ECONOMIC RESEARCH CENTRE

REPORT OF THE FIFTY ·FIRST ROUND TABLE

ON TRANSPORT ECONOMICS

Held in Paris on 20th-21st March, 1980 on the following topic :

"SOCIAL SERVICE, TRANSPORT :. TRANSPORT FOR ELDERLY

AND HANDICAPPED PERSONS

EUROPEAN CONFERENCE OF MINISTERS OF TRANSPORT

The European Coriference of Ministers of Transport (ECMT) was insti­tuted by a Protocol signed at Brussels on 17th October 1953. It comprises the Ministers of Transport of the following 19 countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxemburg, Netherlands, Norway, Portugal, Spain, Sweden. Switzerland, Turkey, United Kingdom and Yugoslavia (associated countries: Australia, Canada, Japan, United Sta(es).

The purposes of the ECMT are : to take whatever measures may be necessary to achieve, at general or regional level, the maximum use and most rational development of European inland transport of international importance; to co-ordinate and promote the activities of International Organisations concerned with European inland transport (rail, road, navigable ways), taking into account the work of supranational authorities in this field

© ECMT, 1980

PubliC en fran~ais sous le lilre:

LES TRANSPORTS SOCIAUX PEASONNES AGEES ET HANOICAPEES

• • •

ECMT publications are marketed by the Sale of Publications Department of the OECD, 2, rue Andre-Pascal, 75775 PARIS CEDEX 16, France.

INTRODUCTION A. Bieber

TABLE OF CONTENTS

PART I - Mobility and the elderly A. Hitchcock

PART II - Mobility and handicapped persons B. Mettler-Meibom

PART III - Evolution of specific welfare services

4

7

23

C. Poulenat-Aballea ~•••••••••••ooooooooooooooooooooooooo 45

PART IV - From analysis to decision-making

A. Bieber ooooooooooooooooooooooooooooooooooooooooooooooo 65

SUMMARY OF DISCUSSION 91 (Round Table debate on the reports)

LIST OF PARTICIPANTS 131

ECMT. ECONOMIC RESEARCH CENTRE

Forthcoming publications oo•••o•o••••o•·········••••o••o••135

3

INTRODUCTION

Recognising the importance of the day-to-day problems that the handicapped persons and the elderly have in getting about, many authorities make a point of studying these difficulties and introduc­ing measures to alleviate them.

The subject is not easy to approach, and no clearly defined philosophy is apparent at international or even national level. There are several reasons for this. The real-life situations indi­cated by the words handicapped and elderly persons are very diverse, the action taken at local, regional and national levels in this area differs from one country to another and even the institutions them­selves that are responsible differ.

The purpose of this report is therefore essentially to present a synthesis of the main facts in order to throw some light on this diversity.

* * *

Two preliminary points must be made. First, it must be re­membered that the report is more or less entirely concerned with the mobility problems associated with elderly and handicapped persons' daily lives. This limits the field of analysis to urban and regional transport. In spite of their great interest, the pro­blems arising for intercity carriers are not referred to. It seemed difficult to include these problems -which are very different and could provide material for another round table on their own - in the same study.

Secondly, the general intention in this introductory report is to focus on the socio-economic problems presented by the transport of the handicapped persons and the elderly. The rapporteurs are well aware of the importance of technological research in this area and the breadth of certain recent projects (such as the United States scheme to make all buses "accessible" by means of technolog­ical aids even to severely disabled persons). But, in Europe, most of the transport improvements made specifically for the handicapped and the elderly have been based on "soft" types of innovation such

4

as the organisation of services in new ways, assistance with fares

and so forth. We therefore felt it better to talk about what has actually been done rather than about future plans and, on that account, the socio-economic aspect has been given precedence.

* * *

The report is in four parts written by four rapporteurs -so as to give the necessary variety of approach, particularly from

the national standpoint - and co-ordinated by A. BIEBER as general rapporteur.

Part I (rapporteur : A. HITCHCOCK, United Kingdom) takes stock of what is known about the transport problems of the elderly

and the extent to which they have affected relevant decisions.

Part II (rapporteur : B. METTLER-MEIBOM, Federal Republic of Germany) deals with the same subjects but with regard to the handicapped persons. It also discusses the problem of compiling statistics on the handicapped and on their transport difficulties.

Part III (rapporteur : C. POULENAT-ABALLEA, France) tells us more about the historical evolution of the ways in which public aid is given to the handicapped persons and the effect this has had on the transport services that are provided in different countries.

Part IV (rapporteur : A. BIEBER, France) attempts to distil, from all the available facts, the various aspects of a possible methodological approach to these problems.

The report attempts therefore to expand on the conclusions of the last ECMT report on this subject LCM(78)22_7 in three directions finding out more about the social position of the elderly and the handicapped, enquiring into what local action has been taken as regards transport and proposing a general diagnostic method as a preliminary to defining priority action for any given urban area.

5

PART I

MOBILITY AND THE ELDERLY

A. HITCHCOCK Transport and Road Research

Laboratory (TRRL) CROWTHORNE

United Kingdom

1.

2.

3.

4.

SUMMARY

INTRODUCTION

WHO IS ELDERLY ? • o. o •••• o •••••••• o •••• o. o •• o. o • o •• o o o •• o

APPROACHES TO STUDY OF THE MOBILITY OF THE ELDERLY

CHARACTERISTICS OF THE ELDERLY

9

12

13

15

5o ' THE OLD AS PATRONS OF PUBLIC TRANSPORT o •••••••••••••• o • • 16

6. THE PERSPECTIVES OF NEED AND OF PERSONAL SPACE ••••o•oo•• 18

7. POLICY CONSIDERATIONS

BIBLIOGRAPHY

8

20

22

1. INTRODUCTION

The very existence of ECMT Round Table 51 illustrates an

increasing concern on the part of many administrations that current

trends in transport provision are causing problems to several more

or less clearly identified social groups, among them people

variously described as "elderly" (French and United Kingdom),

"elderly and disabled" (United Kingdom), "elderly and handicapped"

(United States), "transportation handicapped" (United States).

Similar concerns are not new: French transport law has for 60 years

or more granted special privileges to war wounded, and mothers of

large families, for example, and Britain as well as France has long

given special treatment to the blind. The elderly, however, are a

far more numerous group, and the idea that they should receive

special privileges in transport is relatively new, and the

realisation, now widely accepted by research workers, that the

elderly are not a homogeneous group, so that different kinds of

action are appropriate for different sub-groups, is only just

beginning to penetrate the thinking of policy executives.

Old age and handicap can be - and are - variously defined, but

there is clearly an association between them. National studies in

the United Kingdom give different pictures of the extent of the

association between age and handicap, depending how the latter is

defined. Harris,(l) concerned with the ability of those with

impairment (i.e. physical disorder of a limb or other organ or

mental disorder), and defining handicap largely in terms of ability

to look after oneself, gives figures from which Table 1 has been

derived, but states that the sample may well not include many people

with impairments of kinds which could affect ability to drive or

walk longer distances. With this definition 30 per cent of those

with any impairment were over 65-74 and a further 29 per cent over

75. Hunt. (2) in a study of the elderly asked those not confined to

their beds or houses if they had a disability which interfered with

any activity, and produced Table 2.

9

table 1

Distribution of handic~R{!) .With age, Great Britain, 1971

Figures on percentages o( tot~l population in relevant age and

_s!;!x group - .•.

Severel~ or appreciab1~ Impaired 1 minor

handicapped(*) or no handicap(*) . -- .

Age Men Women All All

16-29 0.2 0.2 0,2 0.6

30-49 0. 7 0.8 o. 8 2. 1

50-64 2.3 3.4 2,9 5. 7

65-74 5. 6 8. 9 7. 6 12.3 75+ 11. 0 16. 8 i5. 0 19. 1

. --Source: Ref. 1 and census i:lata.

*) Refers to ability to look after oneself: see text and Ref. 1.

Table 2

Percentage of me~.a~d women with some disability(*)

or nqne: Great Britain 1974 . -

~ All ages ·-

65-74 75-84 85+ 65+

Men who --are bedfast or

housebound 2 7 16 4

have some disability(*) 51 58 64 53

have none 47 35 20 43

Women who ---are bedfast or housebound 2 8 22 5

have some disability(*) 50 61 53 53

have none 48 31 25 42

Source: Ref. 2.

*) "which interferes with any activity".

In a study in Guildford Hopkin, Robson and Town(3) expressly

investigated "difficulty in walking", using a sample which excluded

those who made no journeys. In comparing this result with the

previous ones it should be noted that Ref. 1 indicates considerable regional variation in Great Britain in the incidence of impairments,

10

the region containing Guildford being at the lower extreme. The

Guildford finding that 11 per cent of the elderly (65+) initially

contacted made no journeys suggests therefore, when compared with

Table 2, that some old people may choose not to go out.

Source:

*) Not

Table 3

Percentage of each age and sex group who make journeys

but with difficulty in walking: Guildford 1977

~

18-24

25-44

45-59

60-64

65-69 70-74

75-79

80+

Ref. 3.

included in survey.

Male

(*)

( *)

(*)

( *)

29

40

62 43

Female

0

8

19

31

39

43

49

66

In the remaining part of this paper we are concerned with

handicapped people only to the extent that they are also elderly - a

parallel paper discusses the impacts of impairment and handicap in

themselves. Demographic projections show that the fraction of the

elderly in the population of ECMT member countries is not constant, and indeed in general as affluence and public health programmes have

increased, life span also increased, and birth rate diminished.

Further, migration, within countries at least, produce variations in

the fraction of the population which is elderly. Some areas have

three times the average number of elderly people. In some area the

fraction of the elderly will continue to increase: Wachs and

others(4) report an estimated doubling in Los Angeles county by the

year 2000. In other areas decreases are expected. Nationally the

current demographic projections for the United Kingdom estimate no

major increase in the number of old age pensioners (men over 65 and

women over 60) over the next 15 years. In the United States an

increase of some 30 per cent in

with less than 10 per cent in

West Germany. (15)

the over 65s is expected compared France and a small decrease in

However in all nations the numbers of the older elderly (75+ or

80+) is expected to increase substantially by 1990, (1. 3 to l. 7

times in the nations cited) and this process will continue

11

thereafter. (Demographic projections over these periods for these

age groups are much more certain than others, since all the people

concerned have already been born.) To the extent therefore that the

older elderly present special problems for transport policy-makers

and planners the magnitude of these problems will certainly increase

greatly in the near future. Since older people are both more likely

to be immobile or have reduced mobility than the 6D-7D age group and

more likely to have low incomes there clearly are problems of this

kind.

2. WHO IS ELDERLY?

Legal definitions of old age have long existed in social and

pension law. In the United Kingdom most men over 65 and women over

6D receive pensions, and can be readily identified by production of

the pension book. The precise definition of the conditions making

someone eligible for assistance are a matter for the local authority

but most accept written evidence of pensioner status or blindness

(the concessions are normally identical for both categories) as a

matter of administrative convenience.. In some cases physical

presence at a County Office or bus office is required and some­

impose a means test. In the United States the Urban Mass

Transportation Act of 1964 as amended in 197D and the National Mass

Transportation Assistance Act, 1974 contain general definitions

slanted at particular physical and mental disabilities, but, as

subsequently enlarged in the regulations, including all those over

65, at a minimum. At least one county authority has interpreted

this minimum as a norm and revised the age at which they previously

gave assistance upwards. In the United States the procedures

required to establish eligibility are complex, and vary from county

to county but usually require periodical physical presence at the

town hall or county seat, with such documents as birth certificates.

Some research, mostly having the character of formal monitoring

of reactions to federal legislation has been carried out in the

United States taking these legal definitions; there is similar work

in the United Kingdom. Little of this work has gone beyond

recording response in terms of patronage and the financial effects

of such new arrangements as has been introduced. However studies

which start with observing the us'e made by the elderly of any

privileges granted them are necessarily constrained by the legal

definitions even if they do attempt to sub-divide the elderly

further.

12

3. APPROACHES TO STUDY OF THE MOBILITY OF THE ELDERLY

In practice, the approaches in reported work are affected both

by the perspectives and objectives of the researcher and the

availability of data. Several perspectives can be distinguished:

i) Profitable use can be made of excess capacity which is

available at off-peak hours - fares and other concessipns

are made to the elderly as a marketing activity. Research

information can be used to make the concessions offered more attractive and therefore more profitable. Most of the work

carried out with this perspective is regarded as

commercially confidential and is unpublished.

ii) The law requires that certain facilities be granted to the

aged. It is of interest to determine the use made of them,

so as to demonstrate that the law is being effectively

obeyed. iii) Many elderly people suffer from specific physical conditions

which cause hand'icap. In this context of health policy, it

is desirable to know what difficulties are caused by

specific physical handicaps, so that suitable social

services can be provided. iv) There is a general political concern that the public

transport system should meet the needs of those who would

otherwise have difficulty in making free economic choices

between services, or living full lives. There is therefore

concern that the activities and attitudes of different kinds

of elderly people be fully described, so that it can be

determined what are the transport needs to be met.'

v) As part of a general concern that the elderly live full

lives, there is a need to ensure that their personal space,

or life space, be as wide as is necessary for this. The

life space which is wished for (or perhaps demanded) is a

function of the cultural pattern of the elderly person when

younger, and of his previous employment and life-style.

Pragmatically, the nature and objectives of work undertaken are

frequently affected by the data bank available. When public

transport concessions are provided, the public authorities or the

bus company frequently maintains a record of those assisted, which

can be used as a sampling frame when the use of concessions is being

studied. Other authorities, e. g. those concerned with health

services, often also have records of their clients. But these do

not cover all the elderly. Wachs, Blanchard, Bunker and Westfall(4)

working in 1976 in Los Angeles used 1970 census data, and a 1967

13

transport study. As their analysis involved studying the changing

distribution of population this was appropriate. However, others

have been more concerned to obtain up-to-date sampling frames, and

have encountered difficulties. Hopkin, Robson and Town(3) in their

study of Gui~dford, contacted a random sample of 3,600 households to

locate 647 people aged 65 or over, and Paaswell & Edelstein(5)

working in Buffalo, New York were able to use the same technique,

since another, broader study provided a random frame. However, in

general, this technique is expensive - a fact reflected in the

sample sizes. The literature suggests generally that this has

proved a real stumbling block especially as the studies clear:y

reveal that for any detailed understanding the elderly cannot be

treated as a homogeneous group.

Unpublished work by Town and Mitchell(6) and by Down(7) based

on the United Kingdom National Travel Surveys of 1972/3 and 1975/6

following show that these variables are significant (with total

samples of 7,000 and 11,000 households, statistical uncertainties

become large as soon as almost any subdivision of the elderly is

attempted):

i) Living alone, with another elderly person, or with younger

economically active people.

ii) Car ownership and licence-holding.

iii) Problems in walking.

iv) Age, sex and socio-economic group.

v) Type of area - at least the classification conurbation/large

town/small town/rural is significant.

Yet other work shows that location within a town is

significant,(3) while the influence of the previous life style,

probably compounded in (iv) above has been drawn out very precisely

by Matalon and Averous(l4) and in a different context by Wach and

others. (4)

Many workers have therefore perforce drawn samples from those

elderly who are in receipt of some form of public assistance.

Nahemov and Kogan(B) working in New York in 1970 report estimates

that their sample frame included 73 per cent of the elderly. But

the general studies indicate that if records are drawn only from

those in receipt of specific transport assistance the fraction is

likely to be low and the sample frame biased. In the Guildford

study(3) over half of the elderly made no use of public transport

concessions. These people significantly differed from the total in

ability to walk, length and frequency of trip making for various

purposes and many other characteristics. Care therefore needs to be

taken in interpreting material drawn from samples of those assisted

by the authorities. Though it clearly has value for certain limited

14

purposes it cannot be used to inte~pr~t the extent to which

transport policies reach those most j.n f'eed, have t;l'le most

restricted personal spaces or, perhaps, f1-1;lfil the intenUof1s of

legislators in enacting certain req4iremt:\lnts, even though they may

suffice to show to what extent the law is beiAg fulfilled.

4. CHARACTERISTICS OF TH~ ~LPERLY

There are no characteristics that are shared by all people over

65, or over 75. Most of them are retired, living on stl!te or

private pensions, _but a significant miflori ty are working. Most of

their children are adult and are either heads of houf;eholds, o:r

spouses of heads of ~ouseholds, but some !'I~QerJ.y men, at least, live

with their own children who are st!l~ gf s~hool age, and others

support adopted children or grandchilcll;eA, Most of those who live

in their own houses own them outright; some of those who rent public

housing have reduced rents or property ta~es; some ~ive active

social, or indeed public, lives; others h§Ye little to !'lraw them

outside beyond the necessities of livin9, As a group, indeed, they

are as varied as the rest of us, but older.

In general, however, their incomes are ,less than th!lY were when

they were younger, and in many cases reoucecl expenditure on housing

and family responsibilities do not comp!'JnsC!te for this. (l'his is

not the place for a full discussion of this issue.) Consequently

many of those who previously owneq · 9 hol.lsehold, car or cars have

found this expenditure no longer possible. Because driving ~a~ less

common than today when older people were younger fewer people of

this age group have ever held driving licences, as they !F'QW older

many tend to give up their licences as well as their qu;s, In the

United Kingdom, 39 per cent of people aged 65 to 6? Hve in a

household with a car and 25 per cent of those aged 70 or over. ( 7)

The Guildford study(3) investigated the driving habits of elderly

people and found that of the 49 per cent of that sample who had ever

held a driving licence the fraction continues to drive pnce a week

or more declined from 57 per cent ill the 65-69 age group to 21 per

cent in the 80+ group. 2Q per cent or so of- previO\JS licence

holders of each age group hac:! retained the licence but no longer

drove, while the fraction who had surrendered it ros.e from 20 per

cent in the 65-69 ag_e group to 55 per cent in the &0+ group. Qf

those who had given up licenGes roughly 30 per cent gave health as a

reason. (See Table 4.)

As more of those accu~tomed to driving become old, these

figures will change - as indeed they hf!ve been doing gver the last

10 years. But the tendency for some elderly people to Qive up car

15

ownership and driving for economic and health reasons is likely to

continue. [Wachs and Blanchard( 16) seem to argue that contrary for

the United States, but do not appear to have examined evidence on

previous car ownership and licence holding in the populations they

consider.]

Statistics on the surrender of driving licences are few and,

more importantly, ·studies on the reduction in driving or driving

ability with ageing seem only to have been carried out in the

context of road safety. This should be remedied.

Table 4

Car use and licence holding among old people in Guildford

who had ever held a driving licence

Age fl.ll respondents who ver held a driving

65-69 70-74 75-79 80+ licence

% % % % %

Drive once a week or more 57 40 28 21 43

Drive less than once a week ( *) 2 0 0 ( *)

Drive, frequency not stated 3 7 0 3 4

Have 1 icence, don't drive 19 10 19 21 16

Licence given up 20 4:1 53 55 36

Weighted number of respondents ( =100%) 123

I 105 57 29 317

Source: Ref. 3.

*) Less than 1 per cent.

It should be realised that licence holding by females is much

lower than that for men in all countries in all age groups.

Consequently, for many years to come the effect on mobility of

becoming a widow (and this is more common than becoming a widower)

will be very pronounced. This event is often accompanied by a sharp

drop in income, and even if this does not make continued car

ownership impossible, lack of ability to drive very often will.

5. THE OLD AS PATRONS OF PUBLIC TRANSPORT

Few, if any, studies have been made of the elasticity of demand

of the elderly for public transport, since such studies are normally

16

made by ticket type, and concessions made to the elderly and to

other groups such as the physically handicapped, and the blind, and

to children are frequently included in the same grouping. There are

however a number of studies reported by Webster and Bly(9) in

general studies of elasticity for both road and urban rail travel

where the population to whom concessions are available is dominantly

the elderly and observed use of them is dominantly by the elderly,

which suggests that elasticities here are much larger than for most

other forms of public transport usage, though still technically

inelastic (e = 0. 8). However Benwell(lO) reports a single

observation in Harlow which suggests an elasticity of unity, while a

small study by Hopkin(ll) in Bracknell can be interpreted as

implying a value exceeding unity. (Money spent on bus travel

decreased when the concession to pensioners was reduced: this seems

to be the only reported study of the effect of real fare increase on

travel by the elderly.) Skelton(l2) however reports a lower figure.

Elasticity with respect to variables other than fares may also

differ among elderly patrons though there is no numerical evidence.

Paaswell and Edelstein's(5) study in Buffalo suggested that the

elderly, with more time to spare than the economically active

expressed less concern about the duration of in-vehicle travel time

than younger people. However, their objection to long or uncertain

waiting times was much greater than that for younger people,· and

they attached greater importance to in-vehicle comfort. Reasons for

their preferences, at least for many elderly people, are apparent,

and are likely to be reflected in patronage to some degree. One

might hypothesise that the elderly's reaction to interchange, in

terms of patronage, would be significant, and strongly affected by

comfort at the interchange point.

Many of the elderly, retired from work, are less constrained

than the economically active in their hours of travel, and most of

their journeys are made in off-peak hours. Concessionary fares are

usually restricted to off-peak times, which of course encourages

this and indeed, concessionary fares are more easily justified in

off-peak hours, since the marginal cost of the capacity occupied by

its users is low provided that peak hour capacity is not exceeded.

There is, however, anecdotal evidence that in some places, notably

parts of London in summer and in certain English seaside resorts,

concessionary fare take-up is large enough to make normal working

hours the times of peak demand. In these places at these times

there is a simultaneous demand by tourists. This could become a

source of financial problems if it is desired, on grounas of equity,

17

to provide common levels and conditions of concessionary fares

throughout a country.

6. THE PERSPECTIVES OF NEED AND OF PERSONAL SPACE

These perspectives concentrate on assessing the effects of

transport availability and to a lesser degree public transport

policy on the life style of elderly people. The "need" perspective

concentrates on access to activities, regarding travel as an

incidental inconvenience or constraint on activity a,way from home,

while the concept of personal space concentrates rather on changes,

with increasing age and changes in mobility, in the area which is

perceived to be accessible, without excessive attention to the

opportunities for activity it presents, for it tends to regard

social contact as a primary source of benefit, and the further one

can range the more opportunities there are for this.

These concepts are to be contrasted with the "disengagement"

theory of Cumming and Henry(l3) according to which some people at

least, as they age, are content to withdraw from social

intercourse. Disengagement is measured in terms of attitudes to

social contacts which make no reference to

Matalon and Averous(l4) base their work on

demonstrate that the degree of disengagement

problems of access.

this concept, and

of old people in

Marseilles is strongly

of the elderly person,

their mobility both

correlated with the former working life style

which presumably cannot be changed, and with

within and more especially outside the

neighbourhood

a f feet. The

of their dwellings, which acts of policy could

a relationship between Guildford study(3) confirmed

travel habits and life-style before retirement but ascribed it to

"primarily economic" reasons, while the Los Angeles work(4) which

characterised seven distinct lifestyles of the elderly as a result

of cluster analyses, ascribes what seem to be the same phenomena to

variations in cultural and, to a degree, ethnic, background. In the

Guildford study(3) reasons for giving up driving licences certainly

include some by 14 per cent of respondents, which would support the

disengagement hypothesis. There was a further 43 per cent who

responded "no need to anymore" or "no car" which could also include

the disengaged. But the study authors clearly interpret their

replies as euphemisms for "can't afford it", which is indeed a

possible explanation for much of the behaviour described here.

Nahemov and Kogan(8) expressly dispute the disengagement hypothesis,

quoting other authors to the effect that social morale is strongly

18

correlated with the extent of personal space and so with provisions of mobility. Hopkin, Robson a"d Town(3) poi"t out that the number of people outside the household with whom elderly people are in

regular social contact is lowest among those living in large households (mean, 1. 80) increases (to 2. 23) for those living with one other person and increases further (to 2. 45) for those who live

alone, which also suggests that at least to some degree many elderly people will seek out social contact if they do not obtain it automatically. Paaswell and Edelstein(5) who appear in part to accept the disengagement hypothesis, point out however, that one type of journey - jqurney to place of worship - is made much more often by the elderly of the group of people in Buffalo, New York and

that they also attach higher priority to it. It is not possible to form a firm conclusion whether the changing attitudes to social

contact measured by disengagement are the cause of reduced trip-making or the effect of problems of access or mobility. Both

may be true . . The old do, however, engage in other activities also.

is taken from the Guildford'study. (3)

Table 5

Table 5

Travel by non-working elderly people(+) and housewives in Guild'ord for different purposes

Purpose Stages(*) per person, per day

Old Peo~ Housewives

Shopping

Social Recreation Personal business

work(**) ES(:Ort Health

*) Walk trips included:

transport excluded.

stages

0.41 0.28 0. 19

0.09

0.05 0.03 0.01

for access to

**) The sample excluded those in full-time employment.

+) 65 or over.

0. 55 0.27

0. 19 0.07

0.21 0.25 0.05

modes of

Other studies confirm that the dominant purpose for which public transport is used is shopping, but the Guildford work

indicated that for the elderly as for all other age groups, the mode of transport most often used for trips for each purpose is

walking. This tendency does not diminish for those who report

'19

difficulty in walking but do engage in some travel. Indeed, since

difficulty in walking is strongly correlated with difficulty in

using buses and driving, those who have difficulty in walking were

found to make a larger fraction and a larger number of their trips

on foot than those who did not, though surprisingly the former trips

had considerably reduced mean length.

Only one study seems to have identified any people who could be

said to be deprived in that the transport system constrained them

from access to activities normally thought to be necessary to life;

the Guildford researchers expressly deny turning up such

individuals, though they were not searching f.or them, but a study

carried out in East Anglia, (a rural area) by the university there

did report that some elderly people were unable to attend hospitals

as out-patients as a result of inadequacies of transport prov1s1on.

But even though one-third of those in the Guildford study who never

went out lived alone they somehow managed at least to remain alive,

and presumably preferred this life-style to the institutional or

other alternatives which would be available to them.

7. POLICY CONSIDERATIONS

The "need" and "personal space" perspectives flourish in

countries where political decisions have been made that the access

to activities or mobility of the elderly are proper matters for

public concern and transport provisions. This is a political value

judgement which, strictly, technical studies may illuminate but

cannot enforce. It is however clear from some of the report that

many research workers engaged on these activities found that the

political value judgement is one to which they are generally

sympathetic, and would perhaps wish to extend or lay greater

emphasis on. This is not surprising, but does perhaps mean that any

approaches to the problems which might point the other way have been

less fully treated in the literature.

