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6. Veterans receive transportation services via community-based organizations. 7. Transit agencies offer transportation to veterans. 8. VAMCs provide transportation information for veterans. VETERANS DRIVE TO VA MEDICAL FACILITIES If they are physically and financially able to do so, many veterans drive to VAMCs. A major issue is that the vast majority of health care services for veterans are provided only at VHA facilities like Medical Centers and community-based outpatient clinics (CBOCs). There are 153 VAMCs and 731 COBCs throughout the United States, but veterans requiring specialized medical care cannot find that care at every VAMC or CBOC. In some rural areas, round trips to the nearest relevant VHA facility cannot be completed in one day. Multiple trips to these far away medical facilities can be burdensome. To offset the travel costs associated with obtaining medical services, qualified veterans may seek beneficiary travel mileage reimbursement (as described in Chapter 3). The number of veterans accessing their medical care by driving was 586,000 in FY 2009, a 30 percent increase from FY 2008 (VA, December 2009). The average amount per mileage reimbursement claim in FY 2009 was $75.66 (VA, December 2009), which suggests that the average round-trip mileage exceeded 185 miles. (An exact figure cannot be calculated because the current reimbursement of 41.5 cents per mile was not in effect for the entire 2009 Fiscal Year.) VETERANS RECEIVE SERVICES VIA NONPROFIT VETERANS' SERVICE ORGANIZATIONS Veterans receive extensive services from nonprofit veterans' service organizations. There is an extremely strong culture of "veterans taking care of veterans" that extends to transportation as well as many other kinds of needs. The voluntary services are an important resource that needs to be incorporated into any successful effort to improve the mobility of veterans. At the same time, it is crucial that one also understand the limitations of these services. 32

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Veterans Use Disabled American Veterans (DAV) Transportation Services Description of DAV Transportation Services The Disabled American Veterans organization (DAV), a nonprofit veterans' service organization, has been offering various transportation services to veterans for many years. DAV serves veterans using DAV's pool of volunteer drivers, and the local DAV chapters also work with VAMCs and other community organizations to secure vehicles. "The Volunteer Transportation Network (VTN) is designed to provide transportation services to veterans seeking benefits at VA facilities, including Veterans Benefits Administration (VBA) offices, and who have no other means of transportation."35 VTN services are not to be used for any other trip purposes. In fiscal year 2008, DAV transported 25,483 veterans and drove 28 million miles.36 On an annual basis, these figures equate to an average of 1,098 miles per year per veteran transported by DAV to medical services. (That figure is nearly equal to the estimated number of miles traveled per year by a veteran who drives to their VHA medical appointments.) For the 2009 calendar year, the figures are similar: DAV volunteers drove 28.3 million miles and provided 743,701 trips to veterans. The average trip length in 2008 and 2009 was 38 miles. The total cost of DAV national transportation network grants in 2009 (to support Hospital Service Coordinators and to purchase vans) was $4 million. 37 The proportion of veterans needing transportation who used DAV transportation in a particular year is currently unknown. DAV operates the largest program in the Veterans Transportation Network (VTN). DAV offers services for most (but not all) locations in the VA healthcare system. Their program provides free transportation for veterans for health care trips. DAV employs Hospital Service Coordinators (HSCs) at major VA medical facilities to operate the transportation program at those facilities. A typical situation is that the local DAV chapter raises contributions that are used to buy vans; the vans are donated to the VA, which then provides insurance, fuel, and maintenance. DAV does not purchase vehicles accessible to veterans in wheelchairs, and DAV's volunteer drivers are not authorized to lift or provide medical services to any rider. 35VHA Handbook 1620.02, Volunteer Transportation Network, May 24, 2007. http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1572, accessed November 19, 2010. 36 Interview with Michael J. Walsh, National Director of Voluntary Services, December 2009. 37 Michael J. Walsh, DAV Annual Report, http://www.dav.org/volunteers/documents/AnnualReport.pdf, accessed November 22, 2010. 33

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Example of DAV Transportation Services Program: DAV Transportation Services Location: Lebanon, Pennsylvania Key Features: Volunteer driver-based transportation Door-to-door, shared-ride program No accessible vehicles available DAV-supplied vehicle and volunteers; the VAMC is responsible for fuel, maintenance, and insurance. The DAV transportation program associated with the Lebanon VAMC uses 13 vans and has 70 volunteer drivers. The program transports 30 to 35 passengers daily. The service covers 13 counties and is available for longer trips throughout the state on an as-needed basis. On any given day, volunteer drivers start driving at 6 a.m. to pick up the first veteran rider; they then continue their assigned route in their region. By 8:30 a.m. they arrive at the VAMC with their passengers. The HSC and scheduling staff at the VAMC, as well as the patients themselves, attempt to ensure that all medical appointments are completed by 12:30 p.m. The DAV vans depart the hospital no later than 1 p.m. The volunteer drivers may have spent a total of 10 hours or more that day (driving, waiting, and driving) by the time all passengers are dropped off at their respective homes. Two key factors are needed to successfully operate DAV transportation program: qualified volunteers and collaboration with VAMC. Volunteers are crucial to this program. All drivers, as well as the HSC, volunteer their time to help veterans. They all believe in veterans serving other veterans and work hard to make the program work. Another important factor is partnership with VAMC. The DAV hospital service coordinator needs to work with various VAMC employees, such as travel office staff, scheduling office staff, and clinical staff. The HSC assists veterans to decide appropriate level of transportation services by referring them to VA travel office. The DAV hospital coordinator also reminds the medical scheduling office of the DAV van schedules; this helps ensure that veterans who need transportation get medical appointments when transportation service is available. In addition, it is often the hospital coordinator who makes sure that group riders' appointments are 34

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not delayed so that they can get a ride home. If veterans driven by DAV are not able to get a return ride, the HSC may need to find ways to arrange alternative transportation. Veterans Receive Services via Nonprofit Veterans' Service Organizations Description of VSO Transportation Services Veterans' service organizations (VSOs) may be better informed about veterans' needs than other human service agencies. VSOs have unique characteristics that can be beneficial to veterans. Many volunteers and staff working for VSOs are veterans themselves or have strong ties to veterans. They are committed to their work and often go above and beyond their prescribed duties to help veterans. Example of Nathan Hale Foundation Transportation Services Program: The Troops in Transit Program, Nathan Hale Foundation Location: Plymouth, Massachusetts Key Features: Includes both paid and volunteer drivers Provides door-to-door service, shared ride program Offers prescheduled trips and some flexible trips. The Nathan Hale Foundation offers pre-established schedules Monday through Thursday so veterans know when to make their appointments. For example, a veteran traveling to the West Roxbury VA Hospital knows that the van goes to that location on Mondays. On Fridays, the Foundation provides trips for local appointments such as dentist, dialysis center, blood work, or grocery shopping. It is unique that this organization covers non-VA sites as well. The vans are driven either by volunteer drivers or staff drivers. Most volunteers come to the rider's door. Their volunteer drivers are highly qualified (police officer, fire fighter, combat veterans, and transit drivers with Commercial Driver's Licenses [CDLs]) and are committed to work with veterans. To be eligible for the rides, one needs to be a veteran. As long as the rider is a veteran, disability status or income level is not considered. 35