A Report by the Sarnia/Lambton Health Transportation Working Group to
The Erie St. Clair Local Health Integration Network for
A Unified Health Transportation Service in Sarnia/Lambton Appendix
November 2013
Appendices
Planning Documents 1. Sarnia/Lambton Transportation Working Group Terms of Reference 2. Sarnia/Lambton Transportation Working Group Work Plan 3. Sarnia/Lambton Transportation Working Group Communication Plan 4. Sarnia/Lambton Transportation Working Group Contact List 5. Erie St. Clair LHIN Vehicle Replacement Policy 6. Transportation for Health Services in Sarnia Lambton - Constitution
Presentations 7. Lambton Elderly Outreach 8. Lambton County Developmental Services 9. Canadian Red Cross 10. Family Services Kent 11. Easy Ride 12. Cancer Society 13. MetroLinx
Reports 14. Dillon Report 15. Lambton Lift 16. Toronto Ride 17. Toronto Ride Memorandum of Understanding 18. South West Proposal 19. County of Simcoe Survey Results 20. NSM LHIN Transportation project 21. Eric Marr Thesis 22. OTN Listing 23. The Road Ahead 24. Canadian Red Cross and Lambton Elderly Outreach Memorandum of Understanding 25. Transportation Survey
59
DRAFT
Terms of Reference for a Sarnia/Lambton Health Services Transportation Working Group
Vision The Sarnia/Lambton Transportation Working Group will establish an integrated transportation system for health services in Sarnia/Lambton. The working group will strive to achieve this goal through a process that: 1. Brings together those agencies providing transportation services for medical, health, and social services in Sarnia/Lambton. 2. Unifies advertising and promotion, nature of service, fee structures, dispatching, software, fleet operations, routes, revenue/costs, client profiles (health/social) and other information that is required to provide an integrated service. 3. Builds a comprehensive understanding and knowledge of tthe transportation services in existence and requires a collaborative relationship amongst providers. 4. Identifies problems, overlaps, duplications and aany challengges or obstacles being faced both now and in the near future by the providers. 5. Examines various options or “models” for achieving an improved and integrated transportation service. 6. Proposes a model that most effectively serves the client population of Sarnia/Lambton. This includes criteria that should be met by a new service. 7. Provides a community engagement process that includes the working groups findings and stakeholder feedback. From the information gathered, the working group will rrecommend an organizational framework that achieves a more efficient and integrated transportation service for clients and patients. It will also recommend a methodology for surveying from time to time the users, stakeholders, and the public on the effectiveness of the new transportation system.
Current Challenges The following highlights some of the current identified challenges: A combination of factors, including an increasing demand for health transportation, together with a limited supply of funding (respecting service accountability agreements prohibiting deficits), has resulted in health service providers limiting theiir transportation subsidies or limiting their transportation service. Changing demographics, settlement patterns, rising costs, and provincial health care policies present unprecedented challenges in the delivery of health care services. The City of Sarnia’s concern surrounding the reduction in subsidies at Lambton Elderly Outreach. There is concern that local/regional resources not assume financial responsibility for (unfunded) provincial health care policy decisions. There are limited public transportation options throughout the county. Potential redundancies and a lack of coordination have resulted in possible missed opportunities to leverage existing resources including technology, vehicles, staff, and related infrastructure. Local community service providers, such as the Kiddney Foundation’s dialysis service, have discontinued transportation services for their clients creating further demand pressures on current services.
Deliverables Establish a multi-agency working group with the health transpoortation providers and the Erie St. Clair LHIN. Examine the cost structure and the subsequent fee structure for transportation services provided by health agencies (While different local agencies have different funding sources and abilities to raise revenues it is in the interest of fairness to clients, over time, to move toward more consistent client fee schedule). Examine the current inventory and utilization of current health related transportation assets. Inventory of transportation assets to include: vehicles, utilization/available capacity, eligibility, technology (scheduling, trip management, etc.), and financials. Examine the current and forecasted demand for transportation services. Examine recent reports such as the Windsor/Esssex Accessible Transportation Network report. Consideration of alternate governance and service delivery models including enhanced coordination/collaboration; brokerage - one-call, one-click; etc. Examine the opportunity for coordination of softwaare for scheeduling, dispatching, routing, vehicle utilization, and data analysis, and if necessary make a recommendation on a lead agency to purchase and manage fleet services. Innvolve the Ministry of Transportation and other local transportation providers in the process. Prepare a policy guide with emphasis on standardization of procedures, providing user friendly access, and establishing a central intake. Make recommendations on efficient and effective county-wide service delivery.
Facilitatoro The Erie St. Clair LHIN will fund an external facilitator too assist with the review process.
Timetable Meetings every three weeks from early February to May 2013 and monthly from May 20013 to October 2013. While the working group’s report should be available by a June 2013 timeframe, it is foreseen that the working group may become a standing body addressing ongoing transportation needs. This meeting structure would be conducive to implementation in stages of both short term and long term actions.
Working Group Members Bluewater Health Faciilitator Canadian Cancer Society Kidney Foundation of Canada Canadian Red Cross Lambton College Erie St. Clair Community Care Access Lambton County Developmental Services Centre (CCAC) Lambton Elderly Outreach Erie St. Clair LHIN Sarnia Care-A-Van United Way – Sarnia Lambton Observer: St. Andrew’s Residence Observer: Family Services Kent
Sarnia/Lambton Transportation Working Group Work Plan
START INFORMATION INFORMATION INFORMATION WORKPLAN GATHERING GATHERING GATHERING Feb 25/13 TASK Mar 12/13 Mar 25/13 Apr 8/13 Feb 12/13
> Easy Ride > LEO Presentation Presentation > LCDS Presentation > Sarnia/Lambton > Canadian Red > Further information Transportation Strategy Cross Presentation gathered Presentation >Care-A-Van update > Terms of Reference/Scope > Future Projections > Task > Information Collected > CCS Presentation > Workplan > Brainstorming > Objectives > Facilitator Analysis > Community > Communication Plan Recommendations > CE Plan > Member updates > Data Collection Tool > Facilitator Analysis > SWOT > Communication Plan > Facilitator Analysis > > Recommendations
COMMUNITY REPORT TO LHIN - OPTIONS PARTNERSHIP ROLES ENGAGEMENT Review Options REPORT PREFERRED OPTIONS REVIEW OF MODELS August 13 2013 FRAMEWORK PRELIMINARY REPORT September, 2013 October, 2013 June 11, 2013 May 7, 2013 July 9, 2013
> Community Engagement > Finalize >HSP Presentations >Integration Recommendations >Identify Stakeholders > Interim Report >Updates > Options Recommendations to LHIN > Workshop Ideas >Identify CE processes Board > Implementation ??? > Facilitator Analysis
Paul Brown, ESC LHIN, April 2, 2013
Communications Plan Name Sarnia Lambton Transportation Committee Date March 14, 2013 Context • In an effort to better coordinate transportation within Sarnia/Lambton, the Sarnia/Lambton Transportation Committee was convened. Further details to be found on the TOR. Strategy • Provide proactive communications and public relations support for the Sarnia/Lambton Transportation Committee
• To mitigate potential issues related to the controversial Opportunities contained within the Strategy
• Work with all Sarnia/Lambton transportation agencies to collaboratively find ways to improve access to transportation services for residents of Sarnia/Lambton
Outcomes • To foster support for the initiative and improve access to transportation services
• To highlight new opportunities as positively impacting quality of health care services for the consumer and family (seamless, access to care, quality, equity)
• To demonstrate ways to sustain (value) while creating opportunities for better care and better experiences
• To demonstrate partnerships and collaborative planning with funded and non-funded stakeholders
Phase 1
Tactic Audience Strategy Timeline Person Assigned Evaluation Identify • ESC LHIN • Gary Switzer/Shannon initiative’s • All stakeholders Completed Sasseville spokespeople • Internal • A resource to be used as a • Media • Communication Team Key messaging reference for consistent and Completed • Stakeholders • Paul Brown accurate messaging • General public • Dedicated web page where all public information regarding the LHIN initiative will be posted including website/Facebook • All stakeholders March 2013 • Andrew Tompsett minutes, resource documents, /Twitter communiques, news releases, reports, TOR, etc.
• Transportation Committee Communiqué • Communiqué released as • ESC LHIN (print and e-news • All stakeholders needed to provide updates and Schedule TBD Communications Team to format) next steps post and disseminate as required
Media Clips • Transportation • Share related media clips with • ESC LHIN As required Sharing Committee the committee Communications Team • ESC LHIN Bd • Transportation Advisory Presentation at • Stakeholders • Present report in open ESC Committee LHIN Open Board May 28, 2013 LHIN board meeting Mtg • public • Ralph Ganter/Shannon • media Sasseville • Engage with media in a Media • Media proactive or reactive manner as As needed • Shannon Sasseville Engagement opportunities occur Presentation to • Council • Update the council on the report Lambton County June 2012 • Gary Switzer stakeholders and outcomes from the group. Council
Key Messages:
• Health care related transportation remains a continuing challenge, especially in rural areas. Further, these services are vulnerable to variable funding pressures such as: rising gas and insurance costs, variability with donations, increase in ridership, etc.
• Transportation services need to be efficient, timely, equitable, and appropriate – especially for seniors and other vulnerable populations.
• While LHINs do not receive targeted transportation funding from the Ontario Government, they do use components of their health services funding streams to help support improved access, by means of transportation for local residents.
• Transportation services are not as well coordinated as they could be. By increasing coordination amongst providers the residents benefit from improved access, easier system navigation and a more efficient service.
• In order to address the above, the Erie St. Clair LHIN has established the Sarnia/Lambton Transportation Committee in order to develop solutions and recommendations related to health care transportation in Sarnia/Lambton. The Transportation Committee will build on work that has taken place to date.
Contact List Paul Brown (Chair) Spencer Dickson (Co-Chair) Don Cook Health System Manager Executive Dean Facilitator ESC LHIN Lambton College [email protected] 519-351-5677 x 3211 [email protected] [email protected]
Agnes Soulard Nick Salaris Caen Suni Chief Executive Officer General Manager - Property Dir. of Strategic Planning Lambton Elderly Outreach Inc. Lambton County Developmental ESC CCAC 519-845-1353 Ext. 230 Services (519) 436-2222 asoulard@lambtonelderlyoutreac 519-882-0933 x 12 [email protected] h.org [email protected] Cheryl Tompkins Elaine Hayter Helen Cole/Laura Wall (Tammy Fauteux) Senior Development Manager Manager Senior Manager CSS Programs Kidney Foundation of Canada Canadian Cancer Society Canadian Red Cross 519-344-3462 (519) 332-0042 519-332-6380 [email protected] [email protected] [email protected] Jane Joris Jim Stevens Ron Sheppard Administrator Director of Transit Lead, Community Engagement & North Lambton Lodge/AECs Sarnia Care-A-Van Health System Manager (519) 786-2151 519-336-3271 x 5301 ESC LHIN [email protected] [email protected] 519-351-5677 x 3230 [email protected] Shannon Sasseville Sue Roger Colleen Close Director, Communications & Business Director, Medical Administrative Assistant Public Affairs Programs ESC LHIN ESC LHIN Bluewater Health 519-351-5677 x 3226 519-351-5677 x 3225 (519) 464-4400 Ext. 8264 [email protected] [email protected] [email protected] Carolynn Barko Brad Davis Dave Brown Executive Director Executive Director Executive Director St. Andrew’s Residence Family Service Kent United Way Sarnia Lambton 519-354-8103 519-354-6221 519-336-5452 ext. 7 [email protected] [email protected] [email protected]
Final
Erie St. Clair Local Health Integration Network (LHIN) Vehicle Replacement Policy
Policy Objective:
The objective of the policy is to prescribe requirements for life cycle analysis and replacement of transportation vehicles
Planning:
During the first quarter of the fiscal year the agencies will be informed in writing of the LHINs intention to support the purchase of transportation vehicles
During the second quarter of the fiscal year the LHIN will determine a prioritized list of anticipated vehicle replacement requirements
The Health System Account Manager will prepare replacement proposals on a regional basis based on regional requests that are submitted
The Health System Account Manager will prioritize the motor vehicles requested to meet operational needs based on the Assessment Guide
Preferentially consideration will be aligned with the Health Links strategy in terms of enhancing Health Links business plans that have identified an urgent or strategic requirement in addressing the needs of the 1% target population
The following information is mandatory for the request to be considered
• Institution where the vehicle is situated • The location • The intended utilization • The specifications • The estimated number of years and kilometers for the vehicle lifecycle • A justification for the vehicle
The Health System Design Transportation Lead will prepare the final Erie St. Clair LHIN-wide procurement plan for approval to the Design and Delivery Committee, as well as for the Board.
Page 1 of 2
Acquisition:
All new vehicles will be procured through a single source agency. 20% of core Urgent Priority Funding (UPF) will be set aside yearly for vehicle replacement. The LHIN will provide up to 50% of the cost of the vehicle (unless otherwise justified through the business case). The LHIN expects all purchased vehicles to be delivered prior to the conclusion of the fiscal year. Any justified additional purchases (e.g. replacement after accident) must be made through a business case. Service volumes will need to be tracked for all vehicles purchased through this initiative.
The following assessment guide will be utilized to determine prioritizations Analysis Element Criteria Age One point for each year of service Kilometers One point for each 25,000 km of use Type of Service One, three or five points will be given based on service assignment • Highway utilization with two or more vulnerable passengers: 5 point • Inner city utilization with two or more vulnerable passengers: 3 points • Materials and low risk transportation: 1 point Reliability One, three or five points will be given based on frequency of repairs: • An average of one or more times per month in the garage: 5 points • An average of once every three months: 3 points • Once a year: 1 point Maintenance Life cycle costs points will be given based on: • Life cycle costs exceed purchase price: 5 points • Life cycle costs exceed 50% of purchase price: 3 points • Life cycle costs exceed 25% of purchase price: 1 point Condition Vehicle condition points will be given based on: • Body condition poor, rust, interior condition poor and high accident record: 5 points • Body condition poor rust and interior condition poor:3 points • Body condition poor, rust: 1 point
Evaluation Ranges for Prioritization:
• Under 20 points: Excellent to very good condition • 20 – 24 points: Good Condition • 24 – 29 points: Qualifies for replacement planning • 30 points and above: Consider for immediate replacement
Page 2 of 2 Transportation For Health Services In Sarnia Lambton
Constitution
Principle Process Health Services Client Services are viewed from the perspective of the user. A coordinated approach promotes Focus both effectiveness for the user and efficiency for the provider. A system approach aligns with user needs. Priority: a) There are direct health transportation needs such as hospital transfers, physician visits, a)Health community health centre appointments. b) Health Determinant b) There are indirect needs related to transportation for the frail elderly and people with disabilities. Examples are day programs and education classes. Priority is given to a) Health when resources become limited. Integrated Communication A common communication design and delivery package provides a streamlined service for a) 1800 number residents of Sarnia Lambton. Clear communication is vital to an understanding and b) One brochure provision of a county-wide health transportation system. c) One Website Hours of operation, fee schedules, trip scheduling, etc. require clear communication to d) One Branding users and health service providers e) Client evaluation Coverage of service Lambton County. This includes the City and Sarnia and the County. This is recognized as a particular challenge requiring and multi –agency systems approach. County service should be complimentary to, or integrated with, the city’s “Caravan” service. Geographic coverage must be identified. Member of a transport Providers are to plan and work as a cohesive group. Cooperation extends to non- profit cooperation group transporters as well as for profit transporter enterprises. There may also be benefits derived from working with municipalities, ministry of transport, boards of education, social service agencies, etc. in establishing a sustainable county-wide health transportation service. Cooperation is to include Chatham Kent and Windsor Essex health transporters as well. Standardized appeal When services are denied to a user there is a standard appeal process for the user. process A formal “appeals committee” hears the appeals application. Vehicle Replacement The ESC LHIN provides assistance with vehicles in accordance with the LHIN’s “Vehicle Replacement Policy”. Vehicle usage records and Annual records on vehicle utilization are kept, shared and available. Ranking is covered in ranking the vehicle replacement policy.
Partnership Initial partners are Canadian Red Cross Lambton Branch and Lambton Elderly Outreach. Other potential partners are Lambton County Developmental Services, and Caravan. Linked with local hubs Transportation is to be integrated with other local health services in Lambton County. Benefits, such as reduced trips, may come from linking with services such as CHCs, seniors centres, family health teams, etc. Linked with Ontario The utilization and integration of transportation with OTN services and mobile Telehealth Network application, along with linkage to health centers, senior centers, etc., may reduce the demand for transportation trips and enhance utilization of finite resources. Erie St. Clair LHIN: Paul Brown, Health Systems Manager 16 September 2013
Lambton Elderly Outreach
1 5/8/2013 Introduction
Lambton Elderly Outreach (LEO) is a non- profit organization that provides Community Support Services in Sarnia and Lambton County for seniors over the age of 60 and for adults with disabilities.
Established in 1970 Incorporated in 1980 United Way member agency since 1982 Amalgamation with Senior VIP 2008
2 5/8/2013 Mission and Vision
Mission To deliver excellent community support services that enable people to live with dignity and independence.
Vision To be the provider of choice for Community Support Services.
3 5/8/2013 Community Support Services
What Are Community Support Services? Care and support services that help people to live at home.
Who Do They Help? Seniors People with disabilities Caregivers Community Support Services
How Do They Help? Helps maintain independence and prevent disease.
Assists people with activities of daily living and instrumental activities of daily living (ADL’s and IADL’s).
Helps to maintain health through good nutrition and keeping a safe home environment.
Prevents premature admission to Long Term Care.
Supports caregivers to reduce the stress and burden of providing full time care.
Reduces social isolation & depression through social and recreational opportunities. Funding
Lambton Elderly Outreach receives funding from: The Erie St. Clair Local Health Integration Network (LHIN) (70%) The United Way of Sarnia Lambton Client Fees Fund Raising Grants Donations Our Programs
Transportation Homemaking / Home Help Personal Support Services Caregiver Respite & Support Friendly Visiting Client Intervention & Assistance Grocery Shopping Home Maintenance & Repair Meals on Wheels Diners Club (Seniors Luncheon) 55 Alive, Driver Refresher Course Forever Fit, Exercise Classes for Seniors
7 5/8/2013 Transportation
Two Types: Volunteer Transportation For clients able to get into and out of a car independently, or who require minimal assistance.
Van Transportation For clients requiring assistance into a vehicle and for those using a mobility device (e.g. walker, wheelchair, scooter)
Operate within 160km radius of our head office (excluding USA)
Available seven days a week, 365 days a year with flexible hours of service More About Accessible Transportation
Lambton Elderly Outreach is the only Not for Profit provider of accessible transportation in rural Lambton County
The number of one way trips we provide has more than tripled in the last five years:
26, 386 trips at the end of 2012 compared to 7759 trips at the end of 2007.
We are projecting that these numbers will continue to grow for the current fiscal year.
To meet the growing demand for service, we have had to increase our fleet size. We have gone from 8 vans to 15 vans over the past five years.
Age & Mileage (kms) of Our Vehicles
2001: 248 443 (purchased used) 2008: 188 352 (bus) 2002: 64 655 (purchased used) 2008: 237 852 (not accessible) 2002: 417 830 (not accessible) 2008: 356 164 2003: 248 443 (purchased used) 2009: 305 559 2005: 360 248 2009: 289 849 2006: 393 059 2010: 190 671 2007: 371 358 2012: 16 767 2007: 308 583 (bus) The Cost of Aging Vehicles
Maintenance costs for the past five years: 2008: $40 647.76 2009: $65 130.95 2010: $67 801.66 2011: $87 694.52 2012: $86 696.92
Maintenance costs for the current fiscal year: 2013: $92 771.30 (to date, not to year end)
How Vehicle Purchases Are Funded
A new accessible vehicle costs approximately $65 000.
We have previously paid for vehicles through: Use of Fundraising Dollars Donations earmarked for van replacement Retention of surplus dollars One time funding from the LHIN Questions
13 5/8/2013 Contact Information
Lambton Elderly Outreach
4486 London Line Wyoming, Ontario
519-845-1353 Toll Free: 1-800-265-0203
www.lambtonelderlyoutreach.org LCDS Fleet Presentation
April, 2013
http://lcdspetrolia.ca Mission & Vision
Vision “All people will have the freedom, support and advocacy to pursue their dreams and aspirations.” Mission “Lambton County Developmental Services (LCDS) is a network of people, working together to provide support for people with developmental disabilities in pursuit of their life dreams.”
Services
As a professional support service organization, we believe in: . Service excellence. . Quality of life for all people. . Flexible and adaptable support services. . Courtesy, respect, dignity and consideration for all people. . Community inclusion for all people. . Marketing and promotional activities that are consistent with the Mission, Vision and Ethical Values.
Services Cont’d
LCDS provides a variety of support services: . Residential & Home Supports . Day Program Support . Employment Support . LCDS supports approx. 250 clients and has a staff base of approx. 270 Included in the support services for the people we support is a transportation component for those living in LCDS residential locations or taking part in day program supports. Transportation Services
. LCDS is funded by the Ministry of Community & Social Services and receives no direct funds allocated to transportation. . Budget $ for transportation our carved out of global budget. . LCDS currently runs a fleet of 17 vehicles located throughout the County (excluding Sarnia). Vehicles that make up the fleet include: Para-transit buses (7), Mini-vans (6), full-size vans (3) and pick-up truck (1) – please see hand out “LCDS Fleet Listing”. . Vehicles are not housed or stored at a yard, but at each location. . LCDS maintains a CVOR and requires passenger seating in vehicles to be 10 people or less to avoid extra MTO licensing requirements. Transportation Services Cont’d
. In addition to our own fleet LCDS utilizes external providers, staff vehicles and volunteer vehicles to provide services. . Scope of services includes, medical appointments, social outings (groceries, dances, shopping etc…), appointments, vacations, etc… . Staff are required to attend an agency provided Vehicle Training Day Fleet/Transportation Pressures
Fleet/Transportation pressures include (which are common to all stake holders): . Aging fleet . Aging clientele – needs changing, size of wheelchairs . Inspection costs and requirements (MTO) . Increased maintenance/repair costs . Fuel . Lack of funds/funding for replacements/repairs . Increased insurance costs . Client-based approach and philosophy
Summary
In light of difficult financial times, LCDS has had to re- define and refine how we do business. As rural based agency, transportation has always been a vital component of how we provide services to the people we support. However, with transportation the lack of a long-term planning can have a significant impact on transportation services. Along with planning; creativity, partnership and innovation will also go a long way in helping to ensure strong and effective transportation service models for Sarnia-Lambton moving forward.
Sarnia – Lambton – Chatham - Windsor Community Support Services • Homeward Bound • Meals on Wheels • Nutritional Networking • Transportation • Health Equipment Loan Program • Supportive Housing
The Homeward Bound program provides services to eligible seniors who require transitional assistance and links to community support services, in order to return home with confidence after a hospital stay or emergency room visit. VISION
In accordance with the Canadian Red Cross Mission, Vision, and Values the Homeward Bound Program will enable seniors to live as independently as possible by: • Providing a full range of services • Seeking innovative and relevant solutions for seniors • Working with partners for a stronger future. OBJECTIVES
• Facilitate timely discharge of seniors from hospital by providing necessary assistance & efficient transition back to the comfort of the client’s home • Promote the independence and well being of seniors by providing information on the supply of all community services available • Clients live within city of Sarnia/Lambton County (including North Lambton) • United Way Funding received to enhance access for our rural population in North Lambton Comparative to 1st quarter of program inception Referral Sources BWH GEM Nurses Health Service Agencies CCAC HomeFirst Physicians Family members/self NLCHC HOMEWARD BOUND SERVICES • Transportation from hospital to home
• Meals on Wheels for 2 full days
• Home Management- essential laundry, light housekeeping, meal preparation
• Companionship- 7 hours of scheduled service over 4 days provided by a Transitional Support Staff FEEDBACK FROM CLIENT SURVEYS
“TSS was wonderful. I appreciated the help in preparing meals & helping me with my laundry.”
“Excellent program. I have no family in town. Shawna (TSS) helped me with laundry & took my prescription to the pharmacy for me.”
“The volunteer driver was wonderful. I wouldn’t have been able to go home that day without their help. My daughter couldn’t take me home because of the snow storm.” Meals on Wheels Marshall Cosmos and Chef Nigel suiting a variety of dietary
Swiss Chalet
apetito, Meals on Wheels
Services provided by the program include: provided Services Frozen Meals are delivered on Tuesdays These are prepared by restrictions Service area is Sarnia, Brights Grove and Pt. Edward Subsides available through United Way Hot meals 5 days a week Monday, Wednesday and Friday prepared at Gowland Manor Thursday rotate between Tuesday meals are provided by FACTS
• Empowers clients and their families by encouraging independence and dignity for those choosing to enjoy quality life outside of a long-term care home • Provide balanced diets and promote healthy eating among the elderly and vulnerable individuals in our community • A healthier ‘target’ population translates into reduced hospital admissions, emergency room visits and medical appointments • This maintains a level of dignity for these people, while encouraging better opportunities for increased health and independence • In addition to providing respite care to family support, it provides a regular social contact • 24,933 meals delivered in our community in 2012. • 200 Volunteers spend 5,825 hours and drove 29,002 kms What are the clients saying?
• My wife and I can stay in our home • I eat healthy meals, as I am unable to prepare them myself • It helps me in preparing my in home meal planning • I do not have to operate stove or oven • Less cooking and shopping required (5) • I can’t stand too long getting meals • I am able to get nourishing meals on regular basis • I live alone and it gives me one stable meal each day Nutritional Networking . Volunteers assist seniors to meet their nutritional requirements A. Trained volunteer will pick up grocery list, purchase requested items, return them to the client’s home and unpack them B. RC Van and trained volunteer will pick up client at home and accompany them to grocery store Transportation Transportation
Client base is frail, elderly and/or disabled This is a door-to-door service Clients reside in Sarnia, Brights Grove and Pt. Edward and North Lambton Destinations are for medical appointments, day programs, medical centres, groceries & social outings, food bank deliveries and pickups Monday thru Saturday; Medical appointments accommodated 24/7. All else is 8:00 am to 4:00 pm Out of Town destinations are along the London – Windsor corridor; Medical only Operates 24/7 Subsidies available through United Way for low-income clients and/or frequent flyers United Way Funded North Lambton Transportation Initiative
Clients are indigent and low-income adults Referred by North Lambton Community Health Centre Collaborative Model supported by back-office integration. NLCHC supplies office, equipment (office & vehicle) and administration Clients have physical or cognitive disorders; at-risk community living persons with limited access to nutrition No-Charge to clients Scheduled trips to food banks, grocery stores, methadone clinics and medical Benefits are access to nutrition and reduction in social isolation Vehicle Kilometers 400000
350000
300000
250000
200000
Kilometers 150000
100000
50000
0 2001 2002 Ford 2004 2004 2005 Ford 2005 2006 2008- 1 2008 - 3 2008 - 8 Chevy Windstar Dodge Dodge Freestar Chevy Dodge Dodge Dodge Dodge Venture Caravan Caravan Venture Sprinter Grand Grand Grand Caravan Caravan Caravan Distance History and Program inflation
YEAR Kilometres Driven Ave Price of fuel Volunteer Hours
2010 345,624 108.7 10,735
2011 389,026 122.87 12,086
2012 398,437 126.79 13,495
79% increase in vehicle repairs in last 3 years
17% increase in the cost of fuel
26% increase in Volunteer Hours
16% increase in distance driven Transportation Performance
Year Units of Service No. of Clients Served 2010 14,838 715 2011 15,992 790 2012 18,032 844
Supported locally by Jiffy Lube Extreme Auto Health Equipment Loan Program
This program rents affordable equipment such as wheelchairs, walkers and commodes for those individuals recovering from injury, illness or surgery CRC Transportation Program will deliver equipment on a case by case basis to clients that are unable to pick up Equipment delivery can be accommodated as part of the Homeward Bound Program We rent our equipment on a monthly basis to a maximum period of three consecutive months. 1,327 pieces of equipment were loaned in 2012
June 2013 Presented by :
DIANE D. LOZON M.S.W., R.S.W. MASTER’S CERT. H.C. MANAGEMENT MANAGER: CLINICAL AND C.H.A.P. PROGRAMS
JESSICA BRODIE, B.S.W. CANDIDATE C.H.A.P. CLIENT SERVICE COORDINATOR Mission Statement Family Service Kent supports, empowers and advocates for individuals and communities to reach their full potential Our Program Supporters:
Ministry of Community & Social Services Ministry of Child and Youth Services Ministry of Attorney General United Way of Chatham-Kent Ministry of Health/ LHIN Donators and benefactors A.P.S (Adult Protective Services)
Advocacy and support for adults with an intellectual disability. Services include the following: • Crisis Intervention • Trusteeship • Supportive Counselling • Advocacy regarding criminal and family court matters • 119 Individuals Served K.I.D.S. Team (Kent InterDisciplinary Support Team) Assistance for families/children with complex and special needs. KIDS Team offers the following: • Information and Referral Services • Advocacy • Service Coordination • Access to short-term funding to bridge service gaps • 42 Families Served *K.I.D.S. Team is the local access mechanism for residential treatment facilities. SUPERVISED ACCESS PROGRAM (S.A.P.)
Offers a safe, supportive, and neutral environment for parent-child visits and exchange. • Supervised Visits provide an opportunity for non-custodial parents to spend time with their children while custody issues are being resolved. • Supervised Exchange provide non- confrontational transfer of children between parents for an off-site visit. • Currently 23 families accessing service Counselling Services Individuals Couples Families
• Male & female sexual • Self esteem enhancement assault & abuse • Depression • Separation & Divorce • Anxiety & panic • Mediation (couple & work- • Anger management related) • Interpersonal difficulties • Family issues • Grief, loss & adjustment • Sexual offences • Stress management • Relationship problem resolution • Parent/child conflict *Workshops and seminars are also available. Partners
• United Way-Fee for Service
• LTIS- Ministry of Health, hospital
• Male Survivors- Ministry of Attorney General
• Ontario Works, Children's Aid Society Employee Assistance Programs (EAP) • An accredited, professional and confidential counselling service for employees and their family members • EAP is designed to provide employees with voluntary, quick and direct access to counsellors who help to resolve problems before they impact: – Health – Family Life – Job Performance
*Profits from EAP services are redirected back into local communities Back on Track An Anger Management Program A program for those who are tired of feeling angry, stressed out and unhappy with life… • Manage stress and anger more effectively • Stop negative thinking from controlling your life • Improve your personal relationships • Resolve conflict constructively Credit Counselling
A Program to consolidate debt and create an effective method of remaining debt free… • Personal Money Management Counselling • Debt Management • Promotion of Consumer Credit Education • Bankruptcy Counselling • First Session is FREE (United Way)
C.H.A.P. Programs Frozen Meals Home Helper Caregiver Counseling & Support Client Intervention & Assistance Transportation Volunteer Coordination/Community Development
Total number of unique individuals served: 1823 Frozen Meals
• Healthy nutritious meals for every diet • Meals $4.25; Desserts, soups and muffins all $1.50 • Delivery Available at no additional cost
198 Unique Individuals 8985 Units Home Helper • Brokerage model • Services to maintain home • Housekeeping, laundry, cooking, yard and seasonal assistance • Relief for family members
249 Clients 18 268 Hours of service; over 50% of hours for attendant care, caregiver relief, companionship, and medicine reminders 33 Self employed resource contractors Caregiver Support
• Individual counselling and education for those who are caring for loved ones • Confidential, professional service that is free of charge • Appointments in office or location of your choice • Support groups and workshops available Client Intervention & Assistance Program • Urgent intervention and support • Advocacy • Transitional care planning • Elder abuse • Accessing to services and community referrals • Addressing concerns that affect the safety and wellbeing
271 Individuals served 810 Face-to Face Visits 703 Telephone Visits 92 New Referrals Transportation • For any senior or adult who is deemed to have a disability • Paid and volunteer based drivers • Local and long-distance drives • Drives to medical & hair appointments; groceries & errands • 5 vans: 3 are wheelchair accessible YEARLY 5 STAFF DRIVERS AND 81 VOLUNTEER DRIVERS SERVE 1093 UNIQUE CLIENTS PROVIDING 29,638 ONE WAY TRIPS OVER 25,627 HOURS AND 747,321 KILOMETERS Average Daily Stats 2012/2013
Number of units 97
Number of W/C units 19.25 Vans • 1996 Dodge Caravan 227655 km (Not in Use) • 2003 Dodge Ram Van 361516 km W/C • 2005 Dodge Grand Caravan 350169 km • 2008 Dodge Grand Caravan 117324 km • 2009 Ford Ecoline E350 200000 km (Mini Bus)
Maintenance Repair Expenses $29,995 Volunteer Reimbursement
GAS PRICE PER VOLUNTEER • Staff drivers LITRE REIMBURSEMENT $0.70 $0.34
$0.75 $0.35 are paid by the $0.80 $0.35 $0.85 $0.36 hour $0.90 $0.37 $0.95 $0.37 • Volunteer $1.00 $0.38 $1.05 $0.39 drivers are $1.10 $0.39 $1.15 $0.40
$1.20 $0.41 reimbursed $1.25 $0.41 $1.30 $0.42 their kilometers $1.35 $0.43 $1.40 $0.43 driven $1.45 $0.44 $1.50 $0.45 Volunteers
• 81 Volunteer Drivers • Yearly Training -Drive Wise -Canadian Mental Health -RPN -Alzheimer's Training • Yearly Volunteer Recognition and Awards Event CHAP Transportation Rates as of July 1st, 2013 CHATHAM TO: COST: BLENHEIM TO: COST: TILBURY TO: COST: WALLACEBURG TO: COST: Blenheim 25.00 Blenheim 7.50 Tilbury 7.50 Wallaceburg 7.50 Bothwell 35.00 Chatham 25.00 Leamington 32.00 Chatham 25.00 Charing Cross 16.00 Cedar Springs 20.00 Merlin 25.00 Blenheim 40.00 Cedar Springs 25.00 Erieau 22.00 Wheatley 25.00 London 85.00 Chatham 15.00 Erie Beach 22.00 Comber 25.00 Newbury 56.00 Dresden 25.00 Leamington 60.00 Coatsworth 25.00 Sarnia 35.00 Erieau 27.00 London 75.00 Chatham 25.00 Windsor 85.00 Erie Beach 27.00 Newbury 53.00 Wallaceburg 47.00 RIDGETOWN TO: COST: Guilds 27.00 Ridgetown 20.00 London 92.00 Ridgetown 7.50 Highgate 35.00 Sarnia 70.00 Blenheim 40.00 Chatham 30.00 Leamington 60.00 Thamesville 30.00 Windsor 42.00 London 72.00 London 80.00 Tilbury 40.00 Sarnia 85.00 Morpeth 15.00 Merlin 25.00 Wallaceburg 40.00 Rodney 63.00 Newbury 35.00 Mitchells Bay 25.00 Windsor 75.00 Belle River 30.00 Rodney 35.00 Newbury 55.00 BOTHWELL TO: COST: WHEATLEY TO: COST:Thamesville 15.00 Ridgetown 30.00 Bothwell 7.50 Wheatley 5.00 Sarnia 70.00 Rodney 50.00 Leamington 75.00 Chatham 35.00 Windsor 85.00 Sarnia 60.00 London 65.00 Windsor 50.00 DRESDEN TO: COST: Shrewsbury 30.00 Chatham 40.00 Merlin 25.00 Dresden 7.50 Thamesville 25.00 Windsor 85.00 London 105.00 Chatham 25.00 Tilbury 25.00 THAMESVILLE TO: COST: Sarnia 105.00 London 78.00 Wallaceburg 25.00 Chatham 20.00 Leamington 25.00 Newbury 45.00 Windsor 70.00 Windsor 63.00 Blenheim 55.00 Ridgetown 35.00 London 73.00 Rodney 73.00 Sarnia 50.00 *All prices are flat Sarnia 55.00 Belle River 35.00 Wallaceburg 20.00 rates for round trip Newbury 20.00 Comber 25.00 Windsor 75.00 tranportation. One Bothwell 20.00 Coatsworth 20.00 way rates are not London 73.00 available. Day Programs
• St. Andrew’s Community • Alzheimer's Society • BIACK-Brain Injury Association of Chatham- Kent • 30 Day Program Client Participants
* Flat rate to allow all individuals to take part in the community programs Subsidy
• Reduced rate compared to overall total cost • Day programs • Dialysis clients • Financially in need Community Partners •ODSP •CMHA • Ontario Works •CKHA • Sydenham EMERGING TRENDS
• Accompany Transportation -Incontinence • Mental illness • Aggressive behavior • Many clients need an attendant but do not have a caregiver or family support • Increased level of risk to clients, drivers and support services FAMILY SERVICE KENT NEW ADDRESS AS OF AUGUST 01’13 50 ADELAIDE ST. S CHATHAM, ONT N7M 6K7
South West 201 Queens Avenue, Suite 700 201, avenue Queens, bureau 700 LOCAL HEALTH INTEGRATION NETWORK London, ON N6A 1J1 London, ON N6A 1J1
RÉSEAU LOCAL D’INTÉGRATION DES SERVICES DE SANTÉ Phone: 519 672-0445 Téléphone : 519 672-0445 du Sud-Ouest Toll-free: 1 866 294-5446 Numero sans frais : 1 866 294-5446 Facsimile: 519 672-6562 Télécopieur : 519 672-6562 Email: [email protected] Courriel : [email protected]
www.southwestlhin.ca
Aging at Home (2008/09) Health System Improvement Proposal (H-SIP) Form
The Aging at Home Strategy has a strong focus on innovation and prevention in addition to enhancing existing services for seniors to enable them to stay healthy and live with independence and dignity in their homes. Proposals should be strategic demonstrating a comprehensive client-centered bundling of services that also address caregiver needs to improve access to a coordinated continuum of services for seniors aging at home.
Section 1: Name of lead organization and participating partners
Section 2: Proposed improvement summary
Section 3: Project description
Section 4: Service details and financial impact
Tip: Use TAB key to move from field to field.
Area Provider Table Alignment *SSPC Only: Please indicate sub-group (check all that apply) London Health Providers Alliance Grey Bruce Integrated Health Coalition (GBIHC) Middlesex Providers Alliance Huron Perth Providers Council (HPPC) Oxford Health System Integration Task Force South Service Providers Council (SSPC) * Elgin Health Systems Planning Group
Section 1 – Name of lead organization and participating partners
1.a Proposal Title
Rural Transportation Coordination Across Huron Perth
1.b Name, address and email of Lead Organization
Contact Wendy Orchard
Org name Stratford Meals on Wheels & Neighbourly Services
Address 643 West Gore Street, Stratford, ON N5A 1L4
E-mail [email protected]
Telephone 519-271-2217 x 21
1.c Other Health Service Providers and Partners Identify Health Service Providers that have collaborated in developing this proposal and the role of each partner organization.
Contact Organization Role of your organization Information
Midwestern Adult Day Services Anne Rollings Accessible Transportation Provider 519-482-7800 Mitchell & Area Community Vicky Wolfe Hinz Accessible & Volunteer Transportation Provider Outreach 519-348-9765
North Perth Transportation Shirley Hanlon Accessible Transportation Provider Board 519-271-7991 Perth East Transportation Dianne Lichti Accessible & Volunteer Transportation Provider 519-595-8755
St. Marys & Area Home Support Kim Leis Accessible & Volunteer Transportation Provider Services and Mobility Bus 519-284-3272
Town & Country Support Mary Atkinson Accessible & Volunteer Transportation Provider Services 519-357-3222
VON Perth Huron Shirley Hanlon Volunteer Transportation Provider 519-271-7991
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Please list any additional contacts here:
Dale Howatt, Community Services Advisory Committee 519-272-1897
Section 2 – Proposed improvement summary
2.a Key directions addressed (check all that apply)
Promoting wellness and healthy living; Supporting and caring for caregivers; and Supporting individuals at risk of hospitalization or long term care home placement. 2.b Type of improvement being proposed (check all that apply)
Expansion/enhancement of existing service New service to community Improved service coordination for client Training/education Other (specify) [Enter here]
2.c Alignment with South West LHIN Integrated Health Service Plan (IHSP) and Aging at Home directions. Please identify how this initiative relates to the South West LHIN IHSP and Aging at Home directions.
Transportation is a critical service element to aging at home. It was one of the ten preliminary priorities identified by the SW LHIN consultation as early as November 2005 and continues to be an „implementation imperative‟ in SW LHIN planning documents and strategies. The IHSP states that “to serve our clients in rural, remote, and even in some urban areas, we must make effective use of existing local transportation systems, and work to enhance them”. This proposal will do just that.
This proposal addresses the following SW LHIN priorities:
Building linkages across the continuum: The collaboration to centralize and streamline the access to transportation services across Huron and Perth counties ensures that seniors have ready access to the necessary transportation services to keep them engaged and independent within their communities. It allows them to link with the community and health resources they need to maintain a healthy quality of life while remaining in their homes.
Accessing the right services, in the right place, at the right time, by the right provider: This proposal supports seniors having barrier-free access to the right services and promotes their independence as they can go to the service rather than the service provider coming to them.
Management of chronic illness: People with chronic illness often rely on regular medical treatments, which need to be accessed in a timely manner. In the past, ambulances have been utilized to transport some chronically ill people to their treatments, resulting in missed appointments and long wait times for returns. This project provides a more cost-effective transportation alternative while focusing on the client need and comfort, thereby increasing the quality of their life and reducing time spent at treatment centres.
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E-health (enabling priority): This proposal outlines the requirement for a standardized, web-based scheduling tool which will allow the partners to readily exchange information and statistics to facilitate continuous quality improvement to this critical service.
This project additionally addresses the other LHIN priorities but in a more indirect way: By enhancing seniors‟ independence and engagement within their communities, there is a significant improvement in their quality of life as they maintain greater control of their life, a strong sense of autonomy and active involvement in community life. This improved quality of life will have positive outcomes on their health, hence less demand for health services in general.
This initiative relates to all three Aging at Home directions. It promotes wellness and healthy living by enabling seniors to actively participate in their communities, go to appointments, get groceries and live with dignity. It supports and cares for caregivers by alleviating the significant stressor of providing or arranging for transportation for multiple appointments and by encouraging independence and autonomy. Anecdotally, we know that many seniors are hospitalized or inappropriately placed in long-term care homes because transportation is a major barrier for themselves or their caregivers. When they are able to get out to medical appointments, attend day programs, get groceries and other necessities of daily life, these admissions can be delayed or averted entirely.
2.d Alignment with innovation funding component
Please indicate if this proposal, or a component within, meets the following criteria for innovation and therefore should be considered for innovation funding? (check all that apply)
Unusual, different or new concept;
May not be proven; could have an element of risk;
Variation on an existing service that includes a new method of service delivery, a new target population, or a service provider that has not traditionally provided health care services to the LHIN;
May include a program that has demonstrated effectiveness in another jurisdiction, but has not yet been used in the LHIN;
May include a program that has been tried on an informal basis, but not been formally funded or evaluated;
May involve a process or technology from another discipline (such as education) that has not previously been used in health care or senior care;
May require adjustments or innovations in other aspects of the system, such as policy, legislation, procedures;
Intuitive, i.e. likely to provoke the reaction “That‟s a good idea!” from both funders and consumers.
2.e Funding request: Base $108,863 2008/09 One-time $149,440 $225,771 2009/10 $231,116 2010/11 Total $565,750 over 3 years
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Section 3 – Project description (Maximum of 3 to 5 pages)
3.a Brief Description
Provide a brief overview of the initiative identifying the programs and services to be offered as well as the population served including eligibility criteria and catchment area.
There are currently six rural transportation providers throughout Huron and Perth Counties, which have developed in response to local need and have built upon local community strengths by leveraging both volunteer and financial resources. They offer both accessible and volunteer transportation. In addition, Midwestern Adult Day services has two accessible vans, which it uses to transport clients to and from its programs but remain underutilized the remainder of the time. VON Perth Huron provides volunteer transportation in North Perth and partners with the North Perth Transportation Board to provide accessible transportation.
All provide service to seniors and frail elderly clients under the criteria established in the Planning, Funding & Accountability Policies & Procedures Manual for Long Term Care Community Services. They are a critical community partner for day programs, long-term care homes and hospitals seeking to provide transportation for their clients. While the providers make every attempt to coordinate services, access can be challenging for referral agents and new clients alike due to the number of providers and the geographical limitations created by other funding sources. Inequities in funding from other sources have contributed to „inequities‟ in both service availability and cost from one geographical area to another. In addition, some providers have recently had to limit service due to budgetary constraints.
This initiative proposes a single, coordinated 1- 800 call centre/dispatch for all six providers and clients throughout the Huron and Perth community. The coordination of accessible transportation will occur in year one; the coordination of volunteer transportation will be phased in during year two.
In addition, the project will develop common intake/assessment, financial needs assessment and fees for service. An important aspect of this proposal is the development of a centralized scheduling tool which can be accessed by all partners and which would align with the collection of data to support the agencies‟ reporting requirements. This scheduling tool will also facilitate a two-county-wide view of the transportation services and provide information on where there are gaps and where there are points of leverage.
All of these project elements will ensure that the „right person is in the right seat at the right time‟, optimizing both client service and resource utilization with a single telephone call. Clients will benefit from expanded service hours to book their trips, making accessing transportation more convenient and equitable across both counties. The re-allocation of current dispatch functions at local providers will increase service to eligible clientele.
3.b Rationale
Describe how seniors and their families will benefit from the proposed service improvement. Please provide any qualitative, quantitative and best practice evidence available that supports the rationale for the initiative.
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Coordinating transportation services has been called “the best way to stretch scarce resources and improve mobility for everyone” (Ohio Department of Transportation, 2005). Although Canadian research is limited, there are numerous U.S. studies and best practices, which indicate that, “Access to supportive services through transportation and choices of transportation services are critical for seniors‟ ability to age in place, in their communities” (Carbonell, 2005).
When seniors are able to get out to medical treatments and appointments, attend day programs, get groceries and other necessities of daily life, they are able to actively care for themselves and participate in their communities. This promotes wellness and healthy living, enables our seniors to live with dignity and can therefore delay or entirely avert premature or inappropriate admissions to hospitals or long-term care homes. It supports and cares for caregivers by alleviating the significant stressor of providing or arranging for transportation for multiple appointments and encouraging independence and autonomy.
This initiative optimizes service provision by providing a single point of access and fully coordinated scheduling of vehicles while honouring local volunteer and financial commitments.
3.c Benefit to the community
Briefly describe how this proposed improvement will improve the health care system and/or health status of the community (e.g., health outcomes, access to health services, quality of care, coordination of services, consumer choice, adoption of best practice).
As noted above, the enhancement of transportation across Huron and Perth Counties will allow seniors to remain mobile, independent and engaged in their communities while aging at home – all of which lead to better health outcomes.
This centralized service model brings together eight agencies and promotes the development of ongoing, enhanced collaboration and the implementation and sharing of best practices. It will ensure that seniors across our counties have easy and equitable access to transportation services which enable them to remain in their homes for as long as possible. This initiative will also contribute to equitable and timely access to health services across the catchment area.
The development of a centralized dispatch/coordination service will promote greater efficiencies in service delivery and optimize utilization of accessible vehicles and volunteer transportation services across the two counties. It will allow the partners to monitor where there are gaps in service, build linkages between providers to optimize service and proactively develop strategies to minimize these gaps.
3.d Collaboration
Briefly describe how the existing and new collaborating health service providers and other partners will work together to implement the proposed initiative.
All Ministry of Health / LHIN funded rural accessible transportation providers in Huron and Perth County are collaborating in this initiative. In addition, Midwestern Adult Day Services has two accessible vans used to transport its clients to and from the day program. They have agreed to make them available to the coordinated effort in „off hours‟. VON Perth Huron also provides volunteer transportation in North Perth and will participate when the coordination of volunteer transportation is integrated into the service
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model in year two.
The partners will form an Advisory Committee that will oversee the project. Stratford Meals on Wheels and Neighbourly Services has agreed to take on the responsibility of lead agency. A Dispatch Coordinator will be hired to coordinate implementation and ensure the service functions smoothly. It is anticipated that s/he will spend significant time with each service provider, learning the intricacies and idiosyncrasies of each service to ensure a seamless transition. Best practices from each provider will be incorporated into central dispatch. In addition, technology supports need to be addressed. Providers currently use different scheduling software, most of it inadequate for their current needs. Central dispatch will utilize a web-based version of the scheduling software currently utilized by Town & Country Support Services (CIMS) to ensure that each agency can access/input information as required. Ideally, this software will also address other data collection and analysis needs of the organizations and consistency across the two counties.
3.e Health system sustainability
Briefly identify how the proposed initiative will result in efficiencies to the health care system and/or your organization(s). (e.g., reduced duplication of services, new model of care introduced, reduced length of stay or readmissions, demonstrated cost benefit, collaborative budgeting, reinvestment of existing resources, leverages other resources, etc. )
All transportation providers are currently „stretched to the limit‟; all report inadequate time for scheduling and billing. Some have had to limit service provision due to budgeting and human resource constraints. Central dispatch will remove and centralize one function from each agency, thereby enhancing their capacity to provide and expand service while decreasing duplication.
It will also maximize the use of current resources – accessible vehicles, volunteer time and good will.
Ultimately, enhanced transportation provision will contribute to reduced lengths of stay and readmissions as well as premature and inappropriate admissions to both hospitals and long term care homes by providing critical supports to enable seniors to live with dignity and/or recover at home.
3.f Performance Measures and Evaluation
What are the key indicators that will demonstrate success?
Increased units of service, increased referrals from community partners, client and referral agent satisfaction feedback (informal and annual questionnaire/interviews).
3.g Implementation Challenges
What are the potential risks and challenges to implementation (including policy or regulatory barriers) and how will you mitigate?
Data collection: Some partners currently use the Ontario Healthcare Reporting System; others do not. This will require integration early in the project. Ensuring data collection and reporting accurately reflects service provision will be extremely important to the individual partners and the overall project.
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The partners also need to develop a common intake/assessment and financial needs assessment process that will be uniform and meet their unique needs. This will be addressed early in the process. A consultant will be engaged to facilitate discussions and draft common documents.
It is important that clients continue to experience the level of personalized service and care that they currently receive and that the strengths of each service are incorporated into the integrated model. A critical early component of this proposal is that the Coordinator will spend two weeks at each site, learning how the service is currently operated and interacting with local clients at this site.
The integration of volunteer transportation into this proposal also represents a risk since volunteers are recruited, trained and supervised by local providers. In general, volunteers tend to feel a great deal of loyalty to local service, so the transition will need to be handled carefully. It will not be incorporated until year two of the project, after central dispatch for the accessible vehicles is running smoothly. Local agencies will continue to recruit, train and supervise their volunteers, but dispatch will call them for specific trips.
Several providers currently enjoy a great deal of local municipal support, some of which is closely tied to vehicle utilization within municipal boundaries. It will be important to ensure that the benefits of this initiative are clearly communicated to ensure that ongoing support.
3.h Communication and Knowledge Transfer
How will communication and knowledge transfer occur to ensure success?
Partners are committed to working collaboratively to ensure success. Regular Advisory Committee meetings (biweekly in year one, monthly thereafter) will ensure that all partners have formal and informal opportunities to oversee the development and implementation of the project as well as provide feedback. The project requires a significant investment in IT to ensure that the web-based scheduling software meets the scheduling, data collection and participation needs of each provider.
Section 4 – Service details and financial impact
Service/volume details * Proposed service change Details Service code (if (volume/outcome) (i.e., additional number of visits, units of service, applicable) services provided or residents/clients served) No change [Enter here] Increase/New 4000 trips during 1st year of implementation, 04A incremental increases due to Aging at Home initiatives thereafter Decrease [Enter here]
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Financial details $ $ $ Details 2008/09 2009/10 2010/11 No new funding [Enter here] required Savings Savings realized by local identified providers will be re-invested to re-instate services that have been cut due to budget constraints and increase service delivery. One-time [Enter here] project funding (ongoing funding not required) Start-up funding Consultation/training (one-time) Policy Development & 24,000 Service Integration (6 sites) 24,000 IT Consultation & Support 2,340 (6 sites) Training related travel Staff (salaries & benefits) Other (specify) 27,500 Server, VPN Connections 5,000 per site, Software 4,000 Telephones 4,000 Computers (3), Printer, 25,600 Fax 23,000 Office furniture (3) Data conversion (15,000 files) 10,000 Web based GPS tracking & communication software & equipment (14 vehicles) Marketing Material Development & Implementation
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Base operating Staff (salaries & benefits) 81,063 178,171 183,516 1.0 FTE Coordinator 3.0 FTE Dispatch (13 \ wks in year one) Supplies 2,400 1,200 1,200 Other (specify) Rent 4,800 9,600 9,600 Telephone (1-800) 2,400 2,400 2,400 /Internet 8,600 8,600 8,600 GPS tracking & Communication and 12,000 12,000 Technical Support 9,000 9,000 Software licensing 9,600 4,800 4,800 PR & Client Communication Other funding Supervision 3,094 3,187 3,282 sources or in- Local training 7,200 kind Advisory Committee 4,431 2,339 2,409 contributions participation 600 300 300 Meeting Space 9,600 9,600 9,600 Advertising in existing communications *Do not be constrained by existing service codes if not applicable to new strategies
4.a Does the proposed improvement require capital? (check all that apply)
Renovation
Expansion
Equipment investment
Information technology (IT) investment – web-based data management, scheduling, billing and GPS Software; server upgrade to accommodate software
4.b If the proposed improvement involves a capital project, provide a brief description of the capital project and indicate whether or not you have submitted a capital request to the Ministry of Health and Long- Term Care (MOHLTC).
No
Yes Please provide date and MOHLTC Capital Branch consultant assigned to your request (if known):
[Enter here]
4.c Has this proposal form been submitted to other LHINs?
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No
Yes Please indicate which LHINs
4.d Please provide estimated timelines for project development and implementation from April 2008 to March 2009 and beyond if applicable.
April – Oct 2008 Policy Development & Service Integration ▪ Consultant meets with each provider, identifies commonalities and concerns, drafts common intake/financial assessment tools and joint policies ▪ Bi-weekly advisory committee meetings ▪ Consultant assists with governance & local funder communication/education as required April – Oct 2008 Software Analysis, Recommendation, Purchase, Installation ▪ Adaptation of CIMS to web based format ▪ Server upgrade April 2008 Hire Coordinator May 2008 Training ▪ At Lead Agency ▪ Attends Advisory Committee meetings Jun – Aug 2008 Coordinator rotates through partner organizations and works with consultants, identifying best practices, policy challenges & IT requirements Nov 2008 Software training at partner agencies Nov 2008 – Jan 2009 Data conversion and post-conversion integrity verification Nov 2008 – Jan 2009 Hire & train additional staff Jan – Mar 2009 Service Promotion ▪ Marketing material development ▪ Client mail out ▪ Presentations to referral agents and community groups Feb – Mar 2009 Central Dispatch launched in staged process April 2009 – ongoing Monitoring, evaluation, service improvement Oct 2009 – Mar 2010 Integration of Volunteer Transportation
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Signature
I acknowledge that this submission is not formal notice of a proposed integration to the LHIN as contemplated by s. 27 of the Local Health System Integration Act, 2006 (“LHSIA”). Health service providers wishing to provide notice to the LHIN of a proposed integration under s. 27 of LHSIA should contact the LHIN for more information.
Signature:
Name: Wendy Orchard Title: Executive Director Date: 04/01/08
Please e-mail completed form to: Cathy Ferrie [email protected] Program Assistant, Planning, Integration and Community Engagement South West LHIN (519) 672-0445, ext. 211 / 1 866 294-5446
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WHAT IS EASYRIDE?
A transportation service shared by Community Support Service agencies across Huron and Perth Counties
By teaming up and sharing our vehicles and drivers, we can offer frequent and flexible door- to-door service
One number will get clients door-to-door with EasyRide services
519-272-9875 or 1-877-500-9875
BACKGROUND
Rural Transportation has always been an issue SW LHIN funding under the Aging at Home Strategy in 2008/09 Health System Improvement Process provided an opportunity to look at creating a Huron Perth system for Transportation Out of 30+ projects applying for funding, Rural Transportation Coordination across Huron Perth was rated #1 PARTNER AGENCIES IN HURON & PERTH Lead Agency
Amalgamation in January 2011 now: FUNDING PROVIDED BY
SW LHIN Aging at Home Strategy
2008/09 $109,000 base; $137,000 1-Time 2009/10 $228,224 base 2010 – present Ongoing funding CENTRAL DISPATCH COORDINATION
Agencies retain ownership and operation of vehicles Single point of contact – toll free and local phone number Central office has access to all agency vehicles and books trip based on what makes best sense Web-based scheduling software is accessed centrally and can be viewed by local agencies 1-way interface between database and scheduling software (input client data from partner and export billing information to partner) PARTNERSHIP RESOURCES
7 collaborative agencies (with amalgamation, now 5) 2 agencies affiliated with municipal bodies (West Perth, Town of St Marys) 24 agency owned and operated vehicles - 8 wheelchair accessible buses - 8 full size wheelchair accessible vans - 5 wheelchair accessible low-floor minivans - 3 7-passenger caravans 34 paid staff drivers Large volunteer base across the geography (200+ volunteer drivers Approx. 4000 clients served and more than 100,000 trips coordinated in 2012/13
BENEFITS OF EASYRIDE
One number to call for CSS transportation- easier access for clients, hospitals, CCAC, LTC facilities, etc.
Affordable and accessible transportation for clients throughout Huron and Perth
Increased efficiencies, access to more vehicles, drivers and volunteers
Frees up staff time locally
SCHEDULING SOFTWARE:
NOVUS: TRANSPORTATION MANAGEMENT SYSTEM Browser-based system allows Local Agencies to access Novus remotely for real-time information sharing Permission based security Advanced scheduling algorithms ensure efficient use of resources Client intake, Trip booking, Scheduling, Dispatching & Reporting
TYPES OF TRANSPORTATION
Wheelchair accessible transportation for clients who require specialized transportation Volunteer drivers for ambulatory clients who require the assistance of a volunteer or who need transportation to out-of-town medical appointments Agency owned Passenger vans for in-town transportation Coordinated transportation (taxis, patient transfer vehicles, etc.) where it makes sense (e.g. 3rd party billed trips, awkward times, etc.)
WHO CAN USE EASYRIDE? All clients accessing the service must:
Be a registered client (i.e. completed intake process with local CSS agency). Eligibility criteria will apply. Be a senior or a client who: - Has physical or cognitive limitations - Requires specialized transit - Is without access to transportation or where public transportation is not available - Does not have family and friends who are able to help out PROFILES OF CLIENTS SERVED
Ambulatory or Non-ambulatory (requiring wheelchair accessible transportation)
Clients with medical appointments, diagnostic work, consultation or procedures in London, KW, Toronto, Owen Sound, etc.
Discharges or admissions to/from hospitals to residences, retirement homes or LTC homes
Clients requiring transportation to Adult Day Programs
Clients requiring transportation to or assistance with shopping and errands
Clients requiring mobility or transportation assistance for special occasions
Facilities requiring chartered transportation for programs
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CLIENT FARES
Costs vary by service provider and location Flat fees apply for in-town trips Fare ranges: $3.50 - $5.50 per in-town volunteer trip $3.75 - $10 per in-town accessible trip Long-distance rates are charged on a per/km basis Fare ranges:
• $0.37 - $0.46/km for in-town volunteer trips
• $0.40 - $0.80/km plus wait time for accessible trips Clients are responsible for all transportation costs, including parking if required INFORMATION REQUIRED TO BOOK A TRIP
Bookings are taken Monday to Friday between 8:30am and 4:00pm (but trips may be delivered outside of those hours)
Bookings can be one-time or for regularly scheduled trips
Same day bookings may be accommodated when possible (dependent on driver/vehicle availability)
Service is door-to-door. Attendants/escorts are not provided by EasyRide
ESCORT/ATTENDANT NEEDS
The level of care for each Client when traveling will determine the need for an escort/attendant. Escorts/Attendants may be required if the Client: Requires supervision (i.e. cognitively impaired) Frail, needs support Requires assistance with mobility device Requires personal care
Hospital, LTC Facility, client or family must provide an escort/attendant as required. Escort/Attendant should be: Familiar with the client Willing and capable of providing the appropriate assistance as necessary
Total Trips Coordinated 2012/13 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 4000 One Care Statford MCO
MACO VON 3770 3560 3500 SMHS MADS 3359 TCSS One Care Huron 3262 3257 3168 3080 3000 3060 3036
2910 2930 2881
2500 2340
2224 2111 2138 2060 2066 2048 2000 2036 2035 1979 1983 1995
1660 1666 1684 1544 1547 1500 1566 1392 Trips Coordinated Trips 1493 1439 1323 1471 1201 1246 959 828 845 1000 774 867 765 898 720 757 852 780 736 767 714 709 785 741 452 426 697 667 658 475 611 487 510 547 564 474 529 526 555 500 482 458 459 440 270 278 277 252 262 289 206 251 239 192 215 232 0 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Milestones: Technology: o Common brand, logo o Web-based and phone number scheduling software is o Common policies and used centrally and can procedures developed be viewed locally oCommon processes Success: o Trip information is Project Vision: implemented EasyRide has been a leader exported to local o After hours on-call o Create a “system” for community databases for OHRS o Mobile application support transportation through central in creating a model of reporting and billing using BlackBerry's coordination of trips using web-based coordinated transportation eliminated paper scheduling software which continues to be shared o One number to call to access service with LHINs, transportation 1-877-500-9875 or 519-272-9875 providers and CSS agencies o Centralized intake, scheduling and across the province Client Testimonial: dispatch “I am trying to stay in my home and this service o Standardized Policies and Procedures (EasyRide) allows me to do that”. Quick Stats: o 98,628 trips coordinated for 4076 clients (increase of 36% over previous year) o 25 agency-owned vehicles including Challenges: Lessons Learned and buses, accessible vans and passenger Partnership – Actions: Goals & Objectives vans Moving partners o Helping partners develop o Improve access to Community o 200+ volunteer drivers toward the same trust in the partnership so Support Service transportation vision of they could comfortably let o Expand and enhance existing Total Trips Coordinated 2011/12 integrated service go of local control transportation services delivery o Recognizing that 10000 o Reduce duplication of service Focus – What is spending more time on o Reduce client/other agency 8000 best for clients planning may have made confusion over who to call 6000 rather than local the process easier on staff o Increase potential for agency practices 4000 efficiency oAgencies retain ownership of 2000 agency vehicles 0 Next Steps: o Moving closer to standard client fees & processes o Updating policies and procedures
Target Population: Primary focus is seniors and persons with disabilities across Project Lead: Melanie Higgins Huron & Perth Counties. For more info contact: 519-271-2217 x 2224; Website: onecaresupport.ca CONTACT INFORMATION
Melanie Higgins Transportation Supervisor Lead Transportation Coordinator 519-271-2217 x 2224 [email protected]
Kelly Breuls Manager, Community Support - Transportation 519-271-2217 x 2221 [email protected] Questions? Canadian Cancer Society, Ontario Division Transportation Program
Volunteer Driver Program
The Canadian Cancer Society volunteer driver transportation program is one of the largest volunteer transportation programs in North America. It has existed since the early 1960s. We take people to chemo/radiation, as well as diagnostic tests where cancer is suspected and follow-up appointments to their doctor.
This program is designed to complement the client’s own transportation arrangements. It is not an emergency service. We help people with the greatest need – the ones who do not have anyone else to help out, or whose family can help out some of the time, but not all of the time.
It ranges from 8-15% of cancer patients in Ontario that use our service each year. In our last client satisfaction survey, 97% of clients would recommend the service to someone else, and 1 in 5 clients said they would have missed their cancer appointments if it were not for this program.
The Process Individuals need to first register through their community office or by calling 1-888-939-3333. To be eligible they must be ambulatory and have a stated need for rides to their cancer related appointments. After they are registered, clients will contact the transportation coordinator at their local community office to book their rides. The transportation coordinator for Lambton County and Chatham-Kent is Karen Blain – 519-352-2245 or 1- 855-772-7004 - [email protected]
The clients need to provide three business days’ notice prior to their ride. It is a shared-ride service, so there may be other clients in the car with them. They also need to refrain from wearing scents on the day of the ride, and if they are smokers refrain from smoking. Clients need to provide an escort if they have challenges getting in and out of the car on their own. If we aren’t able to provide the ride we will provide 24 hours’ notice. We always advise our clients to have a plan B just in case we aren’t able to provide the service.
Volunteer Drivers Our volunteer drivers are the backbone of this program. The dedication and great work of our volunteer drivers is well recognized. Drivers pick clients up at their home, take them to the cancer centre or hospital oncology program, and then bring them back to their doorstep. Last year, they drove 11,830 clients nearly 13 million kilometres across Ontario. Volunteer drivers volunteer their time, the use of their 100% smoke-free vehicles, are required to have $1 million in liability insurance and have no more than 3 demerit points on record. They are reimbursed at $0.30 per kilometre.
Stats for Lambton County and Chatham-Kent February 1, 2012 – January 31, 2013
Community # Clients # Trips # Drivers # kilometres Office Chatham-Kent 214 2518 37 271,891 Lambton County 218 2317 66 239,257
Transportation Assistance Program Canadian Cancer Society provides short term assistance to individuals in need who are eligible under our transportation program where volunteer resources are not available or for appointments greater than 400 km from home. We will reimburse the client for the lowest cost ground transportation to the appointment.