The most common form of response to the general policy demand

is the prov1s1on of concessionary fares on public transport,

followed a long way after by the provision of specialised services

for the handicapped, many of whom are also elderly. These special

services are often limited to particular journey purposes (special

provision for journey to health facilities is particularly common,

but see Table 4 and Ref. 5). The high fare elasticity of demand for

public transport by those elderly who use it indicates that this

response is not inappropriate, but even in New York, where travel

distances may perhaps be particularly long and other modes

particularly unsuitable only some three-quarters of those eligible

20

took up the concession after very substantial publicity; in

Guild ford the figure is below hal f. The Guildford finding that

those who have difficulty walking are also constrained from using

buses, and the fact that the elderly elderly, who contain a greater

fraction of those who have walking problems, are increasing in

numbers, may suggest that concessionary fares are not the whole

answer. Specialised ser~ices for those with difficulty in walking,

or some more limited group, may, however, also present problems.

They could well turn out to be very expensive per trip, and will

undoubtedly be complicated to administer. But it is not only

because of financial constraints that their provision could reduce

the level of activity of the more active elderly. Provisions which

make life easier at terminals or in areas of major activity for

people who propel themselves or are pushed in wheelchairs can make

life more difficult for those who walk, but with difficulty.

According to the Guildford study,(3) such people perceive ramps as a

much greater barrier than steps. Similarly, on- or off-vehicle,

wide areas in which chairs can readi·ly be manoeuvred are equally

broad gaps which must be crossed before another reassuring hand-hold

or resting place can be reached. On vehicles lashings for chairs or

storage for sticks are things that can be tripped over. And so on.

There seems too, to be very 1 itt le work about the features of

the man-made environment which causes difficulty to the ambulant

old, especially for those with walking difficulty, in the most

common mode of transport - walking. Work on bus design has shown

that lowcost, minor changes - rails which can be hooked on to by

arthritic hands, post close enough to enable a hand hold to be

retained while walking down a bus, seats which are high enough to be

risen from, and have hand holds to help - can make a major

difference to many elderly people with slight impairments. But no

corresponding work seems to have been reported on the design of

pavements or street furniture. It should be.

In the meantime decisions about fares, concessions and about

specialised services will no doubt continue to be needed. If

financial considerations force choices here, they will not be easy.

21

1)

2)

3)

4)

BIBLIOGRAPHY

Harris, A. I. , Handicapped & Impaired in Great Britain, HMSO London, 1971.

Hunt, A. '

The Elderly at Home, HMSO London, 1978.

Hopkin, J. M. ' Robson, P. and Town, s. w. ' The Mobility of Old· People: A Study in Guildford, TRRL LR 850, Crowthorne, 1978.

Wachs, M., Blanchard, R.O., Bunker, J.B. and Westfall, M., Determining the Future Mobility Needs of the Elderly: Development of a Methodorogy. School of Architecture and Urban Planning, U. California L.A. , 1976.

5) Paasvell, R. E. and Edelstein, P. A., A Study of Travel Behaviour of the Elderly, Trans Plan and Tech, 3 pp. 43-154, 1976.

6) Town, S.W. and Mitchell, C.G.B., Private Communication 1979.

7) Downe, D. Private Communication, 1979.

8) Nahemov L. and Kogan, L. S., "Reduced Fares for the Elderly". City University of New York, 1971.

9) Webster, F. V. and Bly, P. (eds.), "Factors Affecting Public Transport Patronage - An International Study" - to be published.

liJ) Benwell, M. , "An Examination of the Extent and Welfare Implication~ of Bus Use by the Elderly in Harlow". CTS Research Memo 22, Cranfield Institute of Technology, 1977.

11) Hopkin, J. M., Private Communication.

12) Skelton, W. G. , Travel Patterns of Elderly People Under a Concessionary Fares Scheme, TRRL SR 280, Crowthorne, 1977.

13) Cumming, E. and Henry W. E., "Growing Old; The Process of Disengagement", Basic Books, New York, 1961.

14) Matalon, B. and Averous, B., The Mobility of Elderly People: The Influence of Retirement and Former Life Style in "Mobility for the Elderly and Handicapped" (proceedings of a conference). Loughborough Institute of Technology, 1978.

15) United Nations Department of Economic and Social Affairs. Demographic Trends, New York, 1973.

16) Wachs, M. and Blanchard, R. D., "Life Styles and Transportation Needs of the Elderly in the Future", School of Architecture and Urban Planning University of California, L.A., 1975.

22

PART II

MOBILITY AND HANDICAPPED PERSONS

B. METTLER-MEIBOM Socialdata, Institut fur

empirische Sozialforschung GmbH MUNICH Germany

SUMMARY

1. DEFINITION OF HANDICAPPED PERSONS

2. NUMBER OF HANDICAPPED PERSONS AND FUTURE TRENDS

3. PROBLEMS CONCERNING THE DATA BASE AND THE

25

31

COLLECTION AND EVALUATION OF DATA...................... 33

4. IMPORTANT RESEARCH TOPICS . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4. 1 . Number of trips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4.2. Barriers to mobility.............................. 36

4. 3. Social status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

4.4. Policy sensitive groups ..... ............ .......... 38

4.5. Need for transport facilities which assist mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

5. CONCLUSIONS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

24

1 • DEFINITION OF HANDICAPPED PERSONS

It was not only by accident that the year 1981 has been declared by the United Nations to be the year of handicapped persons. The intention is to stress the fact that both in highly industria­lised countries and in developing countries a large proportion of the population is handicapped. Being handicapped means not being able, owing to functional disabilities of a physical, mental or psychological nature, to take part in community life to the same extent as non-handicapped persons can. This definition implies that there is a close correlation between social conditions and the nature and effects of a handicap. In other words, what a handicap is and what its effects are depend partly on social conditions.

This connection between society and handicap emerges clearly if the use made of transport facilities by handicapped persons is investigated. Communities in which the degree of car-use and mobi­lity is low have barriers to mobility different from those communi­ties where the reverse is true. In the latter it matters greatly whether the transport infrastructure is based on the motor car (United States), on more equality between public transport and car­use (the Federal Republic of Germany, the United Kingdom and France) or on precedence for public transport (e.g. socialist countries). However, there are differences in social conditions and therefore in infrastructure not only between the populations of different countries, but also inside communities, e.g. in areas with different population densities (gap between town and country). Consequ~ntly what is true of one community, e.g. in the United States, is by no means true of another, e.g. in Europe, and what is· found in towns by no means applies to rural areas (see IRT)(1).

Two further distinctions need to be made. Studies on persons who are handicapped, disadvantaged or in need of care show that individual ability to cope with handicaps varies widely from one person to ano~her, even i~ the same situation. There are some blind people who move about without help outside their homes, and there are others for whom the outside world proves to be a barrier to mobility. As the research by SOCIALDATA (2) shows, the difference depends in both cases on the ability to help oneself. Personal fac­tors such as energy, tenacity and a positive attitude to life are therefore an important element in differentiating among handicapped persons. However, the IRT (1) rightly points out that there are other differences owing to the social conditions in which handicapped people live. For example, disposable income plays an important part

25

in overcoming barriers to mobility; being accustomed to a certain radius of action (e.g. by travelling) through belonging to a parti­cular social class is also an important factor; not only do poorer population groups usually travel less, but poor handicapped persons usually travel less than well-to-do handicapped persons. But now let us turn to the terminology.

:tn German, French and English it is usual to speak of "handi­capped" persons without reference to mobility. It should be remem­bered that by no means all handicapped persons have reduced mobility, and conversely that the mobility of other persons who would not nor­mally be classified as handicapped is reduced. For this reason the American writer, Hoel (3), has classified handicapped persons to­gether with elderly, young and poor persons under the heading timobili ty limited handicapped". We shall deal here with handicappe£ persons, distinguishing as far as possible between them and mobilitr= l.imi ted handicapped persons.

Disablement is usually classified by types for administrative or statistical purposes; as a result of which there are many different classification systems, which makes it very difficult to compare data.

One kind of classification is by causes of disablement, e.g. disease, accident, war injury or age. Here it is of interest to know how the relative proportions change.

It is also usual to make distinctions by forms of disability, i.e. physical, mental, psychological and compound disability. Whereas physical and compound disability is of great interest to us, we shall largely ignore (purely) mental and psychological disability for the purposes of our study.

Other classification systems are based on which parts of the body and bodily functions are impaired, with varying breakdowns for each part of the body •

. A classification system mainly of importance for social insurance purposes is based on the degree of residual earning ability. This encounters the same kind of problem as attempts to determine the degree of disablement and base breakdowns thereon. In addition, the question of which types of disability should be included is unresolved. For example, the category of legasthenics has been included in Federal German statistics only in recent years.

Five classification systems are given below for purposes of comparison. The first is used by the United Nations and the United Kingdom Central Statistical Office, the third is based on limited mobility criteria, the fourth takes types of functional activity

•into account and the fifth stresses the social aspect. These five systems alone suffice to show the bewildering multiplicity of data

26

involved and how each set of data conceals a specific and perfectly

defensible approach to the problem. It is difficult, however, to

identify the relevant target group.

Table 1

Main cause of impairment

I. Infective and parasitic diseases

II. Neoplasms

III. Allergic, endocrine, metabolic and nutritional diseases

IV. Diseases of blood and blood-forming organs

V. Mental, psycho-neurotic and personality disorders

VI. Diseases of central nervous system

VII. Diseases of circulatory system

VIII. Diseases of respiratory system

IX. Diseases of digestive system

X. Diseases of genito-urinary system

XI. Disorders of sense organs (including blindness)

XII. Diseases of skin and cellular tissue

XIII. Diseases of bones and organs of movement

XIV. Congenital malformations

XV. Injuries Amputations

XVI~ Senility and ill-defined conditions

Source: Office of Population Censuses and Surveys, Social Service Division, A. HARRIS: Handicapped and Impaired in Great Britain, London.

27

Table 2

Type of disability (5)

Physical impairment of upper limbs and shoulders

Physical impairment of lower limbs and hips

Physical impairment of spinal column

Other rhysical impairments (including cleft lip, jaw or palate)

Chronic diseases and malformations of internal organs, etc.(*)

Seriously impaired vision and blindness

Seriously impaired hearing and deafness including deaf­and-dumbness

Mental disorders, convulsive diseases, behavioural disorders, etc.

Speaking and learning disability, difficulty in reading and spelling

*) Only with official approval.

Source: Korperlich, geistig und seelisch behinderte Personen. Ergebnisse des Mikrozenses Mai 1976, (Physically, mentally and psychologically disabled persons. Results of the micro-census of May, 1976), in Wirtschaft und Statistik, II. 8/1978, p. 494.

The point to remember is not only that determining a state of

limited mobility still involves considerable problems, but also that

psychological and both micro- and macro-sociological factors are of

great importance in such a state.

28

Table 3

EXAMPLE OF "MEDICAL" ERGONOMIC CLASSIFICATION OF PHYSICALLY

AND MENTALLY HANDICAPPED PERSONS BY TYPE OF HANDICAP

(FEDERAL REPUBLIC OF GERMANY, 1966)

Type of handicap Total in Percentage of 1 000 population(l)

Walking/ Lower limbs Loss one side 196 0.33 standing both sides 20 0.03

Serious one side 552 0.92 handicap both sides 97 0.16

Gripping/ Upper limbs Loss one side 134 0.22 holding on both sides (7) 0.01

Serious one side 232 0.39 handicap both sides 21 0.03

Other impairment of limbs 84 0.14

Disease/ Paraplegics 154 0.26 lesion of

bD the spinal Others, unspecified ~ column and including back 90 0.15 ·rl

TI injuries ~ oJ +' Nervous diseases (including Ul

paralysis) 339 0.5 -...... bD ~

·rl Others, or unspecified nervous 0.05 ..'<: 22 rl or mental diseases ro :s:

Diseases Heart/ciculation 506 0.85 of organs Respiratory organs 254 0.43

Gastro-intestinal organs 158 0.27

Sight Eyes Total blindness 65 O.ll Diseases, lesion, partial blindness 189 0.32

Hearing Ears Deafness 32 0.05 Diseases, lesion, Partial deafness 81 0.14

Mentally handicapped persons 172 0.29 Serious speech disorders 14 0.02 Chronic skin diseases (8) O.Ol Other diseases 444 0.75 Unspecified handicaps 184 0.31

Total 4,054 6.80

l) Micro-census of resident population in 1966: 59.6 million inhabitants.

Source: Forschung Stadtverkehr (urban transport research) Volume 23 - 1978 - German Ministry of Transport

29

1.44

0.65

0.14

0.60

1.55

0.43

0.19

0.29

0.03

1.06

6.80

Table 4

"FUNCTIONAL" ERGONOMIC CLASSIFICATION WITH REFERENCE

TO PROBLEMS OF MOBILITY

Stage

Finding the boarding point

Access to boarding point

Waiting

Boarding the vehicle

Travelling in the vehicle

Standing or sitting still

Alighting from the vehicle

Function concerned

Communication

Improvement

Standing

Moving in an upright position and gripping

Walking about and gripping things (shaking movements)

Keeping one's balance

Moving in an upright position and gripping

Population groups concerned

Blind persons and persons with dimi­nished vision

Amputation, paraly­sis, ·various forms of traumatism, diseases of the

-lower limbs, myo­pathic persons, wheelchair cases

As above (except wheelchairs)

As above plus impairments of upper limbs

As above plus slight balancing difficulties (elderly persons)

As in item 4 above

Source: Flores - Utilisation des transports collectifs par les personnes a mobilite reduite (use of public transport by persons of reduced mobility).

Table 5

"SOCIOLOGICAL CLASSIFICATION"

(based on lifestyles)

Limitation of mobility of handicapped population:

- Difficulty in getting out of doors

- Requiring intermittent help

- Requiring an escort

- Housebound

- Bedfast

Total

40%

23% 9%

21% 7%

100%

Source: United States National Health Service, November 1974.

30

2. NU}ffiER OF HANDICAPPED PERSONS AND FUTURE TRENDS

Against this background of limited knowledge the following

figures are relevant. German statistics (4) for the year 1976 give

a total of 3,299,000 handicapped persons or 5.4 per cent of the resi~

dent population. According to estimates by the STUVA (5), 7.7 per

cent of the total population (of the Federal Republic of Germany)

suffer from limited mobility and this number goes up to 8 per cent

if persons whose mobility is limited temporarily (by injuries) are

included. Estimates by the United States Department of Transporta­

tion (6) give 6.3 per cent for limited mobility and 6.5 per cent

when temporary limited mobility (due to injuries) is included. The

HEW (7) gives an absolute figure of 13,370,000, which is divided

between young and old handicapped persons roughly in the rat~o of

45 to 65. For Sweden the figures given are 12 per cent for persons

who have difficulty in travelling and 2 per ce~t for persons who

cannot use public transport without help from others.

The statistics for handicapped and mobility-limited persons in

France (9) give estimates for the year 1977 of 2,300,000 physically

handicapped persons, including 200,000 minors and 1,300,000 persons

aged over 65, to whom l million mental cases have to be added.

The United Kingdom Office of Population Ce~suses (10) estimates

the number (in 1968/69) of handicapped perso~s aged 16 and over

living at home at 3,071,000 and gives breakdowns by causes and

regional distribution.

There are handicapped persons in all age groups, but some age

groups contain more than others. The breakdown of handicapped per­

sons by age groups is again given by the relevant national statis~

tics (11), according to which about four-fifths of all handicapped

persons are over 40. When the proportion of handicapped persons is

compared with the corresponding age group of the resident population,

it is found that it rises steeply with age and particularly upwards

of retirement age. However, SOCIALDATA (12) figures for handicapped

children, who are often not classified separately in statistics,

show that there are relatively more handicapped children than young

persons, which indicates that many handicapped children die young,

While it may be assumed in the case of most handicapped elderly

persons that their mobility problems resemble the problems of age,

it must be assumed that in the other age gro1,1ps the situation qf

handicapped persons differs sharply from tl}at of their comtemporaries.

A comparison of different countries' statistics (13) shows that the

proportion of handicapped elderly persons (aged 60-65 and over) is

between one-half and two-thirds of all handi.capped persons.

31

It is difficult to know what demographic trends are in store.

It is undeniable that the number of war wounded is declining, but

most of them have reached the age at which they are 1ikely to be

classified less as handicapped and more as elderly. As regards ex­

pectation of life, Schaefer und Blohmke (14) among others have pro­

duced figures for some highly industrialised countries which show

that in recent years the trend has been slightly downward. It should

also be remembered that about one-half or two-thirds of all handi­

capped persons are elderly. These factors mean that the future

trend in the number of handicapped persons is considered mainly in

terms of how elderly persons as a group behave as such and as a

proportion of the total population (see Section 1). However, the question then remains of how the development of

medical science will affect the prevention of congenital disabili­

ties in future and what trends are to be expected in road and in­

dustrial accidents. Allowing for medical progress it may be supposed

that a) handicapped persons will be saved from an early death and

b) many children will avoid becoming handicapped thanks to preven­

tive treatment, so that a rough numerical balance will be maintained.

As regards road accidents, it may be expected that increasing

car-use, speed limitation and safety precautions will lead to less

aggressive driving behaviour and gradually decreasing figures for

accidents and the frequency of serious accidents. As regards indus­

trial accidents it is difficult to make a forecast. The proportion

of handicapped persons among those aged up to sixty should not fluc­

tuate greatly and should tend to decline. The proportion among

older persons should, we think, also decline owing to the decrease

in war injured, but the falling birthrate will increase the propor­

tion of older persons.

This means that with a decreasing absolute total of handicapped

persons, the proportion of mobility-limited persons would seem to

be increasing. This is a serious matter, especially because at the

same time the family care system, with the declining number of multi­

generation families, is becoming less able to help to overcome the

barriers facing mobility-limited persons. The decrease in support

applies to handicapped persons in all age groups, but especially to

the elderly. One may therefore expect an increasing demand of a new

kind for measures to improve mobility.

This leaves out of account the possibility that the figures

might be appreciably changed by new legal or administrative inter­

pretations of the concept of disability. For example, in 1974 the

legal definition of handicapped persons was considerably broadened

in the Federal Republic of Germany.

32

3. PROBLEMS CONCERNING THE DATA BASE AND THE COLLECTION AND EVALUATION OF DATA

Any research on handicapped persons which is relevant to trans­port planning must arrive at some figure for approximate numbers of mobility-limited persons and must identify target groups for speci­fic transport planning measures. As, however, has already been seen in the Section on problems of definition, it is extremely difficult to obtain figures for handicapped and mobility-limited persons and even in highly developed industrial countries this question has not been solved or only very unsatisfactorilyo

This is due to the variety of different handicapped categories, to the nature of the target group and to research practice. Even constituting a random sample and finding people's addresses raises great problems, and this has serious consequences for the research results, as SOCIALDATA (15) was able to show.

Owing to the variety of handicapped categories, to obtain re­presentative data means not only a very large test sample, but also

one covering a large_ area. Current procedures for random surveys vary in their geographical coverage. A test sample compiled from the files in residents' registration offices woula be desirable (which, in the United States for instance, is not possible). Where this procedure is not feasible, the straight percentage procedure is not recommended owing to the distortions it causes. Better re­sults are obtained from a random-route procedure using large samples or, if necessary, a combined random-route plus percentage procedure.

A further difficulty consists of the handicapped persons them­selves. As a group they are characterised by a low level of parti­cipation in community life, partly owing to their tendency towards withdrawal and shyness. This makes the usual way interviewers are used difficult, if not impossible. If the validity of the survey

procedure is not to be thrown into doubt, it simply must be tailored

to suit the target group. In addition, however, the evaluation of the results themselves

is a problem, because handicapped status is often not clearly

established.

When, in addition to information about the number of handi­capped, datas are needed for transportation planning to improve mobility, it is essential to arrive at a disaggregated procedure which ascertains all the relevant factors influencing an indivi­dual's mobility behaviour and classifies persons with comparable individual situations into homogeneous policy sensitive groups. This means that, on their own, trip data are just as irrelevant for planning as data on modal split.

33

There are several authors who point out that data of special quality are needed. Thus Paaswell (16) finds that in practice a research approach which concentrates on the criterion of "trips made" or "choice of vehicle" makes no headway and that one must take account of the heterogeneous nature of destinations/purposes/ situations. The Institut de Recherche des Transports (17) applies sociological theory and goes as far as a full study of the social

and economic situation of handicapped persons in relation to their limited mobility.

The American writers, Hood, Bell, Sovchen and Heathington (18), approach the problem from the standpoint of market segmentation for

transport facilities, thereby coming to the same conclusions as Brag, of SOCIALDATA in Germany, who advocates a disaggregated

situation approach to transport research from the policy sensitive

perspective (19).

In conclusion it may be said that both in collecting and evalu­ating data we are still beginners in the empirical study of handi­capped persons in transport, and that more knowledge is urgently re­quired, as a consideration of current or planned policy measures will show. This applies especially to the identification and quanti­

tative definition of sub-groups for whom similar mobility-assisting transport facilities might be planned.

4. IMPORTANT RESEARCH TOPICS

Without intending to go further into research concepts and

methods, and without being able to deal with holiday travel ques­tions, we would mention some of the more important topics and

research findings.

o What are found to be the trips, trip frequencies, purposes

and destinations of handicapped persons and what means of transport do they use?

o What are the barriers to mobility for handicapped persons? What effect has social position on the nature and extent of mobility?

o What groups sensitive to remedial action are found among handicapped persons?

o What is the demand for mobility-assisting measures in connec­tion with transport infrastructure?

We shall deal with each of these questions in turn.

4.1 Numoer of trips

The number of trips recorded in the surveys varies widely. The American writers, Hartgen, Paske and Howe (20), using a 165 random­route sample of handicapped and elderly persons, arrive at an aver­age of 1.06 trips (one way) to work and 5.8 other trips per week,

34

with handicapped persons exhibiting relatively less mobility than elderly persons. According to this survey, handicapped persons-' modal choice was: 82 per cent private cars (30 per cent driving themselves), 15 per cent buses, 3 per cent taxis and 0 per cent spe­

cial buses and walking. Very different figures are arrived at by Feeny, Ashford, Morris

and Gazely (21) on the basis of a random sample of 166 mobile and 29 non-mobile elderly and handicapped persons in Coventry. The

following table show the purpose and the transport modes. Apart from survey quality questions, socio-cultural differences between

the United States and Europe may also be a reason why such diver­gent modal choice results are obtained especially as regards

walking.

Table 6

Frequency of travel for different purposes (%)

Shopping Sociali Personal Medical All 'Business Purposes

Basis 166 respondents Daily 20 18 1 1 40

Several times per 38 27 1 1 41 week About once a week 20 22 36 1 13 Between weekly and 1 6 4 7 l monthly About once a month 1 4 2 18 2

Less than once a 4 7 7 32 3 month Never 16 16 49 40 0

The second table makes clear the importance of journeys on foot and the first table, as regards purpose, of shopping trips, but the random sample does not take sufficient account of mobility­

limited persons making trips to work and school.

35

Table 7

Frequency of use of main transport modes (%)

Mode Walk Bus Car Car All driver passenger modes

Frequency Basis 166 respondents

Daily 32 l 7 l 40

Several times 28 18 4 ll 41 per week

About once a week 15 12 0 17 l3 Between weekly and 2 10 0 14 l monthly

About once a month 2 4 - 8 2

Less than once a month 7 10 - 35 3 Never 14 45 89 14 0

The general conclusion is that, irrespective of the number of

trips they make, mobility-limited persons normally have the same

range of activities as other persons due to belonging to different

age groups and social classes, but that they perform fewer activities

and that those they do have are not of the desired quality.

Paaswell (22) comes to similar conclusions.

L~.2 Barriers to mobility

Because it was realised that one does not arrive at results of

much relevance to policy action by aggregating figures for trips

and transport facilities, the reasons for mobility limitation, i.e.

the barriers to mobility have been studied. This means not so much

barriers due to social position like belonging to a particular class

and residentia~ district, but factors connected with physical obsta­

cles, general infrastructure and transport infrastructure. A first

point is that sufficient attention has not been given so far to

psychological factors, i.e. withdrawal symptoms caused by disablement.

The study of immobile handicapped persons by Morris/Gazely (23)

has shown that immobility is mainly due to physical barriers. In

other words, without drastic reorganisation it would not be possible

to reach this relatively small group of persons and even then only

to a certain extent if the psychological barrier were overcome which

is additional to the physical handicap (e.g. with regard to accept­

ing being in a wheelchair).

As Gazely/Morris (24) show, the problems of handicapped per­

sons going out of doors are of different kinds. When they are walk­

ing, by far the greatest obstacles are steps, stairs, ramps and

inclines, followed by the problems of carrying things. On the other

hand traffic density~ crowds.of people, or uneven ground cause rela­

tively slight problems, although they do exist.

Getting into and out of cars presents special difficulty,

whereas the main reason for not using buses is the distance to the

bus, the height of the entrance and fear of falling during the trip.

The figures show that the distance to the bus should not exceed

600 m and that lack of seats at bus stops causes further problems.

However, the greatest obstacle is boarding and alighting.

In the case of train journeys, which are made even more seldom

than bus trips, access to the ticket office, the platform and the

train are more serious barriers than those which discourage the use

of buses.

All the above-mentioned barriers to mobility are particularly

difficult to overcome if the handicapped persons have to use wheel­

chairs, the main problems being steps and the width of the doors of

lifts, buses and trains.

Barriers to mobility in the home have been studied relatively

little, but SOCIALDATA (25) has ascertained that some permanently

immobile persons are in that state because stairs, steps and sills

prevent them from getting out of doors and there is insufficient

help from members of the family.

4.3 Social status

Studying the question of whether social and economic conditions

affect the way in which people (can) deal with their mobility limi­

tations is one way, and an important one, of going beyond aggregated

approach methods. It can be supplemented by considering the effects

on a person's social status of a disability he contracts. The

Institut de Recherche des Transports (26) has given special atten­

tion to these questions and has recently published the findings of

a pilot study.

The authors, Mrs. Poulenat and Mr. Tarrius, investigate the

repercussions of a disability for members of the upper, middle and

lower classes in towns and rural areas.

They find that, depending on social position, there are wide

differences in the ability to keep a job and maintain one's income

and social relations. While the upper class handicapped are able

to keep their jobs and maintain their economic standards and pattern

of social relations l'ri th little sacrifice, distinct tendencies to­

wards social decline can be seen in the middle class, e.g. women

find marriage prospects are not so good and men cannot continue in

37

careers which require manual and organisational skills. The same

applies to members of the traditional middle class. In comparison,

the intellectuals in the middle class have least difficulty in

dealing with a disability, because there are less problems in con­

tinuing to do brain work. Among the working cla·ss and rural popu­

lation a disability may lead to social promotion, if it occurs early

and the family can afford to pay for training. As regards the other

cases, if they have to stop work, they run the risk of great impover­

ishment, having their radius of action restricted to their family,

and becoming socially estranged.

