You see the
ads for the various scooter and power wheelchair places. They’ll help
anybody get a scooter, right? Well, yes, if you have the money.
Otherwise, unless you can meet Medicare’s stringent rules you are out
of luck. So what are those rules?
How to Know if You Qualify for a Power Wheelchair or Scooter
You must meet all of these conditions to qualify for a power wheelchair or scooter:
- •You have a health condition where you need help with activities of
daily living like bathing, dressing, getting in or out of the bed or
chair, moving around, and using the bathroom.
- •You are unable to operate a manual wheelchair.
- •You are able to safely operate the controls of the power wheelchair or scooter.
- •You have had a face-to-face exam and received an order for the equipment fromthe doctor or practitioner who is treating you.
- •You must be able to safely use the power wheelchair or scooter in your home.
- •You have interest in using a power wheelchair or scooter
.You must also meet the conditions below to qualify for a scooter:
- •You must be willing to use a scooter.
- •You must meet the weight capacity of the scooter.
- •You must have good vision.
- •You must be mentally able to safely use a scooter.
- •You must be able to safely get on and off of a scooter.
Remember, you must have a medical need for Medicare to cover a
power wheelchair or scooter. Medicare won’t cover this equipment if it
will be used mainly for leisure or recreational activities, or if it’s
only needed to move around outside your home.
So basically what this boils down to is that you have to need a lot
of help to qualify for a power wheelchair or scooter. You must need it
inside your home. However, this doesn’t specify if that means inside
your tiny 600 sq. ft. apartment, or does it mean you can’t get to the
lobby for your mail without it.
OK, I can bathe, dress, transfer and toilet myself. I can walk
around my apartment. I can even walk a couple of blocks. What I can’t
do is go to the grocery store without a scooter. I can go to the
library, but it is painful. I can’t go to a park. I can’t go anywhere I
have to do much walking. I have conditions with my arms that would make
a manual wheelchair painful for me. So basically, without a scooter, I
am stuck at home most of the time. This is a set-up for depression. And
I’m already a chronic depressive that needs three antidepressants daily
to get out of bed.
I am not the only one to point this out. In 2004, the Center for Medicare Rights issued a paper
(pdf) pointing out that the “in the home” rules Medicare applied were
40 years old, and no longer matched the law regarding disability
rights. They also point out, as I have, that not being able to
participate in community activities can lead to secondary health
concerns, such as falls or depression. Certainly, confining durable
medical equipment to what is needed in the home does not meet the
letter or the spirit of the Americans with Disabilities Act. It’s been
four years, and still we have these restrictive and repressive rules.
So what can I do? I can ask for a chore person to help with
housework and groceries. Unless the person is a volunteer, I am costing
more per year than a scooter would cost. This is a stupid waste of
money. So is the increased antidepressants and therapy I will need to
cope with being stuck indoors a lot of the time.
Also, these guidelines don’t make sense. I have to need help with
ADL’s and still be able to safely get on and off the scooter? If I need
help to bathe, dress, get in or out of bed or chair, moving around and
using the bathroom, how can I get safely off and on a scooter? Or by
help, do they mean I need to use a walker to get in and out of chairs,
or a mobility dog? WTF? I don’t know.
So right now, with my scooter which my father bought me broken, I
feel like I am imprisoned. Places in the neighborhood that I could get
to easily on my scooter, like the grocery store, are out of reach. The
grocery store I go to is down a steep hill, dangerous in a manual
wheelchair. Or I can go the long way, around the block, and down a not
so steep hill. *sigh* Or I can go shopping at the more expensive
stores. And I don’t have food stamps, I make too much money. It’s a
conundrum.
I am not the only one for whom this imprisonment is a problem. Many
disabled people who require home care are then not even able to go to
lunch with friends (8) for fear of losing their home care
benefits. If they lose them, they end up in nursing homes, at a much
greater cost. These interpretations were ruled improper by the courts
in 1998 (9), so why are we still fighting this battle ten years later?
It was only in 2000 that the restrictions were loosened enough to allow
the “homebound” to attend religious services.
One advocate for the disabled contends that CMS, the Center for
Medicare and Medicaid Services, willfully misinterprets the rules in
order to keep costs down. (7) I think this is correct. Why else require
people to stay at home, or so narrowly interpret the rules as to keep
people confined in their homes, and not provide them with services that
could keep them out of nursing homes, or enhance their ability to
interact with a community, an important part of preventing depression
in any group. Especially the disabled. Efforts made in 2003 to change
the homebound rule to one which stated that it took “considerable and
taxing effort” to leave home have apparently come to naught. The
standard should not be whether the patient can leave the house, but
rather whether it would cost more to confine them to a nursing home. It
almost inevitably would.
Bibliography
- Latest Medicare Wheelchair Proposal: Friend or Foe
- Medicare Rules Targeting Fraud Hit the Severely Disabled
- Protecting Medicare’s Power Wheelchair and Scooter Benefit
- Forcing Isolation is Another Word for Abuse of the Disabled
- Bush Administration Falls Short on Medicare Homebound Rule
- Medicare’s Wheelchair Policy ‘Imprisons’ The Disabled-Study
- Discrimination Against Wheelchair Users Imprisons Them in Their Homes
- Hostages of Home Care
- Home-Care Denial in Medicare Cases is Ruled Improper
- Medicare Homebound Rules Update-2002
Crossposted From
The View From the Bottom of the Shaft
