Category Archives: travel and the elderly

Elderly Drivers and Autonomous Cars- Linked

Korea-AV
Autonomous Car for Elderly?

 

Elderly drivers and autonomous cars have an oddball linkage. They share some common denominators despite their gaps in years and tech experience. Both the elderly driver and vehicle tech firms wish to avoid accidents at all cost, keep insurance providers out of the mix, and drive more defensively than offensively.

Autonomous cars are being designed for all age groups, not just the elderly, but for a myriad of reasons, they currently  behave on the road more like older drivers. There is a certain irony here since the older driver may say they have less trust in this technology than younger groups, yet be one of the first groups to benefit from using them.

SPEED NOT

Elderly drivers don’t speed for many reasons; they are afraid of being pulled over and, if so, losing their license and insurance, they want to be prepared and able to stop, and they compensate for their slower reaction time. In the same way, the current designers of autonomous cars want to keep rolling- and that means keeping accidents, like the recent Tesla auto-pilot failure, out of the limelight.

Everyone has a favorite story about the old person who barely reaches the steering wheel, gets on the freeway in the middle lane, and then proceeds to be passed on the left and right by speedier vehicles. The older driver is probably going at the posted speed limit, or slightly under it. In an area posted at 65 mph, other drivers might be doing an average of 70 mph leaving the senior in the dust.

The current crop of driverless cars will behave like the older driver- they do not exceed posted speed limits. A self-driving car can be even more exacting- and reduce speed to conform to the posted limits on yellow advisory signs. (Of course, this could change if a rogue programmer decided to ignore traffic laws or tailgate other vehicles).

WEATHER NOT:

On a bad day, a (wise) elderly driver will stay at home- rather than venture out in their car- and for now, so will the autonomous car. By bad day, we mean one where weather conditions, like heavy snow or torrential rains, obscure markings on the road bed, and make it difficult to “see”.  Automotive engineers are currently working on this problem and reducing the number of “stay-at-home” days– testing has spread from sunny California to snowy, cold Michigan and Sweden. But, like the older person who is afraid of sliding off the road in icy conditions, autonomous cars will also need, at least for the time being, to adjust to and accommodate “weather.”  That said, the technology is overtaking the skill set of many older drivers. Autonomous cars are being tested in low-light conditions, and their ability to navigate at dark is improving. For the elderly, and near-elderly, driving safely at night is often a concern.

FUNCTIONAL YES

The third connection between elderly drivers and autonomous cars can be characterized as more of a design factor, less one of engineering. Elderly drivers often favor plain vanilla, sensible, coupes and older model sedans. The sporty “Little Old Lady from Pasadena” is a rare find. Most older drivers do not use their car to make a statement about their lifestyle or income level. They favor functional cars that go from “point A” to “point B”.

The current crop of autonomous cars has the same sensibility. The Google car is said to resemble a jelly bean, and other test models are small and boxy. Function has overtaken form, at least for now. It may portend a sea change: Mobility from “point A” to “point B” will be the goal, and the vehicle that does it will not need to glam with extra trim and chrome. There may be even less glam, more functionality, as  individual/household cars evolve to shared ones.

SUMMING UP:

The elderly are likely to be one of the first markets for autonomous cars- along with other people with limited vision, and handicapped adults who have difficulty driving today. They will not be looking for a sports car, but rather, a way to safely and reliably to get around. The autonomous car will be a safe choice- and a reliable one. It will less resemble a “car” as we describe it today, and more a mobility aid and travel companion. The picture at the top of the blog gives a hint of things to come: this is a Korean designed self-driving vehicle prototype; to some, it resembles a crossover- that is a crossover of  a scooter and a  motorized wheelchair.  

Meanwhile, future autonomous cars may be “cars” in name only. A new type of mobility may be on the horizon- one that is less about sport, as in motor-sport- and more about safety, speed limits, and security. For the present, the person sitting in that slow car ahead of you could either be an old timer, or a  young techie monitoring the LIDAR array.

Autonomous Cars for Boomers- Model 2016

Baby Boomers will be surprised to learn that their personal autonomous car has been invented…and it’s called the “TNC, Model 2016.”

Lest the picture deceive, TNC, stands for Transportation Network Company, an acronym for services like Uber, Lyft, Lift Hero and other ride share firms. Ironically, both Uber and Lyft are investing in the technology for autonomous cars. While that technology is under beta testing….more conventional TNC service will suffice for the coming years.

