The San Francisco Chronicle posted an article titled, “Stuck in place: How older adults end up trapped inside their own homes“. To give context to this article, one of the post’s image captions reads, “Betty Gray in the Berkeley apartment where she had been confined since taking a bad fall in February.”
One of the main barriers for the elderly woman is physical access. She had a flight of stairs that she fell down and got discharged back to her home with the same set of stairs. She refused to go to a nursing home so this was the discharge plan that the team decided was ‘safe’ for her I guess.
But her low income and need for an accessible living unit severely limited Gray’s choices. Even with a Section 8 housing voucher to help, she struggled to find adequate quarters, leaving her stuck in a place that wasn’t a good fit — physically or mentally.
In this article, they talk briefly about coverage for durable medical equipment. They say many people aren’t aware that coverage for home modification exists or how to access it. I would say that instead, the issue is that no such coverage exists in the first place – at least not under Medicare. According to Medicare.org,
Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) offer a comprehensive set of benefits that cover many different needs. Even though Medicare Part B does provide coverage for many different types of durable medical equipment (DME), such a wheelchair itself or a lift to help you move from a bed or chair into a wheelchair, a ramp is not covered under these benefits.https://www.medicare.org/articles/does-medicare-cover-wheelchair-ramps-for-my-house/
I am not so sure about Medicaid coverage for wheelchair ramps either. And the thing with Medicaid is that it is still up to each individual state whether coverage exists or not. So most likely, it’s just the same as Medicare – no coverage. The SF Chronicle article cites a wheelchair ramp to cost up to $10,000, keyword up to. The issue with this is that wheelchair ramps generally do not cost that much to be installed. It’s literally wood and nails and the cost of labor like a contractor or handyman to install it.
So this issue of trapped in place is not a patient’s lack of knowledge or awareness issue, it’s a coverage issue. And this is especially common with low-income or racial inequalities. Having both low income and being a minority makes it even worse. So to bring about change and to advocate for our elderly who wish to age in place and not be trapped in place, we need to advocate and lobby for coverage of things such as wheelchair ramp services from Medicare or Medicaid. That’s all there is to it.
From an economic standpoint, I would argue that yes, there is a cost up-front for the installation, but in the long-term, I am willing to bet that this is much less than repeated hospitalizations from falls and expensive long-term nursing home services. Then there’s the cost of the mental health harm done from anxiety, PTSD, and depression that likely co-exists with being trapped in place – not to mention occupational deprivation such as IADLs and socialization.