Against this differentiated background the authors raise the

question of the connection between the socia~ positions of handi­

capped persons and their mobility. It is found that the availability

of means of help, primarily a car, is more important than the fact of

being handicapped. Accordingly it can also be seen that the well­

to-do classes largely maintain their degree of mobility and radius

of action, while the less privileged classes suffer greater restric­

tions on their mobility. Consequently the authors query the assump­

tion that a restriction of bodily functions always results in the

same degree of restriction on mobility and they recall that mobility

is not only a physical but also a social fact ("one drives to work

or to go and meet someone as a function of one's social situation,

preference and financial means").

In thus attempting to adopt a.disaggregated approach they help

towards rethinking the problem, but it should not be overlooked that

other research approaches also make some distinction based on the

social status of handicapped persons, although not with the same

result. A case in point is the United States research into limited

mobility, which treats poor people as a separate group of mobility­

limited persons.

4.4 Policy sensitive groups

Research into the connection between social position and mobili­

ty is convincing because it tries to adopt a differentiated approach,

but it too so far fails to achieve results which are relevant to

policy action. If planners cannot act meaningfully by taking the

same measures for all handicapped persons, they must as an alterna­

tive work out measures for sub-groups, i.e. groups which are sensi­

tive to the same kind of policy. Comparable social status does

indeed confer some homogeneity on members of a group, but it is

found that other factors (which also correlate with social status to

some extent) such as car ownership, access to the transport infra­

structure, spectrum of activity and degree of physical barriers to

mobility must also be taken into account. This approach received

its greatest theoretical development from Werner Brog (27) and its

38

most logical application to handicapped persons from Hood, Bell, Sovchen and Heathington (28). Their aim is to identify groups of ~isabled persons for each of which appropriate measures for aiding mobility can be taken. The policy sensitive groups are based on the following dimensions:. driving licence ownership, availability (of a car, local public transport or special vehicle) and cost and accessibility (of and to special vehicles). With these dimensions the authors arrive at seven situation groups distinguished by type of policy needed (ranging from assistance in providing a car as the simplest means to individual special transport). This approach is no more than a beginning because it leaves out subjective factors like attitude for instance, as a determinant of behaviour, but it does suggest a way whereby the community of mobility-limited persons as a whole may be meaningfully structured with reference to policy, i.e. at bottom, transport facilities, which would enable planners to spend their funds without loss from piecemeal solutions. (See, as well Chapter 4.)

4.5 Need for transport facilities which assist mobility

It should be evident by the preceding paragraphs that the demand for mobility-assisting transport facilities.cannot simply be derived from the number of handicapped persons. Thus Paaswell (29) writes that demand is usually overestimated. The two French and United States research teams mentioned above had made it clear, each in their own way, that this is not due to any lack of desire to be mobile, but to the heterogeneous nature of the demand for mobility. In particular, meeting this varied demand with only~ type of transport facility is just as impossible with the handi­capped as it is with the non-handicapped.

5. CONCLUSIONS

Which of the foregoing considerations deserve special attention, or by which facts should we be guided in planning measures to make handicapped persons more mobile?

Two facts in particular strike us as essential and are briefly discussed below:

o Handicapped persons and disablement situations are inheren­tly so heterogeneous that one cannot proceed as if there were only ~ group, let alone ~ kind of demand or ~ policy for all handicapped persons.

o ThB way in which handicapped persons make known (or do not make known) their needs varies widely in intensity and ex­tent, and with the social, economic and political channels used. Consequently we have to deal with a heterogeneous spectrum of handicapped groups ranging from organisations

39

-I> 0

Age

6 - 14

6 - 14

25 - 30

25 - 30

75 - 85

75 - 85

Household situation

parents with children

with grandparents

with spouse

staying with gain­fully employed parents

living alone

living with their children

Table 8

Class background

upper class

lower class

middle class

lower class

middle class

lower class

Place of residence

town

rural

town

rural

town

rural

Degree of mobility

can move in a wheelchair

has no wheelchair but requires one

blind, must be led

bedfast

difficulty in walking

difficulty in walking

Destination/ purpose

local special school

special school in the town

to work

outing

errands

leisure

Main measures for assisting mobility

local special school bus

monetary aid for wheel­chair; special taxis, cross-country bus

organisation of self-help

out-patient service

additional aid in walking/ standing, hand-holds for elderly per­sons in public transport facilities

self-help

capable of action on the one side to marginalised and unorganised individuals on the other side.

On closer inspection it becomes clear that there are formal distinctions between disablement situations (see also IRT, 30). The fact that policy discussions continually assume that there is a single target group presumed to be homogeneous points more to over­simplification of the subject than to the findings of a serious study of it.

Let us consider at least some of the situations in which mobility is limited, as described by the following table. If this table were developed and completed, it would reveal that there are many situations in which people's requirements cannot be met by homogeneous measures. To this extent it may be said that precisely because disablement occurs at all ages, in all social classes and in all areas, the global approach is not relevant. The need is rather to identify target groups for policy and to assist them with measures tailor made for them. The much discussed lifting platform on buses helps only a small minority of the mobility-limited and not the mobility-limited as a group!

It may therefore be noted that what matters in the case both of handicapped and of non-handicapped persons is to take into account all the factors which cause a person to make a trip with an appropriate means of transport. Only with this background knowledge can one plan the types, range and frequency of transport systems and design measures for specific areas or sub-areas.

As regards the second question, i.e. the way in which handi­capped persons make known their requirements, we should turn to Chapter 3. The wide variety of levels of organisation are clearly seen from the old age-handicapped who are not really organised as handicapped persons.

When translating needs in terms of organisation and policy implementation there are conflicts under at least the following headings:

o physical incompatibilities; o conflicts regarding financial and social resources; o conflicts of attitudes; o conflicts of an institutional and inter-institutional

nature.

The various handicapped groups have succeeded in resolving these conflicts themselves in widely differing ways. There are good reasons for saying that there exists a privileged class of handicapped who - without being in real need - come to enjoy all kinds of financial and other aid measures (including mobility assistance). At the other extreme are groups who are seldom or

41

never assisted, mainly eideriy persons, but also poor persons if the definition of limited=ffiobl1ity is widened in this way.

C6nseq~ently policy ae~i©n should be evaluated by the criterion of wblch sobial classes 6r whi5h aegrees of disability they assist. The valUe of what are o:fien vtJf'y costly measures depends on whether they reach the really underp~iviieged groups of handicapped persons.

Ih suftinling up the consiclera'bie>ns of this chapter, we are coming to ~he con~iusion that: A. Who ;hs classed as a handicapped person is partly a question of defihi tiorh There are iwo def:bn.i tioris of handicapped, one narrow, in the sense of physically iiantiicapped and the other wide, in the sense 6f limited mobility. The iatter includes as well poor persons and a ;;:'urther fraction of tile elderly.

B. Nlimerical ·data and p6pu1ation forecasts vary with the defini­tiM. If it is limited to 'the physically handicapped including handicaps due to old age, ihe iarge proportion of persons aged over 60-65 among them is striking! they account for between one-half and two-thirds of all handicapped persons, so that statistical estimates for the handicapped coincide largely with those for elderly persons. c. Research into the mo~ility of handicapped persons is still in its infancy. This is trUe of the methodology and of the conceptual approach, and further research is therefore required. D. Handicapped persons cannot be treated as a homogeneous target group either for research or for policy purposes. Instead it is precisely the heterogeneous nature of their situations and require­ments which should be taken as a starting point for thought and action. Following the implementation of policy there is also a need for ex-post evaluation to determine whom these measures really benefit and to what extent.

42

BIBLIOGRAPHY

l) See Institut de Recherche des Transports (IRT): Les Conditions de l 1 Insertion Sociale des Handicapes physiques et sensoriels comme determinants de la mobilite, Paris 1979, p. 15.

2) See SOCIALDATA: Anzahl und Situation der zu Hause lebenden Pflegebedlirftigen, Teilendbericht 2, Situationsgruppenanalyse, Mlinchen 1979.

3) HoelL. et al., Latent Demand for Urban Transportation, TRI Research Report No. 2, Carnegie - Mellon University, 1968.

4) Korperlich, geistig und seelisch behinderte Personen. Ergebnisse des Mikrozensus Mai 1976, in: Wirtschaft und Statistik, Vol. 8/ 1978, p. 494.

5) Forschung Stadtverkehr - Sonderheft - Vol. 23, published by Bundesminister fur Verkehr, Bonn-Bad Godesberg, 1978.

6) Department of Transportation UMTA: The Additional Cost of Provi­ding Mobility for the Elderly and Handicapped on the Washington Metropolitan Rail Rapid Transit System, National Technical Infor­mation Services, NTIS-Report, May 1973.

7) See Transportation Systems Center for the Urban Mass Transporta­tion Administration: The Handicapped•and Elderly Market for Urban Mass Transit, October 1973.

8) STATENS OFFENTLIGA UTREDNINGAR (SOU). Den Behinderten angepasster Verkehr, Hako-Utredningen, Liber Forlag, Stockholm 1979.

9) Liaisons sociales No. 7617 September 1977. 10) Office of Population Censuses and Surveys/A.J. Harris: Handi­

capped and Impaired in Great Britain, London, p. 4. ll) BRD: Korperlich, geistig und seelisch behinderte Personen,

Ergebnis des Mikrozensus Mai 1976, in: Wirtschaft und Statistik, V9l. 8i 1978. Frankreich : Liaisons sociales N° 7617, September 1977. GB : Office of Population Censuses and Surveys/ A.J. Harris : Handicapped and Impaired Great Britain.

12) See dazu SOCIALDATA : Anzahl und Situation zu Hause lebender

13) Pflegebedlirftiger, Munich 1979. · Wirtschaft und Statistik, op. cit., Personen mit 65 und Jahren stellen 65.3 per cent der Behinderten insgesamt. of the Census, op. cit., The 65 and over group accounts 57.9 per cent of the 16 and over group.

mehr Office

for

14) H. Schaefer und M. Blohmke : Sozialmedizin, Thieme Verlag, Stuttgart 1978 (second edition).

15) See the comparative analysis in two empirical surveys. SOCIALDATA : Motorisierte und nicht-motorisierte Verkehrsteil­nahme, Mlinchen Juli 1979. Kap. 4, Vergleich der KONTIV-Ergebnisse mit anderen BAST-Untersuchungen zur Verkehrsteilnahme von alteren Menschen sowie Kindem und Jugendlichen.

43

16) Robert D. Paaswell, Travel and Activity Needs of the Mobility Limited, Fourth Internat. Conference on Behaviour Travel Modelling, Eibsee Germany 1979.

17) IRT, op. cit.

18) Hood, Bell, Sovchen,' Heathington: Transportation Services for the Transportation Disadvantaged, Transportation Center of the University of Tennessee, June 1978.

19) Werner Brag: Verhalten als Resultate individueller Entscheidun­gen in sozialen Situationen, Conference on Mobility in Urban Life, Arc-et-Senans France, September 1978.

20) New York State Department of Transportation, Preliminary Research Report No. lOB, No. 4, August 1976.

21) Transport and Road Research Laboratory, TRRL. Supplementary Report 480, 1979.

22) See Robert E. Paaswell: Travel and Activity Needs of the Mobility Limited, in: Fourth Internat. Conference on Behavioural Travel Modelling, Eibsee, Germany 1979.

23) A. Morris/D. Gazely: A Study of Physically Handicapped Non Travellers in Coventry, Institute of Consumer Ergonomics and Department of Transport Technology, University of Technology, Loughborough, Leicestershire 1977.

24) Gazely/Morris: An Investigation into the Behaviour Travel of Selected Handicapped Persons, Institute for Consumer Ergonomics and Department of Transport Technology, Loughborough, L Leicestershire 1977 and TRRL, Supplementary Report No. 480, op. cit.

25) SOCIALDATA: Anzahl und Situation der zu Hause lebenden Pflegebedlirftigen, Teilendbericht 1 and 2, Munich 1979.

26) IRT, Rapport de recherche N° 40, Paris, 1979

27) Werner Brag: Verhalten als Resultate .•• op. cit.

28) Hood, Bell, Sovchen; Heathington, op. cit.

29) Paaswell, op. cit.

30) An excellent discussion of need analysis is given by A. Bieber: ~ote de Lecture, December 1977 published by the Institut de Recherche des Transports.

44

PART III

EVOLUTION OF SPECIFIC WELFARE SERVICES

C. POULENAT-ABALLEA Institut de Recherche

des Transports

Arcueil

France

SUMMARY

1. THE SPIRIT OF THE LEGISLATION, THE LEGISLATIVE FRAMEWORK AND THE EVOLUTION • • . • • • • • • • • • • . • • • • • . • • • • . • • • • 47 The new conception of the place of the disabled and the elderly in society • • • . • . • • . • • . • • • • . . . • . • • . • • • • • • • • . • • • • • 47 Help for the elderly and the handicapped •.•.•••......• ". 49

2. WELFARE ACTION AND THE WORK OF PRIVATE ASSOCIATIONS 51

54

54 56

3. T~ POLITICAL RESPONSE AND FORMS OF PUBLIC WELFARE Public welfare institutions For~s of pubiic welfare

4. "MORPHOLOGY" OF SPECIAL TRANSPORT SERVICES 58 Do the special services meet the independence req,1,1trement ? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 62

46

The purpose of Part III is -!<9 achieY!? a 'Detter understi'!I'!\l~n~

of how specific welfare services have be~4r!. "99 be organised pr':bmg,rj)_y

for the handicapped! but also for the eldr=rly q.nd also to a..ns.ly.;J~

the extent to which these services correspBp.d to the idea t:P8't thl'l handicapped and the elderly themselves pgve qf their place tn society.

1. THE SPIRIT OF THE LEGISLATION, THE LEGJ~LATIVE FRAMEWO~~. foNB ITS EVOLUTION

The national or regional legislation§ wn!ch have sought pver

the last few years to improve the status Q{ the elderly ('J.ng the handicapped are inseparably linked with qurrent thinking on the plq.ce

such persons should have in society. rhte is the case for the French

Outline Act of 30th June 1975, whose aill] is t.o use ever-y possib'].e

means to help the l'l,§tndicapped find their place in society, a,n<i notably through Priority Action Programme J'lq, 15, whose purrose is, during the period of the VIIth Plan, to qe:;Lj) the elder-ly cont'\,f)1Je to

live in their own homes and thus continue to be a part of :!,i:fl'= in their town or village.

The new conception of the place of the disa):lled and the elderly_in

society

Ideas about disablement have change~ g. ~reat deal over the cen­

turies in every country, especially sin9e the last World War. The very first point to remember q.qc;no~t ;handicapped pe-rsonil is

that disablement is directly linked with the state of a soctety,

its technical level and its social orga,rri,§a.'l;,ton. The histgry pf

disablement is largely ~ matter of what §getety has done to ];lrevent

and remedy it, or to create new conditior~.s t.o cause it (war 1 the age of the motor car, the product:\, vi ty dem.a,nQ.s of an industr.i('J.l

civilisation, etc.). The handicapped as a c?tegory have cl'l,a,nged,

47

too. If only because of changes in the origin and nature of their

disability, the composition (sex, age and class) of the category is

obviously not the same today as it once was. Nowadays, anyone in

any social class may become disabled and this could well be one of

the reasons for the growing interest of society (i.e, public opinion,

the lawmakers or private charities) in the handicapped or a specific

category of handicapped. Other factors, of course, are responsible

as well, such as the system of values dominating a particular era

(philosophy of t~e Rights of Man and the promotion of education for

the deaf and the blind) and full employment (promotion of employment

for the handicapped).

The degree of interest that society takes in the handicapped

varies a great deal, however, often depending on the origin of the

disability: governments took action about ex-servicemen well be­

fore anything was done for the victims of industrial or road acci­

dents and where no liability can be assi.gned the handicapped are

very often wholly dependent on their families. In fact, the history

of the position of the handicapped has always been a story of in­

equality based on the origin of the disability and not, as might

have been supposed, on its severity or the financial position of

the handicapped person.

Broadly speaking, a study of the changing conception of the

handicapped person's place in society and of the changing ways in

which assistance has been given them for their handicap shows that

almost every country has moved on from the charity preached by all

religions (the "infirm" at first depended on the Churches for help)

to the notion of welfare (early this century) sanctioned on two

grounds: the protection of public order, to which excessive poverty

could be a threat, and the duty of the community to provide for

every person's basic needs. This notion of welfare tended early in

the 20th century to assimilate the position of the handicapped with

that of the elderly. Finally, the concept of the rights of the

disabled - to financial aid of course - emerged. This concept has

since been gradually extended to education and employment (in 1977,

for instance, French legislation made it compulsory, though the

right is still often theoretical, for the handicapped to be found

suitable jobs). However, latterly, the demands of the handicapped

have gone beyond higher benefits and the right to work and extend

increasingly to the right to a social life, in other words the right

to choose their place of residence, to have access to public build­

ings and to recreational and sports facilities, and the right to use

the mode of transport of their choice, including public transport

and taxis.

The whole trend may be summed up in terms of the claim to the

right to independence and to a kind of integration in which

48

ghetto-like segregation has no part. It means in particular that

every handicapped person must be allowed, as far as he or she is

able, to live, learn and work in a normal environment. This uni­

versal claim to independence directly raises the problem of certain

legislation which, while designed to establish the right to inde­

pendence, introduces or increases the degree of control and the

number of the administrative decisions that affect the lives of

handicapped persons.

The way that the place of the handicapped in society has

changed is very similar to what has happened for elderly people:

charity at first ·did what the family could not; State welfare then

provided financial aid and beds in hospitals or similar institutions.

Today, help for the elderly is changing, no doubt because of their

number (there were 7,500,000 people over 65 in France at the 1975

census) but also because it has been generally observed that up­

rooting people ~rom their usual surroundings only isolates them

further and accelerates the ageing process. There are financial

considerations as well (i.e. the cost of having someone in an insti­

tution). What old people want is to be able to continue to live at

home and be a part of social life.

But is this wish actually recognised by current legislation?

Help for the elderly and the handicapped

As a rule, all legislation does is to confirm rather than anti­

cipate a trend in society. French legislation on the elderly and

handicapped is no exception. But legislation may accelerate the

trend by enforcing the application of the necessary resources (both

material and financial) provided, of course, that public opinion

and the various pressure groups agree to this use of resources.

The VIIth Plan 1 s Priority Action Programme No. 15 concerning

elderly persons is designed to help the old to continue living in

their own homes and to take a bigger part in social life. It thus

meets the wishes of most elderly people, often expressed in terms

of their unwillingness to go anywhere. A new attitude has thus been

adopted towards old people 1 s welfare: cash benefits have rapidly

become less prevalent with the advent of retirement pensions; al­

though placing in an institution is still frequent, the priority

objective is now to keep a person at home; this calls for improve­

ments in housing and for help at home in cash or kind (medical wel­

fare, home help services, old people 1 s clubs and restaurants) and

the organisation of activities promoting social life. In the same

spirit, old people have been given priority since 1977 for the in­

stallation of telephones and, in certain cases, do not have to pay

the installation charge. The VIIth Plan includes the relevant appro­

priations, but the objectives yet have to be taken on board by the

public authorities and the bodies responsible for building.

49

As regards handicapped persons, the Outline Act of 30th June

1975 states that the "preventicn and identification of disabilities,

and the medical treatment, education, training and guidance, employ­

ment, minimum income maintenance, social integration and access to

sports and leisure facilities for handicapped minors or adults con­

stitute a national obligation".

The Act thus endorses handicapped persons' claim to independ­

ence, especially in the section requiring, that, wherever possible,

"handicapped minors-or-adults should have access to institutions

open to the general public and should be maintained in normal work­

ing and J:iving conditions".

For the purposes of this social integration and access to

sports and leisure facilities, the Act stipulates, among other

things, that the architectural designs and fittings of housing and

of buildings open to the public must allow for access by handi­

capped persons; it also lays down that, in order to·make it easier

for them to travel, public transport services must be modified,

appropriate changes to vehicle design specifications phased in and

access systems to these vehicles improved. Another of its require­

ments is that steps be taken to facilitate the introduction and

operation of special transport services for the handicapped or,

failing that, their use of private cars.

Indeed, it is only by implementing such measures, combined

with guaranteed incomes and employment opportunities, that the ob­

jective of social integration can be achieved. But, before they

can be implemented, regulations have to be framed, and it is inte­

resting to note that the first of these were introduced on

1st February 1978 (accessibility of new buildings, etc. open to the

public) and 9th December 1978 (accessibility of existing buildings,

etc. open to the public and modification of public transport ser­

vices), in other words three years after the date of the Outline

Act, that yet another year went by before the fmplementing orders

and circular for the 1st February 1978 Decree were issued, and

that the implementing orders for the December 1978 Decree on the

access.i bili ty of existing buildings, etc. and the modification• of

public transport services are not yet out. In addition, of course,

all of these regulations make provision for numerous exceptions.

The French legislation concerning the handicapped is not

unique nor is it the first to come out. The Scandinavian countries,

in particular, brought out theirs before 1975, and recent American

legislation also lays down a number of rules regarding accessibility

of public transport which were brought into general application and

at the same time extended by Regulation 504 of the 1973 Rehabilita­

tion Act, whose provisions have been in force since 2nd July 1979.

50

In fact, most Western legislations concur in their view of the posi­

tion of the handicapped and the need for their social integration.

This seems less significant however than the contrast between

the way public opinion professes (at the philosophical level one

might say) to be against the segregation of a certain category of

the population and at the same time (with often the same people

involved) is unwilling to accept the constraints that the social

integration of that category implies. One example is' the increasing

intolerance of reserved seats for disabled persons or the elderly

on public transport. Others, as we have seen, are the delay in

issuing the implementing regulations and the exceptions allowed

against general compliance, but there is also the control which the

State means to retain over the handicapped population: true enough,

the spirit of the 1975 Outline Act is the right to independence,

but with the Act laying down that administrative bodies shall be

responsible for taking all the important decisions (schooling -

training - employment - housing - incomes) in the lives of handi­

capped minors or adults, it is reasonable to ask what freedom of

choice is still left to the handicapped themselves concerning their

way of life. Has the right to independence really taken over from

welfare aid?

The question arises in the case of both the elderly and the

handicapped and the answer to it governs the type of help given

and the action taken by the public and private associations con­

cerned with these categories.

2. WELFARE ACTION AND THE WORK OF PRIVATE ASSOCIATIONS

The claim to right to independence and to social integration

voiced by the vast majority of handicapped persons and their associ­

ations, which has been written into recent legislation, is therefore

the culmination of a trend to which private associations have made

a very important contribution, particularly in the case of the

disabled.

These groups, associations and institutions, often set up with

a particular handicapped category in mind (the blind, the deaf,

paralytics, etc.), formed, together with the Church (and before

the State took an active interest in the handicapped, the first

aid network. But this aid has always been and still is very diverse

and, above all, was given with very different aims in view.

Historically (not that this type of help has disappeared),

these associations and institutions (whether private or semi-State,

lay or church) saw what they did as being strictly within a

"disabled" universe: it was to give psychological and moral support

51

to the handicapped by getting them to join a community of disabled

people to help them understand the administrative procedures with

which they had to deal and in particular obtain certain financial

aids and to provide them with education, functional rehabilitation,

readjustment and training facilities in special centres set up

specifically for the handicapped. Thus, the major associations and

institutions, many of them established between the two wars, became

the administrators of various kinds of organisation for the handi­

capped. The institutions for the blind and the deaf, for example,

like the "Ligue pour l 1 Adaptation des Diminues Physiques du

Travail" (L.A.D.A.P.T.), opened educational, vocational training

and employment centres (including work therapy centres) and hostels

for the handicapped, but always in the waterlight context of a

handicapped universe.

In fact, this approach comes under the heading of welfare in

the form of help for the needy with street collections, donations

and bequests by "benefactors" a prominent feature. The associa­

tions and institutions, generally claim to be apolitical, and are

usually presided over by wealthy or influential people who are not

necessarily disabled. Their role has been highly important in

France and other countries in helping the handicapped to break out

of their isolation and in bringing pressure to bear on the State.

It is still important in many cases for disabled people in the

poorer classes of society: belonging to an association for the

handicapped is often the last alternative to a world apart and the

last refuge for the outcast of society. Moreover, by providing the

handicapped with, in particular, educational and training facili­

ties. It could be that they have made it possible for other cate­

gories and other associations to claim the right to live outside

special institutions and to have a place in society.

More recently created associations do not have the same aims

and strategies. Over the last few years they have been concentrat­

ing on action to promote the handicapped's access to the normal

environment (in education, housing, work and recreation) the object

being to render them as independent as possible.

The first concern of these associations is not to organise

hostels or rehabilitation centres but to look into transport prob­

lems, the modifications to public buildings and towns, and access

to sports and even holiday travel.

As opposed to the big institution-running associations, which

are apolitical, these have a social and political base. Their

thinking and their leaders (always disabled persons and often from

relatively poor backgrounds) have varyingly close affinities with

those of the trade union federations or left-wing leanings, and

they assimilate the condition of the handicapped with that of the

52

other "underprivileged" or "rejected" members of contemporary. so­

ciety. During the last few years, the same divisions and forms of

action have emerged in the "handicapped world" as in the rest of

society with public demonstrations against street collections,

protest movements in hostels against house rules and strikes in

work therapy centres, all expressions of the refusal to be confined

exclusively to a handicapped universe reinforced by the widespread

dislike of hostels, contempt for a miserly wage and so forth.

The organisation by the associations or rehabilitation centres

of urban public transport systems accessible (in terms of both ser­

vice and vehicles) to the handicapped comes under this heading of

the claim to independence. Such transport facilities are, unless

they can drive a car, the only means they have of not being depen­

dent for the slightest journey on help from family or neighbours.

Whatever the country, it seems that private associations have al­

ways been first to organise special transport services.

The associations' demands and action do not stop there; they

naturally also demand accessibility on the streets and to the build­

ings open to the public and they serve on the special commissions.

But whether it be in the United States, the Scandinavian countries

or France, their latest demands have more particularly concerned

total accessibility for the disabled to all existing or future means

of public transport. This is a formidable claim whose implications

should perhaps be looked into more closely. The fact remains that

the choice of means of transport is directly bound up with the

choice of placed residence, occupation and recreation.

The associations do not attempt to deny the fact that some

very serious cases remain for whom education, work and travel are

only possible under very special conditions and who therefore have

a very limited choice and must of necessity be grouped with other

handicapped persons. But what they presumably seek is more flexi­

bility than has so far been accepted in the "dividing lines".

