A Personal Emergency Response Alternative?

After the sudden death of her husband on New Year’s Eve, a friend was really in a daze. She has a lifelong hearing loss and now has arthritis that can flare up in times of stress. She also had a stroke a few years ago and has fallen at home before.

Her family and friends thought some type of personal emergency response (PERS) device was needed. She and her husband had tried a service in the past and hated it.  They had the service calling at all hours for false alarms, would forget to put the device on and did not think it was worth the money.

apple watch in rose gold with fabric bandHowever, as someone with training in art and design, she loves Apple products and has an iPhone. We decided to try the Apple Watch from Verizon which will connect to service even if her phone is not nearby. Apple phones and the watch now have an SOS feature.

Apple Watch face with the SOS featureThe SOS feature on the watch works in few different ways, depending on how you’ve set it up.  Here’s information on how to make an SOS call:

  1. Press and hold the side button on your watch until the Emergency SOS slider appears.
  2. Continue to hold down the side button. Wait for a countdown to begin and an alert to sound.
  3. You can also choose to turn off auto call and instead drag the Emergency SOS slider to start the call.
  4. When the countdown ends, your watch automatically calls emergency services.

You can also add emergency contacts using the Health app on your iPhone. When you have emergency contacts identified, after an emergency call ends, the SOS feature alerts your emergency contacts with a text message, unless you choose to cancel. Your iPhone/Apple Watch sends them your current location, and, for a period of time after you enter SOS mode, it sends updates to your emergency contacts when your location changes.

hand holding apple watch with icons of all apps on the face

She loves the watch and finds new feature on it every day! I’ve reminded her how to use the SOS feature a few times, but we haven’t actually called 911 yet. The other day, she was talking to a neighbor and she’d forgotten to charge her phone. The phone turned off due to low power in the middle of the call. The neighbor was worried and called back. She was able to answer the call using her watch and explain what happened. Otherwise she would have had the First-Responders at the door.

She’s also learned to ask Siri on the watch to call people. This could be a helpful first step if she needs some help but it’s not a life threatening situation. We’ve begun practicing with these feature by calling friends who are close by and willing to help.

Upside:

  • The best AT is the one the person will use.
  • The watch is fun and attractive.
  • If she doesn’t hear the phone ring, which happens at times due to the hearing loss, the Apple Watch vibrates on her wrist for notification and she can see who is calling. This is also an advantage as she may decide to just call back if the phone is not close by.
  • The Apple Watch has multiple uses while a typical “panic button” or Personal Emergency Response is limited in function.
  • No monthly fee though for the cellular version, Verizon has a monthly $10 line charge.

Downside

  • Battery life. The watch needs to be charged just about every day.
  • Many falls happen in the bathroom and, according to Apple:  “Showering with Apple Watch Series 2 and Apple Watch Series 3 is ok, but we recommend not exposing Apple Watch to soaps, shampoos, conditioners, lotions, and perfumes as they can negatively affect water seals and acoustic membranes.”
  • It’s difficult or impossible to practice using the SOS feature. If you can contact your local 911 you might be able to go all the way through the steps to practice, otherwise risk accidentally having first-responders show up at your door!
  • Cost may not be covered by some services/insurance while the traditional PERS could be covered.

For my friend, the Apple Watch has been a source of joy in a dark time. It remains to be seen how useful it will be as PERS.  Have you used a smart watch as Assistive Technology? Please share your experiences!

Here’s some more information on using the Apple Watch and SOS feature:

Pregnancy AT to the Rescue!

By Aimee Sterk, LMSW, MATP Staff

I’m just about to hit 32 weeks pregnant. With my age (42), and gestational diabetes making for a big baby to carry around, I’m starting to get very tired very fast. I’m also much more awkward and find myself having to grab things to catch my balance. Luckily, I went through this a mere year ago with our first baby we got to hold, so I’m resurrecting this blog from that pregnancy.

From 2016:

my new tub set up with my shower bench installed and my handy handheld showerheadI told my husband the thought of showering exhausted me. And, smart man that he is, (and married to someone that works in AT), he immediately suggested a shower chair. It was a relief to even hear him offer. He measured our tub and took off for the nearest Meijer and came home with just what I asked for—one as wide as possible, without a back, with drainage holes and height-adjustable. Paired with our pre-existing handheld showerhead, I had the most relaxing and comfortable shower I have had in months! Yay for AT!

