Mobility and Medicare: A Practical Guide, Part III

Earlier this month we wrote about Medicare and eligibility requirements for coverage of power vehicles, walkers and canes. This week we tackle manual wheelchairs. It’s a bit complex, so pour yourself some lemonade and focus.

Manual wheelchairs fall under a category called “capped rental.” What this means is that Medicare sets up a “rent to buy” approach when covering manual wheelchairs. The assumption is that the need for a manual wheelchair may be temporary, or the need might not be clear after just a short period of time. Rather than covering the purchase outright, Medicare sets up this approach to ensure that only the need is covered. Here’s how it works.

You still need all the same essentials as previously mentioned:

• A written and signed order from your physician with a clear diagnosis and length of need. This must be in the dealer/provider’s hand before you can get the wheelchair.
• The physician must have a written evaluation in his/her medical charts of your condition that supports the need for a manual wheelchair. (You might recall from our earlier discussions that this need is primarily to address MRADLs, mobility-related activities of daily living in your home. The fact that you would like to get out and shop once in a while is not a covered reason!)
• Signed forms and copies of your Medicare card to leave with us, the dealer/provider of the wheelchair, so we can do the complimentary billing for you. The paperwork also gives us permission to work directly with the physician to ensure all materials are provided. We help assess the likelihood of whether your claim will be covered or not.
  

So, let’s assume you have the written and signed order and show up at Capabilities. You also have your Medicare card. (If you have the Power of Attorney or are the spouse of the individual needing the wheelchair, you have the authority to sign. We still need the Medicare card to copy for our records.) The prescription (written order) makes it clear, for example, that you must have an 18” standard manual wheelchair for an indefinite period of time in order to perform MRADLs in your home.

You must fill out Medicare paperwork and a “capped rental” agreement that sets a monthly fee for the use of the wheelchair. You pay Capabilities directly for that monthly fee since our arrangement with Medicare is such that we collect payment up front. If Medicare accepts your claim, you will be reimbursed for the covered amount (generally about $57). You will not be reimbursed for any additional fees that the dealer/provider charges. If we believe your claim is not viable, or if paperwork is incomplete, we will explain to you up front that we have reservations about the claim. You can choose to continue by signing an authorization that allows us to continue, called an ABN (Advance Beneficiary Notification) that acknowledges that you know Medicare may deny the claim and not reimburse you. You can also decide not to proceed at this point. The choice is yours.

If Medicare covers your claim, you will continue renting the wheelchair on a month-by-month basis for up to 13 months (or sooner if the rental fees equal the covered cost of the wheelchair in less time). At the end of that period, you effectively own the wheelchair.
If, however, your need for the wheelchair ends sooner than that period, you must return it and Medicare will cease reimbursement.

We should briefly mention other types of manual wheelchairs. In some cases, a patient might not have the upper body strength to self-propel a standard wheelchair. This is one of the evaluation points that the physician must be clear about in his/her notes. If there is insufficient strength for a standard wheelchair, but the physician determines there is enough strength for a lightweight manual wheelchair, the order must clearly state this to be the case, along with the diagnosis and length of need. In some cases, upper body strength is so weak, a power wheelchair is the only solution. We have already discussed coverage of this item in previous blogs.

We are also asked about whether Medicare covers transport wheelchairs. These are the chairs with smaller wheels and must be pushed by someone else. As you might guess, there are very particular, and rare, circumstances when a transport chair will be covered. Coverage requires evidence of a caregiver in the home, for example. Reimbursement is minimal and many dealer/providers do not offer a billing option for this type of wheelchair. As always, it is best to discuss your needs fully with your physician.

Clear as mud, right? We can help you sort your way through the morass of paperwork. What we cannot do is hustle the process along. You should expect the process to take several months before you receive a clear response to the eligibility of the claim. We get calls all the time from customers who wonder where their reimbursement is. Sometimes we can easily track down the claim with Medicare, other times it takes an army. Claims often get rejected several times due to insufficient information from physicians, old codes, or details that are not completely clear to the administrators processing the claims. If there is a problem, we work on solving it as speedily as possible if it something we can troubleshoot. If, in fact, the physician has not provided the appropriate diagnosis or proof of evaluation of your situation, there is little we can do to remedy that situation. Believe me, when Medicare accepts the claim, you will know about the same time we know.

As we have mentioned previously, the way to appreciate Medicare is to view it through the same lens you would use for any insurance coverage. There are covered benefits and there are many situations not covered. To imagine Medicare as an entitlement or to rely solely on it for all your medical needs is to invite heartache and disappointment. When the circumstances match the eligibility requirements, Medicare is an important tool in managing your healthcare. Always feel free to ask us questions at Capabilities where we have experience working with Medicare.

Please post your questions and comments and we’ll get back to you right away.

Medicare, Capped Rentals and Other Mysteries

As we continue our series on understanding Medicare, we focus this week on the phenomenon called “capped rentals.” We mentioned them earlier when we spoke about how Medicare covers manual wheelchairs. It’s a kind of “rent to own” program, designed to deal with the fact that people sometimes need certain types of equipment temporarily. Hospital beds, also known as patient beds, also fall into this category, as do TENS units, patient lifts and oxygen.

Here’s how the “capped rental” process works. You still need all the documentation required from your physician explaining why you need the equipment. As outlined in our previous blogs, the physician’s chart notes must clarify the diagnosis and length of need as well as other details of your condition. For items specified as “capped rentals you work directly with the provider or dealer of the equipment who sets up a rental agreement. If you qualify for Medicare coverage, you have up to 13 months of coverage from Medicare. As with all Medicare coverage, providers/dealers are authorized to bill Medicare either through assignment or non-assignment. Assignment means that the provider/dealer is reimbursed directly by Medicare for up to 80% of the “capped rental” costs. Non-assignment means that you, the consumer, are reimbursed. You pay for the rental of the equipment directly to the provider/dealer and you receive the reimbursement of up to 80% of the rental costs from Medicare directly. In all cases there are agreements that specify terms of the capped rental arrangement. The provider/dealer explains which terms (assigned or non-assigned) and works with you and your physician to complete the necessary paperwork.

