Part IX:

Assistive Technology

Relevance to Centers for Independent Living (CILs)

Assistive technology (AT) is not a new concept for those working in CILs. But many older consumers may be afraid, reluctant or refuse to use assistive technology. The term "assistive technology" may frighten them. In this section, CILs will learn how to introduce assistive technology to older consumers. Using the terms "helpful products" instead of AT when introducing an assistive device and providing information or training will be less threatening to the older consumer. CILs will learn that the consumer's (and their family, caregiver) attitudes about technology will determine device acceptance or refusal. For example, consumers have refused to use devices because the devices appear to be complicated to use, or "it's ugly," or "it makes me look old."

CILs are in a good position to help older adults overcome "technology phobia," through providing information, awareness, and training about devices that may improve or maintain functional level. CILs can help direct older consumers to funding sources or assistance.

Part IX Assistive Technology

Introduction | Funding sources for AT

Introduction

What is assistive technology (AT)? It is defined as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. AT service is directly assisting an individual with a disability in the selection, acquisition, or use of an assistive technology device."¹ Basically, it is a product that helps an individual with a disability do an activity that they might not otherwise be able to do. Although the individual has a disability, the assistive device enables and/or enhances functional capabilities. An example would be a bathseat. The person may not be able to use the tub for bathing and have to sponge bathe if a bathseat was not available.

What is the difference between having an impairment, disability or handicap? According to the World Health Organization (WHO), an impairment is "any loss or abnormality of psychological, physical or anatomical structure of function."² A disability occurs when the impairment interferes with the person's functional ability to be able to perform an activity in a way that is considered normal. A handicap is representative of the person-environment relationship (WHO). A handicap occurs when the person with an impairment or disability is unable to fulfill normal roles.

There are many assistive devices on the market that can help people with disabilities. Yet, many elderly consumers and their caregivers are not aware of them. CILs can be a valuable resource in the education and training of assistive technology to elders. Also, CILS can help people to obtain funds and purchase needed devices.

Assistive technology can be divided into several categories: low-tech, high-tech, medically necessary, durable medical equipment (DME) or convenience/luxury.

• Low-tech: these devices are usually characterized as easy to make, easy to obtain and inexpensive.They do not have mechanical, electrical or computerized components (i.e. sock aid, long-handle shoehorn, modified eating utensils)

• High-tech: these devices are usually characterized as hard to make, hard to obtain and expensive. These devices have features or options that are computerized or electromechanical (i.e. print enlargement systems, voice recognition devices, electronic communication devices, smart phones)

• Medically necessary: means that the device is prescribed by a physician, is used to restore or approximate normal function of a missing, malformed, or malfunctioning body part, directly related to a diagnosed medical condition; and expected to improve the user's ability to function.³

• Durable medical equipment (DME): means that the device can withstand repeated use, is primarily or customarily used to serve a medical purpose; generally is not useful to an individual in the absence of illness or injury, and is appropriate for use in the home.⁴

• Convenience or luxury devices: these devices are primarily considered as a convenience or luxury for most people (garage door opener, TV remote control, microwave oven). Payment for these devices are not covered by HMOs or health insurance. But these devices become assistive devices for people with disabilities who are unable to open the garage or operate TV buttons manually due to arthritis, limited mobility or range of motion. A microwave oven becomes an assistive device for someone who cannot bend to use a conventional oven or for someone with memory problems who may not turn off the stove or oven when finished cooking.

Another way to differentiate between assistive technology is in the way the technology will be used.

• General-purpose - these devices can be used to serve more than one need, such as a reacher, mouthstick, or joystick on a wheelchair. These devices usually involve low-tech AT.

• Specific-purpose - these devices are used to assist performance in one particular activity, such as feeding, dressing, communication, and hearing. These devices are specialized and are designed to assist the person with one activity.

Another differentiation of AT is whether or not it is:

• Commercially available - these devices are mass produced and are designed to be used by anyone. For those with disabilities, these devices can be used with some modifications added (i.e. personal computer or microwave oven).

