9 Thirty participants from a rural community in New Brunswick were interviewed in the fall (September and November). There were four groups of participants: (a) eight older adults registered for the bus service (mean age = 72.5, SD = 11.0), (b) two bus drivers, (c) three program coordinators, and (d) seventeen older community residents who were not using the bus service (mean age = 70.5, SD = 8.2). (Five older adults who registered for the service part way through the study and two bus takers whose intake forms were not received by the researcher were not included in analyses.) Three bus takers (37.5%) lived in the community where the long-term care facility was located and five bus takers (62.5%) lived in rural communities in the surrounding area. This is in contrast to the participants who were not using the bus: sixteen lived in the targeted community (94.1%), and only one (5.9%) lived in the surrounding area. In February and March, six bus takers and thirteen non-bus takers were interviewed a second time. Participants who were lost to follow-up could not be reached and it was reported to us that many were travelling during this time.

10 The following standardized instruments were used with all of the older adults during telephone interviews. The Satisfaction with Life Scale (Diener et al.) is a 7-point, five-item scale determined to have favourable psychometric properties, with a test-retest reliability coefficient of .82 and a Cronbach alpha of .87. Example statements include “In most ways my life is close to my ideal” and “If I could live my life over I would change almost nothing.” Scores can range from 5 to 35, with a higher score indicating a higher level of life satisfaction.

11 The Depression in Old Age Scale (DIA-S) developed by Heidenblut and Zank asks participants to respond true or false to ten statements about depressive symptoms. Examples of statements include “I am feeling down” and “I am worried about the future.” In the first validation of the scale, it showed good internal consistency (Cronbach’s alpha = .84) and an acceptable correlation with a diagnostic criterion (r = .73, Heidenblut and Zank 43). Scores range from 0 to 10, with a high score indicating a high level of depressive symptoms.

12 The demographic survey used was developed for this study. Older participants were asked to provide their age, marital status, and information about where they lived. For bus takers, some of this information was provided by the intake form filled out by participants when they joined the program. For non-bus takers, this information was gathered during the telephone interview. During the telephone interviews, older adults were asked to rate their health compared to others their own age, and then to rate their disability, both on scales from 1 to 10, with 1 being very low functioning and 10 being very high functioning. Additionally, they were asked the following questions: (a) Do you currently drive? (b) Do you have a car? (c) How do you usually get to where you want to go? (e.g., food shopping, clothes shopping, medical appointments, visiting friends), (d) Are there desired trips that you are unable to take? and (e) Is transportation a limiting factor?

13 Older participants were also asked to evaluate the shuttle bus program. For participants who used the service, these questions included how many times and how frequently they used the service, whether they used the service alone, and how satisfied they were with different aspects of the service. Satisfaction was measured using a scale ranging from 1 (not at all satisfied) to 10 (very satisfied). They were also asked to name two things they liked and two things they did not like about the service. Older participants who did not use the service were asked questions about whether or not they currently have a driving licence and a car, how they see their lives in five to ten years, whether transportation and mobility are a source of concern for them when thinking about the future, whether their current transportation gives them independence, and whether they feel they have family and friends who can assist in the future with transportation needs. They were also asked questions including whether or not they knew of the bus service offered by the long-term care facility, and under what circumstances they would and would not use the service. During the second interview (in the winter), participants were also asked if the weather affected their access to transportation.

14 In addition to the surveys for older adults, evaluations of the program were gathered from the bus drivers and the program coordinators. First, the bus drivers were asked to fill out a form after each trip. Each week, the driver noted when the bus left the long-term care facility, how many older adults were on the bus, pick-up and drop-off points, and concerns or issues that arose on the trip. Second, at one point during the study, bus drivers were interviewed, and guiding questions were used to ask about riders’ behaviour during the trips, perceptions of the benefits of the program, and concerns regarding the long-term viability of the program. Third, the program coordinators were interviewed regarding how and why the program was initiated, and their perceptions of the strengths and weaknesses of the program.

15 The shuttle bus service was advertised widely throughout the community, and older community residents were asked to call the long-term care facility to register for the program. When individuals registered for the service, the bus coordinator filled out an intake form with demographic and physical health status information via the telephone. Once the intake process was completed, these older adults were asked if they would be willing to be contacted to participate in a survey. If they agreed to participate, they were contacted by the researcher via telephone, and after informed consent was obtained, the telephone interview took place. At the end of the interview, participants were asked for permission to be contacted again in February or March to do a follow-up interview. Older community members not using the shuttle bus were recruited through church bulletins, posters at public locations, and invitation cards distributed to members of seniors groups within the community. We did not offer an incentive for individuals to participate in the study.

