Two different transportation problems live on Cape Cod, and families keep trying to solve them with the same phone call.

The first is local: getting a wheelchair from a house in Dennis to an appointment in Hyannis and back. The second is the bridge: getting somebody in a wheelchair from Chatham or Brewster to Dana-Farber, Mass General or Brigham and Women's, for a treatment that will happen again next week and the week after.

They need different answers. Here are both, with prices, and an honest account of what already exists before you pay anybody.

Start with what is already available

We would rather you know these than not, even though they are not us.

Your town's Council on Aging. Most Cape towns run some form of senior transportation, and Dennis, Mashpee, Falmouth and Brewster all do. Coverage, vehicle type and cost vary by town, and not every town's vehicle takes a wheelchair, so ask that specific question. This is the cheapest option by a wide margin and it should be your first call for local trips.

The Cape Cod Regional Transit Authority. The CCRTA runs DART, a demand-response service that you book in advance, and it also runs a Boston Hospital Transportation service specifically for Cape residents traveling to Boston for medical care. If your treatment schedule is predictable and you can work within their days and times, that service exists precisely for the problem you have.

MassHealth PT-1 rides. If the person is a MassHealth member, rides to covered appointments can be arranged through the PT-1 process by the medical provider. It takes advance arranging and it only covers covered appointments, but it is a real benefit.

Where all of these break down is the same place: the appointment that does not fit the schedule. The discharge at four on a Friday. The treatment that runs two hours long. The day the eligibility paperwork is still sitting somewhere. That is when people call a private van.

What does private wheelchair transportation cost?

Our rate is $115 each way, or $230 round trip , within five miles, and $2 a mile beyond that.

On the Cape that mileage figure matters more than anywhere else we work, because the distances are real. A trip within Hyannis is a short trip. Orleans to Boston is not. We are not going to print a single flat number for the Cape and then revise it upward when you call, so here is how it actually works: you give us the pickup address and the destination, and you get the exact figure on the phone, before you book anything.

Two honest notes on Cape trips specifically. Availability depends on the date, because our vans are based off Cape and a Cape run is a long booking, so give us as much notice as you can and ask about your date rather than assuming. And a Boston trip in July at two in the afternoon is a different piece of driving from the same trip in February, because the bridges are the bridges. Book the early slot when you have the choice.

What about the front steps?

On Cape Cod this is not a footnote. It is frequently the whole problem.

The housing stock here was not built for wheelchairs. A great many Cape houses sit up on a few steps, sometimes because of the water table, often because that is simply how they were built. The old cottage with three wooden steps and a narrow storm door. The raised ranch with a flight to the front landing. The summer house that became a year round house without anybody adding a ramp.

A van with a ramp gets somebody from the driveway to the hospital. It does nothing about the four steps between the door and the driveway. We provide stair assistance at $200 a visit : two trained staff and a motorized stair chair, down and back up.

Tell us about the steps when you call, not when the van arrives. How many, whether there is a railing, how wide the doorway is, and roughly what the person weighs. Those four facts decide whether the trip is possible.

Who goes into the appointment with them?

This is the part that matters most on a Boston trip, and the part almost nobody books until the first time it goes badly.

Your mother is dropped at the entrance of a hospital complex she has never been in, in a city she does not drive in, ninety minutes from home, and told to find the third floor of a different building. If she has any hearing trouble, memory trouble, or is simply having a hard day, being dropped at the door is not the same as getting to the appointment.

We provide medical appointment escorts: somebody who goes in with her, waits, comes into the appointment if she wants that, takes notes, and calls you afterward with what was actually said. For a long distance treatment trip that is usually worth more than the driving is.

It also matters for anything with sedation. If the procedure requires an adult escort to take the patient home, a driver alone often does not satisfy that requirement, and the hospital can cancel on the day. Ask the hospital exactly what they require before you book the ride.

Is this an ambulance?

No, and the difference saves families a great deal of money.

An ambulance is for someone who needs medical care during the journey. A wheelchair van is for someone who is medically stable, sits up in their own chair, and just needs a vehicle that fits it. Cape families sometimes book an ambulance for a routine off Cape appointment because they do not know the middle option exists. It does, and it is a fraction of the cost.

If something is genuinely wrong, call 911. That has not changed.

Booking a Cape Cod wheelchair trip

Care Remedy runs wheelchair-accessible transportation across eastern Massachusetts, with offices in Brockton, Woburn and Springfield, and completes around thirty thousand trips a year. Brockton is the closest office to the Cape and is where Cape trips run from.

Have these ready:

• Pickup address and destination address
• Date and appointment time, and whether you need the return
• The chair: manual or power, and whether it folds
• Steps at the pickup door, and how many
• Whether the procedure requires an escort to take the patient home

Call 781-957-8076 . We will quote the trip on that call and tell you plainly whether we can cover your date. If we cannot, we will say so rather than leave you waiting on a call back, because a family with a Tuesday appointment does not have time to find that out on Monday.

And if this is a course of treatment rather than one appointment, tell us at the start. A standing schedule is easier for everybody than a scramble every week.