Supporting People as They Age in Community: Transportation
THIS SERIES OF ARTICLES EXPLORES HOW RHODE ISLAND CAN SUPPORT PEOPLE AGING IN COMMUNITY THROUGH HOUSING, TRANSPORTATION, SENIOR CENTERS, AND ACCESS TO INFORMATION.
Rhode Island’s population is among the oldest in the country, and the number of older adults in the state continues to grow rapidly. By 2040, people over age 65 will make up a quarter of the state’s population, up from 14% in 2010. The vast majority of these older adults will age in the community, rather than nursing homes or other forms of institutional care. For many people, aging in community is preferred because it offers greater independence, lower costs, and more opportunities for social interaction and community engagement. However, some older people struggle financially, physically, and emotionally to stay in homes or communities that are not designed to accommodate their changing needs. Robust programs, policies, and supports are needed in order for aging in the community to truly benefit seniors, their caretakers, and the state as a whole.
Access to transportation is essential for older people who want to live independently in the community and enjoy a high quality of life.
Transportation allows them to get to doctors’ appointments, go grocery shopping, participate in community events, and stay connected to family and friends. By providing access to medical care, social services, and fresh food, transportation helps keep seniors healthy. It also facilitates social connections and community engagement, which have been shown to promote both physical and mental well-being among older people.(a)
a) Remaining connected to and contributing to family and community has a positive impact on health and well-being later in life. Studies show social relationships can have as much impact on physical health as blood pressure, smoking, physical activity, and obesity.1 Volunteering is associated with better health, fewer functional limitations, reduced use of healthcare services, and decreased mortality risk.2
The independence of being able to go where one wants, when one wants often slips away as people age. Physical and mental impairments can make it harder for older people to drive, walk, or use public transit like they used to. Two-thirds of Rhode Island’s older adults have four or more chronic diseases and more than one in five have difficulty walking.3 These health issues can make it challenging or impossible for people to drive themselves, walk, or access existing public transportation options.
The inability to drive or otherwise get around is among older adults’ top fears about what may keep them from being able to live independently in their own homes.4 While some older people rely on rides from family, friends, car services, or special public transit programs for the elderly, others are forced to choose between being isolated in their homes or moving into nursing homes or assisted living facilities where transportation is provided or is no longer a concern because all amenities are available on site.
Rhode Island’s older population is projected to increase 75% over the next 30 years.5 Expanding transportation options for these seniors is an essential part of making it possible for them to age in community and lead healthy, independent lives.
Fig. 1 Transportation is an Important Concern for Older Adults
Source: Prince Market Research (2007).4
Transportation for Older Adults in Rhode Island
Private car is the predominant mode of travel for older people. Nationally, people ages 65 to 84 make an estimated 90% of all their trips by car, most often serving as the driver themselves. Those over age 85 take 80% of their trips by car, but only drive themselves half the time.6 In many cases, the ability to drive a car on one’s own ends before the final years of life. Research from the 1990s suggests that, after age 70, women spend an average of ten years unable to drive and men spend seven years without driving.7 A more recent report from the AARP found that one in five adults over age 65 does not drive.8
Those who are unable to drive themselves may rely on family, friends, or private taxi services. In Rhode Island, federal grants were used to defray the cost of 13 wheelchair-accessible taxis purchased by local taxi companies. These vehicles serve 17 of the state’s 39 communities and TF Green Airport, and charge standard taxi fares.
Fig. 2 Modes of Travel Used by Older Adults
Source: Rosenbloom (2009).6
The second most common mode of travel for older people is walking, which accounts for 9% of all trips by people over age 65.6 However, walking can become more challenging as people age. A national study found that 14% of people age 65 to 74 and 28% of people over age 75 had difficulty walking a quarter of a mile.9
Even if older people are physically able to walk, it may not be an option if they live in an area without good walkability features, such as sidewalks and well-designed pedestrian crossings. According to Walk Score, a ranking of the walkability and transit-friendliness of different geographic areas, only two of Rhode Island’s largest cities, Providence and Central Falls, are highly walkable.10 Four of the ten most populated cities – representing about a quarter of the state’s older population – are car dependent, meaning most errands and activities require a car.
Fig. 3 Walkability and Transit-Friendliness of Rhode Island’s Largest Cities
Source: Walk Score (2016),10 U.S. Census (2010).11
Nationally, public transit is the mode of travel least often used by older adults, comprising just 1% of their trips.6 A survey of Rhode Island Public Transportation Authority (RIPTA) riders found that just 6% were over age 65.12 According to Walk Score, none of Rhode Island’s cities are very transit friendly.10 Providence scores the highest with a 48 out of 100, just shy of the cutoff of 50 and above defined as having “good” transit.