16 The shuttle bus drivers and program coordinators were contacted directly and asked to participate. Interviews with the drivers were carried out in person, and interviews with the program coordinators were carried out over the telephone. Finally, the second author travelled on the bus one day in October, and was present on the bus from the time it left the long-term care facility at 9 a.m. to when it returned approximately five hours later. The researcher observed how the service works, how older adults interacted with the driver and each other, how long was spent at each stop, what happened at each pick-up and drop-off point, and any challenges that occurred on the trip.

17 All of the interviews were recorded. Participants’ responses to open-ended questions were transcribed and then coded independently by two researchers. Interrater reliability was 87%. Responses to qualitative questions were coded using content analysis, and frequency counts were determined. For the quantitative data (satisfaction ratings and normed scales) inferential statistics were carried out using SPSS.

19 According to interviews with the program coordinators, the goal of the project was to keep older community residents in their own homes. As one coordinator said, “I think that it’s intended to allow seniors to stay in their home as long as possible. It is a benefit to seniors, the government; everyone benefits.” The program began offering free weekly rides to older adults in July 2014, and was still in effect in March 2015 when the present study was completed. When not driving the bus, the two drivers worked in the long-term care facility, one as a resident assistant and the other as the activity director. Shuttle bus riders were picked up at home and were taken to a local town about thirty minutes away, or to the regional centre approximately one hour away. Stops included banks, pharmacies, stores, malls, and the grocery store. The service ran twenty-seven times during this thirty-week period with an average of 4.4 riders (SD = 1.79). The number of riders ranged from one (immediately before Christmas) to seven (three different trips in October and November).

20 As part of the present study, the second author spent a day on the bus during one of its routine trips in the fall. The bus left the long-term care facility at the usual time of 9 a.m. to begin picking up individuals at their homes. It took just under an hour and a half to pick up the riders for that day and arrive at the local town. There were six older adults, the bus driver, a special care assistant accompanying one older adult, and the researcher. One participant was in a wheelchair. It was observed that scheduling was a challenge. Each rider had called the program coordinator during the week to say that they wanted to take the bus that day, and knew that it left the long-term care facility at 9 a.m. However, riders did not know who else was riding the bus that day and because participants lived far away from each other, it was difficult for them to judge when the bus would arrive at their home. In some cases, the bus would have to wait outside a senior’s home, and in others the senior was standing by the side of the road waiting for the bus to arrive. On that day, one person was not at the expected meeting point at all and time was lost waiting for them. The researcher also observed that many bus riders lived down long winding roads, which would make pick-ups during the winter difficult.

21 Coordination was also a challenge in town where the bus made a number of stops. For example, only one participant went in to the pharmacy and everyone else waited in the bus. At other locations, such as at the mall, everyone would get off and agree on what time they would meet outside the bus again. Because some passengers did not return by the agreed time, some were left waiting for others. At the lunch hour, the bus riders had to choose between going to the final shopping point (in this case the grocery store) and getting lunch for the bus ride back at a fast-food restaurant. Some of the older adults on the bus mentioned to the researcher that they were uncomfortable on the bus. They complained about how bumpy the ride was, and the researcher also felt that the bus seemed crowded. The bus was designed to seat fourteen, but two rows of seats were removed to allow for wheelchairs. After the shopping was completed, there was not much space left on the bus because of all of the packages and groceries.

22 Despite these challenges, the older adults seemed happy and more engaged with each other as the day progressed. The bus driver was very friendly with the bus riders: She helped them get on and off the bus and would get off the bus at the stops and chat with the waiting bus riders. The researcher did note, however, that it was physically challenging for the bus driver to help load and anchor the wheelchair onto the bus.

