Wednesday, October 12, 2005

Zen and the Art of Wheelchair Maintenance

Most wheelchairs occupied by seniors don't leave the building where the person lives.
Family, physical therapists, doctors, nurses, even shrinks come to the residence. At most the wheelchair gets to the patio or around the block, so it rarely needs repair.
But Mom's wheelchair had an exciting life, thrown into the back of a van almost daily, wheeling all over Santa Irena--until today, when its wheel fell off.
Emily, Jona, and Mom were a few blocks from Ocean View, taking a walk, when Emily noticed the wheelchair wobbling a little. Then a lot.
Then the left wheel came off the axle, and Mom would have been dumped out if Emily had not been there and caught the collapsing wheelchair.
Note 1: Emily visits once a week; Jona goes out pushing Mom in the wheelchair every day. By the grace of God, the wheel fell off with Emily right there to help.
Note 2: Bill doesn't want Mom on Coumadin because Mom might fall, and any head injury with thin blood can result in fatal bleeding.
"She can't fall," I keep telling him. "She's in a wheelchair with a caregiver 24/7."
"Yesterday I did surgery on someone who was knocked out of a wheelchair and hurt. There was internal bleeding everywhere--it was a complete mess."
"She won't fall out of the wheelchair," I told him. But now, a few days later, it almost happened.
Anyway, Emily pushed the wheel back on and for the next two blocks managed to walk alongside Jona and Mom, holding the wheel on and calling me on her cell phone.
"The wheel came off--can you call the rental company and get them to replace it? We have to have a new wheelchair immediately."
I didn't see how this was going to work. New wheelchairs do not arrive immediately, especially when you call at 4:30 pm. I had placed a few calls to OxyTech in the last three days trying to arrange a repair, and there had been no reply to my message.
"Emily, we should just buy a new one," I countered
We debated the issue as the injured wheelchair rolled on, held up by Emily.
Finally she and Jona got Mom back to Ocean View and up to the third-floor dining room.
"I need to go to the bathroom," Mom demanded.
"No," said Emily and Jona. After any outdoor trip, we return to her room and the toilet, but not this time.
Emily ran to the parking garage and showed up at the medical equipment store at 4:55 pm.
"We're closing," announced Frank, the patient, perennially cheerful salesman.
"I need a wheelchair," Emily countered, and within five minutes the deal was made.
She walked out with a shiny new titanium blue "companion chair" with four small wheels, costing $350. "Companion" means Mom can't push it by herself, using her arms; there are no big wheels. This is okay because she is pretty much beyond self-locomotion and because the brakes are on the two rear wheels, easily locked and unlocked by someone pushing her.
Note 3: Maintenance of the old wheelchair was a full-time job. It had arrived on October 1 a year ago, when Mom moved to Ocean View Assisted Living from the skilled nursing facility where she had done rehab after breaking her left hip, undergoing surgery, and spending ten days in the hospital.
We had planned to buy a wheelchair, but the SNF staff told us that they would measure her and order the right one through Medicare at no cost to us.
Within a day or two we rolled out the door with a free wheelchair, as promised, but after a few weeks the brake mechanism was loose. When the brakes were on, the wheels would still slide backwards a few inches while Mom transferred into it from a chair or toilet.
I became good friends with Jeff from OxyTech, who usually showed up within a day after I called for a repair. It turned out that we had a rent-to-own plan, so he was obligated to maintain the chair. Usually a few adjustments with his tools did the job, but then the leg rests got bent and were hard to take on and off; finally one had to be replaced.
Sometimes when a repairs were needed on a holiday weekend, I took out a wrench and screwdriver, trying to do it myself. That was hopeless.
A few months ago I called for a repair involving both the leg rests and some plastic part under the seat that had broken.
"How could you break this?" asked Jeff when he saw it. "I've never seen this break before. I'll just have to replace the whole chair."
I refused to feel guilty. "We go out in the van almost every day, and I'm not strong enough to lift it gently into my van. I just kind of heave it in."
What I didn't say was, "At least she goes out--the other people who rent your chairs probably never leave a 300 square foot area."
Almost no one from the Reminiscence Neighborhood ever leaves, even for the afternoon. Out of 28 people, maybe 4-5 go out with family members or on bus excursions, and those are not the ones in wheelchairs.
After the purchase I called Jeff to tell him we had bought a new wheelchair and needed to end our rental contract. When he arrived to pick up the broken chair, I raised the issue of money--we had rented for a year. Didn't we own a chair by now? Maybe he owed us a working wheelchair.
"We didn't make any profit on this one," he said. "There were so many repairs, and it's the second one I gave you. This chair can't be repaired--I'll have to junk it."
"Okay," I conceded. "But I want a statement of how much we have paid, through Medicare and Blue Cross, and what the total cost of the chair was, and when we would have finished renting it and just owned it."
Jeff agreed to send a statement, and meanwhile I began calculating: 13 months with Medicare paying $59.52 per month and Blue Cross Blue Shield paying $14.88. Apparently Oxytech had received $74.40 per month, a total of $967.20, after billing $105 per month or $1365.
Was the chair's original price that much? I doubt it.
At any rate, Mom now rides in a simpler chair, with smaller wheels, arm rests that don't allow her chair to slip under a dining room table, and leg rests that do not adjust the angle at which they're inclined. It was neither the cheapest chair ($250) nor the most expensive--but it's probably what we should have done in the first place.

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