BEXLEY WHEELCHAIR SERVICE
ELIGIBILITY CRITERIA
Bexley Wheelchair Service
Eligibility Criteria
November 2004
Review date: November 2007
Revised 2010
Date for revision: April 2016
- Provision of Standard Manual Wheelchairs
Definition of Equipment
A wheelchair issued from stock such as an 8 or 9 series, Access or Uni. Standard chairs are from a range normally held in stock by the wheelchair service at Contractor’s premises, and supplied following written referral from a GP, District Nurse, Physiotherapist or Occupational Therapist.
Criteria for provision
A standard manual wheelchair will be provided to clients who meet the following criteria:
A user who has a permanent impairment or medical condition lasting more than six months restricting their ability to walk, or for those who are terminally ill.
A user who is able to self-propel, or who has regular identified carers who are deemed able to push the chair safely.
Note
The service does not supply standard transit wheelchairs for residents in nursing or residential homes either for transferring from room to room within the home or from bed to toilet or armchair.
- Provision of lightweight or high performance self-propelling wheelchairs
Definition of equipment
A lightweight wheelchair is defined as such by the manufacturer. It usually weighs less than 15 kg.
A high performance wheelchair is intended for everyday use by an active user. Such chairs have a range of features and are configured to suit an individual’s needs – for example, choice of rear wheel and castor size and position, high-pressure tyres.
Criteria for provision
A lightweight or high performance self-propelling wheelchair may be considered for full-time users, or for other users who have a deteriorating medical condition which may lead them to become a full time user. Equipment will be issued according to the manufacturer’s specification for use. Either of the following should apply:
A full-time user who is unable to maintain independent mobility in a standard wheelchair and can demonstrate an increase in their level of independence through this provision, and whose lifestyle would indicate real benefit.
A user who is an independent driver who cannot put a standard wheelchair in to their car on their own without detriment to their health.
Situations not included
Where the carer finds the chair heavy to lift or push. In this case the carer will be given instruction on alternative ways to put the wheelchair into a car. The user may choose to opt for the Voucher scheme and purchase a chair of their choice, or advice can be given regarding the purchase of car hoists for wheelchairs.
Note
The assessment of need for lightweight and high performance wheelchairs will focus on the user’s basic clinical and lifestyle needs, and supply of equipment will be from a specific range.
Any user requiring a high performance chair for employment should have their needs met by Access To Work or a similar scheme.
- Provision of Electrically Powered Indoor Wheelchairs (EPICS)
Definition of equipment
An electrically powered wheelchair to be used within the user’s home environment.
Criteria for provision
The user must be unable to walk and unable to propel a manual wheelchair effectively in their own home.
The user has a long-term need for indoor powered mobility, using the chair on a daily basis in order to increase mobility and independence around their home, leading to an improved quality of life.
The user must demonstrate the ability to use an EPIC safely and independently within their property.
The user must have a suitable home environment, including adequate space for the movement of the wheelchair (including footplates) within their home, and a suitable area with a power supply for charging the batteries overnight.
The user must be able to charge the EPIC as recommended by the manufacturers, or have the support to do so.
The user must meet the weight limits as stated in the manufacturer’s specification for the chair.
The user must be at least 3 years of age.
Note
An indoor powered wheelchair will not normally be supplied by Bexley Wheelchair Service for sole or primary use within a school/college/day centre except with authorisation from the Service and the establishment.
Clients in their own homes will be provided with a standard non-powered NHS chair as a secondary chair.
If a client is already in possession of a lightweight manual chair at the time of EPIC provision, this will not be removed but subsequent replacement provision will be form the standard NHS range.
- Provision of Indoor/Outdoor Powered Wheelchairs (EPIOCs)
Definition
An EPIOC is a powered wheelchair, which can be used indoors and outdoors in accordance with the manufacturer’s instructions.
Criteria for provision
The user should:
Be permanently resident in the Bexley Borough at the time of issue.
Be unable to walk or self-propel a manual wheelchair indoors or outdoors.
Have a permanent need for an indoor/outdoor powered wheelchair.
Have the potential through frequent and regular use to benefit from the chair, gaining increased mobility and independence leading to improved quality of life.
Be at least 3 years of age
The assessor may, with the consent of the user, seek further medical advice about individual users from their GP or Consultant. The user should be medically fit to control a powered wheelchair indoors and outdoors independently:
Free from conditions causing loss of consciousness and epileptic seizures in waking hours within the past year, in line with the DVLA requirements for motor vehicle drivers.
Free from any combination of medical conditions and/or treatments likely to make independent powered wheelchair control unsafe for themselves, pedestrians or other road users.
Have a visual acuity of at least 6/60 (able to read a number plate at 27 feet).
Have a field of vision of 120 in a horizontal plane and above/below this plane.
Have no profound hearing deficit.
