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Appropriate assistive technology helps disabled people regain independence and function. The right mobility device can mean the difference between total disability and a successful return to the workplace. And while many clients achieve excellent function with standard equipment, there are other clients whose unique needs require case managers to seek the assistance of certified specialists if they want to ensure optimal outcomes.
Many patients don’t require the special skills and expertise of a certified assistive technology supplier or practitioner, says Jean Minkel, PT, a seating and mobility specialist in Cornwall, NY, and chair of the professional standards board of the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) in Arlington, VA. "A large volume of stroke and orthopedic patients may have a temporary, or even permanent, need for home care equipment, such as a cane, walker, or bath seat. If the client and the case manager understand the client’s needs, there are not many choices, and a large number of suppliers can adequately provide the necessary items without any special considerations."
Rehabilitation technology comes into play when the client has specific needs that require a trained practitioner to assess the needs and a skilled supplier to fulfill those needs, she says.
LuRae Ahrendt, RN, CRRN, CCM, nurse consultant with Ahrendt Rehabilitation in Norcross, GA, works with severely disabled clients with a wide range of complex and specialized needs nationwide. "I always want to get the best long-term benefit from any equipment I invest in for a client," she notes. "As a case manager, I look for solutions which are reasonable, cost-effective, and have the longest-term results. There’s nothing worse for a payer than investing in expensive assistive technology that doesn’t benefit the patient in the long run."
If a client requires a piece of equipment that is quite complicated technologically, Ahrendt looks for suppliers and therapists certified by RESNA as assistive technology suppliers (ATSs) or assistive technology practitioners (ATPs). "When I come into a new community where I have never worked before, I consult the RESNA directory for a certified vendor," she notes. "For example, selecting an electric power chair with integrated computer capability requires quite complex rehabilitation skills. I look for certified therapists and vendors because I realize the purchase will be costly and I have to assure the client and the payer that the equipment is appropriate for the client now and can be adapted as necessary if the client’s needs change."
Minkel and Ahrendt say case managers should consider consulting with a certified assistive technology supplier or practitioner on certain types of cases, including, for example:
• A young paraplegic highly motivated to return to work and remain independent. "If you have a young, physically fit, healthy paraplegic who is provided with a non-adjusted seating device, he may as well be an 85-year-old man recovering from a stroke," stresses Minkel. "He simply won’t be able to accomplish his goals or regain his independence with that standard chair in the same way he could with an adjustable chair."
"It’s not always the most complicated case that requires the most creative solutions, but the most visionary case," notes Ahrendt. "It may not be your client’s intensity of impairment, but the intensity of his goals that dictates that you call on the services of a certified assistive technology professional. It’s the clients with the brightest future and most visionary rehabilitation goals who need our support to reach those high goals for maximum independence and function."
• A person with a degenerative disease. "A patient with multiple sclerosis [MS] who has been readmitted to the hospital three times in 12 months has probably been fitted with technology that is not flexible enough to meet her needs as her situation deteriorates," says Minkel.
Weesie Griffin, ATS, CRTS, branch manager for the Atlanta office of Chattanooga, TN-based National Seating and Mobility, agrees. "One of our biggest battles is with young patients with degenerative conditions, like MS, who want to use a three-wheeled scooter," she says. "That scooter is fine today, but a year from now, that client may not be able to sit up safely in that scooter. Payers don’t want to pay $3,000 for a scooter and then have us come back two years later and ask for an adjustable chair."
Working with certified suppliers and therapists ensures that case managers will find cost-effective solutions that meet their clients’ long-term needs. "We look at the clients’ entire environment," says Griffin. "Do they live in a three-story walk-up apartment? If so, what would they do with a power chair? Or, what good is a chair, if it doesn’t fit in the family car?" Griffin stresses that the goal of a certified supplier, or ATS, is to "provide exactly what the client needs — nothing more and certainly nothing less. My relationship with the client really begins the day the equipment is delivered. If I don’t get it right, I’ll hear about it!"
• A person with a closet full of unused equipment. "It doesn’t take an economist to figure out that if an expensive piece of assistive technology is sitting in the closet, it’s not worthwhile," says Minkel. "For our own survival, assistive technology suppliers and assistive technology practitioners must work closely with the client to provide the correct solution for the individual’s unique needs."
The RESNA code of ethics hangs on the wall of the Atlanta office of National Seating and Mobility, adds Griffin. "People know that they are working with certified individuals when they come to us, and if we get it wrong, they know they can file a complaint with RESNA. I think that’s important," she stresses. "The biggest compliment I receive is when a past client calls to say they need a new chair and they want to come back to us."
When case managers consult with a certified ATS or ATP, they should receive not simply a description of the recommended assistive technology, but a thorough explanation of the specific needs the equipment meets, says Minkel. She adds that case managers should find the following components in the ATP’s report:
"It’s important that the ATP not only include a description of the recommended assistive technology but a thorough explanation of what needs will be met by the technology," she says. "If the ATP recommends a more expensive joystick be installed on a power chair, there should be an explanation as to why the standard joystick that comes with the chair is not suitable to the client. For example, the lower-cost power chair may come with a small joystick box which doesn’t give the client adequate room to stabilize his hand."
To further ensure a "good fit" of client and assistive technology, Griffin says it’s best for the ATS to come into a seating clinic or therapy clinic and work together with the client and the client’s therapist. "This is not an out of the box’ or out of the catalog’ experience," she says. "Clinics have a wide range of chairs and cushions to try out. That’s very important when you are trying to select between a wide range of choices."
Griffin works with the client and the therapist in the seating clinic to write up a "spec" for the client’s chair. She takes her notes back to the office and works with a technician to integrate the necessary components and make them all work together.
"It’s truly a team effort," she notes. "In addition, we try to be realistic about funding options. We know what we can get funding for and what we’ll have trouble with. I don’t like to tell a client they can’t have the equipment they want because it costs too much," notes Griffin. "If I think that it’s what the person really needs, we’ll go for it. If we can’t get it funded, it’s because we didn’t do an adequate job explaining to the funding source, describing the client’s specific needs and how the technology will meet them."
"As a case manager," says Ahrendt, "working with individuals who are certified reduces my liability. And, ethically, finding the appropriate and qualified individuals to help clients meet their rehabilitation goals is what I’m required to do."
As a RESNA member, Ahrendt carries the RESNA directory with her to help her find certified suppliers and practitioners when she works with clients in a community she’s unfamiliar with, she notes. In addition, the RESNA Web site at www.resna.org has a member locator service which is constantly updated.