When I posted about the shower chair on a Facebook group I’m part of for pregnant women, so proud of my husband’s brilliant idea, several other women said they already had purchased shower chairs as well and loved them too. One even had a stylish teak one. Her budget is larger than mine the teak ones I found on Amazon were in the $100-$130 range while my plastic bench was $35 at Meijer and $25 on Amazon.

lotion applicator--small oval sponge on a stickAlso newer to me, is difficulty putting on my socks and administering medication for my toe. Again, AT to the rescue. A sock aid and long handled lotion applicator, and I am back in business. My favorite sock aid has fingers that are easy to squish together to load the sock and terry cloth on the outside to better grip the sock. It is called the Carex sock aid or sometimes the sock aide flexible deluxe and is about $9 on Amazon. sock aidThe lotion applicator I chose has replaceable sponge heads and is about $15 for two applicators and 6 replacement sponges.

Final on my wish list are shoes that can handle edema (without laces). This summer I found sandals to be the perfect option. When my feet were swollen, I just adjusted the Velcro straps larger for more comfort. Then when the swelling went down, I could make them smaller again. Now that winter is here, I’m not finding good options for expansion and contraction so I’m just borrowing my mom’s shoes that are bigger.

 

What AT do you find useful when fatigue is affecting you? Or edema? Or pregnancy?

Winter Weather Protection for Your AT

by Laura Hall, MATP Staff

Old man winter blowing out snow

Well, the weather outside is frightful today, with the Lansing area expecting up to 10″ of snow.  For users of assistive technology, winter weather is certainly not always delightful.  During these months we are often more reliant on our AT, which makes it even more important that they are well maintained and protected from the elements.

As a powerchair user, winter can feel isolating because it is so hard to drive in the snow.  As great as my new chair, the Flash is, it doesn’t stand a chance against the white stuff.    While snow and ice will always be difficult for wheelchair users, ensuring that your chair is in the best shape possible can help.  Replacing bald tires can make all the difference.  In her blog “Maintaining Your AT – Wheelchair Edition”  Lucia Rios gives some great tips for maintenance, like working with a bike shop to replace parts.Mobility Light on WalkerSpiked walker or cane tipShoes with traction cleats

Using a walker, cane, or crutches can be especially treacherous during the winter months, and while care must always be taken to reduce falls, there are a few AT items that could make things easier.  For example, a mobility light, that attaches to the tubing of a walker, crutches or a cane, can help increase visibility and awareness of obstacles.  Spiked tips for walkers and crutches may also help with stability.   Shoe traction cleats may also provide more grip while walking in the snow.   The American Foundation for the Blind has other tips for white cane users in their article Traveling with Your Cane in Winter Weather.

man's head, wearing a headband with warmers over earsDid you know that winter weather can cause damage to hearing aids?  Cold temperatures can drain batteries faster.  Damage can occur when moving from the cold weather outside to the warmer temperatures inside as condensation builds up.   Audiologists recommend opening the battery compartment when not in use to allow for airflow. Wearing earmuffs, a hat, or a headband (some have inserts for hand warmers) may also protect the device, and some people use a hearing aid dryer or dehumidifier.

To discover other ways to protect you and your AT this winter, check out our webinar “Your Assistive Technology in Winter“.

As much we may complain about the winter and snow, there is no denying it’s beauty and the fun that can be had during the season.  I hope these tips help you to get out and enjoy what the season holds.

 

 

Winter scene from the Keewenaw Peninsula
Winter in the Keewenaw.  Credit: K. Wyeth

 

 

 

 

 

 

How Paid Leave Can Be a More Flexible Accommodation

Return To Work Cycle, with 3 sections, Accommodations (Accesibility Standards, Duty to Accommodate, Assistive Technology),Support For Recovery (Sick leave-injury-on-duty leave, Disability benefits-workers compensation, early intervention, case management and remain-return to work plan), Prevention (Employee Assistance Program and Wellness Programs, Special Working Arrangement, Occupational Health and Safety legislation and standards, Emergency and business continuity plans)
Returning To Work

Until recently, the general approach to paid leave as an accommodation was to allow or require it unless it reached the ADA threshold of an “undue burden”. For example, Federal ADA guidance suggests the following two-factor approach to this threshold:

“Undue burden means significant difficulty or expense. In determining whether an action would result in an undue burden, factors to be considered include —

