Persons with disabilities (20% of the nation) are ignored by Legislators and insurance underwriters Even though the CDC acknowledged over a decade ago that persons in wheel chairs are the group of pedestrians most frequently killed in automobile crashes, few resources have been devoted toward assessing how widespread the danger is and what modifications should be mandated to make wheel chairs and POVs (scooters) more visible and more steady, Persons in wheelchairs are three times more likely to be killed by automobiles than other pedestrians. Studies of Emergency Room data shows that tipping over is the cause of most accidents involving manual wheel chairs.
Legislators are quick to mandate that anyone who can work, works. They do not hesitate to add work requirements to Food Stamp and housing grants. Yet they discourage additions of safety features to wheelchairs which are purchased through government funded insurance. They persist in approving Medicare/Medicaid rules which hinder physically challenged persons from traveling more safely to work in wheelchair’s or POVs which have hooks to secure them in vans or lights and reflectors to make them more visible in parking lots and crosswalks.
Medicare/Medicaid (and private insurance) guidelines disregard features which help prevent tipping on uneven terrains or which make wheel chairs more visible to motorist in parking lots and at cross walks, citing that these features are “unnecessary for use in the home.” Even low-cost , such as reflectors, are considered unnecessary for in-home use. Equipment with lights or reflectors are classified as upgrades and usually are excluded from models paid for by insurance. Frequently they are not classified as models which are “medically necessary” for use in the home, even when they are suitable for inside use. Getting them is cost prohibitive for most wheelchair users without insurance reimbursement.
Realistically, most mobility impaired persons are on fixed or low incomes. People take what they can get insurance to pay for, even it is not as steady as they need or lacks important safety features. Medicare does not demand that the equipment be used solely in the home. It can be used outside, however, reimbursement guidelines are tailored totally on in-home use. Few mobility impaired persons remain in their houses 100% of the time. Some work. Some volunteer. Most travel to medical appointments. If you can’t walk, you use your wheelchair. This means that thousands of wheelchairs without reflectors or lights and which are not designed to be steady on uneven pavements are used in parking lots and in public road crosswalks each day.
Insurance/Medicare/Medicaid payment guidelines discourage safety features on wheelchairs and POVs (scooters) . Most non-fatal accidents for person in wheelchairs are from tipping over. Most fatalities are from being hit by another vehicle. Over 90% of the drivers who hit and kill persons in wheel chairs said that they did not see them.
Legislators are fast to require persons to work to qualify for critical services and programs, yet they continue to draft legislation and allow Rules which classify wheelchairs and POVs with hooks for securing them when in buses and vans, or lights and /or reflectors, as unnecessary because they are more important outside than inside the home. These determinations are made without studies to show how beneficial they are inside the home.
Manufacturing cost is nominal for many of these features when included in the original chair design, but are very expensive as "add on". Many manufacturers are already including them on several models. Unfortunately, insurance underwriting guidelines and federal Medicare/Medicaid rules classify most of these models as not medically necessary and do not allow insurance reimbursement on them. I personally know of a person who is confined to his chair during his entire waking day. Insurance replaced his chair. It cost him over $2000.00 out-of-pocket to get the connectors added so that he could safely use it in his wheel-chair modified van.
PROBLEMS WITH CITY DESIGN
City planners who fail to consider sidewalk accessibility and curb-cuts which are hazard free for persons who are in wheelchairs or scooters or who are blind contribute to many of the accidents suffered by disabled persons.
One in five Americans have some form of disability. The ABILITIES of 20% of Americans are important. To work or volunteer it is necessary to LEAVE ONE'S HOME. Changing the Medicare/Medicaid/Insurance guidelines for DME is important to help capture the talents of mobility impaired persons and to enable full integration of disabled persons into the community.
It is difficult to assess the full scope of the risk or to evaluate what helps alleviate the risks because:
1. Law enforcement accident forms are not designed to help policy makers determine what factors play the greatest roles in causing or preventing accidents involving pedestrians with disabilities.
2. Persons in wheelchairs or who are visually impaired are merely listed on accident reports as pedestrians. Accident reports are not designed to distinguish between persons in wheel chairs, or to capture information about what safety equipment is on chairs involved in auto collisions. Accident reports on passengers injured in auto collisions do not capture information about persons in wheelchairs and what equipment is used to secure the chair into the vehicle.
2. Accident forms do not capture whether accidents involving wheelchairs and scooters involve equipment with or without reflectors and/or lights or about the visibility.
3. Accident reports do not capture information about manual or power wheel chairs tipping over due to bad sidewalks, uneven terrain, or restrictive curb-cuts. They do not capture information about accidents involving visually impaired pedestrians at curbs which are uneven or insufficiently marked.
4. Many municipalities use diagonal curb-cuts which force persons in wheel chairs to enter lanes of traffic coming from both directions to cross the street. Accident reports do not include data showing how many more, or how many less accidents occur at intersections with horizontal curb-cuts versus diagonal curb-cuts.
5. No information is gathered about the model of wheel chair or POVs so that policy makers and manufactures can use it to help determine which designs are safer and which are problematic.
6. When a physician writes a prescription for a wheel chair or a POV, it is difficult for the patient to get information about what models / features Medicare or other insurance will cover. Once they locate a supplier who accepts Medicare, they are usually sold whatever model that supplier chooses to sell them. Patients deserve to know if there are suppliers who will provide other models with safer features within the Medicare allowable guidelines before being locked into using a particular supplier. The process is not transparent from the consumer’s point-of-view.
We need to begin collecting data to help better understand what modifications should be made to improve safety for persons with disabilities. Some fatalities can be avoided by making persons in wheel chairs and who are visually impaired more visible to drivers. Some can be avoided by changing the Underwriting guidelines to promote better stability and visibility inside and out of doors. If a vehicle is more stable outside, it will also be more stable inside. Most homes have some uneven door entry ways or other obstacles.
Much can be done through training and governmental guidelines for urban planners. Persons with disabilities comprise 20% of the nation. There is no one size fi all category. Some are multi-degreed and very active in professional and civil life. Others are more vulnerable and less visible. There is a mixture of skills and expertise. To contribute people usually need to be able to leave their homes and ride across a parking lot or cross a street without being three times more likely to be killed by an automobile whose driver fails to see them.
For mobility impaired persons wheel chairs are tools, not luxuries. Using them means the difference between being efficient or able to contribute and vegetating. Those which are paid for by insurance go to persons who have proven a demonstratable medical necessity. The reality is that there is a necessity for improving the design and availability of safer wheel chairs and POVs for those who have a genuine medical necessity. It does not require a “top of the line” greater cost piece of equipment to be safer. Underwriting guidelines should promote safer features instead of limiting access through insurance to models which have greater stability and features such as lights or reflectors which make them visible inside and outside of the home.
Manufacturers should be rewarded, not penalized, through medical equipment coding policies, for providing equipment at reasonable costs which includes features which currently are considered by underwriters to be unnecessary for use inside a home.
If every Legislator and City Planner were required to undergo training in which they actually use wheel chairs on city streets, and actually navigate at intersections with blinders to enable them to understand what signage and designs are safest for visually impaired and mobility impaired persons, they would be better equipped to design urban spaces and set policies which promote greater safety for all of our citizens. They should spend a day in a chair indoors and ride a handicap van in one before they stipulate that safety features are unnecessary for use inside the home.