Family Provided Transportation Assistance If a family is in financial need, and a volunteer driver isn’t available, Canadian Cancer Society will provide financial assistance to assist with taking a child to cancer treatment. As an escort is always required for a child, we will reimburse for the lowest cost ground transportation for both escort and child to the child’s appointment if the distance is greater than 40km. Transportation Community Collaborative October 17, 2012 Committee
Community Transportation Survey Phase 1 Results Summary
1
Agenda
Research Details Findings Conclusions Discussion
• Purpose • Target Client • Phase 1 • Future research • Objectives Population Conclusions Considerations • Methodology • Geographical • What can be done • Q&A • Research coverage • Open discussion Limitations • Resources •Funding • Challenges
Prepared on behalf of the Transportation Community Collaborative Committee 1 Irena Pozgaj, Research Analyst, Children and Community Services Transportation Community Collaborative October 17, 2012 Committee
Purpose & Objectives
PURPOSE: Clearly identify transportation requirements and establish an integrated transportation system to improve timely access to health services
Identify the scope of the health Gauge an understanding of the transportation services provided in geography coverage of health North Simcoe Muskoka; transportation services in North Simcoe Muskoka;
Determine the clients’ demand and satisfaction of health transportation Measure the scope of resources in the services and identify whether there are health transportation sector; any existing gaps in the service; Determine the demographic Identify transportation issues and characteristics of the target client opportunities in the sector population, as well as current trends and changes through the demographic groups;
Methodology & Limitations
The full research process consists of the following phases:
Phase 2: CitCommunity agencies Phase 1 Limitations Online survey Phase 3: Phase 1: Service Customer Providers (n=16) satisfaction Census response rate of the Paper survey Client intercepts transportation service providers in North Simcoe Muskoka wasn’t achieved. Only 16 transportation Purpose: agencies completed the survey. Transportation for health & social The paper questionnaire used services in phase one was designed before full research scope was determined.
Prepared on behalf of the Transportation Community Collaborative Committee 2 Irena Pozgaj, Research Analyst, Children and Community Services Transportation Community Collaborative October 17, 2012 Committee
Target Clients & Service
Health Transportation Passenger Assistance Service Agencies’ Target Clients (n=16) and Transportation Fee (n=14)
Seniors 9 3 2 Free Free Physical limitations and mobility 4 issues 5 4 Paid Cancer or life threatening 4 Paid diseases
Narrow target service (aboriginal, 2 kids) No Yes
The majority of the transportation services were 50% of the transportation providers directed and provided to individuals aged 65+. offered passenger assistance service.
Large groups receiving health transportation Five of the agencies offering passenger services were also individuals with physical assistance charged their clients for limitations and mobility issues, as well as transportation and service individuals suffering from cancer or other life threatening diseases. 5 out of 14 providers offering health transportation in North Simcoe Muskoka Two agencies were specialized in providing didn’t charge their clients for service and services to more narrow groups: children, assistance. aboriginal people, etc.
Geographical coverage
Fifteen transportation service providers reported the following geographical coverage of their services
Larger area (GTA, Parry sound, etc.) 9 North Simcoe Muskoka 2 Simcoe County only 2
Barrie only 2
Average clients’ residence geographical location (n=15)
40% Rural 60% Urban
Two providers served Barrie clients only (100% urban)
Prepared on behalf of the Transportation Community Collaborative Committee 3 Irena Pozgaj, Research Analyst, Children and Community Services Transportation Community Collaborative October 17, 2012 Committee
Resources Agency Owned Vehicles (n=11): Total of 50 vehicles + 39 Barrie Transit vehicles
17 17 16 39
non-accessible vehicles accessible vehicles not specified vehicles Barrie Transit
Transportation Providers’ Drivers Resources (n=12): - 2 agencies reported they rely only on volunteer drivers; - 6 providers used only paid drivers’ services; - 4 agencies relied on mixed drivers’ service: both volunteers and paid drivers
43% of total health transportation was 57% of total health transportation was serviced by volunteers. The percentage serviced by paid drivers. The percentage equals equals to 2909 total approximate number to 3833 total approximate number paid driver volunteer driver hours per month, reported hours per month, reported by 12 transportation by 12 transportation providers. The ranges providers. The ranges per agency varied from 7 per agency varied from 35 to 2100 driver to 3100 driver hours. Barrie Transit’s 11,600 paid hours. driver hours weren’t included.
Funding The transportation service providers reported the following funding sources:
9 Funded 7 Non-funded Transportation Transportation providers providers
Private / 3 of the 9 funded service LHIN Corporate Donations providers didn’t charge their clients for transportation Municipal Government Fundraising 4 of the 7 non - funded Ministry of Health Private pay agencies provided free transportation service ODSP Red Cross
Trillium Local Service Club
United Way
Veterans Affairs
Prepared on behalf of the Transportation Community Collaborative Committee 4 Irena Pozgaj, Research Analyst, Children and Community Services Transportation Community Collaborative October 17, 2012 Committee
Referrals
Various agencies and institutions referred clients to the transportation providers.
Healthcare Professionals
Health & CCAC Community Agencies Transportation Service Providers
Family / Hospitals Self referrals
Challenges
The Transportation Service Providers have identified the following trouble spots (n=16):
Note: Statements are based on verbatim responses
Resources: Difficulties in recruiting volunteer drivers (n= 3) Resources: Demand exceeded the availability of services (n= 1) Resources: Not enough vehicles (n= 1) Geographical Coverage : Large area and limited service out-of-town (n= 2) Service: No centralized booking system (n= 1) Service: Not able to serve emergencies sometimes (n= 2) Funding: Lack of government funding or more funding needed (n= 4) Funding: Clients were not able to pay for services (n= 1)
Prepared on behalf of the Transportation Community Collaborative Committee 5 Irena Pozgaj, Research Analyst, Children and Community Services Transportation Community Collaborative October 17, 2012 Committee
Conclusions
Diverse demograp hics: NNhSiorth Simcoe MkkhlhMuskoka health transportat ion agenc ies provided services to a broad range of demographics.
Broad geographical coverage: The majority of the health transportation agencies provided not only services to local destinations, but also to inter-municipal, GTA, Parry Sound and other further destinations. They successfully managed to serve clients residing in the rural areas.
Lack of funding: The lack of government funding for 44% of the surveyed providers, along with the inability of some clients to pay for service, made the agencies rely on volunteer resources and public or private donations.
Conclusions - continued
Not sufficient resources:
Although the survey analysis showed that 11 providers owned 50 vehicles, one of the biggest challenges the agencies emphasized on was the insufficient number of owned vehicles, as a consequence of the exceeding demand of health transportation services in North Simcoe Muskoka.
Half of the respondents reported they rely on volunteer drivers fully or to a certain degree, and 43% of all transportation was serviced by volunteers. However, agencies were faced with difficulties of recruiting unpaid drivers.
Prepared on behalf of the Transportation Community Collaborative Committee 6 Irena Pozgaj, Research Analyst, Children and Community Services Transportation Community Collaborative October 17, 2012 Committee
Future Research Considerations
Upon completion of Phase 3, a demographic profile of the health transportation clients will be created and compared to the providers’ target population. This approach will help us identify whether any demographic gaps exist in the sector.
The second and third phase of the research will appraise the trouble spots, and challenges, as well as help us identify opportunities for enhancement from the perspectives of the different stakeholders.
Q & A
Prepared on behalf of the Transportation Community Collaborative Committee 7 Irena Pozgaj, Research Analyst, Children and Community Services Transit Procurement Initiative 8-m Procurements October, 2013 Philippe Bellon Manager, TPI
1 Outline What is TPI? How does a TPI procurement work? TPI will work with Ontario Current 8-m procurements transit systems to achieve best value for money by strategically facilitating joint Upcoming 8-m procurements procurements for buses and the goods and services that support transit bus operations.
As a result, stakeholders will see TPI as the leader in transit procurements in the province, participation will grow and opportunities for new projects will increase.
2 What is the Transit Procurement Initiative?
Joint transit procurement across Ontario is a mandate of Metrolinx (Metrolinx Act 2006) TPI strives to achieve best value for money TPI focuses on buses and the goods and services that support transit bus operations. Goals are to be a transit procurement leader in the province, to grow participation and to launch new projects
3 Transit Procurement Initiative
By the end of 2013, 735 buses will be delivered through TPI since 2007 Vehicles procured include 12-m (diesel and hybrid), 9-m, 8-m (HF and LF) Bus parts were added through the Transit Inventory Management System (TIMS) in 2011 24 municipalities, non-for-profits and commissions have taken advantage of our services In 2011, TPI prepared a 5-year Strat Plan with 17 recommendations to be implemented over 4 years . 10 of these recommendations have already been implemented or are on their way
4 Our Partners
5 How does a TPI procurement work?
Governance Agreement (MX and Purchasers) Master Agreement (MX and Supplier) Bus Purchase Agreement (Purchasers and Supplier)
6 6 Role of Purchasers
Participate on Steering Committee(s): . Comprises managers from the participating municipalities/transit systems . Chaired by municipal/transit system representative The role of the Steering Committee is to: . Oversee the development of all aspects of the procurement process . Provide overall management direction, approvals and monitoring . Follow-up on all aspects of the consolidated procurement Provide Technical Expertise . Fleet managers/technical experts from participating transit systems participate in vehicle specification development and evaluation of Proposals
7 7 Role of Metrolinx
Coordinating the development of common vehicle specifications and RFP documentation in concert with municipal/agency partners Implementing an open, fair and competitive procurement process . Fairness Commissioner retained to oversee integrity of process Entering into a Master Agreement with the successful Supplier . Specifies the terms and conditions of the contract Ensuring compliance with the terms and conditions of contract . Project Officer funded by Metrolinx Providing comprehensive quality control program . In-Plant Inspector funded by Metrolinx Encouraging and enabling additional municipalities/agencies to participate (to increase economies of scale)
8 8 Current 8-m Procurement
Builds on 12-m and 9-m experiences Helps the smaller agencies and Non-Profit operators that have the most need for a joint procurement Process to recruit Purchasers and develop RFP started in 2009 RFPs took place in 2010 (2011 delivery year) and 2012 (2012 and 2013 delivery years)
9 9 RFP Development Process
Development of Vehicle Specification with support from Purchasers Development of RFP with support from MX corporate services Process was monitored by Fairness Commissioner Evaluation is 65% technical and 35% price. Proportion maintained in 2012 to optimize vehicle quality Application of MTO Canadian Content policy
10 10 Specifications Development
Vehicle Spec Working Group built on existing collective expertise Fleet manager/technical expert from each prospective transit system or agency Project Officer – Industry expert retained by Metrolinx Draft a performance-based specification Identify minimum performance and technical requirements rather than specific components thus enabling bus suppliers the flexibility to bid in the most efficient, cost-effective manner Conduct Information Session with Suppliers for further input, if required
11 11 Characteristics of Vehicle Specification
Performance Based 8-metre, up to 25 seats, up to 6 PMD positions (LF), cutaway 7-years Altoona Tested Van Platforms, RWD Emphasis on Cab Characteristics Emphasis on Warranties (role of dealer, 3yr/90k Cab Warranty) Major options to meet the needs of individual Purchasers (Seats, PMD Positions, Gasoline option, Suspension)
12 12 2012-2013 8-m Low-Floor Contract
Low-Floor Contract Awarded to Creative Carriage Manufactured by Arboc Mobility Contract until March 2014 Base Price (Diesel) of $160k ($20k less than 2011 contract) . Fire Suppression . Up to 6 PMDs
13 2012-2013 8-m High-Floor Contract
High-Floor Contract Awarded to Overland Manufactured by Glaval Contract until March 2014 Base Price (Diesel) of $90k . Fire Suppression . Up to 5 PMDs
14 Manufacturing and Inspection
Both plants are in Indiana Inspection of LF is done by Vehicle Technology Center Inspection of HD is done by First Transit Allows to close the loop with deliveries Project Officer face-to-face meetings with Inspector and Supplier are essential
15 15 Upcoming 8-m Procurements
Market for LF specialized transit buses is growing There has been significant changes in designs since the mid-2000s TPI recommends the utilization of RFIs to structure the collection of information and the discussion with vendors in a fair, open and transparent way – target date is Nov 2013 RFP for 8m buses should be out in first half of 2014
16 17 Development of an Integrated Transportation System Model in Huron and Perth Counties
Final Report
December 2008
Stratford Meals on Wheels and Neighbourly Services
08-9795
Submitted by
Dillon Consulting Limited
Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
TABLE OF CONTENTS
Page 1.0 INTRODUCTION...... 1 1.1 Background...... 1 1.2 Study Purpose...... 1 1.3 Study Approach...... 2 1.4 Aging at Home...... 2
2.0 OVERVIEW OF EXISTING SERVICE PROVIDERS...... 4 2.1 Huron/Perth Demographics ...... 4 2.2 Agencies/Service Providers ...... 4
3.0 ISSUES, NEEDS AND OPPORTUNITIES...... 9
4.0 BEST PRACTICES FOR EFFECTIVE SERVICE COORDINATION ...... 11 4.1 Key Applications of Coordination...... 11 4.2 Applicable Service Coordination Models...... 15
5.0 DEVELOPMENT OF A COORDINATION FRAMEWORK ...... 19 5.1 Recommended Coordination Model ...... 19 5.2 Applications for Coordination in Huron and Perth...... 19
6.0 RECOMMENDATIONS / IMPLEMENTATION PLAN...... 30
LIST OF APPENDICES
Appendix A – Summary of Agency Characteristics
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1.0 INTRODUCTION
1.1 Background Dillon Consulting was retained by Stratford Meals on Wheels and Neighbourly Services (representing seven community support agencies) to oversee the development of an implementation framework for an integrated transportation system across Huron and Perth Counties.
The seven agencies represented in this study provide a variety of services to seniors, persons with disabilities and other members of the community. The agencies represented include:
1. Stratford Meals on Wheels and Neighbourly Services 2. Midwestern Adult Day Services 3. Mitchell & Area Community Outreach 4. Community Outreach Services – Milverton 5. St. Marys and Area Home Support Services and St. Marys and Area Mobility Service 6. Town and Country Support Services 7. VON Perth Huron
These agencies have developed in response to local need and have built upon local community strengths by leveraging both volunteer and financial resources. They offer volunteer and accessible transportation to their clientele, looking to promote accessibility for persons that do not have the means to transport themselves. In addition, they provide a variety of programs specifically targeted to seniors, including Meals on Wheels, exercise classes, shopping services, and social outings. The objective is to provide independence to members of the community, particularly seniors and frail elderly clients, and to provide home support services.
The number of seniors in Huron and Perth Counties is forecasted to double over the next 16 years. With this aging population, the demands are increasing, which will place a significant strain on resources and the ability to provide needed services at an acceptable level of quality. This trend emphasizes the need to best manage public resources and find innovative ways to provide appropriate care to this demographic and keep seniors active at home, out of long-term care facilities and hospitals.
The South West Local Health Integration Network (SW LHIN) recognized this, and approved funding to develop an integrated and coordinated transportation system across Huron and Perth Counties. The funding approval forms a part of the Ministry of Health and Long-term Care (MOH<C) and SW LHIN’s Aging at Home Strategy.
1.2 Study Purpose The purpose of this assignment is to enhance the capacity of service to existing and growing clientele by developing a coordinated transportation framework for the seven community support agencies / rural transportation providers in Huron and Perth Counties. The model will provide a one stop resource for clients to request services, and a framework that will allow the most effective
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008 service to be provided. It should be noted that while each of the community support agencies provides a variety of services for their clientele, the scope of work and recommendations presented in this report are limited to the coordination of transportation services.
The development of an Integrated Transportation System for these seven agencies will help achieve better resource management, cost-effectiveness in service delivery, and potentially increase capacity and service quality for clientele across the two regions. While certain functions need to remain localized, it is important to ascertain which functions will provide improved capacity, service quality, and cost efficiency in a coordinated service delivery model.
1.3 Study Approach Coordination of services will bring various benefits, but can also be challenging without effective and agreed to policies and procedures in place. Therefore, the overall approach for this assignment was to understand service delivery approaches being undertaken by each agency and any issues and opportunities faced, identify best practices, and then build a framework based on consensus among all parties.
The tasks involved in this assignment were the following:
1. Meet with each community support agency individually to understand their existing structure, services provided, funding, procedures, and key issues and opportunities. This is documented in Appendix A. 2. Review best practices in transportation service coordination through a review of literature and interview with other rural service providers. 3. Conduct a project workshop with all seven community agencies to solidify project goals and objectives, guiding principles and the model for coordination that should be achieved. This process also helped determine which functions are better off coordinated and which functions should continue to be administered locally – an imperative component in framing the new model.
1.4 Aging at Home In August, 2007 the Ontario government announced the Aging at Home Strategy to help seniors live healthy, independent lives in their own homes. The Strategy has a strong focus on innovation and prevention. Recent estimates project the seniors’ population in Ontario will double in the next 16 years, putting a strain on health services in the province. As such, it is imperative that seniors are able to remain in their homes for as long as possible both for their well-being and to reduce pressure on hospitals and long-term care facilities.
One method to enhance existing services, as promoted in the Aging at Home Strategy, is through coordinated transportation. Coordinated transportation services will enable seniors to remain mobile, engaged in their community, and stay in their homes for as long as possible. This promotes wellness and healthy living and ultimately will reduce the need for unnecessary admissions into hospitals or long-term care facilities. Coordinated transportation services are the best way to stretch
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008 scarce resources and ensure seniors across communities have easy and equitable access to transportation services.
The $700 million Aging at Home initiative is being led by the Local Health Integration Network (LHIN), with each LHIN receiving a specific funding allocation to meet the needs of local communities.
The strategy for coordinated transportation in Huron and Perth Counties aligns itself with LHIN goals and objectives. It promotes “building linkages across the continuum” by ensuring that seniors have ready access to transportation services. This keeps them engaged in their communities while enabling them to continue living in their own homes. It provides a more cost effective method of transporting chronically ill patients, thereby increasing their quality of life and reducing time spent at treatment centres. It outlines the requirement for a standardized web-based scheduling tool which will allow the service providers to regularly exchange information and improve the services offered. Finally, by enhancing seniors’ independence, they will achieve an improved quality of life thereby lessening demand on health services.
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2.0 OVERVIEW OF EXISTING SERVICE PROVIDERS
2.1 Huron/Perth Demographics Perth County is located north-west of the Regional Municipality of Waterloo and north of the City of London. It is predominantly rural, with the City of Stratford and the Town of St. Marys as larger urban areas (although both have been separated from the county’s jurisdiction). Within the County, there are also a number of villages and hamlets including Listowel, Milverton and Mitchell. Perth County has a population of 74,344, with approximately 11,000 persons, or 15 percent of the population, aged 65 or older1. This percentage of seniors is comparable to the Ontario average of 14 percent.
Huron County is located along the shores of Lake Huron and north of the City of London. It is dominated by agricultural lands which act as an important economic base for the region. Residents live in nine newly amalgamated municipalities including Bluewater, Horwick, Central Huron and Ashfield-Colbourne-Wawawosh. The major population centres are Goderich, Wingham, Seaforth, Clinton and Exeter. More than half of Huron’s residents live in non-urban areas, making Huron County one of Ontario’s most rural regions. Huron is also one of Canada’s “oldest” populations with 10,620 persons aged 65 or older out of a total population of 59,325. This number of seniors represents 18 percent of the total population, compared to the provincial average of 14 percent.2
The aging population of both counties combined with an aging demographic has made transportation one of the top priorities to be dealt with among the senior population.
2.2 Agencies/Service Providers The following section presents a summary of the seven agencies/rural transportation providers that provide services in Huron and Perth Counties. Further detail on each of these agencies is provided in Appendix A.
Stratford Meals on Wheels and Neighbourly Services Stratford Meals on Wheels and Neighbourly Services (SMOW&NS) provides a range of services vital for seniors and persons with disabilities to remain independent in the City of Stratford and surrounding area (Perth County). The services offered include Telephone Reassurance, Volunteer Visiting, Diners’ Club, SWIFT, Home Maintenance and Repair and Meals on Wheels.
SMOW&NS also offers Volunteer, Coordinated and Accessible Transportation. Coordinated and Accessible transportation is offered 24hours/day, 7 days/week (24 hours notice is not required).
Volunteer Transportation services are provided for clients who require assistance when going to medical appointments in town or out of town, for shopping or errands and to day programs. Twenty-four hours notice is required to arrange a volunteer driver.
1 Source: Statistics Canada, 2006 Census 2 Source: The State of the Huron County Economy.
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Coordinated Transportation is provided when volunteer assistance is not required. This service can be arranged on short notice with SMOW&NS and is provided using the Dodge Caravan (SMOW&NS employed drivers operating Monday to Friday from 8:30am to 4:30pm) or through one of the local taxi companies. Clients are charged a subsidized rate, with the agency paying the difference to the taxi company.
Two wheelchair accessible vans are also available to provide Accessible Transportation both in and out of town to clients who require the use of a mobility device. Vans are owned by SMOW&NS and are driven by the same local taxi company that provides Coordinated Transportation. Transportation is available 7 days a week (including short notice and same day service). Bookings are accepted Monday to Friday from 8:00am to 4:00pm.
Community Outreach Services - Milverton Community Outreach Services – Milverton provides assistance to seniors and persons with disabilities who require assistance in order to keep their independence in the Municipality of Perth East, in Perth County. The services offered include Seniors Day Out, Friendly Visiting, SWIFT, Home Repair, Telephone Reassurance, Lifeline, the Footcare Clinic and Meals on Wheels.
Transportation services are also provided via Perth East Transportation and Volunteer Transportation.
Perth East Transportation provides a reservation based door-to-door accessible service within Milverton and to other destinations in Perth County and the surrounding area. While Perth East Transportation operates its own accessible bus and van, it also brokers out transportation services, matching the client with the best service alternative, including volunteers, Aboutown, Laidlaw Bus Lines, Stratford Meals on Wheels & Neighbourly Services, Mitchell Community Outreach and taxis. Perth East Coordinated transportation service is offered on Tuesdays, Thursdays and Fridays between 8:30am and 4:30pm. Services are available at other times via charters. Besides the elderly and disabled, Perth East Transportation also transports a large number of children and Amish people.
Volunteer transportation services are provided anytime during the week, given volunteer driver availability. Service areas include Milverton and Stratford; other areas around Perth County; London; Kitchener/Waterloo; and around Southern Ontario. Volunteers are reimbursed per kilometer for providing transportation with their own vehicle.
Mitchell and Area Community Outreach/Ritz Lutheran Villa Mitchell and Area Community Outreach offers services aimed at enriching the lives of seniors in the Municipality of West Perth. The services offered include Congregate Dining, Home Maintenance and Repair, Home Help, Meals on Wheels and Wellness for Seniors.
Transportation services are also provided via Mitchell and Area Mobility Bus and Volunteer Transportation.
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The Mitchell & Area Mobility Bus is a door-to-door transportation service available in the Municipality of West Perth, through advance booking for seniors, the disabled, and those recovering from injury, illness, or accident. The service is offered Monday to Friday. Times vary by day. Services are available for all hours outside of these times via charter. Transportation is provided using two vehicles (one accessible bus and one mini-van). Besides regular local trips, two-thirds of their trips are regional. Major regional destinations include London, Stratford, Kitchener, and Seaforth/Clinton. The vehicles are owned by the Municipality of West Perth, but operated by the Ritz Lutheran Villa.
Volunteer Transportation is provided for clients when going to medical appointments, running errands or grocery shopping, and for social purposes. Besides seniors, Mitchell and Area Community Outreach also transports students with special needs and Ontario Disability Support Program (ODSP) clients.
St. Marys and Area Home Support Services and St. Marys and Area Mobility Service St. Marys and Area Home Support Services offer a range of services to enable seniors, people with disabilities and people recovering from illness or injury to live independently at home as long as possible. The services provided are Meals on Wheels, Volunteer Visiting, Congregate Dining, a Footcare Clinic, Home Help Referral Program, Shopping Service, SWIFT and Telephone Reassurance.
St. Marys and Area Mobility Service offers accessible and non accessible transportation to seniors and people with disabilities to enable them to live an independent life in the St. Marys and area community. The two agencies work in close partnership, and provide services to the St. Marys community and surrounding area. Volunteer drivers are recruited by Home Support Services and scheduled by the Mobility Service.
The Mobility Service owns one accessible bus and two accessible vans and also uses the services of volunteer drivers. Volunteer transportation services are provided for clients who require assistance getting to appointments out of town, and for some trips and shopping services in town. Both the bus and the vans operate 7 days a week, 24 hours a day as required, however bookings are requested 24 hours in advance. The office takes bookings Monday through Friday between 8:00am and 4:30pm. Weeknight and weekend trips are often provided by either the bus or van depending on the circumstance.
Regular weekday transportation is provided for the Adult Day Service. The bus is often busy during the weekday providing both accessible and non accessible in town transportation. The vans provide most of the out of town accessible transportation. Shopping trips are also conducted on a monthly basis to Stratford and less regularly to London. The vehicles are also used to provide transportation to Home Support dining outings.
Midwestern Adult Day Services Midwestern Adult Day Services provides services for seniors and adults with special needs to assist them in maintaining independence in Huron County, North Lambton and South Bruce. All of Midwestern’s services are offered at one of its Day Centres. Services offered focus mainly on therapeutic programs, such as exercising, bathing, foot care and hair dressing.
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All transportation provided by Midwestern is for transporting clients to and from one of the five Day Centres located in Clinton, Wingham, Exeter, Grand Bend and Goderich. For transportation to the Grand Bend site, Lambton Elderly Outreach is used. Their 2 buses and 1 van are used between 8:30am and 10:00am to deliver patrons to the Day Centres and between 3:00pm and 4:30pm to deliver patrons home. Since the bus drivers are also the day centre program assistants, the buses remain unused between 10:00am and 2:45pm. Volunteers drive other Day Centre participants using their own vehicles, primarily for participants that are not “on route”. Agency vehicles are also used occasionally on Saturdays. There is an interest by Midwestern Adult Day Services to see if these buses can be put to good use during this period.
Midwestern is also currently operating a three-month trial of a fixed route transit route in Goderich using a Grand Caravan donated by the LHIN. The Grand Caravan Transit Route service is a 20-stop transit route for seniors only. The route runs six times per day and operates on Monday and Friday only, between 8:30am and 4:30pm. It is not a door-to-door bus service and will only load those physically capable of entering and exiting the vehicle on their own. Upon completion of this pilot project the use of this van will be reviewed.
Town and Country Support Services Town and Country Support Services provides services to seniors, disabled adults and children in Huron County and surrounding areas. Services offered include Personal Support/Homemaking, Diner’s Club, Wellness for Seniors Program, Home Maintenance Referral Service, Meals on Wheels, Home Help, and Telephone Reassurance.
Town and Country also provides transportation services via Mobility Van Transportation and Volunteer Transportation.
Mobility Van Transportation provides transportation to wheelchair bound clients or those who have mobility difficulties getting to medical appointments or other appointments. Transportation is typically available during the day and during evening hours, but is available 24 hours a day, 7 days a week for emergencies (based on driver availability). The accessible vans are utilized Huron County wide and are stationed in Wingham, Exeter, Clinton and Goderich. The accessible vans provide services in their community, and also long-distance trips throughout southwestern Ontario. The service is operated by paid casual drivers, who are called on when trips are booked.
Volunteer Transportation services are offered for clients when friends and family are not available. Besides seniors and disabled adults, Town and Country also provides the occasional transportation service to the Mennonite community in North Huron.
VON Perth Huron (North Perth Community Transit) VON Perth Huron provides a range of services to seniors, the frail elderly and adults with a disability in the North Perth community and surrounding area. Services provided include Meals on Wheels, Wellness Program, Visiting Nursing, Volunteer Visiting, Adult Day Program, Congregate Dining, and others.
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VON Perth Huron also provides transportation services via North Perth Community Transit and Volunteer Transportation.
North Perth Community Transit is a reservation based door-to-door service to individuals living in North Perth who are elderly, frail or who have a developmental or physical disability. North Perth Community Transit uses volunteer drivers, a mobility bus and van to ensure coverage is available as much as possible. The service is available seven days a week based on the driver’s availability.
Volunteer Transportation provides transportation services to eligible individuals residing in the Municipality of North Perth. Hours of service are based on the needs of the client and availability of volunteers. Volunteers use their own vehicle and are reimbursed expenses based on a per kilometer rate.
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3.0 ISSUES, NEEDS AND OPPORTUNITIES
Several issues and opportunities for coordination were identified during the consultation process with representatives from each agency and from experience elsewhere. These issues need to be addressed when developing an overall coordinated framework.
Opportunities
1. Existing Environment of Cooperation – All seven agencies meet regularly to discuss common issues. Four of the seven agencies have already developed a common Policies and Procedures Manual.
2. Existing Brokerage Model – Some of the agencies already broker service to other agencies when they cannot accommodate a trip.
3. Development of a Common Database Platform – Six of the seven agencies have purchased the same database platform (Client Information Management Systems, or CIMS- HR) to standardize information collected in a common format.
4. Similar Eligibility Criteria – Most agencies use a common eligibility criteria established by the Ministry of Health guidelines. While there are some exceptions (i.e. some deliver services to seniors only), most provide service mainly to persons with disabilities and to seniors.
5. Dispatch of Long Distance Trips - Most transportation is generally localized, but there are a number of trips to both London and Stratford hospitals. These long distance trips provide an opportunity for coordinated transportation.
Issues/Challenges
1. Challenges in Servicing Unique Population Groups – Many registered users are accustomed to a certain level of service and processes, as well as a familiarity of drivers and agency personnel. Moving to a coordinated structure will involve a certain degree of change that will need to be dealt with. A good example is the Amish Community who is served by Perth East Transportation. Many members of this community do not have a phone and therefore a trip needs to be arranged and booked on the initial call.
2. Privacy Issues – Using the same database platform to standardize the information collected could give all agencies access to client information that is considered confidential to one particular agency. It is important to ensure that client confidentiality is not jeopardized. CIMS can be used to block discrete information from individual and specific agencies, ensuring that privacy is maintained.
3. Stable Funding – It is important when developing a coordinated framework that existing funding sources are not jeopardized. While all agencies share some similar funding sources
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(i.e. funding from the LHIN), others receive funding for other sources such as MTO Gas Tax funding. Specific coordination models may jeopardize this funding.
4. Different Pricing and Volunteer Remuneration Structure – The seven agencies represented have different pricing structures and remuneration rates for volunteers. This can be difficult to standardize, particularly if clients are required to pay more.
5. Cost to Establish a 1-800 Number – If a central intake and/or dispatch system is established, this may require the purchase of a 1-800 number. This will be funded by the project.
6. Cost of Scheduling Software – The CIMS database may not be sufficient to provide coordinated scheduling. This may require the purchase of scheduling software, which can be expensive and must be integrated into the existing CIMS database.
7. Deadheading Costs When Traveling Between Service Areas – While coordination can potentially reap a number of efficiencies, such as increased availability of trips for clients, increased deadheading costs for vehicles traveling between communities will need to be accommodated.
8. Different Service Hours – Each agency has different hours of service for both transportation and for receiving calls for intake and trip reservation. While these hours are fairly similar, some agencies provide more limited service hours.
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4.0 BEST PRACTICES FOR EFFECTIVE SERVICE COORDINATION
To better understand the need for coordination, a literature review was conducted along with an interview of existing rural agencies that are already coordinating transportation services. This information was used in the development of a service model for Huron and Perth Counties.
4.1 Key Applications of Coordination It is well documented that coordinated transportation is needed in many communities; and where implemented can have profound effects on the efficiency and effectiveness of service. Implementation, however, can present both opportunities and challenges. Properly completed, service coordination can increase the cost effectiveness of service delivery and capacity for clientele by combining resources and distributing them in an effective manner. However, there are certain elements, particularly with an aging demographic, that require a degree of local knowledge and customer care. In these cases coordination may not make sense, or may be difficult to implement without straining the important relationship between the service agent and the client. To determine an appropriate approach to be taken the benefits, limitations and caveats of rural transportation coordination were assessed based on information gathered from numerous sources. Some of the key applications for coordination are identified below along with issues and opportunities that potentially exist.
1. Centralized Intake Process A centralized intake process coordinates the registration of new clients for transportation services among all participating agencies, usually through establishing a common 1-800 number for clients. In this process, a new client that requires transportation services calls the central 1- 800 number. New clients are screened and referred to the most appropriate agency that offers the service they are requesting. This is typically done by asking three basic questions:
a) Where do you live? b) How old are you? c) What is your level of mobility?
This reduces the number of inappropriate referrals, client wait times, and client confusion. It also ensures that the client is referred to the most appropriate agency. It should be noted that in this application, the choice of actually conducting the intake process can still be done by individual agencies. If each agency has their own ‘process’ requirements that need to be fulfilled to receive funding or accreditation, then this application can be done individually.
2. Centralized Marketing/Public Awareness A centralized marketing and public awareness campaign establishes a central brand for agency transportation services and pools resources, thereby increasing client awareness of how to access transportation services. In order for this approach to be successful, it must be a joint initiative between all agencies and each individual agency should reduce their individual brands in favour of a centralized brand. The major challenge is changing the mindset of clients so they are aware
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of the new central intake number and so that they feel their needs continue to be satisfied. To achieve this goal, the coordinated framework should be marketed as a ‘one-stop-shop’ to meet the transportation needs of the client. An emphasis should be placed on the ease of use of the system compared to the old system.
3. Centralized Scheduling and Dispatch In establishing a central 1-800 number, many coordinated networks have also established a single and centralized dispatching office. The central dispatcher is responsible for taking trip reservations, placing clients on available and appropriate vehicles and tracking vehicles. The scheduling office is also responsible for staffing the office during the hours of operation of the entire system.
A centralized scheduling and dispatch system can increase the overall efficiency of the system and reduce costs through an increase in the potential for shared rides. Many reports, including those of the Transit Cooperative Research Program (TCRP), suggest that ridesharing improves efficiency by limiting the number of vehicle trips with one or two passengers3. Centralizing scheduling or dispatching can aid in distributing passengers to the appropriate vehicles so that vehicles are operated with as many passengers as possible.
Centralized dispatching can also reduce the number of local dispatching staff required. This can reduce overall costs, freeing up funds to pay the central dispatch office, freeing up local staff to perform other functions important to an individual agency and allowing funds not used on staff time to be directed to actual transportation delivery.
The disadvantage of a centralized dispatch system is that it has the potential of losing local awareness because a single agency becomes the main contact for clients. In small communities, clients get to know the dispatcher well, including the protocols or procedures they follow when booking trips. For example, Perth East Transportation books a number of rides for the Amish Community. Many members of this community do not have telephones available for call backs, and thus a trip typically needs to be booked and confirmed on the initial call. This localized situation needs to be understood by the centralized dispatcher while still maintaining a centralized process.
As well, in order for a centralized scheduling and dispatch system to be effective, new scheduling software may be required to maximize sharing of trips and overall efficiency. This will invariably increase short-term agency costs. Methods will also need to be found to integrate the software into the newly purchased CIMS database.
4. Service to Hospitals Hospitals have a great need for transportation services to be provided to individuals without access to a vehicle or without family members that can provide them with transportation. Given the shortage of beds in many hospitals across Huron and Perth Counties (and the surrounding region), many hospitals are looking to discharge patients as quickly as possible to free up needed beds for other patients. The cost per trip by ambulance is approximately $400.00. Hospitals will
3 Source: Transit Cooperative Research Program
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try to avoid transporting discharged patients by ambulance whenever possible due to the expense; however, alternatives are not always available, particularly during the late evenings. Better coordination of trips is required to better service a portion of this market. A larger coordinated group of agencies may be able to provide better service to and from hospitals. However, this is a major issue that involves an agreement between the service provider and the hospital on an appropriate rate and availability of service. Such an agreement would also need to include hours of service, advance notice, availability of drivers, attendants, physical limitations, etc.
5. Standard Fares Standardizing fares for trips made is important when developing a centralized transportation framework. It helps establish the goal that a client, no matter where he/she is located in the region, will receive a similar level of service at a similar fare (or rate). This is particularly important for service beyond an individual agency’s boundaries. Standardizing a fare (either flat or fare by distance) will ensure that customers are charged the same fare for a trip no matter which service provider they use. This promotes equity in the service and increases customers’ understanding of the coordinated framework. Clients are no longer able to bargain between agencies to find the best price, as the cost for a long-distance trip is the same regardless of what agency vehicle is being used.
To achieve a common fare, some agencies would need to increase their fares while other may have to lower fares. A common fare should be revenue neutral and take into account deadheading costs.
Since some agencies may be required to raise their prices to match the agreed upon rate, the result may be increased fees for some clients. To avoid any negative backlash that this may cause, agencies must emphasize the improved efficiency and reliability of the service to clients.
6. Standard Eligibility Creating common eligibility criteria can improve the effectiveness of a coordinated framework. Contrarily, differences in eligibility criteria between local agencies will reduce the overall effectiveness of a coordinated framework, as dispatchers may be limited in their ability to coordinate and share rides. For example, if only a few agencies consider children as eligible for a trip, the dispatcher will be limited in the agencies or vehicles that will be able to provide the trip. The dispatcher will be even more limited in being able to share the trip with other clients.
7. Central Database A central database collects, processes and disseminates comprehensive information about the client for both billing purposes and for transportation purposes. The system should include a centralized inventory of vehicles, capacity, and accessibility; as well as client information, including age, level of disability, and location. The Framework for Action, a U.S. based resource to assist leaders at all levels develop a coordinated and integrated transportation service, outlines the importance of regularly collecting and updating data to identify service gaps and other inefficient service delivery mechanisms.4
4 Source: Framework for Action: Building the Fully Coordinated Transportation System
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A central database also provides a common statistical tracking tool so that all agencies can maintain up-to-date information on their clients. Although there are many advantages of information-sharing, a mechanism must be in place to prevent certain client information from being shared with unauthorized parties. Client Information Management Systems (CIMS) has the ability to respond to these privacy issues.
8. Standardized Policies and Procedures A set of standardized policies and procedures for service providers is an important component of successful coordinated transportation. Standard policies should include risk management, driver training, attendant policies, level of service and assistance, emergency response, vehicle breakdown, etc. This creates a situation where best practices can be shared among participating agencies and implemented as part of a coordinated framework. It also provides the client with an assurance of a consistent level of service and expectations, no matter which service provider is actually delivering the service.
Certain levels of passenger assistance may be an issue for some agencies. For example, some may provide door-through-door service whereas others, due to insurance restrictions, only provide curb-to-curb service. In developing a common set of policies and procedures this issue must be addressed.
9. Vehicle Purchase Standard criteria for vehicle purchase should be developed with a focus on standardizing vehicle specifications, such as the amount of space required and lift capabilities. Different models of coordination promote different practices for vehicle ownership and sharing. In some cases, vehicle ownership is shared by agencies and in other cases one agency is responsible for vehicle procurement, purchase and disposal. Where there is a large vehicle requirement, agencies may be able to reduce the unit cost if vehicles are purchased in bulk.
10. Vehicle Insurance/Maintenance In some cases, agencies have identified one insurance provider and one maintenance provider. In these cases, agencies have achieved economies of scale, thereby reducing costs. A maintenance contract should consider multiple locations or only major maintenance to avoid potential deadheading costs for servicing or light maintenance. This would also save downtime.
11. Sharing Volunteer Drivers Creating a pool of volunteer drivers through sharing can greatly reduce stress on volunteers because they no longer have to do more than they can handle. It also expands the pool of volunteers in certain areas that have previous history of not being able to access volunteers for services. Sharing volunteer drivers involves identifying existing volunteers that are willing to work for the coordinated system, not just for one individual agency. This, however, can be an issue because some volunteers only want to work for a particular agency or in a particular area.
To help resolve this issue, organizations such as the Wellington Transportation Group have developed an opt-in or opt-out system which allows volunteers to either volunteer for the central agency, or to volunteer solely for a local agency. Another issue that may arise is the level
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of compensation volunteer drivers should receive. This can be addressed by establishing a common reimbursement rate for all volunteers regardless of their agency affiliation.
Some centralized agencies have moved beyond a sharing agreement to the establishment of a centralized volunteer recruitment process. This process includes standardizing volunteer policies, procedures and training, as well as pooling resources to find and recruit volunteers. The advantage of this approach is being able to dedicate a staff person to this role and ultimately put more resources to this activity. The disadvantage is that a representative from a centralized agency may not be as effective at finding local volunteers as someone that knows the local community.
12. Centralized Software/Computer Solutions Utilizing technology to coordinate operations, manage information and enhance customer service is paramount to the success of coordinated transportation services. Investments in registration and scheduling technology can improve efficiency of services by allowing more shared trips to be made and utilizing a network of vehicles across a larger service area to provide access to transportation services.
The Peel Red Cross, for example, worked with a vehicle routing and scheduling software supplier to develop a routing optimization system that reduced the number of vehicles required by 15 percent and the time spent by customers on route. The Peel Red Cross also combined the routing software with their Central Intake Management Software (CIMS) database, which is expected to improve the value of passenger transportation and meals on wheels programs across their service area.5
Other organizations, such as DARTS in Dakota County, Minnesota have established simpler reservation and scheduling systems, appropriate for smaller organizations6. In these cases, the database systems improved efficiency in customer and driver scheduling and billing.
Cost is the major barrier to implementing a registration and scheduling system. Potential costs include the purchasing of the license, installation fees and the cost of training employees. The capital cost of a scheduling software package can range from $40,000 to $75,000, plus a $5,000 to $7,000 annual licensing fee.
4.2 Applicable Service Coordination Models The potential applications for coordination described above present a list of options that are available when developing a coordinated transportation framework. The application of each is partially dependent on the service coordination model that the seven agencies want to pursue, as different levels of coordination or centralization are applicable in each.
Four strategic organizational models were identified as potential alternatives to transportation coordination in Huron and Perth Counties.
5 Halton Peel Transportation Network Project 6 Transit Cooperative Research Program: Report 105
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1. County-Wide Transportation System Model In the County-wide Transportation System Model, all transportation operations and vehicle ownership is pooled and managed by a single-entity. Individual vehicles remain parked at local locations, but are dispatched from a common point.
The advantages of this model are economies of scale; it takes full advantage of all resources; and it is the best model to provide true coordination and increase county-wide accessibility.
The disadvantages are that localized autonomy is lost, certain funding may be at risk, and there is a potential for a loss of volunteers and for increased costs. As well, local knowledge and individual matching of passengers with drivers could be hindered. Finally, there could be a perceived loss of local customer service.
The Suburban Mobility Authority for Regional Transportation (SMART) provides a good example of this type of model. SMART is a very mature and large public transit system established in 1967 to serve South-eastern Michigan and the suburbs of Troy and Oakland. Their system has a total of 640 vehicles and 990 employees. They receive over 50% of funding (both capital and operating) from grants and subsidies.
Of interest is their approach to serve the rural areas, where they use 71 of their total vehicles. These vehicles are dispersed throughout the total service area, but centrally dispatched. In order to minimize deadheading, vehicles are parked in multiple locations. Since inaugurating this rural service, ridership has significantly increased.
Other notable features of this service are that drivers are paid employees; no volunteers are utilized; and the software used is a commercially available product.
2. Brokerage Transportation Model In the Brokerage Transportation Model, individual agencies retain ownership and operation of their vehicles. However, customers looking for service do so through a single point of contact. This point of contact, such as a lead agency, contracts out service to the most appropriate agency if local transportation is not available. The fee for the trip is transferred between agencies. The dispatcher will also schedule vehicles and trips, bill funding sources, and track utilization. This method has been proven through case studies to reduce costs.
Creating or assigning a single agency as the administrator or broker of services, leads to improved customer service and an easier to use system for the client. It also allows resources to be pooled. Local agencies also retain ownership and more ‘say’ in the provision of transportation services.
The major issue that has arisen, resulting from a single point of contact system, is that some customers see the program as less responsive to their needs than a purely local system. Addressing this issue can be challenging, but not impossible.
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3. Central Dispatch Transportation Model Similar to the Brokerage Model, in the Central Dispatch Model agencies retain ownership of their vehicles. The individual agencies and transportation providers would remain independent, but customers wishing to access a ride could do so through a single point of contact. This point of contact would have access to all vehicles in the network and would book the trip based on what makes sense.
This model establishes single dispatch software that has a “master” at the central dispatch office and a “slave” at individual agency offices. As trips are booked, information would automatically update everyone’s record. This allows all system coordinators to know what is available. However, it has the added advantage of allowing the local agencies to upload call taking. The hours of dispatch between the seven agencies are consistent weekly from 9:00am to 5:00pm. However, the central dispatch office is always open. This means that a local agency can automatically transfer all calls to the central dispatch. As trust and proficiency is gained in central dispatch then all calls come to a 1-800 central office and that office can be transferred locally if so desired.
Another major advantage is to long distance trips. For example, a medical trip from Mitchell to London goes through Stratford and St. Marys. That single vehicle could be used to deliver the other two trip requests.
In this model, the difficulty would be meeting local needs and maintaining local knowledge. Additionally, there would be a need to standardize eligibility criteria and fare structure in order for the model to be effective.
A good example of this transportation model is the Holmes County Transportation Coordination (HCTC) in Ohio. HCTC, which began operations in April 2000, works in partnership with 27 member agencies to provide coordinated transportation for eligible Holmes County residents. HCTC provides curb-to-curb service to senior citizens, developmentally disabled students, schools, and residents with medical appointments outside of the county.
HCTC takes all of the trip reservations and completes the vehicle scheduling. Upon scheduling a trip, HCTC contacts each agency to assign specific trips. The 27 agencies have a combined fleet of 130 vehicles to deliver the service.
For two days of each month, HCTC provides trips for the residents of Holmes and Morrow Counties to hospitals in Cleveland. A single telephone number has been established for people to call to schedule pickup. This service uses a pool of volunteer drivers. The result has been a lower cost for passengers, reduced vehicle miles, and higher ridership. By establishing one telephone number and scheduling office, Holmes County has been successful in reducing the duplication of services.7
7 Transit Cooperative Research Program: Report 101
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4. Volunteer Coordination of Local Resources Model This model requires the least amount of coordination. In effect, agencies continue to operate independently, with no major changes being witnessed by the customer. Coordination does occur in certain areas. Agencies develop common policies for vehicle purchases (including specifications), insurance, maintenance, dispatch software, policies and procedures. There is also no need to standardize eligibility or fare structure because agencies remain largely unchanged operationally.
Customers may find this model less responsive to their needs because capacity or the quality of service is not increased. Dispatching continue to occur at the local agency.
The Wellington Transportation Group provides a good example of this model and how it can evolve towards a more coordinated model. The Group is a collaborative network of six community service providers in rural Wellington County who provide volunteer-based transportation services to residents. The Wellington Transportation Group provides central intake through a 1-800 number. Each participating agency operates under its own mandate, rules, and eligibility criteria based on a clients age, geography or level of disability. When new clients call, they are screened centrally and referred to the most appropriate agency. Registered clients call individual agencies directly for a trip. This process has reduced customer confusion and frustration and improved efficiency at the agency level. It also has reduced the number of inappropriate referrals to individual agencies.
Wellington Transportation Group also set out clear policies and procedures to ensure a consistent level of service delivery among all the service agencies. This involved standardizing how drivers deliver the service (i.e. level of assistance for clients) and overall driver training. Currently, they are developing a process to share volunteers. Volunteers are now asked if they will volunteer for the Group rather than an individual agency. This process will create a larger pool of volunteers for all agencies and ensure a volunteer is available for required trips and that individual volunteers are not overworked.
Since the inception of the Wellington Transportation Group, the individual agencies have seen a cumulative increase in the number of drives performed by seven percent. The next step that the Group is looking to undertake is to establish a centralized scheduling function. This will provide the same ‘one-stop number’ to call to reserve a ride and allow for a higher degree of coordination between the various member agencies.
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5.0 DEVELOPMENT OF A COORDINATION FRAMEWORK
An evaluation session was held with representatives of each agency to discuss, evaluate and decide on the applicable coordination model as well as applications for coordination that should be considered for Huron and Perth Counties. The following presents the results of the evaluation based on these discussions with agency representatives, the literature and best practices review, and professional judgement. Based on this assessment, a recommended framework was developed.
5.1 Recommended Coordination Model As discussed in Section 4.2, four coordination models were explored and discussed during the evaluation session.
The County-wide Transportation System model was assessed and removed from further consideration. While this model provides the highest degree of coordination, it was not considered appropriate, at this time, since it had the potential of jeopardizing certain funding sources, and was not considered politically realistic. Many agencies have different boards that they are accountable to, including municipalities (i.e. the Town of St. Marys) and national organizations (i.e. the VON). Creating a County-wide agency would cease this reporting structure and would require other players at the table. It is recommended that this model be explored in further detail once a successful coordination framework is in place.
The Volunteer Coordination of Local Resource Model was also assessed and removed from further consideration. It was felt that a lot of volunteer coordination is already taking place, and moving to this model would not lead to a noticeable improvement in efficiencies and level of service to customers.
This leaves two coordination models for consideration:
1. Brokerage Transportation Model 2. Central Dispatch Transportation Model
These models are very similar in structure. Some of the differences between the two are based on the applications for coordination that make sense. These are discussed below.
5.2 Applications for Coordination in Huron and Perth The potential applications for coordination that were identified in Section 4.1 were applied to Huron and Perth Counties and assessed in more detail to determine the overall benefit of moving forward with each. The assessment was based on a number of criteria:
1. Ease of Implementation – is the application easy to implement based on existing reporting structures and ability to alter existing processes within each agency? What are the costs required to implement and is funding available to do so?
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2. Cost Efficiency – are cost efficiencies gained through the implementation of this application (i.e. less duplication of staff, increased ride sharing)?
3. Effectiveness – does the application allow the agency to better reach its intended goals (provide quality service to eligible residents) and increase overall ridership?
4. Access to Service – does the application improve the ability of a client to register for service or request a trip (i.e. hours of service, client’s knowledge of service and eligibility)?
5. Capacity of Service – does the application improve the ability of the service provider to provide a trip to the client?
6. Level of Service – does the application improve overall level of service to the client?
5.2.1 Centralized Intake Process The centralized intake process will involve a central point of contact where a client can call to register for a service. The lead coordinator will then refer the client to the correct agency for actual determination of eligibility and processing.
Criteria Assessment Ease of Implementation Fairly easy step to implement at a minimal cost Cost Efficiency Can reduce number of inappropriate referrals to local agencies and improve overall efficiency Effectiveness Can reduce number of inappropriate referrals and free local agency staff time to perform other functions Access to Service Central phone number can improve client’s ability to find a service that is applicable to their needs Capacity of Service N/A Level of Service Can reduce customer confusion and frustration
Based on the above assessment, it is recommended that this activity be coordinated in a centralized framework. To achieve this, the following steps are required:
1. Set up a 1-800 number and advertise in the community. 2. Conduct a gap analysis for each agency to determine what services and client groups each agency are capable of accommodating. 3. Based on results of analysis, develop a screening process based on three questions to determine which agency a new client should be referred to. The three questions should seek to discover: a. Where the new client lives (to identify the agency that provides service to that area) b. Whether the person is a senior citizen (for eligibility purposes)
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c. The potential clients level of mobility (for eligibility purposes) 4. Train the central dispatcher initially to take calls for new clients. If client waiting times exceed 1 minute, an additional staff person funded through the Aging at Home initiative should be used to conduct this function. The central intake person is responsible for screening new clients and referring them to the most appropriate local agency. Registration of new clients will continue to occur at the local level.
5.2.2 Centralized Marketing / Public Awareness The centralized marketing / public awareness process will involve the development and promotion of a central ‘brand’ for transportation services within Huron and Perth Counties.
Criteria Assessment Ease of Implementation Fairly easy to implement, however, does require some initial funding to develop and advertise the brand. Phase One Aging at Home funding has allotted some funding for marketing/brand development. Marketing tools can both be central and local. Cost Efficiency Can reduce individual marketing budgets in each agency. Effectiveness Ability to reach a broader audience and reduce client confusion about who to call and how to use services. Can lose some local identity. Access to Service Can improve clients ability to find transportation services (know who to call). Capacity of Service N/A Level of Service N/A
Based on the above assessment, it is recommended that this activity be coordinated in a centralized framework. To achieve this, the following steps are required:
1. Hire a graphic designer/communications expert to develop a ‘brand’ (name and logo) and marketing plan for the coordinated framework using the approved Phase 1 Aging at Home funding. Input and consensus will need to be achieved by the group. 2. Develop a marketing plan of engagement of the individual agencies incorporating the central brand. 3. Use the ‘brand’ to communicate with the clients and potential clients about the transportation service (i.e. how to register, who is eligible, how to reserve a trip) 4. Maintain local agency brands as “participants” of the coordinated framework brand.
5.2.3 Centralized Scheduling and Dispatching The centralized scheduling and dispatching process will involve establishing a single and centralized dispatching office. The central dispatcher is responsible for taking trip reservations, placing clients on available and appropriate vehicles and tracking vehicles.
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Criteria Assessment Ease of Implementation A Transportation Coordinator is already in place. Developing agreed to processes and training will take some time. Dealing with specialized population groups may take some time. Update CIMS to get all information displayed and potentially purchase scheduling software ($50,000 to $75,000 initial investment for scheduling software). Cost Efficiency Reduces duplication of staff and increases the potential for shared rides through distributing passengers to appropriate vehicles. The above reduces overall costs, but for long distance trips there may be an increase in costs if deadheading is not minimized. Effectiveness Ability to increase overall ridership by improving access to service and capacity of service. Access to Service Ability to cost effectively increase office hours for trip reservation for both Counties (only need to pay one staff person to increase office hours instead of 7). Capacity of Service Ability to increase overall capacity of service, therefore number of potential trips available to clients. Through the use of expanded volunteers there is an opportunity to utilize the 4 idle vehicles of Midwestern Adult Day Services between 10:00am and 2:45pm in Huron County. Level of Service Can reduce customer wait times.
Based on the above assessment, it is recommended that this activity be coordinated in a centralized framework. To achieve this, the following steps are required:
1. Establish a centralized scheduling and dispatching office at the lead agency’s headquarters (in progress) 2. Hire or appoint a central dispatcher responsible for coordinating scheduling and dispatching (completed) 3. Provide data to the central dispatcher on number of vehicles, vehicle specifications, eligibility, and client information. Ensure this information is visible to the dispatcher when booking trips. 4. Modify CIMS software to allow access of all agency information to the Central Dispatcher. This will include collaborating with the VON so that the CIMS software can be interfaced with Procura and appropriate information pertinent to transportation can be shared and displayed in a similar format. 5. Ensure protocols are in place to protect privacy issues (i.e. ensure CIMS and Procura only displays necessary information to the Central Dispatcher).
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
6. Develop an opt-out option for certain population groups (i.e. the Amish Community) where calls can continue to be taken locally for an initial period. 7. Look to purchase a specialized scheduling software to improve overall coordination.
5.2.4 Service to Hospitals Service to hospitals would involve providing coordinated transportation services to individuals without access to a vehicle or without family members that can provide them with transportation.
Criteria Assessment Ease of Implementation Complicated to implement. Many hospitals request trips in the late evening/early morning that are not easy to accommodate. A central coordinated agency would make providing this service easier. Agreements have been difficult to reach in the past. May require change of eligibility requirements. Cost Efficiency Has the potential to increase costs without increasing efficiency because of late service hours, which may require a driver to be on call. Effectiveness Could increase ridership (to and from Hospitals). Access to Service N/A Capacity of Service N/A Level of Service N/A
Town & Country is currently conducting a demonstration project for service to hospitals. The demonstration project will be completed at the end of the year and discussed with the group. Based on the above assessment and through conversations with the seven agencies it is recommended that the coordinated transportation group further investigate providing service to hospitals during business hours.
5.2.5 Standard Fares Standardizing fares for trips will involve charging customers for the same fare for a trip no matter which service provider they use.
Criteria Assessment Ease of Implementation Fairly easy to implement, however, potentially would require some agencies to increase fares (rates) to customers. Some agencies may pay more if fares are reduced to a common standard. Justifying increase in fare or modification to fare structure to a client may be difficult, particularly for local trips.
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Criteria Assessment Cost Efficiency N/A Effectiveness Promotes equity in the Counties by providing a standard fare. Clients also cannot look for the cheaper price when trying to book an interregional trip. Access to Service N/A Capacity of Service N/A Level of Service May reduce costs for some clients, however, may increase costs for other clients.
Based on the above assessment and through conversations with the seven agencies, this activity is recommended for the implementation in the long term. Consideration should be given primarily to standardizing long distance fares, such as for trips between Perth and/or Huron Counties to London. To achieve this, the following steps are required:
1. Conduct an agency-wide review of fares before next budget submission. 2. Settle on a standardized long-distance rate based on “fare by distance” model. 3. Once in place, look at opportunities to standardize local fares (medium-long term).
5.2.6 Standard Eligibility Standardizing eligibility will involve eliminating differences in eligibility requirements across all agencies, in order to increase coordination.
Criteria Assessment Ease of Implementation May be difficult to include certain groups, i.e. the Amish. Certain funding sources are tied to specific population groups (i.e. Aging at Home is for Seniors only) Cost Efficiency Can increase ridesharing by allowing a wider variety of population groups to share a ride. Effectiveness Can increase ridership. Access to Service N/A Capacity of Service N/A Level of Service Improves service to certain population groups by increasing the number of agencies that can provide that service.
Based on the above assessment and through conversations with the seven agencies, this activity is recommended for implementation. To achieve this, the following steps are required:
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
1. Conduct an agency wide review of eligibility criteria and work towards standardizing as much as possible. Allowance must be left with individual agencies to continue to serve clients that are deemed a source of revenue or special needs.
5.2.7 Central Database A central database will include establishing a centralized inventory of vehicles, as well as client information.
Criteria Assessment Ease of Implementation Cost associated with implementing. Requires establishment of policies and procedures to address privacy issues. VON uses the Procura software, which may be difficult to integrate with CIMS. Cost Efficiency Decreases duplication of services. Simplified billing process. Effectiveness Can identify service gaps and other inefficient service delivery mechanisms. Easier for agency reporting by establishing a standard procedure. Access to Service N/A Capacity of Service Client information is more easily tracked, making it easier to match client’s needs with a service provider. Level of Service Simplified billing process may be easier for a client to understand.
Based on the above assessment and through conversations with the seven agencies, this activity is recommended for implementation. To achieve this, the following steps are required:
1. Develop a software ‘bridge’ between the CIMS and VON Procura system to share pertinent information necessary to coordinate transportation between the seven agencies. 2. Explore the acquisition of a new scheduling software package that may be easier to achieve the sharing of databases with CIMS and VON Procura. Ensure that that an appropriate application can be development to allow a ‘bridge’ between the scheduling software and CIMS/Procura to allow data to be transferred between the three programs. This will avoid duplicate entry of client information.
5.2.8 Standardized Policies and Procedures Standardizing policies and procedures will involve establishing consistency in areas such as risk management, driver training, cancellation policy, emergency response, vehicle breakdowns, etc.
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Criteria Assessment Ease of Implementation Four agencies have already developed a common Policies and Procedures Manual. However, this manual does not have a lot of operational policies related to transportation – these would have to be developed. Certain agencies have policies that need to be followed to meet accreditation. Other agencies may need to alter their standards to match the accredited criteria. Any policies and procedures adopted by the group will need to be approved by individual agencies’ boards. Cost Efficiency Reduced number of training courses, less duplication of services (i.e. emergency response). Effectiveness Ability to provide more effective service by sharing experiences and best practices between agencies. Access to Service N/A Capacity of Service N/A Level of Service Clients know they will receive the same service regardless of agency.
Based on the above assessment and through conversations with the seven agencies, this activity is recommended for implementation. To achieve this, the following steps are required:
1. Develop sub-groups within the Steering Committee to determine policies and procedures that can be standardized. Identify best practices, opportunities and constraints. 2. Develop a common Policies and Procedures Manual and a set of operational policies related to transportation for the Coordinated Framework. 3. Any policies and procedures adopted by the group will need to be approved by individual agencies’ boards.
5.2.9 Vehicle Purchase Coordinating vehicle purchasing will involve all agencies purchasing vehicles with standard specifications, such as amount of space and lift specifications.
Criteria Assessment Ease of Implementation Fairly easy to implement. Cost Efficiency There may be little cost efficiencies gained by purchasing in bulk due to the limited number of vehicles purchased each year. Effectiveness By standardizing specifications, the coordinated agency can inform funding providers the type of vehicle required to service the population group.
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Access to Service N/A Capacity of Service Coordinating specifications can ensure all vehicles can adequately handle all types of mobility devices, thereby increasing the number of vehicles available to each client. Level of Service N/A
Based on the above assessment and through conversations with the seven agencies, it is recommended that vehicles continue to be purchased or acquired by the local agency. However, to improve overall coordination and meet the objectives of the coordinated framework, the following actions are recommended:
1. Establish guidelines for vehicle purchase, outlining required vehicle specifications. This will involve each agency reviewing the mobility devices currently used by their clients and other mobility devices commonly used by potential clients 2. Communicate with the SW LHIN (or other suppliers of vehicles) the vehicle specifications required 3. Develop a strategy to ensure that new donated vehicles (i.e. through Aging at Home) are provided to the Coordinated Framework and distributed locally based on a collective discussion of need and benefit.
5.2.10 Vehicle Insurance/Maintenance Vehicle Insurance/Maintenance would involve using the same insurance and maintenance providers agency-wide.
Criteria Assessment Ease of Implementation Difficult to implement. Some agencies are insured through a local municipality or through another board, making it difficult to find one common insurance provider. The long distances between the various service areas make it difficult and expensive to select one maintenance provider. There are few auto repair shops that have multiple locations in both Counties that could be utilized. Cost Efficiency Could reduce the cost of insurance and maintenance through economies of scale. Effectiveness N/A Access to Service N/A Capacity of Service N/A Level of Service N/A
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Based on the above assessment and through conversations with the seven agencies this activity would be difficult to implement and would not provide a noticeable improvement in cost efficiency and level of service in the short-term. Therefore, it is not recommended at this time.
5.2.11 Sharing Volunteer Drivers Sharing volunteer drivers will involve identifying existing volunteers and hiring new volunteers that are willing to work for the coordinated system, not just for one individual agency. This initiative is planned for Year 2 in the original H-SIP proposal to the SW LHIN.
Criteria Assessment Ease of Implementation Requires some policy changes, making it potentially difficult to implement. Some volunteers do not want to drive outside their own community. Sharing volunteers may lead to local volunteers being unavailable for a local trip if they are assigned elsewhere. Volunteer reimbursement is different in many agencies and would need to be standardized. Cost Efficiency The availability of system wide volunteers would improve the use of existing fleets. If moving towards central volunteer recruitment, the number of volunteer coordinators can be reduced and replaced with one central volunteer coordinator/recruiter. Effectiveness Potential to increase ridership by having access to more volunteers to provide trips. Access to Service N/A Capacity of Service Increases the pool of drivers available to provide service. Level of Service N/A
Based on the above assessment and through conversations with the seven agencies, this activity is recommended for implementation. To achieve this, the following steps are required:
1. Hire a half time Volunteer Driver Coordinator with funding received by the SW LHIN. 2. Identify current volunteer drivers willing to work for the coordinated system. 3. Standardize volunteer reimbursement rates and methods of payments.
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
5.2.12 Centralized Software/Computer Solutions Centralized software/computer solutions will involve utilizing technology to coordinate operations, manage information and enhance customer service, while considering technology to improve scheduling and routing optimization.
Criteria Assessment Ease of Implementation Requires modifications for scheduling and training, and implementation of privacy policies. Funding for the purchase and maintenance of scheduling software has been approved in the H-SIP proposal Training of staff may take time. Cost Efficiency Purchasing, licensing, registration and training costs. Reduces duplication of services. Improves efficiency in customer and driver scheduling and billing. Effectiveness Improves speed and efficiency of screening and scheduling processes. Access to Service N/A Capacity of Service Simplifies and speeds up the registration and scheduling process. Increases number of shared rides. Optimized trips (i.e. for multiple pickups). Level of Service Reduced wait times for clients. Certain clients may not like sharing rides.
Based on the above assessment and through conversations with the seven agencies, this activity is recommended for implementation. To achieve this, the following steps are required:
1. Determine which scheduling software would fit best, the cost and if one-time funding through the SW LHIN is sufficient to purchase the software and train staff. 2. Develop a Request for Proposals or provide the contract to a reputable software company. 3. Ensure the RFP or contract includes a plan to integrate the scheduling software with CIMS and VON Procura (allowing information to be accessed between the programs). 4. Ensure funding is available to allow IT personnel from CIMS and Procura to develop a ‘bridge’ between the two database programs and the scheduling software. This will allow pertinent information necessary for dispatch to be shared between these programs without inputting client and trip information separately into both systems. 5. Purchase software and train necessary employees to use the system.
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
6.0 RECOMMENDATIONS / IMPLEMENTATION PLAN
This report concludes with a set of recommendations and an implementation plan based on an evaluation of alternatives and an assessment of the evaluation session conducted with representatives of the group of seven agencies.
1. Model and Commitment It is recommended that a Central Dispatch Transportation Model be implemented, eventually moving towards a Brokerage Transportation Model as each of the agencies gain a greater level of comfort working with each other in a coordinated manner.
