Social Mobility for Seniors

New York State Office for the Aging

Greg Olsen, Deputy DirectorDivision of Policy, Research and Legislative Affairs

New York State Public Transit Industry Fall ConferenceNovember 20, 2009

Holiday Inn, Albany NY

Forging Strong Transit Partnerships

The core mission of the New York State Office for the Aging is to help older New Yorkers to be as independent as possible for as long as possible through advocacy, the development and delivery of person-centered, consumer-oriented, and cost-effective policies, programs and services which support and empower older New Yorkers and their families, in partnership with the network of public and private organizations which serve them.

Medicaid spend-down and nursing home diversion programs

Cost effective community-based services

Local network of providers

59 AAA’s – thousands of subcontractors

NYSOFA Mission

Demographic Changes

• By 2015, 54 New York counties will have at least 20% or more of population aged 60 or older

• People express an overwhelming desire to want to remain in their own homes and

communities, but may not be able to if needs and preferences can’t be met

• Baby Boomers have expectations that things will be different for them as they age.

• There are significant economic benefits for New York if our communities are places where people can grow old and continue to engage financially, civically, and socially.

Empire State Development

Age-Specific Net MigrationNew York State, 1990-2000

-20.0

-15.0

-10.0

-5.0

0.0

5.0

10.0

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Age

Source: Empire State Development, residual net-migration

New York’s 62 Counties % Change 2000-2015

-2

-0.2 0.8

2925

38

33

-7-10

0

10

20

30

40

50

Per

cen

t C

han

ge

Age 0-24

Age 25-59

Age 60+

Age 85+

44 Rural Counties

18 Urban Counties

Automobiles• As with most people, older Americans depend on their automobiles for

transportation. This dependence poses serious safety and mobility challenges for diminished-capacity older drivers, who rely on the private automobile for access to the necessities of life.

• The problem is compounded by where older people are living and how communities have been designed and zoned: three out of four seniors live in rural or suburban communities, which lack the density for traditional mass transit.

• Older people who stop driving become dependent on rides from family and friends, particularly in areas where public transit options are limited. This state of dependence can last a decade or more. Women who stop driving outlive their decision by ten years, men by six. Those who continue to drive face limited mobility and the highest fatal crash rate of any group except teenagers.

• The Aging Network in New York expends a significant amount of its limited service dollars to provide transportation services. In State Fiscal Year 2007-2008, a total of 124,872 older persons were transported through the Aging Network at a cost of $18,965,824. All AAAs currently expend resources on transportation and many more could benefit from this service, as the request for transportation service exceeds the Aging Network’s capacity to respond.

Automobiles

• Driving is the usual mode of transportation for adults ages 50 and older.

• After the age of 85, there is a slow decline in the number of drivers.

• Nevertheless, approximately 80% of people ages 75-84 and 60% of those ages 85 plus said their primary mode of transportation was to drive themselves.

• According to the Federal Highway Administration, the number of persons ages 85 plus who are licensed drivers grew 50% between 1994-2002. Among all persons ages 85 plus, the proportion of licensed drivers grew 8%, from 40%-48%, over that time period.

• An AARP survey showed that health and functional status, not chronological age, is the strongest predictor of mobility within the community. Individuals ages 85 and older in excellent health and functional status are more mobile than their younger counterparts with poor health and functional status.

Older drivers face the following challenges:

•Reductions in acuity, e.g., not processing the broad range of details on a busy road•Reductions in contrast sensitivity•Narrowing of visual field•Restrictions in visual attention•Increased sensitivity to glare•Increased dark adaptation•Decreased motion sensitivity, e.g., a slower reaction time•Vision impairments•Cognitive Impairments•Prescription drug risks/abuse•Alcohol abuse

Some older drivers, AARP findings suggest, may benefit from driver training, counseling, rehabilitation after a stroke or heart attack, or use of adaptive equipment in their vehicles. Some seniors, depending on their capabilities, may need to limit their driving to, say, a 15-mile radius of their homes.

Driving One’s Own Vehicle

Highway Deaths

• Highway deaths for motorists under 65 have dropped by 3% since 1995 but deaths among seniors have jumped 15%.

