics. To this end, AOA is currently developing a plan for 
evaluating the various supportive services, including transportation, 
provided through its Title III-B programs. The evaluation effort will 
address the needs of states and communities for supportive services and 
the extent to which the Title III-B program is meeting the needs and 
preferences of the elderly for those services. As part of the 
evaluation, AOA plans to address questions about the role of AAAs in 
providing supportive services, how needs assessments are performed by 
state and local entities, and how the results of those assessments are 
used by states in implementing the Title III-B program. On the basis of 
the results of our interviews with AAA representatives, the AOA 
official responsible for the planned evaluation said that it would be 
useful to obtain some additional information during the evaluation to 
determine the need for services under the Title III-B program, 
including (1) identifying how needs should be defined and measured; (2) 
determining the range of methodologies that AAAs use for assessing 
seniors' need for services, including transportation, and unmet needs; 
and (3) identifying the kinds of guidance that AAAs want from AOA and 
states to help them perform their required needs assessments. AOA plans 
to complete its evaluation of this program by January 2006.

Other federal program regulations also require or encourage local 
agencies to assess need to be eligible for funding. For example, DOT's 
Capital and Training Assistance Program for Over-the-Road Bus 
Accessibility (which provides funds to bus operators to help make their 
services more accessible to persons with disabilities) lists 
"identified need" as one of the criteria for selecting grantees, and 
HHS's Community Services Block Grant Program (which provides funds for 
services to address the needs of low-income individuals) requires 
grantees to assess need for services and report this information to the 
state. However, these agencies do not provide guidance for assessing 
need for most of these programs. DOT officials said that they allow 
local applicants for the Capital and Training Assistance Program for 
Over-the-Road Bus Accessibility to decide what measures to use to 
demonstrate need, and the measures vary accordingly. For example, some 
of these applicants have provided information on the number of trips 
that were denied for lack of an accessible vehicle, while other 
applicants demonstrate need on the basis of the number of trips 
provided using an existing lift-equipped vehicle. For its Job Access 
and Reverse Commute Program, DOT asks applicants to provide data on the 
percentage of low-income persons in the area as well as on 
transportation gaps between existing services and employment 
opportunities for these persons, and the agency provides some guidance 
on how to identify such gaps.[Footnote 41] HHS provides some guidance 
for assessing the need for services under the Community Services Block 
Grant Programs, but the guidance is for assessing a wide range of 
services, of which transportation is only one.

Federal officials report that it is difficult to measure unmet mobility 
needs largely because of difficulties in measuring the unmet needs of 
those transportation-disadvantaged seniors who are not trying to access 
transportation services (such as those who do not call for service 
because they have given up trying to get transportation or are not 
aware of services). Some AAA officials and federal officials said that 
collecting this type of data is time-consuming and expensive. In 
addition, there may be other difficulties in reaching these seniors. 
For example, they may have difficulty hearing questions posed over the 
telephone, may be wary of providing personal information, or may be 
reluctant to admit that they need assistance or that they can no longer 
safely drive themselves to activities they need or want to attend.

Transportation Service Providers Implement Practices That Enhance 
Senior Mobility with Some Federal Support, but Implementation 
Difficulties Remain: 

Transportation providers use a variety of practices--which we have 
grouped into three categories--to enhance the mobility of 
transportation-disadvantaged seniors and promote the cost-effective 
delivery of transportation services. These include practices that (1) 
improve service efficiency through increasing the use of technology and 
by coordinating services with other providers in the community; (2) 
improve customer service by providing training sessions for service 
staff and seniors, using vehicles that can accommodate seniors' 
mobility challenges, and increasing the level of service provided; and 
(3) leverage existing resources by increasing volunteer involvement and 
forging financial partnerships with public and private entities in the 
community. According to the local service providers we interviewed, 
these practices, which were implemented with some federal support, 
resulted in more senior-friendly transportation services and more cost-
effective service delivery. All 10 local transportation service 
providers we interviewed indicated that they had been able to use funds 
from 1 or more of the 15 key federal programs in implementing practices 
that enhance senior mobility. The most commonly used programs were 
DOT's Capital Assistance Program for Elderly Persons and Persons with 
Disabilities (Section 5310) and HHS's Title III-B and Medicaid 
Programs, followed by DOT's Nonurbanized Area Formula Program (Section 
5311), and HHS's Community Services Block Grant Programs. However, 
according to the providers we interviewed, certain characteristics of 
federal programs may impede the implementation of practices that 
enhance transportation-disadvantaged-seniors' mobility.

Certain Practices Enhance Transportation-Disadvantaged Seniors' 
Mobility and Promote Cost-effective Delivery of Services: 

According to a 2002 report prepared by DOT's Transit Cooperative 
Research Program (hereafter referred to as the TCRP report),[Footnote 
42] local transportation providers have implemented a number of program 
practices to improve public transportation services for seniors. The 10 
local service providers we interviewed in urban and rural areas have 
implemented some of these practices, as discussed below.

Improvements to Service Efficiency: 

Increasing the use of technology: According to the TCRP report, using 
advanced technology can improve efficiency, productivity, and cost-
effectiveness. Global Positioning Systems (GPS) and other advanced 
technologies can provide real-time information about where vehicles are 
located, when they will arrive to pick up a senior, and how long the 
trip may take. Two of the 10 local service providers we interviewed are 
using advanced technology to improve their trip scheduling. For 
example, Sweetwater Transportation Authority in Rock Spring, Wyoming, 
is using GPS technology on board each bus, connecting the bus to 
software that will automatically schedule rides and provide an accurate 
estimated time of arrival to passengers. The Friendship Center, which 
offers door-through-door transportation services in Conroe City, Texas, 
is involved in the early stages of implementing a computerized 
dispatching and mapping system that will allow same-day scheduling to 
transport seniors to their destinations. In the past, all scheduling 
was done manually and seniors often had to call 48 hours in advance to 
schedule a ride. According to Friendship Center officials, the 
implementation of the computerized mapping system will increase 
efficiency and coordination of their transportation service, which will 
also improve the level of service provided to seniors.

