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SPECIAL NEEDS EQUIPMENT PROGRAM INFORMATION

General Program Information Special Needs Equipment Depot

Locations Universal Loan Equipment Restricted Loan Equipment

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GENERAL PROGRAM INFORMATION January 1, 2018

Special Needs Equipment (SNE) is one of the Saskatchewan Aids to Independent Living (SAIL) programs offered by the Ministry of Health. SaskAbilities operates the program under contract with the Ministry of Health. Special Needs Equipment is:

a loan program for people of Saskatchewan a recycle program – equipment is provided to clients from an

available pool of recycled equipment designed to meet the long-term needs of the client when

equipment is required for more than three months administered from five SNE depots located throughout the

province This manual has been prepared by the SaskAbilities to provide general program information. For a complete list of SAIL programs and policies please refer to their website at http://www.saskatchewan.ca/residents/health/accessing-health-care-services/health-services-for-people-with-disabilities/sail. SAIL GENERAL ELIGIBILITY REQUIREMENTS – UNIVERSAL LOAN EQUIPMENT

Applicant must be a resident of Saskatchewan Applicant must possess a valid Saskatchewan Health Services

Card Applicant must be referred for service by an approved health

professional – (Refer to the Appendix for the Special Needs Equipment Eligible Requisitioners list.)

Unless authorized by Saskatchewan Health, the services must be obtained in Saskatchewan

Applicant is not eligible to receive the service from any other agency or government: First Nations and Inuit Health Branch, Health Canada – contact

Non-Insured Health Benefits Saskatchewan at 1-866-885-3933 Veterans Affairs Canada Canadian Armed Forces Federal Penitentiaries Workers Compensation Board Saskatchewan Government Insurance

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SAIL ELIGIBILITY REQUIREMENTS - RESTRICTED LOAN EQUIPMENT Recipients of the Supplementary Health Program (SHP), Saskatchewan Income Plan (SIP), or the Family Health Benefits program (FHB) may be eligible for the loan of additional low-cost devices at no charge. The SAIL general eligibility requirements listed above must also be met. For clarification of SHP, SIP, or FHB coverage, contact the Ministry of Health at (306) 787-7121.

All clients meeting SAIL general eligibility requirements listed above qualify to loan mobility equipment (walkers, wheelchairs

with a cushion).

Individuals residing in personal care homes, special care homes, and group homes are not eligible for environmental equipment

(hospital beds, commodes, etc.) only mobility equipment.

Patients in an acute care facility are not eligible for SAIL benefits except as part of a definitive discharge plan.

ACCESSING THE LOAN All equipment loans require a requisition to be signed by the appropriate requisitioning authority. Each piece of equipment in the manual has the approved requisitioning authority listed. Refer to the Appendix for a complete listing of program equipment and eligible requisitioners. Requisitions may be obtained by calling the local SNE depot or by emailing [email protected]. Refer to the Appendix for printable (Adobe PDF) requisition and application forms.

Special Needs Equipment Requisition Special Needs Equipment Wheelchair Requisition

Requisitioners must be registered in the SNE database. Call your local SNE depot to confirm or have your name added to the requisitioning list. All requisitions must be complete and legible or they may be returned to the requisitioner and cause delays in equipment delivery for the client. Please note the following when completing SNE requisitions:

A shipping (street) address is required if the equipment is to be delivered. Deliveries cannot be made to a PO Box.

If the equipment is required to facilitate a discharge from an acute care facility, please include the discharge date to enable

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prioritization of requests. Replacement wheelchair requests for clients who already have a wheelchair issued to them will not be prioritized to facilitate a discharge.

Include relevant equipment sizing information (i.e. client wrist height for walker, desired seat-to-floor height for a wheelchair, cushion size, ceiling height for Sask-A-Poles, etc.) for all requests.

Provide an explanation if similar equipment has been issued to the client previously. If equipment issued previously has not been returned and an explanation is not provided, the equipment will NOT be replaced.

The weight capacity varies for all equipment types. Provide the client’s weight to ensure that appropriate equipment is issued.

Attach any additional application forms when ordering cushions, specialized wheelchairs, or hospital beds.

Please ensure that equipment needs have been discussed with the client before equipment is requisitioned. Equipment is often shipped back unopened and refused by the client resulting in unnecessary costs for the program. Frequently equipment is added on to requisitions in different handwriting or different pen colour. Please be advised that Special Needs Equipment will not provide this equipment unless it can be confirmed that the authorized signee has requisitioned and approved the safe use of the equipment. Models of equipment described within this manual are the current products purchased by the program. Alternate models may be substituted for models described dependent on availability.

Requisitions can be submitted to any SNE depot by mail, fax or dropped off in person. Please confirm with the local depot that the fax has been received and is legible. To avoid duplication of orders please do NOT mail the form to the depot if it has been

previously faxed.

EQUIPMENT PICK-UP Clients wishing to pick up their equipment can do so at any SNE depot. Hours of operation are 8:30 to 4:30 Monday to Friday. Depots are closed on statutory holidays. Equipment does not have to be picked up by the client requiring the equipment. Family members or friends can pick it up on their behalf. A completed requisition must be presented in order for the equipment to be released.

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DELIVERY In stock equipment to be delivered to the client is generally shipped within two weeks of the receipt of the completed requisition. Custom orders will be delayed. Clients living in an urban center that has a SNE depot are responsible for picking up their equipment. If they are unable to do so, delivery costs are charged to the client. SNE will cover the charges for equipment that is shipped to locations that do not have a SNE depot. Equipment is shipped by the least costly and most direct method. For larger items such as hospital beds, delivery companies will require assistance from the receiver to help with the unloading of the bed. INSTALLATION OF EQUIPMENT The SNE program does not install equipment. Installation of equipment is the client’s responsibility, including any costs involved. EQUIPMENT REPAIRS Trained technicians at each SNE depot will repair loaned equipment at no cost to the client. Appointments are required to ensure that a technician is available to perform the service. The client’s personal health services number is also required to book an appointment. If equipment cannot be repaired, SNE technicians will provide a replacement piece of equipment. Exact model replacements cannot be guaranteed due to product availability. SNE will cost-share the shipping of equipment coming in for repairs for clients living in a center that has a SNE depot. Clients and SNE will each pay for one-way transport. SNE will cover the costs of shipping both to and from the SNE depot for people living in communities that do not have a depot. If equipment is being sent in for repair, please ensure that a note is securely attached to the equipment. The note should include the following information:

Full name, address and telephone number, and health services card number of client that the equipment has been loaned to.

A complete description of the repair that is required. Equipment returned to a SNE depot without this information may be received into stock and re-issued to another client.

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Maintenance and repair of privately-owned equipment is not a SAIL benefit. EQUIPMENT REPLACEMENT Equipment will be replaced for a client if:

1) The needs of the client have significantly changed making the existing equipment inappropriate (ex. weight gain/loss affecting wheelchair size, etc.) OR

2) The equipment requires extensive repair where SNE technicians have deemed it unrepairable (due to parts availability, cost to repair, etc.). Clients and/or therapists can request an assessment of the equipment be performed however, only SNE technicians will make the decision on whether the equipment requires replacement.

EQUIPMENT OWNERSHIP The Special Needs Equipment program retains ownership of all equipment loaned to beneficiaries for their use. Such equipment must be returned to Special Needs Equipment when a beneficiary:

has equipment replaced; is deceased or no longer requires the equipment; moves out of Saskatchewan; becomes otherwise ineligible for the benefit.

CLIENTS MOVING OUT OF PROVINCE Equipment such as wheelchairs may be taken to the new province of residency and used during an interim period (approximately 3 months) until coverage is available in the new province. We ask the client or therapist to contact the Special Needs Equipment Manager to obtain necessary approval and discuss equipment alternatives prior to the move. EQUIPMENT RETURN When equipment is no longer being used by the client, it must be returned as soon as possible to the nearest SNE depot. SNE will accept shipping charges for equipment that is being returned if the client does not live in a city that has a depot. Please contact the nearest SNE depot for courier/transport company referrals for your location. It is the responsibility of the client to make the necessary arrangements for pickup of the equipment. Please do not return equipment to SNE that is not part of the loan program. All equipment issued is identified by a SaskAbilities return sticker and identification number.

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Clients/caregivers may contact any SNE depot for a list of equipment currently on loan. The client’s health services card number will be required to access this information. MAINTENANCE Some items on the SNE program benefit list (i.e. bathtub lifts and hydraulic patient lifts) require regular scheduled preventative maintenance. Clients with equipment on loan will be contacted by letter when the equipment maintenance is due. Upon confirmation with the client, the nearest SNE depot will replace the client’s equipment with newly-serviced equipment, and the old equipment will be returned to the SNE depot. SNE will cover the costs of shipping associated with this maintenance program. Clients should inspect all loaned equipment on a regular basis and should concerns arise, contact a SNE depot immediately. EQUIPMENT IDENTIFICATION All loaned equipment is identified by a 6-digit unique identification number. This number is the code used to track who the equipment has been provided to and it is not to be removed from the equipment. If equipment does not have this number, and you believe that it is a loaned item, please contact the nearest SNE depot. Please do not affix labels/stickers or write on equipment with marker to identify which client the equipment is on loan to. Should name identification be required, please use a hospital band, luggage tag or similar to label. TRANSFERRING EQUIPMENT BETWEEN CLIENTS Equipment must be returned to the nearest SNE depot when it requires maintenance, cleaning and safety inspections before being reissued, or if it is no longer required by the client. Please do not transfer equipment without the approval of the SNE program. PRIVATE EQUIPMENT PURCHASE Private purchases of equipment, within or outside of Saskatchewan, are not reimbursable by Special Needs Equipment or SAIL. EQUIPMENT UPGRADES Equipment will not be ordered with features that are not a benefit of the program (i.e. seats on walkers, environmental controls on wheelchairs or an elevated seat in a wheelchair). Clients cannot pay the difference in cost to have an additional feature added to a loan item.

