With some exceptions, medical equipment and disposable medical supplies are not designed for people with a specific disease or condition. Rather they are designed for people who have a particular functional limitation that is a result of their medical condition. That is, they have trouble walking, using their hands to do chores or using ordinary bathroom fixtures such as showers and toilets.
Sometimes the need for these aids is immediately apparent, for example, when an elderly person breaks a hip. At other times the need appears gradually as people have more and more trouble doing things they have always done. Caregivers must be alert to the potential need for an assistive device, since older people may try to hide their increasing disabilities. Even a visit to the doctor may not reveal that there is a problem at home with walking or cooking.
The patient's limitation of function and the duration of impairment usually determine if a device is needed and, if needed, what particular type of equipment will best improve that function. A person who only has difficulty walking long distances will require a different kind of wheelchair from one who has suffered a debilitating stroke. A scooter may be the best answer for the moderately impaired person. The number of hours per day a person will be using an item is also important in determining which equipment will be most effective. The patient's ability to operate a medical device independently, or the availability of a caregiver, also dictates whether or not a product should be prescribed and, if so, which product.
Convenience and comfort are additional factors in deciding which assistive devices a patient needs. Cushions, pillows, heating pads, special moisturizers, specialized canes, lift seats, specialized clothing for the wheelchair-bound and other such products can make it much easier to care for a patient and can prevent some common problems such as skin breakdown. Safety railings, aids for transferring from a bed to a chair, special shower heads or other similar items can be extremely helpful when caring for someone who is able to do little alone.
Assistive devices like these often ease the burden of what is called "custodial care." Third-party payers define "custodial care" as care for someone who does not require "skilled nursing care," a category used to determine whether someone is eligible for a professional nurse's visits. This is not to say that the "custodial care" patient does not require intense care, including help with personal care such as bathing, eating and getting out of bed (some of the activities of daily living referred to as "ADLs"). It simply means that the third-party payer has decided that the patient has no special medical needs such as wound dressing or IV infusion that require the skill of a nurse. Of course, many non-nurses, including family members with no training at all, often perform these same tasks. In these cases the care is called "informal," that is, unpaid.
Some durable medical equipment is more disease-specific than others. For example, oxygen cylinders are used for respiratory therapy for those suffering from asthma, emphysema and other lung diseases. A nebulizer - a machine that transforms liquid medicine into a spray - may also be used for patients with breathing disorders. Catheters and ostomy products such as drainage bags are used for patients who have lost normal bowel or bladder function due to surgery or illness. Artificial nutrition is supplied through liquids administered parenterally (feeding by vein) or enterally (feeding by tube inserted in the stomach). These products must be prescribed by a doctor.