Assistive Technology / Remote Monitoring

by Thomas Day

Assistive Technology

Assistive technology is a broad term and may mean different things to different people but for our purposes we will define it as the following:

1. Devices or systems to help people who have no skilled medical needs manage their disabilities
2. Devices or systems that may also support disabilities with people who are receiving Medicare home care
3. Personal items or devices that make life easier for people with disabilities
4. Living environments that accommodate disability
5. Consultants, books and other advice
6. Home Modification

Devices or systems to help people who have no skilled medical needs manage their disabilities.

Many assistive technology devices and systems that support disabilities may serve as well a disability caused by a medical condition , but we have chosen in this article to differentiate between a medical or a non-medical use because we are talking about the elderly. As a general rule Medicare will reimburse 80% of the cost for rental or purchase of devices or systems that support disabilities due to a medical problem. Some items on the list we provide below of these devices or systems may also be included in Medicare's list of allowable durable medical equipment. Here is our list of devices in this category:

• Lifts
• Oxygen equipment
• Sensory Augmentation Devices
• Computer Usage Arrangements for the Disabled
• Wheelchairs and Scooters
• Other mobility related devices

Devices or systems that may also support disabilities with people who are receiving Medicare home care:

• Lifts
• Oxygen equipment
• Sensory Augmentation Devices
• Wheelchairs and Scooters
• Other mobility related device

If there is a medical need and if the device or system meets Medicare's definition of durable medical equipment (DME) below, then Medicare will pay for 80% of the cost and the Medicare recipient pays for the other 20%. In addition if the care recipient has a Medicare supplement policy, that policy usually covers the other 20% of the cost. We have included a portion of Medicare's list of durable medical equipment below in order to give our readers an idea of what and what not is covered by Medicare. This list is current as of the middle of 2005.

The term DME is defined as equipment which:

• Can withstand repeated use; i.e., could normally be rented, and used by successive patients;
• Is primarily and customarily used to serve a medical purpose;
• Generally is not useful to a person in the absence of illness or injury; and
• Is appropriate for use in a patient's home.

Medicare's (partial) Durable Medical Equipment Reference List:

