Lynnwood resident Emily Wickham struggled to access health care once she stopped driving. Now, volunteer drivers from Northwest Neighbors Network help her travel to medical appointments. (Photo by Julia Wiese)

This is the fourth of a five-part “Health Matters” series focused on health topics in South Snohomish County and sponsored by the Verdant Health Commission.

Read part 1 — “As county’s demographics change, immigrants struggle to access health care” — here, part 2 — “Area’s increasing density prompts gardeners to get creative growing in small spaces” — here, and part 3 –“Despite clear value, many people delay or skip health screenings — here.

When Lynnwood resident Emily Wickham, 76, developed rheumatoid arthritis, she lost the ability to drive. Medical treatment could ease her debilitating symptoms, but that meant she’d need to travel to Northgate for the appointments.

As she struggled to move her arms and legs, Wickham considered her transportation options. A private ride service like Uber or a taxi would cost roughly $100 roundtrip, a tough regular bill on a fixed income. There were no bus routes near her home, and sitting for long periods on a shared transit shuttle would be painful.

“I was thinking: I don’t know what I’m going to do about this,” she said. “I can’t afford to get there, but how am I going to survive without treatment?”

Wickham’s conundrum is familiar to many local residents who struggle to access transportation for health care. Sometimes, getting to the hospital or clinic can be so daunting that people skip critical health appointments. Nationwide, nearly 6 million people delayed medical care over a one-year period because they did not have transportation, a trend that’s increasing, studies have reported. For people who already face disadvantages, such as low-income individuals and people with chronic conditions, other research has shown the barriers can lead to even greater health consequences.

Even as Snohomish County makes substantial strides in advancing transit capacities, local residents say it can be tough to navigate the diverse options, especially when you’re in the throes of a health crisis.

“People don’t recognize the importance of transportation until they’re unable to drive themselves,” said Brittany Blue, the chief marketing and philanthropy officer for Sound Generations, a nonprofit that helps older adults and people with disabilities access transportation. “Transportation plays a huge role in health.”

What’s available for non-drivers?

In South Snohomish County, several recent steps are improving the transit landscape. The “once-in-a-lifetime” light rail expansion has prompted Community Transit to redesign the bus system, creating more frequent local service as well as providing easier access to King County destinations through links with the light rail, the agency reported.

Zip Alderwood Shuttle provides low-cost service (Photo courtesy Community Transit)

Along with buses, Community Transit provides DART Paratransit, an on-demand ride sharing service for people unable to use bus service. People outside of those service areas can use Transportation Assistance Program (TAP), which offers transportation for older adults and people with disabilities. Meanwhile, the Zip Alderwood Shuttle, which launched two years ago, offers low-cost service in Lynnwood’s Alderwood Mall area.

Along with public options like those, there are nonprofit and volunteer services that offer driver or shuttle services – though some only apply to certain groups like veterans, older adults, people with Medicaid, or patients traveling for cancer treatment. Identifying these diverse offerings can be tricky, transportation advocates say.

“Knowledge of these services is a really big barrier,” said Brock Howell, the executive director of the Snohomish County Transportation Coalition (Snotrac), which advocates for improvements in transportation services, especially for those with specialized needs.

New tool offers potential

Residents test out Hopelink’s new website Findaride.org, a trip planning website that will officially launch in Snohomish County next year. (Photo courtesy of Hopelink)

A new online tool from Hopelink, a King County-based nonprofit, aims to provide some clarity. The site –Findaride.org— creates a central place where people can filter their local transit options in King, Pierce and Snohomish Counties.

“Often people contact us in a bit of a crisis mode after they’ve exhausted their own network,” said Laura Loe, the Find a Ride program manager. “It would be so great if people knew about all of this before there was a crisis.”

While the site won’t officially launch in Snohomish County until next year, the tool already lists dozens of options for residents who need transportation assistance. People can adjust the results based on characteristics that might influence their options, like whether they have a disability, use Medicaid insurance or are a veteran. Knowing different options will help people find something that’s best suited to their needs. For example, even if someone qualifies for a public transit shuttle, they might not be comfortable sharing spaces with others or have the time to wait while the driver picks up other passengers.

