Tuesday, October 15, 2019
Client Centred or Funding Dictated?
Over the past couple months, we have been discussing power wheelchairs. We covered everything from drive wheel configuration to power seat functions and even the integrated technology like Bluetooth. I hope that you were able to learn one or two new facts throughout this time. What happens now? As we move onto the next topic series, I first wanted one more blog to really discuss why this all matters. It is easy to read a blog and then just continue on with our busy days. Do we take the time to read and really think about how our clients can be impacted by the equipment they receive?
This can be a hard discussion to have or to even think about. For many and most countries around the world, we talk about the idea of client-centred care. This means that we are completing our treatments, planning our goals, and prescribing equipment around the client. This is what most of us discussed and learned in our university. However, often we find that we are limited in this client centred approach. What is this limitation? FUNDING! Every country that I have lived in, worked in, or visited have all had the same barrier – Funding. We can allow funding to take over this client-centred approach and it then turns into the funding guiding our decisions on what is best for our client. Why does this matter? Our founder of Permobil perfectly answered this question so many years ago:
Every person has the right to have his or her disability compensated as far as possible by aids with the same technical standard as those we all use in our everyday lives.
So, does funding have it all wrong? No, this is not a blog to be negative to any funding. We have to remember that funding is guided by a LOT of different pieces. Some of these pieces we cannot change. However, when appropriate we can discuss and demonstrate how important it is to build and design the equipment to the client versus fitting the client into funding. This also means that we can demonstrate to our funding bodies/systems how client centred prescribing can lead to improved outcomes, increased function, increased independence, and an improved quality of life.
Many funding systems will allow the therapist to write an assessment or justification to explain why a piece of equipment is necessary if it is outside of the normal funding amount, code, or list. This can be overwhelming to many therapists to write this justification and for many good reasons. Sometimes we can be aware of the improvements in a client’s function, independence, medical benefits, but we are unable to understand how the equipment is making this change. Power wheelchairs, seating products, manual wheelchairs, they are all complex. A high-quality product is designed utilising the highest amount of research, an understanding of materials, and engineering principles. You might understand that one power wheelchair is easier for the client to maintain their position over uneven terrain versus another, but are you able to discuss how this can be related to the suspension, seating components, and their drive wheel configuration? This is where the challenge can come. How as therapists are we supposed to understand both our clients and the equipment to this high degree? As you continue to prescribe equipment this will become easier and you will continue to learn, but in the beginning remember that you have resources to help!
Reach out to your mentors, educators, manufacturers, etc… to help provide you with this information that you need. Ask the questions! There is so much information and research out there to help explain why your client might benefit from a certain function or design of their equipment.
The final thought I want to end on is to keep pushing. We have to remember how far we have come and that we have to continue to keep pushing for our clients. If we do not attempt to ask for funding on equipment that we believe is justified in improving our client’s lives, then we will never see a change in the funding. The funding system needs to hear that what they are funding is not always enough when that is the case. They may not be aware of new features and new technology and how this impacts your client. Unless you write a justification or assessment to tell the funding system that your client requires something different, we cannot blame them for not funding it. Remember to appeal too! Perhaps your first attempt did not fully explain why this equipment is necessary. If you get a denial, think about if this equipment is necessary to your client. If the answer is yes, go back to your resources, gather more information, and try to explain this again. If we do not appeal a denial, then we are essentially agreeing that this equipment is not necessary for our clients. I know this can be overwhelming at times, but remember we are here to help!
New Zealand Therapists!
I will be travelling across New Zealand at the end of November to come and talk about power wheelchairs and how the design and technology can impact our clients’ lives. Reach out to your local territory sales manager if you are interested in attending the event near you! You can always reach out to me directly at Rachel.Fabiniak@permobil.com.