Item						Coverage Status
Augmentative Communication Device						Under certain rare circumstances
Bathtub Lifts						deny--convenience item; not primarily medical in nature (§l861(n) of the Act)
Bathtub Seats						deny--comfort or convenience item; hygienic equipment; not primarily medical in nature (§l861(n) of the Act)
Bed Lifter (bed elevator)						deny--not primarily medical in nature (§1861(n) of the Act.
Beds-Lounge (power or manual)								deny--not a hospital bed; comfort or convenience item; not primarily medical in nature (§l86l(n) of the Act)
Beds--Oscillating								deny--institutional equipment; inappropriate for home use
Bidet Toilet Seat								(See Toilet Seats.)
Braille Teaching Texts								deny--educational equipment; not primarily medical in nature (§1861(n) of the Act)
Canes								covered if patient's condition impairs ambulation (See §60-3.)
Carafes								deny--convenience item; not primarily medical in nature (§l861(n) of the Act)
Commodes								The term "room confined" means that the patient's condition is such that leaving the room is medically contraindicated. The accessibility of bathroom facilities generally would not be a factor in this determination. However, confinement of a patient to his home in a case where there are no toilet facilities in the home may be equated to room confinement. Moreover, payment may also be made if a patient's medical condition confines him to a floor of his home and there is no bathroom located on that floor (See hospital beds in §60-18 for definition of "bed confinement".)
Communicator					Allowed if definition is met
Continuous Passive Motion					Continuous passive motion devices are devices covered for patients who have received a total knee replacement. To qualify for coverage, use of the device must commence within 2 days following surgery. In addition, coverage is limited to that portion of the three week period following surgery during which the device is used in the patient's home. There is insufficient evidence to justify coverage of these devices for longer periods of time or for other applications.
Crutches					covered if patient's condition impairs Ambulation
Cushion Lift Power Seat					(See Seat Lifts.)
Disposable Sheets and Bags									deny--nonreusable disposable supplies (§l861(n) of the Act)
Elevators									deny--convenience item; not primarily medical in nature (§l861(n) of the Act)
Exercise Equipment									deny--not primarily medical in nature (§l861(n) of the Act)
Fabric Supports									deny--nonreusable supplies; not rental-type it (§l861(n) of the Act)
Grab Bars					deny--self-help device; not primarily medical in nature (§l861(n) of the Act)
Hydraulic Lift					(See Patient Lifts.)
Incontinent Pads							deny--nonreusable supply; hygienic item (§ l861(n) of the Act.)
Medical Oxygen Regulators			covered if patient's ability to breathe is severely impaired (See §60-4.)
Mobile Geriatric Chair			(See Rolling Chairs.)
Motorized Wheelchairs			(See Wheelchairs (power operated).)
Overbed Tables			deny--convenience item; not primarily medical in nature (§l861(n) of the Act)
Oxygen			covered if the oxygen has been prescribed for use in connection with medically necessary durable medical equipment (See §60-4.)
Oxygen Humidifiers			covered if a medical humidifier has been prescribed for use in connection with medically necessary durable medical equipment for purposes of moisturizing oxygen (See §60-4.)
Oxygen Regulators (Medical)			(See Medical Oxygen Regulators.)
Oxygen Tents			Might be covered, complicated requirements
Parallel Bars			deny--support exercise equipment; primarily for institutional use; in the home setting other devices (e.g., a walker) satisfy the patient's need
Patient Lifts		covered if contractor's medical staff determines patient's condition is such that periodic movement is necessary to effect improvement or to arrest or retard deterioration in his condition.
Portable Oxygen Systems:		1. Regulated (adjustable --covered under conditions specified in flow rate)§60-4. Refer all claims to medical staff for this determination. 2. Preset (flow rate -- deny --emergency, first-aid, or not adjustable) precautionary equipment; essentially not therapeutic in nature
Portable Room Heaters		deny--environmental control equipment; not primarily medical in nature (§l861(n) of the Act)
Portable Whirlpool Pumps		deny--not primarily medical in nature; personal comfort items (§§l861(n) and l862(a)(6) of the Act)
Preset Portable Oxygen Units		deny--emergency, first-aid, or precautionary equipment; essentially not therapeutic in nature
Quad-Canes	(See Walkers.)
Raised Toilet Seats	deny--convenience item; hygienic equipment; not primarily medical in nature (§l861(n) of the Act)
Rolling Chairs	covered if the contractor's medical staff determines that the patient's condition is such that there is a medical need for this item and it has been prescribed by the patient's physician in lieu of a wheelchair. Coverage is limited to those rollabout chairs having casters of at least 5 inches in diameter and specifically designed to meet the needs of ill, injured, or otherwise impaired individuals. Coverage is denied for the wide range of chairs with smaller casters as are found in general use in homes, offices, and institutions for many purposes not related to the care or treatment of ill or injured persons. This type is not primarily medical in nature. (§l861(n) of the Act)
Safety Roller	Covered under very special conditions
Sauna Baths	deny--not primarily medical in nature; personal comfort items (§§l861(n) and (l862(a)(6) of the Act)
Seat Lift				covered under the conditions specified in §60-8. Refer all to medical staff for this determination.
Sitz Bath				covered if the contractor's medical staff determines patient has an infection or injury of the perineal area and the item has been prescribed by the patient's physician as a part of his planned regimen of treatment in the patient's home.
Spare Tanks of Oxygen				deny--convenience or precautionary supply
Speech Teaching Machine				deny--education equipment; not primarily medical in nature (§l861(n) of the Act)
Stairway Elevators				deny--(See Elevators.) (§l861(n) of the Act)
Standing Table				deny--convenience item; not primarily medical in nature (§1861(n) of the Act)
Support Hose				deny (See Fabric Supports.) (§l861(n) of the Act)
Surgical Leggings				deny--nonreusable supply; not rental-type item (§l861(n) of the Act)
Telephone Alert Systems				deny--these are emergency communications systems and do not serve a diagnostic or therapeutic purpose
Telephone Arms	deny--convenience item; not medical in nature (§l861(n) of the Act)
Toilet Seats	deny--not medical equipment (§l861(n)of the Act)
Trapeze Bars	covered if patient is bed confined and the patient needs a trapeze bar to sit up because of respiratory condition, to change body position for other medical reasons, or to get in and out of bed.
Treadmill Exerciser	deny--exercise equipment;not primarily medical in nature(§l861(n) of the Act)
Walkers	covered if patient's condition impairs ambulation (See also §60-15.)
Wheelchairs	covered if patient's condition is such that without the use of a wheelchair he would otherwise be bed or chair confined. An individual may qualify for a wheelchair and still be considered bed confined.
Wheelchairs (power operated) and wheelchairs with other special features	covered if patient's condition is such and that a wheelchair is medically necessary and the patient is unable to operate the wheelchair manually. Any claim involving a power wheelchair or a wheelchair with other special features should be referred for medical consultation since payment for the special features is limited to those which are medically required because of the patient's condition. (See §60-5 for power operated and §60-6 for specially sized wheelchairs.) NOTE: A power-operated vehicle that may appropriately be used as a wheelchair can be covered. (See §60-5 for coverage details.)
Whirlpool Bath Equipment	covered if patient is homebound and has a (standard) condition for which the whirlpool bath can be expected to provide substantial therapeutic benefit justifying its cost. Where patient is not homebound but has such a condition, payment is restricted to the cost of providing the services elsewhere; e.g., an outpatient department of a participating hospital, if that alternative is less costly. In all cases, refer claim to medical staff for a determination.
Whirlpool Pumps	deny--(See Portable Whirlpool Pumps.) (§l861(n) of the Act)
White Cane	deny--(See §60-3.)