We have not so far mentioned what private associations do for

the elderly. The fact is that, apart from charitable institutions

(old people's homes) or the help (especially medical) provided at

home by church bodies, cases of private institutional aid for this

category are rare. One exception is the United Kingdom, where

lay charities have long cared for the elderly who are also organised

into "pressure groups" to influence the government. In almost all

cases the State has been prompt to take over directly from the

charities. A question here, incidentally, is why there are no

private welfare associations for the elderly; could it indicate

society's tendency to associate mainly negative values with the

fact of being old?

53

3. THE POLITICAL RESPONSE AND FORMS OF PUBLIC WELFARE

Pressure from the handicapped transmitted through various

institutions and occasionally exerted by political parties or trade

unions has, as we have seen, forced the authorities to take these

categories' needs into consideration. In the case of the elderly,

because of their isolation and practically universal poverty,

governments were quick - in Europe at least - to provide financial

assistance; more recently, the large proportion of the population

they account for has been one factor deciqing governments to define

a general welfare policy.

Public welfare institutions

We shall not review national legislation concerning the elderly

and the handicapped. As already explained, governments have in

general changed their attitude from that of providing welfare for

separate or, in a way, marginal categories, featuring a wide variety

of financial aids and policies covering medical ~reatment, educa­

tion and employment, narrowly confined to these specific environ­

ments, to the recognition that the disabled must be integrated in

society and that the elderly must continue to be part of social

life. The first point to be made here is that this change is

relatively slow in coming about and that the executive units in the

various government departments do not all appear to be fully aware

of it.

Another possible comment is that even where. a general national

objective has been defined, governments have allowed various public

institutions, usually at local level, to work out welfare strategies

whose aims may not necessarily be consistent with those of other

·official bodies. Admittedly, these local institutions sometimes

began their activities before the State itself intervened, but the

fact remains that currently there are as many public welfare insti­

tutions as there are objectives pursued.

If we take access by the elderly and the handicapped to medi­

cal treatment, education and work as an example, it is clear that

this implies an improvement in the mobility of the persons con­

cerned, which is why an almost infinite variety of public medical

or social welfare services organise transport as an ancillary

activity in order to meet a single type of need. The proliferation

of such welfare services in the United States is a familiar example:

Veteran Administration, United Cerebral Palsy, Easter Seal Society,

etc. In France, too, the trend for every functional rehabilitation

centre, every school (both special schools and others) and every

old people's social centre is to satisfy its own operational needs

direct. The situation is similar in the Federal Republic of Germany.

54

The result is a piecemeal response to needs that are artificially

fragmented; the transport problem, of course, is only one example

among many.

Undoubtedly, the "special" subsidies provided by the various

Ministries are one of the main causes of the proliferation of public

welfare services in every sector and of the overlapping observed.

In this way certain public welfare institutions for the handicapped

and the elderly, like some special private institutions too, tend

to go in for empire building and are more concerned with their own

problems of expansion than with what is involved in helping these

groups.

This explains why most countries are now anxious to "federate"

the many activities in the various channels of social welfare, but

not of course to lose the benefit of the present diversity (through

which it is·easier to get to know certain sections of the public

concerned, reap the benefit of competition and attract voluntary

help). One study made in the United States for the Federal Highway

and Transportation Administrations by the University of Tennessee

Transportation Centre concludes, among other things, that an agency

ought to be set up to co-ordinate the activities of the various wel­

fare services for the handicapped at both national and city levels.

A project along these lines has now been launched in Berlin with

financial help.from the Federal Government, the aim being to intro­

duce a general transport system for the disabled by co-ordinating

the various existing services and by setting up another service to

cater for any needs or categories of handicapped they do not cover

("telebus" or "dial-a-bus" system).

In France, after the 1975 Act, a "Comite de Liaison pour le

Transport des Personnes Handicapees" was set up consisting of

representatives of the various government departments involved,

transpart operators and vehicle manufacturers, and the welfare

associations for the handicapped, together lastly, with persons

specially qualified iri this area. Although it has no decision­

making powers, this committee has been instructed to look into

transport problems, weigh up possible solutions and draft regulations

(particularly those needed to implement the 1975 Act).

A third decision-making level in elderly and handicapped per­

sons' welfare is that of local government in small towns and vil­

lages, cities, conurbations and sometimes even counties or regions,

which has played a considerable part, with or without the support

(mainly financial) of the Ministries concerned, in setting up,

organising and financing schemes designed to meet the needs of the

elderly and the handicapped. One of the traditional sectors of

local government action has always been social welfare (in cash and

kind) for the poor, who included and often still include elderly

55

and, occasionally, handicapped persons. Nowadays, these local

authorities act in a wide variety of areas such as housing, the

organisation of home care or "meals on wheels" for the elderly or

special transport services for the handicapped (sometimes also avail­

able to the elderly); services of this kind have been very quick in

developing in almost all European countries, the United States and Canada.~

Local governments have sometimes felt obliged to take action

to fill certain gaps left in State policy on behalf of the cate­

gories concerned. But even when the central government has adopted

a general welfare policy, the role of the local authorities is vital

for its implementation and especially for organising daily welfare

services. It should be noted, however, that local government action

is in most cases supplementary to action by the various specialised

welfare services; this certainly does not help the elderly and the

handicapped to make an informed choice among the different forms of

help, and invites overlapping, to say nothing of the risk of failing

to cater for all the different needs of the categories concerned.

The forms of activity of the public institutions in some res­

pects reflect the wide variety of bodies that are responsible.

Forms of public welfare

Very often, and in any event initially, the authorities found

they had to give financial assistance both to handicapped persons

and to the elderly. This financial assistance was and still is

given in certain countries in the form of welfare benefits, some­

times channelled through the general social security scheme as in

France, and in that case complementary or supplementary to the

social security scheme itself. Welfare benefits, understood here in

the broadest sense, have developed into new forms of action and new

services since the last war. Coverage of medical risks, and in

general all medical treatment and functional rehabilitation, is now

standard as is payment of a minimum income to both the handicapped

and the elderly in a number of countries. But the attainment of

objectives like social integration or helping the elderly to con­

tinue living at home call for other types of action: housing aid

for the elderly and for handicapped persons; home help or the cost

of meals in old people's restaurants and clubs, education allowances

for handicapped children and government grants for firms or insti­

tutions providing jobs in normal or sheltered environments. In

other words, welfare benefits cover practically the whole spectrum

of a person's daily needs and may, especially where the minimum

guaranteed income is enough (which is far from true in every case),

facilitate or maintain their participation in society. But for

56

this objective to be achieved, the welfare benefit machinery must

not imprison elderly and handicapped persons in a tight jacket of

administrative controls and a question that arises here is whether

this machinery does not help to perpetuate the principle of de­

pendence on welfare.

The most common and traditional forms of public welfare, still

include pricing benefits, e.g. reductions or exemptions applied to

TV licences and telephone charges. But the most frequent examples

of this kind of help apply to transport, including national rail and

air networks and urban transport. In the case of handicapped per­

sons, these measures often depend on the origin of the disability

(disabled ex-servicemen - civilian blind - more rarely the physi­

cally motor disabled) and occasionally the degree of disablement.

A recent decision (1st October 1979) by the Federal German Government

for example, allows handicapped persons with over 50 per centre­

duced working capacity free travel within a radius of 50 kms from

their homes (the escort is also entitled to the reduction). Handi­

capped children are often a case apart with the State directly bear­

ing the cost of their transport to school. For the elderly, urban

transport authorities nearly always allow lower fares, depending on

age and sometimes income, and for the very poor the fare may be

waived altogether. In France, the cost of reduced fares is borne

wholly by the local authorities in the case of urban transport and

by the carriers in the case of the national systems. In other

countries, the cost may be met jointly by the government, local

authorities and operators. In recent years, a new form of fare

assistance has been introduced in certain countries including the

Scandinavian countries, the United States, Belgium and the United

Kingdom, whereby taxi services specially organised for handicapped

persons are paid for by a "taxi cheque" system, the user paying only

a very small fraction of the cost of the journey by purchasing

vouchers at a much lower figure than their face value; the taxi

driver is paid the difference by the responsible authority. This

scheme comes under the heading of individual transport aids.

But while these aids and fare reductions may improve the mo­

bility of the elderly, the possibility is still theoretical for most

disabled persons, for whom the streets, public transport, public

buildings and blocks of flats are inaccessible. A new form of

public welfare therefore consists in defining and enforcing access­

ibility standards for blocks of flats and other buildings and for

public transport, as part of a general obligation to improve

accessibility for the disabled. In many countries, therefore,

national and local government works departments have begun to de­

sign and install the technical improvements necessary to enable the

disabled, especially those who use wheelchairs, to use the streets,

57

enter buildings open to the public and live in housing designed £or

all categories o£ people.

In this connection, the United Kingdom has introduced an

"orange badge" which entitles disabled persons using a car (as

driver or passenger) to park, close to their destination, almost

regardless o£ where this may be.

The problem OI the accessibility OI transport systems is at

present among the most sensitive. Initially, as we have seen, the

private associations and their local governments organised public

transport services specifically for the handicapped with vehicles

specially equipped to accept wheelchairs and taking the person con­

cerned from door to door, Such systems are now very widespread.

However, under pressure from the handicapped and their associations,

governments are today confronted with the demand for "total access­

ibility" in other words £or all public transport vehicles to accept

people in wheelchairs. United States Regulation 504 and the French

1975 Act both explicitly provide £or such total accessibility to

transport systems (the French Act being distinctly more reserved

than the American regulation). This strategy presents many problems

of implementation as regards the design of vehicles and installa­

tions and also with regard to operation. In particular, many

people feel that it would be far too costly by companies or with

the slight benefit that handicapped persons would gain. Certain

disabled people and some of their associations appear to share

this view.

It is not possible £or the present to predict whether public

welfare will really make total accessibility of transport systems

its aim or whether new tyPes of help will develop such as payment

for the conversion of private cars, the more general application

o£ indiVidual aid and so on. Be that as it may, there can be no

denying that accessibility to the different modes of transport is

one of the prerequisites £or the social integration o£ handicapped

persons.

4. 'JMORPHOLOGY" OF SPECIAL TRANSPORT SERVICES

This is not the place for an exhaustive list of the special

transport services for handicapped persons and/or the elderly.

Such services now exist in the majority of European countries, and

in the United States and Canada. They have developed rapidly over

the last ten years, especially in the United States, but the

Scandinavian countries are apparently still well ahead, both in

the number of services provided and in the variety o£ needs that

are met,

One of the major difficulties with which special services have

to contend is this great variety of needs. Research studies have

shown how the wide differences in handicapped persons' social, cul­

tural and economic background affects the organisation of their

lives. In view of these differences, it is reasonable to suppose

that their transport "demands" will not be the same and that an

apparently similar demand will not relate to the same "needs", nor

have the same significance for some as it does for others.

Without going into the details of a typology of paratransit

(which has already been the subject of a Round Table), the purpose

in this section is to analyse the main features of special services

and to see to what extent they meet the needs of handicapped and

elderly persons and especially their need for independence.

The first point in our view, is the question of the correlation

between the organisers of the services and the purposes assigned to

them, the organisation of these services and, in the final analysis,

the type of person using them.

We have already stated several times that the operation of

special transport services - particularly those for handicapped per­

sons - was at first the result of private initiative by associations

or institutions providing care, education and employment for the

persons concerned. The public medical or social welfare services

and those of local authorities in particular have increasingly taken

over these services, sometimes with financial assistance from the

central government (subsidies and/or loans). In our view this

change at organiser level has affected the type of service. It

seems to us, for example, that when a public or private organisation

decides to set up a transport service specially for the disabled,

the aims it assigns to the service as regards satisfaction of needs

are closely bound up with its own idea of what welfare for the

handicapped should consist of and what their place in society should

be.

In France, an association originally called the "Groupement des

Intellectuels Handicapes Physiques" was responsible for starting most

special transport services. This association, which is run by dis­

abled ex-members of universities naturally tried first to facilitate

access to university and school for students and school children.

The association later became the "Groupement pour l 1 insertion des

handicapes physiques" and opened the transport services it had set up

to employees and others to help with integration, but it continues,

in the eyes of the handicapped, to bear the mark of its origin,

since some of them still feel that the services provided are not for

them. At all events, the aims of this association, the needs it

regards as being the most urgent and the categories of person it has

in mind are obviously different from those that would apply in the

59

case of an association running special institutions (for treatment,

education, training, etc.) that decided to set up a transport ser­

vice. The organisation of the service itself would differ: the

first case, a door-to-door dial-a-ride service for a special public

and selected destinations, comes under the "many to few" heading in

the paratransit typology; its subsequent extension (in theory) to

all users and to all destinations classifies it under the "many to

many" heading. In the second case, the object is often to take a

group from a hostel to an institution or, more rarely, to provide a

multiple pickup point ("many to one") service. At all events, no

matter what private association of handicapped persons initiates

the service, it appears that certain categories of the disabled will

purely and simply refuse to use it since they see it as part of the

"world of the handicapped" which they reject.

However, the fact that a local authority is the organiser of

a transport service does not guarantee that its aim will be to

satisfy the wide variety of needs of all handicapped persons. Thus,

the thinking on special transport differs greatly depending on

whether it is operated by a social welfare office (very frequently

the case in German towns) or the public transport services (as in

French, and often American, towns). In Federal Germany, for

example, applicants have to meet certain conditions as regards both

their medical state (which also applies in Stockholm and in certain

French towns), and their income. Sometimes the conditions include

the proviso that the handicapped person or his family does not

have the use of. Furthermore, needs regarded as having priority are

often defined more restrictively in the case of a transport service

run by a social welfare office than when the service is provided

by the public urban transport undertaking, the latter disregarding

the purpose of the trip, whether it be for shopping or sports acti­

vities or even commuting (most services in Germany do not allow

this kind of trip). Yet the need for commuting facilities(between

home and job, school or university) is in fact regarded by local

authorities organising special services as having greatest priority,

together with access to treatment. These are the needs that have to

be satisfied first, the others (taking part in cultural, social and

other activities) being met only to the extent that capacity per­

mits, which of course makes it harder for handicapped persons to

take part at will in urban activities generally. One might well

ask, incidentally, whether these needs ought not to be met by a

different system such as individual aid; is a special service

really capable of meeting all needs, particularly if it has to cater

for people living and working in normal conditions and therefore

serve a very wide range of pickup points and destinations?

60

ORGANISER NEEDS MET ORGANISATION OF THE CONDITIONS OF ACCESS USERS SERVICE

Associations Treatment, education, Group transport - - Must be handicapped Handicapped persons running training, employment "many to one" - I'lust belong to the attending special institutions with other handicapped institutions

people institution

Associations not School, work, socio- Many to few Must be handicappe_d All handicapped persons running institutions cultural activities Many to many

(normal or sheltered)

Local authorities

- Social welfare - Treatment trips for Many to few Relatively restric- Handicapped person satis-office - Public official purposes tive (medical, fying the criteria welfare services and, rarely, work financial) etc.

- Old people's clubs Many-to-one Must be over 60 or 65 Elderly people and restaurants, Group transport senior citizen activities

- Public transport All needs, but in Many to many Medical conditions in All handicapped persons services fact priority for some cases

school, work and treatment

The situation with regard to elderly people is rather different:

measures to improve their general mobility are often based on reduced

fares on general public transport; the prime aim of the special ser­

vices, usually run by the social welfare office, is to give them

access to the social and cultural activities organised for "senior

citizens", old people's clubs and restaurants and treatment and rest

centres, which are all essential to the policy of helping them con­

tinue to live at home.

It is' thus possible to establish a "morphology" of special ser­

vices by analysing the types of organiser, the needs regarded as

having priority, conditions of access and users; this "morphology"

will help us finally to .consider the extent to which the special

services meet the independence requirement.

A point worth stressing is that the services for the handi­

capped, even those with the fewest constraints, mainly meet the need

for transport to one or more (normal or sheltered) group-type

destinations.

Do the special services meet the independence requirement?

In order to answer this question in depth, we would have to

have a very detailed picture of the users of the special services,

including the purposes for which they use them and the changes the

use of these services brings about in the.lives of handicapped per­

sons. It will be equally important to know who the non-users are

and why. By finding out who does and does not use the public trans­

port services for the handicapped, it should be possible to study

the importance and meaning of the "transport factor" in their stra­

tegy of integration or re-integration and thus assess the real

"usefulness" of these services.

We can already go some way towards giving an answer. The

"morphology" table of the special services; rudimentary though it

may be, shows that some mobility needs are rarely satisfied, either

because they have not been taken into account by the organisers or

because they can only be allowed for to the extent that the capacity

of the service permits. This is particularly the case for shopping,

trips for official purposes and socio-cultural and sports activities

in general. At the same time, certain conditions, such as the limit

to the number of trips which can be made using the special service

(often the case in Germany), sometimes very severely restrict the

categories of handicapped who can use the service and therefore its

usefulness in an integration strategy. More broadly, the opera­

tional obligations of the services such as the need to book in ad­

vance (24 hours in some cases), the restricted timetable (little or

no service in the evenings or on public holidays, for example) and

62

the time the trip takes have the same effect, a9 does the def·ini~

tion of priority needs by the organisers (owing, in particular, to

financial constraints).

The use of private cars by handicapped pero;ons provides another

element for assessing the usefulness of the o;pecial services: an

analysis of the modes of transport at present u$ed by the physically

handicapped shows that the car is way ahead of the others with the

taxi often second. This is undoubtedly because of the fact that in

peripheral urban areas (and especially r1..1ral areas) the car is still

the only means of transport accessible to ~any handicapped persono;.

But it is also apparent that even where a special service exists,

many disabled people who have the use of a car (whether they drive

it themselves .or not) continue to use it, especially for "non­

essential journeys", in spite of parking problems (cf. the "orange

badge" in the United Kingdom),

The demand for the use of taxis also points to a certain lack of

suitability on the part of the special services. Taxis seem to be

the only mode which provides full door-to-door transport, eqpecially

for disabled persons in wheelchairs, eliminating all the distressing

problems from which there is no escape once any other form of

transport is boarded. They seem also to be the most suitable for

private trips for shopping, recreation, etc. and are certainly much

used for these purposes in many countries li~e the United Kingdom,

Sweden or the United States, usually in association with an indivi­

dual aid scheme.

These few facts are not sufficient, of course, to judge the

usefulness of public transport services for t]1e handicapped but. they

may highlight their limitations. The speci~l services can undoubted­

ly play a by no means negligible role particularly in norma~ school,

university and occupational integration. They are also essential

for a policy designed to help both handicapped and elderly people

to continue living in their own homes. The very wide variety of

organisers and services themselves although it does imply definite

risks, could be a favourable factor in terms o;t: a broader coverage

of needs, provided that efficient co-orqinatipn is maintained,

especially at conurbation level, together wit):1 an efficient system

for informing the persons concerned about all the facilities. But

must the services be obliged to meet all needs and all demands?

Should they not be regarded as just one of t]1e ~odes of transport

provided for handicapped and elderly persons?

63

PART IV

FROM ANALYSIS TO DECISION-MAKING

A. BIEBER Institut de Recherche

des Transports Arcueil France

SUMMARY

1 • IDENTIFYING NEEDS 67

2. ASSESSING THE SERVICES PROVIDED BY EXISTING FACILITIES 70 2.1. Use of _transport 70 2o2. Analysis of the operation of the various

sub-systems •••••••••••••••••••••••••••••• o •••••••• 72 2.3. Appraisal of services provided by special

agencies and transport arrangements •o••o••oooooooo 76 3o THE DESIGN OF VEHICLES: THE CONTRIBUTION OF TECHNOLOGY •o 77

4. PROVIDING EFFECTIVE PUBLIC AID •••••••••••••oo••o••o••ooo 78 4o1o Centralised or decentralised aid? oo••••o•••o••ooo 80 4o2o Individual aid or aid to the transport operator?,, 81

5. REDUCING THE COST OF SERVICES 84

6o INTEGRATING TRANSPORT PROGRAMMES AND TOWN PLANNING PROGRAMMES 0 0 •••••••••••••••••••• 0 0 • • • • • • • • • • • • • • • • • • • • • • S5

FINAL COMMENTS

BIBLIOGRAPHY

66

87

89

In this part we shall endeavour to show how the information that

is collected can assist with the decisions which the public authorities

have to take to facilitate the mobility of elderly and handicapped

people.

It should be noted that help for the handicapped, and to a lesser

extent the elderly, is largely the achievement of the numerous social

service and welfare agencies which have taken the place of the charit­

able bodies that formed in the 19th century.

Historically, pressure by these bodies has led the public

authorities to join in efforts to mitigate the reduced mobility of

elderly and handicapped people. As a result, policy has frequently

been made up of a considerable range of highly specific initiatives

launched at different times and meeting needs in varying ways and to

varying degrees. Action by the authorities generally stems from a

wish to jntroduce more uniform public aid, the chief policy aim should

be to ensure that the various categories of people involved are

helped equitably rather than equally. A number of matters have to be

considered here and they will be examined in succession, under six

headings:

1. Identifying needs.

2. Assessing the services provided.

3. Design of equipment: the contribution of technology.

4. Devising an effective form of public aid.

5. Reducing costs.

6. Integrating transport and town planning policies.

1. IDENTIFYING NEEDS

The notion of need directly involves a comparison between given

specific circumstances and an ideal, and it soon becomes clear that

these specific circumstances are both numerous and varied. Very few

studies on the handicapped do not contain their own typology of handi­

caps. These typologies then play an essential role in shaping the

need concept, so it is important to consider their classifying func­

tion and their validity in terms of the real circumstances of indivi­

dual handicapped people.

Three main variables are found in these classifications.

The first, in frequency of use and without doubt in relevance

too, are ergonomic variables dealing with the difficulties or barriers

to normal mobility. The variables may be highly disaggregated (those

of the medical type, according to the kind of lesion producing the

handicap), or partly aggregated, based on more functional analysis of

6'(

mobility difficulties, or else highly simplified and almost sociologi­

cal in character (presence or absence of escorts, for instance).

These variables are defined in more or less detail according to

the type of problem under consideration. A common feature is that

they all attach very great importance to walking problems, which are

considered as the chief obstacle to normal mobility.

However, these ergonomic classifications give no idea at all of

the importance of mobility in a person's life. For this reason a

second type of classification has been devised, based on the concept

of activities, and more specifically levels of participation in

certain activities. These classifications may take various forms

and the one now described is taken from J.A. Miller(1) who takes a

detailed set of activities and indicates first the actual levels of

participation of a disadvantaged population, and second the extent

to which the people concerned would like to increase that participa­

tion. The diagram below summarises the results of this analysis.

DESIRE TO PARTICIPATE

VERY HIGH

FAIRLY HIGH

LOW

NON· EXISTENT

% 0

«DISCRETIONARY» ACTIVITIES

50 100 ACTUAL PARTICIPATION

68

The diagram clearly shows how handicapped people's mobility is

reduced to what may be termed the functional portion of social life,

with a low level of participation in leisure activities but, at the

same time, very considerable desire to take part in them.

It illustrates how much remains to be done before handicapped

people can enjoy comparable lives to the normally mobile.

A third variable, income (which is generally far lower than in

the reference population), is manifestly important in determining

the way of life of the handicapped, and to a lesser extent the

elderly.

When the way of life of handicapped people, and the factors in

that way of life that affect the need for mobility, are examined in

greater detail, factors relating to the family environment naturally

arise. These factors, more difficult to express in formal terms,

provide the best definition of the individual's degree of integration

in society. But such definitions are never the outcome of simple

one-way mechanisms(*). The social environment clearly creates special

needs for mobility, but may obscure others.

Lastly, it should be noted that some trips by an elderly or

handicapped person may be replaced by a service at home. This intro­

duces a further problem in the evaluation of mobility needs, that of

mobility substitutes, and it would be unwise to ignore these system­

atically because in certain circumstances they can be of great

importance.

It can thus be seem that four types of classification are in

general use for analysing the transport requirements of elderly and

handicapped people. The first type, relating to the handicapped only,

is linked to the nature of their handicap. The three other classifi­

cations, which cover both the elderly and the handicapped, deal with

essential components of their way of life: levels of participation

in activities making up that way of life, levels of financial resources

and the relevant constraints, and lastly forms of social integration

and in particular the forms of aid available (particularly when they

are a substitute for mobility).

The wide range of social circumstances of handicapped people is

an argument for methodological approaches that encompass the social

environment of the groups concerned, rather than variables that simply

describe the handicap.

A good deal of caution must accordingly be used when considering

any of the highly synthetic model approaches, such as presenting the

mean frequency of movement observed over a group of handicapped people,

*) POULENAT-ABALLEA, TARRIUS, Les conditions de l'insertion sociale des handicapes physiques - Research Report No. 40 Institut de Recherche des Transports, March 1979.

69

for example, as a "social norm" which can be transposed from one case

to another. This observation is borne out by the very wide range of

trip frequencies that are found in surveys. This applies first to

variations in space, as each experiment with transport for the handi­

capped produces different observations.

The frequencies also vary widely in time, as can be seen from the

findings reached at Goteborg regarding the very slow penetration of

special services for the elderly and the handicapped (from 2,246

users in 1969, when the scheme was set up, to 12,651 users in 1975,

with absolutely linear growth over the seven years).

This means that only surveys that aim at ascertaining levels of

participation in activities, and the desire to take part, perceived

constraints and help for individual handicapped people (services at

home) and break them down by precise sub-groups of the elderly and

handicapped population, are capable of providing local authorities

with information on need intensity. This analysis must be accompanied

by an assessment of the services provided by facilities already in

existence.

2. ASSESSING THE SERVICES PROVIDED BY EXISTING FACILITIES

2.1 Use of transport

The numerous surveys on the trip patterns of the handicapped and

the elderly, the wide range of which has already been mentioned, bring

out a number of significant facts which are summarised below.

In the case of elderly people, the salient feature is the rela­

tively minor incidence of public transport. The considerable import­

ance of walking for day-to-day purposes in the European context should

also be noted.

The two tables below illustrate this:

USE OF DIFFERENT MODES BY THE ELDERLY(2)

Shopping

Health

Leisure/ various

Never go

; Drive car

5.8%

9.8%

70

Driven by friend

20.6%

25.3%

18.8%

Walk i Take !the fbus

10.3% 1 .6%

4.3% 5.7%

7.1% '1 .9% . ___ j ___

USE OF DIFFERENT MODES BY THE ELDERLY(3)

-· l I Car Car Walk Bus ! (driver) (passenger)

Shopping 1 9% 5% 63% 21% -------------

Clubs and i I 37% 47% 16% leisure facilities ! <£:--- +

--~------ --.

Visits to friends I 20% 69% 11% and relatives i '-·-~ ··--- >

!

