Obstacles that Make Rural Mobility Challenging in Our Region
Everyone needs reliable transportation, whatever form it may take. There’ll never be as many viable alternatives to driving in rural Washington as there are in urban places, so it’s important we make the most of the ones that can work in our highly rural region.
This plan is focused on rural mobility but especially as it concerns those who don’t drive. Two-thirds of our residents live outside of any incorporated place; many of them live far outside of town. It takes a network of service providers to meet these rural mobility needs.
This section summarizes an array of issues that make it hard for people to get where they need to be when they need to be there, conveniently and affordably. These are the challenges that make travel harder than it seems like it should be or more expensive, or consequential when it doesn’t work out right.
Issues are assembled from a variety of public sources: public comments and surveys associated with various planning processes including this update; provider polls; provider discussions and meetings; Community Health Needs Assessments and Community Health Assessments; transit and service provider plans and reports; statewide plans and data; social media feeds; and other local, regional, and statewide sources. They are organized by issues that individuals face trying to get where they are going, issues that human services providers confront when helping their clients overcome mobility barriers to access services, and issues that transportation providers navigate in delivering reliable rural mobility options that are convenient and affordable.
Issues that Individuals Face
The vast majority of people who live in the Peninsula Region drive for most or all of their travel needs, Those who don’t drive in this highly rural region, and even many who do, face a variety of challenges. Some are associated with rural lifestyles. Distances are far, so travel can be expensive and take a long time. Not surprisingly, available services are rarely as convenient or as fast as driving.
There are lots of travel options, more than many people realize. There are over two dozen service providers supporting some facet of essential rural mobility that connects people with the health and human services available to them. That comes with its own challenges, though.
Every provider has its own service area boundaries, ADA accommodations, eligibility requirements and intake processes, fare structures, reservation scheduling requirements, and more. It’s hard to know what services are available for what kind of trip purpose or eligibility criterion unless you’re a transportation planner.
We’ve grouped these roughly by type of issue though they regularly overlap; several are likely to be true at one time.
At Some Point, People Living an Independent Rural Lifestyle Lose Their Ability to Drive
After a lifetime of driving, advanced age makes driving unsafe for some or all trip purposes. That loss of independence is not an easy transition anywhere, but for rural residents who live in outlying areas it is particularly challenging because there are few alternatives to driving.
People who’ve always lived an independent rural lifestyle sustain an injury or disease, or eyesight fails or slight dementia or other chronic conditions develop that eliminates their ability to drive safely, leaving them isolated unless there is travel assistance from some source.
Working households cannot keep up with inflation. Wages don’t cover basic living expenses. Owning and operating a vehicle is already expensive in rural areas, but soaring gas prices make driving so expensive that people simply can’t afford to drive anywhere but they don’t have other options.
Available Transportation Services and Facilities Don't Meet Everyone’s Needs
Buses don’t run early enough in the morning to get people to their destinations on time, or they don’t run late enough at night to get them home, or they don’t run frequently enough for trip convenience
Some buses don’t operate on Sundays
People don’t live close enough to any bus service to be able to get to it.
Some people may live close enough to get to bus service and they would take it, but there aren’t safe ways to walk there, or they have to cross US 101 or other busy facility either going or returning, which can be dangerous.
Sometimes there aren’t safe places to wait for the bus once people get to the stop and the weather can be too awful to wait for the bus if there’s no shelter.
People who live too far from fixed-route transit don’t have access to complementary ADA-compliant paratransit services.
Volunteer driver programs help many who live in outlying areas to access services, but most rely on personal vehicles that do not accommodate people in a wheelchair or other mobility device.
Tribal travel needs don’t always line up with available public transit services.
People can’t always plan their travel needs in advance, which is required for on-demand and non-emergency medical transport (NEMT) service.
Logistically, it’s hard to shop or run a variety of errands in one trip without a personal vehicle.
People in outlying areas who’ve undergone a surgical treatment like a hip replacement or suffered a traumatic brain injury or had a stroke, can find themselves in need of mobility support for a temporary time to access health services and other needs, but their rural lifestyle has them far from the nearest public transit service area.
Long-Distance Travel is Hard
Many residents travel 50 miles or more one way to access locally available health care and human services. This can be cost-prohibitive with gas costs as high as they are and it can be very time-consuming by transit.
The scarcity of rural health care services and long appointment wait times means a lot of people must travel out of county or even out of region for care, requiring system transfers that can be confusing and require extra coordination in trip planning and traveling. Many can navigate the primary transit services on the Olympic and Kitsap Peninsulas, but once they arrive in Seattle, they don’t understand how that transit system works, or they don’t have experience with ride-hailing services like Uber or Lyft that can provide an efficient alternative.
Paratransit service coordination for passenger transfers between counties does not work well.
The Dungeness Line will get people directly to the medical facilities in Seattle, but people can’t afford the fare, or some who can afford the fare can’t get to a Dungeness Line pick-up point.
Many veterans’ services are in Seattle, Tacoma, or American Lake, and while it’s possible to get there by transit, it’s a long and complicated trip without assistance for those seeking care.
