Improving ADA Complementary Paratransit Demand Estimation (2007)

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Long-term trends in ADA paratransit demand cannot be predicted in the same way that the demand estimation tool predicts short-term demand. However, likely trends and influences can be discerned by consideration of the available literature. Where no clear evidence is available, some possible tends have been identified using the experience of the research team. There are five fundamental components of demand for ADA paratransit services that need to be considered when thinking about potential ADA paratransit demands in the next 20, 30, or 40 years. These trends may differ from community to community, so practitioners should carefully form their own judgments about trends in their own service area. These fundamental compo- nents can be seen as the independent variables in an equation in which the demand for ADA paratransit services is the dependent variable. The five major considerations regarding estimates of future specialized paratransit demands are as follows: • The numbers of persons with disabilities. • Geo-spatial settlement patterns. • The overall community-wide supply of transportation resources. • Significant societal trends. • Overall policy considerations. Projections of future trends can be made with relative confidence for the numbers of persons with disabilities, but confidence in the accuracy of future projections decreases as one proceeds down the list of these five factors. There are obvious interrelationships among these factors, and each factor has obvious sub- components, all of which increase the difficulty of projecting future ADA paratransit demands with any degree of certainty. It appears likely that demand for paratransit services will increase in the future. The proportion of that future demand served by ADA complementary paratransit services is liable to increase as well, but those projections are less certain. The Numbers of Persons with Disabilities The number of persons with disabilities in the United States—now estimated at about 51 million persons with some level of disability7—is expected to increase in the future. Among certain groups, the proportion of the population with disabilities is declining, but overall 34 C H A P T E R 5 Long-Term Trends that May Affect ADA Paratransit Demand 7 “In 2002, 51.2 million people (18.1 percent of the population) had some level of disability and 32.5 million (11.5 percent of the population) had a severe disability.” Erika Steinmetz, Americans With Disabilities: 2002 U.S. Cen- sus Bureau, 2006. http://www.census.gov/hhes/www/disability/sipp/disab02/awd02.html

Long-Term Trends that May Affect ADA Paratransit Demand 35 population growth is currently projected to create a larger number of persons with disabilities. This is likely to be one of the largest influences on the overall level of demand for specialized paratransit services and will have the effect of increasing the demand for services. Major Trends The trends that are likely to have the greatest impact on the numbers of persons with disabili- ties are described below. Some of these trends could reduce the potential rate of growth in the number of persons with disability, but they do not keep the overall number from growing, which indicates that the overall level of demand for ADA paratransit services will continue to rise. • There are rising rates of disability in the United States due to the aging of the population, poverty, and “medical advances.” In addition, recently recognized “emerging conditions” have added to overall rates of disability, although much of the growth in disability due to emerging conditions may be attributable to increased awareness and access to treatment.8 • Current trends show a declining rate of disability (the percentage of the population that has disabilities) among older population groups.9 The most recent Exhibits10 show an accelerating rate of decline in chronic disability among older Americans, leading to more optimistic assess- ments of seniors’ future health and functioning than were previously available. The Director of the National Institutes on Aging calls this finding “one of the most encouraging and important trends in the aging of the American population.”11 • Our society is rapidly aging: the number of persons age 65 and over is projected to nearly double from 2000 to 2030, to a total of 71.5 million seniors in 2030. During that period, the proportion of the population 65 and over is projected to rise from 12.5 % to nearly 20 %.12 This trend to increased aging will most likely increase the number of persons with disabilities, even if the rate of disabilities declines, because an increase in disability is a common component of advanced age.13 In localities where the average age increases significantly in the future, the growth in the number of persons with disabilities may be dramatic. Furthermore, while the elderly of the future are likely to exhibit patterns of higher education, higher incomes, and better health status than 8 Glenn T. Fujiura, “Emerging Trends in Disability,” Population Today, August/September 2001, accessed at http://www.prb.org/Content/NavigationMenu/PT_articles/Jul-Sep01/Emerging_Trends_in_Disability.htm. 9 “. . . disability levels for people age 65 and older have been falling at an accelerating rate since 1982 . . .” National Institute on Aging, Strategic Plan: Research Goal A, Subgoal 2: Maintain Health and Function, http://www.nia.nih.gov/AboutNIA/StrategicPlan/ResearchGoalA/Subgoal2.htm 10 Manton, K.G., Gu, X., & Lamb, V.L. (2006). Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population. PNAS, National Academy of Sciences, 103(48); 18374-9. 