Lack of transportation is a roadblock to health care
Pat Howard, living with multiple sclerosis for decades, gets around in a powered wheelchair since she can no longer put any weight on her legs. Last summer, her daughter Cindy was driving her 74-year-old mom back from an adult day care facility 30 minutes from her Santa Clarita, California, home when the car overheated and broke down.
“We were stuck,” Cindy recalled in a recent phone call. “I was freaked out about driving the overheated car and worried about our safety. Our only vehicle was now sitting by the side of the road.”
They called for a tow truck, called friends and anyone they could think of for help. Complicating matters, Cindy’s cell phone battery was nearly dead. Eventually, a friend got them to a nearby church, getting them some water and out of the scorching summer heat. Then they had to maneuver the car forward enough to set up a wheelchair ramp to get Pat out of the car.
A while passed because the auto club, AAA, was unable to locate a vehicle that could fit Pat and her wheelchair. Both Pat and Cindy feared they were stuck. “I felt despair,” she recalled. “Luckily I’m a person of faith so I knew something would work out. But you think, what am I gonna do? She can’t get out. Her wheelchair doesn’t fold and fit in a trunk. She needs it to get around.”
Fortunately, the folks at AAA had a unique option. They contacted Butterfli (correct spelling), a new Los Angeles-based tech start-up company, which provides assisted transportation for the elderly and the disabled for non-emergency situations like doctors’ appointments and hospital visits.
Butterfli sent a special wheelchair-enabled van with a medically-trained driver and was able to get Cindy and Pat home safely. Recalling the relief when the incident was over, an exasperated Cindy said “we were literally stuck with no options. . . . what would I have done if
Butterfli wasn’t available?
Debajyoti Ray, Butterfli’s CEO, sees Pat and Cindy as the kind of folks he set up the company to help. “Cindy’s mom is someone no one is thinking about. Unfortunately there are tons of examples like this. There is a huge need here and current solutions don’t provide it. It is a problem people haven’t thought about.”
Ray said he has talked with cities and states and roadside assistance companies all around the world and realized that no one is really properly equipped to handle the para-transit passenger. If you need a tow truck with a wheelchair ramp or a disabled person needs that kind of assistance, there’s almost nothing available, Ray said in a recent interview. Butterfli is trying to fill that need, focusing on non-emergency medical transportation for the disabled and elderly.
Around the U.S., lots of people miss their doctors’ appointments because they don’t have reliable transportation to get to and from the doctor. A 2005 Transportation Research Board study estimated that approximately 3.6 million people annually miss or delay medical treatment because of transportation issues.
Patients without transportation access may wait for a medical emergency just to be able to see a doctor, Shreya Kangovi, a professor of medicine at the University of Pennsylvania told The Atlantic in 2015.
“Mr. Jones might have a disability that makes it difficult for him to use public transportation, so he has been waiting until he’s really sick, short of breath and then calling an ambulance because there is no other good way to get care,” she said.
Low-income neighborhoods are the hardest hit, often dealing with shoddy transportation infrastructure (unreliable buses, subway service that’s not available, or no public transportation whatsoever). Now add in that you are disabled, obese, chronically ill or in a wheelchair and imagine yourself navigating the bus, subway or even ride-sharing services.
There aren’t any hard numbers on how bad the problem is. But some statistics illustrate the problem.
• A 2001 study in the journal Health & Social Care in the Community found that a third of the more than 400 adults living at or near the poverty line in Cleveland, Ohio, reported it was “hard” or “very hard” to find transportation to their doctors.
• A 1997 study of cancer patients in Texas, published in the journal Cancer Practice, found that some patients had to forgo their cancer treatments due to transportation problems. It also found much higher rates of that for African American and Hispanics surveyed.
• A 2012 survey of low-income patients in a New York City suburb who rode the bus to the doctor’s office were twice as likely to miss appointments as patients who drove cars and they also often missed filing prescriptions.
Missed appointments inevitably lead to other health problems, especially for folks with chronic diseases like diabetes, hypertension, arthritis, asthma, cancer, COPD (Chronic Obstructive Pulmonary Disease), cystic fibrosis or Alzheimer’s and other dementias that require
ongoing active care. While medical facilities can provide the greatest care in the world, it doesn’t matter if the patient can’t get to it or get home after getting the care.
This problem is about to get exponentially larger. There are 46 million people over the age of 65 right now. That number will grow to 55 million by 2020, 83.5 million by 2050 and 98.2 million by 2060, according to the U.S. Census.
Right now, there are some 49.5 million people in the United States that have a disability. Of those, 3.5 million are so disabled they never leave their homes and 23 percent, or 11.4 million seniors currently need some sort of specialized assistance or equipment to travel outside their home, anything from walkers, canes, crutches, another person, or a wheelchair or electric scooter.
Whether they have transportation options depends largely on where they live in the U.S. That study found 11.5 million seniors in 241 metro areas with populations of 65,000 or more had “poor” transportation access (to buses, subways, ride-sharing and public transit) and a University of Montana study found that 40 percent of all rural residents live in 1,200 counties in the U.S. that offer no public transportation services whatsoever.
Finding a solution
Each state has a “non-emergency medical transport” benefit for people with Medicaid, covering a number of rides per month. While Medicare does not cover any kind of ride-sharing or non-emergency medical rides, some Medicare Advantage plans cover a limited number of trips each year depending on what each state allows.
Several states, cities and communities have contracted with local companies to provide rides and others work with volunteers or hire taxis. Many, in a variety of forms, are offering ride-sharing services to their communities. The Independent Transportation Network in Maine uses a combination of paid and volunteer drivers, providing more than a half-million rides serving 27 local communities.
Other cities with similar ride-sharing services include San Francisco, San Diego, Los Angeles, Houston, Washington D.C., Miami, and New York City. There are also state-run efforts in Maryland, South Dakota, Michigan, Nevada and Hawaii. Many of these are subsidized by the community, the state, or completely free to consumers. Others offer services at reduced rates from normal transportation costs. A handful of these have figured out a way to use insurance to cover the costs.
Also getting on board are the big ride-sharing companies, Uber and Lyft, which have partnerships in several cities. The big difference tends to be that the consumer has to pay directly for the Uber and Lyft rides using a credit card, either through an operator or with a smartphone app.
Some hospitals are also getting into the business of getting their patients back and forth to medical appointments. While these efforts are in their early stages, both hospitals and medical transportation providers think there is a big potential for growth in this. In Washington D.C. and the Maryland suburbs, MedStar Health, the nonprofit hospital and health care system, has partnered with Uber, which the patient arranges through the hospital’s website.
National MedTrans Network provides rides for people in managed care plans. They also work with government and social service organizations in partnership with Lyft in several states including New York, Nevada and California.
Additional resources might be available to seniors through local faith-based groups. The Beverly Foundation (www.beverlyfoundationlegacy.org) has funded a series of transportation resources including a volunteer drivers program and you can also find useful information at the federal government’s Elder Care Locator, http://www.eldercare.gov.
Medicare recently gave insurance companies, hospitals and doctors an added incentive to fix this problem, when it issued its long-awaited but far-reaching overhaul of how it compensates doctors and other clinicians. The goal is to reward quality, cost-effective care instead of just paying piecemeal for services.
Another solution is being tried around the country: health care providers are employing community health workers, who help patients navigate the health care system by helping people make appointments and help motivate older folks to take their medications and implement positive lifestyle habits. In 2014, there were an estimated 50,000 community health workers, according to the Bureau of Labor Statistics.
Also contributing to this story were The Atlantic, AARP and Twin Cities Public TV.