Coordinating transportation services: According to the TCRP report and 
our previous work, coordination of transportation services can improve 
the overall efficiency of operations, increase the productivity of 
services, reduce service costs, and increase mobility.[Footnote 43] Our 
previous work indicated that the extent of coordination of 
transportation services varies. Several service providers we 
interviewed have implemented a coordinated transportation service, 
including Mountain Empire Older Citizens (MEOC), which is located in 
central Virginia.[Footnote 44] MEOC recognized that coordination was 
needed because each human service agency in the area was transporting 
its own clients exclusively, while other vehicles from other agencies 
were picking up passengers in the same area. Under its coordination 
contract, MEOC leases vehicles from other specialized transportation 
service providers and coordinates all aspects of transporting their 
clients (including other transportation-disadvantaged groups, such as 
people with developmental disabilities). As a result, MEOC has 
maximized the efficient use of vehicle fleet and realized cost savings 
in service delivery, according to an agency official. Another service 
provider, the Friendship Center, coordinates its transportation 
services with medical facility staff to schedule medical appointments 
for seniors. The dispatchers at the center work directly with the 
medical providers to schedule medical appointments for seniors when the 
center's transportation services are available. In addition, the 
center's hours for transportation services reflect those of the medical 
centers. By coordinating their services, the center helps ensure that 
seniors do not encounter transportation scheduling problems. Lastly, 
Medical Motor Service, which provides transportation and 
brokerage[Footnote 45] services to seniors in Monroe County, New York, 
coordinates with other nonprofit agencies to provide volunteers who 
serve as "shopping buddies" to help seniors carry packages or assist 
them with their groceries.

Improvements to Customer Service: 

Providing training to staff and seniors: According to the TCRP report 
and a brochure on innovative transit services for seniors developed by 
the Beverly Foundation and the Community Transportation Association of 
America (hereafter, Innovations Brochure),[Footnote 46] training for 
service staff--particularly drivers--and for senior riders is important 
in improving transportation services. The TCRP report states that staff 
training should address customer service issues, such as the need for 
polite and courteous interactions by drivers with passengers and the 
physical constraints seniors encounter while using public 
transportation. The TCRP report also indicates that customer service 
training should be part of an overall change in organizational focus, 
from just operating vehicles to serving customers. Several service 
providers we interviewed were implementing training to improve customer 
service by helping seniors feel more comfortable while being 
transported. For example, Altoona Metro Transportation, which provides 
public transit service to the general public in central Blair County in 
Pennsylvania, developed a driver-training sensitivity program through 
which drivers receive specialized training to recognize the diverse 
needs of seniors. In what is considered a "hands-on" session, drivers 
wear special glasses to distort their vision so that they can 
temporarily experience the physical limitations that some seniors face 
while riding public transportation. An Altoona Metro official also told 
us that drivers are encouraged to socialize with senior passengers and 
foster relationships to make seniors feel comfortable and welcomed. In 
addition to training for staff, providers are also implementing travel-
training programs to teach seniors who are not accustomed to using 
transit services how to use public transportation. One service 
provider, North County Lifeline, Inc. (a curb-to-curb[Footnote 47] 
transit service located in the northern San Diego area), developed a 
travel-training program for seniors to learn about public transit and 
reduce any concerns they may have about personal safety when using 
transit. The program includes instruction in how to problem-solve, map 
out a trip, make transfers, and understand the rights and 
responsibilities they have while riding public transportation.

Using vehicles that can accommodate seniors' mobility challenges: Using 
vehicles that accommodate the mobility challenges of seniors--such as 
purchasing low-floor buses,[Footnote 48] equipping vehicles with lifts, 
or modifying vehicles to make them identifiable and visually appealing 
(by using buses with distinctive colors to designate specific routes or 
with large see-through windows)--may help address some of the physical 
challenges (such as difficulties boarding a bus or van) and emotional 
challenges (such as concerns about boarding the wrong bus or personal 
safety) that seniors may face while using public transportation. For 
example, the TCRP report states that low-floor buses provide advantages 
over conventional buses because they shorten the distance between the 
first step on the bus and the curb (e.g., the first step on a 
conventional bus is approximately 9 to 12 inches above the curb, 
whereas the first step on the latest low-floor buses is less than 3 
inches above the curb). However, there may be constraints in using such 
buses--one service provider we interviewed found them impractical for 
the provider's service area, which contains hilly terrain[Footnote 49] 
and many narrow streets. The majority of service providers we 
interviewed use lift-equipped[Footnote 50] vehicles to transport 
seniors who use wheelchairs. Several of the service providers are also 
using vehicles that are easily identifiable and visually appealing to 
further address concerns seniors may have about using public 
transportation. For example, several of the service providers we 
interviewed said that they transport seniors in vehicles that are 
color-coded to designate specific routes or that have large, nontinted 
windows to limit the confusion that seniors face while trying to 
determine which bus to board, to provide a sense of personal security, 
and to "demystify" public transportation for seniors.

