Introduction

North Carolina is expected to grow by 3.4 million people in 2050, a 32% increase from 2020. This growth is driven by migrants moving in that view North Carolina as a desirable place to live and work. Net migration will counter the effects of the declining fertility rate, as deaths are expected to outnumber births around 2040 (“Population Projections,” 2022).

At the same time, baby boomers are aging and retiring. Working age populations in rural counties are growing by a third of what they were a decade ago, with most eastern and some western counties experiencing a loss during that time (Figure 1). Despite this, the older North Carolinian population continues to grow in urban and rural areas alike (Figure 2).

Figure 1. Change in Working Age Population, 2011-2021 (“Where are the workers,” 2021)

Figure 2. North Carolina 65 and Older Population, 2022-2042 (“North Carolina’s Aging,” 2024)

North Carolina’s 65 and older population is expected to increase 48 percent from 1.9 million to 2.8 million by 2042. By next year, older adults will comprise 1 in 5 North Carolinians (“NC’s Multisector,” n.d.).

Aging in place is a priority among older North Carolinians. 94 percent of older residents surveyed in the 2022 Age My Way NC survey considered staying in their current community as “extremely/very important.” The majority of respondents drive themselves and expressed concern over when they can no longer drive. Many rated transit features in their communities as “poor,” including aspects like accessibility, affordability, reliability, safety, and special services for people with disabilities (“Age My Way,” 2022).

Older adults desire mobility, autonomy, and the ability to age in place. But given the car-dependent built form of North Carolina in urban and rural areas alike, these goals are difficult to achieve when driving becomes expensive or unfeasible due to cognitive, visual, or physical impairments.

While fewer older adults in the U.S. have a drivers license than younger adults, they have been keeping their licenses longer. The proportion of licensed drivers for adults 70 and older increased from 73 percent in 1992 to 87 percent in 2022. As Americans continue to age, the total number of older drivers increases (“Older drivers,” n.d.).

Older adults drive less than younger adults, though their average yearly mileage is increasing (“Older drivers,” n.d.). Much of this reduced travel is due to limit setting—older drivers tend to avoid driving at times and situations that make them uncomfortable, like at night or on high-speed roads. Seniors also tend to have more time flexibility and a lower need to travel than younger cohorts, contributing to this trend (“Countermeasures,” 2023).

Driving at older ages poses safety concerns. The average fatal crash rate per-mile for drivers 70 and older is higher than all other age groups except for 16 to 19 years olds. Part of this is explained by frailty—older adults are more likely to endure serious injuries or fatalities than younger adults in a crash. Further, older adults primarily drive on local roads that have more points of potential hazards, despite being lower-speed than highways and major roads  (“Countermeasures,” 2023).

Most states have different drivers license renewal laws for older adults. North Carolina requires adults 66 and older to renew their license every five years, as opposed to eight for the general population. North Carolinians who are 75 and older must renew their license in person rather than online or by mail. Vision testing is required at every NC license renewal (“Older drivers: License renewal procedures,” n.d.).

Tefft (2014) found that in-person license renewal and vision testing were associated with a significant reduction in the fatality of crashes involving adults 85 and older. For older adults younger than 85, these policies did not make a significant safety impact. Further, requiring more frequent license renewals for older adults was not associated with safety improvements.

The safety benefits of mandatory driving tests and license restrictions for older adults is mixed. Some states assess older drivers for license restrictions based on police, medical, and family referrals. These restrictions limit where and when drivers can travel, though many who receive restrictions already limit their driving behavior (“Older drivers,” n.d.).

Together, older adults face a trade-off between mobility and safety, especially as they age and develop impairments that impact driving. Although seniors today are driving more and keeping their licenses longer than seniors of past generations, changes in travel behavior at older ages remains the same—less trips are taken, nighttime trips are limited, and travel on local roads is strongly preferred to highways and thoroughfares. Thus, older adults may experience travel suppression and forgo certain trips due to safety concerns.

This paper assesses how older adults in North Carolina can travel without driving themselves. Current options are limited in their reliability, flexibility, and service coverage. To address identified problems in current services, I recommend that NCDOT develops a statewide mobility-as-a-service platform to make trip planning easier.

