The Multigenerational Garage

firegaragedoor

Multigenerational households are growing in number and that’s a noteworthy trend for an aging population. But, the multifamily garage may be the source for the most vital trend. Today, about 20% of seniors live in a multigen household and their travel patterns do not fit the norm. A travel behavior specialist uncovered an unusual pattern.

But, first, what is leading different generations to live under one household?

On the surface, generations living side-by-side are “made-for-TV”,  like the fictional Ewings of Dallas who lived under one roof on the their expansive Southfork ranch. A recent WSJ story reinforces the growing demand from the well-to-do. They  are remodeling their “Next Gen“ homes with dual kitchens and side-by-side amenities.

MULTIGENERATIONAL TRENDS

But the reality that drives most multigenerational housing is less glamorous.  The rate of household formation among those 18 to 24 and 25-34 has been declining for some time- probably, say researchers at  Pew Social Trends, due to lower paying jobs or the lack of jobs. Meanwhile, the marriage rate in the U.S. has declined steadily, and single people are more likely to “stay at home.” A third factor driving the multigenerational household is immigration- modern immigrants are more inclined to live under one roof.

The number of multifamily homes is growing. In 2008, about 16% of the U.S. population lived in a family household that contained at least two adult generation or a grandparent and at least one other generation (Pew). By 2012, the rate was 18%, and Pew notes that it continues to rise, even as the economy recovers.

The multigenerational household may be a good trend for aging Baby Boomers, but for the current cohort of elders, the signals are mixed. Most analysts have been looking upstairs, and writing about the economic and cultural factors that bring these families together.  But the most interesting story may be in the garage.

ARE MULTIGENERATIONAL ELDERS MOBILE?

Do multifamily households tend to share transportation and does it become easier for the oldest member of the household (seniors) to keep their mobility?

According to travel specialist Nancy McGuckin  transportation in the multigenerational household is quite distinct from other household travel patterns.  She analyzed data from the 2009 National Household Travel Survey- approximately 8% of the sampled households qualified.

A key finding is that compared to all people 65 and older, the elderly parent in a multi-generational household is more likely to have a medical condition that makes it difficult to travel and is unlikely to be a driver. Although over one in five (21%) aged 65 and older do not drive, that rate is three times higher for elderly parents living with their adult children.  In the multigenerational household, 64% do not drive.

The reason these older people do not drive seems to be health related. In the multi-generational household,  51.5% report a travel disability, a medical condition that makes it difficult to travel outside the home. That number is nearly double the 26.7% percentage in the general population.

OF HEARTH, HEALTH, AND HOME

McGuckin’s transportation study points us to an interesting,  but hidden, link between health and home. If the elderly parent owns the multi-generational home, i.e. has title to it, there may be further complications. It would disrupt the younger generation to sell, so these elders will be less able to afford assisted living, a nursing home or additional medical care. In more than one way, they lack for alternatives and are literally, more housebound.

Hence, it would be useful to map the geographical locations of these multigenerational household.   A post World War II suburban home, with a sprawling layout and ample square footage, is likely to be beyond the reach of public transit and the Dial-A-Van. But, it might appeal to a large family needing schools and access to highways (for jobs).  An earlier style of multigenerational housing, the triple decker, often found in New England mill towns, might be closer to a bus stop and walking distance to a hospital.

 

Paratransit for Uber

ride-2Boston Globe, p. A11

Letter to Editor:

3/8/2016

 

YOUR MAR. 6 editorial, “Getting Paratransit up to Speed,” raises vital issues for an aging population. With proposed fare increases looming for the T, there is an urgent need to lower “The Ride’s” operating cost from an average of $45.00 per trip. The editorial notes that about 20 percent of the Ride’s customers need wheelchair-accessible vehicles with trained drivers. Although there is not yet a marketplace to match these trained drivers with passengers, couldn’t Boston help it to develop? This would keep Boston on the cutting edge of progress.

A precedent can be found in Florida, in the Orlando suburb of Altamonte Springs. There, the city officers said it was impractical to provide comprehensive transit service across its sprawling nine square miles. So, beginning next week, they will start a one-year, $500,000 pilot partnership with Uber. The city will pay a portion of Uber fares within the municipality, and for rides to the SunRail station.

Perhaps Altamonte Springs will offer a lesson. Businesses and services will meet new (and old) needs when everyone, including public agencies, go the extra mile.

Healthcare and Transportation-Partners

kidanddr

 

Healthcare and transportation are moving partners. Literally.

About 3.6 million Americans miss at least one medical trip each year for lack of transportation, according to the AARP. This population, says the AARP, is disproportionately female, older and poorer. They view the number of missed appointments as a growing crisis, since the U.S. has a rapidly aging population.  By 2030, the youngest of the Boomers, born in 1964, will turn age 66.

