CHAPTER IX

TRANSPORTATION: STILL UPHILL

"The character of the transportation problem faced by older Americans as expressed in the transportation background paper of the 1971 White House Conference on Aging remains unchanged; the elderly are not well served by the transportation facilities available to them." -Joseph S. Revis,1 December 1974.

Assessments of mobility problems faced by older Americans usually point to several major root causes:

-Retirement income is often inadequate for purchase of the transportation services needed.

-Public transportation-when it is available is generally directed to work related trips and not to the unique needs of the older person.

The automobile, the dominant transportation mode, often is ruled out because of income or physical limitations.

Architectural and psychological barriers reduce attractiveness of those public transit systems that are available to older persons.2 The practical consequences of such problems were described in an April 1975 National Council of Senior Citizens publication, "A National Policy for Older Americans . . . Response to their Special Needs":

Lack of transportation is like having a modern kitchen with all the latest appliances and no electricity. Lack of transportation is a barrier to obtaining necessities and necessary services; a barrier to socializing; a barrier to participating in activities, a barrier to mental growth or even keeping one's sanity. Lack of transportation is a cause of stress and worry, loneliness, hunger, undue suffering and, in fact, might be a cause of death.

The urgency of the problem has caused mounting demands for coherent and effective governmental action.

1 Mr. Revis, Senior Consulting Associate of the Institute of Public Administration, was the author of the 1971 White House conference background paper cited in the above quotation, which appeared in Transportation for the Elderly: Action at the Local Level, prepared for the National Forum on Aging for Local Government Official, sponsored by the National Retired Teachers Association-American Association of Retired Persons, Washington, D.C.

2 See Older Americans and Transportation: A Crisis in Mobility: Senate Report No. 91-1520, Senate Special Committee on Aging, December 1970; and Chapter X, "Transportation and Other Consumer Issues, in Developments in Aging: 1973 and January-March 1974, Annual Report, Senate Committee on Aging, May 13, 1974, for additional details. A more recent appraisal appears in Transportation for the Elderly: The State of the Art, Department of Health, Education, and Welfare Publication No. (OHD) 75-20081. This publication is intended to provide a general overview of special projects designed to help the elderly and to examine specific "case-study" projects. The study was undertaken in response to requirements under Title IV, Section 412 (a) of the 1973 Older American Act Amendments, which ordered a study of this nature.

In 1974 and in early 1975, there were signs of progress toward that end:

-Legislative enactments further spelled out a Federal responsibility for improving mobility opportunity for the elderly. -Court action resulted in accelerated inter-departmental action intended to speed action and clarify responsibilities and goals. -The Administration on Aging was preparing in April 1975 to issue recommendations emanating from a special study and its own round of hearings, even as the Department of Transportation considered regulations to make transportation more accessible to the elderly and the handicapped.

Progress, however, was uphill. Important questions were raised about the multiplicity of Federal programs which provide limited help through specialized transportation projects. Delays and apparent confusion also deepened in regard to a grant and loan program intended to assist in providing transportation needs to meet the special needs of the elderly and the handicapped.

I. THE ENACTMENTS: BUILDING UPON THE 1970

MANDATE

The first Congressional statement on recognizing the mobility problems of the transportation deprived was a 1970 amendment to the Urban Mass Transportation Act which stated:

It is hereby declared to be the national policy that the elderly and handicapped persons have the same right as other persons to utilize mass transportation facilities and services; that special efforts shall be made in the planning and design of mass transportation facilities and services so that the availability to elderly and handicapped persons of mass transportation which they can effectively utilize will be assured; and that all Federal programs offering assistance in the field of mass transportation (including the programs under this Act), should contain provisions implementing this policy. In addition, the amendment gave discretionary authority to use $46.5 million to adapt transit systems for better service to the elderly and handicapped.

At hearings early in 1974,3 witnesses complained that progress under the 1970 amendment had been slow, and that the Urban Mass Transportation Administration had no strong commitment to this type of capital expenditure.

In 1974, important new developments occurred:

National Mass Transportation Act: This landmark legislation which had Senator Harrison Williams and Representative Joseph Minish as chief sponsors-requires in Section 5 (m) that rates charged the elderly and handicapped persons during non-peak hours in DOTfunded projects are not to exceed one-half the rate applied to general transit users during peak hours.

3 "Transportation and the Elderly: Problems and Progress," U.S. Senate Special Committee on Aging, Feb. 24, 27, 28, 1974, Washington, D.C., Senator Lawton Chiles, presiding. Public Law 93-503, Nov. 26, 1974. In addition to the provisions mentioned above, the Act provided 3.9 billion in funding for operating subsidies and 7.8 billion for capital grants over a 6-year period.

993

basis, in workshop structures, seminars, symposia, and informal classroom situations. In testimony before the Committee on Aging, Robert Curry, Training Director of the Community Nutrition Institute, defined short-term training as "learning interventions into the working lives of individuals, which are immediately and directly helpful." Other witnesses recognized the need for both long- and short-term training and appreciate the need for a systematic coordination between the two processes. Walter Beattie, Director of the All-University Gerontology Center of Syracuse University, stated:

Certainly there is a great need for the personnel now directly working with the older persons, who never had any preparation, to have short-term training . . . but we must also pay much attention to the trainers of the trainers, because again as I say in my testimony, so often we have persons of almost the blind leading the blind.*

Despite the obvious need, training programs have faced uncertainty and decreases in funding. With the advent of the Older Americans Comprehensive Services Amendments of 1973 (P.L. 93-29), it appeared that training would receive increased support but as indicated by the following table, long-term training has dropped markedly since 1972.

