Asthma
Hyperresponsive airways are manifested by a narrowing of the airway.
Bariatric Products
Designed to have a weight capacity of 300 pounds (or more) for those who need that extra support. Bariatric chairs maximize the patient’s ability to sit and stand with reduced effort and lessen the chance of lifting injury to the caregiver.
Bariatric beds have extra bracing integrated into the home care bed frame and a wider surface and truss assembly to provide maximum support.
Bi-PAP (Bi-Level Positive Airway Pressure)
A device that provides ventilation for patients by delivering air to the lungs at two pressure levels, either cyclically in an anesthetized patient or triggered by the patient’s attempts at breathing when awake.
Bili Light (Phototherapy)
Also known as phototherapy, it is used to help infants with jaundice, a yellowing of the skin and eyes related to abnormal liver function.
Cane
Adjustable-height canes can improve balance and reduce fatigue. Travel canes can fold up and be carried in a travel case. Standard crook canes are lightweight and durable, helping to improve balance and reduce fatigue. Quad canes are used when additional stability is needed. They have a base with four legs, affording greater stability than straight canes. Quad canes can be ordered with narrow or wide bases.
CHF (Congestive Heart Failure)
Heart failure in which the heart is unable to maintain adequate circulation of blood in the tissues of the body or to pump out the venous blood returned to it by the venous circulation
Child/Junior Wheelchair
Children and young adults need chairs to accommodate their changing needs as they grow. In addition, it is important that wheelchairs for children or teens be adaptable to classroom environments and ” friendly-looking” to help the user fit more readily into social situations. Manufacturers today are becoming increasingly sensitive to these market demands and are attempting to address them with innovative chair designs and a variety of “kid-oriented” colors and styles.
Commode
3-in-1 Commodes are adjustable and include back, pail w/lid, toilet seat, and cover. Some can be used as a free-standing commode or a raised toilet seat. Lift/commode is an FDA-registered medical device, ideal for people with musculoskeletal or neuromuscular limitations. It is motorized and designed to operate as a lift system and adjustable height commode. It can be used as a bedside commode (helps reduce bedpan use) or as a transfer system to move a person from a bed to a seated or standing position.
Compression Stocking
Problems with the veins of the leg occur in both men and women of all ages, but certain factors increase the risk of venous problems. Health conditions, lifestyle habits, heredity, injury, surgery, age, and pregnancy all play a role. A broad range of compression hosiery, including knee, thigh high, waist chaps, open-toe, and closed-toe, is manufactured to meet your needs. For more information, visit http://www.jobst-usa.com.
Continuous Passive Motion (CPM)
Devices are available for synovial joints (hip, knee, ankle, shoulder, elbow, wrist, and TMJ) following surgery or trauma (including fracture, infection, etc). The device moves the affected joint continuously on a 24-hour basis, without patient assistance. The device is held in place across the affected joint by Velcro straps. An electrical power unit is used to set the variable range of motion and speed. The speed and range of motion can be adjusted depending on joint stability, patient comfort level, and other factors assessed intraoperatively.
COPD (Chronic Obstructive Pulmonary Disease)
A catch-all term for a number of respiratory diseases. The diseases of COPD include chronic bronchitis, pulmonary emphysema, asthma, and bronchiectasis (a chronic inflammatory or degenerative condition of one or more bronchi or bronchioles marked by dilatation and loss of elasticity of the walls).
CPAP (Continuous Positive Airway Pressure)
One of the most common sleep disorders is sleep apnea – a disorder that causes a person’s airway to close several times during one night’s sleep. For those with sleep apnea, relief usually comes with continuous positive airway pressure (CPAP). Continuous Positive Airway Pressure (CPAP) devices deliver a prescribed level of positive pressure non-invasively to the upper airway for the treatment of sleep apnea. Extremely easy to use, CPAPs come with different features such as ramping to allow comfortable adjustment to the pressure; software to capture specific usage and breathing events; and automated altitude adjustment. Accessories, such as nasal interface applications and humidification devices are provided to afford maximum comfort to ensure patient compliance.
Crutch
Standard adjustable crutches are lightweight and easily adjust to size. Forearm crutches have contoured arm cuffs for extra comfort and stability.
Cylinder
Available in various sizes. Carrying cases or carts are used for the different size tanks
M2 – Weighs less than 2 pounds and only 7.9 inches in length, this extremely lightweight, compact medical oxygen cylinder is the perfect solution for anyone who needs a convenient, easily transportable medical oxygen supply for a short amount of time. This cylinder is the smallest aluminum oxygen cylinder in the world yet can supply up to 2 hours of oxygen.
M4 – medical oxygen cylinder is a great solution for anyone who needs a convenient, easily transportable medical oxygen supply for a short amount of time. This cylinder weighs under 3 pounds and is only 12 inches in length. This cylinder can supply up to 7 hours of oxygen.
M6 – extremely popular medical oxygen cylinder is the perfect balance between portability and oxygen supply duration. The M6 cylinder is less than 15 inches in length and weighs only 3 pounds and can supply up to 10 hours of oxygen.
ML6 – Similar to the M6 cylinder, the ML6 is a great balance between portability and oxygen supply duration. This cylinder weighs under 4 pounds and is shorter and wider than the M6 cylinder. This cylinder can provide up to 10 hours of oxygen.
M9 – a popular cylinder is a great balance between portability and oxygen supply duration. The M9 is less than 16 inches in length and weighs only 4.5 pounds yet can supply up to 14 hours of oxygen.
Cystic Fibrosis (CF)
A life-threatening disorder that causes severe lung damage and nutritional deficiencies. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts, and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF. Each year approximately 3,200 white babies are born in the United States with CF. The disease is much less common among black and Asian-American children. Most babies born with CF are diagnosed by age 3, although mild forms of the disease may not be detected until the third, fourth, or fifth decade of life. In all, about 30,000 American adults and children are living with the disorder. Although there’s still no cure, the emerging field of gene therapy may someday help correct lung problems in people with CF.
Diabetes
Disease in which blood glucose levels are above normal
Type 1 diabetes: diabetes of a form that usually develops during childhood or adolescence and is characterized by a severe deficiency of insulin secretion resulting from atrophy of the islets of Langerhans and causing hyperglycemia and a marked tendency toward ketoacidosis — called also insulin-dependent diabetes, insulin-dependent diabetes mellitus, juvenile diabetes, juvenile-onset diabetes, type 1 diabetes mellitus
Type 2 diabetes: a common form that develops especially in adults and most often in obese individuals and that is characterized by hyperglycemia resulting from impaired insulin utilization coupled with the body’s inability to compensate with increased insulin production — called also adult-onset diabetes, late-onset diabetes, maturity-onset diabetes, non-insulin-dependent diabetes, non-insulin-dependent diabetes mellitus, type 2 diabetes mellitus
Diabetic Supplies
Blood glucose monitoring – there are a variety of systems available that allow testing on arms, fingers or thighs, with fast and accurate results and minimal cleaning required.
Environmental Control Unit
Permit remote control of electronic devices in the immediate surroundings. A person can independently turn lights, radio, and television on and off, answer or initiate phone calls, and unlock a door. Essentially any aspect of the environment can be controlled depending upon the system’s complexity. For more information and products visit http://www.makoa.org/ecu.htm.
Helios Portable Oxygen System and Reservoir
Small, lightweight, and long-lasting, encourages an active lifestyle for long-term oxygen therapy patients. No tubes, heavy canisters or batteries are required. The system is also extremely economical. Its pneumatic oxygen conserving device gives it a conservation ratio over continuous flow oxygen of approximately 4:1. This provides up to 10 hours of use at a setting of 2. The portable unit can be refilled in about 40 seconds from the home reservoir, which typically lasts four to six weeks between refills.
Hepatitis C HCV (Hepatitis C Virus)
An inflammation of the liver causing soreness and swelling. It is the most common chronic blood-borne infection in the United States. The hepatitis C virus usually is transmitted through contact with infected blood, most commonly by sharing needles during intravenous drug use, or getting a blood transfusion before 1992. Hepatitis C also may be spread through unprotected sexual intercourse, but this is uncommon. Most people don’t feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.
Hospital Bed
Allows for positioning and safety not possible with standard beds. There are basically three (3) types of hospital beds available for home use: Semi-Electric Beds – allow for raising and lowering the head and the knee break through the use of an automatic hand-held control. Raising the entire bed height is accomplished through use of a manual crank. Manual Beds – allow for raising and lowering the head of the bed and the knee break through the use of a manual crank. Full or half-side rails are available. Full-Electric Beds – allow for the raising and lowering functions of the head and knee break, and the entire bed height adjustment is operated by a hand-held control.
Hypertension
Blood pressure greater than or equal to 140/90 mmHg.
Institutional/Nursing Home/Depot Wheelchair
The least expensive type of chair available, an institutional chair, is designed for institutional usage only, such as transporting patients in hospitals or nursing homes. It is not an appropriate alternative for anyone who requires independent movement, as the institutional chair is not fitted for a specific individual. These types of chairs are now also used as rental chairs and by commercial enterprises (such as grocery stores and airports) for temporary use.