• When a crash occurs, older motorists are 25% more likely to die than those 55 and younger, more likely to have a TBI.

• Older drivers are more at risk of being responsible for causing a crash. For every 100 fatal accidents involving an older driver, the older driver is responsible for 85 of those accidents.

• Drivers 65 and older account for one-third of all deaths at intersections. Nearly half of these deaths occurred while attempting left turns.

• Elderly drivers are more likely to be involved in multi-vehicle collisions that result in more serious injuries than those involving younger drivers.

Highway Deaths• Of traffic fatalities involving older drivers 82% happened in the daytime, 71% occurred on

weekdays, and 75% involved a second vehicle.

• When a crash involved an older driver and a younger driver, the older driver was 3 times as likely as the younger driver to be the one struck. Moreover, 28% of crash-involved older drivers were turning left when they were struck-- 7 times more often than younger drivers were struck while making left turns.

• Older drivers involved in fatal crashes and fatally injured older pedestrians claimed the lowest proportion of intoxication--defined as a blood alcohol concentration of 0.10 grams per deciliter or higher.

• While only 55% of adult vehicle occupants (ages 18 to 69) involved in fatal crashes were using restraints at the time of the crash, 70% of fatal- crash-involved older occupants were using restraints.

• On the basis of estimated annual travel, the fatality rate for drivers 85 and over is nine times as high as the rate for drivers 25 through 69 years old.

Giving Up the CarA Survey of Families and Caregivers Concerned About the Safety of an Older Driver was part

of the Older Driver Family Assistance Project. The Project was funded by the New York State Governor's Traffic Safety Committee and supported by the NYS Department of Motor Vehicles, State Police and the Allstate Insurance Foundation. http://aging.state.ny.us/explore/drivers1.htm

• Over 70% of family members reported that they had been concerned for a year or more that an older person was not driving safely.

• Of the drivers identified as unsafe, 85% were ages 75+. Over 30% were ages 85+. Over 90% lived in their own homes/apartments, and almost 75% were alone.

• The safety problems most identified by respondents were: – slow reactions; slow driving,– inattention to other road users and hazards,– driving at night, in bad weather, and during rush hours. – Almost half reported that the driver's car also had at least some minor crash

damage.

• Over 70% identified help from a physician, such as a letter telling the person not to drive and/or the physician reporting the person to DMV

Emotional Consequences of Not DrivingEven when warranted, the cessation of driving negatively affects older individuals’

subjective well-being. – Life satisfaction and morale are lower among former drivers (Cutler, 1975;

Fengler and Jensen, 1981; McGhee, 1984), and former drivers are less satisfied than drivers with their transportation arrangements (Glasgow, 2000, Forthcoming).

– Older non-drivers report greater loneliness (Carp, 1998), and they are more likely to be depressed (Thompson, 1996) than drivers.

– The cessation of driving is problematic for older individuals and should not be encouraged or undertaken unnecessarily.

– In-home technology, such as computers, the Internet, and telephones, allow people to connect with ties and to perform many personal business functions from home, but most people value face-to-face human interaction, and viable transportation arrangements are important for that.

• When seniors are asked what is the most important issue that they think they will face as they grow older, the number one answer – more than health, housing, insurance – was their fear that they would not be allowed to drive. In one person’s words, "If I didn’t have the means to go somewhere when I wanted to go, I couldn’t live that way."

• More than disease or injury, "the strongest predictor of premature death among the elderly is social isolation," according to Patricia Waller, former Director of the University of Michigan Transportation Research Institute and former Director of the University of North Carolina Injury Prevention Research Center.

Issues facing older adults who may be losing their ability to drive.

• Currently, there are about 8.4 million senior citizens who depend on others for their transportation.

• Shortly, the number of older drivers will more than double, making the issue of senior transportation even more critical. In fact, according to the Administration on Aging, by the year 2030 the number of drivers over age 85 will be 4–5 times what it is today.

• Because America’s roads and automobiles are not designed for the existing elderly population—and because the skills and abilities associated with driving tend to diminish with age—viable alternate forms of transportation for the elderly will continue to be an important issue for years to come.

