How Do You Choose a Wheelchair
Many caregivers that I’ve met over the last few years (especially after the pandemic) have had questions about wheelchairs. This is mainly because their loved has had more trouble getting around. Sometimes it’s because of weakness, other times it’s because of pain. Then, with others, it’s because they may have trouble breathing, especially when going to a doctor’s appointment and they have to walk from their car to the physician’s office. It’s only worse when the weather isn’t agreeable.
In most cases, the caregivers are disappointed to learn that their insurance won’t cover the cost of a wheelchair or the diagnosis won’t “justify” the “need” of a wheelchair. Many people don’t know that Medicare will not cover the cost of a wheelchair if it’s solely used for in the community such as shopping or going to medical appointments. And while that may sound harsh, because of this, the cost of purchasing a wheelchair falls on the patient or family. In this case, a good question is “how to choose a wheelchair that fits your specific needs?”
What Type of Wheelchair Do I Need?
The scope of this particular guide is “manual” rather than “power” wheelchairs as this is what most caregivers need when going short distances running errands or going to medical appointments. The primary types of manual wheelchairs are the standard and the transport chairs and initially, we’ll look at their differences so you can decide which one is best for your situation.
A standard manual chair is the one most people are familiar with. It has 2 small wheels in the front and 2 much larger wheels in the rear. The larger wheels allow the rider in the wheelchair to “self-propel” with little effort and they also allow for a smoother ride as the larger wheels tend to absorb bumps and shocks. Because the chair is designed for it’s rider to “drive” it, the brakes are also accessible by the rider/driver.
Standard chairs are larger than their transport cousin and more comfortable as well as durable. Because of this they are more sturdy but also heavier and more difficult to lift or stow. Standard chairs generally come with removable arm rests, the option for static or elevating leg rests, and can be adjusted for height in the majority of cases.
The transport chair, on the other hand, is lighter and can collapse to a smaller size. This makes it a lot easier to lift and stow in a car trunk or even a back seat. It is not designed to be propelled by the rider but by the caregiver who will push from behind. Therefore, it has 4 smaller wheels and the brakes are difficult for the rider to reach and engage. As the wheels are smaller, the ride is not as smooth as the standard chair. But, the rider is not meant to be in the chair for long periods of time.
In most cases, the armrests are not removable and the leg rests are fixed and do not elevate. Also, the back and seat are not as substantial as the standard chair and don’t offer the support that makes extended periods in the chair comfortable.
Insurances when they do cover the cost, it will be for the standard chair. In general, if a transport chair is what you think you need, it will probably be an out of pocket cost.
How Do You Choose The Right Size Wheelchair
Like people, wheelchairs come in different sizes to accommodate the specific needs of each situation. But if you want to know how to choose a wheelchair for the elderly or how to fit someone for a wheelchair, whether standard or transport, you generally go by the width of the seat. Wheelchairs typically come in even numbered seat width sizes such as 16 inch, 18 inch, 20 inch, and so forth.
The width of the seat is meant to accommodate the width of the rider at the widest part of their hips or thighs with a little room to spare. If your hips measured 19 inches, although you may be able to squeeze into a 16 inch chair, it probably wouldn’t be comfortable. A 20 inch chair would probably be more to your liking.
So, if you’re wondering, “how wide do my doors have to be?”. Here’s something to keep in mind when buying a manual (and even transport) wheelchair is that the seat width is the “inside” width of the seat area and not the overall width of the chair itself. For a manual “20 inch” chair, the overall width may be 27-28 inches. So measure all applicable doorways as you’ll want to make sure that it will fit through them (remember to not just measure the door frame but the “width” of the access thru the door which can be limited by how wide the door itself opens).
So, How Do You Measure a Person For a Wheelchair
When considering the right sized chair to get for your loved one or care recipient, you have to measure the widest point in the hip/thigh region while they are sitting in a fairly firm chair. This will allow the hips and thighs to “spread” out and it’ll give you a better picture of how much room they will need to be comfortable.
Have them sit in a dining chair, eyeball the widest parts of their body and using a tape measure, record what that number is. It’s better to be generous here rather than concerned about “size”. If a chair is too tight, yes, it may be uncomfortable, but it could also cause scrapes and sores from repeatedly getting into and out of the chair.
Most standard chairs will accommodate individuals that weigh 250-300 pounds or less. And there are wheelchairs for larger persons also. As would be expected, they are heavier and not as easily stowed.
Does Medicare Pay For Wheelchairs
Medicare will pay for a wheelchair if it’s deemed a “medical necessity”. This is something that you and the primary care physician (and possibly a physical therapist) can determine. Medical necessity includes several factors that include, but are not limited to, the primary diagnosis, the anticipated length of need, whether the person can actually walk, and whether their mobility in the home is determined to be unsafe.