Increasing level of service: According to the TCRP report, increasing 
overall service levels is vital to meeting the mobility needs of a 
growing senior population. Some of the local service providers we 
interviewed said that the practices they implemented allowed them to 
improve their services by expanding service hours for life-sustaining 
trips (as much as their funding allows), accommodating all requests as 
they arise (even if that means temporarily modifying a route), and 
expanding services to include life-enhancing trips (e.g., field trips 
sponsored by senior centers and trips to a therapeutic warm-water pool 
program). For example, a MEOC official told us that the provider 
expanded its service from 8 hours to 12 hours per day on weekdays to 
provide transportation for life-sustaining trips (e.g., medical 
appointments), and that the agency plans to modify an existing route to 
provide service regardless of how little notice is given. MEOC's 
computer scheduling system enables dispatchers to radio the nearest 
driver and ask him or her to modify the current route to fit in an 
extra pick-up or drop-off. In another example, Gold Country Telecare, a 
nonprofit agency that provides accessible specialized transportation in 
rural northern California, learned through interviews with others in 
the local community involved in senior transportation that seniors were 
often isolated on weekends, when transportation services were rarely 
available for them. To address this need, the agency increased its 
service level by implementing an all-day Sunday transportation service 
for seniors to get to church or other activities, such as grocery 
shopping.

Improvements to Leverage Available Funds: 

Increasing volunteer involvement: According to the TCRP report and the 
Innovations Brochure, volunteer involvement may lead to cost savings in 
delivering transportation services to seniors by reducing the need for 
paid staff. The local service providers we interviewed used volunteers 
in a variety of ways. For example, Gold Country Telecare implemented a 
volunteer driving program under which volunteers are reimbursed for 
mileage expenses incurred in using their personal vehicles to transport 
seniors to medical and health treatment facilities located in a nearby 
urban center. According to a Gold Country Telecare official, this 
program allows seniors to participate in health therapies or medical 
services not found in their rural community. OATS, Inc., a 
transportation service provider in Missouri, uses volunteers who act as 
dispatchers, taking calls in their homes from people in the community 
who need trips. The volunteers transfer requests to the driver, who 
then schedules the trips. The use of volunteers allows OATS to provide 
more cost-effective and more frequent service by avoiding the 
administrative expense of having an office in each of the 87 counties 
it serves. Furthermore, according to an OATS official, the value of the 
volunteer hours (including the in-kind allowance for the use of their 
personal telephones and space in their home) translates into 
approximately $1.6 million in cost savings per year.[Footnote 51]

Forging partnerships with private and public entities: The TCRP report 
suggests forging financial partnerships with public and private 
entities in the community to address funding concerns and to diversify 
funding sources. Several of the local service providers we interviewed 
developed private/public partnerships such as (1) contracts with 
private entities to engage in revenue-enhancing activities, such as 
using the service providers' vehicles to transport other groups when 
the vehicles were not being used for senior transportation or 
transporting seniors to specific locations, such as shopping sites, or 
(2) joint agreements with human service agencies to provide specialized 
services for clients who need additional assistance. For example, the 
Friendship Center contracts with private entities to provide shuttle 
services from employee parking to employment sites, from overflow 
parking lots to special event venues, to community churches on Sunday 
mornings, and other similar transportation services. According to 
center officials, these additional contracts for shuttle services bring 
in approximately $140,000 in additional annual revenue, which is being 
used to provide additional senior transportation services and 
represents approximately 15 percent of the center's annual budget for 
senior transportation. Another local service provider that diversified 
its funding sources, Medical Motor Service, developed a partnership 
with a regional private supermarket to supplement its fund-raising 
efforts. Under this arrangement, Medical Motor Service receives 
approximately $300,000 in annual funding from the supermarket to 
transport seniors to and from the grocery store. This sum represents 18 
percent of the provider's annual senior transportation budget. As a 
result of this arrangement, seniors residing in 55 housing complexes 
have transportation for grocery shopping or for renewing medical 
prescriptions at any of the 14 supermarkets located in Monroe County. 
However, one trade-off in having an exclusive partnership with one 
grocery store chain is that, unlike seniors (and others) who can drive, 
seniors who rely on such a service do not have a choice of where to 
shop. In that regard, Special Transit, a local service provider in 
Boulder, Colorado, identified a need to diversify its funding sources 
to reduce dependence on any one source of funds, helping to ensure 
continuity of service for all of its clients, including seniors. To do 
so, it hired an outreach coordinator to identify other service 
providers in the community (such as senior day care programs, senior 
centers, and local hospitals) that were interested in having Special 
Transit provide transportation services. In addition, the coordinator 
was tasked with identifying opportunities for generating private 
donations. Through its partnerships, Special Transit reduced its 
dependence on public funding (including federal and local government 
grants and matching funds) from more than 80 percent of its total 
revenue sources in the mid-1980s to approximately 65 percent in 2004. 
Presently, Special Transit's service contracts and private donations 
account for approximately 30 percent of its total revenues.

Summary of Practices and Funding Sources: 

Table 3 provides examples of some of the practices and federal funding 
sources used by the local service providers we interviewed.[Footnote 
52]

Table 3: Practices Implemented and Funding Sources Associated with 
Selected Local Transportation Service Providers: 

Provider name and associated federal funding sources: Altoona Metro 
Transportation; 
* Section 5307; 
* Section 5309; 
Practices: Training and safety: Driver sensitivity training program; 
Practices: Vehicle modification: Low-floor buses; 
Practices: Service delivery: Markets its services specifically to 
seniors; 
Practices: Volunteer involvement: Senior companion volunteers promote 
"Bus-Buddy" program. 

Provider name and associated federal funding sources: Friendship 
Center; 
* CSBG; 
* Section 5310; 
* Title III-B; 
Practices: Technology: Computerized mapping system to schedule same-
day service; 
Practices: Coordination of services: Coordinates with medical facility 
staff to schedule medical appointments for seniors; 
Practices: Vehicle modification: Lift-equipped vehicles; 
Practices: Service delivery: Customer-focused organization; 
Practices: Financial partnerships: Uses vehicles after hours to 
increase revenue through contracted services.

