Wheelchairs, walkers, and canes: what does Medicare pay for, and who benefits?

Medicare's role in the distribution of mobility-related assistive technology has not been well documented, yet rapid growth and regional variation in spending, and concerns over "in-the-home" coverage criteria, highlight the need for facts. Using the 2001 Medicare Current Beneficiary Survey, we find that 6.2 percent percent of beneficiaries obtained mobility assistive technology under the Medicare durable medical equipment (DME) benefit. These beneficiaries were disproportionately poor, disabled, and users of both acute and postacute services. Average per item spending ranged from $52 for canes to $6,208 for power wheelchairs. Among beneficiaries who acquired such technology through the DME benefit, these devices comprised just 2 percent of overall Medicare spending.

Receiving help at home: the interplay of human and technological assistance.

OBJECTIVES: This research investigated use of mobility equipment as a substitute for human assistance and also examined whether use of mobility equipment results in out-of-pocket cost savings associated with formal home care services. METHODS: The authors analyzed data collected from 9,230 respondents to the Adult Followback Survey of the Disability Supplement to the 1994 and 1995 National Health Interview Survey (NHIS-D) who reported both mobility and limitations in daily living activities to test study hypotheses, using regression analyses to control for selection effects in mobility equipment use. RESULTS: Use of canes and crutches (but not walkers and wheelchairs) reduced both formal and informal hours of care received per week by sample members; there was also evidence of substitution on the individual activities of daily living task level. Use of canes and crutches was also associated with lower out-of-pocket costs for formal helping services. DISCUSSION: Findings suggest that canes and crutches are effective and efficient home care resources that have the potential to increase the autonomy of adults with disabilities and to facilitate chronic condition self-management.

Canes, crutches and home care services: the interplay of human and technological assistance.

This brief reports the results of a study investigating the efficacy of canes, crutches, walkers, and wheelchairs for people who need assistance with everyday activities and asks the question, does low assistive technology replace human help for people with disabilities? Study results show that canes and crutches are low cost, versatile aids that can partially substitute for human assistance by reducing the overall number of hours of care required. They can also reduce out-of-pocket expenses for supportive services. Walkers and wheelchairs, on the other hand, appear to supplement, rather than substitute for, human assistance. The brief concludes by recommending that greater use of canes and crutches be actively encouraged to increase the independence of people who need help with daily activities.