1. He needs a wheelchair because the alternative, a rollator, is unsatisfactory because it is causing him harm and putting him at risk.
2. The question of whether he uses a wheelchair is more problematic. It sounds like he doesn't use one consistently at present because he does not have a suitable one. Dependent on motivation and volition, of course, you can argue that _if_ he did have an appropriate wheelchair (a power chair) he _would_ use it consistently and cease damaging his shoulders and putting himself at risk of falls and subsequent injury (and further cost to the health service or insurers or whatever). The question is posed in an unsatisfactory way. You can't really be sure what actual behaviours will result from your facilitation of the use of a powered chair.
I had a similar case where a 60-something year-old person with mild cerebral palsy (unimpaired cognition) was told to stop using crutches and other walking aids to preserve the use of the upper limbs as shoulder arthritis was already quite advanced. The person stated a desire to get an accessible flat so that a power chair could be used. We arranged rehousing to a flat that would be accessible using a powerchair that was issued by the local wheelchair service (they had agreed they would issue it when a suitable flat was arranged) and we fitted electric door openers (at considerable cost). The door openers were needed whether the person would or wouldn't use the wheelchair, to be fair. On subsequent visits, it seemed that the power chair wasn't being used indoors -- not regularly at least -- but at least it facilitated outdoor mobility.
At least part of the question is a grey area because it depends on how he would behave should the chair be provided, so it's a bit of an unknown, but you suggest that he does sometimes use the manual chair indoors when the pain allows, so you can argue that you do have evidence of intent to use the chair and that the intent is thwarted only by the unsuitability of that particular type of chair so it would seem reasonable to argue that it is likely that he would use the power chair if it was provided. But why doesn't he use the manual chair more? You might think that the chair should always cause less pain than bearing nearly all his weight through his upper limbs on crutches, perhaps? Maybe there are other reasons why he doesn't want to use a chair?
If it were possible to acquire a power chair on a trial basis, you could further evidence his need for it and willingness to use it.
It's a tough one. The medical necessity of the chair depends at least in part on his willingness and ability to use it (and environmental factors such as door widths, circulation space and changes in level are relevant, too.) I'm not very familiar with the Certificates you mention or the way your healthcare system works, so this may not be very relevant.
-- Mike
On Thursday, Sep 25, 2003, at 12:46 Europe/London, Ron Carson wrote:
D. I need clarification because the question is really in two parts.
1. Does the patient require a wheelchair
2. Does the patient use a wheelchair
Ron
=============================================================== On 9/25/2003,[EMAIL PROTECTED] wrote:
dz> To me, it seems that the answer is YES and that you have
dz> justified the reasons.� He is presently ambulating via a walker and
dz> crutches, however this is not safe for him (as he has fallen) and it
dz> has��resulted in OA.� Because of all this, a power chair is
dz> necessary to safely and independently ambulate within his home, not
dz> to mention, to�prevent further damage/deterioration of his
dz> shoulders.�� Did that make any sense?� Let me know if you'd like
dz> alittle more clarification.
dz> D����
From: Ron Carson
Reply-To: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Subject: [OTlist] Medical Necessity for a Power Wheel Chair
Date: Wed, 24 Sep 2003 19:58:23 -0400
I am struggling to complete a Certificate of Medical Necessity (DMERC
form 02.03A) for a power wheel chair.
Question 1: Does the patient require and use a wheelchair to move around
their residence?
The client in question has an old spinal cord injury that left him with
incomplete lower extremity paralysis. He has been ambulating in the
house via a 4-wheel rolling walker and/or Lofstrand crutches while
placing almost 100% of his body weight through his arms/shoulders. His
adapted form of ambulation has resulted in developing OA in his left
shoulder with a resultant decrease in ROM secondary and significant
increase in pain. He only uses a manual wheelchair in the house
infrequently because he can't push it secondary to shoulder arthritis.
he has fallen 6-8 times this past year while ambulating with his walker.
It appears that the answer to question 1 is a 'no'. If this is true,
does this mean that a power wheelchair is not medically necessary for
this client?
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