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SASKABILITIES SPECIAL NEEDS EQUIPMENT DEPOT LOCATIONS

July 15, 2019

Depots Mailing Address

Telephone Number

Fax Number

Email Address Saskatoon

2310 Louise Ave. Saskatoon, SK S7J 2C7

(306) 664-6646

(306) 955-2162

[email protected]

Regina #2-1723 Francis St. Regina, SK S4N 7N2

(306) 569-1262 (306) 352-4282

[email protected]

Prince Albert 1205 1st Ave. E. Prince Albert, SK S6V 2A9

(306) 922-0225 (306) 764-8376

[email protected]

Swift Current

1551 North Railway Street West Swift Current, SK S9H 5G3 Entrance B

1-833-526-5299

(306) 773-7460

[email protected]

Yorkton 144 Ball Road Yorkton, SK S3N 3Z4

1-833-444-4126 (306) 783-1234

[email protected]

Hours of operation are Monday to Friday, 8:30 a.m. – 4:30 p.m. Depots are closed on all statutory holidays. Use the Saskatoon mailing address above for inquires to be directed to: Carrie McComber, Special Needs Equipment Manager [email protected] Michael Yaehne, Special Needs Equipment Coordinator [email protected]

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UNIVERSAL LOAN EQUIPMENT July 15, 2019

Mobility Aids

Wheelchairs Standard manual wheelchairs Standard recliner manual wheelchairs Ultralight manual wheelchairs Tilt-in-space manual wheelchairs Standard power wheelchairs Tilt-in-space power wheelchairs

Wheelchair cushions Foam T-foam Contoured foam Matrx Posture Seat (PS) Gel Jay cushions Roho cushions Vicair Vector cushions

Walkers Folding walkers Kaye postural walkers Gutter attachment (accessory) Auto-stop kit (accessory)

Paediatric Mobility Aids Convaid Cruiser Kid Kart

Forearm Crutches Environmental Aids

Bathroom Accessories Transfer tub seats Stationary commodes Combination commodes Child’s commodes Bathtub lifts

Transfer Assists Sask-A-Poles Sask-A-Pole trapezes Sask-A-Pole kneeboards Versa Helper trapezes with floor stands

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Hydraulic patient lifts Hospital Beds & Accessories

Electric hospital beds with mattresses Overbed tables

Mobility Aids and Environmental Aids listed above are available at NO CHARGE to SAIL beneficiaries. See general eligibility

requirements on page 2.

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RESTRICTED LOAN EQUIPMENT (SIP, SHP AND FHB) April 1, 2014

Mobility Aids

Canes & Crutches Off set handle canes Quad (four point) canes Gutter canes Walk canes Axillary crutches Quad crutches Gutter crutch attachment (accessory) Ice gripper (accessory)

Environmental Aids

Bathroom Accessories Bathtub clamps Wall bars Utility bath seats (with and without back) Raised toilet seats Toilet arm rest sets

Other Environmental Aids Helping hand reachers Transfer boards

See Eligibility Requirements for Restricted Loan Equipment on page 3.

Restricted loan equipment types are also available for purchase at all SNE depots.

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WHEELCHAIRS Wheelchair Policies Measurement Considerations Summary of Eligibility Criteria Standard Wheelchair Standard Recliner Ultralight Tilt-In-Space Manual Power Tilt-In-Space Power Wheelchair Tray (Accessory) Oxygen Tank Holder (Accessory) Elevating Leg Rests (Accessory) Anti-Tippers (Accessory)

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WHEELCHAIR POLICIES April 1, 2019

GENERAL POLICIES

Clients are eligible for ONE manual wheelchair through the Special Needs Equipment program. If a replacement wheelchair is requested, once it has been received by the client, the original chair must be returned to the program.

Wheelchairs will be replaced in two scenarios: if there has been a significant change in needs of the client where the equipment is no longer appropriate or, if the wheelchair requires repair and parts are unavailable or it is no longer economical to repair.

A requisition form signed by an authorized requisitioner is required for Special Needs Equipment technicians to make seating adaptations to wheelchairs (size changes, seat-to-floor height changes, etc.)

Clients may contact the Special Needs Equipment program directly to make minor wheelchair repairs (such as replace arm pads, brakes, etc.)

If equipment is custom ordered for the client (i.e. bariatric sized wheelchairs) it will not be re-ordered due to incorrect measurements being provided. Please measure carefully!

GENERAL POLICIES – POWER WHEELCHAIR CLIENTS

Clients are eligible for ONE power or power tilt-in-space wheelchair through the Special Needs Equipment program.

Clients using a power or power tilt-in-space wheelchair are eligible to receive a standard manual wheelchair as a back-up to their power mobility. Lightweight or ultralight wheelchairs will not generally be authorized as back-up to a power wheelchair.

SASKATCHEWAN AIDS TO INDEPENDENT LIVING (SAIL) TWO SPECIALIZED WHEELCHAIR POLICY Two specialized wheelchairs are available to clients under the following circumstances:

Clients with a tilt-in-space power wheelchair who require constant tilt and are engaged in the community on a regular basis may request a tilt-in-space manual wheelchair as a back-up.

Clients will be allowed to keep an ultralight manual wheelchair when transitioning to a power wheelchair if they have a degenerative condition. (The transition must be unplanned.)

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When the ultralight requires replacement, a standard wheelchair will be issued.

Applications for a second specialized wheelchair must include a letter justifying how the client meets the above criteria and should be sent to the Special Needs Equipment Manager. ULTRALIGHT GRANT IN LIEU OF EQUIPMENT LOAN Effective April 1, 2019, the Ministry will launch the trial of a $2,500 grant-in-lieu option for ultralight wheelchairs through the Special Needs Equipment Program at SaskAbilities. The trial is expected to take place for up to two years and will provide the information needed to confirm the feasibility and impact of adding a grant option to the SNE Program. ADAPTIVE SEATING FOR ALL WHEELCHAIR TYPES Adaptive seating refers to modular or custom adaptations/modifications to a wheelchair. Examples would include headrests, bolsters, trays, drop seats, backrests or other supportive devices. Licensed occupational and physical therapists as well as specialists such as orthopaedic surgeons and physiatrists have requisitioning authority for adaptive seating components. Saskatoon A standard prosthetic and orthotic requisition form should be completed for all adaptive seating and forwarded to SaskAbilities at 2310 Louise Avenue, Saskatoon SK, S7J2C7. In Saskatoon, clients may be assessed at seating clinics at Saskatoon City Hospital, at the Alvin Buckwold Child Development Program located at the Kinsmen Children’s Centre or in conjunction with seating technicians at SaskAbilities. Contact SaskAbilities - Specialized Seating Department 306-385-7215 for more information. Regina Adult clients from Regina and southern Saskatchewan who require adaptive seating in their wheelchairs are assessed at weekly held seating clinics at Wascana Rehabilitation Center (WRC). A referral from a licensed healthcare practitioner is required for this service. Referrals can be faxed to (306) 766-5634. A team approach is used in the seating clinics and team members include a physical therapist, occupational therapist and seating

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specialist. Examples of seating that is provided include supportive seats/backrests (custom or commercial), foam in place seats/backrests, head supports, foot supports, custom wheelchair trays and other inserts as required to support and comfortably seat clients. Contact WRC – Adult Program at (306) 766-5517 for more information. Therapists from acute care and the community may also access the WRC seating specialist by submitting a fully completed Prosthetic/Orthotics requisition. In addition to the P&O requisition, accurate client and/or wheelchair measurements must also be sent in order to construct the seating components. The requisitioning therapist may be required to attend consult/fitting appointments at WRC with the seating specialist for involved clients.

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MEASUREMENT CONSIDERATIONS April 1, 2014

SEAT WIDTH

Measure across hips or thighs (whichever is widest)

SEAT DEPTH

Measure from the crease behind the knee to the back of the buttock

For people propelling the chair with their feet, allow 2-3” of clearance between the seat and popliteal fossa (behind the knee)

If a back cushion is to be used, add the compressed cushion thickness to the measurement

SEAT HEIGHT

Measure from the bottom of the heel to the crease behind the knee; knees should be at approximately 90°

Wheelchair standard seat heights are as follows: Standard chair =19 ½” Hemi low chair =17 ½”

If a seat cushion is to be used, subtract the compressed cushion thickness from the measurement

ARM HEIGHT

Measure from the seat to the bent elbow (90°) If a seat cushion is to be used, add the compressed cushion

thickness to the measurement BACK HEIGHT

Measure from the seat platform to under the extended arm or to the inferior angle of the scapulae (shoulder blade)

If a back cushion is to be used, add the compressed cushion thickness to the measurement

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SUMMARY OF ELIGIBILITY CRITERIA April 1, 2014

Level of Mobility

Used <1/week (occasionally required to enhance mobility)

Used >1/week but <2 hours/day (can walk <50 m.)

> 2 hours/day but <10 hours (can walk <20 m.)

Full time (>10 hours/day). Totally reliant on chair for mobility and daily activities. Unable to functionally ambulate.

Clients Residing in the community – Independent Propulsion

Not Available Standard

Standard Lightweight *

Lightweight * Ultralight*

Clients Residing in the community – Assisted Propulsion

Not Available Standard Standard Lightweight *

Lightweight * Ultralight *

Clients Residing in Special Care Homes, Group Homes and LTC – Independent Propulsion


Lightweight * Ultralight *

Clients Residing in Special Care Homes, Group Homes and LTC - Assisted Propulsion


Standard Lightweight *

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*Additional criteria must be met.

Wheelchairs are loaned for long-term use only. (The need for the wheelchair should be a minimum of three months.)

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STANDARD WHEELCHAIRS October 17, 2016

MODELS/DESCRIPTION Invacare Tracer SX5

SPECIFICATIONS

Overall chair weight is 34 lbs. Seat widths of 14-22” wide; seat depths of 16-18” deep 250 lbs. maximum weight capacity (300 lbs. on the 20” and 22”

chair widths) Standard adult wheelchair height is 19.5” from the floor 24” urethane rear tires with mag rims 8” front solid casters Standard swing-away foot rests Standard back upholstery height of 18” Adjustable height (10-14”) flip-back arm rests with full arm pads

(14” long) Auto-style buckle seatbelt Push to lock brake assembly

AVAILABLE OPTIONS

Lower seat-to-floor height options – 15.5” or 17.5” (height requested will determine size of rear tires and front casters)

Desk length arm pads (10” long) Elevating swing-away leg rests with calf pads Brake extensions Anti-tippers (rear or front) Angle adjustable foot plates Amputee kit

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One-arm drive (must be previously trialed; not available on a 15.5” or 17.5” seat to floor height chairs)

Oxygen tank bracket (for clients on SAIL Home Oxygen Program) Wheelchair tray

ALTERNATE WHEELCHAIR MODELS The standard Invacare Tracer SX5 model of wheelchair may be substituted with a model listed below dependent on a variety of factors including client weight, requested chair size (width & depth), hip-angle adjustability, transit requirements, etc. Model Available

Widths Available Depths

Seat To Floor Heights

Weight Capacity

Overall Weight

Invacare 9000 XDT

16”- 22” 16” – 20” 17.5”, 19.5” or 21.5”

350 lbs. 36 lbs.