Every time Loe gives a demonstration of the Findaride tool in the broader community, people notice resources that are new to them. For example, in a recent Seattle meeting, community members were enthusiastic to learn about the Downtown Circulator, a free, fixed-route shuttle bus that connects riders to health providers in downtown Seattle. Hopelink plans to share the tool with leaders in diverse communities, from city librarians to tribal transportation leaders. As they continue to develop the resource, they’ll focus on equity barriers, such as exploring how people without Internet or with low vision can best access the tool. Ultimately, Loe hopes the resource will reduce the number of people who forego healthcare because of transportation barriers.

“We talk a lot about the trips not taken,” Loe said. “We know there are a lot of trips for health care that people have given up because the system is so difficult to navigate. We want to get to the point where people don’t have to be transportation experts themselves just to know how to get around.”

Even so, she acknowledged the tool won’t share services that don’t exist, and gaps persist especially for last-minute needs. What happens, for example, if wildfire smoke suddenly triggers someone’s asthma and they must quickly get an inhaler prescription filled?

Locals share health obstacles

Pati Ingraham is just one example of the numerous residents who cancel appointments because they simply can’t get there. Ingraham, 89, scaled back on driving since her medications make her feel dizzy and loopy.

“I’ve always been independent and driven myself,” said Ingraham, a retired school custodian who once worked at the former Petosa’s grocery in downtown Edmonds. “But I don’t drive far anymore. I feel really bad when I can’t get somewhere.”

With medical appointments in places ranging from Edmonds to Everett, transportation is a common struggle. Ingraham has canceled several recent visits because she doesn’t have a ride. Even though volunteer drivers from nonprofits like Catholic Community Services have been helpful, they can’t always guarantee a driver for a specific day and time. One of Ingraham’s missed appointments was for a skin cancer treatment. Since providers are booked several months out, she can’t get another until the end of December.

“Transportation is really hard for seniors,” she said. “You just can’t get anywhere.”

Edmonds resident Bette Bell, 84, a retired high school teacher, has faced similar struggles. Recently, she injured her foot and suddenly found herself unable to drive. Bell needed to visit the doctor every Wednesday for treatment. From her home to Swedish Medical Center is about an hour’s walk, but her injury made walking impossible. While she could afford a taxi for a one-time appointment, the cost for ongoing trips was too high. Bell doesn’t have any family nearby who could drive her, and her friends were facing their own health and transit challenges. Without care, though, the sores on her foot placed her at risk for infection and amputation, she said.

Bell reached out to Northwest Neighbors Network. The group has connected her to volunteer drivers, who also accompanied her to the appointments. Now, her foot is healed and she can walk and drive again. Bell hesitates to think about what might have happened to her foot – and her overall health—without the transportation help.

“I don’t think it would have healed and I might have died,” she said. “That group was a miracle that really saved the day for me.”

Addressing the transit/health connection

Gary Renville, who leads Project Access Northwest, says it’s important to understand the transit/health care connection. (Photo courtesy Project Access Northwest)

These individual stories are all too common, said Gary Renville, the president and CEO of Project Access Northwest, a nonprofit that connects low-income and uninsured patients with specialty health care appointments. That’s why the group doesn’t simply make appointments; they help people figure out how to get there.

“We recognize all the barriers to transportation, particularly throughout Snohomish County,” he said. “We ask: How are you going to get there? Do you have a car? Do you have someone who can drive you? Nine times out of 10, they say no.”

If that’s the case, the group walks a patient through their transportation options and comes up with a clear plan. For some people, they might review a bus route and identify when they need to arrive at the stop. They might also discuss when to get off the bus and how to dress for the weather. When someone is reticent to use public transit, they’ll discuss other organizations that offer services, such as Hopelink for Medicaid beneficiaries. If someone relies on a grown child for driving, the group will try to schedule appointments outside of common working hours to make that ride more feasible. For people who do drive themselves, they’ll address where they might park to avoid a steep fee, another potential obstacle.

All of this assistance is intended to ease the burden of organizing transit so that people can focus on their health. Addressing potential transportation barriers has been hugely successful: 97% of people referred to Project Access Northwest make it to their appointment. That success underscores the importance of addressing factors beyond health care itself that can influence how people access care, he said.