Personal items or devices that make life easier for people with disabilities
This could include some of the following exclusive items for disabled persons or for those going through rehab at home.

Therapy Equipment
Hydrotherapy, Paraffin & Fluidotherapy, Iontophoresis, Biofeedback, Hot & Cold Therapy, Wellness & Massage Therapy and Electrotherapy & Ultrasound

Supports
Arthritis Supports, Wrist Supports, Elbow Supports, Cervical Collars, Back Supports, Ankle, Foot, & Heel Supports, Foot Management, Bed Positioning & Safety Products, Compression Products, Edema Garments, Thumb Supports, Contracture Management Splints, Upper Extremity Positioning/Supports, Thoracic & Pelvic Support, Knee Immobilizers, Knee Straps, Knee Supports, Thigh Supports, Ankle / Foot Orthoses, Heel & Elbow Protectors, Lower Extremity Positioning, Wound Care Products, Scar Management & Gel Products, Lymphedema Products and Taping Products

Dining
Knives, SupergripT Utensils, Sure Hand Utensils, Tapes & Tubing (for enlarging the diameter of an object), Utensil Holders, Acute Care Tables, Clothing Protectors, Dycem® Nonslip Plastic Food Catchers, Home Care / Long Term Care Tables, Non-Slip Matting & Trays, Cups, Mugs & Nursers, Drinking Aids & Straws, Nosey Cups, Self Feeders & Arm Supports, Feeders, Arm Supports & Overbed Tables, JAECO / Rancho Mobile Arm Supports, Mobile Arm Support Accessories, Dinnerware, Feeding Evaluation Kits, Food Guards, Scoop Dishes, Suction Bowls & Plates, Tableware, Jar & Bottle Openers, Kitchen Supplies And Cooking Utensils

