This article is an introduction to the process of screening those long-term care individuals in our facilities that may benefit from a more personalized wheelchair seating system. You don’t have to be a wheelchair expert to determine when there is a need for better seating and positioning. As therapists, we are the best eyes in our facilities as we walk the halls numerous times a day to attend to our next patient.
We have all seen the patients/residents who are leaning to one side with an upper extremity either hanging over the armrest or trapped between the armrest and their trunk. Or maybe you have seen someone in a sacral sitting position looking as if at any moment they are about to slide out of their wheelchair (and sometimes they do!). How about those individuals who sit in a forward flexed posture as if they are intently staring at their lap or the floor? We know these people. Many times we treated them when they first came into our facilities, or they might be on active caseload right now.
These are the individuals who would benefit the most from our attention as they are at risk for shearing and pressure sores. Optimal wheelchair seating and positioning can also enhance their interactions with their environment. Maybe, by providing a wheelchair that addresses their needs, they can tolerate longer time in their chair so they can participate in facility activities, or visits from their families. Improved positioning in a wheelchair can positively affect one’s ability to eat and swallow. And let’s not forget about breathing. How well can you breathe when you are slumped forward? Good wheelchair seating and positioning can also diminish an individual’s complaint of pain.
So, what are the steps you need to take to secure the right wheelchair for a patient? If the patient benefits from Medicaid, a wheelchair request can be submitted to Department of Social and Health Services (DSHS) in Washington; or check with your state health department on how to submit a request. For private pay, approach the family to assess their willingness to pay out of pocket for a personal wheelchair. I cannot speak for all vendors, but the wheelchair vendor I use has “gently used” wheelchair frames at a lower cost. The styles of backrest and pressure relief cushions are new and added to the overall cost of the wheelchair. Ask your vendor if this option is available.
We created a screening form (click here to print your own!) to determine the need for a personal wheelchair. The bottom portion of the form acts as your MD order. You can designate whether the order is for Physical Therapy or Occupational Therapy. Once the signed MD order is returned, you can coordinate with your wheelchair vendor for a consultation. You can also check with the facility to see if an appropriate wheelchair is available.
Infinity Rehab therapists are required to submit two evaluations; one for the facility through ROX (our internal therapy management software) for home office approval and one for the state-level department of health. When the department of health evaluation is completed it must be submitted to the attending physician for their signature and include their credentials. Once the signed state evaluation form is returned, it can then be faxed to the vendor (the vendor provides their documentation along with the completed, signed department of health evaluation). The entire order process can take up to six weeks to be approved. Be prepared to provide further justification to the state at their request. I find the more thorough I am in my documentation, the fewer requests I receive for justification by the state.
For more, be sure to check out part 2 and part 3 of our wheelchair assessment series.
Keri Poffel is a Physical Therapist and Master Clinician with Infinity Rehab. She earned her Master’s in Physical Therapy from Eastern Washington University. She joined the Infinity Rehab family soon after graduation and has practiced at Avamere Olympic Rehab of Sequim since December 2003. Keri became a board certified Geriatric Clinical Specialist in 2008 and earned her Clinical Instructor accreditation from the American Physical Therapy Association in 2009.