sky. [laughter] the stateturn to lead and nation. it is your turn. well behaved women rarely make history. [applause] so get out there and miss behave. thank you and thank you all for being here. >> good night. >> one of the headlines this morning, the white house announces healthcare.gov met their repair goals as it tries to get the federal health insurance website to operate more smoothly for most users. you can watch the progress and performance reports for yourself, or is a link to it at

thinkprogress.org. on december 1, is night and day from where it was. the site is now stable and operating at its intended capacity at a greatly improved performance. here is more. >> we start at the top of page six on response times. response times, this is the measure of how quickly responds go to a user request. you can see on a bar on the left-hand side that in late october, the response time was running around eight seconds, which was clearly unacceptable and very frustrating for consumers. we now have much faster response times. the line graph shows average

response time by day in the last three weeks. you can see the average response time is well under one second. the chart on the bottom of page six shows system error rate, another key operating metric. oftens a measure of how the system presents an error message. you can see the progress that has been made. the far left shows where we were in late october with an error rate of approximately six percent. we got that down to two percent by november9, 21% 16, and this was -- and it was approximately .75 or three quarters of a percent. we have also made measurable progress increasing the system

system's ability -- system's stability. the percent ofby time the site is available on a given day, excluding planned downtime for scheduled maintenance. is now seeing uptime consistent above 98%, as you can see in this chart. you can see this system uptime for the week ending in november 2 was only 42.9%. we thinkthat is what the system average through most of october is as well. the uptime improved to 79.1% by november 9. it has been consistently above 90% since then, including 90 for --t including 90% uptime

including 90% uptime. we expect to see further improvements given the redundancy and capacity we have added to the system. we do experience system glitches or slow downs, we can resolve issues much more quickly do the -- due to the continuous monitoring and rapid response teams. in october, a typical system outage lasted several hours or more. now the teams who have debt -- who have diagnosed root problems and made necessary fixes within 60 minutes. we have a much more stable system that is reliably open for business. that is important because at the end of the day we need system up times sows -- so consumers are able to use the system to mouth allowed applications, shop, then and role. of allritical the result

the improvements we made is we have double the system's and now support its intended volumes. the bottom of page seven outlines the simple math. the site now has the capacity to 50,000 concurrent or simultaneous users at one time. know each vendor spends an average of 20 minutes to 30 minutes on the site per visit. willite will report -- support 8000 consumer businesses per day. to be clear, there likely will be times, even with this increased capacity, that it will not be sufficient to handle peak demands. system to put a new serve consumers in an orderly fashion and allow them to

request e-mail notifications when it is time to come back to the site. we have made significant progress in improving healthcare.gov and achieving a system that runs smoothly to the vast majority of consumers. response times are under one second. -- areates are well on well below one percent. we now have a rapid response team and continue monitoring to ensure system performance and respond quickly to glitches and other issues that have cropped up. means the site has the ability to serve 50,000 supportnt users and

800,000 consumer businesses per day as consumers seek information, fill out applications, shop, and and roll. any website, the team will continue to address additional bugs and glitches and will continuously evaluate emerging infrastructure needs. the general contractor and rapid response team has served us well . while we still have work to do, we have made significant progress, working smoothly for the vast majority of you -- vast majority of consumers. >> you can take a look at those charts in the administration's progress and performance report. a look now at some tweets from members of congress. keith ellison says --

the houses and tomorrow at 2:00 eastern time for legislative business. they will have votes after 630 eastern. turnd wednesday they will to small business and jobs legislation. flex -- >> that look he had on his face, i can close my eyes and see him on the stretcher right now. i can see him putting his hand

up, i can see his eyes. i can close my eyes and i can just see it. i will never forget that first case, bringing me to reality of what was going on here. this initial sort of triage, it gets there and we see him and he goes in to the tent and everybody starts to work. we got pulled in, myself and my inleague, we both got pulled because the other team wanted us to begin right away. they said you guys have to get involved right away and they pulled a sin and it was like a jolt. now you have to act. you have to be at dr. coming up be a surgeon, you have to be a care provider. yourave to dismiss

emotion. you have one objective. you have to stop the bleeding and get him back home to his family. etteh uses hist military experience to write about physicians working in afghanistan, tonight at 8:00 on c-span's "q and a." next, a look at challenges for seniors getting around and transportation challenges for aging baby boomers. some alternatives for using cars, this is the senate special committee on aging. they talked for about an hour and 20 minutes. my dear friend, senator collins, for suggesting this hearing today on the need for safe and reliable transportation options for seniors.

