A shortage of volunteers complicates access to care in rural America.Health News from the Healthiest Communities

Christina St. Louis, KHN

Several times a month, Jim Maybach drives the 5 miles (8 km) from his home in Hay Creek, Minnesota, toward the Mississippi River.

Arriving in Red Wing, a city of about 17,000, the 79-year-old retired engineer stops to pick up seniors and take them to appointments like dentist appointments and exercise classes. After the appointment, Maybach takes the person home.

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

Maybach is an unpaid, executive volunteer organized by Red Wing’s Face in Action, a non-profit organization that relies on retirees to transport residents to necessary services.

Passengers are primarily older people who do not have ready access to transportation, especially in rural areas where public transportation options are limited or non-existent.

There are several such programs serving rural Minnesota, but like other services across the country, the number of volunteer drivers is steadily declining, according to transportation advocates. Its existence is precarious. Volunteers will either be unable to drive due to age or be unable to maintain the costs associated with volunteering. For decades, Congress has refused to raise the rate at which driver fees are reimbursed.

Public transport in rural areas is already inadequate, experts say, and rural residents have to travel long distances to access health care, so the collapse of the volunteer driver network could lead to a loss of life for older people. There will be even less transportation available, and health care can be hampered. Already, social organizations that rely on volunteers have begun limiting service options and denying ride requests if drivers are not available.

Volunteers were often the first to sign up, recognizing the need for drivers in the community, but as car insurance and gas prices rose, the effort became “as attractive as it once was.” It’s no longer a “win-win”, said Frank Douma. University of Minnesota Humphrey School of Public He is Director of State and Local Policy and Outreach for the Institute of Urban and Regional Infrastructure Finance at Affairs.

Volunteers like Maybach are entitled to a 14-cent reimbursement per mile, but this usually falls far short of covering gas and vehicle wear and tear. The Internal Revenue Service also said he raised the business tax rate from 58.5 cents to 62.5 cents per mile in June, but not the charity tax rate because it falls under the authority of Congress and must be set by law. did. The last time the charity tax rate was changed was in 1997.

For years, the United Community Action Partnership, a nonprofit organization that operates volunteer driving programs in southwestern Minnesota, has used business tax rates to reimburse drivers, despite years of charitable tax rates. I went to Program administrators were unaware that the IRS could count volunteer reimbursements above the charity tax rate as income.

Driving program administrator Shelly Pflaum said the organization reduced the number of volunteer drivers before the covid-19 pandemic after learning about IRS rules and telling volunteers about the tax implications of higher reimbursement rates. experienced its “first significant decline”. .

And while the nonprofit continued to reimburse at the business rate, the rest of the drivers said the rate remained at just 58.5 cents per mile after gas prices spiked in the spring, covering gas and maintenance costs. I was frustrated that I didn’t.

“When you’re spending nearly $5 on gas, it doesn’t do you any good anymore,” says Pflaum. “So there were some concerns. The essential conclusion was, ‘For the amount of money I spend driving my car, this is no longer reasonable for me. I can’t afford to volunteer.’ was.”

An increase in the IRS business tax rate in June convinced most drivers to keep driving, but Pflaum said he lost a volunteer who had been driving for nearly 20 years.

The issue of fee inequality has received bipartisan attention as two bills have been introduced in Congress. Both were sponsored by Minnesota legislators proposing to raise the redemption rate for charity mileage to business rates. Similar proposals have been made before in Congress and failed.

According to a 2018 study by the Volunteer Driver Coalition, Minnesota had 1,900 volunteers that year, serving a total of 77,000 riders.

One of the hurdles volunteers face is convincing auto insurance companies that they are actually volunteers and not hired drivers like Lyft and Uber drivers. Otherwise, insurance companies may require them to purchase more expensive commercial ride-hailing driver policies.

As of September 2020, seven states will have insurance companies denying or canceling coverage or raising rates because drivers are volunteers, according to an AARP Public Policy Institute analysis. I know there is a law in place that prohibits that. At the time, he was the only two states whose insurance laws differentiated between hired drivers and volunteers.

Last year, Minnesota passed a law that differentiates between volunteer and hired drivers. Legislators have also eased drivers’ potential in-state tax liability.

Southeast Minnesota has implemented a program to reduce the types of rides offered by the nonprofit Semcac due to a driver shortage. User is limited to her two non-medical trips per month.

Semcac operations manager Jessica Schwering said: “There are more needs than we can provide, and it’s only getting worse.”

If Semcac can’t find a driver for a community member who needs a ride, that person must find an alternative, such as a family ride, or have their health insurance company find one. Semcac partnered with certain insurance companies to bring clients to medical and dental appointments. Not all volunteer driver programs have this structure.

Schwering manages 53 drivers spread across six local counties. About half of them are in Winona County, a swath of about 650 square miles southeast of Minneapolis along the Mississippi River. She estimates the average driver is her 80 years old.

Schwering said volunteers who quit driving for her nonprofit most often cite health reasons, such as not getting clearance from their doctor.

University of Minnesota’s Douma said the average age of volunteers is also contributing to the decline. “When the baby boomers retired, they were driving the silent generation and the greatest generation of people, but they were fewer than the baby boomers, so fewer people, more people. can now drive,” he said. “But now that baby boomers are aging, the best people to drive them are Generation X, a much smaller generation.”

Jim Maybach started driving face in action after retiring in 2011. Six years later, his wife, Judy, now 78, joined him after she retired from nursing. They have a hard time imagining quitting any time soon.

Still, their volunteer program has begun planning new recruitment strategies to bring in a much younger base of stay-at-home moms.

Katherine Bonine, executive director of Faith in Action, said: “If you have older people, they may transition from volunteers to recipients as they get older and their driving abilities change.”

This story was produced by KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism and major operating programs on health issues. KFFMore (Kaiser Family Foundation). Posted with permission.