Non-Self-Driving Transportation Options for Older Adults and Their Limitations

Demand Response Paratransit

Many counties and municipalities offer demand response services for older adults and people with disabilities, in which passenger vans pick up riders at a specified place and time. This service requires riders to schedule rides several days in advance, limiting flexibility and spontaneity in travel. The pickup window can be tight, with some riders complaining about vans that left before they were supposed to or never came at all. Further, different services vary in factors like service boundaries, fares, hours of service, eligibility requirements, and trip purpose. Understanding who can go, where you can go, when you can go, and how you can go can be confusing to riders. Nevertheless, these services provide essential transportation to people who otherwise may not have an affordable or reliable alternative.

Senior Shuttles

Some NC municipalities have designed fixed-route bus lines specific to older adults. Chapel Hill Transit’s Senior Shuttle, for example, loops between assisted living facilities, grocery stores, the Seymour Senior Center, and Chapel Hill Public Library. Similarly, Durham has a shuttle that moves between senior communities and Walmart.

Mobility Management and Volunteer Driving Programs

One strategy for some communities is to hire a full-time mobility manager who assists older adults with transportation questions, teaches about how to use local transit options, and helps with trip planning and coordinating rides. For example, Orange County’s mobility manager oversees a volunteer driving program that matches volunteer drivers with riders. Finding volunteers is an issue—there are currently two drivers in the program, and when riders can go depends on the drivers’ schedules. However, this program can be much more cost-effective than typical demand response paratransit (to the credit of tremendous volunteers). Community institutions like churches have initiated similar programs that connect attendees with drivers. These programs may be more successful at a smaller, local, and community- or institution-based scope.

On-Demand Microtransit

On-demand microtransit (ODM) offers curb-to-curb service that can be ordered online at any time within service hours, similar to rideshare apps. Typically, rides must be within specified zones. This differs from traditional demand response systems, in which rides must be reserved one to two days in advance and do not allow for flexibility or spontaneity.

In 2022, North Carolina received $10.4 million from the USDOT Rural Surface Transportation Grant to fund its Mobility for Everyone, Everywhere in NC (MEE NC) program (Figure 3). These funds were distributed to eleven transit systems in rural, low-income areas to “confront unmet transit needs, provide a more equitable transportation system, and improve access to opportunities, services, and resources for transportation disadvantaged populations” (“Mobility for Everyone,” 2022).

Figure 3. MEE NC Project Location Map (“Mobility for Everyone,” 2022)

In a report on North Carolina ODM pilots by the Institute for Transportation Research and Education (ITRE), researchers identified a need for inclusive decision-making early on in the planning process. When choosing how to distribute MEE NC funds, it is unclear if NCDOT and local agencies worked with all relevant stakeholders, including “large trip attractors, such as senior centers, business centers, large employers, and major supermarkets” (Bardaka et al., 2023, p. 64).

The ITRE report acknowledged that North Carolina microtransit is not “one-size-fits-all,” as programs have different structures that address unique needs. But for residents in rural areas—including older adults—there is growing evidence that on-demand microtransit could serve as a reliable model for the future.

For example, Wilson’s award-winning RIDE program (“Wilson RIDE,” 2021) led to a surge in transit ridership after the city abandoned its fixed-route bus system (McMurray, 2023). Rides are on-demand, cost $2.50, can be shared with others, and take you where you need to go. With support from MEE NC and other grants, several rural areas in the exploration and planning phases are trying to follow suit.

For riders, this is a fantastic deal; for transit operators, this is unsustainable without state and federal subsidies. Limited seating and inconsistent trip destinations make microtransit service costly to scale. Unlike traditional transit that has the capacity to carry many people, increasing ridership is a detriment to microtransit; Wilson’s ridership stalled from April to September 2021 when its fleet could not handle trip demand (Zipper, 2023).

ITRE’s report recommended that transit operators seek diverse funding sources, but it is unclear whether funding microtransit long-term is plausible. Raising fares or imposing local taxes counters the cost-effective nature of the program and burdens the low-income residents it serves.

Figure 4. On-Demand Microtransit Services in North Carolina (“Where”, n.d.)

One solution is to designate specific pick-up and drop-off spots near key corridors, which makes trips more efficient. But this is not a realistic solution in areas without proper walking facilities and for people that struggle with mobility issues.

ODM Operation and Technology Network Companies

On-demand microtransit may work best in tandem with fixed-route bus systems. Wave Transit in Wilmington uses its RideMICRO platform as a first-last mile connection to link riders to major bus stations within four zones. Riders can also travel between points within the zone (“RideMICRO,” n.d.). Charlotte is developing a similar system for its bus and rail corridors.

