Paratransit Skills

An article about community mobility skills (1) reminded me that OTs do not know if clients can use paratransit without knowing the demands of the systems available to them.  Here is a comparison of two systems I used.  One covers the state of New Jersey.  The other covers only my county.    

Language.  To qualify for the county service I only had to give my address and diagnosis during a brief phone conversation.  The state required a one hour in-person interview where I had to give specific examples to explain why I could not take public transportation.  Giving my diagnosis was not enough.  When making a reservation, both systems asked me what ambulatory device I used (e.g. cane, wheelchair) so they knew what type of vehicle to send.

Balance.  My balance is poor so I would fall if I was standing when the vehicle started moving.  Both services did not allow the drivers to start driving until I was seated and had my seat belt fastened.  Vehicles that carried wheelchairs had tie-downs which the drivers handled. 

Strength.  The county provides door-to-door service which means the driver provides physical assistance to go up and down stairs and carry packages.  The state provides curb-to-curb service.  This meant the driver stood by the vehicle while I got myself in and out of the house, on and off the vehicle, and transported packages.  Both services had vehicles with a wheelchair lift to get a client in and out of the vehicle.

Endurance.  I had to wait for the county service to pick up a few seniors that wanted to go to the senior center.  I had a short 2 mile ride with the seniors before I was dropped off at the grocery store.  The state service picked me up from 20 minutes before to 20 minutes after the time I requested (a 40 minute window).  The state may run long trips with multiple riders who have different destinations.  When I had to wait for other people to be picked up and dropped off, I might ride for an hour before reaching my destination.  With both services I had to be at the door so I could see the vehicle pull up which would wait only 5 minutes.  I bought a folding three-legged stool with a shoulder strap that hunters use so I could sit down if I got too tired in a store.  

Planning Ahead.  For the county a reservation had to be made 2 weeks in advance and they asked only for my name because they took me to only one destination.  For the state a reservation could be made 24 hours in advance and they asked for my paratransit identification number.  To remember the pick-up times at each end of my trip I wrote them on a calendar for the day of the trip.  The county service required only the name of the store because the person making the reservation was local and knew the area.  The state service required exact addresses and names of cross streets because the person making the reservation was miles away.  I got out a list of this detailed destination information before making a reservation.  Both services had a two bag limit.  This meant I had to plan multiple trips when I needed bulky objects like toilet paper.  I also had to plan repeated trips because paratransit took me to only one destination at a time - grocery store, drug store, doctor, dentist, out-patient therapy, etc.

Money Management.  The county service was free.  The state service required exact change.  They told me the cost of a one-way fare when I made a reservation.  Cost was based on what it would cost me to make that trip on public transportation (e.g. bus fare of $2.25).  I kept a supply of one dollar bills and coins.  homeafterstroke.blogspot.com

1. Dickerson A, Davis E.  Ckecklist of community mobility skills. OT Practice. 2020;October:13-16.

Feeling Embarrassed is a Luxury I Cannot Afford

At a patio dinner party I was the only person who wanted watermelon for dessert.  That meant I got the round end of the watermelon that rocked every time I touched it with a spoon.  Eating it was a slow process because the best I could do was get a thin slice each time.  My hostess tried to help me because she was so uncomfortable with my awkward attempts.  This is the first time my friend has seen what happens the first time I try a new task.  She does not know my performance will improve because I often discover solutions that make my 2nd attempt go better.  She does not know I can count on getting faster and smoother with repetition.  I refused to let her help me because I will never know if I can do a new task if I do not try.

A few minutes later another friend at the dinner party asked me if I get embarrased.  I told her my plate is often too full to feel embarrased.  For example, able-bodied people stand up without any conscious awareness of what their body is doing.  When I stand up I have to make sure my center of gravity is over my feet before I straighten my legs.  If I lean too far backwards I fall back onto the couch or chair I was sitting on.  If I lean too far forwards I fall on the floor.  My stroke often forces me to concentrate so hard that I do not have the mental energy to worry about what other people are thinking.  homeafterastroke.blogspot.com

I Am Feeling Better

I still wake up at 2 a.m. to go to the bathroom and have trouble falling asleep unless I listen to a meditation CD.  However, since reading The Moth Snowstorm - Nature and Joy by Michael McCarthy I have not been waking up with a sense of dread.  This book inspired me to sit on my patio every day.  The 1st thing I notice is the smell of plants.  The sun and cool breeze on my face also feels wonderful.  I am entertained by bird drama.  One day I saw hawks flying slowly in circles while they looked for prey.  A few minutes after the hawks disappeared, I saw one small bird and then two and then a trio flying in a tight triangular formation.  The trio flew to the west and disappeared.  Then they flew back to the east and disappeared.  Finally they flew to the west and did not come back.  Another day I saw 6 tiny birds land on a telephone wire with a perfectly synchronized touch down.  It was like watching a miniature version of the elite air force flying squad the Blue Angels.  Bird TV is better than being aggravated by TV commercials for car insurance that repeat every 7 minutes.  

As I sat on my patio I noticed a shadow moving on my walkway.  The two photos below were taken 15 minutes apart.  Cocooning indoors for months made me completely forget I used to know time was not one momotonous unending event.  These images reminded me I used to see each day progress by seeing the angle of the sunlight change when I went outside. 

The sound of the wind in the trees behind my house helped me remember a happy childhood memory.  My parents rented a cabin in the woods for a summer vacation.  I enjoyed a gentle wind blowing in the trees that lulled me to sleep as I lounged on a screened-in porch after lunch.  

Being outdoors has helped me pay more attention to my surroundings.  Tuning out because I am listening to stories I create in my head has decreased.  I feel joy some of the time when good things happens when I am inside.  I am getting better.  homeafterastroke.blogspot.com

I Am Losing the Will to Live - Again

I lost my will to live after my stroke when I was kept inside for 3 months except when my home health PT took me for a walk outside.  I learned I cannot stay sane if all I do is stare at the outside world through a window.  I was imprinted on the natural world as a child because we did not have a TV until I was a teenager and the Internet had not been invented yet.  As soon as I got home from school I went ouside to play.  If only two children were available to play baseball, we invented rules for imaginary players on base.  If I was alone I played hopscotch, practiced throwing a basketball at the hoop, or rode my bike.  As an adult I went camping with friends, jogged outdoors in all seasons, tended a vegetable garden, and took vacations in national parks.  My most vivid vacation memory is riding a mule down into the Grand Canyon.

This hot, humid summer meant I lost the opportunity to walk around my neighborhood, sit on my patio to watch the clouds rolling out to sea, and feel a cool breeze on my face at the lake in Mercer County Park.  At sunset I missed watching pairs of birds racing each other down the middle my street at car height or playing "I can push you off the telephone wire if I land one inch from where you are sitting."  I realized how deep my depression is when my friend Janet talked about a book that describes about how we developed a relationship with nature for tens of thousands of years of human evolution.  The book is called The Moth Snowstorm by Michael McCarthy.  

Michael reminded me that nature can both stun and gradually soothe me until I fall silent.  I do not mean I just stop talking.  I mean nature can stop the constant chatter I create in my head but forget is there because it is so constant.  Covid has turned a lot of my internal chatter into catastrophic thinking which is depressing.  I need to find ways to get nature back in my life because I know it has a powerful effect on me.  homeafterastroke.blogspot.com