The following examples are hypothetical but will give you an idea of how things work.
Mrs. Smith, an 82 year old woman who has fallen and broken her ankle recently had surgery and the doctor wanted her to be non-weight bearing on that ankle for 6 weeks. She lives by herself and her daughter comes over twice a week to help with cleaning, meals, and chores.
Since Mrs. Smith cannot put weight on her foot because of a doctor’s order, the ability to safely walk and mobilize around her home is severely limited if not impossible. This is an example of having a diagnosis, limitation, and medical need for the ability to safely mobilize around her home.
Then theres Mr. B. He is a 75 year old man, who is out of shape and has trouble walking long distances because of low back pain and he runs out of breath. His son asks his primary care physician for a prescription for a wheelchair to help Mr. B get to his doctor’s appointments because he has trouble walking from the parking lot to the intake office.
This second scenario is not a matter of medical necessity but only of patient convenience. Being “out of shape” is not a medical condition and so, not a diagnosis. Mr. B can also walk, he just runs out of steam and would find a wheelchair helpful, but not necessary. In this case, Medicare would probably not pay for a wheelchair for our Mr. B.
Where can I Get a Wheelchair
Most people think that they need to go to a medical equipment store to purchase a wheelchair. And while this is an option, it’s not the only option for folks in the 21st century. Medical supply stores may be able to help you navigate the insurance reimbursement situation when a piece of equipment is prescribed by a physician. And, it can also be helpful at times to actually talk to a real person face to face about a particular piece of equipment when you’re not sure of all of your options.
But, there are other options available, especially if you’re purchasing a wheelchair out of pocket. Naturally, there is Amazon. But, there’s also Walmart, CVS, Walgreens, and RightAid that may carry what you’re looking for whether online or ordering from your local store.
So, Now, How Do I Use or Adjust a Wheelchair
So, let’s say that you’ve gotten a new chair. Most chairs right out of the box are not adjusted for the one who needs to use it and many times, caregivers aren’t even aware that wheelchairs can and should be adjusted. In this section, we will look at how to use a wheelchair to get the most out of it.
When a wheelchair is delivered, it’s usually collapsed, in a streamlined box, that makes it easy to transport and deliver. Once you get it out of the box, struggle to open it to sit in, you’re stuck trying to figure out how to put the leg rests on.
Let’s back up and look at folding and opening the wheelchair for easy stowing and then getting it ready for use.
How Do You Fold Up a Wheelchair
Once the wheelchair comes out of the box and you get it open and ready to sit on, when it comes time to fold it up and put it out of the way, it doesn’t cooperate. Many people grab the handles and try to push them together to get the chair to fold up to it’s original position in the box. But this tends to be a lot of work.
The way you collapse a wheelchair and make it streamline is to grab the middle front and middle back of the seat and simply lift up on them together. This will bring the sides together, making the chair thin again and you can roll it out of the way until it’s time to use it again.
Just as an aside, when you’re moving a wheelchair that is collapsed or folded together, take the brakes off and tilt it back. Then roll it on the 2 rear wheels. Sometimes, the front wheels get turned around making “steering” in the folded position difficult.
How Do You Open a Wheelchair To Use It
When you’re ready to use the wheelchair again, keep it folded while you move it to general vicinity where you want to use it and then put the brakes on. Holding onto one handle, tilt the chair to the side, lifting one of the back wheels off the ground about an inch or so. Then push down on the “edge of the seat” opposite the raised wheel.
IMPORTANT! Make sure you are using the flat of your hand when pushing the seat down. Don’t grab the edge of the seat with your fingers or you will smash them between the seat edge and wheelchair frame. Speaking from experience, this DOES NOT feel good.
The chair will open to it’s normal and open position and is ready for use.
How Do You the Put Footrests on a Wheelchair
Do you call them footrests or leg rests? The jury is out on that one. But, putting the footrests on a wheelchair is simple, but at the same time frustrating. This is because the footrests have to go on “just right”. You’ll understand when I explain it.
Most wheelchair footrests are held in place by a couple of upright pegs on the wheelchair that allow it to swing but stay in place at the same time. And there is also a latch that locks them in place.
The footrests have 2 holes that need to slide over the pegs at the same time in order for it to work. This means that the holes in the footrests have to be perfectly horizontal in order to slip into place. What some people do (and it causes all the frustration) is that they try to put one peg in the hole first and then the other and it’s not meant to work like that. But, once you got the hang of it, it’s just like riding a bike and becomes second nature.
But what about the “latch” you ask?