Invacare Tracer IV

18” – 24” 18” – 20” 17.5” or 19.5”

350 or 450 lbs. *

42 lbs.

Quickie LXI 12” – 20” 12” – 20” 16” – 20”

265 lbs. 30 lbs.

Invacare Topaz (bariatric)

20” – 30” 18” – 20” 17.5” or 19.5”

700 or 1000 lbs. *

82 lbs.

Quickie M6 (bariatric)

22” – 30” 18” – 22” 17” – 20”

650 lbs. 53 lbs.

* Dependent on configuration

Invacare 9000 XDT Quickie LXI Quickie M6

Wheelchairs wider than 22” are generally not kept in inventory. They may need to be custom-ordered for clients causing delivery

delays.

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ELIGIBILITY

Must meet general eligibility requirements Must be required for use more than once a week (refer to

Summary of Wheelchair Eligibility Criteria chart on p. 17-18). REQUISITIONING AUTHORITY

Physiatrist Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse

ORDER DETAILS

Chair sizes must be ordered in even-numbered width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.)

Please ensure that accurate measurements are provided and a home assessment has been completed to ensure that the chair

will fit in the environment it will be used.

Approximately 8” should be added to the seat width of the wheelchair to estimate the overall width of the chair needed.

FORMS

Special Needs Equipment Wheelchair Requisition

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STANDARD RECLINER WHEELCHAIRS October 17, 2016

MODELS/DESCRIPTION Invacare Tracer SX5 Recliner SPECIFICATIONS

Seat widths of 14-22” Seat depths of 16” or 18”; 20” depth available by custom order

only Seat-to-floor height of 19 ½” 24” back height plus 10” removable head rest extension Dynamic recline range from 90 to 180 degrees 250 lbs. maximum weight capacity (300 lbs. on 20” and 22”

widths) Full length arm rest pads Elevating swing-away leg rests Anti-tippers (rear)

ELIGIBILITY

Must meet general eligibility requirements Must be required for use more than once a week (refer to

Summary of Wheelchair Loan Criteria chart on p. 17-18). OPTIONS AVAILABLE

Hemi–low chair height of 17.5” from the floor Desk length arm pads Wheelchair tray

Oxygen tank brackets cannot be installed on recliner wheelchairs.

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REQUISITIONING AUTHORITY Physiatrist Licensed Occupational Therapists and/or Physical Therapists

ORDER DETAILS




Approximately 8” should be added to the seat width of the client to estimate the overall width of the chair.

FORMS

Special Needs Equipment Wheelchair Requisition

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ULTRALIGHT WHEELCHAIRS April 1, 2019

MODELS/DESCRIPTION Adult: Quickie 2 (folding), Quickie GPV (rigid) Paediatric: Zippie 2 (folding), Zippie GS (folding) SPECIFICATIONS

Model Available Widths

Available Depths


Weight Capacity

Overall Weight

Transit Option Available

Quickie 2 12”-22” 12”-20” 14” – 22” 265 lbs. (HD - 350 lbs.)

29 lbs. Yes

Quickie GPV 12”-22” 12”-22” 15” – 23” 250 lbs. 24 lbs. No Zippie 2 12”-16” 12”-18” 15” – 20” 165 lbs. 25 lbs. Yes Zippie GS 10”-18” 10”-20” 14” – 20” 165 lbs. 29 lbs. Yes

Quickie 2, Zippie 2 and Zippie GS are transit approved models for

the occupant 24” mag full polyurethane rear wheels 8” polyurethane front casters

ELIGIBILITY

Must meet general eligibility requirements Must be required for use daily (refer to Summary of Wheelchair

Eligibility Criteria chart on p. 17-18). In addition to the above eligibility requirements the following must

be met:

Photo Unavailable

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16 YEARS OF AGE OR OLDER The client must have a complete cervical lesion or have a

condition that would render the client functionally paraplegic; and The client must be completely non-ambulatory; and The client must be capable of independent propulsion; and The client’s condition must be permanent, not temporary.

CHILDREN UNDER 16 YEARS OF AGE

The client requires the aid of a wheelchair to perform the activities of daily living, and

The client can independently perform more activities using an ultralight wheelchair (i.e. demonstrates a significant improvement in functional independence), and

The client can propel an ultralight wheelchair independently from both physical and cognitive perspectives, and

The client does not require specialized seating or a tilt-in-space mobility base. Extra support for the child’s trunk and sitting posture (adaptive seating) may be used if it does not impair the ability to propel the wheelchair.

OPTIONS AVAILABLE

20” or 22” rear wheels and 6” casters; to accommodate varying seat heights

REQUISITIONING AUTHORITY

Physiatrist only NOTE: Licensed Occupational Therapists and/or Physical

Therapists may requisition replacement wheelchairs for clients once the initial approval has been provided by the physiatrist.

ORDER DETAILS

Order chairs in even width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.) whenever possible

Odd sized wheelchairs (i.e. 17” width) are custom ordered and will only be considered for clients who are established independent wheelchair users. If a custom back is required, please consult with a Seating Technician to ensure that the back required is available in an odd width.



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Approximately 8” should be added to the seat width of the client to estimate the overall width of the chair.

FORMS

Ultralight Wheelchair Application Form 2019 Ultralight Wheelchair Options & Declaration Form 2019

Application for ultralight wheelchairs (signed requisition and completed application form) must be sent directly to the Special

Needs Equipment Manager/Coordinator.

ULTRALIGHT GRANT OPTION - IN LIEU OF EQUIPMENT

Effective April 1, 2019, the Ministry will launch the trial of a $2,500 grant-in-lieu option for ultralight wheelchairs through the Special Needs Equipment Program at SaskAbilities. The trial is expected to take place for up to two years and will provide the information needed to confirm the feasibility and impact of adding a grant option to the SNE Program.

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TILT-IN-SPACE MANUAL WHEELCHAIRS November 15, 2019

MODELS/DESCRIPTION

Advanced Mobility Systems (AMS) iTilt1 & iTilt2 SPECIFICATIONS

Seat widths of 16” – 24” Seat depths of 15” – 20” 30 degrees of maximum tilt for iTilt; 47 degrees on iTilt2 Overall chair weight 60 lbs. Weight capacity of 250 lbs. (350 lbs on 22” and 24” widths)

ALTERNATE WHEELCHAIR MODELS The standard AMS iTilt model of wheelchair may be substituted with a model listed below dependent on a variety of factors.

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Model Available

Widths Available Depths


Weight Capacity

Overall Weight

Maximum Degree of Tilt

Zippie TS paediatric

10” – 18” 13” – 20” 15.5” – 20”

165 lbs. 29 lbs. 45

Kid Kart TLC

6” – 13.5” 8” – 14” 75 lbs. 43 lbs. 30

Invacare Solara

12” – 24” 12” – 22” 12.5” – 19”

300 lbs. 73 lbs. 50

Quickie TS 14” – 20” 14” – 22” 16.5 – 20.75”

250 or 350 lbs. *

65 lbs. 53

PDG Stellar

14” – 32” 16” – 22” 14” – 20”

500 lbs. *

60 lbs. 45

PDG Bentley

14” – 32” 16” – 22” 15” – 20”

450 lbs. *

70 lbs. 20

* Dependent on configuration

ELIGIBILITY Must meet general eligibility requirements

The following guidelines are intended to assist therapists with applications. Although clients should meet the following criteria, it is not absolute. Each client will be considered individually.

The client is wheelchair-dependent and their average daily use is at least 4 hours (adults) or 1-2 hours (children).

They meet one of the following two categories: They have poor trunk and/or head control, and require support

from the chair, or the client requires pressure relief that cannot be addressed

with cushioning. The following factors will also be considered:

The client cannot consistently perform independent transfers. Caregiver availability and safety may be an issue.

The client demonstrates altered muscle tone that impairs trunk balance.

There are orthopaedic considerations that interfere with upright seating.

There are transportation, community accessibility, pain, or fatigue issues that are addressed through the use of a tilt-in-space system.

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The client has demonstrated benefit from the system through a trial.


Physiatrist Selection Committee for Specialized Seating Designated therapist working as part of the seating team at

Wascana Rehabilitation Centre SASKATOON Specialized seating refers to specialized manual wheelchairs (such as tilt in space) with custom or modular adaptations to provide a comfortable and supportive seating position for a client. Applications for specialized seating are completed by a licensed occupational therapist or physical therapist and are reviewed by the Selection Committee for Specialized Seating. The application form provides detailed information regarding orthopaedic/skin health considerations; critical details for fitting including height, weight, seating measurements; client and caregiver goals; identification of major seating concerns and therapist goals. A physiatrist serves as a member of the Selection Committee so requisitions are completed at the meeting as applications are approved. Specialized Seating clients may be assessed at seating clinics at Saskatoon City Hospital, at the Alvin Buckwold Child Development Program located at the Kinsmen Children’s Centre or in conjunction with seating technicians at SaskAbilities. Contact SaskAbilities to obtain Specialized Seating application forms or for additional information contact Specialized Seating at 306-385-7215. REGINA Adult clients from Regina and southern Saskatchewan who require adaptive/specialized seating are assessed at weekly held seating clinics at Wascana Rehabilitation Center (WRC). A referral from a licensed healthcare practitioner is required for this service. Referrals can be faxed to (306) 766-5634. A team approach is used in the seating clinics and team members include a physical therapist, occupational therapist and seating specialist. Contact WRC – Adult Program at (306) 766-5517 for more information. ORDER DETAILS


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FORMS Special Needs Equipment Wheelchair Requisition Application for Specialized Seating Device

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POWER WHEELCHAIRS November 15, 2019

Mid Wheel Drive Rear Wheel Drive Models

MODELS/DESCRIPTION

Quickie Xperience Invacare TDX Quickie P222 Invacare 3G Arrow/Torque

Quickie Xcel Invacare TDX Spree SPECIFICATIONS

Model Drive Wheel Position

Overall Chair Width

Available Seat Widths

Overall Chair Length

Available Seat Depths

Weight Capacity

Seat to Floor Heights

Quickie Xperience (adult or paediatric)

Mid Wheel

24” 10” – 22” 43” 10” – 22” 300 or 400 lbs.

15.75” – 20.5”

Invacare TDX

Mid Wheel

23.5” or 25.5” dependent on battery type

12” - 24” 45” 12” – 22” 300 or 400 lbs.

16.5” – 20.5”

Quickie Xcel

Mid Wheel

27.375” 20” – 28” 43.5” 17” – 24” 550 lbs. 16.5” – 20.5 “

Quickie P222

Rear Wheel

22” or 24.5” dependent on battery type

14” – 24” 43” 14” – 20” 350 lbs. 18” – 20”

Invacare 3G Arrow

Rear Wheel

25.5” 12” – 24” 45” 12” – 22” 300 or 400 lbs.