• Custom made - devices that are specifically designed and made to meet a particular person's individual needs (molded wheelchair seat cushion). These costs are usually expensive.

Designing technology to be used by all people will certainly contain costs. Universal design is a concept that an increasing number of product designers use when developing new technologies. Products or environments with universal design can be used by all people to the fullest extent possible without it having to be adapted, modified or specialized (NC State University, The Center for Universal Design, 1997). The NC State University Center for Design has conceived and developed seven principles of universal design that can be used as a guide to determine whether or not the products or environments can be used by all people. These principles are listed below and more detail about each principle can be found at the Center for Design's website:
(http://design.ncsu.edu/cud/univ_design/principles/udprinciples.htm) ⁵

Principles of Design

ONE: Equitable Use

The design is useful and marketable to people with diverse abilities.

TWO: Flexibility in Use

The design accommodates a wide range of individual preferences and abilities.

THREE: Simple and Intuitive Use

Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level.

FOUR: Perceptible Information

The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.

FIVE: Tolerance for Error

The design minimizes hazards and the adverse consequences of accidental or unintended actions.

SIX: Low Physical Effort

The design can be used efficiently and comfortably and with a minimum of fatigue.

SEVEN: Size and Space for Approach and Use

Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility.

Barriers to use and non-use of assistive technology

Although there are thousands of devices available, researchers have identified barriers that exist among the elder population to determine if the technology will be accepted, utilized or abandoned. Four factors were identified:

1. inadequate training and orientation for the elder consumer,

2. inappropriate match between the assistive device and the person's need,

3. cumbersome designs, and

4. failure to understand that assistive technology involves more than just giving a person a device

In 1990, Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) reported that caregivers believed older people were reluctant to use new technology. Initially, researchers thought that this reluctance was partially due to the older person's decreased ability to learn.⁶ This has been proven false. Older people do retain their ability to learn, but may need one-on-one training. Researchers have learned that the training approach used to introduce elders to assistive technology will have a critical impact on their understanding and on acceptance of the device.

Introducing Assistive Technology to the Older Consumer

• The device must be perceived as needed and meaningful and linked to the lifestyle of the consumer. The elder consumer will not use the device if it is not vital to independence.

• Consider what the individual thinks and feels about the device. Some think the device may detract from appearance. They may feel stigmatized if the device is bulky.

• The idea of using the device may need to be introduced several times before the individual is willing to try it. (The elder consumer needs to get use to the device and its function and how it will impact their life. The consumer needs time to feel comfortable with the device).

• Disbelief in ability to learn how to use a device must be considered. Sometimes the elder consumer does not have confidence about learning new technology. The trainer must be positive and exhibit realistic attitudes to encourage the consumer.

• Focus must be placed on the practical application of the device rather on technical features. The trainer should focus more on how the device can help the individual in their daily tasks, i.e. energy conservation, improve safety, increase independence instead of focusing on all the many features of the device.

• Omit irrelevant information. Keep it simple. Provide basic information for successful learning, confidence building and device acceptance.

• Choose a time to introduce the device when the consumer is not preoccupied with pressing personal problems. The consumer will not be interested in learning how to use a device for bathing if worried about the ability to pay the heating bill this week or about a recent death in the family).

• Relate the information to the individuals' past experiences. Remind the individual of successful uses of devices he/she has used in the past, i.e. learning to use a VCR or microwave oven.

• Reduce extraneous noises and distractions during training. Turn off TV or radio for full attention.

• Training sessions should be held in the home or at a location where the device will be used. The consumer is more at ease if training is provided in a familiar setting. It is best to train how to use a dressing device in the bedroom or cooking/feeding device in the kitchen. This is especially true for those with mild cognitive impairment. There is greater association with the activity and device.

• The consumer should know the person introducing the device. A level of trust between the trainer and the consumer has been established and the consumer will be more willing to experiment with the device.

