1. The Business of Coordinated Transportation

The objective and daily task for a coordinated transportation system is to assemble the wide variety of individual requests for rides for the following day and create efficient, effective routes. The passenger takes some responsibility in this process as well; systems usually require flexibility from riders, including a time "window" in which their pick-up is considered acceptable.

Every day, employees of coordinated transportation systems report to work to "do it all over again" - to plan and deliver high quality, safe, productive, personalized transportation service for members of the community who would otherwise be homebound.

The process of assembling productive routes is difficult and time consuming, complicated by the unique characteristics of both the supply - our tools and human resources - and the demand - our passengers and their trip requests. The following section will discuss some of those unique characteristics.

1.1 Coordinated Transportation Systems - Consumers

Many passengers using coordinated transportation services in rural areas are able-bodied men, women and children going to work, school, or the market. However, a significant portion of riders is not as capable of using the service.

Coordinated transportation passengers include persons with ambulatory issues, including dependency on wheelchairs or walkers, crutches or other aides. Some passengers have knee joints that cannot bend, thus making bus or van steps impossible. Some have physical weaknesses, or are very frail. Others deal with vision, speech, and hearing impairments.

Less obvious forms of disability include respiratory illnesses, kidney failure, incontinence, emotional, cognitive or mental disorders, dementia, and disorientation. Some passengers must adhere to strict medicine and/or eating schedules.

When planning service for a passenger, schedulers must take into account not only the individual passenger's special characteristics, but the special characteristics of his individual trip as well. Consider, for example, the possible combinations of factors that must be juggled by a scheduler attempting to assemble efficient yet responsive routes and schedules.

It is important to note that in addition to a coordinated transportation system's consumers, there are many other beneficiaries of this service in the community. Systems must constantly work at its relationships with these beneficiaries, nurturing as many partnerships as possible. These partnerships are critical to a number of the difficult issues that systems routinely face, especially issues of responsiveness. Some community beneficiaries include:

• Families and caregivers of passengers
• Health, social, and community care service providers
• Local businesses and services
• Elected officials and community leaders
• Local employers

Consider as an actual example how the special characteristics of one beneficiary - a passenger's caregiver - can impact a coordinated transportation system's daily processes. A woman with a full-time job also cares for her mother with Alzheimers. The rural coordinated transportation service picks up Mom each morning and takes her to an adult day care program. Mom cannot be left alone at all because she wanders, so the woman cannot leave for work until the coordinated transportation vehicle arrives for Mom. Mom's pick-up time varies depending on the number and location of other pick-ups that driver has assigned to him on any given morning. Conversely, the woman must be home in the afternoon before Mom is dropped off, otherwise Mom is returned to the day care center, which charges a "late pick-up" penalty.

In another actual example, a man in a rural community with a full-time job and family responsibilities has an adult brother with a cognative disability living with him in his home. The man has been working hard with his brother to help him lead as independent a life as possible. Each day the coordinated transportation system transports the brother to and from a vocational rehab center which the brother refers to as his "job."

In each of these cases, the dependability and integrity of the coordinated transportation system has a very significant impact not only on the lives of its passengers, but on their caregivers and family members. The quality of the coordinated transportation service will determine whether a mother with dementia or a brother with mental disability can continue to live and interact as part of the community.

1.2 Types of Trips

In coordinated transportation systems, some portion of the day's business is repeat in nature. Passengers call to arrange a ride every day to work, or every Thursday to therapy, or every Wednesday and Saturday to a volunteer assignment. Systems refer to these types of trips as "repeaters," "subscriptions," "standing orders," "reruns," etc. Rerun trips can represent from about 30 to 70 percent of a system's volume.

The balance of the business is random in nature, and very likely to be very different on any two days. A passenger requests a ride for a medical appointment, a banking errand, a special event being held at the library, etc. Following is a list of possible "destinations" served by coordinated transportation systems:

• Medical, including regular appointments, appointments related to a hospital stay, therapies, dialysis, outpatient mental health, substance abuse clinics, etc.
• Nutrition-related, including grocery shopping or senior centers with hot meals
• Vocational rehabilitation or workshops
• Education, including vocational training
• Employment, including Welfare-to-Work initiatives
• Volunteer workers, to and from the work sites
• Day care, for elderly adults, cognitively impaired, special needs children and children of working parents
• Socialization, recreation, visiting, local events, etc.

Coordinated transportation systems often face the issue of "prioritizing" trips by purpose, especially in systems with more demand than supply. This is a sensitive problem that often causes bad publicity for the agency. It is obvious that trips that are life-sustaining in nature, such as kidney dialysis trips, can be considered top priority. Beyond that, any ranking will be subjective.

