Transportation Services for Older Adults: What Caregivers Should Know

While the Americans with Disabilities Act (ADA) requires public buses and trains to be accessible, keep in mind that wheelchair lifts may be broken, and escalators and elevators may be out of service, Gleason notes. It’s therefore a good idea to verify that their route remains accessible when they need to use it, either by calling the transit agency or by checking its website for service interruptions.

2. Paratransit serves disabled riders

The ADA requires public transit systems to provide service for riders who are unable to use fixed-route buses and trains. Wheelchair-accessible vans or minibuses transport qualified riders from “curb to curb,” which means they’ll pick your loved one up outside their home, for example, and drop them off in front of their destination.

However, paratransit operates only within three-quarters of a mile of a regular bus route and during the same hours. So if your loved one lives far from a public bus route or needs a ride when the public bus isn’t running, they’re out of luck.

Pros. While eligibility requirements may be strict, “there is such a thing as conditional eligibility,” says Gleason. “For example, if you can see well enough to use the fixed route during the daytime but not at night, you might be eligible for paratransit in the evenings.” Personal care attendants can ride along for no additional cost. Companions are often allowed to accompany riders but may have to pay their fare, Gleason notes.

Cons. Riders may have to book at least a day in advance and leave ample time to get to their destinations, as multiple riders may be picked up and dropped off. For older adults with musculoskeletal issues or incontinence issues, longer trips are tougher on the body, says Freund. “Those circuitous routes are more difficult.”

3. Microtransit offers shared rides on demand

Microtransit is an emerging type of public service for local trips; it’s a cross between public paratransit service and private ride-hailing apps, Gleason explains.

Like paratransit, rides are shared and typically take place in small-format vehicles like shuttles or minibuses. Unlike paratransit, however, there are no eligibility requirements.

Pros. Rides usually are “on demand,” which means you can use an app to book them when you need them — similar to a ride-hailing app like Uber but less expensive, since they are usually operated by public transit agencies.

Cons. Microtransit isn’t available everywhere, and service typically is offered only within designated “zones.” Traveling outside the designated service area typically requires transferring to a fixed-route public transit system.

4. Partnerships offer flexibility for paratransit riders

Some cities provide “on demand” paratransit in partnership with taxis or transportation network companies (TNCs) like Uber and Lyft. The idea is to make paratransit more convenient by allowing riders — specifically, those who qualify for paratransit service, like riders with disabilities — to book rides on demand instead of making advance reservations, and by allowing riders to travel directly to their destination by receiving an individual instead of a shared ride.

Pros. Subsidies are offered, and users can book directly through a taxi service’s call center or through a TNC’s app.

Cons. Partnerships exist only in select cities. And even with subsidies, trips may be too expensive for some riders. There may be long wait times for wheelchair-accessible vehicles, plus drivers may not undergo formal passenger assistance training or receive regular drug testing, Gleason says.

5. Transportation is available for doctor’s appointments

Non-Emergency Medical Transportation (NEMT) is a Medicaid benefit that covers travel to medical appointments. Rides typically take place in wheelchair-accessible vehicles — vans and minibuses, for example — and usually are booked through NEMT brokers, who act like dispatchers by taking trip requests from passengers and sharing them with partnered providers who subsequently schedule trips and complete them. You should contact your state’s Medicaid program to find out which broker it uses.

Pros. Private insurance, including some Medicare Advantage plans, may provide NEMT.

Cons. You have to qualify for it, and it has to be for medical purposes.. Riders may get only a limited number of rides per month; you must book in advance, and it may be a shared ride. While it is covered by Medicaid, Medicare reimburses for rides only in limited circumstances.

6. Volunteer programs offer a personal touch

Typically run by nonprofit or faith-based organizations, these volunteer programs connect volunteer drivers with older adults who need transportation. The scope of programs, fees and how services are scheduled vary. Probably the biggest hurdle volunteer transportation faces is a lack of volunteers, according to Freund. To recruit more of them, she says ITNAmerica has established America’s Volunteer Driver Center to sign up drivers for programs across the country.

Pros. Volunteer programs may pick up the slack in areas without robust transportation options. They’re often free, and riders frequently have the same driver, for more personal — and personable — service.

“We do door through door and arm through arm — not curb to curb," says Freund about services provided by ITNAmerica. "We escort people right into the doctor’s office if they need it.”

Cons. Rides might be restricted to medical appointments or other trip types. Drivers may use either their own cars or agency-owned vehicles, which means they may or may not have wheelchair-accessible rides and might not be able to help their passengers into buildings.

How to find transportation in your community

Transportation professionals known as mobility managers can help you find and coordinate local transportation options. To find one, consult your local aging services organization, typically the Area Agency on Aging, says Bill Wagner, director of the National Center for Mobility Management (NCMM), which helps create transportation solutions.

“Some communities are moving toward ‘one-call, one-click’ … models that coordinate between transportation providers so that if one option doesn’t work out, the person in need of a ride isn’t left hanging,” says Gleason, who recommends checking to see if your state has what’s called a coordinated public transit human services transportation (HST) plan. These plans help communities address transportation gaps for older adults and individuals with disabilities. “It’s worth seeing … what kinds of mobility management initiatives are a part of that.”

In addition to the resources listed below, try calling your public transit agency or health care and hospital system to ask for a mobility manager.

Area Agency on Aging. Area Agencies on Aging address the needs and concerns of older adults. To find your local Area Agency on Aging, search Eldercare Locator by ZIP code or call 800-677-1116.

Rides in Sight. This national transportation database from ITNAmerica shows the cost, eligibility requirements and hours of operation in your area, as well as the availability of wheelchair-accessible vehicles. Search online or call the toll-free hotline at 855-607-4337. 

National Center for Mobility Management has a searchable Community Transportation Provider Map of providers with information on public transit systems, volunteer driver services, mobility management programs and other transportation providers serving your area.

Dial 211. Operated by United Way, the service offers referrals to transportation as well as other services. Call 211 or search their site. In addition to the resources listed above, try calling and asking for a mobility manager at your public transit agency or health care and hospital system.

This story, originally done in 2020, has been updated with new sources.