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Limited Mobility: Lack of transportation options a problem for many in rural America

The federal government allocates only 11% of public transportation funding to these areas
Published: Aug. 23, 2021 at 2:52 PM CDT
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HIGHLAND COUNTY, Va. (InvestigateTV) - Robert “Wes” Maupin is a lifeline for the elderly residents in this rural, Appalachian community.

For nearly eight years, Maupin, has climbed into the driver’s seat of the county’s senior transportation van and driven residents through the twisty, steep mountains to doctor appointments.

Without that van and the kindness of Maupin, many elderly residents wouldn’t have access to needed medical care.

Heavily involved in community activities and supporting his friends and family, Robert “Wes”...
Heavily involved in community activities and supporting his friends and family, Robert “Wes” Maupin drove Highland County, Virginia to hour-long visits to nearby counties five days a week. Maupin finds fulfillment in being able to provide this help although the county lacks real access to transportation.(Courtesy of Wes Maupin)

“Community service is a passion, no matter what it is. When I see a need, I always try to step up and fill the need because I have the time and I have the energy,” Maupin said.

The lack of transportation – either owning a vehicle or having access to a bus or ride-share service such as Uber – plagues many parts of rural America.

Hospitals, primary care doctors, urgent care clinics, grocery stores and employment opportunities often are miles and miles away from the residents who live there.

Nationally, an estimated 91% of households in the U.S. owned at least one vehicle in 2017, federal data shows.

But ownership rates are much lower in the Appalachian and Mississippi Delta regions. About 20% of the 662 counties in these regions have household vehicle ownership rates below the national average, according to InvestigateTV’s analysis.

“It makes it harder for citizens to maintain the kind of commitment to health care and health improvement in their individual lives when they have a real challenge getting in to see health care providers that are helping them do that,” said Guy Land, congressional liaison at the Appalachian Regional Commission (ARC), a federal agency that helps promote economic stability in the region that stretches from New York to Mississippi.

Limited transportation options

Since 66-year-old Maupin began driving seniors in Highland County, Virginia, he has noticed the increasing need for public transportation in the community.

“It’s growing, we are an aging community. We have a disproportionate number of seniors, a number of people retire out here,” Maupin said. “We’re very volunteer driven out here.”

Maupin is the only paid driver for the Valley Program for Aging Services that provides transportation for adults 60 years and older or those with a disability of any age who can no longer drive.

The program also relies on a handful of volunteer drivers to fill the gaps.

The van service costs $10 for a ride to medical appointments and $5 for a trip to the grocery store, which is about an hour away in the town of Staunton, Virginia.

InvestigateTV found that in Highland County it also takes 55 minutes to drive to the nearest urgent care. If there was access to Uber in the county, a trip to the clinic and back home could cost as much as $100.

Other counties face similar obstacles.

In Issaquena County, Mississippi, a resident has to travel more than two hours for medical attention. If there was an Uber in this county and a driver willing to take on an hours’ long trip, the fare could cost $195.

Though Holmes County, Ohio posts the lowest percentage of vehicle ownership in the two regions, 80% of the population is Amish, many of whom rely on horse and buggy for transportation.

In other rural, non-Amish areas of the regions, East Carroll Parish, Louisiana and Owsley County, Kentucky have the lowest vehicle ownership in their respective regions – at 79% and 81%, respectively.

In Owsley County, there were 43 employers in 2019, according to census data. But most workers in the county have to travel an average of 30 minutes to work.

Issues with transportation are exacerbated in rural areas where distances are greater and public transportation is nonexistent.

“Appalachia is a very rural area. It is not unusual for people to travel 10, 15, 20, 25 miles to get to a health care facility,” Land said.

In Highland County, Virginia, access to reliable transportation is a necessity.

More than a third of its 2,000 residents are senior citizens, an age group that typically suffers with many health ailments.

The county has three stores that accept food stamp benefits: a dollar store, a general store and a seasonal farmer’s market. The full-service grocery with fresh produce, meat and dairy is an hour away.

A health care clinic in the county’s largest town offers primary care and dental services. But its hours are limited and there are no specialists.

Meeting transportation needs

Angelika Levien was attracted to the beauty and serenity of Southwest Virginia when she emigrated from Germany in 1978.

She didn’t mind the distance or the time it took to drive to stores and doctors.

But after her husband died in 1997, Levien began to worry about what she would do if she had a medical emergency because she has glaucoma and can no longer drive.

“If you are really sick and if the helicopter has to take you from here . . . you go to Charlottesville,” she said.

