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and to maintain. If there is no compelling need for larger vehicles, one may consider using smaller vehicles. For instance, one VSO used a 15-passenger van and a 17-passenger bus when the average number of passengers per vehicle was 5. Other regions have hired taxicab companies to transport veterans individually. In some instances, they were able to reduce costs per trip and provide veterans with quality service; in other situations, transporting only one passenger at a time proved to be extremely expensive. There is no "one size fits all" solution to improving the mobility of veterans; each community should find the program that works best for them given existing needs, resources, and constraints. Misconception # 5: Veterans Who Cannot Be Treated in One VAMC Must Be Transported to Another VAMC and Cannot Be Treated at a Local Non-VA Site Veterans often have to travel long distances to get to the nearest VAMC from their homes, but the nearest VAMC may not offer the kinds of service veterans need. When veterans cannot get treatments from a nearby VAMC or other government facility, VHA may work with a non-VHA facility to treat veterans. One permissible occasion for such arrangement is when a VHA facility is not within reasonable geographic proximity. While it is unknown how frequently this practice occurs, it definitely saves transportation costs, especially for long-distance travel. The VA Medical Center in Indianapolis has developed a computer program that lists the kinds of care offered at VAMCs, CBOCs, and local community facilities. When scheduling medical trips, the VAMC will advise veterans of the closest facility that offers the medical care needed. If appropriate, the VAMC will coordinate with medical staff to arrange transportation associated with non-VA care or VA care that is close to the patient's residence. STRATEGIES FOR IMPROVING VETERANS' MOBILITY This section on strategies for improving mobility for veterans is intended for transportation professionals, including public or private providers, who currently work with veterans or who wish to establish a business relationship with the veterans' community. Some strategies may only apply to certain types of transportation providers. Others, however, may be broadly applied to many providers. VSOs should also be aware of all of these strategies. The following pages discuss operational strategies and coordination strategies for community transportation providers. 60

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Operational Strategies Offer Reduced Fares for Veterans and Other Service Members Some transit agencies offer free or reduced fares to veterans who ride fixed route services. The Bay Area Rapid Transit (BART) system in California allows active duty military personnel to ride free on BART, which helps veterans and creates good will. Offer Flat-rate Rides for Veterans Some transportation providers have established contracts with the local VAMCs. As part of their contractual work, transportation providers receive regular trip requests and are able to increase their overall volume of business. This enables them to offer flat-rate rides to veterans. For VAMCs, this kind of arrangement eliminates the unpredictability of billing for rides by other methods, and veterans continue to receive quality service. For example, Indianapolis Yellow Cab has a contract with its local VAMC under which the taxi drivers serve veterans with flat-rate fares. Institute Competitive Contracting VAMCs and VSOs that purchase transportation services from transportation providers may benefit from competitively bidding transportation services for veterans. Agencies serving veterans can decide what contractual mechanisms would work better for them--mileage-based, trip-based, hourly-based, or fixed rate are pricing options that trip purchasing agencies can adopt--and find vendor(s) that can work with the agency. Alternatively, instead of asking the vendors to bid on one particular payment method, veterans' agencies can be flexible about finding the best options for them by crafting requests for services that allow the vendor to propose different pricing mechanisms. In addition to pricing, trip purchasers may work with multiple vendors to create a competitive environment to ensure high-quality customer service. Provide Dispatching Services for a Veterans Service Agency Transit agencies or transportation vendors have professional dispatching capability. Other transportation providers may be able to offer rides but cannot keep up with in-house technology. 61