a crucial topic to seniors in order to be able andet out -- to get around enhance the quality of life. the lack of dependable aansportation clearly a fax senior's quality of their lives. if they don't have it, they cannot go to the grocery store, a cannot yet to the doctor's appointment. they cannot connect with their friends. having access to transportation helps many older americans remain independent and self- , two very important things. issue witha cost transportation representing 20%

of consumer spending, second only to housing. obviously that is a big chunk out of a senior's income. florida has a few examples that we can learn from. the golden passport program reduces the rate of transportation for seniors. it allows residents of the south florida county who are 65 years or older to ride on all the transit system buses and rail for free. urban suburban and rural communities face different transportation challenges. a variety of options are needed to provide seniors with safe and

reliable transportation. greater mobility has a real impact on health care costs when you consider that shoulders with available transportation are more likely to use office-based care rather than emergency with the greater impact on cost to the overall health care .ystem access to transportation has been linked to even reduced hospital readmissions. but, we have to do a better job with coordinating that a dollars and working with private partners to ensure that we get the most out of the dollar we have available. current path,our estimates are that the national cost of alternative

transportation for seniors will ande anywhere between 500 trillion byand $2.2 the end of this decade, correction, by the end of next decade, by the end of 2030. 30 gao found that while federal programs fund transportation services for the disadvantaged, the total spending is unknown. well, we have to find out. the gao recommended that improved coronation has the potential to improve both quality and cost effectiveness of these services. has ate of florida coalition that has brought together over 20 organizations,

agencies, and the universities to improve transportation safety , mobility, and access for our seniors. in addition to safety for all road users, including drivers, pedestrians, and transit users, the coalition serves as a resource on the options for ,eniors in each community connecting those seniors with a range of public and private services. we need coordination like this. it's fairly simple. we need to ensure that those who can drive are able to continue. if a senior should not be driving, then they ought to have

an alternative. and we do not want a senior getting behind the wheel who , even not be driving though the pressure is there on gets to where they need to get for whatever the reason is. seniors deserve nothing less. we are going to do something different here today. since senator collins was so insightful to suggest this hearing today, what i want to do is i want to turn the gavel over to her. senator collins. it >> thank you very much, mr. chairman. must gracious of you and i say it feels so good to have the gavel back in my hand.

i will pledge right now that iould there ever be a change will be as wonderful to you as you have been to me. i want to start by thanking you for holding this important hearing. we focused on a number of the great challenges facing our nation as our population ages. much of that discussion revolves around health care, social security, financial security, scans directed at our seniors. there is another daunting challenge that has rarely been discussed at a public hearing. i refer to the challenge of senior transportation. we americans love our automobiles from the time most enough -- of us

are old enough to drive. having a car and being able to drive it means the freedom to go where we want, when we want. age, we find it harder and harder to use that freedom given to us by automobiles. decline,ilities driving becomes more and more complicated. comes when wey wonder whether we should keep driving at all. don't, how will we go about our daily lives? struggle with how to -- it is one of the hardest

conversations. for millionscome of our senior citizens. ,ccording to census bureau roughly 19% of our population or 13.9 million people will need transportation -- will need alternate transportation options in order to continue living independently. identify conference transportation as the third most important issue for seniors out of literally hundreds of options for priority. is particularly a critical concern in rural states, like my state of maine. drive takes a to particular toll on seniors living in a rural, low density population. gao found thate 60% of non-drivers in several areas-- and rural

reportedly stayed home on a given day because they lacked transportation. over the age of 75 living in the suburbs reported withficant dissatisfaction how their transportation needs are being met compared to those living in cities. of four oldert individuals live in low density areas, these concerns raise a very real policy question. transportation, which is often hailed as a primary solution, simply does not meet the needs of many senior sites. my state is only the largest communities that have any public transportation at all. more than one third of those over age 60 nine have no public transportation in the communities.

even those that do have to plan around fruits, restrictions, on even trips, frequencies, hours of operation, or advanced notice reservations. in rural areas, the option may not exist at all. -- if, fories example, you have problems with ,our site or mobility transportation on a mass transit system can be daunting. people use state-funded home .are services just 65% of those over age 65 reported they can always get to the doctor when they needed -- need it. rely, 90%, on family and friends to drive

them. it is not surprising since one in five americans 65 and older does not drive. seniors must find some other way to get the places they need to go. lot about doctors appointments and grocery stores. there was an issue with social isolation, not being able to drive to go see your friends, to keep up with family members. o.at matters to challenge of providing transportation alternative to our seniors is literally growing by the day as the silver synonymy starts to hit our country. to meet the challenge we must find reasonable and practical transportation models allows seniors to stay active and

mobile even after they stopped driving. one such model is i.t. in america, which has been operating in my home state of 1990s andce the mid- has since branched out to other communities across the nation. itn america uses private automobiles to provide rise to seniors whenever they want, almost like a taxi service. of itn america .s here with us today i am delighted she is able to join us as well as the rest of our outstanding panel of witnesses. is an issue that is only going to grow as people are living longer and the baby boomers, 10,000 of us every day,