The first step will be to implement a Centralized Scheduling and Dispatch System. A formal agreement (Memorandum of Understanding) between the participating agencies should be established that outlines their commitment to the project and its principles. The Memorandum of Understanding should be drafted by a Registered Lawyer and signed an authorized representative of each agency, as endorsed by their individual Board of Directors.
As agencies move towards common operating structures, the possibility of shared funding should be investigated. Furthermore, it should commit to a Central Intake (registration) process, where the central agency refers new clients to the appropriate agency.
2. Central Marketing It is recommended that the agencies retain the services of a communications/public relations firm to develop a “brand”, including messaging and graphics. This would include communicating change to agency customers. The hired firm should also develop an execution plan that engages the participating agencies.
This will need to be completed in the 08/09 fiscal year with a communications/public relations firm hired to take advantage of approved one-time funding from the H-SIP.
3. Database/Software A comprehensive review of how to implement a central database/scheduling/dispatch system should be conducted. There are two major options:
a) Acquire a new commercial scheduling software package and create suitable links to CIMS and VON Procura; or b) Acquire a new commercial scheduling software package that provides the necessary scheduling/dispatch capability.
This will need to be completed in the 08/09 fiscal year with a software solution selected and purchased to take advantage of approved one-time funding from the H-SIP.
4. Policies and Procedures The seven agencies should work towards standardizing various service delivery policies and procedures. The priorities, in order, are:
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
a) Central Intake b) Long Distance Fares c) Service Standards d) Vehicle Specification e) Driver Training in the 2nd year of the project.
5. Volunteers A coordinated volunteer recruitment program should be inaugurated with an opt-in/opt-out option for the total area or local area availability. This should also include a standard reimbursement policy. The program should begin in Year 2 (the 09/10 fiscal year) as indicated in the H-SIP proposal.
6. January – March 2009 Action Plan Sufficient funds are available in the remaining budget to complete the next steps to establish a coordinated central dispatch transportation model. The following priority steps are recommended:
Recommendation Estimated Cost Timeline Decide on a software solution for a scheduling $45,000 (software) January 2009 optimization package $15,000 (modify CIMS/Procura) Establish a Coordinated Marketing Plan $7,500 January to February 2009 Agree on priority policies with the aid of a facilitator $7,500 January to February 2009 Retain a solicitor to draft a Memorandum of $5,000 January to Understanding February 2009
Establish a “1-800” telephone number and upgrade the $10,000 February 2009 communication system between participating agencies
Print (acquire) marketing material as well as vehicle logos $5,000 March 2009
The above estimated costs would leave a contingency budget of $10,000 form the original $137,000 in one time funding.
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APPENDIX A Summary of Individual Agency Characteristics
Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Summary of Individual Agency Characteristics
Stratford Meals on Midwestern Adult Day Mitchell & Area Community Outreach St. Marys & Area Town & Country VON Perth Huron Wheels and Services Community Outreach Services - Milverton Mobility Service Support Services Neighbourly Services Volunteer Transportation - Own vehicle Provided Provided Provided Provided Provided Provided Provided - Agency vehicle - In town Provided Provided Provided Provided Provided Provided Provided - Out of town Provided Provided Provided Provided Provided Provided - Medical Provided Provided Provided Provided Provided Provided - Non medical Provided Provided Provided Provided Provided Provided Provided Agency Provided Service - Minivan (not accessible) Operates a non Local Fixed Route Bus No No No 1 non accessible van used 1 (7 passenger) accessible 7-passenger service in Goderich for for local social trips. caravan. seniors (trial). May be used in Clinton upon completion of this trial and used where needed. - Minivan (accessible) Two wheelchair 1 vehicle serves the 1 accessible van for 1 accessible van Operates a mobility Five mobility Vans No accessible vans are Wingham Centre for adult individual and charter trips service using a small bus available to wheel chair available to provide day services only (intown and out of town) or van (operate as needed) bound clients or those transportation in and who may have mobility out of town. Available 7 Two full sized accessible difficulties. Van is utilized days a week. vans (accommodates 3 Huron County wide, ambulatory and 2 therefore availability may A third accessible van wheelchair) be limited. Van stationed with stretcher capability in four areas: will be in operation at - 1 Wingham some point in the future. - 2 Clinton - 1 Goderich - 1 Exeter - Mobility bus (accessible) 1 bus serving Goderich, 1 1 mobility bus for individual 1 accessible mobility bus 1 accessible bus (12 No 1 accessible mobility bus in Clinton with service in and charter trips (intown (public transportation ambulatory, 5 wheelchair) (12 passengers, 2 w/c or Exeter on Tuesdays for and out of town) service provided) variations) Adult Day Services. - Taxi Coordinate with local No No No No No No taxi company for clients who do not require accessible transportation or the assistance of a volunteer (7 days a week)
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Stratford Meals on Midwestern Adult Day Mitchell & Area Community Outreach St. Marys & Area Town & Country VON Perth Huron Wheels and Services Community Outreach Services - Milverton Mobility Service Support Services Neighbourly Services Destinations - Intown Provided Provided (to Adult Day Provided Provided Provided Provided Provided Centre) - Out of town Provided Occasional Shopping Provided Provided Provided Provided Provided Trips Trip Purpose - Medical Provided No Provided Provided Provided Priority (70%) Provided - Non medical Provided Non medical only (Adult Provided Provided Provided Also provided Provided Day Centre Only) Ridership / # of Trips - Annual 23,500 annual (2007/08 1,800 annual (2007/08) 5,784 annual (2006/07) 7,651 annual (2007/08) 7,600 annual 6,859 annual (2007/08) YTD total) - Daily 2-50 daily 35 (approx.) daily 30 (approx.) daily 0-10 daily (varies) / Hours & Days of Service - Volunteer Provided No Provided Anytime during week Provided as needed Based on client needs - Agency Provided Accessible and Goderich bus (pilot) – Monday to Friday (hours Public transportation Seven days a week as Available 7 days a week, 7 days per week based on coordinated available 7 8:30am to 4:30pm vary) – mobility bus (Tuesday, Thursday, needed daytime and evening driver’s availability days a week Monday and Friday Friday 8:30am to 4:00pm) (bookings between 8:00am and 5:00pm) Adult Day Services – Charter Services provided weekdays between 8:00am at other times and 9:00am and 3:00pm and 4:00pm Fares and Fee Structure - Volunteer $0.40 per km ($4.50 $0.37 per km (increased in Flat fee gas and parking Sliding scale based on gas $0.40/km plus parking $4.00 one way in-town. $0.37/km within Stratford) September) reimbursement paid by client prices. Adjusted monthly. $0.40 per km for out of town. - Agency Provided $5.50 within Stratford $18.00/day for Day $3.50 within Mitchell, $3.00 $2.50 per person per stop $3.75 one way (in-town) Mobility: $5.00 one way + Within North Perth: $3.50 (Coordinated) Program (includes per additional stop (outside $7.50 round trip $5.00/hr one way w/in 6 km. radius transportation) fares vary - $11.00 to $39.00 of Municipal office; $7.00 depending on location) one way beyond 6 km. radius to North Perth boundaries $5.00 within Stratford $4.00 a day for Goderich $4.00 w/in 10km radius of White Van: $2.00 Outside North Perth: (Accessible) transit route home and destination roundtrip, $15.00-20.00 $0.95/hr + $12.00/hr /person for out of area waiting rate Out of Town - Out of Town - $42.00 run Out of Town charge is $0.40/km for accessible, time, $25.00 wait time $0.60/km + $5.00/ hour coordinated and volunteer
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Stratford Meals on Midwestern Adult Day Mitchell & Area Community Outreach St. Marys & Area Town & Country VON Perth Huron Wheels and Services Community Outreach Services - Milverton Mobility Service Support Services Neighbourly Services Reporting Structure - Who do they report to? Board of Directors LHIN LHIN LHIN LHIN LHIN LHIN (monthly), MTO United Way Municipality MTO LHIN (quarterly & Villa board, Municipality, Board of Directors financial audits), Municipality MTO, United Way (annual), Bus advisory committee MOH, City of Stratford Knollcrest Lodge Board (annual) of Directors Staff - Number of transportation 300 (deliver Meals on 150 (total volunteers) 32 8 9 transportation 55-60 20 volunteers Wheels); 30 volunteer 35 are drivers volunteers drivers drivers 40 (total volunteers) - Number of transportation 1.5 FTE Coordinators 4 coordinators (not solely 3 part-time (perform other 1 part-time (perform other 1 Service Coordinator 6 Community Support 3 part-time coordinators coordinators dedicated to transportation duties) duties) coordinators (all services) transportation - Number of drivers 4 (part-time) 1 part-time; 9 spare 1 part-time; 1 casual 1 regular, 4 casual 10-12 casual part-time 3 (part-time) At Knollcrest Lodge, 2 Agency Staff with appropriate licenses Clients - Number of registered 2007/08: 1392 total 140-150 416 482 Mobility Services – 300 YTD: 334 (volunteer); 119 85-100 clients clients (908 (accessible) transportation clients) - Trip purpose Medical, errands, social, Adult Day Centres Medical (70%), some social Medical, shopping, social, Medical, Social, Day Medical, some shopping Medical, shopping, social, VON VON programs programs, Errands, VON ADP Shopping Eligibility Criteria - Defined criteria “senior or adult with a Day Centre participants Developmentally/physically Use MOH guidelines (65 65 or older and/or level of MOH and LTC document Seniors, frail elderly, disability” only; transit route must be challenged, physical need – older, disability, no disability (Use the MOH physically disabled, 65 or older and registered based on need, not age vehicle, etc.) guidelines) mentally challenged with office Amish Trip Reservation Process - Reservation service hours 9:00am and 4:00pm Does not apply 9:00am to 5:00pm 8:30am to 4:30pm 8:00am to 4:00pm 9:00am to 2:00pm 8:30am to 4:30pm
- Advance reservation Taken as required 24hrs required 24hrs (some last minute 24 hours requested, but do Taken as required Same day if possible bookings – if it works some take in as required with existing routes) - Confirmation of bookings Volunteer calls client Call backs when required Provided Call back when required 95% confirmed after Accessible: on phone (i.e. for volunteer drives, (i.e. for volunteer driver) drivers arranged Volunteer: call back when message left for booking the bus)
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Stratford Meals on Midwestern Adult Day Mitchell & Area Community Outreach St. Marys & Area Town & Country VON Perth Huron Wheels and Services Community Outreach Services - Milverton Mobility Service Support Services Neighbourly Services - Cancellation / No Show Cancellation up to No shows billed; no 24hrs (not strict); billed No policy in place Must cancel min 2hrs No charge for cancelation; policy 10min before pick-up cancellation policy for no shows before pick-up/No shows no shows billed one way time is acceptable billed Bill no shows - Attendant / Companion Ride for free No charge for attendant; if No cost; all children must Allowed Ride for free Accessible: one attendant policy not assisting they pay be accompanied free Companion: pay one way Billing Method Cash is only accepted by Daily fee/clients billed Pay as you go, bus pass, Clients pay driver on Transportation clients Every 4 weeks; CIMS Manual; mthly invoicing; volunteer drivers, both mthly; Goderich transit mthly billing return trip; many billed invoiced monthly produces invoices for volunteer paid directly Accessible and fee collected onboard mthly clients & pays volunteers Coordinated. LTC facilities billed monthly
Transportation is either paid by pre-paid tickets or is invoiced monthly Funding Sources - Fares Yes Yes Yes Yes Yes Yes Yes - Donations Yes (United Way) Yes Yes (& fundraising) Yes (United Way) Yes Yes Yes - Gas Tax No Yes Yes Yes No Yes - Municipal No See grants Yes Yes (grant) No Yes (for mobility bus) - LHIN/MOH Yes Yes (81% of funding) Yes Yes Yes Yes (& MOH) Yes (& MOHLTC) - Grants Yes (City Grant) Yes Yes (Annual Municipal) Yes (Annual Municipal) No No No - Other In-kind service, Fundraising 4 service clubs contribute Limited fundraising In-kind for vehicle Fundraising/in-kind fundraising maintenance. Vehicles - Total 4 TOTAL 4 TOTAL 2 TOTAL 2 TOTAL 3 TOTAL 5 TOTAL 2 TOTAL - Vans (accessible) 3 1 1 1 2 5 0 - Vans (not accessible) 1 1 0 0 0 0 1 - Mobility Bus (accessible) No 2 1 1 1 0 1 - Stretcher capabilities Yes (one van) Yes (van) Yes (one van) Yes (2) Yes (bus) - Ownership SMOWNS MWADS Municipality (Ritz Villa Knollcrest Lodge – St. Mary’s Mobility Bus Town and Country VON Perth-Huron operates) Community Outreach Issues and Opportunities - Problems facing agency Insufficient resources Decreasing number of Fundraising, non- Funding, Amish, cannot Client fees need to be Drivers (accountability, New vehicles (operating drivers computerized data, non-ideal accept any debt, streamlined, subsidization training); policies & proc., implementation); workspace, minimal scheduling, ridership process, procedures; training (need volunteer driver transportation policies needs more time spent) recruitment; transit service; relationship with taxis
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Stratford Meals on Wheels and Neighbourly Services Development of an Integrated Transportation System Model in Huron and Perth Counties Final Report – December 2008
Stratford Meals on Midwestern Adult Day Mitchell & Area Community Outreach St. Marys & Area Town & Country VON Perth Huron Wheels and Services Community Outreach Services - Milverton Mobility Service Support Services Neighbourly Services - Coordination Centralized dispatch; Vehicle coordination Multiple bookings, dealing Common Coordination/dispatch, Policies, procedures, Piggy-backing to reduce opportunities vehicle coordination (other agencies using with difficult clients, public policies/procedures; training & policy pricing; load the vehicles; costs (see interview) MWADS vehicles during education unique population being development, fleet late night returns from Day Centre hours) served. insurance, bus purchases hospitals - Issues with Coordination Different levels of May need vehicles at Ensuring service doesn’t Scheduling difficult, Difference between Sharing rides (client Local community buy-in; service; funding sources unscheduled times change for client, fee communication b/w agencies, agreement from choice?); coordinating volunteer support; structures, hours of service agency and driver Board of Directors or dispatchers; privacy issues maintaining local flavour Municipality, handling (i.e. sharing of info) volunteers, donors
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Transportation Project Community Steering Committee DRAFT: November 22, 2012
Terms of Reference Purpose
To inform and advise on the design and implement an integrated transportation system to improve timely & seamless access to required health and community services.
General Responsibilities
• Support the development of an integrated system of health and community services that provides person-centred, timely, equitable access, high quality, evidence-based services in an efficient, effective and sustainable manner; • Identify innovations in the delivery of integrated services across the health system continuum; • Lead change and guide transformation to enable an integrated health system that better services consumers, their families and health service providers; • Ensure alignment with the Care Connections integrated implementation roadmap and make recommendations on priority projects; • Plan for future system capacity; • Facilitate continued emphasis on inter-professional collaboration and standardization; • The engagement and creation of opportunities for involvement of people in community transportation within North Simcoe Muskoka, including cultural diverse populations (i.e. Aboriginal People, Francophone, etc.); • Ensure communication, coordination and standardization with other Coordinating Councils and Project Steering Committees as it relates to key deliverables; and • Work in collaboration with the LHIN to identify appropriate performance measures and indicators to ensure success. • To ensure the diverse needs of the five Geographic planning areas are considered in implementation
Specific Responsibilities
Oversee and ensure the: • Completion of project deliverables as outlined in project charter • Communication of project progress highlighting successes, concerns and issues to Coordinating Council • This document will be reviewed on an ongoing basis, with a minimum of a one year interval
November 22, 2012
Community PSC - Terms of Reference April 30, 2012 Project Steering Committee Chair
Lead organization CEO or designate. The Lead organization for the Project Steering Committee was named by the LHIN Board upon recommendation of the LHIN Leadership Council. Lead organization for the Project Steering Committee may change over time.
Role and Responsibility of the Committee Chair
• Chair meetings & oversee distribution of agenda/minutes/supporting material to committee members; • Act as liaison between the Sub-committee and the Coordinating Council; and • Facilitate work towards fulfillment of Project Charter.
Role and Responsibility of the Committee Vice-Chair:
• Jointly prepare agendas; • Act as Chair in the absence of the Chair.
Role and Responsibility of Committee Members:
• Attend meetings & participate in completion of project charter • Each member will leverage their influence and authority at whatever level possible to advance the work of the Community Transportation Steering Committee.
Community Sub-Committee Composition: (Appendix B) Chair Vice Chair LHIN Liaison Engineering and Planning – County of Simcoe Director of Ontario Works – County of Simcoe Ontario Disability Support Program – County of Simcoe Administrator, Long Term Care – County of Simcoe Muskoka Seniors Helping Hands, Orillia BANAC Research Analyst – County of Simcoe Children’s Aid Society, County of Simcoe Community Reach – (North Simcoe) Community Services - District of Muskoka Community Health Unit – (North Simcoe) Community Health Unit – (Muskoka) RNR Patient Transfer Service Victorian Order of Nurses Municipal Transit, City of Barrie 211 Cancer Care Coalition Canadian Red Cross Customer / Caregiver / Family member of lived experience Children’s Aid Society – County of Simcoe Page | 2
Community PSC - Terms of Reference April 30, 2012 CCAC Hospital - Kidney Care
Ad Hoc Membership (as Required)
• Advisory Committee membership as determined by the Steering Committee or at the call of the Chair to attend meetings on a consultative basis and may include: . LHIN liaison, Finance . LHIN liaison, Francophone and Aboriginal Designate . Community Support Agencies . Consumers . Health Service Providers . Other Government Ministries . Representative from workplace or community with experience in AODA legislation.
Delegates
• Regular attendance at the Project Steering Committee Meetings is requested. Delegates can attend in the place of Project Steering Committee Members in an emergency. The Project Steering Committee delegate should be the same for all meetings for continuity. Delegates can vote on behalf of members.
Accountability
• The Lead Organization will be accountable to the LHIN to ensure the functioning of the Coordinating Council. An amendment made to the current Service Accountability Agreement that will outline the expectation for leadership, roles and responsibilities for the lead organization. • The Council and its Project Steering Committees will report through the Coordinating Council Chair to the LHIN CEO through the NSM LHIN Leadership Council. The LHIN CEO will forward recommendations to the LHIN Board as required. • On a schedule determined by the NSM LHIN Leadership Council, the Coordinating Council will report on progress and outcomes of its work, and as it relates, to impacts on established priorities. • Nothing in these Terms of Reference shall remove or restrict or be construed to remove or restrict the governance powers or authority of the Boards of Directors at each of the organizations unless otherwise outlined in the Service Accountability Agreement.
Quorum
A quorum for the meeting will be 50% plus one of the voting members, not including the LHIN ex- officio members. Voting members can vote electronically if they are unable to attend.
Confidentiality/Transparency
Members are expected to be open and candid in discussing items. For this reason, members will agree not to disclose information or views expressed by individuals during meetings, including any confidential information or documentation. Declarations of confidentiality should be announced Page | 3
Community PSC - Terms of Reference April 30, 2012 during the meeting. Members agree to support the decisions of the Council and to speak with one voice outside the meetings.
Consensus Building
Any disagreement or dispute which might arise between the members will be resolved harmoniously, creatively and constructively through a process of consensus decision making. In the event that an agreement is not forthcoming and the members are at an impasse, the following protocol will be invoked: a) An impasse is defined as an unresolved or unmanageable disagreement that has discernible and measurable negative consequences for the committee or the project. b) Best efforts will be given to resolving the impasse in a timely manner by openly acknowledging and applying the guiding principles noted above. c) If warranted, the Coordinating Council will be consulted to resolve the disagreement
Code of Conduct
The following guidelines will apply: • Members operate under the Terms of Reference • Members will make the Project Steering Committee a priority to attend meetings and complete assigned tasks on time and on budget • Members will arrive on time to all meetings, and actively participate throughout the full duration of each meeting • Members will be transparent and collaborative in their approach, and support full discussion of ideas during meetings • Members will be responsible for completing any preparatory work or information required in advance of task force meetings • Membership will strive for consensus building approach to making recommendations • Membership will be responsible for discussing opportunities for change with key stakeholders in their own organizations, to gain stakeholder inputs and build buy-in to key decisions.
Evaluation
The Coordinating Council and its Project Steering Committees shall evaluate the effectiveness annually in meeting its objectives and designated responsibilities, as noted in these terms of reference and Project Charter, and submit its report to the NSM LHIN Leadership Council.
Frequency of meetings
Meetings will be held a minimum of six (6) times per year or at the call of the Chair.
______Community Steering Committee Chair Coordinating Council Chair
Date Approved: ______
Date Revised: ______
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Community PSC - Terms of Reference April 30, 2012
Appendix A
DECISION-MAKING:
Decision Making Framework (Refer to Tool)
Available to the Coordinating Council, if required, is the NSM Decision Making Framework that includes the following steps:
Step 1: Frame the question Step 2: Determine decision makers Step 3: Screen for strategic fit Step 4: Finalize decision criteria Step 5: Gather relevant information Step 6: Apply decision support tool Step 7: Identify and assess risks and controls DECISION Step 8: Communicate the decision Step 9: Evaluation & Continuous quality improvement
Appendix 4: Mapping the Ontario Health Quality Council Attributes to the Gibson Mitton Tool Gibson Mitton OHQC Domain Criteria Attributes Measurable Indicators Strategic Fit Alignment No obvious No obvious alignment alignment Degree of impact on Mapped onto advancing IHSP and/or ASP goals and priorities.
Strategic Fit
Alignment with provider system role Extent to which program/initiative is consistent with the provider(s) mandate and capacity compared to other providers in Ontario System Sustainability Appropriately 1. Overall spending Performance Resourced and value for money Impact on clinical, 2. Information financial, and human The health system Mapped onto technology resources capacity should have enough 3. Healthy work over time. qualified providers, environment funding, information,
equipment, supplies 4. Health human and facilities to look resources after people’s health needs System Integration Integrated Discharge/transitions Performance (ensuring that Page | 5
Community PSC - Terms of Reference April 30, 2012 Gibson Mitton OHQC Domain Criteria Attributes Measurable Indicators Extent to which All parts of the accurate information program/initiative health system is available and improves Mapped onto should be shared with the coordination of organized, patient and his/her health care among connected and work family doctor and health service with one another to providers and provide high quality access to in-patient community providers care. rehabilitation post to ensure continuity stroke) of care in the local health system and provision of care in the most appropriate setting as determined by patient/client's needs System Quality Safe 1. Hospital infections Performance 2. Adverse events Extent to which Mapped onto People should not 3. Mortality in hospital program/initiative be harmed by an 4. Drug safety accident or mistakes improves safety, 5. Avoiding harm in when they receive effectiveness, and LTC and CCC client experience of care. 6. Avoiding harm in health services(s) home care and the provided community
System Access Accessible 1. Wait times in ED Performance 2. Access to Primary Extent to which People should be Care program/initiative able to get the right 3. Surgical Wait times Mapped onto care at the right time improves timely and access to in the right setting by access to specialists appropriate level of the right healthcare 4. Access to LTC health services for provider defined population(s) in the local health system System Equity Equitable 1. Primary care-access Values and effectiveness Impact on the health Mapped onto People should get 2. Prevention status and/or access the same quality of measures to service of care regardless of 3. Diseases that could recognized sub- who they are and be avoided with a populations where where they live. there is a known population health health status gap focus between this specific 4. Healthy behavior population and the general population as compared to current practice/ service. System Efficiency Efficient 1. Cost per services Values delivered Extent to which The health system 2. Right service in the program/initiative should continually right place Mapped onto look for ways to contributes to 3. Avoiding reduce waste, efficient utilization of unnecessary drugs clinical, financial, including waste of and tests and human supplies, equipment,
resources capacity time, ideas and
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Community PSC - Terms of Reference April 30, 2012 Gibson Mitton OHQC Domain Criteria Attributes Measurable Indicators to optimize health information. and other benefits within the system. System Values Client-Focused Patient Centred Patient experience in acute care hospital and Extent to which Mapped onto Healthcare providers ED care program/initiative should offer services meets the health in a way that is needs of a defined sensitive to an population and the individual’s needs degree to which and preferences. patients/clients have a say in the type and delivery of care System Values Innovation Safe 1. Hospital infections 2. Adverse events Impact on Mapped onto People should not 3. Mortality in hospital generation, transfer, be harmed by an 4. Drug safety and /or application of accident or mistakes 5. Avoiding harm in new knowledge to when they receive LTC and CCC solve health or care.
health system 6. Avoiding harm in problems; evidence home care and the of evaluation plan community and application of leading practices Innovation (As Effective 1. Use of right above) treatments in People should hospital receive care that 2. Chronic Disease works and is based Management Mapped onto on the best available (Diabetes, CHF, scientific information COPD) 3. Readmissions to hospital (AMI, COPD, MH, post Surgery) 4. Keeping people health in LTC 5. Keeping people health in CCC 6. Keeping people health in home care 7. Avoidable ED visits System Values Partnerships Patient Centred Patient experience in acute care hospital and Degree to which Healthcare providers ED care appropriate level of Mapped onto should offer services partnership and/or in a way that is appropriateness of sensitive to an partnerships will be individual’s needs achieved in order to and preferences. ensure service quality enhancement, optimal resource use, minimal duplication, and/or increased coordination System Values Community Patient Centred Patient experience in Page | 7
Community PSC - Terms of Reference April 30, 2012 Gibson Mitton OHQC Domain Criteria Attributes Measurable Indicators Engagement acute care hospital and Healthcare providers ED care Level of involvement should offer services of target population Mapped onto in a way that is and other key sensitive to an stakeholders in individual’s needs defining the project and preferences. and planned involvement in evaluating its impact on population health and key system performance. Innovation Impact on generation, transfer, and/or application of new knowledge to solve health or health system problems; evidence of evaluation plan and application of leading practices.
Population Health 1. Health status Focused on 1. Healthy behavior (clinical outcomes & Population Health 2. Maternal and infant Health status Quality of Life) health (clinical outcomes Mapped onto The health system 3. Sexual health & SOL) Impact on clinical should work to 4. Preventive prevent sickness outcomes for the measures and improve the patient/client, 5. Deaths and harm health of the people that could be including risk of of Ontario. adverse events, avoided by and/or impact on prevention physical, mental or social quality of life, as compared to current practice/ service.
2. Prevalence
Magnitude of the disease/condition that will be directly impacted by the program/initiative as measured by prevalence (i.e., # of individuals with the condition in the population at a given time).Health promotion and disease prevention Impact on illness and/or injury prevention and promotion of health and well-being as measured by Page | 8
Community PSC - Terms of Reference April 30, 2012 Gibson Mitton OHQC Domain Criteria Attributes Measurable Indicators projected longer term improvements in health and/or likelihood of downstream service utilization reduction.
3. Health promotion & disease prevention
Impact on illness and/or injury prevention and promotion of health and well-being as measured by projected longer term improvements in health and/or likelihood of downstream service utilization reduction.
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Community PSC - Terms of Reference April 30, 2012
Appendix B
MEMBERSHIP LIST:
Jane Sinclair Chair, Transportation Coordinating Council General Manager, Health and Emergency Services County of Simcoe 705-726-9300 ext. 1154 [email protected]
Chair Cheryl Tompkins Canadian Red Cross 519-312-0029 [email protected]
Vice Chair Jamie Moran Director, Ontario Works County of Simcoe 705-726-9300 ext. 1117 [email protected]
Committee Admin Kim Osborne Canadian Red Cross 705-721-3313 [email protected]
LHIN Liaison Gary Hurd 705-326-7750 ext. 205 [email protected]
RNR Patient Transfer Service Rob Soczka [email protected]
Lois Irvine [email protected]
Community Connection/211 Pam Hillier 705-444-0040 ext. 234 [email protected]
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Community PSC - Terms of Reference April 30, 2012 City of Barrie – Municipal Transit George Kaveckas 705-739-4220 [email protected]
Community Services – District of Muskoka Terry DaSilva 705-645-2100 [email protected]
Susan MacDonald Community Reach [email protected]
Donna Nairn Muskoka Seniors 705-789-6676 [email protected]
Tolleen Parkin Administrator, Sunset Manor County of Simcoe 705-445-4499 [email protected]
Mary Camley Victorian Order of Nurses [email protected]
Mary-Ann Willmott BANAC [email protected]
Sue Simpson BANAC 705-734-1818 ext. 222 [email protected]
Gary Staines Helping Hands 705-325-0003 ext. 300 [email protected]
Kristen Dawson Cancer Care Coalition 705-726-5199 [email protected]
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Community PSC - Terms of Reference April 30, 2012 Gail White Planner Engineering, Planning and Environment County of Simcoe 705-726-9300 ext. 1185 [email protected]
Ontario Disability Support Program TBA
Brenda Jenkins Community Member 705-325-2201 ext. 3557 [email protected]
Tim Latondress Lived Experience Member 705-686-7126 [email protected]
Orillia Soldiers Memorial Hospital
Christine Johnston Simcoe Muskoka District Health Unit 705-526-9324 ext. 7031 [email protected]
Ted Soucie Senior Service Manager Children’s Aid Society County of Simcoe 705-726-6587 ext. 2327 [email protected]
Ad Hoc Nathan Westendorp Planner Engineering, Planning and Environment County of Simcoe 705-726-9300 ext. 1360 [email protected]
LHIN Liaison – Francophone Ernie Vaillancourt 705-326-7750 ext. 221 [email protected]
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Community PSC - Terms of Reference April 30, 2012
Joanne Lane County of Simcoe AODA representative [email protected]
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TORONTO RIDE
STANDARD OPERATING TERMS
May 11, 2012
TABLE OF CONTENTS
1.0 PARTNERSHIP GENERAL INFORMATION 1.1 Mission , Vision , Strategic Plan, Service Definition 1.2 Strategic Plan (SMC to update)
2.0 TRANSPORTATION SERVICE DELIVERY 2.1 Service Areas (SMC to discuss catchment areas) 2.2 Service Eligibility 2.3 Client Information 2.4 Client Ride Requests 2.5 Interagency Ride Sharing 2.6 Ride Scheduling 2.7 Driver Run Sheets 2.8 Daily Operations
3.0 FINANCE AND STATISTICS 3.1 Service Fees 3.2 Ride Cancellations and No-Shows (review appointment changes) 3.3 Statistics
4.0 ETHICS
5.0 HUMAN RESOURCES 5.1 Drivers 5.2 Driver Training
6.0 EMERGENCY PROCEDURES 6.1 Client Pickup/No-Shows 6.2 Passenger Safety – Assistance and Escorts 6.3 Vehicle Accident
7.0 PROTOCOLS (for review by SMC) 7.1 Transportation Funding 7.2 Transportation Funding Requests 7.3 Toronto Ride Funding/Funds Allocation 7.4 New Member Admission 7.5 New Partner 7.6 Revisions to Standard Operating Terms
8.0 COMPLIANCE INTRODUCTION
As defined in the Toronto Ride Memorandum of Association dated March 26, 2008, this Standard Operating Terms document contains the terms that apply to all members of Toronto Ride providing transportation to both their own clients and to other agencies’ clients through ride sharing. All members must abide by these Standard Operating Terms in order to maintain their membership in Toronto Ride. Under the terms of the Memorandum of Association this document can be revised at any time by a majority vote of the Senior Management Committee of Toronto Ride.
1.0 PARTNERSHIP GENERAL INFORMATION
1.1 Mission, Vision, Service Definition
Approved:
Mission
To provide on an ongoing basis an efficient co-ordinated, integrated and affordable, easily accessible non-emergency community transportation service by which seniors and persons with disabilities can access the health care system and certain social/ recreational functions, such as shopping and community programs.
Vision
To ultimately achieve recognition for Toronto Ride as the “third spoke” of the existing public transportation system currently provided by T.T.C./ Wheel Trans and the non-emergency service of Emergency Medical Services (EMS) for seniors and adults with disabilities who are ineligible for or unable to use T.T.C. WheelTrans or EMS services.
Service Definition (CNAP 2009)
Rides for seniors who are unable to use public transportation and are not eligible for “Wheel Trans”, York Region Mobility or other municipal transport programs. Rides are provided to medical or therapy appointments, shopping and various social activities and programs. Transportation is provided by paid staff or volunteer drivers.
1.0 PARTNERSHIP GENERAL INFORMATION
1.2 Strategic Plan
Approved:
Three year Strategic Plan: (to be revised by SMC)
1. Maximize service capacity by moving from the current operating model toward a logistics/ transportation operating model
2. Evolve the partnership to a high commitment, high participation partnership
3. Expand coverage
4. One stop access to transportation
5. Advocate for increased funding for transportation services
2.0 TRANSPORTATION SERVICE DELIVERY
2.1 Service Areas
Approved:
STANDARD
Toronto Ride partner members directly provide transportation services to clients who reside within their service catchment areas. Clients are registered with the agency servicing the neighbourhood where they reside.
Better Living Health Etobicoke Services for Seniors Harmony Hall Humber Community Mid-Toronto Community Services Neighbourhood Link SPRINT St. Christopher House St. Clair West Storefront Humber Storefront Humber Warden Woods West Toronto WoodGreen Community Services
PROCEDURES
1. Each member registers only clients who reside within their catchment area to provide transportation service for these clients. (Is it possible to have more clearly defined catchment areas and create a map that can be put on the website so potential clients accessing the website can contact the appropriate agency directly.
TRANSPORTATION SERVICE DELIVERY
2.2 Service Eligibility
Approved:
STANDARD
Criteria
1. Members provide personalized responsive transportation service to seniors and adults with disabilities who:
●are unable to use public transportation services; ●are able to enter and exit the agency vehicles with limited assistance (i.e. arm for support); ●have limited or no family or caregivers available to provide transportation; ●are registered with Wheel-Trans, unless special circumstances are presented to CSS member agencies; ●have a pathway from the client’s door to the vehicle that is safe and free of obstacles and hazards.
2. Service may not be provided to individuals who:
●require lifting; ●are unable to enter and exit vehicles independently, unless they have a personal escort accompanying to assist them ●are eligible for Wheel Trans and do not have special needs requiring service from a Toronto Ride member agency; ●present with a behaviour that may put others/himself/herself at risk.
2. Service is not provided to persons under the age of 18 years.
4. CSS agencies do not transport animals with the exception Guide dogs.
PROCEDURES
The above eligibility requirements will be the criteria for: 1. accepting clients for the member’s transportation program; and for 2. interagency client ride sharing.
TRANSPORTATION SERVICE DELIVERY
2.3 Client Information
Approved:
STANDARD
Client information collected by members for new clients will include general contact information, mobility, cognitive function, language, escort required, and other special needs/ instructions.
PROCEDURES
Members will collect from the client and/or caregiver registering the client the following information and enter it into their agency database:
1. Client’s name 2. Address 3. Telephone number 4. Name and phone number(s) of Emergency Contact Person and the relationship to the client 5. Medical conditions 6. Mobility limitations 7. Cognitive function 8. Language 9. Special needs/instructions
2.0 TRANSPORTATION SERVICE DELIVERY
2.4 Client Ride Requests
Approved:
STANDARD
Toronto Ride members provide transportation service to clients for:
1. Medical / therapy appointments 2. Grocery shopping 3. Community programs 4. Social outings 5. ADP rides
Ride priority is given to medical/ADP appointments.
PROCEDURES
1. Clients are asked to call their member agency at least 5 business days in advance to request their ride.
2. Clients are encouraged to call with late requests, including same day requests, since late or same day requests may be scheduled if space permits.
3. Clients are asked to give the following information when making a ride request: ●Date and time of appointment ●Return time, if two-way ride ●Destination address and phone number ●Special instructions (i.e. specific entrances) ●Escort accompanying the client, if applicable ●Mobility aids. (i.e. walker, cane) that the client will be bringing ●Type of ride request (i.e. medical, therapy, social)
4. If the member agency cannot fill the ride request, the request is posted for member agencies. See Section 2.5.
2.0 TRANSPORTATION SERVICE DELIVERY
2.5 Interagency Ride Sharing
Approved:
Currently faxed to Toronto Ride or some agencies e-mail or phone each other – should wait until SharePoint is in place to add this section.
Important to include all necessary details for clients rides including any cognitive/mental health issues so drivers are aware of clients’ needs when transporting other agency’s clients.
2.0 TRANSPORTATION SERVICE DELIVERY
2.6 Ride Scheduling
Approved:
STANDARD Member agency creates an initial schedule for clients’ rides at least three days in advance posting any rides that cannot be meet. Client will be informed by the member agency they are registered with of their scheduled pickup time prior to their ride.
PROCEDURES 1. Priority is given to rides for medical/therapy appointments. 2. Rides are scheduled taking into consideration the appointment time, distance, other rides and traffic. 3. Rides that cannot be met by the client’s home agency are posted as per Section 2.5. 4. When a ride has been accepted, the accepting member informs the posting member of the pick-up time. 5. Each member agency will inform its own clients of their scheduled pick-up times prior to their ride, and indicate to the client which agency will be doing the ride. 6. If a client does not answer the phone and does not have voicemail, it is the client’s responsibility to call the office to confirm their ride and learn of the pick-up time. 7. Last minute ride requests are scheduled if space permits 8. It is the co-ordinator’s role to monitor and adjust the drivers’ schedules daily to accommodate changes that are made (i.e. rides added, rides cancelled). When a change occurs on the actual day, the co-ordinator will notify the driver by cell/radiophone. Any changes i.e. cancellations or additions, must be recorded for statistics and billing purposes. 9. Each member is responsible for communicating any changes to ride requests and/or clients’ concerns to the member that picked up their ride posting.
2.0 TRANSPORTATION SERVICE DELIVERY
2.7 Driver Run Sheets
Approved:
STANDARD Driver run sheets will contain accurate information to ensure that rides can be completed safely and in a timely manner.
PROCEDURES 1. Drivers will be provided with daily run sheets containing the following information: ●client’s name ●pickup address, with special instructions re entrances, doors, etc. ●client’s phone number ●pick-up and return times ●destination address, with special instructions re entrances, doors, etc. ●mobility and sensory information, e.g. impaired vision, walkers, etc. ●whether or not the client will have an escort ●any special instructions, e.g. “Do not leave alone.” 2. Run Sheets are confidential documents and must be kept in a closed “binder”. 3. Drivers are expected to note all changes on their run sheets including address changes, additional escorts, added or cancelled rides and changes to a client’s mobility or cognitive abilities. 4. It is the responsibility of the Transportation Office staff to review the run sheets on a regular basis and update the relevant files accordingly i.e. client profiles, billing and statistics. 5. If the driver’s note refers to another agency’s client, it is the responsibility of the Transportation Office staff to relay the relevant information to the appropriate agency.
2.0 TRANSPORTATION SERVICE DELIVERY
2.8 Daily Operations
Approved:
1. Drivers must follow their daily run sheets as printed unless instructed otherwise. 2. Drivers will ensure that their radio/cell phone is on at all times with the volume audible and respond promptly to calls. Drivers who are not using hands free phones must pull over and stop in a safe location prior to responding to a call. 3. Drivers’ duties include: ●Assisting the client into and out of the vehicle providing an arm for support as necessary; ●Storing client mobility device(s) in the vehicle trunk; ●Ensuring that the client’s seatbelt is buckled before starting the vehicle; ●Ensuring that any oxygen tanks are securely and properly fastened as per regulations. 4. Drivers will make every effort to ensure that the client arrives at his/her appointment safely and on time. If drivers are running late, they will notify the Transportation Office to allow for scheduling changes to be made. 5. Clients must be ready for their ride 15 minutes prior to the agreed upon pickup time. 6. If the client is not ready, the driver must notify his/her own agency’s Transportation Office staff immediately. The Transportation Office staff may advise the driver to wait up to 15 minutes past the agreed upon pickup time if the schedule allows. 7. If a client cancels at the door, the Driver will inform the Transportation Office staff immediately. 8. If a client is a “no show” the Driver will inform the Transportation Office staff immediately, and remain at the client’s home until authorized to leave by the Transportation Office staff. Transportation Office staff will then take the appropriate steps to follow up with the client and/or the client’s emergency contact to ascertain the client’s well being. 9. Drivers will note all client cancellations and/or additions on their run sheets. The accuracy of the run sheet is essential to ensure correct billing and ride statistics. 10. Drivers will also note changes in a client’s mobility, health and/or cognitive ability on their run sheets. Transportation Office staff will review the drivers’ notes, update the agency database and/or follow up with the client and/or the client’s caregiver as necessary. 11. When the changes noted on the run sheet refer to another agency’s client, Transportation Office staff will relay the information to the appropriate member agency.
3.0 FINANCE AND STATISTICS
3.1 Service Fees
Approved:
STANDARD
All member agencies charge common fees for rides billed based on distance travelled. Fees for group rides vary. The fee is calculated based on the distance from pickup address to destination address, as calculated by the scheduling software used by the member agency.
PROCEDURES
1. The fees based on distance travelled are as follows:
Distance Fee 0 to 5 km $6.00 5 to 10 km $9.50 10 to 15 km $14.00 15 to 20 km $17.00 20 to 25 km $21.00 25 + km $1.00 per km *effective June 1, 2011
2. Fees are set by Toronto Ride Senior Management Committee and are reviewed annually and/ or at the request of members.
3. Members must comply with the Toronto Ride fee structure for all distance- based rides.
4. Clients are billed for their rides by their home agency regardless of which agency did the ride.
5. Member agency accepting the ride invoices the agency posting the ride. Interagency ride sharing invoices will be sent on a monthly basis.
3.0 FINANCE AND STATISTICS
3.2 Ride Cancellations and No-Shows
Approved:
STANDARD
Clients are required to cancel their trip by noon the business day before to avoid being charged for the ride. Failure to do so may result in the client being charged for the one-way cost of the scheduled ride.
PROCEDURES
1. During initial service orientation, client will be notified of the procedure for ride cancellations and no-shows. 2. When a client cancels their ride before noon the previous business day, the co-ordinator will change the ride status from “filled” to “advance cancellation”. If the ride was posted and picked up by a partner agency, the posting agency will immediately notify the accepting agency of the cancellation. The Transportation Office staff will then make the appropriate changes to the driver’s run sheet, if necessary. 3. When a client cancels their ride after noon the previous business day the co-ordinator will change the ride status from “filled” to “late cancellation” and inform the client that there may be a one-way charge for the ride, if applicable. The Transportation Office staff will then make the appropriate changes to the driver’s run sheet, if applicable, or contact the driver via cell/radiophone to advise of the change and instruct the driver to note on his run sheet whether the client is to be charged for the ride. If the ride was posted and picked up by a partner agency, the posting agency will immediately notify the accepting agency of the cancellation. 4. The accepting member may charge the posting member the equivalent of a one-way fare for any rides cancelled after noon the previous business day.
5. If a client calls to cancel a ride due to an appointment change, and re-schedules the appointment, the ride that is cancelled is marked as “changed appointment”. If the ride is changed with more than 24 hours’ notice, it is treated as an advance cancellation; if the appointment is changed with less than 24 hours’ notice, it is considered a late cancellation and the client may be charged the equivalent of a one-way fare. (Review at SMC meeting and with co-ordinators)
3.0 FINANCE AND STATISTICS
3.3 Statistics
Approved:
STANDARD
Members will send monthly ride statistics to the Toronto Ride Network Manager. Monthly interagency ridesharing statistics are due by the 10th of the following month. Total agency statistics are due by the end of the following month.
PROCEDURES
1. Each Member will complete a monthly statistics form (See Appendix 1) and either e-mail or fax it to the Toronto Ride Network Manager by no later than the end of the following month.
2. Interagency Ride sharing statistics will be reported to the Toronto Ride Network Manager by no later than the 10th of the following month.
3. The Toronto Ride Network Manager will compile the interagency ride sharing statistics monthly for the LHIN progress report.
4. The Toronto Ride Network Manager will provide a monthly Operations Report to the Senior Management Committee including the ridesharing statistics from the previous month.
4.0 ETHICS
Approved:
STANDARD
Members charge their employees and volunteers with the responsibility of maintaining high standards of conduct, to encourage client independence and to contribute to clients’ welfare.
PROCEDURES
Each member employee and/or volunteer will:
1. treat each individual with respect and accept that all individuals have worth; 2. maintain the confidentiality of information acquired through employment and/or volunteer service and only disclose this information when authorized or legally obligated to do so; 3. follow agency policies and procedures, Code of Conduct and the Procedures outlined in the Toronto Ride Standard Operating Terms 4. ensure that personal activities do not interfere with judgement and competence; 5. fulfil his/her obligations and responsibilities in a dependable and honourable manner; 6. provide client-centred care by encouraging the client to make his/her own decisions; 7. promote client involvement in his/her own affairs, including appropriate family and community involvement; 8. encourage the client to contribute to his/her own welfare by doing tasks of which he/she is capable; 9. contribute to the safety and security of the client and his/her personal property and physical environment; 10. assume personal responsibility for and contribute to workplace safety.
5.0 HUMAN RESOURCES
5.1 Drivers
Approved:
STANDARD
Toronto Ride members will ensure that clients are served by qualified drivers (including volunteers) who have been trained as per Toronto Ride set training (see Section 5.2) in providing rides to seniors and disabled adults.
PROCEDURES
All members must ensure that all drivers, both paid staff and volunteers, have the required skills and training to safely perform their responsibilities which will include:
1. Valid Driver License, verified annually; 2. Driver’s Abstract from Ministry of Transportation; abstract will be submitted annually; 3. A satisfactory police screening check upon hiring; 4. A signed a Confidentiality Statement before they begin to drive for the agency. (Confidentiality means that a driver cannot give anyone any personal information – both written (written or verbal) concerning a client and/or staff including client and staff identity, lifestyle and problems 5. Proof of personal automobile insurance with liability coverage in the amount of $2,000,000, verified annually, if the driver is using his/her own personal vehicle.
5.0 HUMAN RESOURCES
5.2 Driver Training
Approved:
STANDARD
Toronto Ride members will ensure that all drivers (including volunteers) driving more than 12 hours per week will participate in annual driver training.
PROCEDURES
1. All drivers driving more than 12 hours per week will participate annually in a driver training program approved by the Senior Management Committee. The program must include both an in-class component and an in-car evaluation and address the following topics:
●Keys to defensive driving ●How attitudes, values and personality affects your driving ●Managing risk conditions; and ●Changes to the Provincial traffic laws, Highway Traffic Act and local traffic issues 2. When a driver fails an in-car evaluation, the driver will not be permitted to drive other agencies’ clients and will be re-evaluated. 3. If the driver fails to pass a road evaluation on a second try, the driver will be required to participate in additional training followed by a further on-road evaluation.
6.0 EMERGENCY PROCEDURES
6.1 Client Pickup/No-Shows
Approved:
STANDARD
If a client is not at specified location or experiences any difficulty while using the service, the driver must notify the Transportation Office staff at his own agency immediately and await further direction. It is the responsibility of the Transportation Office staff to follow up to ascertain the client’s well being.
PROCEDURES During Business Hours 1. If the client is not present, the driver must call his/her agency’s Transportation Office staff immediately, and remain at the location until authorized to leave by the Transportation Office staff. Transportation Office staff will then take the appropriate steps to follow up with the client and/or the client’s emergency contact person to ascertain the client’s well being. 2. If the “no show” is another agency’s client, the driver will contact their own agency’s Transportation Office staff and remain at the location until authorized to leave by the Transportation Office staff. The Transportation Office staff will then contact the posting member to report the “no show”. It is the posting member’s responsibility to follow up with their client and/or the client’s emergency contact. After Hours and Weekends
1. For rides being provided for their own agency’s clients, the procedure is the same as during business hours.
2. For after hours ridesharing the posting agency must provide the accepting member with the client’s Emergency Contact information. In the event of a “no show”, the Transportation Office staff will follow up by attempting to contact the client and/or the client’s Emergency Contact Person to ascertain the client’s well being. A followup e- mail will also be sent to the posting member to alert the agency of the situation.
6.0 EMERGENCY PROCEDURES
6.2 Passenger Safety – Assistance and Escorts
Approved:
STANDARD
All drivers will act in a manner that promotes passenger safety when transporting clients. Driver assistance is defined as offering an arm for support and /or folding mobility aids. If clients require more assistance, they must provide their own escort.
PROCEDURES
1. Assistance Provided by Drivers Drivers will assist clients in and out of the vehicle, fold and store assistive devices such as walkers and wheelchairs, and provide assistance in ensuring that the client’s seatbelt is properly buckled. 2. Escorts ●If a client needs more assistance than the drivers can provide, they must arrange to bring their own escort. ●The drivers must offer assistance to clients even if they are travelling with an escort and must help with folding and storing of assistive devices. ●Clients must inform the Transportation Office staff that an escort will be accompanying them at the time the ride is being booked. ●When posting a ride, the posting agency must indicate whether or not the client will be bringing an escort. ●Clients can bring one escort at no extra charge. Additional escorts will be charged the full cost of the ride. ●Clients with dementia who require an escort must travel with an escort. If there is an escort listed on the run sheet and there is no escort present, the drivers must contact the Transportation Office staff immediately for further direction. If the client’s profile shows that they must travel with an escort drivers must not transport the client. If it is a posted ride, the accepting member must inform the posting member of the situation.
6.0 EMERGENCY PROCEDURES
6.3 Vehicle Accident
Approved:
STANDARD
In the case of an emergency the driver will follow their agency’s emergency protocol/ practice. The posting member will be contacted if their client was involved in the emergency.
PROCEDURES
1. Each member will have an emergency protocol which will include the following: ●the Driver will obtain medical treatment immediately, if necessary; ●Once it is determined that any medical emergencies have been dealt with, the driver will immediately contact their agency to report the accident; ●If a partner agency’s client has been involved in the accident, the Transportation Office staff will immediately contact the partner agency to inform them of the accident. 2. All accidents involving interagency ride sharing will be reported to Toronto Ride for tracking purposes. 3. All accidents involving interagency ride sharing will be reported to the Senior Management Committee monthly as part of the Operations Report.
7.0 PROTOCOLS
7.1 Transportation Funding
Approved:
STANDARD – To be reviewed by SMC
Members annually provide transportation information to the SMC.
PROCEDURES
Annually, by August, the SMC determines the transportation funding information to be collected from each member.
Annually, each September, members will provide to the Program Administrator their agency’s transportation funding as per procedure 7.1-1.
Annually, each October, the Program Administrator will bring the funding information from all members to the Utilization Committee for analysis.
The Utilization Committee will develop recommendation(s) i.e. scope (capital, operating funds, vehicles, demographic, fees etc), target (which funders or bodies) and action for the SMC’s consideration.
The SMC votes on the recommendations based on scope, target and action.
7.0 PROTOCOLS
7.0 PROTOCOLS
7.2 Transportation Funding Requests
Approved:
STANDARD – To be reviewed by SMC
Members must inform the SMC, in writing, within a reasonable timeframe, of their transportation funding proposal(s) prior to submission to funder.
PROCEDURES
1. Each Member, in writing, will submit to the Program Administrator their agency’s transportation funding proposal(s) request inclusive of the following:
1.2 Funder 1.3 Funder category for private (non government) funders (Foundations, Fundraising campaign, etc.) 1.4 Amount requested 1.5 Purpose for funding
2. The Program Administrator will inform the SMC, within a reasonable timeframe, of the member’s funding request.
7.0 PROTOCOLS
7.0 PROTOCOLS
7.3 Toronto Ride Funding/Funds Allocation
Approved:
STANDARD – To be reviewed by the SMC
The SMC approves Toronto Ride service delivery funding breakdown by member for Toronto Ride funds received, where Toronto Ride controls how funds are allocated among members.
PRODEDURE
2. The Program Administrator informs (via e-mail or at a meeting) the SMC of service delivery funding opportunities (not Central Function funding for Central Function use) for Toronto Ride as they become known.
3. The SMC determines an appropriate funding opportunity to pursue and strikes a sub committee to work with the Program Administrator to develop a draft funding proposal for SMC consideration.
4. The sub committee drafts recommendations on the proposal’s funding breakdown by members for SMC consideration. With regard to the recommendations, the sub committee’s considerations include: 1. Scope (capital, operating funds, vehicles, client demographics, etc) of the funding submission. 2. Percentage of overall transportation funding by LHIN for transportation funding by member. 3. Percentage of overall transportation funding of each member. 4. Demand/ Need/ Gap across the system.
5. The SMC votes on the recommendation(s).
7.0 PROTOCOLS
7.4 New Member Admission
Approved:
STANDARD
All requests for membership in the partnership must be sent to the SMC.
PROCEDURES
1, Potential new members will be required to provide the following information: ● number of vehicles and drivers ● number of ride requests received ● geographic area served ● transportation funding
2. The SMC will be advised of the new membership request and provided with the particulars noted above (see No. 1)
3. Potential new member will be advised in writing of their responsibilities as a member of Toronto Ride, including the signing of the Memorandum of Association which includes compliance with the Standard Operating Terms.
4. The membership request will be considered by the SMC at its monthly meeting. All partners must receive a minimum of five days’ notice of the request being on the Agenda.
5. The SMC will review the information provided (see No.1), consider any issues existing members may have with the new member’s request and whether any changes to SOT 2.1 (Service Areas) are required.
6. If any member raises an issue that cannot be immediately resolved, the SMC will defer the vote to the next meeting to give members time to discuss issues and amend the SOTs listed above.
7. If no issues are raised, the SMC may vote immediately on the new member’s admission into the partnership. 7.0 PROTOCOLS
7.0 PROTOCOLS
7.5 New Partner
Approved:
STANDARD – to be reviewed by SMC
All requests for partnership are sent to the SMC.
PROCEDURES
The Network Manager will inform members, within a reasonable timeframe, of those potential new partners the Network Manager is in discussion with.
Partnership requests are sent to the Network Manager. The Network Manager adds the partnership admission request to the SMC Agenda and sends by e-mail 5 business days prior to meeting.
Partners include:
2. Contractual partners – provide funds to Toronto Ride i.e. TC CCAC, TC LHIN
3. Expert partners – offer expertise in selected areas i.e. Wheel Trans, EMS
4. Working relationship partners – on-going relations i.e. Hospital, Rehabilitation facility
Where there is public acknowledgement or SMC obligation, the SMC holds a vote.
Partners may be invited/ request to provide expert advice and or/ offer a presentation to the SMC; such an address to the SMC will be added to the SMC Agenda and sent by e-mail 5 business days prior to meeting. 7.0 PROTOCOLS
7.0 PROTOCOLS
7.6 Revision to Standard Operating Terms
Approved:
STANDARD
The SMC votes on all additions and/or amendments to the Standard Operating Terms.
PROCEDURES
1. The Standard Operating Terms shall be reviewed annually each February and/or updated on a continual basis as necessary.
2. New Standard Operating Terms and/or changes to the existing SOT’s can be proposed by either a member or by the Network Manager at any time.
3. The member will submit the requested change to the Network Manager in writing.
4. The Network Manager will add the SOT request to the SMC agenda and inform the members by e-mail a minimum of 5 business days prior to the meeting.
5. The SMC will review the request and vote on the proposed change. If accepted, the SMC will request that a draft of the new SOT be prepared.
6. The draft will be added to the next SMC Agenda and sent to each member by e-mail a minimum of 5 business days prior to the meeting.
7. The SMC will then vote on the new/revised SOT(s).
8. An electronic version of the revised document will be distributed to each member as changes are made.
8.0 COMPLIANCE
Approved:
STANDARD
All members are expected to comply with the Standards and Procedures documented in the Standard Operating Terms.
PROCEDURES
1. All members will sign off on a Standard Operating Terms compliance memo annually in March. (See Appendix 2)
2. If a member does not provide the compliance memo, then the member will be in non- compliance with the Memorandum of Association.
3. Non-Compliance will be dealt with as set out under Section 14 of the Memorandum of Association.
Appendix 1
Agency: Month:
Rides Completed Medical Social Shopping ADP TOTAL 0 Prior to Post Cancellations confirmation confirmation Medical Social Shopping ADP TOTAL 0 0 TOTAL CANCELLATIONS 0 Unfilled Rides Medical Social Shopping ADP TOTAL 0 TOTAL REQUESTS Medical 0 Social 0 Shopping 0 ADP 0 TOTAL 0
Number of Escorts
POSTINGS - Rides Sent Out Completed Cancelled Unmet TOTAL Toronto Ride Other agencies (please specify):
TOTAL 0 0 0 0 Rides Picked Up (specify agency) Completed Cancelled Unmet TOTAL
TOTAL 0 0 0 0
Appendix 2
Toronto Ride Standard Operating Terms Memorandum of Compliance
(Name of Partner Agency) is in compliance with the current version of the Toronto Ride Standard Operating Terms.
______Executive Director Date
Assessing Transportation Disadvantage and Public Transportation Opportunities in Rural Ontario: A Case Study of Huron County
by
Eric Marr
A Thesis presented to The University of Guelph
In partial fulfilment of requirements for the degree of Master of Science in Rural Planning and Development
Guelph, Ontario, Canada
© Eric Marr, September, 2012 ABSTRACT
ASSESSING TRANSPORTATION DISADVANTAGE AND PUBLIC TRANSPORTATION OPPORTUNITIES IN RURAL ONTARIO: A CASE STUDY OF HURON COUNTY
Eric Marr Advisor: University of Guelph, 2012 Professor John FitzGibbon
In virtually all rural areas in Ontario the limited transportation alternatives means that rural residents without access to a personal vehicle are at great risk of transportation disadvantage. The primary research method for this research involved testing a transportation disadvantage framework using fourteen Key Informant Interviews undertaken with service providers operating within the case study of Huron County. The research found that residents within five demographic groups are at risk of transportation disadvantage within Huron County: older adults, those with physical or mental disabilities, youth, low-income households, and women. The research confirmed that transportation disadvantage exists on a continuum with some groups more disadvantaged than others, but also within groups with some accessibility needs more attainable than others. The research concludes with suggestions for a public transportation system to improve unmet transportation needs in Huron County along with recommendations for improving transportation access within the county.
ACKNOWLEDGEMENTS
There are several people that I would like to acknowledge who contributed to the completion of this research. First, I would like to thank my supervisors Professor John
FitzGibbon and Professor Wayne Caldwell for their feedback and contributions over the course of my research. I would also like to thank Sandra Weber at the County of Huron for her feedback, local knowledge, and interest in seeing this work completed.
I would like to thank Jay Nuttall at the Ministry of Transportation for introducing me to the study of transportation and sparking my interest in the topic of this thesis. I would also like to thank him for his continued moral support and expertise all these years later.
I would like to acknowledge my friends and classmates who have always been there to remind me that this research is important and to contribute their own ideas and experiences. I would like to thank Michaela especially for always being there for support as well as providing her own expertise in research methods and editing.
Finally, I would like to thank all of my interview participants for taking the time out of their busy schedules and away from their important work to speak with me about this issue. This research could not have happened without your contributions. From a more personal perspective, the people I met and the stories I heard reminded me that there are many people working tirelessly to provide essential services to those most in need.
iii
Table of Contents ABSTRACT ...... ii ACKNOWLEDGEMENTS ...... iii Index of Tables ...... viii Chapter One: Introduction ...... 1 1.1 Introduction ...... 1 1.2 Background ...... 2 1.3 Research Statement ...... 3 1.4 Goals and Objectives ...... 3 1.5 Scope ...... 4 1.5.1 Why Public Transportation? ...... 5 1.5.2 Alternatives to Public Transportation ...... 6 Chapter Two: Literature Review ...... 9 2.1 Introduction ...... 9 2.1.1 Methodology ...... 9 2.1.2 The Rural Transportation Problem ...... 10 Part 1: Needs and Opportunities ...... 12 2.2 Accessibility Needs ...... 12 2.2.1 Social Inclusion ...... 13 2.2.2 Access to Supplies ...... 14 2.2.3 Access to Essential Services ...... 15 2.2.4 Access to Training, Education, and Employment ...... 17 2.3 Mobility Limitations ...... 17 2.3.1 Older Adults ...... 18 2.3.2 Physical or Mental Disability ...... 23 2.3.3 Youth...... 25 2.3.4 Low-Income Households and Individuals ...... 28 2.3.5 Women ...... 31 2.4 Opportunities...... 33 2.4.1 Mitigation of Greenhouse Gas Emissions...... 33 2.4.2 Alleviate Issues Associated with Increasing Fuel Prices ...... 34
iv
2.4.3 Reduce Instances of Impaired Driving ...... 36 2.4.4 Macroeconomic Advantages ...... 37 2.4.5 Cost Savings in Social Services ...... 38 Part 2: Public Transportation Models for Rural Areas ...... 39 2.5 Conventional Transportation Model ...... 39 2.6 Flexible Transportation Model ...... 41 2.7 Community Transportation Model ...... 42 2.8 Private Taxi Model ...... 45 2.9 Mixed-Services Model ...... 46 2.10 Summary ...... 48 Chapter Three: Methodology ...... 49 3.1 Literature Review...... 49 3.1.1 Transportation Disadvantage Framework ...... 50 3.2 Secondary Data ...... 50 3.3 Previous Survey Findings ...... 51 3.3.1 Huron Transportation Taskforce Survey (2008) ...... 51 3.3.2 Huron County Transportation Demand Management Study (2011) ...... 51 3.4 Key Informant Interviews ...... 52 Chapter Four: Case Study: Huron County, Ontario ...... 55 4.1 Background and Context...... 55 4.2 Rurality of Huron County ...... 57 4.3 Transportation in Huron County ...... 58 4.3.1 Drivers in Huron County ...... 58 4.3.2 Personal Vehicle Ownership ...... 59 4.3.3 Travel Patterns in Huron County ...... 60 4.3.4 Transportation Mode in Huron County...... 60 4.3.5 Existing Intra-Community Public Transportation Services ...... 63 4.3.6 Specialized Transportation in Huron County ...... 63 4.4 Recognized Transportation Issues in Huron County ...... 65 Chapter Five: Transportation Disadvantage in Huron County ...... 67 5.1 Older Adults ...... 67
v
5.1.1 Mobility Limitations of Older Adults ...... 70 5.1.2 Accessibility Needs of Older Adults...... 74 5.1.3 Trends ...... 77 5.1.4 Design Characteristics ...... 80 5.2 Physical or Mental Disability...... 83 5.2.1 Mobility Limitations of those with Physical/Mental Disabilities ...... 85 5.2.2 Accessibility Needs of those with Physical/Mental Disabilities...... 87 5.2.3 Trends ...... 93 5.2.4 Design Characteristics ...... 93 5.3 Youth...... 97 5.3.1 Mobility Limitations of Youth ...... 99 5.3.2 Accessibility Needs of Youth ...... 103 5.3.3 Trends ...... 109 5.3.4 Design Characteristics ...... 111 5.4 Low-Income ...... 113 5.4.1 Mobility Limitations of Low-Income Households/Individuals ...... 116 5.4.2 Accessibility Needs of Low-Income Households/Individuals ...... 120 5.4.3 Trends ...... 128 5.4.4 Design Characteristics ...... 128 5.5 Women ...... 131 5.5.1 Mobility Limitations of Women ...... 133 5.5.2 Accessibility Needs of Women ...... 135 5.5.3 Trends ...... 138 5.5.4 Design Characteristics ...... 139 5.6 General Considerations ...... 141 5.6.1 The Car Culture of Huron County ...... 141 5.6.2 Liability and Regulatory Limitations ...... 141 5.6.3 Mandates and ‘Territory’ ...... 142 5.6.4 Residents Unconnected to Service Providers ...... 143 5.6.5 The Question of Needs and Responsibility ...... 143 5.6.6 The Theory of Planned Behaviour ...... 144
vi
Chapter Six: Applicability of Transportation Models ...... 145 Chapter Seven: Discussion and Recommendations ...... 150 7.1 Discussion ...... 150 7.2 Recommendations ...... 154 Chapter Eight: Future Research ...... 158 Work Cited ...... 160 Appendix A: Transportation Adequacy Framework ...... 167 Appendix B: Guiding Questions Used in Key Informant Interview Process ...... 168 Appendix C: Demographic Graphs for Huron County ...... 169 Appendix D: Map of Huron County, Ontario ...... 170
vii
Index of Tables
Table 1: Vehicle Population Totals for Huron County, Ontario
Table 2: Where, and how often do you travel to/from most?
Table 3: How often do you use the following transportation options to reach your destination?
Table 4: Mode of transportation to work, Huron County
Table 5: OneCare Huron Trip Purpose
Table 6: What do you think are barriers to available transportation options in Huron County?
Table 7: In your opinion, what are the top three transportation improvements in Huron County that you would like to see?
Table 8: Older Adults in Huron County (Aged 65-84)
Table 9: Population Projections for Older Adults in Huron County (Aged 65-84)
Table 10: Older Adults in Huron County (Aged 85 and older)
Table 11: Population Projections for Older Adults in Huron County (Aged 85+)
Table 12: Incidence of Disability by Age Group
Table 13: Population with Participation and Activity Limitations, Huron County
Table 14: Youth in Huron County
Table 15: Prevalence of Low-Income Classification in Huron County
viii
Chapter One: Introduction
1.1 Introduction
Access to transportation is essential for almost every facet of our everyday lives. Whether it is going to work; getting groceries and other supplies; participating in the community or civic functions; seeking entertainment or social inclusion; accessing healthcare or other social services; among other essentials for maintaining quality of life. Nevertheless, in rural communities transportation options are generally limited with very high reliance on personal vehicles. Indeed, as E.B. White once put it, “Everything in life is somewhere else, and you get there in a car” (E. B. White, 1940). This is particularly true of rural areas where opportunities for active transportation are limited and general use public transportation is rare.
