Transportation feature — Riding high

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Access to reliable, safe vehicles can boost your facility's image – and improve the quality of life for your residents.

Resident transportation involves far more than merely taking passengers from Point A to Point B. A well-run program keeps residents connected to the community, fosters socialization and instills a sense of independence. All of this can improve quality of life and make for a smoother transition into the skilled nursing environment.
Certainly, a quality resident transportation service is largely dependent upon the availability of safe, reliable and well-equipped vehicles that can adequately meet the special needs of their passengers. Unfortunately, many long-term care providers aren't doing their due diligence when selecting, operating and maintaining their vehicles, sources contend. The result is a service that neither maximizes resident benefits nor gives the facility the competitive edge it needs to make the operation successful on a broader scale. Even worse, that lack of thoughtful planning, in some cases, is placing residents at risk and opening providers up to potential lawsuits.
"Transportation is definitely not something that should be taken lightly," stresses Ed Sawicki, sales manager for Matthews Buses Inc., Ballston Spa, NY. "A lot of time, money and planning goes into a successful, [well-functioning] transportation program. It isn't just about taking [residents] where they need to go, but being able to do it safely, comfortably and efficiently."

Exploring the options
Providers may be pleased to learn that today's transportation options are limited only to the imagination, with convenience, comfort and safety being at the core of vehicle design.
By most accounts, wheelchair accessibility is a must, and the good news is passenger vehicles — whether they're buses, vans or minivans — can be outfitted more easily and cost-effectively than ever before to accommodate those with limited mobility.
Customization is key and providers need to be aware that virtually any vehicle can be configured to their own specifications.
"So many people don't know the options they have available," said Bob Johnson, regional sales manager of Owings Mills, MD-based Allstate Leasing Inc., which operates a family of dealerships and service centers in the mid-Atlantic region. Through Allstate Leasing's partnership with Mid America Coach, a leading bus, van and shuttle sales and service provider based in Kansas City, MO, customers can order a "truly custom" wheelchair-equipped vehicle. Johnson described one situation where a facility wanted a cargo van that could also pull double-duty as a passenger vehicle, when needed.
"Mid America designed the van with fold-away seats, so they were able to get the most out of their investment," he explained, adding that by factory-ordering a vehicle, customers can be sure they're getting exactly what they need and want, as opposed to just trying to make do with whatever is on the lot.
Some options, which may have been cost-prohibitive for many long-term care providers in the past, can now be incorporated at relatively minimal expense. Drop-down video screens and global positioning systems are two examples. Other features include digital windshield-displayed speedometers and cameras that can monitor and record driver activities and the road ahead. Many of these features can be easily added to existing vehicles, according to transportation expert Halsey King. More and more, customers are taking advantage of such opportunities, he said.
"Health and safety are really the primary focus. We're seeing more defibrillators and bio-kits on buses today than ever before, and this is really just the tip of the iceberg," said King, who owns and operates Halsey King & Associates, a management advisory firm based in Carlsbad, CA. He predicts that enhanced interior lighting systems, micron air filtration systems, and even high-tech electronic steering that allows vehicles to essentially park themselves, will be taking off in the bus and van segment in the near future.
"New technology always comes at a premium, but it won't be long before some of these options become more affordable," he said.
Look for other safety features, as well. Past safety concerns – such as those sparked by fatal bus fires – are paving the way for buses with state-of-the-art fire suppression systems, heat detectors and advanced tire pressure gauges, according to Norman Littler, vice president of regional and industry affairs for the American Bus Association and executive director of the Bus Industry Safety Council.
Driving value
Because even small, minimally equipped resident vehicles can be a costly proposition for many long-term care providers, it's important that those in the market for transportation have a clear picture of their acquisition options.
As with any other vehicle purchase, leasing and financing are both possible. Both come with pros and cons. Leasing can be a good move for facilities with limited capital and that are looking to stretch their transportation dollar, Johnson says.
"For for-profit facilities, leasing offers a distinct tax advantage, as opposed to depreciating the value," Johnson explains, adding that a properly structured lease may offer the added benefit of allowing facilities to have two vehicles instead of one. Hidden costs often associated with leasing agreements also can be avoided by using open-ended leases. "Open-ended leases are structured to fit a customer's unique needs and everything is disclosed upfront. There's no mileage penalty or other hidden fees to worry about at the end of the [term]."
To maximize investments, he recommends acquiring vehicles at the beginning of the model year and disposing of existing vehicles in the spring, when prices tend to be higher.
Of course, owning vehicles outright also has its benefits. Sawicki believes purchasing is always the best value.
"This type of product is a utility. You buy it, you own it and you run it until that utility expires," he says. He acknowledges that some facilities do upgrade vehicles that are still in good working condition to maintain a positive image and gain a competitive advantage over neighboring providers.
Although such seemingly premature vehicle upgrades offer providers access to well-functioning used buses or vans, Sawicki said long-term care providers shouldn't automatically assume that used vehicles are the most cost-effective option.
"When you're transporting a fragile population you need to consider the safety and reliability of the vehicle. How reliable is a 10-year-old wheelchair lift? Will the A/C (air conditioning) fail you? Just because a vehicle seems to run well today does not mean it won't let you down in the near future," says Sawicki.
"Vehicles can malfunction when they're new, but that risk obviously increases the longer a vehicle's been in operation."

