Harris County’s coordinated approach to transportation helps thousands get a lift
/ By Maria Sprow

Every Monday, Tuesday and Wednesday, 31-year-old Jesus Ybanez Jr. spends his days crushing boxes, sweeping, mopping and doing other chores at his job at a Houston area Wal-Mart.
Ybanez, who has Down syndrome, has been at the job for 10 years, but wouldn’t be able to work at all if it weren’t for a program started by the Harris County Commissioners Court several years ago. Not that he wouldn’t be able to work; he just wouldn’t have a safe way of getting to and from his job, which is about eight miles away from his home.

Ybanez can’t drive, and while his mother, Maria Guadalupe Ybanez, used to take him to work, the trips just got to be too much for her to handle, so she started to look into other ways of allowing him to have some freedom and responsibility. Luckily, at the time she was looking, the county had just developed its Coordinated Transportation Program, now called Rides, designed to help residents who are low-income, disabled or elderly and who have no other transportation available to them.

Maria said the program has been a blessing for her, and for Jesus.

“Instead of me taking him to work, sometimes I just can’t drive, sometimes I just can’t go. I have doctor’s appointments and things. It just got to be too much,” she said, adding that the program’s reliability gives her some piece of mind. “I know (Rides) is going to be there to pick him up and drop him off at home.”

Maria said she had no complaints about the program. It’s affordable for what it offers her – time – and the service does “good” when it comes to picking up Jesus on time. The program, which uses vouchers to give clients a discount on their transportation needs, allows her and its other customers to choose which transportation vendor in the county they want to use. Jesus rides with the American Red Cross, which provides transportation around Houston.

“That was the one I started off with when he first started working,” said Maria. “I was very happy with it, and it was convenient for me, so I stuck with it.”

To Martha Mayes, transportation is almost the same as food and water – a basic necessity of the human condition. On a daily basis, people need to be able to get where they have to go – the doctor’s office, the grocery store, the pharmacy, the mall.

Mayes, who works with the Houston chapter of the American Red Cross, first began realizing just how important transportation is more than 10 years ago, when the organization’s Community Service Transportation program began to overflow with requests for rides to doctor appointments.

“We were being swamped, we couldn’t keep up,” Mayes said, adding that the organization attempted to reach out to other associations who were in the business of providing free non-emergency medical transportation in an effort to help solve the problem of having to turn people away.

The attempt failed – the organization sent out a letter, but nobody responded.

So then-Red Cross Board of Directors chair Rob Mosbacher tried a different method – contacting his friend Robert Eckels, the county judge.

“We hear all kinds of proposals and initiatives. This didn’t really fit under our administration, but it did fit in that it needed to be a countywide, coordinated program,” said Rose Hernandez, the judge’s director of infrastructure initiatives.

Eckels sent out his own request to the local organizations, and his community leadership skills proved invaluable as transportation providers and users began discussing the problem – the holes in the county’s Metropolitan Transit Authority, or METRO, routes; the overflow of calls; how the county’s poorest, oldest and disabled residents may not have a way to get themselves to a doctor, and how not having a way to prevent or treat medical problems could lead to greater health risks and costs later down the line.

“I think when other agencies saw a letter from the Red Cross, they just thought it was one agency saying, ‘Okay, you folks come here and try to help us out,’” Mayes said. “When the county judge sends a letter, it carries more weight, and I think because of the judge’s letter, people knew that it was serious, that there was a real problem at the table.”

The consortium of groups working on the issue included the area’s hospital district, METRO, the Red Cross, the Houston-Galveston Area Council and the City of Houston Area Agency on Aging. Together, they sought grant funding and formed the Harris County Transportation Coordinating Council, with the intended goal of identifying the unmet transportation needs of the county’s residents and coming up with a plan for meeting those needs.

Members of the group were all aware that there was a problem, but didn’t know exactly what the solution was, or how to pay for it, so they sought grant funding from the Houston-Galveston Area Council to commission a study in 2000.

