This article is part of a yearlong occasional series on late-in-life health care — when chronic illness or a constellation of medical problems can cause a cascade of new needs, complications and worries.
Several years ago, Bob Halko began cutting back on his driving. He stayed off the freeways, avoided rush-hour traffic and stopped driving at night. Then he found he could no longer drive, and that public transportation couldn’t move him efficiently from his home in Inver Grove Heights to the places he wanted or needed to go. His four daughters, each living in widely scattered Twin Cities suburbs, stepped up, shuttling him to and from medical appointments in St. Louis Park, to the pharmacy and on shopping errands.
“Between us, we made it work,” says daughter Trish Halko. “We drove him all over the place.”
Their support enabled Bob to remain in his home until he died, at age 81. Eventually, the experience led Trish to help organize, and now to chair, a local affiliate of a national nonprofit here, ITNTwinCities, which will transport the growing ranks of nondriving seniors living mostly in Hennepin County’s northwest suburbs starting this fall.
Learning about the challenges of providing transportation for older seniors was an eye-opener for Trish Halko, and a telling sign of what lies ahead for many more households here. In 2010, 143,325 people 75 and older lived in the seven-county metro area. By 2020, the Metropolitan Council projects that the region’s over-75 population will surge to 189,878 in 2020, and by 2030 to 310,824. Aging baby boomers and longer life expectancies are fueling the trend. (The life expectancy for Minnesotans at birth is 79.3 years, the highest for any state other than Hawaii.)
Nationally, one of every five adults over 65 doesn’t drive, and each year more than 600,000 people 70 and older stop driving — and then must depend on others to meet their transportation needs. It is a wrenching change, says Connie Shaffer, who heads Minnesota’s largest private driver testing center (see accompanying story at right side of page). When a person loses the ability to drive, Shaffer says, “it’s almost like losing electricity in your house. It affects everything you do in some fashion.”
At a White House Conference on Aging a few years ago, delegates named availability of transportation as the No. 3 concern for seniors among 50 policy priorities, trailing only concerns about Medicare and Medicaid.
Most of all, later-in-life seniors need to get and from medical appointments and run errands. ITN, which has 27 affiliates in 21 states, makes 46 percent of its trips to clinics and other medical destinations and 24 percent for shopping. The rest are mostly for recreational and cultural purposes and religious services. That’s a fairly typical pattern.
Today, even before the aging demographics kick in big-time, the needs of seniors who don’t drive for transportation exceed the availability of this service. Precise estimates of the gap between the demand and the availability of services are impossible to pin down, says Courtney L.B. Whited, mobility management program director at DARTS, a longtime nonprofit provider of transportation for seniors in Dakota County.
“No matter how much service we provided, it was never enough,” says Dick Graham, who founded DARTS in 1974 and led it until retiring in 2005.
Critical to living independently
One major concern: Transportation is typically a critical element in enabling older people to continue living independently in their own homes. If they can’t get out and about, they often have no choice but to move into more pricey institutional settings. The more the population in these environments, the greater the expense to families and to society. Again and again, providers stress that it does little good to provide seniors with all kinds of services — everything from high-grade medical treatment to bargain-rate university courses — if they can’t get to and from where the services are offered.
To compound the challenge, the Twin Cities area — unlike many other large urban regions where growth has been impeded by mountains, lakes or oceans — has contracted a serious case of urban sprawl. Comparing the population density of metro areas is complicated, but one recent ranking by the USA.com site showed that the region has the second lowest population density of the nation’s 25 largest metropolitan areas. The lower the density, the longer the distances people must travel to get to their destinations.
Finding transportation services for the aging in the region and learning how best to use them can be a challenge. The Metropolitan Council has directed a $440,000 New Freedom Fund grant — 80 percent of it from the federal government and the rest from Dakota County and the St. Paul Foundation — to DARTS to create an updated resource guide for users and their families. Whited says the end result will be an all-purpose website covering services available in Dakota County. The site is being designed as a model for building similar guides in other metro counties.
Families play a big role
“Families are the biggest providers” of rides for seniors, says Jean Wood, executive director of the Minnesota Board on Aging. Bob Anderson, associate director at the Metropolitan Area Agency on Aging, adds that many people would be surprised by the time families and friends spend helping elderly people get out and about. “They’re just so unsung,” he says. “Transportation is so important to keep people from becoming socially isolated.”
