I think everyone familiar with the state of Complex Rehab Technology (CRT) wheelchair repair would agree the system is broken. The repair process for medically necessary seating and mobility equipment can be achingly slow and tangled in red tape, with good intentions crashing up against reality.
CRT stakeholders —consumers and their families, clinicians, referral sources, wheelchair suppliers, wheelchair manufacturers, and payers — are unhappy across the board.
After that, however, opinions sharply diverge on the best way forward… or even what’s to blame in the first place.
Hearing Consumers’ Pain
Ultimately, the CRT consumer is the one stranded when a wheelchair or seating that doesn’t work. Broken equipment can hinder timely and efficient weight shifting, can make transfers more difficult, can make mobility-related activities of daily living impossible to perform.
The loss of functional seating and/or the wheelchair can confine consumers to home or bed, thereby interrupting work, school, community involvement, and inclusion.
So any discussion of fixing the repair process needs to keep consumers at its heart.
The palpable pain and frustration of CRT consumers and their families have been well documented by social and mainstream media. And public outrage is one of the factors behind multiple states’ right-to-repair movements that would give consumers the ability to purchase replacement wheelchair parts and make repairs themselves.
Unfortunately, right-to-repair laws wouldn’t resolve the overall wheelchair repair problem because most repairs are not as simple as swapping in a new set of batteries. Car owners have the right to make many repairs, but how many of us would attempt an engine swap?
The vigorous push for right-to-repair laws demonstrates how complicated the wheelchair repair problem is. Right-to-repair could be part of the solution. But it won’t fix everything.
How Did We Get Here?
The current state of wheelchair repair is a massive tangle of unrealistic expectations, unneeded bureaucracy, and an infrastructure that falls short. For example: I can’t think of a comparable type of equipment that is robustly used for hours a day, that traverses all sorts of terrains and performs so many different functions… and is isn’t entitled to routine maintenance.
I’ve never understood why funding sources that paid for wheelchairs also require prior authorizations to repair those same wheelchairs. Or why wheelchair technicians aren’t compensated for the time it takes to drive to a consumer’s home and diagnose the problem, even though technicians in other fields charge routinely for house calls to examine garage doors, dishwashers, and other equipment far less crucial than wheelchairs.
Service was already a deck stacked against wheelchair providers and the consumers who depend on seating and wheeled mobility.
Then COVID-19 hit.
The Perfect Storm
Caught up in global supply chain slowdowns, CRT manufacturers struggled to purchase raw materials and electronics. Providers waited much longer for replacement parts, frustrated that a single missing part could stall an entire service order. Wheelchair techs donned protective gear and adjusted to new requirements at hospitals, clinics, and skilled nursing facilities… and some of those technicians caught COVID themselves.
A nationwide labor shortage made it difficult to hire and train new technicians to take the places of those on the sidelines.
The pandemic turned an already vulnerable repair process into the perfect storm of frustration and desperation for consumers and the rest of the industry.
A Solution Requiring Everyone’s Involvement
Wheelchair repair stories, many of them heartbreaking, are all over mainstream news. As desperation does, this has led to suggestions that sound simple to those who don’t fully understand CRT.
For example, one suggestion is for wheelchair providers to purchase, configure, and loan comparable wheelchairs to consumers whose equipment is down. But a wheelchair is medically necessary equipment; it’s not as simple as an automotive insurance company renting me a Ford Focus while my Toyota Corolla is in the shop. A CRT wheelchair is unique, custom fit, configured, and/or built to fit a single individual’s functional needs. We cannot quickly and safely swap one CRT chair for any other.
Nor can CRT providers stock every possible replacement part at all times. Even if providers can get the parts in the first place — still a pandemic-hangover challenge — we circle back to the unique nature of CRT. Providers can’t purchase and store thousands of parts that might or might not be eventually used in a repair.
I’m not a CRT consumer or a repair, policy, or funding expert. But I’ve heard enough of their conversations to conclude that the best repair solutions will require interwoven strategies.
For example, health insurance companies cover preventive services such as six-month dental cleanings because they’d rather pay for a small cavity than a root canal. Could payers reimburse for preventive wheelchair maintenance every six months or so, before small problems escalate into larger ones that take much longer to fix?
What if we created a path to maintain “backup” wheelchairs to pinch hit when primary chairs were being repaired? For that very purpose, many consumers keep their old chairs after getting replacement ones. Could there be a way to keep those backup chairs in fighting shape to be called on when needed?
Could the industry develop a career path for wheelchair technicians? Before I began covering the CRT industry, I covered the motorcycle industry, which created schools, career paths, and recruitment strategies for motorcycle techs-to-be.
And how about funding for diagnostic calls to cover the costs of driving a service van into rural communities (or in traffic-snarled urban areas)?
Bottom line: The best solutions will include all stakeholders. We’ll need manufacturers to share data on their systems. We’ll need clinicians and providers to gather real-life data, and we’ll need researchers to examine that data to tell us when we should expect wheelchairs to need service. We’ll need policy experts to work with funding sources; we’ll need to recruit, train, and support next generations of technicians.
And we’ll need to seek feedback and listen to consumers and their families every step of the way.
CRT repair is a deeply complex issue without a single, easy answer. No idea mentioned here is perfectly simple; for example, preventive maintenance plans would require funding for providers to hire more technicians, buy more service vehicles, etc. The best resolution will require all stakeholders to share openly, to listen with humility, to brainstorm inclusively, and to work together to build a constructive way forward.
Thank you to everyone already involved in doing just that.