Most of us would love to live our lives without the need for mobility aids, but as we age, we begin to realize that this wish may be unrealistic. We could need a cane or a walker for a short time while recovering from surgery, or we may eventually need to use a wheel chair or a power scooter to get around safely. Either way, a tool to help us move from place to place and avoid falls can mean the difference between living independently and depending on others for our basic needs.
When I see some of the newer mobility aids on the market, I immediately think, “I wish that had been available for my mom.” My mother’s options back in the day were a basic cane and later a stripped-down walker, which I did my best to modify so she could carry things around with her. However, with the growing number of new devices and models available comes growing confusion over which one is the best fit and whether insurance will cover it.
Expert Advice Is Crucial
Too often, a well-meaning friend or relative will buy a used cane or walker for a loved one without realizing that one size does not fit all. The wrong device can negatively affect a senior’s stability, cause posture-related problems and even result in pain. Mobility aids come in all shapes and sizes, so selecting the right equipment and achieving a proper fit usually requires a professional’s assistance and expertise.
Nancy Froslie, certified Assistive Technology Professional and district operations manager for Sanford HealthCare Accessories in Fargo, N.D., says that the first step in choosing a mobility aid is to make a doctor’s appointment.
“The physician should do a physical exam and discuss any difficulties the senior is having with completing activities of daily living (ADLs) at home,” she says.
From there, the doctor may provide a referral to an occupational therapist or physical therapist, especially for higher-end and customizable equipment.
“The therapist will conduct a one-time mobility assessment to evaluate gait and balance and perform muscle and strength testing,” Froslie explains. “They will also have the patient try different types of equipment to document what is and isn’t effective.”
These appointments often involve an assistive technology professional (ATP) from a medical equipment supplier. Not only is it important to choose the correct type of walking aid, but it is important to ensure the user is fitted for the device and trained by a professional on how to use it properly. A certified ATP is someone who has been trained to identify the needs of individuals with disabilities, recommend appropriate technologies and equipment to help them live independently, and provide instructions for using these aids.
“ATPs like myself help determine what devices will best fit a senior’s needs both medically and within the layout of their home,” Froslie notes.
To get started on finding a mobility aid for a loved one, explore the detailed list of common devices below and how they’re usually prescribed. Keep in mind that, while some seniors may be able to purchase more basic equipment like a cane or walker without a medical professional’s help, the fit may not be ideal, and you’ll end up paying out of pocket for these items.
Mobility Aids for Ambulatory Seniors
Canes provide seniors with an additional point of support to enhance safety and stability. As a rule of thumb, a cane should be able to support up to 25 percent of a person’s body weight and is most useful for those whose balance is minimally impaired or who have one leg that is significantly weaker than the other.
Canes require moderate hand and arm strength and come with either a hook (“C” cane) or horizontal grip (functional grip cane). The horizontal grip is recommended for people with hand weakness, as it provides for a secure grasp and a larger weight-bearing surface for the hand. The tip of a cane can be a single contact point or a quad base composed of four separate feet. The additional feet provide more stability, and the bases are available in various sizes. A quad cane can stand upright when not in use, but these models are usually somewhat heavier than traditional designs.
To select the proper length for a cane, have the user stand up straight with shoes on and arms at their sides. The top of the cane should reach the crease on the underside of their wrist, and their elbow should be flexed 15 to 20 degrees when holding the cane while standing. An adjustable cane is a good choice for accommodating different styles of shoes.
Walkers and Rollators
A walker may be the next option when a cane cannot provide sufficient support. Use of a walker also requires moderate hand and arm strength and, depending on the style of walker, it may be able to support up to 50 percent of a senior’s body weight. A standard design has two or four fixed legs and must be lifted and maneuvered with each step. This standard model is best for someone with significant stability issues.
Wheeled walkers, also known as rollators, come in many variations with anywhere from three to seven wheels and are generally easier to maneuver. Most models can be folded for easy storage, and some include locking handbrakes for added safety, a bench seat for resting, or a basket for carrying personal items. Rollators are commonly made of lightweight metals like aluminum and are similar to walking with a shopping cart. Compared to standard walkers, rollators allow for a more normal gait and the ability to move with less fatigue. However, rollators may not provide adequate stability for seniors with significant posture and balance issues.
The correct height of a walker is measured from the floor to the wrist, and the elbows should be flexed in a range of 15 to 20 degrees. Be sure the walker is large enough to surround the user on three sides, so they can use the device for both front and side support.