Seniors, low-income residents and those with disabilities who had used public or non-profit transportation services were polled on the availability of transportation in the area. Surveys were handed out to 11 different agencies and mailed to 1,500 low-income homes. The results showed that 53 percent of the responders did not have a driver’s license, 77 percent did not have an automobile, 53 percent used a walking aid and 59 percent stated that they had missed medical appointments before because they “don’t drive and don’t have a friend/ family member to take me.” The study concluded that in 2000, there had been 2.5 million “essential” trips to places such as doctor’s offices and grocery stores that had not been made because the person lacked a mode of transportation.

The study identified areas in the cities of Houston, Pasadena, Baytown, Tomball and Humble where public transportation was lacking and residents were suffering as a result. The county’s METRO and METROLift services do not reach areas in the eastern, far north, northwest and southwest parts of the county.

Multisystems, the company that performed the study, also made recommendations as to how to best fix the problem. The study concluded that the county’s current transportation providers, including METROLift, the Medical Transportation Program (which helped low-income individuals pay for their medically necessary trips via METRO) and the Houston/Harris County Area Agency on Aging, were operating efficiently, so coordination by itself wouldn’t solve the problem. Instead, Multisystems recommended a subsidized transportation program using sponsors and grants that included multiple transportation providers and a neutral program administrator. The benefits of such a program would be more affordable transportation for customers, who are able to make their own transportation arrangements via existing providers, so there would be no new start-up costs for a new provider.

Coordination, the study said, should be done by having joint training programs for defensive driving, first aid and CPR; joint purchase agreements for equipment and services; use of automated scheduling packages to help maximize scheduling processes; and referrals to the other providers in the program if one cannot meet up with its trip demands. The county followed those recommendations as closely as funding allowed, securing larger competitive grants from H-GAC and TxDOT to start the Harris County Coordinated Transportation Program in 2003. The program was so successful that it won a Texas Association of Counties Best Practices Award for Superior Innovation in 2005.

“HCCTP is a market-based approach, innovative within the transportation arena, to expand services for the elderly and disabled, while increasing the coordination of the existing resources, promoting customer choice, coordinating multiple funding sources and monitoring performance in service delivery,” stated the county’s Best Practices application.
The program, now called Rides, operates through an RFP process in which Rides contracts with transportation providers in the area. It then partners with local agencies serving the disabled, elderly and low-income communities, and the agencies purchase vouchers for rides at half price. The other half of the cost is paid for by the county, through grants. The agencies then give a limited number of vouchers to each of their clients, for them to use however they want. If a resident is in need of transportation but is not a client of any agency, or does not fit into the perimeters where one of the agencies would sponsor a person’s transportation, the person can go through the county to pay the co-pay themselves. So a $5, 3-mile trip would cost an individual $2.50, or nothing, if an agency sponsors the voucher.

To be eligible for the program, a person must live in a zip code not covered by the METRO services and have either a doctor’s letter or Social Security award letter for proof of disability, or be at least 60 years old or have an income of less than $21,000. Rides Director Vernon Chambers said the program creates a win-win-win situation for residents, providers and agencies. She added that the program has not had problems with getting enough providers or agencies on board.

“It’s to the advantage of the nonprofit agencies to partner with us to provide transportation, since part of the attractiveness of this is that we assist in the payment of the trips,” Chambers said. “If they went out on their own to get the service for their clients, it would be much more expensive.” Residents benefit because of the program’s flexibility, she added. Residents using the program can choose between eight different vendors, depending upon their need – if they require transportation immediately, how far they must travel to get to their destination, how regularly scheduled their trips are, if they need special assistance.

“We operate from referrals. If one provider cannot provide the service, then we have seven other providers. The consumer has their choice. If they don’t like a provider for some reason, they can select someone else. It creates a natural competition without having friction,” Chambers said. “Because who gets the money is based on the consumer’s choice, all the providers want to do a good job.”

And, of course, providers benefit because they are getting additional business and are being paid the same amount of money for the trips as they would be getting from regular consumers.
Currently, the Rides program has 3,400 active clients, she added. Many of those clients have come from community outreach attempts through churches, United Way meetings, presentations at senior citizen centers and non-profit agencies, or referrals through METRO. A new website also launched several months ago, and word is spreading.