Provider name and associated federal funding sources: Gold Country 
Telecare, Inc; 
* SCSEP; 
* Section 5310; 
* Title III-B; 
Practices: Vehicle modification: Lift-equipped vehicles; 
Practices: Service delivery: Sunday transportation service and 
follow-up and preventive healthcare transportation services; 
Practices: Volunteer involvement: Neighbor- to-neighbor volunteer 
driver program. 

Provider name and associated federal funding sources: Medical Motor 
Service; 
* Medicaid; 
* Section 5310; 
* Title III-B; 
Practices: Coordination of services: Coordinates with other nonprofit 
agencies to provide senior shopping buddies; 
Practices: Vehicle modification: Wheelchair-accessible vehicles; 
Practices: Service delivery: Provides door-to-door escort service; 
Practices: Financial partnerships: Contracts with regional grocery 
chain to transport seniors for grocery shopping.

Provider name and associated federal funding sources: Mountain Empire 
Older Citizens, Inc; 
* Medicaid; 
* SCSEP; 
* Section 5310; 
* Section 5311; 
* Title III-B; 
Practices: Coordination of services: Coordinates transit system that 
provides door-through-door, one-on-one services to special needs 
populations; 
Practices: Vehicle modification: Lift-equipped vehicles; 
Practices: Service delivery: Customer-friendly and flexible service to 
meet the needs of a multicounty rural community; 

Provider name and associated federal funding sources: North County 
Lifeline; 
* Section 5307; 
* Section 5310; 
Practices: Coordination of services: Collaborates to establish a Web-
based referral system to highlight transportation options for seniors 
and assist social service providers; 
Practices: Training and safety: Travel-Training Program teaches seniors 
how to use fixed-route transportation; 
Practices: Vehicle modification: Lift-equipped vehicles. 

Provider name and associated federal funding sources: OATS, Inc; 
* CSBG; 
* JARC; 
* Rural Health; 
* Section 5310; 
* Section 5311; 
* SSBG; 
* Title III-B; 
Practices: Volunteer involvement: Use volunteers to fulfill functions 
such as dispatching calls to drivers, fund-raising, and serving as 
liaisons to the community. 

Provider name and associated federal funding sources: Special Transit; 
* Medicaid; 
* Section 5310; 
* Section 5311; 
* Title III-B; 
Practices: Training and safety: Easy Rider Program teaches seniors how 
to use fixed-route transportation; 
Practices: Vehicle modification: Vehicles have large, nontinted 
windows to alleviate seniors' safety concerns. 
Practices: Volunteer involvement: "Friends and Family" mileage 
reimbursement program. 

Provider name and associated federal funding sources: St. John's 
County Council on Aging; 
* JARC; 
* Medicaid; 
* Section 5310; 
* Section 5311; 
* Title III-B; 
Practices: Coordination of services: Coordinates services with local 
transit authority and taxicab services; 
Practices: Training and safety: Driver-training program that emphasizes 
safety and customer service; 
Practices: Vehicle modification: Vehicles are brightly decorated to 
attract senior ridership; 
Practices: Service delivery: Customer-focused organization. 

Provider name and associated federal funding sources: Sweetwater 
Transportation Authority; 
* CSBG; 
* Medicaid; 
* Section 5310; 
* Section 5311; 
Practices: Technology: Global Positioning Systems technology on 
vehicles to aid in accurate and automatic trip scheduling; 
Practices: Coordination of services: Coordinates transportation 
software with city and county emergency response transportation 
systems. 

Legend: 

CSBG: Community Services Block Grant Programs: 
JARC: Job Access and Reverse Commute: 
Rural Health: Rural Health Care Services Outreach Program: 
SCSEP: Senior Community Service Employment Program: 
Section 5307: Urbanized Area Formula Program: 
Section 5309: Capital Investment Grants: 
Section 5310: Capital Assistance Program for Elderly Persons and 
Persons with Disabilities: 
Section 5311: Nonurbanized Area Formula Program: 
SSBG: Social Services Block Grants: 
Title III-B Grants for Supportive Services and Senior Centers: 

Source: GAO analysis of interviews with local service providers and a 
review of the senior mobility literature.

[End of table]

Local Practices Have Enhanced the Senior-Friendliness and Cost-
effectiveness of Services: 

The implementation of these practices contributed to the improvement of 
senior transportation services by making them more senior-friendly, 
according to the 10 local service providers we interviewed. In 
particular, these practices collectively addressed the five A's of 
senior-friendly transportation previously discussed--availability, 
accessibility, acceptability, affordability, and adaptability--as 
follows: 

* The majority of service providers told us that they made 
transportation services readily available for seniors to get to needed 
medical locations.

* The 10 providers said that their services are tailored to ensure that 
seniors can access the vehicles: that is, pick-up locations are easy 
for seniors to walk to, one-on-one escort service is available to 
seniors who need special assistance, or lift equipment is installed in 
the vehicles.

* Several service providers stated that they use vehicles that are 
identifiable and visually pleasing to make sure their vehicles are 
acceptable to seniors.

* Most of the service providers also indicated that their services are 
affordable because they are free to seniors or minimal donations are 
requested at the time of service.

* More than half of the service providers said that their services are 
adaptable and flexible enough to accommodate the service requests and 
the mobility limitations some seniors may have.

In addition, the majority of the service providers we interviewed said 
that their organizations realized cost savings and increased the 
quality and quantity of service by implementing the practices. For 
example, as previously noted, the coordinated transportation service 
implemented by MEOC allowed lower per-unit costs, which also resulted 
in cost savings for all the agencies involved. According to a MEOC 
official, the cost savings allowed MEOC to increase the number of trips 
provided, increase the hours of operation, continue to afford 
dispatchers, hire more transportation managers, and provide adequate 
training for drivers--all of which translated into improvements in the 
quantity and quality of service to MEOC's clients.