Lifts/Seating System
Power lift chairs gently move the person to a standing, seated, or reclined position.
Lightweight/Sports Wheelchair
The most popular type of wheelchair for everyday use for a person with good upper body mobility is the lightweight manual wheelchair. Lightweight chairs provide maximum independence of movement with a minimum of effort. Many active wheelchair users also prefer the sportier look of the lightweights compared with the more standard-looking everyday chair. It should be noted, however, that heavy or obese persons may be unable to use these types of chairs because the lighter weight of the frame results in a reduced user capacity as compared to standard everyday chairs. Once used primarily by wheelchair athletes, the lightweight chair today is used by people in virtually all walks of life as a preferred mode of assisted mobility. Three-wheeled chairs, also developed for such sports as tennis and basketball, are also an everyday chair alternative.
Liquid Oxygen System
Consists of a large main tank and one or two portable units. The portable units are used as needed for travel outside of the home. When they are empty, they can be refilled from the large tank. Portable units can be carried with a shoulder strap or cart. Liquid oxygen will evaporate if not used frequently. Therefore the portable units should be filled just prior to use.
Multiple Sclerosis
A chronic, potentially debilitating disease that affects your brain and spinal cord (central nervous system). The illness is probably an autoimmune disease, which means your immune system responds as if part of your body is a foreign substance. In MS, your body directs antibodies and white blood cells against proteins in the myelin sheath surrounding nerves in your brain and spinal cord. This causes inflammation and injury to the sheath and ultimately to your nerves. The result may be multiple areas of scarring (sclerosis). The damage slows or blocks muscle coordination, visual sensation, and other nerve signals. The disease varies in severity, ranging from a mild illness to one that results in permanent disability. Treatments can modify the course of the disease and relieve symptoms. An estimated 400,000 Americans have MS. It generally first occurs in people between the ages of 20 and 50. The disease is twice as common in women as in men.
Muscular Dystrophy (MS)
A group of rare inherited muscle diseases in which muscle fibers are unusually susceptible to damage. Muscles, primarily your voluntary muscles, become progressively weaker. In the late stages of muscular dystrophy, fat and connective tissue often replace muscle fibers. In some types of muscular dystrophy, heart muscles, other involuntary muscles and other organs are affected. There are many forms of muscular dystrophy, some noticeable at birth (congenital muscular dystrophy), others in adolescence (Becker MD), but the 3 most common types are Duchenne, facioscapulohumeral, and myotonic. The various types of the disease affect more than 50,000 Americans. There’s no cure, but medications and therapy can slow the course of the disease.
Nebulizer
A type of inhaler that provides a fine mist of medication to the lungs. This is performed by breathing the medicated mist through a mouthpiece or mask attached to the nebulizer device, which is driven via a plastic tubing, attached to the compressor unit. The medications used in nebulizers help you by loosening the mucus in the lungs so it can be coughed out more easily, and by relaxing the airways so that more air can move in and out of the lungs. Nebulizer treatments take approximately 15 minutes to deliver the medication and are prescribed by your physician.
Negative Pressure Wound Therapy (Wound V.A.C Therapy)
Also known as wound V.A.C therapy, this device uses negative pressure through a controlled suction to close large wounds and promote faster healing. This patented, FDA-approved device is composed of a sophisticated pump, hoses, and monitoring system held within a portable compact case weighing less than 20 pounds. It is recognized as an advanced line therapy alternative for patients when traditional dressing changes are not effective. It is a method that is considered among recovering patients in hospitals, nursing homes, and other home health care settings. It meets the needs of most cost-effective modalities and an estimated 5 million American patients suffering from chronic or acute wounds.
Osteoporosis
A disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrist, hip, pelvis, and upper arm. Osteoporosis and associated fractures are an important cause of mortality and morbidity.
In many affected people, bone loss is gradual and without warning signs until the disease is advanced. Osteoporosis is also known as “the silent crippler” because a person usually doesn’t know they have it until it’s too late. Unfortunately, in many cases, the first real “symptom” is a broken bone. Loss of height – with gradual curvature of the back (caused by vertebral compression fractures) may be the only physical sign of osteoporosis.In the United States, osteoporosis causes more than 1.5 million fractures every year — most of them in the spine, hip, or wrist. And although it’s often thought of as a women’s disease, osteoporosis affects many men as well. About 8 million American women and 2 million American men have osteoporosis, and nearly 18 million more Americans may have low bone density. Even children aren’t immune.
Ostomy Supplies
Pouching systems may include a one-piece or two-piece system. Both kinds include a faceplate/flange (barrier or wafer) and a collection pouch. The pouch (one-piece or two-piece) attaches to the abdomen by the faceplate/flange and is fitted over and around the stoma to collect the diverted output, either stool or urine. The barrier is designed to protect the skin from the stoma output and to be as neutral to the skin as possible.
One-piece Pouching System
The ostomy pouch and skin barrier are joined together permanently. The pouch and skin barrier are applied and removed together – in one piece. Easy to apply and remove and more flexible than a two-piece pouching system.Two-piece Pouching System
The ostomy pouch and skin barrier are separate. The pouch can be removed without removing the skin barrier. Because it is separate from the pouch, the skin barrier can be more easily positioned around the stoma.Pediatric Pouching Systems
Available as either one-piece products or two-piece products and are designed for premature babies, infants, and children. These systems can also be used to manage adult conditions such as small wounds, drain sites, and fistulas. Irrigation systems – Some colostomates can “irrigate,” using a procedure analogous to an enema. This is done to clean stool directly out of the colon through the stoma. This requires a special irrigation system, consisting of an irrigation bag with a connecting tube (or catheter), a stoma cone, and an irrigation sleeve. A special lubricant is sometimes used on the stoma in preparation for irrigation. Following irrigation, some colostomates can use a stoma cap, a one- or two-piece system which simply covers and protects the stoma. This procedure is usually done to avoid the need to wear a pouch.Oxygen Concentrator
Electronically powered device with a series of filters that extract oxygen from room air. Also, a backup system, usually a stationary compressed gas system must always accompany a concentrator in case of power failure or other emergency. Regular household current is sufficient for its use. In limited cases, a humidifier bottle may be necessary to increase moisture to the oxygen as it passes through the tubing to the mask or cannula.
Common Diagnoses:
- Chronic Obstructive pulmonary diseases (COPD)
- Emphysema
- Asthma
- Chronic Bronchitis
- Lung Cancer
- Acute Myocardial Infarction
- Acute Pulmonary Heart Disease
- Congestive Heart Failure
- Viral Pneumonia
- Bacterial Pneumonia
- Bronchlectasis
Oxygen Conserver
A type of regulator, which conserves the amount of gaseous oxygen in portable cylinders. Oximetry testing is required to ensure proper oxygen saturation during use of a conserver.
Parkinson’s Disease
Parkinson’s disease belongs to a group of conditions called movement disorders. It is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.
Parkinson’s disease occurs when a group of cells, in an area of the brain called the substantia nigra, that produce a chemical called dopamine begin to malfunction and eventually die. Dopamine is a neurotransmitter, or chemical messenger, that transports signals to the parts of the brain that control movement initiation and coordination. When Parkinson’s disease occurs, for unexplained reasons, these cells begin to die at a faster rate and the amount of dopamine produced in the brain decreases.Four Primary Symptoms:
- Tremor of the hands, arms, legs, jaw, and face
- Rigidity or stiffness of the limbs and trunk
- Bradykinesia or slowness of movement
- Postural instability or impaired balance and coordination
Patient Lifts (Power or Hydraulic)
For assistance with patient transferring. Lift/commode is an FDA registered medical device, ideal for people with musculoskeletal or neuromuscular limitations. It is motorized and designed to operate as a lift system and as an adjustable-height commode. It can be used as a bedside commode (helps reduce bedpan use) or as a transfer system to move a person from a bed to a seated or standing position.
Pediatric Nebulizer
A special breathing device usually used 3 or 4 times daily as needed; or as directed by your doctor. It works in the lungs by opening breathing passages to make breathing easier. This device is intended for use in children but may also be used for adults requiring smaller doses.
Phototherapy (Bili Light)
Also known as a bili light, used to help infants with jaundice, a yellow coloring of the skin and eyes related to abnormal liver function.
Portable E-Tank
Portable smaller units called E tanks are used for transport. A key is required to turn the tank on and off. The portable tanks must be replaced when empty. Therefore, the family must plan ahead for trips outside of the home. Portable E tanks may be used for backup in case of power failure.
Portable Lifting Cushion
Provide that extra lift needed to help you get in and out of any armchair on your own by shifting your weight forward and pushing off gently with your arms and/or legs. The pneumatic lift will help to gently raise you up to an almost standing position. The cushion is portable and weighs approximately 9 pounds and flattens quickly for easy transport.
Portable Oxygen System
Incorporate either the electronic conserving device, the pneumatic conserving device, or standard flow regulators. These systems provide individuals with a convenient, lightweight supply of oxygen. Systems are available with one or multiple M4, M6, M9, MD, or ME cylinders, fiber-wrapped cylinders, shoulder, horizontal, backpack, or fanny pack style carrying bags, cart, regulator, cannula, and supply tubing. All systems are also available with a straight post valve, handtight or a toggle CGA870 valve.