The rideshare giants Uber and Lyft have launched related programs to connect riders to transit stops. Local governments can work with the companies to address gaps and inefficiencies in service, like replacing a failing bus route with ODM, offering discounted rides for nighttime workers after regular bus service stops, and first-last mile connections to transit. Other transportation network companies (TNCs) offer similar products.

ITRE’s report on ODM in North Carolina provides an overview of how current services across the state differ in purpose of implementation and service delivery models (Bardaka et al., 2023). Beyond first-last mile connections and replacement of inefficient routes, cited purposes for ODM include transit service in low-density areas, convenience beyond demand response paratransit, and service at times of day not covered by fixed-route transit (Figure 5).

Figure 5. Classification of on-demand services based on purpose of implementation (Bardaka et al., 2023)

Figure 6. Classification of on-demand services based on service delivery models (Bardaka et al., 2023)

Regardless of service delivery model, the success of on-demand microtransit relies on strong private-public partnerships. Individual transit agencies lack the capacity to provide the software needed to operate ODM.

Other Transportation Options

Beyond the aforementioned options and traditional fixed-route transit (i.e., regional bus systems and light rail in Charlotte), a few non-self-driving opportunities exist, including:

• Rides from friends and family members

• Taxi and ride hail services

• Local non-profit organizations that offer rides to older adults (e.g., H2GO LLC)

• Senior center transportation services

• Senior housing community/assisted living facility transportation services

Some older adults are also eligible to use non-emergency medical transportation (NEMT) services. People who lack transportation access to medical facilities often forgo or delay needed health care (Scaturro, 2024). States are required to provide free or low-cost NEMT for Medicaid recipients who cannot transport themselves. These rides are typically contracted to third-party brokers like taxis and private shuttles, but recently Uber and Lyft have lobbied states to contract their Uber Health and Lyft Concierge services. NEMT for non-Medicaid recipients is sometimes provided by local government, hospitals, and non-profit organizations, but these options may not be reliable, flexible, or cost-effective.

Current Issues and Efforts in Aging and Transportation in North Carolina

In 2023, Governor Roy Cooper signed Executive Order No. 280, titled “North Carolina’s Commitment to Building an Age-Friendly State.” This order assigns various tasks to different state agencies, taking a whole-of-government approach to supporting older adults. Included in this was the development of a multisector plan for aging, which was adopted in September 2024 as All Ages, All Stages NC. This document reviews current aging issues across the state and proposes recommendations for respective state agencies (“NC’s Multisector,” 2024).

The 2022 Age My Way NC survey informed the multisector plan’s development, as well as focus groups held in 2023 with groups underrepresented in the survey results. These focus groups identified six ongoing challenges for older adults in the state:

• A lack of awareness and confusion about available resources and services

• Difficulties and inconsistencies in transportation access, with a need for expansion

• Obstacles to aging-in-place

• The affordability of long-term care options

• The need for increased support for social connections

• Opportunities for intergenerational engagement and sharing of wisdom

In 2022, North Carolina held the Age My Way NC Summit that summarized the survey's results (“Age My Way,” 2022).  Transportation was a focus of the Summit’s presentation; researchers noted that 18 percent of adults 65 and older do not drive, 35 percent of women 75 and older do not drive, and older adults are overrepresented in pedestrian fatality rates.

The Summit also highlighted ongoing transportation challenges, including service reliability, routes that extend outside city/county limits, costs and funding, education on available resources, shortages in drivers and staff, and adaptability to changing needs of older adults.

Current and future transportation needs identified in the Summit included technology that connects riders with available transportation resources, increased on-demand transit in rural areas, and the future use of autonomous vehicles.

NCDOT is already working towards addressing these needs. The Multisector Plan for Aging emphasized the Department’s plans in addressing transportation challenges for older adults:

The department plans to implement additional projects aimed at improving the coverage, quality, reliability, and convenience of public transit. This includes expanding passenger rail services and enhancing first and last-mile connections to fixed-route rail and bus services. NCDOT will also focus on increasing the convenience and flexibility of public transit by expanding on-demand micro-transit services and developing a statewide Mobility-as-a-Service system for seamless trip planning, scheduling, and payment across various services, modes, and jurisdictions. Furthermore, NCDOT will pursue additional deployments, testing, and analysis of shared autonomous mobility technologies under the Connected Autonomous Shuttle Supporting Innovation (CASSI) program to assess their viability as safe and convenient transit options for aging adults. (p. 39)

Policy Proposal: Make Transportation Resources Easy to Access

Based on the feedback provided in the Age My Way survey, recommendations made in the NC Multisector Plan for Aging, and current planning efforts by NCDOT and NC DHHS, I propose that North Carolina focus on providing an easy way for older adults to learn about available resources and plan trips.

