What to know
Recipients of the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities grant are telling success stories of how they are addressing COVID-19 related health disparities and advancing health equity through programs funded by the grant.
Overview
With funding from CDC’s COVID-19 Health Disparities Grant, the Connecticut Department of Health funded Geer Senior Services to expand an on-demand transportation pilot program to a rural community with older adults who needed better access to health services. The program was designed to address non-emergency but vital rides that older adults could use to meet basic healthcare needs. The Connecticut Department of Transportation continues to fund and provide this on-demand rural transportation service.
Challenge
During the COVID-19 pandemic, the Connecticut Department of Health identified a lack of transportation and reduced access to healthcare and basic services in rural Northwest Connecticut where distances to healthcare services are greater than in suburban and urban areas of the state. Public transportation in this part of the state is also limited, and most towns do not have access to bus services or on-demand ride options, such as taxis, Lyft, or Uber. Although Non-Emergency Medical Transportation (NEMT) and some shuttle services exist, there are barriers to use these services, such as 48-hour advanced reservation requirements and lack of reliability.
The COVID-19 pandemic highlighted the needs of isolated and immobile adults in rural communities. In the early stages of the vaccine rollout, older residents were the first to be vaccine-eligible, but the vaccine access points were limited to urban centers, which were challenging for rural communities to access. This coincided with winter, which is typically more severe in Northwestern Connecticut. In addition, like the other New England states, Connecticut is an aging state, and the Northwest Connecticut demographic skews older than the rest of the state.
Older adult populations facing multiple disparities often forgo care if the barriers to access are too high, leading to higher incidence of disease and premature death from preventable causes. By increasing transportation services for our older adult populations in rural communities, access to healthcare and basic social services is enhanced, thereby improving health equity.
Geer Senior Services, a nursing home and assisted living provider, saw a need for expanding transportation access by creating on-demand services for older adults in rural Connecticut. Their goal was to make accessing services as easy as possible since an older individual is less likely to continue to use services if they are presented with barriers.
Solution
With funding from CDC's COVID-19 Health Disparities Grant, the Connecticut Department of Health funded Geer Senior Services to expand an on-demand transportation pilot program to a rural community with older adults who needed better healthcare access. The program is designed to address non-emergency but vital rides so that older individuals can meet their basic healthcare needs.
Eligibility criteria included people over 60 years of age, and those under 60 years of age with a disability. Program pre-enrollment was also required. Early data showed heavy utilization of the program in the first weeks and months of an individual's enrollment, tapering off to a lower-volume periodic use, suggesting that users were availing themselves of care that they had put off.
How CDC Health Disparities Funds were used
Funding from CDC's COVID-19 Health Disparities Grant was leveraged primarily for van drivers' salaries, vehicle operation and maintenance. Rides began on March 28, 2022. The following steps were taken to ensure program success:
Hiring and training of drivers
- Complete installing and testing of new software to manage the service
- Setting up of new phone and web systems to accept new riders
- Implementing new rider intake system – both phone and web based
- Conducting outreach to social service and health service partners, housing authorities, senior centers
Impact
By funding and supporting Geer Senior Services, an agency that is local and already invested in the community, users reported high satisfaction and receipt of high-quality services. Transit was reliable and on time, drivers were courteous and accommodating, and local organizations that promoted the service were very pleased to have this service for their clients. Data for the program shows that nearly 6,000 rides were provided, and 453 individuals were served.
Several riders have left testimonials demonstrating the benefit of Go Geer On-Demand Rural Transportation Program. One rider, Ingrid, states that she is "overwhelmed of happiness that [Greer Services] can come and help us because this was a real help today." Another rider, Gregory, highly complimented his driver who was "cordial, courteous, and a tremendous asset to [the] company" and notes that he hopes to "get in contact with [Geer Services] again and utilize the service because it really helped [him] out a great deal."
Another testimonial from a local mental health agency highlights the freedom and ease riders feel when utilizing this service:
"Go Geer has been life changing for so many of our clients who have transportation barriers in this area. Since Go Geer was introduced to us last year, the individuals that we serve have been utilizing Go Geer regularly and it has increased their confidence and independence."
Intake and education of the providers and riders was intensive and took time and patience. During initial training and testing of the drivers and systems, the drivers themselves also conducted outreach to providers to make introductions. This helped to reduce barriers, create a comfort level with the program and provide reinforcement.
It is always difficult for the riders, many of whom are older and/or disabled, to access mainstream transportation. The riders needed significant support from their caseworkers or the dispatching staff to learn how to use the service. The riders are appreciative and relieved they can now get and keep healthcare appointments that were previously difficult to access.
The following partners were important to ensure they were reaching underserved populations: a community action agency, Federally Qualified Health Center, behavioral health providers, and an agency for people with disabilities. Meeting regularly with other transportation providers, the Northwest Hill Council of Governments, and the Northwest area Mobility Manager to coordinate transportation services throughout the NW corner of the state, also contributed to the success of this program.
The start-up funds from Connecticut Department of Public Health and CDC's COVID-19 Health Disparities Grant provided the ability to demonstrate the need and ramp up services during the pandemic. The program continues through the Connecticut Department of Transportation.
Lessons Learned
- Some riders who use this service tend not to have smart phones and therefore still rely on calling the dispatch office to reserve their ride. This is more staff intensive than anticipated, as Go Geer staff had planned to educate riders on using the app.
- Processes needed to be tweaked and improved over time. For example, hours of operations were changed to better meet the needs of riders.
- Having the software tools and the ability to closely communicate via technology with the driver was key to making this program successful.