• The attitude of the trainer must be positive and realistic. If the trainer fumbles with the device or exhibits negative attitudes, the consumer will pick up on this and reject the device.

• Repeated short training sessions are more effective than longer sessions. Repetition and consistency improve the learning process. It helps activity performance become more automatic.

Matching the person's needs to the appropriate device is key to successful use and acceptance of the device by the user. It can become very costly and time consuming if the device and person are not matched properly. In order to obtain an appropriate match between the person's abilities and the device, it is recommended that the evaluator must have a solid knowledge of physical functional needs assessment techniques and a strong background in the field of assistive technology. It is most important to remember that the consumer should be actively involved in making the decision about the assistive technology. The device must be incorporated into the person's lifestyle - who the person is physically, emotionally, culturally and personally. M. Scherer states, "We know already that the single most important reason devices are not used by consumers is lack of consumer involvement in selection. People select their assistive technologies based, first, on how well they satisfy goals, needs and preferences, then according to their attractiveness and appeal. If the device meets the person's performance expectations and is easy and comfortable to use, then a good match of person and technology has been achieved. The perspective of the user will increasingly be the driving force in device selection, not which technology is most affordable or quickest to obtain."⁷ Also, funding sources want to be assured that purchased devices are needed, appropriate, and will be used.

There are advantages to using assistive technology. In 2001, Mann determined that assistive technology has the potential to ease the burden of caregivers. He stated, "Any device that increases the level of independence for a person will at the same time decrease the amount of assistance required from a care provider."⁸ Gitlin and her colleagues (2001) found that assistive technology and home modifications could provide caregivers immediate relief, reduce stress and help them provide care more easily and safely.⁹ Another study conducted by Mann and his colleagues (1999) found that assistive technology and home modifications can reduce home care costs for older adults and help delay institutional placement.¹⁰

Who are AT users? Assistive technology users can be classified into five groups:

1. caregivers - those caring for others who use AT to decrease burden of care

2. elderly consumers - use devices to promote safety or reduce the risk of injury

3. those with age-related changes/functional decline - use devices to promote independence and minimize disability

4. first-time disability/multiple chronic conditions - use devices to perform ADLs

5. people aging with disability - use devices over long period of time to support daily activities

When is assistive technology use effective during the aging process? According to Gitlin (2002), there are three key points when assistive technology may be effective during the aging process. They are:

1. "The period prior to the onset of functional decline in which assistive technology may have a preventive role." (Safety-grab bars in bathroom)

2. "The period following acute onset of a potentially disabling condition, such as a hip fracture or stroke." (Rehabilitation-restore and maintain function)

3. "Long-term care. Older person may experience a combination of progressive physical and cognitive impairments." (Maintain social, psychological, and physical function and cognitive awareness and orientation)¹¹

What key points should be considered when recommending assistive technology to the elderly consumer? There are thousands of devices available. Recommending and selecting the right one will depend upon the person's needs, the setting in which it will be used, and the particular activity to be performed.

Key Points to Consider for AT Selection

1. What are elder consumer's specific needs? Do they need help with dressing, or need to compensate for a memory problem, such as forgetting to take medications. Which device allows the greatest independence?

2. What are the elder's strengths? The assistive device should incorporate the person's strengths. Is it age, gender and culturally appropriate? How does the consumer feel about the device? Are they comfortable with the appearance and operation of the device?

3. How interested and skilled is the elder in using technology? The user must be involved in the selection process. Abandonment or refusal of the device can occur if the consumer is not interested. Need to address the family's attitude and reaction to recommended devices.

4. In what setting will the device be used (home, work, social setting)? Not all technology will be appropriate in every setting. Need to decide where it can be used, stored or if adaptation is needed to use the device.

5. Will the elder need to use the device in more than one place? Larger devices will be difficult to transport. Think about transportability.

