Many medical services and procedures that used to require an overnight hospital stay—like heart catheterizations or pacemaker implants—are now done on an outpatient basis in an effort to lower healthcare costs. But this shift has produced a serious problem: How do patients who may be bedridden or wheelchair-bound get transportation to and from the hospital or their doctor's office for either a one-time or routine procedure or service?
“On any given day in this country, there are between 3 and 5 million people who use some type of specialized transportation,” says Dale Marsico, executive director at Community Transportation Association of America (CTAA) in Washington, D.C.
“The number of people is growing by extraordinary numbers, all of whom need transportation on a regular and consistent basis, back and forth for treatment and continuing care,” he says, explaining that the increase is occurring because people are living longer.
When discharged from a hospital or rehabilitation facility, for example, Marisco says patients or caregivers should ask the discharge nurse or social worker about available options for nonemergency transportation. More often than not, these types of facilities have established connections. Ask if the facility has a preferred provider or can make the arrangements for you.
Unfortunately, he says transportation resources, eligibility criteria and fees vary from state to state and also between cities in the same state. For example, Marsico says people living in Cape May, N.J., can access the county's paratransit services for free, regardless of their age or ability, but those living in almost every other city must pre-qualify and pay a fare.
“We sometimes forget that the transportation needs of the American people are more like a quilt than a fabric,” says Marsico. “Every patch of that quilt is going to be different because every community is different.”
WHAT'S AVAILABLE IN MY COMMUNITY?
The best place to start is the local transit company that runs the buses in your community, says Robert Carlson, technical assistance specialist at the CTAA. He explains that every fixed-route bus operator must have a paratransit component for people who are unable to ride the bus.
“Paratransit was created as a means for people who are unable to use a fixed-route bus for transportation,” says Carlson, adding that it was originally developed for people who use wheelchairs, crutches and walkers and are physically unable to walk up the steps of a bus.
The level of assistance varies by location. Some pick you up at your front door while others offer curb service. Although the fee cannot exceed twice the cost of your city's standard bus fare, he says a companion, whether it's a caregiver, relative or friend, can ride with you for free, according to requirements under the Americans With Disabilities Act.
Other resources to consider:
* Call 2-1-1 if the information service is offered in your state. It's a great way to learn about volunteer transportation programs and Medicaid- or Medicare-covered transportation services.
* Ask local taxi companies if they have wheelchair-accessible taxis. Many cities do, such as Seattle, Memphis, Tenn., and Washington, D.C.
* Call Eldercare Locator at 800-677-1116. They will refer you to local transportation resources.
* Contact faith-based organizations such as churches or synagogues that may support volunteer programs or be connected with nonprofits that offer specialized transportation.
* Talk to your local Area Agency on Aging, which can help you find local transportation assistance.
Resources are also available for patients who are bedridden. For example, some ambulance or transfer services are coordinated by volunteer organizations. In Virginia, Carlson says they're called Rescue Squads. In Pennsylvania, volunteer fire companies sometimes provide such services. Call your local fire department to find out what's available in your area.
The CTAA has also been involved in creating reimbursement for stretcher carriers, which are similar to ambulances but don't have medical staff or equipment onboard. They're designed to transport people in nonemergency situations who can only ride on a portable bed. They're now available for Medicaid and some private insurance recipients as well as private pay patients. Unfortunately, the service is not a covered benefit for many Medicare recipients, says Marsico, adding that major cities such as Philadelphia offer stretcher carriers. Local hospitals and ambulance services can provide contact information.
“We ask people to take full responsibility for their health care,” Marsico says. “Think about transportation in the same way. Make sure the people you work with are just as good as [your] doctors.”
And just as reputable, adds Carlson. Do they have a phone number and physical address? Is the taxi driver licensed? Is the business published or advertised? Is the vehicle in good condition? Talk to people in your community about the quality of their services.
“Don't just talk to a driver you see dropping somebody off,” he says. “Look at the vehicle. If it's not in good condition, you might want to reconsider using that service.”
MORE HELP, MORE OPPORTUNITIES
Besides the doctor's office, caregivers frequently transport their loved ones to and from a variety of places in town like the mall, supermarket or restaurants. However, they may not know how to safely move an individual–someone who is wheelchair-bound, for instance—in and out of a car.
“The caregiver may also not have enough dexterity or strength,” says Mary A. Leary, Ph.D., assistant vice president at Easter Seals Transportation Group in Washington, D.C. “Depending upon the injury someone has sustained, the person might have increased agitation. Being aware of ways you can de-escalate that and help someone stay calm is important.”
The organization offers a free guide, Transportation Solutions for Caregivers, available at seniortransportation.net (click on NCST Library). It discusses the challenges faced by caregivers while transporting older adults and shares practical tips and solutions.
Another problem is that not all caregivers can afford to take time off of work to drive a parent or relative to the doctor for an office visit or hospital for tests that may take several hours. Finding transportation in rural areas appears to be the biggest challenge, she says, adding that people should contact the largest, closest hospital, even though it may be miles away, for potential sources. Likewise, if your community doesn't support a public transit system, Leary suggests asking around for information about government-funded volunteer driver programs.
“Providing safe transportation for loved ones who have a mobility challenge is not easy, but there are more and more resources to help,” says Leary. “Keep hope, persevere and chances are, somebody will be able to help.”
Need help getting to your doctor's appointment or supermarket? These organizations can help:
STP Exchange stpexchange.org
Offers information about nationwide supplemental transportation programs for seniors and people with disabilities.
The National Council on Independent Living ncil.org
An advocacy group that directs people to local resources that provide transportation assistance.
Easter Seals Project Action projectaction.easterseals.com
Promotes access to transportation for people with disabilities, answers questions about ADA rights and responsibilities, offers two free newsletters, directs callers to additional resources and more.
Community Transportation Association Information Station 800-527-8279
Offers specialists who can address a variety of transportation topics involving training, seniors, medical, paratransit, rural, tribal, employment, urban and veterans.
The National Center on Transportation seniortransportation.net
Provides information and free resources to help older adults and caregivers become more familiar with transportation options.
© 2012 American Heart Association, Inc.