RIPTA operates 55 fixed bus routes and 10 Flex Service routes in the state. One-way fares for both types of routes are $2.00, with multi-day and monthly passes available. Seniors and people with disabilities are eligible for reduced price fares. All fixed-route buses are equipped with wheelchair lifts or ramps, and Flex Service vehicles can also accommodate wheelchairs.
The routes RIPTA offers are predominantly designed to serve commuters, bringing them into Providence from the suburbs. To get around their own town by bus, non-commuters are often forced to take a circuitous trip into Providence on one line and back to their hometown on another. For example, North Kingstown residents, including many living in senior housing, can only reach a local Walmart that is less than three miles away by taking a half-hour bus trip into downtown Providence and then transferring to a different commuter line that stops at Walmart.
RIPTA’s Flex Service is designed to address some of this gap by serving suburban and rural areas that have limited fixed-route bus service. From Monday to Friday, passengers can call for a ride or pick up a Flex Vehicle at one of its regularly scheduled stops. They can take the vehicle within a certain geographically defined Flex Zone or use it to connect with a fixed-route bus service that travels outside the zone. Interviews with RIPTA officials suggest that the Flex Service is not widely used by older people and that many of the most popular routes serve colleges like URI, CCRI, and RIC.13
Text Box 1. Free and Reduced RIPTA Fares for Seniors and People with Disabilities
In addition to its regular public transit service described above, RIPTA operates the state’s Americans with Disabilities (ADA) paratransit program. The ADA program provides people with disabilities with van service pickup and drop-off within three-quarters of a mile of a fixed bus route. The cost is $4 per one-way trip, and between 1,800 and 2,000 trips per day are provided under Rhode Island’s ADA program.15
The Elderly Transportation Program (ETP)
The Rhode Island Department of Human Services administers the Elderly Transportation Program (ETP), which is managed under a contract with LogistiCare. The ETP provides trips to medical appointments, adult day care programs, congregate meal sites, and the In-Sight program for visually impaired seniors. The price is $2.00 per one-way trip, although not all drivers consistently collect the fee and the fee is not charged for trips to adult day care programs.
Data from LogistiCare show that the number of people over age 60 using the program increased from 1,319 riders in July 2014 to an average of 1,810 riders a month in 2016. Seventy-eight percent of ETP riders are age 70 and over and 32% are age 85 and over. The average rider uses the ETP service around eight times a month.16 In 2016, 30% of the trips were for dialysis treatments, 24% to adult day care programs, and 12% to meal sites.17
The ETP is subject to available funding and is not an entitlement. Due to funding and policy constraints, the program is limited in its ability to meet all the transit needs of the state’s older population. It does not provide rides for activities such as shopping, personal errands, or social and civic events, which are important to the well-being of people aging in community.
Fig. 4 Average Monthly Riders of the Elderly Transportation Program (ETP), by Age (2016)
Source: LogistiCare (2017).18
Medicaid Non-Emergency Medical Transportation (NEMT)
The NEMT program provides transportation for Medicaid enrollees to healthcare appointments that are difficult to access. Patients able to walk a half mile and understand common directions and signage are expected to use regular bus routes if their home and the medical provider are both within half a mile of a bus stop. Otherwise, they can book a ride with NEMT from Monday through Friday by scheduling 48 hours in advance. Like ETP, NEMT is provided under a state contract with LogistiCare. In 2016, an average of 3,391 riders over age 60 used the NEMT service each month.
Fig. 5 Average Monthly Riders of the Non-Emergency Medical Transportation (NEMT), by Age (2016)
Source: LogistiCare (2017).18
Municipal and Volunteer Transportation Programs
A number of Rhode Island municipalities offer their own transportation assistance to seniors and people with disabilities.19 These local programs vary greatly in the types of trips provided, frequency of operations, vehicle capacity, and passenger fees. Most only provide service within the local area. Providence, which has the largest elderly population in the state and the highest poverty rate among older adults, does not provide any city-supported transportation services for seniors. There are also several community-based transportation programs across the state that rely on volunteer drivers. However, their resources are limited and cannot meet all the transportation needs of older adults.
Funding & Management of Senior Transportation Programs
In Rhode Island, one cent per gallon of state gas tax revenue is dedicated to transportation for the elderly and disabled.(b) In fiscal year 2017, this amounted to an estimated $4,430,000. Of this total, 79% ($3,500,000) went to RIPTA to partially subsidize reduced fares for the elderly and disabled, the ADA paratransit program, and paratransit vehicle purchases and maintenance. The remaining 21% ($930,000) was dispersed to the Department of Human Services to partially fund the Elderly Transportation Program (ETP).20 The rest of the funding for Rhode Island’s transportation programs for the elderly comes from the state’s general revenue, federal Medicaid matching funds (for medical trips for Medicaid clients), and federal grants like the Social Services Title XX block grant.
