Caregiving Matters

When asked to provide money for an assistive device or to plan for future costs of care, it is important to have an understanding of the technology and costs involved. This article reviews the cost of some of the common equipment prescribed, the process for accessing this equipment and possible alternative funding sources available.

For the record, an “assistive device” is a piece of equipment such as a cane, wheelchair, walker or transfer device designed to improve the independence or safety of a client.

The assessment

When considering buying an assistive device, an assessment by a therapist is usually the best way to begin. The cost of hiring an occupational or physical therapist familiar with assistive technology to complete an assessment is a sound investment. This will help ensure that the prescribed piece of equipment is most suited to the client and will meet his/her needs and goals.

Clients who are inpatients may already have a therapist working with them who is able to prescribe the needed device. For clients who live in the community or who are in a setting where they do not have access to a therapist, hiring one privately is an option. Rates can vary depending on the degree of involvement required. As an example, in Ontario a therapist may charge $80 for a walker assessment, $125 for a manual wheelchair assessment and $200 for a power wheelchair assessment.

The equipment

The type of equipment most suitable for an individual client depends on the client’s diagnosis, living situation, functional abilities and goals. Within each category of equipment listed below, it is important to recognize that—as with cars and appliances—different types of mobility device offer different features that can significantly impact the cost. The therapist can help to identify which features are needed and recommend the most appropriate piece of equipment within that category.

Equipment	Approximate cost ($)
Folding walker	150
Rollator	500
Transport chair	200
Manual wheelchair	2,500-4,500
Cushions and back supports	350-1000
Scooter	3,800
Power wheelchair	10,000
Power wheelchair with power dynamic seating	16,000+
Raised toilet seat	60
Bath bench	60
Grab bars	40, plus installation
Commode	400-3,800
Folding portable ramp	500
Stair glide	3,500-17,000 depending on the stairway
Therapeutic support surface: non-powered	800-3,000
Therapeutic support surface: powered	5,000+
Repositioning sheets	180
Ceiling lift with sling	3,500
Adapted van	60,000

Folding walkers

Folding walkers are used by people who have poor balance but are still able to walk, or who need to take part of their weight off their legs. Folding walkers can be adapted with wheels or small plastic skis so that the client can push the walker on rather than lifting it between steps.

Rollators

Rollators are usually equipped with a basket or back and have a seat where the client can sit if he/she gets tired walking. These devices typically have four wheels so they move easily in front of the person, and a breaking mechanism. Careful assessment by a therapist is required to ensure the client can use this device safely, as it may tend to move away from the person.

Transport chair

A transport chair may be appropriate for a client who is able to move over short distances, but has trouble over longer distances. A caregiver is needed to push the chair. The client should not sit in this chair for long periods of time. This chair is relatively lightweight and can fold up to fit in the trunk of most cars.

Manual wheelchairs

This category incorporates many different types of wheelchairs, from a standard folding chair to ones that tilt and recline. Most have removable footrests and height-adjustable arm rests. As with shoes, chairs come in many shapes and sizes and it is important to have one that is specifically fitted for the individual client. A chair will generally last approximately five years before requiring replacement, although this may vary depending on the wheelchair and how much it is used. A change in the client’s condition may necessitate an earlier change of chair.

Cushions and back supports

Many different types of seat cushions and back supports are available. It is rare for a wheelchair to be prescribed without a cushion because cushions are important for comfort and to help prevent some medical complications such as pressure ulcers. You can expect a cushion to last between two and five years, depending on the materials it is made from and its use.

Scooters

A scooter is a great way to increase outdoor mobility and independence for clients who are able to walk within their home, but struggle with outdoor mobility. If the scooter is being stored outside, it needs to be located in a secure, sheltered location with easy access to an electrical outlet. Clients should discuss their options for storing and charging the scooter with their therapist or sales representative prior to purchase.