Mobility Aids for Seniors Who Are Unable to Walk
A motorized scooter can be helpful for seniors who have some arm strength and dexterity but are unable to walk long distances. However, the user must be able to sit upright for an extended period of time and control a scooter’s throttle. Not all people (especially those with arthritis) are able to keep their arms extended in front of them to control speed, steering and braking. Some individuals may experience aches and pains while doing this, depending on their diagnosis.
Scooters come in many different designs, including three- or four-wheeled models, those intended for indoor use, outdoor use, or both, heavy-duty models designed for rugged outdoor terrain and carrying heavy loads, and lightweight travel models.
Indoor scooters typically have a narrow base, three wheels designed not to leave marks on floors, and front-wheel drive for greater maneuverability in tight spaces. Rear-wheel drive provides greater traction for outdoor models, which typically feature four wheels for enhanced stability on a variety of terrains. Both types usually have adjustable chassis, armrests, and seats, and come in models designed for specific body types, such as taller, shorter or bariatric users. They are also available in ultra-light varieties that can be partially disassembled or collapsed for easy portability.
While a wide variety of scooters for various uses are available on the market, insurance companies will only cover durable medical equipment that is needed within a senior’s home. Devices intended for use outdoors or over long distances will not be covered. For example, Medicare Part B requires an in-person examination by a doctor, whose prescription and notes must show that a power scooter is medically necessary for the senior to remain mobile within their home. For most people, that is not the case.
Excessive fatigue, unsteadiness, difficulty rising from a chair and occasional falls are indications that a cane or walker may not provide sufficient support. If your loved one is unable to sit upright or lacks the arm strength or dexterity to operate a scooter, a wheelchair might be the best option to help them remain independent and participate in the activities they enjoy.
When it comes to manual wheelchairs, there are three basic types: standard, lightweight and ultra-lightweight. A standard wheelchair is just like what you see in the hospital. It is very basic and doesn’t feature much adjustability. The person’s height, weight and hip measurements will be used to determine what size is needed. The biggest drawback is that these models weigh about 40 pounds, so it is important that a caregiver or family member is able to assist with transporting it for use outside the home.
Lightweight wheelchairs weigh about 35 pounds. The only time insurance companies will consider covering a lightweight wheelchair is if the individual is unable to self-propel a standard model. The ability of the person’s spouse or caregiver being able to lift the device into and out of a car does not factor into the insurance company’s determination. Both coverage and need are solely based on the individual who is using the equipment.
Ultra-lightweight models are typically used by individuals who have experienced a spinal cord injury. They weigh approximately 28 pounds or less. Again, in order for insurance to consider covering this device, it has to be medically proven that the person is unable to self-propel a standard or lightweight model. Ultra-lightweight wheelchairs are great because they can be customized to the individual. Body measurements are taken, and the chair is made by the manufacturer according to those specifications. Different types of armrests, tires and colors can also be selected to further help an individual self-propel.
Selecting a power wheelchair will require familiarity with terms normally associated with a car purchase, such as front-wheel drive and independent suspension. Each type of system has its advantages, and you may need to balance the doctor’s prescription with insurance coverage, budget limitations and personal preference to determine the best power wheelchair for your loved one’s needs.
These devices come in a variety of makes, models and sizes. They usually have a smaller footprint for increased maneuverability and perform well both inside and outside the home. A person’s diagnosis will determine the type of wheelchair their insurance may cover. For example, individuals with a progressive disease, such as multiple sclerosis, muscular dystrophy, or ALS, would qualify for a power wheelchair that can be modified to meet their unique needs as their condition progresses. Only those individuals who are unable to ambulate or use a manual wheelchair would qualify for coverage of a standard power wheelchair.
Costs and Insurance Coverage for Mobility Aids
It may be tempting to buy a mobility aid online or at a local drugstore or resale shop, but keep in mind that the experts are extremely knowledgeable in these matters. Not only will they be able to recommend the best device and fit it to your loved one, but they will also be able to explain how to use it and help ensure it is covered by insurance.
“No matter what type of equipment you may need, there is always a lot of paperwork involved for insurance companies to determine if they will cover durable medical equipment,” Froslie mentions.
Keep in mind that most companies will only pay for the basic necessities, but some extra features and accessories can be added and paid for out of pocket. This keeps costs down and ensures that seniors do not end up relying on devices that provide more support than is required. For example, opting for a power scooter or wheelchair before it is truly needed can permanently affect a senior’s mobility, activity levels and overall health.
Taking steps to improve a senior’s safety and mobility is a gamechanger for many families. Just be sure to confer with a professional to learn what works best for your loved one’s situation, what is paid for by insurance and what “frills” you can afford to enhance the functionality of a mobility aid.