Federal Programs Support the Implementation of Practices That Enhance 
Transportation-Disadvantaged Seniors' Mobility to Some Extent: 

According to the service providers we interviewed, the most common way 
in which federal programs support the implementation of practices that 
enhance transportation-disadvantaged seniors' mobility is by providing 
funding. As previously noted, the 10 providers we interviewed use funds 
from at least 1 of the 15 key federal programs in implementing 
practices that enhance transportation-disadvantaged seniors' 
mobility.[Footnote 53] (See table 3 for the federal funding sources 
associated with each service provider.) We found that DOT's Capital 
Assistance Program for Elderly Persons and Persons with Disabilities 
(Section 5310) and HHS's Grants for Supportive Services and Senior 
Centers (Title III-B) and Medicaid Programs are the federal programs 
most often used by the 10 providers we interviewed, followed by DOT's 
Nonurbanized Area Formula Program (Section 5311) and HHS's Community 
Services Block Grant Programs.

According to some of the service providers, the federal programs had 
both a direct and an indirect role in providing technical assistance 
for the implementation of practices to enhance transportation-
disadvantaged seniors' mobility. In some cases, federal programs 
provided direct technical assistance (by providing information on how 
to apply for program funding or how to implement the service or by 
providing contact information for other resources) through program 
representatives or through the program's Web site. Several providers 
stated that, as grantees, they obtained technical assistance from DOT's 
Intelligent Transportation Systems (ITS) program,[Footnote 54] which 
assigned consultants to their organizations to provide assistance in 
selecting software and hardware and developing requests for proposals. 
One service provider further added that he found DOT's ITS program Web 
site to be useful in obtaining information on best practices and on 
other technology-related resources. Another service provider received 
technical assistance through both Federal Transit Administration 
representatives and the state's transit association on how to obtain 
funding through the Job Access and Reverse Commute Program. In other 
cases, some providers stated that the federal government indirectly 
provided guidance or technical assistance. For example, guidance on 
implementing practices and marketing services to the senior community 
was provided through federally funded professional organizations, such 
as the Community Transportation Association of America and the National 
Academy of Sciences' Transportation Research Board.

Other service providers we interviewed told us that the federal 
programs did not provide assistance (other than funding) or guidance on 
implementing practices to enhance transportation-disadvantaged 
seniors' mobility, so they had to look to other state and regional 
transit agencies or other local transportation service providers to 
provide guidance or technical assistance. One service provider said 
that it researched and sought out other mobility management programs 
and travel-training programs to learn how to implement such programs, 
because this information was not available from federal or state 
agencies. Several providers told us that finding information on 
successful practices for enhancing transportation-disadvantaged 
seniors' mobility required considerable staff time and other resources, 
and that a centralized source--particularly a Web-based source--for 
such information would be useful. Many of the providers suggested that 
providing such a Web site would be an appropriate role for the federal 
government. AOA, the lead federal agency for coordinating programs for 
seniors and the dissemination of information relevant to seniors, has 
some transportation information available on its Web site, but there 
are some limitations to this information, as discussed in more detail 
in the section below on senior mobility obstacles and strategies.

Local Transportation Service Providers Continue to Face Difficulties in 
Implementing Practices That Enhance Transportation-Disadvantaged 
Seniors' Mobility: 

According to the local providers we interviewed, certain 
characteristics of federal programs can impede the implementation of 
practices that enhance transportation-disadvantaged seniors' mobility. 
Although federal programs provide financial support for practices that 
enhance senior mobility, an expert in senior mobility and several 
service providers stated that receiving federal funds entails 
burdensome reporting requirements. Often, the local service providers 
receive funding from several federal programs with different reporting 
requirements and therefore have to submit several different reports 
calling for different data. One provider stated that submitting all of 
the required documentation for DOT's Capital Assistance Program for 
Elderly Persons and Persons with Disabilities (Section 5310) and HHS' 
Grants for Supportive Services and Senior Centers (Title III-B) Program 
necessitated the dedication of 720 administrative hours each year 
(equivalent to over $10,000), costing the provider more in 
administrative costs than the actual funding received through the 
federal programs.[Footnote 55] Another service provider we interviewed 
said it has designated about 1,690 administrative hours annually to 
complying with the reporting requirements of the Title III-B program, 
Medicaid, and DOT's Congestion Mitigation and Air Quality Improvement 
Program,[Footnote 56] including doing such tasks as tracking the 
different data requested by each program, organizing documents, and 
following up on required information.[Footnote 57] The provider noted 
that the 1,690 hours (equivalent to about $60,000 in costs) represented 
a significant portion (14 percent) of the total federal program funding 
received under those programs.[Footnote 58] Federal officials have told 
us that the Coordinating Council on Access and Mobility--a federal 
body, consisting of representatives from 10 federal agencies, including 
the Departments of Education, Labor, Health and Human Services, 
Transportation, and Veterans Affairs, that is charged with coordinating 
transportation services provided by federal programs and promoting the 
maximum feasible coordination at the state and local levels--is 
examining possible ways to streamline reporting requirements of the 
various federal programs that fund transportation for disadvantaged 
populations. Council officials said that a paper addressing this issue 
will be developed and presented in 2004 or early 2005.

Some of the local providers said that federal guidance on how to apply 
for funding and comply with reporting procedures is limited. For 
example, one service provider stated that it has not received technical 
guidance from DOT that explains the funding process for the Urbanized 
Area Formula Program (Section 5307). Instead, the provider contacted 
other local nonprofit organizations to seek their technical assistance 
in understanding the funding process, but the funds were delayed in the 
meantime. The provider said that it contacted local DOT representatives 
but was unable to determine the cause of the delay in funds. As a 
result, the provider said that it had to convince its nonprofit board 
of directors to continue to provide services without the promised 
federal funds so that seniors would still have transportation services 
available.

