144586 tn?1284666164


This is a big topic and I will only say a few words at present. To begin with the so-called "rental" wheelchairs, provided by medicare/medicaid are totally unacceptable for taking a person outside. They have very hard non-resilient wheels, for one. They are designed for indoor use on smooth hard surfaces, such as in a nursing home.  The provider, who is usually a salesman, gives you what they have in stock. These salesman also usually have great bargains on bridges in Brooklyn. This is usually two types or sizes. The wheelchair rental racket is a scam. Just a personal opinion. Obtaining a custom comfortable wheelchair will be the best investment you could make.

Purchase one. Even if the insurance pays for a rental you end up with a Faustian bargain. They never tell you that wheelchairs come in a number of sizes (amazing), heights, wheel types, and the push-handles come at varying heights above the ground.

You ideally need two (count-em) wheelchairs. A small four-wheeled (small wheels) chair for inside the house, with brakes that can be set by the caregiver, and an out-door chair.  The foot activated brakes tend to be secured by bolts that loosen and then the health-care aid will vacuum them up and the chair won't have brakes. For some reason the brake supports seem difficult to order from the manufacturer if they fall off. There are several small pieces. . Tighten the bolts that secure the brakes when you get the chair, or better yet, apply some lock-tight to the bolts and re-tighten.  These may be Phillip's (the "x" kind) or tightened by an Allen wrench. The appropriate Allen wrench should run you about a dollar. When you roll the four-wheeled chair to a table, the brakes are set so it doesn't move away when the patient pushes on the table or moves while eating.

An outdoor chair must have a soft tire. These tires come in two types. Inflatable (like bicycle wheels) and foam (semi-solid). If you want to see the difference have someone push you around for an hour in the streets in a hard-wheeled chair and then try the ones with resilient tires. In some cases resilient tires can be added to a rental wheelchair.

You will also need a  foam cushion for the seat of both chairs. A thin cushion for the four-wheeled indoor chair and a thick one for the outdoor chair.  These are available at medical supply stores.

Now you need the leg extensions, of course, but you need something else for the patient who is very elderly. You need to cut a plywood board about 24" long by 8: wide to go over the two foot rests. This is not always needed, but it prevents the infirm patient's legs from slipping between the leg extensions. A stroke patient may not be able to tell you and you won't notice you are twisting and damaging their feet. I used to secure this when going out with a length of duct tape, and later with a belt of velcro.

Now you think about a velcro belt to keep the legs from slipping out. These are very inexpensive and locally available at the .99 cent stores for a buck. This should be very LOOSE, and simply prevent the patients legs from slipping forward over the edge of the plywood board or leg extensions.

Finally, you need to obtain some scotch-light reflective tape (comes in red, striped and yellow) to wrap around cylindrical surfaces. At night this tape will pick up a headlight and insure visibility. They have little blinking strobes, but the Scotchlight (available at auto accessory stores) will work as well and less trouble.

Of course you require an accessory bag to hook to the two handles that may be used for medicine, snacks, hydration (a small thermos), a blanket, cap, gloves, scarf, and most important a small flashlight. I prefer the fireman's disposable lights, but the new LEDS are super. I like to tape a cord to the flashlight and tie it to one of the straps on the accessory bag. Inventory this stuff before going out.
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144586 tn?1284666164
If you have a hired aide to take out your mom, dad or loved ones, you should establish a wheelchair protocol. Do not assume because someone has "been doing this for twenty years" they can pour water out of a boot with directions on the heel. I ended up firing thirty-seven (count em') heath care aides before fining several that were competent.

(1) Instruct them that the patient will only be take  across streets at crosswalks and then only then the light turns green and only when the light changes from red to green.

(2) no talking on their cell phones while pushing the wheelchair.

(3) If there is a very steep ramp, make sure they hold on with both hands, and consider having them back down the ramp. In the case of my little one there was a specific steep ramp at her apartment  Immediately after tell me "I've been doing this before you were born..." she let the wheelchair run away and my little one barely escaped with her life. After this I kept a "safety lanyard" in the chair storage compartment. Essentially a short length of clothesline tied to the chair the air with another end to loop around her wrist whenever negotiating this dangerous slope..

(4) Set up "approved routes" to take your loved one for an outing. Walk the aides through these routes. Avoid cobblestones and rough sidewalk surfaces. Do not assume an aide will be able to take your loved one out with such guidance.

(5) When the wheelchair is parked with the patient, ideally this will be with the chair at the end of the park bench so the caregiver is next to them and able to both hold their hand and have them see them. Not with the wheelchair parked in front of them.

(6) Instruct them to make sure to be extra careful when crossing in front of a the truck with a high cab. The driver will NOT be able to see you and many will "jump the light". Be careful if you see the light change to green and a tanker is approaching. In an unbaffled tanker, water, gas, oil or chemical, the fluid can slosh forward and slide the rig right across the crosswalk. After the vehicle has apparently come to a full stop!.

(7) Seat belts are an issue. I see no need for them around the house (in the little four wheeled chair), but some health care aids will insist on using them for "insurance purposes". They can be psychologically upsetting to an elderly person. I solved this problem by cutting them off the indoor chair and forcing the aides to remove the belt whenever the chair was parked using the large outdoor chair.

(8) Have the aides lower the chair over a curb while you are watching, and have them set up and fold the wheelchair under your supervision at least once.

(9) On a bus always remain next to the patient (when if you have to stand) and preferably keep a hand on their shoulder. Some streetcars and subways have no way to secure the wheelchair in the car, so make sure both brakes are set with the chair at ninety-degrees to the wall.

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144586 tn?1284666164
One of the "protocols" involving wheelchairs should be to insure the wheels are sanitized after a trip outside. I was in the habit of keeping a bottle of rubbing alcohol and a rag in the carrier behind the chair when taking my charge outside. When we parked I would wipe the wheel top.  I am willing to bet that the average wheelchair user never ever washes the wheels. Nor do the health care aides.

The biggest problem in the park where I used to like to go was dog poo. It seemed to be everywhere, despitethe pooper-scooper laws.  It would get on the wheels and my little one would like to rest her hands on the wheels when we parked. Needless to say the elderly cannot afford infections and it is but a small distance from the bacteria on the wheel to the hand and to the patient's mouth.

The wheels on both the small four-wheeled chairs and the larger chairs (with the big wheel) should be sanitized on a daily basis.
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144586 tn?1284666164
Another handy item to keep in the tote bag is an ordinary doorstop. If you have to assist someone through a door there might not be someone to hold it open. This includes bathroom doors.
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