G APS IN S ERVICE I DENTIFIED

This subsection discusses gaps in transportation services within Los Angeles County and identifies the geographic areas where trips may be needed.

5.4.1. Institutional Communication Gaps

Coordination of the transportation services operated by public transit and human services agencies/organizations is impacted by the challenges of working between two very distinct service systems. For public transit, operating service is its core business, around which significant infrastructure has been built. For the human services agencies, transportation is a support service, and is sometimes viewed as a distraction from the agencies’ primary purpose. Although both serve the public, differences are clearly evident at the institutional level. Human service organizations are closer to the client, have a better understanding of individual needs and requirements, and focus their day-to-day efforts on addressing and resolving issues on behalf of the individual. Public transit is more attentive to “mass” needs only in relation to providing service, with considerably less awareness of the individual. This was evidenced in the inventory process where human service agencies/organizations identified a breadth of needs while a much smaller proportion of responding public transit agencies/organizations could pinpoint customer needs.

FINAL 53 SEPTEMBER 2007 It follows that since the day-to-day business objectives of these two public service industries are not the same, it is logical to find that they speak different “languages”, or rather interpret, process and respond to things differently. For example, public transit operators talk in terms of one-way passenger trips, and apply productivity measures of cost per hour and passengers per hour. Human services personnel speak of client days, per diem rates and often understand trips as vehicle trips. These differences can and do make communication challenging.

One such difference in understanding, related to service provision is the drive to greater service efficiencies that a shared-ride system represents and the need to pick up several passengers in a given hour. This can contrast sharply with the individualized orientation of human services personnel to meet the needs of a single consumer who may have had a difficult dialysis session, and is more frail than usual, or the individual whose medication regime makes waiting in the sunlight particularly challenging. Shared ride demand response programs have difficulty meeting such individualized needs.

These disparities reflect different value systems, reflecting the different core missions of each industry. These issues must gradually be addressed in the development of coordination projects that will work effectively between systems. At a minimum, it is important to establish an individual “translator” who can work with these two systems, understanding each sufficiently to navigate in both and to design responsive, cost-effective coordinated transportation programs. 5.4.2. Capacity

The activities associated with the development of the assessment of services confirm that there are already significant public transportation services currently operating in Los Angeles, offering a range of modes and services for riders. There are also considerable human services transportation programs in place, with varied methods of service provision that include staff members driving consumers in their own car with mileage reimbursement, volunteer-based programs, directly operated services and various scenarios for contracted or taxi-based service provision.

However, the assessment also shows that some of the needs of the target population are not being met. In fact, the needs described exceed the services now in place. This mandates that the existing network of transportation services must be re-configured to handle the ever- increasing need, as Los Angeles County realizes continuing population growth in the future. The potential to coordinate and leverage transportation resources is a logical next step.

5.4.3. Meeting Individualized Needs

One of the main objectives of the Action Plan is to recommend ways that public transit and human service agencies can work together to develop plans and projects to meet the needs of seniors, disabled persons and low income individuals. Providing service to some difficult-to- serve sub-segments of the target population (e.g. frail, chronically ill and disabled individuals) is the highest level of individualized service that can be offered to consumers, will require a significant commitment by public transit and human services and resources.

The Action Plan has identified specific areas of individualized need for segments of the target population that must be addressed on some level to improve mobility overall. Public transit and human service agencies and organizations must find ways in which to meet needs consumers describe, and agency/organization personnel enumerate on their behalf. Actions and strategies

FINAL 54 SEPTEMBER 2007 developed as elements of this plan have been designed to improve the ability of operators of specialized transportation to serve a higher level of individualized trip needs with greater efficiency.

5.4.4. Improving Performance of Demand Responsive Services

During the stakeholder involvement process, consumers and agency/organization representatives raised a number of issues related to service quality: on-time performance, late pick-ups, and late arrivals at appointments due to long rides and shared rides, and no-show vehicles. Reliability of paratransit services is an important issue and represents a need that persists and that can translate into critical situations for frail, vulnerable and dependent populations.

Comments on this issue have related to Access Services because it is the entity charged with responsibility for development of the Action Plan. This is primarily due to the high level of expectation on the part of stakeholder agencies and organizations in securing transportation for their clients, and lack of understanding about the nature of the paratransit services operated by Access Services.

Therefore actions and strategies that improve the quality of services that are already in place will help to better meet identified needs. In addition, public transit efforts to communicate effectively with human service agencies/organizations should be improved.

Communication Between Drivers, Dispatchers and Passengers

Improving communications between everyone involved in the provision of specialized transportation services can improve the capability of agencies and organizations to address individualized needs.

This initially involves improved driver training to sensitize both public fixed-route and paratransit drivers to recognize and facilitate transportation for persons with special needs. In addition, technological tools may improve the capability of the system to strengthen the connection between the rider, the vehicle and dispatch in a real-time situation. This will serve to minimize long waits, absent information about the vehicle’s arrival time. Dispatchers and call takers may require additional training to assist high-needs consumers more effectively and to be sensitized to their requirements.

Capacity building then, for specialized transportation, has two purposes: 1) to increase the quantity of what is available and 2) to improve the characteristics of what is available, whether in terms of measures of cost-effectiveness, getting more for the dollars expended, or in terms of the types of service, greater responsiveness to the target populations. Capacity building translates into an array of activities: training and professional development, use of technologies to achieve increased efficiency and effectiveness, and all possible methods of expanding the quantities of service available.

FINAL 55 SEPTEMBER 2007 Inter-Community Medical Trips

Much has been written about the need for medical trips which are usually lengthy and typically require individuals to travel to regionally-based medical facilities. This is a state-level policy issue that relates to Medi-Cal reimbursement to public transit for medical trips provided to the eligible Medi-Cal population. At present, California is unique among the states in not reimbursing public transit for non-emergency medical transportation. In many other areas of the country, this is a significant funding source for this type of transportation. If California Medi-Cal policies are modified to allow reimbursement to public transit operators, this would provide some assistance to the senior population frequently making long-distance, medically related trips. Currently, Medicare, the national senior health care program, does not support transportation expense. Managed care programs, including Kaiser Permanente and SCAN, among others, speak to issues of need to get consumers to their regional, specialty facilities, but there is disproportionate financial participation accomplishing this. In short, there needs to be continued policy focus and attention, at both federal and state levels, to this type of transportation, even as local initiatives are implemented to assist in meeting long-distance, medically related transportation need.

Some of these trips are between counties, a particularly difficult issue to address with a plan focused on an individual county. Los Angeles County receives many persons from neighboring and distant counties who have special transportation needs and are traveling distances, often to go to this county’s premier medical facilities. Some need to travel short distances, just over the county lines, while other are arriving by inter-state carriers, including Greyhound bus and air lines and are in need of specialized transportation options available at the terminals at which they arrive. Over the long-term, planning to meet these inter-county trip needs is important.

FINAL 56 SEPTEMBER 2007

CHAPTER 6 – EXISTING TRANSPORTATION ENVIRONMENT