11 December 6, 2006 press release from the National Institutes on Aging describing the release of the Manton study. 12 A Profile of Older Americans: 2005, Administration on Aging, U.S. Department of Health and Human Services, Washington, DC. 13 National Institute on Aging, Strategic Plan: Research Goal A, Subgoal 2: Maintain Health and Function, http://www.nia.nih.gov/AboutNIA/StrategicPlan/ResearchGoalA/Subgoal2.htm. Using 2004 U.S. Census pro- jections, the percentage of persons with disabilities in the population would have to fall from the 2000 level of 19 percent among persons 5 years of age and older to 15.8 percent in 2030 to register no increase in the number of persons with disabilities, based on a 2000 population of 262,907,000 persons 5 years of age and older and a projected 339,312,000 2030 5-and-older population. See “U.S. Interim Projections by Age, Race, and Hispanic Origin,” www.census.gov/ipc/www/usinterimproj/. The percentage of the U.S. population in 2000 who could be considered as “transportation disadvantaged” was 5.3 percent, according to projections based on the Bureau of Transportation Statistics’ 2002 National Transportation Availability and Use Survey. See Wallace, R., Hughes- Cromwick, P., and Mull, H. (2006). “Cost-Effectiveness of Access to Nonemergency Medical Transportation: Comparison of Transportation and Health Care Costs and Benefits.” Transportation Research Record 1956, Transportation Research Board, National Academies, Washington, DC., 2006; pp. 86–93.

the elderly of today,14 some analysts project that many elderly will outlive their ability to drive by 7 to 10 years,15 thus increasing the demand for additional transportation services. • General trends toward higher education, higher incomes, and better health status could reinforce the trend toward declining rates of disabilities among the older population, although population increases among seniors will still lead to higher numbers of seniors with disabilities despite the decline in disability rates among seniors.16 Other Trends of Note There are a number of other trends that must be taken into account. These could have the effect of increasing the number of persons with disabilities and thus the demand for ADA para- transit services. • Current trends involving increasing rates of obesity could overwhelm the other factors that would otherwise lead to reduced disability rates and thus reverse the disability rate gains of recent cohorts.17 Obesity increases the risk of diseases such as Type 2 diabetes, heart disease, osteoarthritis, and cancer, as well as increasing the probability of being disabled at a younger age. At lower levels of severity, increases in such conditions could increase ADA paratransit demands; at higher levels of severity, they would increase demands for nursing home place- ment, which would likely reduce ADA paratransit demands. • War and global illnesses could increase the number of persons with disabilities.18 To the extent that these factors affect people living in the United States, demands for ADA paratransit ser- vices could increase. • Increases in medical technology may lead to greater survivability of injuries and illnesses but in conditions of partial disability, thus increasing the number of persons with disabilities and potentially increasing ADA paratransit demands. Other Considerations An extremely important consideration that must be examined when making local projections of the numbers of persons with disabilities is that there are currently very large variations from community to community in the percentage of the population with disabilities.19 In fact, some communities now report nearly triple the percentages of persons with disabilities reported in other communities. The model developed in this project was not able to determine how incidence of disability affects paratransit demand; however, that is most likely due to limitations of existing 36 Improving ADA Complementary Paratransit Demand Estimation 14 National Academy on Aging, Old Age in the 21st Century: A Report to the Assistant Secretary on Aging Regard- ing His Responsibilities in Planning for the Aging of the Baby Boom, Syracuse, NY: Maxwell School, Syracuse University, 1994. 15 Daniel J. Foley, Harley K. Heimovitz, Jack M. Guralnik, and Dwight B. Brock. “Driving Life Expectancy of Persons Aged 70 Years and Older in the United States.” American Journal of Public Health, August 2002, Vol 92, No. 8. 16 NIA Strategic Plan, op cit. 17 “Since the late 1980s, adult obesity has steadily increased in this country. About 64 percent of Americans are overweight and more than 30 percent are obese. . . . As Americans get heavier, their health suffers. Overweight and obesity increase the risk for coronary heart disease, type 2 diabetes, and certain cancers.” Calories Count: Report of the Working Group on Disability, 2004, U.S. Food and Drug Administration, http://www.cfsan.fda.gov/ ~dms/owg-toc.html. 18 Medact, 2004, Enduring Effects of War, cites increased mortality, morbidity, and disability among the effects of war: http://www.medact.org/content/wmd_and_conflict/Medact%20Iraq%202004.pdf. 19 The differences between communities with the lowest percentage of persons with disabilities (such as Naperville, Illinois; Provo, Utah; Gilbert, Arizona; and Plano, Texas) and communities with the highest per- centages of persons with disabilities (such as Patterson, New Jersey; Miami, Florida; Newark, New Jersey; and Detroit, Michigan) is approximately a factor of 3, according to Disability Status: 2000 - Census 2000 Brief. www.census.gov/hhes/www/disability/disabstat2k/table4.htm. See also table5.htm.