Well, the latch is what keeps the footrest facing toward the front rather than swinging to the side. The latch is typically tucked under the seat and behind where the person’s leg rests. In some cases, people can’t figure out how to work it. But, keep in mind, the latch usually operates horizontally. Pushing or pulling it horizontally unlocks or locks it when necessary. However, it usually will swing into place and lock itself.
Okay, How Do You Take Off the Footrests on a Wheelchair
Once you’ve mastered putting the footrests “on” a wheelchair, taking them off is a breeze. Simply find the latch that locks the footrest in place and push it “horizontally under” the seat. This will unlock it from the wheelchair frame and allow it to swing freely.
Once the foot rest is unlocked and out to the side, simply lift the unit straight up and it will slide off the pegs. Then you can stow them somewhere out of the way so as they won’t be a tripping hazard and bring them out when you need them.
How Do You Adjust Footrests on a Wheelchair
Since this guide is addressing wheelchair basics from the position of a new owner, it’s safe to assume that the foot or leg rests have not been adjusted appropriately for the user’s height or leg length.
With most new wheelchairs, the leg rests tend to be shipped adjusted to their shortest lengths. And while this may be perfectly fine for many people, others with longer legs may be a bit uncomfortable trying to use these shorter footrests.
Each footrest should have a nut or a button that will allow you to adjust them for length. In the case of having the nut, you will need a ratchet, adjustable wrench, or pair of vise grip pliers to loosen and then tighten the nut back after adjustment.
In the case of the button, simply depress the button and extend the leg rest to the desired length.
But how do you know what the desired length is, you ask?
The foot rest should be lengthened to allow for a 90 or greater degree angle at the hip joint. Or, for a better visual, the thigh bone of the rider should be at least horizontal to the ground to give them the most comfort.
One thing to keep in mind is that if you extend the footrests closer to their limits, the rider’s feet or the footrests themselves may scrape against the ground or a ramp with any level change.
Can You Remove The Armrests On a Wheelchair
Most standard wheelchairs come with removable or swing away/flip back armrests. By having the option to remove armrests (or at least get them out of the way) provides at least 2 advantages. For one, it allows a person more room to sit comfortably when arm rests aren’t needed. But, more importantly, it improves the ability to transfer to and from the wheelchair more easily.
For those who may not be able to stand, removing an arm rest allows a person to be able to use a sliding board. And even if you’re not using a slide board, you still remove an obstacle that the person in the wheelchair would ordinarily have to get past.
In the majority of cases, the armrests are removed by pressing a button at the base of the front and rear of the arm rest. Some chairs have clips that snap into place. With the majority of standard manual chairs, the armrests are interchangeable side to side that will allow for a couple of different things. When the armrests are in one position, front is lower than the back of the armrest. This allows a person to roll up to a desk or table fairly close. It’s perfect for eating at a dinner table or working at a computer desk. But when you switch the armrests to opposite side, the lower portion is in the rear and it allows for the person to propel the chair much easier.
How to Get a Wheelchair Over a Step or Curb
Pushing a loved one around in a wheelchair on flat surfaces is easy enough, but what do you do when you encounter a step or curb? There is a little known feature that is built into the rear of the wheelchair that makes going up or down a curb/step easier on the person pushing and the person riding.
Long story short, you generally go up or down on the back wheels of the wheelchair.
Alongside either rear wheel, there is a post that juts out from the frame. On some chairs these same posts are made for “anti-tip” wheels but are also used as levers for your feet to tilt the wheelchair backwards.
You can go down a curb forwards or backwards, but the chair itself is tilted backwards. It’s much easier on the caregiver to go down a step or curb backwards.
When going up a step, tilt the chair backwards and gently lift the front wheels up and over the step or curb. Then roll the rear wheels up to the step and gently lift and push the rear wheels onto the step.
How Do You Use a Transfer Board From Wheelchair to Bed and Back
Using a transfer board, or “slide board” as therapists call them, to get into the bed or out of the bed using a wheelchair is fairly simple.
- You first have your care recipient sit on the edge of the bed.
- Then, bring the wheelchair next to the bed and remove the armrest.
- Have the care recipient “turn their back” toward the chair and point their toes away from the chair.
- Then lift the leg closest to the chair and place the slide board underneath that leg and make sure that the other end of the slide board is positioned no further from the middle of the wheelchair.
- The care recipient can then begin scooting across the board or the caregiver can assist and slide the client across the little bridge to the chair.
- Once in the chair, lean and lift the leg and remove the slide board from under the client.
You can use sliding boards when transferring from wheelchair to toilet or chair. However, it’s a little difficult to use a slide board when transferring from wheelchair to car. And if a person is strictly non-weight bearing it may not be possible to safely transfer them to a car and they may need to be transported in a wheelchair van.