A second significant feature is the high proportion of car trips

in the United States. It is also noted that a very large number of

trips by car require an escort, who in many cases is not the husband

or wife (the survey population included a high proportion of single

or widowed people).

In the case of the handicapped, a recent survey in Lyons(4),

covering only handicapped people who are unable to walk and so use

wheelchairs, showed that fewer than one-third have regular use of a

private car, and fewer than one-sixth can drive. In spite of these

low proportions, the modal split is as follows:

Wheelchair (unassisted) 14%(*)

Car

Taxi

Special vehicle

68%

9%

6%

Public transport bus 3%

In an American study, a highly detailed breakdown by trip purpose

and type of handicap brings out the considerable importance of the

car for all journeys (between 50 and 70 per cent), scheduled and

special bus s·ervices have practically equal shares of the balance. ( 5)

It can thus be seen that elderly and handicapped people are not

entirely dependent on public transport. This should not be taken as

a reas,7n for glossing over deficiencies .. in .the public transport sector,

but the analysis of the services provided to the handicapped and

elderly would be considerably impaired if it were confined to public

transport alone. A safe and convenient pedestrian environment, well­

located parking, arrangements for providing information about the

facilities available to the handicapped in public places, and so on,

also play their part in satisfying the mobility needs of these dis­

advantaged categories. A comprehensive survey of these factors is

accordingly required if attention is not to focus too greatly on one

particular aspect of th~ problem.

More especially for the handicapped, a satisfactory approach

would· no doubt be to examine the various components of the transport

*) The length of these journeys is as a rule well below 2 km. Only 3 per cent of the population studied have powered wheelchairs.

71

system in the light of the problems facing the various categories of

handicapped people. This is the method used in a recent American

study(6), from which the following classification is taken.

In spite of its inherent simplifications (in particular, the

yes-no answers to the questions) this division into segments has the

merit of indicating a range of possible forms of action.

Group

Group 2

Group 3 Group 4

Group 5

may be assisted in using their own cars (reserved parking

spaces, etc.) .

may desire very substantial ancillary services, although of

a highly specialised kind (minor adjustments to buses,

information for people with impaired sight or hearing, etc.).

chiefly requires user-side subsidies.

may benefit from operating innovations (call points for the

main generators, route changes requested by telephone, etc.).

in addition to the measures listed above, may benefit from

arrangements with taxi companies.

Group 6 requires special services with modified vehicles (minibuses

with lifts).

Group 7 calls for user-side subsidies for the use of the only vehicles

that are accessible in such cases (ambulances, etc.).

2:2 Analysis of the operation of the various sub-systems

A pragmatic approach to the mobility problems of handicapped and

elderly people should follow from the principle of ,a balanced improve­

ment in all the various modes accessible to the individual groups

mentioned earlier.

Surveys made in a number of pilot studies indicate that none of

the groups mentioned earlier is negligible, as can be seen from the

table below, and that there are numerous ways in which each could be

helped.

EXAMPLE OF DISTRIBUTION OF ELDERLY AND HANDICAPPED POPULATION

IN THE 7-GROUP CLASSIFICATION DESCRIBED IN SECTION 2.1

(data collected at San Diego, California)

Source: reference (6) ---------------..,.-----------------------

Total

Group

1

2

3&4

5 6

7

Trips per day

133,100

21,200

9,600

30,400

3,400

not known

197,700

Percentage

67%

11%

5%

15%

2%

100%

Accordingly, an assessment of the services provided to handi­

capped and elderly people should not disregard any of the numerous

72

Group 1

Figure 1 SEGMENTATION OF NEEDS EXPRESSED BY A HANDICAPPED POPULATION

Gr. 2

Gr. 3

Segmentation proposed in 7 groups

73

Gr. Gr. 4 5

[SOURCE 6]

CAN USE CONVENTIONAL TRANSPORT IF VEHICLE

COMES TO DOOR ?

CAN USE VEHICLE WITH SPECIAL

FEATURES FOR ACCESS

Gr. 6

Gr. 7

services which, in additi.Qn "j:p __ walking(*), contribute to satisfying

their needs.

2. 2.1 As_sessment of :t.h~. ISJ?r:vices rendered by cars can be

provided by gen~:tal .Jll-9.bi.Li ty surveys

Sev~ral special aspects may be noted:

a) P8,rl;dng difficul tie~S where reserved spaces are not available

(especially for severely handicapped people).

b) .Cohst~aints implici;t ___ iti se.rvices provided by friends or

rejatives: for many JQUrneys, the elderly or handicapped

need a driver or someone to be an escort. While the services

provided by friends or relatives are important for car use by

handicapped and elderly people, it should be noted that often

there are major constraints. Apart from those related to

timing or destination, there may be major psychological

obstacles because of the possible "cost" to the person who

is helped of having io conduct the negotiation.

c) Economic constraints, Keeping a vehicle in running order may

make considerable calls on the usually slim budgets of handi­

capped or elderly people. This difficulty should not be

underestimated.

2.2.2 Appraisal of s~ry.:i,gf?.s. provicl,ed by taxis

Taxis involve difficuities over and above those noted with

private cars, and they must be clearly established.

One of the foremost difficuities appears to be that some taxi

drivers will not accept handicapped people. Though by no means a

general ruie, the time needed to embark handicapped people makes some

drivers refuse. Local authorities may issue regulations on this score

(compulsory acceptance of passengers), often associated with fare

concessions (special fares, with or without a municipal subsidy).

A second factor inhibiting the use of taxis by handicapped people

is the 'problem of third party insurance during the taxi journey.

In spite of these difficulties, taxis are very much used as a

means of transport for the elderly and handicapped.

A report on New York taxis(7) estimates that elderly and handi­

capped people make up 15 per cent of all customers using radio taxis

in New York.

In Stockholm, which has introduced special measures for the han­

dicapped and elderly, they account for some 40 per cent of taxi trips,

i.e. 4 million trips in 1977 by over 60,000 holders of cards issued

by the health authority (out of a total population of 800,000). In

*) For walking, the elimination of physical barriers together with general improvement to pedestrian safety is clearly a very impor­tant aspect, not covered in this report, of the policy to be implemented.

74

Stockholm, 90 per cent of non-private trips by handicapped people

appear to be made by taxi, and only 10 per cent by demand-responsive

minibuses (although there were 205 of these vehicles in 1977).

2.2.3 Appraisal of services provided by scheduled bus routes

The problem takes quite different forms for elderly non­

handicapped people and for handicapped persons, whether elderly or

not. For the first group, who use ordinary public transport in con­

siderable numbers, conventional ridership surveys provide a picture

of utilisation patterns. As a rule, the effects of the concessionary

fares available to the elderly (or certain categories of older people)

can be deduced by observing the impact of fare changes on levels of

bus ridership.

For the second group, a detailed examination of the present

barriers to the use of buses by handicapped people leads to the

inescapable conclusion that by and large scheduled bus services play

a small part in satisfying the mobility needs of many handicapped

people.

HARTGEN(8), working on a sample of handicapped people in the

State of New York, has drawn up a table that clearly shows the many

barriers to the use of buses by handicapped people.

PERCENTAGE OF ELDERLY PEOPLE INTERVIEWED SAYING THEY

HAVE DIFFICULTIES AT VARIOUS STAGES IN THE CONVENTIONAL

PUBLIC TRANSPORT CHAIN

Barrier

Information:

reading the timetable

reading the route map

telephoning for information

Access to stopping points:

walking up or down ramps

crossing roads

bad weather

apprehension about their safety

distance from the stop

lack of shelter

no seat in shelter

Access to yehicles:

climbing steps

having to stand

fear of crowds

difficulty in paying ·

moving around inside the vehicle

space for wheelchair

7?

Percentage

7.6 8.3 6.9

16.6

16.6

18.0

7.6 14.6

7.6 11 . 1

26.4

15.9

10.4

5.5

20.1

3.8

During the trip:

poorly designed seats

jolting and shaking

trip takes too long

Getting down from the vehicle:

requesting a halt (telling the driver)

getting out of vehicle

11 • 8

3.5 5.5

6.3 8.3

We shall return to this subject when dealing with the problems

of improving vehicles.

2.3 Appraisal of services provided by special agencies and transport

arrangements

This is the most important task as far as public transport is con­

cerned. It is hard to analyse because of the large number of bodies

which provide such services, either directly or through contracts

with carriers (cf. Section 3).

The ~xpansion of specific paramedical services, particularly in

the United States, makes it virtually impossible to list all the

agencies which provide transport to and from specialised establish­

ments (health care, education, social welfare) for various groups of

permanently or temporarily handicapped people.

While it is somewhat less developed in Europe, this is still a

difficult area to survey. A number of stages are recommended:

i) survey of specialised care and education establishments;

ii) survey of community homes;

iii) survey of carriers and taxi drivers' associations;

iv) cross-checking with the help of information on sources of

public funding (where this exists);

v) cross-checking with the help of data held by social service

agencies (municipal or area offices).

Appraisal of the operation of these services will relate to the

following points:

a) type of service provided;

b) conditions of access;

c) quality of service;

d) financial aspects.

The criteria here are different from those normally used in con­

ventional transport research.

According to Teixeira and Karash(9), the main factors in analysing

quality of service are:

i) the period of advance notice that users must give. Many of

these systems are too small to meet demand, and several days'

notice must often be given;

ii) reliability of the service;

iii) type of assistance in boarding provided by the driving crews;

76

iv) ~ehicle fittings (especially for wheelchairs);

v) more conventional aspects (such as cost, journey time, etc.).

3. THE DESIGN OF VEHICLES: THE CONTRIBUTION OF TECHNOLOGY

Technology's contribution to overcoming the mobility problems of

elderly and handicapped persons is unquestionably one of the most

spectacular and most popular topics with authors of the specialised

literature on the subject.

There is no denying the vast improvements which technology has

made in the lives of the handicapped; the wheelchair is an obvious

example of this (although it is clear that further development of

such technological innovations is often limited by economic factors,

e.g. in Lyons, only 3 per cent of wheelchair users currently have a

version with an electric motor, which is obviously much more expensive

than one without).

The recent trend in American legislation concerning access to

buses is a good illustration not only of the political and symbolic

attraction of a technological improvement (in this case, installing

lifts for wheelchairs on scheduled bus services) but also of its dis­

advantages, i.e. its disastrous cost-benefit ratio, its very limited

impact on the handicapped and the very mixed reaction of the non­

disabled.

A French study has made a more systematic analysis of the tech­

nological modifications required on buses.(10) One of this study's

merits is to show that for all handicapped persons as a group

(severely plus slightly disabled) there are many improvements which

could be made apart from just installing lifts for wheelchairs.

Shallower steps, hand rails, doors staying open longer and simpler

fare-paying would be a considerable help in removing the "barriers"

confronting what is a far from negligible proportion of passengers

if one includes the large number of elderly persons with only a slight

handicap.

The existence of numerous specialised agencies means that special

vehicle types are produced in very small numbers. Such specially

designed vehicles embody more radical modifications improving both

wheelchair access (ramps, lifts or the lowering of the entire vehicle)

and interior. fittings (anchorage for wheelchairs, safety devices).

In the case of underground railways (and existing rail facilities

~n general) it is often difficult to retrofit existing stations to

cater for the severely handicapped. Moreover, it soon becomes apparent

that if the modifications are made, they are little used (since the

distance to the station is often the major obstacle). However, many

recent projects include special and even highly complex installations

(e.g. lifts, ramps, special fare-paying systems, etc.).

77

Taxis too are often the subject of proposals for vehicle modifi­

cations. Apart from futuristic suggestions for taxis designed entirely

for the handicapped, there are more realistic suggestions for the

fitment of sliding or swivel seats (for the front passenger) and some

notable, but isolated, examples of what has been done by certain

taxi-operators(*).

Lastly, the category of handicapped where technological develop­

ment can be most crucial in its effects is that of people with a

sensory disability, the specific reference here being to information

and the mass media where defective sight or hearing are a particular

disadvantage.

4. PROVIDING EFFECTIVE PUBLIC AID

Public aid to the elderly and handicapped is by no means confined

in the main to assisting them in their travel. The solution to their

mobility problems is, to a certain extent, already facilitated by the

financial assistance given to certain categories of the population

which deserve the sympathy and support of the community on various

grounds. However, in addition to this general non-transport form of

assistance, which constitutes a social and economic transfer for the

benefit of the disadvantaged sections of the community, there is this

aid relating spec~fically to transport.

It can be classified into five major categories:

a) Fare concessions (special rates for certain categories of

elderly or handicapped persons) on established transport

services (buses and taxis).

b) Aid in the form of "capital outlay" for the established

transport services, e.g. State grants for installing lifts

for wheelchairs on some public buses (cf. American

legislation).

c) Financial assistance to a body organising a special transport

service - the organising body being either a medical service

or a social welfare service. These funds are generally used

in one of two ways:

either employed directly by the organising body which will

then run a transport service linked to its main medical

or social activity,

or employed indirectly via a transport operator under

contract to provide a transport service linked to the

organising body's activity and on its behalf.

d) Individual aid for making a certain number of trips on all or

part of a public (bus) or private (taxi, minibus, etc.)

transport system.

*) Cf. The Oslo project for the first and the Canton of Geneva scheme for the second.

78

In the first case (individual :;tic;l for bus transport) this is

merely a special form of fare subsidy limited, for example,

to a specific number of journ~ys. In the secqnd case (taxis)

it is again a system of fare svbsi~y with the same underlying

economic principle, but with the agditional advantage of

epabling methods to be used (e,g. taxi-vouchers) whereby such

aid can be easily monitorE?d in a conte;<t where a service is

provided by a large number of 9wner~operators(*),

e) Lastly, the direct operation by the public authority of a

special service accessible to _e~de~1y and handic~pped persons,

with or without concessionary fa~es.

Such a service may take one of several forms:

door-to-door, all-user service to any destination;

- door-to-door, all-user service to specific destinations;

- door-to-door, specific-user service to specific destinations.

In addition to this aid with regard to the public transport

services, there are various forms of ~nqividual mobility allowances

which are only referred to here as a reminder, but which are of con­

siderable importance:

- aid for the purchase of a powered wheelchair;

- aid "in kind", i.e. making it easier for elderly and handi-

capped persons to get about on foot (removal of physical

"barriers" to mobility);

- aid to car-use by handicapped persons, e.g. modifications to

the vehicle, allocation or creation of special parking

facilities;

aid through the provision of "mobility substitutes" (e.g.

"meals-on-wheels", laundry services, hqme delivery services);

- aid through the provision of escorts for certain journeys.

There is a strikingly wide variety of public aid measures in

this area. Bearing in mind the historical origin of aid services

for the elderly and handicapped (cf. Part III, Morphology of Special

Transport Services) it is easy to understand this vast profusion of

varyingly specialised forms of assistance. It naturally gives ~ise

to wide disparities in individu.al treatment and, with them, to the

feeling that a general transport service for elderly and handicapped

persons, under the direct responsibility of the local authority,

would do much to reduce sucq disparities.

*) This analysis does not cover individual aid connected with medi­cal treatment, i.e. a journey generally made by ambulance 9ut which, in certain cases, may-be made by taxi, with the fare reimbursed as a social security benefit.

79

4.1 Centralised or decentralised aid?

The first point at issue with regard to the effectiveness of

public assistance concerns the merits of public, centralised administ­

ration of aid for the handicapped versus decentralised administration

by providers of medical and social services.

Thus, with regard to the preceeding classification, solutions

of type (e) contrast with those of type (c) in one respect, and with

type (b) in another. The main arguments on either side are as

follows:

- The role of voluntary organisations

Many authors, though not underrating the value of these organisa­

tions, nevertheless stress one feature that works against providing

aid of a uniform and effective kind. In the first place, aid cannot

be uniform because each organisation, if it is to survive, must defend

the interests of a particular category of handicapped person. Its

action may as a result be concerned with a highly specific category

of handicapped persons, in particular in the negotiations to obtain

subsidies from the ministries concerned.

Secondly, aid cannot be effective because the ability to organise

transport services may be lacking. What is more, in the case of some

of the larger organisations, a particular concern to consolidate their

position may lead to the creation of jobs and services which are not

properly utilised. An American report (Hood, op. cit.) has recognised

this danger, and refers to:

"some human service agencies that are 'empire builders'. They

are more interested in increasing their budgets, employing more

personnel, and operating more equipment than in providing a cost­

effective programme to their clientele".

- The system of subsidy by central authorities

The "historical" statutory frameworks for social aid programmes

need close examination: some of their provisions hinder the efficient

operation of transport services for the handicapped.

The system of "special" subsidies allocated by various ministries

are a root cause of the increasing number of services and the over­

lapping that is found and which prevents public funds being used

effectively. One answer would be to set up an agency at local and

central level to co-ordinate the activities of such services.

- Risk of disorganised competition (duplicatlon)

In some countries, the vast number of organisations dispensing

aid makes one suspect that there may be a certain degree of overlap.

The making of an inventory of such services is therefore generally

regarded as a methodological priority. It is not however apparent

that such an inventory would suffice to bring closer a solution to

80

the problem of co-ordinating services whose co-existence in many cases

has roots which go much deeper than just a lack of information.

- Possible unreliability of smaller systems

This obvious aspect of the operation of highly specialised

systems can result in very poor quality service {e.g. the problem of

waiting lists).

However, the disadvantages of decentralised administration need

to be weighed against some of its undeniable advantages:

- Possibility of using unpaid helpers

Many observers have noted that total or partial reliance on

voluntary help tends to diminish as the size of the transport system

increases. Thus, if the smaller, specialised systems were to be

replaced by centralised systems, this could result in a diseconomy

of scale. The extent of this economic loss needs therefore to be

set against the expected economies of scale from a rationalisation

of the services provided.

- Better knowledge of users

The drivers employed by small, specialised systems can acquire

a very good knowledge of users' life patterns. Such knowledge can

contribute enormously to efficient planning of itineraries and

schedules (cf. the experience with "dial-a-bus" systems). Here again

there could be a danger of a certain diseconomy of scale.

- Psychological aspects

This is no doubt one of the most important and controversial

issues in the argument about specialisation, particularly when a

special service (type e) is proposed as a solution to the problem of

total accessibility (type b) on scheduled bus services.

The unquestionable attraction of being able to use the same

services as the non-handicapped has to be weighed against the psycho­

logical stress which .this can create in practice. Some handicapped

persons are aware of this and apparently prefer a special service,

whilst others have no such apprehensions and are even strongly in

favour of "immersion" in the world of the able-bodied. These two

opposing and not easily reconcilable attitudes occur whatever the

degree of specialisation involved. From this point of view the

"specialised" solution often appears less risky and therefore the one

preferred, particularly by the local authorities.

4.2 Individual aid or aid to the transport operator?

The second difference·of opinion is between supporters of indi­

vidual aid (type d) and supporters of other forms of aid (channelled

via a transport operator or organiser).

81

The principle of individual aid is simple, i.e. users (belonging

to certain specific groups) purchase transport vouchers, at a price

substantially below the value of the voucher, which they exchange for

transportation services. The transport operators then redeem these

vouchers from the public authority at values agreed to in advance.

These vouchers can be in the form of tickets, charge slips or

credit cards. They provide the funding agency with the information

it requires to determine the amount to be paid to the transport

operator. The user pays either a fixed amount per journey or a per­

centage of the normal fare (ranging from nothing to the full fare).

The user pays for the journey either by handing the transport operator

a voucher purchased in advance or by paying cash when he makes the

journey and signing a charge slip for the remainder of the fare. The

administrative problem where such "user-side" schemes are concerned

is to ensure that the subsidy paid to the transport operator actually

corresponds to journeys made by members of the client group concerned.

However, it would seem that fraud is not a serious problem for several

reasons:

- Because such schemes are administered at a local level, a

tight check can be kept on the tickets used individually by

members of the client group.

- It is unlikely that private transport operators, whose activi­

ties depend to a large extent on the local authority, would

associate themselves with fraudulent practices which could

jeopardise their existence.

- Users can easily obtain information about the fare structure

for available services.

This school of thought considers that the fundamental advantage

with the system of user-side subsidy is that it is based on real

market laws. By reducing the cost of a service for certain users, it

stimulates demand and this increased demand is relied upon to generate

an increased supply of services. Transport operators are expected

to attract customers in order to obtain the subsidy. In a free

market situation, the user-side ~ubsidy system ought to result in

transport operators providing a high quality service at the lowest

possible cost. The existence alongside this of a regulated market

(as far as operators, services and fares are concerned) would obviously

reduce the effectiveness of user-side subsidies.

The system does however give the agencies responsible for such

programmes a great deal of flexibility because it enables them to

specify who will be assisted, to what extent and for what type of

trip. By identifying those eligible for such aid (by means of a

special identity card) the subsidy can effectively be restricted to

journeys made by such persons. Similarly, a fixed number of tickets

can be allocated to each person and such tickets can be restricted to

82

certain types of trip. But, above all, the advantage of a user-side

subsidy system is that funds can be used from various agencies con­

cerned with different client groups without this involving duplication

of transport facilities (which is very difficult where the subsidy

goes to the transport operator) - for example, for the same transport

service, one client group can be subsidised at a certain level and a

second at a different level, without the entire community being

subsidised.

This form of user-side subsidy is already in use in several

towns (particularly in the form of taxi vouchers) but few of these

experiments have been sufficiently carefully monitored for it to be

possible to evaluate costs and quality of service.

However, in the United States, UMTA has financed a series of

experiments which should provide a global evaluation of user-side

subsidy for public transport services - the earliest of these being

the Danville (Illinois) shared taxi service, a detailed assessment

of which (covering administrative procedures, costs, levels of service

and number of journeys) was published in 1977-1978(11), which showed

that a user-side subsidy system can be operated at very low c·ost to

the community. These experiments also enable an analysis to be made

of the use of user-side subsidies in different transport contexts,

i.e. shared taxi services, shared taxi services plus scheduled public

transport, and shared taxi services plus regular private transport.

This system of subsidy could of course be applied (although this

is rarely the case) to semi-ambulatory persons and persons in wheel­

chairs who require special assistance or specially equipped vehicles.

This would in some cases avoid the need to create separate transport

systems for the exclusive use of such persons.

In general, the user-side subsidy system should be considered

as a means of maintaining a degree of competition between transport

operators and improving the efficiency of transport services by

directly relating the financial benefits received by transport

operators to the satisfaction of users• needs.

Apart from the apparently relatively minor risk of fraud, the

drawback associated with user-side subsidies is the problem (essen­

tially political) of devising a simple series of eligibility criteria,

acceptable to the different sections of opinion, for the issue of

vouchers (or tickets) for taxis (or minibuses where a "dial-a-ride"

system exists).

The other problems are the classic difficulties encountered in

dealing ~ith a self-employed profession (taxi operators in this case),

e.g. persuading every operator to respect the rules, rivalry within

the profession, unreliability of certain operators, etc.

83

5. REDUCING THE COST OF SERVICES

The experience of many countries has shown that unit costs for

these specialised services can be high.

They are higher still when a high proportion of door-to-door

transport is involved. This is true for all the special services for

the elderly provided by the State of Massachusetts: Teixeira and

Karash(9) in 1976 noted productivity levels ranging from 10 persons

per vehicle/hour for fixed route services to 2-3 persons per vehicle/

hour for full door-to-door services. Operating costs, which vary

from $5 to $10 per vehicle/hour, give a cost per person carried

ranging very broadly between $1 and $5 (but lying in most cases

between $2 and $3).

A Dutch report(12), based on some 15 cases in the Netherlands,

noted costs ranging from Fl.30 per person carried for a multiple

pick-up/single destination system (many-to-one) to Fl.90 per person

for a dial-a-ride system (many-to-many). Taxi systems proved con­

siderably less costly (Fl.15- Fl.30 per person carried).

Generally, therefore, the very high cost of these systems is

stressed. It should however be remembered that a direct comparison

between such costs and the more usual costs of ordinary public trans­

port is meaningless, since the constraints of a door-to-door service

are bound to have a considerable effect on costs.(13)

Several points need to be made about ways to improve such

systems' cost-benefit ratio:

1. For each of the categories catered for, they often involve

providing a service at specific times of day. This may

mean low productivity, with drivers being used for only a

small part of the day. A definite improvement would there­

fore follow if more rational use were made of vehicles and

drivers, where schedules can really be re-organised which

means (a) that the services must be on the necessary scale

and (b) that they can be used on a multi-purpose basis

catering for several categories of user.

2. The services have no joint facilities, e.g. staff training,

vehicle maintenance, etc. As a result, the figures for

these particular expense items are often very high.

3. The services may often be organised without any accounting

system, with complete overlapping between the organiser and

carrier functions. It is difficult to maintain proper

management control in such circumstances.

4. The services use minibuses which .are not designed to with­

stand the wear and tear of a public transport passenger

service. The minibuses used need to be more strongly built.

5. In some cases, the booking and control system via a switch­

board is not efficiently organised (e.g. too many telephone

84

operators for the number of vehicles involved, lines open for

too long a period, etc.).

Lastly, it is important to stress the effect on costs of the

type of driver used. Experience with dial-a-ride systems in particu­

lar has shown how effective the use of taxi drivers can be for these

low productivity services. There is an added advantage therefore in

using systems of individual aid in that they do not affect the taxi

supply and, as a result, could well help to bring down costs, even

taking into account the lower productivity involved in dealing with

a large number of elderly and handicapped persons (with the slower

operating times this implies).

6. INTEGRATING TRANSPORT PROGRAMMES AND TOWN PLANNING PROGRAMMES

Programmes designed to increase the mobility of the elderly and

the handicapped must be seen within the broader context of the housing

policy for such persons.

The fact is that, although public authorities have until recently

undertaken only limited action with regard to transport, the same is

not true of housing for which numerous programmes exist in every

country. These programmes have considerable bearing on where certain

categories of elderly and handicapped persons decide to live. It is

therefore important to show the connections there may be between

housing policy and mobility-aid policy.

The aims of a housing policy for the lonely are necessarily to

some extent conflicting - the following extract is a good illustration

of this (taken from an official brochure "comment lager les isoles"

published by the French Ministere de l'Equipement in May 1975):

"It is therefore essential to provide the lonely with accommoda­

tion in the vicinity of aid services and activity centres. They

must also be given the means to overcome their isolation and integrate

with the rest of the community. For this reason, everything possible

must be done to avoid grouping them together in complexes designed

exclusively for their use."

It can be seen that the general idea is to house the lonely in

areas within easy reach of the facilities provided for them, but that

this is qualified by the concern to avoid, where possible, any

definite segregation (as, for example, in the traditional type of·

old people's home).

This apparent contradiction loses some of its edge once the

problems are studied for specific categories of person.