“Someone who is living in poverty has lots of other things on their minds,” said Renville, who has experienced being unhoused himself. “I come from a family who got medical care from the ER because they didn’t know how to navigate the health system.”

The experience of addressing client’s transportation barriers has made Andrea Castell, an operations nurse with Project Access Northwest, pay closer attention to obstacles the larger community might face – even among people who can afford private transportation services. Recently, an 80-year-old friend shared that she was unable to use ride services such as Uber because she didn’t know how to set up the app on her smartphone. Even using the app interface can be troublesome for some people.

“Your fingers have to be nimble,” Castell said. “Just think: What if your hand is stiff and arthritic?”

Addressing fear, creating social connections

Throughout the county, volunteer drivers help fill in the gaps for people unable to drive. At Northwest Neighbors Network, which connects South Snohomish County residents to volunteer drivers, about half of the monthly transportation requests — or about 150 — are for medical visits, said Danie Belfield-Vigh, the director of community operations and outreach.

“A lot of people told us they weren’t going to the doctors as often before Northwest Neighbors Network,” she said. “I think we also take a little of the fear away and make them feel more at ease.”

While volunteers don’t do anything medical, just having someone along can feel comforting. Volunteer drivers can also accompany people to the appointment itself, which is especially beneficial if someone has vision loss or movement struggles. Having a companion can also improve someone’s mental health. There’s the social aspect of having engagement during the ride, and many volunteers pick up the same people over and over, creating relationships along the way, she said.

Ian Watson, senior manager of transportation at Homage. (Photo courtesy Homage)

Indeed, transit’s connection to health isn’t simply about getting someone to their doctor’s appointments, explained Ian Watson, the senior manager of transportation for Homage. A Lynnwood-based nonprofit, Homage provides non-emergency transportation service to people 55 or older, disabled people, or low-income people who are outside of the DART (Dial a Ride) service area. Watson points to a recent experience giving a ride to a couple, one of whom now uses a wheelchair. The couple hadn’t been out socially together because of challenges transporting the wheelchair, something that took a toll on their ability to enjoy life together.

“Once they found us, they got to go to Costco and restaurants together – that’s a beautiful thing to have,” he said. “Those are the people we try to service, the people who don’t have an option.”

While people’s distinct needs might lead them to different transit choices, the impact is clear: Having transportation can improve both physical and mental health.

That rings true for Wickham, the Lynnwood resident with rheumatoid arthritis. After reaching out to her church, Wickham ultimately got connected with Northwest Neighbors Network. Her volunteer drivers have become like family at a time when she doesn’t have a lot of social support. The help getting to appointments allowed her to access to life-changing care. The medical infusions for her condition have greatly improved her health, she said, adding: “It’s given me my life back.”

She’s hopeful other people in need can find ways to access transportation help. It’s hard enough to experience aging and related health concerns. Knowing you can get to an appointment can ease some of the fear that accompanies medical diagnoses.

“You worry: How am I going to cope?” Wickam said. “How am I going to get through this?”

Learn more about transportation options:

Find a Ride: This new effort from Hopelink, which will officially launch in Snohomish County next year, already offers a list of resources as well as filters to gauge your eligibility for certain services.

Zip Shuttle Alderwood | Community Transit. This on-demand shuttle offers rides within the Alderwood area of Lynnwood.

Northwest Neighbors Network: A volunteer team serves seniors in North King and South Snohomish Counties, including transportation needs. While no one is turned away, the group suggests a $50/month donation.

Community Transit: Check out maps and schedules for local public transit routes.

Transportation Resources | Snotrac: The coalition offers mobility service maps, from fixed route to door-to-door services.

— By Kellie Schmitt

Kellie Schmitt is an award-winning health reporter based in Edmonds. She covers health policy, public health and children’s health for a variety of publications including the Johns Hopkins University Public Health Magazine, ParentMap, and USC’s Center for Health Journalism. She has a master’s in science writing from Johns Hopkins University.

This series is supported by funding from the Verdant Health Commission. The My Neighborhood News Network maintains full editorial control over content produced as part of this series.