Powered Wheelchair (Power Chair)
A powered wheelchair must be selected carefully in order to ensure it not only meets the needs of the individual who will use it but also represents good value for the money being invested in it. Physical considerations include posture, strength, sensation, visual acuity and perception, and the ability to learn how to use the wheelchair safely. A functional evaluation should include actual use of the wheelchair in everyday settings; an evaluation of the individual’s ability to get in and out of the wheelchair; and the ability to perform needed activities from the wheelchair. Transportation to and from various settings also is an important consideration: Is a van available to transport the individual in the chair, or is it necessary for the chair to fold or disassemble in order to be carried in an automobile trunk?
Powered Wheelchair Armrest
Armrests also come in several styles or with a combination of features. They may be full- or desk-length, or wraparound, and they may be fixed, removable, pivoting, and/or adjustable height.
Powered Wheelchair Battery
A determining factor in the range and power of a powered chair. Generally, the larger the chair’s batteries, the greater the power and the longer the chair’s range between charges. Many chairs require two rechargeable 12-volt batteries. Most wheelchairs utilize U1, group 22 or 24 batteries, although other batteries are also used. More manufacturers are designing chairs around the group 24 battery because it affords a longer range. The type of battery required is also an important consideration in terms of safety, maintenance, and transport. Powered chairs may utilize lead acid, gel cell, or sealed wet batteries. Gel cell batteries require the least maintenance and have less danger of leaking than do the other battery types. Gel cell batteries are also required by a number of airlines when transporting powered chairs.
Powered Wheelchair Brakes
Most powered chairs utilize a dynamic braking system in which the motor and brakes work together to slow and stop the chair when the joystick or other controller is released, and which automatically engages the brakes when the power is off or when the chair is not being powered in a forward or reverse motion with the controller.
Powered Wheelchair Controls
Powered chairs generally include as a standard feature a manually controlled joystick to regulate the chair’s speed and direction. However, most manufacturers offer customized control options to accommodate the varied abilities of the user, including sip-n-puff systems, head and chin switches, push-button controls, trackballs, and tillers. Many chairs also have programmable control features which allow the user or a dealer to adjust or set the chair’s speed and control limits as the user’s abilities change.
Powered Wheelchair Drive System
The means by which power is delivered to the chair’s wheels. Standard drive systems include gear drive, direct drive, and belt drive. The type of drive system affects the power available to propel the chair and the amount and type of maintenance the chair requires.
Powered Wheelchair Footrest
A variety of footrest assemblies are available on both types of wheelchairs. They may be a rigid single unit, 90 degree-90 degree platforms, folding, flip-up, detachable, adjustable length, hemi- height, or have a combination of features.
Powered Wheelchair Frame
Many traditional-style models utilize the traditional cross-brace frame which allows the chair to be folded or collapsed for storage and transport once the batteries have been removed. Other traditional models and some power base chairs disassemble for transport. A number of chairs, however, are designed to be transported while carrying the user; consequently, they do not fold or disassemble.
Powered Wheelchair Seating System
Sold separately from the wheelchairs themselves, as seating must be chosen on an individual basis. It is important when selecting a wheelchair or a seating system to ensure that the two components are compatible. Power base chairs, because of their more modular construction, frequently feature customized chair-style seating systems.
Powered Wheelchair Special Power Features
Powered chairs may offer specialized powered features to meet the user’s needs, either as customization or options on a standard chair or as a chair designed specifically for a particular purpose. Among the available features are elevating and lowering seats, and reclining and/or tilt-in-space seats. Specialized chairs have the capacity to raise the user to a standing position, to negotiate stairs, or to be used as a lift or in transferring.
Powered Wheelchair Upholstery
For wheelchairs must withstand daily use in all kinds of weather. Consequently, manufacturers provide a variety of options to users, ranging from cloth to new synthetic fabrics to leather. Many manufacturers also offer a selection of upholstery colors, ranging from black to neon, to allow for individual selection and differing tastes among consumers.
Powered Wheelchair Wheels/Tires
Power base chairs typically use four wheels of the same size, usually 8 to 10 inches in diameter. These chairs may have pneumatic, semi-pneumatic, or solid tires.
Ramp
Portable ramps for wheelchairs and scooters roll up for easy carrying with storage bag. Scooter ramps have side rails and center panels that slide easily into place, locking securely to provide a solid drive surface. Suitcase ramps are convenient and compact, fold up easily and have a built-in carrying handle. Telescopic channel ramps each extend to be used on steps, vans, or curbs. For storage, simply pick up each rail and depress the guide buttons to collapse. Chair lifts allow you to lift and carry your power chair fully assembled.
Scooter
Typically, scooter users have some ability to walk, but are limited in distance or stamina–stroke survivors or people with milder forms of cerebral palsy, multiple sclerosis, post-polio syndrome, arthritis, and cardiac conditions, among others. Scooters are used to increase and extend the range of personal mobility and help conserve energy. Scooter users often have difficulty propelling manual wheelchairs, but do not require the sophisticated electronic controls and seating systems common in powered wheelchairs.A number of other physical factors must also be evaluated when determining whether a scooter is an appropriate mobility aid. A scooter user generally must be able to sit upright for extended periods and have sufficient seated balance to maintain an erect posture. Further, sufficient upper body and arm strength to master the controls and steer and maneuver the unit are required. In addition, uncorrected vision disabilities, or conditions which may cause confusion or memory loss or which inhibit proper safety awareness may render a scooter an unsatisfactory mobility aid.
Scooter Accessories
In addition to the standard features common to all scooters discussed above, manufacturers offer a variety of standard features and optional accessories. Most scooters are equipped with a key lock for turning the scooter on and off, thus conserving battery life and preventing unauthorized use; a battery-level indicator and a proportional speed controller to limit maximum speed.A wide range of accessories also are offered on most scooters, such as crutch and cane holders, oxygen carriers, front and rear baskets, trailers, headlights, tail lights, horns, canopies, and others. Some manufacturers even offer sidecars to allow an additional passenger. As when purchasing a car, options and additional features increase the base cost of the unit, but accessories should be evaluated in light of their capacity to create a mobility aid which provides maximum user independence. At the same time, it should be kept in mind that some options may decrease battery life, maneuverability, and/or travel range.
Scooter Armrest
Another consideration in seating. Some scooters offer armrests only as an option; others offer fixed armrests as standard with flip-up armrests available.
Scooter Base Unit
Basically the body of the scooter. Generally it consists of a steel, aluminum, or composite frame with a fiberglass or composite floor to support the feet and batteries. Some scooter bases also include a shroud over the front wheel and drive head, creating a dashboard for the unit. The base also includes the wheels and the drive train. In some scooters, the seat post is also part of the base. The base unit is the primary determinant of whether the scooter is designed for indoor or outdoor use, the vehicle’s maneuverability, the size of its wheelbase, its ground clearance, its turning radius, and its overall dimensions.
A scooter should not tip easily during sharp turns or on inclines such as curb cuts (if the scooter is designed for outdoor use). Anti-tip wheels should be included as part of the frame to help support and stabilize the scooter. On front-wheel drive units, anti-tips are often located laterally just behind the front wheels because they generally lack the power for steep inclines. Because most rear-wheel drive scooters are intended to negotiate more rugged terrain, they are usually equipped with rear anti-tips to support the scooter on hills. Side anti-tip wheels are sometimes offered as options. It should be noted that lateral anti-tippers may cause difficulties on curb cuts and ramps.On some scooters, the base unit may be comprised of modular units or may otherwise be disassembled for transport and storage. These same features may also allow the scooter to be converted from three- to four-wheeled models and/or from indoor to outdoor use.
Scooter Battery
Most scooters utilize 12- or 24-volt motors and electrical systems generally with one or two 12-volt batteries to power the drive train and controls. Twelve-volt systems are most frequently found on front-wheel drive scooters, and usually require one 12-volt battery, although two six-volt batteries are sometime used. Some manufacturers offer add-on units for 12-volt systems which allow them to utilize two batteries to extend the scooter’s range between charges, although speed and power are not affected. Rear-wheel drive systems generally require two twelve-volt batteries to power 24-volt systems.
These batteries are “deep cycle” batteries intended for wheelchairs and scooters and generally last between 12 and 18 months, although with conservation and regular charging, longer life may be achieved. Deep cycle batteries are designed to provide a steady supply of power and be discharged and recharged on a regular basis. Automotive and marine batteries, on the other hand, are designed to be starter batteries, providing short bursts of power only. Consequently, marine and automotive batteries should never be substituted for deep cycle batteries.