In the case of retired persons, a clear distinction has to be

drawn between the elderly and the very old. For the former, who are

generally able-bodied, current policy is to help them to continue

living in their own homes whereas with the others the problem is

quite different and the solution is generally one of segregation in

8~

some form of home. For the more able-bodied amongst the very old,

there is some attempt to make the system more flexible, as for in­

stance with "sunset homes", which provide various facilities grouped

at a central location in relation to the individual housing units

rented for such persons in residential buildings in the immediate

vicinity.

For handicapped persons, the solutions differ from one country

to another. Some countries are much in favour of the system of com­

bined residential and activity centres for large groups of handi-·

capped persons (as many as several hundred). Others prefer to put

a ceiling to the number of handicapped persons living in one centre

(usually 1 00) •

As a general rule therefore, the trend is towards desegregation

and even living at home in the case of the slightly handicapped.

The inevitable result is a greater need for transport facilities and

home help.

From the methodological viewpoint, a knowledge of the location

of the various activity centres is obviously essential both in

analysing changes in mobility needs for which "specialised" trans­

port is required and in planning the practical details of routes to

and from such centres.

The serious transport and access problems implicit in low

residential density already noted in the case of the elderly but

able-bodied also apply in the case of handicapped persons.

TABLE 9

Source: M. HILLMAN(3)

Percentage of pension-· TYPE OF ENVIRONMENT ers with a facility Average within 10 minutes walk Urban Rural

Density High Average Low Scattered

Post office 77 69 67 68 70 Chemist 83 59 61 55 63 Park 53 44 33 16 38 Library 53 55 43 52 50 Retail shops 89 53 26 18 47 Mobile shops 26 23 38 25 29 Bus stop 73 41 47 29 21

Public telephone 90 88 89

Despite all its drawbacks, towns provide ways and means of

overcoming the isolation of the elderly and handicapped which are

not, contrary to certain preconceived ideas, to be found in villages.

86

Handicapped persons are often much worse off in rural areas than

they are in an urban environment. Overcoming the isolation of _the

handicapped in rural areas is a much more expensive operation than

it is for those living in towns. In the former case, it is clear

that transport alone cannot solve the problem and that it is particu­

larly necessary to envisage such solutions as resettlement in those

villages that show the most life with, if need be, special centres

to cater for the lonely during the winter. The weaknesses of solu­

tions based solely on the provision of better transport facilities

is much more apparent in rural than in urban areas.

FINAL COMMENTS

These few final comments may perhaps serve as starting points

for the Round Table discussions.

From everything that has been said it would seem that there are

two types of general conclusions to be drawn about the development

of transport services for the elderly and physically handicapped.

The first concerns the widely differing situations of the var­

ious social groups comprising this category of the population and

the consequent difficulty of formulating simple planning principles

based on mobility or accessibility criteria and applicable, for

example, to all of the areas in a single region or even a single con­

urbation. This basic diversity is further accentuated by the speci­

fic reactions of the welfare institutions and statutory authorities.

In view of this, a priority objective for authorities organis­

ing transport services for the elderly and handicapped should be to

discover more about the widely different social situations at the

origin of the mobility requirement.

The second concerns the changing situation as regards the crea­

tion of transport services for the elderly and handicapped. We have

noted the radical historical changes that have taken place, espe~

cially in the pressures that have led to the creation of such

services.

Two types of organisation have been successively involved.

Initially, motivated by the desire to aid the poorest and most neces­

sitous, highly de centralised social welfar.e agencie·s developed in

towns, where they set up numerous "ad hoc" services which now need

to be co-ordinated.

More recently, in response to demands from more militant organis­

ations, local regional and even national authorities have attempted

to satisfy the claim to an express "right to transport" for those

with the most serious forms of handicap by providing less specialised

services, catering for all discernible needs and even, in some extreme

cases, aimed at "totally accessible" public transport facilities.

87

These two types of general conclusion seem to us to indicate

that there is a major risk in treating this subject purely as a pol­

icy problem. This would limit consideration to "e"xtreme" scenarios,

one consisting of very limited, highly decentralised community pro­

grammes provided solely by social aid agencies and the other, more

spectacular but ineffective, for a single category of handicapped

persons (e.g. the installation of wheelchair lifts on all buses in

an urban transport system), or even a special service available in

theory to all handicapped persons for all their journeys, but in

actual fact marred by the many barriers it would present for certain

types of disability.

All four parts of this report express the transport analyst's

natural distrust for these extreme scenarios. They draw the atten­

tion of participants at the Round Table to the need to base public

decisions on an analysis of local situations covering all types of

person with restricted mobility that would identify all the require­

ments for satisfactory social integration of these different g~oups,

ensure that the utmost strictness was applied in choosing.priorities

in an area where any improvement measure has heavy financial implica­

tions and not rule out any of the modes of transport that can be used

(even the most ordinary such as walking and taxis, etc.) or improve­

ments relating to the smallest detail.

Btl

BIBLIOGRAPHY

1) J. A. MILLER, Latent Travel Demands of the Handicapped and Elderly, Transportation Research Record, No. 618.

2) J. L. MIKLOJCIK, Mobility and Older Americans: an Analysis. Michigan Survey of Needs - Transit Journal: May 1976.

3) M. HILLMAN et al., Transport Realities and Planning Policy, PEP, London, December 1976.

4) SEMALY, Le transport des handicapes physiques a Lyon, May 1979.

5) FALCOCCHIO et al., Travel Patterns and Mobility Needs of the Physically Handicapped, Transportation Research Record, No. 618.

6) HOOD et al., Transportation Services for the Transportation Disadvantaged - NCHRP Project 8-16, Transportation Research ~. 1978.

7) A. J. MAUTNER, Demand-responsive Taxi Systems: New York City Experience, Traffic Quarterly 453.

B) D. HARTGEN et al., Forecasting Non-work Public Transit Demand by the Elderly and Handicapped. Preliminary research report No. 108, August 1976, New York State Department of Transporta­tion, Albany.

9) TEIXEIRA and KARASH, An Evaluation of COA Dial-a-Ride Systems in Massachusetts, Transportation 4 (1975).

10) FLORES, Utilisation des transports collectifs par les personnes a mobilite reduite. Bulletin Recherche Transport IRT, January 1979.

11) User-side subsidies for shared-ride taxi service in DANVILLE, UMTA Report. IL 06-0034-77-1.

12) AGV, Alternatief vervoer voor handicapten in Nederland: een typologie, August 1978, Utrecht, Netherlands.

13) A. KIDDER, Transportation Research Record, No. 660.

89

SUMMARY OF DISCUSSION

An international comparison of experiments in the transport of elderly and handicapped persons is especially valuable in that approaches to the question have varied widely from one country to another. There are, moreover, two further reasons why such a study is fully relevant:

- The lack of information as to needs Very little is known regarding groups whose ability to move about is limited, and even less concerning their attitudes towards transport. This lack is largely due to difficulties in promoting surveys, owing to:

- the distressing problems apt to be involved; - the often underpriviledged status of those concerned; - the fact that handicapped people are inclined to withdraw

into themselves, a tendency which may be aggravated by the attitude of family members and friends who, because they are afraid of what people will say, avoid outside contacts as much as possible and build up a family-help system difficult to penetrate.

- The policy-making issues involved in the search for solutions. The extent to which elderly and handicapped people's requirements have been met has always depended not only on their own motivations but above all on the aims of the social groups which make policy. It now seems extremely likely that, in the Europe of the future, such aims will gain added strength. When all the components determining the trend in numbers of handicapped people are considered (demography, medical advances, road accident trends, gradual decrease of combat casualties), the assumption is that whereas the absolute number of handicapped should normally decline, their relative number- a'highly sensitive policy

issue - instead will increase.

It is with these two factors in mind - reflecting the classic division between supply and demand - that the question of transport for disadvantaged groups will be considered.

91

1. IDENTIFYING NEEDS

The transport needs and wishes of disadvanted groups clearly must be identified. This problem, one largely due with the diffi­culties met with in collecting data by means of surveys, first con­sists in determining exactly what groups are concerned, a task made all the harder as their requirements differ considerably.

1.1 Determining what groups are concerned

To carry out a proper study of transport needs, the statistician must be able to rely on suitable groups for sample surveys. So far, however, to pinpoint such sample groups has proved to be a particu­larly thorny task, since "elderly" and "handicapped" indivicl.ual:s hard to identify exactly and existing official classifications are inadequate.

Differences among the elderly are considerable, in fact quite as marked as in any other social group, thus resulting in a wide variety of acquirements.

Although "handicapped" and "elderly" categories overlap to a large extent, the substantial disparities between the two do of course affect· requirements:

- Many disabled persons are of working age, and their needs

will not be the same as those of elderly retired people; - When the handicapped and elderly groups are compared, family

structures of course considerably differ. Handicapped persons'

parents, in particular, play a vital role and, more generally speaking, helpers of the handicapped and helpers of the elderly will not be the same people.

- While neither the disabled nor the elderly can be said to constitute a uniform group, there is certainly more diversity in the circumstances of the disabled than there is among the

elderly

In fact it is difficult even to arrive at a clear idea of what constitutes a handicap; there are obvious two-way links between disablement coupled with its consequences and the handic~pped person's

status on the fringe of society. A handicapped person's situation and therefore his requirements will, for instance, vary from one country to another and according to whether he lives in an urban or rural area. Moreover the handicap and how it is accepted and dealt with are undeniably linked, an aspect that so far has been very in­adequately studied.

Because· it is so hard to succeed in objectively defining a

handicapped individual, statistics.on the subject are not comparable. Those available are invariably based on specific requirements and

92

have been compiled for specific purposes (meeting the needs of Ministries of Labour or of Health, social objectives, experiments in social integration, etc.). Statistics thus differ widely, since they are based on criteria difficult to compare (causes, types of handicap, how they affect mobility, etc.). When based on official classifications, they are generally of little use in determing the exact transport needs of those who find it difficult to move about. There are, in fact, many people officially registered as handicapped who are largely mobile, while others not so officially recognised -(those slightly disabled, such as arthritics) do in fact have serious mobility problems. In many instances a minor disablement can in fact be recorded only with difficulty, even when it does represent a severe handicap in moving around. There is thus, when it comes to finding out what needs exist, a conflict between the officially recognised legal status and the actual ability to move about. The evidence shows that definitions tend to rely unduly on medical criteria and thus fail to cover people who actually have difficulty in moving around (those slightly or temporarily disabled), with the drawback of highlighting the most conspicuous needs at the expense of the most important requirements.

Thus no satisfactory way of identifying those persons whose mobility is reduced has yet been found and research is still in­adequate. More qualitative research seems to be needed, so that the widely varying circumstances of handicapped and elderly people, their requirements and the ways of satisfying them can be taken into account. Only a sufficiently detailed breakdown according to needs presumably will make effective action possible. In particular, it would be well to avoid the hitherto all too frequent tendency to concentrate on such marginal but eye-catching requirements as those of wheelchair cases, while neglecting the less obvious needs of other much broader categories of people who are especially disadvantaged.

1.2 Ascertaining needs

Clearly the survey methods so far used to study needs a~e much too simplistic and should be thoroughly revised. It is not enough to ask respondents how they would like to get about, since they have no way of knowing how they would react to unfamiliar situations. The results of such surveys are inevitably distorted. Caution is doubly necessary because:

- There is a considerable difference between needs as perceived beforehand and what happens once the transport services are really there, when all kinds of hitherto unsuspected snags crop up. Since actual behaviour often bears no relation to estimated needs, whenever possible their measurement and the

93

launching of pilot schemes would seem a first advisable step. The trouble is that this is a fairly expensive and therefore not always feasible approach, while the results are difficult to transpose. More sophisticated ways of assessing needs in advance must hence rapidly be found.

- While certain unsound prior assessments must be regarded with circumspection, it is more important still to be wary of accepting a multitude of preconceived ideas regarding supposed needs of certain categories of user. In particular, great care must be taken not to confuse elderly people's real requirements with what young people think they are.

If reliable information on transport needs is to be obtained and lead to effective action, far more sophisticated survey and research methods therefore seem essential. Accurate assessment of the needs of certain categories of transport users who find it hard to get about calls for information not only on the particular handicap physically hampering mobility but also on the subject's past and pre­sent life style, which undoubtedly has a bearing on requirements and behaviour. Recent research on these lines shows, for instance, that elderly people's behaviour is largely influenced by the way other sections of society see them. It is because of the popular tendency to lump all old people together, that they do in fact, react in a certain way. This is proof enough that any serious study of the transport needs of people whose mobility is restricted cannot be confined to mere consideration of the physical handicap, since it may not always be the main reason for reluctance to move about. Such a study must include all components of the life style, and the various groups must be seen as entities with a social status of their own, as perceived by other sections of society, and as perceived by themselves.

From a more general standpoint, the problem of mobility is not only one of transport. The aim is not simply to move people from one place to another. The whole question of mobility must be looked at in the light of the life style desired, one moreover largely deter­mined by what it has been in the past. Any solutions regarding transport must hence be made to fit into the overall desired pattern, and must be based on an analysis of their way of life in terms of the activities they do and would like to share in. Any such research should attach great importance to the subjects' desire for autonomy. Studies on these lines have thus shown that what older people want most of all is to be able to get around their own neighbourhood; hence the first concern must be to find out what they need near home and provide the relevant facilities. It is in this sense, rather than merely in terms of travel or transport, that the concept of accessibility should be dealt with in assessing requirements.

94

Close analysis of needs moreover shows that certain individuals adjust fairly easily to their new circu~stances (living with a handi­cap, retirement), while others are not resigned and tend to withdraw into themselves. Some think that this life of seclusion is inevitable, and others feel instead that it is ~ot desirable. In fact, serious consideration of certain disadvantaged groups' desire for mobility is bound to show that any atte~pt to solve transport ~sers' diffi­culties must leave people free to chogse the kind of life they want. As far as possible, transport should not be allowed to constitute a barrier - but neither should ~y relevant measures imgos~ a parti­cular way of life on certain disadvantaged groups.

Such an approach to mobility requirements undoubtedly can better help to weigh the contribution which measures taken to promote trans­port can make, as well as their limitatigns. Presumably it is the only way to guarantee the effectiveness gf decisio~s aimed at helping people whose mobility is restricted. Certainly those who so desire should be provided with the means to take part in normal community life, and often quite simple tr~sport ss1utions exist which can largely overcome the difficultiee caused by a physical handicap. But since individual attitudes towards travel are not solely deter­mined by physical disablement, it must be realised that once people whose mobility is restricted - and especially older people - have settled into a secluded way of life, the ~rovision of transport facilities will make little difference. In fact transport has a significant role to play only when the physical handicap or retire­ment has just begun and can thus prevent such a way of life from becoming ingrained. Since disabled and elderly people find them­selves in a social situation which soon becomes irreversible, measures which seek to overcome only the physical problems involved in getting about, while they may forestall the irreversible aspect, are unlikely to have any effect once those concerned have become used to living a withdrawn form of existence without venturing far afield.·

*

* *

In discussing the identification of needs, a point made that these and measures taken to meet them are so closely linked that only for didactic purposes - as in this summary ~ can they be separqte1Y analysed. Needs differ in each case and so2utions must be tailored to suit each individual. Thus any measures of general, centralised or ostentatious kind must be regarded with suspicion, since the real needs that have to be met are differentiated, decentralised and often inconspicuous.

95

When it was considered how reduced mobility groups and their needs might be identified, some of the problems of introducing the reQuisite transport facilities came into focus. A search for effec­tive solutions in fact reQuires caution on two counts:

- distrust of any dramatic approach, due to overreliance on medical criteria and on actions which will impress public opinion. It is very tempting to reduce the problem of public transport for the elderly or disabled to simple components. Political circles are apt to show a marked preference for measures that are uncomplicated to implement and which may strike the public fancy. Hence, owing to the difficulty of assessing needs with any accuracy, the first reQuirements to be met are likely to be those attracting the most attention; under these conditions, such av approach as for example meeting the problem for the disabled by providing wheelchair lifts, may thus well be the type of mea~~re adopted. This attitude, born of the considerations politicans have to take into account, has been further encouraged by the tendency to view the QUestion in purely medical terms, naturally inducing governments to take a greater interest in severe handicaps than in lesser disabilities, where the scope for action is nevertheless considerable. Only ~really careful approach to needs, by uncovering such disabilities (often the cause of serious mobility problems but neglected because involving inconspicuous actions) can obviate such a narrow view, the root cause of ineffective planning.

- distrust of quantitative approaches, especially of the aggre­grated type. Confining assessment of needs simply to the calculation of mobility standards for the elderly or disabled, as all carriers tend to do, should be avoided. Research based on such standards (e.g. number of weekly journeys by handicapped persons) is doomed to failure. The contribution of transport to mobility cannot be ordained on the basis of statistics showing the number of elderly and disabled persons transported. Various experiments - in Goteborg, for instance -show that specialised transport services are slow to achieve results; an un~eniable fact is that transport authorities as well as disabled or elderly passengers need time to get used to them. The learning process is extremely important, lengthy and-above all varies widely according to the people, circum­stances and countries involved. This points to the need, if satisfactory results are to be. achieved, for a highly QUali­tative approach in assessing reQuirements, one based on an intensive study of the life style of people who cannot move about easily. While the extent to which they share or would

96

like to share in activities of various kinds must also be

considered.

In seeking relevant solutions to requirements that are obviously extremely varied in nature, this dual caveat must be borne in mind.

2. THE SEARCH FOR SOLUTIONS

A valid assessment of the effectiveness of the various solutions

first calls for a better understanding of the genesis of previous systems to help the elderly and handicapped get about. How such a concept as the place in society of groups whose movements are impaired and how the help they have received has evolved over time must thus be given special attention. The changes have been far-reaching, pro­gressing from charity to assistance, from assistance to recognition of the right to financial aid and recently to that of autonomy and of integration in community life.

Solutions to the mobility problem of the elderly and.handicapped have in fact long since been sought at the three following levels: the State, public bodies, and private groups. The role and relative significance of these various parties have of course been affected by the above-mentioned trend. Serious efforts have been made to ensure that changing concepts regarding the place in society of the elderly and disabled would be reflected in national legislation, but a contradiction which undeniably still persists is a public

which while opposed to any segregation of the elderly and handicapped is reluctant to put up with the ensuing constraints. Although the policy-makers' response has progressed from the idea of assistance to that of integration in community life, progress has admittedly been so slow that the various public bodies have developed their own strategies, the resulting inconsistencies inevitably weakening the effectiveness of measures adopted. First among these bodies is local government, which after the central government certainly ranks as the chief policy-making instrument: local authorities thus play a key role in organising everyday services for disadvantaged groups, and are especially qualified to ascertain their specific needs. While private groups have long since campaigned for the social inte­gration of handicapped and elderly people, their action, like that

of public or semi-public bodies, has taken different forms as con­cepts concerning aid to disadvantaged groups have evolved. In the last twenty years these have been notably active as managers of

special services for the elderly and handicapped, but as they mainly focussed on what might be called "closed" solutions (management of

specialised centres, specific transport services etc.), contributed to setting up a world apart for older and handicapped persons.

97

Recently, however, private initiative has undergone a change, and there are now groups and associations which emphasize solutions open

-to the outside world, i.e. which will help those who have difficulty in moving around to fit into normal community life.

Aid to the elderly and handicapped takes three main forms which have also varied in scope and application as attitudes changed.

- Financial assistance is administered mainly in conjunction with social assistance but it was soon found insufficient to enable handicapped and elderly people to enter fully into normal life. For this reason the concept of social assistance has considerably broadened over the past few years. Financial assistance is now complemented by-housing, household, educa­tional and other aids. As most decisions concerning this type of assistance are taken at local level, methods of prac­tical application vary considerably. Aid schemes therefore differ widely from one locality to another, hence tend to keep the elderly and handicapped living in one place. The fear of losing certain advantages they have gained, of having to go through all kinds of complicated formalities or getting used to new schemes only adds to the reluctance to move of such people, who in any event are averse to change. To counter this immobilism and avoid the kind of inconsistencies that lead to irrational residential situations, action should be promoted in the various countries to harmonize local aid or financial-assistance schemes. But as this first type of measure on behalf of the elderly and handicapped far exceeds the scope of transport, it will not here be dealt with at any greater length.

- Fare measures long accounted for the main if not only form of aid provided to help the elderly and handicapped move about. In fact 90 per cent of the money spent for this purpose by the authorities still goes to subsidise reduced fares on public transport for certain disadvantaged groups. The politi­cal impact of such measures is considerable, --since at election time they _are simple, effective devices. This explains why such a form of action, long resorted to in the transport sector,

is so popular. Unfortunately, on closer examination the effec­tiveness of such fare measures proves limited:

- Studies invariably show that elderly and handicapped people take little advantage of the preferential fares provided. This is because they use public tranport very seldom in any case, while the price of the ticket is certainly not the main reason for their not making use of conventional public transport facilities.

98

- The specific requirements of certain categories of users largely fail to be met by such general measures as free transport or reduced fares, owing to the conditions of entitlement. While some officially registered handicapped persons experience no real difficulty in getting about, others not officially recognised as handicapped, hence not entitled to preferential treatment, do. Since preferential fare schemes are not sufficiently differentiated and are merely based on age or type of disablement, they may well favour people who have no real difficulty in moving about and be of no assistance to those who really need them.

- Preferential fares granted to elderly and disabled persons cause problems for the carrier at rush hours by increasing demand at a time of day when saturation sets in. Conflict with the interests of other users then.is a danger. For this reason all experts agree that preferential fares, or at least those granted to the elderly, should apply only outside rush hours, hence during periods when the cost to the carrier is negligible and there is little conflict with other users.

For all these reasons fare measures, the most common response to the general demand for action on behalf of the transport of handicapped and elderly persons, are certainly not the whole answer. Although undeniably useful, as shown by price elasticity studies, they are still inadequate because ill-adapted to highly varied and often little expressed requirements. Awareness of such limited effectiveness, coup­led with the increasingly stated objective of integrating the elderly and handicapped in community life, has naturally led in recent years to the placing of heavier emphasis on techni­cal measures which are particularly suited for meeting highly specific requirements and are thus an indispensable &djunct to financial or fare aids. Among the measures which can be

' envisaged for improving the mobility of elderly and handi-capped individuals, in line with the view taken by the Round Table/during discussions of possible solutions this report has chosen to stress actual transport systems, i.e. the technicalities of organising those available to such groups. This approach appeared all the more justified in that fare measures have already amply been dealt with in the litera­ture and at length in the introductory !eports.

- technical aids. European countries patently have not yet acquired sufficient experience in providing technological answers to the mobility problems of handicapped and elderly

99

persons for any radical conclusions to be drawn. Yet here again changing attitudes have caused markedly different solu­tions to be adopted. Whereas these used to be based on re­course to special transport services in recent years the in­creasing tendency has been to make greater use of existing facilities, by gradually shifting the emphasis towards measures fulfilling such a purpose. Actually this shift but reflects in technical terms the transition from the concept of an introverted to an extroverted lifestyle where the elderly and disabled are concerned.

2.1 Use of specialised services

The specific requirements of the elderly and handicapped which are brought to light by any reliable survey, naturally led early on to the introduction of special services for transporting social groups whose mobility was reduced. The reason why such services started to be used so soon is that many of the first to tackle this type of problem were private groups or bodies. Owing to their very nature, an obvious function of the latter is to find answers to the specific travelling requirements of the people they are trying to hP.lp when organising special transport services. Because they are highly adaptable to time, space and quality requirements, special services appear at first sight to provide an ideal solution and thus were long regarded as the ultimate weapon for solving the transport problems of elderly and handicapped persons.

Owing to changing concepts regarding the status of handicapped and elderely persons in society and increasingly burdensome economic

and financial constraints, the effectiveness of special transport services has recently been challenged to some extent. Questions first arose out of a much closer look at the requirements of reduced mobility groups, and especially their attitude towards specialised transport systems, and were later to hinge on the cost and organisa­tional problems involved.

A. Users' attitude to specialised systems As yet, little is knowr1 about the attitude of the elderly

towards the specialised transport systems at their disposal. The available data. are contradictory and research to date fails to show whether they prefer systems designed specifically for them or

whether instead they feel that special services cut them off from society and would therefore prefer using ordinary but suitably adapted transport systems.

Info~mation on the handicapped is however much more precise, and indicates that special services do not always meet ~he desires

100

of this type of user. For example, a social survey in Amiens and Nancy aimed at assessing special services shows that those relying entirely on this type of service for moving about are usually very low-income, severely handicapped persons with limited economic and

educational assets, and whose mobility has been impaired fairly late in life. As a rule, they go out very little - only to receive medical care or attend meetings for the handicapped; The survey showed that other reasons for journeys account for a mere 10· per cent of their total movements. According to the findings, of all the handicapped persons interviewed this type of user alone is fully in favour of specialised services; moreover their only wish is the broader coverage of time and area requirements (in particular on public holidays). Other handicapped persons, who are usually younger and who use both specialised Services and other transport facilities however have far more mixed feelings about the specialised kind. Many of them often feel that the latter tend to make the social ghetto in which they tend to be confined even worse. Actually they use such facilities only when no other means of transport are available. Their greatest wish, so far as their economic status allows, is to own private cars adapted as need be to their requirements.

Awareness of the frequently inadequate solutions provided by specialised services in meeting the travel requirements of certain persons who have difficulty in getting about has lately been further heightened owing to current economic conditions, ·with far more attention being paid to the operating conditions and running costs of specific transport systems.

B. Running costs of specialised services

The mixed feelings of userff towards these services have recently been compounded by growing criticism on the part of policy-making and financial authorities regarding the operating conditions and running costs of certain specialised transport systems. The joint effect of both arguments was bound to raise doubts in the minds of those who regarded such systems as a cure-all for the transport problems of certain disadvantaged groups.

a) The evidence

Because such transport services are of a highly specific kind, their costs are usually fairly easy to estimate, although they vary markedly according to the standard desired. Furthermore, as experi­ments so far have been narrowly localised, except perhaps in. Sweden, costs are known at community level only. Since at this scale situa­tions vary considerably, it iS difficult to transpose the data obtained. On this score a stage has undoubtedly been reached where nationwide experiments should be conducted and feasible solutions

compared accordingly, before the cost of specialised services can be conclusively assessed. The evidence however is that even though fairly well meeting certain kinds of requirments, special services are very expensive on the whole. This is mainly due to the particu­larly marked impact of personnel costs on overall operating expendi­ture, even allowing for the sharp rise of this item in all types of public transport during recent years. Labour costs represent 80 to 85 per cent of the running costs of specialised transport services, as against 70 per cent for conventional public transport. This is bound to form a major obstacle to the development of specia­lised services, especially since·the economic situation compels pub­lic authorities to scrutinize the subsidies they grant even more closely.