6. How easy or difficult it is to learn about and operate the device? Is the device easy to use? Does it require training prior to its use? If so, where and how can one obtain it and how much will it cost? Operating instructions should be simple and brief. If it appears too complicated, or the trainer has problems with the device, the elder consumer will believe they will have difficulty learning the device's operation.

7. How reliable is the device? Need to know how well the device holds up under continuous use. Does it frequently break down or need repairs? What is its life span use? How difficult is it to obtain services for the device?

8. Does it need other technologies in order to work? This usually applies to high tech devices such as computer systems and software, but can also apply to low-tech devices such as an assistive listening device that connects to a TV. The TV must have an AC jack to be able to accommodate the listening device.

9. Is there technical support available when needed? Consumers need to know where to turn for help if the device does not operate properly. Check for telephone numbers and websites for product warranties, limitations, costs and length of operation time.

10. Does the consumer have a personal support system? Success often depends upon having a local support system nearby such as friends or family members who may know about the device or own a similar one.¹²

(Listing adapted from the Nova Scotia Network's website). ¹²

It is very important to remember that devices that are easy to use, setup, transport, and that are lightweight and inexpensive to obtain and repair are more acceptable. The assistive technology should improve functional performance, increase self-esteem and self-efficacy and socialization. The device becomes an extension of the person. Therefore, consumer choice and selection are key to the needed assistive technology solution for the user.

The elderly adult spends a great deal of time at home. They interact in various activities (eating, cooking, dressing, bathing, playing and socializing) within the home. Assistive technology is available to assist older consumers in performing these and other activities by increasing function, enhancing independence and environmental control, promoting communication, increasing visual and auditory access participation, improving mobility and promoting play, leisure and family socialization.¹³

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Funding sources for AT

Private health insurance

Since private health insurance coverage varies, consumers must check their individual health plans for specific details regarding assistive technology.

Medicare: 1-800-633-4227, TTY/TDD: 1-877-486-2048

Medicare is a health insurance program that was established in 1965 by Title XVIII of the federal Social Security Act. Individuals eligible for Medicare include persons age 65 and older, some disabled persons under age 65, and individuals with end-stage renal disease. The Medicare program is divided into two parts:¹⁴

1. Medicare Part A provides the beneficiary coverage during a stay in a hospital and/or skilled nursing facility, as well as coverage for home health care and hospice care. Most individuals do not pay to participate in the Medicare program under Part A.

2. Medicare Part B is an optional, supplemental plan that covers healthcare costs outside of the hospital. This includes coverage for doctors, outpatient hospital care, and other medical services. Individuals enrolled in Part B typically must pay a monthly premium, an annual deductible, and a specified co-payment of Medicare's approved amount to be charged for a specific device or service.

Assistive technology (AT) is generally covered under Medicare when the device meets Medicare's specific description of Durable Medical Equipment, Prosthetics, Orthotics, and/or Supplies (DMEPOS). Additionally, in order for a device to be covered, the supplier must provide a Medicare billing number and "the device must be either reasonable or necessary for the treatment of illness or injury or to improve the functioning of a malformed part."¹⁴ Some items require only a prescription by the physician, while other items call for a "certificate of medical necessity" to be submitted with the claim. Once submitted, claims are processed by one of four Durable Medical Equipment Regional Carriers (DMERC), which were established to help Medicare manage claims. Each DMERC possesses a coverage manual for providers/suppliers that details covered and non-covered items, as well as describes the classification of rental only items, purchase only items, and items that can be either rented or purchased. These manuals are available online on DMERC websites.

Medicare Part B is typically the portion of Medicare that pays for DMEPOS. The types of devices covered by Medicare can vary between carriers. Examples of commonly covered items include: canes, walkers, bedside commodes and wheelchairs. Hearing aids and other assistive listening devices are not covered. Eyeglasses and other low vision aids are also normally not covered. Appealing a denial may result in eventual payment of a claim by Medicare. A publication by Lighthouse International "SharingSolutions, Spring 99 issue" discusses a similar scenario involving closed caption televisions (CCTV) which are typically not covered under Medicare. The article offers a step-by-step guide for appealing a Medicare denial of a CCTV claim. Following the guidelines has reportedly resulted in success for some beneficiaries.

