Counseling, Caregivers and Alternative Transportation Panel C 12/02/03

Context Paradigm shift: transportation systems should serve needs of older consumers Paradigm shift: transportation systems should serve needs of older consumers Ageism Ageism Funding challenges Funding challenges Lack of community support and political will Lack of community support and political will

Counseling Redefine counseling: expand to include Redefine counseling: expand to include –marketing –PR –training –traditional counseling Heterogeneous group Heterogeneous group Approaches vary widely Approaches vary widely

Techniques Senior transportation resource center Senior transportation resource center Client-centered approach: 1:1 counseling Client-centered approach: 1:1 counseling –Seniors –Adult children/spouses Centralized mechanisms for information: community specific information Centralized mechanisms for information: community specific information Publicize Older American’s Act Publicize Older American’s Act & other local transportation benefits for seniors & other local transportation benefits for seniors

Techniques Educate seniors, friends and caregivers on existing options Educate seniors, friends and caregivers on existing options Promote community conversation Promote community conversation Educate providers Educate providers –dealing with the transition issues –directing to appropriate resources –understanding role of and supporting caregivers –providing guidance in the decision making process

Techniques Involve in volunteer transportation opportunities Involve in volunteer transportation opportunities –part of solution for others –may facilitate planning for one self Educational campaigns, e.g., drunk driving campaign Educational campaigns, e.g., drunk driving campaign Peer/pastoral counseling Peer/pastoral counseling Sensitivity in revocation process Sensitivity in revocation process Use of communication devices to supplement mobility Use of communication devices to supplement mobility

Essential Elements Above all: Respect for consumer Above all: Respect for consumer Take a positive approach Take a positive approach –use benefit not burden approach –focus on action consumer can take Effective communication strategies Effective communication strategies –empathy –listening skills –empower consumers Understand impact of not driving Understand impact of not driving –symbolic meaning –actual meaning

Essential Elements Reciprocity Reciprocity Cultural sensitivity Cultural sensitivity Approach: focus on action consumer can take Approach: focus on action consumer can take Identify social support & community services Identify social support & community services Consumer to stay connected in a meaningful way Consumer to stay connected in a meaningful way Cost of alternative transportation vs. driving Cost of alternative transportation vs. driving Venue for support and discussion Venue for support and discussion Non-profit system fosters capacity building Non-profit system fosters capacity building

Essential Elements Effective follow-up and follow through Effective follow-up and follow through Participation in the decision-making process Participation in the decision-making process

Evaluation Built into the approach as necessary component Built into the approach as necessary component Quality of life/ successful aging measures Quality of life/ successful aging measures

Counseling: Conceptual Model Self Perception of Competency and Actual Competency Concordance Model (Dobbs and Dobbs, 2000) Self Perception of Competency and Actual Competency Concordance Model (Dobbs and Dobbs, 2000) –Initial model that must be tested and interventions designed

Self-Ratings-Driver Examiner Ratings Congruency Matrix Self-Perceptions YesNo ActualPerformanceYes X (Group A) No X (Group B) 

Counseling: Program Model Florida DMV Florida DMV –Mobility counselors –Resource centers –Connectivity with the community Consider term: “medically/functionally at risk” to move beyond ageism Consider term: “medically/functionally at risk” to move beyond ageism

Inventory: Assumptions Integrated Integrated Dynamic hybrid Dynamic hybrid Triage for individual needs Triage for individual needs Multi-level system Multi-level system –Informal to formal –Dependent to independent Degree of regulation or oversight varies within each system Degree of regulation or oversight varies within each system

Alternative Transportation Continuum Stop to stop Stop to stop Curb to curb Curb to curb Door to Door Door to Door “Arm to Arm” “Arm to Arm”

Alternative Transportation Continuum Family/friends & caregivers Family/friends & caregivers Non-kin informal Non-kin informal –Existing relationships Pass ride concept: TRIP Pass ride concept: TRIP –Reciprocity –Payment to friends and neighbors Volunteer Volunteer

Alternative Transportation Continuum Independent Transportation Network (Freund) Independent Transportation Network (Freund) Juncture between volunteer and transit Juncture between volunteer and transit Specialized transit Specialized transit –Hospital –Airport –Senior housing Contracted private transit Contracted private transit Taxi Taxi –voucher –traditional

Alternative Transportation Continuum Para transit Para transit –ADA Para transit –Public Para transit –Dial-a-ride Senior transportation Senior transportation –Alternatives provided by jurisdictions –Fixed route and flexible routes Jitneys Jitneys Non emergency medical vehicles Non emergency medical vehicles Public transportation Public transportation –Alternatives provided by jurisdictions –Fixed route and flexible routes *Low speed vehicles *Low speed vehicles

Keys to Success: Alternative Transportation for Seniors Community focus and community support Community focus and community support Consumer perspective Consumer perspective Imagination and creativity (not taking no for an answer) Imagination and creativity (not taking no for an answer) Flexibility to accommodate the changing demands Flexibility to accommodate the changing demands Family of services Family of services Partnership/stakeholder Partnership/stakeholder –coordination –who will contribute

Keys to Success: Alternative Transportation for Seniors Business model Business model –bottom line –costs and revenues Sustainability (service has long range multi- year perspective supported by consumers, investment from the community) Sustainability (service has long range multi- year perspective supported by consumers, investment from the community) Sense of public and private ownership Sense of public and private ownership Technology Technology

Keys to Success: Alternative Transportation for Seniors Total quality management and continuous quality improvement Total quality management and continuous quality improvement Quality service Quality service –polite, friendly and courteous –punctuality, driver courtesy, improve environmental conditions, e.g. shelter from weather Positive marketing for alternative transportation…overcoming the barriers Positive marketing for alternative transportation…overcoming the barriers Burkhardt et al

Implications for Future With appropriate choices the need for counseling will be reduced With appropriate choices the need for counseling will be reduced Planning for alternative methods Planning for alternative methods –curriculum (school age/ transportation provider training) –life long mobility –long term planning, e.g. elder lawyers, financial planners –transportation savings account –insurance incentive Public policy: incentives for private solutions for transportation financial planning Public policy: incentives for private solutions for transportation financial planning

Implications for Future Alternative to driving needs to be part of the whole driving process Alternative to driving needs to be part of the whole driving process Marketing benefits of not driving Marketing benefits of not driving Land use e.g., Communities for a Lifetime Smart Growth, WalkAble communities Land use e.g., Communities for a Lifetime Smart Growth, WalkAble communities Develop/choose model Develop/choose model Research Research –“emotional preparedness” –evidence based Interdependency of research, policy and program Interdependency of research, policy and program

Implications for Future Identify next steps Identify next steps Develop champions Develop champions

Limitations Lack of research and methodology Lack of research and methodology Evaluation Evaluation