23 A summary of demographic information for bus takers and a comparison group of non-bus takers is presented in Table 1. In addition, both older adults taking the bus and a comparison group of older adults not taking the bus were asked to rate (a) their health and (b) their level of disability, both on scales ranging from 1 to 10 in the fall and winter interviews. Two separate 2 (season) × 2 (group) repeated-measures ANOVAs were carried out on these ratings. Non-bus takers (M = 8.39, SD =.26) had significantly higher health self-ratings than bus takers (M = 7.10, SD =.41), F (1,16) = 6.92, p = .02, η² = .98. There was no significant effect of season on health, F (1,16) = .47, p = .47, η² = .03, and season affected both groups similarly F (1,16) = .23, p = .23, η² = .09. Non-bus takers (M = 8.92, SD = .34) had somewhat higher disability self-ratings than bus takers (M = 7.60, SD =.55), F (1,16) = 4.19, p = .06, η² = .21. Neither the season factor (F (1,16) = .09, p = .77, η² = .005) nor the interaction were significant (F (1,16) = .09, p = .77, η² = .005) on this measure. Older adults in both groups were asked how frequently they went to medical appointments. Two participants reported a few times a month, and the rest reported a few appointments a year. When asked about health conditions, the most frequently listed condition was diabetes (25% of bus takers and 17.6% of non-bus takers).

24 Participants were given the Depression in Old Age Scale, and scores indicated that for the bus takers, scores increased from the fall (M = 1.67, SD = 1.5) to the winter (M = 1.83, SD = 1.46). A similar shift occurred with the non-bus takers (fall, M = .54, SD = 1.13; winter, M = .85, SD = 1.6). A repeated-measures ANOVA showed that this increase across the seasons was not statistically significant (F(1,17) = 1.35, p = .26,η² = .07). The group effect was not significant, although the fairly large effect size suggests that with a larger sample, a significant finding could have emerged showing higher levels of depressive symptoms in the bus takers (F (1,17) = 2.82, p = .11, η² =.14). There was no interaction (F (1,17) = .12, p =.73, η² = .007). Scores on the Satisfaction with Life Scale did not differ meaningfully across the groups or the seasons; they ranged from a low of 27.8 (SD = 4.66) for the bus takers in the winter to a high of 29.15 (SD = 3.29) for non-bus takers in the fall.

25 Following the recorded telephone interviews, the answers to the “typical day” question were transcribed and coded for types of socializing. These results are shown in Table 2. Chi square tests were conducted at Time 1 (fall) and Time 2 (winter). Non-bus takers have more social interaction overall, and more varied social interaction than the bus takers, both at Time 1, χ² (2, N = 19) = 7.98, p = .02, and Time 2, χ² (2, N = 19) = 8.27, p = .02. There was no significant difference found in where the two groups visit at Time 1, χ² (2, N = 24) = 3.72, p = .15, but in the winter, non-bus takers have more outings than bus takers, χ² (2, N = 19) = 7.98, p = .02). Similar findings were obtained when we counted the number of different activities reported in response to the question “What do you do for fun?” A repeated-measures ANOVA showed that non-bus takers (M = 3.39) overall reported more activities than bus takers (M = 1.75), F (1,17) = 10.39, p = .005, η² = .38; season had no significant impact, F (1,17) < .01, p = .95, η² = 0, and there was no significant interaction, F (1,17) = 2.25, p = .15, η² = .12.

26 Open-ended questions asking participants to describe a typical day also suggested group differences, namely that bus takers had more limited scope for social engagement. Non-bus takers would usually describe days that were quite filled with activities, chores, and opportunities to socialize. For example, one non-bus taker described a typical day as “pretty busy and involves volunteering, working every Monday, Bible study, cross-country skiing, or the singing group.” In contrast, bus takers often listed fewer activities and their days often involved less socializing. For example, one bus taker said, “Just sit rocking my chair in the wintertime. There is nothing to do. Maybe some food prep and cleaning the apartment.” Indeed, when asked what they do for fun, a number of bus takers replied jokingly, “What is fun?” or “Fun doesn’t exist when you’re a senior.”

27 Participants in both groups were asked questions regarding their personal transportation options and typical transportation behaviours. As outlined in Table 3, there are a number of differences in these variables between the two groups. Although a surprisingly high number of bus takers own a vehicle or still drive, they are nonetheless more likely to have missed desired trips. (Unfortunately, the small sample precludes statistical tests of group differences.) When non-bus takers were asked open-ended questions concerning what conditions they would see themselves using the bus, the most common responses were if they didn’t have a car and were unable to drive. Many said that taking the bus would be inconvenient and would require planning and organization. During the winter interviews, 6 (50%) of the older adults reported that the weather resulted in their staying at home, but 9 (75%) reported that the weather did not have a significant impact on their ability to get around.

