Funding for 24-Hour Posture Management

pink piggy banks in a row

PIGGY BANKS: QUINCECREATIVE/PIXABAY

While there are many benefits of managing posture 24 hours a day, getting funding for this equipment can be a challenge.

“There are frustrations over preventative measures with some funding sources,” said Ryan Rhodes, MS, OTR/L, ATP/SMS, Pediatric Sales Specialist for Leckey at Sunrise Medical. One example: “Some won’t pay for a cheap shower chair for our elderly population because third-party funding does not find it medically necessary. But they’ll pay $100,000-plus for surgeries, hospital stays, therapy and home care when [the client] falls and breaks a hip.

“Same thing with postural supports. If we’re only sitting them in a beanbag or a chair, five years from now, we could be doing full-on spinal surgery with Harrington rods, or we may have a permanently dislocated hip that we now have to manage with pain medication and palliative care, which is not cheap and that we could have avoided with a $2000 piece of equipment 10 years ago.”

Rhodes recalled working as an occupational therapist is Louisville, Ky., when “we were very blessed with what was funded. When a kiddo came in, I would write a letter for a new mobility piece of equipment, some sort of specialty bed with a specialty mattress, a car seat if necessary, a bath chair, a standing frame, a gait trainer, an activity seat — all of it for 24-hour positioning.

“We’d talk about activities of daily living, bathing, toileting. ‘Mom and Dad, how are you doing with these transfers? What can I help with on that?’ All while looking into the future with the lens of avoiding further complications to improve quality of life.”

Matching the Optimal Equipment to the Activity

Linda Bollinger, PT, DPT, ATP/SMS, Pediatric Sales Specialist for Leckey at Sunrise Medical, said some payors question the need for multiple pieces of positioning equipment.

“We’re challenged by funding approving all these devices,” she explained. “‘Do you need a stander and a gait trainer?’ Well, yes: For standing, we want to try to develop the hip, and we’re looking to try to elongate, and with a gait trainer, we’re trying to increase functional gait and ambulation. They’re not mutually exclusive. Funding is sometimes also a challenge for bath seats, the Sleepform [sleeping] system, toileting systems: ‘Why do you need a bath seat and a toileting seat?’”

Bollinger said she still recommends the equipment she believes will best serve the child. “Every funding source is different, but as a therapist, I recommend what they need and let the chips fall where they may in trying to get funding,” she said. “Look for alternative funding: Is there a waiver, is there a great aunt who can pay for it, is there a fundraiser?

“I think sometimes therapists are reluctant to recommend so much equipment, but if we make those clinical recommendations and then address the funding afterwards, I think the outcomes are better. If the therapist is comfortable with the seating system being the same in the mobility base and the activity [base], then that works out. But if they’re looking for two alternatives — so in the mobility base, I want this to be achieved, and in the activity seat, I want this — then that might be a challenge. That’s for the clinical team to decide. Are they looking for multiple [pieces of equipment] because they’re trying to achieve alternative positioning? Or are they looking to have that same position and consistency? It just depends on how they’re approaching each child. Every child has different needs.”

This article originally appeared in the July/August 2021 issue of Mobility Management.

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