EAST COAST COMMUNITY HEALTHCARE WHEELCHAIR SERVICE

ELIGIBILITY CRITERIA

CRITERIA FOR REFERRALS

1. The client has a long-term or permanent disability (ie in excess of 6 months) and has limited or no walking ability.

2. The client is aged over 30 months. Clients under 30 months may be referred for exceptional special seating needs.

3. Where the client has a terminal illness.

4. Where the client will use the wheelchair for a minimum of 4 times a week.

Wheelchair Services do not supply electric wheelchairs for outdoor use only.

Wheelchairs for temporary use (i.e. for less than 6 months) may be available from The British Red Cross, Ipswich Disabled Advice Bureau, DIAL Lowestoft, and other voluntary organisations.

MANUAL WHEELCHAIRS

Priorities For Provision

For those people who meet the criteria for referral and who do not exceed weight limits on available

products, the proposed priorities are:

High Priority

1. Long term full-time wheelchair users who are not able to walk and have no other form of mobility ie:

People who have limited or no ability to self-propel, require an attendant to push the chair and are dependent for many basic daily needs.

People who have limited ability to self-propel but display a degree of independence in basic daily needs and may require an attendant for outdoor mobility.

People who can self-propel and can achieve independent mobility and lifestyle in a wheelchair.

2. People with a terminal illness.

Medium Priority

People who have a high degree of independence but who require a wheelchair to maintain their level of independence and quality of life-style. They have variable walking ability due to their fluctuating condition.

Low Priority

People who are able to walk short distances, mainly indoors, and require a wheelchair at least 4 times a week for outdoor use or to enhance quality of life for the person and their carer.

LIGHTWEIGHT ATTENDANT –CONTROLLED MANUAL WHEELCHAIRS

Provision will be based on the following criteria in relation to the family carer:

a need to lift the wheelchair established

family carer has a long-term medical condition which contra-indicates lifting a standard wheelchair, less all accessories and removable parts, and where alternative lifting techniques are inappropriate.

Where necessary a written report may be requested from a carer’s GP.

following assessment agreement should be reached that the lifting technique used by the carer is appropriate

This category of equipment will only be issued if the wheelchair user satisfies the manufacturer’s recommended weight limit.

SELF-PROPELLING LIGHTWEIGHT WHEELCHAIRS

Within current resources priority will be given to full-time wheelchair users who meet

the following criteria:

they must have a permanent physical disability

they must be unable to functionally self-propel in a standard wheelchair

they must demonstrate tangible improvements in their mobility/independence

through the use of a lightweight wheelchair

they must be able to demonstrate an awareness of the safe management of the

wheelchair and be able to carry it out.

HIGH PERFORMANCE WHEELCHAIRS

Full time active wheelchair users who meet the following criteria:

Have a permanent physical disability

Demonstrate tangible improvements in their mobility / independence through the use of a high performance wheelchair

Where appropriate demonstrate their ability to load the prescribed wheelchair into a vehicle independently.

Demonstrate safe transfer with the prescribed chair.

The model of wheelchair provided will be based on clinical need and the current range of chairs provided.

A wheelchair requested by the user that is not currently provided by the service will need to be purchased via the voucher scheme.

All wheelchairs are provided to meet the users essential daily activity needs. The service does not provide wheelchairs for sport.

Only one high performance wheelchair will be supplied.

ELECTRICALLY POWERED INDOOR WHEELCHAIRS (EPICS)

Provision of an indoor powered wheelchair may be considered for those people who are unable to walk and whose ability to self-propel is limited and/or for whom self-propelling is contra-indicated on medical grounds. The powered wheelchair must be shown to provide a significant degree of independence in the home, at school or at work. Only one such powered wheelchair will be issued.

An EPIC will only be provided where it is required for long-term use.

The person must demonstrate the potential ability to use an EPIC safely and independently (based on an agreed assessment procedure).

There may be occasions when practical arrangements and the home environment will be unsuitable for provision of a battery powered chair eg where the person and their carer are unable to cope with day to day battery care.

Powered wheelchairs are not generally issued to people with the following conditions:

Uncontrolled epilepsy or recurring loss of consciousness Blindness Behavioural problems Dementia and associated psychotic disorders Perceptual/cognitive problems

High Priority:

Children in school People at work People who are totally unable to walk or self-propel where

independence in the home will be significantly promoted.

ELECTRICALLY POWERED INDOOR/OUTDOOR WHEELCHAIRS (EPIOCS)

People must meet all of the following basic eligibility criteria before they can have a

specialist assessment for the provision of an EPIOC:

1. be severely and permanently restricted in mobility;

2. be permanently unable to walk (except to take a single step, to facilitate transfer

for example);

3. be unable to propel a manual wheelchair and have a need to use an electrically

powered wheelchair for indoor mobility;

4. have the ability to comply with DVLC requirements for motor vehicle drivers

concerning epilepsy and other causes of loss of consciousness;

5. have a visual acuity which meets Class 3 vehicle requirements under the 1988

Road Traffic Regulations (ie can read car number plate from 40’), or as

subsequently amended. Have no major visual field defect;

6. have a residential environment which is accessible by an EPIOC and is

compatible with its use or has the potential to become so;

7. have access to a local outside environment which is generally compatible with

use of an EPIOC;

8. be able to ensure that an EPIOC can be maintained in accordance with the local

conditions of loan.

ELECTRICALLY POWERED INDOOR/OUTDOOR WHEELCHAIRS

(EPIOCS)

CONT.