turn 65. this is a challenge that has not received the attention it deserves. that is why i am so delighted that our chairman has agreed to shine a spotlight on this issue today. first we are going to hear from the deputy administrator of the federal transit administration. we'll talk about the efforts to address the transportation and mobility needs of our nation. we will hear from the director unintentionaln of injury prevention at the centers for disease control and prevention. from thehen hear

of the national center of senior transportation, by the partnership with the national association of the area agencies on aging. and finally, as i mentioned, we will hear from the founder and america, whoitn will talk about the innovation of -- innovative presentation model that she developed. alsorine, i hope you will tell the story of how you became interested in this issue, and you have done so much over so many years. we will start with ms. mcmillan. thank you all for being here. chairman elson, ranking member collins, i am so excited to be able to be here with you today. mcmillan, and i

want to thank you for the opportunity to highlight the efforts to highlight the mobility needs of america's seniors. our nation is undergoing a shift.cant demographic by 2050, the number of americans age 65 and older is projected to more than double, and the number of men and women 85 years and older could increase five fold during that period. this population can face significant challenges including increased poverty, isolation, and the struggle to access medical services. the department of transportation is committed to helping older americans age in place and live with ticket -- with dignity. collaboration is the federal interagency quarter mating council on access and

-- shared by the transit agency agree -- secretary. awarded grants of more than three dozen states and territories to help solve one call, one click access to transportation. with a special focus on military veterans and their families. through this program, patients in lakea clinic county, florida will be able to arrange rides on the spot using a computer kiosk installed on- site. importantly, many of these veterans are seniors. my agency, the fta, has entered into many other innovative cooperative agreements to improve locally-coordinated access to public transportation for older individuals. for example, working with easter seals another industry partners,

we have launched a new national center for mobility management. the center will among other things develop a database to identify best practices to the liver and registration to seniors as ugly as possible. ability management -- as quickly as possible. mobility management will extend fta's assistance into communities. this approach helps both public and private at the local level. there is no one size fits all. those who know their communities best will serve them the best. year 2012, fta provided over $40 million for mobility management projects, at 4% increase over fiscal year 2011. -- ongoingll going investments in this area, today

there are over 400 mobility managers nationwide, and over half the states are planning call centers. the funding picture is decidedly mixed. on the one hand, map 21, our current authorization, enhances funding and services for seniors and others. for example, our program to enhance mobility for seniors and people with disabilities is authorized to receive $28 2012on more in fiscal year than under the prior authorization. map 21 also increases spending by 25% for rural transportation, rural states are home to many of the nation's low income and transportation dependency. to 21 enables the fta

leverage its own investments and quarter nation activities with matching funds drawn from a variety of other federal programs ranging from medicaid to head start. appropriations committee sequester, and continuing revolutions have left the federal transit administration unable to find modestre missed -- even technical assistance. this reduces fta's ability to invest in transportation coordination at a time when it is needed most. to spite these and other challenges, we must continue helping communities to identify and fill the gas and others. often times, seniors simply may not know what services and transportation options are available to them or how to connect with them. we need to support mobility managers and similar initiatives

across the country to foster even greater connectivity. mr. chairman, ranking member collins, this concludes my testimony and i would be happy to answer any questions. >> thank you. dr. baldwin. afternoon, chairman nelson and ranking member collins. thank you for the opportunity to speak today. i am pleased to join my fellow panelist and speak about how transportation affects the health of older adults. i will also discuss how to help older adults remain safe, active, mobile, and independent and help the faa's. at the committee is aware, the u.s. population continues to age. in 2012, 14% of the u.s. population was 65 years or older, and by 2030, it is expected to reach 20% heard this is a proximally 72 million older americans. the fastest-growing segment of older adults are those aged 85 and older. this group is that the greatest

risk for expressing frailty and required assistance with mobility. taken together, the up coming growth in size and life expectancy will create more challenges for older americans to get around. many older adults are dependent on cars. this is particularly true in the suburban and liberal areas where public transportation is often limited. nine out of 10 trips why older -- by older adults are made by people aged 65 to 74. the environment, the human made characteristics of a community can present challenges. if a community has an abundance of streets with fast and high- volume traffic or lacks infrastructure like sidewalks and save the street crossings, it will be harder and more dangerous to walk, bike, or use other forms of active

transportation. it is more than safety. environments can enable, facilitate, and encourage older adults to be physically active, reducing their risk of obesity, diabetes, heart disease, and other chronic conditions. car, publicether by transit, or another form of transportation, is critical for an older adult to remain independent. ride shuttles and volunteer driving services offer innovative transportation options for american seniors. beyond keeping an elderly connected with family and friends, mobility also enables older adults to receive a vital health and preventative services. use of mobility may enable older adults to receive a volunteer or paid work opportunities, bringing a sense of the mom -- fulfillment of their lives and benefiting their communities as well. the benefits of mobility underscore are made to understand the factors that enable older adults to successfully and safely manage the transition from driving to non-driving.