A SPRAWLING DEMAND :

The demand for autonomous cars, via TNC, has to do with the geographic sprawl of Baby Boomers. This is the first generation to settle far from urban areas, and develop homes without spatial links to transit or rail. Because of sprawl and low density, it has been uneconomical to provide transit service, vis a vis road building. Only 17 percent of Boomers live in dense cities with mass transportation. An estimated 70 percent live in areas served by limited or no public transportation (see references, Chapter One, Aging in Suburbia). The remainder have settled in semi-urban areas, where it has been difficult, until now, to solve “first mile/last mile” transportation issues so most Boomers drive.

Meanwhile, cabs/taxi service has been scarce and expensive; spotting a taxi driving on these suburban roads is like encountering an endangered species in the wild. Currently, the popularity of the TNCs has made taxis even less accessible there. Taxi drivers are said to be circulating less and congregating more in places where there is reduced TNC competition like airports. It would be unlikely that a suburban resident could ever “hail” a taxi- that is flag down a vehicle just passing by through the neighborhood. Yet, essentially, that is what a TNC app, enabled by a smart-phone, makes possible. The TNC may be the leveler between urban and suburban transportation.

OLDER TNC DRIVERS:

Meanwhile, a TNC presence is growing in suburbia… in many cases because Boomers are signing up as occasional drivers. It is estimated that a quarter of Uber drivers are age 50 and older.  Boomers approaching retirement age find that the gig economy provides them with a spare source of income (next avenue). It also helps them get out and meet other people. And, since Boomers are a generation that generally likes cars, and favors time on the road, driving for Uber or Lyft is an agreeable choice.

Meanwhile, Boomers have a growing demand for an “autonomous car” service. Uber even made a promotional video to explain the benefits.

SEEKING A RIDE:

An essential reason has to do with the age of the Boomer population. Today, the youngest Boomers are age 52 and the oldest are 72. A difficulty driving safely at night is one of the first onsets of advancing age.  Yet it is in the evening that people throw parties, patronize the arts and concerts, and go out to eat. One only has to visit the matinee performance of a Broadway show to understand the demographics of those who do not drive after-dark.

So, having a “designated driver” at night is likely to keep Boomers active and engaged…throughout the evening. Although they will not be taking an autonomous car, the TNCs can meet the Boomer’s current need to keep busy and engaged after dark. Over time, the Boomers will seek their “designated driver” for more occasions, expanding from service at night to more daytime trips.

Medical trips are a second arena where the “autonomous car”, via TNC, is making inroads among Boomers. As they age, Boomers need a way to get to and from doctor’s visits, medical centers, and hospitals and these trips are the fastest growing source of their travel demand.  Driving your personal car from suburbia, often to a large medical complex in a more urban area, is not fun. There’s the anxiety about the visit, the set-aside time to park the vehicle, and, of course, and the for-profit, per/hour hourly parking charge levied by most medical centers. But the real crunch, and need for the autonomous vehicle comes during the ride home. The driver, in this case the patient, is probably tired, and may be somewhat impaired by a prescription drug or pain reliever. It would be useful if someone, or something else, bore the responsibility for a safe trip back to suburbia.

MORE RIDES, MORE BENEFITS:

The future autonomous car brings other benefits for aging Boomers who settled in aging suburbs. The autonomous vehicle can be regulated to reduce traffic congestion, obey speed limits, and make the streetscape safer for pedestrians and bicyclists too. That can only bode well for Boomers who need to stay healthy and fit outdoors, without driving to exercise and spending hours at the gym.

It will seem odd to Boomers, who have spent so many years of their lives in their car, that they can now liberate themselves from it. But, as they gain years, they will need to shed old habits. Keeping fit, healthy, and socially engaged will take priority for them over almost anything else.

Cracking the Timely Mile

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“The Timely Mile” is about to be cracked with Lyft’s new program called Scheduled Rides.

The “Timely Mile” is about waiting for a bus or taxi, and fearing that the service will not show up on time. Rather than run that risk, people will choose to drive themselves. Driving takes precedence when you have to get to the airport on time, or show up promptly for an appointment or business deal.