The user should:
Have demonstrated in a driving test and/or by other means that they have the insight, intellectual capacity and dexterity to operate an EPIOC safely and responsibly on their own and without assistance. Users should also demonstrate the capacity to compensate for their sensory or physical impairment.
Meet the weight limits stated in the manufacturers’ specification for supply of a chair.
Have a suitable home environment, with:
-adequate space indoors for storage of the wheelchair with a power supply for charging the battery
-adequate space for movement of the wheelchair within the home (with footplates in situ)
-wheelchair access to the property / ramping which can accommodate weight of user and chair i.e. concrete
-local environment conducive to wheelchair use (e.g. dropped kerbs)
The user must agree to the Bexley Wheelchair Service conditions of loan.
Situations not included
User / attendant controlled powered wheelchairs for outdoor use only are not supplied by Bexley Wheelchair Service.
Note
Clients in their own homes will be provided with a standard non-powered chair as a secondary/back-up chair.
If a client is already in possession of a lightweight manual chair at time of EPIOC provision, this will not be removed but subsequent replacement provision will be from the standard manual range.
For clients with complex seating needs, a temporary loan EPICmay be available in an emergency whilst the EPIOC is being repaired.
- Provision of Dual Operated Electrically Powered Indoor/ Outdoor Wheelchairs
Definition of equipment
Electrically powered indoor/outdoor wheelchairs where the user controls the chair, but with a second joystick control mounted near the push handle for the carer to take over control of the chair as necessary.
Criteria for provision
The user should:
Fulfil all criteria for EPIOC provision, (e.g. they are unable to walk and self-propel, and have a suitable home environment – please refer to the full EPIOC criteria), and
Be able to operate an EPIOC, but due to a deteriorating or fluctuating medical condition may require occasional assistance in controlling the chair when outside.
Dual controls may also be added to a child’s electric chair during the learning process, and for all younger children who have not developed road sense and are therefore accompanied by parents/guardians when out.
- Provision of Wheelchairs with User-Operated Powered Tilt/Recline
Definition of Equipment
Tilt – ability to adjust the angle of the seat whilst maintaining the seat to back angle.
Recline – adjustment of the back support in order to change the seat to back angle.
The user must be able to control the equipment independently and manoeuvre the wheelchair safely – (please refer to the EPIC / EPIOC criteria as appropriate).
Criteria for Provision
User must have clinical diagnosis for which tilt and/or recline is appropriate.
Moving to an alternative static chair is not possible because of disability and/or user requirement to be mobile.
User needs frequent changes of position to be able to remain in wheelchair, for example for comfort or pressure relief.
User is unable to tolerate angle of fixed tilt and/or recline for long periods.
Custom-made special seating does not aid pressure relief and comfort sufficiently.
User needs to alter own position independently to relieve pressure and maximise function/posture.
User/carer must have an awareness and understanding of any adverse effects of tilt and recline on posture e.g. spasms, pelvic tilt.
User must be able to use the powered wheelchair safely and to enhance independence.
Situations not included in this provision
- Where tilt is only required for aspects of feeding management
Note
Joint funding with other agencies may need to be considered where tilt-in-space is desirable but not clinically essential for mobility/postural needs.
- Provision of wheelchairs with Manual Tilt
Definition of equipment
Tilt – the ability to adjust the angle of the seat whilst maintaining the seat to back angle.
Criteria for provision
A standard wheelchair with a semi-reclining back and wedge cushion should be considered as the first option where a user needs to sit in a tilted position. Any environmental constraints will be considered when prescribing this type of wheelchair.
The user must meet all of the following criteria:
The user is unable to mobilise
The user will spend more than 4 hours per day in the wheelchair
The user has significant postural needs which cannot be met in any other wheelchair
The user will gain significant improvements in their posture and mobility from the provision of a tilt-in-space wheelchair
Where the wheelchair will be used by carers to take the user out.
Situations not included in this provision
When a posturally supportive armchair will meet their needs
When the user is continuing to show improvement in their posture and mobility.
Where tilt is only required for aspects of feeding management.
Note
Hospital or Rehabilitation Units are expected to supply their own tilt in space wheelchairs to be used during rehabilitation. Assessment for a tilt in space wheelchair will not be carried out while progress is being made and posture and/or mobility is still improving.
Joint funding with other agencies may need to be considered where tilt-in-space is desirable but nor clinically essential for mobility/postural needs.
- Provision for Children – Standard Buggy with no Postural Support
Definition of equipment
Buggy – A pushchair to enable a very young child to be taken out long distances by parents/carers.
Criteria for provision of standard buggy
Where the child is developmentally delayed, is not able to walk distances due to reduced mobility and it is envisaged that the buggy will still be required for at least two years.
The child has to be 36 months or older (it is expected that buggies are normally used by any child until this age)
A buggy is age appropriate for the child
Situations not included in this provision
When the child is under 36 months of age
When the request for the supply of a buggy is for social or behavioural reasons only.