we finding cdc study, many older adults anticipate driving for years to come and do not plan for when they will be unable to drive. some older adults will face the meditations and their inability to drive at night, when the weather is bad, or due to age- -- declines.es in addition, cdc is developing a tool to help older adults their ownsess mobility. changes to the built environment olderso improve for adults. suitable housing options can allow older adults and others living with disabilities to age in place and remain in their communities. the availability of public transit and the proximity of grocery stores, parks, places of worship and medical officers, -- offices.

lives, protectve people, and save money through prevention. as america's leading health protection agency, we work with many partners to identify, develop, and test programs they can make a difference in communities across the country. longesthe strongest and standing collaborations is with the u.s. department of transportation. we are partners with shared interests during this includes a memorandum of understanding with the national highway traffic safety administration, anchored to a mutually agreed-upon annual toion plan, we work together reduce the number of motor vehicle injuries by including data, strengthening policy, energizing research, and translating evidence-based interventions into real-world settings. were currently discussing ways to include older mobility in our plans. for those older adults who are able to drive, we must continue to find ways to improve motor vehicle safety, and reduce the disproportionate numbers of fatalities and injuries suffered by older adults, whether they

are drivers, passengers, or protest rants string. we understand more progress can actions,hrough including by partnerships with organizations like aarp and others. in summary, at the intersection of transportation and public health, our solutions that can help people get where they want to go and keep them safe across a lifespan. by helping older adults stay safe, active, mobile and independent as they age, we also have an opportunity to help them remain healthier longer. transportation's impact on health and safety is why these collaborations are a priority for cdc. good transportation is good for public health. thank you tou. >> thank you, very much. thank you, chairman nelson, ranking member collins. it is an honor to be here today to address the transmission of older adults in the pivotal role of coordination and increasing

availability of transformation options -- transportation. in our work with communities, we have seen first hand the importance of coordinating transportation resources across most and payment resources fear the value is making connections between transportation and health and human services. as our country ages, it is increasingly important that we get this right. seniorional center on transportation was created by congress in 2005. it is funded by fta, and it is squawked diddley administered by eastern seals and the national association of various agencies on aging. our mission -- to increase transportation options for older adults and enhance our ability to leave -- live more infinitely within our community. it is achieved by gathering and sharing best practices, providing information, technical assistance, and training, facilitating partnerships and

community engagement, and administering grants. our work progresses -- our work addresses the full range of presentation options. ncft has provided more than $1 million in grant funding. a wisconsin, they created system to help provide transportation to dialysis patients. in knoxville, tennessee, an ncst grantee receiving grant to provide specially equipped vehicles to provide older adults the travel assistance they needed. florida, a small grant to the united we guide project developed a one call system to information about presentation -- transportation options, safety, and mobility. in wichita, kansas, outreach to

encourage the hispanic community to use transit from ash resulted in creation of a violent wheel -- of a bilingual management. being able to get her on the community is vital to be able to age successfully in place. medical appointments can exacerbate -- missed medical appointment can exacerbate problems. improvements in transit and roadways address the needs of older adults may benefit the community as a whole by making it easier, safer, and more comfortable for everyone to get where they need more to go. as older adults make up an increasing proportion of the overall population, in most u.s. communities, their economic and social contributions cannot be ignored. an increasing number of older adults continue working in

their 60's and 70's. often it is older adults who are the volunteer drivers and escorts who give lights to other older people. our communities need to do a better job coordinating programs andfunding and use public private mobility resources more efficiently to help older people travel. this is both financially and prop -- and programmatically found. communities also need support to find unique local solutions that work. even in urban areas were transit is robust, we know that many more older adults who currently use the system could benefit from the service. traveltervention such as training and safe and secure walking routes to transit. know that most older adults live in suburban or rural environments with fewer accessible transit options. to create a solution such as the volunteer driver program,

insisted transportation, funded with accommodation of federal, state, local, and private funds, can help fill the need. there are several things the congress can do with an existing framework to help support communities, looking to enhance mobility for older adults. first, there needs to be the computer news -- the continued breaking down the federal and to mobilityrs assets. the review and i did we write initiative provides an excellent -- the united we ride initiative provides service. to help former advocates and key decision-makers, to help regulations in support of consistent coronation guidance, to recipients of federal , adoptiontion funding

of consistent legislative language on transportation and coordination. in the older americans act, map 21, and other up -- upcoming authorizations. as coordination across federal funding is multijurisdictional, this committee might see the opportunity to act on older adults. toneed to work together drive systems change, to assure the community transportation response to the needs and preferences of older adults. one option is to infuse the concept of person centered mobility management, which includes those individual edge of patient and counseling on -- education and counseling. i could be infused in all federal transportation programs. i trulyf of ncst, appreciate the opportunity provided by this hearing to spread understanding of the importance of mobility for all