Scheduled Rides 

Lyft has a solution for the “Timely Mile” with a new program. The pilot, in San Francisco, is called Scheduled Rides. It allows riders tap a clock icon and set the desired time for a pickup. Their trip can be scheduled up to 24 hours in advance but cancelled up to 30 minutes before the requested time.

“Scheduled Rides” may seem like a small wave but it has the potential to be a bigger swell. The ability to control  “Timely Miles” can bring new riders, and new opportunities for transit network companies (TNCs).

Today, public transit and walking have become more accessible because the TNCs help sort out the “first/last mile” issues for users. Now, “Scheduled Rides” begins to sort out a different piece of the transportation puzzle. It can help time-sensitive car owners feel less dependent on the need to drive.

Old and Timely

Admittedly, transportation to/from the airport will be first.

Still, one the first markets for “Scheduled Rides” will be seniors. Seniors frequently depend on public transportation to get to and from appointments, but are still reluctant to use Uber and Lyft.  Since 1983, the number of medical trips made by people aged 50 and older has increased fourfold. Yet, transportation options have not kept up. An estimated 3.6 million Americans, of all age groups, miss or delay medical care because they lack appropriate transportation to their appointment.

It is a trust issue for elders, to know when a vehicle is scheduled to come, and when a different one is scheduled for the trip back home. The most needy and dependent seniors are accustomed to scheduling paratransit for medical trips, but there are numerous stories of the paratransit van not showing up on time, or even missing the stop entirely.  Currently, trips made in paratransit vehicles do not tend to serve anyone well… the average cost of a paratransit ride is currently $45.00 in Boston, and elsewhere.  Since the 1970’s, public transit agencies have had to foot the excessive cost of this specialized, one-on-one service.

Older people who use these services have been “conditioned” to book ahead, sometimes as much as a week in advance. When they switch to a program like Lyft’s Scheduled Rides there will be comfort knowing that the trip has been scheduled in advance. And, because so many older people are awkward using their smartphones for transportation, the 24 hour waiting period will give them the opportunity to check and recheck that they made the booking correctly. Over time, they are likely to become more familiar with how to do a successful booking with their phones.

A prediction is that once older people are comfortable and at ease with this process they will be willing taking many more trips on Lyft and Uber. These will be new trips for shopping, leisure, visits, and recreation.

Younger and Stranded

It would be an oversight to think that Lyft’s program only addresses the “Timely Mile” for the elderly. More than likely, the inspiration for the program came from an anxious Lyft employee working at home in the suburbs of Vallejo Ca. or Pacifica, Ca. wondering if they could make a 5a.m. flight from SFO without driving alone.

There are probably similar stories throughout the suburbs. These suburbanites are already registered with a TNC and use it when they work or travel to a big urban area. But, because they reside in America’s far-flung suburbs where public transit is scant, even taxi service can be unpredictable.

It is not to say that Lyft can guarantee that a driver and vehicle will show up in these far-flung suburbs…Lyft has not released the “behind the curtain magic” that powers the Scheduled Rides algorithm. In today’s suburbia, there does not appear to be a driver available for every need at every hour. That, in itself, may be an important reason that both Lyft and Uber are pursuing partnerships with autonomous vehicles. But, until that technology rolls out, having Scheduled Rides stitches closer together the needs of suburban residents and on-demand vehicles.

Lyft seems to be opening a new playbook- one that can blossom into shared rides everywhere/anytime.

Understand Vehicle Trends? Ask a Woman

 

Womens-Favorite-Cars-1024x778

 If you wanted to understand vehicle trends and jumpstart the autonomous car, it is good practice to ask a woman. Although females are underrepresented in the auto industry— they hold only 27% of the jobs in motor vehicles and manufacturing and compose ~14% to ~30% of Uber/Lyft drivers, they have a remarkable ability to spot market niches and trends.  

In a recent blog, we noted that older women will be the “first responders” for autonomous vehicles. There are numerous reasons: women are likely to be living alone in far-flung suburbs, but recognize, at an earlier age their limitations as safe drivers.  Women are also more inclined than male drivers to ask directions (!), to use public transit, and be less wrapped up in an image-driven car culture.

The ability of women to nail transportation trends has a long, if somewhat muted, history.