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These small agencies could develop working relationships with transit agencies so that dispatching can be done by the experts. In a similar fashion, call center responsibilities could be fulfilled by an agency that has full-time staff devoted to that purpose. VSOs Should Work with Other Agencies with Transportation Programs Veterans' service organizations often provide many services other than transportation. Sometimes their organizational structure or scope of activities may not allow them to provide transportation for their veterans. However, they can work with other entities that have transportation components, which may include other VSOs, non-profits, and public or private transportation providers. Provide Trips to Local VAMCs Local transit and paratransit services can actively work with veteran communities. Significant numbers of paratransit riders might also be veterans; transit and paratransit services could provide trips to local VAMCs for veterans within the scope of their current services. In Iowa, a rural veterans' clinic was closed and veterans formerly using that clinic then needed to travel to Des Moines instead. Des Moines Area Regional Transit (DART) established a bus link directly from the closed medical clinic to the VAMC in Des Moines, providing rural veterans with continuity of care in the services they received. (See page 46 for more information.) Provide Feeder Service to DAV Vans Sometimes existing services need a little help in maintaining or improving services. In 2009, a Washington state bridge closure would have adversely affect DAV transportation programs accessing services in Seattle. The state DOT, working with local VAMC and DAV offices, devised a plan for veterans to access mainland services using existing DOT rural public transit routes which would link on the mainland with DAV vehicles which would transport veterans to the VAMC. A voucher-based subsidy was used to fund the transaction. The rural public transit services did not have to change their operation to accommodate veterans and the DAV vehicles were made more effective by eliminating a major part of their typical mileage. (See page 48 for more information.) 62

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Offer Advance Scheduled Out-of-County Trips to VAMCs Transit agencies are in a position to add one more service line as long as there are enough customers. The Ocean Ride transit service operates an advance scheduled service for veterans. Each day of the week, veterans can travel to specific out-of-county destinations on a specific schedule. This type of advanced scheduling allows the transit agency to offer trips beyond county lines and has been a great resource for veterans whose nearest VA medical care is outside of their county. (See page 43 for more information.) Offer Assistance in Vehicle Acquisition Public transit and other transportation agencies may be in a position to include VSOs in capital acquisition plans or to transfer older vehicles to VSOs. These actions could take a large responsibility from the VSOs and enable them to focus resources on other activities. Community transportation providers could assist VSOs by referring them to the National Rural Transit Assistance Program (National RTAP) and other transportation industry resources. One of National RTAP's recent publications is How to Buy a Vehicle; it contains a wealth of information about vehicles, relevant funding programs, and possible procurement programs.43 Both VSOs and VAMCs should be seen as contact points for the distribution of such information. Share Resources for Driver Training Transit agencies can offer their driver training programs to other drivers from smaller agencies. Volunteer driver programs can exchange information on driver training and share training responsibility among them. VAMCs can send their drivers to one of the transit agencies or to medical transportation providers to get professional training for the drivers. This will save management's time spent on developing the training materials and actually training the drivers. 43 See http://www.nationalrtap.org/FeatureDetailsaspx.aspx?id=262&org=a2GSpnDbruI=. 63

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Target Marketing Efforts to Veterans Sometimes veterans do not know what services are available to them, or they may be only aware of one service but not others. In order for veterans to learn about the existing transportation programs, transportation providers are encouraged to reach out to veterans' communities, to veterans' national/local events, and to work with veterans' organizations to get the words out. Inform VSOs About FTA's Section 5310 Program Veterans' organizations need to know about Federal Transit Administration's ( FTA's) various programs, including the Section 5310 program that provides assistance for vehicle and other capital purchases for agencies (primarily nonprofit agencies) that serve seniors and persons with disabilities. This could serve as an additional source of capital funds for VSOs that are providing trips for veterans. One important proviso is that FTA funds are intended for the use of all riders, so that it would not be possible for the VSOs to restrict the use of the vehicles to veterans alone. (See also the Vehicle Acquisition section above.) Coordination Strategies for Community Transportation Providers Besides the operational strategies listed above, community transportation providers may need to adopt a variety of coordination strategies if they are interested in greater levels of coordination with agencies that are now offering transportation services to veterans. The following strategies are suggested for improving coordination: Be proactive: Get to know the veterans' agencies and providers in your community. Gather information and research the operations of these organizations. See where you can assist: If you offer to help solve problems rather than take over services, your efforts are likely to be more successful. Focus on several key issues: o Veterans with mobility disabilities: Current veterans' transportation services tend to focus on ambulatory riders; veterans with special travel needs can benefit from public transportation services. o Long-distance trips: Particularly in rural areas, long-distance trips can be a challenge for any transportation provider. The coordination of long-distance trips could serve the public and veterans at the same time, greatly enhancing the cost-effectiveness of both operations. 64