Government agencies, nonprofits and for-profit companies are also important players. The nonprofits typically got into the field purely by happenstance. In the process of offering other services to the elderly, they discovered a critical need for transportation.
Marion McCarthy, who lives in the Episcopal Homes development at Fairview and University Avenues in St. Paul, relies on the region’s largest single transporter of older seniors, the Met Council’s Metro Mobility service. McCarthy, 87, has nine children, scattered from Seattle and New York to Japan. She lived in the Detroit area for 84 years, but in 2011, after her son there moved to California, her children persuaded her to resettle in the Twin Cities to be close to another son who lives with his family in St. Paul’s Highland Park neighborhood. McCarthy stopped driving in April of 2013. She has used Metro Mobility’s vans routinely, to get to downtown St. Paul for medical appointments, to Lumen Christi Catholic Church in Highland Park, to lifelong learning courses, to cultural amenities and to play bridge.
Metro Mobility cannot be all things to all riders. McCarthy says doing a series of errands is almost impossible. She must schedule a ride at least 24 hours in advance if she needs one. And the round-about pickup routes mean it can take up to an hour to get to a relatively nearby destination. But overall, she’s highly satisfied. Fares are only $4 in rush hours, $3 an hour at other times. The vans are clean, the drivers respectful and helpful. “They walk you to the door. That’s very reassuring. I think it’s a wonderful service.”
Serving outlying areas: not so easy
Elderly citizens living on the fringes of the urban area aren’t so fortunate. The service doesn’t reach seniors in outlying parts of the seven-county area.
Metro Mobility, which operates seven days a week, expects roughly 1.9 million door-to-door rides and 17,000 riders this year. The ride count is up from 1.3 million in 2006. Riders must be certified, under provisions of the Americans With Disabilities Act, as unable to use regular fixed-route bus service because of a disability or health condition. About half of its active riders are 65 or older.
Metro Mobility contracts its service out to five providers. Two for-profit companies handle the lion’s share of the business: Transit Team, which serves much of Hennepin County including part of Minneapolis (55 percent) and First Transit, which covers the rest of Minneapolis and East Metro including St. Paul (30 percent). DARTS handles much of Dakota County (10 percent).
The Met Council also operates the five-day-a-week Transit Link, a dial-a-ride small bus service that offers curb-to-curb service to the general public in parts of the metro area where regular route transit service is not available. Last year, Transit Link provided about 369,000 rides, including many for seniors. Transit Link’s buses shuttle riders to fixed-route Metro Transit bus lines and to specific destinations such as workplaces and clinics. Travelers accounting for about 6 percent of these trips transferred to/from fixed Metro Transit routes or other Transit Link service routes.
In the winter, people who live within a quarter-mile of a fixed bus route can’t use Transit Link buses; in the summer, this restriction extends to half a mile. Meeting demand in the outer reaches of the region can be a challenge, because more scattered riders make it harder to schedule pickups efficiently in these areas. Also, the Met Council recommends that users reserve rides in advance; while nearly all requests are met, slots can fill up. Fares range from $2.25 to $6.75, depending on the distance traveled. Transit Link’s growth has lagged far behind Metro Mobility’s. Transit Link officials says that’s largely because many potential riders are not yet aware of the service, formed in 2010 through a reorganization of a patchwork of existing services.
Nonprofits trying differing approaches
Many nonprofits, including churches, run bus or van services for seniors. Some have gone out of business. Others have come in, testing fresh business models. Here’s a sampling of what’s happening on the nonprofit front:
- DARTS is the largest nonprofit provider. Based in West St. Paul, its fleet of 60 vehicles, mostly buses, provided 225,000 rides last year. In addition to its role with Metro Mobility, it operates a dial-a-ride service in Dakota and Ramsey Counties and handles the Transit Link service in Dakota County.
- Jewish Family and Children’s Service of Minneapolis has sustained a small service for 20 years. The center taps three staff drivers and 24 volunteers who use their own cars to provide about 6,000 rides a year to 150 clients. The program is informally known as “Deikel Transportation,” after key funder Ted Deikel. “For most people, this is the only way they can get where they want to go,” says Annette Sandler, aging and disability services director. “It’s a very individualized service.”
- WeCAB (Western Communities Area Busing) launched late in 2011. It serves half a dozen western suburbs and is planning to expand soon to Carver County. Today, it has 29 drivers and 278 riders. The drivers use their own cars. Riders are asked to pay a $5 fare. “Getting drivers is the most challenging part of this,” says director LuAnn Fransen, “but once they get into it, they really enjoy it.”