Good business
Facilities that own their own vehicles can realize value in other ways as well, as one Bronx, NY-based long-term care provider discovered. Kings Harbor Multicare Center, a skilled nursing facility with more than 700 residents, owns three vans – two that accommodate 10 passengers and one wheelchair-accessible model with room for six. Owning the vehicles enabled the facility to place their logo on the vans, serving as an effective branding opportunity.
They also were able to customize the vehicles to better meet the needs of the transportation services provided. Kings Harbor's transportation program was developed to allow residents to stay connected to their families and their communities by either transporting the residents themselves or providing transportation for family members who can visit their loved ones at the facility. Three fully trained drivers – two full-time and one part-time – are employed by Kings Harbor, allowing vans to operate seven days a week. Daily service is provided in the Bronx and vans run in New York City five days a week. Each driver carries two-way communication devices to stay in contact with the dispatch center and to provide a courtesy call for family members 10 minutes before arriving at their front door.
"We pick up at a family member's or friend's front door and return the visitor to the front door," said Joan McAuley, administrative coordinator for King's Harbor. Transportation service, offered free of charge, makes it possible for family members to attend care plan meetings and participate in other facility activities alongside the resident. The transportation service continues even if a resident is transferred to a hospital. "Many times, a family member is as old as or older than their relative [in the facility] and it would be a burden [for them] to use public transportation." Children also have been considered, with vans equipped with car seats to allow children who are traveling with adults to ride safely.
When Kings Harbor residents are transported on various trips, which may include annual "stay-on-the-bus" excursions to view Rockefeller Center's Christmas tree and light display, safety is always the top priority. A recreational therapist is always on board and nursing staff also accompany residents, when needed.
"[A transportation program] is a costly venture, but we have been able to attract residents who may not have considered Kings Harbor if this program were not available," McAuley continued, adding that the program has gone a long way in improving resident's quality of life.
"We have found that [residents'] ability to remain connected to the community has resulted in successful adjustment to long-term care placement, for both residents and their loved ones," she continues. "In our case, it's a program that has definitely been worth the expense and effort."

Proceed with caution

Before forking over the funds for a bus or van – whether new or used — facilities need to be aware there is far more involved in running a successful transportation program than just buying vehicles.
Providers need to factor fuel and insurance premium costs into the equation, as well as expenses associated with driver training, salaries and benefits – and above all, the price of ongoing maintenance, which is a must for ensuring safe, comfortable and reliable transportation.
To that end, it's imperative to work with a dealer who understands the special needs of vehicles used for long-term care, is committed to learning as much about your facility's operations to help determine the best solution, and is able to provide post-purchase product support and service.
"The longevity and reliability of a vehicle will depend, in large part, on the quality of service that it gets," stresses Nick England, president of Lasseter Bus & Mobility, Lewisville, TX, and founding member of the North American Bus Dealers Alliance.
England said providers should partner with a dealer that asks questions, such as:
&bull What passenger capacity is required?
&bull What combination of ambulatory and wheelchair passengers can typically be transported simultaneously?
&bull Will wheelchair-bound residents transfer to fixed seats once in the bus or remain in their wheelchairs?
&bull Who will provide scheduled maintenance and repairs?
&bull Does the interior need to outfitted for luxury or practicality? Will seats need to be upholstered with incontinent passengers in mind, for example?
&bull Will the vehicle be used for local trips, or will they be used for longer, out-of-town excursions?
For tips on ensuring safety and security when partnering with a passenger carrier company, log onto the U.S. Department of Transportation's Federal Motor Carrier Safety Administration Web site at: www.fmcsa.dot.gov.