Transportation is an Essential Resource for Chronic Care Management (99490)

Although Americans are healthier and living longer than ever before, seniors are outliving their ability to drive safely by an average of 7 to 10 years ⁽¹⁾. As age increases, Medicare and Chronic Care Management patients face more challenges associated with driving safely. Chronic conditions such as, Alzheimer’s disease, macular degeneration, and Parkinson’s disease may lead to a CCM patient’s driving privileges being revoked. Decreased range of motion, a sensory deficit, and/or cognitive impairment puts this population at a significant risk of injury. More than 75 percent of drivers age 65 or older report using one or more medications, but less than one-third acknowledged awareness of the potential impact of the medications on driving performance ⁽¹⁾. A Chronic Care Management patient could voice a loss of freedom or sense of isolation due to having his or her keys taken away. Compared with older drivers, older non-drivers in the United States make ⁽³⁾:

• 15 percent fewer trips to the doctor
• 59 percent fewer shopping trips and restaurant visits
• 65 percent fewer trips for social, family and religious activities

Many CCM patients may not initially realize their options, and coordinators should be empathetic and responsible for providing knowledge of transportation options to uphold patient independence and quality of life.

Challenges for CCM Patients without Transportation

Transportation is a basic but necessary step for ongoing healthcare and medication access, particularly for those with chronic diseases. However, limited to access to transportation results in delays in clinical interventions  ⁽²⁾. Such delays in care may lead to a lack of appropriate medical treatment, chronic disease exacerbations or unmet health care needs, which can accumulate and worsen health outcomes ⁽²⁾. According to the United States National Library of Medicine, studies have found transportation barriers impacting health care access in as much as percent of the population sampled ⁽²⁾. Missed appointments with providers and inability to obtain medications from the pharmacy increase risks for patient hospitalization and noncompliance to medications. The following behaviors may reflect experiences of a CCM patient with transportation barriers:

• Recurrent missed/rescheduled provider appointments
• Non-compliance with health maintenance screenings
• Poor medication adherence
• Little social activities
• Less access to food supplements

Based upon the above concerns, access to transportation resources through coordinators should provide Chronic Care Management participants opportunities to improve their health outcomes and lead more independent lives.

Options of Transportation for CCM Participants

Chronic Care Management patients should receive transportation options with eligibility, accessibility, and affordability as key considerations.  Coordinators should explain and encourage the use of resources to improve patient autonomy and mobility.  Transportation options should keep CCM patients connected to daily activities, both necessity and social (e.g., appointments, book club meetings, senior centers). Communication among volunteer/community, insurance, and public transportation options can be given by coordinators serving Chronic Care Management patients.

Listed below are descriptions of transportation resources and services for coordinators to consider and/or use for CCM patients ⁽⁴⁾:

• Volunteer Driver Programs: Local faith-based and nonprofit organizations frequently have a network of volunteers who offer flexible transportation for shopping, doctors’ appointments, recreation, and other activities.
• Paratransit Service: Public transit, aging organizations, and private agencies provide door-to-door or curb-to-curb transportation using mini-buses or small vans (vehicles for less than 25 passengers). Paratransit and van services offer reduced fares for older adults and persons with disabilities, and some providers may operate on a donation basis.
• Transportation Vouchers Programs: Area Agencies on Aging, Aging and Disability Resource Centers, and other social service organizations often provide fare assistance programs that enable qualified persons (usually economically disadvantaged older adults or persons with disabilities) to purchase vouchers for transportation services at a reduced rate. The vouchers are then used to pay for services from a participating transportation provider that can include public transportation, volunteer programs, or taxis and other private companies.
• Public Transit/Fixed Route Service: Public transit agencies provide bus and rail services along established routes with set schedules on a non-reservation basis — also referred to as “public transportation” or “mass transit”. Reduced rate fares and additional transportation services are available for older adults and persons with disabilities.

Although not every option from the above list may be available to each Chronic Care Management patient, a diligent coordinator should locate resources according to each patient’s circumstance. Additionally, local Area Agency on Aging support, disability resource centers, and/or department of human services locations, should be utilized to provide optimum transportation options. The combination of Chronic Care Management and advantages of transportation resources should result increased patient satisfaction and improved clinical outcomes.

References

1. SeniorDriving.AAA.com. AAA. [Online] [Cited: October 31, 2016.] http://seniordriving.aaa.com/resources-family-friends/conversations-about-driving/facts-research/.
2. US National Library of Medicine. US National Library of Medicine. [Online] [Cited: October 31, 2016.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265215/.
3. PubMed Central. US National Library of Medicine . [Online] [Cited: October 31, 2016.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447231/.
4. ElderCare.gov. [Online] [Cited: October 31, 2016.] http://eldercare.gov/eldercare.net/public/Resources/Brochures/docs/Trans_Options_Panels.pdf.