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Mom has serious mobility issues. Has bone on bone arthritis in one knee and has had 3 replacements of left hip. Due to post surgical infection, (as well as her age and general medical condition) she can not have knee repaired. She also has severe spinal (lumbar) and cervical stenosis.

She is in constant pain and we always must choose between pain coverage and mental status...so sensitive to pain meds that she usually takes just advil or tylenol...and suffers.

PT folks have said there is no hope in getting her stronger...so when is it time? And who (which Doctor) orders this so that we can get some coverage for the needed equipment?

* If you have done this with your loved one, how did it go?
* How did you keep them able to transfer independently?
* Did you need to get a wheelchair van/car etc for transportation?
* How did you parent deal with the idea of being "chair bound"?

Thanks for your help and ideas!

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We have tried a variety of pain patches - but if we get enough meds going in they cause vertigo and other issues.

Rollator won't work because of her limited strength, the rollator goes too fast. Her gate is un-even and the rollator makes that worse. (She has a rollator and used to use both a 4 wheel and three wheel one.

I took mom to the grocery store - her favorite thing!!! She is so happy and independent on the store MART CART. She zooms all over the store. Chats up clerks and customers. Get people to get her things from the top shelf, etc.

I think the same would be true at home...maybe it is time!
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Get her doc to sign off on an RX for a Rollator walker so that Medicare covers it.
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Have prescription strength pain patches been tried?
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Thanks folks for all the information and suggestions.

Mom is unable to use a rollator because they "go too fast" for her limited mobility. Currently she only leaves the house when someone can take her in a transport chair. I think the time is coming when this is a good decision for all concerned. We live downstairs from her and she can't come down to visit without us going to get her...very limiting.

I'll let you know how it goes...
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"while the contractor gets to decide who needs care and probably makes a fortune cause the materials are dirt cheap."

This certainly doesn't apply to the oxygen market. And I really don't understand how "the contractor" (and who is "the contractor" - or do you mean supplier?) can make decisions on who is in need of care.

Probably makes a fortune? Again, this most certainly does not apply to the DME oxygen market. Suppliers have gone out of business, other DME suppliers have drastically cut back their services, and patients are the ones who are caught in the jaws of these changes.

But from what I've told by a knowledgeable former oxygen supplier, competitive bidding is in part a response to the legislation creating Part D; funds needed to be shifted from somewhere to fund Part D and DME was one of the targets.
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what really stinks about that whole deal with the scooter store is that the free market got bumped because medicare went to contracted bidding for equipment, which means that, rather than allowing the consumer to have a choice of product at a capped dollar amount, (with the option to pay the difference in price for upgrades of thier own choosing, like blue tooth enabled, etc), everyone is now forced into being "given" much cheaper built and not as durable equipment in the interest of saving money for medicare.....(which it doesn't really because the amount was always paid before, just in a lump sum, not a capped rental like it is now) and people get stuck with a much poorer machine, while the contractor gets to decide who needs care and probably makes a fortune cause the materials are dirt cheap. ANother option if a person wanted to avoid the capped rental/cheap equipment route....care credit has reasonable terms on financing, and a person can get what they want. I think the scooter store had decent equipment but someone decided that cracking down on "abuse" was a good idea. Lotta people can't get those chairs serviced anywhere anymore and are really stuck. lousy deal, imho. You Tube has videos about transfering in and out of the car. I put my chair on the back of my car and walk around to the seat using my walker as a chair, but I don't have a lot of help. Now, I have a van, but back before the "Hoover round" was approved, I had to make do. I love how the doctors office started calling it "Hoover"......first the vaccumme cleaner, now the "car".......lol
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Yes, true, cars can be fitted with lifts, etc. Check with the dealer on the torque of the car frame, because some (not all) cars will need to have heavy duty shocks and struts installed, eventually, or risk being pulled out of alignment, if the chair is transported every day or regularly. I have been using one for about twenty years or longer and am care giver for an elderly family member...I have been through it with chairs (and we hire folks for some things i can not do.....). There is a place called wholesale batteries direct dot com that supplies batteries for half the price as what is charged for replacement batteries at the medical supply store. They usually last several years, but are not cheap to replace.