- ITNTwinCities will start small with 10 volunteers driving their own cars and a goal of 6,000 rides for 320 passengers by the third year. Annual memberships will be sold to riders for up to $75 a year. The service will use sophisticated software that catalogs information on specific drivers and their cars and the needs of specific passengers — data on folding walkers, for example, and whether the drivers are willing to take a dog to the vet — then matches the drivers with the riders. The organization is seeking to raise money from private donors, but is not going after public subsidies. “There just won’t be enough public funds to go around,” says Debra Burton, executive director.
- Store to Door, an enduring grocery shopping and delivery nonprofit based in Roseville, was founded 30 years ago by a former Wilder Foundation researcher. Its special wrinkle: helping seniors to stay in their own homes by taking their grocery orders, going out to buy the items and then delivering them for a modest charge. The service, which has grown to 10 delivery vans, 400 volunteers and 1,800 beneficiaries, partners with Cub Foods. It serves the seven-county area. The clients are primarily women over 80, living independently with chronic health conditions. “They just can’t get to the store by themselves, walk around it and get their groceries back home on their own,” says Mary Jo Schifsky, executive director.
Providers shut down
Expenses for providing the rides and fund-raising difficulties have led some nonprofit services to shut down.
One of the largest dropouts was the St. Paul affiliate of the American Red Cross, which ended its popular driver service after it merged with the Minneapolis Red Cross unit to form a Twin Cities-wide organization in 2006. “That was a big hurt,” says Courtney Whited.
Another significant loss came last year, when Golden Valley-based PRISM (People Responding in Social Ministry) shut down its PRISM Express program. This service had provided more than 70,000 rides a year to seniors in seven northwest suburbs. The shutdown quickly prompted another closing at Five Cities Transportation, a smaller provider nearby that had been using buses supplied by PRISM. Whited, who used to be at PRISM, compiled a directory in 2011 that identified 40 such services in Hennepin, Ramsey and Wright County. Today, she says up to a third of them are no longer in business.
Many of the transportation-for-seniors efforts trace their roots back to federal legislation decades ago. DARTS was formed in the wake of the Older Americans Act, passed in 1965, which provided funds for new services for seniors. The Metropolitan Council got engaged in the 1970s with its Project Mobility initiative, which evolved into Metro Mobility. In 1990, the federal disabilities act led public transit agencies to get involved in a big way. But today, finding the money for transporting seniors has gotten harder even as the demand for these services keeps rising.
A look at the heavily subsidized funding for Transit Link illustrates the challenge. Riders’ fares accounted for only 12 percent of the $7.3 million in 2013 funding for the service. The rest of the money came from federal, state and local governments, with the state as the principal funder.
Metro Mobility’s annual budget has nearly doubled to $60 million since 2006. In 2013, fares accounted for only $6.5 million or just 13 percent of overall service costs of $50.5 million.
“Providing these specialized services is a very complicated and very expensive proposition,” says Natalio Diaz, who retired in 2005 from a longtime post as the Met Council’s director of transportation planning. As people age, they become disabled and the council’s financial base “is not growing fast enough to keep up with the demographics.”
Adds Jean Wood: “The challenge for us is a point-to-point ride, and that’s an expensive form of transportation.”
Meredith Vadis, communications director for the Metro Council, says the council agrees that demand for specialized transportation for the aging will grow. She adds, “We also know that providing the anticipated growth in Metro Mobility service will require financial resources beyond our current funding sources. Gov. Dayton and the council support increased transportation funding for both roads and transit.”
But as great as the challenge is, the Twin Cities area has an ace in the hole: an unusually engaged public. The U.S. Census Bureau reported that In 2010-’12, volunteer rates in the Minneapolis-St. Paul area ranged from 36 percent and 41 percent for persons over 46 years old — the highest for any of the nation’s 25 largest metro areas.
Thus many people stand ready to pitch in and help, as Trish Halko is doing. Perhaps that’s the region’s secret sauce for dealing with this rising concern.
This series is funded through a regrant by Allina Health from the Robina Foundation. It is conducted in conjunction with media partners Ampers and Twin Cities Public Television (tpt), whose documentaries (click on “Archive” on the linked web page) on late-in-life care are focusing on Minnesotans enrolled in a multiyear Allina study involving patients at this time of life.