Access to personal primary transportation, such as a car or adapted vehicle, has long been associated with independent living for seniors and people with disabilities. A new, decade-long research study by Johns Hopkins School of Medicine, published in the July, 2006 issue of the American Journal of Public Health, suggests there might be profound public policy implications for all Americans regarding access to primary transportation for aging and disabled Americans because of its link to the need for long-term care. The comprehensive study, funded by the National Institute for Aging, found that seniors who were not able to maintain personal mobility were four times more likely to end up in long term care programs.
It is common knowledge among advocates in the aging and disability communities that lack of access to reliable transportation is one of the most persistent personal care problems for these populations. This is particularly true for people in isolated rural communities and underserved suburban and inner city areas. Ultimately, as the study reveals, it’s not just about the independent ability and desire of an individual to continue to drive. Without this personal primary transportation or reliable access to a comparable public transportation, individuals may not be able to meet basic needs like health care. The reduced health care is what eventually causes the problems. It is understandable that older drivers who have a drivers license and a car try to hold on those despite societal and family pressure for them to give up driving -- their personal costs can be devastating. The study suggests that if there is no alternative to the loss of a personal vehicle, the possibility that an individual will need living assistance “categorically’’ increases dramatically. What is more likely, the researchers found, is that older people risk prematurely entering expensive long-term nursing home care programs to overcome the lack of accessible transportation to attend to their medical needs.
The Johns Hopkins study set out to see if this loss of driving access or lack of comparable transportation actually does play any role in the need for long term care. Why would that be important to the rest of us? For one, the cost of long-term care is considerable, with average yearly costs of around $69,000 and the average costs of assisted living around $30,000. It does not take a genius to figure out that moving people into expensive Medicaid funded nursing homes because of their lack of transportation is just not smart public policy. Public costs become immense.
Non-drivers across the entire age group studied had four times the risk of long-term care entry compared to drivers, and the absence of other drivers in the home doubled the risk of entering long-term care. Nine percent of those studied entered long-term care for three months or more. By the end of the study, 29 percent of men and 58 percent of women had no other drivers in the household, and 22 percent of people who were driving at the beginning of the study reported that they stopped driving during the study.
It looks like there are some very wise things to do when planning for long term care. First, family caregivers need to plan for transportation independence as part of long term care planning and not assume transportation access will just happen. What is important to take from this study is that it’s not just about individuals being able to continue driving: it’s more about making health care accessible to people who are aging or disabled. Second, state and federal policy makers might want to consider whether it is wise public policy to spend limited long term care dollars because of the lack of adequate personal or public transportation and alternatives contingency planning. State Medicaid programs might want to consider devising systems similar to rehabilitation programs that help participants to maintain or acquire driving skills -- even to the point of providing assistive technology. It makes a lot of sense to invest in solving transportation problems before we have to pay for the lack of personal mobility with scarce Medicaid dollars.
As the Johns Hopkins study suggests, if we look at the implications of costs, sizeable societal savings can come by helping seniors to remain as independent in their homes with access to reliable personal mobility. Given the immense political pressure on states to hold down and reduce Medicaid expenditures, we could have some unneeded pressures as the numbers of aging persons grow exponentially over the next care and need long term care. This seems like a no-brainer to solve, but it appears that many states are cutting back because of budgetary concerns exactly when they need to be investing more in community transportation infrastructures for older Americans. Down the road these poor politically-based choices add up unreasonable high societal costs for scarce long term care dollars that a growing population of aging citizens will need.
© Daniel Scarborough, 2006