After 10 months of reimbursement from Medicare you have the option to buy the equipment. If you decide to purchase the item, the supplier transfers ownership of the item to you following the 13th rental month. The decision to buy the equipment changes the rental payments to installment payments. Remember, if you decide to continue renting the equipment, Medicare will stop paying for the equipment following the 13th month, except for certain service and maintenance.

It is usually quite clear after that 10 month period whether you will continue needing the equipment. It is important to discuss these needs with your physician and the provider/dealer with whom you are working. At Capabilities, we stay in touch with our customers through the billing process. We make reminder calls when the monthly rental period is due for renewal and conduct the renewal process over the phone through the use of credit card transactions. Each provider/dealer will have a specific process to follow.

If you do not have need of the equipment after the 10 month rental period, you are obligated to return it to the provider/dealer. Your physician or other health care professional will help you determine your needs.

At Capabilities we rent manual wheelchairs, TENS units, patient beds (semi-electric only are covered by Medicare), and patient lifts. As a Medicare provider, we accept these items on non-assignment, which means that we expect payment for the rental term from you before delivery of the equipment and submit billing on a complimentary basis to Medicare. As with all Medicare claims, we help you and your physician complete the extensive paperwork required to determine your eligibility.

Please contact us through email or a post here to ask your questions about capped rentals, Medicare and any other insurance-related question you might have. At Capabilities we pride ourselves on being a source of information and resources as well as the provider of one of the largest selections of products for health, comfort and independence.

Mobility and Medicare: A Practical Guide, Part II

Last week we discussed the guidelines Medicare uses when considering coverage for electric scooters and power wheelchairs. This week, we will look at the process for purchasing canes and walkers through Medicare.

As you saw last time with the series of questions the physician must respond to when charting your case, Medicare will cover the equipment needed for mobility related aids for daily livings (MRADLs). If a cane or walker will respond to the need, Medicare will cover the appropriate one and not a manual wheelchair or power operated vehicle.

The critical documentation needed before you can obtain a cane or walker is a written, dated and signed order by the physician. You must present that order to the provider of the cane or walker, although a faxed copy will often suffice. The key is that this order must be dated BEFORE the purchase. At Capabilities, we do complimentary billing for Medicare, so you will typically pay for your cane or walker up front and we will submit the billing to Medicare.

As with the case of power operated vehicles, however, the physician’s records must reflect why you are in need of a mobility device. A clear diagnosis must be included in this documentation. Our billing office is in contact with the physician’s office to complete the documentation required before the claim can be submitted.

Be advised that Medicare has reimbursable limits for each item. In the case of a cane, for example, that reimbursement is $21.07. This amount usually represents only a percentage of the true price of a cane. A quad cane (with a four-pronged base) has a slightly higher allowable of $47.55. (Remember that these are current figures and are subject to change.)

Walkers are slightly more complex as there are many varieties. Medicare is most likely to cover a standard walker, or a standard walker with wheels, typically 3-inch or 5-inch wheels. There are rare circumstances when Medicare will cover a “rolling walker,” the type with four wheels, a seat and hand brakes. If your physician believes this is the only type of walker that will work with your condition, s/he will have to be very specific about the condition and why this is the only option. As with canes, the order must be written, dated and signed by your physician. We need the order in hand before we can sell you the piece of equipment.

It’s important to keep in mind that once Medicare covers one piece of mobility equipment, there must be a significant change in condition for Medicare to approve another claim for more mobility equipment. There are, of course, conditions whose symptoms progress dramatically, and in these cases the diagnosis and medical chart will clearly reveal the need.

Check future blogs for more information about Medicare.

Please email us or post your questions or comments regarding Medicare in general or if you have a specific question.

Mobility and Medicare: A Practical Guide, Part 1.

Now, here’s a topic we spend a lot of time explaining to many of customers. We thought we’d start a conversation in this week’s blog, and invite you to join in by posting your own experiences and thoughts about it. We know passions run deeply on the subject, so don’t hesitate to put in your two cents.

Until recently most working people over the generations believed deeply that between Social Security and Medicare, most of our needs as we age would be taken care of. Talk to most 40 and 50 somethings today, however, and you will hear a lot of cynicism on the subject. And anyone younger than that will say plainly that they are working on alternative solutions to ensure ways to take care of themselves when they are older. There are, however, many folks over 65 who still believe in these programs. And for some, the programs will deliver as promised long ago. Let’s peel back a few layers of this complex situation of Medicare, starting with a focus on mobility. We will write periodically on the topic, reviewing different products and how to consider whether it is likely that Medicare will cover them or not.

Individuals must qualify for Medicare coverage for mobility equipment, or mobility assistive equipment as it’s officially called. The process starts with a prescription signed and dated by a physician that must contain:
• the name of the beneficiary of Medicare
• the date of what’s called the “face-to-face” examination (more on that later)
• a description of the product ordered, such as a “power wheelchair” or “scooter,” a pertinent diagnosis and explanation of the conditions that relate to the need for the power mobility device
• length of need

Very often the process stops right here for us at the store. A customer in need (or someone in his or her family) arrives with a prescription that simply has the words “wheelchair” on it. The customer explains that the doctor said Medicare would pay for a power chair, although the prescription does not indicate such. Now, we respect doctors very much. We also know that they are focused on care and treatment, not on maneuvering their way through the wiles of insurance systems, especially one with as many details as Medicare. So, it is perfectly understandable that in many cases physicians believe they have completed their part of the deal, or they know that we will continue the work with someone in their offices to complete the paperwork that Medicare requires. The disappointment of that customer in that moment, however, is hard to witness and we do the best we can to help with the situation.

You should know that in no circumstance could you actually drive the power operated vehicle (power wheelchair or scooter) out of the store even if the written order had every detail covered.