The electric vehicle (EV) was, and perhaps remains the woman’s vehicle of choice. In 1898, the first woman to buy a car selected an EV and  in 1908 Henry Ford bought one for his wife, Clara. Electric vehicles were favored by women. Although the EVs did not have the range of gas powered vehicles, they were quieter, did not smell of petro, and importantly, were easier to start since gas powered cars had to be cranked by hand.  Since they EVs were used for local city travel, range-anxiety had yet to be invented. There might have been a niche market for the electric car, but the desire for acceleration and range took hold and left the electric car in the dust.

Speed up 100 years though, and we again have women pioneering electric vehicles. According to a recent Forbes Asia story, while Tesla and Apple are (re)working electric car technologies, a women entrepreneur from the Southern Indian city of Coimbatore is pioneering a different segment- electric cycles, scooters, and load carriers.

The entrepreneur, Hemalatha Annamalai, is focusing on the mobility needs in smaller towns. Her customers are farmers, shopkeepers and rural traders. These communities have been overlooked by the big automotive players, even Tata. She has also, per Forbes, developed a battery-powered vehicle for the disabled that travels 16 miles per hour, and has a 25 mile range.

While some might see India as a special case, a female entrepreneur here in the U.S., also succeeded when she identified a new automotive niche. Robin Chase, challenged the model of individual car ownership. Chase, the former CEO and founder of Zipcar, then started a peer-to-peer car service that was sold to Drivy. Chase has never valued speed, style, and beauty over the more basic intrinsic need to get from point A to point B.

Returning to the story of the electric car,  UC Davis researchers noted in 2012 that women composed just 29% of Nissan Leaf owners, 24% for the Volt , and just 16% for the 16% of Tesla S.  When the researchers  studied the driving habits of electric vehicle adopters, they found that women had more anxiety about range. Perhaps their mindset went  like this: “What if…the kids gets sick, what if… grandma needs a ride, or someone asks me for a lift…”.  

The men (and women) designing cars might take note. On the one hand, they can either continue to market gas powered cars with better mileage, or… and this is the clinch…address range anxiety by engineering an easy way to swap out batteries, provide flash recharging stations, or keeping a small petro cache.

There are multiple ways to harness a new technology, and a trajectory of different paths that could be followed. The key is that if women ruled the automotive boardroom (today they are just 16%) and were more influential in engineering and planning, we would probably be on a faster path towards developing a quieter, electric, and fully autonomous car. Even so, we will probably get there, but it will be, ironically,  a slower journey.

 

Boomers Shape Auto Industry Trends

car+phoneBaby Boomers have shaped auto industry trends over the past forty years and they will continue to be influencers. Although America may have passed “peak auto” this cohort has not peaked when it comes to Detroit. The Boomers, currently ages 52 to 70, will have a substantial effect on the types of vehicles that are produced, and provide a ready market for innovation.

The underlying reason has to do with their sheer number, and demographics. Plus, of course, aging-in -suburbia.

AN OLDER, READY MARKET

In 2020 when the first self- driving cars reach the market, the oldest Boomers will be reaching age 75. Safety and mobility issues will be high on their agenda. By 2035, when most new cars are predicted to be capable of driving themselves, the oldest Boomers will be close to 90 and the youngest will be in their 70s.

Polls show that even today, there is a surprising level of interest in the self-driving car among older people. Autonomous cars will find a ready market with Baby Boomers as they grow older or frail. In contrast to other types of innovation, it is the disenfranchised- in this case, those who cannot or should not drive, who could be innovation pioneers. A Google car spokesperson, Chris Urmson, intuited this in a recent talk.

The Boomers differ from other generations in how they think about the need for cars. For this cohort, travel by car is synonymous with independence and well being. This association might have been cultivated by 40 years of popular culture- think images of cars and the good life depicted in TV shows, movies, SuperBowl Ads, and billboards. Having access to a car will continue to be vital to aging Boomers, as the majority do not know of a different lifestyle.

CHANGING THE OWNERSHIP

Meanwhile, as the autonomous car both prequels and propels mobility, there is a second trend that the Boomers will need to assimilate. Although Boomers may be accustomed to owning or leasing their personal vehicle, they are likely to discover, and prefer, a different business model.

