Old Without Wheels
About 600,000 elderly stop driving every year. How can we keep them mobile?
The Symptoms: America's population is growing old fast. In 2000, the U.S. Census Bureau estimated that 40 million Americans were 65 or older, comprising about 12 percent of the total population; by 2030, the Census Bureau projects, that number will swell to 71.4 million, or about 1 in 5 Americans. And as people grow older, they become less eager or able to get behind the wheel of a car: According to the National Institute on Aging, some 600,000 people who are 70 or older cease driving each year, which can leave them cut off from crucial goods, services and social functions. AARP's "successful aging" formula reports that a third of older non-drivers complain of "frequently feeling isolated from other people," whereas only 19 percent of older drivers say the same.
That's partly because an increasing number of Americans are growing old where they have lived their whole lives: in rural areas, small towns and suburbs not serviced by efficient or reliable public transportation. Fewer than half of all American adults live near transit, and a third of Americans older than 75 have a medical condition that significantly affects their ability to travel efficiently. Arranging informal rides from family members or friends can fill some of the transit gaps, but a 2002 survey of adults aged 50 and older found that many are self-conscious about asking for rides. About half said "feelings of dependency" and "concerns about imposing on others" stood as obstacles.
The Disease: A seminal 2004 study from the Surface Transportation Policy Partnership and AARP called "Aging Americans: Stranded Without Options" found that in areas where adequate transit is available, older people tend to use it, making 310 million trips in 2001. But the report also found that half of all non-drivers older than 65 — 3.6 million Americans, in total — remain at home on any given day, in part because they lack transportation. Compared with older drivers, elderly non-drivers in the United States make 15 percent fewer trips to the doctor, 59 percent fewer shopping trips and visits to restaurants and 65 percent fewer trips for social, family and religious activities.
"Today, more than 3.5 million Americans age 65 and older risk isolation simply because they don't drive, and their numbers will explode after 2025 when boomers enter their 60s, 70s and 80s," AARP board member Byron Thames said of the report. "Federal, state and local policymakers must start now to plan for the time when Americans who grew up in cars put down their keys for good."
But in a recent nationwide online poll of 378 metropolitan planning agencies, the New England University Transportation Center and the MIT AgeLab asked whether the metro organizations were ready to meet the needs of the older population. More than half responded that their current transportation services were insufficient, and 68 percent said the needs of baby boomers will force them to radically alter their existing transit systems. Only 11 percent reported that their regions are adequately funding the vehicles, services and other infrastructure that aging baby boomers will require two decades from now.
Initial Treatment: Capital funding for the nonprofit firms, human service agencies and transportation organizations that run many of America's transit programs comes from the federal Elderly and Persons with Disabilities Transportation Program. But all of those different service providers have to be funded independently, with specific regulations governing who they can transport and where they can go. Even small communities can have dozens of different agencies and nonprofits operating sparsely occupied vans. In some cases, regulations actually forbid a van funded to transport the elderly from picking up, for example, the mentally retarded along the way.
The U.S. Department of Transportation also requires a 20 percent local match for federal grants, a level that can be difficult to attain for rural communities whose budgets are already strained.
A Second Opinion: In an effort to streamline funding and eliminate redundancy, President Bush in 2005 signed a law with the jawbreaker acronym SAFETEA-LU: the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users, with funding until 2009. The law requires all communities receiving Federal Transit Administration funds from one of three programs to create a local Coordinated Human Services Transportation Plan. In practice, that means a wide range of participants – from county board members to senior advocacy groups to residents – must agree on which transportation agencies, nonprofits and health providers are responsible for specific transport services. Beginning last year, communities couldn't get money unless they had a coordinated plan.
Meanwhile, financing has been made more flexible. To come up with the 20 percent local match, communities can now use federal funds from sources other than the Department of Transportation, including Medicaid, Medicare and the Older Americans Act. For jurisdictions with populations under 200,000, certain federal funds can also be used for operating costs, rather than just for capital expenses such as new vans.
Follow-up Appointment: The Wisconsin Department of Transportation has emerged as a national model for creating a transit coordination program, bringing together the regional and metropolitan planning commissions of the state's 72 counties. The agency developed a "toolkit" for local planners and a set of worksheets to compare and quantify transportation services and costs, so county boards have hard data in hand when seeking matching funds. Washington, Ohio and Minnesota have also pioneered innovative coordination plans.
But the federal mandate to coordinate transportation services has not proved as easy to satisfy elsewhere. Take, for instance, the droll, grim but brutally honest executive summary of one Southeast Alabama Coordinated Human Services Transportation Plan. It states: "Due to the lack of resources available locally, we found varying degrees of enthusiasm for the coordination process. For many, it was difficult to rationalize a coordination process when no resources or assets existed on the ground to be coordinated."
Toward a Cure: The reasons older people stop driving vary: A recent survey by the Northern Virginia Transportation Commission found that 42 percent of respondents 75 and older hadn't driven in the past week because of general physical problems; 1 in 5 said slow reaction times made them turn in their keys; and another 18 percent reported vision trouble. Although studies have shown that older drivers and pedestrians are not more likely than younger people to get in an accident on a per-capita basis, the elderly are more likely to be in accidents per mile driven and are more vulnerable to injury in an accident.
Increasingly, volunteers have been plugging the gaps in senior mobility, a development that transportation activists generally hail as a key element of overcoming the transit problem. But there's a worrisome aspect to one segment of volunteers: In 2006, the Beverly Foundation in Pasadena, Calif., conducted a survey of volunteer driving programs and found that of 500 drivers in 288 cities, more than half were 65 or older. Still, volunteer driver programs are springing up nationwide, from the Bus Buddy Program in Eugene, Ore., to Making the Ride Happen in Appleton, Wis., and the AARP's 2004 study highly recommended an expansion of volunteer efforts.
"As we look to the transportation horizon, we need dignified, economically sustainable alternatives to the private automobile," says Kathy Freund, president and executive director of the Independent Transportation Network. "Volunteer driver programs are public transportation's parallel reality. I'm thrilled to see this report recommends policy to support them."