We need evidence that the face-to-face examination was conducted and that it yielded appropriate results. In fact, we must submit the physician’s chart notes as evidence that we, as the dealer of the power operated vehicle, have done due diligence, too.

Let’s take a closer look at what kinds of questions get uncovered during that examination.
The primary question that has to be answered is this:

Does the patient have a mobility limitation that impairs participation in what are called Mobility Required Activities of Daily Living (MRADLs) in the home? MRADLs are things like eating, dressing, toileting. Unfortunately, being able to go out shopping or to the library does not count as MRADLs. Note, it also says “in the home.” So, the fact that you have not been out to dinner in six months is not what Medicare will worry about when they consider coverage for your power chair.

If the doctor cannot answer this question affirmatively, the process stops there. You do not qualify for coverage. If the answer is yes, the next question is whether the limitation can be compensated by the addition of other “mobility assistive equipment” to improve the ability to participate in MRADLs in the home. This means, can the situation actually be helped by the addition of some type of mobility assistive device? If no, you do not qualify for Medicare coverage. If the answer is yes, then there are a series of questions about specific alternatives. I will simply list the next series of questions that must be answered.

• Is the patient or caregiver capable and willing to operate the mobility assistive equipment (MAE)? If no, then stop. No coverage. If yes, go on.
• Can the mobility deficit be safely resolved by a cane or walker? If yes, stop and order cane or walker. If not, why not. You can only go on with the next question when the doctor has documented why these simpler devices will not work.
• Does the patient’s home environment support the use of a wheelchair or power operated vehicle, such as a power wheelchair or scooter? If no, you are not qualified for coverage. If yes, the supplier (like us at Capabilities) has to do a home evaluation to ensure the type of equipment does in fact work in your home.

There are more questions, so buck up. Take a break, get a cup of tea and read on…

• Does the patient have the upper extremity function to safely propel a manual wheelchair in order to actively participate in MRADLs in the home? If yes, stop and order the manual wheelchair. If not, go on.
• Does the patient have sufficient strength and trunk stability to operate a power operated vehicle in the home? The doctor has to explain a bit more about this part of the assessment. For example, how does he or she know the patient has sufficient strength. If yes, go on to next question. If no, skip to the following question.

Are you still following me here? No easy feat, is it?

• If patient has sufficient strength and trunk stability, is the patient able to maneuver the power operated vehicle in the home? Explain. If yes, stop and order that power vehicle, most likely a scooter. If no, go on.
• Does the patient need additional features (e.g., customized seating, joystick, reclining back) of a power wheelchair to participate in the MRADLs in the home? Why? If no, stop. There is no rationale for Medicare to cover this vehicle. If yes, one more question.
• Is the patient safe and able to maneuver a power wheelchair in the home? If yes, stop and order it. If no, stop.

The physician has another page of information required before we can consider doing the home evaluation and completing the paperwork for your power wheelchair.

While onerous, the process is designed to weed out fraud or unnecessary purchases for those who truly do not need such high powered and expensive equipment. Unfortunately, like most processes that really do have a purpose, it can also be so difficult that people get discouraged or angry. They find it hard to believe that something they believe they were entitled to can be so impossible.

Medicare is insurance and as for every insurance policy, there are conditions that must be met. If you keep this perspective, you can maneuver more easily through the process without raising your blood pressure. We will help you do this as best we can.

I’ve learned a lot about Medicare in these two years. Not only can I help our customers understand the process more effectively, I know I will be a better consumer of Medicare when it’s time for me to qualify as a card carrying member.

Let us know if this type of informational blog is helpful to you by posting your comment below or email us. What else would be helpful? As I mentioned, we will continue with our series on understanding and using Medicare effectively in coming weeks.

Our Prescription for Change

So, the election is over. Whether you are delighted or not about the outcome, let’s get focused on one of the major issues facing our nation, health care. We see a particular set of concerns through our lens here at Capabilities. We see families facing some of the biggest and scariest challenges of their lives. When physical illness or injury arrives on your doorstep, or when finally you realize the effects of aging are catching up with your parents, or yourself, the world changes. We have written a lot about that "deer in the headlights" look that comes over us when we are confronted with this type of change.

What will the new President do? What will the new administration do to address the difficulties so many families face? We cannot pretend to know the answer to the many questions of how to help families facing illness, injury and the impact of aging. We do know what does not work well now.

Take Medicare, for example. As a Medicare provider, Capabilities works with folks to address needs for durable medical equipment, DME, as its called. The types of equipment and amounts covered shrinks all the time. The process is onerous, causing many to give up. We have written in this blog before about Medicare. In the coming weeks, we will review again some of the key requirements for Medicare coverage for such products as wheelchairs, power equipment, lift chairs and patient beds. Suffice it to say here that for folks who have worked long and hard and have an expectation of receiving help through Medicare after age 65, the laments are many and the list, long on complaints.

We have built Capabilities to respond to individuals, not to insurance companies. However, we do our fair share of intervening. We are happy to do so for our customers, although we clearly see the writing on the wall.

We urge everyone to bring your voice to the table of our newly elected government. As our leaders think, discuss and imagine the future, your voices need to be there. You have ideas and concerns. If you are part of a family facing enormous change because of illness, injury or aging, no one can describe more vividly the impact it is having on your life, your lifestyle and your family. Tell us your stories and we will do our best to pass them on, too.

More Pre-Owned Products

With this economic squeeze continuing, our customers are on the search for bargains they can trust. This year we have introduced a broader selection of pre-owned products in categories that are generally considered too expensive for many folks to consider. Power wheelchairs, for example, are a much desired item for aging relatives or for those whose conditions, such as MS, ALS and Parkinson's disease are advancing, making mobility more and more of a challenge. While power wheelchairs are a Medicare covered item, many people do not qualify based on their diagnosis or situation, or Medicare might have previously paid for equipment that they consider still operable. You might recall from earlier discussion in our blog about Medicare coverage, the eligibilty requirements for power vehicles is dependent on your physician's diagnosis, prognosis and detailed evaluation. Capabilities then performs an in-home evaluation to determine usability requirements. Medicare covers products for use based on needs inside the home, not outside.

