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Monday, September 19, 2016

Inequities and Wheelchair Repair

My wheelchair frame is 30 plus years old. I have bad insurance. Bad insurance equals limited coverage. My insurance deems a wheelchair a one time life time purchase. When it comes to adaptive gear that makes my life go I am screwed. It all comes out of my pocket.  Given this, I opted out of the durable medical goods industry long ago. I read about new wheelchair designs and keep up with the industry from afar. No current wheelchairs are of interest aside from a Panthera manual wheelchair made out of carbon fiber. The decision not to buy a Panthera wheelchair is easy--it costs about the same as a new Fiat. Sorry but no. I am not going to spend a small fortune on a wheelchair that cannot be insured nor repaired without proprietary parts. 

The above leads me to question: what do you do when your customized wheelchair breaks? If you are a power chair user the answer is get ready for a tortuously long wait. A long time here can be weeks, months and in some instances years. Getting parts for any wheelchair is not easy. Finding a person competent to repair a wheelchair is an epic battle. Getting insurance to pay for the most mundane of repairs requires one to navigate byzantine bureaucracy. Every time my wheelchair breaks, a truly rare event, I consider myself lucky. I can repair or replace almost any part on my wheelchair. However, getting parts gets harder by the year. My wheelchair frame is ancient and finding parts that routinely wear out such as bearings, tires, and wheels is now a challenge. While I find newer wheelchairs of interest I always fall back on a simple reality--old technology works.  

What do you do when your wheelchair needs a repair? Be prepared to wait. If a person is reliant on Medicare the website states the following: 

If you have a chronic condition and will need DME for a long period of time, it important to learn about Medicare’s rules for replacing your equipment. Replacement means substituting one item for an identical or nearly identical item. For example, Medicare will pay for you to switch from one manual wheelchair to another, but will not pay for you to upgrade to an electric wheelchair or a motorized scooter. Medicare will pay to replace equipment that you rent or own at any time if it is lost, stolen, or damaged beyond repair in an accident or a natural disaster. Medicare should cover a new piece of equipment with proof of the damage or theft.
If your equipment is worn out, Medicare will only replace it if you have had the item in your possession for its whole lifetime. An item’s lifetime depends on the type of equipment. An item’s lifetime is never less than five years from the date that you began using the equipment in the context of DME replacement. Note that this five-year time frame differs from the three-year minimum lifetime requirement that most medical equipment and items must meet in order to fall under Medicare’s definition of DME. The item must also be so worn down from day-to-day use that it can no longer be fixed. Keep in mind that Medicare will repair worn out equipment up to the cost of replacement before the end of its lifetime. Medicare will only cover replacement equipment if your doctor writes you a new order or prescription with an explanation of the medical need. If you are affected by the competitive bidding demonstration, you must use a contract supplier to replace your equipment. If you are not affected by the competitive bidding demonstration, you can use any Medicare-approved supplier to replace your equipment. However, you will pay the least if you use suppliers who accept assignment. 
Read the above and it is very clear if your wheelchair breaks you are essentially out of luck. For a person like me if my wheelchair breaks it must be repaired immediately. If my wheelchair breaks forget going to work. Forget the bathroom. Forget cooking. Forget life. My wheelchair must be fixed when I hear the shuddering creek of metal, jarring on my front wheelchair wheel or something as ordinary as a flat tire. Again, I can replace or repair pretty much anything on my wheelchair but what if you can't? Lots of people can't. Most people can't--especially those that use power wheelchairs. Remember too that wheelchairs are highly customized. Here is the worst part: wheelchair repair shops do not exist. Imagine you are content without a care in the world and you are in your impressive and speedy power chair. What happens when it just stops working? This scenario is far worse than what I encounter and not at all uncommon. 
The above thoughts were prompted by an article in the BBC News. At the Paralympic Games there is an adaptive sport gear repair shop.  The repair center is operated by Ottobock. A German Company, Ottobock is one of the largest makers of durable medical goods in the world. Here in the USA I think of Ottobock as being a prosthetics company but they manufacture all sorts of things. In Rio, Ottobock shipped 18 tons of equipment for the games. 16,000 spare parts, 1,100 wheelchair tires and 70 prosthetic running blades. Since the Paralympic games started, 2,970 repairs have been made. Those repairs have been made with speed and precision. 
In the United Sated one of the largest companies that manufacture wheelchairs is Sunrise Medical. They make Quickie wheelchairs most commonly used by paralyzed people. They are commonly used because Sunrise Medical meets insurance industry price points. This does not mean their wheelchairs are well made or durable. Regardless, google Sunrise medical. Search "repair" on the website. The search will yield "no results". Try another large manufacturer such as Invacare. They make Top End wheelchairs and hand cycles. They also make many different power chairs. Good luck trying to locate repair services on their website. 
Replace the word wheelchair with the word car. If your car broke down how long would a repair take? Most people would be furious if a repair took more than a day. One would certainly expect to get a loaner car of comparable quality while the repair was made. This would be a seamless experience. We are talking about a lot of money. Start on the low end. Being very conservative if I had a Panthera wheelchair it would cost at least $10,000. Parts would likely need to be ordered and shipped. That could take weeks if not months. Would this be acceptable if I owned a $10,000 car? Not a chance.  A generic power chair cost at least $10,000 and can reach super car price ranges. A repair to a power chair with something more than a battery issue is going to take a while. A while here is weeks if not months. Would any reader be willing to wait months for a car company to repair a vehicle? If that was the norm the car company would be out of business in a heart beat. Yet wheelchair companies appear to be exempt from the repair business. 
How can this be? The answer is ableism is rampant. Cripples can wait. Our life sucks or so many bipeds tell me. We are poor. We are unemployed. We have no life. We are the symbolic representation of the limits of medical science. We are not thought to be "well" nor are we "sick". We are fish nor fowl. We are a curiosity. Our lives are an open book for others to question. Ableists complain that our existence is costly. One judge in Connecticut thinks severely disabled children are incapable of learning and valuable resources are being wasted on such students. The message is unrelenting--we cripples are a problem. Your wheelchair is broken? Tough luck. You can wait. Wheelchair repair shops don't exist. Of course not, there is no money to made in repairing wheelchairs. The fact that wheelchairs empower people is conveniently ignored. Our lives are devalued in every way imaginable. Being devalued is built into the fabric of society. Nothing is ordinary about our lives.

Frankly, I am angry. Just today I read the following:  Most discussions of ableism prioritize its external forms: staircases without ramps, misguided offers of help, applauding disabled people for being “so brave.” Disability itself remains something we “tolerate” or “live with” (but would, of course, “fix” if we could). That kind of ableism – that turns us against ourselves by lying about what success, politeness, health, and independence look like – isn’t broadly acknowledged as internalized oppression yet. Link: The ADA is 26 years old and while the law is on my side, the ADA, one could argue it is stealth legislation. People know the ADA exists and there is the general sense the law solved problems we cripples encountered. The ADA has not solved the problem. The problem is that I and my fellow cripples are not a problem. The ADA has created a bureaucracy and there is a sense the letter of the law must be met. The result can be something like the multimillion dollar Syracuse University promenade.  Many bipedal people have repeatedly told me how great the promenade is. It has enhanced wheelchair access at Syracuse! The people that state this do not use a wheelchair. The people that I know who use a wheelchair consider the promenade to be a symbolic fuck you. Bipeds do not like this reaction. I can't blame them one bit. There is cultural divide here as broad and as expansive as the Grand Canyon. Somewhere in that expanse my voice and the voices of other cripples get lost. More than ever, the slogan nothing about us without us fits.