There are three basic types available for use with scooters: Lead acid (or wet cell) batteries, sealed lead-acid batteries, and gel cell batteries. Lead acid batteries are the least expensive of the three types, but they also require the most maintenance. In addition to regular charging, electrolyte and water levels must be checked regularly, with water added frequently to maintain appropriate levels. Because these batteries are not sealed, there is danger of acid spillage and explosion if the batteries are not handled properly. Despite these potential problems, lead-acid batteries provide the benefits of a two- to six-month longer battery life and up to a ten percent greater running time than other battery types. Sealed lead acid batteries are maintenance-free versions of these batteries. Because they are sealed in cases, it is unnecessary to add water and the danger of acid spillage is reduced or eliminated. The cases are vented to prevent gas build-up that can lead to an explosion. Finally, gel cell batteries are the most commonly used battery type on scooters. They are sealed in their cases and require no maintenance other than regular charging. Gel cells are the safest of the battery types, with no danger of spillage and limited risk of explosion. However, gel cells are more expensive, and may have a somewhat shorter life than other battery types.
Scooter Brakes
Most rear-wheel drive scooters utilize an electronic or electro-mechanical dynamic, regenerative braking system. This type of braking system works in tandem with the motor, first to slow and then stop the vehicle when the pressure is released on the thumb levers or the controls are otherwise disengaged. When the scooter is not being powered forward or in reverse, the brakes are engaged, thus preventing the scooter from moving. During the application of the brakes, excess power from the motor is channeled to the batteries, providing recharging. Because the brakes are engaged when the scooter is being actively powered, most scooters with this braking system are equipped with a clutch on the motor or another release lever to manually disengage the brakes to allow the scooter to be pushed in case of emergency.
Some scooters also use disc brakes or disc brakes in combination with the braking system discussed above. Some scooters–usually front-wheel drive models–are not equipped with electronic or electro-mechanical brakes. In the absence of a brake system, a manual parking brake applied by lever to a rear wheel is provided. Manual parking brakes may also be offered either as optional or standard features on other scooters to provide extra braking on hills and inclines.
Scooter Drive Train, Brakes and Power System
The drive train is an integral part of the base unit and provides either front- or rear- wheel drive for the scooter. Front-wheel drive is usually found on smaller scooters designed primarily to be used indoors or outdoors on flat, paved surfaces. The motor of the front-wheel drive scooter is located over the front wheel and drives only that wheel. Because of the motor and wheel configuration, front-wheel drive scooters are usually direct-drive units, eliminating chains and belts. However, this also means that the front wheel pulls the weight of the unit and the rider. Consequently, these types of scooters have a lesser capacity to move their load than do rear-wheel drive models, and are therefore less capable of handling hills, curb cuts, and other outdoor terrain. This is compounded by the fact that front-wheel drive models generally have smaller motors, causing them to have a shorter range, less speed and power, and a smaller rider weight capacity.
Rear-wheel drive scooters are powered by motors connected to the rear axle, either via a chain, a belt, a transaxle unit, or some combination. Because the scooter is driven by the rear wheels, they push the combined weight of the unit and the rider, rather than pull it. The combined weight of the rider, the motor, and the batteries over the rear wheels, generally create better traction than that usually provided by front-wheel drive models. The increased traction combined with the more powerful motors used on rear-wheel drive scooters results in better climbing ability. The units also have a greater maximum speed, a longer traveling range between battery charges, and a larger rider weight capacity. These scooters have a wider wheel base and a greater overall length, making them less maneuverable and rendering some models unsuitable for indoor use. They may also be too large for van or bus lifts.
Scooter Seating
The most common seat found on scooters is a chair-style seat similar to those found on boats. The basic seat is molded hard plastic or fiberglass, but most manufacturers offer a padded-seat option, usually with a choice of vinyl or fabric upholstery. Vinyl upholstery is frequently less expensive, but because it is a slipperier surface, it may not be the best choice for those whose disability makes it difficult to maintain position or balance.
Scooter Tiller
The control and steering mechanism for the scooter, usually containing the controls to drive the scooter forward or in reverse, as well as steering the front wheel or wheels. Most scooters offer one type of standard tiller with other controllers available as options. Possibilities include thumb levers, loop handles, joysticks, and others. Thumb levers are the most common controls, allowing the user to keep both hands on the handle bars while using the left thumb to power the scooter in reverse and the right to power the scooter forward. The amount of pressure applied to the lever will determine the speed of the vehicle (unless it is equipped with a proportional speed control). Consequently, a fair amount of hand control is necessary for safe operation. Finger control levers or a joystick may be alternatives. Some manufacturers may also be able to adapt controls to user requirements at extra cost.
The tiller itself is often an upright post attached to the front wheel. However, it is also becoming common to find flexible, accordion-style tillers which can be adjusted for height and/or position. This not only enables the user to place the tiller in the most comfortable position while driving, but also allows it to be moved up and out of the way during transfers. In the absence of a dashboard or shroud over the front wheel, a control box with the key lock, battery level indicator, speed controller, and other features may be
affixed to the tiller handlebars.Since a joystick controls both speed and direction, scooters equipped with them generally do not have the post-and-handlebar tiller; the joystick is usually attached to an armrest or to an armrest extension, with a choice of right or left mounting. While this frees the space in front of the user and may accommodate easier transitions for some, the lack of handlebars may make transfers more difficult for others.
Scooter Wheels/Tires
The size of the wheels and tires on a scooter have a direct effect on the scooter’s ability to surmount obstacles and its stability. Scooters are generally equipped with six-, eight-, or ten-inch wheels, although other sizes may also be used. Some models use the same size wheels both front and rear, while others may have smaller wheels in front and larger rear wheels. Smaller wheels are generally found on front-wheel drive scooters intended for indoor use. As a rule, the intended use of the scooter should dictate the size of the wheels and tires. The larger the wheels, the more stable the unit. Similarly the larger and wider the tires, the greater the unit’s traction and capacity to manage such obstacles as curb cuts and uneven outdoor terrain.
Several types of tires are available for scooters. Manufacturers generally offer a specific tire as standard equipment, with others available as extra-cost options. Pneumatic tires include air-filled tubes and are similar to those found on automobiles. Air pressure should be checked regularly to maintain proper levels, and tires may need to be replaced if punctured. The addition of an anti-flat compound before inflation reduces the risk of tires going flat. They provide good shock absorption when properly inflated. Foam filled tires are similar to pneumatic tires, but include foam inserts rather than air-filled tubes. These tires cannot be deflated and, therefore, require less maintenance. They may be more expensive than pneumatic tires and may not offer a consistently comfortable ride. The least expensive tire option is the solid rubber tire. These tires require the least maintenance, but provide minimal shock absorption and are intended primarily for indoor use.
Sleep Apnea
A chronic medical condition where the affected person repeatedly stops breathing during sleep. These episodes last 10 seconds or more and cause oxygen levels in the blood to drop. It can be caused by obstruction of the upper airway, resulting in Obstructive Sleep Apnea, or by a failure of the brain to initiate a breath, called Central Sleep Apnea. It can cause and worsen other medical conditions, including hypertension, heart failure, and diabetes.
Specialty Wheelchair
Because of the diverse needs of wheelchair users, wheelchairs have been designed to accommodate many lifestyles and user needs. Hemi chairs, which are lower to the floor than standard chairs, allow the user to propel the chair using leg strength. Chairs that can be propelled by one hand are available for people who have paralysis on one side. Oversized chairs and chairs designed to accommodate the weight of obese people are also offered. Rugged, specially equipped chairs are available for outdoor activities. Aerodynamic three-wheeled racing chairs are used in marathons and other racing events. Manual chairs that raise the user to a standing position are available for people who need to be able to stand at their jobs, or who want to stand as part of their physical conditioning routine. These and other specialized chair designs generally are manufactured by independent wheelchair manufacturers who are trying to meet the needs of specific target markets.
Standard/Everyday Wheelchair
Some wheelchair users still prefer or require a standard wheelchair, which is characterized by a cross-brace frame, built-in or removable arm rests, swing-away footrests, a mid- to high-level back, and push handles to allow non-occupants to propel the chair.
T.E.N.S. Dual Channel Unit
A transcutaneous electro-nerve stimulator; pain control that goes where you do. A small medical device slightly larger than a beeper, attaches to your pants or belt and helps alleviate pain while you wear it.
T.E.N.S. Unit
Dispensed by doctors to their patients for home use. They operate on a 9v. transistor battery and have small wires and pads that adhere to a painful area and alleviate pain. Tiny free nerve endings secrete a chemical called “substance P” that transmits pain signals to our brain. T.E.N.S. units artificially stimulate free nerve endings, thereby depleting them of substance P, literally stopping the pain signal in its tracks.
Urinary Incontinence
Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine to a complete inability to hold any urine. Urinary incontinence affects approximately 13 million people in the United States and is more common in women than in men. It occurs in 10 percent to 25 percent of women younger than age 65 and in 15 percent to 30 percent of women older than age 60 who do not live in nursing homes. Among nursing home residents, incontinence is even more common, affecting more than 50 percent of female patients.
Urinary Pouching System
Urostomates can use either one or two-piece systems. However, these systems also contain a special valve or spout which adapts to either a leg bag or to a night drain tube connecting to a special drainable bag or bottle.
For more information on ostomy and ostomy supplies visit http://www.ostomy.org/Ostomy_Information.html#gen_info and http://www.hollister.com/en.
Ventilator
An automatic mechanical/pneumatic device designed to reduce or provide the work required to move gas into and out of the lungs.