Our selection of pre-owned, affordable power chairs has grown significantly over the past couple of months. See our previous discussion of some of these products, including details about the power chairs and pricing. We have also added reclining lift chairs, low vision equipment, and the occasional patient bed, a semi-electric bed similar to a hospital bed to help with home care.

Don't miss our wonderful special on a pre-owned reclining lift chair that was only in someone else's hands for two months. We sold the chair originally, so we know exactly its history. Not only is it a classic, but this chair comes with heat and massage, often a luxury that many people agree to live without. You can get this chair, complete with heat and massage, a manufacturer's warranty, AND our own labor warranty for $1000!! Contact us now if you would like more information about this incredibly affordable and comfortable solution for you or someone you care about.

Please contact us for more information about our pre-owned products or stop by our flagship store to see for yourself what value you can get from shopping with Capabilities.

Time to Move! Choosing Mobility That’s Right For You

It’s Spring! It’s all about getting outside and going places again. Whether you have a permanent or temporary injury or illness, or whether you just don’t have the umphh you once had, considering something to assist your mobility might be on your mind. Or if you already have some mobility equipment, it might be time to upgrade. Here are a few tips to keep in mind when shopping for something that will get you where you want to go.

How do your current mobility tools, if you have them, work for you? Knowing what works and does not work for you is sometimes half the battle. If you like some features of your current equipment, but not others, make a note of that before you talk with us. That way you can describe clearly what you like and don’t like.

Where do you want to go? What do you want to do that you can’t do so easily now. Identifying the kinds of activities you most enjoy and need to do is a first step in assessing your mobility needs. You might do just fine with a cane most of the time, for example, but when you go to the zoo with the grandkids or shopping or on a long walk with your honey, you find the cane just does not give you enough support. Looking at a walker with wheels and a seat or an electric scooter for such occasions might make all the difference in your enjoyment level. Consider several different types of tools depending on your activities.

How have your mobility needs changed over time? Are your facing a mobility challenge for the first time or is your condition progressing? Does the time of day or intensity of activity affect you? If you have a temporary situation you might consider renting equipment to try it out. Remember that there are many tools out there, so don’t limit yourself to just what you have seen or heard about before. Talk with us to explore alternatives that might be infinitely more comfortable or suitable to your situation. If you are living with a more permanent situation, or a progressive one that will change your mobility over time, talk with your doctor or physical therapist to get a sense of just how quickly things might change so you can take that into account when making your purchase.

Is the equipment part of your treatment or rehabilitation plan? In many instances involving rehabilitation, it’s quite clear that you will need a mobility device to continue your progress. In other cases, you may know that it is more a matter of your comfort. And then there is the great gray area of whether insurance or Medicare will help cover the costs of your equipment. We have written extensively in our blog about the latest Medicare requirements. For other insurance, you will have to speak with your representative to find out if your needs match eligibility requirements. In any case, speaking with your physician or physical therapist will also help clarify if and how a particular piece of mobility equipment will help you.
What makes you comfortable? While there are lots of techniques we use to ensure that a piece of mobility equipment fits you properly, one of the key measures is how comfortable it feels for you. Don’t settle! Be persistent with trying things out, describing just what makes you comfortable, what you hate. Sometimes renting something is a good way to test the waters, especially if you have never worked with a particular piece of equipment before. Being comfortable will ensure that you will use the equipment. You probably already lots of things lying around the house that you thought you’d love, but just did not work out.

How will you integrate the equipment into your daily life? This is an extension of the comfort question. Let’s suppose your break your ankle while enjoying one of your favorite outdoor activities. Once you get over the initial pain and absolute annoyance of your spring and summer being interrupted, you do have a few choices you can make to ensure you will heal as fast as possible. Nearly everyone knows about the ubiquitous pair of crutches, one of the oldest pieces of mobility equipment on the planet. Did you know you can get comfy armpads and handgrip pads to take the sting and ouch out of using the crutches? You don’t have to wrap a bath towel around it to endure the agony. Or, have you seen the many forms of knee walkers out there? We have one we think is the best around called the Rolleraid. It gives you a kind of independence you just can’t recreate with crutches. Or, if you have been saving to buy a scooter, but don’t think about how you will transport it, you could be disappointed when you find you are still trapped at home because you forgot to inquire about a lift or to check out the travel scooters that come apart in three or four pieces so you can pop them in the trunk.

Whatever your situation, find folks you can trust to talk with. Contact us to learn more about the array of mobility tools that might work for you. Share your experiences about choosing the right piece of equipment here.

What Can I Do With That Old (or New) Thing?

Since we’ve been in the business of helping find solutions for all kinds of life’s challenges, we’ve become aware of another thing that can drive a person crazy. Used wheelchairs, walkers and scooters! This equipment is wonderful when being used to help someone maneuver through a temporary or permanent illness or injury. But we’ve all been faced with what to do with the stuff when it’s no longer needed. I’m sure you know someone who has a walker sitting in the garage, sure that one day someone in the family or a friend will need it. Or that scooter that Dad loved so much when his MS worsened. He thought for a while he’d never get out and about again. Like most vehicles, even power chairs and scooters lose value the minute they are driven away from the store, but that doesn’t mean there is not still a market or use for them out there. But where to turn?

We have been thinking about this since we opened the store, as we receive many calls about selling or giving away used medical equipment. Or in some cases, someone’s looking to buy something used because the need is so temporary. So, we decided to experiment by putting a bulletin board feature on our new website. To find it, take a tour around www.capabilities.com, and click on Exchange. You will see a place to post whatever it is you are looking to sell, buy or giveaway. In fact, a group of parents of kids with special needs are organizing a Toy Swap at Capabilities in the summer. They have already posted their event on the Exchange.

Please keep your expectations under control, though. While that power wheelchair Medicare covered for Mom might have had a sticker price of $5000, once she received it, the actual value diminished significantly. And Medicare won’t take it back. You probably know already that if you donate your used vehicle to a charitable or not-for-profit organization, you can most often take a tax deduction. Be sure to speak to your tax advisor on such matters.