This raises the question of how rural residents are to get around if, for any number of reasons, personal transportation is not available. Those without access to personal transportation can be described as being transportation disadvantaged as they lack the mobility necessary to access services and activities essential for quality of life. Furthermore, in virtually all rural areas in Ontario the limited transportation alternatives means that rural residents without access to a personal vehicle are at great risk of transportation disadvantage.
Moreover, public transportation in rural Ontario is very rare and where it does exist it is usually confined to a specialized transportation service for older adults, those with physical mobility limitations, or school transportation for youth. Therefore, this situation excludes public transportation access for the general public in rural communities and particularly for groups such as low-income individuals who are often in particular need of transportation. Finally, trends in
Ontario, such as demographic changes and increasing fuel prices, may suggest an increased need for public transportation in the future.
1
Therefore, this research has two purposes relating to transportation in rural Ontario. First, it provides a framework for identifying transportation disadvantage that was tested, through the use of Key Informant Interviews, within Huron County representing a case study of a rural area in the province. Second, this research provides general use, intra-community public transportation models that may be appropriate for addressing transportation disadvantage in rural
Ontario.
1.2 Background
Fundamentally, the issues of transportation disadvantage in rural areas stems from the long distances that rural residents must travel in order to access their needs. Indeed, Statistics
Canada defines rurality as a factor of both distance and population density (Bollman &
Prud’homme, 2006). This means that rural residents must travel longer distances than their urban counterparts in order to access equivalent services. As well, low population densities often mean that some services are not available locally and rural residents will need to travel to larger centres to access these requirements. Overall, these factors result in a context where active transportation
(walking/cycling) is often not a viable mode of transportation as distances are too long to be practical. Therefore, motorized transportation is often the only option for rural residents to access their needs, and due to a lack of public transportation service, this generally equates with personal vehicle access.
This scenario raises questions about accessibility in rural areas. Indeed, everyone needs to travel in order to have quality of life and participate in society. Nevertheless, in rural areas there are groups who cannot travel due to mobility limitations thereby reducing their ability to access these needs. Chapter 2 will provide a look at these accessibility needs as well as the groups that are unable to access them in rural areas due to mobility limitations.
2
1.3 Research Statement
Throughout much of Ontario a personal vehicle is the only transportation option available, which severely restricts the mobility of those that cannot drive. Particularly in rural areas where transportation alternatives are rare, those residents who do not have reliable access to a personal vehicle in order to access quality of life essentials are put at great risk of transportation disadvantage. This research will develop and test a transportation disadvantage evaluation framework in a case study in Ontario, specifically Huron County. The anticipated outcome of this research is an evaluation method that may be applied elsewhere in Ontario, and
Canada, for identifying transportation disadvantaged groups as well as options for addressing this issue through a general use, intra-community public transportation service.
1.4 Goals and Objectives
The first goal of this research is the development of a framework for identifying transportation disadvantage within the context of rural Ontario. This was achieved by reviewing the literature to determine demographic groups residing in rural areas that are found to have mobility limitations for physical, legal, economic, or social reasons. These factors were reviewed alongside the accessibility needs that these groups must reach in order to maintain quality of life.
The framework was then applied to the case study of Huron County to determine its applicability within the context of a rural area in Ontario.
A second goal of this research was to identify options for addressing transportation disadvantage within the context of rural Ontario. Specifically, the options for a general use, intra- community public transportation service were evaluated using literature and case studies.
3
This research strove to meet four objectives:
1) Present a comprehensive look at the issue of transportation disadvantage in rural areas and the demographic groups most at risk.
2) Develop a framework for identifying transportation disadvantage in rural Ontario.
3) Apply/test the framework in Huron County as a case study representing a rural Ontario municipality.
4) Present options for public transportation models applicable for addressing transportation disadvantage in the rural Ontario context.
1.5 Scope
It is important to note the scope of this research to ensure a clear understanding of what this research does, and does not, address. First, this research does not address opportunities to shift transportation modes in rural areas away from personal vehicles. That is to say, it does not address transportation for those who already have access to a personal vehicle. While there are reasons for encouraging this shift, such as environmental, energy, and health considerations, it is often found that the deterrents do not presently exist to make it achievable. Indeed, deterrents such as congestion, inadequate parking, and road pricing do not exist to enough of a degree in rural areas to actually deter driving and initiate a shift to alternative transportation modes
(Cullinane & Stokes, 1998). Thus, this research will only deal with accessibility for those who are without reliable transportation options.
A second clarification comes with the terms ‘general use’ and ‘intra-community’ transportation systems, which are the focus of this research. Quite simply, general use systems are available to everyone whereas specialized transportation systems are available only to certain groups and/or for certain purposes. One drawback of much of the literature on transportation disadvantage in rural areas is that most sources concentrate on specific groups, which is then translated into practice with most existing rural transportation services in Ontario, Canada, and
4 elsewhere being specialized to meet the needs of specific demographics. A key goal of this research is to look at transportation disadvantage in rural areas cumulatively and then present public transportation models which may meet the mobility needs of several demographic groups.
The term intra-community refers to a system operating within a given community that may act as a collector system bringing passengers into a town or as a feeder system bringing passengers to an inter-community transit service. In contrast, an inter-community service transports passengers between different communities, such as a coach bus or train service, generally without stopping in between. This research will not address inter-community transportation services as they meet different transportation needs and use different public transportation models than intra-community systems. For the purposes of the case study, Huron
County will be considered to be a single community.
1.5.1 Why Public Transportation?
While public transportation is the method for addressing transportation disadvantaged emphasised in this research it should be noted that it is not always accepted as being viable within rural communities due to their inherently low populations, low population densities, and long distances between people and services. For instance, the 2011 Transit-Supportive
Guidelines prepared by the Ontario Ministry of Transportation suggests that the minimum density to support a basic transit service is 22 units per ha or 50 residents and jobs combined
(MTO, 2011). While not a standard, this suggested threshold does exclude most rural areas from considerations of public transportation service.
Nevertheless, this opinion is not universally accepted and as shown in Part 2 of Chapter
2, models and cases from Europe and North America demonstrate that certain public
5 transportation designs and models are viable in rural areas with low population densities.
Further, Paul Mees argues in his 2011 book Transport for Suburbia that the use of population density as the basic indicator for transit viability is fundamentally flawed and goes so far as to state that “density is not the main barrier to providing public transport that offers a real alternative to the car; rather, it is a rationalization for inaction.” The opinion that public transportation is far more viable in rural areas than is often perceived has been found to be common throughout the literature on the topic.
1.5.2 Alternatives to Public Transportation
Another important consideration to note is that public transportation is not the only method for addressing transportation disadvantage in the rural context. Indeed, Transportation
Demand Management (TDM), active transportation, and land-use planning all play a role in addressing mobility and accessibility needs. However, individually none of these options can meet the needs of rural residents completely.
Transportation Demand Management (TDM) attempts to manage why, when, where, and how people travel (Transport Canada, 2010). A key element of TDM is the opportunity to reduce the need to travel in order to access services, employment, and other needs. For instance, the delivery of services online or workplaces offering telecommuting can be considered TDM tools to reduce the absolute need to travel.
However, an important consideration for tools such as these is that for some needs travel will always be essential. As an example, accessing health services or supplies, such as groceries, will generally require travel for either the provider or the client. Therefore, while TDM is an
6 important element of addressing transportation disadvantage in rural communities it cannot be the sole method used.
Another alternative to public transportation meeting the same end is active transportation.
Active transportation can be used to describe any mode of human-powered transportation and generally refers to walking or cycling. This is another important element of a complete plan for addressing transportation disadvantage but again cannot stand alone in a rural area. Indeed, as
Cullinane & Stokes (1998) describe “walking and cycling could probably have a larger impact in rural areas than many imagine” however they go on to qualify this by stating that “many rural journeys could never easily be transferred to walking and cycling due to long distances, harsh weather conditions, or hilly terrain.”
Similarly, travelling for supplies, such as groceries, could not always be undertaken by rural residents due to the practical obstacle of carrying them home, even if they were in walking distance. Furthermore, rural residents with physical mobility limitations may be unable to make use of active transportation at all as described by Sherwood & Lewis (2000) with the statement
“six miles is not far, but, for many, particularly those with physical limitations, it is too far to walk.”
A third alternative to public transportation is that of land-use planning. Again, this method plays an important role in addressing transportation disadvantage but has limitations, particularly in a rural context. Opportunities to utilize land-use planning as a means to address transportation disadvantage generally stem from planning principles such as mixed-use developments, intensifying settlements, clustering services, directing growth to settlements,
7 among other attempts to reduce distances and thereby the need for automobiles to meet travel needs.
However, while these principles are certainly applicable in rural settlements, those living outside settlement areas will still require transportation to meet their needs. Another argument presented by Mees (2011) is that the built form changes very slowly and that issues of transportation disadvantage and automobile dependence cannot be put off for decades while communities are re-built. This may be especially true in rural areas where growth is particularly slow and re-development and intensification is less common when compared with cities, which often rely on these methods, having exhausted their land supply.
To conclude this section, it is clear that none of the four methods presented here (public transportation, TDM, active transportation, and land-use planning) can solve the issue of transportation disadvantage alone in the rural context. Instead, they should be considered together in any comprehensive transportation plan being implemented within a community.
8
Chapter Two: Literature Review
2.1 Introduction
Access to transportation is an essential element of ensuring quality of life in our society.
Particularly in rural areas where few alternatives exist, lacking access to transportation prohibits residents from availing themselves of the services, interaction, and activities necessary for meeting their basic needs. Indeed, there is a considerable body of research on the transportation disadvantage of rural residents and the limitations imposed by personal vehicle reliance and limited alternatives. Moreover, a parallel body of research provides information on public transportation models available for meeting these transportation needs, which are designed specifically for the conditions of rural areas.
2.1.1 Methodology
This section provides the results of a review of the literature on the topic of transportation disadvantage and public transportation models in rural communities. The literature review is broken into two distinct sections each with differing goals. The first section provides findings on transportation disadvantage as well as opportunities associated with public transportation provision within rural areas. The second section provides findings on public transportation models as well as their applicability in rural settings and ability to meet the transportation needs of rural residents.
A review of the literature identified that much of the writings on public transportation in rural areas comes from jurisdictions outside of Ontario or Canada. Therefore, while an emphasis was placed on identifying sources pertaining specifically to the context of Ontario and Canada it was accepted early on that this would provide an insufficient look at the considerable literature
9 on the topic. Therefore, this literature review will often refer to findings from outside Canada, specifically from the United States, Australia, and Europe.
This should not pose a problem as the transportation needs for rural residents within each of these jurisdictions will be largely the same. While definitions of rural areas vary, on the subject of transportation each will share similar characteristics. Indeed, Nutley (1996) describes the rural environment of developed ‘western’ countries as sharing a number of characteristics including:
an absence of significant congestion, parking and pollution problems, higher car ownership rates due not to wealth but to greater need and lack of alternatives, much lower levels of public transport due to the economic problem of serving a highly dispersed pattern of demand, longer distances to middle- and high-order centres of economic activity, and a greater social gulf between car owners and non-car owners with the latter possibly exhibiting problems of isolation and hardship.
Similarly, while transportation models may not be directly transferrable between each of these jurisdictions, at the conceptual level they are relevant to consider.
A final note is that the resources for this literature were obtained from a variety of sources including academic, government, and ‘grey’ literature. It was deemed important from the outset that each of these sources be considered due to the applied nature of the topic of public transportation thereby making findings from practitioners and community groups highly relevant.
2.1.2 The Rural Transportation Problem
Before delving into a discussion of the transportation needs and opportunities present within rural areas it is important to first define the fundamental transportation problem inherent within most rural contexts in the western world. In basic terms, the rural transportation problem can be described as the fact that everyone needs mobility of some form in order to access their
10 basic needs and in a rural context, where distances The Rural Transport Problem: Most rural households are dependent on the car. are long and people and services spread out, this Alternatives to the car are poor or non-existent. means that transportation of some form is Rural drivers do more driving and spend more on fuel than urban essential. drivers. Fuel is more expensive in rural areas. Households will struggle to cope In most rural areas reliable alternatives do with the effects of rising fuel prices. Rising motoring costs will not exist and therefore transportation access undermine the sustainability of rural communities and lead to increased directly equates to personal vehicle access or social exclusion. ownership. Indeed, Gray et. al. (2001) raise the Adapted from: (Gray, 2000) important distinction between the “absolute need for a car to maintain mobility when no other option is available (for example, disabled people or rural populations); and the perception of reliance on a car, without actively considering the alternative.” They refer to this distinction as structural dependence (absolute need) and reliance (perception of need) and determine that most rural residents of rural areas can be described as structurally dependent on a personal vehicle.
This structural dependence on personal vehicles in rural areas leads to an additional issue referred to as transportation disadvantage. The term transportation disadvantage has been defined as “the inability to travel when and where one needs without difficulty. Transport disadvantage, as a concept, exists on a continuum, with some more transport disadvantaged than others” (Denmark, 1998). Indeed, for physical, legal, economic, or social reasons some groups within rural areas are unable to make use of a personal vehicle and are therefore described as being transportation disadvantaged. Further, it is important to note that transportation disadvantage is a function of both accessibility and mobility (Cullinane & Stokes, 1998;
Kamruzzaman & Hine, 2011).
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Quite simply, accessibility can be described as the degree to which services and activities can be reached (Gray, Shaw, & Farrington, 2006). While often this means physically moving to reach a service this does not have to be the case (Cullinane & Stokes, 1998). For instance, services may be brought to residents in the form of deliveries, homecare, or online services.
Nevertheless, many accessibility needs must still be accessed in person requiring the corresponding concept of mobility.
The concept of mobility can be described as the ability to physically move around and to make trips or journeys (Cullinane & Stokes, 1998). As a standalone subject, mobility is not very important as people do not need mobility for its own sake; however, when combined with accessibility it becomes very important. Indeed, rural residents often need mobility in order to access the necessities of life and in most cases mobility requires transportation as walking or home deliveries are unavailable. Therefore, those without mobility are described as transportation disadvantaged as they are unable to access the essentials of life. In recognition of both the accessibility and mobility aspects of transportation disadvantage the following section will be divided between the accessibility needs and mobility limitations of rural residents.
Part 1: Needs and Opportunities
2.2 Accessibility Needs
The quality of human life depends on the amount of access we have to one another. We must have contact to exchange goods and services as well as joys and sorrows. People need to be brought together to take advantage of the economies of scale in industry (Schaeffer & Sclar, 1980).
Within our society we require access to a range of activities, interactions, events, and services in order to maintain quality of life. However, in order to access these essentials, we require mobility of some form and in most rural areas this means access to a personal vehicle.
This section will present findings from the literature relating to the needs that rural residents
12 must access in order to maintain quality of life while the proceeding section will present findings on why some groups face limitations in reaching them. The key accessibility needs arising from the literature that will be discussed here are social inclusion; access to supplies; access to essential services; and access to training, education, and employment.
2.2.1 Social Inclusion
Inclusion in society is essential for all people in order to ensure quality of life. Indeed, social inclusion includes access to such activities as: visiting friends and family; attending cultural or religious events; participating in civic functions; participating in recreational or leisure activities; among others. Overall, it is necessary for social purposes and to combat issues of isolation and loneliness. However, rural residents are at particular risk of social exclusion due to their dispersed population and the long travel distances associated with these areas. Indeed, without transportation access rural residents are particularly at risk of social exclusion as many are forced to stay home rather than participate in activities, attend events, or visit each other
(Bailey, 2004; Hall, Havens, & Sylvestre, 2003; NACA, 1993; Site & Salucci, 2006).
The linkage between transportation access and social inclusion has been made quite frequently in the literature, particularly from the United Kingdom (Gray, et al., 2006; Halden,
Farrington, & Copus, 2002; Kamruzzaman & Hine, 2011; Nutley, 1996; SEU, 2003). Indeed, the literature from the United Kingdom and elsewhere typically identifies specific groups residing in rural areas as being particularly at risk of social exclusion due to mobility restraints. For instance, one source from the European Union found that social exclusion was greatest amongst the unemployed and older adults due to access problems (Site & Salucci, 2006). Particularly for older adults, similar findings have been made in the United States (Bailey, 2004) and Canada
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(Gallagher, Menec, & Keefe, 2008; Hall, et al., 2003; NACA, 1993; Scott et al., 2009; Senate of
Canada, 2008).
However, other groups have been found to face issues of social exclusion in rural areas due to accessibility problems. For instance, the United Kingdom’s Social Exclusion Unit identified youth, the disabled, the unemployed, and families with young children as being at particular risk (SEU, 2003). Indeed, this report provides an example pertaining to youth where “a comprehensive school with a large isolated rural catchment area found that 40–45 per cent of pupils were missing out on after-school activities due to transport constraints” (SEU, 2003).
Findings from a study of rural youth in Ontario demonstrate a similar connection between transportation access for youth and social inclusion and found that “activities that were considered to present transportation challenges were getting to social activities, to visit friends and to attend sports/recreation events” (Herold & Kaye, 2001).
Further, some women residing in rural Northern Ontario were found to be socially excluded as they did not have adequate access to transportation (O'Leary, 2008). Similarly, findings from Grey, Bruce, and Huron Counties found that “the isolation caused by the lack of transportation and inability to access needed services has a direct impact on women’s mental health” (Purdon, 2002).
2.2.2 Access to Supplies
Another key accessibility need for all people is to access the supplies we need for survival. In particular, the availability of groceries is frequently cited in the literature as an accessibility need. In rural areas this may pose an obstacle for those without access to transportation. Indeed, home visits, such as the milkman, are essentially non-existent today and
14 even small town grocery stores are closing in favour of large scale stores centralized in urban areas with larger populations (Schaeffer & Sclar, 1980). Within the United Kingdom this was presented as an issue by the Social Exclusion Unit which made a connection between the centralizing of food retailers, lack of transportation, and a resulting poor access to healthy and affordable food (SEU, 2003). It should be noted that, in recent years the private sector has attempted to fill this gap with food delivery services, such as the Grocery Getters home delivery service operating in the predominantly rural Municipality of Chatham-Kent in Southwest Ontario
(Grocery Getters, 2012). Nevertheless, as these services are profit based, they will always require a premium on grocery costs and therefore raise questions about affordability for those most at risk of transportation disadvantage.
2.2.3 Access to Essential Services
The literature on rural accessibility often cites the need to access essential services such as social programs, pharmacies, banking facilities, post offices, and in particular the need to access health services. While many of these services are now offered online through advancing telecommunications technology, a parallel trend in Canada is that services are being centralized in urban centres thereby making any need to travel to such services increasingly difficult (Senate of Canada, 2008; Transport Canada, 2006).
A key set of services in which physical attendance is almost always necessary are the health services with one source stating that “without transportation, even a short distance to care can become an insurmountable problem. The opportunity for health care consumers to have a vehicle to transport them to a practitioner or facility is especially important in rural settings
15 where distances are relatively great, roads may be of poor quality, and public transportation is seldom available” (Arcury, Preisser, Gesler, & Powers, 2005).
Indeed, there is substantial literature on the need to access health services and the obstacles faced by rural residents with one source referencing “the growing evidence demonstrating an inverse relationship between the distance from a health care facility and its use” (Sherwood & Lewis, 2000). This situation has been found to be accurate in a recent article covering the situation of rural Canada (Pong et al., 2011).
Another study from rural North Carolina found that transportation was a major impediment to healthcare access (Arcury, et al., 2005). This study found that “those who had a driver’s license had 2.29 times more health care visits for chronic care and 1.92 times more visits for regular checkup care than those who did not” and that “respondents who had family or friends who could provide transportation had 1.58 times more visits for chronic care than those who did not” (Arcury, et al., 2005). Further still, this study found that the individuals with the greatest need for healthcare and public transportation as well as a recognized inability to drive themselves were older adults, more likely female, and in poorer physical and mental health (Arcury, et al.,
2005). Finally, this study concluded that “it is the elderly who have the greatest limitations in the use of personal transportation (driving a car) as well as a great need for health care” (Arcury, et al., 2005).
Several additional studies have found a particular need for healthcare access among older adults residing in rural areas and issues of accessibility due to limited transportation availability.
Such findings come from rural Vermont (Nemet & Bailey, 2000), the United Kingdom
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(Sherwood & Lewis, 2000), Australia (Broome, Worrall, McKenna, & Boldy, 2010), and rural
Manitoba (Hall, et al., 2003).
2.2.4 Access to Training, Education, and Employment
The final accessibility need for rural residents which will be discussed here is that of access to training, education, and employment. Indeed, the literature on the topic often identifies the need for transportation to access opportunities associated with training and education as well as the need to access employment for livelihood. The literature also identifies obstacles imposed upon several groups residing in rural areas due to their limited transportation options thereby inhibiting their access to these opportunities and essentials (Burkhardt, Hedrick, & McGavock,
1998; Cartmel & Furlong, 2000; Fletcher, Garasky, Jensen, & Nielsen, 2010; Site & Salucci,
2006).
In particular, within Canada low-income people, women, and youth residing in rural areas have been found to be at particular risk of being unable to access training, education, and employment opportunities due to transportation limitations (Garven & Associates, 2005;
O'Leary, 2008; Senate of Canada, 2008). For instance, one study from rural Ontario found that
48 per cent of rural youth could not access employment due to transportation limitations (Herold
& Kaye, 2001).
2.3 Mobility Limitations
“If one does not get around, then one is not normal in rural areas. One does not have a normal life if one cannot get around. It is essential to be able to get around for accessing all the normal things in life.” – Anthony Fuller, Professor, School of Environmental Design and Rural Development, University of Guelph (testifying as an individual), Evidence, October 31, 2006 (Senate of Canada, 2008).
A review of the literature on the topic of mobility limitations in rural areas identifies several demographic groups who often have unmet transportation needs thereby inhibiting the
17 mobility and accessibility necessary for quality of life. Indeed, for many rural residents the lack of mobility is synonymous with lacking or limited access to a personal vehicle, which for many groups presents a serious obstacle. This section will provide findings on the key demographic groups in rural areas identified as being transportation disadvantaged due to limitations on their mobility. The key question that this section hopes to answer is why certain groups are at risk of transportation disadvantage and face limitations in their ability to access the quality of life essentials presented in the previous section.
2.3.1 Older Adults
Probably the most recognized demographic group at risk of transportation disadvantage is older adults residing in rural areas. Older adults are typically presented as those 65 years of age and older with particular limitations arising around the age of 80-85 years (Rosenbloom, 1999).
For a variety of reasons this group has been found to have mobility limitations resulting in restricted access to services, activities, and events. For instance, one finding from the United
States indicates that “compared with older drivers, older non-drivers in the United States make:
15% fewer trips to the doctor; 59% fewer shopping trips and visits to restaurants; [and] 65% fewer trips for social, family and religious activities” (Bailey, 2004).
There is a considerable amount of research from Europe, Australia, the United States, and
Canada on the limitations faced by older adults residing in rural areas, the unique transportation needs of these residents, as well as the looming challenges of aging populations alongside aging- in-place policies and preferences.
As people age they tend to face a number of limitations to their mobility including physical, mental, social, legal, and economic hurdles. These limitations also tend to be
18 exacerbated in rural areas where personal vehicles are the primary, if not only, mode of transportation. Indeed, while less common in rural areas, where general use public transportation does exist in a rural or small town setting, older adults are frequently found to be heavy users
(CUTA, 2003; Transport Canada, 2006; P. White, 2011).
An unfortunate yet accepted fact is that as we age our physical and mental capabilities will diminish. This may be the result of natural causes, medical conditions, or even side-effects of medication (Owsley, 1999). Common issues include declining: eyesight, motor skills, reflexes, memory, and cognitive abilities (Owsley, 1999; Sylvestre, 2001). As well, in Canada the prevalence of such conditions is quite high, with one source stating that “23 percent of seniors 65 to 74 years old have a mobility-related disability, as do 43 percent of those older than
75” (CUTA, 2003). The result of such conditions may be an inability to operate a vehicle with one study from within the Canadian context, finding that “while declining health contributes to the loss of automobility, the percentage of drivers tends to decline rather slowly with age up to
85 years, with a substantial drop afterward” (Scott, et al., 2009). This finding was echoed in another study on older adults in rural Manitoba where “the cessation of driving due to health problems was reported to be a problem of particular significance” (Hall, et al., 2003).
A corresponding issue is that of older adults continuing personal vehicle operation when it is unsafe to do so. In rural areas, this situation is particularly problematic where few alternatives exist and where “older drivers who may not be physically or mentally fit to drive but, out of necessity, do so to satisfy personal and social needs” (Scott, et al., 2009). For instance, it has been found in a rural Canadian example that “the lack of public transportation (or a convenient alternative) was identified by service providers as the reason for seniors continuing to drive for longer than was safe to do so” (Gallagher, et al., 2008).
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In addition to the physical and mental limitations resulting from aging, older adults in rural areas also often face social limitations which inhibit necessary mobility. Once older adults can no longer drive, or give up their license (voluntarily or otherwise) they become reliant on active transportation, public transportation, or rides from friends and family (Arcury, et al., 2005;
NACA, 1993; Schaeffer & Sclar, 1980). However, for many older adults in rural areas public transportation is not available and active transportation is not an option due to distance or physical ability (Sylvestre, 2001). Indeed, older adults in rural areas are sometimes referred to as
‘transport dependent’ due to their high reliance on others in order to meet their transportation needs (Sylvestre, 2001).
Nevertheless, older adults residing in rural areas are subject to social limitations for accessing transportation. Findings from the United States have identified that many older adults are unwilling to ask for rides due to self-consciousness, feelings of dependency, or concerns over imposing on others (Bailey, 2004). This issue of dependency has also been identified in the rural
Canadian context (Gallagher, et al., 2008; Hall, et al., 2003). For others, declining social ties have been found to reduce the availability of rides from friends and family. For instance, the dispersed nature of many families means that children often do not live in proximity to their parents as they have left the rural area to seek educational or employment opportunities elsewhere (Nemet & Bailey, 2000; Senate of Canada, 2008). Similarly, older adults often have different transportation needs that prevent them from accessing rides from volunteers. For instance, older adults often need transportation during the day for shopping or medical appointments (Gallagher, et al., 2008).
A third key transportation limitation for rural older adults comes in the form of legal constraints. As mentioned earlier, it is common for older adults to voluntarily give up their
20 license due to recognized limitations in physical or mental abilities. However, as also mentioned earlier, many older adults in rural areas continue driving out of necessity even when it is no longer safe to do so. This creates issues of driver safety and many sources (though not all) find that older adults are more prone to driving-related accidents (Scott, et al., 2009). In an effort to resolve this issue some jurisdictions have made efforts to revoke licenses from drivers deemed to be unable to maintain adequate road safety. For instance, in Ontario the Senior Driver Renewal
Program was created due to safety concerns and requires that drivers 80 years of age and over undertake testing in order to renew their licence every two years (MTO, 2010c). However, such programs provide an issue for rural drivers who are dependent on their personal vehicles due to a lack of alternatives. Indeed, Schaeffer and Sclar (1980) state that revoking a driver’s license means that a person is “legally prevented from going to work, shopping and generally taking care of personal business, unless a relative or friend who can drive is available.” This same concern was found in older adults within the rural Canadian context in multiple studies and reports
(Gallagher, et al., 2008; Hall, et al., 2003; Scott, et al., 2009).
The final key limiting factor for transportation access in older adults is economic barriers.
Many older adults rely on limited or fixed incomes to meet their financial responsibilities. In some cases this means that the cost of owning and operating a personal vehicle is no longer affordable. Particularly in rural areas the inability to afford a personal vehicle has been shown to be a major cause of transportation disadvantage for some people within this demographic group
(Scott, et al., 2009; Senate of Canada, 2008; Sylvestre, 2001).
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2.3.1.1 Challenges
A key challenge associated with the transportation needs of older adults is the aging
‘Baby Boomer’ population currently being experienced by most ‘Western’ countries. The impacts of this trend can be particularly observed in rural areas which often have higher proportions of their populations in the eldest cohorts when compared to their urban counterparts.
As described in the preceding sub-section, many rural areas will be faced with an increasing number of older residents who are unable to utilize personal transportation in order to meet their mobility needs. This raises questions about how these needs will be addressed with one potential method being public transportation provision.
While little has been written explicitly on this topic, several sources were identified that mentioned it as an emerging concern (Bailey, 2004; Transport Canada, 2006; TRB, 1999). For instance, one Canadian source states that mobility “issues related to aging will become more acute as it is projected that the national proportion of persons 65 and over will increase to 22.6% by 2041” (Sylvestre, 2001). This source goes on to emphasize the concern being that “the most rapidly growing segment of the senior population will be those over 80, [when] issues of mobility will become increasingly important due to the growing number of frail elderly requiring greater support”(Sylvestre, 2001). This trend may be particularly problematic for rural areas of
Canada which presently have higher proportions of their population 65 years of age and older and are aging more rapidly than urban areas in the country (Dandy & Bollman, 2008).
Within the context of Ontario we see these national trends echoed. Indeed, the most recent Ontario Ministry of Finance population projects demonstrate that “the number of seniors aged 65 and over is projected to more than double from 1.8 million, or 13.9 per cent of
22 population, in 2010 to 4.1 million, or 23.4 per cent, by 2036” (MOF, 2011). Similar to Canada overall, those areas outside the Greater Toronto Area were also found to have higher proportions of their population 65 years and older (MOF, 2011).
Corresponding to the trend of a rapidly aging population in Canada is another trend towards ‘aging at home’ as opposed to aging in long-term care facilities. Indeed, Ontario has seen much discussion surrounding this option and has created its own Aging at Home Strategy
(MOHLTC, 2010). This interest in encouraging aging at home is at least partly driven by economic considerations, with Canadian findings demonstrating that aging at home is a less costly alternative to conventional residential care for older adults (Laviolette, 2010).
However, in order to take advantage of the benefits of an aging in place strategy, transportation options must be available for those older adults who are still predominantly independent but who cannot drive for any reason, with one option being new or expanded public transportation service (Laviolette, 2010; Transport Canada, 2006). Indeed, one source reiterates the importance of available transportation and states that “what drives the aged finally to move to old-age homes or to their children’s home is frequently their inability to perform the local trip- making that is required to maintain a household” (Schaeffer & Sclar, 1980).
2.3.2 Physical or Mental Disability
Another key group at risk of transportation disadvantage are those with physical or mental disabilities. Indeed, the obstacles faced by this group are somewhat similar to older adults in that physical or mental conditions prevent the operation of a motor vehicle; licensing; or in some cases the use of conventional public transportation. The actual conditions that prohibit mobility and contribute to transportation disadvantage are quite varied and may be permanent,
23 life-long conditions, or temporary afflictions. The Canadian Medical Association lists the following medical categories which may result in an inability to operate a vehicle: diseases of the nervous system, sleep disorders, metabolic diseases, cardiovascular diseases, cerebrovascular diseases, peripheral vascular diseases, limited vision or hearing, respiratory diseases, renal disease, musculoskeletal disabilities, effects of anesthesia or surgery, and other general debilities
(CMA, 2000).
In Ontario every driver must meet certain medical standards in order to be licensed for motor vehicle use. Indeed, Ontario Regulation 340/94 (s. 14) states that any applicant for, or a holder of, a driver's licence must not “suffer from any mental, emotional, nervous or physical disability likely to significantly interfere with his or her ability to drive a motor vehicle of the applicable class safely” (MTO, 2010a). Furthermore, Section 203 of the Highway Traffic Act states that:
Every legally qualified medical practitioner shall report to the Registrar the name, address and clinical condition of every person sixteen years of age or over attending upon a medical practitioner for medical services, who, in the opinion of such medical practitioner is suffering from a condition that may make it dangerous for such person to operate a motor vehicle. (MTO, 2010b)
This may result in the revocation of a license until the condition is reviewed by the Medical
Advisory Committee. The following table presents the more common conditions that are to be reported to the Ontario Ministry of Transportation (MTO) for review by the Medical Advisory
Committee.
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Alcohol Dependence Visual Field impairment Drug Dependence Diabetes or Hypoglycemia-Uncontrolled Seizure(s)-Cerebral Other metabolic diseases Seizure(s)-Alcohol related Mental or Emotional Illness-Unstable Heart disease with Pre-syncope/Syncope/Arrhythmia Dementia or Alzheimer’s Blackout or Loss of consciousness or Awareness Sleep Apnea-Uncontrolled Stroke/TIA or head injury with significant deficits Narcolepsy-Uncontrolled Both Visual Acuity and Visual Field Impairment Motor Function/Ability Impaired Visual Acuity Impairment Source: (MTO, 2009)
As this group has a physical, and generally legal, inability to operate a motor vehicle, it should be quite clear why they would be at risk of transportation disadvantage while residing in rural areas. However, it is important to keep in mind that conditions may not be as apparent as one might assume. For instance, many conditions will allow for regular involvement in society, including employment, but may prohibit the use of a motor vehicle either permanently or temporarily. An example might include an injury or temporary mental condition which may not impact one’s everyday life, but may make an individual unable or unfit to drive. This may cause considerable hardship in maintaining one’s lifestyle and livelihood if transportation alternatives do not exist.
2.3.3 Youth
“Dependent always on some adult to drive them, children are unable to practice being adults. They cannot run so simple a household errand as picking up a carton of milk. They cannot bicycle to the toy store and spend their money on their own. They cannot drop in on mother at work. Most cannot walk to school. Even pickup baseball games are a thing of the past, with parents now required to arrange car- pooling with near-military precision, to transport the children at the appointed times. Children are frozen in a form of infancy, utterly dependent on others, bereft of the ability to introduce variety into their own lives, robbed of the opportunity to make choices and exercise judgement.” - Andres Duany, Elizabeth Plater-Zyberk, Jeff Speck cited in (Gilbert & O’Brien, 2005).
Youth residing in rural areas are another group often at risk of transportation disadvantage due to both de jure and de facto conditions. Indeed, the prevalence of school bus
25 service in Canada demonstrates recognition that this group should have access to educational opportunities, nevertheless additional mobility needs have been found in the literature to be largely unmet for rural youth. For instance, several studies have identified that a lack of transportation is a major obstacle for rural youth and their ability to access social activities, employment, volunteering, after-school activities, as well as recreation and sports (Cartmel &
Furlong, 2000; Cullinane & Stokes, 1998; Fuller & O'Leary, 2008; Gilbert & O’Brien, 2005;
Herold & Kaye, 2001; SEU, 2003).
Various sources also demonstrate the very high reliance that rural youth have on alternative transportation including active transportation where it is feasible (CUTA, 2004).
Youth have also been found to be very high users of public transportation where it is available
(CUTA, 2004; P. White, 2011). Nevertheless, most rural youth still rely on other drivers, generally parents, to meet their transportation needs with one source stating that “youngsters below driving age have little independent mobility, but must rely on their parents to chauffer them. In the one-car family they must wait until father is home from work so that he or mother can chauffer them” (Schaeffer & Sclar, 1980).
The definition of youth does vary in the literature with different age cohorts experiencing different levels of transportation disadvantage. For instance, one source from Ontario presents independent travel as becoming important between the ages of 12-15 years and particularly important between the ages of 16-19 years of age (Gilbert & O’Brien, 2005). However, another source from Ontario made use of the United Nations’ definition of youth, being 15 to 24 years of age (Herold & Kaye, 2001). This distinction is important as in Ontario driver licensing begins at
16 years of age and therefore those below this age are legally prohibited from driving.
Nevertheless, it is also important to consider that even once a driver’s license is acquired
26 obstacles still exist associated with license conditions, vehicle access, and affordability. Thus, regardless of the definition of youth, those in this group are often at risk of transportation disadvantage and reliant on alternatives to the car where they exist (CUTA, 2004).
The first issue inhibiting the mobility of rural youth can be found in driver licensing. In
Ontario a system of graduate licensing exists with the first stage, referred to as a G1, being available at 16 years of age. However, a report by Herold & Kaye (2001) found that even once a driver’s license is obtained, there are still several obstacles associated with the conditions of the graduated licensing system, particularly for rural youth where few alternatives exist. For instance, G1 conditions limit the time of day that youth may drive as well as the types of roads which they may utilize (i.e. no expressways) (Herold & Kaye, 2001). Nevertheless, the key condition under the G1 license is the requirement that the holder be accompanied by a fully licensed driver with a minimum of 4 years experience (Herold & Kaye, 2001). This severely restricts the independence of the youth as well as doing little to circumvent the issues of relying on others for a ride as the youth is tied to the availability of another driver. In order to progress to the G2 level youth must hold the G1 license for 1 year or 8 months if they participate in certified driver’s education; assuming this is affordable and accessible (Herold & Kaye, 2001). At this time a driving test is taken, and if passed, the holder may drive independently and with fewer restrictions with the G2 license.
Therefore, until at least 17 years of age, rural youth in Ontario are heavily reliant on others in order to meet their transportation needs. Indeed, until age 16 rural youth require access to vehicles and drivers in order to be chauffeured to their destination. Even at the age of 16 when rural youth may drive themselves, they remain reliant on the availability of a car and driver-as- passenger effectively providing little improvement to their transportation access. Further still,
27 even after obtaining a G2 license many rural youth are still unable to afford the high costs of vehicle ownership thereby maintaining their reliance on a family vehicle, albeit no longer on an additional driver. Indeed, this has been a point raised in the literature that a one or even two-car household may not be meeting the transportation needs of its residents particularly if there are driver age children in the family (Schaeffer & Sclar, 1980).
A particular limiting factor for youth with G2 driver’s licenses and above is the high cost of car ownership. Indeed, findings from one study of youth aged 15 to 24 residing in rural
Ontario found that only 13 per cent owned a vehicle (Herold & Kaye, 2001). This makes the vast majority of youth completely reliant on a family vehicle being available at the times that they need it. As well, this source provides qualitative findings from youth indicating that the inability to afford the high cost of vehicle ownership is part of a vicious cycle and linked to the inability to access employment due to limited or unreliable vehicle access (Herold & Kaye, 2001).
2.3.4 Low-Income Households and Individuals
Another key group at risk of transportation disadvantage are members of low-income households residing in rural areas. In Canada, low-income is generally determined using one of three methods: Low Income Cutoffs (LICOs), the Low Income Measures (LIMs) or the Market
Basket Measure (MBM) (Giles, 2004). Each measure incorporates different indicators and utilizes a different methodology. While the LICO measurement has been most commonly used it has also been criticised for underestimating the extent of low-income households in rural areas as it does not take transportation costs into account (Senate of Canada, 2008).
Nevertheless, while the definitions of low-income will vary between contexts the conditions of low-income households can be expected to be similar enough for comparison.
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Indeed, this group may have difficulty affording the high costs of vehicle purchase and operation and therefore may be deprived of transportation for financial reasons. For instance, one study found that low-income households exhibit a “range of transportation problems that reflect a lack of driving skills, inability to obtain a valid driver’s license, lack of access to consumer credit, as well as the high costs of insurance, maintenance, and repairs” (Fletcher, et al., 2010).
In Canada, recent estimates state that operating and owning a car costs approximately
$8,883.85 per year (CAA, 2011). For rural Ontario, Statistics Canada states that as of 2009 and utilizing the Market Basket Measure thresholds for a reference family of two adults and two children a household making $28,775 or less is considered low income (Statistics Canada, 2011).
This means that a low-income family residing in rural Ontario would be spending approximately
30 per cent of their income on transportation alone. This figure might actually be higher when considering that in rural Canada “travel costs (for fuel and repairs) tend to be higher than in urban parts of the country” (Senate of Canada, 2008).
Moreover, some sources have found evidence that low-income households may still operate a vehicle they cannot actually afford thereby reducing the financial resources required for other necessities (Gray, 2000; Gray, Farrington, Shaw, Martin, & Roberts, 2001; Pucher &
Renne, 2005). This also suggests that if alternative transportation were available in rural areas many low-income households would not operate personal vehicles (Gray, 2000).
It is also important to note that the transportation needs of a household may not be met by a single car. This means that low-income households who struggle to afford a single car likely have unmet transportation needs in their household, particularly for women or youth who may not have preferential access (Senate of Canada, 2008). Further still, sources have found that out
29 of necessity this single car may actually be older and less reliable thereby increasing maintenance costs and possibly increasing the risk of losing transportation access (Fletcher, et al., 2010; O'Leary, 2008).
A lack of access to transportation is a major issue for low-income households in rural areas. Indeed, studies consistently demonstrate the connection between transportation access and employment with one study from the United States finding that welfare recipients consistently mention access to transportation as a key barrier to employment (Fletcher, et al., 2010). Indeed, this study found “a positive correlation between car ownership and employment” with additional studies reinforcing causation (Fletcher, et al., 2010). Research from the United Kingdom shows similar findings (Cullinane & Stokes, 1998). Moreover, access to transportation is essential for finding employment as well as maintaining it with one source stating that “in job hunting a car is far more necessary than in holding a job” (Schaeffer & Sclar, 1980).
Finally, the literature on the topic also presents the increasing rates of personal vehicle ownership and assumptions of universal personal vehicle access as issues for low-income households residing in rural areas. While increased overall mobility may be expected to be a benefit for all rural residents, it has been argued that it may actually put low-income residents who cannot afford a personal vehicle at a greater disadvantage. Indeed, rural areas have seen a decline in local services with centralization in larger centres often only accessible by personal vehicles (Stokes, 2002). This is often not seen as a problem due to the assumption of near universal access, nevertheless those that cannot afford a vehicle are put at a greater disadvantage
(Stokes, 2002).
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2.3.5 Women
The final demographic group at risk of transportation disadvantage that will be described here is that of women residing in rural areas. While it would be inaccurate to suggest that all women living in rural areas are at risk of transportation disadvantage research has found that women living in non-car or single-car households often are (Cullinane & Stokes, 1998; Fuller &
O'Leary, 2008; Garven & Associates, 2005; O'Leary, 2008; Purdon, 2002; Senate of Canada,
2008). In particular, sources assert that mothers with young children are at particular risk of transportation disadvantage (Gray, et al., 2001; Higgs & White, 1997).
The cause of transportation disadvantage among some rural women is that of a lack of access to a personal vehicle. Unlike older adults, youth, and the mobility impaired, rural women may be able to drive in legal and physical terms but lack the access to a vehicle in order to do so.
For instance, one study undertaken in rural Ontario found that 65 per cent of women had normal access to a motor vehicle whereas 35 per cent had poor (intermittent) or no access to a motor vehicle (Fuller & O'Leary, 2008). This was found to be particularly true among low- income and unemployed participants who often reside in non-car or single-car households (Fuller
& O'Leary, 2008). Similarly, research undertaken on women in Northern Ontario found that 47 per cent of respondents identified that transportation was a problem for them (O'Leary, 2008).
This was found to be particularly true amongst those with incomes less than $20,000 per year
(O'Leary, 2008).
Moreover, it is often emphasised that women residing in one-car households may have unmet transportation needs with one author stating that “in households where a vehicle is shared, women may be considered to have the same transport options as a household without any cars”
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(O'Leary, 2008). The rationale behind this perspective is that in one-car households the primary wage-earner is often the man thereby making the transportation needs of other family members secondary (O'Leary, 2008). While this traditional household structure is changing, it is still quite common and contributes to transportation disadvantage among women without transportation alternatives (Rosenbloom, 2004).
The issue of transportation disadvantage for women is often framed around access to employment, training, and education particularly due to the linkages between low-income and transportation disadvantage among this group. Indeed, findings from the United Kingdom indicate that rural women without reliable and consistent access to transportation alternatives are unable to access these services or must limit employment searches in terms of time or distance
(Cullinane & Stokes, 1998). This limits the opportunity of these individuals to meet their economic potential and personal objectives.
Similarly, research from Ontario has found that access to transportation is a major obstacle for rural women in accessing employment, training, or education (Garven & Associates, 2005;
O'Leary, 2008; Purdon, 2002). Again, this limits the income potential of some women and may thereby perpetuate the cycle of poverty (Garven & Associates, 2005; O'Leary, 2008; Purdon,
2002).
An additional, albeit less researched, issue for transportation disadvantaged women in rural areas is domestic violence. Indeed, multiple sources specific to rural Canada and Ontario have raised the linkage between lacking transportation access and increased risk of domestic abuse
(Purdon, 2002; Senate of Canada, 2008; Stone, 2010). The linkage is explained by the fact that
32 without access to transportation women and children may be physically unable to leave abusive households and thereby remain stuck in an abusive relationship.
2.4 Opportunities
While there are several demographic groups in rural areas who often have unmet transportation needs there are also a few issues in rural areas that public transportation may help mitigate as well as provide community benefits. Indeed, the literature demonstrates that for rural communities, public transportation need not be seen as the last resort for those in need, but also as an opportunity to address existing or emerging issues.
2.4.1 Mitigation of Greenhouse Gas Emissions
The concern about overall greenhouse gas emissions has risen to the forefront in recent years with increased research and societal acceptance of climate change and its causes. Indeed, the transportation sector is commonly seen as a major contributor to greenhouse gas emissions due to the internal combustion engine releasing airborne pollutants such as: carbon dioxide, lead, carbon monoxide, nitrogen oxides, volatile organic compounds (VOCs), particulates, and sulphur dioxide (Cullinane & Stokes, 1998).
In particular, personal vehicles have been seen as a key contributor as well as an opportunity for reduction due to the prevalence of long commutes, congestion, and single- occupant vehicles. Within the rural context there is some disagreement over the contribution of personal vehicle use and greenhouse gas contribution. Overall, rural areas have a smaller population than urban areas and thereby, in absolute terms, contribute less greenhouse gas emissions. Rural areas also generally do not experience the same level of congestion as urban
33 areas which should result in fewer emissions as vehicles use less fuel per kilometre in uncongested conditions (Mees, 2010).
However, in per-capita terms there are questions surrounding the contribution of rural residents. For instance, Cullinane and Stokes (1998) state that:
Contrary to popular assumptions, vehicle use in rural areas does contribute considerable emissions on a per capita basis. In at least one study from the UK it was found that on a per capita basis rural residents actually contributed more emissions from transport than those in urban or intermediate areas with almost all of this resulting from personal vehicle use.
The authors explain this situation by stating that “while rural residents do not suffer the same congestion as their urban counterparts, they do tend to drive long distances at speeds above the optimum speed for car travel” (Cullinane & Stokes, 1998). Additional findings from the United
Kingdom indicate that “people residing in rural areas on average produce nearly 50% more CO2 from travelling than the national average” and that rural residents were “identified as those with the highest CO2 per person per year, in particular for travel by car (as driver), which accounted for just under 2,000kg CO2 per year” (CRC, 2008). Therefore, there may be a role for public transportation to play in improving the efficiencies of transporting rural residents and thereby reducing greenhouse gas emissions.
2.4.2 Alleviate Issues Associated with Increasing Fuel Prices
It can be argued that households in the most isolated areas, who are structurally dependent on the car (as opposed to merely reliant on it), who have a high annual mileage, and who may be among middle to low income groups could struggle to absorb the additional cost [of fuel] in the short to medium term, and face a reduced quality of life in the long term. This would involve enduring greater financial hardship, or disposing of a necessary vehicle with associated concerns for mobility, employment, housing and overall quality of life. (Gray, 2000)
The combination of increasing fuel prices and potential future fuel scarcity is an emerging issue within rural communities. This issue will have serious implications for the
34 sustainability of rural communities as well as the price of rurality. Indeed, rurality is defined by distance and population density and therefore, an increase in the price of distance will result in an increase in the price of rurality (Bollman & Prud’homme, 2006). In Canada, the price of transporting people has been rising over time driven largely by increases in fuel costs (Bollman
& Prud’homme, 2006). Rural drivers face not only long distances but often pay more for fuel than in the urban parts of the country (Senate of Canada, 2008).
Findings from the United Kingdom reinforce the impact that increasing fuel prices have on rural communities with one source stating that “it has become accepted wisdom that rising fuel prices will have a devastating effect on rural communities” (Gray, 2000). Indeed, in a similar source Gray, et al (2001), investigated the incremental taxation system known as the fuel duty escalator, which increased the cost of fuel, through taxation, incrementally over time. The findings from this source indicate that this increasing fuel cost would bring significant impacts on the affordability of transportation in rural areas, and particularly for low-income households who were already making sacrifices to own and operate a vehicle (Gray, et al., 2001).
The role of public transportation in mitigating these impacts is currently not clear with little research on the topic. Indeed, in Ontario rural residents appear to be absorbing the recent increases in fuel prices, with the possible exception of low-income households however the evidence is scarce. Nevertheless, at least one study undertaken in rural and small towns in the
Mid-Western United States found that “increasing fuel prices does have an impact on transit ridership though there is uncertainty over its long-term versus short-term impact as well as the degree to which people change their habits” (Mattson, 2008). Similar findings on increased ridership associated with increasing fuel prices come from the urban United States (Lane, 2010) and the United Kingdom (Cullinane & Stokes, 1998).
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Irrespective of what evidence on past experience may tell us about the role of public transportation in alleviating the impacts of increasing fuel prices we may expect that it will play a much larger role in the future. This is particularly true when considering the possibility of much more rapidly increasing fuel prices or even the possibility of future fuel scarcity. Indeed,
Cullinane and Stokes (1998) point out the flaws of assuming that technology will resolve these issues without changes in travel behaviour or mode. As well, in terms of energy efficiency, public transportation is a much better choice than personal vehicle use and may therefore be more favourable, if not necessary, in the future.
2.4.3 Reduce Instances of Impaired Driving
It is generally accepted that the rural areas of Canada have higher rates of impaired driving when compared with urban areas. For instance, a study from Alberta found that
“impaired driving citations are issued at a three-fold higher rate in rural (versus urban) areas”
(Kmet & Macarthur, 2006). As well, this source elaborates by stating that “given the low probability of encountering a police officer while driving, impaired driving citations likely underestimate the true impaired driving rate, and such underestimation is probably greater in remote rural areas compared with urban areas” (Kmet & Macarthur, 2006). A recent, albeit simple, analysis undertaken in rural Ontario found similar findings and states that “there were 2.4 convictions for 1,000 drivers. But in urban and suburban areas, where there is better access to public transportation, the rate was substantially lower, at 1.7 per 1,000. Indeed, the data suggests a strong link between impaired driving convictions and accessible public transit” (McGregor,
2011).
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Another large study was undertaken in Atlantic Canada and provides further insight into the impaired driving behaviour of rural residents. Indeed, this study concentrated on youth and found that rural residence was an independent risk factor for riding with a drunk driver (Poulin,
Boudreau, & Asbridge, 2006). This study further explains that:
Rural residence may be a structural determinant of adolescents’ choosing to be a passenger with an alcohol impaired driver, due to the mechanism of having little if any access to public transportation, particularly at weekends and at night. In Canada, rural residence has also been found to be associated with a higher prevalence of drinking among adolescent males (Poulin, et al., 2006).
Again the issue of lacking public transportation in rural areas is raised. However, it should be noted that this link between impaired driving and a lack of public transportation is speculative as questions emerge as to whether impaired drivers would actually make use of this service. Indeed, the explanations for this situation are varied including social acceptance and, longer distances between home and establishments, in addition to a lack of transportation alternatives.
2.4.4 Macroeconomic Advantages
An additional opportunity associated with public transportation that has been raised in the literature is macroeconomic advantages. Indeed, some sources have mentioned the big picture advantages associated with enabling individuals to access training, education, and employment alongside the personal benefits associated with these opportunities. For instance, Cullinane and
Stokes (1998) discuss the macroeconomic benefits of rural residents attaining their full productivity potential and state that:
Human resources cannot be used efficiently if individuals are constrained in economic terms by their lack of mobility and accessibility. If an individual with a particular skill does not use that skill because he cannot get to a workplace to apply that skill, besides being of concern to the individual in terms of their own income and fulfilment, it is inefficient from an economic point of view (Cullinane & Stokes, 1998).
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Similarly, additional studies go further in an attempt to demonstrate benefits to employers, local business, as well as less tangible considerations such as costs of unmet social or health needs
(Burkhardt et al., 1969; Burkhardt, et al., 1998; Harmon, 1995).
2.4.5 Cost Savings in Social Services
The final opportunity to be discussed here is the possibility of cost savings in service provision for social service agencies through the provision of public transportation. While little has been written on this topic explicitly it has shown through in some sources. For instance, as mentioned earlier there may be an opportunity to allow for a greater proportion of older adults to age at home if they are able to access their transportation related needs without a personal vehicle. As well, one study from Ontario suggests an opportunity to decrease healthcare expenditures for rural residents through the following findings:
The patterns with respect to risks of physician visits and hospitalization in Ontario were fairly consistent: rural residents, regardless of sex, were generally less likely to visit a physician than their urban counterparts, though they were more likely to be hospitalized for the same disease categories and for injuries and poisonings (Pong, et al., 2011).
This suggests that rural residents make use of less preventative or primary care and wait longer to seek medical attention, until it is too late and costly hospitalization is required. At least one other source confirms this situation (Gamm, Hutchison, Bellamy, & Dabney, 2002). Pong, et al
(2011) elaborate on the causes of this issue with the following statement:
Variations in access to and utilization of health services may be a function of many things, not just the unavailability of services or resources in local areas. For instance, lack of means of transportation could deter some rural residents from seeking care that is available only in distant urban centres. Thus, solutions to the problem of lack of access do not reside exclusively in the health care domain and improving transportation services could be just as important (Pong, et al., 2011).
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Furthermore, a study undertaken in rural North Carolina found that utilization of healthcare services may actually be influenced more by access to transportation rather than distance from the service (Arcury, et al., 2005). Therefore, while it is quite controversial, this suggests that centralization of social services may not be as problematic for rural residents as is commonly expected as long as adequate transportation alternatives are provided. Nevertheless, this is not an opinion commonly held in the literature.
Part 2: Public Transportation Models for Rural Areas
Part 1 of this literature review presented, in some detail, the issue of transportation disadvantage in rural areas. In this section, various models of general-use public transportation systems will be presented, which may be appropriate for addressing transportation disadvantage in a rural setting. While there are numerous models, and considerable literature on the topic, this section will present only a high-level description of the models. Their applicability for addressing specific transportation needs will be addressed elsewhere in this thesis.
2.5 Conventional Transportation Model
The Conventional Transportation model is also sometimes referred to as Fixed-Route and is the model generally found in urban centres. The overarching term Conventional
Transportation covers such modes as rail, subway, trams, and full-size buses with fixed-routes
(Cooper, Nelson, Wright, MacInnes, & Edwards, 2006). Indeed, this is reflected in a simple definition of Fixed-Route Transit as follows “this is the familiar ‘bus route’ in which a vehicle, usually a bus, travels a consistent path, stopping at specific locations at scheduled times one or more days each week. This model can be efficient in communities with dense populations and large numbers of people who have easy access to routes” (RTC, 2007).
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In a rural setting, conventional transportation relating to intra-community transportation is less common due mainly to long distances and low ridership thereby making this model financially unviable or inefficient for most rural communities. However, examples from Canada do exist where inter-community transportation services will pick up passengers along their routes between urban areas creating a quasi intra-community transportation system serving rural areas.
Examples of this include Chatham-Kent Transit Conventional Bus Service in Ontario and the often referenced Kings Transit in Nova Scotia. Nevertheless, there are some examples of true intra-community conventional transportation services within rural areas.
Sogn og Fjordane County, Norway
Sogn og Fjordane fylkeskommune is a rural county located in Western Norway. The county has a population of 108,124 and a land area of 17,676.11 km² resulting in a population density of 6.12 persons per km² (SSB, 2011b, 2012).
The county is responsible for the delivery of public transportation and operates buses and ferries through the public corporation Fjord1. The intra-community transportation offered within the county can be categorized as conventional as it makes use of full-size coach buses, is available to the general public, and has fixed-routes with regular stops along the way. Indeed, employees of the County of Sogn og Fjordane anecdotally stated that 80 per cent of their population was within a ‘short walk’ from a bus stop. Overall, the service resembles an urban public transportation service transplanted into a rural setting.
While the public transportation service in Sogn og Fjordane is available to anyone, there is a clear emphasis on youth. This includes a specific emphasis on access to education, including the local college. In addition, the county offers a program called “Safe home for a 50 crown bill” intending to deter impaired driving among youth by providing a safe and affordable alternative (Ness, 2010).
Nevertheless, while public transportation within this county is quite comprehensive, discussions with county employees found that the county may actually be over serviced by the bus system they have. Indeed, it was stated that buses often had few or no riders on some of their routes indicating that they were too large and/or too frequent to justify the population they served. Findings from Statistics Norway reinforce this observation being that the average bus size in the county is 42 seats while only 22 per cent of the system’s capacity is being used (SSB, 2011a).
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2.6 Flexible Transportation Model
When compared with the Conventional Transportation model the Flexible Transportation model is considered to be more appropriate for rural areas. Indeed, this is reflected in the prevalence of this model in rural areas where public transportation exists (P. White, 2011). The term flexible transportation can be used to broadly cover a range of public transportation systems that do not use fixed routes and/or schedules.
The style most often associated with flexible transportation is Demand-Responsive
Transportation, also referred colloquially as dial-a-ride transit. A basic definition of Demand-
Responsive Transportation is provided by the United States’ Federal Transit Administration which describes it as “a transit mode comprised of passenger cars, vans or small buses operating in response to calls from passengers or their agents to the transit operator, who then dispatches a vehicle to pick up the passengers and transport them to their destinations” (Ellis & McCollom,
2009). White (2011) expands upon this definition with the following:
Demand-responsive (DR) services, whose routeing is varied according to passenger demand within a specified area. A typical form is the “many to one” operation in which a focal point such as a small market town, is served, with flexible routeing within a catchment area around it. This could consist of wholly flexible patterns, in which the vehicular journey varies according to passenger demand, or a semi-flexible pattern, in which a loop route might be followed with variations, or a route between two fixed points with variations between them. The fixed point may also act as a transfer point to fixed-route interurban services providing links to larger centres.
Overall, the actual design of the service is quite flexible and can be adapted to meet the needs of rural residents and the context in which it operates.
While the feasibility of conventional transportation systems is often questioned, it has been argued that flexible transportation is actually becoming increasingly viable with advancements in transport telematics/Intelligent Transport Systems (ITSs) (Mulley & Nelson,
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2009). Indeed, this new technology has overcome many of the issues with routing as well as time delays between booking and accessing transportation.
Connect2Wiltshire: Wiltshire, United Kingdom
While there are many examples of flexible transportation systems in operation across Europe and North America one of the most established examples is the Connect2Wiltshire system operating in Wiltshire, United Kingdom (Enoch, Ison, Laws, & Zhang, 2006). Connect2Wiltshire was initiated in 1998 by the local government with the original name Wigglybus and operates a range of services across the dispersed rural areas of Wiltshire (Enoch, et al., 2006). The service has been succinctly described as “a conventional hourly circular route bus service with a booking service and defined drop-off provision. The bus operates along a pre-defined route but 'wiggles' off to pickup passengers that have booked. All pick-up and drop- offs must be within the defined operating area” (DfT, 2010).
The Connect2Wiltshire system is divided into zones each with their own timetables, fares, and reservation requirements. For instance, the amount of time that a user must call ahead, or go online, to book a pickup will vary by zone ranging from 20 minutes to 24 hours ahead of time (Wiltshire Council, 2011). According to the Department for Transport (2010) the aims of the service are to: provide an attractive transport alternative for those who already own a car; support social inclusion in rural areas for those without a car; prevent unsustainable and environmentally damaging patterns of travel in rural areas, especially faster than average traffic growth; and support local economic and social activity and regeneration in the countryside.
2.7 Community Transportation Model
Another important model is that of Community Transportation which is a broad term covering many forms of less formal public transportation provision generally offered by non- profit organizations, community groups, charities, or volunteers (Cullinane & Stokes, 1998).
Some forms of community transportation could include the following adapted from Cullinane and Stokes (1998):
Community Buses: Systems resembling formal public transportation (conventional or flexible) however run by volunteers on a non-profit making basis.
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Voluntary car schemes: Transportation provided by residents making use of their own cars. These drivers may be reimbursed for the cost of gas or mileage. Examples might include coordinated volunteers providing rides for frail older adults; car pool coordination; or car sharing programs. Free shoppers’ buses: Large retail outlets may provide free buses (shuttles) to some rural communities to transport shoppers to their outlets.
The level of government involvement will vary considerably depending on the style and context.
For instance, governments may provide ongoing funding, start up funds, marketing support, in- kind support, or have no involvement at all.
Within the rural context community transportation is relatively common, however its presence has been described as an indicator of a failure of formal services to meet the needs of rural residents (Cullinane & Stokes, 1998). Indeed, community transportation can suffer from inconsistent funding or volunteers and may not meet all of the needs of rural residents on a consistent basis. This has been described in the United Kingdom where committed individuals from a previous generation are retiring with little interest in uptake from younger residents thereby making volunteer drivers hard to find in some cases (Cullinane & Stokes, 1998).
Another issue associated with community transportation is limitations imposed by regulatory, insurance, and liability concerns (Senate of Canada, 2008). Indeed, the high cost of insurance as well as regulatory constraints on organizational mandates has been found to be a serious limitation on community transportation service in rural Canada (Senate of Canada, 2008).
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Bancroft Community Transit: Bancroft, Ontario
Bancroft Community Transit is a non-profit transportation service operated by volunteers and servicing the community of Bancroft, Ontario. Drivers are reimbursed for their mileage and riders, or sponsoring agencies, pay based on trip distance (BCT, n.d). The program is supported by the United Way, the Ontario Trillium Foundation, and the County of Hastings Social Services.
Bancroft Community Transit does not have a set catchment area for picking up or transporting passengers. Instead it is based on a range of organizations covering different populations in the Bancroft area. Based on a catchment area of Hastings County it can be estimated that Bancroft Community Transit services a population of 134,934 residents covering a land area of 6,103.48 km2 resulting in a population density of 22.1persons per km2 (Statistics Canada, 2012a).
The service offers door-to-door transportation based on passenger bookings which must be made at least 24 hours ahead of time (BCT, n.d). These appointments may be made using an online form, via email, or by telephone.
However, it is important to note that this service is not technically a general-use service as there are certain limitations on users and trip purposes. Nevertheless, these are quite broad and will cover a wide range of mobility and accessibility needs. For instance, due to the existence of other senior transportation Bancroft Community Transit is not available to those over the age of 55 (BCT, n.d). As well, it is only available to those registered with certain organizations, although the listing of eligible organizations is quite comprehensive and would cover each transportation disadvantaged group. Furthermore, according to the Bancroft Community Transit website the service is only available for the following purposes: legal appointments special programs counseling appointments medical appointments day care work placements necessities of life Once again these eligibility requirements are quite broad and will incorporate most accessibility needs while reducing unnecessary mobility.
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2.8 Private Taxi Model
The private taxi model pertains to the familiar service of a privately operated, and commercially motivated, service responding to clients’ requests for transportation to a specific destination. Private taxis are very common in the urban areas of Canada and have a presence in rural areas, although are far from being uniformly available to rural residents across the country
(Senate of Canada, 2008).
While private taxis are very flexible and generally feasible in areas with lower densities they still do require economies of scale in order to justify operations. Further, due to long distances in rural areas, taxi fares may be found to be too expensive for some groups (Mott
MacDonald, 2008). Therefore, a mixed approach including privately operated taxis with subsidization from a local authority provides an opportunity to expand taxi service into areas generally considered financially unfeasible. This option has been found to commonly be used in
Europe (CfIT, 2008; Mott MacDonald, 2008).
In terms of financial viability, sources have found that private taxis are often the best choice for low density areas where conventional or demand-responsive services cannot be justified (CfIT, 2008; Mott MacDonald, 2008; Mulley & Nelson, 2009; Site & Salucci, 2006). It should also be noted that the private taxi model can be adapted or mixed with other services with numerous cases from North American and Europe demonstrating innovation building from this model (CfIT, 2008).
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Taxi Voucher or Subsidized Taxi Service
There are two primary models for delivering public transportation through the use of private taxis. First is the taxi voucher option where groups deemed to be in need of transportation are provided vouchers by a public agency which may be exchanged for private taxi service (CTAA, 2008). The goal of such programs are to provide incentives to private taxi providers to enter low-demand markets as well as to assist those with limited income in accessing transportation (CTAA, 2008).
An example of such a program can be found in the City of Olathe’s Taxi Coupon Voucher Program in Kansas. This program offers vouchers to older adults, those with physical mobility limitations, and low- income individuals to be used for rides with private taxi companies. The program also divides trips into different trip purposes (employment, medical, groceries) each with varying costs which riders must contribute ranging from $1.00 to $3.00 per voucher (City of Olathe, 2012). The vouchers may then be claimed by the taxi companies for reimbursement by the city.
An alternative to taxi vouchers is subsidizing the taxi service itself rather than the riders. Under this option agencies seek tenders for private taxi companies to provide transportation services. The agency then provides some degree of funding to the private taxi service to reduce rates and/or provide services to areas they would not otherwise. An example of this model can be found in the Highland Council of Scotland where a range of private taxi operators exist with public subsidies to provide services within the context of a small and dispersed population (Highland Council, 2012).
2.9 Mixed-Services Model
A final, albeit least discussed, option for public transportation in rural areas is that of mixing services which already operate in these areas such as school buses and mail delivery.