17.5” – 19.75”

Invacare TDX Spree (paediatric)

Mid Wheel

24” 12” – 16” 39” 12” – 18” 165 lbs. 14.5” - 18.5”

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ELIGIBILITY

In addition to meeting general eligibility requirements, the following must be met:

16 YEARS AND OLDER

Beneficiaries who are functionally non-ambulant and are unable to manually propel a conventional lightweight or ultralight wheelchair, and

the power wheelchair will be used as the client’s primary mode of mobility; and

beneficiaries who demonstrate sufficient cognition, judgement, spatial perception, and social interaction skills to safely control a power wheelchair in his/her environment, and

beneficiaries whose home or place of residence is accessible for power wheelchair use

CHILDREN UNDER 16 YEARS

Children who are wheelchair-dependent and are unable to propel a manual wheelchair in an efficient manner

Children who have had a home and/or school visit completed by a licensed occupational therapist and/or physical therapist

Children who are aware of the cause and effect of using switches as determined by an assessment (preferably in a trial wheelchair)

Children who will demonstrate sufficient cognition, judgement, spatial perception, and social interaction skills to safely control a power wheelchair in his/her environment

A home assessment by a licensed occupational therapist and/or physical therapist is required.

OPTIONS AVAILABLE

Right or left hand proportional control Full or desk length arm pads 70, 80 or 90 degree swing-away footrests; Centre mount

footboard; manual elevating leg rests Attendant control - NOTE: this option will not be provided for

clients using a standard joystick controller. REQUISITIONING AUTHORITY

Physiatrist only

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NOTE: Licensed Occupational Therapists and/or Physical Therapists may requisition replacement wheelchairs for clients once the initial approval has been provided by the physiatrist.

ORDER DETAILS


FORMS

Special Needs Equipment Wheelchair Requisition Specialized Wheelchair Application

Application for power wheelchairs (signed requisition and completed application form) must be sent directly to the Special


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TILT-IN-SPACE POWER WHEELCHAIRS August 1, 2014

Mid Wheel Tilt / Recline/ Power Legrests

MODELS/DESCRIPTION

Quickie Xperience Invacare TDX SP Quickie P222SE Invacare 3G Arrow

Quickie Xcel Invacare TDX Spree SPECIFICATIONS

Model Drive Wheel Position

Available Seat Widths

Available Seat Depths

Weight Capacity

Seat to Floor Heights

Maximum Degree of Tilt

Quickie Xperience (adult or paediatric)

Mid Wheel

10” – 22” 10” – 22” 300 or 400 lbs.

15.75” – 20.5”

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Invacare TDX

Mid Wheel

12” - 24” 12” – 22” 300 or 400 lbs.

16.5” – 20.5”

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Quickie Xcel

Mid Wheel

20” – 28” 17” – 24” 550 lbs. 16.5” – 20.5 “

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Quickie P222

Rear Wheel

14” – 24” 14” – 20” 350 lbs. 18” – 20” 50

Invacare 3G Arrow

Rear Wheel

12” – 24” 12” – 22” 300 or 400 lbs.

17.5” – 19.75”

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Invacare TDX Spree (paediatric)

Mid Wheel

12” – 16” 12” – 18” 165 lbs. 14.5” - 18.5”

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ELIGIBILITY

In addition to meeting general eligibility requirements, the following must be met:

Beneficiary meets the criteria outlined for a power wheelchair,

and demonstrates compliance and understanding of using tilt-in-

space feature, and has a history of pressure sores, or has a significant predisposing condition to skin breakdown,

such as C5 or higher quadriplegia, or shows measureable limitations in respiratory function where

documentation of objective data can be provided as to how a power tilt-in-space would maximize respiratory function, or

requires trunk support from the chair, or experiences progressive fatigue due to diagnosis

OPTIONS AVAILABLE

Right or left hand proportional control Full or desk length arm pads 70, 80 or 90 degree swing-away footrests; Centre mount

footboard; manual elevating leg rests Attendant control - NOTE: this option will not be provided for

clients using a standard joystick controller. REQUISITIONING AUTHORITY

Physiatrist only NOTE: Licensed Occupational Therapists and/or Physical

Therapists may requisition replacement wheelchairs for clients once the initial approval has been provided by the physiatrist.

ORDER DETAILS


FORMS

Special Needs Equipment Wheelchair Requisition Specialized Wheelchair Application

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Application for power wheelchairs (signed requisition and completed application form) must be sent directly to the Special


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WHEELCHAIR TRAY (ACCESSORY) January 1, 2018

SPECIFICATIONS

Made of white plastic Secures to wheelchair arm assembly with Velcro straps Fits wheelchairs 16” and 18” wide

ELIGIBILITY

Must meet general eligibility requirements Provided for use on Special Needs Equipment issued wheelchair

only. REQUISITIONING AUTHORITY


ORDER DETAILS

Please provide the ID number and type of wheelchair being used by the client

Can be ordered on chair with a new equipment issue or as a replacement part at a later date

Custom size or padded trays are to be ordered through Specialized Seating – SaskAbilities / Wascana Rehabilitation Center – Prosthetic & Orthotic requisition required

FORMS

Special Needs Equipment Wheelchair Requisition (on chair) OR,

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Special Needs Equipment Requisition (replacement part)

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OXYGEN TANK BRACKET (ACCESSORY) April 1, 2014

SPECIFICATIONS Securely attaches to most models of manual wheelchairs

ELIGIBILITY

Must be on SAIL Home Oxygen Program Provided for use on Special Needs Equipment issued wheelchair

only.

REQUISITIONING AUTHORITY Physiatrist Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse

ORDER DETAILS


Can be ordered on chair with a new equipment issue or as a replacement part at a later date

FORMS

Special Needs Equipment Wheelchair Requisition (on chair) OR, Special Needs Equipment Requisition (replacement part)

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ELEVATING LEG RESTS (ACCESSORY) April 1, 2014

ELIGIBILITY Must meet general eligibility requirements Provided for use on Special Needs Equipment issued wheelchair

only.

REQUISITIONING AUTHORITY Physiatrist Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse

ORDER DETAILS

Indicate right leg, left leg or both legs as required Please provide the ID number and type of wheelchair being used

by the client Can be ordered on chair with a new equipment issue or as a

replacement part at a later date FORMS


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ANTI-TIPPERS (ACCESSORY) April 1, 2014




ORDER DETAILS


Provide current seat-to-floor height of client’s wheelchair Can be ordered on chair with a new equipment issue or as a

replacement part at a later date FORMS


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CUSHIONS Cushion Policies Foam T-Foam Contoured Foam Invacare Matrx Posture Seat (PS) Gel Jay 2 / Jay 2 Plus Jay 2 Deep Jay Easy Roho Quadtro Select High/Low Profile Roho Enhancer Roho Contour Select Roho Nexus Spirit Vicair Vector 6 & Vector 10

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CUSHION POLICIES May 1, 2016

GENERAL POLICIES

Clients are eligible for ONE cushion with cover through the Special Needs Equipment program to use as an accessory to their wheelchair. If a replacement cushion is required, once it has been received by the client, the original cushion must be returned to the program. Note: An exception may be granted to the policy above

to allow clients who are at such high risk of skin breakdown and cannot be without the cushion for an extended period of time (i.e over the weekend while the SNE depots are closed). A letter of medical rationale and requisition form signed by a Physiatrist or Plastic Surgeon is required. These requests should be directed to the Special Needs Equipment Manager. The back-up cushion provided will be the same type/size of the originally issued cushion.

ONE cushion cover will be provided with the cushion. Clients who do not use a wheelchair for their primary mode

of mobility are eligible for the loan of one cushion if they meet all of the following criteria: the client has a current pressure ulcer, past history of a

pressure ulcer, or wound on the area of contact with the seating surface;

the client has a Letter of Medical Necessity which demonstrates a valid medical rationale for the provision of this cushion; and,

the client is eligible for coverage through the Supplementary Health Program, Seniors’ Income Plan, or Family Health Benefits Program.

Cushions will be supplied in the most appropriate size to fit the wheelchair used by the client.

Roho cushions will be repaired by SNE Technicians before replacement cushions are considered.

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FOAM CUSHIONS April 1, 2014

MODELS/DESCRIPTION Low density foam with a cloth cover Low pressure relief and low positioning benefits Primarily used to provide comfort on wheelchair seat

SPECIFICATIONS

2” foam thickness Available in 12-20” widths and 12-20” depths Weight capacity is 250 lbs. Cushion weighs approximately 1 pound

ELIGIBILITY

Must meet general eligibility requirements Client requires the use of a wheelchair for mobility and will use the

cushion as an accessory to the wheelchair SIP/SHP/FHB clients may be eligible for a cushion without the use

of a wheelchair – see cushion general policies REQUISITIONING AUTHORITY


ORDER DETAILS

Specify size required Order in even-numbered width by depth dimensions (i.e. 16” x

16”, 18” x 18”, etc.) - odd-sized cushions are not available.

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FORMS Special Needs Equipment Requisition

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T-FOAM CUSHIONS April 1, 2014

MODELS/DESCRIPTION Medium density foam Provided with an incontinence cover – zipper closure Body heat and weight causes the cushion to conform to body

contours Good pressure protection for low to medium risk clients Firmness increases when cold

SPECIFICATIONS

3” foam thickness Available in 12-30” widths and 12-22” depths (Note: not all sizes

are kept in stock) Weight capacity is 350 lbs. Cushion weighs approximately 4 lbs.

ELIGIBILITY


cushion as an accessory to the wheelchair. SIP/SHP/FHB clients may be eligible for a cushion without the use



47

ORDER DETAILS




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CONTOURED FOAM CUSHION April 1, 2014

MODELS/DESCRIPTION

Nighthawk Superior Thin Contoured Cumfy Cushion Contoured foam cushion with a cloth cover (zipper closure) and a

rubber non-slip base Soft Sunmate top layer with hard-medium density foam base Built in leg channels Design of cushion contours to eliminate pressure in the ischials Laterally beveled to accommodate sling of wheelchair

SPECIFICATIONS

Available in 12-22” widths and 12-20” depths Weight capacity is 220 lbs. Cushion weighs approximately 2 lbs.