You can browse the Exchange easily, but you will have to register and login in order to post items or respond to postings. This is to prevent malicious people from posting spam and other undesirable items.

Check out our Exchange feature and see if it fits your needs. It’s just one more way that we looking to provide resources to the community and each other. Let us know your thoughts by sending us an email or posting a comment (click on Comment link below).

Five Reasons for Health Insurance Reform

Somewhere during the summer, health “care” reform switched to health “insurance” reform, and the debate came alive in new ways. While our system of health care itself is worth questioning, in fact vigorously by some, including Michael Moore in his award-winning film, Sicko, what makes a lot of sense now is challenging the way we package health care, pay for health care, withhold health care, dole it out. And, when looked at in that light, “insurance” is definitely the aspect of our health system that needs reforming.

As we make changes to Capabilities, separating ourselves from selling products, while highlighting still the importance of access to products and services that promote independence, the voice I use in this blog will change sometimes. Ever interested in putting a whole picture on the table, I have particular experiences that do shape my perspectives and beliefs. I am not always neutral on these matters of great importance.

To insist that our health care insurance options today should be the choices of tomorrow ignores some realities that are out there, maybe not for all of us, but for enough of us Americans to take notice. I have five situations (at least) that make me believe that the time is now to change some fundamentals about health care and health insurance. I have changed the names to protect privacy. The situations are real, though, and some version of these situations presented themselves on a nearly daily basis.

1. Mike, a 40-something, has a debilitating disease made all the more complex by premature arthritis that causes severe spinal and hip pain. He lives on SSI disability income and Medicaid. In this case, he has options that some others do not. Medicaid has paid for a wheelchair, a patient bed and equipment for the bathroom. He cannot sit or stand for any period of time, however, and he needs a chair, a reclining lift chair. Medicaid will pay for one of those, too. The approved one. Mike has tried that chair under several conditions and it causes him excruciating pain. He has found the one that works for him. Medicaid will not approve this chair; they approve the other chair and deliver one to him. He does not use it. They will not take it back. He called to tell him he just cannot sit in it.
2. At 84, Margaret could no longer manage her day-to-day activities in her home. After discussion, her family and she decide that if she had a power wheelchair to get around the house, she could stay at home longer. Margaret and her family worked with one of those dealers advertised on TV, who made it easy for her to get approved, advising her how to work with her own doctor or providing one in their networks. They sent her a chair. It was too big for her home and for Margaret. Her family tried to work things out with the dealer, but to no easy avail. Margaret passed away a few months later. The family now has a big power wheelchair. They are trying to sell it. “It’s a $6000 chair,” they say in the ad. Everyone knows they did not pay a penny. Medicare footed the bill for something that proved useless for Margaret.
3. Gloria is barely 50. She lost her job with the downturn. She has fibromyalgia, a syndrome that causes myriad physical problems, including mobility issues. She also lost her insurance coverage because the COBRA payments were too high for her to continue the coverage as properly offered by the company. Within a few months, with still no job prospects, Gloria’s condition worsens. She needs a walker to get around the house and something more powerful when she goes out to look for work. She cannot afford even the basic one. She spends her time looking for a donation and applying for grants at local churches. Her job search falls by the wayside.
4. Jose became an American citizen years ago and worked diligently to provide for his family. He paid his insurance premiums faithfully. At age 60 and a widower, he struggles with COPD, diabetes and congestive heart failure. He cannot work anymore and after the COBRA coverage ran out, he tried to buy individual coverage. Because he has pre-existing conditions, he is not insurable. Luckily, he had savings. They are used up now, so he sold his home to be sure he can buy oxygen, a must-have to get through his days.
   Jim and Alice are about to bring Alice’s mother in to live with them. She has advanced macular degeneration leaving her nearly blind. Her children want very much to find her some tools to help keep her active. A CCTV costing about $1700 would give her enough independence during the day while Jim and Alice work to read, do her needlework and write checks to pay her bills. Surely, insurance will help cover this needed tool that will give Alice’s mother some quality of life? Jim and Alice get very angry when they learn that neither Medicare, nor the high priced supplemental insurance she has, will pay anything towards vision tools, other than corrective lenses, exams and surgeries.
   
   I have seen hundreds of people disappointed, angry, frustrated and despairing when they find that “after all these years of paying into insurance” they are left to handle the situation themselves. Of course, health insurance does pay for certain procedures and pieces of equipment. And for those who have great coverage, the complaints are few. But, there are things so necessary, so vital to quality of life, to mobility, to independence, to comfort, to managing pain that individuals pass up every day, or sacrifice even more to get. In more certain times, adult children, grandchildren, nieces, nephews have taken up the slack, filling in the gaps to ensure the right thing happens. In these difficult economic times, everyone thinks twice before opening a wallet, including loving and caring family members.
   
   Reason tells us that we cannot as a country satisfy every need and comfort. After these years of working with honest, hard-working families who face physical challenges that may lie just around the corner for every one of us, I am more persuaded that there is a place for oversight and regulation of health insurance at the very least, and perhaps even a greater role for government to ensure that the list of health care basics for every American gets redefined.
   
   One interesting idea is to shape the health insurance industry after the public utility model. While privately held companies can compete to deliver electricity, for example, there are guidelines and regulations that ensure a modicum of fairness in access to the utility, pricing and safety.
   
   What do you think? What gets under your skin about health care and health insurance? What do you like about the way things are? Please post your comments here or email.

How Massachusetts Politics May Affect Health Care

The election of Scott Brown, a Republican, has dominated the news all day. The potential impact on the pending health care legislation in Washington is anyone's guess...and everyone is guessing. Ideas range from the sublime to the ridiculous. Here are two that may not be so crazy:

1. Congress reviews the bills from the House and Senate, pulls out the most impactful on the American public, and brings each important piece one by one for a yes/no vote. The three main issues discussed at length today are no pre-existing conditions, coverage for over 30 million people, and making Medicare prescription care more affordable by eliminating the so-called "donut hole."
2. The House accepts the Senate bill as is, the President signs it, and the Congress immediately works to fix some of the problems with it.