Long-Term Trends that May Affect ADA Paratransit Demand 37 data and should not be taken to imply that there is no effect. Local baselines, causative factors, and mitigating factors need to be addressed in making detailed local estimates. Geo-Spatial Settlement Patterns The residential patterns of persons with disabilities, coupled with overall community land-use patterns of employment, commerce, services, and other destinations, is likely to have a large impact on demands for specialized paratransit services and the cost of operating those services. Current trends suggest a noticeable increase in demand for these services, especially in locations that involve relatively expensive trips. Major Trends The following geo-spatial settlement trends are expected to have the largest impacts on demands for specialized paratransit services, and they are expected to have the effect of increasing ADA paratransit demands. • The overall decentralization of residential, employment, and economic activities is likely to create significantly increased overall vehicular miles traveled (VMT). This is expected to hold true for ADA paratransit services as well as for other modes of travel: the average number of miles per ADA paratransit trip is expected to increase (which is expected to increase the aver- age ADA per trip cost). • Assuming that persons with disabilities age in place, there will probably be increased numbers of persons with disabilities in the future living in the suburban and rural communities that are not now well served by public transportation. How public transit agencies will react to these developments is not obvious at this point; if fixed-route services are extended, ADA paratransit service areas would be extended too. Further research in this area is needed. • While a majority of new developments will probably focus on undeveloped or underdeveloped land outside of central cities, existing central cities and inner-ring suburbs may experience pop- ulation growth leading to greater population densities per square mile in these areas. If this is the case, then public transit options may become more attractive in these communities. The impact on ADA paratransit demand is unclear: more attractive public transit services could reduce the demand for ADA paratransit, but the results of the sketch modeling process suggest that a greater emphasis on public transit services could increase ADA paratransit demands. The Overall Supply of Transportation Resources The supply of transportation resources needs to be considered on an overall community-wide basis. All modes of travel need to be considered. On a national basis, passenger travel on all modes is expected to increase by 68% as a result of population increases and per-person travel increases in the time period from 2000 to 2025.20 Automotive Travel Automobile ownership and use is expected to increase in the coming decades. This is expected to have the effect of reducing the probable growth in the overall demand for specialized para- transit services. 20 John S. Miller, Expected Changes in Transportation Demand in Virginia by 2025. Virginia Research Council, Charlottesville, VA, 2003.

• Auto ownership is expected to become even more widespread in the next several decades. By about 2025, the United States will have 260 million vehicles, up from 221 million in 2000.21 Autos owned per household will increase, and the percentage of households without an auto will decrease. However, the number of households without autos is likely to remain nearly constant or increase very slightly due to overall population growth.22 • Auto travel is expected to increase. Both trips per day and total mileage driven are expected to increase, as they have in recent years, but it is possible that they will not increase as fast as they have in recent years. • The next cohort of senior citizens will include persons who have driven all their lives and will expect high-quality transportation services. Seniors (especially, older women) are likely to continue to be drivers later in life and to take more trips per day.23 These once-highly-mobile seniors are predicted to outlive their abilities to drive by 7 to 10 years.24 Assuming that, by the time they can no longer driver, these seniors have also outlived their ability to use conven- tional public transportation, this could create an increase in ADA paratransit demands. This is an area in which further research could provide a more definitive answer regarding future travel demands. • The continuing spatial dispersion of origins and destinations is expected to increase the need for transportation modes—like the private automobile—that are highly flexible in terms of factors such as origins and destinations, timing, and special trip-by-trip needs like transport- ing children or packages. If general public paratransit services arise to serve such demands, that might reduce the demand for ADA paratransit services. Public Transit Services The public transit industry appears to be at an historic crossroads with significant uncertainty of which path will be taken. Potential trends could have the effect of increasing or decreasing ADA paratransit demands. • On the one hand, the industry could embrace new paradigms involving mobility management strategies that would increase modal options and ridership. The new paradigms approach has the potential for a significant growth in the proportion of community trips served by new kinds of services, some of which might be supervised (if not provided) by public transit agencies.25 Such a trend would be particularly significant for future paratransit demand if new services are designed to better meet the needs of people with disabilities, for example, using flexible routing and higher levels of driver assistance in community service. The availability of new services could increase the demand for demand-responsive services in general, might decrease the per- trip cost of demand-responsive services if more shared-ride demand-responsive services became popular, and thus might decrease the demand for paratransit services limited to ADA- certified riders. 