Informal Social Support and Use of a Specialized Transportation System by Chronically Ill Older Adults

Abstract

He has conducted research and published extensively in a number of areas, including environment and aging; baby boomer health dynamics; health promotion, self-care and aging; older drivers; living arrangement change over the life course; and family, social support, and intergenerational issues.ABSTRACT: Aging is commonly associated with an increase in chronic disease and disability, affecting access to transportation. This study examines factors that contribute to the decision to use Handy Dart transportation (a handicap-specialized service) among 869 elderly, chronically ill residents of a metropolitan region in British Columbia. Drawing on Chappell's complementary model of support, the authors hypothesized that informal social support will be positively associated with specialized transportation service use. The authors employ the Andersen-Newman model of health use to help organize the other expected predictors. Results of logistic regression analysis revealed that the presence of regular social support, a positive attitude about Handy Dart helpfulness, being retired, disability because of arthritis, and perceived ill health were the strongest predictors of use. Age, gender, marital status, knowledge, and number of comorbid illnesses did not predict use of the service. The results are discussed within the context of changing needs for specialized transportation services.

Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation

“…Centers for Medicare and Medicaid, the Federal Transit Administration, and the Administration for Community Living are federal sources of funding for specialized transportation for older adults and adults with disabilities. However, funding varies by state and by federal funding source (Lynott, Fox-Grage, & Guzman, 2013). The scope and size of many Medicare and Medicaid programs will expand with the passing of Health Care Reform in the United States (Community Transportation Association of America, 2009).…”

“…For example, at the state level, gas taxes could support transportation efforts. Support at the state level is also necessary for the successful funding of Medicaid NEMT (Lynott, Fox-Grage, & Guzman, 2013). Second, involving the medical community could assist in reducing missed appointments through better coordination with transportation.…”

“…Engaging medical staff to ensure that patients have transportation for their appointments could improve utilization and reduce longer term costs. Currently, the Affordable Care Act provides an incentive for hospitals to reduce readmissions (Lynott, Fox-Grage, & Guzman, 2013). Similarly, efforts should be introduced that incentivize preventive care, which has potential to reduce the prevalence of canceled NEMT appointments.…”

“…Finally, the effectiveness and efficiency of this program should be continually evaluated at the state level. It has been suggested that costs should be better monitored and that Centers for Medicare and Medicaid should make state Medicaid NEMT program data publicly available for policy research (Lynott, Fox-Grage, & Guzman, 2013). To address the service efficiency and cost, many paratransit agencies have implemented policies to reduce client no-shows and late cancelations.…”

Transport policy and the provision of mobility options in an aging society: a case study of Ontario, Canada

“…In Canada, a recent study among a Caucasian, well-educated senior population in British Columbia, the use of specialized transit services has been linked to: (1) social networks which serve to inform and encourage seniors in the use of services; (2) among chronically ill seniors, the attitude toward the service based on their knowledge of the benefits of its use; and (3) perception of health as poorer than others because of physical disabilities (Nasvadi and Wister, 2006). The same study suggested the need to conduct a similar inquiry in other provinces in Canada and also emphasized the importance of considering older people from different ethnic backgrounds.…”