The panoply of voices today, though, also reveal a Democratic party torn, fatigued and certainly worried. As one of the pundits said, though, "I wish they would stop worrying about their jobs and start focusing on the jobs of everyday Americans." The job and foreclosure numbers will, in fact, trump any decision about health care, it seems.

Among the least believable options are those that suggest "waiting," or "starting over again." To arrive at November without anything tangible is not an option.

As someone who has seen just how broken our health care system is (in spite of some terrific practitioners and approaches) as I worked with individuals facing major physical challenges in their lives, I am a firm supporter that we need change. As someone who has run a business and worked inside of many companies, I also know change does not happen quickly. I can live with the incremental. Can you?

Post your thoughts about health care and what might happen now.

Super Bowl 2010 Ads Please and Annoy

Over 106 million people watched Super Bowl on Sunday, February 7, 2010. More than the final episode of M.A.S.H. It was a record breaker! And today, millions more are voting for their favorite commercials. Betty White in the Snickers ad is topping the chart. What a bonus when Abe Vigoda also appeared at the end of that commercial!

There were other age-related ads, including one with Brett Favre, the oldest QB still playing in the NFL. Looking older with gray hair, he is accepting the MVP award at Super Bowl 2021. “Maybe I should retire,” he says with a touch of irony at the end of this Hyundai commercial. The Who performed at half-time. Pete Townsend has a blog. Oh, and did you see Kiss, the 36-year old band, shilling for Dr. Pepper? Read more about these “aging is funny” ads.

Meanwhile, the Centers for Medicare and Medicaid released its latest figures on health care spending in the U.S. Health care costs represented 17.3% of GDP in the U.S. last year. Within a few years this percentage will grow to 20%. In other words $1 of every $5 spent in the U.S. will be on health care. Many countries have nationalized health care. The UK has a national system for health care which represents about 7% of the economy. Some argue that the U.S. has no system, no organized way of controlling costs. As a political commentator said tonight, “Having a health care system of some sort seems fiscally responsible, or at least fiscally insane not to.”

Exchange: Buy, Sell or Donate Used Equipment

You may have noticed we have a tab on our website called Exchange. We’ve mentioned it before, but we thought it was time to draw your attention to it again. We created that space in direct response to our customers’ requests about what to do with that walker or wheelchair of Mom’s or Dad’s now that they no longer need it. Street value of all equipment drops like a rock once it’s out of the showroom. You know that from all the cars you’ve purchased over the years. On the other hand, there are always folks looking for equipment whether it be for a permanent illness or injury or something more temporary. As insurance and Medicare rules change continuously, many are finding it too difficult to purchase new products. Our Exchange bulletin board gives you the chance to post your need, whether you have something to sell or want to buy. We also encourage donations to non-profit organizations. When you make such a donation, you can usually write off the value of that object on your taxes. Check with your tax advisor on this before you proceed.

If you have equipment in good and usable condition in your basement or garage that you’ve said a thousand times you want to do something with, now is the time. It’s still a new feature, of course, but as you post, we get more traffic. You get more eyeballs seeing what’s out there.

Be sure to see the Toy Swap planned for July. Check our Events page, too, for more information.

Capabilities Expands Selection of Pre-Owned Products

As the economy bears down on all of us, people everywhere are making sacrifices, holding off on purchases that they might once had considered a necessity, but now have put on the "someday" list. We see folks everyday wishing they could get their mother that reclining lift chair that could make all the difference in her enjoying the day to day. Or, the woman who came in recently searching for a way to get her husband out of the house again. He gets around the house on a walker alright, so Medicare won't cover a power wheelchair. But she knows if he had one, he would be willing to visit the kids and maybe go to Target with her occasionally. There is Aunt Bess whose macular degeneration has gotten bad enough that her old trusty handheld magnifier just won't do the trick to read the morning paper anymore.


If you recognize one of these stories, or have your own wish list, visit or contact us for more information about some of our pre-owned products. We will tell you just what we know about these products, many of them sold originally by Capabilities, so we know for sure their history. Here is just a sampling:


Pride Z Chair: $3000
Pride Jazzy Power Chair with elevating leg rests and wide seat: $1500
Pride Reclining Lift Chair with Heat & Massage: $1000
Telesensory Olympia Video Reader: $1200

Health Care From Our Perspective

The health care debate can stir passions in a heartbeat! As President Obama tries to tackle this thorny topic, we hear about how the House and Senate debates are going. We hear, too, from insurers, businesses and individuals as all wrestle to find common ground. Unless you are in the durable medical equipment (DME) or home medical equipment business (HME), the ordinary person does not get a view from this perspective.

While we do not solely identify ourselves as DME or HME, we clearly have products that fall into those categories. We also spend our days working with individuals and families who face situations that they expect qualify for help from private or government insurance plans. As business owners in this field, Pam and I are often the messengers of bad news. In so many cases, neither government sponsored or private insurance companies cover what the ordinary, everyday person considers a "must have." Sometimes the response is an angry one, as if we, ourselves, have orchestrated events so as NOT to provide coverage. Other times, we see resignation as folks hear the same story over and over again that a particular product is not covered, or that their own eligibility for that product does not hold up under the scrutiny of insurers. And then there are those who fight, who take their case to those in high positions, who push the envelope, who insist that their case be considered. While these types are few and far between, we know they exist. We often do not hear the outcome, though.

So, our story as a business owners is a mixed one. We offer a store full of an array of practical products (and a bunch of unique ones, too) that people might find in five or six different venues, including online stores. We love that we can contribute to someone's independence or a family's set of potential solutions for a loved one in this very tangible way. On the other hand, we all too often have to deliver the unpleasant news that Medicare, or some private payer, will either not cover the item, or will not let us be the provider because we are still an emerging business.