older americans. of personncept centered mobility management has an effective model to better serve the need that federal, state, local officials and communities can embrace. i look forward to your questions, and the opportunity to work with you. thank you third wife thank you very much for your testimony. you turreted >> thank you very much for your testimony. >> chairman nelson, senator s, on behalf of the older people we serve, i thank you for the opportunity to be here today. my name is kaplan freund -- my freund, anderine i'm president of the first and only nonprofit transportation service for america's aging oblation dirt i want to begin by thanking senator collins for her long-standing the poor for sustaining senior transportation and i would like to emphasize how much the independent

transportation network anditn -- and itn re: collaboration of public drive it. my three-year-old son was run inr by an 84-year-old driver 1998. ryan survived and is today a healthy young man, but others are less fortunate. in 2011 alone, more than 5000 180r people were killed and 5000 were injured in vehicle crashes. with support from aarp, the transit idea program, the federal transit demonstration, nine -- national highway traffic safety, the southern main industry on aging, private philanthropy, and the people of portland, maine, we created a social enterprise that uses efficient business practices to build transportation that will scale with the aging population. we call our enterprise into

printed -- independent reservation network or itn, and we built it with a replicable model. today, itn has 25 affiliates in 20 states. we have delivered 600,000 right, we are serving more than 5000 people, and we are growing at a rate of 100,000 write the year. these numbers are small when you look at the aging population. with 10,000 boomers turning 65 everyday. what is important about itn is that it does not depend on taxpayer dollars. use uptn affiliate may to 50% of public money to launch, but after five to eight years, it must be sustainable through reasonable fares and a diversified base of private- local support. for my policy respecter, it is easy to justify public resources for senior mobility. the classic justifications for policy intervention, public

safety and market failure are the problement, but of insufficient public resources is a fiscal reality unlikely to change. affiliates are nonprofit membership organizations that use automobiles and a combination of paid and volunteer drivers to provide service 24 hours a day, seven days a week. business innovations are the core account and a flexible approach to resources managed through itn rides, in a price for the kenexa itn -- that affiliates across the country. the portfolio hold assets in many forms. older people may trade their they no longer drive to pay for rights. volunteer drivers may save credit to blame for their own transportation future.

credits can be transferred to other itn affiliates. the result is an average fare of about $11 with the most common fare six dollars, which might 30% topensive, but with 40% of our members with an income of less than $25,000 a year, our last five years of customer satisfaction survey tell us that itn members by about 10 to one field at the service is inexpensive for what they receive. there is dignity and independence and paying for one cell. more than 40% of itn rides are for health care, 20% for health care and shopping, -- are for almost 40% of volunteers save their credits for their own future needs. similar amount to donate their credits to the rhodes scholarship fund for low income seniors.

to assure these innovative practices comply with public policy, itn america has worked with state and local policymakers and the state including florida, maine, illinois, new york, cannot -- kentucky, missouri, ohio, and tennessee. itn america has completed a 50 state imagery of policies that create incentives or renew barriers to the use of private resources. with the national conference of state legislatures, we are disseminating results to 10,000 policymakers. database is designed to study mobility for seniors. with the centers for disease control, we are studying diet -- driving transition to seniors in 17 communities across the country. --have just computed completed six years of research to expand itn to rural communities through itn everywhere, a suite of software programs that bring together right chair, car share,

volunteer transport and community transport. itn everywhere is what ebay is to flea markets. senator nelson, senator collins, public resources may be scarce, but through the use of information technology and policy that remove barriers to the voluntary use of private resources, the future for community mobility is right and exciting. we get any credit, susan and i, for having this hearing that we could then transfer on? >> for when we need them. >> senator nelson, you may have all of my credits. [laughter] to every much for your testimony. senator nelson, would you like to go first on questions? ok. thank you. i am of all, catherine, very glad you talked about the personal experience that

stimulated your getting involved because so many people would have reacted to that terrible instead with anger, and , you look at the problem of the 84-year-old driver who clearly should not have been driving and came up with a solution, and i think that is just so commendable, and i wanted you to share that, and appreciate that you did. you, ms. to start with mcmillan peered into thousand six, i sponsored legislation --t became part of the ms. mcmillan. in 2006, i sponsored legislation that became part of the older american act, to establish a national nonprofit senior transportation network to help provide some transportation

alternatives to our aging population. to report that the demonstration on aging really has done nothing with the program but i created. -- what we to you is have better success if we , to dor this program this pilot project from the administration on aging to the department of transportation? it seems to be more interest at the dot in the program oddly enough than at the administration on aging. >> thank you, senator, for that question. i guess the first thing i would say is that one of the important concepts that i think all of us on the panel have stressed is that dealing with the challenge of transportation for seniors really involves work on a number of levels, and we need to be