This admittedly rather gloomy assessment of the costs of specia­lised services must be tempered, however, by taking into account several aspects which, on a more general level, must not be overlooked in any reliable evaluation of whatever steps are taken to help people whose capacity for movement is reduced:

the cost of transporting disabled persons by means of specia­lised services, particularly commuters between home and work, must be set against the probably much higher cost of provid­ing home assistance if they are unable to work. When con­sidering the ?osts involved in transporting the disabled and elderly, it should be borne in mind that they represent only a fraction of the overall social costs of operation, e.g. urban costs, involved for these persons. In particular the cost of finding appropriate accommodation fo~ them, which can be very high, must be taken into account, and both trans­port and residential costs for the-various categories of elderly and handicapped persons should always be examined at the same time. Residential arrangements for such people vary extremely from country to country: in France, for example, the policy is rather to enable elderly and disabled persons to remain where they are, whereas in the Federal Republic of Germany the tendency is to group them in the same area. Such options are bound to affect the costs of transport systems which are organised. Thus in Brussels only 5 per cent of the running costs of special transport services are covered by revenue, but no valid conclusion can be dra·,m without considering that this situation is largely the outcome of policy decisions aimed at allowing disabled persons to remain in their homes.

Any superficial survey _of operating costs of specialised transport services may therefore lead to erroneous conclusions. What is needed is an overall assessment simultaneously

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covering transport costs, accommodation costs and all other expenditure involved for elderly and handicapped persons. Transport is merely one factor, one component of an overall product. Any estimate of the costs of special services must therefore cover a far broader spectrum than the transport problem alone. In this connection there is a close link between place of residence, urban planning and transport, one which policymakers ought to be aware of. It must however be recognised that research on the subject is woefully inadequate.

- Before dogmatically criticising the operating costs of spe­cialised transport services as excessive, it should also be remembered th~t usually the reason for the latter's existence is to remedy the shortcomings of other transport modes (un­suited public transport facilities, inadequate use of private cars or lack of funds for purchasing any, inefficient use of taxis and ambulances, etc.). Moreover, however high they may be, the costs of specialised services should be systema­tically compared with the even higher costs if in existing con­ventional public transport systems were to be radically altered in order to meet identical requirements under similar conditions. Finally, the running costs of special transport services should be studied over a sufficiently long period of time to be

satisfactorily asses~ed. This is because once they are estab­lished the use of such services is slow to develop, a trend apparent from all experiments, due to the slowness with which the need for them are felt.

b) Possible answers

In spite of all these factors tempering any over-hasty assess­ment of the financial aspects of operating specialised transport services, owing to the normally very high costs entailed the follow­ing steps should systematically be taken:

A comparison of the costs of specialised services and taxi services. Experiments conducted in Sweden, among other countries, show that in a vast majority of cases, taxis could be used quite as easily as the specialised services to trans­port elderly and disabled persons. Closer analysis shows in fact that many services provided by special buses or minibuses basically are little different from taxi services, although they are more expensive. In Brussels, after two years of running a special bus service, it was found that in 60 per"cent of journeys the buses carried a single passenger. The undue expansion of specialised transport services in

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recent years has all too often resulted in the organisation of services similar to taxi facilities, but by special buses or minibuses, often entailing extra costs incommensurate with the better meeting of requirements. Research shows that on the whole thei~ operating costs are at least some 25 per cent higher than those of taxis. Under the circumstances, there is a need to take a really close look at many special services that have often inordinately proliferated in recent years, using operating costs for taxis as a basis for setting costs against objectives. The only services likely to pass this kind of test are those meeting requirements too specific for taxis, although ambulances may also here have a role to play or else services where at least three persons are carried per trip, this being a rough estimate of the profitability thres­hold of specialised systems as compared with taxi services.

- Considerable efforts to reduce the operating costs of specia­lised services wherever they are justified on socio-economic grounds. The following three approaches seem worthy of investigation:

making specialised services available to users other than those for whom they are originally intended, although care should be .taken to ensure that the latter receive priority, and competition with existing public transport services is avoided;

- development of volunteer schemes such as community work for young people (instead of military service); although this type of solution is likely to meet with opposition, in particular from trade unions, and even if opinion is somewhat divided on the subject, research along these lines would seem to be highly useful in view of the heavy manpower costs weighing on the budget of specialised services;

- more effective co-ordination between the different transport systems, enabling, among other things, drivers and various types of vehicle to be rationally used.

All these measures for reducing the running costs of specialised transport .services ought to form part of a general scheme to improve the organisation of such services. A hardly surprising recent con­crete development is that the discussion of transport systems speci­fically for the elderly and handicapped should have led to a critical appraisal of their organisation.

C. Organisation of specialised services

Much of the debate on the subject has focussed on problems due to the identity of those organising such services. As stated above,

104

specialised transport systems for the elderly and disabled have primarily developed at the instigation of private or semi-official groups and organisations, whose actions, more or less based on charitable grounds and through frequent recourse to voluntary schemes, have often been lacking· in consistency.

This kind of organisation clearly has a number of good points, as attested by its considerably rapid growth. By setting up special transport services for disabled persons, charitable •associations were certainly of considerable help in the past. Through them prompt action could be taken whenever specific travel requirements arose and the major deficiencies of conventional public transport systems thus be offset owing to their excessively rigid management, itself largely due to the ideas then prevailing in policy-making and administrative quarters concerning measures for elderly and disabled persons. By basing the organisation of special.ised trans­port services on action taken by a large number of private or semi­official institutions, the particular requirements of disabled users unquestionably can very closely be matched. This undoubtedly meets the need for decentralising the decision-making required owing to the highly specific nature of demand. Since charitable institutions as a rule are small and their area of operation is relatively limited, they are extremely mindful of the requirements of those using their services, which are run on a more considerate basis.

Nevertheless, although special systems match requirements fairly closely, they are so numerous and have been launched so haphazardly by so many private or semi-official institutions that several problems have arisen. Not the least of these -is their operating deficits due to excessive running costs, which, in the present economic- situation, the government is increasingly reluctant to make up for by granting unconditional subsidies. An added factor contributing to such a reserved financial attitude is the sharp criticism, due to the chang­ing view regarding the role elderly and handicapped persons play in society, of the way specialised transport services are organised. These ob j actions can be summed up as fo·llows:

- The aim of matching specific requirements exactly, and the somewhat overready government response in granting compensa­tory subsidies for the purpose are frequently offset by a costly tendency of charitable institutions to more than meet the demand, owing to the lack of any comprehensive approach; Associations setting up and operating specialised transport services are thus quite apt to maintain elderly and disabled persons in a closed environment. This kind of organisation would in fact seem all the less able to help such individuals fit into normal community life, as the bodies responsible for specialised services are very likely to have particular

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interests directly conflicting with other, even more important social objectives. For example, they naturally first will want to fill the specialised assistance facilities they manage and thus to prefer transport schemes which fail to give the elderly and disabled enough access to the outside world. Such people then may end up being virtually enmeshed in a web of interconnecting forms of aid. In this type of system, the objectives set by the organisers of the transport services actually will narrowly depend on the organisers' often too limited view of what kind of aid disadvantaged persons should receive.

- The somewhat overenthusiastic recourse to volunteer workers for running specialised transport services organised by charitable institutions and the like must be tempered. In many associations work is in fact only on a semi-voluntary basis, and consists of part-time work in various forms. Furthermore, even semi-voluntary work is criticised in some quarters as leading to a kind of tribalism in the organisa­tions established. When private charitable institutions set up specialised transport services they are often apt to build up virtual private, mafia-like preserves, whereupon it later becomes very difficult to rationalise the services and re­structure the organisations. Lastly, wherever voluntary helpers are used by private institutions the services offered are bound to be less reliabie. It is by no me~~s certain, for example, that those providing the transport have the skills and training required for carrying people who are especially hampered in their movements.

- Finally, one of the most biting criticisms levelled against multiple, specific types of private action is that the specialised services then provided are likely in the end to be a major obstacle in setting up a comprehensive and consis­tent transport service for the elderly or disabled at city or regional level.

*

* *

The discussions on specialided transport services and the criti­cism levelled against mfu~Y projects promoted this field by private or semi-official bodies on charitable or social grounds by no means imply that every such type of action to help the elderly and handicapped should be called into question. It would indeed be a great pity to do away with all that has so far been contributed by private initiative.

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The recent discussions regarding the role of specialised trans­

port services for people whose mobility is impaired in fact enable

conclusions to be reached ~s to:

the context required for specialised services to become fully

effective; the scope of such· services, which was shown to be less than

at first supposed.

So far specialised transport services have admittedly been hampei·ed by inadequate co-ordination, often leading to wastefully run systems. While the usefulness of steps taken in this field, notably by private bodies, and without going so far as to adopt radi­cal solutions where the latter are concerned, the specialised services must unquestionably be rationalised and their actual value reviewed

case by case. Government action must be taken to this end, through subsidies

in particular. Underlying the problem is the time-worn controversy

opposing those in favour of centralised aid and thus opting for some measure of decentralisation, those championing subsidies directed towards a centralised transport system &~d those who prefer aid to be granted to various services and a large number of small firms on the grounds that the latter are likely to be better informed of market conditions and have lower wage costs. While a continuing debate, it does not always produce clear-cut answers. This does not, however, appear to be the case for specialised social transport services. Circles at all levels are becoming increasingly concerned

about the countless numbers of local, provincial, regional and other transport services, and regarding the proliferation of subsidy, aid and organisation systems set up not only as a result of the many

initiatives taken at these levels but also owing to unremitting action on the part of the central authorities. Hence an undeniable broad consensus is that the present services should be co-ordinated to some extent, and that to begin with official action must be rationa­lised. In particular, those responsible for allocating public funds should from now on pay greater attention to the operating conditions of specialised transport systems receiving financial aid, while the subsidies granted to organisations running such ·services must be made conditional on a minimum amount of co-ordination in the interests of users.

In addition, for the specialised systems to be made fully effec­tive, all services provided should be integrated, not only those for the elderly and disabled. The first task should therefore be to inventory each and every specific transport service, whether for the

elderly and disabled, children (school buses), workers (transport to and from work), or consumers (customer services of department

stores), etc., since they are not usually co-ordinated in any way.

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Since the various special-purpose services do not, for example, have the same timetables, their overall harmonization is bound to improve the use of drivers and vehicles: thus sch~ol buses only used mornings and evenings could amply serve at other times of the day to transport elderly persons or other particular users. Likewise, existing natio­nal emergency facilities, such as ambulance services, could be used to better purpose through greater recourse to them for transporting elderly and handicapped persons whose mobility is severely impaired. The costly institution of competing specialised services would thus be avoided.

Current attitudes towards the integration of persons with mobi­lity problems in society, the highly diversified requirements de­noted by intensive typological research involving recourse to a variety of solutions, and the economic constraints affecting public finance, call for a review of the s~rategy of assigning a dominant social transport role to specialised services. There is no overall, single solution regarding the mobility of elderly and disabled per­sons; it is bound to be differentiated. In order to make travel easier for people whose mobility is reduced, and thus enable them to share in community life and meet the transport constraints they may or may not be experiencing, no solutions must be barred in providing a wide range of transport options. This approach is in fact consi­stent with the need described in Part 1 for people to remain free to choose their own way of life rather than impose any particular lifestyle by adopting transport measures of a specific kind. From this angle, provided they are suitably co-ordinated and rationally managed, specialised services are undoubtedly an effective answer, but merely one among many. They fulfil certain types of require­ments fairly well, such as travel to and from places of work or study or medical treatment, and more generally, they_are ideally suited for travelling to public centres of attraction. Yet, no matter how open, they cannot meet all requirements for technical or financial reasons. They can merely try to meet narrowly specific· requirements, choice of the type of services offered and their neces­sarily limited number moreover meaning that needs must be weighed against each other.

Specialised services must therefore be set up only where a com­parison with other transport systems shows that, in the light of spe­cific needs and community-life objectives on behalf of people whose mobility is reduced, such solutions are absolutely necessary. Accord­ing to the latest thinking on aid to the elderly and handicapped, specialised transport facilities should merely be regarded as an adjunct to such conventional modes as public transport, private cars and taxis. These would seem better suited for achieving current open-society objectives as well as meeting the desires of persons who have trouble in moving about, as shown in the most recent user

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surveys. In technical terms, the shifting of oplnlon in favour of an open as opposed to secluded lifestyle for the elderly and handi­capped means that the use and adjustment of existing transport sys­tems to this end is now being strongly emphasized, a trend bound to be further promoted by the economic streamlining required in the current financial context.

2.2 Use of existing transport facilities

Certain distinctions have to be drawn in studying the future implications of a more efficient use of existing transport facili­ties. In particular, it appears necessary to consider first, con­ventional public transport: buses, trams, railways, etc., and second­ly .the other methods of transport, among which the private car, taxi and walking seem the likeliest solutions for people whose mobility is impaired.

There is no question of making it easier "in a general way" for persons of limited mobility to have access to existing transport systems. Both technical and financial reasons call for a qualified solution to be based on what transpires from an examination of the two issues below:

- the suitability of the different transport systems to the transport needs of elderly and handicapped persons;

- the actual scope for adaptation of the systems to cope effecti­vely with these requirements.

A. The suitability of different methods of transport

Before any consideration can be embarked upon the technical improvements which can be made to the various transport techniques enabling them to cope with the specific transport problems of users who are unable to get about freely, the first step would be to assess the scope afforded in this respect by the various existing trans­port systems. The limitations on usefulness of these systems to elderly or handicapped persons should especially be highlighted, thus enabling the types of journey they can most efficiently provide to be determined. For greater ease of policy-making, all the solu­tions available should be considered and each one of them subjected to a genuine cost-effectiveness study.

a) Conventional public transport

The use of conventional public transport facilities such as buses, trolleybuses and railways in an urban environment can in no way provide a blanket solution to the transport needs of persons with impaired mobility.

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In the first place, severely handicapped users do undoubtedly have considerable problems of access to mass transport facilities

of this kind. Moreover, a classification in depth of the handicapped, such as the San Diego Study(1) shows that a number of people with considerably impaired mobility will never be able to use traditional forms of public transport. The solutions which can be involved to

counter this problem, besides being very costly, are liable to gene­rate conflict not only with ordinary users but also among the handi­capped themselves, and indeed the great diversity of the needs of

this category was highlighted earlier. For instance, the technical arrangements for carrying wheelchairs are very likely to cause con­siderable inconvenience to other users with relatively minor handicaps.

Besides, as was shown in the discussion on fare aid, traditional public transport appears incapable, during peak hours, of providing

a satisfactory solution to demand from persons suffering from a fairly marked impediment to mobility. Access by this type of user to mass transport during peak hours, when it is already overcrowded, inevitably sparks off a whole trail of difficulties, leading to serious conflicts of interest with other users and heavily inter­fering with the operation of these transport systems:

- The difficulty experienced in boarding or getting down from

vehicles by persons with appreciably impaired mobility in­evitably involves loss of time at stops and thus still further reduce the service-speeds of public transport vehicles,

already low during peak hours. Such persons therefore con­siderably delay the travel time of other users, whom they may well deter from using public transport.

- In order to prevent excessive inconvenience to other users when large numbers of journeys are made by aged and handi­capped persons using traditional public transport, carriers are compelled to operate extra vehicles during peak hours, thus making for even more uneconomic operation arising through differences in demand between peak and off-peak hours. In Nice, for instance, the mere fact of making public transport available free of charge to elderly persons without restric­tions as to when they could use if along with the slowness of these users in boarding the vehicles, was enough to compel

the operators, during peak hours, to run a fleet of buses 10 per cent larger than before. Lastly, serious problems of security arise in making public transport available to persons with a severe motor handicap,

1) Cf: C. HOOD, T. BELL, C. SOVCHEN, K. HEATHINGTON: "Transportation services for the transportation disadvantaged University of Tennessee. AASHT Study, NHCRP Project 8-16, TRB, 1978.

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such as: the emergency evacuation o:f ;paraplegics from an underground train brought to a halt between two stations or from aircraft at the outbreak of fire ~ these problems are technically difficult to overcome and here again considerable expense is incurred by the carriers, During peak hours, problems such as these are particularly acute since the

occupancy rates for vehicles g.re often very high.

In the outcome of a study in some considerable depth, access by the severely handicapped to conventional public transport, which has recently rather flauntingly been ch;:unp:j.onE)d in some quarters as a means of integration into the life of the community, appears to be no effective solution, especially during rush hours. In any case such a measure does not provide any general answer to the nee(ls. of persons with impaired mobility, as contrary to the hope of authori­ties no doubt unduly attracted by its dramatic impact and in any case it proves a very costly one. Such a conclusion cannot fail to affect the choice of technical measures aimed at mQre closely meeting the needs of elderly or handicapped persons.

The inordinate fascination with conventional public transport as

a solution to the mobility problems of elderly and handicapped persons - a tendency which recently made itself felt under the banner of social equality - has had the regrettable consequence of divert­ing attention from the scope offered in this area by other transport modes. Prominent among these, and all too often neglected when the issue of collective public transport is consideren, is the taxi, whose advantages in enabling persons with restricted mobility to get

about, even though considerable, have so far been little explored.

b) Taxis

As stated earlier, taxis seem in many cases able to provide trans­port facilities for elderly or handicapped persons in every way compar­able with those of specialised transport systems while invariably at lower cost. Unfortunately, theoretical and experimental.work in this field has admittedly been inadequate, largely due to the emphasis during the past few years on conventional public transport. The recent success of taxi services in Sweden, which is the only count~y to have made any really systematic attempt to promote use of this mode by persons with mobility problems, howev"er bears witne9s to

this method's considerable latent potential fo~ carrying the e~derly or the handicapped. As of now, nine taxis are used in Sweden by the elderly and handicapped compared to every one bus, proof, if any were needed, that this method of transport is 1J.ighly suited to the ever-varying needs of users with motor handicaps.

The prospects offered by taxis for carrying elderly or handi­capped persons appears all the greater since the reluctance to impose any single, predetermined "transport" solution on this type of user

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and the increasing cost of specialised services are stimulating con­siderable interest in personalised systems of aid, such as transport cheques or vouchers. Moreover this type of aid, as well as being

suited to the use of conventional public transport, also works with taxis, which in many cases are easier to board than conventional public transport vehicles. Two schools of thought can be distin­guished among the advocates of personalised aid:

- the theorists: these favour a liberal, non-interventionist approach'to transport; in their eyes, personalised aid is the only specific means of assistance compatible with their

doctrine. - the pragmatists: to them the system of transport vouchers is

well suited to widely varying needs, in particular one enabl­ing the potential of taxis to be more fully exploited as well as their effective integration in an overall scheme for public transport managment.

In view of all the advantages that these solutions appear to offer in this area the limited testing of such safeness should be

criticised, since apart from assessing entitlement of the elderly or handicapped few practical difficulties are involved. Therefore, in discussing the issue of affording such groups easier access to public transport in general, the scope afforded by taxis should henceforth broadly be stressed, since these prove especially effective as a mode of travel for users with impaired mobility. In order to achieve this, thought must be given to ways of improving the opera­tion of this type of transport; little advantage has so far been taken of its possibilities, not least because of time-worn habits of management. The operating conditions for a taxi system undoubtedly offer a broad prospect which could well do with a breath of fresh invention.

Research and experimentation on more efficient use of taxis deserve all the more to be encouraged as the transport needs of many persons with. a temporary handicap have until now received scant

attention. The very flexibility of taxis, in marked contrast to the institutional rigidity of specialised services, presumably would

particularly suit the requirements of users with a temporary motor handicap.

Hence it is imperative that any overall scheme of public trans­port management which takes account of the specific requirements of the elderly and handicapped, should also cover taxis which moreover need not unduly be altered to improve ease of access. In fact, taxis provide a very effective solution midway between conventional public transport, whose role on behalf of users with seriously impaired mobility is necessarily restricted, an~ the private car a solution

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to which a great many handicapped people aspire but is one thwarted by the lack of financial resources.

c) The private car

One reason in particular for the lack of overall measures to promote use of the private car by elderly and handicapped is the fairly general emphasis in recent years on the revitalisation of traditional public transport. Motivation studies are most inade­quate in this respect, and one factor showing the little attention paid to this kind of solution is the lack .of information on the inner promptings of certain elderly people who give up their cars.

The few in-depth research projects recently undertaken on transport needs clearly reveal a strong desire on the part of persons with restricted mobility to use cars adapted to their needs, pro­vided their finances permit. This they see as a way of gaining greater independence of movement and as contributing to their inte­gration into life community, unlike specialised services which are accused of further walling in the ghetto to which such people tend to be confined. Moreover, handicap classifications such as in the San Diego study show that the number of handicapped persons needing wheelchairs is relatively small and that a very high proportion of persons with impaired mobility are perfectly capable of running a car given the necessary means with which to purchase and operate the vehicle.

All experts are agreed nowadays in recognising such aspirations as legitimate, especially where the handicapped are concerned, and in seeing the private car as an effective way of providing transport for persons with restricted motor ability. Moreover, it has to be admitted that certain social policies which involve moving the elderly and handicapped out of their homes and grouping them together are in most cases an imposition upon such persons and deeply resented by them. It therefore appears highly desirable instead to afford these users easier access to the motor car, owing to the considerable scope provided for travel while homes can be retained and any change in living habits thus be avoided.

The objection has often been made to a policy of this kind that handicapped persons were liable not to have full control over their vehicles and so were a likely danger to other road users. Undoubtedly, there ought to be a thorough examination of their aptitude for the driving of vehicles specially adapted to their needs, but the con­clusion reached in all the studies of any weight is that provided these conditions are adhered to there is no specific safety problem involved in allowing motor vehicles to be driven by handicapped persons. More reassuring still is a survey conducted not very long ago by French insurance companies, which showed that handicapped drivers had an average of 25 per cent fewer accidents than ordinary drivers.

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If the argument is thus set aside that motor vehicles are dan­

gerous when driven by persons suffering from impaired mobility, the conclusion is that so long as people have the ability - though this should be closely and regularly monitored - to drive their cars, this practice should be encouraged both on technical and financial

grounds. This type of response to the transport problems of persons with restricted motor ability is in any case perfectly in keeping with solutions for integration in community life or contact with

the outside world which have now been advocated for some time, and hence calls for closer attention than in the past.

d) Walking

In the topical literature, considerable space is devoted to walking as a means of travel, particularly for older people. Actually walking cannot in any way be regarded as a blanket substitute to vehicle transport for elderly or handicapped persons, if for no other reason than that users with serious walking problems are also those who have the greatest difficulty in using the various methods of transport. ~alking is nevertheless a necessary adjunct, one un­doubtedly of special importance for this type of person. Surveys demonstrate that persons with impaired mobility show a marked liking for short journeys on foot. For them this is a way of compensating for the difficulties of undertaking trips some distance away from home, and with this in mind they show a strong wish for pedestrian amenities to be altered within the immediate neighbourhood of their homes.

Until fairly recently, little of practical import emerged from the theoretical consideration of walking amenities to meet the travel needs of elderly handicapped persons. Our civilization,

dominated as it is by the phenomenon of the automobile, has under­standably meant that solutions have largely focussed on the use of motor vechicles, and this is to forget that walking is either the indispensable adjunct to all motor journeys at their beginning and

end, or a substitute for them in the case of movements within the neighbourhood. The American segmentation diagram(1) shown in the Introductory Report and intended to highlight the need of persons with impaired mobility moreover quite clearly reflects the scant attention paid to walking; the initial premise in the diagram is whether or not a driving licence is held, and the importance of

walking in urban life for the handicapped and elderly is totally overlooked. Hence the diagram precludes consideration of solutions appropriate at this level, and may well largely be criticised on this score.

1) See: C. HOOD et al. op. cit.

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The conclusion emerging from all thorough going studies on

transport needs for persons with impaired mobility is, is fact, that efforts should be made, notably in European countries, to take advantage of the possibilities afforded by walking and to re-assess this means for getting about. Research into the walking process should be promoted, and transport planning, traffic light devices, etc. be tried out in such a way as to encourage mobility for handi­capped and elderly people by making it easier to use pedestrian

amenities.

*

* *

To remedy the limitations of specialised services in moving the elderly or the handicapped, the study in depth of the suitability in this respect of the various methods of transport shows that con­ventional public transport can in no way be relied upon as a univer­sal cure, while other techniques have interesting possibilities hitherto comparatively disregarded. Hence, in dealing with widely varying transport needs and largely dissimilar handicaps, a broad

spectrum of technical answers for the handicapped and the elderly to choose from is shown to be necessary. The considerable diversity of suitable responses to satisfy multifarious types of demand is

highlighted, with the reminder that a single response to the mobility problems of persons with a motor deficiency will not do; attention is drawn to the need for a detailed scrutiny of requirements and for solutions which are adapted accordingly. A thoroughgoing typology of handicaps should be used to underpin the various transport tech­niques brought into play. Such a conclusion is obviously liable to affect the kinds of adjustment which will fully enable the various methods of transport to satisfy the requirements of persons with impaired mobility.

B. Adjustments to various modes of transpoTt

If the costs of modifying existing transport services in order to make them accessible to persons with restricted mobility are analysed with some care, two types of expenditure can be clearly distinguished:

- sizeable, very costly adjustments aimed chiefly at meeting the needs of those handicapped persons who are not self-sufficient;

- simpler adjustments which can be carried out in the short term and often at low cost, basically intended for those handi­capped persons enjoying some measure of self-sufficiency.

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A striking feature of technical aid to transport for the elderly and handicapped is that whereas at first the focus was on developing specialised services, later on the emphasis hardened around the desire for "total accessibility" of existing transport systems to the handi­capped and the elderly. An especially clear instance of this line of thought, which would involve the use of technology to ensure access to conventional public transport for all users whatever their degree of handicap, is the debate in the United States on Section 504 of Public Law 93-112 (Rehabilitation Act) which deals with the problem of conditions for carriage of the handicapped. Under this section, in the United States no handicapped person can on the basis of his handicap alone be excluded from sharing in, and be deprived of the

benefits of any programme or activity receiving Federal aid(1). A policy of total accessibility in point of fact is difficult

to implement on many counts. First of all considerable expenditure is required, as by undertaking the very costly installation of lifts for wheelchairs and of ramps. Moreover, the reason for the extremely high cost of large-scale transformation work under total accessibility policies is that measures cannot merely be taken piecemeal. Fo~ such alterations to be really worthwhile, all the transport networks in­volved must be modified. Nor do policies of this kind always· seem fully to meet the approval of handicapped and elderly persons. As the installations involved are especially conspicuous, the sensi­tivity of users is often aroused, making them reluctant in resorting to the systems devised for them.