Consider, for example, two requests for rides:

• An elderly man going to his primary care physician for an appointment
• An elderly woman going to the local beauty salon for a "wash and set"

At first glance, most would agree that the gentleman's ride to his doctor appointment would be more important than the beauty salon trip. But would the scheduler assembling tomorrow's rides, with limited resources, know that:

• The gentleman's appointment is a weekly trip to his doctor for a B-12 shot, which many physicians would claim to be superfluous
• The woman's appointment would be the first time that she is able to have her scalp and hair washed in seven weeks because she is too frail to handle this job alone in her home

To avoid the pitfalls of ride prioritization, many systems establish a "first come, first serve" policy. Other systems "black out" certain hours of the day for medical, employment, day care and education trips only.

1.3 Levels of Service

The levels of service provided by a coordinated transportation system can be as diverse as the types of trips they provide to their consumers. Levels of service can be viewed as a continuum, from very basic to very complex, as depicted in Table 1.

Systems must choose which levels of service they can afford to provide, and frame policies and procedures around their decision. Service levels may be dictated by Federal or State regulations, or may be shaped by the system in cooperation with the community.

Determining appropriate service levels for a given community is a balancing act, trading levels for cost. For example, a community may be willing to forfeit "same day service" to assure "door-to-door service." Once determined, service levels, or system parameters, must be clearly and consistently articulated to passengers and communities. In times of financial hardship, coordinated transportation systems have reduced service levels until funding/financial security is restored.

1.4 Administrative Structure

Coordinated transportation service is delivered through a variety of administrative models. Systems can be non-profit or for-profit corporations, departments of county or city government, or transit authorities.

Systems can choose to provide the service directly, keeping these functions "in house:"

• Human resources: hiring, training, certifying, disciplining, evaluating, etc.
• Vehicles: buying, insuring, maintaining, replacing, etc.
• Trip scheduling: call-taking, scheduling, dispatching, billing and accounting, etc.
• Marketing, strategic planning, passenger and community relations, etc.

Systems can choose another model of service delivery, acting as a lead agency, for example, taking primary responsibility for coordinating services among a number of systems, or serving as a broker with responsibility for accepting all trip requests and allocating these requests to other systems under contract.

A coordinated transportation system's administrative structure will determine its level of involvement in day-to-day operations, specifically the function of assembling and scheduling the community's request for service.

1.5 Equipment

A system's vehicle inventory is at the crux of the system's "supply." It is the first determination of how much service can be provided, and when.

Coordinated transportation systems experience the same peak-hour phenomenon as fixed route and school bus systems. All available vehicles will be deployed during the conventional peak hours of 7 to 9 a.m., and 3 to 5 p.m. During the off-peak hours, the same number of vehicles may not be needed, but the specific characteristics of certain vehicles may be called for. Examples of vehicle characteristics affecting their scheduling include:

• Capacity for both ambulatory seats and wheelchair tie-down locations
• Hydraulic lifts or ramps for boarding wheelchairs and passengers unable to handle bus steps or stepping up into a van
• Location of wheelchair tie-down "seats"
• Ability to safely handle child car seats, oversized wheelchairs or motorized scooters
• Requirement for a professional CDL licensed driver
• Size, and ability to negotiate narrow and/or steep driveways and roads, or in the case of some converted mini-vans, ground clearance
• Compliance with appropriate regulations, such as the Americans with Disabilities Act

Coordinated transportation systems depending on federal and state capital grants for vehicle replacement must plan strategically. Procurement cycles can often take an average of 18 months.

1.6 Driver Characteristics

While the vehicle inventory is the first factor when determining a system's ability to provide service, the characteristics of the system's drivers will make or break the efficient, effective use of the vehicles.

Coordinated transportation systems have to have a supply of trained, competent drivers willing to handle the vagaries of coordinated transportation: little predictability to their schedules and assignments, passengers with an assortment of special needs, and in most cases, a wage that is less than competitive.

These drivers will most likely be subjected to drug and alcohol testing on a pre-hire, random, post-accident and reasonable suspicion basis. They will often be required to push and pull heavy wheelchairs up and down some number of steps. They must be able to brave all kinds of weather conditions. They will have to keep their concentration on the road, in spite of a half dozen youths with emotional disorders on board, being transported to a special after-school therapeutic program. They must be adept at securing wheelchairs and motorized scooters on vehicles that have a variety of different lock-down systems. They may have to have a CDL or other special license to drive specific vehicles. And at some point in their day they will want and need a lunch break.

