Motorized Wheelchairs for Nursing Home Residents
On February 27, 2007, after four years of community organizing and contentious litigation, a federal court in Illinois approved a class action Settlement Agreement that requires more than 13,000 persons with disabilities in nursing homes be assessed and evaluated for customized motor wheelchairs. If wheelchairs are found medically appropriate for a person, the Settlement Agreement requires a motorized wheelchair be provided.
Access Living, the Chicago Center for Independent Living and its attorney, Max Lapertosa, recognized that there were many persons in nursing homes who needed and were being denied motorized wheelchairs. We used the Minimum Data Set (MDS), to establish categories of persons in nursing homes who might need a motorized wheelchair, e.g., "other person wheels," "totally dependent on others" for movement, "locomotion off unit," "quadriplegia," and many others. This information is available in your State for each nursing home with the MDS.
The Settlement Agreement developed a "triage" form that will be used for all 13,000 people who, according to the MDS, falls within a specific category. After this form is completed, persons will be assessed by a "qualified professional" and, if determined medically necessary and appropriate, will receive either a customized motorized wheelchair (paid for by the State), or a non-customized motorized wheelchair or manual wheelchair (paid for by the nursing home out of the per diem it receives from the State).
The Illinois Health Care Association representing the nursing facilities/homes went to court and opposed the Settlement Agreement. Why? The Illinois Health Care Association presented three arguments:
1. Nursing facilities did not have "qualified professionals" who can do "rehabilitation seating and positioning."
The Settlement Agreement defined "qualified professionals" as an occupational or physical therapist or other health professional who either has "at least two years' experience in rehabilitation seating and positioning" or currently is licensed and received at least five hours of training in the past year, or is certified by RESNA, the professional association.
Even the State defendants stated that the Settlement Agreement's "evaluation process is no more than what nursing facilities should be doing on a routine basis to determine whether any nursing facility resident needs any kind of care, including durable medical equipment."
2. Nursing facilities did not want to pay for non-customized motorized wheelchairs out of their per diem, and Medicaid does not reimburse for non-customized motorized wheelchairs.
However, the federal Medicaid statute requires each nursing facility to furnish any medical equipment that "will promote maintenance or enhancement of the quality of life of each resident." Also, non-customized motorized wheelchairs are standard durable medical equipment for nursing facility residents and are part of the Medicaid per diem reimbursement.
3. Because the Settlement Agreement required that if nursing facilities did not comply, the State must "take all appropriate action" against the nursing facilities, including "decertifying the facility as a MA provider" or imposing "fines and/or [other] licensor action," the Illinois Health Care Association strenuously objected.
The Illinois Health Care Association was afraid that the "state agency" might really do what a state agency is supposed to do! Even though the federal court approved the Settlement Agreement, the nursing facilities' opposition was appalling.
Nationally, according to CMS, there are about 469,000 persons in nursing facilities are classified as "totally Dependent to move off their unit." In that subgroup, 215,000 require "extensive assistance" to move off their unit, and about 88,000 "actually did NOT" move off their units. You should be addressing the mobility needs of these people.
In your States, how many people in nursing facilities would benefit from a motorized wheelchairs? How many people would increase their independence and maybe even think about going outside, if they could ambulate with a motorized wheelchair? Is your State holding the nursing facilities accountable? Are the doctors in the nursing homes prescribing wheelchair evaluations and assessments? Are disability advocates raising this issue in your State?
Steve Gold, The Disability Odyssey continues