Rather than owning a vehicle that sits idle 96 percent of the time, Boomers and other users will transact mobility with their cell phones in order to order a trip-based vehicle. Even in the suburbs, cars might evolve into a “travel-on-demand” service. This radical change has benefits for older people, who no longer need to buy and maintain a vehicle, and bear rising insurance costs. A car-on-demand will help ensure safer travel in a state-of-the-art vehicle. And, in keeping with their reverence, the car-on-demand might turn out to be stylish and luxurious too, a vehicle that can reflect their personal tastes, as well as the more basic need to travel.

EMPTY GARAGES AND FULL TRIPS

Meanwhile, imagine the emptiness of the suburban home with its capacious two- car garage and 400 to 600 square feet of open space. Planners have begun to talk about repurposing the parking spaces that the autonomous car will free up (up to an estimated 24% of the area in U.S. cities) but they have not paid attention to the more lowly suburban garage.

Boomers have had a love affair with the car throughout their lives, and current data suggests that they are not cutting back on their driving as they age. This is the generation that has innovated with cars in many ways: they ushered in the two car family, vastly increased VMT (vehicle miles traveled), and substituted vehicles for short trips instead of on bike or foot.
As they get older, the Boomers will continue to be the generation on the forefront of automotive change. As their age and infirmities bring new mobility needs, the automotive industry (and tech firms) will find this generation to be ready first-responders.

Slowing Down is Age-Friendly

texting-while-driving

“Slowing down” is an age-friendly expression. But what if slowing down could actually be a good thing, and helped you live longer and better?

In the case of Aging and Transportation, slowing down, the traffic that is, carries benefits. 2015 was the deadliest driving year since 2008 with an estimated 38,300 deaths, and 4.4 million serious injuries (NHTSA data). While it may be coincidental, the four states that saw the biggest percentage rise in traffic deaths also have a surging population of aging Baby Boomers, namely Oregon, Georgia, Florida, and South Carolina.

Slowing down traffic speeds is particularly vital for aging Boomers, and others needing to cut back their driving. A primary reason is that reduced speed helps the older driver feel safer on the road, and it reduces the likelihood of injuring himself or an innocent bystander.

A car trip that takes them a few minutes longer will not be viewed as a deterrent. Here is the reason:

If a pedestrian is hit by a speeding driver at a default speed limit of 30 miles per hour (mph) there is a 30 percent chance that person will die. That number goes up to 80 percent if the driver is going 40 mph. At 20 mph, a safe speed limit for an urban area, there is a 98% chance the same pedestrian will live.  

A related reason for Boomers to support “slowing down” is that when roads reduce speeds they then become safer for all other transportation modes. In recent years the mode share for bicycles, walking, and transit has accelerated, particularly in urban areas. Although Millennials have led this trend, it bodes well for older people. Bike lanes and wider sidewalks unlock the streets to new modes. For seniors, this may encourage more travel on bike as well as short trips via battery operated scooters, small electric vehicles, golf carts, and other variants. Slower road speeds make these alternative vehicles more likely.

A third reason that slower speeds matter has to do with reaction time- an AAA site notes that during each mile driven- the average driver makes about 20 major decisions. Drivers have less than one-half second to react to avoid a potential collision. With advancing age, drivers have to manage slower reaction times, and often decreased muscular flexibility.  A lower speed limit gives the older driver a fraction of “time” to deal with the cognitive flood.

Meanwhile, there is a growing safety problem that plagues drivers of all ages. It is called “distracted walking.” Pedestrian injuries are spiking as more people walk, but are distracted from the pavement by their electronic gear and smartphones.   Lowering the speed limit gives drivers more time to react to something that crosses their threshold, like a pedestrian oblivious to a right turning car.  At some point the older pedestrian will be the one to amble, and the lower speed limit might help them safely transverse a wide, busy street.

“Slow” driving- an upper speed limit of 55 on the freeways, was introduced by the federal government in the 1970’s as a fuel saving measure, but raised to 65 mph in 1987.  Then, in 1995 Congress repealed the law, and returned the speed limit setting authority to the states.  Faster speed limits are the province of truckers, big states with dispersed populations, and anti-regulation groups.  The need for speed has also played well with advertisers that link fast cars to concepts like independence, performance, and sportiness.

But, “slow speed” is making a return, as it did in the 1970’s. This time it is an urban initiative. There is currently a council proposal to lower speeds in Boston, Mass. New York City lowered its default speed limit from the standard 30 mph to 24 mph in 2014.