Walker
Available in a variety of styles to meet individual needs. Folding, adjustable walkers can be easily transported in vehicles. Hemi-walkers allow for one-hand utilization. Wheeled walkers minimize lifting. Many accessories, such as walker trays, baskets or pouches are available.
Wheelchair Armrest
Many lightweight manual chairs are designed to be used without armrests. The absence of armrests makes it easier for the user to roll up to a desk or table, and many active wheelchair users prefer the streamlined look of a chair with no armrests. However, armrests are helpful if the user has difficulty with upper body balance while seated. Armrests come in a variety of styles including desk length (to allow the user closer access to desks and tables) or full length and both types may be flip-up, fixed, or detachable.
Wheelchair Brakes
Brakes or wheel locks are available in several different designs, and can be mounted at various heights to maximize convenience to the user.
Wheelchair Footrest
Usually are incorporated into the frame of the chair as part of the design. Cross-brace folding chairs often have footrests which swivel, flip up, and/or can be removed.
Wheelchair Frame
The two most common types of frames currently available are rigid frame chairs (where the frame remains in one piece and the wheels are released for storage or travel), and the standard cross-brace frame (which enables the frame to fold for transport or storage).
Wheelchair Seating System
Sold separately from the wheelchairs themselves, as seating must be chosen on an individual basis. It is important when selecting a wheelchair or a seating system to ensure that the two components are compatible.
Wheelchair Upholstery
Must withstand daily use in all kinds of weather. Consequently, manufacturers provide a variety of options to users, ranging from cloth to new synthetic fabrics to leather. Many manufacturers also offer a selection of upholstery colors, ranging from black to neon, to allow for individual selection and differing tastes among consumers.
Wheelchair Wheels/Tires
Most wheelchairs use four wheels, with two large wheels at the back and two smaller ones (casters) at the front. The standard tire used for the rear wheels on most wheelchairs is a pneumatic tire, for which the standard size is 24 inches. Smaller and larger sizes, however, also are available. Many manufacturers now also offer other types of tires–such as solid tires, semi-pneumatic, or radial tires–at extra cost. Mag wheels and off-road wheels also are options on some chairs. Casters, too, vary in size (ranging from six to eight inches in diameter) and composition (pneumatic, solid rubber, plastic, or a combination of these).
Wound V.A.C Therapy (Negative Pressure Wound Therapy)
Also known as negative pressure wound therapy, this device uses negative pressure through a controlled suction to close large wounds and promote faster healing. This patented, FDA-approved device is composed of a sophisticated pump, hoses, and monitoring system held within a portable compact case weighing less than 20 pounds. It is recognized as an advanced line therapy alternative for patients when traditional dressing changes are not effective. It is a method that is considered among recovering patients in hospitals, nursing homes, and other home health care settings. It meets the needs of most cost-effective modalities and an estimated 5 million American patients suffering from chronic or acute wounds.
View Website Resources
The Internet is a great source of information for you to use in managing your health care or the health care of a loved one. It can also be a good way to locate the support resources you need as a patient or caregiver. Below is a list of links that we hope will help you find the information and support you need.
Please call our office directly if we can be of any assistance to you. When in need of outside help, a local information/referral service can be very useful. Even if they don’t have the specific information you’re looking for they most likely will know where you can get it. The yellow pages of your phone book should have a guide to local service agencies listed in the Human Services section. 949.713.1404
If you’re unable to find a Human Service guide or the specific service you’re looking for, call the local service of a national service organization and explain your problem. They should be able to direct you to the right place.
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Health Conditions and Organizations
- Aging Parents — http://www.aging-parents-and-elder-care.com/
- Allergy and Asthma Network/Mothers of Asthmatics — http://www.aanma.org
- ALS Association of America (ALSA) — http://www.alsa.org
- American Association for Respiratory Care — http://www.AARC.org
- American Cancer Society — http://www.cancer.org/
- American College of Allergy, Asthma, and Immunology — http://www.acaai.org/
- American Heart Association — http://www.heart.org
- American Lung Association — http://www.lung.org/
- American Red Cross — http://www.redcross.org/
- American Sleep Apnea Association — http://www.sleepapnea.org/
- Arthritis Foundation — http://www.arthritis.org/
- Asthma and Allergy Foundation of America — http://www.aafa.org
- Brain Injury Association of America — http://www.biausa.org/
- Center for Neurologic Study — http://www.cnsonline.org
- Cerebral Palsy Guidance — https://www.cerebralpalsyguidance.com/
- Cord Blood Center — https://www.cordbloodbanking.com/
- Cord Blood Guide — https://www.cordbloodguide.com/
- Forbes Norris MDA/ALS Research Center — http://www.cpmc.org
- Les Turner ALS Foundation — http://www.lesturnerals.org
- March of Dimes — http://www.marchofdimes.com/
- Mesothelioma & Asbestos Awareness Center — https://www.maacenter.org/
- Mesothelioma Cancer Alliance — http://www.mesothelioma.com/
- Mesothelioma Group — http://www.mesotheliomagroup.com/
- Mesothelioma Hub — https://www.mesotheliomahub.com/mesothelioma/mesothelioma-caregivers/
- Mesothelioma Veterans Center — https://www.mesotheliomaveterans.org/
- Mesothelioma.net — https://mesothelioma.net/
- MesotheliomaPrognosis.com — https://www.mesotheliomaprognosis.com/
- Muscular Dystrophy Association — http://mda.org/
- National Asthma Education and Prevention Program — https://www.nhlbi.nih.gov/health/resources/sleep/healthy-sleep
- National Family Caregivers Association (NFCA) — http://www.nfcacares.org/
- National Home Oxygen Patient’s Association — http://www.oxygenconcentratorstore.com/breathe-easy/resources/nhopa/
- National Jewish Medical and Research Center – Pulmonary Disease — http://www.nationaljewish.org/
- National Multiple Sclerosis Society — http://www.nationalmssociety.org/
- People for Quality Care — http://www.peopleforqualitycare.org
- Spina Bifida — http://spinabifidaassociation.org/
- The Mesothelioma Veterans Center — https://www.mesotheliomaveterans.org
- The Pulmonary Paper — http://www.pulmonarypaper.org/
- Understanding an Asthma Attack — http://www.healthline.com/asthma/anatomy-animations
- United Ostomy Association — http://www.ostomy.org/
- United States COPD Coalition — http://www.uscopdcoalition.org
- Visiting Nurses Association — http://www.vnaa.org/
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Healthcare Resources
- AAHomecare — http://www.aahomecare.org
- American Healthcare Association — http://www.ahcancal.org/
- Basic health issues — http://www.healthcentral.com
- CareFlash – keep loved ones connected & updated! — http://www.careflash.com/?affCode=VGMForbin
- Dr. Green – pediatric health issues — http://www.drgreene.com/
- IHS — http://www.ihs.org/
- Intelihealth – variety of health information — http://www.intelihealth.co.za/
- Mayo Clinic — http://www.mayoclinic.org/
- Medline Plus® — http://www.medlineplus.gov/
- MySeniorCare – Assisted Living — http://www.myseniorcare.com/senior-housing
- MySeniorCare – Home Health Care — http://www.myseniorcare.com/home-care
- MySeniorCare – Hospice — http://www.myseniorcare.com/end-of-life
- Senior.com – https://senior.com/
- WebMD — http://webmd.com/
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Social / Government Services
- Medicare — https://www.medicare.gov/
- National Council for Aging Care — http://www.aginginplace.org/
- Social Security Administration — http://www.ssa.gov
- United Way — http://national.unitedway.org/
- YMCA — http://www.ymca.net/
- YWCA — http://www.ywca.org
Guide to Medicare Coverage
Who qualifies for Medicare benefits?
- Individuals 65 years of age or older
- Individuals under 65 with permanent kidney failure (beginning three months after dialysis begins), or
- Individuals under 65, permanently disabled and entitled to Social Security benefits (beginning 24 months after the start of disability benefits)
The Different Benefits of Traditional Medicare
- Medicare Part A benefits cover hospital stays, home health care, and hospice services.
- Medicare Part B benefits cover physician visits, laboratory tests, ambulance services, and home medical equipment.
- While oftentimes you do not have to pay a monthly fee to have Part A benefits (you only have to spend money when you use the services), the Part B program requires a monthly premium to stay enrolled (even if you do not use the services). In 2019, the standard premium was $135.50 per month (but it could be waived or increased) depending on your income. Typically, this amount will be taken from your Social Security check.
- Medicare Part C is coverage offered through various insurance companies that offer Medicare Advantage Plans. These plans are offered as an alternative to Medicare Part B. Medicare Advantage Plans cover the same benefits as your Part B plan but often have limited provider networks and may require authorization for services before making payment. Premiums and deductibles vary by plan. Some plans offer unique perks like gym memberships as a participation benefit.
- Medicare Part D offers optional program benefits that cover prescription drugs. The premiums for these plans also vary by plan and income level.