First, there has been recognition that school buses already operate a specialized public transportation service in rural areas which could be expanded. For instance, in Chesterfield
County, North Carolina (APTA, 2007) and in Mason County, Washington (KFH Group, 2001) the school bus mandate was expanded to allow adults to utilize this existing service. Similarly, in
Ystad, Sweden the Byabussen service was founded on a school bus service which was expanded into a general use public transportation service (Svanfelt, Morin, Fredriksson, & Andersson,
2006).
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Moreover, the recent Transportation Demand Management Plan conducted for the
County of Huron identified the opportunity to utilize school buses outside of school hours in order to address the transportation needs of the general public (MMM Group, 2011).
Nevertheless, attempts to achieve this mixed-service model have met considerable obstacles from regulations and public opposition to students and adults riding together (Burkhardt, Nelson,
Murray, & Koffman, 2004).
A second opportunity for mixing services in rural areas comes from combining passenger transportation with mail delivery. This model is generally referred to as a Postbus and has been utilized in the United Kingdom and Switzerland (P. White, 2011). The concept behind this option is quite simple in that mail delivery already takes place in most rural areas and an opportunity exists to increase the size of vehicles in order to accommodate passenger transportation. This could be in the form of transporting passengers between collection and sorting locations (inter-community) or along with the actual delivery of mail thereby resembling a fixed-route service (intra-community) (P. White, 2011).
Postbus: United Kingdom and Switzerland
The PostBus model has been implemented to some degree by several countries with varying success. For instance, the United Kingdom has seen a considerable decline in postbuses and today Royal Mail operates only a few lines with infrequent scheduling (Royal Mail, 2012). Overall, Royal Mail (2012) states that today they transport only 50,000 passengers per year across the entirety of the UK. Two key reasons for the decline in Postbus use in the United Kingdom are deregulation of public transportation as well as user dissatisfaction with very slow and indirect services (P. White, 2011).
Probably the most successful postbus service can be found in Switzerland. Indeed, PostBus Switzerland Ltd is the largest public transportation operator in Switzerland transporting more than 300,000 each day as well as winning tenders to operate public transportation in neighboring countries (PostBus, 2012). Nevertheless, while still associated with Swiss Post, the PostBus passenger transportation service is now largely separated from mail delivery.
A similar service, known as Bussgods, exists across Sweden and Finland which transports parcels and passengers in a shared vehicle (Bussgods, 2012).
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2.10 Summary
The following table provides a simple summary intended for comparison between each of the models discussed here. This table is based on observation and not a thorough evaluation of cases or the literature and is merely intended to provide a basis for further considerations.
Moreover, it should be noted that these are general observations on each model and that in practice each model is highly variable and can be adapted to meet the contexts and needs of their environment.
User Considerations Government Considerations Public Cost Involvement Transportation Frequency Coverage Accessibility Cost Flexibility (Fare) in Delivery Model Medium- Medium- Medium- Conventional Low High High Low Low Low High Medium- Medium- Flexible Varies High High High High High High Medium- Community Varies* Varies* High Low Varies High Low Medium- Private Taxi Varies High High Low Low High High Mixed-Services Low Low Low Medium-Low Low High Low * Community transit can take many forms ranging from coordinated volunteers to a fixed-route bus service.
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Chapter Three: Methodology
This study makes use of four separate research methods in order to develop and test a transportation disadvantage framework within the rural context. The four methods may be seen as an inverse pyramid with each level down becoming more context specific to the situation of
Huron County.
Literature Review General Findings
Secondary Data
Past Research Findings
KII Context of Huron County
3.1 Literature Review
The first method used for this research is that of a comprehensive literature review presented in Chapter 2. The methodology used for this undertaking was presented at the beginning of the previous chapter.
The purpose of the literature review is the provide a comprehensive look at past research on the topic of transportation disadvantage; underlying trends and considerations; and a high level overview of public transportation models available for addressing rural mobility needs.
Resulting from this literature review was the transportation disadvantage framework which was
49 applied to the Huron County case study to evaluate the presence of transportation disadvantaged groups within this locale.
3.1.1 Transportation Disadvantage Framework
Key Accessibility Needs
Access to Access to Social Access to Training, Access to Essential Inclusion Supplies Education, and Shelters and Services Employment Support
Older Adults ✔ ✔ ✔
Physical or Mental ✔ ✔ ✔ ✔ Disability
Youth ✔ ✔ ✔
Low-Income Households ✔ ✔ ✔ ✔
Women ✔ ✔ ✔ ✔ ✔ TransportationDisadvantaged Groups
3.2 Secondary Data
The second method utilized in this research was the collection of existing demographic data for Huron County. This was collected from Statistics Canada using the 2006 Census of
Population as 2011 Census of Population data was not yet adequately available. Data on transportation related indicators was also collected from the Ontario Ministry of Transportation and existing transportation service providers located within Huron County. The purpose of this data collection was to provide context as well as the degree to which groups at risk of transportation disadvantage are present in the County.
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3.3 Previous Survey Findings
This research incorporates findings from previous surveys undertaken in Huron County relating to transportation disadvantage. Individually, none of these studies have enough respondents to be statistically representative so, their results were only used to supplement the other findings of this research. Nevertheless, their findings are relevant and contribute to a more complete view of transportation disadvantage in Huron County.
3.3.1 Huron Transportation Taskforce Survey (2008)
Concluding on May 5th, 2008 the Huron Transportation Taskforce undertook a questionnaire based survey of service providers within Huron County. The task force distributed questionnaires to Nursing Home facilities, Long term care facilities, Employment Agencies,
Social Service Agencies, Food banks and Learning Centres resulting in 256 responses returned from 12 agencies. This survey provides a look at transportation needs in the County through the lens of service providers rather than users.
3.3.2 Huron County Transportation Demand Management Study (2011)
MMM Group recently undertook a Transportation Demand Management (TDM) study on behalf of the County of Huron. This study utilized two research methods to gather public input on transportation in Huron County and the findings will be incorporated into this research. First, a questionnaire was available to the public online along with paper copies distributed at public information sessions. The survey was completed in May 2011 with 142 respondents.
Second, the TDM study undertook two public information sessions with the first being held on November 1, 2010 at the Rural Energy Expo and the second being held on March 25,
2011 at the Contactor’s Expo in the Knights of Columbus Community Hall with 32 attendees.
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The public information sessions provide qualitative findings in the form of comments from
Huron County residents.
3.4 Key Informant Interviews
The final method utilized for this research is that of Key Informant Interviews (KII).
These were undertaken with representatives of organizations working with each of the demographic groups deemed to be at risk of transportation disadvantage. A conscious attempt was made to have each demographic group equally represented by the participants resulting in each group being described by at least two participants that worked predominantly with these clients; in the end 14 key informant interviews were conducted. Due to the confidential nature of the interviews the organizations and individuals will not be named in this research and instead a general description of each participant is described in the following table.
Primary Client Primary Service Description Group(s) Category Participant 1 (P1) Older Adults Access to Essential Participant 1 provides predominantly Services health related services to older adults (primarily health) in Huron County. This organization does provide its own formalized transportation for its client group. Participant 2 (P2) Low-Income Access to Supplies Participant 2 is a food bank located Households in Huron County. This organization does not provide transportation for its clients. Participant 3 (P3) Low-Income Access to Training, Participant 3 provides services Households Education, and primarily to low-income households Employment in order to help them access training, education, and employment at multiple locations in Huron County. This organization does not provide formal transportation for its clients. Participant 4 (P4) Older Adults; Various Participant 4 provides transportation Physical or Mental (primarily health) for older adults and those with Disability physical or mental disabilities in order to reach a range of destinations. However, the organization has an emphasis on health services.
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Participant 5 (P5) Various Various Participant 5 supports the delivery of (Focus on older a wide range of services primarily to adults, youth, and older adults, youth, and low-income low-income households. This organization does households) not provide transportation for its clients. Participant 6 (P6) Youth Access to Shelters Participant 6 provides support and and Support shelter to youth, specifically in their upper teens, in Huron County. This organization provides transportation as a last resort for medical appointments or other essential services on a case-by-case basis. Participant 7 (P7) Physical or Mental Various (essential Participant 7 provides a range of Disability services, support for those with developmental employment, social challenges residing in the southern inclusion) half of Huron County. This organization provides formal transportation for its clients to access its services as well as other needs. Participant 8 (P8) Physical or Mental Various (essential Participant 8 provides various Disability services, services for those with mental illness employment, social residing in the southern part of inclusion, supplies) Huron County. This organization provides transportation formally to access its own services and informally in few cases for external services. Participant 9 (P9) Youth Social inclusion Participant 9 provides social inclusion opportunities particularly through the form of recreation. This organization works with youth particularly 10 years and older with clients across Huron County. This organization does not provide any transportation assistance to its clients. Participant 10 Low-Income Essential Services; Participant 10 provides financial (P10) Households Access to Training, assistance to low-income households Education, and throughout Huron County as well as Employment support in accessing training, education, and employment. This organization provides transportation for its clients to access medical appointments and some employment, education, and training purposes. Participant 11 Physical or Mental Various (essential Participant 11 provides various (P11) Disability services, services for those with mental illness employment, social residing anywhere in Huron County. inclusion, supplies) This organization provides
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transportation formally to access client needs where necessary. However transportation is not a major, or advertised, component of their service delivery. Participant 12 Youth Social inclusion; Participant 12 provides social, (P12) Skills training recreational, and learning opportunities for young children (under 10) as well as skills training and other learning opportunities to their parents. This organization does not provide transportation but does conduct its services throughout Huron County in an effort to bring the service closer to rural clients. Participant 13 Women Access to Shelters Participant 13 provides access to (P13) and Support shelters and support services for a range of clients but with an emphasis on women. For those facing domestic abuse, Participant 13 provides transportation for a range of purposes including access to shelters and counselling, among other support services. Participant 14 Women Access to Shelters Participant 14 provides access to (P14) and Support shelter and support. This organization operates a women’s shelter in Huron County as well as providing a crisis line; counselling; advocacy; housing search support; among other supports for women facing a crisis of any kind. This organization provides transportation in order to access their own services as well as for accessing health and other essential services for their clients.
The purpose of these interviews was to test the transportation disadvantage framework with context specific information and the experience of service providers. The interviews also helped to provide qualitative information to supplement the demographic data and past study findings.
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Chapter Four: Case Study: Huron County, Ontario
The transportation disadvantage framework presented in the previous chapter will now be tested in Huron County, Ontario. This section will begin with a description of Huron County, followed by a presentation of overall transportation indicators before finally addressing the mobility limitations and accessibility needs of specific demographic groups.
4.1 Background and Context
Huron County is located in Southwest Ontario along the shore of Lake Huron (see map in
Appendix D). As of the 2006 Census of Population Huron County has a total population of
59,325 and an area coverage of 3,396.68 km2 resulting in a population density of 17.5 persons per km2 (Statistics Canada, 2010). Appendix C also presents graphs depicting the age structure of the county`s population in 2006 as well as projections for 2036. These images show that Huron
County presently has a large portion of its population in the elder cohorts; moreover projections demonstrate an aging population.
In terms of economics, Huron County is widely recognized as an agriculturally based community, which is reinforced by the significant employment presence of residents in the agricultural sector (Statistics Canada, 2010).
The population of Huron County is also quite dispersed as opposed to a few major settlements containing the majority of the population. Indeed, the settlement pattern of Huron
County is similar to other agricultural areas of Southern Ontario where populations are not concentrated solely in settlements but also dispersed across farms and small hamlets.
Correspondingly, due to the timing and style of development in Southern Ontario, Huron County is based on a concession system resulting in a grid pattern of lots and roadways. Nevertheless,
55 residents of Huron County do travel frequently to the larger urban centres of Stratford and
London which are approximately a 20-30 minute drive from the border of the county (see
Appendix D). The interviews reinforced that residents frequented these locations with much higher populations in order to access higher order services, such as complex medical procedures, or in some cases for employment.
The Huron Transportation Task Force Report estimates that of Huron County’s 59,325 residents, 20,500 (35%) reside in towns while the remaining 38,825 (65%) live in one of the villages or countryside areas (Croteau, 2008). The 2011 Census of Population identifies the seven population centres of Huron County as being Brussels (1,157), Clinton (3,114), Exeter
(4,785), Goderich (7,521), Hensall (1,173), Seaforth (2,627), and Wingham (2,875) (Statistics
Canada, 2012c). These communities are the most densely populated settlements in the county and will therefore contain the majority of higher order services. Below these population centres
Statistics Canada defines designated places as being Bayfield (1,023), Blyth (1,005), and Zurich
(865) (Statistics Canada, 2012b).
This is the lowest geographical level that Statistics Canada provides; nevertheless the
County of Huron Official Plan identifies numerous hamlets and villages present in the county with the terminology of secondary and tertiary settlement areas (County of Huron, 2010).
Examples of secondary settlements include Dashwood, Belgrave, and Egmondville while examples of tertiary settlements include Belfast, Henfryn, and Nile (County of Huron, 2010).
Little information is available on these smaller communities however they are important for consideration as they may contain lower order services meeting some needs of local residents, such as a post office, a small food retailer, or a church. As well, in discussions of a transportation network in the county these dispersed hamlets and villages may serve as collection points for a
56 feeder system serving their periphery and coinciding with an inter-community service linking these smaller settlements to the larger population centres.
Overall, these are important considerations for transportation within Huron County as the dispersed nature of the population results in long travel distances thereby limiting non- recreational opportunities for active transportation modes. Therefore, the dispersed settlement pattern results in a significant portion of the population living outside of the main settlements
(approximately 65%), where most services will exist. This large share of the population can be expected to be structurally dependent on personal vehicles due to a lack of alternative transportation options.
4.2 Rurality of Huron County
Regardless of the definition used, Huron County can be classified as a rural area. In
Canada there are three main methods of classifying rural areas: the Metropolitan Influence Zone
(MIZ) typology, the Census rural population, and the OECD Regional typology. According to the MIZ typology Huron County is classified as a rural area with a weak MIZ meaning that more than 0 per cent but less than 5 per cent of the employed labour force living in the County works in an urban core (CID, 2011; du Plessis, Beshiri, Bollman, & Clemenson, 2002). Similarly,
Huron County is considered to be a predominantly rural area through the Census definition, which states that 60 per cent of Huron County’s population resides outside centres of 1,000 or more inhabitants and outside areas with a population of 400 or more inhabitants per square kilometre (CID, 2011; du Plessis, et al., 2002). Finally, according to the OECD Regional typology Huron County is classified as a rural non-metro-adjacent region (CID, 2011).
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Furthermore, an additional rural classification is used by the Government of Ontario referred to as the OMAFRA Working Definition of Rural. Quite simply, this definition identifies rural areas as being all of Ontario outside the Province’s nine largest urban areas (OMAFRA,
2009). Once again, Huron County would be identified as rural when using this definition.
Overall it is clear that Huron County is a rural area and therefore presents a valid case study of a rural Ontario jurisdiction for this research.
4.3 Transportation in Huron County
This section will provide a look at the existing transportation situation for Huron County.
It includes information on vehicle ownership, mode usage, and existing alternative transportation options. Overall, it clearly demonstrates that the residents of Huron County are structurally dependent, as opposed to merely reliant, on personal vehicles in order to meet their transportation needs.
4.3.1 Drivers in Huron County
Information on the number of licensed drivers within Huron County is unfortunately not available. Nevertheless, the number of prospective drivers is available using 2006 Census of
Population data. Indeed, considering the age at which drivers may obtain a license where they can drive alone (17 in Ontario) and the age at which drivers are expected to be less safe, and thereby tested for capabilities (80 in Ontario), a range of 17-79 years of age can be expected.
Therefore, it can be estimated that, as of 2006 data, there are 45,253 residents of Huron County within the eligible age range for driver licensing (Statistics Canada, 2006b).
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4.3.2 Personal Vehicle Ownership
The accompanying Table 1 presents the vehicle population totals for Huron County as provided by the Ontario Ministry of Transportation. When considering non-recreational personal transportation vehicles (passenger, motorcycles, and mopeds) it is found that Huron County contains 32,379 personal vehicles.
One way of contextualizing this information is through the use of the personal vehicle saturation level which, when reached, means that “all those aged Table 1 between 17 and 75 who are likely to want, or be able to use, a car Vehicle Population Totals for Huron County, Ontario (31 actually have one” (Cullinane & Stokes, 1998).The December 2011) Passenger 30,775 personal vehicle saturation level is measured as a rate per 1000 Motorcycles 1,590 Mopeds 14 and is generally accepted to be between 600 and 700 personal Commercial 14,559 Buses 80 vehicles per 1000 inhabitants within the European and North Trailers 21,890 Snow Vehicles 3,355 American contexts (Christidis, Hidalgo, & Soria, 2003). Off-Road 3,441 Source: Brazier, T. (email However, one source estimates the personal vehicle saturation correspondence with MTO: Licensing Services Branch, February level for Canada specifically at 845 per 1000 (Dargay, Gately, & 17, 2012).
Sommer, 2007). Nevertheless, given the figures for Huron County it is found that the ownership rate is only 546 per 1000 residents.1 This is well below the anticipated saturation levels, and given the limited transportation alternatives present within Huron County, may indicate an unmet transportation need.
1 Note that this number may be skewed by farm vehicles being registered as commercial but also used for passenger transportation. 59
4.3.3 Travel Patterns in Huron County
The previously completed TDM Study (2011) survey identified some basic travel patterns among respondents in Huron County. Table 2 indicates, as can be expected, survey respondents travel internally within Huron County very regularly and outside the county much less frequently. This suggests that Huron County residents would benefit most from an intra- community transportation system based on their regular travel patterns.
Table 2 Where, and how often do you travel to/from most? A few A few A few Every Response Answer Options times a times a times a Never day Count week month year Within my neighbourhood 112 20 0 0 0 132 Within my town/village 100 30 1 0 1 132 Within Huron County 59 52 28 4 0 143 Outside of Huron County 11 30 72 20 2 135 answered question 147 skipped question 2 Source: (MMM Group, 2011)
4.3.4 Transportation Mode in Huron County
4.3.4.1 Mode of Transportation Overall
According to findings from the TDM Study (2011) survey, respondents from Huron
County were very reliant on personal vehicles to meet “I’ve started walking and people stop their transportation needs. The survey indicated that the because they assume my car must have broken down. It doesn’t look like vast majority of respondents drove a vehicle daily to something people would naturally do in the country” (Interview Participant reach their destinations while almost none used public 12). transportation or taxis to meet their transportation needs.
A significant number of respondents did walk to reach their destinations however it may be
60 expected that these respondents lived in settlements which are inherently more walkable than the countryside areas of the county. The remainder of the findings are presented in Table 3.
Table 3 How often do you use the following transportation options to reach your destination? A few A few Every A few times a Response Answer Options times a times a Never day week Count month year Drive a vehicle 104 28 4 2 5 143 Carpool or vanpool 2 8 23 33 51 117 Ride a bike 4 31 26 31 31 123 Walk 33 43 31 16 10 133 Passenger in a vehicle 5 44 47 24 8 128 Transportation service (such as Town and County Support 0 3 1 4 112 120 Services) Taxi 1 2 3 23 94 123 Other 9 answered question 147 skipped question 2 Source: (MMM Group, 2011)
4.3.4.2 Mode of Transportation to Work
The following table provides figures obtained from the 2006 Census of Population detailing the mode of transportation used to access work. These figures provide some insight into the transportation mode used by residents of Huron County, as well as the availability of alternatives. However this indicator does have important drawbacks. For instance, it does not account for those without employment, such as some youth, older adults, mobility impaired individuals, or some low-income households; all of which are deemed to be at particular risk of transportation disadvantage. Similarly, it only accounts for those able to reach employment through some transportation mode and does not account for those unable to gain employment
61 due to a lack of transportation. Therefore, it should not be considered to be a proxy for transportation availability for all residents within the County.
Table 4 Mode of transportation to work, Huron County (2006) Total Male Female
# % # % # %
Total employed labour force 15 years and over with a usual 25,820 100.00 13,740 100.00 12,075 100.00 place of work or no fixed workplace address Car, truck, van, as driver 20,735 80.31 11,300 82.24 9,435 78.14 Car, truck, van, as passenger 1,815 7.03 855 6.22 960 7.95 Public transit 65 0.25 30 0.22 40 0.33 Walked or bicycled 2,900 11.23 1,370 9.97 1,530 12.67 All other modes 300 1.16 185 1.35 115 0.95 Source: (Statistics Canada, 2010)
The preceding table demonstrates that the labour force of Huron County is heavily reliant on the personal vehicle for accessing employment. Indeed, 87 per cent of those employed in
Huron County use a personal vehicle, as driver or passenger, in order to reach their workplace; whereas, only 0.25 per cent made use of public transportation. Therefore, given the limited alternatives available within the County it is reasonable to surmise that the majority of the labour force of Huron County is structurally dependent on personal vehicles in order to access employment.
Another point relevant for consideration is the differentiation between male and female transportation modes. Indeed, these findings demonstrate that females employed within Huron
County made less use of a personal vehicle as a driver and instead were more often passengers or utilized alternatives such as public or active transportation when compared with males. This
62 suggests that females working within the County may have less access to a personal vehicle when compared to males.
4.3.5 Existing Intra-Community Public Transportation Services
Huron County presently has very few transportation alternatives to the personal vehicle.
In terms of general use, intra-community transportation “There is no public transit in the there are only private taxi companies with varying county so we have a joke that you stand on the corner a long time in degrees of coverage and availability. According to the Huron County waiting for a bus” (Interview Participant 12). recently completed TDM Plan for Huron County, the
County has nine taxi companies with the following characteristics:
Of the nine companies, one (Huron Taxi) operates 24 hours, but only serves Clinton and its surrounding area. Another two companies (Star Taxi and Goderich Taxi) operate county-wide, 6:30 AM to 11:00 PM, Sunday through Thursday, extending their hours to 1:30 AM on weekends. Exeter Taxi serves the urban area of Exeter and operates from 7:00 AM to midnight Mondays through Thursdays, extending hours until 3:00 AM on weekends, and reducing hours on Sunday to 10:00 AM to midnight. B&B Taxi operates in Goderich from 6:45 AM to midnight, Mondays through Thursdays, extending its hours to 2:00 or 3:00 AM on weekends. Finally, A1 Taxi operates within Huron County and outside the County’s boundaries, making trips as far as Toronto between the hours of 7:00 AM (6:00 AM in St. Mary’s) to midnight Mondays through Thursdays, extending its hours to 2:00 or 3:00 on weekends. (MMM Group, 2011)
The report also comments on gaps in the taxi service relating mainly to limited coordination of the various independent companies as well as issues of affordability for groups at risk of transportation disadvantage.
4.3.6 Specialized Transportation in Huron County
While general use, intra-community transportation service is limited within Huron
County, there are specialized transportation services in operation that provide important services to specific demographic groups. The first service is that of Huron Perth Student Transportation
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Services, which provides transportation specifically to youth for the purpose of attending primary or secondary school within the Avon Maitland District School Board or the Huron-Perth
Catholic District School Board.
In addition to the school bus service provided for youth, specialized transportation also exists within Huron County for older adults and those Table 5 OneCare Huron Trip Purpose with disabilities. Indeed, the EasyRide service represents April 1 – December 31, 2011 # % a partnership of six community support agencies from Total 3,262 100.00 Huron and Perth Counties that provides demand- Adult Day Care 1,654 50.71 Medical 629 19.28 responsive service for older adults and those with Shopping/Errands 363 11.13 Dialysis 154 4.72 disabilities (OneCare, 2012a). EasyRide provides door- Social 383 11.74 Source: Orchard, W. (email to-door transportation through volunteer drivers, correspondence with ONE CARE Home and Community Support wheelchair accessible vehicles, as well as vans, cars and Services, March 05, 2012). taxis which are coordinated through a central dispatcher (OneCare, 2012a). The purpose of the service is to provide transportation for older adults and those with disabilities in order to access appointments, shopping, errands or social activities, as presented in Table 5. EasyRide will also provide transportation to health services for individuals in the Ontario Works program or the
Ontario Disability Support Program (ODSP).
However, it should be noted that a report undertaken by Dillon Consulting in 2010 found that the level of service provided in Perth County was much higher than in Huron County, which is reflected in the number of trips made in each county. Indeed, this report found that 12,326
(0.21 per capita) trips were made in Huron County annually whereas 59,984 (0.81 per capita) were made in Perth County (Dillon, 2010). The report concluded that this suggests an unmet transportation demand within Huron County.
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Furthermore, it is important to note that OneCare, the lead agency of EasyRide, also offers homecare services to older adults and those with disabilities thereby reducing the need to travel for some accessibility purposes (OneCare, 2012b). According to the OneCare website these services include:
In-Home Personal Support: Personal care is provided by certified Personal Support Workers.
Home Support/Home Help/Respite: Assistance with household chores and daily tasks. Respite
care when the family care-giver needs a break.
Meals on Wheels: Delivery of nutritious, affordable hot and frozen meal programs.
Reassurance: A volunteer checks in regularly (in-person or by telephone) to ensure all is well.
Home at Last: (HAL) A free service to help aging adults and those with special needs to settle in
at home safely and comfortably after a stay in hospital.
While not transportation services, these are important considerations as they allow for accessibility without personal mobility for older adults and those with disabilities.
4.4 Recognized Transportation Issues in Huron County
Past reports undertaken in Huron County have regularly identified that transportation is an issue for some residents. For instance, the Community Priorities Initiative undertaken in 2006 by the Huron United Way identified that personal transportation was a key area of concern among participants. In particular, the study’s survey found that a lack of public transportation was identified as being the second most significant problem facing the respondents’ community behind only the issue of finding a doctor. The issue of access to personal transportation also regularly arose during focus groups and town hall meetings undertaken throughout the county as part of this study.
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Similarly, the recently completed TDM Study (2011) found that transportation was an issue for survey respondents. For instance, Table 6 presents some particular issues surrounding the presently available transportation options within Huron County.
Table 6 What do you think are barriers to available transportation options in Huron County? (Check all that apply). Response Response Answer Options Percent Count The cost 73.7 84 Limited service area/distance between home and destinations 64.0 73 Lack of options/services available 72. 83 Limited hours of service 46.5 53 Limited knowledge of the options available 37.7 43 Other (please specify) 6 answered question 114 skipped question 35 Source: (MMM Group, 2011)
Moreover, this study found that respondents often stated that the option for public transportation provision was a valued improvement to the transportation system. This is demonstrated in Table 7 derived from an open-ended question in the TDM Study (2011) survey.
Table 7 In your opinion, what are the top three transportation improvements in Huron County that you would like to see? Ranking Answers Relating to Public Transportation Total Responses 1 42 109 2 33 89 3 23 70 answered question 109 skipped question 40 Source: (MMM Group, 2011)
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Chapter Five: Transportation Disadvantage in Huron County
This chapter presents the results of the case study research intending to test the transportation disadvantage framework presented in Chapter 3 (page 50). The results are presented according to each of the demographic groups found to be at risk of transportation disadvantage by assessing the mobility limitations of these groups as well as their accessibility needs specific to the context of Huron County. Moreover, each section will present findings relating to trends within the county which may be expected to impact personal transportation.
Finally, necessary design characteristics for a potential transportation service will be discussed based on the unique needs and capabilities of each demographic group.
5.1 Older Adults
Like much of rural Ontario, Huron County has a relatively large proportion of its population in the eldest age cohorts. As described in Chapter 2, in discussions of transportation it is relevant to consider two distinct groups of older adults. The first are those aged 65 to 84 years of age who often face mobility limitations and those aged 85 years and over who are most at risk of transportation disadvantage.
With regard to those 65 to 84 years of age Huron County has a relatively high proportion of its population within this cohort. As presented in Table 8, Huron County had 15.43 per cent of its residents within this cohort in 2006, notably higher than the province of Ontario overall. As well, it is apparent that the proportion of this age cohort is increasing in both the province and
Huron County.
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Table 8: Older Adults in Huron County (Aged 65-84) 1996 2001 2006
# aged 65 - 84 % aged 65-84 # aged 65 - 84 % aged 65-84 # aged 65 - 84 % aged 65-84
Huron County 9,275 15.40 9,180 15.38 9,155 15.43 Ontario 1,209,195 11.24 1,322,095 11.59 1,457,370 11.98 Source: Statistics Canada, Census of Population (1996, 2001, 2006)
Furthermore, population projections produced by the Ontario Ministry of Finance demonstrate that the population of Huron County aged 65 to 84 is expected to increase significantly in the near future. Table 9 demonstrates that this age cohort is expected to increase to a considerable proportion of the population in Huron County as well as within Ontario overall.
Nevertheless, Huron County is expected to see a rapid increase in this age cohort rising from
18.47 per cent of the total population in 2016 to 27.31 per cent in 2031.
Table 9: Population Projections for Older Adults in Huron County (Aged 65-84) 2016 2021 2026 2031
# aged 65 - % aged % aged # aged 65 % aged # aged 65 % aged # 65 - 84 84 65-84 65-84 - 84 65-84 - 84 65-84 Huron 11,110 18.47 12,950 21.53 14,990 24.91 16,370 27.31 County Ontario 1,948,700 13.73 2,335,460 15.50 2,799,600 17.53 3,241,070 19.21 Source: (MOF, 2011)
Similar findings are identified for the 85 years and older age cohort residing within
Huron County. As shown in Table 10, the proportion of older adults aged 85 and older is not significant, nevertheless is growing rapidly in Huron County increasing from 1.71 per cent of the total population in 1996 to 2.47 per cent in 2006. As well, the proportion aged 85 and older residing in Huron County remains higher than in the province overall and is increasing significantly faster. This is important to note as those within this age group typically exhibit the greatest need for mobility support as well as healthcare access.
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Table 10: Older Adults in Huron County (Aged 85 and older) 1996 2001 2006 # aged 85+ % aged 85+ # aged 85+ % aged 85+ # aged 85+ % aged 85+ Huron County 1,030 1.71 1,205 2.02 1,465 2.47 Ontario 124,910 1.16 150,075 1.32 191,810 1.58 Source: Statistics Canada, Census of Population (1996, 2001, 2006)
Furthermore, Table 11 demonstrates that the 85 and older age cohort is projected to increase at a considerable rate as a proportion of Huron County’s population. Indeed, these
Ministry of Finance projections show that this age cohort is expected to increase from 2.91 per cent in 2016 to 4.22 per cent in 2031. While these proportions are smaller than in Ontario overall they remain considerably high in Huron County and can be expected to have a significant impact on transportation within the county due to the needs of this age group.
Table 11: Population Projections for Older Adults in Huron County (Aged 85+) 2016 2021 2026 2031
# aged % aged # aged % aged # aged % aged # aged % aged 85+ 85+ 85+ 85+ 85+ 85+ 85+ 85+ Huron 1,750 2.91 1,870 3.11 2,150 3.57 2,530 4.22 County Ontario 478,430 3.37 530,210 3.52 644,160 4.03 845,100 5.01 Source: (MOF, 2011)
The following sub-sections will assess the degree to which older adults in Huron County experience transportation disadvantage. The key source of information is the interviews conducted in Huron County with service providers working with older adults. In particular,
Participants 1, 4, and 5 provided the most relevant information for this demographic group. A summary of these organizations is provided in the following table:
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Primary Client Primary Service Description Group(s) Category Participant 1 (P1) Older Adults Access to Essential Participant 1 provides Services predominantly health related (primarily health) services to older adults in Huron County. This organization does provide its own formalized transportation for its client group. Participant 4 (P4) Older Adults; Various Participant 4 provides Physical or (primarily health) transportation for older adults and Mental those with physical or mental Disability disabilities in order to reach a range of destinations. However, the organization has an emphasis on health services. Participant 5 (P5) Various Various Participant 5 supports the (Focus on older delivery of a wide range of adults, youth, services primarily to older adults, and low-income youth, and low-income households) households. This organization does not provide transportation for its clients.
5.1.1 Mobility Limitations of Older Adults
“Huron has so many pockets of small towns and villages. There are people who live way up in North Huron who are half an hour or more from the nearest grocery store and have always lived on the same farm and we get clients in their 80’s who say ‘my husband and I own this farm and we’re not moving but we don’t have a car’. You hear more and more of this, it’s not stopping, it’s not a need that’s diminishing.” (P4)
Within Huron County it is widely accepted that older adults experience mobility limitations for a variety of reasons. This research identified that older adults residing in Huron
County faced mobility limitations due to physical/mental conditions; social reasons; legal restrictions; financial barriers; and other practical reasons.
Probably the best known mobility limitation for older adults is that of physical or mental conditions which can inhibit the use of an automobile. Indeed, Table 12 demonstrates that much of Huron County’s older adult population has some form of disability with 33 per cent of those aged 65 to 74 and 56.3 per cent of those 75 and older being found to have some form of
70 disability. This issue also arose during the key informant interviews, for instance, Participant
1(P1) noted that many of their older clients had visual impairments or were wheelchair bound due to deteriorating health. Similarly, both P1 and P4 mentioned that they had older adult clients with deteriorating mental health such as Alzheimer’s disease or dementia that prevented them from operating a vehicle. Finally, Participant 5 stated that even in walkable communities older adults are often unable to walk to destinations due to physical inabilities.
Table 12: Incidence of Disability by Age Group (2006) Age Group Percent of Total Population with Disabilities 0 – 14 years 3.7 15 – 64 years 11.5 65 – 74 years 33.0 75+ years 56.3 Total Population 14.3 Note: Disability is defined as “a condition that limits everyday activities because of a condition or health problem” Source: (Dillon, 2010)
In addition to physical and mental disabilities, seniors residing in Huron County can also face limitations for social reasons. For instance, both P1 and P4 raised the concern that older adults were not utilizing their service due to the unavailability of transportation and an unwillingness to ask for help due to pride or valuing independence. Indeed, Participant 4 stated that “Some people just want to be independent. They’ve never relied on anyone their whole life and they don’t want to start now.”
Similarly, declining social ties can impact the mobility of older adults due to their reliance on “internal support networks (family and friends)” (Dillon, 2010). This is emphasised in the following statement from Participant 4:
“Rurally everyone used to be dependent on your family. You had 6 kids and they all lived within 3 miles and they kind of took turns helping you get to where you needed to be. But now tons of
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people don’t have anybody in Huron County or if they do they are not able to be there all the time. So what can you do if you need to go and you don’t have friends or family available?” (P4)
This quote depicts a changing social structure where the dispersed nature of many families means that children often do not live in proximity to their parents as they have left the rural area to seek educational or employment opportunities elsewhere. It also reiterates the issue around the time of day that older adults require transportation, which is generally during the day when family or friends may be unavailable.
A further limitation for the mobility of older adults is legal, particularly in the form of licensing. Indeed in Ontario the Senior Driver Renewal Program requires that drivers 80 years of age and over undertake testing in order to renew their licence every two years (MTO, 2010c).
This means that older adults residing in Huron County may be legally prevented from operating a vehicle having lost their license which was identified as an issue by Participant 4:
“Some have physical issues or mental health issues and certainly financial issues. As far as our senior population goes they may call and say ‘I just lost my license’ or in some cases have never driven and lost their husband who always drove.” (P4)
This quote depicts two interrelated issues for older adults in Huron County. Indeed, it not only references the loss of a driver’s license but also that some people, particularly women, from this generation never obtained a license. This becomes an issue if the household driver loses their license, their ability to drive, or is deceased.
Another key mobility limitation for older adults in Huron County is financial. This research found that some older adults are unable to afford to purchase and maintain a vehicle or use existing transportation services which was raised by Participants 1, 4, and 5. Indeed, each of these interview participants raised the high cost of taxis and the long distances that need to be travelled by rural residents as being prohibitively expensive for use by older adults.
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As well, when discussing the existing transportation service for older adults Participant 1 stated “I think there are a lot of clients who can’t afford the service.” Similarly, Participant 5 provided the following statement:
“Even the transportation services that exist, EasyRide for example, they are still fee for service which is subsidized yet the cost is still out of reach for some people. You could argue that transportation is available to everyone but it is certainly not accessible to everyone.” (P5)
While transportation is available for older adults in Huron County through the EasyRide service and taxi companies, these operate on a per kilometre rate and therefore increase in cost with rurality.
A final mobility limitation that came through in the interviews is that of practical barriers that older adults in Huron County face. For instance, Participant 1 raised the concern that while some older adults may be able to drive a car, they may not be capable of shoveling their driveway in the winter thereby isolating them. While mostly speculative, this warrants particular attention in rural areas where laneways are often long and for Huron County which, as participants stated, receives significant snowfall.
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5.1.2 Accessibility Needs of Older Adults
“Our agency has a big chunk which is actually in-home services. That is for delivering health services or personal support for those who have just been released from hospital. Every service we provide involves transportation whether we’re transporting the client; volunteers are using transportation; PSW’s are using transportation; meals are being transported; transportation is just huge for everything we do. Even though we have these services that are not transportation the reality is that transportation is a part of all of them.” (P4)
Primary Accessibility Needs
Access to Access to Access to Social Access to Training, Essential Shelters or Inclusion Supplies Education, and Services Other Support Employment Services
Older Adults ✔ ✔ ✔
As presented in the preceding excerpt from the research framework, older adults typically require access to social inclusion, access to supplies, and access to essential services. Within
Huron County this research found that the framework was accurate. Indeed, interview participants described specific services falling into these categories including: dining programs, grocery shopping, adult day care, exercise/wellness programs, social events, meals-on-wheels, telephone reassurance, personal support services, and particularly healthcare appointments.
Interviews with service providers also identified a clear emphasis on allowing for older adults in Huron County to age at home and the provision of services to meet this goal. The rationale for this direction is largely due to the high cost and limited availability of space in long- term care facilities. This is particularly important to consider given that long-term care facilities are actually a means to provide accessibility without requiring mobility. Nevertheless,
Participant 1 stated that long-term care facilities in Huron County have “huge wait times”. As well, Participant 5 provided the following statement:
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“Seniors are another example. They are living in their place of residence their whole life and how long can they actually afford to stay? It may be out of their reach to even consider moving to an assisted living facility at the rates that they charge, $3000, $4000, $5000, $6000 per month. Lots of people can’t even dream of affording that but they paid for their house 25 years ago and as long as they can stay there they are ok. But when the next step comes it’s really difficult.” (P5)
This emphasises the high cost of long-term care facilities and the financial requirement to age at home for some older adults.
Overall, it was found that older adults had good access to each service category, even without access to a personal vehicle. The research found that service providers recognized the mobility limitations of older adults and delivered services accordingly. In particular, due to the aging at home strategy, service providers have emphasised home-care in the delivery of many services whether it be in the form of personal support workers going to client’s homes or food delivery through the meals-on-wheels program.
Nevertheless, home-care is not appropriate or feasible for the delivery of every service. In these cases transportation is required for older adults to meet their needs. However, this is also recognized by service providers and therefore transportation support is generally provided. For instance, Participant 1 described an adult day care program that provided transportation for older adults specifically to access this service. This participant also described a dining program which provides transportation while also being geographically dispersed in churches and halls across the county.
Moreover, the existing transportation service for older adults (EasyRide) was generally discussed as being available for meeting each accessibility need, with Participant 1 stating that the service was available for “everything: grocery shopping, hair appointments, the airport,
75 family visits, anything.” While the primary mandate of the service is healthcare, it was noted that transportation to other services was generally available when clients requested:
“Medical trips are always our number one priority. So say there are 80 people in Huron County and we’ve only got X number of drivers available and someone wants to go out shopping and pick up cat food or go to the bank while another needs to see their family doctor we’ll say ‘hey Mrs. Smith can you get your cat food Thursday instead of Wednesday?’ So I wouldn’t say we turn people down but there are times we need to rearrange schedules.” (P4)
This indicates that while the service is available for a range of purposes on paper, in practice it does also seem to be available for these non-health related purposes when older adults require it.
Nonetheless, while the availability of the service was found to be quite good it was found that the primary obstacle to its use is financial. While a subsidized service it was still found that the cost may still be out of reach for some older adults, particular to rural residents due to the per kilometre rate. A particular example was dialysis patients as described by Participant 1 who stated “I honestly don’t know how dialysis patients afford it” (P1). The explanation provided for this statement is that dialysis patients have regular appointments, multiple times per week in some cases, and “there is a huge wait list in Goderich to get dialysis so they are having to go down to London” (P1). For perspective, this means that a trip from Goderich to London and back for a medical appointment would cost $90.00 based on a distance of 200 KM and a cost of $0.45 per KM.
It should be noted that financial assistance is available for older adults that qualify through a financial assessment. Nevertheless, as stated by Participant 1:
“How much does an agency have to put out of pocket for financial support? It could drain you if you did it all. I think that is one thing that when we look at funding for programs they really need to take into consideration the people that don’t ask for support, and some people don’t access it because they know they cannot afford it. So if there was more money given to look at that financial piece that would be helpful.” (P1)
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This is emphasising that the financial resources are not available to subsidize the costs for each older adult. As well, it was stated that “I believe there are a lot of people who are home bound in
Huron County because the fact that they are too proud to ask for financial assistance” (P1). In contrast, Participant 4 raised the following observation:
“It’s mostly about perception. These people lived through the depression and World War 2 and it’s sometimes a question of whether they really cannot afford it or they think they cannot afford it. They are concerned about whether they are spending all their money while not making any money and whether it will run out. And they are just frugal from living through periods when there was nothing.” (P4)
Indeed, this participant also observed that some clients do not fully appreciate the cost of vehicle ownership, particularly less obvious costs such as maintenance and insurance, and therefore perceived that this service was more expensive than using a personal vehicle.
5.1.3 Trends
During the interview process participants were asked about current trends that may impact the way their service is delivered in the future. In particular, participants were asked about the aging population and increasing fuel prices. On the topic of older adults, participants identified that each of these trends would have an impact, or were already impacting, their service delivery.
It was found that the aging population would impact the participants in the demand for their services as well as their ability to supply them. Indeed, both Participants 1 and 4 were highly reliant on volunteers, particularly for the delivery of transportation. It was also noted that most volunteers were older adults themselves, with Participant 4 estimating that “about 75-80 per cent are between 60 and 80 years of age.” Moreover, due to the fact that older adults require
77 transportation during the day, for instance to medical appointments, retiree volunteers are particularly needed.
However, as the population ages and people are retiring later it was observed that
Participant 1 was not getting as many volunteers at prime volunteering age, stated as being between 55 and 60 years of age. As well, Participant 4 noted that while they have volunteers well into their 90’s, they did not generally have drivers over the age of 80. Further, both Participant 1 and 4 speculated that the culture of volunteering was changing and questioned whether the
‘baby-boomer’ generation would give back as much as the previous generation. For instance,
Participant 4 provided the following statement:
“I think it’s a changing demographic. I think that people that are now 70 or 80 retired and took the time to give back to their community. I don’t think baby-boomers will be the same. Partly because a lot of our volunteers are a couple and they volunteer as a couple. They raised their kids and the kids are gone. The female spouse started to volunteer and then he retired and then they did it together and it’s just a different demographic now so when they retire they will want some time for themselves first. So we’re not really sure what will happen. We think it will be different but we don’t know how different. But it is a concern because the hours our volunteers contribute to our services is huge.” (P4)
While mostly speculative and based on observation this statement does raise questions about cultural changes and the ability to provide a service based on volunteers in the future. Overall,
Participant 4 stated that “with the baby-boomers aging the number of people requiring transportation services is going up, up, up and available drivers is going down, down, down.”
The impact of increasing fuel prices is quite similar due to the high reliance on volunteers. Indeed, Participant 1 stated that:
“Now our dining programs, they actually get a ride free to the program. So we have generous volunteers who drive clients for free to the dining programs. Those are becoming fewer as they are a harder volunteer to find. The price of gas is really killing us right now, big time.” (P1)
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Similarly, the reimbursement of volunteers for their mileage is complicated as it is a set rate yet fuel prices are highly variable. This means that the cost incurred by volunteers has been rising but their compensation has not. Participant 1 described the impact saying that “we’ve had a couple volunteers quit actually. They said it was coming out of pocket now and they just cannot afford it.” This was reiterated by Participant 4 who stated that “there have been a couple
[volunteers] that have retired from driving because of increasing costs....it’s up and down all the time so it’s not something we can keep adjusting our costs.” However, it was again raised that this has a great deal to do with the perception that the cost of driving is increasing more rapidly than it actually is. This is due to the visibility of gas costs rather than the inherent costs of ownership such as insurance, maintenance, and vehicle purchase.
A final trend relating to older adults is that of residents leaving rural communities for larger centres once they reach the eldest ages and living independently is no longer feasible.
Indeed, if the necessary services are not present within the community older adults will be unable to age at home and will be forced to move to a more age-friendly, often urban, community. One such service is transportation with a previous report indicating some recognition of this issue by stating that “several Huron County councillors have expressed a concern about the lack of transportation in their communities resulting in seniors leaving the County” (Dillon, 2010). This is of particular concern in Huron County due to the presence of amenity migrants retiring in rural areas, particularly in lakeside communities. While in the earlier years of their retirement these migrants can be expected to contribute to population growth and the local economy it also raises questions around population stability once these older adults reach the age where they can no longer reside in these communities due to limited service availability.
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5.1.4 Design Characteristics
This research identified several design characteristics important for a potential transportation service within Huron County. These come predominantly from the interview participants who were asked specifically about the needs of their clients. One key characteristic of older adults is that they require services during the day in order to meet their needs, particularly around medical appointments.
The interviews also identified that a service would need to be door-to-door as Participant 1 described:
“If you get someone with a walker and they are trying to meet a bus way down the street and thinking ‘I hope I make it’ or ‘I get there in time’...Plus people are scared of missing it...in this area we’re not used to that kind of transportation. We’re not from Toronto or London where you have to hit a bus; we’re not used to it. It’s the fear of it too. I remember when I went away to school and trying to figure out the buses. I didn’t like it and I was young. I can’t imagine being elderly and trying to walk my walker down to the corner. It would freak me out.” (P1)
This indicates that in order for a service to be useful for older adults in Huron County it would need to be demand responsive or a similar variant rather than a conventional transportation service. Furthermore, the requirement for individualized support was raised by participants and identified as a key drawback of the existing taxi service. For instance when discussing the benefits of volunteer transportation Participant 1 states that “the volunteer will stay there with them so it’s not like they are getting out there on their own. Taxis just drop them off and move on to the next person.”
Another key design consideration is the destinations of older adults. As Participant 1 describes:
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“We don’t have a lot of people going to the same place at the same time. So you’re picking someone up in Fordwich and going to Exeter. You really need something like a taxi service that is door to door because realistically you are not going to be able to fill a bus since it is so rural.” (P1)
Participant 4 provided a similar statement:
“There isn’t the volume. There’s somebody here that needs to go there and someone over here that needs to go there it’s just pockets of people. Maybe something like dial-a-ride would work.” (P4)
This reality has important implications for service design particularly around routing and the size of vehicles. However it is important to consider that this relates to a specialized transportation service for older adults and does not consider other groups which may have similar origins and destinations.
Another unique design consideration was provided by Participant 1 regarding the physical capabilities of older adults. Indeed, in a discussion of a potential shuttle service for older adults to access medical appointments the following statement was provided:
“Those poor elderly people have to sit until all the others get their dialysis done. There’s incontinence issues, there’s diabetes and they need to eat at particular times so you need to consider their whole physical health.” (P1)
This is a very important consideration as it may seem logical to bring groups of older adults from a similar origin to a similar destination, in this case being medical. However it may not be practical, or useful, for this demographic group.
A final design characteristic emphasised by participants was the value of volunteer transportation. As mentioned, Participants 1 and 4 felt that volunteers provided the affordable and individualized support that older adults required. The key issue mentioned by these participants was adequate reimbursement while maintaining affordability for their older adult clients. Further, Participant 1 provided the following statement about volunteers in Huron
County:
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“Rural volunteers have an understanding of what it is like to live in a rural area because they struggle with it themselves. They are just able to get to their appointments on their own. There seems to be a family attitude in rural areas. They are very supportive of their folks.” (P1)
This observation clearly indicates that this participant felt that the needs of older adults are best met through a volunteer service for a range of reasons including the culture and values of Huron
County residents.
In conclusion, when applying the section of the research framework relating to older adults it is found that while older adults have mobility limitations, service providers in Huron
County have found alternative means to meet their needs. These have been in the form of in- home delivery of services or through transportation provision. While access to transportation for the needs of older adults seems quite good, the affordability of the service is brought into question. This is particularly concerning in the face of trends such as the aging population and increasing fuel prices which are expected to increase the demand for transportation services but may reduce the ability of agencies to supply it. Finally, the unique needs of older adults must be considered in the design of a transportation service with participants favouring community transportation in the form of volunteer drivers.
Summary of Gaps in Access for Older Adults:
Affordability of existing transportation services
Increasing demand from an aging population
Homebound older adults who do not seek help due to feelings of pride and independence
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5.2 Physical or Mental Disability
Similar to older adults, those with physical or mental disabilities are often found to experience transportation disadvantage and for similar reasons. Indeed, those with physical or mental disabilities have been found to be limited in their mobility due to physical, legal, or financial reasons. Moreover, those with disabilities often require regular access to health services due to their conditions. This section will assess the mobility limitations and needs of individuals with physical or mental disabilities within the context of Huron County.
The terms physical disability and mental disability can apply to a wide range of conditions. One definition of physical disability is provided in the following excerpt:
Physical disabilities are long lasting physical impairments that significantly impede a person's ability to function. Common physical disabilities include: visual impairments (such as blindness); hearing impairments (such as being deaf or hearing impaired); injuries of the skeletal system including muscles, joints and ligaments (such as being quadriplegic or paraplegic); birth and hereditary disorders such as cerebral palsy, spina bifida and cystic fibrosis. (eMentalHealth, 2012)
As well, a definition of mental disability, or mental illness, is provided by the Canadian Mental
Health Association (CMHA) which states that “mental illnesses can take many forms, just as physical illnesses do” and describes such issues as Anxiety Disorders; Attention Deficit
Disorders (ADD); Bipolar Disorder; Depression; Eating Disorders; Mood Disorders; Psychosis;
Schizophrenia; and Self-Injury (CMHA, 2011b). Further, some individuals may have both physical and mental disabilities and are termed as ‘dual diagnosed’.
Nevertheless, it is difficult to estimate the presence of individuals with physical or mental disabilities in Huron County due to the broad range of conditions, the temporary nature of some conditions, as well as the reality that some remain unreported. While information for mental
83 disabilities is not available specifically for Huron County, at the scale of Canada overall the
Canadian Mental Health Association (CMHA) estimates that:
One in five Canadians will experience a mental health issue in their lifetime. In 2003, an estimated 1.9 million adults in Canada had a mental disorder diagnosis and 1.6 million reported symptoms but were not treated. Mental health is one of the six major chronic diseases in Canada with an estimated economic burden of $51 billion in 2003. One-third of hospital stays in Canada are due to mental health disorders in whole or in part. (CMHA, 2011a)
With regard to the presence of physical disabilities the Participation and Activity Limitations term is used by Statistics Canada and provides some information as shown in Table 13. Using this broad definition it is found that within the Huron County Health Unit area 30.1 per cent of those 12 years and older experienced limitations in 2005. However, it is important to differentiate between those 65 and older who would be classified as older adults and thereby covered in the previous section. Indeed, when considering only those between the ages of 12 and
64 years it is found that 23.8 per cent of residents experienced participation or activity limitations in 2005.
Table 13: Population with Participation and Activity Limitations, Huron County Health Unit (2005) Age Group Total Population With Limitation # % # % 12 years and older 51,972 100 15,659 30.10 12 - 64 years 42,116 100 10,030 23.82 Note: Participation and activity limitation is defined as an individual “whose day-to- day activities may be limited because of a condition or health problem.” Source: (Statistics Canada, 2006c)
The following sub-sections will assess the degree to which those with physical or mental disabilities residing in Huron County experience transportation disadvantage. The key source of information is the interviews conducted in Huron County with service providers working with clients with physical or mental disabilities. In particular, Participants 7, 8, and 11 provided the
84 most relevant information for this demographic group. A summary of these organizations is provided in the following table:
Primary Client Primary Service Description Group(s) Category Participant 7 (P7) Physical or Various (essential Participant 7 provides a range of Mental services, employment, support for those with Disability social inclusion) developmental challenges residing in the southern half of Huron County. This organization provides formal transportation for its clients to access its services as well as other needs. Participant 8 (P8) Physical or Various (essential Participant 8 provides various Mental services, employment, services for those with mental Disability social inclusion, illness residing in the southern supplies) part of Huron County. This organization provides transportation formally to access its own services and informally in few cases for external services. Participant 11 (P11) Physical or Various (essential Participant 11 provides various Mental services, employment, services for those with mental Disability social inclusion, illness residing anywhere in supplies) Huron County. This organization provides transportation formally to access client needs where necessary. However transportation is not a major, or advertised, component of their service delivery.
5.2.1 Mobility Limitations of those with Physical/Mental Disabilities
Those with physical or mental disabilities residing in Huron County generally face mobility limitations. These individuals generally lack access to their own transportation, in terms of personal vehicles, due to physical, legal, and financial limitations. Indeed, when discussing their own clients with physical disabilities, Participant 7 stated that none of their clients had access to a personal vehicle with similar responses from Participants 8 and 11.
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Perhaps not surprisingly those with physical or mental disabilities are often physically unable to operate a personal vehicle due to limited motor skills, cognitive abilities, or other physical characteristics. For instance, Participant 8, who works with clients with mental illness, estimated that over half of their clients could not drive for physical reasons and stated that: “there are a very small number that could [operate a vehicle]. There are others that just due to the complex mental health issues or physical issues just do not have the capability” (P8). Participants
7 and 11 provided similar findings.
Another key mobility limitation for those with physical or mental disabilities is licensing.
Participants 7, 8, and 11 who work exclusively with these groups each indicated that few of their clients had licenses due to eligibility or financial reasons. “In this day and age there Indeed, when asked about licensing Participant 11 stated that is still difficulty for people “if you don’t have money, are you even going to think about to get from point A to point B and some people are having a vehicle” (P11). This leads to the key issue raised by unaware of that.” (P8) interview participants; that of limited financial resources inhibiting mobility.
The key mobility limitation faced by those with physical or mental disabilities was found throughout the research to be financial resources. Indeed, Participant 7, who works with individuals with physical disabilities, provided the following statement:
“Unless they are living at home they cannot get driver’s licenses. Secondly, they don’t have a lot of money. In fact, most of the clients we support would probably be considered living at the poverty level. They make about $900 per month which pays for rent, food, clothing, and other expenses which doesn’t leave much room for spending money.” (P7)
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Similarly, Participant 11 provided a corresponding statement for those with mental illness:
“The thing is that most of the clients will be low-income, most are in receipt of provincial disability benefits, ODSP, or they are on Ontario Works waiting for ODSP eligibility. Most would not have vehicles, in fact very few would have vehicles, so that’s the characteristics of our clients.” (P11)
Each of the participants reiterated the high cost of vehicle ownership as the primary reason that their clients did not have their own transportation.
While many could not drive anyway for licensing or physical reasons it was found that those with the capability to drive were prevented for financial reasons. Indeed, the point was raised that disabilities come in a variety of forms with varying ability to drive as well as work.
For instance, conditions such as anxiety or depression may impact one’s ability to work but not their ability to drive. Thus, those reliant on financial assistance, such as the Ontario Disability
Support Program (ODSP), would have difficulty affording a vehicle and therefore lack access to their own transportation.
5.2.2 Accessibility Needs of those with Physical/Mental Disabilities
“Transportation is the number 1 issue. It prevents them from getting jobs, getting to programs, getting to appointments. There would be a number of people out there that probably are not even hooked up to [our service] yet or another agency to help them figure it out.” (P8)
Primary Accessibility Needs
Access to Access to Access to Social Access to Training, Essential Shelters or Inclusion Supplies Education, and Services Other Support Employment Services
Physical or Mental ✔ ✔ ✔ ✔ Disability
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The literature review conducted prior to this research indicated that those with physical or mental disabilities required access to social inclusion opportunities; supplies; essential services; as well as training, education, and employment. This research found these accessibility needs to be accurate however the actual ability to access these needs did vary within the county.
Similar to older adults, the interviews identified a clear emphasis on independent living amongst those with physical or mental disabilities with the option to move into a care facility being a last resort. Service providers also acknowledged the mobility limitations of their clients and adjusted their delivery accordingly. For instance, Participant 11 provided the following statement:
“The model of service is to go to where people are. I think that we also realize that, if you look at the geography of the communities in the Huron-Perth area, think of all the offices you would need to have; Clinton, Wingham, Seaforth, Goderich, and on and on. And wherever you place an office, you still wouldn’t get people because there are a lot of people who may be close to Mitchell or Seaforth but they’re actually in the little dots of places in-between or really living in the country. So our model is that our workers go to see people where they are and we do that even in Goderich.” (P11)
In contrast, Participants 7 and 8 do offer their services from a central location and therefore provide transportation for those that need it.
Overall, the service providers felt that they were meeting their clients’ needs to the best of their ability. Indeed, each of them offered elements of the aforementioned accessibility needs and provided ways to reach them. For instance, Participant 8 described one aspect of their services as follows:
“With the lunch program we probably have some people who would otherwise just sit at home and wouldn’t socialize and probably wouldn’t get a whole fair meal. A lot of them don’t eat breakfast so they come here and get a really good lunch and then they go home and have a small meal. So here you’re looking at their nutrition and healthy eating...They get involved in the program to
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socialize to get exercise, there’s group learning here. There may be art classes plus some vocational and peace work happening.” (P8)
This quote relates to social inclusion and access to supplies (food) with similar findings from
Participants 7 and 11. Similarly, each participant supported their client’s access to education/training, particularly around life-skills, as well as access to employment either by providing it directly or mediating between clients and employers.
Nevertheless, there were some service gaps identified by interview participants and particularly “We don’t leave anybody. If they want to get here we’re going to around their geographical coverage, their differing figure out a way to get them here. Which does limit a lot of things. mandates, and obstacles associated with the existing We don’t have buses. We do have taxi cabs but the cost is quite transportation services. In terms of geographical high.” (P8) disparities it was found that Participant 7 covered only the southern half of the county and the comparable organization covering the north half did not offer a comprehensive transportation service. Similarly, while Participant 8 and 11 each worked with those with mental illness they did not offer identical transportation service with Participant
8 providing more transportation but only within a small geography in the south of Huron County.
Another gap in the service availability was raised in regard to the organization’s mandates. Indeed, Participant 7 provided comprehensive transportation for its physically disabled clients in order to meet each of their accessibility needs and even stated that “our people are well looked after. It’s the people that don’t drive, those that are too poor to own cars or too old to be able to drive, those are the ones who have problems in Huron County” (P7). However,
Participants 8 and 11, each working with clients with mental illness, could not meet some accessibility needs. For instance, Participant 11 provided transportation on limited occurrences
89 and described the destinations as primarily “medical. It might also be anything related to finances, they might need to go to the ODSP office to verify income. There are groups offered at hospitals that are educational in nature, coping with depression for example...and not just psychiatric appointments but also physician appointments” (P11). However, when asked about access to supplies, such as groceries, Participant 11 stated: “no, we don’t do that. Again this is based on the philosophy of wanting people to be independent...They might if the person is not getting proper nutrition, but more around helping them choose what food to buy, but not as the transportation source” (P11).
The third and final gap identified in the interviews relates to the existing transportation services, particularly around cost and availability. For instance, each participant raised the high cost of taxi services in relation to their clients’ limited financial resources with Participant 8 stating:
“We have used the taxi, which again is pretty phenomenal for the cost. For some people in town, because of the distance, we do provide transportation to get to the drug stores to get their medications with the van or they come here and we get them back home should they choose to use the taxi. Again it could be $15 just to get their medication plus any over and above fees for that.” (P8)
Similarly, the cost for clients to access the EasyRide service was raised by interview participants.
Indeed, it was stated that while EasyRide would provide transportation for those with physical or mental disabilities Participants 4 and 8 noted that provincial assistance would only cover the costs for medical appointments. For instance, Participant 8 provided the following statement:
“I know of people that aren’t hooked up to agencies that need services in other areas. How do they get there? If it isn’t a medical need Ontario Works and ODSP don’t cover it. It could be a learning skills group, how do they get there?” (P8)
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Participant 8 also noted that while EasyRide can conduct financial assessments, which may lead to financial assistance in the form of cost sharing, this participant questioned whether this was adequate in terms of the number of clients who receive assistance as well as the degree to which they are subsidized. This participant also raised the issue that available financial assistance for transportation often operates through a reimbursement method with considerable paperwork that this participant identified as complex for those living with mental illness. Nevertheless, for those that can access the service it was identified by Participant 8 to be quite comprehensive and stated that they “will pick them up at the door and take them to the bank, to the drug store, to the grocery store and will help them get their stuff inside too” (P8).
In addition to the cost of existing transportation services, the issue of the availability of these services was raised. While Participant 7 felt that they were adequately available to meet the needs of their clients with physical disabilities, Participants 8 and 11 each noted that, while they did their best, they did have limitations. Participants 8 and 11 both noted that they were not fundamentally transportation services and merely provided transportation in cases where their clients had no other options. The result is that their transportation is operated on a more ad hoc basis where their staff will drive clients if necessary but do not advertise that such a service exists.
For perspective, Participant 11 estimated that providing transportation would constitute 75 per cent of their staff’s available time were they to provide it wherever it was requested. This participant also provided the following statement about their transportation service:
“This is the challenge for the case manager. You could use all your time being a driving service but that’s not our primary function. You’ve got 20 clients you’re trying to provide support to and you can suck up a lot of time by driving people. So they will drive but they’re going to look for volunteers first. The other thing that we find is that our staff are quite resourceful, so they’ll say
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‘they’ve got to go once a week to employment’ so they look to friends or family and as a last resort the case manager will provide the transportation.” (P11)
Participant 8 provided a similar statement regarding their transportation role:
“Staff do attend medical appointments but only if they need support during those meetings. Otherwise we would run into the problem of just going from medical appointment to medical appointment like a taxicab. We do try to limit that as staff timing and the amount of clients we have are increasing and so are the demands of the more complex clients that we are getting.” (P8)
As these quotes demonstrate, Participants 8 and 11 are not in the business of providing transportation but due to the needs of their clients and the availability of alternatives will do so when necessary. The result is that they are unable to meet all the needs of their clients due to limited time and resources.
A final point raised by Participant 8 is that of stigma and those living with mental illness but not seeking assistance from their organization. This participant provided the following quote on this topic:
“The stigma of mental illness is still out there and our referrals are increasing. If you take a look at the economics of what’s going on today and the rising costs of things and the cutbacks that are happening there’s more and more people out there I’m sure that have some form of illness that haven’t come forth due to the stigma that is there...for example someone who just lost their job and is suffering from anxiety might not come forth due to pride and we might not even know about it.” (P8)
This participant speculates that there are individuals residing in Huron County who need transportation but, due to the stigma or mental illness, do not seek it. Assuming this is an accurate assessment, this means that if a general-use transportation system existed those who need transportation, but are unwilling to be identified as mentally ill, would use the service.
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5.2.3 Trends
The interview participants also provided some observations around existing trends that may impact their clients or services in the future. In particular, increasing fuel prices were considered a concern by both Participants 8 and 11. The limited and inflexible budgets of these organizations made the increasing and variable cost of fuel an issue.
Moreover, Participant 8 raised the issue of the economic recession and the impact that has had on their organization. Indeed, this participant raised the connection between job loss, or other causes of stress, exacerbating mental illness or bringing it to the forefront; with specific mention of anxiety and depression. This participant noted a recent increase in the number of clients coinciding with the economic recession and described the parallel issues of an increasing number of clients, constricting budgets, and increasing fuel costs as a concern for their service delivery in the future.
5.2.4 Design Characteristics
Throughout the interviews participants identified a range of design characteristics necessary for a successful transportation service to meet the needs of those with physical or mental disabilities. In some ways the needs of older adults are quite similar to those with physical or mental disabilities however there are key differences which will also be identified here.
The first thing to note when discussing the needs and capabilities of those with physical or mental disabilities is that they are highly variable. Indeed, Participant 11 noted that:
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“The thing to keep in mind when you’re talking about mental illness is that it isn’t cognitive disability. Generally the folks that we’re working with are very intelligent and capable from that standpoint it’s not a developmental disability.” (P11)
However, when asked about the ability to use a conventional transportation system Participant 7 stated that some of their high functioning clients could use a service but most could not as they require personalized support. This means that some of those living with physical or mental disabilities in Huron County could make use of a conventional transportation service but many would require individualized support in order to meet their transportation needs.
Another important consideration for a transportation system is the frequency that those with physical or mental disabilities require transportation. It was identified by Participants 7 and
8 that their clients require their service on a daily basis during the week as well as having other transportation needs in the evening and weekends. For instance, Participant 8 stated that
“I know there is some socialization that goes on after [we are] closed. And because of certain health needs some people cannot get around...How do they get involved in that group that runs specifically at night and it’s a 3 block walk and they cannot walk it?” (P8)
Nevertheless, due to hours of operation it was noted that most of their clients required transportation on a 9 to 5, Monday to Friday basis.
Furthermore, when considering the design of a transportation service it is important to note where those with physical or mental disabilities are residing. The interview participants stated that their clients were residing throughout Huron County as well as not being concentrated in the main settlement areas. Indeed, Participant 11 stated that:
“If you were to create a graph of where people’s locations are they’re all over and not most of them living in the main communities...They might prefer to live in [a major centre] but they can’t afford to live there because it’s going to cost more.” (P11)
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However, Participant 8 did note that a transportation system did not need to perfectly meet each of their clients’ needs in order to be useful. Indeed this participant noted that if a system did exist case managers could work with clients to determine appropriate routes and schedules to meet their needs. As well, it was mentioned that this organization could better fill the gaps between client needs and an existing transportation system rather than attempting to cover complete trips and being overburdened, as is currently the case.
