Shopping for used durable medical equipment or assistive technology is very much like buying a used car or television set. Whether buying from a friend or relative, at a dealership or through a classified ad, a buyer must be both careful and realistic. Mark Obatake, executive director of the Hawaii Centers for Independent Living in Honolulu, says, "Buying durable medical equipment or assistive technology is no different from buying used equipment for your house."
Why buy used?
The major reason people shop for used items is, of course, cost.
Having a neuromuscular disease can require many specialized everyday items: hospital beds, bath chairs, grab bars, portable ramps, clothing, braces, lifts, crutches, walkers, utensils and much more. The costs of all these "little things" add up quickly, especially if your needs are changing rapidly; you're also paying for modifications to your home; or you're hiring personal assistants. Anyone concerned with cost might be glad to find a source of everyday items at half price or less.
At the higher end of the budget are adapted vehicles and computers, which can mean all the difference in mobility and communication for someone with a neuromuscular disease. Health insurance doesn't usually cover these items, and they can cost tens of thousands of dollars each. For some, the choice of a computer or van comes down to a used one or none at all.
Sherry Baum, a speech-language pathologist, works with ALS patients at the University of Colorado Hospital in Denver. In the search for computers to assist with communication, she points out that "a used piece may not be state-of-the-art, but even so it might serve a purpose."
For the necessities, such as wheelchairs or scooters, even having good insurance doesn't guarantee satisfaction. An insurance policy may not allow you to buy exactly the device that will give you the most mobility and comfort. Some policies don't cover durable equipment, and some only allow one wheelchair a decade or even one in a lifetime.
Power wheelchair owners often keep a manual chair as well for use during travel or emergencies or when the power chair is being repaired or serviced. Insurance policies often won't cover a second chair, so you have to buy it out of your own pocket.
"Usually someone with insurance will have one shot at something," says John Tapper of Houston, who has Charcot-Marie-Tooth disease.
Tapper "had a fiasco" with the new power chair his insurance company bought him. The chair didn't work for him, but insurance wouldn't replace it. He investigated his choices until he knew just what kind of chair he needed. In his local MDA newsletter, he saw an ad for the kind of chair he wanted, secondhand.
"You usually don't find these items for sale," he says. "So I went to Dallas where the chair was and I got it at a fair price." Tapper paid less than a quarter of the chair's original cost.
Where to look
Most shoppers start close to home, noting when friends, relatives, church members or support group members have items they no longer need. Local MDA offices keep clients informed about available used products through newsletters, notices at clinics or word of mouth. Your MDA health care service coordinator may also know of vendors who have good-quality secondhand equipment.
You might also see "for sale" ads on the bulletin boards, Web sites and newsletters of rehabilitation hospitals, independent living centers, your state Rehabilitation Department or other local disability organizations. Ads sometimes appear in the classified pages of the daily newspapers or local "shoppers,"or even on supermarket bulletin boards. Pawn shops and secondhand stores sometimes have walkers, wheelchairs, hospital beds and the like.
Most consumers shop for used equipment close to home but, depending on the item you want, you may decide to look beyond your hometown. Searching the Internet under "durable medical equipment" or "wheelchairs" reveals a growing number of Web sites that list and picture secondhand canes, cushions, wheelchairs, vehicles, walkers and many other devices for people with mobility impairments.
One of the largest of these sites, Med-Sell, allows private buyers or sellers to list products at no charge. Beginning in Northern California in 1996, Med-Sell has expanded its service nationwide, and divides its listings into 12 U.S. regions. (Editor's note: Upon review in 2010, we discovered Med-Sell ceased operations. As an alternative, try a site such as MEDMarketplace.com.)
Med-Sell publisher James Beeson says, "People will travel a couple thousand miles to buy vans, depending on price."
Another cross-country source for used durable equipment is Disabled Dealer, a magazine with regional editions in over 20 states. The listings are heavy on vans and homes, but some ads offer secondhand wheelchairs, scooters and other items. There's a charge for advertising.