(1) The nature and cost of the action needed under this part;

(2) The overall financial resources of the site or sites involved in the action; the number of persons employed at the site; the effect on expenses and resources; legitimate safety requirements that are necessary for safe operation, including crime prevention measures; or the impact otherwise of the action upon the operation of the site;”

In a case in the 7th Circuit, Severson v. Heartland Woodcraft, Inc., No. 15-3754 (7th Cir. Sept. 20, 2017 for Illinois, Indiana, and Wisconsin), the court’s decision set a much more specific standard, by saying that several months or an indeterminate length of paid leave would meet the “undue” threshold. Of course, this decision could be appealed, or other Federal Circuits could define this threshold differently. But, it is typical in civil rights law for relatively flexible standards to become more and more specific over time. This very ordinary evolution of law can be seen clearly in special education law and rules decisions, for example.

I think our community has to assume that over time, paid leave as an accommodation will become less and less flexible. We need to embrace approaches that introduce more flexibility in the use of paid leave, and which support more control by us in the use of it.

One way that has been around for a long time is to look at rehabilitation during paid leave less mechanically than, “You are on rehab leave until you are fully rehabilitated.” Individuals who have experienced a work-related injury receive their rehabilitation services at their work site, and even in the actual workstation,  they used before the accident. PT and OT, for example, are provided focused on outcomes that are tied directly to what the person did prior to their injury.

Embracing the concept that accommodation should not be just passive support, but could be organized around a more flexible concept of “return-to-work”, Assistive Technology could be a resource for an at-work sequence of rebuilding the old job around the new reality of the disability. This kind of support could be implemented without making any assumptions about indeterminate accommodations or what might constitute the ultimate configuration of AT for a person as they reimagine how they might do their old job well. The person could work into a supported version of their job gradually, by learning to adapt and as the need for accommodation evolved during personal recovery. Customization, always a core of effective AT, could be expanded to include the expectation that the configuration of individual accommodations would change during recovery.

Resources:

Accommodation and Compliance Series: Return-to-Work Programs

Return to Work or Stay at Work and Accommodations: Part 1

Return to Work: A Snapshot: Part 2

IMPACT OF ACCOMMODATIONS AND DISABILITY ON WORK (various articles)

Dating, Intimacy, Sex, Disability and AT

By Aimee Sterk, LMSW, MATP Team

This week has been a really weird conglomeration of anniversaries and news that are all muddling together in my head. Eleven years ago this week, I went on my first date with my husband. Two years ago this week, we put a deposit down for IVF that led to us having our son after battling infertility and loss for 9 years. In the news this week and this past year, are daily reports of the MSU doctor who sexually assaulted and abused hundreds of female athletes. His trial is ending and victims are making their statements. I was abused by my pediatrician as a child, the ultimate end result being PTSD that was triggered when we had our losses and I had more invasive treatments for the losses and infertility. A series of NPR stories has covered the epidemic of sexual abuse among people with disabilities, especially women with developmental disabilities. My son turned one and my daughter is due in March. I think about protecting them and teaching them about their bodies, safety, and love. Sexual abuse, domestic violence, dating, intimacy, sexual health, they are all on my mind—and I’m being bombarded with information and stories and reminders.

red and pink interlocking hearts

Like many people with disabilities, I started dating much later in life. Understanding and accepting my bi identity along with facing my thoughts about my body and my worth was necessary before I could consider dating. I waited until I was in my 30s. For many reasons, this turned out to be a good thing. While I spent many years feeling like I was unlovable, in the end I grew emotionally and built a life I loved and truly felt like finding a person to love would just be adding to something that was already pretty awesome. Ultimately, finding and marrying my husband and having children with him was the best thing that has ever happened to me. These experiences have been the very best in my life. I’ve also endured the very worst experiences of my life together with him. Dating, love, marriage—these are things that many people want to experience. With disabilities, there are extra complications and oppression.

Kristy Liddiard, in her work to face and rid ourselves of shame experienced by women with disabilities around the areas of sex and intimacy encourages us, “ …This can only happen by sharing our stories, lives and experiences. Stories can – if voiced and heard – be productive, useful, and valuable. Stories can define a place and people. They offer a sense of collective experience; a means to claim space, foster a positive identities and experiences, and demand social and sexual justice. Collectively, telling and sharing our stories is how we can build sexual cultures and communities as we want them; ones which fit all of our bodies, pleasures and desires; ones which empower rather than oppress. So, what’s your sexual story?”