Medicaid: (Call toll free number for your state)

Medicaid is health insurance for people with low income and families who meet specific criteria. Medicaid does not make payments to the recipients. It makes payments to the providers. The federal government sets up some general guidelines for the administration of Medicaid. Each state establishes the specifics for administration of the program. So there are differences in what services and equipment each state covers and to what extent they cover a service or equipment.

Medicaid covers equipment that is deemed medically necessary. Medicaid defines medical necessity as prescribed by a doctor of medicine or a doctor of osteopathy, a reasonable, appropriate, and effective method for meeting the client's medical need; the expected use is in accordance with current medical standards or practices, cost effective, meaning less costly and medically appropriate alternatives either do not exist or do not meet treatment requirements, provides for a safe environment or situation for the client, utilization is not experimental, investigational, or not generally accepted by the medical community, and primary purpose may not be to enhance the personal comfort of the client, nor to provide convenience for the client or the client's caretaker.

Some items that Medicaid may cover include: wheelchairs, walkers, canes, crutches, commode chairs, hospital beds, augmentative communication devices, home glucose monitors and nebulizers. It is necessary to check with the specific state to see what types of equipment they will cover, and for the purchasing or rental procedure.

Medicaid Home and Community-based Waiver

To be eligible for this Medicaid waiver, the individual must need hospital or nursing home level of care. The waiver then provides services to keep the consumer in the community. Without the services provided they would be in an institutional setting. There are no specific services that states must provide under this waiver. However, there are some states that cover durable medical equipment. The waiver is one of the last sources of funding tapped to cover durable medical equipment. Private insurance is tapped first, then Medicare, then Medicaid, and finally this waiver if the specific state provides it as a benefit. See http://www.cms.hhs.gov/medicaid/1915c/design.asp.

Veteran's Administration: (VA Health Benefits Service Center: 1-877-222-VETS)

To be eligible for veteran's health benefits, veterans must have completed 24 continuous months of active military service:

• Former enlisted persons whose first term of active duty began after September 7, 1980, OR

• Former enlisted persons who originally signed up under a delayed entry program on or before September 7, 1980, and who subsequently entered active duty after that date, OR

• Former commissioned officers and warrant officers whose first term of active duty began after October 16, 1981, OR

• Any other person (officers as well as enlisted) who entered on active duty after October 16, 1981, and who had not previously completed at least 24 months of continuous active duty service or had been discharged or released from active duty under section 1171 of title 10.

These benefits include those serving in wartime WWI, WWII, Korea and Vietnam. There are a few exceptions to eligibility. See http://www.appc1.va.gov/Elig/page.cfm?pg=1.

The VA is required to provide "needed" services to veterans enrolled in the health benefits program. The VA defines need as: "care or service that will promote, preserve, and restore health. This includes treatment, procedures, supplies, or services. This decision of need will be based on the judgment of your health care provider and in accordance with generally accepted standards of clinical practice." See http://www.appc1.va.gov/Elig/page.cfm?pg=3.

One of the benefits listed under covered services in the medical benefits package is durable medical equipment, prosthetic and orthotic devices, including eyeglasses and hearing aids. See  http://www.appc1.va.gov/Elig/page.cfm?pg=10.

Home Improvements and Structural Alterations

The Home Improvements and Structural Alterations program provides funding for eligible veterans to make home improvements necessary for the continuation of treatment or for disability access to the home and essential lavatory and sanitary facilities. Home improvement benefits up to $4,100 for service-connected veterans and up to $1,200 for non-service-connected veterans may be provided. For application information, contact the prosthetic representative at the nearest VA Medical Center or outpatient clinic. See http://www.va.gov/publ/direc/health/direct/195097.htm.