careful about siloing any of us that we have full jurisdiction over this issue. it will be extremely important that the federal agencies continue to work together. i mentioned the coordinated counsel on axis and mobility, and the whole point is to make sure that all of the federal agencies can bring our resources and talents together to renew the program. while there may be a lead administrative agency, and certainly we can look at that, i think the important point is that we all need to continue working together to make sure we are addressing these furry complex issues on various levels. i think that has been one of the that has made the program, for example the successful is this recognition that we need coordination on a number of different levels. withwould be happy to work

your staff and talk about next steps further. >> also, the gao has been quite critical on the lack of coordination. i guess i am going to ask you, and i do not mean to put you on but since the administration on aging has yet to provide funding for this program, which has existed for a long time now, i'm going to ask -- were you aware of this program yo? >> i personally was not, but i do not want to claim that folks in my department were not. >> fair enough. ms. freund, you talked about how you have been able to transform this program into one that relies on a donation, on people who participate paying their way. i think it is important, and i'm not trying to take credit for this, but for us to note that

there was some federal funding that serve as a catalyst. and then you are able to transform it into a self- sustaining program, which is ideally what we always want to see when we are successful in securing some federal funding. do you think you could have gotten off the ground without federalhat initial funding as a catalyst for your program, would have been harder to get it off the ground? much,, it would have been much harder to get it off the ground covered the federal funding came from a number of different places. funds a program which funded some of the initial research. it was that program that directed us to look at technology to create efficiency.

in addition to that, the fta funded it i think three or four different times, first to test some of the ideas, then to deploy the ideas. there was a $1.2 million fta grant to promote the sustainable model, and then there was a grant to plan a national rollout. it really has been a public- private partnership. i think one of the difficulties though is there is a tendency to think that if federal money goes in the estate center -- that it stays in. this is almost venture philanthropy or venture funding provideart of fta to funding and then be able to step away and laid the private sector do it request to me that is what is so impressive in your program it didn't have some federal -- do it. >> that is what is so impressive and your program that it did

have some federal funding. let me ask you, dr. baldwin, and you, ms. dize, the same question. if the federal government to do one thing to help address these reservation needs of our seniors, what would it be? we will start with you. >> i may have already answered that in my testimony because i believe that encouraging coordination and recognizing that creating a new program in a community is a very important thing. it can make a difference in some people's lives. but pulling together all of the transportation resources and all of the players, including older adults and caregivers and advocates, to look at the whole system, identify where there are gaps, and identify the fast way to fill those gaps so that the

whole community benefits, i think that benefits older adults, i think it benefits everyone. >> to record dr. baldwin? -- thank you. dr. baldwin? >> thank you for the question. in my view, there are sort of three goals or touch points that we have three senate -- that we have to be sensitive to. the first is making older drivers safer and managing the transition between driving and nondriving gird the second is making sure that older adults ,ho are in a non-driving mode and it is my understanding that most of us will live six to 10 years after we finish writing, that there are transportation options available to those older adults. -- finished driving, but there are transportation options available. and third, the community level solutions that help all of us from a design perspective. i think there are touch points in each of those major issues that need attention over time.

>> thank you teared mr. chairman -- thank you. mr. chairman. >> you may be surprised to know that in my state, there are 325,000 drivers over the age of 85. now of course i know plenty of 85-year-olds that are white quitee of driving -- are capable of driving, but it underscores that the population ages, more and more why this is an important topic. you all have testified as to a ,umber of ways to go about this coordination, for example, in florida, there is a coalition, as i mentioned, of 20

organizations, agencies, and universities that try to improve seniors.portation for for example, one of them is developed by ride, the university of florida. goes andenior identifies the type of visit , such as it iske need helpvisit, they eke of their disabled, where , the seniore right is presented with various public and private options.

why don't you give us some other efforts other than what you have testified that might stimulate our thinking? >> i would like to discuss a couple of things. a couple of years ago, the ncst provided some support to researchers in missouri. are developed a tool called the assessment of readiness for mobility transition. used totool that can be have a conversation with older adults, to help them identify how ready they are to transition, how important driving is to their sense of self and independents, and that way, and if -- intervention can be designed to help people become more ready and be prepared for driving transitions because, i believe, that

unfortunately so many people are faced with transitions as a threat. bender orhad a fender a much more serious situation. or family members hide the keys from them. and i think that we really need to start having these earlier, beyond toll is one instrument to help that happen. >> senator, one of the basic requirements for making a number of the initiatives we have outlined here, you really need to start with good planning and planning that is focused at the that needs to coordinate these services. the outline in florida is exactly the type of model we need to make work on a much more consistent basis throughout the country. accessurrent rules to