Uncertainty and Lack of Information Makes Travel Even Harder
People don’t know how to ride the bus or read a bus schedule or use a flagstop, and they don’t know where to find the information that helps them learn how.
People don’t know who to call for what service or how to plan a trip that relies on two or more transit systems.
People aren’t sure how to get picked up in outlying areas and connected with fixed-route services and then get back home afterwards.
People find different route schedules for different services confusing.
People are unaware of the various non-profit transportation services that are available, or how to get information about services or qualify or book a ride.
Different types of transportation services have different eligibility requirements that are confusing to keep track of. Many people are surprised to find they do not qualify for income-based services. Or they did not know they needed to qualify before being able to use the service.
Transportation Barriers Can Have Bad Consequences
People may have a vehicle, but they can’t afford to do necessary repairs or pay for gas without skipping other important household expenditures. Without a car they can’t work so they skip other payments.
Some people who don't drive rely on friends or family to take them places but that is not always convenient, or they don’t want to be a burden and so they don’t ask for a ride.
Many people who don’t drive don’t know how they will evacuate if there is a fire or other natural disaster.
People without reliable travel options may miss important scheduled appointments, like court appointments or Medically Assisted Treatment sessions, which will have cascading consequences for them and possibly others.
Some people can no longer drive safely, but they’ve never ridden the bus and just can’t imagine that it’s right for them or they’re ashamed to ask for help, so they continue driving.
Issues that Human Services Providers Confront
Health and human services providers are too familiar with issues their customers and clients face in trying to access the services available to them. In every triennial Community Health Needs Assessment conducted by Federally Qualified Health Centers (FQHC) across the region and Community Health Assessment conducted by each county, lack of reliable transportation surfaces again and again as an issue thwarting the delivery of health and human services. This makes it harder to achieve the health outcomes and community wellbeing that rural organizations are working so hard to provide, and puts undue strain on an already over-burdened system. This HSTP highlights some of the issues they encounter in providing services to those in need.
Lack of Reliable Transportation Negatively Impacts Health Outcomes
Missed appointments set back patient recovery. Missed or cancelled appointments often necessitate another long wait for a future appointment which may come with a deterioration in conditions. At the same time, missed appointments preclude the opportunity for providers to have seen someone else instead. This creates inefficiencies in service delivery that further strain rural health resources.
Patients will decline health care services or forego accessing social services because they don’t have a way to get there. This is particularly true for specialty care that requires long-distance travel. Such appointments may even entail an overnight stay because of the travel distance.
Women without reliable transportation will skip routine prenatal care, and families who have young children will pass up routine exams, because of the challenge with getting to and from appointments.
Because it is too hard for them to get to preventive care, people will put off seeking medical attention until conditions result in emergency response treatment, resulting in more expensive treatment options with possibly poorer health outcomes or other corresponding issues.
The Road to Recovery Care Requires Reliable Transportation
People receiving behavioral health treatment or therapy for cognitive or mental health conditions often do not drive and need help with transportation to and from appointments and yet may have conditions that make travel by bus or in a shared vehicle unsafe for others.
Coordinated efforts to divert people away from the criminal justice system and into mental health and substance use disorder treatment are often stymied by the inability of people who really want treatment to get to health appointments reliably on an ongoing basis because there are no transportation services available to them.
Patients being discharged from hospitals may not have a way to get home and unless they are on Medicaid, there are few or no non-emergency medical transportation options available to them. Liability and insurance restrictions typically prohibit transport by staff.
Clients Don’t Take Advantage of Programs Because They Can’t Reach Them
Children who would benefit from early childhood learning programs don’t attend because it is impractical or even impossible for parents to get them there or back without a car.
Many patients make too much to qualify for Medicaid or Apple Health – and the medical transportation that comes with those programs – and yet they are very low income and unable to afford the expense of driving to obtain services. Federal poverty levels are artificially low and do not account for the majority of low-income people.
Services providers often function as “travel coaches,” helping their clients plan for how they will get to or from services as a part of the treatment plan they are encouraging, reducing the time available to provide care services.
Issues that Transportation Providers Navigate
Transportation providers must navigate their own universe of challenges and constraints that inform the kinds of services each provider offers, where and when they operate and who they serve. Many of these issues have to do with money - how much money they need and how much they can get, what it can be used for, who can be served, how hard it is to get and to administer. These factors are hard-wired into their thinking and planning and implementation, always with the aim of meeting the most need they can with the resources available in a safe, sustainable manner. This can be helpful context for understanding the nature of barriers and the unmet needs identified above and identifying pragmatic strategies that can actually work to address them.
The Color of Money Determines the Services They Can Provide
State and federal grants make up the lion’s share of revenues that transit agencies and other transportation service providers rely on. State and federal grants are vitally important. They enable us to have services and facilities we wouldn't otherwise be able to afford. They can also be very frustrating. Grants are costly to apply for and costly to administer. Every grant has its own restrictions about how it can be spent, what is required for project tracking and reporting, time frames for expenditure, and more. Big projects or ongoing services often entail multiple grants, combining two or more different sources of funding on a single project and increasing the complexity of project administration. It takes resources to manage grants, resources that may be scarce for some of our partners.
