Guest post by Scott Grant, ATP, CRTS
It isn’t at all uncommon. Most seniors in nursing homes need some sort of mobility aid to help them recover from their injury. Unfortunately, the need for this equipment sometimes becomes permanent. But, do you know who pays for this equipment while your loved one is in the nursing home? The answer may surprise you. Here is a spoiler: make friends with the therapy department!
I frequently work with patients and their families in long term care as a custom wheelchair specialist. It almost always surprises them when they find out that their insurance is not going to pay for their grandmother’s new rollator that she needs.
There is one main reason for this. Nursing homes are paid per patient per day by most insurers. This means for every day mom is there, they get a fixed amount of money. This per diem is supposed to cover all their care – including their medical equipment needs.
It is important to note that this stipulation only applies to long term or skilled nursing care. It does not apply to assisted living or senior housing. Medicare and Medicaid consider these types of housing as the senior’s home and covers equipment in these situations.
So, here is the issue. The nursing home is working with a basket of money that is limited. While we all know that nursing homes are expensive, most make very little money at the end of the month. That fixed amount of money must be spent wisely to keep the operation running.
How to Get the Equipment Your Loved One Needs
You shouldn’t have much problem getting the basic equipment your father needs like canes, walkers and rollators, or bedside commodes. Most nursing homes have a supply of these on hand. Usually, the therapy department issues these to the residents and will also adjust the equipment to make sure it fits properly.
The availability of more expensive items like wheelchairs will vary from facility to facility. Most nursing homes keep a supply of these on hand too but this inventory is more limited. Some facilities regularly refresh their supply, but others do not. So, the quality here is going to be different from home to home.
If you need just a basic wheelchair for mobility from their room to the dining room or bathroom, the standard wheelchair will probably be ok. But, if mom and dad have had a stroke, they may require more specialized equipment. This custom equipment is expensive though and can easily cost $3,000 for a wheelchair with custom seating. This is why you often see pillows and blankets propping residents up in their wheelchairs.
How about a power chair? These are almost unheard of in the nursing home environment. A standard power chair can easily cost $3,000 and more custom models can be $20,000 or more. If the patient has one already, some nursing homes will allow them to bring them to the facility. But, some will not. Some homes will require the speed be adjusted down on them so that they are safer to use among the other residents.
If you see that your elderly loved one needs more or different equipment than they have been provided, here is the best way to try to get it.
Start with the therapy department. Good therapists are used to advocating for their patients. Explain your concerns to them in a calm, rational manner. Ask them what would help the situation. Then, ask them to help you get it.
Some therapy departments are contracted and are not actually employees of the nursing home. These therapists aren’t as concerned with going to a “boss” to request equipment they need. So, they might pursue your request more aggressively.
If the therapy department is unwilling or unable to help, ask to speak to the nurse manager. Nurse managers sometimes have a budget to work with and they may be able to help. Again, explain the situation calmly and make your request. Don’t forget the old honey and vinegar adage. These hard working nurses will often help if they can.
If the above fails, don’t be afraid to ask to see the facility administrator. This person usually controls the purse strings for the entire facility and is the final word on facility spending. Request a meeting with them in the patient’s room if possible so they can see your concerns in person. Explain the situation and, politely but firmly, ask for the equipment. Don’t be afraid to be a little more assertive here. By now, you may be known as a squeaky wheel. 🙂
Another option is to pay for the equipment out of pocket. Of course, I understand this isn’t an option for everyone but there are some tips for reducing the costs. I have known people who have had very successful fundraisers to help pay for equipment like this.
Go to your local medical equipment store and explain the situation. Ask if they have a wheelchair specialist or and Assistive Technology Professional who can help. ATP’s (I am one) have special training in mobility and positioning in wheelchairs. They may have suggestions on how to modify the existing equipment, advice on adding better cushions or backs, or may even have slightly used equipment they can sell for less.
Equipment at Discharge
If your loved one’s nursing home stay is temporary, they will probably be able to get the equipment they need at discharge. Once the patient is at home, Medicare and Medicaid will pay for their equipment. Of course, the senior has to qualify for the equipment.
There will also probably be some paperwork to complete. And, more expensive equipment takes some time. As soon as a discharge is even mentioned, begin working with the nursing home to arrange their equipment. If mom needs more specialized equipment, ask them to go ahead and start the paperwork and call in the home medical company. Again, this process usually starts in the therapy department. See why I told you to make friends here!
Nursing homes have been around a long time and most do great work. But, the reality is that nursing homes are a business and they have limited funds to take care of your loved one. But, that doesn’t mean your grandfather has to go without the equipment he needs.
If you see a need that isn’t being met, follow the chain of command I outlined above. Make your request politely but firmly. Remember that most of the people you interact with on a daily basis are hourly employees who work hard and aren’t making a ton of money, but there are ways they can help. You may just have to bring it to their attention.
For more expensive equipment like custom chairs or power chairs, you’ll probably have to wait until discharge. If so, start the process early before your loved one is actually discharged. These items take time and a lot of paperwork to get done.
If you have any questions, please leave them in the comments below and I’ll be happy to answer them.
Author: Scott Grant, ATP, CRTS
Scott is Dad to four beautiful daughters and Paw-Paw to three terrific grandkids. He works as a custom wheelchair specialist at a local home medical equipment company and is also founder and editor of Graying with Grace, a blog dedicated to seniors and their caregivers. When not working, he enjoys running and kayaking.
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