A final, yet very important consideration when designing a transportation service to meet the needs of those with physical or mental disabilities is the role of volunteers. Quite unlike transportation provided to older adults, the participants working with those with physical or mental disabilities rarely, if ever, made use of volunteers. Instead, transportation was provided by staff trained to meet the unique needs of this group. Indeed, the limited role of volunteers is partly due to the need for training in order to work with some people with special needs.
However, the issue was also raised that there is a stigma around people with disabilities that deters the use of volunteer transportation and, as stated by Participant 8, “mental illness frightens people” (P8).
This is a very important consideration as the needs of older adults were being reasonably well met through the use of volunteers. However, for real or perceived reasons volunteers do not seem to be comfortable working with those with physical or mental disabilities. For instance,
Participant 1 stated that:
“One thing we ran into with our volunteers, especially when it comes to mental health, and again you cannot discriminate, so we were transporting clients who were unstable. Kind of going into a department store and having a major [issue] and because most of our volunteers are seniors, they’re elderly folks, and they don’t have a hand for it... You have to protect your volunteers.” (P1)
Participant 4 provided a similar statement regarding their transportation for health purposes:
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“We do most of our transportation with volunteers so it’s maybe not always appropriate to match a client we aren’t familiar with but we know there are mental health issues. Our comfort level with putting that individual in a volunteer’s car, where that volunteer is willing to drive, but that volunteer is not trained to handle situations. It’s not fair to our volunteers. We can’t put them in situations that they do not feel they are in control of.” (P4)
Indeed, these participants clearly indicated that they did not feel comfortable transporting people with mental illness using volunteers and instead use trained staff or even taxis (P1 and P4). This raises questions around stigma for those with mental illness and the perception of unsafe conditions for volunteers. It also raises questions around the willingness of volunteers to transport those with physical or mental disabilities and a potentially selective volunteer base more interested in working with specific demographic groups.
To conclude, this research found that when applying the section of the research framework relating to Huron County residents with physical or mental disabilities it is found that these individuals often experience mobility limitations as well as varying access to necessary services/activities. Indeed, it was found that access varied based on geography, with those in the south of the county being better served than those in the north. Similarly, it was found that those with physical disabilities had better transportation provision than those with mental illness due to the differing capabilities and mandates of the organizations serving each group. It was also found that existing transportation services may be unaffordable for some individuals or only meet specific needs, in particular healthcare access. Finally, when designing a transportation service it is important to consider the needs of those with physical or mental disabilities as well as the practicality of certain models, with particular concern over the use of volunteers.
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Summary of Gaps in Access for those with Physical or Mental Disabilities:
Access to supplies (i.e. food)
Cost of existing transportation services
Geographical variance in access (south of county appears to be better served than north)
Those with physical disabilities appeared to have better access to transportation than those with
mental disabilities (specific mention of access to social inclusion and training, education, and
employment)
Those with disabilities that do not seek help due to stigma (specific mention of mental illness)
5.3 Youth
Youth residing in rural areas are typically found to experience transportation disadvantage typically due to legal restrictions, vehicle access, and financial limitations. The degree to which youth are transportation disadvantaged varies greatly between youth depending on their location, financial resources, age, and household characteristics. Indeed, some youth may be able to walk or bicycle to all their needs while others may be too remote to do so.
Similarly, some youth may have their own license and reliable access to a vehicle where another may be below licensing age and reside in a non-car family. Therefore, it is important to consider that being designated as a youth does not equate with transportation disadvantage, nevertheless there are obstacles that are unique or exacerbated for those within this age group.
When discussing the transportation needs of youth we can consider two distinct groups each with particularly different transportation needs and capabilities. Indeed, there are those youth that are at the age where independent transportation is important, which has been defined as between the ages of 12 to 19 by one author (Gilbert & O’Brien, 2005) or between the ages of
15 to 24 by another (Herold & Kaye, 2001). In contrast, youth in the younger age cohorts will
97 require transportation along with their parents/caregivers who may be transportation disadvantaged themselves, thereby making them disadvantaged by proxy. The total number of youth residing in Huron County in 2006 based on each definition is presented in Table 14.
Table 14: Youth in Huron County by Varying Definitions (2006) # %
12 to 19 7,140 11.65 under 12 8,548 13.95
15 to 24 8,319 13.57 under 15 11,177 18.24 Source: (Statistics Canada, 2006b)
Another important note is that youth may be living in very different living situations, which adds to the complexity of the needs of this group. For instance, interview participants discussed youth living on their own as well as youth living in family units. Similarly, participants mentioned the issue of homelessness with Participant 6 stating that:
“In rural communities it is absolutely hidden. I can tell you that in the past there have been youth that have slept in parks for weeks on end. Right now there are young people that are couch surfing from place to place and have no idea where they are going to go next” (P6).
It is also important to note that participants mentioned the mobility limitations of parents with young children but also the additional limitations placed on young parents, still considered youth themselves, with young children. Overall, it is important to keep in mind that, like with all groups, the issue of transportation disadvantage exists on a continuum, with some youth more disadvantaged than others.
The following sub-sections will assess the degree to which youth residing in Huron
County experience transportation disadvantage. The key source of information is the interviews conducted in Huron County with service providers working with youth. In particular,
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Participants 6, 9, and 12 provided the most relevant information for this demographic group. A summary of these organizations is provided in the following table:
Primary Client Primary Service Description Group(s) Category Participant 6 (P6) Youth Access to Shelters and Participant 6 provides support Support and shelter to youth, specifically in their upper teens, in Huron County. This organization provides transportation as a last resort for medical appointments or other essential services on a case-by-case basis. Participant 9 (P9) Youth Social inclusion Participant 9 provides social inclusion opportunities particularly through the form of recreation. This organization works with youth particularly 10 years and older with clients across Huron County. This organization does not provide any transportation assistance to its clients. Participant 12 (P12) Youth Social inclusion; Skills Participant 12 provides social, training recreational, and learning opportunities for young children (under 10) as well as skills training and other learning opportunities to their parents. This organization does not provide transportation but does conduct its services throughout Huron County in an effort to bring the service closer to rural clients.
5.3.1 Mobility Limitations of Youth
“A car is seen as a necessity in this area rather than a luxury even though if you talk to people at Queen’s Park they’ll say that a car is a luxury” (P12).
Youth residing in Huron County generally face mobility limitations due to legal restrictions, limited vehicle access, few financial resources, as well as often overlooked practical
99 limitations. Interview participants working with youth indicated that their clients generally walked to destinations if possible, relied on others to drive them, or even hitchhiked. Within the most rural parts of the county where active transportation is not an option, parents were generally relied upon for transportation, however it was also noted that they were not always willing or available to provide transportation for every destination. This puts youth in a difficult situation, particularly due to their somewhat unique limitations which will be discussed here.
As described in Chapter 2 of this thesis, youth in Ontario may obtain a G2 license at age
17 (or slightly sooner with driver’s education training). This means that anyone below age 17 is completely reliant on others to meet their mobility needs either as drivers or passengers.2 For instance, Participant 9 stated that their youth clients began accessing their services independent of their parents at age 10 and those within walking distance regularly did so. However, this participant also noted that those outside walking distance were completely reliant on others to drive them between the ages of 10 and 16.
An additional consideration around the issue of licensing is that of youth at licensing age being unable to obtain one due to financial or vehicle access issues. Indeed, in order to obtain even the most basic driver’s license youth require a vehicle to undertake testing. Participant 6 raised this issue and states that:
“For some of the young people that live independently we do our best through donations to provide them with their G1 to increase their employability. So for some young people we are able to do that if they are living on their own and don’t have any other resources” (P9).
2 Within the Ontario Driver Licensing system those holding a G1 may drive but only with fully licensed driver who has at least four years driving experience. 100
This indicates that for youth living independently, or in low-income households, access to a vehicle and financial resources can restrict the ability to obtain a license even once licensing age is reached.
In addition to licensing restrictions, youth residing in Huron County also face mobility limitations due to limited vehicle access. There are two aspects to this issue that have similar results. Indeed, youth without a driver’s license will require someone to transport them to their destination whereas youth with a driver’s license, but who do not own transportation, generally rely on family vehicles. In each case youth face limitations in vehicle access either due to vehicles being in-use or drivers being unavailable. During the interview process Participant 9 commented on the particular limitations of youth relying on transportation from others in obtaining mobility:
“Definitely in the youth there are a lot of rural members and a lot of their parents are farm parents and they’re not going to be able to drive their kids in all the time and then pick them up. So there is a challenge in getting those kids in here. Now the older ones that can drive on their own we see and the younger ones, say those in swim lessons, parents tend to get the mentality that if there is a scheduled event they’ll bring their kids. But just to bring them for the evening to hang out or go swimming we see less of that” (P9).
This participant observes that youth relying on others for transportation are particularly limited in their mobility with specific mention of the busy lives of parents. Participant 9 went on to note that they felt the long distances that parents had to drive youth also deterred them from providing transportation to non-vital destinations.
However, it is also important to keep in mind that some youth residing in Huron County are in one-car or no-car households. This issue was raised by Participants 6 and 12 who noted that youth may not have access to a vehicle at all or will have secondary access to their parents’ vehicle. For instance, with regard to young children Participant 12 stated that for some one-car
101 families “the vehicle was being used for work and that leaves the other partner at home. So they may have a vehicle but they don’t have transportation outside of work hours and that creates isolation for a lot of families” (P12).
An additional mobility limitation for youth in Huron County is a lack of financial resources. This issue was frequently raised with regard to youth and their families by interview participants. For instance, when asked why transportation was a difficulty for their youth clients
Participant 6 stated that:
“It’s definitely financial. Their only option would be a cab and they simply cannot afford that. And not just for the youth that I work with but their families as well. We’ve encountered families that are in financial distress and they can’t even get to their Ontario Works appointments either to apply or meet the requirements of every 3 months checking in” (P6).
Similarly, Participant 5, who works with youth as one of several client groups, stated that:
“They may be too young to drive, they may not have parents at home to drive them, they may be old enough to drive but not have a license, or they might not have a car because insurance is so expensive especially for young males and young people more generally... Taxis are expensive and they really could be spending on something else, especially for young parents. If they’re trying to live on their own and they don’t have family support and they’re trying to buy their own food that can be a huge barrier as well” (P5).
In each of these quotes we see that financial resources are a major obstacle for youth and their mobility. Indeed, this applies to youth living with their parents, families with young children, and youth living on their own.
The final mobility limitation to be discussed here is practical obstacles to youth mobility which are often not considered in discussions of transportation. For instance, when discussing parents with young children Participant 12 noted that:
“Even if they tried to share vehicles, you have a mom with two or three kids and she wants to share a vehicle with another mom and they want to come to the programs together there isn’t enough room in the vehicle for carseats” (P12).
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While this may seem like a minor point it may very well be a reality for many families and a significant limitation to their mobility. This quote provides an example of a practical mobility limitation however there are likely many others that must be recognized when considering transportation disadvantage within the county.
5.3.2 Accessibility Needs of Youth
“We’re running a parenting program in the evenings from the office here and a mom in Goderich would come, it’s not that far, but has no transportation to get here so she misses out. We offer some of the things as a group to make it more cost effective but it still means that some people can’t participate” (P12).
Primary Accessibility Needs
Access to Access to Access to Social Access to Training, Essential Shelters or Inclusion Supplies Education, and Services Other Support Employment Services
Youth ✔ ✔ ✔
Within the literature on transportation disadvantage, youth are generally considered to be in need of social inclusion; access to training, education, and employment; and access to shelters or other support services. The interviews conducted as part of this research reaffirm these findings however also add additional needs not originally considered.
The interviews conducted with service providers in Huron County working with youth found that these organizations recognized the mobility limitations of their clients and, in two of three cases, made efforts to mitigate them. Indeed, Participant 6 who provides access to shelters and support services for youth does not have a central office and instead goes to each client individually to provide their services. Participant 6 noted that: 103
“We meet with young people primarily in their schools, in their family homes, in coffee shops or restaurants wherever the young people are...This is on our opinion the best way to supply the service to young people” (P6).
This service design was created out of a recognition that youth are often without transportation in
Huron County and particularly low-income youth which make up the majority of this organization’s clients. While very costly for the organization, by going directly to youth this organization eliminates the need to travel in order to access their service. Furthermore, when asked if they provided transportation for youth themselves Participant 6 stated that:
“We do transport young people as well. For example if they require an Ontario Works appointment or a doctor’s appointment there are times that we would transport and times we would send them in a cab... The odd time we’ve helped out with transportation to and from work but that is very unusual circumstances. It’s not something we can make a habit of based on our budget. So when I say absolutely not, there are sometimes that we make a decision that it’s in their best interest for that to occur but it depends on each individual. But we’re not going to take them on an hour long ride to go hang out with friends on a Friday night and we have had requests for that” (P6).
Like many organizations in Huron County, Participant 6 provides transportation on an ad hoc basis out of necessity due to the needs of their clients and the lack of alternatives. However, as stated, these are almost exclusively for financial assistance appointments or medical purposes.
The other organization that has made efforts to mitigate the mobility limitations of its clients was Participant 12. This organization does have a home office but conducts the vast majority of its service delivery throughout the communities of Huron County. Indeed, Participant
12 states that:
“In some places we do lending and programming. So we have qualified staff to do child programs for these kids in their community rather than have them travel to bigger centres to get that early education or just that play experience... [We] generally take our programming out to the community because of the transportation issues. Most of the people we work with are lower income families some may have vehicles and if they do have vehicles it costs a lot to insure them and put gas in them so they have to be very careful about where they go” (P12).
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Again, Participant 12 recognizes the mobility limitations of their clients, in this case parents and young children, and states that “if we didn’t go out probably no one would benefit from the programs” (P12). However, unlike Participant 6, this organization does not, generally, go directly to the homes of clients and rather reduces the distance that they need to travel by providing programs in smaller communities. This organization recognized that some families may still be unable to participate due to their inability to make it from their homes to these smaller centres. Also unlike Participant 6, this organization does not provide transportation services themselves.
Therefore, we see that between these two organizations the need for access to shelter and other support services is reasonably well addressed within the county. Similarly, efforts have been made to provide improved access to social inclusion and parenting skills training to young children and their families in the most rural parts of the county. However, the interviews did identify gaps in accessibility needs for youth in the county, particularly around access to social inclusion/recreation for all age groups and for access to employment.
The need to access social inclusion and recreational opportunities is essential for the development of youth of all ages. However, the interviews identified that there was no opportunity for rural youth to access these services if they did not have their own transportation or someone available to drive them. For instance, Participant 6 states that:
“Those that are attending school do have the ability to be bused to and from so that is helpful. But again there are limits. So they get picked up at quarter to 9:00 in the morning and need to be on the bus by 3:15 so no extracurricular activities and no opportunities for employment” (P6).
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This quote refers to the inability of rural youth attending primary or secondary school to participate in sports teams, clubs, social activities, or other ‘in-town’ events or activities if they cannot secure a reliable ride home.
This issue was reinforced by Participant 9 whose organization works with youth by providing access to social inclusion and recreational opportunities. This participant stated that:
“The people that we miss based on transportation the most would be 10 to 13 year olds that don’t live close enough to walk and the people that don’t necessarily have special needs and aren’t affiliated with any community groups” (P9).
This participant went on to elaborate the following about this observation:
“I think that a key thing would be that we don’t have a lot of programs for people that fall in between. Meaning that we have a lot of programs for people that have either physical or financial difficulties and those people seem to be able to get access. And the people that seem to be doing well and have time and disposable income seem to be able to get access. It’s the people in between that we don’t seem to have any programs for. It’s those people that I would say if you focus in those areas they would have the most impact. The regular middle income people where money might be a little tight but not enough that they qualify for social programs. Those are the people that have the most potential to come” (P9).
This is referencing the gap whereby youth without access to transportation and who are also not recognized as in-need by another service group may be excluded from participating in this organization’s activities. During the interview Participant 9 provided the following case, which reinforces the view that youth would be interested in attending their service were they physically able to reach it:
“This year we have kind of a unique situation in town...now they found mold in one of the rural schools last year and since they had recently closed a school in town the school board decided to move those [rural] children into that other [closed] school in town. So the kids are mostly rural kids out in the country. And one of the anomalies that happened because of that is now we have all these rural kids in town and we offer free skates a couple days of the week and we started seeing 20 or 30 kids from that school who would come over after school to go skating because for them it was always an hour bus ride and then they would go home and do their farm chores or just sit there and they didn’t have a lot of opportunity to do those kinds of things. So those kids are now close
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enough where their parents feel comfortable with them walking over with their skates and doing activities on their own...It’s a unique situation and a good example of youth that wouldn’t normally have access to the facility. And we have seen more of them engaged in activities because they are in town and close enough where they can just walk over here” (P9).
This story provides a very interesting case of a group of rural students suddenly being provided access to this facility and their significant uptake. It suggests that the obstacle to their participation is their limited mobility, not limited means or interest.
Participant 9 also raised another issue for social inclusion and access to recreation, at least within the context of their organization. While Participant 9 provided a generous financial assistance program for youth unable to afford membership costs it did not provide any transportation for low-income youth. This suggests that were youth able to physically reach the facility they may be able to afford the membership costs due to this reduced rate, however this gap has not been addressed.
In addition to access to social inclusion and recreation for youth, the need to access training, education, and employment is not entirely addressed within the county. Within the county the school bus service guarantees all youth access to primary and secondary school. As well, there are no postsecondary institutions in the county; nevertheless there are opportunities for online degrees, which reduce or eliminate the need to travel for this level of education.
However, the interviews frequently cited the issue of youth being unable to access employment due to mobility limitations. For instance, Participant 12 stated that:
“If you live in this community and you don’t have a car it is impossible to find a job. Often a lot of the jobs, except the very low paying ones, anticipate that you’ll be driving. If you take a look at the job ads around Huron County they will say ‘your own reliable transportation is required’ because you aren’t going any place in any other way. So the expectation is that people have those basics even before employment” (P12).
Participant 6 made a similar statement around access to employment for youth:
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“It is difficult to find employment if they cannot find employment in their local community. So if they are living in a place like Brussels, they don’t have any employment options outside of their community unless they can find transportation. It is difficult to find someone who is willing to make that kind of commitment to get them to and from. So there are definitely barriers around employment opportunities” (P6).
Because youth often do not have access to their own transportation, maintaining employment commitments is a major obstacle. If finances are the main obstacle, which they often are, it may also lead to a vicious cycle of not having access to employment resulting in an inability to afford a personal vehicle resulting in an inability to obtain employment.
A final consideration around accessibility needs raised in the interviews was the issue of youth living independently outside of a family unit. “There are some young people that, When discussing youth we often assume that those for a variety of reasons, are living completely independently. And those within this age group are living in their family home are the ones that require the most support. What happens is that they and are reliant on parents or caregivers in order to meet move to rural areas due to the affordability of rent. So often these are their basic needs, such as food and shelter. However this old farmhouses in the middle of nowhere and once there it really limits is not the case for all youth residing in the county. their ability to access any kind of resources” (P6). Indeed, some youth have decided to live independently voluntarily while others have had to live alone due to family conflicts among other drivers. For youth living in these situations the mobility limitations will be largely the same as other youth, however the accessibility needs will be expanded. In practice, it may be expected that these youth have limitations and needs more similar to those with low-income than with youth residing in family units.
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5.3.3 Trends
The interviews conducted as part of this research identified several trends which may be expected to impact the mobility and accessibility needs of youth in Huron County. While often speculative, due to their experience as service providers it is worth noting their observations and to consider what impacts these trends may have on rural youth.
The interview participants each regularly referenced the economic crisis and the issues for mobility and accessibility needs this has caused. For instance, Participants 6 and 12 who provide services mainly to low-income households each noticed an increase in demand in recent years while, Participant 9 who provides social inclusion and recreation saw a decline in enrollment. On a similar note Participant 6 stated that the Goderich tornado also exacerbated this existing trend:
“We’ve never had a shortage of young people. The numbers keep increasing every year and the needs of the young people keep increasing. We’ve seen a huge impact after the tornado. At first we thought it would be a small trend but we’ve got families with unresolved trauma and grief, which is impacting the entire family dynamic and there’s been job losses and people have been displaced from their homes. So I don’t foresee a shortage of need” (P6).
While not necessarily a trend, the results of the tornado in Goderich may be expected to be felt for years to come due to the loss of homes and livelihoods somewhat similar to the effects of the economic recession.
Another trend found to be impacting the delivery of services and their youth clients is the increasing cost of fuel. Both Participants 6 and 12 demonstrated a concern relating to their ability to meet the needs of their clients due to the fact that they deliver their services in the community and already spend a considerable amount of their budgets on transportation. Indeed, when asked about the impact of the increasing cost of fuel Participant 12 provided the following:
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“I think for sure that has impacted us in two ways. First is that of participants coming to the program so if it means groceries that week or driving to the program we’re not going to have them show up. But for us too we really need to think about where we are going to offer programs. So it’s sort of like putting a puzzle together, we can run programs over here by having them all in one area but maybe the real need is over there. So do you sacrifice the three programs you can run cost effectively or do you go to another area in need?” (P12).
This suggests that these service providers will have difficulty keeping up with the demand for their programs due to the dual issue of increasing fuel costs and stable or declining budgets.
In addition to the issues of the economic recession and increasing fuel prices, participants also touched on the issue of youth out-migration and the role of transportation availability. In particular, Participant 12 stated that:
“Demographically the smallest proportion of people living in Huron County are those between the ages of 16 and 25...most of them have transportation of some kind. Those that don’t are generally living in the towns or have more incentive to leave” (P12).
While perhaps based on speculation, this does provide an interesting consideration around what drives youth to leave rural areas. Indeed, if a young person is unable to afford a vehicle but has the option to move to a larger centre which is more walkable or has a public transportation service they may be more inclined to leave their rural community.
A final trend mentioned by interview participants is that of increasing activity levels in youth and reducing childhood obesity. Only Participant 9 raised this issue in connection with transportation access however this individual did provide an interesting observation:
“In my era, when I was a child, children played on their own. We organized baseball games in their own backyards or in the field and said ‘I’ll meet you on Saturday’ but that’s not the way it works anymore. Everything is scheduled. We schedule a playdate and kids used to just play. That’s typically the way it works here. If mom and dad know that Thursday night is the night they like to go to the gym then they bring their kids. But if it’s not scheduled they don’t feel it is something they need to do. Children are driven by their parents’ need to have everything scheduled” (P9).
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Again this is speculative, however is based on years of observation and experience in the field of child development and recreation. If accurate, it would suggest that in order to combat obesity and increase youth activity in rural areas access to organized sports or recreation facilities (such as gyms or skating rinks) is becoming increasingly necessary.
5.3.4 Design Characteristics
Interview participants also provided ideas and issues around the design of a potential transportation service meeting the needs of youth in the county. For youth in school it is quite clear that these individuals require transportation after school, on weekends, and in the summer whereas those outside of school may require transportation at any point in the day. However, the issue was also raised by Participant 12 that the use of volunteers for transportation within their organization is complicated by liability concerns as well as questions around the appropriateness for youth to ride alone with adults. Therefore, the use of volunteers may only be appropriate for parents riding along with their children or possibly for older teens, although questions were raised around whether a volunteer base existed interested in transporting teenagers to their various destinations.
The most commonly raised option for transporting youth throughout the interview process was expanding the role of school buses. For instance, Participant 9 stated that:
“If you think about it, all the kids that go to rural schools get picked up on a bus. So in theory if you had enough people interested in the programming, it would be no different to run a bus to pick them up and bring them to [their destinations]...typically those are the times of the year when the bus companies are available and not using those big yellow school buses. So the opportunity would be there. The challenge is organizing it and making it cost effective” (P9).
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Participants 6 and 12 provided similar comments on the opportunity to better use the school buses for non-school purposes. However it was noted that it may not be adequate for those outside of school who may require transportation when the school buses are in use.
Furthermore, interview participants provided their ideas on routing and destinations.
Participant 6 stated that:
“I think that some sort of regular busing that would hit every community on the way and come to a larger centre. For example in Exeter if they had a Huron Park stop and a Hensall stop and I think that would be utilized by every population” (P6).
Participant 12 provided a similar statement:
“It would be wonderful if you had a transportation system that connected Seaforth, Wingham, Exeter, Goderich and brought people on a regular basis. That would certainly address some of the needs of our at-risk families” (P12).
While merely the opinions of these two service providers these statements do provide a starting point for considering where those in need reside and where they are trying to reach.
In conclusion, this research found that youth residing in Huron County experience mobility limitations as well as restrictions in their ability to meet their accessibility needs. While there is a clear spectrum of risk of transportation disadvantage within those defined as youth, those residing in rural areas will almost always be reliant on others to meet their transportation needs. Moreover, Huron County has very few transportation options for youth. Indeed, this research found that youth had good access to education, at least until the end of secondary school, through the school bus service. As well, it was found that access to shelters and other support services was available to youth as service providers delivered this service to youth wherever they were located. Similarly, for young children and their families, social inclusion and parenting skills training was available within smaller communities meaning they would not have to travel to major centres to reach this service.
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The key gaps were identified as being access to employment and access to social inclusion and recreation opportunities for youth, particularly beginning around the age of 10 where independence becomes important. For these accessibility needs there is no transportation service available, aside from potentially taxi services which are very costly. Finally, it was identified that some youth are living independently and therefore require access to additional needs such as food or shelter.
Summary of Gaps in Access for Youth
Access to social inclusion opportunities such as sports, social gatherings, clubs, etc.
Access to employment
Access to basic needs for youth living independently
5.4 Low-Income
The issue of transportation disadvantage among individuals and households classified as low-income is widely recognized and has been a key finding in past reports within Huron
County. The most obvious reason for this is, of course, financial and the ability to afford reliable transportation. Indeed, those residing in Huron County and unable to afford a personal vehicle are generally reliant on active transportation modes (where feasible), rides from friends or families, or transportation support from service providers where it is within their mandate to provide it. This research found that interview participants unanimously agreed that mobility was an issue for their low-income clients however there was a clear difference of opinion around the issue of accessibility and whether certain accessibility needs were actually unreachable by this group.
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When discussing those classified as low-income we can use several different measures to determine whether an individual or household would be classified as low-income. While the
Market Basket Measure (MBM) is preferable in discussions of transportation in rural areas, data for Huron County could not be identified. Therefore, for the purposes of this section the Low-
Income Cut Off (LICO) measure will be used as presented in Table 15. It is also important to note that while often used interchangeably, the terms low-income and unemployed are not synonymous. Those deemed to be underemployed and working few hours or for low pay may be expected to experience the same level of transportation disadvantage as those without employment as the financial threshold for reliable car ownership is quite high, and rising with the increasing cost of fuel.
Table 15: Prevalence of Low-Income Classification in Huron County: Low-Income Cut Off Measure (2005) Total Number Low Income After Tax (#) (%) Total economic families 16,900 3.3 Couple economic families 15,120 2.5 Male lone-parent economic families 415 2.4 Female lone-parent economic families 1,235 13
Total persons 15 years and over not in economic families 6,555 15.5 Males 15 years and over not in economic families 2,950 16.1 Females 15 years and over not in economic families 3,605 15
Total persons in private households 57,845 4.8 Total persons less than 6 years of age 3,745 8.5 Total persons 65 years of age and over 9,600 0.8 Source: (Statistics Canada, 2006a)
As demonstrated in the preceding table, as of 2005 Huron County had 16,900 economic families of which 3.3 per cent were classified as low-income as well as a total of 57,845
114 residents of which 4.8 per cent have low-income. It is important to note that within those living in economic families, female lone-parent families had a much higher proportion of households with low-income at 13 per cent. Similarly, children less than 6 years of age also had a higher presence of low-income classification with 8.5 per cent. This is of particular concern as women with young children are at a heightened risk of transportation disadvantage, as discussed in the previous section on Youth in Huron County.
For those outside of economic families Table 15 demonstrates that, as of 2005, a total of
6,555 residents were not in an economic family of which 15.5 per cent were considered low- income. This is considerably higher than those within economic families. When broken down by males and females it is found that the percentages are much the same.
The following sub-sections will assess the degree to which low-income households in
Huron County experience transportation disadvantage. The key source of information is the interviews conducted in Huron County with service providers working with those classified as low-income. In particular, Participants 2, 3, and 10 provided the most relevant information for this demographic group. A summary of these organizations is provided in the following table:
Primary Client Primary Service Description Group(s) Category Participant 2 (P2) Low-Income Access to Supplies Participant 2 is a food bank Households located in Huron County. This organization does not provide transportation for its clients. Participant 3 (P3) Low-Income Access to Training, Participant 3 provides services Households Education, and primarily to low-income Employment households in order to help them access training, education, and employment at multiple locations in Huron County. This organization does not provide formal transportation for its clients.
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Participant 10 (P10) Low-Income Essential Services; Participant 10 provides financial Households Access to Training, assistance to low-income Education, and households throughout Huron Employment County as well as support in accessing training, education, and employment. This organization provides transportation for its clients to access medical appointments and some employment, education, and training purposes.
5.4.1 Mobility Limitations of Low-Income Households/Individuals
As mentioned earlier, those considered to be low-income households or individuals are widely recognized as having mobility limitations when “There are a lot of more rural people residing in rural areas. While this is mostly tied to the who can’t just walk or ride their bike in. So we see people hitchhiking. high cost of vehicle purchase and ownership, this They hitchhike into town for different things and definitely hitchhiking goes research also found that licensing was often an issue on” (P2). for this group. Indeed, Participant 2 states that in order to reach their service this organization’s clients “bike, walk, hitch a ride or get a ride with a friend or family, maybe they get a [case manager] worker, or they pay for a cab” (P2).
With regard to the issue of licensing, Participant 3 provided the following statement around the legal barriers that their clients face in obtaining mobility through the use of a personal vehicle:
“For the majority of my clients in Huron they just don’t have a license. So whether they have access to a vehicle through a friend of family member or not it’s not having their license. A lot of it is that they’ve had their license and then they’ve lost it and the fines have built up from lack of payments where its $7,000 or $8,000 and they can’t afford to get it back” (P3).
Participants 10 and 2 provided similar statements with Participant 2 providing the following:
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“Lots and lots of our clients do not have transportation. They just don’t have enough money to have a car or they’ve lost their license and don’t have money to get it back. People have ID issues where they cannot collect back the ID they need. They don’t have enough money to pay the fees required. So for whatever reason the majority of our clients do not have transportation” (P2).
The interview participants also noted that addiction was often an issue amongst their clients and that having clients who lost their license due to driving under the influence (DUI) charges was common. This situation made it difficult for their clients to leave the circle of poverty if they did not have transportation access.
Nevertheless, the main mobility issue for low-income households or individuals residing in Huron County is the inability to afford a personal vehicle. Participants noted that there were a range of issues preventing their clients from purchasing a vehicle including the initial cost, maintenance, insurance, and fuel. For instance, Participant 2 stated about their own clients that:
“They cannot afford the insurance and they don’t have the money up front to get one. But then to keep the vehicle on the road for most people, no. There are some clients that have them, and they’ve had whatever happen to them, like a medical problem, but they’ve managed to maintain their vehicle and keep it running and it has been a priority for them. But for most people, like if you’re on Ontario Works, to get a vehicle, I don’t know how you would” (P2).
Participant 3 reiterated this issue by stating that “for someone that is on Ontario Works and living on $600 or $700 per month even if you own a car once you pay for the insurance that’s such a large portion of your cheque gone it’s just not feasible for a lot of them without employment” (P3).
However, going beyond the actual ownership of a vehicle, Participant 10 went on to discuss the issue of having a reliable vehicle. On this issue Participant 10 provided the following statement:
“So there’s owning a vehicle, in which you are looking at maybe 10% to 15% [of clients] if you’re lucky and when I say owning a vehicle it can be the junker sitting in the side yard. And then you’re looking at people that have access and that might be friends or family” (P10).
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This issue was echoed by a service user in the recently completed transportation study undertaken in Huron and Perth Counties entitled “The Road Ahead”:
“I live in fear of something going wrong with the car there’s no way I can afford to get it fixed. So I’m pretty careful about how I use it and how much. Sometimes I give my friends a lift and they help me with the gas. And sometimes they gift me a lift, too” (Lynn Bowering Consulting, 2012).
Participant 10 expanded on this point with the difference between owning a vehicle, and owning a safe vehicle for both their clients and other drivers. Indeed, for the safety of other drivers on the road, Participant 10 stated that:
“If you did have a vehicle the challenge becomes upkeep, your challenge becomes your license every year, and the challenge, especially in a rural community this is huge, is insurance. So you opt not to have insurance, which isn’t something that is monitored, but happens a lot within our client base” (P10).
Here this participant is describing the situation where their clients cannot afford insurance, but due to the necessity of vehicle ownership, illegally drive without it. Similarly, this participant described the issue of driving unsafe vehicles with the following quote:
“I would say the majority had vehicles before they came on assistance. So [the vehicles] may not be new. Quite often there are issues around whether they are [government] safetied, and can be safetied. I’ll give you an example: a wonderful woman had been abused but has all the services around her now, her partner is in jail, her problem now is safety. She insists on living in a rural farmhouse and has three children, older, but have medical issues. So she has an old junker, $900 to fix the vehicle, but you invest the $900 and tomorrow something else could go wrong. If she invests the $900 then she doesn’t have the money to keep up the insurance and to keep up the licensing. So it becomes a Catch 22. Within our policy we do have the ability to fund minor repairs, but what becomes minor? To me that’s needing a new tire, or the water pump’s gone, or something, but it has to be to a vehicle that tomorrow something else isn’t going to go. And that is a challenge” (P10).
Here this participant is describing the issue of low-income individuals driving unsafe cars because they cannot afford to make repairs or purchase a new vehicle.
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Nevertheless, participants also reiterated that their clients were often able to obtain mobility through rides from friends or family. Indeed, Participant 10 stated the following:
“So you have a unique situation in Huron County where family generally helps family. Or you get pockets of individuals that are on assistance that support each other. So one of them has a car and you kind of lean heavily on that person and that increases the numbers [with access]. So I think everyone on social assistance would say they don’t necessarily have reliable transportation but the problem solving skills to find transportation to get where they need to be for appointments is there for probably 75% of our clients. That’s just a rough guess. But I would say probably [the other] 25% are either new to the county and haven’t build the friendships or don’t have relatives to support them, or have burnt bridges” (P10).
Participant 5, who also works with low-income households and individuals, provided a similar statement:
“Sometimes we get really down on this issue and we forget there are lots of good people providing rides to their neighbours, their friends, or their relatives. Imagine if that wasn’t happening. But it’s really the people who don’t have that relational safety net around them that are in the most trouble when they don’t have the connections. They don’t know their neighbour or they don’t have strong relationships in their community” (P5).
Overall, the participants agreed that the role of friends and family was key to providing mobility to their low-income clients. However, it was also frequently noted that these rides were not always available, particularly for time-sensitive destinations such as employment or reaching the food banks during their operating hours.
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5.4.2 Accessibility Needs of Low-Income Households/Individuals
“I would argue that people who most need our services have the least access to them due to a lack of transportation. So if they cannot afford $2.50 for the [Stratford] bus then they may not be able to get across town in time for their appointment. If they have children they may not be able to afford childcare. So it really is the most vulnerable people that need the services but cannot access them due to transportation availability” (P5).
Primary Accessibility Needs
Access to Access to Access to Social Access to Training, Essential Shelters or Inclusion Supplies Education, and Services Other Support Employment Services
Low-Income Households/ ✔ ✔ ✔ ✔ Individuals
Those considered to be low-income are expected to be in need of social inclusion opportunities; supplies; essential services; and training, education, and employment.3 While low- income households and individuals are often seen as unable to meet these accessibility needs due to a lack of mobility, this research found that the ability to access these needs varied greatly depending on what low-income households or individuals are attempting to reach. In particular, it was found that support existed in reaching medical, financial assistance, and employment related services however there was no transportation support provided to reach supplies
(specifically food) or social inclusion opportunities.
3 That is not to say that they do not require access to shelters and support services but rather this is not inherent in residing in a low-income household. 120
With regard to social inclusion opportunities, this research did not identify any transportation support for low-income households or individuals. As mentioned in the preceding section on youth, Participant 9 provides financial assistance to low-income families in order to gain access to social inclusion and recreation “We do get some from those opportunities. However, it was noted that there was underlying areas. For our service, if transportation is a problem for them, not transportation support available and therefore Ontario Works will usually pay for a cab to get to appointments. But I the majority of those taking advantage of this mean, as far as their daily activities go, grocery shopping and that kind of program were within walking/bicycling distance. stuff, it’s not available” (P3).
Nevertheless, it was mentioned by one participant that there may be transportation for social purposes provided by faith based organizations however specific examples were not identified. Overall, it was found that very little, if any, transportation support was available for those with low-income in order to provide access to social inclusion opportunities including attending civic functions, voting, and recreation, among other social inclusion needs.
This research also identified that access to supplies was sometimes an issue for those with low-income due to limited mobility. Of course, access to food is essential for everyone however those with low-income require access to affordable groceries or food banks. With regard to affordable groceries, Participant 10 stated that “where the difficulty is, is with the [clients] that are in smaller locations like Brussels, Blyth, Bayfield where you don’t necessarily have a cost effective grocery store. If you have one, prices are going to be high” (P10). The issue of heightened food prices in rural areas was also raised by other participants during the interview process.
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Moreover, access to food banks is a particular accessibility need for some of those with low-income. This research found that food banks generally recognized the mobility limitations of their clients and did their best to reduce the need to travel by providing food bank locations across the county. However, one food bank, Participant 2, also recognized that they did not have the resources to provide transportation for their clients which left some needs unmet. Indeed, this participant stated the following:
“We don’t have a lot of volunteers who do driving for us [specifically a total of 2 volunteers driving 3 clients]...but it’s not a service I can offer either as delivery or a volunteer driver. There have been situations where I have been very concerned about someone walking with the amount of groceries or their health and I have cabbed them home. But I can’t do that on an ongoing basis, we don’t have the funding to cab people to the food bank and back every time they come” (P2).
Like many organizations in Huron County, Participant 2 did provide transportation or delivery in rare cases on an ad hoc basis. However, due to limited resources this is not a service they can advertise. Moreover, Participant 2 went on to emphasise the inability, and in some ways inappropriateness of providing deliveries for their clients to eliminate the need for mobility to access this service:
“I have on rare occasions delivered. Mostly around Christmas time. Just kind of trying to make it work out for someone at the last minute. But generally I can’t really be delivering. The other thing is that people that come here choose their own food...so they like to come in and see what there is, what they want, and what they will use” (P2).
The issue was also raised that even for people who could walk to the food bank it was not necessarily practical. Participant 2 provided the following statement around that issue:
“In the two towns where we have family services offices or food banks people can walk there if they are well enough. They use grocery carts or bikes and a bag or they just carry the food home. But sometimes that’s really hard. I mean, that’s a lot to carry on a bike. So they might make two trips and if they’re in town that’s ok. Some may be lucky enough to have someone who can drive them, making sure it coincides with the time we are open. People, if they don’t have a ride, are usually walking. But if they are not well, or it’s very hot or very cold, that’s worrisome” (P2).
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Participant 2 also noted that for people outside the settlement areas access was even more of an issue due to the increased cost of using a cab and the inability to walk or cycle to the food bank.
This participant provided the following quote around that issue:
“I think in the city it would be reasonable to pay a couple of bucks and hop on a bus and go to the food bank and back. It would still be money out of their limited amount if you think about someone on Ontario Works but it’s worth it because you’re going to get this amount of food. But to justify a $20 cab ride you just can’t do it” (P2).
Overall, it was found that access to food was an issue for those with low-income in Huron
County and particularly for those outside the main towns due to the increased cost of groceries and the difficulty of reaching food banks.
Another need for those with low-income is access to essential services, such as healthcare or financial assistance programs. Within this accessibility need interview participants generally agreed that transportation was available to ensure mobility for low-income households and individuals. In terms of access to healthcare services, interview participants noted that Ontario
Works provided transportation, in the form of financial reimbursement, taxis, or EasyRide, in order to access medical appointments. Participant 10 expanded on this point to note that transportation was also provided in order to access psychologist appointments with the following statement:
“We have a psychologist that provides cognitive assessments for us on various clients. Since her time is worth a lot of money we taxi people, even if they have a vehicle, to ensure that they get to the appointment” (P10).
Similarly, it was found that access limitations are also considered when delivering financial assistance. Participants 3 and 10 noted that Ontario Works has a mandatory 3 month check-in with their clients which are conducted over the phone if their clients are unable to reach it in person. However it was also noted that the initial appointment to apply for Ontario Works had to
123 be conducted in-person and transportation was not provided for this purpose. Overall, it was found that access to essential services was placed as a priority for these organizations and that this accessibility need seemed to be well met.
Probably the most unique accessibility need for those with low-income is access to training, education, and employment. With regard to access to training and education, participants did not raise this as an issue, likely due to the limited availability of postsecondary institutions within Huron County. Indeed, Participant 3 stated that if their clients wished to pursue postsecondary education they generally had to leave the county and therefore their jurisdiction. Nevertheless, it was noted that Ontario Works would provide transportation for clients wishing to reach educational or training opportunities on a case-by-case basis as well as access to the training workshops they provide within the county.
When discussing the need to access employment this topic garnered some polarization of opinion over whether this need was adequately met. Indeed, this differing of opinion seemed to arise from different organizational values and particularly around the question of choices and the personal responsibility of their clients. When discussing this topic we can see two connected issues, that of accessing employment counselling, job search tools, interviews and other activities in the pre-employment stage and secondly accessing a workplace on a regular basis to attend employment in the post-employment stage.
Within the pre-employment stage, participants recognized the limitations for their clients and made efforts to work within them. For instance, Participant 3 noted that their funding is only provided if clients go to them in person thereby reducing their ability to provide home visits to their clients without transportation. Similarly they noted that many of their clients did not have
124 access to a computer or the internet at home thereby reducing their ability to provide online services to their clients in the place of physical visits. Instead, this organization provided the following statement around their service delivery model:
“I would say half, if not more, of my case load at least doesn’t have internet and in a lot of cases even a computer. As far as we go, we set up locations throughout Huron in: Exeter, Goderich, Clinton, and Wingham. We try to do the best we can to get to the different main areas to see them so they don’t have to try to find transportation and so they aren’t coming from Clinton to Goderich every time to meet with us” (P3).
While not a perfect system for those living outside these settlement areas, this model does at least reduce the distance they will need to travel.
With regard to accessing interviews and other pre-employment stages, participants noted that they also provided transportation for these purposes. Indeed, Participants 3 and 10 each provided transportation in order to obtain employment with Participant 3 stating:
“In the case of our clients, if they need to go meet with an employer and they don’t have transportation I will take them to meet with their employer to have an interview or deliver their resume” (P3).
However, once employment was obtained it was found that little transportation support existed.
Participants 3 and 10 noted that transportation support from Ontario Works was available for the first week of employment (depending on the first pay period) however even at this point those with low-income were unlikely to be able to purchase a vehicle and gain their own transportation.
The interviews found differing opinions as to whether this lack of transportation support provided in the post-employment stage was actually an issue. For example Participant 5 stated that:
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“I would argue that transportation is a barrier also to employment which creates a larger dependency on those services. So if someone needs to get a job out of town because there is nothing in the community they are living in then they are going to have an issue getting to the interview and the job every day. The nature of the jobs that are available to some of the people in those circumstances aren’t very high paying so the idea of them even being able to afford transportation even with a job is unrealistic” (P5).
Nonetheless, this was not necessarily seen to be a problem by Participants 3 and 10. This is where the question of choice and personal responsibility was raised by participants reflecting an organizational value. For instance, Participant 3 stated that:
“I think people make choices to live where they live and lots of people we see have opportunities for employment in other areas but they refuse to move. So the opportunities are there, they’re choosing not to take them. It runs into a Catch 22 as well, because a lot of clients for us live in Clinton because the Vanastra area is cheap housing but there’s no employment. So it’s cheap housing with low employment and a lack of transportation or having a job and living in a more expensive area” (P3).
Participant 10 provided a similar statement:
“The assumption is that you have choices when you take a job. If it is outside of your community you either find someone that is working in that organization coming from your community and you get a ride or you move” (P10).
These quotes demonstrate a very clear position from these service providers that if one does not have the transportation to access employment then they have the choice to move or decline the position. Recognizing the other perspective, Participant 10 provided the following statement:
“If your doctor’s here, your family’s here, your support system is here, there’s services you go to here, all that. [Moving is] not something people will do. It’s hard to get a doctor and there are people that need their support system in their life whether it’s their friends or family a professional or whatever. They aren’t going to move away from that because all the other issues in their life could deteriorate” (P10).
This participant presents the opposing case that community supports may be important for those with low-income and outweigh the benefits of employment. This suggests that the position that those with low-income should merely move to find work where available is not realistic nor necessarily in the best interest of low-income households and individuals.
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However, Participant 3 in particular did not see this position manifesting in a loss of opportunity. This participant noted that their clients had “We don’t see it as a big issue because creative ideas when it came to accessing the services it’s always been what we’ve worked with. I think people we are working they wanted or needed and that they had never heard of with who don’t have a car say ‘oh my God I can’t get there’ but when you a client losing their job because they did not have start talking with them about options and different things they could do it access to transportation. In fact, this participant went on opens things way up” (P3). to discuss how they felt the lack of transportation was sometimes used as an excuse by their clients who did not wish to find employment and provided the following statement:
“There’s people that say they can’t come because they can’t afford the gas but you know that’s probably not true, they pissed it away on something else. Right? They use that as an excuse because they just don’t want to see you” (P3).
This participant also noted that some clients perceived that they were unable to access employment due to a lack of transportation, but again this participant saw this as an excuse.
Around this issue Participant 3 provided the following example:
“So I have a client who we have been working with for a long time, a middle-aged man, and we were helping an employer do some hiring by having aptitude tests done by about 400 people. He had one of the highest scores of those 400 people and got offered an interview but it was not within the town that he lived in. Because he just lived in a small place and he would have had to move to Listowel. So because the job was in Listowel, he totally sabotaged the interview. And he’ll say he can’t get anywhere because he doesn’t have a vehicle...So he sabotaged it because he doesn’t want to have to leave and go somewhere else” (P3).
Through this research it is difficult to say how much of the issue of transportation access for employment purposes is a reality and how much is perceived. Indeed, Participant 3 in particular felt that public transportation could be beneficial for their clients in accessing employment but it was not a necessity.
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5.4.3 Trends
The participants in this research identified two trends as impacting their service delivery to low-income households and individuals in Huron County. The first trend was the economic recession and recent closures of major employers which was increasing their case loads but reducing their available funding. The second key trend put forth to participants was that of increasing fuel prices. This question garnered differing responses. Indeed, Participants 3 and 10 felt that it did not impact their clients very much as very few of them drove anyway. However, it did impact their own service delivery as it increased their costs for providing transportation to these clients. In contrast, Participant 2 did feel that it impacted their clients indirectly with the following statement:
“For clients coming in I would definitely say that the days where you could give someone $5 to drive you to the food bank are over. People are a lot more reluctant to do driving favours because of the cost of gas” (P2).
As an indirect impact this observation may, or may not, also hold true for other organizations but has not yet been recognized.
5.4.4 Design Characteristics
This research also identified several important considerations for a potential transportation service in order to meet the needs of those with low-income. For this group it is important to keep in mind that individuals may require transportation at any point in the day.
Indeed, they may require transportation for medical appointments or access to the food bank during the day whereas they may also need transportation in the evening for social inclusion or employment purposes. It is also important to note that, inherently, this group is without much
128 disposable income and therefore fares would need to be kept low or financial assistance programs made available to those in need.
When discussing transportation options, interview participants provided a few of their own ideas or observations. For one, it was noted by Participant 10 that volunteer drivers would probably not be appropriate for the needs of this demographic group. While it may be appropriate for other groups, it was observed by this participant that their low-income clients often faced stigmas in the population and that volunteer drivers wishing to transport this group were hard to find. Participant 10 provided the following statement related to this situation:
“A lot of the volunteer base is seniors. And that is wonderful having a senior driving a senior or driving someone who is very sick or has a sick child and that works very well. Within the social assistance realm, people that have been longer term unemployed there seems to be a high rate of alcoholism and drug addiction...So looking at clients for probation, the court system, or even a general medical appointment there is a level of, maybe this isn’t the right word, but risk involved...It just takes that one incident to put the flags up to say, do you want a senior who is a volunteer to be put at risk to provide that service? So it’s kind of stigma but it’s kind of a reality” (P10).
This participant reiterated that for most of their clients it would not be a risk to have volunteers providing transportation, but also that they are not in a position to decide who is a risk and who is not. For this reason, it is deemed inappropriate, and likely unrealistic, to expect a volunteer driver to provide transportation for their clients.
Instead, Participant 10 favoured a formal transportation service and suggested the following design as a starting point:
“The transportation service could start by connecting the towns, and whether that is hospital to hospital for a starter or whether it is to the core of each town. And regular, two or three times a day, so there is a time schedule” (P10).
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This participant felt that this would begin to meet the needs of their clients but also allow them to reduce the amount of public money they spend on transporting people their entire route and allow them to instead fill the gaps by transporting their clients to hubs which connect with buses.
Furthermore, like many other participants, Participant 3 favoured an expanded use of the school bus system. Indeed, Participant 3 states that:
“We do have buses driving through the county every morning and every afternoon that are half empty. The school buses are half empty, why can’t they be utilized better? They are going anyway; there would be no additional cost to filling it up....Offer people $10 to get on the bus. They have a set schedule and you know what you are getting” (P3).
In a similar vein, Participant 10 favours the use of school bus companies, but not necessarily school buses, as existing transportation companies which already have expertise in rural transportation.
In conclusion, it is found that those with low-income residing in Huron County are at risk of transportation disadvantage. This research identified multiple factors that may limit this group’s mobility, as well as gaps in their ability to reach their accessibility needs. In particular, the interview process found that access to social inclusion and supplies (i.e. food) may be difficult for low-income individuals and households that lack their own mobility.
Correspondingly, the interview process found that transportation assistance did exist to support those with low-income in accessing essential services (i.e. healthcare), education and training, as well as pre-employment support. However, a key gap emerged with regard to post-employment access to workplaces on a regular basis. Nevertheless, while the gap in transportation support existed, this accessibility need was questioned by some participants as to whether or not it was a problem.
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Summary of Gaps in Access for Low-Income Households and Individuals
Access to social inclusion opportunities (including civic functions)
Access to supplies (particularly affordable groceries and food banks)
Reliable access to workplaces once employed (debated as an issue)
5.5 Women
Women residing in rural areas are often considered to be at a heightened risk of transportation disadvantage. However, this is a complicated discussion as women have no inherent reason to be transportation disadvantaged and it is impossible to say that every woman residing in a rural area will be at risk. The recent Huron and Perth Counties transportation study provides a good description of why women’s transportation needs and limitations differ from men’s:
“Many women in rural areas are consistently without access to transportation. Even more are without full access to a personal vehicle. Women’s access to personal vehicles may be affected by their status in the household and by their income level. In many cases, men control the use of the household vehicle, making women dependent on alternative forms of transport, if available. Women are often at a disadvantage in securing personal transportation because they generally earn less than men, making vehicle ownership difficult. Women’s transportation needs are also different, because they are often responsible for maintaining the household and spend more time in caring roles, requiring them to travel to different places at different times than men” (Lynn Bowering Consulting, 2012).
Indeed, the issue of transportation disadvantage among women cross-cuts each of the demographic groups presented in this chapter. While women have essentially the same mobility limitations and accessibility needs as men, it is generally found that these are exacerbated within each demographic group. For instance, older women may not have a license or have less experience driving due to the social expectation of men being the drivers in the household.
Similarly, parents with young children are often found to be at risk of transportation
131 disadvantage, which in practice tends to be mothers. This issue has been raised within each section and therefore this section will concentrate on an issue faced mostly by women, that of domestic violence.
While men are not immune to being the victims of domestic violence, in most cases women (and children) are the victims. It is particularly around this issue that women have a unique risk in the ability to reach shelter or support services. Therefore, while not the only transportation issue faced by women, this will be the focus of this section. The content for this section came primarily from two sources working with domestic abuse among women:
Primary Client Primary Service Description Group(s) Category Participant 13 (P13) Women Access to Shelters and Participant 13 provides access to Support shelters and support services for a range of clients but with an emphasis on women. For those facing domestic abuse, Participant 13 provides transportation for a range of purposes including access to shelters and counselling, among other support services. Participant 14 (P14) Women Access to Shelters and Participant 14 provides access to Support shelter and support. This organization operates a women’s shelter in Huron County as well as providing a crisis line; counselling; advocacy; housing search support; among other supports for women facing a crisis of any kind. This organization provides transportation in order to access their own services as well as for accessing health and other essential services for their clients.
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5.5.1 Mobility Limitations of Women
More generally, women may have mobility limitations for any number of reasons and, for the most part, can be expected to have the same mobility opportunities and limitations as men.
Nevertheless, when compared with men, women do face social or cultural obstacles which may reduce their mobility. Participant 14 in particular argued that there are socio-cultural expectations and gender socialization that unevenly distributes access to mobility among men and women. This participant went on to describe their observation:
“I think there is still, even though we are in 2012, a truth that for men and boys getting a driver’s license and having a car is seen as a rite of passage and so the likelihood that would happen in your teenage years is probably heightened for boys. That doesn’t mean that it doesn’t happen for girls, but it isn’t the same rite of passage, it’s not tied to your gender identity in the same way if you are a girl, it’s very tied to gender identity if you are a boy. So that then translates to the likelihood that you are going to get to be 19, 20, or 22 years old and not have a license. There will be more of those women that do not have a license than boys and men” (P14).
While such an observation is difficult to prove conclusively, it is an important consideration for the mobility limitations of women. Especially since, as Participant 14 observes, “I think in a rural community those rigid gender roles are more firmly held” (P14).
Moreover, when discussing domestic violence this research found two key mobility limitations for women in abusive households; finances and control. This research found agreement between Participants 13 and 14 that most of their clients in Huron County who were victims of domestic violence had low-income. Participant 14 specifically provided the following quote around the issue of finances:
“Some women that come to us are working but it’s a truth that shelters provide support to a skewed population. Abuse happens in all socioeconomic groups however those that would choose to use a shelter would be those in the lowest socioeconomic group because they would not have other resources” (P14).
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This is an issue for women in low-income households as they may live in a one-car or no-car household making it very difficult to escape an abusive situation using their own transportation.
Participant 14 also noted the socio-cultural element in this issue of vehicle access:
“Anecdotally, I would suggest that certainly if you are a one car family the likelihood that the man of the household would be deemed to have a greater need for the car would be a truth. For women who are living in abusive relationships their ability to negotiate the use of the car would be diminished” (P14).
This observation suggests that even for women living in a household with a vehicle she may not have access to it as her access may be considered secondary.
Another key consideration for women in abusive households is that of control of transportation. This is an issue that is rarely considered as it is less tangible; nevertheless the reality for women in abusive households may very well be that there are one, or even two, vehicles ‘available’ however she may not have the ability to use them. The interview participants provided more specific explanations around this issue, particularly in a rural context. For instance, Participant 13 stated that:
“It’s also about safety too. Often times, for women abuse, what will happen is their abusive partner will isolate them. So they will get them into the country where there is nobody around them. And even if they have the means to have a vehicle, they’ll take it to work. And if they have the means for two vehicles, they’ll take the keys to the second vehicle to isolate her. So if something happens and she doesn’t have a vehicle to get into and escape, she’s at risk” (P13).
Participant 14 provided a similar description around their experience with control:
“The central thing about abuse is control and so partners who are controlling always control access to vehicles and transportation. So that would be one of the highest reasons that women would not have access to a vehicle, or have access but not be able to use it because they couldn’t explain, or it would be dangerous to say ‘I went to Wingham to meet with a councillor’” (P14).
These participants raised an important issue about the mobility of women from abusive households. Indeed, it suggests that their mobility limitations may go beyond access to a vehicle
134 to practical obstacles such as not having the keys to use them or psychological barriers such as the fear of using a household vehicle.
5.5.2 Accessibility Needs of Women
“A huge piece of what the Victim Quick Response program does is offer transportation. So that sort of links in to what we do, because that is something that, just due to our rural-ness, for people to get to any type of support service, or counselling, or medical, I have a long list of stuff, transportation is a huge roadblock” (P13).
Primary Accessibility Needs
Access to Access to Access to Social Access to Training, Essential Shelters or Inclusion Supplies Education, and Services Other Support Employment Services
Women ✔ ✔ ✔ ✔ ✔
Women, of course, require access to a range of services and activities with few differences from the needs of men. The previous sections in this chapter have addressed more specific sub-populations such as women with low income, older women, or women with young children. Therefore, this section will concentrate on a key accessibility need that does differ from men; access to domestic abuse shelters and other support services.
Within Huron County service providers working with victims of domestic abuse recognize “We work really hard, recognizing the limitations of the lack of the mobility limitations of their clients. For transportation, to take our services to the community” (P14). example, Participant 14 provided the following statement about how the support side of their service is provided:
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“We have an outreach councillor advocate, and I believe this speaks highly in terms of a rural response, because we recognize that women may not have any transportation or even if she has a car she would not be able to explain to somebody why she has used the gas or used the car. And so sometimes it’s important for a woman to be able to access our services in her own hamlet or village. So what we have created is a network of places to meet for women in virtually every hamlet and village in Huron County. The way we are able to do this, with a very limited budget, is that we have partnered with churches who give us space free of charge. However, in the rural context it’s important to recognize that, generally speaking, everybody knows what everybody does all of the time. And if you are in an abusive relationship, disclosing that puts in a much higher risk category... So women can decide for themselves which is the most appropriate place to meet based on their access to transportation, or lack thereof, and their need for confidentiality or anonymity” (P14).
This quote demonstrates that Participant 14 is well aware of the mobility limitations of their clients as well as the issue of confidentiality and anonymity associated with their service which must also be met.
Moreover, Participant 14 provided a crisis telephone line, which does somewhat reduce the need to travel for some of their clients. However, this participant also explained why they did not offer support services directly in the homes of clients:
“What we don’t do, is we do not go into individuals homes. We don’t do that because always when someone is living in an abusive relationship they are living with some level of denial about the danger in which they are living. If we go into that home we are colluding with her in terms of saying ‘it isn’t dangerous’, when we know it actually is so we would not put her or our staff member at risk by doing that” (P14).
This is another important consideration as we often assume that the best way to deliver a service to the client would be to go directly to where they are and eliminate their need to travel.
According to this participant that is not always an appropriate route.
When it comes to accessing shelters women in abusive households must find a way to reach these destinations. Within Huron County it was found that both Participants 13 and 14 provided transportation for this purpose. Indeed, Participant 13 states that they provide transportation using volunteers:
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“The volunteers are driving people if they need to get to the women’s shelter, or to go stay with family, or they need to be put up in a hotel for the night...anything that the victim needs in that moment we will provide transportation for” (P13).
This participant expanded upon the transportation support to discuss other needs associated with domestic abuse beyond shelters and support:
“If we’ve supported somebody and they call our office and they are down-and-out without any money to get food and her husband is in jail and he isn’t allowed to have contact with her, that’s a pretty common call, what we would do is we would pay for a taxi to get to the food bank” (P13).
Participant 14 provided a similar transportation service for their clients; however they do not use volunteers and instead rely on taxis:
“We use taxi cabs. That is not an ideal response as you can well imagine. Again, issues of confidentiality and anonymity although we certainly have met with the cab companies and some of their drivers and we’ve asked them to be confidential. We don’t feel as though we have a lot of control over that. So it’s not an ideal situation...Cabs run very limited hours, generally they stop running at 11 or midnight on weekdays and 2 am on weekends and so we had to enter into a contract with cab companies so that they would be willing to be on call for us 24/7...but this is still precarious as they could change their mind if it no longer seemed to be a good business practice” (P14).
Also similar to Participant 13, this participant provides transportation to other services for their clients beyond just access to the shelter itself:
“A good portion of women that come in initially come in a cab. Often if police have intervened and they’ve told her to call the shelter, a cab is sent to get her...we also use cabs for services, like if a woman needs to go to the hospital or to a doctor’s appointment. If there are safety issues about she or her children going someplace in the world, children to school for instance, it is not safe for them to walk because we fear parental abduction. Then we use cabs for all that as well. We have a pretty hefty cab bill” (P14).
As demonstrated here, service providers working with women who are victims of domestic abuse do provide transportation for their clients. While costly from an organizational perspective, from a user’s perspective the county seems to be well served by the current system.
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Nevertheless, it should be noted that Participant 14 did provide one gap in their service delivery which should be noted:
“I think there are unmet needs. I think we’ve done some really good creative work historically to put these systems in places in recognition of the rural-ness of the community and the lack of transportation. But there are certainly pockets where we don’t have a lot of contact with people. The Northern part of the county, in the Wingham area, we seem to have less referrals or self- referrals. Is that a transportation issue? Probably it is one of the factors” (P14).
This observation suggests that access may be unequally available for women based on geography, with those in the Northern part of the county experiencing a particular limitation in mobility and access. Nevertheless, overall access was found to be available for most women in the county whenever needed.
5.5.3 Trends
The interview participants for this research did not identify many trends associated with their clients’ ability to access transportation. However, one trend that emerged was the economic recession. Indeed, Participant 14 observed the following:
“Certainly we know that in Huron County the economic drivers have been leaving the community. Three years ago the closing of Champion, 500 really well paid jobs. The recent closing of the airport the recent closing of the Bluewater Centre again 200 jobs, some of the best paid jobs, that you’d find anywhere in the province. I understand Zellers is closing so again another collection of jobs...so as the economics lower in the community, people’s access to transportation is going to be lowered, in terms of their own ability to have their own transportation and to the best of my knowledge there is no public system that is going to jump up and take its place” (P14).
This participant observes that the economic recession may be reducing the availability of transportation for the lowest socioeconomic groups. This participant went on to describe the issue of stress and their observation that job losses and the recent Goderich tornado had resulted in increased stress and that this has increased the demand for their service. The reason for this
138 observation was explained as: “there is a truth that, while not a cause of abuse, when there are further stressors it can be a trigger” (P14).
5.5.4 Design Characteristics
“I think that a transportation service would meet a lot of the needs for women that are in our programs. It may actually act as a preventative too...if there was a regular kind of transportation system women may more readily find each other, find supports, and we know that when women have more education and more access to better financial lives the likelihood that they will leave an abusive relationship is increased” (P14).
As discussed here, both interview participants working with women who were victims of domestic violence provided transportation. However, they both recognized that there were limitations associated with their services. Indeed, Participant 13 relied heavily on volunteers which brought its own limitations. For instance, they depended on the goodwill of their volunteers and recognized that this organization could not afford to adequately reimburse them for their mileage. In fact, this participant admitted that if every volunteer claimed their total mileage the organization did not have the funds to reimburse them therefore counting on volunteers to absorb their transportation costs themselves. Nevertheless, this participant felt that the service worked reasonably well and that they had not been experiencing any loss of volunteers due to increasing fuel prices or the aging population.
In contrast, Participant 14 did not make use of volunteers due to the sensitivity of client needs and the immediate response required in crisis situations. Instead, this organization made considerable use of taxis in order to meet the transportation needs of their clients. This participant noted that the use of taxis was very costly for their organization however did seem to meet the needs of their clients.
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Overall, both participants agreed that a public transportation service would be useful in meeting some of the needs of their clients; however they both also agreed that it would not meet all of them. Indeed, Participant 13 noted that they did not expect that their volunteers would use a public transportation service in order to reach a client in immediate need of support, nor would that client be expected to ride a transportation service in order to reach their support services; particularly as they are often in a state of grief or shock when access is required. Similarly,
Participant 14 explained that their clients may need immediate access to a shelter at any time of night if a crisis situation occurs and therefore a 24/7 cab system would still be required to meet their needs. Thus, in the case of women who are victims of domestic abuse, a public transportation service would likely not be able to meet all of their transportation needs although it may meet some.
Summary of Gaps in Access for Women:
Access to education and employment to pre-empt domestic violence.
Secondary access or lack of control over existing vehicles.
Geographical variation in access (observation of less access to shelters/support in North
of county).
Overall, access to shelter and support seems to be available for women in Huron County.
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5.6 General Considerations
This research identified several considerations for transportation in Huron County which cross-cut the demographic groups presented in this chapter. This section will briefly mention these issues as they are important to consider when discussing transportation issues and options in the county.
5.6.1 The Car Culture of Huron County
The participants in the interviews conducted as part of this research often mentioned the car culture of Huron County as being an obstacle to implementing a successful transportation service. Indeed, the data presented earlier clearly “We ‘drive to the fridge for a beer.’ I demonstrates that residents are structurally mean we drive for everything that’s what you do in the country” dependent on their vehicles and shifting the (Interview Participant 12). mindset to using a public transportation option may take time. For instance, one participant raised the issue of stigma around using a public transportation service and the concern that even those that need the service may not use it for this reason.