major funding source for enhanced services for seniors and disabled -- persons with disabilities, we require is coordinated public transit and human services plan. membersre that senior and persons with disabilities must participate in the development of a plan so the users are helping to design the system. a simple thing, but it is incredibly important that when you're designing services that the people you're going to use them are involved very early. what we would like to see is not for thet the standard preservation lang, but as dr. baldwin pointed out, we need to have planning on such things as housing and medicare and the other elements, and so having that type of coordinated landing effort in those sectors as well to link with what we are having

at reservation, to just make it much clearer in terms of what are the services and activities people need to access, and then connect that with how to we get there, which is the transportation. >> yes, ma'am. i think that coordination is there's arent, but some important numbers to remember. public transportation for people and 65, it counts for 2% 3% of the trips they take. one they are to private. a major part of the solution is when you engage the community, do not just engage the demand side of the problem, which is the consumers. is a supply-side business problem. there are not enough resources

to address this. so bring me business community to the table, bring corporate america to the table, and i think a huge thing that could happen, perhaps as a result of these hearings or other federal action, would be to awaken the american people to the social need that we are looking for and encourage everybody to look around and then give an older person a right. i think the solution is sitting in driveways from coast to coast. if people will just open their eyes and see, and i think people are really willing to help each other, but we sell the culture of looking around and realizing that older people have this need . and it is right there. moneynot cost the public at all. that it in your experience a senior will limit their mobility because they do not want to be a burden on their family members to go >> --

family members? >> absolutely. i must've heard an older person say i do not want to be a burden about a quarter of a million times already. nobody wants to be a burden. i think so at any age. >> dr. baldwin. >> one of the innovations i want to bring forward is something we have been charged with at the cdc that is to think about the connection between clinical medicine and public health. dr. friedentember, sent the cdc leadership and note -- how can we improve prevention and health care? he outlined areas that cross walk nicely with preservation. as we get better and better about understanding driver fitness and how to evaluating, reducing variability across health care will be critically important here the second area was engaging the entire health care team. so assisting with the screenings, understanding the

transitions, engaging allied health, occupational therapists and others. and having those professionals connect with those preservation services. the third area was to leverage health i.t. as electronic health records become more ubiquitous, there is a real opportunity to leverage those. one of the issues we all know in older drivers as medication management. those electronic health records can sort of help understand what the issues are at play, and they can help essentially, again, i know there are some hipaa issues, with an active potential individuals who may be at risk to inform and others. and final, one of the drumbeats you are hearing from all of us is in this case remaining patient focused but thinking about the older adults themselves. what are their needs? using some of the older mobility assessment tools that have been discussed, understanding them and then catering services to that end.

opportunityeal connecting clinical medicine and transportation. >> dr. baldwin, how are you all working to promote health and transportation and reaching out between your agency, hhs, and a d.o.t.? sure, so, injuries are the leading cause of death for americans between one and 44 and the fifth leading cause overall. director frieden, this is one of his priority topics because of both the burden, the availability of evidence-based interventions i can be -- readily scaled up. as part of that, i spoke briefly at my remarks about the connection, the strengthening of the connection that we have made with d.o.t., and secular the national highway traffic safety administration. there are some real opportunities there. because transportation impacts so much was in public health and so broadly, i think that is why

it is a public health issue. cdc andthis year, the partners released aging and health in america 2013. one of the issues i was spotlighted here by our colleagues in the healthy aging program at the chronic disease center was in fact mobility. cuts into motor vehicle injury prevention, which is the expertise which i reside, as well is our colleagues in chronic disease and environmental health. it's really a crosscutting issue. >> i would like the two of you to comment -- is there anything in the affordable care act that is applicable to stimulate and to fund transportation solutions? perspective, the biggest has one in the affordable care act that impacts us is through our amenity transformation grants are to have the opportunity to impact over 130 million americans, and we work -- we are currently

working to improve community designed to encourage active preservation -- walking and biking -- for all ages. the first round of funding in 2011, $103 million were distributed 61 state, local agencies including tried to nongovernmental organizations. round two of that funding, an additional $70 billion went to 40 communities, either smaller communities. in fact, impacting your own state of florida, we supported the regional health planning council to incorporate complete street standards of smart growth principles to increase access to safe and comfortable transportation for 1.3 million commuters. senator collins, and your state, maine health is helping active preservation for up to 57,000 people as a result of the preservation grant. >> -- d transportation grant.

