Implications for Program and Policy

Barriers to Improving Mobility: The Effects of Current Regulations

Volunteer Liability

Currently, many regulations are in place that can make it difficult for nonprofit organizations to use volunteers in providing transportation to vulnerable populations. In 2005, Helen Kerschner of the Beverly Foundation presented information regarding some of these restrictions at a White House Conference on Aging listening session (Kerschner, 2005). Kerschner noted that liability in the event of a crash is a major perceived problem facing volunteer drivers, and some are not able to purchase insurance for use in their volunteer capacity.Nonprofit organizations that rely on volunteer drivers often pay large fees to insure their drivers, resulting in increased costs to clients. In response, Kerschner made two policy recommendations: first, to implement a national policy extending the Good Samaritan law so that it limits liability to volunteers who give rides to seniors and, second, to encourage the insurance industry to cover programs and volunteer drivers who provide senior-friendly transportation.

Physician Liability

Physicians are concerned about liability at many points during the process of driver evaluation. Some States do not protect physicians who report potentially dangerous drivers to their State Department of Motor Vehicles (National Older Driver Research and Training Center, 2003). Such gaps in protection make it possible for the patient who was reported to sue the physician for revealing confidential information, despite the fact that it was done in the best interest of the patient and of the public’s safety. In addition, some physicians are reluctant to discuss driving issues with patients because they do not want to be held liable for the patient’s subsequent actions. In the event of a crash the physicians fear being held liable because they had failed to keep the driver off the road. These issues impair the ability of physicians to help potentially unsafe drivers receive evaluations.

Policy Summary

Addressing the policy gaps and barriers surrounding the transportation and mobility needs of people with dementia will be a long-term effort.  As future research and pilot projects explore the issues noted throughout this document, decision-makers will have greater knowledge to affect change and to as sure that people with dementia are able to maintain safe mobility while preserving their dignity and quality of life. The framework for action found in the vision laid out for a future transportation system in the document, Safe Mobility for a Maturing Society:  Challenges and Opportunities (USDOT, 2003) will certainly benefit persons with dementia as well.  Clearly, the general strategy steps need to be taken before the specialized needs can be addressed.  Getting people talking together from federal agencies, Congress, states, counties, municipalities, health and social service agencies, and the private sector is a necessary strategy for the sustainable community interventions needed to address the mobility needs of this vulnerable population.