Samantha Evans agrees, “From the issue of privacy in shared living or with carers, to conditions, medications and treatments making sex difficult, the discussion of sex and disability shouldn’t be shied away from.”

So, let’s take a look at just the tip of this iceberg of taboo around dating, sex, and disability. To start with, dating, there’s a great article about some myths of online dating with a disability in Psychology Today. Dating apps and websites provide a great option for people with disabilities to get into dating. I had my share of frustrations with online dating when I met my husband—I told him I was shutting down my profile and giving up and gave him my email address. That said, it did actually work out and this was very early in the online dating scene. When accessible, these platforms provide a way of meeting lots of people you wouldn’t run into in everyday life to cast a wider net. While there are sites to just connect with other people with disabilities, OKCupid, Tinder, and other mainstream sites are also open to people with disabilities. Choosing to disclose your disability is a big decision. I am quite open about my disabilities so like Emily Landau, I discussed my disabilities and other target identities early and often when online dating. Emily’s piece in the New York Times talks about authenticity and rejection and her decision to disclose when online dating. This is something to consider before creating a profile, or like her, it may be something that evolves.

Getting to know each other and intimacy are a big chunk of the dating framework and how long those last before moving into sexual intimacy is entirely personal. I’m not really coming up with wisdom, advice, or AT for building intimacy right now, so I’ll jump right into sex.

People with disabilities are often left out of sex ed classes. This is a huge disservice to us. Surprise! Many people with disabilities do have sex. We need to know how our bodies work and talk about healthy relationships. We also need information on safe sex, pregnancy prevention, and consent. More and more, this information is being shared, but for many of us that are long out of school, we need to seek out other resources. Here are a few:

All the articles I can find on AT for sexual intimacy focus on physical disabilities, and many commentaries are mostly assuming people are interested in heterosexual intimacy and sex. If you know of resources for AT and sexual intimacy for LGBTQIA people with disabilities, or mental health, sensory, or cognitive disabilities, please share them!

I can’t end this article without some resources on domestic violence and sexual assault. People with disabilities are far more often targets and victims of domestic violence and sexual assault. Key points here for me: it is never your fault and there is help available. We all must work together to end abuse of people with disabilities.

While my journey to find intimacy, love, and sex has had many detours and obstacles, ultimately loving and finding myself, seeing and appreciating my disabilities, and understanding and honoring myself as a sexual human being all have led me to my “fairytale” (for now at least) ending. Online dating was a key piece of AT that I used to address anxiety, meet a variety of people, and explore relationship building in a relatively safe environment. In addition, resources AT for sexual intimacy are also available. As  Valentines’ Day approaches, perhaps you are thinking about finding love and/or sexual partners. Hopefully these resources are helpful.

Maintaining Your AT – Wheelchair Edition

By Lucia Rios, Guest Blogger

Someone resting feet up on an empty wheelchairOne of the most important pieces of assistive technology in my life is the manual wheelchair. It’s the accessory I never leave home without. Wheels enable my independence. Wheeling gives me confidence. Not only has my wheelchair been customized to fit me, but each ding, scratch and tear tells a deeper story of its use.

I use my wheelchair 365 days a year. I use my wheelchair from the moment I wake up until the time comes for sleep. That’s a lot of time!

Yet my wheelchair is not just an object to get me from one place to another, it’s part of my world and loved.  Just like a car, a manual wheelchair can only take so much. I think a wheelchair undergoes more abuse than a car because the demands of its use are constant. And yet it’s like owning a car – you’ve got to keep it running.

I must admit that I’m totally clueless when it comes to maintaining a car, which is why I use a mechanic. You can ask for referrals from friends and there seem to be many options on places to take your car. However, I realized that durable medical equipment providers – such as Airway Oxygen and CareLink – are not always the easiest to connect with or affordable when on a budget.

Let’s be honest, it’s an expense to own a car and the same goes for maintaining a wheelchair. As I started to utilize my wheelchair more often I noticed the upkeep took time, money and problem solving.  I’m not one to keep my information to myself, so here are solutions I learned along the way.

Bike Shops

road bike hanging in repair shopTo be honest I didn’t think of this solution by myself.  While interacting with a new friend – who also uses a wheelchair – I told my woes about wheelchair maintenance. Having to make an appointment at the medical equipment provider, high costs, etc.  He asked if I thought about using a bike shop.  I hadn’t.  