That being said, i am so grateful to not be falling daily, and not having so much pain. I can actually get my own dinner cooked and laundry done in a safe manner now. There are other tools that can help a person transfer to the car...handles for the car, transfer boards for the bathroom, etc. depending on what a person can do on their own. overall, it has been a blessing for me.
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PS. My regret is that I wished I had been more open to the idea and understood/considered the quality of her daily life sooner.
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Lots of interesting info and good advice. If she can transfer at all into a car, most cars can be fitted with a hitch and carrier for the scooter to take with you wherever she goes so you won't necessarily be needing a van (which have all kinds of adaptions required for strapping in a wheeled chair for safety). The hitch for our car $180 installed. The platform a bit more. Your climate may mean a cover to protect the chair when it's on the lift. Talk with the OT and PT about your concerns of pain, mobility, circulation, etc. Quality of life was the biggest consideration in my mom begrudgingly getting an e-scooter as she couldn't enjoy anything or really manage getting out of the house with the other solutions like rollators. When she couldnt leave the house it was definitely time. After some adjustments it helped her a LOT overall. She saved her energy everday for doing things she hadn't enjoyed in a while, like a real vs. sponge baths, talking with friends, etc. she gained strength vs staying in bed bc it was all too hard before. But everyone is different. Good question. Best of luck.
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Medicare can tell you if your state is contracted bidding, in California its hover round. The pm&r doc referred to OT & PT for mobility evaluation. Keep copies of these, they get lost....they must be completed within 30 days of dr referring, and then complete rx must be sent by dr office again, which means two visits to pm&r...the wheelchair company is not allowed to call the patient at all so you must stay on top of them its not a strramlined process. Also the wheelchair company will have their own account number, which needs to be written on every page of the pt report, the ot report and the dr rx. Also her residence needs a clear path throughout and wide enough doors...needed to move about in the home. Medicare only pays for that...taking it anywhere else is a "side effect"....the hard part is that the patient or authorized representative must keep on top of the timelines with the paperwork. Its a very fast turn around and doctors are not always aware. Also it has to be written. Accirding to the language that will be paid for...not just pain, or mobility...there are resources online or the doctor can call the wheelchair provider. Keep copies, the wheelchair provider tends to lose parts of the application. It's worth it once it happens. Noridian is who approves DME with medicare. For me, its "time" when that particular tool will improve my quality of life. A lot of folks seem to have a stigma associated with wheelchair use, which is unfortunate, because actually a persons quality of life improves. Only some people are "confined" to it....even when using it almost exclusively, try to see it as a tool and not a way of life. Btw, if you are not "stuck" using medicare, there is a terriffic company called spin life that has chairs that are a bit better made, and come completely apart, for easier transport. Jazzy makes some that turn on a dime, and have enough power to go a few miles outdoors. If you go with the hover round model dont let them talk you into the 347.00 reclining back....even if the doctor prescribed it, medicare doesn't cover it, but...its a .69 cotter pin that can be removed at home by a ten year old and a pair of pliers. If I had known that, I would have declined it. Elevating leg lifts are covered for edema....otherwise its cash pay....head rest is cash pay, usually, but worth the cost, imho. Good luck and many pain free days. I describe my worst days and keep my hope held out to enjoy days when the pain isn't so bad. ;).
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WOW! I'll check that Scooter Store FBI raid story. I'm shocked!
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It sounds like your mother has some really debilitating issues going on and she could use a scooter. Generally, a person should be able to move as much as possible because the longer a limb doesn't get exercise, the muscle wastes away over time. A few years ago, I was in a similar situation with arthritis in all the joints, recent total knee replacement surgery in both knees and I had 5 rounds of rehab exercises. I first had a walker which is fine for short walks but it's burdensome to the walker to have to pick up and put down over and over, especially if she is in pain or under the influence of pain meds. A rollator is similar to a walker in that you push it but it have larger wheels and a seat that sits down over a basket that can hold many items or it may have a larger basket in front and the seat sits on a couple of bars. I rejected it at first because I didn't want to depend on that but once I use it, I realized I could walk farther than ever before and could sit down to rest for a minute or two before getting up and walking again. I had to strengthen my legs after knee surgery or I would lose the muscle completely. If she is in that much pain, she needs much more than Advil. Get her to a pain doctor who will assess her condition and give her the pain meds she needs. She need to get a rollator which can be pushed easily by someone in the family and also be used by her to scoot along when she's alone. She really doesn't need to be walking much with her health issues and when you get her comfortable with pain meds, she MAY experience dizziness from them, but that's better than living with constant pain. If you can afford it or you want to go thru the paperwork, get her an electric scooter so she can get around by herself. That just makes her independent that much longer. Eventually the time will come when she will need constant care and won't be able to transfer to the scooter but as long as she's able, she will be happier and you will be to if you make it easier for her to go where she wants to go with minimum difficulty.
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Depends on her cognition - if she's able to handle one of those. Personally I think it's best to stay away from those scooters as much as possible. The more a person depends on these devices, the less they can move around. Getting in an out of a car will become impossible unless one has a transporting van and is one step closer to being bed ridden which will follow incontinence. Instead of a motorized scooter try for a walker. Medicare will pay for a walker. I got one for my mom with a doctor's prescription (and also need a documented page that justifies needing the walker), but I found one at Goodwill store for $35 and it's a lot better than the new one. Now those electric scooters are very large and cumbersome. So unless you have a moving van...good luck.
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I've been dealing with insurance coverage for wheelchairs and other DME for quite some time and find it interesting how the Scooter Store seemed to have this "carte blanche" system in play where myself and most others have to fight hard to get coverage for items. I know of many others (including myself) who had to go through months of evaluations, testing and multiple LMN to get even basic needs met. I'm sure there was some shaddy deals made but I don't buy into the innocent doctor being bullied to write a script story. Lets face it....how is that really any different than the drug rep "promoting" his product to the doctor?
The end result with these situations is the insurance companies use it as a platform to delay and deny coverage under some fraud prevention umbrella making it harder for the real claims to get processed. Watch how the criteria for scooter coverage changes in the interest of fraud prevention and the effects it will have on those who need them.
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Jenn, thank you for your very helpful perspective from a medical professional, as well as the info that the FBI raided The Scooter Store. I did some quick checking, learned more about the raid. Actually I was glad this happened because Scooter Store has sent out solicitations to my father and I (I'm most certainly not in need of one!) and has really made a nuisance of itself.