Alternate TransportationThere are three general types of transportation for the elderly, including • door-to-door, • fixed route, and• ridesharing.

Issues facing older adults who may be losing their ability to drive.

• Door-to-door, or demand response, is a system where advance reservations are made to take an elderly individual from one place to another. – Normally these services provide comfort and flexibility, and charge a

small fee.

• Fixed route or scheduled services transport elderly individuals between fixed stops on a route. For this reason, reservations are not required, although a small fee is often charged for each ride.

• Ridesharing programs coordinate rides for elderly persons with someone who has automobile space. – Ridesharing is scheduled and involves a specific destination such as

medical appointments, nutrition sites, places of employment, or senior centers.

Public Transportation• According to the National Governors Association, “Public transportation

may be a more viable option - if the concerns of older people are taken into account.”

• Among the problems that adults ages 75+ and in poor health listed as problems were (in descending order of importance):

(1) destinations are limited; (2) accessibility; (3) difficulty boarding/transfers are difficult; (4) time it takes; (5) concern about crime; (6) getting a seat; (7) condition of stations and vehicles; (8) cost; and, (9) getting information.

The reliability of mass transit lies near the top of seniors’ needs. Delayed buses and trains can lead to missed doctors’ appointments and shaken confidence in the system.

NYSOFA – Project 2015

Project 2015

Was a nine-month planning process involving 36 New York Stategovernment agencies.

It was carried out in 2002 at the direction of the Governor andmanaged under the leadership of the New York State Office forthe Aging (NYSOFA).

The aim of this planning project was to help state governmentagencies prepare to appropriately meet the needs of New York’scitizens as the State’s demographic profile shifts significantly through

the coming years.

Project 2015 – DOT Findings• An overwhelming issue for the elderly is maintaining

mobility. Many of our future elders are likely to be living in suburban locations which traditionally offer few travel alternatives to the automobile.

• Most of the elderly population outside New York City will have spent a lifetime of reliance on the automobile for travel and will expect to continue to drive.

• Many will be unfamiliar with and unwilling to shift to public transportation or walking as alternatives.

• Fifty percent of non-driving elders report that they cannot walk to a bus stop and 53 percent say that they cannot walk to a grocery store.

Project 2015 – DOT Identified IssuesMaking the State’s Transportation System Safer for the Elderly.

This issue pertains to improvements that can be made to the transportation infrastructure to compensate

for the diminished visual and hearing acuity, declining physical fitness, and slowed reaction timesexperienced by the elderly. Implementation of programs and projects to compensate for diminished skillswill contribute to the safety and well-being of the senior population as well as the population as a whole.

Improving the Mobility Options for the Elderly Non-Driver.

This issue concerns the implementation or encouragement of projects and programs that will expandtransportation alternatives for those seniors who do not or cannot drive. Of particular challenge will betravel alternatives to driving for the growing numbers of seniors living in the suburbs and the country.

Making Transportation Services, Maintenance and Operational Practices More Senior Friendly.

This issue recognizes that changing travel patterns, expectations and physical limitations of the seniortraveler should to be considered in designing transportation services, and that operational andmaintenance practices may need to be modified to be considerate of Seniors with their varied travelneeds and their diminished physical capabilities.

Project 2015 – DOT – Priority Issues

PRIORITY ISSUES

Initially, some two dozen policy issues were identified as important in light of the State’s changingdemographics. These issues were consolidated and then evaluated taking into consideration: (1) impactof each on the Department’s mission, (2) cost effectiveness, (3) immediacy of need, (4) safety, and (5)risk of not addressing the issue.

Transportation needs exceed the funds available to meet them. As a greater proportion of New Yorkersretire, there may be fewer dollars available to address transportation needs, thus cost effectiveness isessential. When the risk of not addressing a particular issue has significant consequences, it becomes ahigh priority.

Overarching transportation concerns include: (1) making the State's transportation system safer for the elderly; (2) improving the mobility options for the elderly non-driver and (3) making transportation services, maintenance and operational practices

moresenior friendly.