In May 2014, the ETP and NEMT programs transitioned from being operated by RIPTA to being contracted out to the private company LogistiCare (RIPTA continues to operate the ADA paratransit program). LogistiCare uses a variety of local providers to provide transportation, including taxis, vans, and ambulance companies. The company receives $32.30 per rider per month for Medicaid clients and $200,000 a month for all elderly non-Medicaid clients.17
The transition from RIPTA being the primary ETP and NEMT transportation provider, using its fleet of wheelchair accessible vans, to LogistiCare offering transportation from a variety of vendors and vehicles got off to a rocky start, and some problems continue. Complaints have included a lack of signage noting that vehicles are LogistiCare providers, late and no-show rides, an insufficient number of transportation providers, a lack of sensitivity for dealing with elderly and disabled riders, and confusion about eligibility criteria.21
In response to these concerns, the Alliance for Better Long Term Care instituted monthly open meetings with LogistiCare management and state oversight staff at which issues could be raised by the public and care providers. The Alliance also conducted a number of trainings for LogistiCare drivers to increase their understanding of rider needs. LogistiCare reports that, over time, the ratio of complaints to number of trips has decreased and the provider network has expanded. Their fleet grew from 22 providers in May 2014 to 80 providers by January 2016.
LogistiCare recently instituted a more extensive customer satisfaction survey, including post-trip calls to riders. In March 2017, a survey of 460 elderly customers found an overall satisfaction rate of 92%. However, consumers continue to report problems with LogistiCare services throughout the state. According to data provided to the Long Term Care Coordinating Council, there was an average of 75 complaints per month about the ETP program from January to May 2017, nearly twice as many as there were about NEMT. The most common complaint for both programs was about drivers being late.
b) RIPTA’s normal operations are funded primarily by the state gas tax, along with farebox revenue and federal funds.
Text Box 2. Innovative Models for Increasing Transportation Access
The Future of Transportation for Older Rhode Islanders
Rhode Island does not have a coordinated approach to analyzing current transportation patterns among older adults and projecting demand for the future. There is no comprehensive, ongoing data collection about the use of various public, private, and volunteer transportation services, the cost of these services, and the geographic areas of greatest need.
The federal government requires that a local human services coordinated transportation plan be developed every five years. The last such plan for Rhode Island was issued in 2013.22 This spring RIPTA began developing the next Coordinated Human Services Transportation Plan. To seek public input on the plan, RIPTA has scheduled open meetings in four communities across the state and invited community members to serve on an advisory group.
As RIPTA anticipated embarking on an update to the state’s plan, there was some discussion in the General Assembly about leveraging the opportunity to use federal funds to conduct an Elder Mobility Study and incorporate its findings into the plan.(c) An Elder Mobility Study would examine the transportation needs of the state’s older population, identify best practices for more responsive senior transit, estimate the resources needed to help meet projected future demand, and design a coordinated transportation data system. Similar studies and projections at the national level, such as those conducted by the American Public Transportation Association, could serve as a model for Rhode Island.23
c) A resolution requesting that an Elder Mobility Study be conducted as part of updating the state's Coordinated Human Services Transportation Plan was introduced and heard but did not pass.
The state can also factor the needs of the elderly population into broader transportation planning as it continues its implementation of Safe and Complete Streets policies. Under legislative directive, the Rhode Island Department of Transportation has completed a number of “complete streets” projects to ensure neighborhoods are walkable, bikeable, and transit-friendly.24 These projects and other smart-growth policies foster neighborhoods conducive for older people to age in community. Older adults who continue to walk benefit from traffic lights that provide adequate time for street crossing and sidewalks that are well maintained and clear of debris. Those who use public transit benefit from buses and routes that are accessible, with safe, weather-protected bus shelters.
There are a number of additional opportunities the state might consider for improving transportation options for its older population. It could leverage private services by offering small grants to support the expansion of volunteer transportation programs or piloting a cost-sharing program with taxi companies or ride-sharing services such as Uber and Lyft. To ensure older adults have access to existing options, the state could create a transportation locator website that assists people in finding and accessing available services.
There are also areas where existing services could be enhanced. Rhode Island might consider ways to improve the NEMT and ETP services offered by LogistiCare, for example by requiring an independent consultant to evaluate consumer satisfaction with LogistiCare’s performance and to manage the complaint process. The state recently issued an RFI to seek ideas for strengthening and enhancing the NEMT and ETP programs.