Smart shopping: plan ahead
"Sound consumer practices will always stand you well," Obatake advises those shopping for used equipment. "You get what you invest in time and money."
The first sound consumer practice is to start window shopping before you actually need a product, so you won't have to make a hasty decision when you're in desperate need.
Obatake, who has spinal muscular atrophy and is a former MDA health care service coordinator, recommends, "Do your homework. Get the specs, look at catalogs, talk to vendors."
It's wise to do your homework on power chairs while you're still using a manual; to see the many available kinds of modified vans when you're still able to use a car; or to become familiar with adapted computer equipment such as modified keyboards and speech synthesizers before you need them. Shopping around before you're ready to buy helps you decide whether new or used is more feasible, and helps cut the delays that may come with insurance coverage.
Baum notes, "Few people plan ahead in ALS; they wait till the last minute. But you should think about communication devices as soon as your speech starts to change."
Your homework can begin with talking to others who use the type of equipment you anticipate needing. You can also go to open houses at tech centers, assistive equipment fairs and conferences, and dealer showrooms.
Tapper suggests that potential wheelchair buyers "visit different vendors and make no commitments to anybody but just visit and look. Ask for literature and read, and then talk with disabled people and your support group about the different brands and so forth."
Obatake advises buyers to look at new versions of the device they may want to buy used. "If you know what it was originally supposed to do and look like, the quicker you'll be to see the difference between the two. Is the difference something you can live with?"
Some things to think about early on: how you'll transport the device; which brands and models have convenient and reliable local service providers; and whether you can buy a used version and modify it for your needs.
Get good advice
Many insurance programs, including Medicare, will cover both new and used wheelchairs or scooters. A key to smooth claim processing is getting a detailed prescription.
Your MDA clinic physician will write a prescription for a wheelchair when it's needed. To come up with the best prescription for you, consult with a physical or occupational therapist on such details as seating, back support and fit.
You can ask the therapist about particular models you've found during your market research to be sure they'll work for you. If a therapist seems to be unfamiliar with the models you like, you may want to see more than one OT or PT.
Tapper, who has worked in a rehabilitation hospital, warns, "I wouldn't rely on one vendor's opinion or one OT's opinion. OTs are wonderful people and a real gift to us all, but they do not necessarily have knowledge of the variety of equipment that's out there."
To select communications devices, Baum suggests, "For buying any new or used piece of equipment, get advice from a speech pathologist who has expertise in your needs. There are so many things out there. What one person says may not be the right advice."
Even if you find a piece of equipment in good condition at the right price, it'll be useless unless it suits your needs and abilities. For instance, some communications technology requires good use of hands and some doesn't. Anticipate how your abilities may change and whether you'll be able to use a secondhand item long enough to make the purchase worthwhile.
Insurance generally covers an initial evaluation by a speech, physical or occupational therapist. With the therapist's more detailed advice, you can ask your doctor to include specifications in your prescription.
Tapper warns that, if you buy a used wheelchair, you may have to pay for it, then get reimbursed by insurance. To avoid problems, you should have a dated prescription written before you make your purchase.
When he found the used power chair he wanted, Tapper first obtained a bank loan to cover it. Then, "I got my prescription before I went up to Dallas and bought the chair. So with the dated prescription, down the road I was able to deal with the insurance company."
Check it out
When you've found an item that seems to fit all your requirements, Obatake advises, "Know who you're buying from. Ask questions to determine how reputable the seller is."
If the seller is a commercial vendor, ask other customers if they're satisfied with their purchases. If it's a private party, see if anyone at MDA or the independent living center knows the individual or family and can tell you whether the equipment has been abused.
"We know consumers who take good care of their equipment and we know the other end," Obatake says.
Anyone selling a used car should allow a potential buyer to take it to a qualified mechanic of his choice for an objective evaluation. Expect the same option when you're shopping for a used van, wheelchair or computer.
Many home medical equipment vendors will check out a wheelchair or scooter for free; others charge up to $60. Ask your network of sources to recommend experts to evaluate a van or computer. Some independent living centers have technical assistants who can do this.