If a person meets these basic criteria, this does not mean that an EPIOC will

automatically be provided. A specialist assessment will then be undertaken by a

therapist or other qualified professional. This will take into account the following

aspects:

1. the person’s cognitive function and dexterity to operate an EPIOC fitted with

suitable controls safely and responsibly on their own and without assistance;

2. the extent to which any associated medical conditions might make them a danger

to themselves, pedestrians or other road users;

3. their motivation to use an EPIOC and potential to maintain or improve their

quality of life, through increased mobility.

4. the person’s environment and its adaptability for EPIOC use;

5. the person’s ability to operate the EPIOC safely on the public highway, with

training as necessary.

If subsequently the person fails to meet any one of the criteria, as determined by

review, the wheelchair will be withdrawn.

For further details on this provision, reference should be made to the separate leaflet

“Electrically Powered Indoor/Outdoor Wheelchairs: Local Eligibility Criteria.”

PRESSURE RELIEVING AND BACK CUSHIONS

Suffolk Wheelchair Services only supply pressure-relieving and back cushions for use in wheelchairs, they will NOT be issued for use in armchairs. The person must be registered with the Wheelchair Service AND be willing to accept referral for pressure risk management by appropriate professionals.

Use of wheelchair pressure-relieving cushions should be part of a comprehensive pressure care management plan for each client.

Pressure relieving and back cushions will only be supplied in accordance with an assessment of clinical need. Assessment for pressure relieving cushions will incorporate the use of a standard assessment tool (eg Waterlow score) as a guideline and take into consideration the overall management of a person’s pressure relief.

Alternating air pressure cushions (dynamic pressure cushions) are not supplied by the Wheelchair Service.

Order of priorities:

1. People with existing pressure sores

2. People assessed as at ‘High Risk’ of developing pressure sores

3. People assessed as at ‘ Medium Risk’ of developing pressure sores

4. Low risk people and reviews

Pressure relieving cushions will not generally be supplied to residents of Nursing

Homes, as provision of these cushions would be considered to be part of nursing care.

A person would be eligible if they demonstrate independent mobility from a self-

propelling or powered wheelchair.

POSTURAL SUPPORT/SPECIAL SEATING IN WHEELCHAIRS

The need for postural support will be considered as part of the assessment process and the required adaptations

to seating and wheelchairs will form part of the prescription. Even where minimum support is required,

wheelchair users should be instructed on the importance of correct posture to avoid permanent structural and

muscular damage which may result in significant reduction in their quality of life and avoidable pain relief.

Priorities for special seating will be as follows:

i. Maximum support – severe disability Poor head and trunk control

Unable to sit without support

Limited upper limb function

Prevention of skeletal deformity

Likely outcome: Custom-made seating to provide maximum support

ii. Medium support – moderate disability

Variable head control

Poor trunk control

Requires support to maintain stable position

Limited hand function

Likely outcome: Modular system supporting hip and trunk

iii. Minimum support Good head control

Good to fair trunk control

Stable when sitting unsupported

Likely outcome: Good functional ability when seated on a stable base with minimum support

Special seating will only be supplied when the wheelchair is required for MOBILITY purposes, not to replace an armchair or solely to provide school seating or a transport system.

Care should be taken in selecting the most cost-effective seating on a long term basis, and taking into account social circumstances.

Special seating will only be supplied if it can be demonstrated that trained carers will be available for transfers and correct positioning.

The person’s environment must be appropriate for the special seating system prescribed. A voucher may be considered for clients wishing to fit special seating into manual bases not

within the wheelchair service range. Vouchers will not be supplied for special seating.

CRITERIA FOR THE SUPPLY OF TILT-IN-SPACE

WHEELCHAIRS

A standard wheelchair with semi-reclining back and wedge cushion should be

considered as the first option where a person needs to sit in a tilted position. Hospitals

or Rehabilitation Units are expected to supply their own tilt-in-space wheelchair to be

used during rehabilitation. While progress is being made in posture and mobility, a tilt-

in-space wheelchair will not be assessed for.

The environmental constraints will be considered when prescribing this type of wheelchair.

A person is ELIGIBLE for a tilt-in-space wheelchair when all the following criteria are met:

a) The person is unable to mobilise

b) The person will spend more than 4 hours per day in the wheelchair

c) The person has significant postural needs which cannot be met in any other wheelchair

d) The person will gain significant improvements in their posture and mobility from the provision of a tilt-in-space wheelchair.

A person is NOT eligible for a tilt-in-space wheelchair if:

a) A posturally supportive armchair only is required to meet their needs.

b) The person is continuing to make progress in their posture and mobility. An assessment will only take place when progress has plateaued and a long-term need for a tilt-in-space wheelchair has been established.

WHEELCHAIR VOUCHER SCHEME

Based on Department of Health guidance Wheelchair Services operate a Wheelchair

Voucher Scheme.

Two options are available – the Independent Option and the Partnership Option.

The Voucher is equivalent in value to the wheelchair which the NHS would prescribe to meet assessed needs, but may include a contribution towards repair and maintenance depending on the option chosen. The person meets the balance of cost of the selected chair from their own resources.

After 4 months use of a wheelchair, any wheelchair user may apply. The Voucher Scheme applies to manual wheelchairs, wheelbases for special seating, indoor powered wheelchairs and indoor/outdoor powered wheelchairs.

Wheelchairs purchased through the Voucher Scheme must be of the same category as the prescribed chair ie a voucher for a manual wheelchair cannot be used towards the cost of a powered wheelchair or vice versa.

For further details reference should be made to the separate leaflet, “Wheelchair Voucher Scheme”.