Angelika Levien lives in Highland County, Virginia where a large population of senior citizens...
Angelika Levien lives in Highland County, Virginia where a large population of senior citizens live. With no access to public transportation or ride sharing services, she depends on a local senior driving program to access doctor appointments and visit the grocery store.(Courtesy of Wes Maupin)

Charlottesville is 166 miles away from where Levien lives, making her and others in the community rely on friends and transportation services – especially in emergencies. Levien needs to go to a specialist for her glaucoma 45 miles away and asking friends for a ride isn’t always reliable.

She has depended on Maupin’s van to get to her doctor appointments and to the grocery store.

But in cases of emergencies, the clinic isn’t always an option.

“I had an emergency last week, and I called. Of course, it was a Saturday and there’s nobody here,” Levien said. “I called the rescue squad, and they took me to the hospital in Stanton.”

She had to stay overnight at the hospital that is more than an hour from her home. A friend drove her home the next day.

“People don’t realize that it does become more of a problem the older you get because you need more transportation,” Levien said. “I always think too that the older I get, I will need more transportation and I don’t want to exhaust my friends too soon.”

She has built a friendship with Maupin, who she says, “knows the hilly roads.”

While approximately 20% of the U.S. population lives in rural areas, the federal government only allocates about 11% of transportation grant funding to rural areas.

The American Public Transportation Association tracks available transportation options by county.

An InvestigateTV analysis of the association’s data shows that:

· 93 of the 662 counties in the Appalachian and Delta regions don’t have any public transportation. Fourteen of these counties also have shortages of primary care doctors. In 2018, they had two or fewer primary care doctors working in these counties.

· 117 counties have transportation provided by social service organizations that often are offered only to senior citizens and/or people with disabilities. These providers also have limited schedules and often don’t provide transportation on weekends.

Issaquena County, Mississippi in the Delta has no public transportation – and no doctors, nurses or stores that accept food stamps.

Many rural counties have stagnant economies. Many residents live in poverty and can’t find work. A healthy transportation system – public buses and highways – can help lift residents out of poverty, the ARC’s Land said.

“That’s why we have focused more of our attention on the highway needs,” he said. “Other parts of the country don’t face the winding road challenges that we do.”

Expanding the reach

In other parts of rural America, federal agencies and local nonprofits are trying to fill the transportation void.

Independent Transportation of America, known as ITNAmerica, is a nonprofit organization founded in Maine in 1995 that has branched out to provide transportation to senior citizens and people with visual impairments in communities all across the country.

Its affiliate ITNCountry provides the same service but in rural areas of 10 communities in 4 states – California, Hawaii, Kentucky and Maine.

The nonprofit relies on local volunteers to provide transportation either with their own car or with one owned by the organization. ITNAmerica often will purchase cars from seniors who no longer can drive.

Through its affiliates, ITN completed more than 71,000 rides last year. More than 40 percent of those trips were to medical appointments.

“I am still nibbling at the edges of this big problem. What can we do that will make a very big change?” said Katherine Freund, founder of ITNAmerica. “Look what’s going on, 10,000 people turning 65 a day for 18 years.”

ITNAmerica’s model is success story that can be replicated across rural America, according to the Rural Health Information Hub, a clearinghouse of that helps rural areas improve its health care.

The hub, which is a nonprofit organization based in North Dakota, creates step-by-step guides to help communities. There’s one such guide for ITNAmerica.

“We are always planning for transportation futures. We are all going to age and going to be in a position where we have to decide what we are trying to do,” said Alycia Bayne, a research scientist at the NORC Walsh Center for Rural Health Analysis at the University of Chicago, which is a partner to the hub.

Bayne has extensively researched transportation needs.

“The issue of accessible transportation, affordable transportation, and safe transportation is that these are issues that affect every scope, it is important to care about it,” she said.

The toolkit is designed to be used by rural practitioners interested in identifying resources...
The toolkit is designed to be used by rural practitioners interested in identifying resources to help them plan and implement programs to provide access to transportation within their communities.(Rural Health Information Hub)

The federal government allocates money to match dollars in hopes of expanding public transportation in rural areas and included funding in the pandemic-relief packages.

Through the 2020 Coronavirus Aid, Relief, and Economic Security Act (CARES) the state of Mississippi received $254,000 for public transportation needs. Missouri received $61.7 million grant.

Despite the research and federal dollars dedicated to rural transportation needs, some residents still worry about where they’ll find that next ride to doctors and grocery stores.

For people such as Levien, the service that Maupin has provided to the elderly community in Highland County has been a lifeline.

“Even if you have family here, then if they work, they just can’t take off and do constant transportation for you,” said Levien, the Highland County resident. “You definitely need the service.”

Jill Riepenhoff contributed to the data analysis of this report

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