Home Medical Equipment
[ photo by Marcus Aurelius ]
Importance of home medical equipment.
As I have mentioned before, I work in an acute inpatient rehabilitation hospital. The goal I have for my patients when I bring them into rehab is that they return to their prior residence or at least somewhere where they can live as independently as possible. There are very few patients I have that discharge to home without some sort of home medical equipment, also called durable medical equipment (DME).
(Related blog posts: Where Do You Go After Acute Rehab?, From Independent Living To Senior Assisted Living Facility)
The first thing you might think of is a walker or a wheelchair. Yes, one or both of these are very commonly ordered for a patient as home medical equipment on discharge from the hospital. There are other items, however, that are almost as common as those walkers and wheelchairs; those are the pieces of equipment that help someone to bathe and toilet themselves more independently. Until you begin to have difficulty getting up from that low toilet or some nervousness with standing up to take your shower, you might not even think about how necessary these pieces of equipment are.
Bathing and toileting equipment are high on the needs list.
I recently read a study that specifically looked at the number of older adults who need bathing and toileting equipment but do not actually have it. I was surprised at what it found! This study, printed in JAMA Internal Medicine, found that 42% of older adults who have impairments limiting their ability to safely bathe or toilet without needed equipment did not actually have that needed home medical equipment. These main pieces of equipment included grab bars, raised toilet seats/commodes, and shower chairs. This equipment is very basic, with no special technology, but it allows someone with a particular disability to be able to stay in their own environment in a safer, more independent manner. So why is such basic equipment missing from so many homes where it would be greatly beneficial?
The participants in this study were community-dwelling individuals, meaning they do not live in a retirement home or institutional facility. These participants were noted to need either bathing equipment or toileting equipment based on a questionnaire they were given from the National Health and Aging Trends Study. Once they were placed in the “needs equipment” category, they were then interviewed yearly for four years to determine if their need for equipment was met or unmet. At the end of the four years, 35% with needs for bathing equipment never received it and 52% of those with a need for toileting equipment never received it.
Barriers to obtaining needed home medical equipment.
Why was that? Why is there such a gap in how to obtain this most basic of equipment? There were some theories suggested in the journal article, with the first being that people don’t know this type of home medical equipment exists or that people do not know how to obtain this equipment. I have to admit that I can take this for granted because of working in an acute rehab unit.
We have a team approach in that the therapists will recommend a particular piece of home medical equipment. I will then review the recommendation and write an order for it, if I agree. The order then is given to the case manager who helps the family obtain it. Because not every person receives inpatient rehab, they often do not know where to begin in the process of getting needed home medical equipment.
(Related blog post: Acute Rehabilitation Vs Subacute Rehabilitation: What Is The Difference?)
The next reason hypothesized is that there is a stigma to having this equipment in the home or that the equipment is just not aesthetically pleasing. There are various ways to approach this particular issue, and I have quite a bit of experience with this. One patient I had did not want to install grab bars in her bathroom because she did not like how they looked. We talked about putting a couple of hand towels on either end to camouflage the grab bars, which sold her on them.
Another patient felt his grandchildren would think he was “old” and would not be able rough house with him any longer because he could not even get up from a toilet without special equipment. It just so happened that some of his grandchildren were visiting that day. I took the grand kids on a tour of the therapy gym where we have these pieces of equipment for patients to practice. After each child took turns sitting on “the awesome special toilets” I explained that their grandpa was actually having one put in his bathroom. They were so excited they would get to sit on one every time they went to visit him. These are just a couple of examples. It is not always easy to convince someone to use the equipment, but it can be done.
Another possible barrier to not getting the equipment is the fact these particular pieces of home medical equipment are not covered by Medicare Part B. It certainly does not make sense that this would not be covered given that these fairly inexpensive pieces of equipment could potentially prevent falls and other events that might lead to an expensive hospitalization. These pieces of equipment are not incredibly expensive, but for those on a fixed income, it adds up.
The right equipment can help maintain independence and safety.
Adaptive equipment is such a vital part of helping to keep our loved ones living more independently. It helps an older person safely and more easily perform basic activities of daily living with less assistance and reduces their risk of injury. Home medical equipment can also help to reduce the risk of injuries to the caregivers providing assistance to their loved ones. If you have concerns about your loved one having the necessary home medical equipment to stay safely in his or her home, I can help to guide you on how to go about determining what is needed and how to get it.
(Related blog posts: Taking Care Of Elderly Parents At Home, Caring For Dementia Caregivers)
Would your aging parent benefit from home medical equipment? What items have you found to be the most useful? Share your thoughts in the Comments section.
© 2021 Jessica Kluetz, DO