Driving forces in decline: A shortage of volunteers complicates access to care in rural America

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Several times a month, Jim Maybach hikes 8 miles from his home in Hay Creek, Minnesota, toward the Mississippi River.

When he reaches Red Wing, a town of nearly 17,000, the 79-year-old retired engineer stops to pick up a senior who he then delivers to an appointment, such as a visit to the dentist or an exercise class. At the end of the appointment, Maybach is there to drive the person home.

It’s a route and a routine that he repeats a handful of times each month.

Maybach is an unpaid volunteer among an cadre organized by Faith in Action at Red Wing, a nonprofit that relies on retirees to transport residents to essential services.

The users, mostly older people, are people who do not have immediate access to transport, especially in rural areas where public transport options are limited or non-existent.

There are several such programs serving rural counties in Minnesota, but, like other services across the country, their existence has become precarious as the number of volunteer drivers has steadily declined, transportation advocates say. Either the volunteers reach a point where, due to their age, they can no longer drive, or the costs associated with their volunteering are no longer sustainable. For decades, Congress has refused to increase the rate at which driver expenses can be reimbursed.

Experts say that with public transit in rural areas already insufficient and the long distances residents of rural communities must travel to access health care, a decimated network of volunteer drivers would leave older people with even less transportation options and could interrupt their health management. Already, social service agencies that rely on volunteers have begun to restrict their service options and deny requests for rides when drivers are unavailable.

Recognizing the need for drivers in their community is often what drove volunteers to sign up in the first place, but as car insurance and gas costs rise, commitment is no longer “the winner.” -attractive winner it once was,” said Frank Douma, director of state and local policy and outreach for the Institute for Urban and Regional Infrastructure Finance at the University of Minnesota.

Volunteers, like Maybach, are entitled to reimbursement of 14 cents per mile, which generally does not cover the cost of gas and wear and tear on a vehicle. And while the Internal Revenue Service increased the business rate from 58.5 cents per mile to 62.5 cents per mile in June, he did not increase the charitable rate because it is within the jurisdiction of Congress and must be set by law. The charitable rate was last changed in 1997.

Despite the longstanding charitable rate, United Community Action Partnership, a nonprofit that runs a volunteer driving program in southwestern Minnesota, had been reimbursing drivers using the professional rate for years. Program administrators were unaware that the IRS could count volunteer reimbursements that exceed the charitable rate as income.

The organization experienced its “first major drop” in volunteer driver numbers before the covid-19 pandemic, after learning about the IRS rule and telling volunteers about the tax implications of higher reimbursement rates, Shelly said. Pflaum, the driving program administrator. .

And although the nonprofit continued to reimburse at the business rate, the remaining drivers were frustrated that as gas prices soared in the spring, the rate only remained at 58. .5 cents per mile, which did not cover the cost of gas or maintenance.

“When you’re paying close to five dollars for gas, that doesn’t help anymore,” Pflaum said. “So there were some concerns: ‘With what I’m spending on driving my vehicle, it’s no longer reasonable for me – I can’t afford to volunteer’, that’s basically what it comes down to. summarized.”

The rise in IRS activity rates in June was enough to convince most drivers to stay, but Pflaum said she lost a volunteer who had been driving for nearly 20 years.

The issue of unequal rates captured the attention of both parties in Congress, with the introduction of of them bills — both sponsored by Minnesota officials who are proposing to raise the charitable mileage reimbursement rate to the corporate rate. Similar proposals have already been made in Congress and failed.

According research 2018 by the Volunteer Driver Coalition, Minnesota had 1,900 volunteers that year who collectively served 77,000 cyclists.

A persistent hurdle that volunteers face is convincing their car insurers that they are, in fact, volunteers and not for-hire drivers like Lyft or Uber drivers. Otherwise, insurers could force them to purchase more expensive insurance intended for commercial drivers.

A AARP Public Policy Institute analysis found that as of September 2020, seven states had implemented laws prohibiting insurers from denying or canceling insurance or raising rates because the driver is a volunteer. Only two states distinguished for-hire drivers from volunteers in insurance laws at the time.

Last year, Minnesota passed a law that distinguished volunteer drivers from for-hire drivers. Lawmakers have also reduced the potential tax liability of drivers in the state.

In southeast Minnesota, a shortage of drivers prompted a program by the nonprofit Semcac to reduce the types of rides offered. It limits users to two non-medical trips per month.

“We would allow more if we had the drivers to do it, but we don’t want to take drivers on non-medical rides and someone not making it to their doctor’s appointment,” Jessica Schwering said. , head of operations at Semcac. “There are far more needs than we can supply, and it’s only getting worse.”

If Semcac cannot arrange a driver for a member of the community who needs transportation, the person should seek an alternative, such as transportation of a family member, or ask their health insurance provider for find one. Semcac has partnered with certain insurers to bring their customers to medical and dental appointments. Not all volunteer driver programs have this structure.

Schwering manages 53 drivers across six rural counties. About half of them are in Winona County, a nearly 650-square-mile strip southeast of Minneapolis along the Mississippi River. She estimates that the average driver is 80 years old.

Schwering said volunteers who quit driving for his nonprofit most often cite medical reasons, such as not being cleared by their doctor.

Douma, of the University of Minnesota, said the average age of volunteers is also a factor in the decline. “When baby boomers were retiring, they were driving quiet generation and older generation people, who were outnumbered by baby boomers, so you had more people available to drive for fewer people,” did he declare. “But now that baby boomers are getting older, the ones most likely to drive them are Gen X – and that’s a much smaller generation.”

Jim Maybach started driving for Faith in Action after retiring in 2011. Six years later his wife, Judie, now 78, joined him after retiring from nursing. They find it hard to imagine stopping anytime soon.

Yet their volunteer program began planning a new recruiting strategy to attract a much younger base of stay-at-home parents.

“We were just trying to think, ‘Well, who else can we get?'” said Katherine Bonine, executive director of Faith in Action. “Because when we have our seniors, we’ve had a certain shift from volunteer to beneficiary as they get older and their driving abilities change.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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