- For more information about your benefits or making coverage decisions, you can visit the official website for Medicare benefits at www.medicare.gov. or compare plans and options during open enrollment which generally runs from October 15 through December 7 to make changes for the coming year. As a result of the 21st Century Cures Act, if you have enrolled in a Medicare Advantage plan, you can revert back to traditional Medicare or switch to another Medicare Advantage plan between January 1 through March 31 of each year.
What Can You Expect to Pay for Medicare Part B Services?
- In 2019, in addition to your monthly premium, you will have to pay the first $185 of covered expenses out-of-pocket for Part B services, and then 20 percent of all approved charges if the supplier agrees to accept Medicare payments.
- Unfortunately, your medical equipment supplier cannot automatically waive this 20 percent or your deductible without suffering penalties from Medicare. They must attempt to collect the coinsurance and deductible if those charges are not covered by another insurance plan; however, certain exceptions can be made if you meet qualifying financial hardships established by your supplier.
- If you have a supplemental insurance policy, that plan may pick up this portion of your responsibility after your supplemental plan’s deductible has been satisfied.
- If your medical equipment supplier does not accept assignment with Medicare you may be asked to pay the full price up front, but they will file a claim on your behalf to Medicare. In turn, Medicare will process the claim and mail you a check to cover a portion of your expenses if the charges are approved.
Other possible costs:
- Medicare will pay only for items that meet your basic needs. Oftentimes you will find that your supplier offers a wide selection of products that vary slightly in appearance or features. You may decide that you prefer the products that offer these additional features. Your supplier should give you the option to allow you to privately pay a little extra money to get the product that you really want.
- To take advantage of this opportunity, a new form has been approved by the Centers for Medicare and Medicaid Services (CMS) that allows you to upgrade to a piece of equipment that you like better than the other standard option you may otherwise qualify for. This form is known as the Advance Beneficiary Notice of Non-Coverage or ABN.
- The ABN form that your supplier completes for you must detail how the products differ and requires a signature to indicate that you agree to pay the difference in the retail costs between two similar items. Your supplier will typically accept assignment on the standard product and apply that cost toward the purchase of the fancier item, thus requiring less money out of your pocket.
Purpose of ABN
- The Advance Beneficiary Notice of Non-Coverage will also be used to notify you ahead of time that Medicare will probably not pay for a certain item or service in a specific situation, even if Medicare might pay under different circumstances. The form should be detailed enough that you understand why Medicare will probably not pay for the item you are requesting.
- The purpose of the form is to allow you to make an informed decision about whether or not to receive the item or service knowing that you may have additional out-of-pocket expenses.
Durable Medical Equipment (DME) Defined
- In order for any item to be covered under Medicare, it typically has to meet the test of durability. Medicare will pay for medical equipment when the item:
- Withstands repeated use (which excludes many disposable items such as underpads)
- Is used for a medical purpose (meaning there is an underlying condition which the item should improve)
- Is useless in the absence of illness or injury (which excludes any item that is preventive in nature such as bathroom safety items used to prevent injuries)
- Used in the home (which excludes all items that are needed only when leaving the confines of the home setting)
Understanding Assignment (a claim-by-claim contract)
- When a supplier accepts assignment, they are agreeing to accept Medicare’s approved amount as payment in full.
- You will be responsible for 20 percent of that approved amount. This is called your coinsurance.
- You also will be responsible for the annual deductible, which is $185.00 for 2019.
- If you have chosen to receive an upgraded, fancier product than what Medicare typically covers, you will also be responsible for any additional amounts disclosed on the Advance Beneficiary Notice that identifies the additional features and fees that you have approved.
- If a supplier does not accept assignment with Medicare, you will be responsible for paying the full amount upfront. The supplier will still file a claim on your behalf and any reimbursement made by Medicare will be paid to you directly. (Suppliers must still notify you in advance, using the Advance Beneficiary Notice, when they do not believe Medicare will pay for your claim.)
Mandatory Submission of Claims
- Every supplier is required to submit a claim for covered services within one year from the date of service. However, if the item is never covered by Medicare, your supplier is not obligated to submit a claim.
The role of the physician with respect to home medical equipment:
- Every item billed to Medicare requires a physician’s order or a special form called a Certificate of Medical Necessity (CMN), and sometimes additional documentation will be required such as copies of office visit notes from prior visits with your physician or healthcare provider or copies of test results relevant to the prescription of your medical equipment.
- Nurse Practitioners, Physician Assistants, Interns, Residents and Clinical Nurse Specialists can also order medical equipment and sign CMNs when they are treating you.
- All physicians and healthcare providers have the right to refuse to complete documentation for equipment they did not order, so make sure you consult with your physician or healthcare provider about your need for medical equipment or supplies before requesting an item from a supplier.
- For every new item prescribed by your physician or healthcare provider, you should have a recent office visit that documents the reasons for ordering the equipment and products. Most items require you to have an in-person office visit with your doctor or healthcare provider to discuss the need and justification for the prescription of medical equipment (and even replacement equipment) before a supplier can fill those orders.
Prescriptions before Delivery:
- For some items, Medicare requires your supplier to have completed documentation (which is more than just a call-in order or a prescription from your doctor or healthcare provider) before they can deliver these items to you:
- Decubitus care (wheelchair cushions, pressure-relieving surfaces placed on a hospital bed and air-fluidized beds)
- Seat lift mechanisms
- TENS Units (for pain management)
- Power Operated Vehicles/Scooters
- Electric or Power Wheelchairs and related options and accessories
- Negative Pressure Wound Therapy (wound vacs)
- The list of items that require an office visit and written order before delivery has been expanded due to new provisions of the Affordable Care Act to include all items that cost more than $1000, and commonly prescribed items such as oxygen, hospital beds, wheelchairs and more. There are over 150 products across multiple product categories that are affected. Your supplier will be able to tell you if the item ordered by your doctor or healthcare provider is subject to these additional requirements.
- Your supplier cannot deliver these products to you without evidence of a recent office visit with, and a compliant written order from, your doctor or healthcare provider. They cannot provide services and get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier when a compliant order is not secured before delivery. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.
How does Medicare pay for and allow you to use the equipment?
- Typically, there are four ways Medicare will pay for a covered item:
- Purchase it outright, then the equipment belongs to you,
- Rent it continuously until it is no longer needed, or
- Consider it a “capped” rental in which Medicare will rent the item for a total of 13 months and consider the item purchased after having made 13 payments.
- Medicare will not allow you to purchase these items outright (even if you think you will need it for a long period of time).
- This is to allow you to spread out your coinsurance instead of paying in one lump sum.
- It also protects the Medicare program from paying too much should your needs change earlier than expected.
- If you have oxygen therapy, Medicare will make rental payments for a total of 36 months during which time this fee covers all service and accessories.
- Beyond the 36 months (for a period of two additional years), Medicare will limit payments to a small fee for monthly gas or liquid contents, where applicable, and a limited service fee to check the equipment every six months.
- After an item has been purchased for you, you will be responsible for calling your supplier anytime that item needs to be serviced or repaired. When necessary, Medicare will pay for a portion of repairs, labor, replacement parts, and for temporary loaner equipment to use during the time your product is in for servicing. All of this is contingent on the fact that you still need the item at the time of repair and continue to meet Medicare’s coverage criteria for the item being repaired.
What is competitive bidding?
In many parts of the country, a new program called Competitive Bidding will require you to obtain certain medical equipment from specific, Medicare-contracted suppliers in order for Medicare to pay.
Please note: Due to program reform, there will be a temporary gap in the competitive bidding program for approximately two years beginning January 1, 2019 through December 31, 2020. During the gap you can secure all services from any-willing supplier and will not be limited to designated suppliers. The program is expected to resume in 2021. Your supplier can provide additional information when the program resumes.
Not all products are subject to competitive bidding in the same area. If you are located in a city where the program is in effect, you will need to obtain some or all of the following items from a contracted supplier:
- Oxygen, oxygen equipment, and supplies
- Standard power wheelchairs, scooters, and related accessories
- Enteral nutrition, equipment, and supplies
- Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs), and related supplies and accessories
- Hospital beds and related accessories
- Walkers and related accessories
- Support surfaces (Group 1 and Group 2 mattresses and overlays)
- Manual Wheelchairs and accessories
- Mail-order and local home delivery of diabetic supplies
- Nebulizers
- TENS Units and supplies
- Patient Lifts
- Commodes
- Seat Lift Chairs
- Negative Pressure Wound Therapy Devices and related supplies and accessories
- Medicare has also proposed expanding the program to ventilators, back braces and knee braces. Your supplier can confirm if any of these items are subject to competitive bidding restrictions when the program resumes.
Competitive Bidding areas are designated based on the zip code of your permanent residence on file with Social Security. To find out if your zip code is affected by Competitive Bidding, call 1-800-MEDICARE (1-800-4227). You may also visit Medicare.gov and lookup suppliers in your area by zip code (a notice will appear if your area is subject to Competitive Bidding). If medical equipment is marked with a yellow/orange star, it will need to be provided by a contracted supplier (also marked with an orange star). Throughout this guide, products that are potentially impacted by the competitive bidding program will be designated with a double asterisk **. Your supplier can assist you with answering your questions about competitive bidding and can address whether or not they have been contracted to provide the services you need if subject to competitive bid.