1 Full amount not to be made available for obligation as part of phase out policy. 2 Full amount included in administrative proposal to be rescinded for fiscal year 1975 (Rescission 75-79 OHD-AoA). 3 To be divided between support of long- and short-term training.

However, in its 1973 budget request for the following fiscal year the Administration attempted to reduce and even withdraw support. A history of the struggle follows:

1973. The Administration failed to request any funding for training in the field of aging in its budget request for fiscal year 1974. The Congress responded by appropriating $9.5 million for training for fiscal year 1974. Administration responded to Congressional appropriation for fiscal year 1974 by directing 10% of the $9.5 million for administrative purposes and dividing the remainder between short and long-term training programs.

3 Testimony before the Senate Special Committee on Aging, "Training Needs in Gerontology," Mar. 7, 1975. Testimony at hearing cited in footnote 2.

1974. Administration failed to request any funding for training in budget request for fiscal year 1975.

Congress responded by appropriating $8 million for training for fiscal year 1975.

Administration responded by proposing a rescission of the total $8 million appropriated for fiscal year 1975.

1975.-Congress responds to proposal by disapproving the Administration's rescission measure, thus releasing the funds to be obligated by the Department.

Administration failed to request any funding for training in its budget request for fiscal year 1976.

This chronology was described by Sen. Lawton Chiles as a "trip around the mulberry bush." He indicated that congressional support of the funding will most likely continue on a year-to-year basis if forced to do so. However, this method of funding relies on one-year grants with no secure support for future planning and expansion. A long-range, structured training program would significantly enhance the possibilities and productivity of both short- and long-term training programs.

II. RESEARCH-A NEW INSTITUTE ON AGING

The goal of the National Institute on Aging will be to provide, through biomedical research and socioeconomic as well as environmental studies, the means to help lessen the burdens that are the accompaniment of longer life. Longer living need not be equated simply with survival. We should strive to improve the quality of life, the style of life. The aging individual can be productive despite many handicaps or diseases to which man is heir. He or she can be an economic asset rather than a national liability."

Dr. Robert B. Greenblatt, President of the American Geriatrics Society, expressed this impressive objective for the new Institute at oversight hearings on "Establishing A National Institute on Aging." Under terms of the Congressional mandate, the new Institute is responsible for "the conduct and support of biomedical, social, and behavioral research and training related to the aging process and the diseases and other special problems and needs of the aged." The Institute is directed to carry out public information and education programs, disseminate findings to the general public, and prepare a comprehensive aging research plan for presentation to the Congress. The focus of this plan has been a major point of discussion with gerontologist and geriatricians throughout the country. There are those who feel that the thrust should be purely biological and biomedical, dealing specifically with methods of slowing down the aging process; or, as Dr. Alexander Comfort describes it "finding means whereby humans would take 70 years to reach 60."

On the other side of the issue, there are those who believe that focusing an Institute's efforts and resources primarily on research related

5 Remarks while presiding over hearings for "Training Needs in Gerontology," Mar. 7, 1975. Testimony before the Senate Special Committee on Aging, "Establishing a National Institute on Aging," Aug. 1, 1974. 7 Public Law 93-296.

to the aging process could cause even greater social and economic conditions.

Dr. Ewald W. Busse, then President-Elect of the American Geriatrics Society, testified:

We are not only obligated in searching for biological explanations, we are very obligated to look at the social and physical environment to see what adverse forces impinge on the individual. So that, in my viewpoint, as the new Institute emerges, it will be very shortsighted not to recognize as we move in the basic science of aging, how we can relate organic changes, social stress, and how the individual functions in society. Hostile features in the environment can be altered to reduce the adverse manifestations of many diseases.8

The direction which the National Institute on Aging will take will be significantly influenced by the Institute's new Director, the Institute's Advisory Council on Aging-which according to the law is to advise, consult with and make recommendations to the Secretaryand on the influence of those in the field of aging who are knowledgeable and concerned about the Institute's role.

Clearly, its goals and means will also be seriously affected by the Institute's budget. The Administration is requesting $16.9 million for the new Institute in its budget request for fiscal year 1976. This is a slight increase over the previous year's budget of approximately $15.74 million (amount transferred from the Adult Development and Aging Branch of the National Institute of Child Health and Human Development plus an additional amount for pro-rated management costs). However, when compared with the budgets of other institutes under the umbrella of the National Institutes of Health, the National Institute on Agina's budget is by far the most limited.

In testimony before the Committee on Aging, the American Gerontological and Geriatric Societies recommended a budget of $49.5 million for fiscal years 1975 and 1976. They reasoned that the staff of approximately 152 of the intramural program at the Baltimore Geriatric Center and the staff of 10 from the NICHD's Adult Development and Aging Branch could be transferred to the new Institute and an additional number of staff could be brought aboard to expand the aging research program. Under the Administration's budget proposal, there could be little if no expansion of the program which had been active under NICHD.

THE CHALLENGE

Dr. Carl Eisdorfer, Chairman of the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington (Seattle) and Chairman of the Research, Development, and Manpower Committee of the Federal Council on Aging, stated in testimony before this Committee:

I take second place to no one in my concern for enriching life and for maintaining the integration, or reintegration of Americans of all ages and backgrounds into the mainstream

8 Testimony at hearing cited in footnote 6. 9 Testimony at hearing cited in footnote 6.