38 Improving ADA Complementary Paratransit Demand Estimation 21 U.S. Department of Transportation, Bureau of Transportation Statistics. The Changing Face of Transportation, BTS00-007, Washington, D.C., 2000, See Table 1-1 and pp. 1-11 through 1-13. 22 John S. Miller, Expected Changes in Transportation Demand in Virginia by 2025. Virginia Research Council, Charlottesville, VA, 2003. 23 Burkhardt, J., Berger, A.M., Creedon, M.A., and McGavock, A.T. (1998). Mobility and Independence: Changes and Challenges for Older Drivers (Prepared under contract to the U.S. Department of Health and Human Services and the National Highway Traffic Safety Administration). Bethesda, MD: Ecosometrics, Incorporated. 24 Foley, et al., op cit. 25 Stanley, R.G., Coogan, M.A., Bolton, M.P., Campbell, S., and Sparrow, R. TCRP Report 97: Emerging New Paradigms: A Guide to Fundamental Change in Local Public Transportation Organization. Transportation Research Board, National Academies, Washington, DC., 2003.

Long-Term Trends that May Affect ADA Paratransit Demand 39 • It may be equally likely that current services will not change and that the industry’s focus will remain on mass transit services provided on fixed routes and schedules. Focusing on the tra- ditional fixed-route paradigm could result in a relatively constant number of riders but a smaller and smaller share of total trips in the community. This scenario would probably not create a change in the number of ADA paratransit trips over time. The implications of the find- ings of the sketch modeling process about greater ADA paratransit demand in communities with more intensive fixed-route service remain to be elucidated. • The decentralization of residential, employment, and economic activities will create signifi- cantly increased travel demands, at least in VMT and possibly in numbers of trips as well. (For example, VMT increased by 26% from 1993 to 2003, an annual rate of change of 2.3%.26) Meeting these demands at significantly lower densities is likely to create real challenges for public transportation operators. A key issue is to what degree public transit services will be extended into suburban and rural areas not now served by public transportation. An impor- tant consideration for some transit operators will be whether or not such service extensions will require extensions of ADA complementary paratransit services, which are currently among the most costly services operated by public transit agencies. Taxi and Paratransit Services Technological improvements may make it easier for the taxi industry to schedule shared-ride trips and to equitably establish fares for shared rides even when the riders have discrete origins and destinations. This development could relieve some of the demands on ADA paratransit ser- vices. However, the implementation of such technologies may not be uniform within the indus- try, leading to real differences in capabilities from community to community. Other Trends The overall effects of other trends on paratransit demands are unclear at this point in time. Continued price rises in gasoline costs might reduce the growth in the amount of travel by per- sonal autos, shifting some of that travel to public transit27, although the reduction in growth of auto travel is not expected to be sufficiently large to create an overall decline in the absolute num- bers of trips by autos or miles driven. It is possible that a lower proportion of trips by auto could result in a modest increase in demand for general public paratransit services. Gasoline price increases would not be expected to change demands for ADA paratransit services, but an increase in general public paratransit services could decrease the demand for ADA paratransit services. Significant Societal Trends Some societal trends are apparent that might significantly influence the demand for special- ized paratransit services. But the emergence of “disruptive technologies,” always extremely difficult to predict in advance, could also significantly affect paratransit travel demands. Recent examples of such hard-to-predict disruptions would include personal computers, cell phones with advanced capabilities, the World Wide Web, and the Internet. 26 Bureau of Transportation Statistics, Transportation Statistics Annual Report: November, 2005. U.S. Department of Transportation, Washington, DC., 2005. 27 Several research projects demonstrate price elasticities in the -0.13 range. Currie, G. and Phung, J., “Transit Ridership, Automobile Gas Prices, and World Events: New Drivers of Change?”; Haire, A.R. and Machemehl, R.B., “Impact of Rising Fuel Prices on U.S. Transit Ridership” Transportation Research Record 1992, Trans- portation Research Board, National Academies, Washington, DC., 2007; pp. 3–10 and 11–19.

