By Thomas Goldsmith

Residents of the Wood Spring Apartments in Fuquay-Varina have cut a walking path across a field to a shopping center with a Food Lion, a pharmacy and a couple of restaurants.

Now the people who live at the building serving people 55-and-older would like to see a bus stop at the center for the trips they regularly need to take to the wider world.

That’s the word from Sharon Peterson, who works in the Wake County Planning Office, based on conversations with residents about their need for transportation, a concern that often shows up as a top priority for seniors.

National AARP data presented in December to the General Assembly’s subcommittee on aging showed that older people rated access to a bus stop as a top priority, more than to a grocery store, park or pharmacy. Advocates say access to transportation is an important determinant of senior health, as many older people have conditions that involve medical appointments, often about once a month.

“Most of them wanted to go to medical appointments in Cary, Raleigh or out of the county, at Duke or Chapel Hill,” Peterson said. “When we think of hospitals, we tend to think of surgery or long-term care. In these cases, it’s on the specialist end more than emergency care.”

Shows paratransit buses used for transporting older people, people with disabilities.
Paratransit buses at the Tar River Transit headquarters in Rocky Mount, North Carolina in 2011. Photo courtesy: DanTD, Wikimedia Commons

The situation at Wood Spring is reflected across the state in communities where other amenities are in better supply than transportation that’s accessible to older people. A national livability study showed some North Carolina towns with plentiful services for older people, such as Chapel Hill, had their scores bolstered by the presence of public transportation. Smaller towns such as Tabor City and Warrenton had lower livability scores because of limited transpiration choices.

“I hear this day in and day out,” said Kristen Brannock, executive director for Resources for Seniors in Wake County. Because there’s plenty of demand for spots in Wood Spring and similar developments, owners have little incentive to offer extra services such as transportation, Brannock said.

“There’s not a lot of incentive for these developers and owners to provide a lot of these ancillary services because they have people waiting to move into that Fuquay-Varina center.”

Older people are tending to drive more — the American Automobile Association projects that more than 60 million Americans older than 65 will be licensed to drive by 2030. But that still leaves millions who need help getting around, including some who move within North Carolina or from another state.

“Some of them moved from Raleigh, anticipating they would have the same resources that they have in Raleigh,” Peterson said.

In independent senior living complexes such as Wood Springs, as well as in assisted living and nursing homes, older people may not be fully informed when they move in about the degree of isolation at the center. Long-term care facilities are often located on the edges of town because land is less expensive there, leaving residents outside of transit lines.

Without regular bus service or other help, residents pay out of pocket for rides from individuals or taxis, spending as much as $45 to reach an out-of-county destination.

Riding with Medicaid

Counties across the state are addressing the issue with creativity and planning prowess. Mecklenburg County offers a range of programs, some funded by Medicaid, the tax-funded health-care program that serves low-income people.  (Medicare, the health insurance program for older people, doesn’t typically pay for transportation.) Mecklenburg’s services include Medicaid-funded bus service to medical appointments;  EDTAP, or transportation access for elderly and disabled people; general purpose transportation for long-term care residents and others with disabilities; and rural general purpose transportation for people in outlying areas.

However, Mecklenburg Transit System officials point out there’s not enough funding for everyone who would like to ride: “All MTS programs, except Medicaid Transportation, have limited funding available. As a result, frequencies and types of trips may be adjusted,” it notes at the bottom of the website about the programs.

That reality hit home in Wake and other counties in 2016, when the state transportation department cut back on the areas that were eligible for TRACS or Transportation and Rural Access rides, which cost between $2 and $8 depending on destination and location.

There’s a catch for TRACS riders who want to make medical appointments: They can only make a reservation 24 hours in advance, but may be subject to penalties at a doctor’s office if they miss an appointment because other riders reached the TRACS line first.

“I might have to pay $40 if I miss my specialist appointment, but I won’t know if I have a ride until the day before,” Peterson said.

Other ways to go

Leaders of aging-services agencies such as Alan Winstead of Meals on Wheels of Wake County would like see some of the cost shifted from consumers to the medical practices and companies that benefit from the older people who may have struggled to show up.

“One option is to get health care to pay for transportation,” Winstead said.

Ride-hailing services such as Uber might seem a natural fit for older people in need of transport. And Uber executive Meghan Verena Joyce waxed enthusiastic about the possibility in a recent tweeted response to a reporter’s question.

“Our goal is to make transpo more accessible to people with disabilities through UberASSIST and a number of other initiatives,” Joyce said via Twitter.

However, the UberASSIST program, which involves special training for drivers, is only available in 40 cities throughout the world. Fuquay-Varina is not among them.

“There are not a lot of Uber drivers from what I’m hearing, in that part of the county,” Peterson said.

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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...