The Challenges of Finding and Paying for the Right Assistive Devices

Eleanor Brownridge

Since access to assistive devices is not a federally-mandated program, financial assistance for canes, wheel chairs and braces for patients with arthritis varies considerably from province to province. In fact, the majority of provincial health plans cover none of these aids.

The Ontario Ministry of Health does have an Assistive Devices Program (ADP) which covers a portion of the cost of manual and power wheelchairs, scooters and walkers, back supports, and specialized canes for people with long-term disabilities. ADP pays up to 75 percent of a predetermined price, with the patient paying the remaining 25 percent directly to the vendor at the time of purchase. For those on social assistance, the program will cover 100 percent of the cost. "To access this program, your patient must have a valid Health Card and the device must be authorized by a physiotherapist or occupational therapist registered with the program," says Robert Jankowski, a public information officer with ADP. There are currently over 5,000 registered authorizers working in hospitals, home care agencies or private practice. Physicians or patients can call 1-800-268-6021 to obtain the name of local health professionals authorized to access this program or speak with the local CCAC/Home Care Coordinator for further information.

The Alberta Aids to Daily Living Program administers a similar program in that province. Again, an approved authorizer must assess the needs and eligibility before the benefits are allowed. The patients are responsible for 25 percent of the cost to a maximum of $500 per family per year. Low-income patients or those on income supplement programs are exempt from cost sharing. For more information on eligibility, call 403-427-0731.

Manitoba's Health Services Commission covers only braces worn on the body. It will pay 100 percent of the cost for one device every two years. Similarly, the Saskatchewan Medical Care Insurance Branch covers prosthetic braces. In addition, the Saskatchewan Abilities Council has a free loan program for wheelchairs, walkers and quad canes requisitioned by an approved therapist.

Patients who are not covered under these programs will have to rely on private insurance plans or charitable organizations such as Opportunities for The Disabled Foundation, Kiwanis, March of Dimes, or their own funds.

Even where there are programs covering braces, it may not be suitable for your patient. Annette McClelland, a certified athletic therapist and pedorthist in southern Ontario, says that none of the osteoarthritis knee braces covered by ADP that she has seen align the knee adequately. She fits customized braces which allow people to resume participating in their normal activities--from walking to skiing--pain free and without canes. Unlike Canadian-made braces, these imported models are made from light carbon fibers. "These braces are very expensive--from $900 to $1400," admits McClelland, "but they give the wearer immediate security and stability in the joint. With many clients, if they'd started wearing these braces sooner, they wouldn't have had so much deterioration in mobility." After assessing the patient to ensure that a brace will help, McClelland makes sure that those who have private health coverage do have a referral from a doctor so that the item is covered under the plan. Others willingly pay the price of the device in order to be mobile again.

Other items, such as lifting or opening devices, wheelchair lifts or ramps, electrically-operated chair lifts, home modifications, reaching aids, or even standard walking canes are also not covered under provincial plans. There are many choices available, through catalogue purchase, but that makes it difficult to assess whether the device will help a particular patient. About five years ago, the Ontario Ministry of Health provided a one-time grant to establish five showcases of innovative technologies in major cities around the province. "Patients can come in, look and try, before buying," says Barb McIntyre, occupational therapist at the Easier Living Centre located within the Geriatric Day Hospital, St. Mary's of the Lake Hospital in Kingston. "The problem is that there is no ongoing funding to purchase new equipment. Many of our aids are now out-of-date. Now we have to show people pictures out of the catalogue and tell them that the current device is like this, but not exactly the same."

For more specialized needs that can not be met with off-the-shelf products, patients must often rely on a do-it-yourself friend. McIntyre says she and other therapists can provide a variety of patterns for various trolleys and devices. Also in some provinces, such as Nova Scotia and British Columbia, there are Tetra Societies. These charitable organizations recruit volunteers from the engineering and manufacturing sectors to design and make assistive devices that can not be found elsewhere.

With the right device, many people with arthritis can continue to enjoy independent living.