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Safe Transportation for CCRC Seniors to Medical Appointments – A Frill or A Necessity?

By Lillian L. Hyatt, M.S.W. and a Resident of a CCRC


Excerpted from the Winter 2009 The CANHR Advocate newsletter

Safe transportation for CCRC seniors to medical appointments is a necessity not a frill. As a ten-year CCRC resident at The Sequoias San Francisco I have discover that among CCRC organizations, different communities handle this problem differently. How the lack of such a fundamental service is justified to the residents also varies widely.

Most applicants upon entering a CCRC do not give sufficient attention to the contract they sign, nor do they compare the legally binding contract with the brochure’s promises. They are unable to envision and understand the services they will require as they age. Marketing techniques give the applicant a false sense that all their needs will be met as they age. Ten years ago when I made the decision to invest a substantial part of my life savings to enter a CCRC, I could drive a car, I had excellent vision and I did not need a walker to get around. Foolishly, I assumed that residents requiring transportation services were getting them. I also assumed the cost was included in the monthly care fee. If I had read the wording in the CCRC contract carefully, I would have discovered that exclusion.

At The Sequoias San Francisco, the system requires residents to pay for their own escorts and transportation to their medical and dental appointments. When added on to an already large monthly care fee, this can be a severe financial burden. In contrast, The Sequoias Portola Valley facility provides transportation services for their residents. Although The Sequoias San Francisco has a fully equipped van and employs a driver to take residents on almost daily shopping and pleasure trips, such a program is certainly needed for residents in the Skilled Nursing Facility who rarely get outside.

In the recently published brochure by The Sequoias San Francisco to attract new residents is the statement: “What other amenities does the monthly fee cover? … transportation to medical appointments.” The reason marketing felt they were able to make this statement is that a shuttle van and driver coming twice a day on its own schedule from St. Francis Hospital does pick up Sequoias’ residents going to St. Francis and the medical office building across the street. However, if a resident misses that bus, they are out of luck. If the bus fails to arrive at all, the facility will issue a taxi voucher to the hospital drawn upon one taxi company. What about the many residents who have health care insurance outside The Sequoias San Francisco system and need to get to other medical facilities? Those residents must fend for themselves while paying the full monthly care fee subsidizing the other residents using the facility’s health care system. This very minimal van service offered by St. Francis Hospital for some residents is the fig leaf used to justify the services statement. Uninformed seniors could be misled. A Life Care Residential community cannot in good conscience omit such a fundamental service needed by frail and elderly residents and claim that there is a “continuum of care” for the residents’ entire life: making that statement in its brochure and omitting it from its contract. CCRC administrators need to focus less on the image they market as a country club and focus instead on the realities of their residents’ lives.

according to the Continuing Contracts Branch of the Department of Social Services, Life Care provider promises: “to provided all levels of care, including acute care and physicians’ and surgeons’ services to a resident.” It can be argued that safe medical transportation to the care provider is an essential element of that service. By eliminating that service, the Life Care CCRC is behaving like a fee for service provider. Consumers should ask “Why?”

(Ms. Hyatt is a resident of a CCRC and AARP Policy Specialist on CCRCs)