Addressing ADL: recommending AD/DME

As I learned on one of my level II rotations, recommending DME is a critical task of OT’s working in phys dys, whether it is inpatient rehab or acute care. Of course, sometimes patients being discharged from acute care straight to home don’t need DME ( durable medical equipment) or AD (adaptive equipment), and those not going home will have home equipment needs addressed during treatment in sub acute or inpatient rehab, but acute care OTs still introduce the topic.

I think it is really important for OT students to actually work with DME during fieldwork because just knowing what it is definitely doesn’t help you give a patient recommendations on what to get or how to use it. There are also so many other factors which come into play when making recommendations, such as insurance, length of time the equipment is required, and practicality of the equipment. For example, it would be very non-beneficial and impractical to suggest a toilet safety frame to a patient who is Medicare eligible and can get a bedside commode to place over the toilet. Also, young hip patients who have upper body strength to perform toilet transfers don’t need a higher toilet after their hip precautions are no longer in effect, so it might be more beneficial to suggest a bedside commode that can be rented from the local lending closet, which is usually at the village hall. Also, one of my supervisors pointed out how raised toilet seats are less likely to be continuously used because the inner rim gets quite soiled after repetitive use, and it is our responsibility to recommend DME that patients will use.

Knowing how to use adaptive equipment for lower body dressing is also important because many different surgical procedures have precautions which render the use of AD necessary. Most often these precautions include no bending, or twisting. Gastric bypass , spinal, and hip replacement surgeries are a few examples. However, most of these surgeries are elective, and most patients have family who have already planned to help out and are not interested in adaptive equipment. Many times I feel like my session teaching AD is completely useless, but I tend not to skip that part unless they specifically say they don’t need AD. Sometimes just showing them how to use it is for the best because sometimes I’ll have a patient who says ” you know, i didn’t realize dressing will be so difficult, maybe I will need the equipment.”

Even when patients agree to needing the equipment, I feel bad directing them to our hospital gift shop because I know its expensive there. So, I feel better providing patients with different options. I’ve listed a few below.

Walmart commodes as low as $32

Target beside commode starting from $44

Target sock aid $12

Target reachers different lengths and styles

Target RTS

Home Depot shower chairs

Lowes shower chairs

Walgreens sock and sold only online

toilet tongs from Amazon

Keep in mind that most of this stuff is available on Amazon and is a great way to price compare, but most people sell to be against the idea of ordering DME/AD offline- I would be weary as well, since I wouldn’t know how is been used before or how it’s been cleaned. At least equipment rented from a lending closet is guaranteed to be cleaned and sanitized between each rental.

Lending closets are usually based out of each town’s village hall, and if not, you can call the village hall to find its location. Lending closets don’t carry raised toilet seats for the most part- they are just that difficult to sanitize.

Having a tool box of different DME options is helpful, but knowing how to recommend it is something that only clinical experience can provide. I will update this post if I think of any more tips.

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