NCDOT’s current planning efforts are robust; the state has been one of the most aggressive in pursuing on-demand microtransit, which makes sense given North Carolina’s high rural population and sprawling, Sun Belt urbanism. ODM helps to fill coverage gaps in areas not dense enough for transit or at times not popular enough to have buses running. By pairing ODM with fixed-route bus systems, older adults are able to make more trips without driving themselves.

It is important to note whether ODM is working to complement transit or replace it. Wilson elected to swap its inefficient bus service with on-demand microtransit, but the program became a victim of its own success. The costs and scaling issues associated with ODM make it difficult to designate as a city’s sole transit option, even in smaller cities like Wilson.

Regardless of ongoing efforts in transit planning, seniors will continue to drive themselves as their main mode of transportation—especially those that live in rural areas and lack adequate transit access. However, most of the growth in the older adult population will occur in suburban and urban areas of the state that have existing transit.

Some of the best solutions are not emerging technologies but old-fashioned practices like transit-oriented development, inclusionary zoning, and mixed-use development. The denser a community is and the closer amenities are to transit, the easier it is to live without a car, even for people who are mobility-restricted. And the less spread out everything is, the easier it is to plan for transit. Commitment to these principles will ensure age-friendly communities in the future, but the benefits of these investments may not be reaped for decades. As North Carolinians age, the focus must be on solutions to implement right now.

A consistent transportation issue for older North Carolinians is confusion over what services are available. If North Carolina wants to make an immediate impact, streamlining trip planning and information on available services should be the starting point.

This does not need to be a fancy, statewide mobility-as-a-service (MaaS) platform. Ideally, having a single app or website where riders can plan trips and book rides anywhere in the state sounds great. Connecting this with an autonomous vehicle fleet that can drive to rural residents any time of day would be even better, but that technology is not ready and comes with scores of potential externalities.

Given that NC transit agencies rely on various transportation network companies to provide the ODM software, it is unlikely that a statewide MaaS will happen. Each TNC has its own algorithms, data, and software; even if it was possible to integrate these into one platform, the TNCs would not do so as competing private companies.

Alternatively, NCDOT could provide the software to operate ODM across the state. It is unclear if the Department has the capacity to develop and operate this, and transit agencies would lose the competitive advantages of each TNC’s services. By standardizing the system, it may be difficult to tailor to each agency’s unique needs like private companies can. NC transit agencies do not implement ODM for the same reasons.

So, what can the state do to make trip planning easier and information on available services more accessible? I propose two ideas:

1. Provide funding for every DHHS Area Agency on Aging and/or county to hire a full-time mobility manager

2. Develop a website that allows for seamless trip planning and includes up-to-date information on all available services

First, I believe that establishing a network of mobility managers across the state is essential to addressing confusion over available transportation options. Mobility managers are experts in local transportation challenges and can serve as advisors to NCDOT. Further, many older adults do not have the same level of digital literacy as younger people and may struggle with MaaS platforms, transportation apps, and navigating websites to learn about services. Mobility managers are available to answer transportation questions over the phone and provide direct outreach in the community by coordinating programming. For example, the Orange County mobility manager teaches sessions on transportation resources at the local senior center and organizes a day every year to show older adults how to ride transit.

Second, building an online database on available transportation resources for older adults is essential. Trying to pool information from municipal, county, and transit agency websites is extremely difficult, as these webpages are often out-of-date, hard to navigate, or contain incomplete information.

If all of this information was incorporated into a single webpage—including service-specific features like who is eligible, where you can travel, when you can travel, when rides need to be booked, and how much rides cost—learning how to get around without driving becomes much easier. Since older adults may struggle with digital literacy, this website should make obtaining information as simple as possible. This could function as an interface that returns all transportation options based on your age, ability status, where you live, where you want to go, and when you want to go. A trip planning feature with an interactive map would enhance this experience.

North Carolina has a lot of work to do in building age-friendly communities that allow older adults to live where they want and travel when they want. There are promising efforts underway, but it may be a while until the benefits of transportation investments come to fruition. In the immediate future, establishing a network of local mobility managers across the state and building a seamless platform to learn about available services could address a fundamental transportation challenge that older adults experience. Beyond this, municipalities, counties, and transit agencies should work to strengthen existing transit systems, build density, and encourage inclusionary zoning. NCDOT should continue to explore on-demand microtransit and autonomous vehicles as models of the future.

References

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