that, and inent talking with our partners there, we understand that under the medicaid expansion for household income, up to 133% of the poverty line, transportation is a required service, and so older adults would be eligible to receive transportation access from a cool services with them that envelope. very importantly, though, i would also like to mention how hhs really has been an incredibly strong partner with levels, andber of very importantly -- i mentioned in my testimony, i can elaborate -- the ability to leverage the funding sources that we have available for services for seniors, percent -- for things such as accessing medical care, does require by law a match. but what is made available is

the fact that, like in most -- unlike in most programs of other federal funds, such as hhs funds, can be used by communities to match the church rotation find, and that is very important. particularly for communities that may be stretched in terms of their own local sources that might otherwise need to be brought to bear. it enables a number of the programs that folks might want to pursue with our transportation dollars, including health access, for that to be not such a financial burden because they can deploy the hhs funding to help get those products -- projects on the ground. >> do any of you want to comment on what this last round of done?tration has and what you might expect this , if enacted january 15, of sequestration will do? >> i will comment on that.

the twister is required cdc to cut about five big percent or more than $285 million from fiscal year dirty budget. we applied those cuts evenly across all programs, projects, and activities. this frank way means that every area of cdc was impacted. in addition, prevention and wasic health allocation below the fy 12 number, so cdc program slots about $1 billion or 10% of the entire cdc budget. 12 numbers. >> sequencers and had a very direct impact on the research money that goes to supporting the work of technical assistance centers that we have here. for a number of our centers, we

were able to continue funding them for this year, but unless the situation changes for next her, it will be very tough to continue providing the assistance that is extremely cost-effective in terms of having folks on the ground be able to advance the programs that we are administering. >> thank you all. >> according to the bureau of labor statistics, the average -- spends about 20% of its income on transportation. i will say that was higher than i expected. we tend to think of shelter, fact clothing, when in transportation is right up there ofer housing as a large part

household income expenditures. so ms. freund, when you were talking about seniors being willing to pay the $11, is that because they understand how much a car costs to maintain, to ensure, to drive? senator collins, i'm not sure they understand not only any ind of a cognitive level, but do think that people truly are willing to pay for a service that they need and that they know will help them remain independently in their homes. itn users who use the service very often are spending far less than the cost to support a private automobile. you know, those numbers are shocking, i know, but numbers

are numbers. in reality does not go away. choices. people will willingly spends 20% of household income on transportation, and i think that -- to me, that is a big pot of gold. to me, that is not bad news. to me that is good news. all we need to do is provide a service that they want and they will pay for it. >> exactly. i think that is why when one of first years $11 a trip or six dollars a trip, you think oh, and is that going to be a barrier. but when you look at what people are already spending, it translates into a very , and certainlynt the demand for your service proves accurate i think it would be helpful to the committee if you were to describe to us a typical itn member in the state of maine. >> sure.

i can actually describe a typical itn member in 20 states. >> very impressive. >> well, the numbers are consistent over many years. -- theical member average age is 80, but the most common age is 85. ,0% of our memories are women most of those women are living -- inin the command the the community, and most of those women have a lower to middle income range, and they use their rights most commonly for access to medical care, but also for shopping and social needs and so forth. >> and what about income levels? could you give us a sense of ort the average income level what percentage -- you mentioned that you have a significant percentage below $25,000 in annual income.

>> well, more than half of the people who use the service have an income of $50,000 or less. they use the service between two and four times a week. >> are any of them in rural areas that you go to pick up? >> some are in rural areas but most are in suburban areas. the service we are developing formal role areas is itn everywhere, that is the next phase of what we are doing. i can also tell you that 50%, a little over 50% of the people we serve have some kind of a mobility impairment, either a chair or a walker or a cane, and 30% are either blind or visually impaired, so we are talking ailut a freer -- a fr population very >> at a very vulnerable population that really should not be driving and cannot drive.

>> 25% of the people who use itn are driving at the time that they find out, and then they transition voluntarily because they have an alternative. the valuation of the project that we did for the atlantic philanthropies, we were able to determine that after using the for six months, and again in 12 month, with the amount of mobility, people felt equal to theve was amount of mobility they had when they were driving, which is something that i think nobody thought was possible. but it is possible. >> that is really a terrific result. that is great news. i am very eager to see you expand it to the rural areas of the state, as you know. >> you can have my credits, too, then. thank you. ms. mcmillan, ms. freund said

something i think was for a profound when she said the answer is in our driveways across america. and that there is a lack of public awareness that we each could be really helpful by volunteering to drive an elderly person to an appointment or to see a friend or to the grocery store. you mentioned in your opening statement that there are some 400 mobility managers. what do these people do, and where are they? >> well, they are all across the country, and what mobility is, again, they are e servicehe master rid you might say in terms of eating able tod. -- of being identify what is the customer constituency that you are trying

to serve, where do they need to go, and what is the combination of different services that might get them there, whether that be -- ride sharing volunteer, public transit service, within that community, what are all of the various options that might be there, and then to assist in what we hope more and more through a one call or one click web-based service of how someone can put together the customized ride from a to b need to have. again, we have been able to find those under -- in 2005, i believe, one of the important changes in our authorizing law was