Lastly, several of the service providers perceive that program 
guidelines are rigid and lack flexibility, although the federal 
officials we contacted disagreed with the providers' interpretations. 
For example, one provider stated that the program guidelines for DOT's 
Nonurbanized Area Formula Program (Section 5311) are very rigid in that 
the funds may only be used for transportation for the general public. 
The service provider stated that the Section 5311 guidelines require it 
to track the type of passenger who requests demand-response service and 
the trip destination. If a senior requests transportation to a senior 
center or any other human service program destination, the service 
provider told us it must find another funding source (e.g., Title III-
B) for that trip because Section 5311 funding is designated for general 
rural transportation services and not specialized services. However, a 
DOT official told us that rural transit providers receiving Section 
5311 assistance may transport a senior to a senior center if the 
service is also made available to the general public.

Experts and Stakeholders Suggested Strategies for Overcoming Mobility 
Obstacles: 

Through a review of the literature and interviews with experts on 
senior transportation and aging, representatives of pertinent 
professional associations and advocacy groups, local officials, and 
transportation service providers, we identified several obstacles to 
addressing transportation-disadvantaged seniors' mobility needs and 
potential strategies that the federal government and other government 
levels, as appropriate, can consider taking to better address those 
needs and enhance the cost-effectiveness of the services delivered. We 
grouped these obstacles and strategies around three themes: (1) 
planning for alternatives to driving as seniors age to extend the 
lifespan of their mobility, (2) accommodating seniors' varied mobility 
needs, and (3) leveraging federal and other government funding to 
better use limited resources. The suggested strategies for addressing 
obstacles to senior mobility involve certain trade-offs, and these 
obstacles, strategies, and trade-offs are discussed in each of the 
following sections.

Helping Seniors Plan for Alternatives to Driving Could Increase the 
Lifespan of Their Mobility: 

Figure 5: First Set of Obstacles, Strategies, and Trade-Offs Associated 
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as 
Identified by Experts and Stakeholders: 

[See PDF for image] 

[End of figure] 

Seniors who have relied on driving as their primary mode of 
transportation may experience a sharp decline in mobility if their 
driving becomes limited or ceases. In addition, some seniors may 
continue to drive even when it is no longer safe for them to do so 
because they do not have, or do not know about, alternative 
transportation options. In focus groups conducted by AARP, few 
participants indicated that they had ever thought about giving up 
driving in advance of doing so. Sixty percent of the seniors surveyed 
in another study thought they would get a ride from family members or 
friends when they could no longer drive themselves. Several experts 
have reported that seniors and their caregivers are not sufficiently 
encouraged--by federal and other government entities, family members 
and other caregivers, the medical profession, and others--to identify 
and use multiple transportation modes for their routine trips. As a 
consequence, seniors may perceive that driving is their only viable 
option, and they may become isolated or risk driving when it is unsafe 
for them to do so.

For the large number of seniors who routinely drive, experts and local 
service providers have suggested ways to facilitate a gradual 
transition from driver to nondriver and to incorporate additional 
transportation modes into seniors' daily travel. Advocacy groups, such 
as AARP, have found that seniors have a strong preference for driving 
as their primary mode of transportation, and the transition from driver 
to nondriver may be particularly challenging for seniors as they age. 
While some types of driver-screening programs are currently available 
in some communities,[Footnote 59] the federal government could make 
them more widely and consistently available by supporting or 
encouraging state governments to implement such programs to help 
seniors and their caregivers assess their driving abilities. Seniors 
could also be offered--through new and existing programs--additional 
training, physical therapy, or adaptive equipment to address weaknesses 
identified in the screening (e.g., larger rear-view mirrors and pedal 
extenders can help seniors who have difficulty turning their heads or 
reaching the pedals). AOA officials told us that they have historically 
worked with AARP's Mature Driving Program, the American Automobile 
Association, and others to provide support to seniors in addressing 
their driving abilities, but that sustaining an effort in this area 
would likely require new funding. DOT's National Highway Traffic Safety 
Administration (NHTSA), in partnership with other federal agencies, the 
American Occupational Therapy Association, the American Society on 
Aging, and others, has begun promoting some programs to help seniors 
extend the lifespan of their mobility by making driving choices that 
maximize their personal and community safety and using transit before 
it is their only transportation option. For example, NHTSA is pilot 
testing a social marketing program to increase awareness of senior 
transportation challenges and options. In each of the test sites, 
community groups have surveyed people aged 65 and older regarding their 
perceptions about safer driving behaviors, other modes of 
transportation, and how easy or difficult it is for them to get around 
in their communities. The groups then publicized the survey results and 
initiated a community discussion about how to help people remain safely 
mobile and active as they age. According to a NHTSA official, a final 
report with a prioritized set of recommendations and a booklet 
containing materials tested by the community groups will be prepared 
later this year.