So I started visiting bike shops.  I asked for help airing my tires, and inquired about buying tires for my chair.  The first pair I bought were under $30 and there was no service fee to put them on!  I was hooked.  I ditched the medical equipment venues and went to my local bike store for all my wheelchair maintenance needs.  

Tires, lights to use at night, tightening of spokes and unexpected flats – the bike store was my go to.  Better yet, I didn’t have to schedule an appointment!  With each request I was treated with dignity, charged a reasonable fee, and air was always free!           

Online Stores

When I was being fitted for a new wheelchair – which is exciting because at that point my wheelchair is on its last spin – I hear what insurance considers “extras”.  

  • Tires with better traction for snow – an extra $100 to upgrade.
  • Vibrant colors – insurance won’t cover your preferred choice so you’ll have an out-of-pocket expense.
  • A bag to hold personal items – sorry you’ll have to pay $50 for a standard black tote.
  • And the list goes on.  

Frustrated and looking for a cheaper solution I went online.  I was excited to see their were options for a wheelchair user that were not only affordable, but trendy.

Social Media

I’m a huge fan of social media, especially when it comes to spreading awareness about the disability experience.  Being able to use pictures to explain barriers that I face in my day-to-day life has been a great way to educate, but also challenge others to think of their environments.  Facebook has also been a go to when I’ve run into problems with flat tires, inaccessible venues and a quick way to ask for assistance!  

Once my tires went flat while I was at the store.  I typed a quick message on Facebook, asking if anyone knew of an open bike store – it was business service hours.  Within minutes I had offers to assist, website addresses to bike shops, and a person willing to pick me up!  I took up a friends offer and met him at the local brewery so he could patch up my tire.  He fixed it, bought me a beer and gave me my own small tire repair kit!  

So, I’m curious, what maintenance tips do you have for your AT?

Advocacy Help for AT

By Aimee Sterk, LMSW, MATP Staff

A manual wheelchair reclined back showing the various angles of the tilt in space featureMy friend contacted me last week asking about the process for working with a nursing home to get his father, a resident in the home, a new wheelchair. It seems the nursing home suggested a very specialized wheelchair to meet his father’s needs, but when the home was told they had to provide the wheelchair out of their regular per diem rate, they were now suggesting a far cheaper, inferior option. That made me think it was time for another blog about advocating for AT needs.

There are a couple options to help you advocate for your needs for assistive technology (AT) or durable medical equipment (DME) in Michigan.

If you have a MI Health Link Plan (a combination of Medicare and Medicaid) the MI Health Link Ombudsman Program is here to help you access the DME you need if you have been denied coverage or are having trouble getting what you need. Call them directly—lawyers answer all the calls and are ready to help—at 888-746-6456. It is also possible to contact the Nursing Home Ombudsman program if the nursing facility is not providing needed AT at 866-485-9393 or 517-827-8040 for the State Long Term Care Ombudsman.

If you need help getting AT or DME through your school system, community mental health, the MiChoice Waiver, Medicare, Medicaid (or Medicaid funded nursing facility), or Michigan Rehabilitation Services (if employment related), contact Michigan Protection and Advocacy Services’ AT team at 800-288-5923. Michigan Protection and Advocacy Services receives direct federal funding to help people with disabilities of all ages access the AT they need.

The following is from Justice In Aging:

“Consumers with both Medicare and Medicaid face recurring problems getting approval for Durable Medical Equipment (DME), getting repairs, and finding reliable suppliers. DME includes many vital items, such as wheelchairs, walkers, hospital beds, home oxygen equipment, and even diabetes test strips used with a glucose monitor. ”

Some of the obstacles in getting access to DME include:

  • Conflicting DME approval processes for Medicare and Medicaid
  • DME access problems for people who have Medicaid first and then become eligible for Medicare
  • Getting coverage for repairs, particularly getting Medicare coverage for an item originally obtained through Medicaid
  • Differences between Medicare and Medicaid approved suppliers (many providers are approved for one program, but not the other)”

It is so important that people access the equipment they need to live in the setting of their choosing. Please, use the advocacy services to get the AT/DME you or someone you care about needs.

Have you contacted Michigan Protection and Advocacy Services for help with getting AT? Have you used an ombudsman program? What was your experience? What other advocacy tools have you used?