Recommendations for Improvements

When reviewing what New York State has done, some questions and issuesthat could be brought up include the following:

• According to the Florida DOT, “medical studies have shown that the average 60-year old requires eight times more light than the average 20-year old, which explains why elder drivers have particular difficulty driving at night.” – Enlarge the letters on signs and increasing the brightness on the roads so

elderly drivers can see better.

• Peripheral vision decreases with age. Consider redesigning intersections with elderly drivers and pedestrians in mind. Will there be a need for wider and more reflective lane markers? Install of audible traffic signals for the sight-impaired

• Studies show that many older adults are overwhelmed by the “visual busyness” of the modern roadway system. Research shows that advertisements are distractions for senior drivers, and that highway message boards and Intelligent Transportation Systems offer too much information for the older population to read and absorb in a timely manner.

Most Integrated Setting Coordinating Council (MISCC)

New York enacted Chapter 551 of the Laws of 2002, creatingthe Most Integrated Setting Coordinating Council (MISCC).

New York’s response to Olmstead v L.C.

The Legislature found that while New York provided communitysupports for people of all ages with disabilities, it had nocentralized mechanism in place to determine whether or not people ofall ages with disabilities are residing in the most integrated setting.

The MISCC is designed to bring together governmental agencies thatfor too long were insulated and isolated, to work collaboratively toprovide services in the “most integrated setting.”

Most Integrated Setting Coordinating Council (MISCC)During 2010-11, the MISCC will focus on implementation of the following transportation plan forindividuals with disabilities in New York State. MISCC Transportation Mission• Promote and advocate for the accessibility, reliability and affordability of transportation alternatives for

individuals with disabilities.

MISCC Transportation Vision • The availability of transportation services which give individuals with disabilities access to housing,

employment, health care, education, community services and activities necessary for daily living.

MISCC Transportation Values• Greater economic independence, healthy living and improved quality of live for people with disabilities.

MISCC Transportation Goals• To create a comprehensive health and human services transportation policy for New York State.

Measurable Transportation Outcomes1) To improve mobility alternatives for individuals with disabilities.2) To coordinate public and human service agency transportation mobility alternatives for individuals with disabilities.

Most Integrated Setting Coordinating Council (MISCC)

Implementation Actions - NYSOFA

1. Enhance volunteer resources through NYSOFA’s Community Empowerment Initiative to grow local capacity and produce additional transportation resources for older adults in local communities utilizing RSVP, Faith Based Volunteer Organizations, etc.

• National Governors Association Grant• NYS Commission on National and Community Service• NY Connects Local Long Term Care Councils

2. Through the MISCC Transportation Workgroup NYSOFA will collaborate with other state agencies and consumer advocates to review pedestrian access policies and assist in the development of a plan to address deficiencies and enforcement issues.

• \

Area Agency On Aging Transportation SurveyThe following highlight the results of the transportation component of the survey (85% response

rate): • 44% of the survey respondents indicated that their current transportation services were at

risk of being cut back or reduced due to funding limitations.

• 65% percent of the survey respondents indicated that their current transportation services were limited by available funds to selected/targeted geographic areas in their Planning and Service Area.

• In terms of the priority order of needs for transportation services, survey respondents listed

the following priorities (in rank order).» Paid staff (e.g., drivers, escorts, etc.) » Gas costs » Maintenance costs» Insurance costs» Additional/replacement vehicles for the handicapped» Other additional/replacement vehicles » Volunteer stipends/reimbursement» Other operating costs

GTSC – Older Driver Assistance Networks

With the aging of the baby boomers, New York will see a 50percent increase in older drivers by 2015.

Research shows that older adults can continue to drive safelylonger with the right support.

According to traffic safety experts, the key is to intervene early beforean on-the-road crisis or death occurs.

Older Driver Assistance Networks are being developed to assist olderdrivers so that they may remain safely behind the wheel whenappropriate or access transportation alternatives when they are not.

The Capital Region Older Driver Assistance Network provides various levels ofassistance to an older driver or anyone attempting to help an older driver.

GTSC – Older Driver Assistance NetworksOlder Driver Assistance Networks are a partnership of experts from thefields of:

aging, transportation, healthcare, consumers and advocacy groupslaw enforcement, rehabilitation

Older Driver Assistance Networks provide support and access to older driverresources to anyone attempting to help a potentially at-risk older driver.