Specially Adapted Homes

Disabled veterans may be entitled to a grant from VA for a specially adapted home that meets their needs or for adaptations to an existing house.

$48,000 Grant

VA may approve a grant of not more than 50 percent of the cost of building, buying or remodeling adapted homes or paying indebtedness on those homes already acquired, up to a maximum of $48,000. Veterans must be entitled to compensation for permanent and total service-connected disability due to one of the following:

1. Loss or loss of use of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes or a wheelchair,

2. Disability that includes (a) blindness in both eyes, having only light perception, plus (b) loss or loss of use of one lower extremity,

3. Loss or loss of use of one lower extremity together with (a) residuals of organic disease or injury, or (b) the loss or loss of use of one upper extremity which so affects the functions of balance or propulsion as to preclude locomotion without the use of braces, canes, crutches or a wheelchair.

$9,250 Grant

VA may approve a grant for the actual cost, up to a maximum of $9,250, for adaptations to a veteran's residence that are determined by VA to be reasonably necessary. The grant also may be used to help veterans acquire a residence that already has adaptations for the veteran's disability. Veterans must be entitled to compensation for permanent and total service-connected disability due to (1) blindness in both eyes with 5/200 visual acuity or less, or (2) anatomical loss or loss of use of both hands.

Supplemental Financing

Veterans with available loan guaranty entitlement may also obtain a guaranteed loan or a direct loan from VA to supplement the grant to acquire a specially adapted home.

See Federal Benefits for Veterans and Dependents (2002) http://www.vagreatlakes.org/docs/02Fedben.pdf.

State Alternative Financing Programs

State Alternative Financing Programs were established through Title III of the AT act and administered through NIDRR. These programs offer low-interest loans and/or extended payments for assistive technology. The programs started with federal grants to states and state funding. Some states have a minimum or maximum that can be financed.19

State Technology Assistance Programs

These are funded under the Assistive Technology Act of 1998. The projects work to eliminate or reduce barriers to obtaining assistive technology for people with disabilities. They work to change legislation or policies, streamline funding of assistive technology, provide outreach to ensure that under-served populations are not left out, provide information to increase awareness of assistive technology and funding of assistive technology, and manage assistive technology loan and recycling programs. See http://www.resna.org/taproject/at/about.html.

HUD

A home is eligible for the Home Rehabilitation Program if it is at least a year old and has 1-4 family dwelling units. Under this program, improvements may be made to the home for accessibility to a person with a disability. For example: remodeling the kitchen, bathroom, installing ramps, etc. Mortgage proceeds must be used in part for improvements to a property. The improvements must cost at least $5,000 to be eligible for this program. See http://www.hud.gov/offices/hsg/sfh/203k/203kabou.cfm.

IRS: Deduction for Businesses

Businesses may deduct costs of making a facility or public transportation vehicle more accessible for people who are disabled or elderly. The business must own or lease the property or vehicle they are adapting and for which they are taking the deduction.

The IRS defines facility as "all or any part of buildings, structures, equipment, roads, walks, parking lots, or similar real or personal property." The IRS defines a public transportation vehicle as "a vehicle, such as a bus or railroad car, that provides transportation service to the public (including service for your customers, even if you are not in the business of providing transportation services)."

There is a $15,000 deduction limit per tax year on removing barriers. To be considered eligible for the deduction, the adaptation has to meet very specific requirements according to the type of construction or alteration that is completed. See http://www.irs.gov/publications/p535/ch08.html#d0e6980.

Vocational Rehabilitation

Vocational rehabilitation is to assist people in getting, keeping, or regaining employment. To be eligible for vocational rehabilitation services, a person has to have a mental or physical condition that is interfering with their employment goal. Vocational rehabilitation helps people attain an employment goal and helps them to get, keep, and regain employment. Assistive technology may be covered under vocational rehabilitation if it will help the individual to obtain, keep, or regain employment. See http://www.rehabworks.org/index.cfm?fuseaction=SubMain.Consumers.

