- Courtney Bishop
- Spring 2026
Abstract
Access to reliable transportation is a well-documented social determinant of health (SDOH), particularly among older adults residing in skilled nursing (SNF) and long-term care (LTC) settings. Non-emergent medical transportation (NEMT) is essential for facilitating access to regular healthcare services, including dialysis, specialty appointments, and post-discharge follow-up care. However, existing literature demonstrates that transportation barriers contribute to delayed treatment, missed appointments, and increased hospital readmissions, disproportionately affecting vulnerable populations in institutional care settings.
The purpose of this practicum project was to examine barriers to non-emergent medical transportation within skilled nursing and LTC environments and to identify evidence-based strategies to improve access and continuity of care. This project aimed to bridge gaps between current research and real-world clinical practice by incorporating both scholarly evidence and stakeholder perspectives. Methods included a comprehensive review of peer-reviewed literature published between 2019 and 2025, focusing on transportation barriers and healthcare access. In addition, informal consultations were conducted with key stakeholders, including a Director of Nursing, transportation coordinator, and interdisciplinary staff members within a long-term care facility. Observations and discussions centered on scheduling challenges, missed appointments, system inefficiencies, and discharge transportation issues. Findings from literature were synthesized alongside real-world insights to identify common themes and practical solutions.
Key barriers identified included limited transportation availability, delays in insurance authorization, staffing constraints, and poor coordination between healthcare facilities and transportation providers. Evidence-based strategies to address these challenges include implementing centralized scheduling systems, optimizing use of Medicaid NEMT benefits, improving interdisciplinary communication, and incorporating telehealth services when appropriate. Improving access to non-emergent medical transportation is critical to enhancing healthcare outcomes, reducing avoidable hospitalizations, and promoting health equity among LTC residents. Future efforts should focus on implementing standardized transportation protocols, strengthening care coordination processes, and advocating for policy-level improvements to expand transportation access.
Keywords: non-emergent medical transportation; skilled nursing facilities; long-term care; healthcare access; health disparities; care coordination