Public transit agencies in Washington rely on retail sales tax revenue for stable, predictable local funding. Voter-approved sales tax revenue is the only truly reliable, discretionary revenue transit agencies receive, with the rest of their funding coming from competitive state and federal grants that are unpredictable and fluctuate over time. But the tax base in the three most rural counties is much smaller than that in large urban counties; it doesn’t generate as much here as it does elsewhere. What it does generate provides essential local match these agencies need for those state and federal grants, in addition to supporting ongoing day-to-day operations. There isn’t a lot of discretionary revenue available to rural transits.
Asset Management Is a Priority
Rural travel is hard on vehicles and mileage accumulates fast. It is important to replace vehicles in accordance with asset management plans before they get unreliable or overly expensive to maintain. But funding is not always available for vehicle replacements on a timely basis. This can cause maintenance costs to increase to keep vehicles in safe and reliable operating order. This can be particularly impactful for non-profits that rely on light duty vehicles since these are not always up to the sustained rigors of rural service.
Non-profits and small transportation organizations may not have the staff capability or facilities to maintain their own vehicles. Instead, they rely on service through private shops that may not be able to meet the quick turnaround needs of providers, leaving vehicles out of service and disrupting travel. This is compounded by those with wheelchair lift-equipped vehicles that require more specialized maintenance services.
Making Long Distance Travel Easy is Hard
Out-of-county service connections with ferries in Bremerton, Winslow, and Kingston are unreliable due to unpredictable closures of the Hood Canal Bridge to allow passage of large recreational sailboats. These random closures can stop SR 104 traffic for an hour and unravel scheduled travel plans for service connections and appointments.
A number of essential health services are not available locally, increasing demand for long-distance trips that are difficult and/or expensive to provide, especially if they entail specialized vehicles or personnel. Assisted travel for a dialysis appointment, for example, is a very long day of service when it requires travel to Seattle because there are no clinics on the north Olympic Peninsula.
Operating Costs Can be an Unsustainable Budget Wild Card
As fuel costs go up, operating expenses for transit agencies and other travel providers go up too. Fuel cost impacts service providers as it does individuals and can constrain transportation service availability when it is needed most. Providers relying on multi-year operating grants likely didn’t budget for the recent surge in fuel costs associated with Middle East conflicts.
Complicated reimbursement rates for certain grants mean that some non-profit providers are reimbursed only for the part of a demand-response trip when the passenger is physically in the vehicle. They are not reimbursed for agency expenses incurred while picking up the passenger, waiting for them to complete their treatment, or returning to base after dropping the passenger back home. In a region where people routinely travel over 50 miles one-way for health services, these ineligible expenses can render such service unaffordable for the provider and thus make it unavailable to those who need it most.
Some Places Are Simply More Accessible Than Others
Sometimes agencies receive requests for on-demand door-to-door service or ADA-accessible paratransit service that can’t be accommodated because people live on narrow, unimproved or primitive roads that a wheelchair-lift equipped vehicle can’t navigate or which has no place for a vehicle to turn around. People often overestimate the accessibility of their rural property. By the time they need mobility support, they may not have the capacity to address the issues.
How our communities are built – how they develop and where - directly impacts the mobility choices individuals have and the ability of transportation providers to offer convenient, reliable services when and where it’s needed. This will always be true. Land may be cheaper there but when senior housing, social services, and health care facilities are located on the outskirts of town or in outlying areas, it is much harder to help people get where they need to be when they need support than it is when they are centrally located in town.
It is vitally important that we not lose the health and human services we have locally and wherever possible, that our communities can grow those services over time. We are already challenged to provide all of the out-of-county and long-distance travel assistance people need today to access necessary health services. Any further erosion of local services will only exacerbate that condition, making it harder for more people to access the care they need. In this regard, the availability of local health care resources is a regional transportation concern.
These are some of the issues our transportation partners navigate with every service hour and passenger trip they provide, and they do a good job at it. There’s a lot being done now to make sure people can get where they need to be, whether or not they drive, but maybe we can do more.
We're trying to be smart in how we approach rural transportation services and do what we can to foster a strong and resilient mobility network. Read on to learn about mobility strategies we think can help us preserve the transportation services we have today and make them even better for residents of the Peninsula Region. Let us know what you think.
SECTION CONTENTS
Issues that Individuals Face
Issues that Human Services Providers Face
Issues that Transportation Providers Face
HSTP online site index
Introduction
Human Services Transportation
Unmet Needs and Barriers
Mobility Strategies
Implementation Funding Support
Inventory of Transportation Services
HSTP Resources
Are you completing a Consolidated Grant application? You may find the pdf version of this Unmet Needs tab helpful. It is Chapter 4 in the report document. You can find the whole printable pdf of the HSTP report in its entirety here.
Does this list of unmet needs and barriers look right?
If I’ve overlooked an important issue or mischaracterized any of these, please drop me a note and let me know. Thanks!