The Steps to Funding Assistive Technology

The University of Wyoming has identified nine steps to help develop a systematic and logical approach to funding assistive technology. These steps are:

• Define the need

• Document the need

• Identify the equipment and/or services needed and secure necessary prescriptions and other justification

• Determine if alternative equipment will meet the need

• Determine funding sources

• Collect and submit the required paper work

• Obtain authorization

• Search for co-payment options

• Appeal denials

See website for specific details in each step:

http://www.uwyo.edu/wynot/inforesource/information/funding.asp or at http://www.cybercil.com/library/at_funding.pdf

A company named Tumble Forms lists these nine steps to funding that were prepared by the South Carolina Assistive Technology Project (SCATP). You can find their particular comments at: http://www.tumbleforms.com/bergeron/9steptofun.html.

InterAct Plus has additional information on the funding of assistive technology. This information can be accessed at http://www.interactplus.com/oyw_funding.htm.

Definitions: Quick Reference

AT according to the OAA

The term "assistive technology'' means technology, engineering methodologies, or scientific principles appropriate to meet the needs of, and address the barriers confronted by, older individuals with functional limitations.

AT according to the Assistive Technology Act

The term "assistive technology" means technology designed to be utilized in an assistive technology device or assistive technology service.

The term "assistive technology device" means any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

The term "assistive technology service" means any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device including the evaluation of the assistive technology needs of an individual with a disability.

DME according to Medicaid

DME is equipment that can be used over and over again, is ordinarily used for medical purposes; is generally not useful to a person who isn't sick, injured or disabled, and is appropriate for use in the home. Usually, the equipment must be prescribed by a doctor and be medically necessary.

Influences on Use of Assistive Technology¹⁸

References

¹The US technology-related assistance for individuals with disabilities act of 1988, Section 3.1. Public Law 100-407, August 9, 1988 (renewed in 1998 in the Clinton Assistive Technology Act)

²World Health Organization: International classification of functioning disability and health-ICF Intro, 4.1 Body functions and structures and impairments, pg. 11-13. Available at: http://www.who.int/classification/icf/intros/ICF-Eng-Intro.pdf

³Definition of medically necessary: http://www.ncatp.org/Funding/medicaidstepsad.htm

⁴Definition of durable medical equipment: http://www.ncatp.org/Funding/medicaidstepsad.htm

⁵The Center for Universal Design (1997). The Principles of Universal Design, Version 2.0. Raleigh, NC: North Carolina State University. Available at: http://www.design.ncsu.edu/cud/univ_design/princ_overview.htm

⁶RESNA. Assistive Technology Sourcebook. RESNA Press Publishers, Washington, DC, 1990.

⁷Scherer, M. "The Importance of Assistive Technology Outcomes," January 2002. Available at http://e-bility.com/articles/at.shtml

⁸Mann, W.C. (2001). The Potential of Technology to Ease the Care Provider's Burden, Generations, 25(1), 44-49.

⁹Gitlin, L., Corcoran, M., Winter, L., Boyce, A.., & Hauck, W. (2001). A randomized controlled trial of a home environmental intervention: Effect on efficacy and upset in caregivers and on a daily function of persons with dementia. Gerontologist 41(1), 4-14.

¹⁰Mann, W.C., Ottenbacher, K.J., Fraas, L., Tomita, M., & Granger, C.V. (1999). Effectiveness of Assistive Technology and Environmental Interventions in Maintaining Independence and Reducing Home Care Costs for the Frail Elderly. Archives of Family Medicine 8, 210-217.

¹¹Gitlin, L., (2002). Assistive Technology in the Home and Community for Older People: Psychological and Social Considerations. Assistive Technology: Matching Device and Consumer for Successful Rehabilitation Chapter 7, 109-122.