Technology can also be leveraged to help address older adults’ transportation needs. Smartphone apps make it easier to find public transit options, plan a walking route, or order a private car. Online shopping, meal delivery services, internet banking, and e-library services all reduce the need for personal travel. The increased use of “telehealth” medical services may eliminate the need for some medical appointments, and self-driving cars may be a reality within a decade. Accessibility is a key issue, however, since many older people have neither the devices to access such services nor the knowledge of how to use them.
With the projected increase in the state’s older population in the coming years, particularly those over age 75, the need for transportation alternatives for seniors will only grow. Additional public and private resources are likely to be needed to meet the demand and innovative programs should be explored and piloted starting now.
In 2014, Rhode Island’s state legislature passed the Aging in Community Act, which created an Aging in Community Subcommittee of the Long Term Care Coordinating Council tasked with studying the programs and services needed to support the state's growing older population. This policy brief is one in a series sharing findings from the subcommittee’s final report, the result of eighteen months of research by a team of experts. The report assessed the current level of community livability and “age-friendliness” in Rhode Island, inventoried available services and resources, identified best practices, and proposed recommendations for building age-friendly communities. This brief shares the report’s findings on transportation.
1. House, J. S., K.R. Landis, and D. Umberson (1988) “Social Relationships and Health,” Science, 241(4865): 540-545.
2. Scharlach, Andrew, and Amanda Lehning (2015) Creating aging-friendly communities, New York, N.Y.: Oxford University Press.
3. Dugan E., F. Porell, and N.M. Silverstein (2016) Rhode Island 2016 Healthy Aging Data Report, Watertown, MA: Tufts Health Plan Foundation. U.S. Census Bureau (2015) “C18105: Sex by Age by Ambulatory Difficulty,” American FactFinder.
4. Prince Market Research (2007) Clarity: Aging in Place in America 2007, Nashville, T.N.
5. Rhode Island Statewide Planning Program (2013) Rhode Island Population Projections 2010-2040, Providence, R.I.
6. Rosenbloom, Sandra (2009) “Meeting Transportation Needs in An Aging-Friendly Community,” Generations, 33(2): 33-43.
7. Foley, Daniel J., Harley K. Heimovitz, Jack M. Guralnik, and Dwight B. Brock (2002) “Driving Life Expectancy of Persons Aged 70 Years and Older in the United States,” American Journal of Public Health, 92(8): 1284-1289.
8. Lynott, Jana, and Carlos Figueiredo (2011) How the Travel Patterns of Older Adults Are Changing: Highlights from the 2009 National Household Travel Survey, Washington, D.C.: AARP Public Policy Institute.
9. National Center for Health Statistics (2014) “Summary Health Statistics: National Health Interview Survey, 2014: Table A-10a,” Atlanta, GA: Centers for Disease Control and Prevention.
10. Walk Score (2016) “Cities in Rhode Island [data table],” Retrieved December 2.
11. U.S. Census Bureau (2010) “DP-1: Profile of General Population and Housing Characteristics: 2010,” American FactFinder.
12. Pettine, Amy, Executive Director of Planning, RIPTA (2017) Email message to author, May 16.
13. Pettine, Amy, Executive Director of Planning, RIPTA (2017) Interview with author, May 15.
14. Polichetti, Barbara, Director of Public Affairs, RIPTA (2016) Email message to author, December 6.
15. Rhode Island Public Transit Authority (2016) Presentation to the Long Term Care Coordinating Council, October 19.
16. Sousa, George, General Manager, LogistiCare Solutions (2016) Email message to author, December 5.
17. Rhode Island Executive Office of Health and Human Services (2017) Presentation to the Senate Finance and Human Services Committees, February 14.
18. Donatiu, Edmundo, LogistiCare General Manager (2017) Email message to author, June 20.
19. A list of municipal and volunteer programs is available in: Aging in Community Subcommittee (2016) Aging in Community: Final Report, Providence, R.I.: Long Term Care Coordinating Council.
20. Etchingham, Robin, Assistant Administrator, Rhode Island Department of Human Services (2016) Email to author, February 8.
21. Complaints and concerns about LogistiCare have been discussed extensively at the monthly meetings of the Long Term Care Coordinating Council. The minutes of these meetings are available on the Rhode Island Secretary of State’s website.
22. RIPTA (2013) A Coordinated Plan for Public Transit and Human Services Transportation in Rhode Island, Providence, R.I.
23. Koffman, David, Richard Weiner, Amy Pfeiffer, and Scott Chapman (2010) Funding the Transportation Needs of an Aging Population, Washington, D.C.: American Public Transportation Association.
24. Rhode Island Department of Transportation (2015) Rhode Island’s Complete Streets Action Plan, Providence, R.I.
Type of Research
- Responds to questions of Policy Leaders with research projects that closely align with state priorities
- Provides implications for challenging state issues