As their mobility falls as they age, elderly people face many challenges. Walking gets harder as time passes. Canes, walkers, and wheelchairs—manual and powered—become a part of everyday life.
As physical mobility declines, the value of powered transit—especially automobiles—increases. But at some point, many elderly people face the prospect of giving up their licenses. As a result, elderly people living on their own end up with extremely limited mobility. While some trips can be avoided, especially with the advent of online shopping and grocery delivery, some trips, such as medical appointments, are necessary.
Cities like Washington, DC, have seen residents employ ambulances for such trips, straining 911 resources to the point where the city now employs triage nurses to separate emergency and non-emergency calls.
To help address the influx in the latter, this month Ford announced a partnership with Detroit-centered Beaumont Health to provide these rides to Beaumont patients. The company will manage a fleet of 15 transit vans to pick up mobility-impaired individuals and shuttle them to their appointments. This partnership provides a novel example of how to provide mobility for the disadvantaged without public management.
What many people don’t know is that most localities have programs to provide rides to this segment of the population. “Paratransit” service, as it is known, is an unfunded mandate in the 1990 Americans with Disabilities Act. Put simply, it mandates “complementary” service for the disabled in places where traditional fixed-route transit service exists.
The essence of the law is that if public transit service exists, individuals with any disability must be able to take the same trips able-bodied individuals can while using the service. If this is not the case, the public entity must provide a paratransit system so that individuals with disabilities can complete these trips. Transit services include local bus lines, meaning the mandate reaches most towns of any size in the country.
The Ford announcement hints at a new way to provide trips to medical appointments, in part because such appointments are different than other trips. Medical schedule adherence matters; a delayed arrival for a patient is costlier than other destinations for paratransit trips like those to grocery stores and post offices. Medical facilities have an interest in their patients showing up on time. Contracting with a company to provide more reliable service for particular paratransit trips could prove a worthwhile endeavor if it wastes less doctor time or saves the administrative costs of rescheduling.
Ford’s method also works to better align the incentives of the service provider and the subsidy-funding source. Under the current system, local government pays a private contractor to provide trips for those certified as mobility-impaired. This provides little incentive to ensure reliable service, as repercussions for late individual trips are few. While macro-level statistics about on-time performance could play into talks about contract renewal, and enough complaints might cost individual drivers their jobs, these repercussions are indirect compared to those of the Ford-Beaumont model.
Under the Ford-Beaumont model, a private institution contracts with a private company to provide trips to its facilities. The subsidizing institution has records of whether patients taking its subsidized trips actually reach their destinations on time, and the institution loses money when patients are late.
If the Ford-Beaumont model proves successful, local governments could see private relief of public-service demands. The model would relieve pressure on both emergency services and paratransit service as the most time-sensitive trips shift to more reliable, private alternatives. This would be a win for government, a win for doctors, and, most importantly, a win for some of the nation’s most vulnerable people.