5.6.2 Liability and Regulatory Limitations
The issue of liability and regulatory requirements limiting the ability of organizations to provide public transportation is often raised as an obstacle and therefore interview participants were asked about their experience with this potential issue. Responses to this question were varied. For those participants who already offered transportation, they generally did not feel it would be a problem for them to transport people outside their mandate. However for those organizations that did not provide transportation, they often mentioned that the cost of insurance
141 would likely prove to be an obstacle. Moreover, one participant explained their opinion as to why the issue of liability and regulation is generally raised in discussions of public transportation:
“That’s an excuse. They may not want to pick up the general public because it is not within their mandate. They may be getting finances to help mental health patients, or those with Alzheimer’s, or people with cystic fibrosis [and their funders say] ‘that’s your mandate and we’re paying you to do that and you don’t help other groups’...I think a lot of that is self-imposed” (P7).
While this is merely the opinion of one participant, this comment does raise questions of how real the issue of liability and regulatory restrictions is, and how much it is used as an excuse.
This leads to another issue raised by participants: that of strict mandates and organizations
‘protecting their territory’.
5.6.3 Mandates and ‘Territory’
Another issue raised by participants is the issue of strict mandates and organizations wishing to ‘protect their territory’ thereby complicating opportunities to coordinate and leading to overlaps in service. For instance, Participant 1 provided the following statement around this issue:
“So how do you have all these agencies who need transportation work together in a partnership to use all those resources? Rather than together saying ‘this is ours, this is ours, and nobody can use it’. That’s what ends up happening because people become vey territorial asking ‘well if we don’t do it, is our funding going to be cut?’ So in my eyes when it comes to an especially rural area you have to start looking at what resources are out there and how do we access them all fairly. And it’s all for the client need” (P1).
Participant 4 provided a similar statement around this issue of mandates:
“We get called from a number of clients who may not be seniors, but they don’t have cars and they live out in the middle of nowhere...seniors are our mandate and if they are not on ODSP or Ontario Works but they just don’t have money that is not our mandate and we do not have the resources to provide transportation. We recognize they have needs, but we just don’t have the solutions” (P4).
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This is another issue that must be considered when discussing a potential transportation service as it may seem logical to combine existing services however conflicts of mandates and territory may arise to complicate the process. This suggests that a neutral third party, such as a government department, would be required to coordinate the service.
5.6.4 Residents Unconnected to Service Providers
A further consideration that was raised during the interview process was that of residents of Huron County needing transportation assistance but not being connected to a service provider.
For instance, one participant working with youth observed that those with physical or mental disabilities may actually have better transportation access than those without, due to the eligibility requirements of existing transportation supports. This situation suggests that a general use transportation service may be most appropriate for meeting the needs of these residents rather than specialized transportation services with eligibility requirements.
5.6.5 The Question of Needs and Responsibility
One consideration that was raised throughout the interviews is the question of what is a need and whose responsibility is it to provide it? This is an important consideration when discussing transportation disadvantage, though a difficult one to conclusively address. Indeed, this question relates to individual values and will vary from person to person as to what a need is.
For instance, while most would agree that healthcare access is a necessity, some would question whether social inclusion exists on the same plane or whether a hierarchy of needs exists with some more essential than others. While a valid question, it is too value based to be conclusively addressed here and will vary with each individual’s perspective. Nevertheless, it is a question that underlies this research and therefore should be raised for consideration.
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A similar question arises with that of responsibility and the question of personal and public responsibility. This is the question of who should provide transportation for any given destination. For example, for those wishing to access social or recreational events, is it the responsibility of the public to provide transportation or is it the responsibility of the individual?
Similarly, when questions are raised about access to employment and education, is it up to the individual to find transportation or are these ‘public goods’ that warrant public transportation?
Again, this philosophical question is answered based on individual values but nevertheless underlies this research and should be raised for consideration.
5.6.6 The Theory of Planned Behaviour
A final consideration raised in the research, but not by interview participants, is the
Theory of Planned Behaviour. Quite simply, this theory describes the link between intentions to perform a given action and actual behaviour (Ajzen, 1991). Cullinane and Stokes (1998) apply this issue to rural transportation and state that:
The intention to change mode to walking or cycling from the car is as much influenced by ‘perceived behavioural control’ over the ability to change (their perceived ability to change mode in practical terms), as by ‘subjective norm’ (what they thought others would think), or their own ‘attitude towards the behaviour’. In addition they cite ‘habit’ as being a strong determinant of a lack of intention to change mode. This implies that attitudes may need changing to change behaviour, but also services need to improve and people need to believe they can change (Cullinane & Stokes, 1998).
This important theory needs to be considered in discussions of transportation anywhere, and for the purposes of this research the key consideration is that individuals may favour a transportation service, claim that they will use it, but they may not actually change their behaviour and do so.
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Chapter Six: Applicability of Transportation Models
In addition to assessing the presence of transportation disadvantage within Huron County, this research also intended to provide options for addressing the transportation needs of residents through a general use, intra-community public transportation system. In practice, the varying needs of the residents of Huron County make it very difficult to adequately recommend a single appropriate model within the scope of this research. As such, this chapter will provide ideas, insights, and observations around public transportation models that may provide a basis for further research on feasibility, but not a single recommendation for which option should be pursued.
The conventional model of public transportation was the most recognizable for most of the interview participants but also the least likely to be appropriate for the needs of the county.
The conventional model is inflexible and therefore could not make the door-to-door journeys that are required by older adults, parents with young children, and those with physical or mental disabilities. Due to the differing times that transportation is needed by residents of Huron County it is unlikely that, in present conditions, a fixed-route service could be scheduled frequently enough to be financially viable while also meeting the needs of residents. Nevertheless, it was found that a service between the settlement areas in the county could help to meet some transportation needs of residents. However another service would be required in order to bring those in small settlements and the countryside to these larger towns.
The flexible transportation model of public transportation is likely more appropriate for the needs and realities of Huron County. In fact, the EasyRide service follows a mix between this model and the community transit model by providing door-to-door service where clients call ahead (ideally with 24 hour notice) in order to reserve a pick-up. However, this service is also
145 specialized with little opportunity for the general public to make use of it. Moreover, it is based on a per kilometre fare system which is very costly for users and inherently costs more with increased rurality (distance from destinations). The existence, and apparent success, of this service suggests that with the right financial resources this could be expanded to meet the needs of numerous groups, were it affordable and had an increased rider capacity. However, a key weakness of the service would be those needing regular transportation, such as to employment, where a rigid service schedule is beneficial and where flexibility is less viable.
The third model to be discussed here is that of the community transportation model. This research found that there is considerable opportunity for this transportation model and that several organizations were already using it, in some form, through the use of volunteer drivers.
For some groups in Huron County the use of volunteers works well, for instance service providers working with older adults were found to have success with finding volunteers available during the times that older adults require service. However, for most other groups the use of volunteers was either not appropriate or available to meet their needs. For instance, for some of those with physical or mental disabilities a volunteer is not appropriate due to the level of personal support required. Similarly, it was not likely appropriate for youth to ride alone with adult drivers. Correspondingly, it was found that volunteers were not always available for groups such as those with mental illness or those with low-income who often face stigma in the community.
A secondary option within the community transportation model, along with volunteer drivers, is that of a community bus. There appears to be significant opportunity for service providers representing various groups to come together to create a formalized transportation service. Indeed, the research found that service providers were already spending a significant
146 amount of resources (human and financial) on transportation for their clients or by bringing their services to their clients. There may be an opportunity to pool these resources to create a new service, or expand “If you could take all of the agencies and all those pots of money and pool an existing one, to meet the needs of various them together, what could you do with that?” (P10). demographic groups and their accessibility needs. The issue is overcoming disputes over territory, mandates, and funding obligations which lend credence to the important role of local government in coordinating and facilitating such a project.
A fourth public transportation model is that of private taxis and opportunities for vouchers or subsidization. This research found that Huron County is well covered by taxi companies, which run at most times of the day. It was also found that service providers made considerable use of taxis to provide transportation to their clients. Due to the coverage of taxis, their lack of eligibility requirements, and their (almost) complete flexibility in terms of origins and destinations it can be said that taxis are available for most anyone for any purpose. However, while available, taxis are also not affordable for many people due to their high per kilometre rates which, again, increases their cost with rurality. Therefore, in order to better meet the needs of residents, the cost of taxis would need to be “Providing a taxi ride is very lowered either through the issuing of vouchers or a expensive for the tax payers. So if you look at it from an accountability subsidization of the service. For instance, vouchers standpoint, it’s not appropriate. Does it work at the moment? Yes, but it’s could be issued to those in need of transportation an expensive option. So how can we move people cost effectively around requiring them to provide a reduced flat rate in the county?” (P10). order to access a specific service with the issuing authority covering the remainder. In contrast, a municipality or collection of service providers could supply funds to taxi companies in exchange for a lowered rate, potentially through a tender
147 process. Theoretically, either option could work in order to make taxis more financially feasible for those in need of transportation.
The final public transportation model to be discussed here is that of the mixed services model. Within Huron County there are two key rural services that could theoretically be expanded to accommodate general ridership: school buses and mail delivery. This research found that the opportunity to make better use of the existing school buses was recognized by several interview participants. The recent “The Road Ahead” study undertaken in Huron and Perth
Counties also recommended that the opportunity to use buses in off-peak hours be explored. The use of school buses during the day, in the evening, and in the summer is an opportunity worth exploring. For some residents this may meet some of their needs, however not for all. For instance, those needing transportation for work purposes may very well require transportation when the buses are in use transporting students. Nevertheless, many services are only available during the day, such as medical appointments or food banks, which could be useful for some residents. Similarly, for youth in school evenings and summers are when transportation is most necessary for social inclusion, recreation, and employment purposes.
Thus, the use of school buses outside of school purposes is worth considering, however perhaps most useful is the fact that school bus companies are a local resource specializing in rural transit. Indeed, these organizations already have the knowhow and infrastructure to provide transportation in a rural context and therefore would be worth considering as service providers or partners under any public transportation model.
In conclusion, it is difficult to explicitly say which model is most appropriate to meet the needs of Huron County’s residents. Indeed, each model has benefits and drawbacks making it
148 appropriate for some groups or purposes but perhaps not others. This suggests that a mix of services may be the most appropriate to meet the needs of those without transportation access.
While volunteer drivers may not meet the needs of those with low-income or youth, they may remain the appropriate mode for older adults and those with physical or mental disabilities.
Similarly, we know that for women or children in abusive households, taxis are likely the only mode that can provide the immediate response needed in a crisis situation. Overall, it is important to consider what mix of modes is feasible for the community that also meets the needs of as many groups and accessibility needs as possible.
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Chapter Seven: Discussion and Recommendations
7.1 Discussion
The primary goal of this research was the development of a framework for identifying transportation disadvantage within the context of rural Ontario and the subsequent testing of this framework within the context of Huron County. In order to achieve this, 14 key informant interviews were conducted with service providers working with 5 demographic groups generally found to be at risk of transportation disadvantage: older adults, those with physical or mental disabilities, youth, those with low-income, and women. Moreover, it should be noted that the purpose of this research was to assess the breadth of transportation disadvantage but cannot speak to the depth of its presence in the county.
The term transportation disadvantage as used in this research is defined as “the inability to travel when and where one needs without difficulty. Transport disadvantage, as a concept, exists on a continuum, with some more transport disadvantaged than others” (Denmark, 1998).
This research strove to identify why certain groups were unable to travel (mobility) and what they needed to reach (accessibility). The research found that transportation disadvantage did indeed exist on a continuum within Huron County with certain groups more able to access transportation supports or alternatives than others. However, the research also identified that transportation disadvantage existed on a continuum not only between groups but within groups depending on the accessibility need wishing to be reached. For instance, youth are provided with transportation in order to access education until the end of secondary school; however transportation is not available for social inclusion or employment purposes. Therefore, youth
150 wishing to access education are not considered to be at risk while those wishing to access other accessibility needs would be.
In addition, it was found that transportation disadvantage was compounded by those belonging to multiple groups. For instance, low-income youth or older women generally faced additional limitations. This clearly arose during the research however was not explicitly accounted for in the framework. In fact, only the older adult and youth descriptors were mutually exclusive with the remainder being available in any combination. It is expected that with each additional descriptor an individual would face compounded limitations in their mobility and ability to reach their accessibility needs.
Overall, the issue of transportation disadvantage is highly complex and summaries of the gaps in access for each group are provided in their dedicated sections in Chapter 5. Nevertheless, it is possible to provide some degree of a summary here to identify which groups are most at risk of transportation disadvantage. In order to assess transportation disadvantage it is important to consider the difference between availability and adequacy. Indeed, in Huron County the private taxi service is available for essentially any purpose; however it is certainly not affordable for every group and accessibility need. Instead, in Huron County it is possible to use a simple framework for determining transportation adequacy provided by the Victoria Transport Policy
Institute (VTPI, 2012):
Affordability – Whether transportation options have financial costs within the targeted users’ budget. Availability – Whether transportation options exist at the location and time users require. Accessibility – Whether transportation options accommodate users’ physical and mental abilities, including the total journey experience (i.e., door-to-door). Acceptability – Whether transportation options are considered suitable to users.
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These four essential elements must be available in a transportation option in order to be considered adequate. For example, within Huron County older adults may access social inclusion opportunities using the EasyRide service. Unlike for healthcare access, for social inclusion purposes this service is not subsidized, thus while for this purpose transportation would be available, it would not be considered affordable and therefore inadequate for some older adults.
A generalized assessment using this framework is provided in Appendix A based on each demographic group and accessibility need.
Based on this assessment it is possible to identify particular gaps in access for groups residing in Huron County. As mentioned, the private taxi service is theoretically available for any group or purpose, however due to financial limitations it is likely unaffordable for most individuals within the demographic groups at risk of transportation disadvantage. With this in mind, affordability comes into question and where supports do not exist, we can expect that certain accessibility needs are out of reach for some groups. Below is a summary of the key accessibility gaps identified in this research:
Older Adults o Affordability of existing transportation services, particularly for social inclusion purposes Physical or Mental Disabilities o Access to social inclusion opportunities (particularly for those with mental illness) o Access to training, education, and employment (particularly for those with mental illness) o Access to supplies (i.e. food) Youth o Access to social inclusion opportunities such as sports, social gatherings, clubs, etc. o Access to employment o Access to basic needs for youth living independently Low-Income Households o Access to social inclusion opportunities (including civic functions) o Access to supplies (particularly affordable groceries and food banks)
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o Reliable and affordable access to workplaces once employed Women o Access to social inclusion opportunities o Access to supplies (i.e. food) o Access to training, education, and employment
Nevertheless, it is important to note that this summary is quite simplified and that the individual sections provided in Chapter 5 will provide a much more thorough picture of why, how, and for who the issue of transportation disadvantage manifests within the county.
Overall, it can be concluded that members of each demographic group can be considered to be at risk of transportation disadvantage depending on what they are attempting to access. One method to address this is the creation of a new public transportation system or the expansion of an existing one. It is outside the scope of this research to provide a feasibility assessment of any particular service. Instead, Chapter 6 provides ideas and observations, but intentionally stops short of a recommendation, to help guide future research on a feasible transportation service.
For other municipalities or researchers wishing to conduct a similar study, the framework used for this research proved to be a good starting point for assessing the presence of transportation disadvantaged groups. Nevertheless, it was found to truly be a starting point and that once interview participants got into depth on any particular group or accessibility need the framework was too simple to provide a complete picture of the issue. Moreover, it was found that most descriptors cross-cut groups as well as service providers. For instance, individuals may belong to multiple groups (i.e. low-income and older adult) and often did. Similarly, service providers often worked with multiple groups with similar issues, such as with older adults and those with physical or mental disabilities. In future use of the framework it may be worthwhile to consider ways to account for the compounding issues of belonging to multiple groups.
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7.2 Recommendations
This section will provide some recommendations arising from the research on transportation disadvantage undertaken within Huron County. As mentioned, it is outside the scope of this research to recommend a specific public transportation model that should be pursued. Instead, these recommendations address transportation in the county more generally and are directed at service providers and municipal governments alike. Moreover, these recommendations could be applied to other rural counties in Ontario with similar characteristics.
Recommendation 1: Consider how residents will access new or existing services and activities.
Everyone providing services to Huron County residents should ask themselves ‘how are people going to access this service?’ This should apply to new services, programs, or events as well as existing ones. If the answer to that question is ‘only through the use of a personal vehicle’, options should be considered for those that do not have access to their own transportation. This may include transportation support, such as financial aid or direct transportation provision, or options to reduce the need to travel, such as online delivery or decentralized locations. Often we assume that everyone has access to their own transportation, which this research found to be highly inaccurate. It is important that everyone operating within a rural setting keep in mind that vehicle access is not universal and that transportation is a real problem for some residents.
Recommendation 2: Seek out opportunities to pool resources and coordinate transportation delivery across service providers.
While few of the organizations participating in this research self identified as transportation service providers, in reality many of them were out of necessity. Indeed, due to the lack of transportation options faced by their clients most service providers were offering either
154 formalized or ad hoc transportation or reducing the need to travel by going out into the community or to the homes of clients to provide their service. Overall, this meant that service providers were spending a considerable amount of their limited resources (financial and human) on transportation, whether they considered themselves a transportation provider or not. Similarly, due to limited coordination and communication, a duplication and overlap of services emerged where service providers transported only their clients to specific destinations. The current uncoordinated and individually provided transportation service within the county already costs considerable public funds while being offered inefficiently due to duplication and overlap.
In the end, it was found that while Huron County does not have a public transportation system, in practice a large number of specialized transportation services are being offered by specific service providers. As an example, while the Corporation of the County of Huron would not describe themselves as providing public transportation, the 2012 County Budget indicates that the Social Services department is spending $160,000 in 2012 on medical transportation alone (County of Huron, 2012). Consider if all of the various organizations pooled their resources to provide a general-use public transportation service meeting all of their clients’ needs, as well as currently unmet needs within the county? This is an opportunity that should be pursued further.
Recommendation 3: The Corporation of the County of Huron should take an active role in public transportation.
The county government should take an active role in public transportation within the county, which could range from offering a public transportation service, providing support to existing services, or merely coordinating the creation of a community transportation service. As mentioned earlier, service providers operating within the county often face obstacles in
155 coordination and cooperation due to their strict mandates and concerns with protecting their
‘territory’. As the upper-tier level of government, the Corporation of the County of Huron represents all of the county’s residents and therefore can intervene as an impartial coordinator.
The county government should take a lead role in any discussions around coordinating services, sharing resources, and providing services to the general public rather than merely to specific groups. Moreover, the Corporation of the County of Huron operates at the appropriate geographic scale to provide a new public transportation service, were this deemed a feasible option.
Recommendation 4: Start small and build a system over time.
It is unlikely that a comprehensive transportation service would be feasible or appropriate for meeting the current capabilities and needs of Huron County’s residents. Therefore, it is recommended that a small scale service be implemented, perhaps as a pilot project, to set the foundation for public transportation in the county. Indeed, it will take time to build ridership in a rural area, particularly among those that are unfamiliar with public transportation service. It takes time to create a cultural shift, particularly amongst such a car dependent population.
Moreover, when discussing public transportation in Ontario people tend to envision a
Toronto style service and discount it as infeasible in a rural area. However this is not the reality.
Indeed, if the ridership potential of a rural community cannot justify a large bus operating on a regular schedule, consider a small bus or van operating on a flexible route a few times per day; or even only in response to client requests (dial-a-ride). Overall, it is very difficult to change a community to make public transportation viable, but it is much easier to adapt a public transportation service to meet the conditions of the community.
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Recommendation 5: Do not wait until it is too late.
A successful public transportation system cannot be created overnight. Nonetheless, the corresponding trends of the aging population and increasing fuel prices can be expected to result in an increasing demand for public transportation in rural communities. It is recommended that
Huron County, and rural communities everywhere, consider these long term trends and what options can be put in place today to mitigate their impacts. Indeed, rural municipalities in
Ontario should consider their options and start small with opportunity to expand as the capacity to operate a successful public transportation system must be fostered over time, not when it is too late.
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Chapter Eight: Future Research
There is considerable opportunity to continue research on transportation disadvantage and public transportation opportunities in rural Ontario. To date, very little has been written within the context of rural Ontario with most literature coming from the United Kingdom, mainland
Europe, and the United States. On the topic of transportation disadvantage, this research took the ambitious approach of looking at the issue comprehensively rather than individual groups. This type of research should be continued in order to see a more complete picture of community needs. Indeed, research on the needs of individual groups may be one reason for the existence of specialized transportation which overshadows the needs of other groups within rural areas. If more comprehensive studies were undertaken we may find that a general-use service would not only be necessary, but would also have the ridership to justify a public transportation service.
Moreover, on the topic of rural public transportation, when compared with Europe,
Canada has very little public transportation in rural areas, even in the densely populated communities in Southern Ontario. This begs the question of why and whether the argument that it is unfeasible due to population density is actually an excuse, especially if compared with communities in Scotland, Norway, and other jurisdictions with similar population densities but much more public transportation presence.
Within the context of Huron County research is needed to look at opportunities to address the presence of transportation disadvantage demonstrated by this study. There are two key elements of this. First, it would be valuable to comprehensively look at available public transportation models and evaluate their applicability within the needs and capabilities of Huron
County. This research laid the groundwork for this however it warrants a dedicated study. A second element of this research should include opportunities to utilize existing resources to
158 improve transportation options within the county. This too has been mentioned in this research, however it would be valuable to know where exactly existing services are traveling, how much they are spending, and how they could be combined or more efficiently delivered. This may be an opportunity to reduce the need for new public investment by better using existing public resources.
Finally, this study addressed the presence of transportation disadvantage in Huron
County but not the depth of the issue. Indeed, we can say that some individuals within Huron
County are at risk of being unable to reach accessibility needs due to transportation limitations, however we cannot speak to how many are in need. This suggests that a full-scale survey of residents would be beneficial to determine the depth of the issue and the potential ridership of a service. Nevertheless, there are warnings that come along with such a suggestion. This research found that numerous groups are in need of transportation which may not fill out surveys due to ability or access; for instance youth, frail older adults, those with mental illness, among others. It is important to consider ways to reach these individuals in any future studies which may warrant a mix of interviews and surveys or questionnaires targeted at specific sub-groups generally found to be at risk. Overall, it is important to consider that just because the majority of those answering a general survey state that transportation is not an issue, does not mean it is not a problem for some people. Instead, consider who did not, or could not, respond to that survey and whose issues are not being adequately represented. This goes well beyond a future study in Huron
County and is a word of warning for all future transportation needs assessments.
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Appendix A: Transportation Adequacy Framework
Affordability Availability* Accessibility Acceptability** Older Adults Social Inclusion ✔ ✔ ? Access to Supplies ✔ ✔ ✔ ✔ Access to Essential ✔ ✔ ✔ ✔ Services Physical or Mental
Disability Social Inclusion ✔ ✔ ? Access to Supplies ✔ ✔ ? Access to Essential ✔ ✔ ✔ ✔ Services Access to Training, Education, and ✔ ✔ ? Employment Youth Social Inclusion ✔ ✔ ? Access to Training, Education, and ✔ ✔ ? Employment Access to Shelters ✔ ✔ ✔ ✔ and Support Low-Income
Households Social Inclusion ✔ ✔ Access to Supplies ✔ ✔ Access to Essential ✔ ✔ ✔ ✔ Services Access to Training, Education, and ✔ ✔ ? Employment Women Social Inclusion ✔ ✔ ? Access to Supplies ✔ ✔ ? Access to Essential ✔ ✔ ✔ ? Services Access to Training, Education, and ✔ ✔ ? Employment Access to Shelters ✔ ✔ ✔ ✔ and Support * In theory, the taxi service is available for any purpose. Similarly, for several groups, the EasyRide service is available. However, there are clear questions about affordability of these services for non- medical purposes. ** This research did not include service users so it is difficult to state whether existing services are acceptable. Instead, this column is based on interpreting the findings from service providers. Nevertheless, gaps still exist which are indicated using question marks.
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Appendix B: Guiding Questions Used in Key Informant Interview Process
1) What services do you deliver?
2) Who are your clients (demographics)? What are the eligibility requirements?
3) What obstacles do users experience in accessing your services (i.e. cost, time)? a. Is availability of transportation an obstacle? b. If so, why?
4) How do your clients access your service? (i.e. online, in-person, home visits) a. What method of transportation do they use, if you know? b. Do most of your clients have access to their own transportation?
5) How often do your clients require your service? What time of day do they utilize your service?
6) What geography do you cover?
7) Do you offer transportation support such as rides or funding to your clients? (if yes) a. Please describe the assistance that you offer b. Do you currently recognize any weaknesses with your current system or unmet demand?
8) Are there liability or regulatory limitations which prevent you from offering transportation to your clients? Or, to the general public?
9) Would your organization benefit from some form of formal transportation service within Huron County? Do you believe it would increase the number of clients who would use your service?
10) Does your organization recognize any arising challenges for providing your services related to the aging population, increasing fuel prices, or another trend?
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Appendix C: Demographic Graphs for Huron County
Population Pyramid for Huron County, Ontario- 2006 85 years and over 80 to 84 years 75 to 79 years 70 to 74 years 65 to 69 years 60 to 64 years 55 to 59 years
50 to 54 years 45 to 49 years 40 to 44 years %female 35 to 39 years %male Age Class Age 30 to 34 years 25 to 29 years 20 to 24 years 15 to 19 years 10 to 14 years 5 to 9 years 0 to 4 years 5 4 3 2 1 0 1 2 3 4 5 Percent Source: Statistics Canada. (2010, June 12).
Population Projection for Huron County, Ontario- 2036
90+ 85-89 80-84 75-79 70-74 65-69 60-64
55-59 50-54 45-49 40-44 Population by Age Group
Age Class Age 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0 2 4 6 8 Percent Source: MOF. (2011, June 01).
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Appendix D: Map of Huron County, Ontario
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THIS MEMORANDUM OF ASSOCIATION is made this Wednesday, 03/26/2008.
AMONG:
SPRINT (SENIOR PEOPLE’S RESOURCES IN NORTH TORONTO)
BETTER LIVING HEALTH AND COMMUNITY SERVICES
COMMUNITY CARE EAST YORK
ETOBICOKE SERVICES FOR SENIORS
HARMONY HALL CENTRE FOR SENIORS
HUMBER COMMUNITY SENIOR SERVICES
MID-TORONTO COMMUNITY SERVICES INC.
NEIGHBOURHOOD LINK SUPPORT SERVICES
ST. CHRISTOPHER HOUSE
ST. CLAIR WEST SERVICES FOR SENIORS
WEST TORONTO SUPPORT SERVICES
WOODGREEN COMMUNITY CENTRE TORONTO
WHEREAS:
1. Toronto Ride is a voluntary unincorporated association, comprised of the Members (as defined below), originally established in 1998 as North Toronto Ride to help seniors continue to live in their community by providing, through its Members, assisted non-emergency transportation services to seniors and adults with disabilities who are not able to access other means of transportation and require personalized care.
2. Each Member has agreed to establish an association to be known as Toronto Ride with the following declared objectives and purposes:
(a) to provide on an on-going basis an efficient, coordinated, affordable and easily accessible non-emergency community transportation referral service by which seniors and persons with disabilities can access the health care system and services and certain social/recreational functions, such as shopping and community programs;
(b) to coordinate and liaise with groups and institutions in Toronto so as to help ensure that community transportation services are provided as and when required by seniors and persons with disabilities;
(c) to work together in cooperation and collaboration via sharing of resources in accordance with the terms and conditions of this Agreement for the purpose of coordinating and building:
(i) Toronto Ride’s transportation referral system,
(ii) individual Member client bases, and
(iii) access to the Members’ services, as well as the promotion of the benefits of individual Members’ services and the creation of heightened awareness of transportation issues concerning seniors and adults with disabilities and their families/caregivers;
(d) to ultimately achieve recognition for Toronto Ride’s referral system as the ‘third spoke’ of the existing public transportation system currently provided by TTC/Wheel Trans and the non emergency service of Emergency Medical Services for seniors and adults with disabilities who are ineligible for or unable to use TTC Wheel Trans or EMS services; and
(e) to organize the Members and operate Toronto Ride upon the following terms, conditions and structure hereinafter appearing.
NOW THEREFORE in consideration of the premise and mutual agreements and covenants herein contained (the adequacy of which consideration as to each of the Members hereto is mutually admitted) the Members hereby covenant and agree with each other as follows:
1. Definitions
In this Agreement:
“Agreement” means this Memorandum of Association and all schedules attached hereto and any amendments or supplementary schedules;
“Association” means Toronto Ride;
“Business Day” means a day other than a Saturday, Sunday or any other day on which the principal chartered banks located in the City of Toronto are not open for the transaction of domestic business during normal banking hours;
“Catchment Area” means the defined geographic area within which a Member operates and offers transportation services to clients;
“Client” means any individual designated by a Member to whom community support services are provided;
“Cost Centre” is an accounting term that refers to a department or function in an organization that does not generate profit;
“Fundraising” means the soliciting of funds or gifts in kind from any source;
“GAAP” means the generally accepted accounting principles from time to time approved by the Canadian Institute of Chartered Accountants, or any successor entity, applicable as at the date on which any calculation or determination is required to be made in accordance with generally accepted accounting principals;
“LHIN(s)” means Local Health Integration Network(s). In the province of Ontario there are currently 14 LHINs which have taken on local health system planning and community engagement (devolved from the Ministry of Health and Long Term Care) and are governed by the Local Health System Integration Act, 2006. The 14 LHINs cover distinct provincial boundaries across the province of Ontario. The Ministry of Health and Long Term Care and the LHINs have accountability agreements which set out the mutual understandings of their respective performance obligations.
“Lead Agency” means SPRINT (Senior People’s Resources in North Toronto);
“Member” means an organization that has become a member of Toronto Ride by signing this Agreement, and whose membership in Toronto Ride has not terminated;
“Standard Operating Terms” is a document containing the terms that apply to all Members. All Members must abide by the Standard Operating Terms in order to maintain their membership in Toronto Ride;
“Paradigm ” means Paradigm Technologies Corporation, a networking, programming, consulting and software development company that developed the TRACT software;
“Program Administrator” means a senior operational employee of the Lead Agency who has been appointed by the Lead Agency to the position of Program Administrator for Toronto Ride;
“Posted Ride” means a ride that a Member is unable to fill, which the Member then posts on the TRACT software for other Members to fill if they are able;
“Posting Agency” means an agency that made the original referral for a client for transportation services to an Accepting Agency;
“Referral Partner” means a non-Member that refers clients to Toronto Ride and does not provide transportation, but has patients/clients who are in need of transportation services. The Referral Partner also seeks to expand community transportation options and supports the objectives of Toronto Ride;
“Resource Agency” means an agency that provides specialized expertise and/or specialized transportation related services, not provided by Toronto Ride. It also seeks to expand community transportation options and supports the objectives of Toronto Ride;
“Senior Management Committee” means the committee described in Section 5(a);
“SPRINT” means Senior People’s Resources in North Toronto;
“Toronto Ride” means the voluntary unincorporated association comprised of the Members;
“Toronto Ride Central Functions” means those Toronto Ride functions carried on by the Lead Agency on behalf of Toronto Ride; and
“TRACT” means a Windows based software application designed for the management of community transportation programs. TRACT software was developed specifically for Toronto Ride by Paradigm.
2. Representations and Warranties
Each Member hereby covenants with and represents and warrants to the other Members, and acknowledges and confirms that the other Members are relying on such covenants, representations and warranties in connection with entering into this Agreement, that:
(i) the Member is a corporation duly incorporated, organized and subsisting under the laws of Province of Ontario;
(ii) the Member is duly organized, registered and qualified to carry on its operations and possesses, and expects to continue to possess, all requisite authority, licenses and permits to carry on its operations or activities;
(iii) it can fulfill all of its obligations as a Member of Toronto Ride as provided hereunder without violating the terms of its constating documents, by-laws or any agreement to which it is or will become a party or by which it is or will become bound or by any law or regulation applicable to it; and
(iv) it has the power and capacity to execute and deliver this Agreement and has taken all necessary corporate action to authorize the execution, delivery and performance of this Agreement.
3. Association
(a) General Association
Toronto Ride is a voluntary association of the Members.
An organization becomes a Member of Toronto Ride if it is a founding member that is a signatory to this Agreement or if it has been admitted as a member by the Senior Management Committee pursuant to this Agreement and has signed this Agreement.
SPRINT shall continue to act as the Lead Agency of Toronto Ride until the applicable LHIN(s) determines otherwise.
(b) Roles and Resources
Each Member of the Association agrees to contribute and commit resources to the operation of Toronto Ride as required by the Standard Operating Terms and diligently undertake its various roles as outlined in this Agreement until its membership terminates.
(c) Association Rights
The Association shall consist of Members who shall vote on matters tabled for decisions before the Senior Management Committee. Other persons may attend meetings of the Senior Management Committee on an ongoing or ad hoc basis at the invitation of the Senior Management Committee but their function on the Senior Management Committee shall be purely advisory.
4. Member Agencies
All Members of Toronto Ride agree to:
(i) participate on the Senior Management Committee and attend all meetings of the Senior Management Committee and exercise their voting rights;
(ii) comply with the Standard Operating Terms as revised from time to time by the Senior Management Committee;
(iii) employ or retain such persons necessary (including, without restriction, drivers) in order for the Member to comply with the Member’s obligations under this Agreement and the Standard Operating Terms, and to ensure that all such persons are appropriately qualified, skilled and suitable, all of which persons will be employees or agents of the Member and not of the Association;
(iv) to purchase or lease and to adequately maintain and service such vehicles as are necessary for the Member to provide transportation services and to comply with its obligations under this Agreement and the Standard Operating Terms;
(v) sign an accountability agreement with the Lead Agency, if requested by the Lead Agency, regarding any funds that may flow from the Lead Agency to the Member.
5. Senior Management Committee
(a) Composition
There shall be a Senior Management Committee of Toronto Ride composed of up to two (2) senior management representatives of each Member, selected by such Member, who have been given the necessary decision-making authority by such Member.
(b) Authority of the Senior Management Committee
The Senior Management Committee shall have the following authority:
(i) planning and directing policy, goals, objectives and initiatives of the Association;
(ii) review and approval of Toronto Ride Central Functions project budgets, financial statements and evaluation reports;
(iii) final review and approval of funding applications by the Lead Agency in relation to Toronto Ride which include funds that will flow to other Members for provision of transportation services;
(iv) the formation of working committees of the Senior Management Committee, including definition of terms of reference;
(v) setting and amending the Standard Operating Terms, which shall automatically apply to all Members;
(vi) creating committees of the Senior Management Committee, including an Executive Committee, and delegating functions or powers of the Senior Management Committee to such committees; and
(vii) any other authority clearly and expressly given to the Senior Management Committee under this Agreement.
(a) Staff Support
The Program Administrator shall provide staff support to the Senior Management Committee and shall participate in all meetings of the Senior Management Committee in a non-voting capacity.
6. Meetings of the Senior Management Committee
(a) Chairperson
The executive director of the Lead Agency or such other person as may be designated by the executive director of the Lead Agency, shall serve as the Chairperson of the Senior Management Committee (the “Chairperson”).
(b) Meetings
The Chairperson may at any time call a meeting of the Senior Management Committee upon receiving a written request from two or more Members for such a meeting to be held. When a meeting is so requested by two or more Members, the Chairperson shall, within fifteen (15) Business Days of receipt of such written request, convene the meeting, failing which the requesting Member(s) may themselves convene such a meeting by giving written and signed notice to the Members in accordance with this Agreement. The Chairperson may also call a meeting of the Senior Management Committee on his or her own initiative without the request of any Members. The Chairperson must call at least one meeting of the Senior Management Committee each quarter of the calendar year.
(c) Notice of Meeting
A notice and draft agenda of each meeting of the Senior Management Committee shall be given by the Chairperson to each Member not less than five (5) Business Days prior to the date of such meeting and shall state:
(i) the time, date and place of the meeting; and
(ii) in general terms, the nature of the business to be transacted at the meeting, including notification of any vote related to the admission to or termination of membership status of any organization, of any vote regarding funding, or of any vote regarding the Standard Operating Terms to be taken at the meeting.
(d) Place of Meeting
Each Senior Management Committee meeting shall be held at such place as the Chairperson may reasonably determine from time to time.
(e) Minutes
The minutes and proceedings of each and every Senior Management Committee meeting shall be taken and recorded by a person so designated to do so and shall be approved at the next meeting of the Senior Management Committee. Once the minutes have been approved such minutes shall be prima facie evidence of the matters therein stated and until the contrary is proven, every meeting of the Senior Management Committee in respect of which minutes have been taken shall be deemed to have been duly held and convened and all proceedings referred to in the minutes shall be deemed to have been duly passed or defeated as recorded in the minutes.
(f) Voting Rights
Each Member present at a meeting of the Senior Management Committee shall be entitled to one vote at such meeting. For purposes of clarity, if two representatives of a Member attend a Senior Management Committee meeting, the two representatives shall have only one vote between them. All Members agree to exercise their voting rights on issues tabled for decisions and undertake to participate in the meetings and deliberations of the Senior Management Committee.
All Members have the right to place items before the Senior Management Committee for consideration. Therefore all matters brought to the Chairperson of the Senior Management Committee, in writing at least 6 days prior to the meeting, for inclusion on the agenda must be placed on the agenda. It is the role of the Senior Management Committee, at the time of the meeting, to decide which agenda items will be discussed by the Senior Management Committee as a whole.
(g) Manner of Voting
A decision of the majority of the Members present at a duly called meeting of the Senior Management Committee shall be deemed to be the decision of the Senior Management Committee. Members may not vote by proxy.
In the case of a tied vote, the motion shall fail and the Chairperson shall not have an additional deciding vote.
7. Lead Agency
All Members acknowledge and agree that SPRINT is the Lead Agency for Toronto Ride. The Lead Agency shall have all authority to manage and operate Toronto Ride, except such authority that is specifically given to the Senior Management Committee under this Agreement. The Lead Agency’s authority shall include, without restriction, the following:
(i) chairing Senior Management Committee meetings;
(ii) employing the staff who work in Toronto Ride Central Functions;
(iii) liaising, directly and solely, with the funding organizations regarding funding to the Lead Agency on behalf of Toronto Ride;
(iv) entering into funding agreements with funders, subject to the approval of the Senior Management Committee;
(v) submitting funding applications and reports to potential and current funders, subject to the approval of the Senior Management Committee;
(vi) managing all funds secured by the Lead Agency on behalf of Toronto Ride and making all decisions in relation to such funds including, without restriction, decisions in relation to the distribution, spending, investment or use of such funds; and for this purpose the Lead Agency may require that a Member sign an accountability agreement with the Lead Agency regarding such funds that may flow to the Member, and in such case such Member shall sign an accountability agreement;
(vii) maintaining a separate Toronto Ride Central Function cost centre; managing the Toronto Ride Central Function finances; preparing budgets; distributing and explaining Toronto Ride financial statements to the Members at least quarterly; distributing the designated funds to the Members; and maintaining relevant funder agreements;
(viii) maintaining a central referral point and brokerage function for Referral Partners and Members and allocating ride requests to Members in accordance with guidelines established from time to time by the Senior Management Committee;
(ix) maintaining and distributing to Members a current version of the Standard Operating Terms as it may be amended from time to time by the Senior Management Committee;
(x) being the sole contact for all Members to any Toronto Ride software provider, to ensure uniform development of software for the Members; currently the provider is Paradigm (TRACT developer);
(xi) maintaining a mailing address for the Association;
(xii) maintaining a Register to record the names and addresses of the Members, and maintaining such other records as may be required by law;
(xiii) making on behalf of the Association all recordings or filings with any governmental authority where necessary that are required to be made by the Association; and
(xiv) keeping at its office:
• A list of the full name and last known residence address or address for service of each Member;
• A copy of this Agreement; and
• A copy of the Standard Operating Terms.
For purposes of clarity, governance responsibilities for individual Member transportation programs unrelated to Toronto Ride, and for management of Member transportation systems relating to Toronto Ride, remain with that Member’s Board of Directors, except as limited by this Agreement.
8. Toronto Ride Central Functions (TRCF)
The Toronto Central Functions does the work of the Lead Agency under this Agreement in the operation of Toronto Ride.
The staff for Toronto Ride Central Functions shall be employed by, and be accountable to, the Lead Agency. The responsibilities of the Program Administrator shall be agreed by the Senior Management Committee from time to time and documented in a position description which will form part of the Standard Operating Terms.
9. Referral And Resource Agencies
(i) The Lead Agency may, upon the approval of the Senior Management Committee, form working relationships with other organizations from time to time, including for purposes of referrals and resource assistance. These relationships will be defined from time to time and may be publicly acknowledged as determined appropriate by the Senior Management Committee.
10. Financial Management
For purposes of clarity, the Lead Agency shall have overall authority over the financial management of all funds secured by it on behalf of Toronto Ride; financial management must be in accordance with any funder accountability agreements, where such agreements exist.
The Lead Agency shall assume no responsibility over the Ministry of Health/LHIN transportation program budget or any other budgets of the individual Members secured directly by those Members, as such budgets shall remain under the jurisdiction of the individual Members.
Accounting Records
The Lead Agency shall ensure that proper books of account are kept of the Association funds by preparing accounting and financial reports in accordance with GAAP. The Lead Agency shall have authority over the accounting of all matters, terms, transactions and things as are usually written and entered into books of account in accordance with GAAP and undertakes that it shall at all times furnish information, accounts and statements to the Senior Management Committee and funding organizations (as required) of all relevant transactions pertaining to the Association without any concealment or suppression.
11. Funding
Members agree to the following constraints on funding requests for new transportation funds:
a. Members will inform the Senior Management Committee of Community Support Service (CSS) transportation funding requests to the LHIN prior to submission of said requests;
b. Members will inform the Senior Management Committee of Community Support Service (CSS) transportation program funding requests to other funders prior to submission of said requests;
c. Members will inform the Senior Management Committee of any funding requests for other programs that include a transportation component prior to the submission of said requests; and
d. Members agree that for the purposes of this section 11, funding requests include any funding requests made by a Member jointly with non Members.
12. Use of Toronto Ride Information
No Member may use or disclose any information about other Members, their clients or catchment areas, collectively or individually, gained as a result of membership in Toronto Ride or involvement in Toronto Ride activities, including but not restricted to the following:
a. No Member may use any information about another Member’s transportation catchment area or clients without the consent of the other Member except that it may report the Posted Rides it provided;
b. No Member may solicit another Member’s client in any way for funds or goods in kind as a result of contact or information gained in the course of Toronto Ride activities, without the consent of the other Member; and
c. Members may use Toronto Ride information as permitted by the Senior Management Committee from time to time for Fundraising and other purposes, where the Senior Management Committee permits Members to use such information for such purpose.
Toronto Ride may use any and all transportation information and data available to it for the purposes of funding submissions made by the Lead Agency for the benefit of the Association as a whole.
Any Member may bring a request to the Senior Management Committee for access and use of Toronto Ride information and collective Association data for Fundraising purposes, which request the Senior Management Committee should not unreasonably deny.
13. Non-Solicitation and Confidentiality
(a) Non-solicitation
Each Member covenants and agrees with the other Members and with the Association that it will not knowingly:
(i) solicit, interfere with or endeavor to entice away from the Association or any of the other Members any customer, client or any person in the habit of dealing with or in the catchment area of the Association or any of the other Members;
(ii) seek to liaise directly with any of the funding agencies who provide funds to Toronto Ride, to obtain funds for itself or for the purpose of engaging in a business or activity in competition with Toronto Ride;
(iii) engage in activities that are similar to or in competition with the activities carried out by Toronto Ride; or
(iv) Disclose any client information except in accordance with applicable privacy legislation.
(b) Proprietary Information
All confidential records, material information and copies thereof, and all trade secrets concerning the business and affairs of the Association (collectively, “Proprietary Information”) shall remain the exclusive property of the Association. While a Member of the Association or at any time thereafter, the Members and their principals, as the case may be, shall not divulge the contents of such Proprietary Information to any person (except the Association, Members, Lead Agency, Senior Management Committee, and employees thereof), and the Members and their principals shall not, at any time, use the contents of such Proprietary Information for any purpose whatsoever, except for the exclusive benefit of the Association.
In the event that a Member wishes to use any Proprietary Information for its own individual funding initiatives and proposals, it shall require the approval of the Senior Management Committee, as documented in the minutes of that committee. All Members agree that any unauthorized dissemination or distribution of such Proprietary Information without the required approval of the Senior Management Committee, as documented in the minutes, shall provide cause for the Senior Management Committee to, in its discretion, terminate the membership of the Member in the Association.
(c) Confidential Information
For the purposes hereof, “confidential records, material and information” includes information known or used by the Association or individual Members in connection with the business and affairs of the Association, including but not limited to any legal documentation, contracts, funding proposals, product and service packages, compilation of information, data, program, code, method, technique or process, common practices, information relating to any product, device, equipment or tailored software enhancements, information about or relating to the Association’s or the individual Member’s clients, markets and marketing initiatives, present and future information about or relating to the Association’s potential business and other funding initiatives, financial information of all kinds relating to the Membership and its activities, all ideas, and related material, but does not include any information which was known to the individual Members or their principals prior to them becoming a Member or principal of a Member, as well as any information that is generally available to the public other than as a result of disclosure by a Member or its principal and only such portion of the information which becomes so available.
(d) Specific Knowledge of Business and Affairs of Association
The covenants hereof are made by each Member, each of which hereby represents that its principal has specific knowledge of the business and affairs of the Association and that the Association carries on and intends to carry on business throughout the geographic area specified as the Toronto Ride Area and reflecting the boundaries of the Toronto Ride Area, as shown in the Toronto Ride Map in the Standard Operating Terms.
14. Non-Compliance and Disputes between Members
Subject to section 15 herein, the Members agree to the following: a. Non-Compliance with this Agreement
There will be a standing item on the Senior Management Committee agenda to recognize any non-compliance of Members with the agreement.
The Senior Management Committee may, in its discretion, provide notice to any member that such Member has failed to comply with this Agreement.
To avoid suspension or termination of Membership, the Member so notified must, within five (5) Business Days of receiving the notice of non-compliance, provide the Senior Management Committee with either (i) a statement that it has not failed to comply with this Agreement, as well as the reasons for such statement; or (ii) a plan, including timelines, for achieving full compliance with this Agreement.
If the Senior Management Committee accepts a Member’s statement that it has not failed to comply with this Agreement, the Senior Management Committee shall rescind the notice of non-compliance.
If the Senior Management Committee rejects the Member’s statement that it has not failed to comply with this Agreement, the Member shall within five (5) Business Days of being advised of such rejection, provide the Senior Management Committee with a plan, including timelines, for achieving full compliance with this Agreement.
The Senior Management Committee has the authority to approve or reject such plan. Senior Management Committee will determine what progress reporting is required from such Member in relation to such plan, and the Member shall provide the reporting that is required by the Senior Management Committee.
If the Member does not respond to the notice of non-compliance within five (5) Business Days of receiving such notice, or if the Member submits a plan that is rejected by the Senior Management Committee, the Senior Management
Committee may, in its discretion, make any decision that it deems appropriate including, without restriction, suspending or terminating the membership of such Member. In the event of such suspension or termination, the Senior Management Committee may impose any terms including, without restriction, reasonable financial terms on such Member as the Senior Management Committee deems just. The Senior Management Committee shall have exclusive authority to finally resolve any issue in relation to non-compliance or alleged non-compliance, and the decision of the Senior Management Committee shall be final and binding and not subject to appeal. The Senior Management Committee shall not make any decision that is inconsistent with this Agreement. The Senior Management Committee is not required to hold a hearing.
b. Disagreements between or among Members
There will be a standing item on the Senior Management Committee agenda to recognize any disputes between or among Members in relation to the interpretation, application or effect of, or the alleged non-compliance with this Agreement.
An dispute between or among Members in relation to the interpretation, application or effect of or alleged non-compliance with this Agreement shall be finally and exclusively resolved by the Senior Management Committee under this section 14(b). Any Member (including a Member that is not party to such dispute) or the Senior Management Committee may submit such dispute to the Senior Management Committee under this section 14(b).
The Senior Management Committee shall determine the process that shall be followed in resolving such dispute, but shall provide all Members involved in such dispute with reasonable opportunity to present their evidence and arguments.
The Senior Management Committee shall have exclusive authority to finally resolve such dispute, and the decision of the Senior Management Committee shall be final and binding and not subject to appeal. The Senior Management Committee is not required to hold a hearing. The Senior Management Committee shall not make any decision that is inconsistent with this Agreement.
While the Senior Management Committee dispute resolution process is ongoing under this section 14(b), the Lead Agency may, in its discretion, impose an interim solution as may be required for the continued and smooth operation of Toronto Ride, and such interim solution shall be binding on all Members until the Senior Management Committee issues its final decision in relation to such dispute.
15. Dispute between Senior Management Committee and Lead Agency
In the event of any dispute between the Senior Management Committee and the Lead Agency with regards to the distribution or scope of powers of either the Senior Management Committee or the Lead Agency under this Agreement, either the Senior
Management Committee or the Lead Agency may submit such dispute to arbitration (and not to the courts) for final and binding resolution. There shall be one arbitrator who shall be chosen upon the agreement of the Senior Management Committee and the Lead Agency or, failing such agreement, shall be appointed by the Superior Court of Justice upon application by either the Senior Management Committee or the Lead Agency. The Arbitration Act, 1991 shall apply to any arbitration under this section 15. The arbitrator shall determine his or her own procedure. The arbitrator shall have exclusive authority to finally resolve such dispute, and the decision of the arbitrator shall be final and binding and not subject to appeal. The arbitrator shall not make any decision that is inconsistent with this Agreement. The arbitrator may order either the Senior Management Committee or the Lead Agency to pay the other’s costs of the arbitration. The arbitrator’s costs of such proceeding shall be borne equally by all of the Members.
16. Communications
Communication by Toronto Ride Central Functions and the Senior Management Committee to the Members in respect of matters concerning the services and operations of this Association shall be an on-going process.
All Members are responsible for communication and through the Lead Agency shall provide to the Association contact telephone numbers, addresses, facsimile numbers, electronic mail (e-mail) addresses, and any changes thereto.
17. Enurement
This Agreement shall enure to the benefit of and be binding upon the Members and their respective representatives, successors and assigns.
18. Scope of Association
The rights, duties, obligations and liabilities of the Members pursuant hereto shall be limited to those rights, duties, obligations and liabilities as set out herein or assumed in accordance with the intent hereof in the course of carrying on the business and affairs of the Association in respect of transportation services or arising by virtue of the operation of any applicable law(s) affecting the Association. Nothing contained in this Agreement shall be construed to create any business arrangement or legal relationship between the Members extending beyond the scope of this Agreement. Except as expressly authorized by the provisions hereof, nothing herein contained shall be construed to authorize any Member to act as the agent of any other Member or to permit any Member to act on behalf of or bind the Association or any Member, without the express written consent of the Senior Management Committee and Lead Agency.
Nothing contained in this Agreement shall prevent or prohibit any Member from joining, forming or creating an association, affiliation, partnership or any other arrangement or legal relationship with any other Member(s) or any other agencies for purposes that are not related to the transportations services that are the subject matter of this Agreement and that are not inconsistent with the best interests of Toronto Ride.
19. Liability of Members and Indemnity
All Members agree that all rides or transportation in relation to this Agreement are provided by the Members and not by the Association. All Members agree that each Member is solely and exclusively liable for any loss or damages in relation to any ride or transportation provided to any person by such Member or by any officer, director, employee or agent of such Member, or any other action or inaction of such Member in relation to any such ride or transportation. Each Member hereby agrees to indemnify and save harmless the Association, the Lead Agency and all other Members from any such loss or damages. Each Member also hereby agrees to indemnify the Association, the Lead Agency and each other Member from any loss or damages caused by such Member’s violation of any of its obligations under this Agreement or the Standard Operating Terms. Each Member shall obtain insurance coverage adequate to protect such Member against all possible losses or liabilities arising out of this Agreement or such Member’s provision of rides or transportation in relation to Toronto Ride. Each Member shall, on or before (DATE), provide the Program Administrator with proof, satisfactory to the Program Administrator, that such Member has obtained such adequate insurance coverage.
20. Admission of New Members
The Senior Management Committee has the authority to admit a non-Member organization as a new Member of the Association. No organization may become a Member unless and until it signs this Agreement as it may be amended from time to time.
21. Termination of Membership by a Member
Any Member may terminate its membership by providing the Senior Management Committee with 60 days written notice of its intention to terminate such membership.
Any Member that terminates its membership is deemed, upon the effective date of such termination, to have relinquished any right to any of the Association’s funds or funds held by or flowing from the Lead Agency to the Member, and rights to the Toronto Ride software (currently Tract Software Program).
Each Member hereby covenants that, for the two (2) year period following such Member’s termination of its membership, it shall not (i) solicit, for any purpose, the clients of the Member to whom the Member was introduced through the Association, (ii) solicit the clients of any other Member for the purposes of providing transportation services to such clients, nor (iii) provide transportation services to any such clients, within the Toronto Ride Area. Instead, such member shall refer such clients to Toronto ride during that two (2) year period for the purposes of transportation in the Toronto Ride Area.
A former Member whose membership in Toronto Ride has terminated shall not (without the prior written consent of the Senior Management Committee), divulge to any person the names of any customers or clients of the Members, unless required to do so by law.
22. Commencement, Term and Renewal
This Agreement shall be in effect for a three-year term commencing on March 26, 2008 and ending on March 25, 2011, and shall be automatically renewed for further terms of three (3) years each unless the Senior Management Committee decides, not less than three (3) months prior to March 25, 2011 (or three (3) months prior to the the end of any other three-year term as applicable), that this Agreement shall not be renewed at the end of such three-year term.
23. Amendment
This Agreement may be amended from time to time upon the agreement of all of the Members.
24. Entire Agreement
This Agreement constitutes the entire Agreement between the Members in relation to the subject matter of this Agreement.
25. Survival
A Member’s or former Member’s obligations under sections 12, 13 and 19 of this Agreement shall survive the termination of such Member’s membership in the Association.
26. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein and each of the Members agrees irrevocably to conform to the non-exclusive jurisdiction of the Courts of Ontario.
27. Headings for Convenience Only
The division of this Agreement into sections and the insertion of headings are for convenience of reference only and shall not affect the interpretation or construction of this Agreement.
28. Notices
Except as specifically noted above, any notice, communication or demand required or permitted to be given or made hereunder to a Member shall be sufficiently given or made for all purposes if delivered personally to the executive director or senior manager of the Member, or if sent by ordinary first class mail within Canada, postage prepaid or if transmitted by telecommunications facility, to such Member at the addresses as set forth below:
If to SPRINT (Senior People’s Resources in North Toronto) 140 Merton Street, 2nd Floor Toronto, Ontario M4S 1A1 Attention: Executive Director Tel: (416) 481-6411 Fax: (416) 481-9829
If to Better Living Health and Community Services 875 Don Mills Rd, Unit 7 Toronto, Ontario M3C 1V9 Attention: Vice President, Community Services Tel: (416) 447-7244 ext. 734 Fax: (416) 510-1104
If to Community Care East York 303-840 Coxwell Avenue Toronto ON M4C 5T2 Attention: Executive Director Tel: (416) 422-2027
If to Etobicoke Services for Seniors 1447 Royal Park Road Etobicoke ON M9P 3V8 Tel: (416) 243-0127 Fax: (416) 243-7987
If to Harmony Hall Centre for Seniors 2 Gower Street Toronto, Ontario M4B 1E2 Attention: David Lieberman, Executive Director Tel: (416) 752-0101 Fax: (416) 752-8869
If to Humber Community Senior Services 1167 Weston Rd. Toronto, Ontario M6M 4P5 Attention: Executive Director, Tel: (416) 249-7946 Fax: (416) 249-4219
If to Mid-Toronto Community Services Inc. 192 Carleton Street, 2nd Floor Toronto, Ontario M5A 2K8 Attention: Executive Director Tel: (416) 962-9449. Fax: (416) 962-5541
If to Neighbourhood Link Support Services 3032 Danforth Avenue Toronto ON M4C 1N2 Attention: Executive Director
If to St. Christopher House 248 Ossington Avenue Toronto, Ontario M6J 3A2 Attention: Director of Older Adult Centre Tel: (416) 532-4828 Fax: (416) 532-8739
If to St. Clair West Services for Seniors 1669 Eglinton Ave. W. Toronto, Ontario M6E 2H4 Attention: Executive Director Tel: (416) 787-2114 Fax: (416) 787-8552
If to West Toronto Support Services 80 Ward St. Toronto, Ontario M6H 4A6 Attention: Executive Director Tel: (416) 653-3535 Fax (416) 653-3559
If to Woodgreen Community Centre of Toronto 835 Queen St. E. Toronto, Ontario M4M 1H9 Attention: Director Community Support Services Tel: (416) 469-5211 Fax: (416) 469-2974
29. Transmission by Facsimile
The Members agree that this Agreement may be transmitted by facsimile or such similar device and that the reproduction of signatures by facsimile or such similar device will be treated as binding as if they were originals and each Member undertakes to provide each and every other Member with a copy of the Agreement bearing original signatures forthwith upon demand.
IN WITNESS WHEREOF this Agreement has been duly executed by the Members as of the date first written above.
SENIOR PEOPLE’S RESOURCES IN NORTH TORONTO INC. Per: ______
BETTER LIVING HEALTH AND COMMUNITY SERVICES Per: ______
COMMUNITY CARE EAST YORK Per: ______
ETOBICOKE SERVICES FOR SENIORS Per: ______
CALL-A-SERVICE INC./HARMONY HALL CENTRE FOR SENIORS Per: ______
HUMBER COMMUNITY SENIOR SERVICES Per: ______
MID-TORONTO COMMUNITY SERVICES Per: ______
NEIGHBOURHOOD LINK/SENIOR LINK Per: ______
ST. CHRISTOPHER HOUSE Per: ______
ST. CLAIR WEST SERVICES FOR SENIORS Per: ______
WEST TORONTO SUPPORT SERVICES Per: ______
WOODGREEN COMMUNITY CENTRE TORONTO Per: ______
OTN SITES - ERIE ST. CLAIR - JUNE 2013
LHIN SITE ID SITE NAME ADDRESS CITY PC PROV STATUS LIVE DATE 1 SIT00925 Amherstburg Family Health Team 681 Front Road South Amherstburg N9V 0B4 ON Active Mar-31-2009 1 SIT02349 Bluewater Methadone Clinic - Chatham 69 Grand Ave. Chatham N8A 4K1 ON Active Jun-07-2010 1 SIT05240 Brain Injury Association of Chatham Kent 9 Maple Leaf Dr. Chatham N7M 6H2 ON In Dev 1 SIT02463 Canadian Mental Health Association - 240 Grand Ave West Chatham N7L 1C1 ON Active Nov-16-2010 Chatham - Kent Branch Suite 100 1 SIT02762 Chatham - Kent Community Health Centres - 150 Richmond St. Chatham N7M 1N9 ON Active May-04-2011 Chatham 1 SIT03293 Chatham Kent ACT 75 Thames St. 2nd Flr. Chatham N7L 1S4 ON Active Dec-09-2011 1 SIT01998 Chatham Kent Child and Adolescent Clinic 202 King St. West Chatham N7M 1E5 ON Active Dec-11-2009 1 SIT00364 Chatham Kent Health Alliance 80 Grand Ave. W. Chatham N7M5L9 ON Active Apr-01-2005 P.O. Box 2030 1 SIT02825 Chatham-Kent Children's Services 495 Grand Avenue West Chatham N7L 1C5 ON Active Jan-20-2012
1 SIT00829 Children's Treatment Centre of Chatham-Kent 355 Lark St. Chatham N7L5B2 ON Active Aug-18-2009
1 SIT01743 Copper Terrace Long Term Care Facility 91 Tecumseh Road Chatham N7M 1B3 ON Active Aug-27-2009 1 SIT00839 Dr. Ranjith Chandrasena 80 Grand Ave. Chatham N7M5L9 ON Active Nov-20-2008 P.O. Box 2030 1 SIT00494 Erie St. Clair CCAC - Richmond St. 712 Richmond St. Chatham N7M5K4 ON Active Mar-26-2008 1 SIT00265 Erie St. Clair LHIN 180 Riverview Drive Chatham N7M5Z8 ON Active Sep-06-2006 1 SIT00468 Regional Support Associates - Chatham 330 Richmond Street Chatham N7M1P7 ON Active May-08-2007 Suite 102 1 SIT01585 Riverview Gardens Long Term Care 519 King St. West Chatham N7M 1G8 ON Active Jul-10-2009 1 SIT03334 Thamesview Family Health Team 465 Grand Ave. West Chatham N7L 1C5 ON Active May-29-2012 1 SIT04528 VON Canada - Chatham-Kent 405 Riverview Road, Suite Chatham N7M 5J5 ON Active Nov-09-2012 103 1 SIT00961 Community Living Essex County - Comber 6115 Wallace Ave. Comber N0P 1J0 ON Active Apr-27-2009 1 SIT00530 Community Living Essex County 372 Talbot Street North Essex N8M2W4 ON Active Sep-21-2007 1 SIT00788 North Lambton Community Health Centre - 59 King St. West Forest N0N 1J0 ON Active Oct-16-2009 Forest PO Box 1120 1 SIT02804 North Lambton Community Health Centre - 6275 Indian Lane Forest N0N 1J0 ON Active Jun-07-2012 Kettle Point RR2 1 SIT00629 Grand Bend Community Health Centre 69 Main St E Grand Bend N0M1T0 ON Active Nov-19-2007 1 SIT00900 Harrow Health Centre 1480 Erie St. S. Harrow N0R 1G0 ON Active Mar-10-2009 1 SIT02351 Leamington and Area Family Health Team - 273 Main St. East Kingsville N9Y 1A7 ON Active Nov-17-2010 Kingsville Family Health Centre 1 SIT04527 VON Canada - NPLC Lakeshore 330 Notre Dame St., Suite Lakeshore N0R 1A0 ON Active Oct-03-2012 200
1 OF 4 OTN SITES - ERIE ST. CLAIR - JUNE 2013
LHIN SITE ID SITE NAME ADDRESS CITY PC PROV STATUS LIVE DATE 1 SIT03360 Ing Gary, MD 6020 Malden Rd LaSalle N9H 1S8 ON Active Feb-10-2012 1 SIT00378 Leamington & District Memorial Hospital 194 Talbot Street West Leamington N8H1N9 ON Active Dec-02-2005 1 SIT02049 Leamington and Area Family Health Team - 197 Talbot St. West Leamington N8H 1N8 ON Active Jan-28-2010 Talbot 1 SIT05229 OTN - Kim Piroli 15 Sherway Court Leamington N8H 5K3 ON In Dev 1 SIT00607 OTN - Lori Feltz 183 Ellison Avenue Leamington N8H5J2 ON Active Apr-02-2007 1 SIT03148 Renew Medical Clinics - Leamington 4 Talbot St. East Leamington N8H 1L2 ON Active Oct-06-2011 1 SIT00440 VON Canada - Pelee Island Medical Clinic 1047 West Shore Road Pelee Island N0R 1M0 ON Active May-08-2009 1 SIT00361 Bluewater Health - CEE Site 450 Blanche Street Petrolia N0N1R0 ON Active Jul-01-2006 1 SIT00533 Lambton County Developmental Services 339 Centre Street Petrolia N0N1R0 ON Active Oct-30-2007 1 SIT02352 County of Lambton CHSD - Point Edward 160 Exmouth St. Point Edward N7T 7Z6 ON Active Nov-17-2010 1 SIT03013 St. Clair Child and Youth Services 129 Kendall Street Point Edward N7V 4G6 ON Active Jan-09-2012 1 SIT03303 Austin Marc, MD 118 Victoria Street North Sarnia N7T 2T1 ON Active Dec-21-2011
1 SIT00359 Bluewater Health - Mitton Site 220 North Mitton Street Sarnia N7T6H6 ON Active Dec-05-2005
1 SIT00360 Bluewater Health - Norman Site 89 Norman Street Sarnia N7T6S3 ON Active Apr-04-2007 1 SIT02348 Bluewater Methadone Clinic - Sarnia 118 Victoria St. North Sarnia N7T 2T1 ON Active Jun-07-2010 1 SIT02548 Canadian Mental Health Association - 210 Lochiel St. Sarnia N7T 4C7 ON Active Dec-02-2010 Lambton County Branch 1 SIT04764 Canadian Red Cross - Sarnia Branch 416 East Street North Sarnia N7T 6Y4 ON Active May-02-2013 1 SIT03225 Community Living Sarnia-Lambton 551 Exmouth St. Sarnia N7T 5P6 ON Active Jan-20-2012 Suite 202 1 SIT03245 Community Services Coordination Network - 420 East St. North Sarnia N7T 6Y5 ON Active Mar-07-2012 The Chris Dawson Centre Suite 14 1 SIT03286 Donald Delmar William, MD 118 Victoria Street North Sarnia N7T 2T1 ON Active Dec-21-2011
1 SIT00683 Erie St.Clair CCAC - Pontiac Dr. 1150 Pontiac Drive Sarnia N7T7H9 ON Active Mar-26-2008 Box 185 1 SIT03361 Mountain Garry Brett, MD 118 Victoria Street North Sarnia N7T 5W9 ON Active Feb-10-2012
1 SIT05037 Pathways Health Centre for Children 1240 Murphy Road Sarnia N7S 2Y6 ON In Dev 1 SIT02013 St. Joseph's Hospice of Sarnia Lambton 475 Christina St. North Sarnia N7T 5W3 ON Active Jan-25-2010 1 SIT01602 Thames Valley Children's Centre - Sarnia 1457 London Rd. Sarnia N7S 6K4 ON Active Jun-25-2009 Autism Program 1 SIT01565 The MacKenzie Clinic 168 Essex St. Sarnia N7T 4R9 ON Active Jul-22-2009 1 SIT03447 Toth Anne 265 North Front Street, Sarnia N7T 7X1 ON Active Apr-02-2012 suite 411-D
2 OF 4 OTN SITES - ERIE ST. CLAIR - JUNE 2013
LHIN SITE ID SITE NAME ADDRESS CITY PC PROV STATUS LIVE DATE 1 SIT05213 Twin Bridges NPLC 109 Crawford St. Sarnia N7T 2Y7 ON In Dev 1 SIT04529 VON Canada - Sarnia-Lambton 1705 London Line Sarnia N7W 1B2 ON Active Sep-17-2012 1 SIT00797 West Lambton Community Health Centre 429 Exmouth Sarnia N7T 5P1 ON Active Oct-16-2009 1 SIT00677 Westover Treatment Centre 2 Victoria St. South Thamesville N0P2K0 ON Active May-06-2009 P.O. Box 8 1 SIT04888 Grand Bend CHC - Thedford Site 99 Victoria St. Thedford N0M 2N0 ON Active Feb-05-2013 Box 9 1 SIT04688 Moore Maria 99 Victoria Street, Box 9 Thedford N0M 2N0 ON Active Aug-20-2012 1 SIT00927 Tilbury District Family Health Team 22 Mill St. Tilbury N0P 2L0 ON Active Mar-19-2009 1 SIT04946 Bluewater Methadone Clinic - Wallaceburg 1430 Dufferin Ave. Wallaceburg N8A 2W5 ON Active Feb-26-2013 1 SIT02769 Chatham - Kent Community Health Centres - 808 Dufferin Ave. Wallaceburg N8A 2V4 ON Active May-04-2011 Wallaceburg 1 SIT00594 Chatham Kent Health Alliance- Sydenham 325 Margaret Ave. Wallaceburg N8A2A7 ON Active Feb-26-2008 District Hospital P.O. Box 2030 1 SIT00678 Community Living Wallaceburg 1100 Dufferin Avenue Wallaceburg N8A2W1 ON Active Jan-22-2008 1 SIT03389 Chatham - Kent Community Health Centre - 785 Tecumseh Road Walpole Island N8A 4K9 ON Active Jul-18-2012 Walpole Island 1 SIT01739 Watford Community Health Centre 536 Simcoe St. Watford N0M 2S0 ON Active Oct-16-2009 1 SIT04964 Brentwood Recovery Home 2335 Dougall Ave. Windsor N8X 1S9 ON Active Feb-26-2013 1 SIT00721 Canadian Mental Health Association - Windsor 1400 Windsor Ave. Windsor N8X3L9 ON Active Dec-05-2008 Essex 1 SIT03315 CARE Centre for Internationally Educated 647 Ouellette Ave. Windsor N0M 1L0 ON Active Feb-06-2012 Nurses - Windsor Suite 201 1 SIT00471 Community Living Windsor 7025 Enterprise Way Windsor N8T3N6 ON Active May-08-2007 1 SIT03246 Community Services Coordination Network - 3200 Deziel Windsor M8W 5K8 ON Active Mar-07-2012 Windsor Suite 212 1 SIT04915 Erie - St. Clair Clinic - Windsor 1574 Lincoln Road Windsor N8Y 2J4 ON Active Feb-26-2013 1 SIT00684 Erie St.Clair CCAC - Tecumseh Rd. 5415 Tecumseh Road E. Windsor N8T1C5 ON Active Mar-26-2008 2nd Floor 1 SIT00680 Erie-St. Clair Infection Control Network 4510 Rhodes Drive Windsor N8W5K5 ON Active Jun-09-2008 Unit 701 1 SIT03294 Essex ACT Team 1&2 875 Ouellette Ave Windsor N9A 4J6 ON Active Dec-09-2011 1 SIT00436 Hotel Dieu Grace Hospital 1030 Ouellette Avenue Windsor N9A1E1 ON Active Apr-03-2007 1 SIT04957 House of Sophrosyne 1771 Chappell Ave. Windsor N9C 3E8 ON Active Mar-22-2013 1 SIT02459 Integrated Circle of Care - Windsor 3955 Tecumseh Road East Windsor N8W 1J5 ON Active Sep-14-2010 Suite B
1 SIT01566 John McGivney Children's Centre 3945 Matchette Road Windsor N9C 4C2 ON Active Aug-18-2009
3 OF 4 OTN SITES - ERIE ST. CLAIR - JUNE 2013
LHIN SITE ID SITE NAME ADDRESS CITY PC PROV STATUS LIVE DATE 1 SIT02672 Maryvale Adolescent and Family Services 3640 Wells St. Windsor N9C 1T9 ON Active Jul-06-2011 1 SIT02918 Metis Nation of Ontario - Windsor 145-600 Tecumseh Road Windsor N8X 4X9 ON Active Nov-04-2011
1 SIT02065 Ontario Addiction Treatment Centres - 1101 University Ave. West Windsor N9A 5T1 ON Active Dec-21-2009 Windsor 1 SIT00575 Regional Support Associates - Windsor 4510 Rhodes Avenue Windsor N8X5K5 ON Active May-16-2007 Number 130 1 SIT03016 Saint Elizabeth Health Care - Windsor 2473 Ouellette Ave Windsor N8X 1L5 ON Active Feb-06-2012 1 SIT00664 Thames Valley Children's Centre - Quality Way 3295 Quality Way Windsor N8T3R9 ON Active Nov-19-2007 Suite 401 1 SIT00712 The Hospice of Windsor Essex Inc. 6038 Empress St. Windsor N8T 1B5 ON Active Aug-20-2009 1 SIT04530 VON Canada - Windsor-Essex 4520 Rhodes Drive, Suite Windsor N8W 5C2 ON Active Oct-03-2012 400 1 SIT04895 WECHC - Street Health Program 711 Pelissier St. Windsor N9A 4L4 ON Active Mar-25-2013 1 SIT00926 Windsor Family Health Team 2475 McDougall St. Windsor N8X 3N9 ON Active Apr-30-2009 1 SIT00442 Windsor Regional Hospital - Met Campus 1995 Lens Avenue Windsor N8W1L9 ON Active Apr-03-2007 1 SIT02210 Windsor Regional Hospital - Regional Bariatric 1883 Turner Road Windsor N8W 3K2 ON Active Jun-09-2010 Assessment and Treatment Centre
1 SIT00437 Windsor Regional Hospital - Tayfour Campus 1453 Prince Road, Windsor N9C3Z4 ON Active Mar-01-2005
1 SIT00510 Windsor Regional Hospital - Windsor Regional 2220 Kildare Road Windsor N8W2X3 ON Active Mar-01-2005 Cancer Centre 1 SIT01543 Windsor Regional Hospital - Windsor Regional 3901 Connaught St. Windsor N9C 4H4 ON Active Sep-17-2009 Children's Centre
4 OF 4 The Road Ahead A study of transportation needs across Huron and Perth Counties
A report for the
March 2012 Acknowledgements This report was researched and prepared for the Social Research & Planning Council by Lynn Bowering Consulting. Creative Direction and Layout by SNAP Perth Media Group - Chris Parson. Printed by Huron Perth Health Care Alliance.