Experts, advocacy groups, and local officials have also suggested 
providing a continuum of services to accommodate different trip 
purposes and different levels of need. Such services could include 
safety programs for older drivers; ridesharing information; and public 
transportation and paratransit options,[Footnote 60] including escorts 
and financial assistance. The federal government is currently 
developing ways to support informed driving choices and encourage state 
and local agencies to provide information on the alternative 
transportation options available to seniors who can no longer safely 
drive or are not comfortable driving in certain conditions, such as at 
night or in poor weather. For example, NHTSA (in conjunction with the 
American Society on Aging) has developed Web-based seminars to help 
seniors and their families make appropriate driving choices that 
maximize their personal and community safety. These seminars can also 
help communities maximize seniors' mobility options. In addition, the 
Easter Seals Caregiver Project (funded by the Federal Transit 
Administration and AOA) has developed a template for identifying all of 
the transportation options that are available to seniors in a typical 
community. The template is designed to help seniors and their 
caregivers know what services are available to them and to help service 
providers, caseworkers, and city and county planners assess 
transportation options and identify gaps in transportation services. 
Experts also suggested a publicity campaign to raise awareness about 
the importance of planning for seniors' future mobility needs, as well 
as training programs for seniors on how to access the transportation 
modes available in their communities.

Local service providers and an expert suggested that the Internet could 
be a valuable resource in disseminating information. For example, one 
local service provider collaborated to develop a Web-based database of 
transportation options for seniors in its service area, which reduced 
duplication in referral services and provided comprehensive and current 
information on transportation options to stakeholders and seniors. The 
service provider stated that the result was an interactive, user-
friendly Web site that provided seniors with appropriate, 
individualized information on transportation and referral services and 
enabled social service organizations, healthcare agencies, community 
groups, and caregivers to locate information on transportation options. 
Such information could also be available in document format for those 
seniors and organizations that prefer not to use the Internet or do not 
have access to it, although experts suggest that future generations of 
seniors will be progressively more familiar and comfortable with 
technology, especially as the "baby boomers" join the senior 
population.

The trade-off in encouraging driver-screening programs and publicizing 
alternative transportation options is that these strategies would 
increase their use. Such an increase would have both positive and 
negative results. According to experts and local aging officials, more 
demand would put additional pressure on already stretched 
transportation programs, but also would mean that more seniors are able 
to access the services available to them or are not driving when it is 
unsafe for them to do so.

Growing Senior Population Could Benefit from Policies That Accommodate 
Its Varied Needs: 

Figure 6: Second Set of Obstacles, Strategies, and Trade-Offs 
Associated with Meeting Transportation-Disadvantaged Seniors' Mobility 
Needs, as Identified by Experts and Stakeholders: 

[See PDF for image] 

[End of figure] 

The mobility needs of seniors vary, depending on differing mobility 
limitations they may experience and the reasons they may need 
transportation (such as for work, volunteer activities, medical 
appointments, and recreation). However, according to experts, advocacy 
groups, and local officials, traditional transportation services are 
not always designed to meet those varied needs of seniors, particularly 
transportation-disadvantaged seniors. The health and mobility 
limitations that prevent seniors (particularly seniors aged 85 and 
older) from driving may also present obstacles when they use public 
transit, paratransit, taxicabs, and other transportation options.
[Footnote 61] Many seniors also live in suburban and rural areas that 
are not easily served by traditional fixed-route transit. In addition, 
approximately half of the key federal programs for senior 
transportation fund services only for specific destinations, such as 
medical appointments (rather than for life-enhancing needs), which 
tend to occur during normal business hours. Life-enhancing trips are 
often needed on evenings (e.g., to a concert) or weekends (e.g., to 
religious services) when many paratransit and other specialized 
transportation services for seniors are not available. According to 
one professional association, the limited amount of funding provided 
through HHS's Title III-B program, which senior centers use to provide 
transportation, has meant that providers are often unable to provide 
life-enhancing trips and restrict service to only medically necessary 
trips. Finally, as indicated by the data previously discussed, most 
seniors prefer to travel in private automobiles, which offer greater 
comfort and flexibility than conventional vans and buses, but many 
federally funded services for transportation-disadvantaged seniors 
provide only bus or van travel. Experts suggested that if conventional 
vans and buses are modified to offer greater comfort and flexibility, 
they may appeal to seniors in much the same way as private automobiles.

According to federal officials and experts, many federally funded 
programs are intended for seniors who do not drive at all and need 
assistance all of the time. However, many seniors do not qualify for 
the federally funded transportation programs in their communities 
because they require transportation assistance only under certain 
circumstances, such as in bad weather or when a medical condition is 
aggravated. Experts, advocacy groups, and local officials proposed (1) 
improving conventional public transit services to better accommodate 
transportation-disadvantaged seniors' needs and (2) familiarizing 
seniors with transit options while their health is favorable so they 
feel more comfortable using transit as they age and require the 
adaptability that transit can provide. To accomplish this, several 
suggested that the federal government, or other government levels as 
appropriate, provide incentives for transit agencies to restructure 
routes to encompass areas where seniors travel or live and improve the 
safety and security of waiting areas and vehicles. Additionally, 
several proposed that government agencies encourage service providers 
to provide training for transit operators on how to better serve 
seniors, as well as training for seniors on how to use transit and the 
other transportation options available to them. Although such changes 
could be expensive, several experts countered that they might be less 
expensive than the alternatives (i.e., providing individual paratransit 
service or providing emergency medical care or nursing home care).

To accommodate both the immediate and long-term mobility needs of the 
aging population, experts and advocacy groups suggested that seniors' 
needs be considered in the transportation-planning process. They 
suggested that the federal government encourage or require metropolitan 
planning organizations (MPO) to evaluate the impact of transportation 
systems on seniors' mobility; include seniors when developing the 
transportation improvement plan (currently, interested parties are 
given opportunities to comment on transportation plans, but they are 
not necessarily included in the planning process); and consider the 
accessibility of transit facilities to pedestrians. For example, 
seniors could advocate for safe walking routes to transit stops and for 
the use of low-floor buses (which are accessible to both wheelchair 
users and people with other mobility impairments). Currently, AOA is 
working with the Community Transportation Association of America and 
the Federal Transit Administration to develop guidance for AAAs and 
MPOs on considering seniors' mobility needs in the transportation-
planning process. Additionally, a local government official proposed 
that DOT should hold MPOs accountable by ensuring that senior mobility 
needs are considered in their transportation plans. One senior mobility 
expert acknowledged that including more groups in the planning process 
can slow that process down, but she said that it would be worth taking 
additional time if the planning ultimately results in enhanced mobility 
for seniors.