ELIGIBILITY





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ORDER DETAILS


16”, 18” x 18”, etc.) - odd-sized cushions are not available. FORMS

Special Needs Equipment Requisition

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INVACARE MATRX POSTURE SEAT (PS) June 1, 2018

MODELS/DESCRIPTION

Designed to provide superior positioning, stability, skin protection and comfort

Contoured shape incorporating a waffled ischial relief recess to provide ischial/sacral immersion and helps maintain pelvic position and prevent sliding

Reversible outer cover (incontinent/cloth) with zipper closure and inner liner provides moisture protection to the foam

SPECIFICATIONS

Available in 10-20” widths and 10-20” depths Weight capacity is 300 lbs. Bariatric sizes greater than 20” wide x 20” deep are available by

special order Bariatric cushion weight capacity up to 600 lbs. Cushion weighs approximately 3 lbs.

ELIGIBILITY




Physiatrist

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Plastic Surgeon Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse (in consultation with an Occupational Therapist

or Physical Therapist) ORDER DETAILS




52

GEL CUSHION April 1, 2014

MODELS/DESCRIPTION

Akton Gel Pilot Low profile cushion to enable foot propulsion Cloth cover with zipper closure Sheer/friction protection, pressure and shock protection The gel will not leak, flow, or bottom out

SPECIFICATIONS

1” low profile polymer Available in 16-20” widths and 16-20” depths; other sizing

available by special order Cushion weighs approximately 5 lbs.

ELIGIBILITY




Physiatrist Plastic Surgeon Licensed Occupational Therapist and/or Physical Therapists Home Care Nurse

ORDER DETAILS



53


54

JAY 2 & JAY 2 PLUS June 1, 2018

MODELS/DESCRIPTION

Jay 2 / Jay 2 Plus pre-contoured foam cushions feature a Jay Flow fluid tripad with up to 3” of loading for superior skin protection and an easy to modify base with optional positioning components for optimal stability.

Designed for the client who is high risk for skin breakdown and poor skin integrity

Cushion contains molded foam base with non-skid bottom Fluid maintains its viscosity at high and low temperatures Requires no regular maintenance or adjustment Fluid level self-adjusts for different body types, resulting in less

bottoming out Ballistic-edge stretch cover

SPECIFICATIONS

Jay 2 available in 14-24” widths and 14-20” depths; Jay 2 Plus 20-26” widths and 18-22” depths

Jay 2 weight capacity is 250 lbs. Jay 2 Plus weight capacity is 650 lbs.

Cushion weighs approximately 7 lbs. ELIGIBILITY


cushion as an accessory to the wheelchair.

55

SIP/SHP/FHB clients may be eligible for a cushion without the use of a wheelchair – see cushion general policies


Physiatrist Plastic Surgeon Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse (in consultation with an Occupational Therapist





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JAY 2 DEEP CUSHION June 1, 2018

MODELS/DESCRIPTION

Jay 2 Deep pre-contoured foam cushions feature a Jay Flow fluid tripad with up to 3” of loading for superior skin protection and an easy to modify base with optional positioning components for optimal stability.

Designed for the client who is high risk for skin breakdown and very poor skin integrity

Fluid maintains its viscosity at high and low temperatures Requires no regular maintenance or adjustment Zipper enclosed ballistic-edged cover

SPECIFICATIONS Available in 14-24” widths and 14-20” depths Weight capacity is 250 lbs. Cushion weighs approximately 7 lbs.

ELIGIBILITY



of a wheelchair – see cushion general policies

REQUISITIONING AUTHORITY Physiatrist Plastic Surgeon

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Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse (in consultation with an Occupational Therapist





58

JAY EASY CUSHION June 1, 2018

MODELS/DESCRIPTION

Jay ® Easy ™ is a skin protraction and positioning cushion featuring a hi-resiliency, contoured foam base that accommodates a curved or flat seating surface and Jay ® Flow ™ fluid tripad

Most suitable for client at moderate to high risk of skin breakdown SPECIFICATIONS

Available in 14-24” widths and 14-24” depths Weight capacity is 250 lbs. Cushion weighs approximately 4 lbs.

ELIGIBILITY




REQUISITIONING AUTHORITY Physiatrist Plastic Surgeon Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse (in consultation with an Occupational Therapist


Specify size required Specify base to accommodate flat or curved seat Order in even-numbered width by depth dimensions (i.e. 16” x



Photo Unavailable

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ROHO QUADTRO SELECT HIGH/LOW PROFILE June 1, 2018

Low High

MODELS/DESCRIPTION

Quadtro Select features ISOFLO ® Memory Control ® Unit offers shape-fitting capabilities while the client is seated, allowing quick and easy, on-demand adjustment to maximize function

Cushion is divided into four sections, which allows for progressive positioning for short and long term changes

Frequent monitoring of the cushion is required to ensure that proper levels of inflation are maintained

SPECIFICATIONS

Available in 12-28” widths and 12-20” depths Cushions are available in two different cell types:

Low Profile: 2” cells High Profile: 4” cells

Cushions weigh approximately 5 lbs.

Do not overinflate the ROHOs as they are not designed to provide pressure relief when they are fully inflated. The

general rule is to allow only a finger’s space (½”) between the buttocks and the base of the cushion.

ELIGIBILITY




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REQUISITIONING AUTHORITY Physiatrist Plastic Surgeon Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse (in consultation with an Occupational Therapist




Note: Roho cushions are repairable! Please do not order a replacement Roho cushion if only a repair is required. SNE

Technicians will repair cushions and if deemed unrepairable a replacement will be provided.

FORMS


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ROHO ENHANCER June 1, 2018

MODELS/DESCRIPTION

The Enhancer is a dual-valve system for midline channeling of the femurs, lateral stability and tissue protection

Recommended for enhanced pressure distribution, positioning and posture

Frequent monitoring of the cushion is required to ensure that proper levels of inflation is maintained

SPECIFICATIONS

Available in 12-20” widths and 12-20” depths Contoured cushion containing a combination of low (2”) and high

(4”) profile cells. Cushions weigh approximately 4 lbs.

Do not overinflate the ROHOs as they are not designed to provide pressure relief when they are fully inflated. The general rule is to allow only a finger’s space (½”) between the buttocks

and the base of the cushion.

ELIGIBILITY




62


Physiatrist Plastic Surgeon Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse (in consultation with an Occupational Therapist






FORMS


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ROHO CONTOUR SELECT June 1, 2018

MODELS/DESCRIPTION The Contour Select stabilizes the pelvis back in the wheelchair and

centers the client comfortably in the middle of the cushion Air is locked into each of the four quadrants with ISOFLO ®

Memory Control ® Unit Recommended for enhanced pressure distribution, positioning and

posture Frequent monitoring of the cushion is required to ensure that

proper levels of inflation is maintained SPECIFICATIONS

Available in 15-20” widths and 15-20” depths Contoured cushion containing a combination of low (2”) and high

(4”) profile cells. Cushions weigh approximately 5 lbs.



ELIGIBILITY




64


Physiatrist Plastic Surgeon Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse (in consultation with an Occupational Therapist






FORMS


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ROHO NEXUS SPIRIT June 1, 2018

MODELS/DESCRIPTION

Nexus Spirit provides the stability of a contoured foam base and a Roho cell insert

Allows for increased stability for transferring and positioning of the pelvis and lower extremities for enhanced sitting posture

Frequent monitoring of the cushion is required to ensure that proper levels of inflation is maintained

SPECIFICATIONS

Available in 14-18” widths and 14-18” depths 20” wide available with 18” depth only No custom sizes are available Cushions weigh approximately 3 lbs.



ELIGIBILITY




Physiatrist Plastic Surgeon

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Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse (in consultation with an Occupational Therapist






FORMS


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VICAIR VECTOR 6 & VECTOR 10 June 1, 2018

Vector 6 Vector 10

MODELS/DESCRIPTION

Designed for high level skin protection and a stable seating position

Reversible outer cover - cool breathable cloth on one side and incontinent on the other

Inner cover features two elevated side compartments (front to back) and front-middle pommel filled with SmartCells TM air packets

Low maintenance, no inflation required SPECIFICATIONS

Vector 6 is a 2” high cushion; Vector 10 is a 4” high cushion Vector 6 available in 14-20” widths and 16-20” depths – sizes

larger than 20”x20” are not available Vector 10 available in 10-20” widths and 10-20” depths - larger

sizes (up to 24”x24”) are available however are custom and will not be kept in stock

Weight capacity of 551 lbs. Cushion weighs approximately 2 lbs.

ELIGIBILITY


cushion as an accessory to the wheelchair.

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SIP/SHP/FHB clients may be eligible for a cushion without the use of a wheelchair – see cushion general policies


Physiatrist Plastic Surgeon Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse (in consultation with an Occupational Therapist



16”, 18” x 18”, etc.) to fit wheelchair size. Odd-sized cushions are not available.

Indicate cushion type desired – Vector 6 (low) or Vector 10 (high)


69

WALKERS Folding Kaye Postural Gutter Attachment (Accessory) Auto-Stop Kit (Accessory)

Front Wheels (Accessory)

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FOLDING WALKER May 15, 2017

Adult Walkers Bariatric Paediatric

MODELS/DESCRIPTION

Adult Large – G30755P (replaces discontinued G07755) Adult Medium – G30756P (replaces discontinued G07756) Bariatric Adult Large – G30754B Bariatric Adult Medium – G07768 Paediatric – G07749

SPECIFICATIONS

Lightweight aluminum material Height adjustable Walker folds flat to approximately 4” Provided with standard legs (as shown)

Note: Equipment accommodating higher weight capacities may be available for this equipment type. Please submit a requisition

identifying the client’s weight to the Special Needs Equipment office. Product will be researched and you will be consulted regarding the availability of equipment and an approximate

delivery date.

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Model Walker Wrist Height Range

Weight Capacity

Overall Width

Overall Depth

Inside Grip Width

Wheel Kit Options

G30755P 32.5 – 39.5”

300 lbs. 19.5” 14” 16.5” 3” fixed single wheels and rear glide brakes

G30756P 27.25 – 34.25”

300 lbs. 19.5” 14” . 3” fixed single wheels and rear glide brakes

G07755 (discontinued)

32.5 – 39.5”


G07756 (discontinued)

27.25 – 34.25”


G30754B 32 - 39” 650 lbs. 27” 17.5” 22” 5” fixed dual wheels

G07768 27.5 – 34.5”

400 lbs. 24.5” 14.5” 19” 5” fixed dual wheels

G07749 24.5 – 28.5”

200 lbs. 16.5” 13.5” 12.75” 3” fixed single wheels

ELIGIBILITY

Must meet general eligibility requirements

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OPTIONS AVAILABLE Gutter Attachment 3” fixed single front wheels (can be used with standard rear legs

or rear glide brakes) Rear glide brakes Plastic glide caps – designed to be used with walkers with front

wheels and standard rear legs – for indoor use. (Not to be installed on rear glide brakes)

Bariatric Walker - Front Wheels (5” fixed dual wheel) Paediatric Walker - Front Wheels (3” fixed single wheel)

The 5” dual fixed wheels are NOT designed for use on the standard G07755, G07756, G30755P, G30756P and G07749

models.