Bath , Toileting and Hygiene
Bath & Shower Chairs, Bath & Shower Seats, Bath Boards, Bath Transfer Benches, Bathing Systems, Beluga Bathlift, Folding Shower Seats, Hydraulic Bathlift, Reclining Shower / Commode Chairs, Shower Stools, Bath lifts, Commodes, Folding Commodes, Grab Bars, Lifting & Wooden Commodes, Raised Toilet Seats, Raised Toilet Seats & Splash Guards, Raised Toilet Seats with Armrests, Safety Rails, Toilet Frames, Toilet Supports & Reducer Rings, Bathing & Shower Cushions, Bathing & Shower Mats, Bathtub Grab Bars & Rails, Diabetic Foot Accessories, Grooming & Accessories, Hand-Held Showers, Scrub Sponges & Brushes, Incontinence Products, Mirrors, Catheterization Accessories, Urinals and Mattress Covers

Aids of Daily Living
Reachers, Door Knobs & Grip Assists, Furniture Risers, Home Accessories, Household Helpers, Trolley & Carts, Respiratory Care, Low Vision aids such as magnifying glasses and reading screens, Mouth Sticks & Headpointers, Speech & Communication aids, Language & Cognition aids and activities, Dressing Aids (button hooks, hooks, etc.), Dressing Education, Fasteners & Shoe Laces, Shoehorns, Slippers & Fasteners, Socks & Slippers, Leisure Activities and Helpers, Environmental Controls, Activity Tables, Book Holders, Page Turners & Reading Aids, Scissors, Writing Aids, Dysphagia Resources, Oral Motor aids

Special Clothing
Outer garments, underwear, leisure wear, footwear and other specialized clothing for elderly people with Alzheimer's, arthritis, mobility issues, foot problems, incontinence, scoliosis or obese individuals.

Living environments that accommodate disability
There are a growing number of companies that will make the home into a safe environment for a fee. Here is a list of what one company called Safe Living Solutions, at https://www.safelivingsolutions.com/ will do.

What We Do
Reflecting on our mission statement, we are committed to improving the lifestyles of the older aged and the disabled. The many services we offer are based on an extensive and diligent focus on enhancing the lives of those that have a need of our services and will benefit from them.

SafeLiving SolutionsT (SLST) is a non-profit. community-focused service provider with a commitment to improving the lifestyles of the older aged and the physically impaired that reside in the Yakima Valley and surrounding areas. The many services we offer are based on an extensive and diligent focus on the enhancing the lives of those that have a need of our services and those who will benefit from them.

SLS Tdiffers from many other service agencies because we are consumer-directed. People with disabilities are significantly involved in SLST, not just as clients but as Founder and representative on the Board of Directors and our employment goal is for staff members as well. We are funded through federal, state, and local grants, contracts and private donations.

Our goal is to expand opportunities for people with disabilities to achieve their highest potential in independent living and community life. We provide individualized and group services for people with disabilities, and also are actively involved in community outreach and advocacy. These services are available to all persons with disabilities in the Yakima Valley and outlying areas. Individuals and families can receive assistance through services provided in-office, in-home.

By learning to make independent choices and by taking control of their own decisions, clients, with our support and assistance, move away from unnecessary and costly dependency. SLST itself, through community education and advocacy, works to encourage removal of institutional barriers to full inclusion of people with disabilities in community life allowing Independent Living and remaining in the home.

Daily Living Services
SafeLiving Solutions is the answer for taking care of the things that other services for the disabled do not offer. The majority, if not all, programs only provide services for the immediate care of the individual that is medical related, personal care and in home maintenance care, such as laundry, cleaning and meal preparation.