This debate is surely a hot one now in our country and it is anyone's guess how it will play out. What is certain is that not everyone will be satisfied, including those of us in this DME and HME business. We are looking to make a living. Individuals are looking to get what they need at a minimal cost given the years of contributions they believe they have made. Private insurers want profits. The government wants to keep its promise that affordable health care is possible for every American. Good luck on this one! Pleasing so many disparate parties will be a miracle.

What are your thoughts on the health care debate? Post your comments below or email your perspectives. For updates on various health care proposals you can check the government's official site or read the Kaiser Family Foundation's summaries. This site offers a side-by-side analysis of the various proposals in Congress.

Daily Living - The Effort To Make It Easier.

You have probably guessed by now that in this partnership duo, I am the one who loves to blog. I write all the time and enjoy it immensely. This week we are featuring some musings from Pam Pressel. This is the terrific thing about our being co-founders and owners of Capabilities. We each bring very different talents and skills to the table. The best part is that those differences are complimentary… at least most of the time. Oh, we have our share of issues we discuss and sometimes disagree about, but we always come back to what makes us such a winning team. We share the same passionate vision about Capabilities. When we were working on the plan before we opened, we would give ourselves assignments. For example, we challenged ourselves to each go off and write what we saw as the vision and purpose of Capabilities. It was remarkable to share our notes later and see just how similarly we saw the possibilities. Capabilities would not be the great company it is today without each of our contributions. I feel very lucky to have Pam as my partner. So, while Pam does not do a lot of writing, she is an incredible expert in the field of health and retail. She is my constant teacher and I appreciate her patience and knowledge. She also has many interesting musings about our business and is often asked to speak at public events. This past week Pam was a featured speaker at the National Assistive Technology Technical Assistance Partnership annual conference. This group of project directors for Assistive Technology programs from around the country gather annually to share the latest information regarding how to get tools and programs into the hands of those who need them. You can find out more about all this by reading Pam’s blog. You can see what the Colorado Assistive Technology Project is up to by visiting uchsc.edu/atp.

First of all, let’s clarify the term “assistive device.” Essentially, it is anything that helps someone do something more easily and independently. Those jar openers you see everywhere are “assistive devices.” So are grab bars in bathrooms. We are surrounded by such tools in our daily lives. Our goal at Capabilities – and the goal of those attending the recent conference I spoke at – is to ensure accessibility to the array of assistive devices that make daily living easier and more manageable, regardless of age or ability.

There are three major themes:
1. How generations shop differently, make their decisions for assistive products differently.
2. How a combined physical store presence and web presence spans multigenerational access to assistive devices.
3. How emerging trends are influencing the types of assistive devices available.

First, how generations shop differently.
Customers from the Silent Generation, shop differently from their Boomer children. They tend to be independent and want to do things themselves, including bootstrapping a solution to a problem. They purchase products and services, but they have to be able to perceive the value of an item as a necessary addition, unlike Boomers who sometimes buy things just because they are “cool.” The Silent Generation will often turn away from a needed product because of the price.

Boomers on the other hand are used to buying what they want and expect elements of design, style, choice and price to be present. Boomers are not AGING! Or at least, they are committed to doing it very differently.

We find, being among the Boomer generation, that they, we, are searching now for the products and services that will help them remain healthy, independent and in their own homes. Boomers especially appreciate having choice in the distribution channel. Being able to purchase assistive devices either from the store or online is important, especially when they are helping care for their parents long distance.

These two generations converge in scenarios that look like this: Dad or Mom shops focusing on price and insurance reimbursement. Many pay less to style, choice and personal comfort. Customers over 75 are more likely to settle for whatever Medicare will allow. Since price is often most important to them, they will talk themselves out of a needed device and say they can get by without or figure out a substitute. We see many customers who come in with equipment they have borrowed or purchased at yard sales. Often they are using equipment that is of poor quality or poor fit. When the Boomer son or daughter is shopping with Mom or Dad, he or she usually encourages the parent to get the best and will often purchase it for the parents.

That leads to our second area of discussion. Making products accessible through a variety of distribution channels enhances the odds that people will discover them. As more and more of the public shop on line, we have to be sure that we are adding value as a storefront. Even with the increase in internet based shopping, studies show that a retailer that creates experiential environments for their customer has a better chance of winning that customer loyalty and repeat business. Customer-focused problem solving creates the loyalty and trust that retailers need to keep the customer coming back to the location.

Capabilities began with the mission of creating a shopping experience for our customers similar to Sharper Image and Brookstone. We believe the more someone can touch, experiment with and understand a product before they purchase enhances the overall experience and pleasure of buying it. It’s likely to stay in the customers hands, too, and not come back as a return. Our job is to de-mystify medical equipment and assistive devices and provide appropriate solutions for challenges.

We are using our new web site to extend the look and feel of the bricks and mortar store to the virtual store. Accessibility to products multiplies with this dual approach. Our customers can use either the physical location or the web site. We find that they do so in a combination of ways. They may research first on the web and then come in to touch and feel, or they may come in for a fitting and then use our web site for subsequent purchases. Compression stockings and incontinence supplies are perfect examples.

We actually find that many people in general still like to come into a store and see what a thing looks like. The difference is that the older the customer, the less likely he or she is to shop online. Surprisingly, though, we do see some customers in their early 80s looking online first. They use it for research and then come in to check it out before they purchase. Many still like the idea of having a local retailer in case there is a problem and they need to return the item.

Third, the trends we see and how they are influencing product availability. The emerging Boomer market with its demand for style, design, choice is driving new product development and a new cultural framework around aging. We see 4 categories of changes influencing products and service:

• Design: It’s a slow transformation, but we are beginning to see manufacturers introduce a sense of style. For example, Drive Medical. They’ve engaged Michael Graves, a renowned designer and architect, commissioned by Target and other mega-corporations over the last decade to introduce design into the everyday products they sell. We’re invited regularly to chat with the Michael Graves product designers to offer feedback on their emerging ideas.
  Their first releases due this Fall in the bath safety area have clean lines, a splash of color and rounded edges. As Boomers age and need more products to enhance independence and mobility, this approach to manufacturing will take root across the industry. Pride Mobility released three new designs for lift chairs this year, including new fabric choices and colors. Manufacturers of pillows and cushions are also developing unique and varied designs. Obus Forme, for example, released a unique back support with an attractive and functional curve. They also highlight the scientific research that led them to this design. And manufacturers of wheelchairs, scooters and walkers have made at least one model of each that sports some new design element.