You may even want someone to check out a smaller device such as a hospital bed, especially if it has any electronic components. These can be expensive to repair or replace.
Obatake says a knowledgeable person can analyze a mobility device by examining its "three general operational systems."
The first is structural: Is it straight, is it strong, can it withstand use? Then, mechanical: Can it turn, move or bend? Are the gears working? Is it smooth, rough or jerky? Third, electrical: Is the wiring secure, not exposed or frayed? Check the connections.
To have a van checked out, Ron Smith of Disabled Dealer recommends finding a member of the National Mobility Equipment Dealers Association, who can assess the vehicle's disability features as well as its automotive mechanics. If you're looking at a van that's located out of town, you can have an NMEDA dealer in the seller's state go through it and provide you with written certification of its condition. Shipping a van cross-country runs up to $700, Smith says.
MDA loan closets
One of MDA's most popular programs is its durable medical equipment loan closets, maintained in most local MDA offices.
The program loaned out more than 3,400 wheelchairs, braces, walkers, beds, lifts, air mattresses, communication aids, bath devices and ramps in the 1997-98 fiscal year. There's no charge for loans of equipment to people registered with MDA.
The equipment in MDA loan closets comes from donations made by clients' families or good friends of MDA, donations from hospitals or hospices, and low-cost purchase. MDA uses the loaned equipment at summer camp, to help clients when their own equipment is on the fritz or to help families avoid costly purchases.
The items available vary from office to office. Some loan closets may even have items you can try out while you're considering what devices to buy. Check with the health care service coordinator at your local MDA office.
The bottom line
Even secondhand equipment is out of reach if you don't have the cash on hand. To find financial support for your purchases, the first place to check is private health insurance.
For those who are working, in school or in job training, state vocational rehabilitation programs cover the costs of disability equipment that may relate to employment. State programs vary in their interpretations of what qualifies, with a few states willing to pay for mobility devices, computers, vans and other needs. Public schools are required to provide equipment needed to give a child full inclusion in school programs.
For its enrollees, Medicare pays for wheelchairs and other devices considered medically necessary, either new or used. Check with your Social Security office to find out how to submit a request for reimbursement of part or all of the purchase price for a used item. A few vendors may even assist their customers in obtaining Medicare approval.
Kevin Qualset of Scooter Depot says, "We handle Medicare paperwork, send the form to the doctors and get reimbursement. Most companies won't do that."
A good source of financial help with equipment purchase is the Technical Assistance Project, supported by the federal Technology-Related Assistance for Individuals with Disabilities Act (Tech Act) passed in 1988 and funded through the National Institute on Disability and Rehabilitation Research.
Tech Act programs in every state are helping make assistive technology available to increasing numbers of people with disabilities. Your local MDA office or independent living center can give you the location and phone number of the nearest Tech Act center. Tech Act centers offer assistance in obtaining funding for technology devices; many now have equipment lending, exchange or recycling programs. Exchange programs match those who need equipment — anything from wheelchairs and walkers to augmentative communication devices — with people who have them to sell or donate. Recycling programs store and refurbish donated equipment, then donate or sell it at an affordable price.
The services of Tech Act centers vary from state to state. Sherry Baum says Colorado's Assistive Technology Project can provide consultation on equipment, guide consumers to speech pathologists or suggest sources of equipment. Some programs offer loans for purchasing assistive technology, and others help people with disabilities buy vans.
New pieces of durable equipment and assistive technology should come with manufacturers' warranties. Some vendors will also guarantee used products.
Scooter Depot in Largo, Fla., for example, sells both new and used scooters. "All used equipment goes out with a six-month warranty," says Kevin Qualset, general manager.
If you're buying a used item from a vendor, you may be able to negotiate for some sort of written warranty. But things purchased through private parties will have no warranty. Once you buy it, it's yours, problems and all.
Many states now have "lemon laws" on durable medical equipment and assistive technology, requiring manufacturers or dealers to guarantee products for at least a year. However, most of these laws cover only new equipment. To find out whether you have any legal consumer protections when you buy used devices, call your state's commission on disability.