Resources Are Limited, but Strategies Exist to Leverage Them: 

Figure 7: Third Set of Obstacles, Strategies, and Trade-Offs Associated 
with Meeting Transportation-Disadvantaged Seniors' Mobility Needs, as 
Identified by Experts and Stakeholders: 

[See PDF for image] 

[End of figure] 

The conflict between meeting the mobility needs of transportation-
disadvantaged seniors and addressing the financial burden of providing 
services to meet these needs was evident in the literature and 
interviews. Officials and experts reported that funding constraints 
inhibit local agencies' abilities to address transportation-
disadvantaged seniors' needs. Some suggested increasing funding for 
senior transportation programs and improving funding flexibility. 
Others said the government could facilitate the sharing of information 
between providers, sponsor demonstration projects, and improve the 
coordination of transportation services.

Increasing Funding and Using Volunteer Drivers: 

Experts, advocacy groups, and local providers suggested increasing 
funding for public transit and paratransit as well as for 
transportation services specifically designated for seniors, persons 
with disabilities, and rural areas. Additional funding for public 
transit and paratransit could enable the expansion or improvement of 
services to benefit both the general public and seniors who depend on 
those services. Experts and advocacy groups have reported that 
operators of paratransit demand-responsive, curb-to-curb services have 
been adhering more tightly to ADA eligibility criteria in the face of 
financial constraints, leading to a decrease in paratransit services 
for non-ADA-eligible seniors. One DOT official said that very few urban 
transit providers can provide specialized transportation to non-ADA-
eligible seniors because of the high operating costs for ADA-
complementary paratransit. An increase in federal funds would allow 
providers to expand their level of service; however, any funds for such 
programs would likely have to come either from new revenues or from 
other federal programs.

Federal and local officials and advocacy groups have also suggested the 
use of volunteer drivers to expand transportation options for 
transportation-disadvantaged seniors. However, local service providers 
report that finding insurance to cover community-based transportation 
or volunteer driver programs is difficult, and the cost of such 
insurance is rising. Several service providers told us that they had 
difficulty recruiting volunteer drivers because of liability issues, 
such as concern over being responsible for expenses that were beyond 
their personal insurance limits in the event of an accident. One 
provider overcame these liability concerns by obtaining insurance 
coverage through a nonprofit insurance organization that would provide 
liability coverage for volunteers to drive seniors to their medically 
related destinations. Several experts and advocacy groups suggested 
that the federal government could establish insurance pools for 
volunteer drivers or provide other incentives for volunteer programs.

Increasing Funding Flexibility: 

Local officials and advocacy groups have proposed allowing greater 
flexibility in the use of federal funds. According to several experts-
-as well local providers and agencies on aging--federal programs tend 
to specify that their funds can be used only to provide transportation 
to and from that program's services, making it difficult to make 
effective use of transportation resources and coordinate with other 
service providers. Additionally, some federal programs require 
transportation providers to seek two separate sources of funding--one 
for capital and one for operating costs--which can be burdensome, 
especially for small nonprofits, according to one national senior 
advocacy organization. For example, funds from DOT's Capital Assistance 
Program for Elderly Persons and Persons with Disabilities (Section 
5310) generally cannot be used for operating costs, such as driver 
salaries, gas, insurance, and maintenance, and these costs can be 
considerable.[Footnote 62] With operating costs more burdensome than 
they have been in the past (i.e., higher prices for gas and liability 
insurance), a local provider and several advocacy groups have suggested 
allowing DOT's Section 5310 funds to be used for operating 
expenses.[Footnote 63] However, DOT officials cautioned that such a 
change could decrease coordination among local providers because the 
current need to seek operating funds from different sources results in 
increased communication among local agencies. Another trade-off is that 
increasing funding flexibility can decrease accountability because 
there is less assurance that the funds will be used for their intended 
population. However, another way that an official from a national 
transportation association and a local service provider suggested the 
federal government can increase flexibility is by allowing in-kind 
services, such as the use of volunteers, to count as part of the 
required state/local contribution for federal programs. Some federal 
programs, such as the Department of Education's Independent Living 
Services for Older Individuals Who Are Blind program and HHS's Title 
III-B program, currently allow this, while others do not. Several 
advocacy groups and experts also suggested encouraging or allowing 
federal funds to be used for vouchers for informal volunteer driver 
programs or taxicabs. (DOT's Capital Assistance Program for Elderly 
Persons and Persons with Disabilities (Section 5310) and Nonurbanized 
Area Formula Program (Section 5311) funds can be used for vouchers, 
although one expert says they rarely are.) One study found that voucher 
programs were less expensive than the direct provision of 
transportation services. This strategy would also address the obstacle 
about policies that do not address transportation-disadvantaged 
seniors' mobility needs, previously discussed, because seniors could be 
transported in private automobiles rather than in buses or vans.

Sponsoring Demonstration Programs and Identifying Best Practices: 

According to experts, advocacy groups, and local officials, no 
coordinated senior transportation policy exists at the national level, 
so there is no federal funding stream for local demonstration projects, 
no lead agency or resource for information on best practices, and 
limited coordination among federal programs. In response, the experts 
and officials suggested that the federal government sponsor 
demonstration programs, perhaps through the Federal Transit 
Administration, or share information about innovative programs targeted 
to meet seniors' needs and use creative local partnerships. For 
example, AOA officials told us that they have an ongoi