Home adaptation could put you out of pocket

The cost of adapting a home to provide wheelchair users with greater access, independence and security can be prohibitive. LIANA SHAW looks into basic requirements based on universal design principles and whether medical aids are prepared to foot the bill

When it comes to aids in the home, Ari Seirlis, former CEO of QASA, suggests a number of factors to consider.

“A good starting point is providing an accessible entry into the home, either through a garage facility or through the front door, preferably with some coverage,” he advises.

A modern bathroom facility is essential to accessibility, he says, but the details of the access required are quite personal with regards to whether the user likes to bath more regularly than shower or vice versa. “Access to a basin while on the toilet facility, being able to use a mirror facility as well as being able to lock and unlock the bathroom door and access various power supplies are all essential elements. Access to hot water and controlling the temperature are also important.

“Having equitable access in the kitchen area is important for independence in food preparation,” he adds, “in addition to having access to a good security system.”

The needs for assistive devices may vary depending on the type of injury sustained. Commonly these range from wheelchairs (motorised or manual) to bathroom appliances such as self-propelling commodes, grab rails, shower benches or bath seats and toilet risers, and bedroom appliances such as high-quality pressure-care mattresses, air mattresses or appropriate high-risk foam mattresses. Other devices that may also need to be considered include telescopic ramps, standing frames or calipers, and leg braces. And for people affected by quadriplegia (spinal cord injury above the first thoracic vertebra), home automation systems may prove useful. See “Service providers”.

Widening doors, converting the bathroom space to a step-in-shower, doing away with rugs and thick carpeting, lowering cupboard rods, replacing round doorknobs and tap handles with lever handles, and rearranging the kitchen for better accessibility should also be considered as a way of turning the home into a wheelchair-user-friendly space.

Of course, home adaptation does not come cheap. According to George Louw, who has recently retired after 27 years in the managed healthcare industry, the types of assistive devices and costs that medical aids are prepared to cover vary based on the insurers and their respective benefit options.

“As a rule of thumb, the very expensive benefit options provide reasonable coverage,” he says. “Also, closed-company-owned schemes provide better coverage than open schemes and tend to offer additional ex-gratia support more readily than open schemes.”

According to Louw, medical schemes typically fund up to benefit quite readily, but should a standard wheelchair retail for approximately R30 000 and you are looking to import a chair that is priced closer to R100 000, you will likely have a battle on hand for ex-gratia support.

“Motivations will have to be comprehensive, definitive and clinically supported with evidence of need. Waffling and emotive arguments do not work,” cautions Louw.

“The appliances benefit covers most needs but tends to exclude nice-to-haves such as foldable ramps and so on,” he adds. “The biggest need is for medical aids to understand that quadriplegics need power chairs, which are typically used for routine daily activities, bearing in mind that large power chairs often need trailers, which are not covered by medical aids. For shopping, travel and so forth, when a caregiver is able to push the person with quadriplegia, a manual chair is more practical.”

Adds Seirlis: “I am not aware that medical aids will pay for home adaptations as such. They will reimburse for items such as wheelchairs and shower chairs, but not for hoists and elevators.”

According to Louw, the Road Accident Fund (RAF) is allegedly another source – in some cases, the primary source – of funding of third-party claims. That said, the RAF in its current form is essentially insolvent. The acting CEO of the RAF, Collins Letsoalo, was quoted by Moneyweb on December 4 last year, saying: “It is clear that the RAF is by law burdened with extraordinary liability which exceeds the money allocated to it by law. At the date of this affidavit (November 28, 2019), the RAF owes its claims creditors no less than R17 billion.”

With yet another state entity in a fiscal mess, more support from government for wheelchair users would go a long way towards alleviating some of these financial challenges. Sadly, according to our sources, the current levels of support that wheelchair users can expect to receive from government are extremely basic and difficult to motivate.

SERVICE PROVIDERS

• Accessible housing: triaccess.co.za; studiohb.co.za

• Assistive devices: abilityassist.co.za;
mobilityaids.co.za; pro-mobility.co.za; takealot.com

• Home automation systems: elanhomesystems.co.za; qisystems.co.za; coviva.co.za

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