For all these reasons the so-called "total accessibility" option is currently under heavy fire, and misgivings on this score, espe­cially on the part of carriers, are all the greater as it leads to serious conflict with other users. At a time when the state of public finances now more than ever makes it urgent for the cost/ benefit aspects of expenditure to be examined, it is apparent that to make existing transport facilities accessible indiscriminately to all handicapped persons is too expensive a proposition, hence in most cases is wishful thinking. At any rate considerable caution is called-for in such a policy, since as clearly shown in typologies like the San Diego study, admittedly the heaviest expenditure, even where frequently benefiting other users, in fact only affects a very marginal fri:nge suffering from impaired mobility.

As matters now stand, all experts hence acknowledge that the large-scale transformations under a policy of total accessibility

1) See: "Les transports collectifs a vocation sociale specifique: personnes handicapees et personnes ~gees", Notes de lecture, Division Transports Urbains, Institut de Recherche des Transports, Arcueil, April 1979.

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presumably should be ruled out as far as conventional public trans­port is concerned. As moreover earlier indicated, these forms of transport are almost entirely incapable of meeting the requirements of the more severely handicapped, which ideally remain the province of specialised services. On this score these experts also point out how unfortunate it has been from a technological standpoint, following the over-development of specialised services, that a taste

for the dramatic and excessive reliance on medical criteria ln deal­ing with the problem of the handicapped should have nurtured the myth of total accessibility to conventional public transport. Thanks to this misapprehension, certain adjustments, though simple, inexpensive and effective, have been disregarded, whereas the hitherto largely unused potential of various transport techniques could be developed to serve the purpose of the elderly or handicapped.

In the matter of transport solutions a new way now lies open in dealing with the transport needs of handicapped and elderly users: relatively minor transformations and inexpensive adjustments, which

can be carried out gradually and in the short term, with undeniably beneficial consequences for a great many passengers. Instead of

relying on ostentatious measures which only in fact change the lot of

a few users, the emphasis should henceforth be on a potentially very large number of minor adjustments benefiting as many handicapped or elderly persons as possible. It is thus that the effectiveness which

current economic conditions require can be achieved where transport policies developed in favour of persons of restricted mobility are

concerned. This option is relevant both to conventional public trans­port, whose image is likely to be considerably improved, and to other modes of travel whose advantages, as earlier described, can be turned

to better account.

a) Conventional public transport

Although in the case of conventional public transport, especially

buses, the implementation of total accessibility policies of the kind

entailed by Section 504 of Public Law 93-112 (Rehabilitation Act) in the United States will probably have to be ruled out, and although this will mean the elimination of such far-reaching techni­cal 'adjustments to vehicles as loading ramps or lifts, whose heavy cost is incommensurate with their actual effectiveness, considerable

scope does remain for "soft-technology" innovations. Fairly in­expensive technological adaptations of this kind indeed appear especially suited for.promoting easier access to mass transport facil­ties of this type by elderly and handicapped persons enjoying a cer­tain measure of self-sufficiency, who account for the largest propor­tion of users having some impairment to mobility.

117

4mong minor adjustments in keeping w~th these characteristics, many apply directly to existing vehicles. Several of them are specially worth encouraging as they have a very desirable cost­

effectiveness ratio:

improvements to the boarding steps: without going to the length of installing lifts, efforts should however be made to reduce the height of boarding steps on buses, trams or rail­way carriages, for instance. Moreover it should be recognised that for some time now this matter has received attention from manufacturers and carriers, and is one area where a number of results have recently been achieved. Yet,while technological answers have frequently been provided to counter the diffi­culties caused by access as such, a marked tendency which must be noted is neglect of the many problems arising inside the vehicles. The stress should from now on unquestionably be on technical aids which will enable handicapped and elderly persons to be seated in vehicles without assistance, and chief concerns should be:

- the design of arm rests, whose shape should be altered to increase their usefulness for persons with reduced motor ability;

- the spacing of seats, which is probably too uniform; besides the already widespread practice of reserved seats, it would be desirable for somewhat wider spacing to be provided between some seats in order to facilitate the movements of physically handicapped users, particularly arthritics, whose largely inconspicuous requirements are so often disregarded;

- the devising of an appropriate signalling system both inside vehicles and at stops would also be of invaluable help for the sightless and the hard of hearing.

All these technical adjustments appear capable of being carried out gradually and at no great expense. There do undoubtedly exist a large number of other minor technological alterations which if carried out would.also greatly facilitate the use of public trans­port vehicles by handicapped or elderly person. In order to attract suggestions, competitions might well be held in the various countries concerned, and a type of catalogue containing all feasible improve­ments then be drawn up for transmission to vehicle manufactUrers.

Yet while unquestionably there is room for encouraging low-cost technological adaptations based on alterations to existing vehicles, the emphasis in this area should not only be on "equipment design" but also on "organisational planning". Various improvements appear possible in this respect, with little expense involved:

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- functional improvements at stops. Very special attention should be given to such simple matters as the fitting of

handrails and seats at public transport interchanges. By measures of this kind the movements and waiting of users with impaired motor capacity would undoubtedly be helped, both in

regard to urban transport and long journeys (functional improvements at stations, airports etc.);

- a rethinking of driving behaviour: it would be desirable to organise an awareness campaign for public transport drivers regarding the problems of elderly handicapped users so as to

promote changes in driving behaviour. There appears to be special urgency for a change in the driving habits of urban bus drivers, who, after calling at stops, tend to pull away too sharply, without allowing time for users with difficulty in getting about to reach their seats. Driving behaviour in pub­lic transport is however linked to the more general problem of training staff responsible for facilitating the transport of elderly or handic-apped persons, and in view of the importance

of this issue it will be specifically considered at a later

stage; - the development of a system of helpers: the evidence from

all typologies is that a large number of elderly or handi­capped persons are perfectly capable of using a standard public transport vehicle provided they receive help from some other person. Encouragement should therefore be given to

the setting up of veritable "escort" systems, and to the creation of volunteer groups for the purpose. This would obviate the frequently excessive establishment of specialised

services. The success of such services is thus very largely due to the fact that elderly or handicapped persons are certain to find this type of assistance provided, and in many

cases this is all they really need, and is not of itself sufficient justification for using vehicles specifically set aside for the purpose. By the same token, steps should be taken to cater for guide dogs, especially for blind train and aircraft travellers.

b) Taxis

In the studies available, much space is devoted to technical vehicle adjustments, which should enable taxis to meet the .specific needs of elderly or handicapped users. There is no lack of proposals for the creation of new, specially adapted vehicles. But little of practical import has actually emerged from all the competitions

organised for the designing of a new standard vehicle closely tailored to the requirements of persons deprived of full motor

ability. The necessarily restricted number of vehicles built and the sophistication of the technological solutions adopted would

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undoubtedly make the launching of taxis of this kind a very costly measure. Moreover some misgivings would unfailingly be expressed by the profession, as the purchasing habits of taxi owners would be

considerably affected.

Again, just as in the case of conventional public transport, the

emphasis should be on less radical changes with such measures as slid­

ing and swivel seats for the front passenger. Low-cost alterations of this kind have been carried out by certain craftsmen in Switzerland as well as in Munich, where 25 taxis have been appropriately fitted out at very reasonable cost.

Yet despite each and every conceivable technological measure, the fact remains that a taxi taking on a fare with impaired mobility is highly likely to sustain loss of productivity, with some incon­venience to the driver, on account of time lost in boarding the vehicle, the handling of luggage or wheelchairs etc. This is the explanation for the occasionally unco-operative attitude of taxi

drivers towards this type of patron. Hence, alongside the technical adjustments to vehicles, it would perhaps be expedient, in order to make full use of the very great potential latent in taxi services

for the carriage of elderly or handicapped persons, to institute, through the public authorities, financial incentives for drivers to accept this kind of fare. Besides which, greater awareness of the problem, better information and even training, should be promoted

in the taxi-driving profession, which still arouses very mixed feel­ing among the handicapped, in order that a mode of transport with distinctly social connotations, can most effectively be provided.

c) The private car

In setting needs and measures against each other, priorities should be laid down not only as to needs but also in regard to measures for meeting such needs. As it happens all the studies

reveal that whenever persons of impaired mobility have the opportunity to use a car, it should be given priority since this is in keeping with the most deep seated aspirations of such persons. All typologies

describing handicapped needs, clearly show how important a question it is to adapt the private car to their requirements.

With this in mind, it would appear advisable in the first place to develop systems of financial aid to cover, whenever required, the

cost in needier cases of having alterations made to adapt motor vehicles to specific needs. Measures of this kind are undoubtedly far less costly than radical changes to conventional public transport.

An even bolder policy, undoubtedly, would be to provide finan­cial and economic advantages such that persons with some motor handicap yet able to drive would be afforded access to the private

car. To this end more financial aid than has been previously avail­able should be granted to help with the purchase of special vehicles.

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To encourage such use of the private car by the handicapped and elderly, often of slender means, the possibility of extending systems of personalised aid, whose advantages for improved taxi operation were earlier described would seem to call for careful examination. Since personalised aid is readily adaptable, widely varying requirements can more easily be met, and so it ought to be available to elderly or handicapped persons for the purchase, re­fitting and maintenance of private cars suited to their needs.

d) Walking

As in the case of aid to promote the use of specially-equipped private cars, adjustments designed to make walking easier should receive greater attention in Europe than has so far been devoted to radically altering public transport facilities. It should not be forgotten that elderly persons use walking first and foremost as a way of getting about, and that potentially there are many simple measures which can make it easier.

A study in depth of the walking process should therefore be stimulated, and the improvement of pedestrian amenities be promoted when planning transport schemes, traffic layouts and devices for controlling traffic lights at crossroads or at pedestrian crossings. It should not be forgotten that in making it easier for the handi­capped or the elderly to use public transport, the process of adapta­tation should actually begin downstream from the stops serviced by such transport. Often just having to make one's way from home to the bus station, taxi rank, or even to one's vehicle may be a size­able obstacle. Poorly designed pedestrian facilities can only in­hibit the use of existing transport systems. By the same token, it should be remembered that persons 7 with limited mobility,experience difficulty in getting about not only when confronted with the means of transport themselves but also to a great extent because of poor design in houses or apartment buildings (lifts, staircases, doors, etc.). Thought might therefore well be devoted to this matter, and needed adjustments be promoted if the whole gamut of transport pro­blems for elderly and handicapped persons is to be given a worthwhile solution.

e) Other measures

In the years to come, public authorities would be well advised to examine a whole series of ancillary measures which, both in physi­cal and organisational terms, could appreciably improve the use of existing transport facilities by elderly or handicapped persons. Among relevant measures, the following are especially noteworthy:

- Wheelchair design. Following the de facto priority given to eye-catching measures, the problem of wheelchair access to

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public transport facilities has recently held the centre of· the stage and led to certain concrete achievements. Yet in the manner of tackling this question the order of priorities seems to have been faulty, Thus before dealing with loading and carriage conditions regarding wheelchairs used by the handicapped, there would unquestionably be far more sense in rethinking their design and in devising standards for them. In a recent census, more than 200 models of wheelchairs were recorded, most of them highly unsuited to actual user require­ments. Moreover; nearly all such chairs are designed to move along on the ground and not for carriage aboard other vehicles. The problem with wheelchairs as they stand is hence not just one of size but most of all a matter of storage and braking. Before any thought is given to technical alterations to public transport vehicles enabling them to accommodate special chairs for the handicapped, it would be expedient, especially at international level, to take steps such as to promote a stan­dard wheelchair design especially for railway and aircraft use, which appears far more feasible than for purposes of urban travel.

- Dissemination of information to users. As clearly shown in the first half of this document, in order to achieve effective segmentation of the market and so arrive at more effective and less costly measures, the requirements of persons with impaired mobility must be better known, which means that ex­tensive enquiries covering this category of persons must be organised. But it must be acknowledged that neither does information flow easily in the opposite direction. Elderly or handicapped users are frequently not conversant with the facilities available to them, and thus experience added dif­ficulties in moving about due to the lack of cohesion among the systems instituted and of information about them. Accordingly there would be much to be said for instituting public awareness and information campaigns concerning the full range of existing aids facilities and arrangements designed to help handicapped and elderly people to move about, which they and those around them as a rule are unfamilier with. One way of solving this problem might thus be to set up, in each city, an information centre to advise on services avail­able to such groups. By informing people in this position on both transport and all matters concerning housing, etc., such centres would go a long way towards promoting the inte­gration of the handicapped and elderly into community life, an increasing aim of policies on behalf of these disadvantaged categories.

122

In tandem with attempts at better informing users, special efforts should be made to improve procedures for the manage­ment of funds set aside for elderly or handicapped persons. The administration of these funds should thus be altered ih such a way as to make them more accessible to those disadvan­taged social categories for which they are intended. A clear need exists for simplification and standardization of all administrative formalities required for the granting of such aid, especially transport-related aid. The many different steps which must be taken, the lack of co-ordination between systems instituted according to place of residence, and the dearth of relevant information are further obstacles to the movement of elderly or handicapped people, over and above the difficulties ihherent to their physical disability. Training for personnel transporting the handicapped and the elderly. With reference to measures likely to encourage use of existing transport facilities by persons of restricted mobility, all experts agree that personnel called upon to make travel easier for the handicapped or elderly should be suit­ably trained. The experts stress the importance of this approach in countering a tendency to let matters take their course in a world in which the profit motive, especially where public transport is concerned, is increasingly apt to stiffen attitudes towards the needs of users; hence the indifference of personnel towards the special requirements of the handi­capped and elderly. This emphasis on the training of transport personnel is motivated by the same considerations as those which led experts to highlight the relevance of helper or escort systems. In addition to disseminating information to the users them­selves, an awareness campaign should also be directed towards those in any way involved in transport facilities for handi­capped or elderly persons. Such a campaign should be fairly extensive and not merely restricted to the provision of infor­mation. By standardizing information given to the drivers of public vehicles, taxis and carriers on how handicapped and elderly users should be approached, the ultimate result will be to train those in a position to provide transport facilities for such disadvantaged social categories. A training scheme of this kind should not, however, be restricted to transport staff, but also cover those who can advise the handicapped and elderly in choosing their mode of travel. In the past, too little heed has unquestionably been paid to this aspect. In particular, full and accurate information on the scope afforded by the various transport modes ought to be disseminated among

123

doctors dealing with this type of problem, in order to ensure that they are adequately briefed. In this way, the availability of accurate data on the types and characteristics of transport which the handicapped can use will be of invaluable assistance to doctors in determining the modes best suiting the particular circumstances of their patients. At the same time this would no doubt promote the better use of existing transport facili­ties, which are often less well-known than the specialised services and in many respects are a ready-to-hand solution for sometimes ill-informed medical circles.

In addition to the various measures outlined above, two areas in which effective action could appreciably improve travel for the handicapped and the elderly should be more thoroughly researched:

- The carriage of goods: Efforts here should not be restricted to a study of solutions covering journeys by people but should also closely deal with any and all such options concerning the carriage of goods which can greatly ease living conditions for the elderly and the handicapped. Enquiries should therefore be put in hand regarding measures providing for the efficient delivery of needed goods to persons with a motor disability who prefer not to do the fetching themselves. By avoiding undesired journeys and so respecting the chosen lifestyles of such persons, measures of this kind would be consonant with the need pointed out in the first part, which is to integrate transport solutions for the handicapped and the elderly with their desired overall lifestyle. Such measures would be an important adjunct to a genuinely comprehensive transport policy for the elderly and the handicapped, which through various measures must be adjusted to widely different needs.

- Recreational transport facilities: Generally speaking, jour­neys for purposes of work, health care and purchases have received greater attention than those relating to the recrea­tional activities of persons with impaired mobility. Similarly, surveys and practical schemes have focused more on urban transport than on long distance travel by this type of user. Unquestionably this is a substantial shortcoming which.any really comprehensive policy to encourage elderly and handi­capped persons to get about should be duty-bound to correct.

*

* *

124

The issues which clearly emerge from the study of resources to promote a genuine transport policy for the handicapped and the elder­

ly are the following:

- The need for highly-differentiated aid. In response to highly individualised needs, which in any case need to be better known, the solutions can be but highly varied and must in all circumstances respect the desired lifestyle of handicapped and

elderly persons. - The inexpediency of seeking radical solutions. The fallacy

inherent in the myth of total accessibility should not be yielded to, nor should specialised services be over-extended, but rather be set aside for the more serious cases. From a technical standpoint, a great many simple adjustments and small systems would enable almost all needs felt by the very large majority of handicapped or elderly users to be met at

reasonable cost. The need for a global approach. All equipment or organisa­tional measures in regard to transport would be useless un­less accompanied by careful thought regarding the location of aged and handicapped people. Solutions to the mobility problems of this type of person are indeed heavily dependent on town-planning and locational policies, and on this score it must unfortunately be admitted that resear.ch has been in­adequate. Moreover, much of the effectiveness of technical answers in the transport sector will be lost unless action is undertaken to alter the behaviour of people, especially young people, towards elderly users or those affected by motor disabilities. Since the educational role of the school and the family is not in this respect the same as it used to be, much remains to be done to awaken the public's awareness and thus change the attitude, where public transport is con­

cerned, of young people and adults towards the handicapped

and the elderly.

3. SUMMARY

International comparisons of transport experience in regard to

the elderly and handicapped are of special interest for three reasons: differences in approach as between countries, lack of knowledge con­

cerning needs, and the policy implications involved in the search solutions.

125

1. Identifying needs

1.1 Determining what groups are concerned

Relevant statistical samples are by no means easy to construct since elderly and handicapped individuals are difficult to identify and official classifications prove inadequate. Elderly people differ greatly, while "handicap" is a notion hard to pinpoint objectively. There are undoubtedly links between the handicap and the marginal social conditions of the sufferer and how he comes to terms with his handicap. The available statistics, mainly based on specific needs, are not comparable. Furthermore, since they are mostly compiled on the basis of official classifications, they prove unsuited for high­lighting specific transport needs. A number of minor handicaps may well not be recorded, yet be a considerable impediment to travelling. In identifying needs, the officially recognised legal status can thus conflict with actual mobility requirements.

There are no well tried ways of identifying persons whose capa­city to move is reduced, Further research of a more qualitative kind seems to be needed, so that the widely differing situations of handicappeQ and elderly people can be grasped. Only by adequately segmenting the impaired mobility group in terms of needs would it seem possible to adopt efficient measures and avoid concentrating on conspicuo~s but marginal requirements.

1.2 Identifying needs

The question of mobility should be analysed as part of a study of the lifestyle desired, since there can be no question of imposing a mode of life on the elderly or handicapped through transport measures. Since travel behaviour is not conditioned solely by physi­cal handicaps, transport cannot make such difference once a socially withdrawn lifestyle has set in; transport's only role is to prevent this from happening.

Examining the condition of identifying groups whose mohility is impaired and their needs shows that in trying to devise effective solutions, care must be taken to avoid:

- spectacular, unduly medical approaches and actions designed to impress the public;

- quantitative approaches, especially of the aggregative type, based on establishing mobility standards.

2. The search for solutions

This largely depends on how such a concept as the place in society of groups whose movements are impaired and what kind of help

126

they should receive has evolved over time. There has been a gradual movement from charity to assistance, and then f~om assistance to the right to financial aid and a job, and ultimately, to integration in

community life.

2.1 Use of specialised services

- User attitudes: many users have mixed fe~lings about the special service, feeling that it makes the social ghetto in which they tend to be confined even worse, and will only use such facilities when no other means of transport are available.

- Running costs of specialised services: to assess these pro­perly, they must be compared with the costs of relocating and all other types of expenditure incurred for the elderly and handicapped. They are however undoubtedly high, which suggests that:

- they should be compared with the costs of taxis, which can often substitute for special services; efforts could be made to reduce the costs by opening the ser­vices to other users, develQping volunteer schemes, and in­troducing more effective co-ordination between the various transport systems; the organisation of special services: the present pattern, in which many private and semi-public institutions are involved, does enable specific needs to be met very closely; but it leaqs to over-saturation of the demand, to solutions which are not sufficiently open to the outside world, to the creation of

what are tantamount to private preserves, and to the absence of any well-co-ordinated overall service.

Analysis therefore tends to challenge the strategy of assigning a pre-eminent social transport role to specialised services, which should be designed only to supplement conventional modes:public trans­port, private cars, taxis etc.

·2.2 Use of existing transport facilities

A. The suitability of different modes of transport

- Conventional public transBo:t: this can have only a limited role for severely handicapped users, and during rush hours.

- Taxis: often capable of providing a service quite matching that of special forms of transport, but usually at a lower cost. They are also perfectly compatible with personalised aid systems, which have a considerable future, and can validly meet the requirements of temporarily handicapped users.

- Private cars: so long as people have the capacity (strictly and regularly checked) to drive, they should be encouraged to do so, both technically and financially.

- Walking: those whose mobility is impaired are particularly inclined to make short trips on foot, which is undoubtedly an essential complement to vehicle transport; walking should therefore be encouraged and facilitated.

B. Adjustments to various modes of transport

- Conventional public transport: policies of total accessibi­lity here should certainly be discarded in favour of efficient inexpensive minor adjustments. Such modifications are rele­vant both to equipment design (vehicles easier to step on and off, appropriate design of arm rests, more space between some of the seats, signalling systems for the sightless and hard of hearing, etc.) and organisational planning (layout of stops, influencing of driving behaviour, provision of escorts, etc.).

- Taxis: since it would probably be very hard to have taxis produced to specially adapted new designs, it would be wiser to concentrate on less radical changes, such as sliding or swivel seats for the front passenger. It would also be help­ful to organise an awareness campaign for taxi drivers re­garding the problem of elderly and handicapped users, and pro­vide incentives for accepting them as patrons.

- Private cars: systems of financial aid should be developed for the most disadvantaged to promote adjustment of their vehicles to their specific needs. The elderly and handicapped should also be helped, especially by extending personal grants to fulfil the economic and financial conditions for running a car.

- Walking: research in depth is needed regarding the walking process, the improvement of pedestrian amenities when planning transport schemes, traffic layouts and devices for controlling traffic lights. There is also a need to improve the often inadequate design of houses and apartment buildings.

- Other measures:

- Wheelchairs: it would be useful to promote the design of a standardized wheelchair usable on other transport vehicles

- Tiissemination of information to users: the elderly and handi­capped and their families often do not realise what facilities are available; awareness campaigns and information centres are here required.

128

- Training for transport personnel: by standardizing the infor­mation given to drivers of public vehicles, taxis and opera­tors, about helping the handicapped or elderly user, transport personnel must be effectively trained to make travel easier for these disadvantaged social categories. Similar activities should be developed for physicians, so that they can better determine modes of transport meeting for their patients'

needs.

129

Prof. J.B. POLAK Rijkuniversiteit Faculteit der Economische Wetenschappen Postbus 800 9700 AV GRONINGEN {Netherlands)

Mr. A. BIEBER Chef de la Division des Transports Urbains Institut de Recherche des Transports (IRT) 2, avenue du Gen. Malleret-Joinville Bo!te postale 34 94114 ARCUEIL (France)

Dr. Ph. A. HITCHCOCK Head of Transport Operations Dept. Transport and Road Research Laboratory {TRRL) CROWTHORNE, Berks RG11 6AU {United Kingdom)

Dr. Barbara METTLER-MEIBOM Chef de Section SOCIALDATA Institut fur empirische Sozialforschung GmbH Hans-Grassel-Weg 1 8000 MUNICH 70 {Germany)

Mrs. C. POULENAT-ABALLEA Ingenieur de Recherche Institut de Recherche des Transports (IRT) 2, avenue du Gen. Malleret-Joinville Bo!te postale 34 94114 ARCUEIL (France)

Mr. ARTAUD-MACARI 'rnspecteur General Honoraire des Transports et des Travaux Publics President Directeur General des Transports Urbains de Nice 26, rue de l'Hotel des Pastes 06000 NICE (France)

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Chairman

Rapporteur

Rapporteur

Rapporteur

Rapporteur

Mrs. M. BENWELL Lecturer Centre for Transport Studies Cranfield Institute of Technology CRANFIELD, Bedford MK43 OAL (United Kingdom)

Prof. H. DIEDERICH Johannes Gutenberg-Universitat Fachbereich Rechts- und Wirtschaftswissenschaften Saarstrasse 21 Postfach 3980 6500 MAINZ (:Germany)

Miss J.M. GARDEN Ministerie van Verkeer en Waterstaat (Ministere des Transports et des Travaux Publics) Section de la Planification Plesmanweg 1-6 2500 Ex-s'GRAVENHAGE (Netherlands)

Dr. G. HUPKES Directeur AGV Adviesgroep voor Verkeer en Vervoer bv Willem Dreeslaan 16 3515 gb UTRECHT (Netherlands)

Mr. E. JACOBS Directeur Van Heesewijk Belgie nv (VHB) Frankrijklei 8, bus 11 2000 ANVERS (Belgium)

Professor A. JENSEN I.M.S.O.R. The Technical University of Denmark Lundtoftevej 100 Building 349 2800 LYNGBY (D,2nmark)

Mrs. G. LARBORN Senior Investigational Plann.ing Officer Goteborgsregionens Kommunalforbund Folkungagatan 20 41102 GI:5TEBORG (S'tleden)

Professor B. MATALON Ma1tre de Conference Universite de Paris VIII Rout.e de la Tourelle 75571 PARIS CEDEX 12 (France)

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Mr. V. OLALLA Dr. Ingenieur 1a Jefatura zonal de Construccion Direccion general de Infraestructura del Transporte Ministerio de Transportes y Comunicaciones Agustin de Bethencourt, 25 MADRID-3 (Spain)

Mr. PIERI Ingenieur Universita degli Studi Facolta di Ingegneria Istituto di Trasporti Viale Risorgimento 2 BOLOGNE (Italy)

Dipl.-Ing. V. SPARMANN Managing Director SNV Studiengesellschaft Nahverkehr mbH Joachimstaler Strasse 17 1000 BERLIN 15 (Germany)

Mr. B. SUNDV ALL Assistant Manager Svenska Taxiforbundet Svetax Service AB Radmansgatan 48, 2 tr. 11357 STOCKHOLM (Sweden)

Ms. Janice TAIT Senior Policy Analyst Surface Policy and Urban Transport Assistance Canadian Surface Transport Administration Transport Canada Place de Ville OTTAWA (Canada)

Mr. S.B. VODAHL Civil Engineer (Researcher) Division of Transportation Engineering 7034 NTH TRONDHEIM (Norway)

£ECRET.A.RIAT

Messrs. G. BILLET A. DE WAELE F. ESTEBAN A. H.ATHEH.Y

133

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I900TS 75 81 031) ISBN 92-821-1066-4