1. Goldberg, Arlene OTR/L

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I believe the Medicare durable medical equipment (DME) policy related to electric beds and their coverage is in need of change and I need advice from the clinicians and managers with experience in home care. From many years working as an occupational therapist in home care, I have been seeing scenarios such as the following cases-and many more than once.


Case 1

The caregiver for a 75-year-old woman with multiple sclerosis was her 90-year-old husband. He complained that the care she needed was getting to be too difficult for him. His back was bothering him. His wife needed to be bathed and dressed while in the hospital bed and then transferred into a wheelchair. Although she could bear some weight on her legs, she could neither pivot nor move her legs to assist in any way during transfers. She also had no sitting balance. Although she may have been a good candidate for a Hoyer lift, it would not have fit into their bedroom. (Although this scenario also presents its own safety concerns.)


While watching the husband with his caregiving tasks, I discovered that although he had a hospital bed, it was not "all" electric. This older gentleman had to hand crank it! The crank at the end of the bed, used to raise and lower the height, was too difficult for him to manage.


When I tried it, it was also too difficult for me. Because of this, the DME vendor, who provided the bed, was contacted. They were willing to provide an all electric bed, but would charge $50 a month for the motor, unless the patient pleaded poverty. The family chose to pay rather than supply all their detailed financial information. I have since been informed that the motor costs approximately $80. Doing the math, this means the DME vendor would receive $650 for the length of the 13-month rental of the bed. Something is wrong with this arrangement!


Case 2

The caregiver for an 82-year-old man was his 73-year-old wife. The patient had a recent above-the-knee amputation with a prosthesis. He was also legally blind, had diabetes and was incontinent. During his morning personal care routine the semielectric hospital bed needed to be raised and lowered four times: Raised to put the prosthesis on, lowered to allow him to push his leg against the floor, raised to continue to dress him, and lowered to have him come into a standing position. His wife had sciatica and she was in pain from these care-related activities.


This semielectric bed had a crank at the end to raise and lower the position. His wife was using the hand crank and reported suffering later because of this.


Case 3

A 91-year-old woman with Parkinson's disease had been living with her daughter for 6 years. Moving around had been getting more and more difficult for her. She now needed maximum assistance to get into and out of the hospital bed in her home. The worst thing for her was that she needed to bother her daughter. If she were able to keep it in a low position to get into bed and then raise it by herself to exit the bed, she would not have needed another person's help. Again, this semielectric bed had a hand crank at the foot of the bed, and there was no way she could access it. Because of this, I checked the Medicare regulations to discover that an "all" electric hospital bed was not covered in any circumstances. Sadly for this patient and family, it was considered a convenience rather than a necessity in this instance (Centers for Medicare & Medicaid Services, 2013, p. 117). Clearly, in many cases this, is not so. The system needs to be changed. I would like to work on effecting this change.


Readers of Home Healthcare Nurse can help by supplying me with more information and direction. In exchange, I can keep you informed of the progress-or lack thereof.


More important, as the caregiving and patient population ages, we need to support them both in their efforts. We are all dedicated to keeping people in their own homes. We also need to support the agency aides who treat multiple patients each day. How to go about this?


Do I need to provide Medicare with statistics about the aging population and their caregivers' ages?


Should I do a survey of my organization's aides, asking them how often they use the hand crank at the end of the bed? How often they suffer from back pain? What ideas and insights they offer?


I look to your thoughts and advice. My email address is


Thank you in advance! I'll keep you posted. Together, perhaps we can make an important difference!


VNAA Launches Quality Improvement and Staff Training Resource

Visiting Nurse Associations of America (VNAA) announces the launch of the VNNA Blueprint for Excellence: Pathway to Best Practices, a free online resource for quality improvement and workforce training and development. It includes research- and practice-based tools and training, as well as measurement and evaluation resources to guide home healthcare practices. The VNAA Blueprint is a pathway to best practices for home healthcare providers, a touchstone for the expanded value, and role of home health and hospice in new delivery models.


This Web-based tool is easy to use, easy to access and available any time. The tool can be accessed at


To develop the VNAA Blueprint, a panel of subject-matter experts, academics, and other thought leaders-the Best Practices Work Group-convened and collected and assessed tools and resources used by high-performing nonprofit home healthcare agencies. The committee continues to meet regularly to review and update the VNAA Blueprint and will expand the modules and add topic areas as needed.


Ultimately, the Best Practices Work Group developed four modules: (a) care initiation, (b) clinical conditions, (c) patient engagement, and (d) patient safety-that cover 10 topics:


* Care initiation: frontloading, pneumonia vaccine, medical doctor appointment scheduling, critical interventions in the first/second visits;


* Clinical conditions: depression;


* Patient engagement: patient self-management and self-activation; and


* Patient safety: risk assessment, medication reconciliation, falls risk assessment, and exacerbation of condition.



The VNAA Blueprint is a step-wise, one-module-at-a-time approach that serves the needs of every provider. It is customizable and flexible enough to align with existing workforce development programs. This approach also allows for multiple modes of teaching.


The VNAA Blueprint supports workforce training and new skill development using consistent, validated, reliable processes, as well as providing valuable tools for organizations to standardize key practices and demonstrate their value to policymakers and payers. Using this resource will enhance quality and create consistency in the home care process for nonprofit home healthcare agencies, making them more competitive, competent, and able to partner with other providers in their communities, including hospitals, physician practices, and payer organizations.


Changes in healthcare delivery demand new solutions-solutions we can provide. It is time for the home healthcare industry to claim a seat at the healthcare quality improvement table. The VNAA Blueprint advances VNAA's organizational vision, mission, and goals, and provides a much-needed resource to strengthen care transitions and advance accountable care across the health care delivery system. The VNAA Blueprint is the premier educational and training resource for an industry hungry for valid, trustworthy curriculum materials.




Centers for Medicare & Medicaid Services. (2013). Medicare National Coverage Determination Manual Retrieved from[Context Link]