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Thursday, March 14, 2013

Assistive Technology Promotes Independence for People in Nursing Facilities

by Disability.Blog Team
Photograph of a grandmother, her son and her grand daughter talking to a doctor

By Guest Blogger Chava Kintisch, Staff Attorney and Assistive Technology Project Director, Disability Rights Network of Pennsylvania

Many people with disabilities living in nursing facilities cannot operate a manual wheelchair or communicate through speech. However, people in these facilities can gain independence through Medicaid-funded assistive technology, such as power wheelchairs and augmentative communication devices. This independence can help support their transition back into the community.

According to the Assistive Technology Act of 2004, 29 U.S.C. § 3002, an assistive technology device is “any item, piece of equipment or product system, whether acquired commercially, modified or customized, that is used to increase, maintain or improve functional capabilities of individuals with disabilities.” This includes durable medical equipment (DME) and an unlimited range of other items that people with disabilities use in their daily lives. Assistive technology services include evaluation, adaptation, training, repairs and maintenance.

Generally, a nursing facility should pay for assistive technology when a person is living in that facility and receives Medicaid. The Nursing Home Reform Act requires a nursing facility that participates in Medicaid to provide services “to attain or maintain the resident’s highest practicable physical, mental and psychosocial well-being.” Services include specialized rehabilitative services, such as physical therapy, occupational therapy and speech-language therapy. Nursing facilities should also provide services to maintain or improve abilities in daily activities, including the ability to bathe; dress; groom; transfer; ambulate; toilet; eat; hear; see and use speech, language, or other functional communication systems. All of this can require the provision of appropriate DME and other assistive technology.

About 15,000 nursing facilities nationwide participate in Medicaid and are subject to these requirements. You can use the Nursing Home Compare tool to find out if a particular nursing facility participates in Medicaid.

Your state may also have programs to encourage nursing facilities to provide appropriate DME. However, nursing facilities that participate in Medicaid should provide medically necessary DME even if these incentives don’t exist in that state. For example, Pennsylvania provides additional Medicaid payments to nursing facilities for certain medically necessary custom and expensive DME, and allows people to take the equipment with them if they leave the facility. However, regulations state that nursing facilities must pay for all medically necessary DME, even if they are not given this additional Medicaid payment.

A 2003 State Medicaid Director Letter addresses ways that states can pay for medical equipment under Medicaid to aid transition of people from nursing facilities back into the community. Check with your state Medicaid office to find out if the assistive technology can go with the person if or when he or she moves out of the facility and into the community. Besides the Pennsylvania program described in the paragraph above, Pennsylvania Medicaid will pay for all medically necessary equipment and supplies for use in the community once the person has a discharge date.

Visit the national assistive technology and transition portal to find out what strategies advocates in your state have used to promote assistive technology for people in nursing facilities. This portal was developed by protection and advocacy agencies and state Assistive Technology Act programs to provide information and models for advocacy initiatives.

In Pennsylvania, the Disability Rights Network of Pennsylvania (DRN) worked with Liberty Resources, Inc., a center for independent living, to increase the provision of evaluations and power wheelchairs at a 450-bed public nursing facility. Staff members then developed an online toolkit using their experiences from this effort. DRN also worked with Pennsylvania’s Initiative on Assistive Technology to increase access to evaluations and augmentative communication devices by nursing facility residents statewide through assessment of communication needs.

Mobility and communication are the means to freedom. Residents of nursing facilities should have access to the full range of medically necessary assistive technology to promote independence and transition to the community. Medicaid law can ensure that this happens.

For More Information:
Additional Articles of Interest from the Disability Rights Network of Pennsylvania:
Chava Kintisch is a staff attorney and Assistive Technology Project Director for the Disability Rights Network of Pennsylvania (DRN). She practices exclusively in the area of civil rights for persons with disabilities, representing individuals with disabilities in order to help them gain access to assistive technology and home and community-based services under Medicaid. She can be reached at ckintisch@drnpa.org. This project is funded by a grant to the Disability Rights Network under Protection and Advocacy for Assistive Technology.

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