As any memory care provider can tell you, there’s nothing simple about dementia care, treatment, and diagnosis. Certain factors, however, can make dementia care even more complicated than usual. The Complicated Relationship Between Alcohol & Dementia Care
Alcohol is a perfect example. Heavy alcohol consumption increases the risk of dementias such as Alzheimer’s, but it can also lead to brain damage that mimics symptoms of dementia. This results in countless cases where dementia is misdiagnosed as alcohol-related brain damage, or where alcohol-related brain damage is misdiagnosed as dementia.
The situation is complicated further by the effects of alcohol intoxication, which itself mimics symptoms of dementia. As a result, family members and friends can easily misinterpret signs of drunkenness as sign of dementia or misinterpret signs of a dementia as signs of drunkenness.
If you suspect that a loved one’s use of alcohol is masking or contributing to cognitive decline, you might be confused about whether they need medical attention, addiction treatment, dementia care, or a combination of the above. Here’s a closer look at what may be causing your loved one’s cognitive difficulties, along with next steps you can take.
Understanding Alcohol & Dementia
Heavy consumption of alcohol is linked with a host of health problems, including cognitive impairment and decline. From a dementia care perspective, three conditions are particularly concerning: alcohol-related dementia, alcohol-related brain damage, and Korsakoff’s syndrome. These are conditions that include dementia or that are easily mistaken for dementia.
- Heavy alcohol consumption is a risk factor for Alzheimer’s and other dementias, such as vascular dementia. Alcohol is linked with compromised cardiovascular health, which is a major risk factor for the development of Alzheimer’s disease and the need for dementia care. Individuals who drink heavily also tend to lead unhealthy lifestyles in terms of diet and exercise, which further increase the risk of Alzheimer’s and other forms of dementia.
- Alcohol also increases the risk of brain damage. Brain injuries, for example, are more common among heavy drinkers, who are more likely to suffer falls and get into fights. In these situations, alcohol can indirectly lead to long-term brain damage. Alcohol-related brain damage (ARBD) can also occur directly. Alcohol is a toxin which, over time, causes nerve damage and reduction in grey matter. The result is sometimes referred to as alcoholic dementia, though it isn’t technically considered a type of dementia. Despite this, many dementia care providers include ARBD as one of the conditions they provide care services for.
- Korsakoff’s syndrome is a common condition among individuals who suffer from alcohol dependency, though less common than alcoholic dementia. Korsakoff’s is caused by a lack of thiamine, also known as vitamin B1. Insufficient levels of thiamine can result in damage to important brain centers, including regions of the brain responsible for short-term memory. Korsakoff’s syndrome most typically occurs after Wernicke’s encephalopathy, which is triggered in alcoholics by sudden withdrawal from alcohol. As with ARBD, many dementia care providers will cover Korsakoff’s syndrome as part of their services.
So how can you tell if your loved one is developing dementia, alcohol-related brain damage, or Korsakoff’s syndrome? One sign may be the age at which they begin to show signs of decline. Signs of ARBD typically occur before the age of 55, whereas most cases of Alzheimer’s and vascular dementia occur after the age of 65.
Another sign may be the type of cognitive difficulties your loved one is experiencing. In cases of Korsakoff’s syndrome is usually limited to short-term memory and the ability to make new memories, whereas ARBD and dementia typically have a wider range of cognitive and behavioral symptoms.
Ultimately, the best way to tell is to have your loved one examined by a medical professional. In cases of dementia or brain damage, it’s critical that you seek advice from medical experts, who will provide advice about whether to seek out dementia care, emergency treatment, and/or addiction treatment.
Do you have a loved one in need of dementia care? If so, we invite you to contact your local Visiting Angels® for information on dementia care services in your area. Simply call 800-365-4189 or contact your local Visiting Angels office to learn more.
Note: Visiting Angels does not provide medical care. All information contained in this article should be considered advisory only. If you are concerned about a loved one’s health, please contact their health care professional.
The Complicated Relationship Between Alcohol & Dementia Care
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We’ve all heard the horror stories about working with the Department of Veterans Affairs, affectionately known as the VA, especially when it comes to VA pension applications. You send in your paperwork and it either drops into a black hole never to be seen again or you end up in an infuriating back-and-forth game of claim form whack-a-mole.
Though you don’t have any control over the employees of the VA and their skill (or lack thereof) at processing applications, you do have control over what you submit. That’s why I thought it would be fun to talk about ways to guarantee that your loved one’s VA pension application will take far longer than necessary to process. Do the opposite and you’ll have better results.
#10: Don’t disclose all the necessary information.
Don’t bother to read the application to find out what information you need to provide. And if you do read the application, just skim it. Why concern yourself with the details?
#9: Don’t provide supporting documentation.
Don’t send any of the documents they request, things like an original copy of the veterans’ discharge from service, proof of marriage, or documents that prove the need for benefits. Don’t worry about accounting for assets such as bank accounts, saving accounts, IRA’s, income sources, life insurance, annuities, stocks, deeds for land other than the homestead, and so on. And if you do gather supporting documentation, just throw it all into a shoebox like you do your receipts at tax time and FedEx it to the claims processer. They’ll know what to do with it.
#8: Apply for benefits without knowing which ones to apply for (compensation vs pension).
Pick one the way you’d decide by flipping a coin. VA benefits are VA benefits, right? Pay no mind to the fact that VA Compensation is paid for service-connected disabilities and is meant to compensate a veteran for loss of income due to the disability. Ignore the fact that VA pension is paid to veterans who are disabled because of non-service-connected causes and that it’s meant to provide more income to low income, disabled, active duty veterans who served during a period of war.
#7: Apply for VA pension benefits without knowing whether your loved one is eligible.
Think of it like throwing spitballs at the wall. Wait to see what sticks. Pay no mind to the fact that the VA has a very particular set of qualification for the non-service-connected pension. Don’t think about whether your veteran meets the service requirements (he or she served at least 90 consecutive days with at least one day in a wartime period and received a discharge other than dishonorable). Don’t bother to look up the list of wartime periods even though they’re easy to find online. And don’t bother to dig out your loved one’s separation papers, or DD214m, which would make it easy to confirm both eligibility requirements.
#6: Fill out the wrong forms.
Yes, the VA application process reads like an alphabet soup of forms. But shouldn’t one form be as good as any other? There’s the VA Form 21-22a, which allows the veteran to appoint someone as a representative, someone to help you and speak with the VA on your behalf. There’s the VA Form 4138, which acts as a cover letter for every VA interaction. There’s the VA Form 527 and 534, the actual pension applications. And then there’s the VA Form 2680, the form that the veteran’s doctor completes. And there are many others. Assume that they’re all interchangeable.
#5: Fill out the forms wrong.
Once you have all the forms, leave out crucial information. Leave things blank. Partially complete other sections. Don’t follow directions.
#4: Don’t fill out all the necessary forms.
See #6 above, but only fill out half the forms.
#3: Forget to sign the form properly—or at all.
Whatever the instructions are, do something different.
#2: Assume you don’t qualify.
If your neighbor’s cousin’s best friend’s brother said you won’t get any benefits, believe him. Don’t bother checking with more knowledgeable experts to see whether your loved one might be eligible.
#1: Don’t get advice from a qualified elder care attorney.
Try to do it on your own, in hopes of saving a few bucks. It may take you years to get your claim approved, which means losing out on thousands of dollars of benefits that your loved one may have been entitled to. It might mean that your VA pension application is never approved. But at least you’ll have the satisfaction of knowing that a lawyer didn’t get any of your money.
Despite this tongue-in-cheek look at the potential ways that VA pension claims can go wrong, I truly believe it’s worth the time and effort it takes to apply. If your application is approved, the monthly award can mean the difference between your elderly loved one thriving or merely surviving.
If you want to expedite the processing of your VA pension claim, the Flammia Elder Law Firm can help. Just give our office a call.
Written by Kathleen Flammia, Attorney at Law, one of Florida’s TOP Elder Law & Estate Planning Attorneys. Attorney Flammia is a Member of the National ElderCare Matters Alliance, and she and her firm are Featured in ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources to help families plan for and deal with the issues of Aging.
Hypertension is a state when there are consistent high blood pressure levels. Notably, there are no visible symptoms of hypertension. It could happen to anyone, irrespective of age, and can cause several health issues if not treated timely.
For identifying if you have hypertension, start having regular blood pressure checkups either at a clinic or your home. Hypertension or high blood pressure levels reduce the heart’s efficiency and make it work more rigorously than regular. Furthermore, delicate tissues that are present in the arteries also get affected by the impact of high blood pressure.
The below-depicted infographic gives us an overview of the following:
- Hypertension around the globe
- Possible causes of Hypertension
- How Hypertension affects humans?
- Potential signs and precautionary measures of Hypertension
- Hypertension Treatment.
Hypertension affects all of us at some point in our lives. Hence, it is critical to take the necessary steps to manage our blood pressure levels both in terms of our physical and mental health. Thus, take enough care of yourself and your loved ones, and work hard to overcome the high blood pressure levels.