¹²Points to Consider. Available at: http://www.nsnet.org/atc/tools/consider.html

¹³Bryen, D. N., Goldman, A. S. (2002). Contexts: Assistive Technology at Home, School, Work and in the Community. Clinician's Guide to Assistive Technology, Chapter 2, pg. 17.

¹⁴Medicare Information available at: http://www.medicare.gov

¹⁵Medicaid Information available at: http://www.cms.hhs.gov/medicaid/tollfree.pdf

¹⁶Veteran Administration information at: http://www.va.gov/health_benefits

¹⁷Information available in depth at: http://www.uwyo.edu/wynot/inforesource/information/funding.asp or at http://www.cybercil.com/library/at_funding.pdf

¹⁸Source: American Medical Association. (1996) Primary Care for Persons with Disabilities: Access to Assistive Technology: Guidelines for the Use of Assistive Technology: Evaluation, Referral, Prescription, p.23. Chicago: AMA.

¹⁹Wallace, J. (2003). A policy analysis of the assistive technology alternative loan financing program in the United States. Journal of Disability Policy Studies 14 (2), 74-81.

Assistive Technology Resources

Agencies

Center for Assistive Technology (CAT)
www.cat.buffalo.edu

Center for Assistive Technology and Environmental Access (CATEA)
www.catea.org
Formerly known as the Center for Rehabilitation Technology

Rehabilitation Engineering Research Center on Technology for Successful Aging
www.rerc-tech-aging.ufl.edu

Rehabilitation Engineering Research Center on Technology Transfer (T2-RERC)
http://cosmos.ot.buffalo.edu

Books

Cook, A.M., Hussey, S.M. (2002). Assistive Technologies Principles and Practice, 2nd ed. Mosby, Inc. Available through Elsevier Health Sciences at: http://www.us.elsevierhealth.com/product.jsp?isbn=0323006434

Computer and Web Resources for People with Disabilities, 3rd ed. (2000) Alliance for Technology Access. Available through ATA at http://www.ataccess.org/resources/atabook/default.html

Mann, W.C. & Lane, J.P. (1995). Assistive Technology for Persons with Disabilities, 2nd ed. American Occupational Therapy Association, Inc. Available through AOTA, 4720 Montgomery Lane, PO Box 31220, Bethesda, MD 20824-1220: http://www.aota.org/nonmembers/area7/docs/cat04-7.pdf

Olson, D. & DeRuyter, F. (2002). Clinician's Guide to Assistive Technology. Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, Missouri 63146. Available through Elsevier Health Sciences at: http://www.us.elsevierhealth.com/product.jsp?isbn=0815146019

Scherer, M.J. Ed. (2002). Assistive Technology: Matching Device and Consumer for Successful Rehabilitation. American Psychological Association. Available through APA at http://www.apa.org/books/431667A.html

Scherer, M.J. Ed. (2000). Living in the State of Stuck: How Assistive Technology Impacts the Lives of People with Disabilities, 3rd ed. available through Brookline Books, http://www.brooklinebooks.com/disabilities/assistive/stuck.htm

Helpful Products Catalogs

Websites

Assistive Technology Webliography: An assistive technology websites compiled by Sandra Hubbard, MA, OTR and her class. http://www.uthscsa.edu/sah/assistive_tech/webliography.htm

www.rehabtool.com This site offers a variety of high-tech assistive and adaptive technology products, augmentative and alternative communication devices, computer access equipment, multilingual-speech synthesis and voice recognition software.

www.abledata.com Offers a database of safe, accessible products. Provides information on more than 20,000 products. Available by mail or on the Internet.

www.blvd.com Offers a resource directory that can be downloaded entitled A Disability Resource Directory of Products and Services for the Physically Challenged, Elderly, Caregivers and Healthcare Professionals.

www.dynamic-living.com Offers hundreds of kitchen products, bathroom helpers and unique daily living aids that promote a convenient, comfortable and safe home environment for people of all ages.

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