Physiatrist Licensed Occupational Therapist and/or Physical Therapist Orthopedic Surgeon Home Care Nurse

ORDER DETAILS

Specify client floor-to-wrist height If ordering wheels; specify if they are to be installed on walker or

provided separately.

Note: Wheel and glide brake kits add 1” to the overall height of the walker.

FORMS


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KAYE POSTURAL WALKER April 1, 2014

MODELS/DESCRIPTION

Designed to accommodate children from 18 months to adolescence and young adulthood

Designed for posterior use All models can be used in the reverse configuration (anterior

position); W½ and W1 models require additional anterior wheel kits. Swivel wheel walkers cannot be anterior.

SPECIFICATIONS Model Height to

Top of Handle

Weight Capacity

Distance Inside Handles – Width

Distance Inside Handles – Depth

W ½ B 14.5 - 20” 60 lbs. 13.5” 9” W 1 B 16.5 - 22” 60 lbs. 13.5” 9” W 2 B 19 – 25” 85 lbs. 13.5” 9.5” W 3 B 23 – 30” 130 lbs. 15” 10.5” W 4 B 28.5 - 36” 180 lbs. 16” 13.5” W 5 C 35.5 - 41” 250 lbs. 18.5” 15”

Provided standard with two front wheels and rear legs with tips

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OPTIONS AVAILABLE

4 wheeled design (front standard wheels and rear ratchet wheels) Front swivel wheels (swivel limiter available upon request) Rear silent wheels (one-way roller bearing wheels) Extensor assist pad Pelvic stabilizers Forearm supports (fits either right or left side)

REQUISITIONING AUTHORITY Physiatrist Licensed Occupational Therapist and/or Physical Therapists

Specializing in Pediatrics ORDER DETAILS

Specify appropriate size To determine correct walker size, measure the distance from the

floor to the middle of the clients’ buttocks. This distance is the height to top of handle measurement. (See Kaye walker size chart).

FORMS


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GUTTER ATTACHMENT (ACCESSORY) April 1, 2014

MODELS/DESCRIPTION

Lumex 6132A Used with the folding walker – secured with clamps to allow height

adjustability Padded forearm trough with Velcro straps Adjustable hand grip

ELIGIBILITY

Must meet general eligibility requirements REQUISITIONING AUTHORITY


ORDER DETAILS

Specify quantity required Note: assembly to walker is required

FORMS


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AUTO-STOP KIT (ACCESSORY) April 1, 2014

MODELS/DESCRIPTION Used on the folding walker Fixed 3” wheels attach to the front of the walker - Wheel

attachments are not to be used on the back legs of the walker

Glide brakes attach to the back legs of the walker SPECIFICATIONS

Raises the walker up 1” ELIGIBILITY



ORDER DETAILS

Specify if required If ordering an Auto-Stop kit; specify if they are to be installed on

walker or provided separately.


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FRONT WHEELS (ACCESSORY) April 1, 2014

Bariatric Paediatric

MODELS/DESCRIPTION

5” fixed wheels for bariatric walkers 3” fixed wheels for paediatric walkers Wheel attachments are not to be used on the back legs of

the walker.

SPECIFICATIONS Raises the walker up approximately 1.5”

ELIGIBILITY



ORDER DETAILS

Specify if required If ordering wheels; specify if they are to be installed on walker or

provided separately. FORMS


78

PAEDIATRIC MOBILITY AIDS

Convaid Cruiser Kid Kart

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CONVAID CRUISER April 1, 2014

MODELS/DESCRIPTION

A supportive stroller product offered as an alternative to a wheelchair for paediatric clients

Transit models provided standard with headrest extension, three point positioning belt with depth adjustable crotch strap, foot positioners and a Q-straint transit lap belt

CX10 and CX12 models are provided with a five point positioning/restraint harness; all other models are provided with an H harness with padded covers

Blue upholstery 30 degrees of tilt Overall weight of chair 27-32 lbs.

SPECIFICATIONS Model Seat Width Seat Depth Weight Range CX10T 10” 6-11” 35-66 lbs. CX12T 12” 8-13” 35-66 lbs. CX14T 14” 10-15” 45-100 lbs. CX16T 16” 11-16” 85-170 lbs. CX18T 18” 14-21” 85-170 lbs.

7.5” front wheels and 12.5” rear solid knobby tires Angle adjustable footplates

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OPTIONS AVAILABLE

Adjustable lateral support single or double flap with scoli strap Full torso support vest Padded or occi headwings Headrest canopy – for clients with light sensitivities only Tray with hardware


Physiatrist Licensed Occupational Therapist and/or Physical Therapist

Specializing in Pediatrics ORDER DETAILS

Specify size required FORMS


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KID KART July 15, 2019

NOTE: This item has been discontinued by the manufacturer effective June 1, 2019. Equipment will be provided from the inventory pool as available. MODELS/DESCRIPTION

Suitable for children who have medical needs and moderate to high positioning needs

POSITIONING COMPONENTS

Contoured and planar head supports Back support alternatives serve children of all sizes Butterfly harnesses allow anterior support of the thoracic cavity Planar or contoured lateral supports are offered in both fixed and

swing-a-way models Seat cushions Abductors or medical knee blocks are offered in two sizes Padded foot-straps Therapeutic trays for upper extremity support Special equipment holders designed for ventilator/liquid oxygen

tray, battery tray, oxygen tank holder, and IV pole SPECIFICATIONS

Seat widths of 6 - 13.5” Seat depths of 8 - 14” 30 degrees of tilt Weight capacity of 75 lbs.

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Overall chair weight of 43 lbs. REQUISITIONING AUTHORITY

Physiatrist Selection Committee for Specialized Seating Designated therapist working as part of the seating team at

Wascana Rehabilitation Centre FORMS

Special Needs Equipment Requisition Application for Specialized Seating Device

83

CANES & CRUTCHES Forearm Crutch Off Set-Handle Cane Quad Cane Gutter Cane Walk Cane Axillary Crutch Quad Crutch Gutter Crutch Attachment (Accessory) Ice Gripper (Accessory)

84

FOREARM CRUTCH March 1, 2017

MODELS/DESCRIPTION Adult Tall – G05160 Adult – G05161 Youth – G05162 Child – G05163

SPECIFICATIONS

Vinyl coated, tapered, contoured 3” cuffs Metal push-button height adjustability Molded hand grips Rubber tip

Model Client Height Weight Capacity G05160 (Tall Adult) 5’10” – 6’6” 300 lbs. G05161 (Adult) 5’ - 6’2” 300 lbs. G05162 (Youth) 4’2” – 5’2” 300 lbs. G05163 (Child) 3’2” – 4’6” 200 lbs.



delivery date.

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ORDER DETAILS



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OFF SET-HANDLE CANE March 1, 2017

MODELS/DESCRIPTION

Adult – G050356 Bariatric – MDS86420XWG

SPECIFICATIONS

Height adjustable Contoured vinyl hand grip Rubber tip

Model Height Adjustability Weight Capacity G050356 31 – 40” 300 lbs. MDS86420XWG (Bariatric)

29 – 38” 500 lbs.



delivery date.

ELIGIBILITY

Must meet general eligibility requirements Loan restricted to SHP, SIP, and FHB recipients

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OPTIONS AVAILABLE Ice Gripper


Physiatrist Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse

ORDER DETAILS



88

QUAD CANE March 1, 2017

MODELS/DESCRIPTION

Adult Large Base – G05340S Adult Small Base – G05345S Bariatric Large Base – MDS86228XWG Bariatric Small Base – MDS86222XWG

SPECIFICATIONS Height adjustable Four legs with rubber tips Hook handle Molded hand grip

Model Height Adjustability Weight Capacity G05340S - Large Base 29 – 38” 300 lbs. G05345S - Small Base 25 - 34” 300 lbs. MDS86228XWG - Large Base (Bariatric)

29 - 38” 500 lbs.

MDS86222XWG - Small Base (Bariatric)

29 – 38” 500 lbs.

89



delivery date.

ELIGIBILITY




ORDER DETAILS

Specify base and height required FORMS


90

GUTTER CANE April 1, 2014

MODELS/DESCRIPTION

Metal cane with arm trough Designed for people who cannot support weight through their

hands SPECIFICATIONS

Padded trough with Velcro straps Adjustable hand grip Rubber grips and tips Height adjustable

ELIGIBILITY


OPTIONS AVAILABLE

Ice Gripper REQUISITIONING AUTHORITY


ORDER DETAILS

This item is in limited supply. Call for availability.

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92

WALK CANE (Side Stepper Hemi Walker) March 1, 2017

MODELS/DESCRIPTION Adult – G07770

Youth – G07771 SPECIFICATIONS

Rubber hand grips and tips Adjustable and folds flat for storage and transportation Wider base for more stability

Model Height Adjustability Weight Capacity G07770 (Adult) 32 – 36” 250 lbs. G07771 (Youth) 28 ½ - 32” 250 lbs.



delivery date.

ELIGIBILITY



Physiatrist Certified Occupational Therapists and/or Physical Therapists Home Care Nurse

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ORDER DETAILS Specify height required

FORMS


94

AXILLARY CRUTCH March 1, 2017

MODELS/DESCRIPTION

Adult Tall – MDSV80534 Adult – MDSV80535 Youth – MDSV80536 Child – G5163 Bariatric Adult Tall – G60314B Bariatric Adult – G1314B

SPECIFICATIONS Rubber hand grips & axillary pads 2” diameter rubber tips Height adjustable

Model Height

Adjustability Approximate Client Height

Weight Capacity

MDSV80534 (Tall Adult)

52 ½ - 60 ½” 5’10 – 6’6” 300 lbs.

MDSV80535 (Adult)

44 ½ - 52 ½” 5’2 – 5’10 300 lbs.

MDSV80536 (Youth)

36 ½ - 44 ½” 4’6” – 5’2 300 lbs.

G5163 (Child) 31 – 37” 4’2 – 4’6 250 lbs. G60314B Tall (Bariatric)

52 – 60” 5’10-6’6 550 lbs.

G61314B Adult 44 – 52” 5’1 – 5’9 550 lbs.

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(Bariatric)



delivery date.