Author Bio: Anurag works as a Marketing Manager for Wisdom Policy, India’s leading online insurance provider. His passion for marketing is never-ending, and his contributions so far are unmatched.
Banks and their marketing associates and divisions are vying with one another to capture a thick slice of the “credit card pie.” Offers by phone and mail of free credit cards, pre-approved credit cards, cards with special bonanzas, money back schemes, low introductory rates, and umpteen other perks pour in tempting you everyday.
A credit card is just a form of borrowing that does not come free. Credit terms, interest rates, fees and more can lay a stress on your bank balance. Credit cards are a temptation to spend now and pay later. What invariably happens is that people spend more than they can handle.
Informed consumers must always weigh carefully the pros and cons and compare different options before deciding on a credit card.
Before you decide find out
The advantages of a credit card are that it is a safe alternative to cash. Prevents loss as well as theft of cash. Using a card wisely can build a good credit history which helps when you need a loan or subsidy. It is useful in emergencies like accidents, urgent hospitalization, and unavoidable circumstances like natural calamities and so on. It grants a breather and gives you time to pay the bill. Some memberships offer travel or accident insurance to the card owners at no cost. They also offer privileges like discounts at restaurants, shopping malls, and holiday packages.
The other side is that you can get carried away and live beyond your means, ultimately falling into debt.
To be eligible you need:
- To be at least 18 years old.
- Have some income or the backing of credit worthy parents.
- Have an operational bank account.
- A telephone.
- A good credit rating. Your monthly expenses must not equal or exceed your income. Ideal expenses must account for approximately 50% of your income.
- To get a Visa or Master card your income must exceed US$ 12,000 a year. Or, you need to apply for a secured credit card where you pay upfront a certain amount of money as security deposit.
There are many kinds of credit cards to choose from. Unsecured standard and classic cards are those with a credit limit of US$ 2000 and generally charge higher interest rates and offer lower or less favorable terms than the platinum and gold cards. Unsecured platinum and gold cards are for people with high credit ratings, and the limits for these cards are between US$ 2000 to US$ 100,000.
Here are a few links that will give information and opportunities to apply for cards online:
- Visa at http://usa.visa.com provides information, gives tips, and has listed a number of financial institutions that offer Visa cards and a wide range of services. One can apply for a card online.
- MasterCard International at www.mastercard.com is comprehensive with information, advice, and options of choosing and applying for a card online. They have an online form which when filled will give information of which card would be ideal and a channel which provides instant comparison of various card options.
- CreditCards.com at http://www.creditcards.com has articles, FAQs, a site map, and online application channels.
Tips:
- Pick a card because it has the lowest APR.
- Pick a card because all its terms and conditions have been carefully vetted by you. Read the fine print.
- Never pick a card because it is free for a year or life.
- Do not choose a card because it offers a low introductory rate.
- Do not choose a card because it has a cash back policy or great rewards programs.
Choose wisely and live debt free.
By: Paul Wilson
Boomers who take action now may enjoy better brain health, research shows
Baby boomers often think of 50 as the new 40. This is especially true in 2014 as the last members of the think-young generation reach the half-century mark. Yet with an unprecedented life expectancy – 78.7 years – for the youngest of the boomers, it is more important than ever to incorporate healthy habits to keep your mind beautiful during the second half of life.
The latest science indicates there are simple, but powerful steps you can still take now to help your brain remain strong, healthy and beautiful as you age. A partnership between the National Center for Creative Aging (NCCA) and the life’s DHA brand, Beautiful Minds: Finding Your Lifelong Potential campaign identifies key lifestyle factors known as the “Four Dimensions of Brain Health” that can positively impact your brain health throughout life – diet and nutrition, physical health, mental health and social well-being.
“Keeping the brain healthy is easier than many people realize. Everyday actions such as maintaining a diet including DHA omega-3 and other important nutrients like vitamin E and lutein, as well as staying active physically, mentally and socially, are all good ways to maintain long-term brain health and cognition,” says Michael Roizen, M.D., co-founder of Real Age Inc., author and advisor to the Beautiful Minds campaign.
Revealing how well Americans today are living out these four dimensions, the 2014 America’s Brain Health Index outlines state-by-state brain health rankings and uncovers areas in which where more brain health activities are needed. Here are a few tips for you to follow to help maintain a healthy brain at every age.
The nourished mind
Many important dietary nutrients help to promote brain health, but recent research indicates a potential link between three key nutrients and a reduced risk of cognitive decline. Those nutrients are DHA omega-3, vitamin E and lutein.
For years, research has demonstrated the benefits of DHA in maintaining brain health, yet most people eating a Western diet don’t get enough DHA. It can be found naturally in fatty fish such as salmon and ocean trout, along with DHA-fortified foods like juice, milk, eggs, tortillas, yogurt, and algal DHA supplements.
A study recently published in The Journal of the American Medical Association (JAMA) showed that vitamin E may positively impact functional performance among participants with mild to moderate Alzheimer’s disease. However, just over 90 percent of Americans don’t get enough vitamin E from food. Vitamin E can be found in milk, butter, eggs, vegetable oils, nuts, whole grains, wheat germ and dark leafy greens like spinach, and is also available as a supplement.
Additionally, new research on lutein, typically known for its benefits to eye health, has found a correlation between positive cognitive function in healthy older people and a diet rich in lutein. Incorporate lutein superfoods into your diet, such as dark leafy green vegetables like kale, spinach, collards and turnip greens, or egg yolks, peas and corn.
The physically active mind
Research has found associations between physical activity and improved cognitive skills.
Engaging in physical activity for at least 30 minutes a day may encourage new brain cells and connections. Take a walk over lunch, take the stairs instead of the elevator, join a club sporting league, or do something you enjoy outdoors.
Getting a good night’s sleep regularly as well as maintaining a healthy weight can also help to improve your brain health and minimize your risk of diabetes, high cholesterol and hypertension. And, if you use tobacco – stop. Research shows, regular tobacco users have a higher risk of rapid cognitive decline, compared to those who do not smoke, as well as raised risk for dementia and stroke.
The mentally engaged mind
Studies have suggested brain cells, much like muscle cells, can grow bigger and stronger with cognitive challenges and stimulation. People who continue to learn new activities and develop new skills and interests are exercising their brains in ways that may help to build connections in the brain, helping to support brain function.
Two-time USA Memory Champion, Nelson Dellis, is a role model for those striving to improve memory and maintain a healthy lifestyle. “I wasn’t born with an extraordinary memory, but through a daily regimen that includes aerobic exercise, nutritious foods and supplements and memory practice, I’ve trained my brain,” Dellis says. “Now I can memorize the order of a shuffled deck of playing cards in just 63 seconds. I’m proof anyone can improve their memory with daily practice if they just try it.”
The socially connected mind
Evidence supports the idea that social connectedness is vital to health, wellness and longevity. Experts theorize that having a rich social network may also help support brain health in a variety of ways, including providing us with better resources and stimulation.
Stay socially connected so you feel like you’re part of something – the workplace, clubs, a network of friends, a religious congregation or a volunteer group. Seek out friends and family to get the emotional support you need to help manage stress.
Be inspired by real Beautiful Minds
To learn more brainy tips, see where your state ranks in America’s Brain Health Index and be inspired by real-life “Beautiful Minds” – people who are living the four dimensions of brain health and accomplishing amazing things in the second half of life – visit www.beautiful-minds.com.
Provided by: BPT
Given the turbulent stock market and the soaring price of precious metals, selling gold for cash has become big business, and consumers are attempting to “cash in” in record numbers. You have likely seen billboards, flyers or television ads for companies offering to buy your gold.
Determine why you want to sell: It is important to evaluate why you want to sell your gold jewelry in the first place. Keep in mind that heirlooms, like most gold jewelry, often have strong sentimental attachments that make it difficult to put a price tag on them. Gizzi notes, “If you are determined to sell your gold jewelry, ideal candidates to consider are earrings with a missing partner and broken or outdated items.”
Get an independent appraisal: Once you have determined which items you want to sell, be sure to get an independent appraisal to find out the estimated resale and melt-down value of the pieces. An independent appraisal should come from someone who is not looking to buy or sell the jewelry. Getting an appraisal will not only tell you the jewelry’s value, but will also confirm the karatage — a determining factor in the price evaluation.
Check the value of gold daily: The price of metals fluctuates daily. However, keep in mind that the daily gold quote is not directly transferable to the price you’ll receive. Rather, it gives you a reference to help you determine the best time to sell.
Get multiple quotes: Like most savvy shoppers, you probably shop around to find the best deal on anything from cars to eggs. As you set out to sell your precious gold, it is important to get multiple quotes. The price offers can vary widely. If you are considering a mail-in program, never send your jewelry to a company that does not offer you insurance.
Shop with a reputable jeweler: When selling your gold items, you should deal with a reputable jeweler. Check with your local jeweler to see if they are member of Jewelers of America, the national trade association for businesses serving the fine jewelry retail marketplace. Recent reports have shown that local jewelers offer higher prices than their mail-in program competitors. Most importantly, you can have peace of mind knowing that your gold jewelry is in good hands.
Provided by: CFC