Major Trends Many of the current societal trends could lead to some modest increases in demand for demand-responsive services, although much of this demand could also be satisfied by private auto trips. As previously noted, if such demand is met by general public paratransit providers, ADA paratransit demands could decrease. • Over the long term, the ADA may produce major increases in participation by people with disabilities in activities of all types as a result of steadily increasing accessibility of the built environment as well as greater educational and employment opportunities. Increased activ- ity levels could increase the demand for ADA paratransit, while improved physical accessi- bility may create more alternatives to ADA paratransit, reducing demand. • Per-capita personal income may rise substantially, by as much as 50%, by about 2025, leading to an increase of about 36% in VMT.28 Past increases in personal incomes have led to growing travel demands.29 • Average household sizes have been dropping for decades.30 The proportion of travel needs being met by family members can be expected to decrease because of decreases in numbers of children per family, decreases in the numbers of children in the same community as parents, and increases in the numbers of older persons living alone. Fewer travel needs met by family members could lead to a greater need for specialized ADA paratransit and other transportation services. • Significant growth in Hispanic and other minority populations in the United States may somewhat mitigate the previously noted trend. Families of certain minority cultural groups are said to have closer family ties than do other families. If true, this means that members of these cultural groups are likely to receive more transportation assistance from family mem- bers and may thus need less public assistance with trip making.31 • The decreasing emphasis on industrial employment and the corresponding increase in service- sector employment suggest a greater dispersion of work hours and days, increasing the need for flexible transportation services. • The movement to provide services in community settings instead of large institutions has created a great demand for travel by people who now travel to out-patient services, training, day programs, supported work, and other destinations. The movement to reduce institution- alization in nursing homes or similar facilities by providing community-based health care has triggered a need to bring the former in-patients to adult day health and other programs. Future transportation needs may be most highly influenced by public policy considerations, particularly financial considerations (see the Public Policies section below), but the overall impact of the de-institutionalization movement is likely to be a continued increase in demand for ADA paratransit services. Other Trends Other trends could have positive and negative influences on future paratransit demand; actual effects are difficult to predict at this time. 40 Improving ADA Complementary Paratransit Demand Estimation 28 U.S. Department of Transportation, Bureau of Transportation Statistics. The Changing Face of Transportation, BTS00-007, Washington, D.C., 2000, See Table 1-1 and pp. 1-11 through 1-13. 29 John S. Miller, Expected Changes in Transportation Demand in Virginia by 2025. Virginia Research Council, Charlottesville, VA, 2003. 30 U.S. Census Bureau. Projections of the Total Population of States: 1995 to 2025. Washington, D.C. See http://www.census.gov/population/www/projections/stproj.html 31 Zmud, J.P. and Arce, C.H. “Influence of Consumer Culture and Race on Travel Behavior.” Personal Travel: The Long and Short of It. Transportation Research Circular E-C026, Transportation Research Board, National Research Council, Washington, DC., 2001.