When the request is for a double buggy and the child already uses a wheelchair service single buggy.
Wheelchair Service does not fund raincovers.
Note
For a child under 36 months who needs postural support, and the parents wish to keep their current buggy, the wheelchair service will assess the possibility and viability of making postural support inserts into the parents’ own buggy.
- Provision for Children – Specialist Buggies
Definition of equipment
A specialist buggy offers postural support to the occupant. It may also include a tilt-in-space facility.
Criteria for issue
A specialist buggy will be issued if:
A standard wheelchair and/or seating system is not appropriate
A buggy is age appropriate for the child
The child meets the criteria for special seating (criterion 10)
The child is unable to walk
Special seating cannot be used in the child’s own buggy or in the standard buggy issued by the wheelchair service
Note
Where there is no requirement for postural support, a standard buggy will be issued.
Rain covers are not funded by the Wheelchair Service.
- Provision of Special Seating
Definition
Special seating comprises a range of individually manufactured or modified seating systems to sustain or correct optimum posture of a user within his/her wheelchair. For example:
-Matrix
-Lynx
-MSI
-CFU
-CAPS II
-Jay and Otto Bock back supports
Criteria for provision
The user must be eligible for a wheelchair for mobility purposes through the wheelchair service, and this should be the primary reason for referral (i.e. special seating for use within a wheelchair to enable a client’s mobility, not special seating to replace an armchair or solely to provide school seating).
The user requires the wheelchair for a significant part of the day as part of a postural management programme, and/or the equipment is used in conjunction with other positioning equipment.
The user requires support/stabilisation to achieve or maintain an appropriate sitting posture in the wheelchair and thereby maximise function.
The user should be ‘seatable’ with appropriate equipment (referring to Chailey levels of sitting).
The seating will be used in agreement with user/parents/carer and therapists.
There is a need to:
-enhance postural awareness
-correct posture
-inhibit unwanted movement
-monitor and minimise deformity and discomfort associated with deteriorating neurological conditions.
-maximise functional ability.
The environment should be able to accommodate the seating required.
The user/carer/parents must be able to position the client correctly in the unit.
- Provision of Pressure Relieving Seat Cushions, and Back Cushions
Definition of equipment
Pressure relieving seat cushions – wheelchair cushions supplied by the wheelchair service, for use in wheelchairs, which offer degrees of pressure relief for clients who have, or are at risk of developing, pressure sores. They are made out of a variety of different materials. (Basic foam cushions are not classified under this category).
Back cushions – comfort cushions used behind the user to pad the backrest, to provide basic lateral support, or to alter the back angle of the wheelchair and enable a more upright posture.
Criteria for provision
Cushions are only supplied in accordance with the wheelchair therapist’s assessment of clinical need. Assessment for pressure-relieving cushions incorporates the use of a recognised risk assessment scale e.g. Waterlow, and takes into account the overall management of a user’s pressure relief.
Pressure relieving and back cushions are only supplied for full-time users. They are not supplied for outdoor use only. (Basic 2” or 3” foam cushions may be supplied for occasional users).
Cushions for postural support may be supplied to users who have difficulty in maintaining a symmetrical posture.
The cushion and cushion cover will need to be maintained by the carer.
Cushions must be used according to the manufacturer’s instructions, and with the correct alignment and orientation in the wheelchair.
The user’s district nurse should be consulted (when involved).
Notes
Alternating air pressure cushions (dynamic pressure cushions) are not supplied by the wheelchair service.
Pressure cushions are not generally supplied to residents of nursing homes, as provision of these cushions would be considered to be part of nursing care. A user would, however, be eligible if they demonstrate independent mobility from a self-propelling or powered wheelchair, and spend at least 4 hours of the day in the wheelchair for mobility reasons.
Although some cushions supplied provide high pressure relief, it is not recommended that users with pressure sores sit in their wheelchair for any longer than several hours at a time (even if supplied with a high pressure-relieving cushion), and that they stay on bed rest.
- Provision of Accessories and Modifications
Definition of equipment
Accessories – items added to the chair, which enhance its use but do not change the manufacturer’s specification of the chair.
Modifications – alterations to the wheelchair which change the manufacturer’s specification but do not change it’s original intended use.
Criteria for provision of accessories
Accessories are only supplied in accordance with assessment of clinical need.
Trays – these will be supplied to full-time users who require a tray to facilitate activities of daily living and can demonstrate safe use of the wheelchair with the tray fitted. A tray may be supplied as part of a seating system for postural needs, and should not be used as an alternative to a table.
Head rests / head supports – will be supplied as part of a seating system for postural control. Headrests are not supplied for transport purposes only. The transport provider is responsible for an appropriate head support.
Elevating leg rests (ELR’s) and footboards - these will be supplied if there is a clinical need due to inability to position the leg on a standard foot support.