• Focus on brain fitness: Kathryn has written quite a bit so far in our blogs about this phenomenon and the role we are playing. We are actively looking for more unique products to compliment the addition of this great software to our product mix. Every day we discover new ones as manufacturers jump on this important trend.

• Products for staying home, aging in place as some call this phenomenon, are multiplying as Boomers age. Transforming one’s home becomes more and more feasible. There have been adaptive products for making the home safer and more easily maneuverable, especially since the passage of the ADA in the early 90s. What we notice is that there are more and more manufacturers getting into this arena. Ten years ago there might have been two or three major choices for stair lifts, for example, while now there are a dozen or more, some of them packaged almost as do-it-yourself. Of special interest to us is the Safety Bath. Designed by an entrepreneur in Canada, this tub features a lower threshold lip for easy access, a door that opens out (not in as does the tub that has occupied center stage), whirlpool jets, and a raised cushioned seat. The newest models also sport features of a warm air massage unit. While the technology exists to transform ordinary kitchen cabinets and counter tops into those that adjust to the level of the user, we find they have not yet become a popular choice. We predict this whole arena of home modification and adaptation will grow.

• Low vision is no longer just the realm of handheld magnifiers. Low vision is now recognized to be the critical issue it is. Vision plays a key role in an individual’s perceptions of independence and mobility. Electronic solutions are expanding. One that impresses us gives the user the option of focusing the camera in three different ways: one as a traditional video reader, or CCTV; a second option to point the camera away from the eye to enhance long distance vision; and, a third use as a magnifying mirror. On the service side, Colorado is a leader with a new designation for some Doctors of Optometry. The state now has a special certification specifically for low vision. These are the doctors we invite to present at our seminars.

It is an exciting time to be in now with the “Boomer tsunami” growing. I’ve heard that term twice now in the past 2 months, so it must be building. There is also reference to “Boomsday,” January 1, 2008, when the first of this generation will turn 62 and become eligible for Social Security. Economists are predicting all kinds of economic shifts once this happens. We predict the focus on assistive devices will sharpen. We have opportunities now to create very different futures for ourselves and our children.

Assistive devices are finally emerging out of what has been the sole realm of medical manufacturers, and are now coming from mainstream companies bringing the costs down for many. Volume of product will increase in the coming years; costs will reduce. Continued miniaturization in the computer industry will create new products helping people see, hear, speak, live comfortably and independently. We are thrilled to be at the cutting edge of this new way of bringing assistive technology and devices to the public.

Our Home is "Working" For Us

This week we are delighted to welcome another guest blogger - George Goth. George has held a popular series of informational sessions at Capabilities about reverse mortgages. These financial tools can make very good sense for a large number of people. George helps explain whether they might be a good option for your or your parents. He is also holding a free session on this Thursday at Capabilities. Details on our Events page.

Many people think Reverse Mortgages are just for senior homeowners who have lived in their homes for a long time, own the home free and clear, and need cash. Many homeowners are now utilizing Reverse Mortgages in new and creative ways to finance a wide variety of family needs, ranging from in-home care, to vacations, to remodeling their current home, to purchase of a second home, or even down sizing to a smaller home.

The following is a compelling true story of how one couple used a Reverse Mortgage to pay off their debts, complete some much needed remodeling projects and still receive a monthly income. All of this was accomplished without the requirement to make monthly mortgage payments.

Harvey and Jane Jensen (not their real names) have lived in the Denver area since shortly after they were married in 1965. They still live in the same three bedroom ranch-style home they purchased in 1970. They love their home and have no desire to move.

Harvey’s income situation changed drastically in 1998 and they were forced to take out a home equity loan, just to make ends meet. And that worked well until just recently. Harvey started thinking about retirement, but they were concerned about their ability to continue making the monthly home equity loan payment.

Their oldest son suggested they check out a Reverse Mortgage. He told them he knew they would qualify since they were both over 62 and had equity in their home.

I met with the Jensen’s and provided them with a complimentary, no-obligation, analysis of the Reverse Mortgage program and the funds available to them. They were pleased to learn the funds received from a Reverse Mortgage have no impact on Social Security and Medicare benefits and they did not have to meet any income, employment, or credit score requirements to qualify.

Following my meeting with the Jensen’s, Harvey and Jane attended a free, one hour counseling session with a HUD approved housing counselor. This is a requirement for obtaining a Reverse Mortgage. They left this session feeling even more comfortable with their decision apply for a Reverse Mortgage on their property.

Based on the $193,000 value of their home, the age of the youngest borrower (69), and the current interest rate, the Jensen’s had $102,000 of tax-free funds available. After paying off the existing home equity loan of $38,000, Harvey and Jane still had $64,000 to use however they desired.

The Jensen’s decided to receive a $300.00 monthly payment (guaranteed as long as one of them lives in their home) and leave the remaining balance in a line of credit to use as needed. They plan to use some of the money to remodel their kitchen and upgrade the landscaping.

Harvey said, “The Reverse Mortgage is really great. We paid off our old loan, have a guaranteed monthly income, and now we can finally make the improvements we’ve wanted to make for some time.” Jane added, “All of this is possible without even having to make monthly mortgage payments. We are now making our home work for us. What could be better than that?”

George is a Reverse Mortgage Specialist with Universal Lending. He can be reached at (303) 420-9601, (800) 758-4063 ext. 304, or www.ggoth.ulcreverse.com. Consider coming along to George's session on this Thursday at Capabilities. Details are on our Events page.