Long-Term Trends that May Affect ADA Paratransit Demand 41 • Economic and service specialization will most likely increase travel demands because of the discrete locations demanded by such specialization. Many of these discrete locations will be outside of traditional city centers, so this trend is likely to increase the need for flexibly routed and scheduled services such as the private auto, carpools, and demand-responsive transit ser- vices. Average trip lengths could also be expected to increase. • Poverty has long been linked to disability, both as a consequence and a cause.32 While recent years have seen short-term increases in poverty, long-term trends are difficult to project, as they depend heavily on changing public policies and priorities. The implications of changing poverty rates on ADA paratransit demands are unclear, especially regarding persons with disabilities who live in poverty. Increases in disability are likely to lead to increased ADA para- transit demands, but increases in poverty may decrease overall travel demands, also reducing ADA paratransit demands as suggested by the outcome of the sketch modeling process. • Many persons with disabilities are unemployed or underemployed, leading to poverty or near poverty incomes.33 Only 43% of persons with severe disabilities now work. If policies were implemented to reduce this large proportion of persons with disabilities who want to work now but cannot, employment travel demands among persons with disabilities would be likely to increase. This might create a brief upsurge in transit and paratransit use, but many of these new workers might eventually buy cars. • Persons in poverty are more likely to defer or skip medical examinations or treatments, some- times leading to disabling conditions.34 Again, increases in disability are likely to lead to increased paratransit demands, but increases in poverty may decrease overall travel demands. • Technological advances in at-home medical screening and reporting might reduce the need for some doctor visits. This could be a boon for some persons needing the special kinds of trip assistance provided by many ADA paratransit services, thus potentially reducing the demand for such services from this segment of the population. • Advances in information technology have created a consumer group said to value a “customized shopping experience.”35 Such consumers may be attracted to transportation services that could satisfy individualistic trip demands, possibly increasing the demand for ADA paratransit services. • While telecommuting and other technological changes may make it easier for persons with disabilities to be employed at jobs that more frequently allow them to work from their homes and thus require fewer work trips, experts do not expect an overall reduction in trip making due to telecommuting.36 Telecommuters now represent about 10% of U.S. adults, a figure that has not changed much in recent years.37 32 Glenn T. Fujiura, “Emerging Trends in Disability,” Population Today, August/September 2001, accessed at http://www.prb.org/Content/NavigationMenu/PT_articles/Jul-Sep01/Emerging_Trends_in_Disability.htm. 33 “People with disabilities were significantly more likely to live in poverty (18.3%) than those in the general pop- ulation (9.9%).” Adler, M. (1995). “Conditions and Impairments Among the Working-Age Population with Dis- abilities.” U.S. Department of Health and Human Services. http://aspe.hhs.gov/daltcp/reports/conimpwa.htm. Of persons who live in poverty, 24.1% are persons with disabilities. (Special tabulations from 2002 American Community Survey Exhibits found at http://factfinder.census.gov/servlet/DTTable?_bm=y&-geo_id=04000 US03&-ds_name=ACS_2002_EST_G00_&-redoLog=false&-mt_name=ACS_2002_EST_G2000_P060. 34 Hughes-Cromwick, P., Wallace, R., et al. TCRP Web-Only Document 29: Cost-Benefit Analysis of Providing Non- Emergency Medical Transportation, Transit Cooperative Research Program, Transportation Research Board, Washington, DC., 2005. 35 Marketing to Young Adults, Yankelovich Monitor, pp. 3-14, March 2002, Norwalk, Connecticut, available at www.yankelovich.com. 36 “. . . even if an increase in telecommuting does occur and it reduces traditional work-based peak hour trips, there may still be increases in non-peak hour or nonwork trips.” John S. Miller, Expected Changes in Transportation Demand in Virginia by 2025. Virginia Research Council, Charlottesville, VA, 2003. 37 Ibid.

• Travel technology improvements that tend to automate operational decisions requiring strength, cognition, or responsiveness (such as the skills commonly required to drive) could increase travel options for persons with disabilities and thus increase overall travel demands. Were such systems actually put in place, their effect on paratransit demand is unclear. • Technological advances in the next 30 years in personal mobility devices are possible. The increased use of low-powered vehicles (similar to golf carts or the Segway) for local travel sug- gests that more innovations are possible in this arena. Such advances might reduce the overall demand for specialized paratransit services. Public Policy Considerations Public policy changes could create significant changes in both the supply of and demand for specialized paratransit services. Some of these changes could increase both supply and demand while other changes are as likely to decrease supply and demand. • Debt and budgetary pressures now in evidence could reduce future federal investments in public transportation, potentially leading to declines in the amount and quality of fixed-route transit and paratransit services. Reduced supply could have the effect of reducing ADA para- transit demands. Further research in this area could be most helpful. • Many federally funded human service programs face static or declining budgets at this time, and potential debt and budgetary pressures could reduce future investments in human ser- vice transportation systems. Conflicting scenarios regarding ADA paratransit demands can be imagined if human service program budgets are reduced. First, these programs now provide trips that relieve at least some of the demands on ADA paratransit services, suggesting that demands for ADA paratransit services could increase. Conversely, a number of public transit respondents to this project’s survey have indicated that a substantial proportion of their cur- rent ADA paratransit demand (often 