Lowering the speed limit has more precedents. Drivers are accustomed to honoring reduced speeds around schools, hospitals, and in certain residential neighborhoods with school age children. Boomers can be pleased that their grandchildren are protected by lower speed limits in these special zones.

These same kids might be pleased if Grandma and Grandpa received equal protection. With a modicum of technology, cars can be programmed to travel at the posted speed and a smart chip can display speeding violations, or record them for a driver’s insurance company or “guardian.” Slowing down cars is now feasible- it is the driver’s who must also be won over. That may not be difficult since 21 percent of those  age 65 and older do not drive. The Boomers, who have isolated themselves in car dependent suburbs, will need to find ways to stay-on-the road.

The Multigenerational Garage

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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.

 

Healthcare and Transportation-Partners

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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.

Hollywood Meets Autonomous Cars

connected_mobility_web-grafik_en_02__mediumHollywood has prepped us for the autonomous car. It’s just that the message was subtle and it took a while to register.

In countless movies and shows, we witness the ultra-wealthy whisked away in black limousines and chauffeured vehicles…to consummate cliff-hanging phones calls and business deals from the back seat.  Another vivid Hollywood image is of stretched limos and tricked out Hummers occupied by jubilant rock stars and celebrities. Inside the blackened windows, we imagine an ongoing party replete with food, drinks, and more.

It is not clear that image of  the black car or the stretched limo  well describe our future autonomous cars, but they do provide context. In fact, a recent Ford motor executive commented on a future that looks like the movies.  At the 2015 LA auto show, Sheryl Connelly, said the future cabin could become a productivity capsule, helping people move with their office. Or, she noted, the car could be a place that shields people from incoming calls and email,  where they relax in comfort until they reach their destination.

Millennials and Baby Boomers are “miles apart” in their expectations for self-driving cars. A Carnegie Mellon survey polled 1,000 respondents  respondents about  what they would  do with the free time when the car took over the driving duties. Baby Boomers said they would read more. It is noteworthy that older respondents said they’d appreciate the increased safety provided by self-driving cars, especially at night, in heavy traffic, on unfamiliar roads or on the highway.

Younger people  had a different take: they dreamt of hosting mobile parties, eating lunch in the car, putting on makeup, and, of course, doing work. Perhaps the youngest  Millennials  watched a lot of Hollywood movies. Or, perhaps they saw the future and decided to claw back 50 minutes a day. 

The average commute time in the U.S. is 25 minutes. This does not include additional minutes spent searching for a parking space, parking, and walking the final leg.  And, at the end of the day the commuter turns around and does it all again….Often in a slog of afternoon or evening traffic.

This has not gone unrecognized. A recent report, circulated at the LA Auto Show, suggests that there is a relationship between time spent in congestion and interest in autonomous cars. In India, 85 percent of the surveyed population saw themselves using autonomous cars, while this figure in the US was 40 percent. People in crowded cities where parking space is scarce, waste hours in  traffic each day, so they see the immediate benefits of  the autonomous car. Note that the actual sample and statistics for the survey are not provided in the link.

Baby Boomers, a generation that celebrated driving, have routinized the commute- and found “audio” things to pass the time. They have been party to a succession of entertainment features, from over-the-air radio, 8-track cassettes, CB radio, CD players, and now, Sirius radio over the Internet.  But the phone, whether handsfree or handheld, has had more impact, and may accelerate the need for driverless vehicles. The National Safety Council’s annual injury and fatality report, “Injury Facts,” (2014) observes that the use of cellphones causes 26% of the nation’s car accidents,

Millennials have  taken it one step further and sought transportation options that let them take their hands and eyes off the wheel.

This may partially explain why they are the first generation to delay getting their drivers’  license, and to favor urban areas and  public transit.  Millennials have been the first to embrace Uber and Lyft,  although their elders (The Boomers) are now following suit. Millennials “get”  the benefits of autonomous cars, particularly the environmental impacts. But, the driverless feature may be of greatest significance for anyone who uses the phone while driving, and for aging Boomers, the elderly, and the disabled.

It may take a while before government indexes – the measures that capture GDP and Productivity catch up with what we are doing in our cars. Maybe the mobile office will let people work an extra hour or two everyday, as the Millennials wish. Or, eat on the go, literally. Perhaps  there will just be more time for games, downloads, and chat. If it turns out to be about entertainment, Hollywood will continue to inform us of  entirely novel things we can do in the confines of a moving vehicle.