There are different ways to approach the transportation problem, current and ‘booming’.  The obvious question is why people are missing these medical appointments. Is there  something more systemic, beyond the transportation barrier?  But, since our blog focus is on seniors and transportation, we will assume, for the moment, that the self- reported transportation deficiency is the primary reason for missing appointments.

Fortunately, healthcare and transportation are “moving issues”.  In the future, when many more Baby Boomers will have this need- there will be options- even if transportation by autonomous car is still a few years away.

 

OPTION ONE : FOUR LETTERS AND AFFORDABLE TRANSPORT ACT?

The most straightforward transport answer is a four letter word.  “Uber”, “Lyft”, and other services like Silver Ride, are a useful for getting to and from  medical visits  when people cannot drive.  Today, very few seniors use these Transportation Network Carriers (TNC’s) but that will change with the aging of the Boomers, a generation becoming more experienced with SmartPhones..

Although it is not widely publicized, many of the TNCs are experimenting with senior-friendly transportation. They are working with drivers that have handicap accessible vehicles- vehicles that can accommodate the likes of a wheelchair, a walker, or a service animal. The TNCs are also improving their driver training- so that the driver who picks up an elderly or disabled passenger can be prepared to provide escort service to and from the vehicle. These refinements are not happening overnight, but they are being tested and refined in key markets.

Meanwhile, perhaps abetting the TNCs, is a revisit by health care administrators of what transportation needs are covered under the rubric of medical transportation. For 2010, the  AARP tracks Home Care Based Services (HCBS),a Medicare waiver.  ‘Grants’ of nearly $62 million were provided to 65,542 older adults or adults with physical disabilities. The HCBS goal is  to provide medical service medical service closer to home, in lieu of longer patient stays in  institutions and hospitals.  Going forward,  transportation, funded by Medicare and insurance programs, might be used to bring more people “home” as well as back and forth.

OPTION TWO:  WHOM VISITS WHOM

A different way of addressing the missed medical visits, is to turn the issue on its head. Instead of the patient traveling to the doctor, the physician comes to the patient- a return to days of old. This concept is no longer a concierge service for dignitaries and visitors staying at hotels- it is a viable business model.

In the Bay Area  an app called www.urgentmedhousecalls.com advertises urgent care for patients in their home, hotel or workplace. The app notes there are no waiting rooms where patients risk exposure to other bugs or infections.  Another at-home provider, called The House Doctor, cheerfully notes that he/she can arrive with Bijoux, a therapy poodle.

There is also a different solution- the doctor does not quite come to you, but the patient, seeking consultation, does not travel so far either. Call it the middleground.  Just as Amazon has brought a rethink to the retail industry,  a rethink is occurring about the size and scope of medical facilities. One result has been to shift inoculations and wellness to take place in local pharmacies like CVS and Walgreens. Presumably, clients (patients) can walk-in, or drive less, if the store-front is neighborhood based.  

This trend brings  some serious issues  for hospital administrators. Brick and mortar   projects are being evaluated alongside more local outpatient care clinics and ambulatory surgery centers. Beckers Hospital Review says that hospitals have been forced to reevaluate their capital investments and reconsider renovation or expansion plans.  In 2013 there were 37  ” firm” planned hospital construction projects in the works, estimated to cost $50 million or more.  Will they be reevaluated? 

OPTION THREE: TELE + HEALTH + PHONE

There is yet a third model which challenges the transportation paradigm, and may bring a change to the 3.8million missed doctor’s visits. It may, paradoxically, expand the number of visits overall.

It’s called  telehealth- connecting with a physician or a physician’s assistant using video or mobile phones.  It is by no means a new model- the military began using it years ago to serve the armed forces. In  FY 2014, the US Army completed 33,000 patient encounters and provider to provider consultations in 30 specialities.  overseas populations.

Telehealth is coming to Main Street  now that people have SmartPhones and faster video connections.

The Chief Medical Officer for a telehealth app called “Doctor on Demand” describes the advantages: “We’ve (i.e.  medical providers)  made it really hard to interact with the medical industry, and it’s hard to get appointments. It can often take 22 days to get an appointment and patients typically have to wait to see the doctor for 3 or 4 hours- especially if they are in the emergency room or an urgent care office.  The Medical Officer goes on to estimates that 80 percent of ER cases should not be there.   

Visitng the ER room when you don’t need to is a good example of where people travel too far…for too little.

A great deal has been written on telehealth….the key issue is when it will begin to substitute or complement trips to the physician. The simple theory is that people will substitute travel for telehealth. The more complex, and probably realistic scenario, is that telehealth will complement other types of medical visits. Perhaps there will be increased, more routine follow up, or visits will be used for more preventative care.A

SUM UP: NEW TRAVEL COMPLEMENTS

In summing up, there will be many new options for medical transportation- and many complements. In a research project for AARP Policy Institute (2012), Nancy McGuckin and Jana Lynott observed that the largest growth in trip making by Baby Boomers was for medical visits. These visits are not going away, but the number of options is increasing.