For anyone who's interested in more information, CBS News had a good report (if I provide the dot.com link, it'll just be deleted) so Google "Scooter Store, FBI Raid) and look for the CBS News hit.

That article also linked to a brief but a bit shocking informational report by the Health & Human Services OIG with some shocking revelations, including that unnecessary scooters cost Medicare $95 M in the first half of 2007 alone.

All that money....and now I have to pay for some of my tendonitis treatments out of my own pocket! GRRRRR!

I now know how to deal with all these nuisance solicitors that want to sell me back braces, scooters, pendant alerts, etc. Instead of reporting them on the DNC list, I'll continue the database I've started then forward the information to the HHS OIG and maybe the FBI for action.
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First, there is an ablation surgery which involves just numbing the nerves in the lumbar and cervical area. Medicare pays for this so check with a spine surgeon who does minimally-invasive surgery. Secondly, a doctor prescribes a mobile device. There are mobile scooters so cute now coming in many different colors that getting around in one makes it fun. (I have a scooter dealer around the corner from me and I love to see all the great colors sitting outside).
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Oh yes. I forgot to add. The pain can be terrible, but my cousin received a great relief of pain when she went on Cymbalta. It's for depression, anxiety and PAIN. I don't think it causes any sleepiness like a regular pain pill would. I haven't seen any negative side effects with my cousin. I saw a huge difference in her comfort level after going on this medication. It's taken daily and she reports no pain. It also causes contentment and a sense of well being. Of course, different things work for different people, but I would inquire about it. It was a miracle drug for my cousin.
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There is great advice here. I would encourage you to discuss if the electric is needed or if there are benefits to a regular wheelchair. I'm sure it depends on her medical condition.

I would add that when my cousin, who has severe dementia, went to a wheelchair, it wasn't as I had expected. She was already disabled due to arthritis, when she kept falling and fractured many bones, including her spine. She also has osteoprosis. To my surprise she did very well in a regular wheelchair with the foot rests removed. She is able to propel herself with her feet, even though she can't walk and at times use her hands to propel the wheelchair. It gives her good exercise and keeps her circulation going.