ELIGIBILITY


OPTIONS AVAILABLE

Gutter Crutch Attachment REQUISITIONING AUTHORITY


ORDER DETAILS



96

QUAD FOREARM CRUTCH April 1, 2014

NOTE: This item has been discontinued. Call for availability. MODELS/DESCRIPTION

Forearm crutch with a quad base SPECIFICATIONS

Standard base of 5” x 7” Height adjustable

Tall Adult-33”-39”; user height of 5’6”-6’4” Adult-28”-34”; user height of 4’8”-5’8” Youth-24”-30”; user height of 4’-5’

ELIGIBILITY




FORMS


97

GUTTER CRUTCH ATTACHMENT (ACCESSORY) April 1, 2014

Photo Unavailable

MODELS/DESCRIPTION

LUMEX SPECIFICATIONS

Padded forearm trough for axillary crutch Velcro straps Adjustable hand grip

ELIGIBILITY




FORMS


Photo Unavailable

98

ICE GRIPPER (ACCESSORY) April 1, 2014

MODELS/DESCRIPTION

Designed to flip up when not needed For use with single point canes

SPECIFICATIONS

5-point claw tip Adjustable in diameter size

ELIGIBILITY




FORMS


99

BATHROOM ACCESSORIES

Transfer Tub Seat Stationary Commode Combination Commode Child’s Commode Bath Tub Lift Bath Tub Clamp Wall Bars Utility Bath Seat with Back Utility Bath Seat without Back Raised Toilet Seat Toilet Arm Rest Set

100

TRANSFER TUB SEAT January 2, 2020

G98308A G98309 MODELS/DESCRIPTION

Standard – G98308A, G98309 and BE7200 Bariatric – Merit A312

Non-padded transfer bench Extends over tub edge with two legs in the tub (with suction cups)

and two legs out of the tub Drainage holes to prevent leakage onto floor Reversible back to left or right side

SPECIFICATIONS Model Seat

Height Range

Overall Width

Seat Platform Width

Overall Depth

Seat Platform Depth

Weight Capacity

G98308A 15 - 20”

29” 26” 20” 16” 300 lbs.

G98309 17 – 21.5”

31.5” 28” 21” 14.5” 300 lbs.

BE7200 17 – 21.5”

30” 28” 19” 14.5” 300 lbs.

Merit A312

16 – 21”

25” 25” 16” 16” 500 lbs.

Medline (MDS86952XW)

15 - 19”

29” 26” 19” 16” 550 lbs.

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delivery date.

NOTE: Please lift the release tabs on the suction cup feet to release them from the surface of the tub. Not doing so can

cause the suction cup to tear away from the leg of the transfer seat.

ELIGIBILITY



FORMS


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STATIONARY COMMODE January 2, 2020

Standard Bariatric MODELS/DESCRIPTION

Standard – Breezy 7700, Artisan ATS-510 Bariatric 650# – Merit C314 Welded chrome steel main frame Fixed plastic armrests; bariatric model has drop arms Plastic pail with lid Both models can be used with pail or over most standard height

toilets SPECIFICATIONS Model Seat

Height Range

Seat Width Between Arms

Overall Width

Seat Depth

Weight Capacity

Breezy 7700 and Artisan ATS-510

16.5” – 22.5”

19” 22” 19” 300 lbs.

C314 16.5” – 22.5”

14” (seat only)

27” 18” 650 lbs.

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delivery date.

ELIGIBILITY

Must meet general eligibility requirements OPTIONS AVAILABLE

Splash guard REQUISITIONING AUTHORITY


FORMS


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COMBINATION COMMODE March 1, 2017

ATS-500A ATS-500AF MODELS/DESCRIPTION

Artisan Models Standard – ATS-500A Bariatric – ATS-500AF

Commode with four small locking casters, padded seat cover, and pail

Arms drop down to facilitate transfers Can be used with pail or over most toilets


Width Overall Width

Overall Depth

Floor to Seat Height

Weight Capacity

ATS-500A

18” 21.5” 16” 19” 250 lbs.

ATS-500AF

20” 22” 16” 19” 450 lbs.

ELIGIBILITY

Must meet general eligibility requirements OPTIONS AVAILABLE

Height insert (2 or 3”) available for the ATS-500A model REQUISITIONING AUTHORITY


105


106

CHILD’S COMMODE April 1, 2014

MODELS/DESCRIPTION

Sammons Preston Model Aluminum arms with white plastic seat and pail Adjustable hook and loop-chest strap

SPECIFICATIONS

Overall unit weight of 12 lbs. Overall width of 18” Width between arms is 14.5” Overall depth of 19” Height adjustable legs from 11”-14” 250 lbs. maximum weight capacity

ELIGIBILITY



FORMS


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BATH TUB LIFT July 15, 2019

NOTE: This model has been discontinued from the manufacturer. Equipment will be provided from inventory as available. MODELS/DESCRIPTION

Guardian Spa SPECIFICATIONS

Recline in lowest position Weight capacity of 308 lbs. Height range: Lowest 3”; Highest 16.5” (without 2.5” height

adapter) Size of base – 25” long x 13.5” wide Seat width of 16.5” Battery powered hand control unit; provided with charger

ELIGIBILITY

In addition to meeting general eligibility requirements, the client must meet one of the following for a duration of two months or more: The client is unable to use any of the regular bath seats

independently because of transfer requirements, endurance, or support requirements.

The client is able to use a tub lift independently. The client can physically use a bath seat but would not receive

sufficient immersion in water required by conditions such as: Perineal irritations

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Frequent diarrhea or bladder problems Skin problems

The caregiver is unable to assist transfers safely with any of the other bath seats available.

The client cannot tolerate a shower or spray because of pulmonary conditions.

The client’s tub may not allow the use of any bath seats the client is capable of using.

A home assessment to ensure suitability is required.

This item requires scheduled maintenance.


Physiatrist Licensed Occupational Therapists and/or Physical Therapists

ORDER DETAILS

Specify the criteria that apply FORMS


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BATH TUB CLAMP April 1, 2014

MODELS/DESCRIPTION G980006

SPECIFICATIONS

Height of 13” Adjust to fit tubs 2.75 – 6.25” thick

ELIGIBILITY




FORMS


110

WALL BARS January 1, 2018

MODELS/DESCRIPTION

Silver enamel with knurled grip SPECIFICATIONS

Available in 18 inch, 24 inch or 32 inch lengths Rated to accommodate weight capacity of 300 pounds Bariatric (500 pound capacity) wall bar available in 18 inch length

only ELIGIBILITY




ORDER DETAILS

Specify size required

Maximum of 3 Wall Bars are loaned per client.

FORMS


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UTILITY BATH SEAT WITH BACK March 1, 2017

Standard Bariatric

MODELS/DESCRIPTION Standard – MDS89745A Bariatric – MDS89745AXW

Plastic seat and removable back Metal legs with rubber tips Fits inside tub


Width Seat Depth

Seat to Floor Height Range

Weight Capacity

MDS89745A 19” 12” 13 – 20” 250 lbs. MDS89745AXW (bariatric)

18” 21.5” 16.5 – 20.5”

550 lbs.



delivery date.

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ELIGIBILITY Must meet general eligibility requirements Loan program restricted to SHP, SIP, and FHB recipients




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UTILITY BATH SEAT WITHOUT BACK March 1, 2017

Standard Bariatric

MODELS/DESCRIPTION Standard - G30403 Bariatric - MDS89740AXW

Plastic seat with metal legs with rubber tips Fits inside tub


Width Seat Depth

Seat to Floor Height Range

Weight Capacity

G30403 19” 12” 13 – 20” 250 lbs. MDS89740AXW (bariatric)

20” 12” 14 – 17” 550 lbs.



delivery date.

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ELIGIBILITY Must meet general eligibility requirements Loan program restricted to SHP, SIP, and FHB recipients



FORMS


115

RAISED TOILET SEAT February 15, 2017

Standard 7014 MODEL/DESCRIPTION

Standard Round - 7014 Adjustable seat heights on standard model that can be tilted

anteriorly or posteriorly Height range of 3-6 inches Standard model fits only on toilet seats with round bowl Weight capacity of 300 pounds Bariatric model available upon request

ALTERNATE MODELS (dependent on availability) Model Height Weight Capacity Mobb - MHHRET, Hinged Elongated

4” 300 lbs.

Mobb - MHHRT, Hinged Round

4” 300 lbs.

Mobb - MHLOO - Styrofoam

4 “ 300 lbs.

ELIGIBILITY


116

REQUISITIONING AUTHORITY Physiatrist Licensed Occupational Therapist and/or Physical Therapist Home Care Nurse

ORDER DETAILS

Specify round or elongated toilet bowl FORMS


117

TOILET ARM REST SET February 15, 2017

Lumex 6460A Mobb MHUTSF

MODELS/DESCRIPTION

Lumex 6460A Two arms with mounting bracket that attaches to toilet seat bolts Aluminum legs with rubber feet Plastic armrests Height adjusts from 26”-31” 16.75” depth at the arms; 12” depth at the legs Width between arms adjusts from 18”-24” 250 lbs. maximum weight capacity

Mobb – Ultimate Toilet Safety Frame - MHUTSF 400 lbs. weight capacity Universal fit on all standard toilets Strong & stable; supported by steel hardware and the toilet bowl Legless for easy floor cleaning and walker/rollator maneuverability Integrated toilet paper holder for left & right side Right & Left specific arms, height adjustable Usable with standard toilet seat or raised toilet seat

ELIGIBILITY

Must meet general eligibility requirements Loan is restricted to SHP, SIP, and FHB recipients


Physiatrist

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Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse

FORMS


119

TRANSFER ASSISTS

Transfer Assists Policies Sask-A-Pole Sask-A-Pole Trapeze Sask-A-Pole Kneeboard Versa Helper Trapeze & Floor Stand Hydraulic Patient Lift Transfer Board

120

TRANSFER ASSISTS POLICIES July 15, 2019

GENERAL POLICIES

The provision of an electric patient lift will be considered on an exception basis when a manual hydraulic patient lift does not meet the client’s basic needs. Exception requests must be submitted in writing to the Special Needs Equipment program and should outline the medical needs of the client and the rationale as to why the manual hydraulic patient lift is not appropriate.

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SASK-A-POLE August 25, 2016

MODELS/DESCRIPTION

Steel pipe frame Pressure mount - ceiling mount and floor base for support

between joists SPECIFICATIONS

Poles may be cut down to accommodate varying ceiling heights Model Ceiling

Heights Weight Capacity

Accessories Available

Classic – 8 foot

92 – 101”

250 lbs.

Classic – 10 foot

116 – 124”

220 lbs.