Collaboration among a network of regional partners promotes communityconversations that can lead to increased individual driver safety as well asimproved highway safety for everyone.

By working together network partners have the means to engage as acoordinated resource set providing older driver education, evaluation,individualized interventions and information to address critical safety issuesand problems that if left unabated could result in serious injury and loss.

GTSC – Older Driver Assistance Networks

Capital Region Older Driver Assistance Network partners include representatives fromthe following agencies and organizations:

AARP; Albany County Department of Public Works, Traffic Safety Education Program;American Automobile Association; American Society on Aging; Albany County Department for the Aging; Governor’s Traffic Safety Committee;Medical Society of the State of New York; New York State Department of Motor Vehicles; New York State Department of Health; New York State Office for the Aging;Rensselaer County Department for the Aging; Saint Peter’s Hospital; Schenectady County Office for the Aging; Sunnyview Rehabilitation Hospital; and the Veteran’s Administration Hospital.

GTSC – Older Driver Assistance NetworksCapital Region Older Driver Assistance Network:

1. builds shared capacity among network partners that can be used to assist primary referral sources such as families, physicians, professionals that serve older adults and law enforcement in dealing with safety concerns in relation to an older driver;

2. establishes a reliable, sustainable and broad-based network of mutually supportive referral pathways and coordinated support services for anyone attempting to provide assistance to an older driver;

3. provide information and assistance to help the older driver, their families, and other members of the community to successfully identify and address potentially unsafe and at-risk situations; and

1. provides education to enable a greater awareness in the community aboutinterventions that are available to help older drivers to drive safely longer and to support older individuals that are no longer able to drive without risk to themselves and/or others.

GTSC – Older Driver Assistance NetworksAll of the following descriptions of training and educational activities as well as resourceinformation implemented by the Project Coordinator together with network partners.

1. Education and counseling for seniors about driving cessation and how to obtain a driver skill assessments evaluation.

2. Information about how to register for a driver refresher course designed for older drivers.

3. Education and training for families to help them intervene with an older driver who appears unsafe.

4. Education and training for families on problem solving strategies and options for emergency reporting older drivers.

5. Printed informational material for older drivers, their families and professionals focused on driver safety, community mobility and transportation alternatives. The material will also offer strategies for transitioning from driving to other forms of community mobility should driving independently no longer be a safe option.

6. Printed informational material describing the local inventory of help resources designed to assist older persons with driving safely for as long as possible.

7. Information about the Capital Region Older Driver Assistance Network and how to access local resources within the network for help.

ITNAmericaSustainable Transportation Demonstration Program (Based on the Independent Transportation Network (ITN),

Portland Maine)

All communities have a powerful stake in helping to ensure that older adults can remain mobile in theircommunities once they limit or stop driving. Communities thrive when they take action to keep older adultsconnected to the families, friends and activities that bring meaning to their lives. That action is the power ofthis model.

Everywhere, the issues are the same: – How to provide the kind of door-to-door service older people want and need– How to recruit enough volunteer drivers, and how to manage insurance– How to arrange rides, especially in rural and suburban communities– How to pay for it all

The solution is a community-based, non-profit service that relies on fares from the people who use the service,subsidized by voluntary local community support. ITN brings families, businesses, healthcare providers andcommunity organizations together to weave a strong, local, diversified web of support for senior mobility,without relying on taxpayer dollars for operating or capital expense.

ITNAmerica Dignified —Older adults who join the ITN® in their community become dues-paying members of a non-

profit organization committed to their independence and mobility. When they pick up the telephone to schedule a ride, they are not asking for a favor- they are making a reservation with their own transportation service. The transition from the driver's seat to the passenger seat for diminished capacity older drivers is never easy – for the drivers or for their families – but it is infinitely easier when there is a viable transportation alternative that keeps the older adult in control

Supports Community —The service connects seniors to merchants and health care providers, and to local organizations and residential facilities. When older adults are free to come and go, regardless of whether they choose to drive, they are empowered to participate in the economic life and social fabric of their community.