We provide the variety of services that are just as important to the cared for individual that the other services just do not offer. Our recognizing these simple daily tasks, gives the cared for total relief in their daily lives in knowing it has been taken care of by people who truly care. From pet care, yard care, sitting service, car care, painting, gardening help, outdoor activity accompaniment, dry cleaning transport, mailing and shipping, home and financial organization and assistance to personal shopping for that birthday present for a relative. What the other social and private services do not offer, we definitely do it! In addition to our daily living services, we also offer the following;

Independent Living Skills
Assisting individuals develop their own Independent Living plans - setting short and long term goals with periodic reviews, and teaching consumers skills and techniques for maintaining and increasing their level of independence is a service that SLST provides.

One of our qualified staff will visit the home to evaluate if living independently is possible and safe. If that is not a reality, SLST will assist in making the proper contacts to assess the physical condition of the home owner to decide the type of in-home care that may be necessary for them to remain in the home. If remaining in the home is possible, we then will assess the living environment for the needed safety adaptations and/or modifications to allow independent living.

Social and Recreational Programs
Participation in community social activities, forming groups for recreation and planning special events is a service we provide to engage those who primarily do not get out of their homes and stay active.

Some of the events that we will provide transportation to are, Yakima Farmer's Market, The Capitol Theatre and Sarge Hubbard Park . These are only a few of the community activities that SLST will provide the transportation to and from. We also will provise transportation to enable swimming, golfing and other activities to achieve the important goal of keeping our clients active that live in the immediate Yakima area.

Transportation
Services for transportation to OTHER THAN medical reasons are not offered by the various agencies in the area. We can help with arranging them for you. Arrangements offering door-to-door transportation if needed on lift-equipped vehicles can be made and is subject to availability. Sliding-scale fee may apply. Transportation is primarily for those registered in a SLST service program. Sunday transportation is available if the demand is met. A sliding fee may apply

Home/Worksite Adaptations & Modifications
Structural adaptations, modifications and fabrications in the home, worksite or other areas (ramps, lifts, bathroom changes) that remove or reduce physical barriers for an individual with a disability.

ADA-Related Information & Technical Assistance for the Workplace
Advising businesses open to the public, state and local governments, employers, consumers, and others about rights and responsibilities under the Americans with Disabilities Act (ADA) and related laws. Conducting on-site surveys upon request from individuals or organizations interested in greater accessibility. We focus on all disabilities such as physical limitations, blindness, hearing or emotional issues.

We provide an outreach to people who are deaf or hard of hearing, maintaining resource information about deafness issues as well as an interpreter registry, and making some equipment, such as TTYs, affordable through SLS'sT resources to rent-to-own programs. We have on staff a certified Professor of Linguistics that specializes in sign language and home/workplace modifications for the deaf. Sliding-scale fees may apply.

Environmental Control Systems
Primarily electronic systems that enable someone with limited mobility to control various appliances, electronic aids, security systems, etc. in their room, home or other surroundings.

At home, we all feel more relaxed and in control of our lives. We help them to remain as independent as possible by creating safe living conditions and long-term support resources. The main focus we bestow is in assisting with the needs for daily living by creating accessible, comfortable, attractive and most important of all, barrier free and SAFE living environments to accommodate and enable Independent Living.

Whether the home requires simple modifications, or more difficult ones, adaptation alterations can allow individuals to remain in the home or families to remain together. If planning new construction, Universal Design elements can be included in the initial designing and used to make the home more accessible and friendly to all users. When this is not an option, modifications and assistive devices properly designated and installed will provide independence and confidence to the homeowner and family members.

Assistive Technology (AT)
Assistive Technology (AT) includes both devices and services. A device is any item or piece of equipment used to maintain or improve the functional capabilities of a person with a disability. Many high-tech and low-tech devices are now available to assist people with disabilities with daily living tasks, communication, education, work, and recreation.

Self help aids for use in daily activities such as eating, bathing, cooking, dressing, toileting, home maintenance, etc. are also available.