25% or more) is attributable to persons traveling to human service programs. If there is less funding for the services provided by these programs, fewer individuals will travel to them, thus reducing ADA paratransit demands. Further research here could be of great value. • An increased recognition by public transportation authorities of the wisdom in partnering with agencies relying on volunteers could reduce some of the demand on ADA paratransit services for trips that are the most challenging and expensive to provide. • Changes to policies specifically related to the usage of ADA paratransit services could have real impacts on the demand for these services. • Medicaid and Medicare are the largest social service programs now operating, and their trans- portation policies directly affect the overall demand for paratransit services. The details of Med- icaid transportation policies are set by each of the states and territories, so forecasting local paratransit demands (both on ADA services and transportation services provided by other agencies) requires a thorough knowledge of current Medicaid regulations and practices for a specific state (and, in some instances, for specific counties). By law, Medicare does not currently reimburse riders or providers for paratransit trips (only trips by ambulance are eligible for reimbursement). Changing the Medicare legislation to allow paratransit trips for preventive care services could save the Medicare program billions of dollars,38 but such changes are not currently in progress. Both programs are now under serious pressures to reduce spending wher- ever possible. One result of these pressures is that some states have cut back on Medicaid trans- portation spending,39 putting more pressure on ADA and other specialized paratransit services. 42 Improving ADA Complementary Paratransit Demand Estimation 38 Burkhardt, J., (2002). Benefits of transportation services to health programs. Community Transportation. 20:6. 39 According to interviews with United We Ride Ambassadors, Colorado, Florida, Missouri, South Carolina, and West Virginia have recently decreased Medicaid spending for non-emergency transportation or else have threatened to decrease these expenditures. Iowa and Mississippi are considering similar action.

Long-Term Trends that May Affect ADA Paratransit Demand 43 Overall Impressions An increased demand for specialized demand-responsive services is likely in the next several decades, but the proportion of that demand that is met by ADA complementary paratransit services depends on policy decisions that are extremely difficult to forecast. With no significant policy changes, ADA paratransit demands are likely to exhibit relatively stable rates of growth. Increases in ADA complementary paratransit demand are likely to be in proportion to contin- uing population growth. Significant policy changes could alter the ADA share of the overall demand for specialized demand-responsive services in dramatic fashion. Trends that Could Increase ADA Paratransit Demands Among the most significant factors likely to influence potential increases in the demand for ADA paratransit services, the following stand out: • The forecasted increase in the numbers of persons with disabilities is likely to create significant increases in the demand for specialized transportation services. • Increased travel demands (trips per person per day) are expected, especially for senior citizens. While much of this increased demand will be satisfied by private auto trips, an increase in paratransit demands is also likely. • Trends in employment, geo-spatial settlement patterns, and a number of other factors are likely to increase the demand for travel services with a high degree of flexibility, such as those offered by some paratransit operators. Trends that Could Decrease ADA Paratransit Demands Among the most significant factors likely to influence potential decreases in the demand for ADA paratransit services, the following stand out: • Increasing incomes and overall health are likely to increase the proportion of trip demands satisfied by driving (although the impact of that on ADA paratransit demand is uncertain). • Future federal and state budgetary pressures could easily reduce the proportion of transit budgets available from federal and state sources. This could in turn reduce the supply of transit and ADA paratransit services, thus limiting the level of demand that could be satisfied. Effects of Potential but Hard-to-Predict Changes It is possible that the changes that are currently the hardest to predict could have great influence on future demands for ADA paratransit services. • Hard-to-predict policy changes regarding federal and state funding for transportation could have large influences on the demand for ADA paratransit and other specialized demand- responsive services. These changes could have positive or negative impacts on overall demands, but the current situation suggests that the changes could be negative. • Technological advances to personal mobility devices could reduce the demand for ADA paratransit services as they are currently structured. • Advances in medical technologies and treatment protocols may have unpredictable influences on ADA paratransit demands. • The extent to which possible major revisions are made to existing practices within the pub- lic transit and taxi industries could have major effects on the demand for ADA paratransit services.

Key Areas for Further Research A number of subjects appear as important but hard-to-predict components of future ADA paratransit demands. These subjects would be good candidates for further research. They include the following: • To what extent will future drivers convert to transit and paratransit riders if they eventually experience disabilities that compromise their abilities to drive? • Will advances in automotive technologies significantly extend driving abilities beyond what is possible today? • How will public transit agencies react to the increasing decentralization of homes and com- mercial activities? Will transit agencies follow these new developments or continue to focus on central city services? • If human service program funding declines, will that decrease or increase ADA paratransit demands? • To what extent will potential advances in medical technologies and treatment protocols influ- ence ADA paratransit demands? 44 Improving ADA Complementary Paratransit Demand Estimation