Builds Community—Are designed to build and support your community. That community building takes many forms: As a volunteer who wishes to support older neighbors or as an adult child who needs to help aging parents; as a local government trying to address a difficult transportation need, or as a corporation seeking to support the local community. ITNAmerica™ has successfully pioneered such innovations as transportation gift certificates from adult children, transportation credits for volunteer drivers, and the Road Scholarship Program and the Community Road Scholarship Program™ for low-income riders to help build support and community around dignified mobility for seniors.

Sustainable — The diversified base of family and community support underpins the source and strength of ITNAmerica's™ financial security and sustainability. Rather than rely on taxpayer dollars for on-going economic support for either capital or operating expenses, the ITN® service builds its community connections one person, one family, one business, one town, one corporation at a time. No base of support can be stronger or more flexible than this, nor can it be more capable of enduring difficult economic times.

ITNAmerica

• Individuals & Families• Membership• Gift Certificates

• Vehicles & Gifts in Kind• CarTrade™

• Car Donation• Gifts in Kind

• Merchants, Health Care Providers & the Business Community• Ride & Shop• Healthy Miles• Healthy Smiles• Corporate Sponsorship

• Community Organizations• Ride Services• Ride Sponsorship

• Volunteers• Transportation Social

Security• Road Scholarship Program

• Municipalities & Organizations• Community Road

Scholarship Program 

• Fundraising Events & Programs• March of the Members• Annual Appeal• Adult Child Membership

Campaign• Planned Giving 

Characteristics of an ITN Affiliate

• Uses automobiles to provide rides 24 hours a day, 7 days a week;

• Available for any purpose, without restriction to all ITN® members;

• Sustainable through fares from those who use the service and voluntary local community support, without the use of taxpayer dollars;

• Connected to and served by ITNRides™ information system technology;

• Serves seniors 60 years of age or older and people with visual impairments.

A livable community is one that has affordable and appropriate housing, supportive community features and services and adequate mobility options. Together these facilitate personal independence and engagement of residents in civic and social life. AARP definition of Livable Communities

LIVABLECOMMU

NITIES

ADDRESSES BASIC NEEDS PROMOTES

SOCIAL & CIVIC ENGAGEMENT

ADVANCES HEALTH & WELLNESS

FOSTERS INDEPENDENCE

Characteristics of a Livable CommunityHousing that :•is accessible, appropriate and affordable•offers new construction with universal design•considers retrofitting existing housing to accommodate all•is in neighborhoods that are safe and offer needed goods and services

Streets that:•are easy to navigate for those with wheelchairs, baby carriages, or other assistive devices•safe for walkers and joggers •have clearly marked intersections and properly placed crossing devices

Transportation systems that:•are affordable and accessible•include a variety of options•offer safe driving classes

Arts and Leisure opportunities including:•Community meeting places and modern senior centers•Wellness activities as well as social and cultural events•Libraries and parks with accessible and attractive programming•Opportunities for meaningful civic engagement

Community Empowerment What Does Mean?

• Goal – to stimulate local action to plan for livable communities to assist older adults to age in place, support families

• A locally controlled process that enables people to collaborate and act on issues that they define as important, which affect their lives and communities.

• Community leaders, civic and business organizations, faith based groups, interested citizens play an active role in identifying challenges and opportunities.• Focus on older New Yorkers – tapping their social capital, meeting the

challenges that population growth presents, designing/redesigning communities to meet these changing realities – good for all ages

• It serves as a means of changing the culture and nature of how communities actively engage its citizens.

• Community residents of all ages Seniors, Baby Boomers, Adults and Youth

• Public OfficialsGovernment Administrators, Commissioners, Agency Heads, Public Safety Officers and Zoning and Planning Officials

• Civic leadersRetiree organizations, Civic Organizations, Community and Faith Based Organizations, Business Leaders, Chamber of Commerce, Colleges, Universities, LibrariesCultural Institutions

• Health and Long Term Care Service Providers Hospitals, Nursing Homes and Healthcare Providers• Housing / Builders

IDENTIFY AND EDUCATE STAKEHOLDERS

Contact Information

Greg [email protected]

NYSOFA Websitehttp://www.aging.ny.gov/