Coordinated transportation systems have had great success with hiring mature workers, i.e., men and women who are 55 years and older. As drivers, these men and women have proven to be:

• Very good drivers with low preventable accident rates
• Compassionate towards their passengers
• Reliable with good on-time attendance
• Working more for job gratification than financial security

However, mature driver pools present challenges when attempting to assemble productive routes and schedules. Older men and women often have physical limitations that prevent them from handling wheelchairs on steps or from driving after dark. They may opt to drive only a certain type of vehicle with which they are comfortable. They may be resistant to training and testing for a CDL license.

Ideally a coordinated transportation system could integrate mature workers into their driver forces to benefit from their positive contributions, in spite of the fact that this would require more flexibility in the routing and scheduling process. Systems must determine at what point its schedulers can no longer integrate yet another "special characteristic" into their process of assembling efficient routes and schedules. As with differing levels of service discussed above, coordinated transportation systems must be clear and consistent when articulating driver expectations.

1.7 External Influences

Over the years, coordinated transportation professionals have observed a significant impact on their service related to the changes in the health care field in the '80s and '90s. A single medical "episode of care" would involve a ride to the hospital for admission, and a ride home following discharge - two one-way trips.

Today that same episode may involve as many as 16 or 18 one-way trips

• to the hospital for pre-admissions testing, then home
• to the hospital for "same day surgery," then home
• a return to the hospital the following day for an appointment with the surgeon, and home
• to the primary care physician's office weekly, for four weeks, for check-ups, then home
• to the surgeon one month later for a check-up, then home

Changes in our health care delivery systems have impacted the demand for coordinated transportation service, as well as the levels of service that we offer.

Transporting a patient home from same-day surgery may call for a different level of care than transporting that same person home after a 4- or 5-day hospital stay.

The local economy and its resulting unemployment rate also affect the coordinated transportation systems. High unemployment rates usually offer systems a rich labor pool for drivers, dispatchers, etc. at reasonable wage rates. The low unemployment rate experienced in recent years in many areas forced coordinated transportation systems to be more creative with their employee recruiting and retention efforts, and to consider more realistic "livable wages," with a dramatic impact on operating costs.

State and federal programs are another significant external influence on coordinated transportation systems. Often a system bases its service parameters on requirements of a state or federal program. Such programs can be the "critical mass" that affords the community the opportunity to establish and build coordinated transportation service; sometimes the programs are simply an incremental contract for a system, with new service simply integrated into existing service. Two large national programs warrant noting:

1.7.1 ADA Complementary Paratransit

With the passage of the Americans with Disabilities Act in 1990 came a mandate for public transit authorities across the country to make their fixed route services "accessible" to persons with disabilities. The Federal Transit Administration recognized that in some cases disabled passengers would be unable to use fixed route services, no matter how accessible. Thus "complementary paratransit" service was mandated, requiring fixed route transit service operators to make demand responsive service available to eligible persons with disabilities who live within a 3/4-mile band on either side of all fixed routes. The ADA Complementary Paratransit Program has a very comprehensive set of regulations and service parameters which usually exceed any demand responsive service already established in an area. Often these regulations become the defining parameters of any system participating in the transit authority's program as a contractor. Rural coordinated transportation systems providing fixed route service must comply with all regulations as well.

1.7.2 Medicaid Transportation

State offices that administer the Federal Medicaid Program are required to provide free transportation for Medicaid-eligible persons to access medical services. The programs vary from state to state, but at a minimum, a combination of personal reimbursement and demand responsive services are offered. Like the ADA program, the Medicaid transportation programs have specific requirements on service parameters that apply to all participating transportation providers.

1.8 A Balancing Act

In the previous paragraphs we looked at some of the "special characteristics" of the components of coordinated transportation:

All members of the coordinated transportation team, from the drivers to the governing board, must keep their focus on a very delicate balancing act. Each day the team must attend to and accommodate the "special characteristics" described above within the framework of its principle values:

• Safety - the passengers, the drivers, the office employees
• Responsiveness - is the product delivered by the system what the community needs?
• Quality - on-time performance, driver and staff courtesy, vehicle cleanliness ... would the community be willing to support and defend this service?
• Productivity - is the system making the best use of its resources to meet the need? ... Can the system defend its trip/vehicle hour measure?
• Profitability - "there is no mission without a margin" ... will the system still be around in 3, 5 or 10 years to provide this necessary service to the community?
• Satisfying work environment - are employees generally productive, and gratified by their contribution? Can the system recruit and retain the quality and quantity of employees needed?
• Accountability - are agencies who are buying rides for their clients and patrons comfortable with the trip billing, accounting and reporting processes?