Staying seated in a custom-fitted wheelchair while in a motor vehicle makes sense on multiple fronts. First, there’s the convenience issue: Transferring out of the wheelchair and into automotive seating takes time; so does transferring back into the wheelchair afterward. Some wheelchair users require assistance with these transfers, which can slow down the process and require additional caregivers to pitch in.
But beyond that, automotive seating may not offer the postural support that a custom-built wheelchair or seating system does. Or the wheelchair may include additional equipment or accessories that are difficult and time-consuming to deal with if they have to be moved every time the wheelchair user gets into a motor vehicle.
Having the option of remaining seated in the wheelchair can give wheelchair users and their families more choices and accordingly, more independence. And plenty of today’s wheelchairs fit the bill. But are funding sources keeping up with consumer demands?
WC19: The Standard Is Still Voluntary
As described by the Rehabilitation Engineering Research Center (RERC) on Wheelchair Transportation Safety, the main goal of the WC19-compliant wheelchair “is to provide the wheelchair user with the opportunity and the option to use equipment — i.e., a wheelchair seat, a wheelchair, a wheelchair securement system, and an occupant restraint — that is comparable in design and performance to seats and restraint systems available to able-bodied travelers in motor vehicles.”
In a consumer handout about WC19, the RERC says a WC19- compliant label on a wheelchair “means that the manufacturer has designed the wheelchair for use as a seat in a motor vehicle. This is a big change from when manufacturers told consumers that wheelchairs were not to be used as vehicle seats.”
The handout goes on to say that a WC19-compliant wheelchair “has features that make it easier to secure with four-point strap-type tiedowns” and “is designed so that the person securing straps can do so easily and with one hand.”
Such chairs have passed crash tests with little or no structural damage and withstood “the forces of a 30-mph/20-g change in velocity — the same crash pulse that all automotive equipment must survive.”
The RERC adds that the WC19 standard is voluntary, so wheelchair manufacturers “are not required to comply with standards or produce products that meet them.”
Are manufacturers hearing rumblings of change among payors?
Says Chris Reidmiller, ATP, coordinator of corporate sales for Therafin Corp.: “Medicare and Medicaid have not made crash testing a requirement for seating systems on wheelchairs at this time. We believe there may come a time that this may happen.”
Tim Morrison, custom seating product manager, Sunrise Medical, says, “We are aware that crash testing is an area of focus from Medicare and Medicaid payors, but we have yet to see what the end result will be. We do anticipate some changes, but it is still too early to speculate on what those changes may be.”
The Current State of Funding
Of course, payors’ willingness to pay for systems that meet current crash-testing standards — either wheelchairs (WC19) or seating (WC20) — is also part of the bigger picture.
Jay Brislin, MSPT, director of Quantum Rehab products & clinical development, says getting crash-tested systems paid for remains difficult: “It seems to be one of those things where it’s a break-even type of scenario, or in some cases, a provider may actually lose a couple of bucks on the deal. A lot of private funding sources and Medicaids in certain states seem to ask for this or require it from a transportation standpoint (see Funding Essentials sidebar). We haven’t seen instances where Medicare is requiring it yet.”
“We still hear that providers have difficulty getting crash-tested equipment paid for,” Reidmiller says. “I’m not sure what the future holds. Healthcare needs have increased, and so have the cost of those needs. I believe that crash-tested equipment is not on the radar for funding until something drastic were to happen. Third-party pay sources have reduced reimbursements, and they are trying to keep up with the demand of our aging population, which has affected other aspects of equipment needs throughout the country.”
Understanding the Standards’ Details
In addition to convincing funding sources of the value of crash-tested systems, another challenge for seating & mobility manufacturers and providers can be educating consumer stakeholders — wheelchair users, caregivers, bus drivers, school transportation aides, etc. — about exactly what WC19 or WC20 compliance means.
As the RERC states, “Choosing a WC19-compliant wheelchair will reduce a wheelchair user’s risk of injury in the event of a crash. However, it is important to bear in mind that replacing or modifying any component of a transit wheelchair may invalidate the wheelchair’s status.”
“The issue with tie-downs and crash testing, especially from a rehab perspective, is there are so many variables and so many different seating systems and configurations,” Brislin notes. “Trying to get something to pass, from an occupied transit kit’s perspective, isn’t the easiest thing in the world. It’s very time consuming, very expensive. There are so many different variables that are involved, whether it be the seating system, whether it be the size of the seating system, whether it be the weight capacity. Or you also have the difference between static seating and dynamic seating, or power positioning. That definitely throws another monkey wrench into the whole scenario.”
While changing up some positioning components on a chair, such as a pommel, may not impact the chair’s crash worthiness, Brislin says, “The type of lap belt that you’re using certainly matters. Different aftermarket backs certainly matter: One may pass, and one may not. Because of the way the crash testing works, you’re going to have this system, and you’re going to run it down the sled. For instance, if you have an aftermarket back on… and if those brackets on that back end up failing in crash testing and nothing else on the entire base failed, it’s a failing test. You have to totally go back and resubmit the entire thing.”
The sheer numbers of possible combinations of wheelchair frames, seats, backs and other components make it impossible for a manufacturer to anticipate and crash test every possible configuration a clinician or provider may decide to use. That’s not to mention the fact that other folks along the way — parents, teachers, bus drivers, etc. — may also make changes to the system that could impact its WC19 rating.
Listening to Consumer Demand
Despite those potential complications — not to mention the significant extra commitments of time and money to achieve crash-test certification — many power and manual wheelchair and positioning manufacturers do currently offer systems that have passed crash testing.
Why do they continue to make those investments?
“We owe it to our consumers to give them the safest possible equipment and options if they so choose,” Morrison says. “Although the trend seems to be heading in the direction of crash testing from the payor point of view, it still doesn’t seem to resonate with the marketplace as much as expected, but we do anticipate that to change.
Clinicians are still wanting clients who can transfer to transfer into a vehicle’s seat, which utilizes the vehicle’s safety system.”
“Standards for crash-tested wheelchair seating have been put together, and there are a few manufacturers that have gone through the testing to provide crash-tested equipment,” Reidmiller says. “The crash-tested seating standard (WC20) is not a requirement, but it makes sense to provide a complete package in conjunction with a crash-tested wheelchair/base.
“We also hear that some clinicians are pushing to provide this type of equipment for added safety, and it has been asked for by school systems around the country that are providing transportation for children to and from school. Some transportation companies will transport wheelchair users without it! But we provide a safe solution that is not dependent on a specific chair and seat combination by offering a seating system the people have the flexibility to use on a variety of wheelchair manufacturers’ bases in conjunction with the WC20 seating system.”
Brislin says Quantum Rehab’s Group 3 power chairs will continue to go through crash-testing.
“We feel at this point in the industry that this is what is being asked of us by our providers and ultimately by customers,” he says. “I don’t think creating a chair that does not have that option is even needed or necessary at this point. And that’s really just based on feedback from our providers. The one thing that everybody asks for all the time is to make sure that it’s there. Whether that option is selected or not, the fact that the provider knows it can be done on certain chairs makes them more comfortable in doing those products.”
“The future of crash-tested equipment is still up in the air,” Reidmiller says. “Clinicians and consumers are requesting crash-tested equipment more, but it falls mostly on funding. Transportation is becoming more of a concern when providing equipment that is safer for the user. The need will always be there, and it is up to us to provide for that need because in an environment where regulations tend to increase, it is very likely this will cross over from a voluntary solution to a requirement.”