Standard (Heavy Duty) – 8 foot

92 – 101”

325 lbs. Sask-A-Pole Trapeze ** Sask-A-Pole Kneeboard **

Standard (Heavy Duty) – 10 foot

116 – 124”

250 lbs. Sask-A-Pole Trapeze ** Sask-A-Pole Kneeboard **

Bariatric – SPHD – 8 foot

93 – 99” 450 lbs.

NOTE: Trapeze or Kneeboard accessories have a 250lbs. weight capacity rating.

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ELIGIBILITY

Must meet general eligibility requirements

Maximum of 3 Sask-A-Poles are loaned per client.



ORDER DETAILS

Specify floor-to-ceiling height where the pole will be used


ASSOCIATED DOCUMENTS

Sask-A-Pole Classic Installation Instructions Sask-A-Pole Standard HD and Trapeze Installation Instructions

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SASK-A-POLE TRAPEZE April 1, 2014

MODELS/DESCRIPTION Attaches to a Standard (HD) Sask-A-Pole

SPECIFICATIONS

Weight capacity of 250 lbs. Radius of use (arm length) is 19”

ELIGIBILITY



FORMS

Special Needs Equipment Requisition ASSOCIATED DOCUMENTS

Sask-A-Pole Standard HD and Trapeze Installation Instructions

124

SASK-A-POLE KNEEBOARD April 1, 2014

MODELS/DESCRIPTION Padded swivel kneeboard, which attaches to a Standard (HD)

Sask-A-Pole Used for people who require additional knee stability while

transferring SPECIFICATIONS

Weight capacity of 250 lbs. ELIGIBILITY



FORMS


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VERSA HELPER TRAPEZE & FLOOR STAND April 1, 2014

MODELS/DESCRIPTION

Height adjustable unit that attaches to a floor stand Floor stand includes two legs to support trapeze Unit rests it’s base on floor under bed head or chair Unit is designed to provide support, increased stability and assist

the user when repositioning. It is not designed to support the total body weight.

SPECIFICATIONS

Base clearance of 2” would be required Weight capacity of 250 lbs. Bariatric model to accommodate up to 1000 lbs. is available

ELIGIBILITY



FORMS


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HYDRAULIC PATIENT LIFT July 15, 2019

MODELS/DESCRIPTION

Hoyer HML400 SPECIFICATIONS

Lift range of boom is 28 – 77” Base length 43.5” Base width adjusts from 24”-42.5” Base clearance of 5.5” is required 400 lbs. maximum weight capacity for the lift 6 point cradle hook up Manual hydraulic lifting mechanism

SLING TYPES

Padded U sling with or without head support Nylon mesh bath U sling with or without head support

Sling Sizes User Weight Small 55 to 110 lbs. Medium 99 to 210 lbs. Large 198 to 350 lbs. Extra Large 270 to 400 lbs.

This item requires scheduled maintenance.

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NOTE: This item is not designed to be used as a transport device to move clients from room to room. It is designed to transfer clients from one surface to another. ELIGIBILITY



ORDER DETAILS

Specify sling type and size required FORMS


The provision of electric patient lift will be considered on an exception basis when the manual hydraulic lift does not meet the client’s basic needs. See the Transfer Assists Policies page for more information.

Mesh Sling

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TRANSFER BOARD April 1, 2014

MODELS/DESCRIPTION Sammons Preston 926991

SPECIFICATIONS

Moisture proof, high density plastic One side is striate-sanded for bare skin transfers and other side is

buffed for clothed transfers Overall length of 29” Overall width of 8” 0.5” thick Weight capacity is 400 lbs.

ELIGIBILITY




FORMS


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HOSPITAL BEDS & ACCESSORIES

Hospital Bed Policies Electric Hospital Bed Side Rails (Accessory) Over Bed Table (Accessory)

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SASKATCHEWAN AIDS TO INDEPENDENT LIVING (SAIL) WIDE HOSPITAL BED POLICY

April 1, 2014

Electric hospital beds are 36” wide. For clients who weigh more than 500 lbs., a bariatric bed is available. Bariatric beds are 54” wide.

Wider beds may be issued in situations where a client weight is under 500 lbs. and their medical needs are not being met in a standard 36” hospital bed. Clients’ who require additional width due to girth, perform self-care in bed or need additional width due to medical necessity may request a wider bed. These requests must include a letter documenting the medical necessity for the extra width. For home care clients, confirmation that care will be provided on the wider bed is also required.

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ELECTRIC HOSPITAL BED June 1, 2014

MODELS/DESCRIPTION

Joerns Easy Care 3 Wooden head board / foot board Pendant control Standard 6” foam mattress (36” wide) provided with bed

SPECIFICATIONS

Bed platform size is 35” wide and 80” long Overall bed width is 39” Overall length with headrest/footrest is 88” Bed platform height range of 7” to 30” Weight capacity 500 lbs. Pendant control Provided with 6” thick foam mattress with vinyl cover (36x80”)

42”, 48” and 54” width beds are available; refer to the Wide Hospital Bed Policy. ALTERNATE MODELS Model Mattress

Width Platform Height Range

Weight Capacity

Joerns - UCXT 42” 7 – 30” 500 lbs. Rotech – Multitech

48” 8.5 – 29” 500 lbs.

Rotech - Varitech

54” 13 – 30” 1000 lbs.

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ELIGIBILITY

In addition to meeting the general eligibility requirements, the client will be eligible for an electric hospital bed when he/she meets one of the hospital bed criteria

A home assessment is required by a licensed occupational therapist, physical therapist, or a home care nurse (in

consultation with an occupational or physical therapist).

OPTIONS AVAILABLE

Trapeze Over Bed Table Side Rails - half or split rails (full rails are available but only on

specific models of beds) REQUISITIONING AUTHORITY


ORDER DETAILS

Specify the criteria that apply FORMS

Special Needs Equipment Requisition Hospital Bed Criteria Form

133

SIDE RAILS (ACCESSORY) April 1, 2014

Half Rails Shown MODELS/DESCRIPTION

Rail options vary by model of bed Side rail options may include half rails (head end) and split rails

(half rail at head and foot ends) Full rails available for certain bed models

ELIGIBILITY


Physician Licensed Occupational Therapists and/or Physical Therapists

FORMS


134

OVER BED TABLE (ACCESSORY) April 1, 2014

MODELS/DESCRIPTION

Table on four small casters that fits over bed SPECIFICATIONS

Height adjusts from 29”-42” ELIGIBILITY



FORMS


135

OTHER EQUIPMENT

Helping Hand Reacher

136

HELPING HAND REACHER April 1, 2014

MODELS/DESCRIPTION

Patterson Medical Feather Reachers A665008 – 26” length A665009 – 32” length

Used to extend reach and grasp light items. SPECIFICATIONS Available in two lengths: 26” and 32” 2 ½” jaw opening with rubber tip Reacher weighs approximately 1 lb.

ELIGIBILITY

Must meet general eligibility requirements Loan program restricted to SHP, SIP, and FHB recipients.



ORDER DETAILS

Specify length of reacher desired FORMS


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PAEDIATRIC WOODEN EQUIPMENT

Paediatric Height Adjustable Chair Paediatric Height Adjustable Table Paediatric Therapy Bench

138

PAEDIATRIC HEIGHT ADJUSTABLE CHAIR January 1, 2018

MODELS/DESCRIPTION Wooden height and depth adjustable chair SPECIFICATIONS

Available in three seat sizes: 10” x 10” (small) 11” x 11” (medium) 12” x 12” (large)

Adjustable height on each size: Small – 7” to 10.5” Medium – 8” to 11.5” Large – 9” to 12.5”

Adjustable seat depth: Up to 4” adjustability on each size

AVAILABLE OPTIONS

Seat Pad – 1” or 2” Wedge Seat Pad – 1” or 2” Back Pad – 1” or 2” Angled Back Pad – 1” or 2” Side Pads – 1” or 2” Lap Belt Footrest Note: Accessories such as butterfly vests, headrests, anti-thrust seats and bolsters are available through Adaptive Seating. Please follow the standard process for requisitioning Adaptive Seating components if these types of accessories are required.

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ELIGIBILITY Must meet Special Needs Equipment general eligibility

requirements for universal loan equipment Must be 17 years of age or younger Loan program provides one height adjustable chair only for in-

home rehabilitation and therapy – equipment required for other locations (school, daycare, etc.) may be purchased privately outside of the loan program - please contact SaskAbilities directly regarding pricing


Licensed Occupational Therapists and/or Physical Therapists FORMS

Paediatric Wooden Equipment Order Form

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PAEDIATRIC HEIGHT ADJUSTABLE TABLE January 1, 2018

MODELS/DESCRIPTION Wooden height adjustable table SPECIFICATIONS

Available in two sizes: 22” x 28” table top with 10” x 5” cut out (small)

13” to 18.5” height adjustment to table top 24” x 30” table top with 11” x 5” cut out (large) 14” to 24” height adjustment to table top

AVAILABLE OPTIONS Book Box – 6” x 6” x 10” (attaches to side of table)


requirements for universal loan equipment Must be 17 years of age or younger Loan program provides one height adjustable table only for in-

home rehabilitation and therapy – equipment required for other locations (school, daycare, etc.) may be purchased privately outside of the loan program - please contact SaskAbilities directly regarding pricing

141

REQUISITIONING AUTHORITY Licensed Occupational Therapists and/or Physical Therapists

FORMS


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PAEDIATRIC THERAPY BENCH January 1, 2018

MODELS/DESCRIPTION Wooden height adjustable bench with tilt SPECIFICATIONS

Available in two sizes: 10.5” x 26” padded seat (small) 8.5” to 11.5” height adjustment 14” x 30” padded seat (medium) 13” to 21” height adjustment


requirements for universal loan equipment Must be 17 years of age or younger Loan program provides one therapy bench only for in-home

rehabilitation and therapy – equipment required for other locations (school, daycare, etc.) may be purchased privately outside of the loan program - please contact SaskAbilities directly regarding pricing


Licensed Occupational Therapists and/or Physical Therapists FORMS


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EQUIPMENT MANUAL REVISION DATES

Original Manual Release Date – April 1, 2014 Revision Dates

June 1, 2014 August 1, 2014 October 30, 2014 November 15, 2015 May 1, 2016 August 25, 2016 October 17, 2016 December 1, 2016 Feb 15, 2017 March 1, 2017 May 15, 2017 January 1, 2018 June 1, 2018 January 1, 2019 April 1, 2019 July 15, 2019 November 15, 2019 January 2, 2020

Special Needs Equipment Program Manual--Section 1 · x 0dlqwhqdqfh dqg uhsdlu ri sulydwho\ rzqhg...

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