Twenty, or even ten years ago, wheelchairs, scooters and walkers were rarely seen in Independent Living sections of CCRCs. If they did exist they were rarely seen in formal dining rooms. Residents who depended upon such devices for mobility were frequently expected to eat elsewhere. Today the scene has changed. Some devices, such as walkers, have almost become the new normal as older and frailer residents have become the majority. Also, legislation forbidding discrimination against the handicapped has brought more people into the dining rooms and created parking and transit problems in the corridors and hallways.
CCRCs have struggled to write policies and programs to cope with these new problems. They must deal with many parameters, including training, liability, parking and administration, all of which depend upon the type of assistance device under discussion. ORANJ Health Care Committee proposed a study of such issues to determine the current practices and policies among our members. The Committee proposed to send a questionnaire to every president of member Resident Associations and a draft was submitted to the Executive Committee, the questionnaire was sent to 24 CCRCs on March 15, 2012. Twenty-one participated, an 87.5% response rate, thought it must be noted that not all questions were always answered.
Result of survey on Assistive Mobility Devices (AMD)
Of the 21 CCRCs responding to the questionnaire 70% opened 15 to 25 years ago. As a matter of fact, four out of 21 (19%) opened over 25 years ago.
There is a wide range of the number of residents in the CCRCs. Three out of 21 (14%) have less than 175 residents. Three out of 21 have more over 300. The largest cluster, 12 (57%) have 175 to 250 residents.
The Wellness Center is farther away from residents’ apartments than either the Assembly or the Dining Room. The latter is relatively closer. Looking only at the Wellness Centers, 4 out of 21 (19%) are 500 feet or less from the residents’ apartments and 4 our of 21 are 2000 feet or more away. The number of scooters (SCs) far exceeds the number of electric wheel chairs (EWCs) in the following: 2 out of 21 have over 50 SCs (51 and 58 per facility, while one CCRC has as many as 31 EWCs.
Physical Therapy is most often the authorizing department for the use of AMDs and is by far the department responsible for providing training for their use. When it comes to responsibility for maintaining the registration of EWCs and SCs there is no concensus: 7 out of 21 (33%) said the Wellness Center which 11 of the 21 (52%) said others. The latter included Security Resident Services, and the resident himself/herself.
The resident’s apartment is the preferred or required place for the AMD overnight parking. There is no consensus regarding parking for the Dining Room, though allocated space was more likely to be used for such parking than leaving the AMD in the hall or the Dining Room itself.
As many as 18 of the 21 CCRCs report that they have written regulations for the use of AMDs. To determine what regulations they have in regard to safety and related issues, all respondents were shown a list of 7 possible regulations were asked which pertain to their facility. Fifteen of the 21 CCRCs indicated that “consequences of violating safety rules” is applicable to them. “Rules of the road, e.g. stay on right” and “speed limits for electric wheel chairs and scooters” were reported by 12 and 11 respectively. When misuse of AMDs occur, interpretation of the violation and taking necessary action to prevent recurrence was the responsibility of the following staff members: Doctor, RN, and Director. The final responsibiility to take action was left to the Executive Director. Reevaluation of the competence of the resident using the AMD device was one of the actions.
In response to the question of requiring liability insurance, only 8 CCRCs required insurance be part of their Renters’ Insurance and recommended liability between $100,000 and $300,000. Of the 21 questionnaires submitted, all questions were not answered.
Recommendations
All CCRCs should have a comprehensive policy for the use of AMDs.
All CCRCs should be registered and tagged by management.
The CCRC administration must consider the increased use of AMDs in the future when planning new construction or modifying a facility.
The AMDs, including walkers and canes should have assigned areas where they can be placed when not in use.
The Physical Therapy Department should help order the equipment needed. Consideration should include the limitation of corridors. When smaller equipment can be used safely, they should recommend it.
Electric wheel chairs take less space and are more convenient, especially when a person cannot easily transfer from a scooter to a chair.
When a facility cannot accommodate the increased number of AMDs they should consider an alternate way for residents to access common areas; for example, pickup by a golf cart, pick-up by car at the nearest exit, or valet service in a wheel chair.