Power wheelchairs

A power wheelchair may be most appropriate for clients who are unable to ambulate in their homes and cannot propel a manual wheelchair. Different types of controls are available for driving the chair, ranging from joysticks to head controls. The therapist will be able to determine the safest way for the client to drive the chair and whether this type of device is appropriate.

Power wheelchair with power dynamic positioning

This is a power wheelchair equipped with power tilt and/or power recline. These functions allow clients to change the angle of the seat and back to enable them to change their position in the chair. This type of equipment is often prescribed for clients who need a power wheelchair, but have also lost their ability to shift their weight or reposition themselves.

Bathroom safety equipment

Many falls happen in the bathroom and often result in injury. Investing in bathroom safety equipment (e.g., raised toilet seat, commode, grab bars, bath bench) for clients with decreased mobility may help to prevent falls.

Raised toilet seats fit on top of the bowl to raise the sitting surface, making rising from the toilet easier. A bath seat or bath bench goes inside the bathtub or shower and gives the client somewhere to sit while bathing. The height can be raised, again making rising easier. A commode can be placed by the bedside so the client does not need to get to the bathroom in the middle of the night.

The importance of grab bars cannot be over stated. Clients often try to hold towel racks, soap dishes or vanities for support and balance. These devices are not designed to support a person’s weight and are likely to give way.

Home accessibility modifications

Clients with decreased mobility may require some modifications to improve accessibility both outside and within the home. A folding ramp may be an appropriate temporary solution to negotiate a few stairs at the doorway. A stair glide should be specifically designed for the client’s staircase if there is a curve to it. One the rail has been installed on the stairs, the client can sit in the chair attached to the rail and be transported up and down.

Many other home modifications are also are possible. A therapist can complete an assessment to determine the adaptations needed and help with getting cost estimates.

Therapeutic support surfaces (powered and non-powered)

Therapeutic support surfaces are either placed on top of the client’s bed mattress or take the place of the mattress altogether. This type of device is often prescribed for people at risk of or who currently have a pressure ulcer. Check the manufacturer’s warranty information to determine the expected lifespan of the equipment.

Transfer and repositioning equipment

The ability to move from one surface to another-from the bed to the wheelchair, for example, or from the wheelchair to the commode-is critical to enabling clients to remain in their home environment. Many different pieces of equipment (e.g., ceiling lift, sling, repositioning sheets) are available to assist with these transfers or repositioning the client. Ceiling tracks with a sling can provide a lift for the client, without having to store cumbersome equipment.

Adapted van and other vehicle modifications

An adapted van may be required for a client to travel long distances. A variety of modifications can be made, including driving controls, ramps, lifts, lowered floors and tie-down systems. A therapist specifically skilled in vehicle modification can be helpful in determining the most appropriate modifications.

Funding

The funding available and the processes used to access such funding vary greatly by province. In some cases, devices may rented or obtained from a loan cupboard. Once again, a therapist is an indispensable resource in helping to identify possible sources of funding and whether rental or loan equipment is available. Some sources of funding are listed below; however, this is not an exhaustive list.

Insurance

Many clients have extended health insurance. It is critically important to read the documents that outline the specific coverage. Many policies will contribute to the purchase of one wheelchair or have a limited amount of funding available each year in this category.

A client’s future needs should be considered before accessing this funding. For example, if the client has a deteriorating illness and currently needs a manual wheelchair but will likely require a power wheelchair with power dynamic positioning in the future, it makes sense to “save” the insurance funding for the more expensive piece of equipment.

Government funding-national programs

The Residential Rehabilitation Assistance Program provides assistance for home renovations:

Other programs may also be accessible:

Other provincial sources

Charities

Many charities will consider providing financial assistance for assistive technology. Charities will often work together to help with funding. If a specific charity is unable to provide funding, always ask if they know of any other agencies that may be able to help. Some examples of these agencies include:

Final thoughts

It is important to budget for assistive technology, but also for a therapist’s assessment. Involving a therapist in the process of obtaining equipment will ensure that clients receive the most appropriate equipment, have access to potential sources of funding and have appropriate consideration given to both current and future lifestyle and needs.