28 Non-bus takers were asked a series of questions about their thoughts and perceptions of transportation and mobility in the future. Their responses are outlined in Table 4. These results suggest that for the most part, these older adults had not reflected very much on the possibility of not driving in the future, and what alternative means of transportation they will use if they can no longer drive.

29 During the telephone interviews, the eight bus takers were asked to rate the bus program on a 10-point scale on variables of availability (M = 9.13, SD = .47), frequency (M = 9.2, SD = 2.12), comfort (M = 9.4, SD = 1.6), and friendliness of the driver (M = 10, SD = 0). Ratings were very high, and did not differ significantly when these questions were repeated during the winter interviews. It should be noted, however, that participants commented that during the winter, some trips were cancelled, and at least one individual mentioned not always feeling safe on the bus during the winter time.

30 In order to get the participants to further discuss their experiences on the bus, we also asked them to list two things they liked and two things they did not like about the bus. Relief from driving was the most common positive feature, followed by social reasons and being “good for me.” Independence, convenience, and cost were also mentioned. Participants had difficulty naming what they did not like about the bus. Two participants reported that the trip took too long or did not provide enough time for shopping, one reported that the trips were too infrequent, and one reported lack of comfort on the bus. When asked more open-ended questions about their reaction to the bus program, many of the bus takers had very positive reactions. One participant described the bus as having “dropped from heaven” and knowing that they can go once a week, and have the driver help carry bags to the door is great. Another participant described the program as “fantastic” and particularly helpful because many women in the community can’t drive.

31 Although reactions were generally positive, a few bus riders highlighted problems with the program. It was acknowledged that “the service is great for errands but not for appointments,” and some felt that it would be helpful if the bus ran more frequently or did not leave so early in the morning. It was also mentioned that the older adults were sometimes forced to sit in the back on the more uncomfortable seats because some seats in the front were occupied by a rider’s aid or companion. Finally, there were some participants who stated that they were taking the bus not because they needed to, but in order to ensure the program’s success. (Although at least one of these individuals admitted that she had not run errands in town at all during the three months preceding the beginning of the program.)

32 As a follow-up to the interviews with the older adults using the bus program, we also interviewed the two employees of the long-term care facility who drove the bus and the coordinators of the program. One of the bus drivers noted greatly enjoying the driving because it allowed her to interact with the program participants. The drivers felt that the bus riders were becoming more talkative as the weeks went by, and seemed to enjoy the social aspect of the bus trips. It was noted that the program “offers them freedom” and the opportunity to go shopping without having to ask friends and family for help.

33 The bus drivers also expressed concerns. They found it physically exhausting and stressful to help the riders who were in wheelchairs and needed a lot of support to get on and off the bus. From the perspective of the older adults, the drivers noted that many had found that (a) the timing (when they would be picked up) difficult, particularly at first, (b) some bus riders were frustrated by having to wait for others, and (c) some interpersonal conflicts were present between some of the older adults. The drivers also found it difficult to coordinate the timing when some riders wished to go to the larger (but farther) regional centre, but multiple and time-consuming pick-ups and drop-offs still had to be carried out.

34 Finally, from the perspective of the program in general, the drivers discussed both organizational and long-term feasibility concerns. In terms of day-to-day issues, the lack of clear guidelines on who could take the bus was problematic. For example, one senior used the bus to transport her severely physically handicapped daughter (who was not a senior), which led to complaints from some other riders on the bus. Also, some older adults with severe disabilities were not always accompanied by an aid or companion, which made the driver’s job much more challenging. In a few cases, older adults who had not filled out an intake form decided to go on the bus at the last minute, making it difficult for the driver to plan ahead, and contact information for emergencies was missing.

35 Overall, the biggest concern for both the drivers and the program coordinators was the long-term feasibility of the project. Even a few months before the pilot project was coming to an end, it remained unclear how funds would be raised to continue the project, and how unplanned costs such as bus breakdowns and continued awareness-building would be handled. Both the drivers and the coordinators were very aware that riders were pleased with the program, and that it served an important purpose in helping older community residents get to the bank, to the grocery store, and to the shopping mall. Coordinators, in particular, expressed an overall sense of optimism, and felt that the community was supportive, and had sufficient spirit and drive to make it happen.