Ventilator-Assisted Living©

Summer 2004, Vol. 18, No. 2

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Homebound Exception Demonstration

David Jayne, National Coalition to Amend the Homebound Restriction, Rex, Georgia (www.amendhomeboundpolicy.homestead.com)

In a move that signals that the Centers for Medicare and Medicaid (CMS) has given priority to the implementation of the three-state (Massachusetts, Missouri and Colorado) demonstration that lifts the homebound requirement for permanently disabled beneficiaries, CMS has issued detailed systems directions to its contractors on how to implement the demonstration.

The demonstration will last for two years and essentially waive the homebound requirement for persons who otherwise qualify for Medicare home health under the following criteria:

The effective date of the instruction is October 2004. Complete details are online at www.cms.hhs.gov/manuals/pm_trans/R3DEMO.pdf.


Retrofitting Ventilators for Power Chairs

Jerry Daniel, Vancouver, Washington

When it comes to mounting a ventilator on the back of a tilt-and-recline power wheelchair, it is hard to find a good setup that doesn't throw the chair off balance or protrude too far in back. I constructed a scale model of a retrofitted LP10 ventilator to mount on the back of an Invacare Storm Series wheelchair. The retrofit makes it easier for a ventilator user, attendant or respiratory therapist to get at the control panel and settings. The easier it is to work with the ventilator, the easier it is to keep our caregivers happy and retain good attendants.

photo of Jerry's one-fourth scale model LP10My one-fourth scale model LP10 takes the piston pump and circuit boards to minimum width configuration: 8¼" wide x 15½" deep. The piston pump assembly is placed with the motor in back and manifold in front. The cabinet saves space and allows the ventilator to ride across the back of the chair with minimum protrusion. The two (yellow) working panels on either end of the ventilator face up. Frequently used settings such as pressure monitoring, alarm indicators and reset, and power supply monitoring are easily visible and accessible from either side of the chair. The intake filter, external battery connection and external batter charge condition meter are also easily visible and accessible. The panels have clear plastic lids to guard against dirt and dust. The circuit/tubing output is mounted on a hard plastic turret that rotates 330° and therefore is not easily damaged.

Tilted wheelchair with ventilator trayThe ventilator can be worked from either side because some ventilator users function better with their attendant on the right side; others prefer the left side. The ventilator tray does not move, and the working panels are visible in all positions of tilt and recline. In tilt mode, the ventilator user can go to 45° without adjusting clothing or seating. In the reclining mode, the seat comes close to the ventilator but does not touch it. The ventilator tray can be easily attached or removed from the Invacare base rails without tools.

At night, both the external and internal batteries can be charged by plugging the ventilator into the A/C module. This LP10 version does not carry the power transformer, reducing the weight by 5 lbs. No handling of the battery or external battery cords is necessary. In most cases, no special charger is needed.

An ideal situation for ventilator users would be to keep a large, durable and heavy piston-pump volume ventilator at the bedside and to mount a compact, lightweight and turbine-driven multimode ventilator on the wheelchair. However, the ventilator user would have to be flexible enough to switch from a piston-pump unit to a turbine-driven unit in the morning, and then back again at night.

Both Respironics, Inc. and Puritan Bennett have received my design. They know that I am both a certified service technician and long-term ventilator user. I hope that my consumer input can move them to action. I am planning to build a prototype.

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