I had noticed that most all the foot rests were removed from the wheelchairs in the assisted living and Memory Care facilities. Then I saw why. Only a few had motorized wheelchairs and they were mainly amputees. I would inquire if your mom is able to use a regular wheelchair or if she does need electric.

Even though my cousin can't walk, keeping her feet moving in the wheelchair has allowed her to keep enough strength to be able to transfer pretty well. She can stand up to get in and out of her bed, in and out of the car (her wheelchair folds and fits in the trunk) and on to the toilet. She has trouble stepping onto a scale, but can manage with a lot of help. I'm not sure how long this will last though.
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I'm pretty familiar with this and OTJenn obviously knows and has given good advice on how to start. A skilled OT working with a PM&R doctor will know how to outline "why" she needs this and help avoid an easy insurance coverage denial that fall under the "want" column. One thing to consider is that therapy isn't just about getting better or stronger, having her perform as much as possible during the day will help her maintain what she has. Bone density and circulation are even more important than getting stronger. Pain management is the key driver here so I would suggest discussing this in more detail with a doctor to see about the options to keep her up and mobile. I'm not a drug advocate but there are many options that could provide better comfort and relief than the OTC advil she is taking now.
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I am an OT who works in this area of training, etc. FIrst of you all you need to go to an OT who works in rehab for an evaluation for what you need, as there are strick criteria now from Medicare due to the over use by the Scooter Store (who finallly was taken over by the FBI) but that has made it much wore on others The criteria now is that a person must use their motorized chair for a daily living activiity. The paperwork is very detailed about why they need this and not something else, like a manual chair, Once this is done, then a Dr appt is set for a face to face with paperwork to be filled out by Dr.Your OT should have contacted the service provided to get that paperwork. Then you are on your way. Do not do the Dr. visit first as he will not have this paperwork and Medicare does not allow a past visit. So there are two ways to do this:
1. contact outpatent rehab for OT who deals with electric mobility as you are currently seeing a PT, ask them.
2. if you dont have an OT, call local service provider who supplies these and they will contact at OT for the assessment.
Then onto Dr. Good luck. These can take 90 day or more for approval.
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So sorry this very relevant post got buried.

We got a scooter for my father, but only for outdoor use. Found it at a garage sale and bought it for $150. It wouldn't be feasible indoors because of the configuration of Dad's house - the scooters take up more space than walkers or rollators, and older houses just don't have the right layout.

My father enjoyed riding around the neighborhood on his scooter, but he actually preferred using a rollator because it allowed him to walk and maintain some mobility as well as strength. The rollator also had a basket in which he could store a portable oxygen unit.

He doesn't have the limitations your mother has, so his situation was different. But it sounds as though the time might be right for her. I don't know if there is any specific moment, but if her ability to get around is being compromised and it's affecting her physically and/or mentally, I think the time would be appropriately now.

I'm assuming she has an orthopedic doctor for ortho issues; that doctor would be my first suggestion to write a script. I don't know without checking though if and/or how much Medicare would pay for one.

Transferring wasn't an issue, as Dad's scooter was just for neighborhood exploration. I would think there would be some transfer issues though as I can't imagine any way someone could get into a car w/o standing up from the scooter, which would require painful weight bearing.

A van might be easier than a sedan as your mother could get into a vehicle if the doors slid back rather than opened sideways as passenger vehicles do. Still, I think there is going to be some weight bearing during transfer, and that could be problematic.

I expect though that someone who's had more experience with this could give betters answers than I.

My father's scooter is collapsible and can fit into the trunk of my car, but not easily. I had to remove everything in the trunk and put it in the back sear in order to get the scooter in, and it is dead weight lifting it up from the ground. I wouldn't recommend that. If you have a station wagon, SUV or van, it would be a lot easier to get it in the back as opposed to the trunk of a sedan. A portable ramp would make it even more easy, and especially easier on the back of the person doing the lifting.

I did see a lift adapted to a sedan and watched in fascination as it operated from ground level to hoist the scooter up - but I can't remember if there was a platform on top, or how the scooter was stored.

A company that specializes in mobility vehicles might have to install a lift, if that's what works to store the scooter on a vehicle.

Hope someone else with more experience in this area comes along to post.
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