As PACE programs grow to support America’s aging adult population, the movement towards flexible transportation solutions has picked up steam. As we know, transportation is a key enabler that sets the care model for PACE apart, directly supporting the goal of helping aging adults stay in their homes for longer. It is a requirement for programs to meet CMS (the regulating body) standards with programs traditionally employing a fleet of wheelchair accessible vans and buses to support their participant population.
In 2024, nearly 76K Americans enrolled in the 167 PACE programs across 33 states. As the nation’s population of adults over the age of 65 swells, and lawmakers introduce regulations such as the PACE Anytime Act designed to boost enrollment, enrollment is expected to grow substantially.
As more Americans learn about their local PACE programs, enrollment rates have increased and the needs of transportation programs have started to evolve.
The need to expand routes, add vans, buses, drivers and more is a conversation we frequently participate in… and that “more” part is where things are getting really interesting.
See, while the rest of the world enjoys traditional “curb to curb” rideshare solutions, its a no-go for PACE programs. The nature of that transportation model is out of compliance with CMS Standards. which means no Uber, Lyft or Taxi. Operating out of compliance can result in monetary penalties for the program, suspension of participant enrollment, and in extreme cases – termination for a program.
"A PACE organization’s transportation services must be safe, accessible, and equipped to meet the needs of the participant population" and a Door-Through-Door assisted transport has been deemed the most appropriate level of transportation to satisfy this requirement. The logic here is that there’s a lot that can happen between the car and the door. Think of the curb, ice, extreme heat, stairs, missing keys, door codes, locked gates etc. all of the things that might prevent a participant safely leaving/entering their home, or safely arriving at the program.
These risks present a liability for participants and PACE programs, and for that reason, CMS regulations have been interpreted as such that assisted transportation must be provided from within the pick up location, all the way through the doors of a participant's destination. Hence the term: “Door-Through-Door”. There’s a more to it of course, things like training, communication protocols, certifications, etc. but at the highest level, that’s the gist of it.
But without a solution as common as a taxi, programs can find themselves in a tricky place. See the trouble with removing micro-transit like rideshare from the PACE transportation menu, is that in many cases, a 1:1 ride is operationally more efficient than a 1:many trip, more cost effective, and a better participant experience.
So what’s a PACE program to do then right?
At Onward, we’ve been working with PACE programs across California to introduce a new type of transportation called a Companion Ride. A Companion Ride is a CMS compliant, assisted Door-Through-Door transport. Facilitated by a Companion Driver, a team member that Onward recruits, hires, trains and manages, the Companion Driver is both the driver and the companion.
These individuals assist riders entering and exiting a vehicle, navigating stairs, and provide a warm hand off to care teams or assistance through the doors of a participant’s home. Companion Drivers undergo a litany of training ranging from folding and folding a wheelchair/walker to identifying elder abuse, and best practices for communication. Drivers are background checked, drug screened, CPR/First Aid certified, pass DOT physicals and more to meet CMS regulations.
Our take is that the vans and buses play an important role in a holistic transportation strategy, but when it makes sense to use a 1:1 style of transportation, a PACE program should have a reasonable, and compliant option available. So… A little bit of everything.
If Companion Rides sound interesting or might be a solution for your program, we’re here to help. Learn more about Companion Rides and how we’re helping PACE programs build holistic transportation solutions on our website. Onward moves with the help of partners, if we’re not present in your state or territory, it doesn’t mean we couldn’t be.
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