Copyright © The Social Research & Planning Council 2012. This work is copyrighted. It may be reproduced in whole or in part for educational use subject to the inclusion of an acknowledgement of the source.
United Centre - 32 Erie Street Stratford, Ontario Canada N5A 2M4 Tel: 519 271-7730 Extension 233 Fax: 519 273-9350 [email protected] www.socialresearchandplanning.ca
The Council is generously funded by City of Stratford, Town of St. Marys, County of Perth, through the Department of Social Services, the Municipality of Huron East and United Way Perth-Huron.
A DIVISION OF Table of Contents
Introduction 3
Demographics 5
Existing Transportation Services 7
Recent Research Initiatives 13
Living with Transportation Challenges 18
What’s Been Done Elsewhere? 26
Future Directions 28
Recommendation 30
Acknowledgements 31
References 32
Personal details provided by those interviewed during this study have been omitted, in order to protect the privacy of study participants.
TRANSPORTATION IN HURON & PERTH COUNTIES 1 2 TRANSPORTATION IN HURON & PERTH COUNTIES Introduction
How do people manage without a car in Perth and Huron Counties? Extensive interviews and research show they face many difficulties, not only in travelling outside their own communities, but in the activities of everyday life. This is particularly true for those who are disadvantaged by reason of health, employment, or family circumstance. Rural residents worry that services may not be there when they need them. They are being asked to adapt to rapid changes that are often difficult to understand. This is particularly hard for those who face economic challenges, as many in rural Ontario do:
“In rural areas, even if the necessary social services are in place, they can be virtually unreachable if you lack the means to get there. In many regions, affordable public transit is only a dream. If a family can afford a vehicle, it is often used to transport the breadwinner to work. Eliminating the [lack of basic infrastructure] plaguing Ontario municipalities can allow them to deliver the types of services that can alleviate poverty and stimulate new opportunities”. 1
Transportation in rural communities is a major social and health issue. Services available in Stratford or Goderich, for example, may be completely inaccessible to someone who lives only a few miles outside town, but has no means of transport. While many residents rely on their own vehicle, or friends and family for transportation, this option is not available to everyone. The range of some services available in small towns and villages has diminished in recent years, meaning that residents in those communities are forced to travel further afield in order to conduct the activities of daily living. Many of those without their own transportation risk social isolation and some are unable to visit their families in other communities.
1 Rural Poverty: AMO/ROMA submission to the Standing Senate Committee on Agriculture and Forestry, March 27, 2007 (Association of Municipalities of Ontario/Rural Ontario Municipal Association)
TRANSPORTATION IN HURON & PERTH COUNTIES 3 In early 2011, the Social Research & Planning Council of Perth-Huron called for proposals to provide a review of existing services, and an analysis of available information and statistics relating to personal transportation in Perth and Huron Counties. From this research, potential solutions to transportation challenges have been suggested.
This report describes the demographics of Huron and Perth Counties and outlines existing transportation services. Recent research is reviewed and areas of greatest need are identified. The report concludes with suggested directions for the future of transportation in Huron and Perth Counties and a recommendation toward their implementation.
Particular attention is paid to the needs of outlying rural areas and potentially marginalized populations such as those living on low incomes, those living with disabilities, youth, women, seniors, and distinct cultural groups. Lynn Bowering Consulting was contracted to conduct the project.
Methodology
Between February and June of 2011, the following process was undertaken:
1. Data from Statistics Canada and from the Planning Departments of the Counties of Huron and Perth was obtained and reviewed.
2. Recent reports conducted in both Counties, as well as in other parts of Ontario, were reviewed and analyzed. See pages 13 and 26.
3. A consultation plan was developed, particularly targeting agencies working with disadvantaged individuals and groups, and their clients.
4. Results of recent consultations that took place in Huron 2 and Perth 3 County were augmented by personal and group interviews, and incorporated into the study.
5. Interviews were conducted with many local agencies, as listed in the Acknowledgements (on page 31).
2 The Transportation Task Force in 2008 and the Demand Management Plan in 2010/11
3 The Vision 2013 project conducted by the Huron Perth Healthcare Alliance.
4 TRANSPORTATION IN HURON & PERTH COUNTIES Demographics
The two Counties cover a large geographic area and are adjacent to each other. Perth County covers about 2,200 square kilometres and is about 50% rural. Urban populations are situated in the small towns of Listowel, Mitchell and Milverton. The City of Stratford and the Town of St. Marys, while located within Perth County, are separate municipalities. Huron County covers about 3,400 square kilometres and is more than 60% rural, with small urban populations in Clinton, Goderich, Wingham, Exeter and Seaforth. The combined area covers a total of about 5,600 square kilometres. Population density varies from 34 people per square kilometre in Perth to 18 people per square kilometre in Huron, the latter being one of the most rural counties in Ontario. 4
Perth County Population Table 1 Municipality 2011 Population 2006 to 2011 Increase
Stratford 30,886 1.2% St. Marys 6,655 0.6% Perth County 75,112 1.0%
Huron County Population Table 2 Municipality 2011 Population 2006 to 2011 Increase
Goderich 7,521 -0.6% Huron County 59,100 -0.4%
4 Population information is from the Statistics Canada 2011 Census. All other demographic information is from the Statistics Canada 2006 Census, unless otherwise noted.
TRANSPORTATION IN HURON & PERTH COUNTIES 5 Population Characteristics
As in most rural communities, the population is largely stable, if not declining in some areas. The median age in Perth County is 39.3, slightly higher than the Ontario median age of 39 years. However, in Huron County, the median age is 42.3 years. The percentage of seniors (over the age of 64 years) in both Counties is higher than in the Province as a whole (19% in Huron, 16% in Perth and 13% for Ontario). A high ratio of dependent family members is expected as a result of an aging population. Changing family composition may result in additional pressures for drivers.
Both Perth and Huron Counties are relatively homogenous in terms of ethnocultural diversity when compared to the Province as a whole, with the notable exception of the small Anabaptist populations. 5 The most common languages, apart from English and French, are German and Dutch which are spoken by approximately 10% of the population.
Income
Median family income in 2005 was $62,446 in Huron County and $68,713 in Perth County. Both of these figures are below the Ontario median family income of $69,156. 6 Social and health problems that may accompany poverty can be compounded by a lack of transportation as it restricts access to services.
5 The Anabaptist community is comprised of several local communities which share their historical and religious roots in the Anabaptist movement of the 1500s. The term Anabaptist means “another baptism” and refers to the practice of baptising adults upon confession of faith rather than baptizing infants. Some communities include Old Order Mennonites, Old Order Amish, Conservative Mennonite, Independent Old Order Mennonite, Amish, and Low-German speaking Mennonites from Mexico. The cultural traditions of the Mennonite and Amish vary on a scale of very conservative, with few modern amenities, to fully modern, indistinguishable from mainstream society. (Perth District Health Unit, 2011)
6 Median family income since 2005 has likely decreased due to the global economic recession and rising unemployment rates. For more details relating to the impact of the recession on Perth County, please refer to Facing the Future: The Socio-economic impact of the global recession on Stratford, St. Marys, and Perth County, Social Research & Planning Council (2009).
6 TRANSPORTATION IN HURON & PERTH COUNTIES Service Utilization
Most residents access primary and secondary health services locally. 7 There are hospitals in Stratford, St. Mary’s, Seaforth, Clinton, 8 Wingham, Goderich and Exeter. Huron and Perth Counties are within the South West Local Health Integration Network (South West LHIN). Residents must travel into London for specialized tertiary services, although this has improved in recent years with the advent of more specialized services in the larger hospitals. For those without their own vehicle – or a willing friend or relative – options are very limited. In recent years, some agencies have replaced local offices with online services in an effort to achieve greater efficiency. Unfortunately, that makes life much more difficult for those who must travel to a central location for services or to check in on a regular basis. Social services are usually located in larger city centres – those living in smaller communities or in rural areas must find some way to reach those services.
Existing Transportation Services
Due largely to the geographic size and sparse population density of Huron and Perth Counties, providing a sufficient transportation system is logistically and financially challenging. The following section will provide an overview of transportations systems that provide service within Huron and Perth County. The City of Stratford operates a public transit system that includes services for people with physical challenges. EasyRide is a shared service that operates throughout Perth and Huron Counties and provides transportation to seniors, people with disabilities, and those in low-serviced areas. The transportation solution created by Community Living in Sounth Huron is highlighted. This section also outlines train, bus, and taxi services, and touches on the Huron Perth Student Transportation Service, an amalgamation of the public and Catholic school bus systems to reduce service duplication.
Public Transit
The only community within the two Counties operating public transit is the City of Stratford, operating six bus routes within the City, six days a week: from 6 a.m. to 9:30 p.m. on weekdays and from 6 a.m. to 7:30 p.m. on Saturdays. There is no service on Sundays.
Fares are $2.50 for adults, $2.25 for seniors, students and “special” riders (those on Ontario Works and Ontario Disability Support Benefit, who show required identification). Monthly passes are $55 for adults and $45 for the second category.
7 Source: South West LHIN
8 Members of the Huron Perth Healthcare Alliance
TRANSPORTATION IN HURON & PERTH COUNTIES 7 On May 18, 2011, 70 people attended a lively public meeting to discuss a proposal to reduce evening bus service from half-hourly to hourly service. Many of those in attendance stated they were on low incomes. Women outlined their fear of waiting in the dark in wintertime. Although it had been suggested that this proposal would be a cost-saving measure, it was rejected at the public meeting due to concerns about safety, long waiting times and fear of missing a bus. More than 70% of those who responded to a survey conducted by the City, indicated they would be willing to pay another $0.50 in fares to keep service as is.
The report that followed the City’s public consultation recommended that the City of Stratford maintain the status quo. This was reviewed and rejected by the Council on a tie vote. Some questions were raised as to whether the City needed a transit system at all, given low ridership – particularly in evening hours. It was noted that some other cities (such as Pembroke, Ontario) had eliminated publicly-funded transit in favour of a private system, though that had encountered many problems – private systems in some Ontario communities had failed over the years. The Mayor of Stratford was quoted as saying “the City will never park the buses” 9 and an editorial in the Stratford Beacon Herald supported him:
“It is logical to assume that … some of the people who take the bus do so not because of environmental awareness but because of certain challenges they may face whether they be physical, mental or financial. In our city and our society, that’s just as important” 10
At the time of writing, the City of Stratford had not determined whether evening bus service would be reduced.
Stratford Parallel Transit
This service, usually known as the “Mobility Bus” operates only within the City of Stratford (except for paid charter trips). Its clients are physically challenged individuals, who cannot use regular transit due to disability. Stratford Parallel Transit has five buses, two of which are on the road at any one time. They operate 7 days/week from approximately 8:30 a.m. to 4:30 p.m., with extended hours on Friday. 11
9 Stratford Beacon Herald, Tuesday, July 19, 2011
10 “Publicly funded transit hallmark of caring society”, in Stratford Beacon Herald, Wednesday, July 20, 2011
11 From 8:20 a.m. to 4:40 p.m. Monday to Thursday, 8:20 a.m. to 10:40 p.m. on Friday, and from 8:30 a.m. to 4:20 p.m. on weekends.
8 TRANSPORTATION IN HURON & PERTH COUNTIES The service takes people to medical appointments, hockey games, shopping malls and other destinations. The buses are equipped with assistive devices and can accommodate up to three wheelchairs and five clients with walkers. The current fare is $2.75 per trip (booklets of 10 tickets available), though this will be aligned with the same fare as the regular transit service (currently $2.50) when the Accessibility for Ontarians with Disabilities Act (AODA) is fully in force.
The following are statistics for 2010:
Total Trips Wheelchairs Walk-on Work/School Medical Other 15,605 7,704 7,901 5,587 1,123 8,895
Out-of-town trips cost $1.00/km with a waiting fee of $25. Stratford Parallel Transit also offers flat rates and charters out-of-town trips. The service is funded by the City, and through Provincial grants, Gas Tax funding, and revenue from fares.
EasyRide
EasyRide is collaborative network of transportation services, made up of six agencies from Huron and Perth Counties:
• OneCare 12 • Community Outreach & Perth East Transportation • Mitchell & Area Community Outreach & Mobility Bus • St. Marys & Area Home Support Services • St. Marys & Area Mobility Services • VON Perth-Huron
In June 2009, EasyRide began offering a coordinated booking service that provides “one number to call” to access transportation. 13 This booking system was provided by the South West LHIN through their Aging at Home Strategy which also provided financial support for the purchase of some vehicles.
EasyRide offers service for registered clients including seniors, people without access to transportation, those with physical or cognitive limitations, and those who do not have family and friends who can assist. Trips are for medical appointments, shopping, errands and social occasions.
12 A recent amalgamation of Stratford Meals On Wheels & Neighbourly Services, Town & Country Support Services and Midwestern Adult Day Services. The latter two were based in Huron County.
13 While all the partners share EasyRide booking service, Perth East Transportation does its own scheduling, largely because the Anabaptist population (80% of their clients) find this easier and their service demands are different (source: personal interview)
TRANSPORTATION IN HURON & PERTH COUNTIES 9 Each EasyRide organization has unique costs, clients, governance, transportation demands, challenges, and funders, which effectively determine the fare structure of each partner’s service. For example, if a rural agency most often provides service locally on rough roads, fewer vehicles are required, but the lifespan of each vehicle may be shorter. In an urban area like Stratford, the presence of a public transportation system and taxi service will determine the appropriate rates. In future, one of the goals of the EasyRide partnership is a standardized fare structure, which must be phased in gradually in order for agencies to keep services affordable and to maintain ridership. Funding, while unique for each partner, is provided largely through municipal and Gas Tax dollars, the South West LHIN, the United Way of Perth-Huron, and other contributors.
At present, the most significant barrier to widespread use of EasyRide is cost. For example, a trip from Stratford to London for a medical appointment (a 120 km round trip), could cost $54 (at $0.45/km) – with 2 hours of waiting time (not unusual for appointments with specialists), the client could incur an additional $30, making the total cost of the trip $84.00. For a senior living on a basic pension, or an individual receiving Ontario Disability Support Program benefit (maximum around $1,000/month including rent), this would be a prohibitive cost. Despite its challenges, EasyRide has become one of the best examples of collaborative transportation services in Huron and Perth Counties.
In June 2011, it was announced that Perth County municipalities would receive $254,000 for accessible bus services, based on increased ridership. 14 There is also the possibility to expand services in Huron County through the Gas Tax revenue, although the expansion is dependent on an increase in funding from the County or Municipalities. For more information, please refer to the Future Directions section.
Community Living - South Huron
Community Living - South Huron, who provide support to people with a physical or developmental disability, operate a business called Dashwood Wood Products where clients build wooden crates and pallets. They are a successful small business and social enterprise that teaches on-the-job skills, and creates an inclusive environment where individuals can contribute to their community, develop confidence, and achieve their potential.
Recognizing the difficulty that their employees may face in finding reliable transportation in a rural area, Community Living South Huron invested in buses to transport people to and from work on a daily basis. This has proven to be an effective solution for the small Huron based company and provides an example of a viable response to rural transportation challenges.
14 Stratford Beacon Herald, June 15, 2011
10 TRANSPORTATION IN HURON & PERTH COUNTIES Train Service
At one time, there was extensive rail service to both Perth and Huron County communities, including those on the Lake Huron shore. One gentleman from Blyth reported that, as a youth, he had often visited a relative in Hamilton by train, changing in Guelph. 15 Most of those services ended during the 1970s. Today, there is no passenger rail service in Huron County; someone wishing to take the train would have to find a way to reach London or Stratford. Stratford and St. Marys are served by Via Rail on the Toronto/Sarnia line, with three trips daily Monday to Friday, and reduced services on weekends. This can be very limiting for the residents of the two counties.
Bus Service
In April, 2011, Greyhound Bus announced that it was discontinuing its service on the Kitchener to London route, which had stops in Stratford and St. Marys. It cited “low ridership” as the reason. This took effect in July, 2011. In the meantime, Aboutown Transportation agreed to take over these routes. Aboutown Northlink operates several routes passing through Huron and Perth Counties (part of its service from Owen Sound to London and St. Thomas):
• Wingham-Listowel-Stratford: operates Monday, Thursday, Friday and Sunday. There are 5 buses daily and trip time from Wingham to Stratford is 2 hours (total of 10 stops en route) Fares are: o Wingham to Stratford: $27.50 adult o Listowel to Stratford: $18.00 adult
• Stratford to Kitchener: 2 evening buses daily
• Goderich-Clinton-Stratford: a change of route is required at Lucknow and there are a variety of schedules
As can be seen, travelling time is lengthy and fares are probably out of the reach of low-income families and individuals.
15 Personal communication
TRANSPORTATION IN HURON & PERTH COUNTIES 11 Taxi Services
These are particularly important in rural areas and small towns where there are few alternatives for residents with no vehicle. The Huron County Transportation Task Force identified a total of six taxi companies providing services to various parts of Huron County (Goderich, Exeter, Wingham, Seaforth, Clinton as well as to the County as a whole). Their hours of service vary considerably and their services are usually limited to a specific geographic area, although one company does offer service outside the County as far as Toronto.
In Perth County, there are taxi companies operating in Stratford, Mitchell, Listowel and St. Marys. Service in Stratford and Listowel is available 24 hours daily. In Mitchell and St. Marys, service is available 7 a.m. to midnight Sunday to Thursday and from 7 a.m. to 3 a.m. on Fridays and Saturdays. None of the Perth County taxi companies have a restricted area of service.
On the whole, taxi fares are expensive, even with a flat rate system in place such as the one used in Stratford. The use of a taxi service can be out of reach for people who are living with low income.
Huron Perth Student Transportation Services
This is a consortium formed by the Huron Perth Catholic District School Board and the Avon Maitland District School Board. The amalgamation was mandated by the Province throughout Ontario to reduce the duplication of student bus services among school Boards. There are 357 routes and buses provided by 8 independent contractors from 11 different sites. Vehicles range from a minivan to 72 passenger buses, some of which have been modified to take wheelchairs and other assistive devices.
In order to provide optimal service for students, Huron Perth Student Transportation Service maintains a sophisticated database that is used daily and imported into their Bus Planner GeoRef system, based in Waterloo. The information is available to operators and schools through a query program, allowing access to maps and student transport information.
Buses are often chartered for other purposes, when they are not being used for transporting students or are undergoing maintenance.
12 TRANSPORTATION IN HURON & PERTH COUNTIES Recent Research Initiatives
The following section will outline the most recent investigations into transportation within Perth and Huron Counties. At present, there is extensive information relating to Huron County while little exists pertaining to Perth. 16 Consultations by the Social Research and Planning Council, the City of Stratford Transportation Master Plan, and the Huron Perth Healthcare Alliance – Vision 2013 report have been included.
Social Research & Planning Council Community Forums
The Social Research & Planning Council (SRPC) 17, a division of the United Way of Perth- Huron, conducts research and generates reports that are specific to Perth and Huron Counties. 18 Past reports have been written on Elder Abuse (2009), the Impact of the Global Economic Recession (2009), Mental Health (2008), Literacy (2008), Youth (2007-2008), Minimum Wage (2007), and Poverty (2006). In addition, the SRPC releases a Quality of Life report every four years (2004, 2008) to monitor changes in community conditions.
In 2010, the SRPC held three community forums – in Stratford, Listowel and Clinton. The purpose of the forums was to gain community input regarding social issues and potential next topics for research in Perth and Huron Counties. Through a facilitated process, the groups developed five top issues for their communities. Transportation was identified as one of those top five issues. Lack of affordable and accessible transportation was believed to cause social isolation and restrict individuals from accessing healthcare services, social services, and other resources. The commissioning of this report was a result of the data and opinions gathered at these forums.
City of Stratford Transportation Master Plan
In January 2009, the City began work on a 20 year Transportation Master Plan to update and replace the 1992 Transportation Plan. The report explores the feasibility of truck routes and a Highway 7/8 bypass route, prepares an improvement program for projected population and employment growth, and explores and develops strategies for cycling and other active modes of travel.
16 The most recent study conducted by the County of Perth was undertaken by the former Huron-Perth District Health Council in the late 90s.
17 Formerly the Perth County Social Research and Planning Council.
18 The Transportation Report is the first to include both Perth and Huron Counties..
TRANSPORTATION IN HURON & PERTH COUNTIES 13 Huron County Transportation Task Force
The Huron Transportation Task Force Study was conducted in 2008 and focuses on transportation users. The Task Force prepared an inventory of transportation services by surveying existing providers and agencies that serve seniors and people with disabilities including youth and those living with mental illness. The report noted that:
“Lack of transportation is a barrier in Huron County to providing services to people who need them. Getting to the grocery store, medical appointments, to work, job interviews and daily activities [that] can seem trivial to people that own a car”. 19
Most rural residents report that they use an automobile for transportation. However, information collected from client interviews showed that car owners are limiting vehicle use due to the 30% increase in gas prices over the past year. In addition, particularly in rural areas, those without access to a vehicle can be severely disadvantaged. The report identified the priority groups as seniors, youth, people with disabilities, women, and low income families. The report showed that transportation was the second-highest ranked community issue.
Transportation Demand Management Study
The Transportation Demand Management Study, which focuses on transportation systems, was conducted for the County of Huron in 2010 and 2011 and at time of writing, was still in draft form. This study will include a review of expansion possibilities for the EasyRide program in Huron County based on consultations conducted by Dillon Consulting in 2010. Those studies 20 were reviewed and analyzed for inclusion in this report. Transportation Demand Management is defined as:
“… a multi-faceted and multi modal approach used to reduce or redistribute transportation demand. This increases the efficiency and use of the available transportation infrastructure, through the implementation of strategies which influence travel behaviour and reduce reliance on the single-occupant vehicle. In many situations,
19 Huron Transportation Task Force Report, 2008
20 Huron Transportation Task Force Report, Huron Community Matters, 2008; Transportation Demand Management Plan, MMM Group for Huron County, 2010 and 2011; Assessment of Community Transportation Service Expansion in Huron County, Dillon Consulting, 2010.
14 TRANSPORTATION IN HURON & PERTH COUNTIES these goals can be accomplished by encouraging a shift in travel mode to carpooling or active transportation which will facilitate a reduction in vehicle trips.” 21
While the report does incorporate the 2008 Task Force Report and deals briefly with public transportation, its focus is largely on encouraging changes in current transportation patterns (i.e. increased use of hiking and walking trails, bicycle use, etc. – “active” transportation), rather than in expanding accessibility overall.
EasyRide in Huron County
The 2010 review of the EasyRide program in Huron County, conducted by Dillon Consulting, showed that of the 73,000 annual trips coordinated by EasyRide, 17% originated in Huron County, with the remainder beginning in Perth. While no comparable study has been done on EasyRide Perth, the Huron report attributed this large difference to the level of transportation service available. Since the agencies in Perth County had entered into partnerships with the municipalities they service, it enabled them to receive not only municipal financing, but provincial Gas Tax contributions. This has allowed them to expand their services and provide greater accessibility. The report concluded:
“The EasyRide Huron County transportation providers have the experience and desire to service the needs of seniors and persons with disabilities within the County. However, to meet existing unmet and future latent demand, additional secure funding is required. The provincial gas tax provides a good opportunity to tap into funding sources that will benefit the residents of the County. This would require entering into a service agreement with Huron County to provide additional funds to service this need and benefit the residents of the County.” 22
The Ontario dedicated Gas Tax Program was initiated in 2004, as a means of investing a portion of the provincial gas tax in public transit. In 2009/10, $316 million was allocated among the participating Ontario municipalities based on two cents per litre of the provincial gas tax. These funds are dedicated to transit uses and cannot be used for any other purpose.
21 Transportation Demand Management Plan, p. 1-2
22 Assessment of Community Transportation Service Expansion in Huron County, Dillon Consulting, 2010, p. 19
TRANSPORTATION IN HURON & PERTH COUNTIES 15 They cannot be used to reduce or replace current levels of municipal provincial transportation funding. They can be spent on:
• Expenditures to promote increased transit ridership • Transit operating expenditures • Replacement of public transportation vehicles • Improvements to transit security and passenger safety; and • Major refurbishments on any fully accessible, or to be made fully accessible, public transportation vehicle
The allocation of funds received by municipalities is dependent on the total funding envelope available, their ridership and the municipal population. To be eligible to receive dedicated gas tax funds, a municipality must support and contribute financially towards their public transportation services. The Ministry of Transportation estimated in 2010 that the maximum provincial allocation for which the County of Huron would be eligible was approximately $250,000, assuming a County funding commitment of $333,000 or higher. If the County’s funding commitment were lower, the Gas Tax allocation would be 75% of that commitment.23 At the beginning of the program, many rural areas were ineligible to receive funding, as few had a system in place. Despite a policy change in 2006, the majority of funds are allocated to urban centres, with smaller, rural communities receiving much smaller amounts. 24
As is made clear by these reports, making use of the Gas Tax to expand transportation options depends on municipalities agreeing to provide the core funding. In a time of increasing financial pressures on municipal governments, that agreement is often extremely difficult to achieve.
Huron Perth Healthcare Alliance – Vision 2013
Although the Vision 2013 report focuses on proposed changes to hospital services, it implicitly raises transportation issues. The Huron Perth Healthcare Alliance was formed in 2003 and consists of four hospitals: two in Perth County - Stratford General Hospital and St. Marys Memorial - and two in Huron County - Seaforth Community Hospital and Clinton General Hospital. Of the four, Stratford General is the largest, and has recently undergone extensive expansion and renovation. It acts as the referral hospital for its surrounding area, and includes some tertiary services, such as dialysis, chemotherapy (satellite of the London Regional Cancer Centre), critical care and telemetry.
23 Ibid, p. 13. This report also provides a detailed description of process and reporting requirements for the Gas Tax program.
24 Rural Women & Transportation in Ontario: Rural Women Making Change, 2009
16 TRANSPORTATION IN HURON & PERTH COUNTIES In 2011, the HPHA received approval from the Ministry of Health & Long-term care to install a Magnetic Resonance Imaging (MRI) machine. Presently, 3,100 scans a year take place in London – a total travel distance of 307,520 km. The new MRI is scheduled to operate 40 hours/week, thus avoiding lengthy travel and ambulance trips. 25
In 2010, the Alliance embarked on a strategic planning exercise – Vision 2013 – to address some significant challenges:
• Shortage of healthcare professionals • Disproportionate distribution of services across four sites • Increased quality and patient standards expectations
The Vision is based on four principles, one of which is to retain four viable sites. The strategy involves the realignment of services across the four sites, the redistribution of beds in order to create a “critical mass” at each site and the adjustment of emergency coverage (two 24/7 emergency departments and two 16/7 emergency departments across the four sites). Target date for implementation of the Vision is September, 2012. 26
As the Vision 2013 Project Charter indicates, 27 the four hospitals are within relatively close proximity to each other:
• St. Marys to Stratford: 19 km • Stratford to Seaforth: 39 km • Seaforth to Clinton: 14 km
The Alliance conducted an extensive consultation process, involving public meetings in Mitchell and Clinton, wide distribution of newsletters and information packages, as well as a telephone survey of 650 residents. Not surprisingly, there was vocal community reaction. Despite repeated assertions that no hospital was slated for closure, many in the smaller communities perceived a strong threat to “their” hospital. In St. Marys, for example, signs appeared all over the town urging a fight to “save our hospital”.
The proposed reduction in hours in the emergency room was the most contentious issue in the rural areas. While changes to emergency department hours and redistribution of beds may make perfect sense to health planners, “critical mass” and “quality of care” are not well understood by the general public. In Stratford, there was considerable concern at the proposal to move rehabilitation beds to Seaforth. Consultation results showed a high level of satisfaction with hospital services and a close identification with the local hospital. While many
25 Stratford General Hospital Foundation flyer, May 2011
26 Note the final resolution of the ER issue is dependent upon the outcome of current policy discussions at the Ontario Ministry of Health & Long-term Care.
27 Vision 2013 Project Charter, South West LHIN, 2010.
TRANSPORTATION IN HURON & PERTH COUNTIES 17 understood the need to travel for various services, and were willing to do that, the more rural areas showed greater concern.
Redistribution of beds generated a mixed response. Interestingly, those with a higher income were more supportive of the development of “centres of excellence” at specific hospitals, while those with lower income were less supportive. This suggests that those who are less able to travel for services are more worried about this proposal.
The most negative results in the telephone survey were to the question: “I’d be prepared to give up 24 hour emergency services at smaller hospitals in the region if that meant that a high- quality and well-staffed 24-hour emergency service was available at another site of the Alliance”. Only 35% of respondents agreed with this statement, an indication of the community’s concerns about travelling for care. Results were most striking in the areas around St. Marys, Clinton and Seaforth, 28 demonstrating the higher level of concern in those more rural areas.
Living with Transportation Challenges
Demographic data has shown us that there are a large number of seniors and youth in both Perth and Huron Counties. Family income is below the Provincial average and likely to be further negatively affected by the current financial situation in Ontario. 29 This as well as the research reviewed above demonstrates that the following groups have the most acute transportation needs:
• Those living on low income • Those living with disabilities • Youth • Women • Seniors
Those Living on Low Income
Transportation options in Perth and Huron are limited. There are significant costs involved in using taxis or inter-community buses and these are particularly challenging for those living on restricted incomes. This would include seniors living on a basic pension, those living on Ontario Works or Ontario Disability Support Program benefits and others living on low incomes, at or below the poverty line. During the interviews conducted as part of this project, we heard the stories of many who are struggling to deal with this challenge.
28 Report on Attitudes & Assessment of Health Care Issues & Vision 2013 Activity in Huron Perth: The Strategic Counsel (for HPHA), January 2010
29 For more details relating to the impact of the recession on Perth County, please refer to Facing the Future: The Socio-economic impact of the global recession on Stratford, St. Marys, and Perth County, Social Research & Planning Council (2009).
18 TRANSPORTATION IN HURON & PERTH COUNTIES The Unemployed and Those Seeking Employment
The government-funded organization Partners in Employment works with people to help them find jobs in the Stratford area. They report that even the available public transit in Stratford presents affordability challenges. Many people try to car pool with fellow workers or friends. Some employers in small communities have considered hiring buses to transport employees to and from work– such as Community Living South Huron. A suggestion was made by one interviewee at Partners in Employment, that bus service could be provided to new work sites as they are constructed. The need for affordable and sustainable transportation speaks to the economic well-being of the community for which the service is being provided.
Those on Ontario Works
People who are on Ontario Works (OW) are either in temporary financial need, looking for work, or both. The income of Ontario Works recipients is well below the national poverty line. As such, transportation realities for a person living on OW can be very challenging. OW will reimburse $0.30/km for medical appointments or for trips to seek employment. At present, the program is often forced to pay for expensive taxi rides in order to accommodate the schedules and hours of operation for employment or counselling services. Until about 2004/5, Huron County had OW staff scattered in communities across the County. This presented problems for staff that often had to work alone. Technology has now enabled them to centralize their operations, but this makes it hard for people to reach them and often results in high taxi bills. In Perth County, one young woman described her difficulties in getting the services she needs:
“I’m on OW and they’ll pay for me to take a taxi from Mitchell to Stratford to attend meetings at Choices for Change. They also pay for me to come in for school. But they won’t pay for me to come in to Stratford to go to Narcotics Anonymous. That’s a really important meeting but I just can’t get there, and it isn’t available in Mitchell”
Other unemployed people rely on walking as much as they can, though that is only possible within an urban area, such as Stratford, Seaforth or Goderich. Another talked about his dream of getting a better education:
“I’d really like to go to school in London or Kitchener. If I could get there, I could get some help from OSAP [the Ontario Student Assistance Program] but without some transport it’s impossible. I’m stuck”
TRANSPORTATION IN HURON & PERTH COUNTIES 19 Everyone recognizes the benefits of physical activities for children, but these can be out of reach without transportation:
“I’m looking for work and walk everywhere right now in Stratford – at least it keeps me healthy. But I’d really like my son to play hockey. The only affordable program I can get him into is in Mitchell and with no transportation, I can’t do it. The programs in Stratford are simply too expensive for me”
For many on OW, local bus service can be too expensive. Although they can get a bus pass when they are on the program, once they come off, they lose that benefit. Most walk everywhere when the weather is amenable.
Some of those on OW do have their own vehicle, but most reported they use it sparingly because of the steeply rising price of fuel. Others worry about how to maintain the vehicle on their limited resources:
“I live in fear of something going wrong with the car there’s no way I can afford to get it fixed. So I’m pretty careful about how I use it and how much. Sometimes I give my friends a lift and they help me with the gas. And sometimes they gift me a lift, too”
Those living with disabilities and special needs
Peer facilitators working with the Canadian Mental Health Association (CMHA) of Huron- Perth are themselves consumer/survivors of mental illness. They reported a high level of need in rural communities. One who lived in a small community in Huron County described the difficulties where there are no local doctors or local pharmacies. While pharmacies in urban areas usually deliver prescriptions free, pharmacies in small towns are unable to do this due to their smaller volume, and the patient must pay for delivery. CMHA, like many other agencies, is encountering difficulties getting volunteer drivers, particularly due to the steep rise in gasoline prices over the past year. The cost of providing transportation for clients is becoming prohibitive.
Most interviewees on ODSP complained of uneven application of very bureaucratic rules: some transportation costs are reimbursed, while others are not. Medical transportation forms cause a great deal of anxiety among clients, who otherwise try to rely on each other for a ride.
20 TRANSPORTATION IN HURON & PERTH COUNTIES EasyRide is out of reach financially for most of them. As they put it, “we rely on the goodness of others”. In addition, the increasing difficulty in finding a local physician forces some of them to take drastic measures:
“I had to orphan myself 30 so I could get service at the hospital. Otherwise, they kept telling me to see my own doctor, who is based in another town and I can’t get to him without spending money I need for food”
Everyday tasks like getting groceries become an ordeal. In Goderich, for example, both supermarkets are on highways on the edge of town, and this causes difficulties:
“In good weather, I try to walk there, but I have to get a taxi back with my groceries. In bad weather, I have to get a taxi both ways and that’s a big expense”
Those living in very small towns experience other problems: small town convenience and grocery stores charge higher prices and often charge for delivery. 31 Even family connections suffer:
“It’s really hard to get to Christmas concerts at local churches or schools, especially when the weather’s bad. I miss my brother, but I can only afford to visit him once a year on the bus, because it costs too much money”
When asked why they continue to live in those communities, several interviewees reported that their location is determined by where they can find affordable housing.
Community Living of Stratford & Area (CLSA) reports that EasyRide is too expensive for their clients. As they note, “where you live limits what services you can receive,” people have no choice but to see someone in their own community, even if their preference is for another person elsewhere (e.g. a female physician). CLSA has 8 vehicles, 2 of which are fully accessible units. They provide transportation for medical appointments, recreational, evening and other activities.
30 An “orphan patient” refers to someone who has no family doctor.
31 Source: personal interview
TRANSPORTATION IN HURON & PERTH COUNTIES 21 CLSA supports about 120 people and operates 12 to 14 homes for independent living, where the staff support depends on the needs of the residents. The agency estimates it spends about $125,000 per year on transportation – that does not include the cost of vehicles or staff wages, though it does include use of the Mobility Bus, taxis and volunteer costs. They do receive some help from the City of Stratford to offset the cost of the Mobility Bus.
Agency staff report that many of their clients on ODSP experience difficulties in getting payment for transportation, which has to be pre-approved. The Perth District Health Unit’s Healthy Babies Healthy Children staff also noted the difficulties for families where children needed special services:
“Many low-income families rely [on] begging a ride. If the child needs services that are only available in another community, they may not get them if they can’t get a ride that day. It’s really hit or miss. That means the child isn’t getting the services they need and that can become a vicious circle. There aren’t many options in rural areas”
Many of these individuals are also regular users of the food banks, and report they cannot get back with their groceries without a ride. Some even have difficulties getting a ride to church. The social isolation experienced by those living with disabilities is exacerbated by the lack of transportation.
Youth and Young Parents
Young parents with small children face considerable hardship in receiving services. We met with a group at the Young Parents’ Place in Listowel. Only one of the participants had their own vehicle, and they were struggling with the rising cost of fuel. All the others had no transportation of their own and relied on friends, family or expensive taxis when needed. Most of the time, they walked everywhere but even that can pose problems:
“There are no sidewalks on the main street by the grocery stores, so I have to try and manage the stroller with my kids and it’s dangerous as that is part of the highway. I often have to pay $60 in taxi fares on grocery shopping days.”
Many of those interviewed spoke about their social isolation. While they can get assistance with transportation for some services and medical appointments, there is no assistance available for social occasions. Most of them relied heavily on friends or family where those were available. Many social and recreational activities, even if they are affordable, are not accessible without transportation. Some suggested that sports organizations should consider developing volunteer transportation services, to make their programs more accessible.
22 TRANSPORTATION IN HURON & PERTH COUNTIES One mother in Listowel talked about her problems in taking her daughter to hospital in Stratford: “My daughter has some chronic health problems and I’ve had to take her many times to the Stratford hospital. If it isn’t a real emergency I have to call a taxi, it’s the only way to get there. I don’t always know when she really needs an ambulance”
Youth wanting to travel between communities face similar difficulties if they have no access to a vehicle. Some reported cycling 12 to 20 km into the nearest town, though clearly this is not feasible during severe weather. Most rely on family and friends for transportation. Youth have also noted that lack of transportation limits their ability to get and keep part-time employment. Hitchhiking is often favoured by young people, despite the safety risks. 32
Women
Many women in rural areas are consistently without access to transportation. Even more are without full access to a personal vehicle. 33 Women’s access to personal vehicles may be affected by their status in the household and by their income level. In many cases, men control the use of the household vehicle, making women dependent on alternative forms of transport, if available. Women are often at a disadvantage in securing personal transportation because they generally earn less than men, making vehicle ownership difficult. Women’s transportation needs are also different, because they are often responsible for maintaining the household and spend more time in caring roles, requiring them to travel to different places at different times than men. Without reliable, affordable transportation, finding and keeping a job in rural areas is beyond the means of many women. 34
Women in Huron Second Stage Housing (Goderich) reported that their greatest needs are doctors’ appointments. Most are living on OW or ODSP and try to shop in Goderich where they can take advantage of cheaper prices. For those who live out of town, this can present significant difficulties:
“I live in [a town] but my doctor is in [another town]. Right now, OW pays for my gas but trying to get a new one locally is just about impossible. I have children who are in kinship
32 Listening for Change: Identifying Community Priorities. United Way Perth County, 2005
33 Rural Women & Transportation, Rural Women Making Change, 2009
34 Ibid
TRANSPORTATION IN HURON & PERTH COUNTIES 23 care [being looked after by family members]. The CAS will pay for my son to visit me, but won’t pay for me to visit him. I have no social life, it’s just impossible. I can’t afford the cost of the bus from [my home] to [my son’s] and back”
A federally-sponsored study on woman abuse highlighted the isolation experienced by abused women in rural areas and noted that access to transportation can mean the difference between life and death:
“What happens if you don’t have a vehicle and you have to wait for a taxi? That’s at least an hour. By that time it might be too late … If you’re stuck on a farm, or even in small areas, you don’t have a car and you don’t have any way to these places to get the help you need … you’re stuck” 35
Abused women face added risks in rural areas, where neighbours may be quite distant, there are more registered and unregistered long guns and other firearms in homes, and emergency response times are often much longer. 36
Seniors
Seniors face difficulties living in rural areas, particularly when they have limited or no access to a vehicle. 37 For seniors, EasyRide can be the best-organized transportation program in the area, but those who cannot afford it may rely on family, friends, volunteer drivers (such as those from the Cancer Society or from their church) or other limited services. Those who do not, risk cancelled appointments and reduced access to services. Seniors living in rural areas are often forced to move into town when they can no longer drive. 38 Most retirement residences and long-term care facilities in both Counties provide limited transportation for medical appointments, shopping trips, etc and the EasyRide partnership fills in many gaps.
The United Way of Perth County (now United Way Perth-Huron) found similar results in its 2005 Community Matters Report. Across the County, lack of affordable transportation for seniors, people with disabilities and people on fixed incomes was the primary transportation concern. 39
35 Ontario Rural Woman Abuse Study: Final Report, Government of Canada Department of Justice, 2000
36 Government of Ontario, Neighbours Friends & Families initiative to end violence against women
37 For information about Elder Abuse see, Breaking the Silence: A Report on Elder Abuse in Perth County, Perth County Social Research & Planning Council, 2009.
38 Huron Transportation Task Force, 2008
39 Listening for Change: Identifying Community Priorities, United Way Perth County, 2005
24 TRANSPORTATION IN HURON & PERTH COUNTIES Anabaptist and Low-German Speaking Mennonite Communities
Some of the Anabaptist 40 communities in North Perth and Perth East rely largely on horse and buggy for transportation. Children in these communities either walk, use a scooter, bicycle or their parents drive them to school in the buggy. While members of the community can use the buggy to travel into Milverton to do their shopping, for example, this option is impossible in Stratford, where there are no places to tie the horse. Travelling by horse and buggy is a time- consuming activity and it can take an hour to travel from Poole, for instance, into Milverton.
For any trip they cannot make by horse and buggy, these families hire a driver either from the “English” community or from other Anabaptist communities nearby. A round trip to London can cost from $100 to $175. Even a relatively short trip to a local centre can cost $25. Some residents require extensive and specialized medical services that are only available in London. Repeat visits can be very costly and present a significant hardship for these families. Families report 41 their greatest needs are for medical appointments. While some horse and buggy Anabaptist families have phones on their property, they are located 100 feet from the house. This can pose problems, particularly in the winter.
The Perth District Health Unit Nurse Practitioner provides care to Anabaptist women and children in Millbank, Milverton, Hesson and Poole but sustainable funding is an issue. Other Health Unit programs provide service to this community and this help is clearly valued. Many Anabaptist families in North Perth and Perth East use the Perth East Transportation service based in Milverton, and find it particularly helpful for visiting friends on other farms. This is a very resourceful and efficient community who rely on each other for support. Their greatest need is for an available driver at an affordable price.
There are smaller Anabaptist communities in northern Huron County, who pay English neighbours and family for transportation when needed. Local agencies 42 report that community members also look to their church for help when needed.
The Low German-speaking Mennonite community in Perth (largely Perth East) is a mainly transient community, moving back and forth between Ontario and Mexico. Many members (particularly women) speak little English and local churches offer English as a Second Language (ESL) classes. These classes are also supported by the Avon Maitland District School Board (some offer limited transportation). Unlike some of their neighbours, they do use cars and trucks. Typically, there is one vehicle and the mother is left at home with several children while
40 “Anabaptist” refers to those who are baptized as adults. For a more detailed explanation, see footnote 5.
41 Personal interview
42 Such as the Huron County Health Unit (personal interview)
TRANSPORTATION IN HURON & PERTH COUNTIES 25 the father works long hours. Getting a child to a medical appointment, for instance, would require him to take a day off work. Many families don’t have enough car seats for the children and some of the women do not have a driver’s license. Coupled with the linguistic and cultural barriers in accessing health care services, it is clear these communities face formidable transportation challenges. 43
What’s Been Done Elsewhere?
There have been many rural transportation initiatives across Canada and the United States. A few are considered below:
Wellington Transportation Services
This service is operated by the Community Resource Centre of North and Centre Wellington and is a volunteer-based collaborative venture of community service providers serving the people of Centre, North and East Wellington. Rides (fully accessible) can be arranged for medical, legal and social service appointments, social events and family visiting, as well as the errands of daily life such as shopping and banking. The service also provides transportation to outside centres such as London and Hamilton.
Participating service providers include Community Resource Centre, East Wellington Community Services, Fergus Elora Senior Transportation, Family & Children’s Service, VON Canada, North Wellington Senior Council and Seniors for Excellence, Drayton. Target populations include seniors, those with disabilities, those on low income and individuals who do not have access to transport. There are also eligibility requirements relating to the agency providing the service, place of residence, etc. Clients are assessed at an initial intake interview to determine eligibility. The service operates 7 days a week; rides must be arranged during office hours Monday to Friday, and require at least 48 hours’ notice.
Fees are charged on a sliding scale, based on client’s income, and some would pay no fee at all. Individual service providers may charge a fee based on client assessment criteria. For fee- paying clients, a basic fee of $0.45/km is payable. 44 This service is quite similar to the EasyRide program, although it requires longer notice for bookings.
43 A Descriptive Profile of Amish & Mennonite Communities in Perth County. Perth District Health Unit, 2006
44 Interview with Community Resource Centre
26 TRANSPORTATION IN HURON & PERTH COUNTIES Bancroft Community Transit
This service is a non-profit organization providing a door-to-door transportation service by volunteer drivers. It is provided only to clients of defined health and social services agencies, who are under 55 years of age, as well as those on Ontario Works. (Those over 55 are referred to Senior Support Services).
Bancroft Community Transit provides service for medical, legal, counselling, daycare, work placements and activities of daily life, although rules explicitly state it “will not provide service to the liquor store, beer store or to hotels”. 45 It is not available to the general public. Once an agency has registered a client as eligible for transportation, that client is assessed and thereafter, can book trips on-line, by phone or e-mail. Fares are based on the distance travelled and must be paid to the driver before the trip, unless pre-arranged by the referring agency. Fares charged are kept confidential. 46 Pick-up and cancellation requires 24 hours’ notice.
Ride Haldimand-Norfolk Initiative
This initiative is the latest in a succession of community efforts dating back to 1991. The current committee (composed of representatives of many health and social service agencies) has worked since 2006 to identify and quantify the need for public transportation, as well as to develop a proposal for a transit system crossing both Counties, which have close ties and were formerly a regional government. Feasibility studies in 2009 and 2010 were completed with funding from the Ontario Trillium Foundation. The study found that local agencies were spending more than $1 million a year collectively on transportation for a population of around 108,000. It initially approached both Haldimand and Norfolk Counties for funding, but Haldimand County declined to participate.
In early 2011, the committee approached Norfolk County, who at first rejected a request for seed funding. However, in March of this year, the County reversed its decision, voting $20,700 in the 2011 operating budget to help organize the transit system for a two-year pilot program. 47 Next year’s contribution is estimated at $124,500, although that may be offset by contributions from the Ontario Trillium Foundation, the Norfolk District Business Development Corporation, and others. County funding would also qualify for the provincial Gas Tax subsidy. At the outset, the plan would have Simcoe as the hub, on shuttle lines to Waterford, Delhi, Port Dover and Port Rowan. Norfolk County plans to invite Haldimand County to revisit its decision not to participate. 48 At the time of writing, a local bus company has been selected, though not yet publicly announced, and the service is set to commence in October, 2011. 49
45 Bancroft Community Transit website www.bancroftcommunitytransit.com
46 Telephone conversation with Bancroft Community Transit
47 “Simcoe to be hub of bus line”, Simcoe Reformer, March 18, 2011
48 For detailed information, see Public Transportation Systems in Haldimand and Norfolk Counties – Feasibility Study, Entra Consultants for the Haldimand-Norfolk Rural Transportation Initiative. September 2010
49 Telephone conversation with Haldimand-Norfolk Social Services, August 23, 2011
TRANSPORTATION IN HURON & PERTH COUNTIES 27 Future Directions
This report has outlined the need for improved transportation services in the two Counties, as well as some of the services currently available. It has also reviewed the research that has been done in recent years. Most existing services are limited to specific groups – seniors and those with disabilities, for example – and are not available to others, particularly those in greatest need (women, youth, and others on low income, etc.) Collectively, agencies in Perth and Huron spend a great deal of money providing transportation for their clients. This is in addition to the Provincial and Municipal funding spent on transportation costs for those on Ontario Works and ODSP. Can a better way be found through greater collaboration and coordination?
As was noted in the review of EasyRide in Huron County, further expansion rests on the willingness of municipal governments at either the County or local municipality level to make a significant financial contribution. Neither County has contributed funding to date, although the lower-tier municipalities have provided funding to EasyRide. Additional funding is not easy to achieve at a time of economic restraint at all government levels. Perhaps greater efficiency and improved service can be achieved by other means. The following suggestions offer ways to overcome transportation barriers.
1. Expand existing transportation services by making use of gas tax and/or municipal funding
Perth and Huron Counties to work with local agencies to develop and expand municipal funding for existing transportation services, thereby enabling the Counties to take advantage of the Provincial/Federal Gas Tax funding. Since many municipalities in the two counties do not have public transportation, gas tax is currently unavailable to them. By working in partnership, smaller towns could solve some of the issues around affordable transportation by utilizing Gas Tax funding, thereby helping to reduce the current EasyRide fare structure which is not affordable for people living in poverty.
2. Expanding Rail Service
A collaboration between the City of Stratford, the University of Waterloo, GO transit and Via Rail in conjunction with the Province of Ontario to advocate for the increase and expansion of rail services to and from Stratford. This, in addition to expanded bus services through Perth and Huron Counties, would greatly enhance affordability for travel.
28 TRANSPORTATION IN HURON & PERTH COUNTIES 3. Create a new rural transportation service running between Goderich and Stratford in the Hwy 8 corridor
Huron and Perth Counties and local agencies to work together to investigate the feasibility of a shuttle bus service on the Highway 8 corridor from Goderich to Stratford at regular intervals throughout the day on a fixed route (similar to the new service in Haldimand-Norfolk). Municipal participation would enable access to Gas Tax funding (see pp. 11 & 12). Fares to be set at an affordable level to encourage ridership and the service could be initiated on a pilot basis.
4. Improve access to health services by way of a shuttle bus between hospital sites
The Counties of Huron and Perth and the Huron Perth Healthcare Alliance should work with the South West LHIN to explore the possibility of funding a shuttle bus between hospital sites. Since programs at the Huron-Perth Healthcare Alliance are being realigned and redistributed to improve quality of care and efficiency, this would enable families to visit their relatives who may be in a hospital in another community and also meet a Provincial goal to provide care close to home, as efficiently as possible. (The South West LHIN already provides funding to EasyRide for coordination)
5. Explore alternative modes of transit like employer subsidized buses, the use of buses during off hours, and a coordinated taxi service
Local municipalities, in conjunction with interested community partners, to investigate employer-subsidized buses to bring employees to work. This could be done in collaboration with agencies such as Partners in Employment, and the Provincial government.
The real demand may be for assistance for the working poor - those living on a working income at or below the national poverty line. A suggestion for the future is for bus service to be provided to new work sites are they are constructed. While this would require an agreement between the employer and the City, it would provide a viable and sustainable solution to employees facing transportation challenges. United Way Perth-Huron to work with the Huron Perth Student Transportation Service, the Avon Maitland District School Board and the Huron-Perth Catholic District School Board or Community Living South Huron to investigate the possibility of using buses in hours when they are not needed to transport students or clients. 50
Huron and Perth Counties, as well as their lower tier municipalities, could investigate the possibility of a coordinated and collaborative taxi service at a subsidized cost. This to be done in conjunction with social service agencies that are already using financial resources to provide taxi service for their clients. Taxi services already operate across the two Counties, but the existing services would require a subsidized fare for those clients who qualify.
50 The provisions of the new Access for Ontarians with Disabilities Act (AODA) may affect this recommendation, since many school buses are not fully accessible.
TRANSPORTATION IN HURON & PERTH COUNTIES 29 Recommendation
It is recommended that the United Way of Perth Huron initiate a dual county Transportation Improvement Task Force made up of representatives from municipal governments, and relevant organizations from sectors including health, social services, and education.
The initial mandate of the Task Force will be:
• To review the Future Directions identified in this report; and,
• To initiate action towards implementing the Future Directions; and,
• To review findings from existing reports and from studies underway in both counties.
30 TRANSPORTATION IN HURON & PERTH COUNTIES Acknowledgements
This project owes much to the participation of the many individuals and agencies in Huron and Perth who gave freely of their time to provide their own insights into this issue. Our thanks to all of them for their participation:
Agencies serving communities in Perth County:
• County of Perth Planning Department • City of Stratford Planning Department • Stratford Public Transit/Parallel Transit • CMHA Huron-Perth • Perth District Health Unit • Perth East Transportation • Stratford Tourism Alliance • Community Living Stratford & Area • Conestoga College (Stratford) ESL Program • Ontario Early Years Centre of Perth-Middlesex
Agencies serving communities in Huron County:
• County of Huron Planning Department • Huron County Transportation Task Force • County of Huron Social Services • Huron County Health Unit • Women’s Shelter Second Stage Housing & Counselling Services of Huron • Community Living – South Huron
Agencies serving communities in both Perth and Huron:
• Huron-Perth Healthcare Alliance • Huron-Perth Student Transportation Services • CMHA Huron-Perth • Canadian Cancer Society Huron-Perth • Choices for Change: Alcohol, Drug and Gambling Counselling Centre • Partners in Employment • OneCare (EasyRide)
Agencies serving communities outside Perth and Huron:
• Haldimand Norfolk Social Services • Bancroft Community Transit • Wellington Transportation Services
TRANSPORTATION IN HURON & PERTH COUNTIES 31 References
Association of Municipalities of Ontario. Rural Poverty. Submission to the Standing Senate Committee on Agriculture & Forestry, Toronto: March 2007
Government of Canada. Department of Justice: Ontario Rural Women Abuse Study: Final Report, Ottawa: 2000
Haldimand-Norfolk Rural Transportation Initiative. Public Transportation Systems in Haldimand & Norfolk Counties: Feasibility Study, (Entra Consultants), August 2009 and September 2010
Huron County. Huron Transportation Task Force, 2008
Huron County. Assessment of Community Transportation Service Expansion in Huron County. Dillon Consulting, 2010
Huron County. Transportation Demand Management Plan (Draft). MMM Group, 2010 and 2011
Huron Perth District Health Council. Development of a Coordinated Transportation System – Perth County, 1998
Huron-Perth Healthcare Alliance. Report on Attitudes & Assessment of Healthcare Issues & Vision 2013 Activity in Huron-Perth, The Strategic Counsel, Stratford: 2010
Perth District Health Unit. A Descriptive Profile of Amish and Mennonite Communities in Perth County. Stratford: 2008
Perth District Health Unit. Perth County: A Community Picture Report, Stratford: 2011
Rural Women Making Change. Rural Women & Transportation in Ontario, Toronto: 2009
Simcoe Reformer. “Simcoe to be the hub of bus line”, March 18, 2011
South West Local Health Integration Network. Vision 2013 Project Charter (Huron-Perth Healthcare Alliance), London: 2010
Statistics Canada. 2006 Census
Stratford Beacon-Herald. “Publicly funded transit hallmark of caring society”, Wednesday, July 20, 2011
Stratford Coordinated Transportation Task Force. Business Plan for a Community Transportation System, September 2000
United Way Perth County. Listening for Change: Identifying Community Priorities, Stratford: 2005
32 TRANSPORTATION IN HURON & PERTH COUNTIES
United Centre - 32 Erie Street Stratford, Ontario Canada N5A 2M4 Tel: 519 271-7730 Extension 233 Fax: 519 273-9350 [email protected] www.socialresearchandplanning.ca
A DIVISION OF
Sarnia Lambton Transportation Working Group—Survey
The Sarnia/Lambton Transportation Working Group is looking for ways to improve transportation services in Sarnia/Lambton. To do this, we are asking current clients, or perspective clients, to provide information about their experience using public and not-for-profit transportation services.
Once complete, please return this survey using the pre-paid envelope provided. If you are a caregiver of someone who uses transportation services, a response on their behalf is welcome. The Erie St. Clair LHIN will receive all surveys and report on the overall results to the partners.
Thank you for taking the time to provide your feedback!
1. ☐I am a transportation client ☐I am a caregiver filling out the survey on behalf of a transportation client ☐I am not currently a client ☐Don’t know/Not Applicable
2. Age:
☐21and under ☐22-44 ☐45-54 ☐55-64 ☐ 65-74 75-84 ☐85 and over ☐Decline ☐Don’t Know/Not Applicable
3. Postal code: ☐Don’t know/Not Applicable
4. Do you require special assistance or accommodations when using transportation services?(e.g. help into or out of your destination):
☐Yes ☐No ☐Wheelchair ☐Don’t Know/Not Applicable Please list the type of assistance you require:
5. What means of transportation do you use in a typical month and for what purpose? Please check all that apply.
Trips
Per Work Social Shopping Medical Education Other Month a. Car (as DRIVER) b. Car (as PASSENGER) c. Sarnia Transit – regular bus d. Care-A-Van / Specialized Transit e. LEO (Lambton Elderly Outreach) f. Canadian Red Cross g. Lambton County Developmental Services h. Regular Taxi i. Walk j. Other (specify)
1 Please return survey using the envelope provided by August 16, 2013. If you have any questions regarding this survey, please contact Shannon Sasseville, Director, Communications and Public Affairs, Erie St. Clair Local Health Integration Network at 1-866-231-5446 ext. 3225 6. What cities or towns do you receive transportation to most often? (check all that apply):
☐Forest ☐Grand Bend ☐London ☐Petrolia ☐Sarnia ☐Other: ☐Don’t Know/Not Applicable
7. In the past month have you ever wanted to travel somewhere but could not for any of the following reasons? ☐ No, transportation has always been available for the trips I wanted to make. Or, I could not travel because (check all that apply): ☐ Fares are too expensive ☐ Service was full and unable to accommodate my trip request ☐ Taxis are too expensive ☐ A wheelchair accessible vehicle was not available ☐ Other (please specify)
8. If you have ever used profit or not-for-profit services in Lambton/County, please let us know your thoughts on the following: Partially Don’t Agree Disagree Agree Know It is easy to book a trip. I always get the trip date and time that I request. The operating hours and days of week meet my needs. My service provider always arrives on time to pick me up. I am pleased with the amount of assistance I get from the driver. The transportation services I receive contribute to my independence. The transportation services I receive contribute to my Quality of Life (general well-being).
9. What do you like most about the transportation services you currently receive?
10. What would you like to see improved in the transportation services you currently receive:
2 Please return survey using the envelope provided by August 16, 2013. If you have any questions regarding this survey, please contact Shannon Sasseville, Director, Communications and Public Affairs, Erie St. Clair Local Health Integration Network at 1-866-231-5446 ext. 3225