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Access to Mobility Devices: Policy Report

Your Move Ontario

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Executive Summary

Through the Ontario Ministry of Health’s Assistive Devices Program (ADP), the Ontario Government provides funding for mobility devices, including power wheelchairs and positioning devices, for community-dwelling individuals. These devices are fundamentally important for Ontarians with spinal cord injuries and other disabilities who live at home across the province. They help people with disabilities live the life they choose despite overwhelming challenges. And, because they are at home and not in a hospital or long-term care home, they reduce the financial burden on our health care system. People with disabilities, however, need other basic devices to perform mobility-related activities of daily living that the Ontario Government chooses not to fund. These include therapeutic support surfaces, which are designed to prevent or manage pressure wounds, as well as transfer devices (floor and ceiling lifts), which allow caregivers to transfer individuals without manual lifting. Both therapeutic support surfaces and floor and ceiling lifts are covered by the B.C., Alberta, and Quebec Governments but not in Ontario.

Moreover, mobility aids such as seat-elevate devices and standing wheelchairs can either facilitate safer and more independent transfers, or they can help users meet a variety of medical and functional needs. They should be covered, too. If the Ontario Government helps ensure that people with disabilities have the right mobility device, the right support surface, the right transfer device, and the right bathroom equipment, it would not only go a long way to providing these Ontarians with the equipment they need to live the life they choose, but also decrease Long-term Care (LTC) home waitlists and reduce the number of Alternate Level of Care (ALC) patients who are unnecessarily occupying hospital beds today. In many cases, it would save costs that are currently incurred by the province’s health care system needlessly. This policy paper examines therapeutic support surfaces, transfer devices, seat-elevating devices and standing wheelchairs, including their rationale, the research associated with their use, and what other jurisdictions are doing. In each section, it provides specific recommendations as it relates to government funding.

Report Highlights

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Ontario’s Ministry of Health should fund pressure-management beds or therapeutic support surfaces for community-dwelling individuals when it is deemed medically essential to prevent skin breakdown, maintain skin integrity, or manage pressure injuries when they occur. Therapeutic support surfaces are currently covered in B.C., Alberta and Quebec.

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Ontario’s Ministry of Health should fund a floor or ceiling lift for community-dwelling individuals when it is medically necessary to facilitate the transfer of a person in a bedroom or bathroom. Floor and ceiling lifts are currently covered in B.C., Alberta and Quebec.

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Ontario’s Ministry of Health should fund seat-elevating devices for people using power wheelchairs who have the potential to use the device when transferring from the wheelchair to another surface to perform mobility-related activities of daily living, or who have the potential for paid or voluntary employment.

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Ontario’s Ministry of Health should fund standing wheelchairs for people who have the potential for paid or voluntary employment.

Supporting Research

Julianna Arva, Mark R Schmeler, Michelle L Lange, Daniel D Lipka, Lauren E Rosen. “RESNA position on the application of seat-elevating devices for wheelchair users.” Assist Technol. 2009 Summer. https://pubmed.ncbi.nlm.nih.gov/19715251/.

Chan BC, Nanwa N, Mittmann N, Bryant D, Coyte PC, Houghton PE. “The average cost of pressure ulcer management in a community dwelling spinal cord injury population”; International Wound Journal; 2013.

Health Quality Ontario. “Pressure Injuries: Care for Patients in All Settings.” Quality Standards. https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-pressure-injuries-clinical-guide-en.pdf.

Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition. Letter to the Centers for Medicare and Medicaid Services. September 15, 2020. https://itemcoalition.files.wordpress.com/2020/09/letter-to-cms-re.-request-for-reconsideration-of-ncd-for-mae.pdf.

National Council on Disability. “NCD letter to CMS regarding standing and seat elevation systems”. August 31, 2020. https://ncd.gov/publications/2020/ncd-letter-cms-regarding-standing-and-seat-elevation-systems.

Birgitta Nordström, Annika Näslund, Margareta Eriksson, Lars Nyberg and Lilly Ekenberg. “The Impact of Supported Standing on Well-Being and Quality of Life”. Physiotherapy Canada. 2013 Fall. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817885/.

Linda Norton. “Lifts and transfers: Thoughts for caregivers” Caregiving Matters. October 5, 2012. https://caregivingmatters.ca/lifts-and-transfers-thoughts-for-caregivers/

Rehabilitation Engineering & Assistive Technology Society of North America. “RESNA Position on the Application of Wheelchair Standing Devices”. March 2007. https://www.rstce.pitt.edu/RSTCE_Resources/RSTCE_Res_Doc/Resna_position_on_wheelchair_standers.pdf

University of Toronto, McMaster Health Forum and March of Dimes Canada. “AGE-WELL NCE: Access to Assistive Technology in Canada: A Jurisdictional Scan of Programs”. June 2017. https://agewell-nce.ca/wp-content/uploads/2019/01/age-well_jurisdictional-scan_2017_June-30_FINAL.pdf.

WorkSafeBC. “Handle With Care: Patient Handling and the Application of Ergonomics (MSI) Requirements”. https://www.worksafebc.com/en/resources/health-safety/books-guides/handle-with-care-patient-handling-application-ergonomics-musculoskeletal-msi-requirements?lang=en

WSIB. “Independent Living Devices.” https://www.wsib.ca/en/operational-policy-manual/independent-living-devices. And University of Toronto, McMaster Health Forum and March of Dimes Canada. “AGE-WELL NCE: Access to Assistive Technology in Canada: A Jurisdictional Scan of Programs”. June 2017. https://agewell-nce.ca/wp-content/uploads/2019/01/age-well_jurisdictional-scan_2017_June-30_FINAL.pdf

Let’s ensure Ontarians have access to the assistive devices they require.

Why does the Ontario government fund some mobility devices for Ontarians with disabilities, and yet it chooses not to fund the devices people need to get out of bed and go to the washroom? How does that make sense?.

– SCIO Community Member
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