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The Autonomous Car: Double Blessing for Boomers

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The Autonomous Car will be a double blessing for Baby Boomers, the generation that is currently between ages 51 and 69.

Transportation experts know that the autonomous car is well suited to aging Baby Boomers, because it will keep them mobile, and enable them to travel- even when their health or eyesight fail. This is an essential problem, since even today 21 percent of the population over 65 does not drive.

The double blessing is more subtle. As people age, they have basic needs to get outdoors, to exercise, amble safely, and stay on their feet.  Older American tourists often comment that they walk extensively when they travel abroad, but have difficulty continuing the habit at home.  

MAKING STREETS SAFER..FOR PEDS

Here is where the autonomous car will help- by making the streets safer for all users, not only for drivers, but also for pedestrians and mobility devices, like the street legal scooter. Traffic engineers seem to design streets with the reaction times of an average 40 year old in mind. But, with an aging population, there are new baselines for the autonomous car to accommodate.

For example, an elderly person may require more time to cross a busy street. The elderly person may be tired, slow on their feet or riding a scooter.  At a busy intersection they may find the standard 15 or 30 second pedestrian walk cycle to be daunting. So, through no faulty of their own, they are stranded in the intersection when the light turns green. A car operated by a human driver will honk, swerve and hopefully, slide to a stop. The autonomous car will detect a pedestrian (age neutral) in the intersection and not move.

FIRST MILE/LAST MILE

The autonomous car accommodates this. Another need that comes with age is  “first mile/last mile” assisted travel. Older pedestrians may have the best intentions to get out, walk about, and keep mobile but first they need to get to a safe place… with sidewalks. Many Boomers, who plan to age-in-place live in modern suburbs that lack sidewalks, walkable paths or trails. They must first travel by car to reach a safe place to exercise. But what if they are not capable or able drivers? The autonomous car will help them cover the “first mile” and bring them to the walking track.

STREET LEGAL VEHICLES AND THE DARK

There is a third transportation baseline. A growing number of users, mostly older,  employ street legal electric scooters, electric driven wheelchairs, and in the future “Uni-Cub/Honda” like robots. Operators of these devices, riding on public streets, know how dangerous it is for them to co-mingle with bigger vehicles. In the daytime their mobility vehicles are barely registered by regular drivers, and at night they seem to be invisible. The NHTSA (see link below) reports that 72 percent of pedestrian fatalities take place when it is dark outside. The autonomous car will make mobility safer for riders of scooters and wheelchairs. It will detect them in all lighting conditions, and faster than human-drivers.

In the current configuration of sidewalks and city streets, older pedestrians face many risks. The risks come from driver’s who do not obey speed limits, drivers distracted by phones and dashboards, and simply human error.  The National Highway Traffic Safety  Administration  (NHTSA) reports that in an estimated 94 percent of crashes, human error is the critical cause. Vehicle related factors are the critical reason in only 2 percent. They report that in 2014 there were 4,844 pedestrian deaths, and 66,000 injured.  On average, a pedestrian was killed every 2 hours and injured every 8 minutes in traffic crashes. (Note: across all age groups). Two final numbers: Nineteen percent of the pedestrian fatalities in 2013, and an estimated 10 percent of those injured were people 65 and older.

THE DIFFUSION CURVE.. SAFE, THEN SAFER!

The autonomous car has a diffusion curve of some import. As more of these vehicles substitute for conventional cars, there will be fewer accidents between cars, and reduced pedestrian/biker/scooter collisions. Then, at some “tipping point” when autonomous cars outnumber conventional vehicles, the safety factor will grow exponentially as the rules of the road change. The results could lead to lower speed limits, reduced travel lanes, safer curb cuts, and the like. Streets will be less dangerous and more functional for both cars and people. Hence the double blessing.

This is only good news to an aging Baby Boomer population. Boomers are known as a  generation that continually reinvents itself and “rethinking mobility” can be their last and greatest reinvention. There is no reason to expect Boomers tol remain wedded to cars with steering wheels, when an autonomous car promises to extend the longevity of their “vehicle years.”  Even more importantly, the autonomous car will extend the longevity of their “non-vehicle years” and help them get out and about as pedestrians.