Securing the right equipment to maximize safe and independent function

For people who are mobility-limited, using the appropriate equipment, devices, products, or resources can be the single difference between living an independent life and being dependent on others. Although financial and environmental factors are common determinants of equipment that can be acquired and used, often, the exposure and knowledge of what is available may be the primary determinant. This is beyond unfortunate since there are many professionals and resources that are available to educate people with mobility limitations and their caregivers. However, the vast majority of patients whom I have worked with learn about products available to them from me for the first time. I cannot fathom that. I am not usually the first, fifth, or tenth professional that they have worked with to address their mobility limitation(s).

In the United States, the healthcare system seems to be so divided that there seems to be a belief that someone else will provide information about equipment or access to a resource. The physical therapist (PT) may assume the occupational therapist (OT) will take care of the grab bar recommendation. The occupational therapist may assume the social worker (SW) will be the one to help the patient learn if the grab bar will be covered. The social worker may assume the equipment supplier will install the product. The physician may assume the nurse has taken care of the prescriptions and referrals needed for the grab bar so the patient can stop falling while just trying to go to the bathroom in their own home.

The US healthcare system includes a seemingly endless “red tape,” including processes for ordering updated or replacement equipment. Based on select Centers for Medicare and Medicaid Services (CMS) policies, certain durable medical equipment (DME) will not be replaced until it has reached its “reasonable use lifetime” (RUL), which is defined as five years. For people who require a wheelchair for daily functioning, it is not uncommon for these devices to break down. Although repairs are covered by CMS, it is not uncommon for the Medicare beneficiary to be penalized since this may increase the defined RUL. This results in people who rely on a quality wheelchair deciding whether they will pay for repairs instead of being told the five-year RUL has been expanded due to a repair being covered.

Consider the recent incident where employees at Miami International Airport tossed a wheelchair down a luggage slide off an American Airlines plane. There is a high likelihood that the wheelchair was damaged. If the wheelchair was customized, replacement needs to be expedited not just as a just resolution of this event, but to avoid the potential medical side effects. Not having the appropriate wheelchair can result in medical side effects, including new or worsening pressure ulcers, posture-related pain, and the effects of functional limitations requiring dependence on others and social isolation, which can increase depression.

A sequence of pictures showing the loose manual wheelchair uncontrollably tossed down a slide for a worker at Miami International Airport to plop on top of luggage. Attribution: @haez93/TikTok

Although few healthcare professionals have earned the Assistive Technology Provider (ATP) credential, all healthcare professionals should be knowledgeable about DME which can improve safe function. After all, what is the use of prescribing medicine or exercises if the patient cannot move safely? There is an ongoing debate about whether a physician who provides the prescription for DME should be educated more about the items they are, by definition, directing a patient to use. It is logical to think that physicians can utilize PTs or OTs (rehabilitation professionals) to help the physicians with this process. A compounding problem is that physicians tend not to refer to rehabilitation professionals in these situations, and many rehabilitation professionals are not prepared to provide services to recommend DME when patients come in with this need.

Until rehabilitation professionals integrate DME review and recommendations into their standard clinical care, patients will be underserved and forced to fend for themselves online or with DME suppliers. The patient is not served by clinicians who do not consider how DME can supplement other clinical interventions. When healthcare providers reflect on their duties toward their patients, improving quality of life through safe and independent function is an element toward maximizing health. After all, health as a construct is improved through a well-rounded approach requiring one’s physical, emotional, social, and functional elements to be considered as a standard in clinical care. Helping one secure the appropriate equipment can satisfy this standard.