Mom tires easily. Her feet are sore. She struggles to stand. She wobbles as she walks. Her reflexes are slow, and she can’t catch herself when she trips.
One day a doctor, nurse or social worker hands you a medical order. It says “durable medical equipment” is now “medically necessary.”
WHAT DOES THAT MEAN?
Mom is at increased risk for a serious fall.
According to the National Institutes of Health, “more than one in three people age 65 years or older falls each year. The risk of falling – and fall-related problems – rises with age.”
People don’t fall just because they’re older. Seniors’ chronic medical conditions or medication side effects usually are at fault. Muscle weakness, balance and gait issues, blood pressure swings, sensory problems, poor vision, dizziness or confusion leave them unsteady. A mobility aid becomes medically necessary, because a fall can be a medical disaster.
According to the NIH
- Falls send more than 1.6 million older adults to emergency rooms each year.
- Among older adults, falls are the number one cause of
- Hospital admissions for trauma,
- Loss of independence and
- Injury deaths.
- Hip fractures are among the most frequent and serious injuries – and most likely to
rob older adults of their independence.
Mom can reduce her risk by removing trip and fall hazards. She can work to strengthen core
muscles, improve balance and control medical symptoms. At some point, that might not be
enough. Then she’ll need durable medical equipment to safely move about.
WHAT IS DURABLE MEDICAL EQUIPMENT?
Let’s break it down, using terms defined by Medicare.
- To be “durable,” equipment must have an expected life of at least three years.
- To be “medical equipment,” only someone who is sick or injured would use it.
- To be eligible for Medicare reimbursement, it must be
- Intended for use in the home,
- Prescribed by a doctor, following a recent face-to-face exam, and
- Prescribed as “medically necessary”: needed for specific medical reasons, following accepted standards of medical practice.
(Other insurers may use different criteria.)
In this post, we focus on mobility aids. While much information applies to canes, walkers,
crutches, power mobility devices and patient lifts, we’re looking specifically at manual
wheelchairs. (Many of the links include information on other mobility aids, too.)
WHO ORDERS THE DURABLE MEDICAL EQUIPMENT MOM NEEDS?
If she’s hospitalized for a broken hip, the nurse or social worker who plans her discharge also should arrange for any equipment and supplies she’ll need at home.
If she’s staying in a rehab unit, a physical therapist should assess the need for equipment at home and arrange the ordering.
If she’s in an assisted living setting, things aren’t as clear. Sometimes an observant physician sees the need and writes an order. Or a worried nurse, therapist or family member contacts the doctor with safety concerns. In these cases, there is no streamlined process to obtain and pay for equipment.
In every case, if Mom needs help, a family caregiver needs to serve as her fact-finder and advocate. Are you concerned that she’ll fall without assistance? What advice and support can members of her health care team offer? What equipment would they recommend? Who should you contact to see that it’s ordered and delivered? What are your payment
EVEN IF SOMEONE ELSE SHOULD ASSESS MOM’S NEEDS AND ORDER EQUIPMENT, BE
PREPARED TO FOLLOW UP!
(We also recommend this article from AgingCare.com. It provides helpful background for anyone
who needs durable medical equipment or medical supplies.)
WHAT ARE THE CHANCES MEDICARE WILL PAY FOR MOM’S WHEELCHAIR?
Not great – less likely than in the past – and zero if you don’t follow very specific guidelines. But go ahead. Explore the possibility.
Begin by gathering background information with an Internet search. Learn what sort of questions you should ask. Research the terms of Mom’s insurance coverage.
For Medicare to cover a purchase, Mom’s doctor and medical supplier must be enrolled as Medicare providers/suppliers. If she’s covered by a Medicare Advantage plan, be sure they’re in network, too.
You may be required to use a specific supplier, or to rent a wheelchair before you can buy the one you need.
Don’t commit to buy before you’ve done your homework. When in doubt, call Medicare’s 24-hour help line: 1-800-MEDICARE.
WHY WON’T GRANDPA’S OLD WHEELCHAIR DO?
Mobility aids aren’t one size fits all. You can borrow a “loaner” to whisk Mom from the car to the doctor’s office. If you’re using it every day, you need to be certain it “fits.” Otherwise, it’s uncomfortable at best. At worst, it’s dangerous.
- Mom must be measured, weighed and assessed to determine
- Seat width, height and cushioning,
- Armrest type and placement,
- Leg and foot rest requirements and
- Frame strength.
- You’ll need to know how often, and for what length of time, the chair will be used.
- Does Mom have the upper body strength and coordination to roll the chair forward
on her own?
- Will others maneuver it through doorways, down hallways and over garden paths?
Where do Mom’s daily routines take her?
- Will her caregivers be able to push her in the chair and to fold, lift, store or transport
it as necessary?
(Find more details on the United Spinal Association’s website and in Cerebral Palsy’s Online
Guide. There are plenty of other online guides – many produced to sell equipment. Always
consider whether the information is expert, current and unbiased.)
DON’T YOU HAVE A BIG CLOSET FULL OF EXTRA WALKERS AND WHEELCHAIRS?
It’s not unusual to find an extra walker or wheelchair in health care or senior living settings.
They’re meant for temporary or emergency transport. They’re no better suited for Mom’s
long-term use than any other poorly fitted piece of equipment.
At Care Haven, we focus our resources on providing expert Alzheimer’s and dementia care.
We leave the storage and custom fitting of durable medical equipment to capable medical
For a list of area providers, see The Johnson County, Kansas Aging and Accessibility
DO I HAVE TO BUY SOMETHING NEW?
You don’t have to buy. Explore whether renting makes sense.
If you buy, you don’t have to buy new – as long as you can find suitable equipment that fits your loved one.
- For help finding the right wheelchair, start with a reputable medical supply company. These dealers buy durable medical equipment or take it in trade for newer models. After inspection and reconditioning, they offer it for resale with a limited warranty. (Be certain all guarantees are in writing.)
- Buying equipment from a private seller? Ask Mom’s nurse, social worker and physical or occupational therapists what features she’ll need. Ask the seller plenty of
questions – about the equipment’s past, repair record, past problems. Know where
to go if it needs to be refurbished.
- Look for durable medical equipment exchanges in your area. These programs
provide assistive devices to people with disabilities or serious medical conditions.
Most restrict availability based on income requirements. Others serve people with
specific medical conditions (e.g., multiple sclerosis or Parkinson’s).
The following are local exchanges – and places to donate equipment you no longer need:
• Kansas Equipment Exchange
• MidAmerica Alliance for Access