Giving up the car keys is rarely about the car. It is about whether the cardiology appointment still happens. Getting that right takes matching the trip to the right service - and most families default to whatever is easiest to book rather than what is actually safe.
The four levels of service
- Curb to curb. The driver stops at the curb. Standard taxis and rideshare. Fine for an independent rider.
- Door to door. The driver comes to the door and helps to the vehicle. Most paratransit and many private services.
- Door through door. The driver stays with the passenger from inside the home to inside the destination - and helps back afterward. This is what someone with a walker, dementia, or post-procedure grogginess needs.
- Door through door with accompaniment. The escort waits through the appointment, takes notes, and reports back to family. Invaluable when you live in another city.
Book the level of service the return trip requires, not the outbound one. People come out of procedures less steady than they went in.
Options in the United States
ADA paratransit. Public transit agencies must provide comparable service for riders who cannot use fixed-route transit. Fares are typically about twice the local bus fare - inexpensive - but you must apply and be certified, and rides usually need booking one to two days ahead within a pickup window.
Non-emergency medical transportation (NEMT) through Medicaid. State Medicaid programs must ensure eligible enrollees can get to covered medical appointments. Coverage is arranged through a state broker; call the number on the Medicaid card several days ahead.
Medicare Advantage transportation benefits. Some plans include a set number of one-way trips per year to medical appointments. Check the Evidence of Coverage and call the plan to arrange it.
Area Agency on Aging and volunteer driver programs. Many communities run volunteer driver networks, often donation-based or free. Reach your local agency through the Eldercare Locator at 1-800-677-1116.
Rideshare and taxi. Uber and Lyft both offer assisted or accessible ride categories in many markets, plus family-managed booking. Convenient, but curb to curb by default.
Private assisted transport. Independent specialists who drive, escort, and wait. Typically $35-$75 per one-way trip, with accompaniment from around $40 per hour, and wheelchair-accessible vehicles priced higher.
Options in Canada
Most municipalities run a specialized transit service for riders with disabilities - Wheel-Trans in Toronto, Para Transpo in Ottawa, HandyDART in Metro Vancouver, TransHelp in Peel. These require an eligibility application and advance booking, and fares match regular transit. Alongside them, community support services and organizations such as local Red Cross branches, Canadian Cancer Society Wheels of Hope programs, and seniors' centres run volunteer driver programs for medical appointments, usually with a mileage-based donation. Provincial health plans generally do not cover routine transportation, though some northern travel grant programs exist. Private assisted transport fills the same gap it does in the US.
Choosing well
Ask any private provider:
- Is your service curb to curb, door to door, or door through door?
- Do you wait through the appointment, and how is waiting time billed?
- Is your vehicle wheelchair or walker accessible, and how is the passenger secured?
- What is your commercial insurance coverage for transporting passengers?
- Is the driver trained in transfers, and in dementia care if that applies?
- Will you communicate with an out-of-town family member after the appointment?
Practical logistics
Keep a standing list at the front door: appointment time and address, physician name, health card or insurance card, medication list, and the family contact number. Build in a 30-minute buffer - paratransit pickup windows and clinic delays both run long. For recurring appointments like dialysis or physiotherapy, set up a standing booking with the same driver; consistency reduces anxiety far more than any single ride quality.
Find assisted transport and accompaniment specialists in your city on CareProximity, or request a free concierge match.