Examples are: wheelchairs, Velcro, adapted clothing and toys, computers, seating systems, powered mobility, augmentative communication devices, special switches, assisted listening devices, visual aids, memory prosthetics, and thousands of other commercially available or adapted items. AT services support people with disabilities or their caregivers to help them select, acquire, or use AT devices. Such services also include functional evaluations, training on or demonstration of devices, and purchasing or leasing devices.

Computer Technology Adaptation
Input and output devices (voice, Braille), alternate access aids (head sticks, light pointers), modified or alternate keyboards, switches, special software, etc. that enable persons with disabilities to use a computer. This category includes speech recognition software.

Augmentative or Alternative Communication (AAC )
Electronic and non-electronic devices that provide a means for expressive and receptive communication for persons with limited or no speech.

Advocacy
Many people with disabilities may not be aware of options that might allow them to live more independently. SLST educates consumers about available opportunities. They can then choose to use what they've learned to set new goals. Through community advocacy, SLST works to expand the available range of choices.

We assist clients in exercising their rights to obtain services or benefits. Speaking out on behalf of the rights and interests of people with disabilities through community outreach and involvement by staff, board members, volunteers, and consumers Advocacy.

SLST will be establishing support groups promoting a positive self-image for people with disabilities through provision of speaker panels for schools, social service agencies, and other service providers, and facilitating attitude change within the community.

• People with disabilities, through their experience in being disabled, are aware of the needs of people with disabilities
• Support services should be based on consumer controlled policies
• The goal of SLST is to provide the skills needed by an individual to cope with a disabling environment
• The goal of services is full integration into the community

Resources Information & Referral
There are endless resources to services, programs, funding, and volunteer programs available. We will only refer those that bestow integrity and have shown themselves to be outstanding in their field to be placed on our professional referral list.

Consultants, books and other advice
There are numberless books available from bookstores and from online sources that give advice to caregivers in all areas of disability support. These sources often go beyond the issue of devices and equipment and deal with such things as meal preparation, menus, activities, music and other social issues important to the disabled. Private and government consulting are also available. Check online or dial 211 or call the local area agency on aging.

Home Modification

Many people with disabilities want to remain in their home as long as possible. Such things as narrow doorways that cannot accommodate wheelchairs, more than one living level and inconvenient layout of the home may prevent a person from living there. In addition disabled people often require rails, special bathroom facilities and special dining facilities as well. There are three options to look at when considering home modification.

• Research can be done and materials procured to make the home more livable and the family friend or relative can pitch in and do the remodel.
• A contractor can be employed to do the necessary modifications.
• An attempt can be made to find a local company that specializes in the home modification for the disabled. These providers may be readily available in larger population areas.

In addition help can be sought from the following community service providers.

• Local area agency on aging
• State department on aging
• State housing finance agency
• Department of public welfare
• Department of housing and community development
• Senior center Independent living center

The national Association of home builders and the AARP have teamed together to form the Certified Aging-in-Place Specialist (CAPS) program. These people have been trained in the unique needs of the older adult population, aging in place home modifications, common remodeling projects, and solutions to common barriers. It may be possible to find a person in the desired area by going to https://www.nahb.org/or by calling the local home builders Association and asking for someone certified in this area.

Also, consider taking these steps:

• Get recommendations from friends who have had similar projects completed.
• Hire a licensed and bonded contractor. Be specific about modifications in advance.
• Ask for a written agreement with only a small down payment. Make the final payment only after the project is completed.
• Check with the local better business Bureau regarding the contractor's or program's reliability and performance record.

Alarm, Tracking and Prevention Devices

This area of assistance focuses more on the use of devices that warn of problems with homebound people who are often without caregivers for certain periods of the day. This may include:

• 24-hour vital sign monitoring,
• video surveillance,
• emergency signaling systems or
• GPS locator devices for wandering care recipients.

These services are very popular and can be found in the Yellow Pages or by visiting the Medical Alert, Health Monitoring & Home Safety page on our site.