“Word of mouth has been very instrumental in spreading news about the program,” Chambers said. If somebody contacts the program directly, “mobility managers” help walk them through the process. The mobility managers try to connect the resident to one of the sponsor agencies and provide a guide to the different transportation providers so that the resident can select the provider that best meets their need.

“If we have an agency we can connect them to to purchase the vouchers for them, we try to do that,” Chambers said, adding that agencies operate geographically or according to a person’s disability. “We do have some parts of the county where we may not have any partner agencies.”
Those involved with the program said they believed having a coordinated transportation program is easily replicable in other areas, especially
if there is a source of funding for the co-payments of rides.

“I think having a voucher program is necessary to get the coordinated program off the ground,” said Mayes, with the Red Cross. “You have to get people engaged in the idea of coordination.”

So far, agencies and residents associated with the program have good things to say. Though cost is still a concern for both, with non-profits operating on limited budgets and most of the residents having to either pay costly medical expenses or living on a social security income, many say the Rides program is essential to their way of life.

Jane Bavineau, the vice president of the non-profit Sheltering Arms Senior Services, said having access to transportation is critical to many of the people who use her facility. It’s so critical, in fact, that Sheltering Arms had previously tried to provide their own transportation service to clients – but the attempts failed miserably. Bavineau went so far to call the outcomes of those attempts “horrible.”

“We got involved with Rides because we tried to handle the transportation issue ourselves in so many different ways, and they all failed,” she said, adding that they tried raising money to be able to afford to contract with a transportation provider themselves, but were unable to raise enough. “We tried having our own van service, and that was not a good idea. It was such a staffing challenge to make sure we had the staff and drivers and that the vehicles were in good working order and that everyone was well-trained. It ended up being pretty unreliable because of our inability to stabilize just what it takes to run even two vans. … It was awful.”

Though Sheltering Arms is no longer an actual sponsor of the program – the organization paid for the co-pays during the first year, but then began passing along those costs to the clients when funding came up short – many of the people who use its services, which include an Alzheimer’s Day Center, have opted to purchase the vouchers themselves.

Harris County resident Mary Chatham was diagnosed with Alzheimer’s three years ago. Four days a week, she visits the Sheltering Arms day center, where she is treated to therapy, friends, food, pedicures, manicures, brain exercises and other quality-of-life enhancements.

“She loves going to the day center,” said her daughter and caregiver Donna, who lives in Pasadena, about 15 miles away from the center. “It allows her to get out of the house. It’s stimulating and healthy for her.”

But Donna said such services wouldn’t be available to her mother if not for the Rides program.“We live a ways away from the center, and I have to work and take care of the house. If would be two to three hours out of my day if I had to drive back and forth myself. It would be hard, I don’t think she’d be able to go,” Donna said. “I don’t know what we’d do without
it, to tell you the truth.”

Mary uses the transportation provided by the American Red Cross, Donna added, which also is a big benefit to the program.

“She feels secure. She wouldn’t get on that bus if she didn’t feel like they could take care of her,” Donna said, adding that she pays the costs of the co-pay herself and that though it’s getting expensive, she’d be apprehensive about leaving the Rides program in favor of some other, unknown cheaper option. “I feel pretty confident about the Red Cross. It’s usually a handful of the same drivers, so they all know her pretty well. It’d make me nervous to end up switching.”

In total, the Red Cross provides about 1,000 to 1,200 trips per month to Rides clients, said Mayes. The program has helped the Red Cross’s administrative costs because it minimizes the number of contracts the organization has to sign with agencies seeking services. Instead of signing contracts with 10 different non-profits, Red Cross can sign the one with Rides. The program has also increased communication between the various transportation providers, resulting in less wasteful trips over time.

“Before we were doing this, some of the same transit providers that are now providers with Rides, we were passing them on the same street picking up people at the same time,” Mayes said. “That’s insane.”

There are still ways in which the program can be improved, Mayes added, including use of Smart Cards instead of paper vouchers or by implementing some sort of central dispatching for further coordination.

“I think we are not there yet, simply because you have so many different providers involved at so many different levels using different technology,” Mayes said about possibilities for further development.

“But I think it is possible. I think it just takes time.”