alberta aids to daily living€¦ · notices the client is having difficulty getting in and out of...

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Alberta Aids to Daily LivingPrimary Module B

Part 3OT/PT/RN

Patient Lifters and Slings

Homecare Beds and Accessories

Two APL’s – (L) and (BL)1250 Form(s)

Module B Part 3 – Outline____________________________________________________________________________________________________________________________________

• Overview:– Patient Lifters

– Homecare Beds and Accessories

• Formal Recycle versus Non-Recycle

• Authorizers

• Vendors

• Eligibility criteria

• Forms and Processes

• Examples

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Overview:

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• Overhead and Floor Patient Lifters

• Slings

• Overhead and Floor Patient Lifters

• Slings

Patient Lifters and Slings (L)

• Bed Frames and Accessories

• Overbed Table, Trapeze, Bedrails

• Mattress – standard or pressure redistribution

• Bed Frames and Accessories

• Overbed Table, Trapeze, Bedrails

• Mattress – standard or pressure redistribution

Homecare Beds and Accessories (BL)

Alberta Health - Pharmaceutical and Suppelementary BenefitsPrimary Module B, Part 3 - Patient Lifters and Slings, Homecare Beds and Accessories

© 2019 Government of AlbertaMarch 2019

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Formal Recycle versus Non-recyclable Benefits

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• Overhead and Floor Patient Lifters (AADL Recycled)

• Homecare Beds and accessories (AADL Recycled)

• Homecare Pressure reduction mattresses

• Overhead and Floor Patient Lifters (AADL Recycled)

• Homecare Beds and accessories (AADL Recycled)

• Homecare Pressure reduction mattresses

Formal Recycle Program

• Standard mattress underlay for use under pressure reduction overlays

•Slings

• Standard mattress underlay for use under pressure reduction overlays

•Slings

Non‐recycle

Formal Recycle versus Non-Recycle Process

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Formal Recycle

• Authorization form required

• AADL orders equipment

• Tracked and repaired by AADL

• Client returns equipment to AADL vendor for recycle to another AADL client

• Authorization form required

• AADL orders equipment

• Tracked and repaired by AADL

• Client returns equipment to AADL vendor for recycle to another AADL client

Non‐recycle

• Separate Authorization form required from recycle benefit

• AADL does not order the equipment –the authorization is sent to the vendor.

• Slings may be recycled in the community at your risk/discretion – may not always be appropriate.

• Not to be sold.

• Separate Authorization form required from recycle benefit

• AADL does not order the equipment –the authorization is sent to the vendor.

• Slings may be recycled in the community at your risk/discretion – may not always be appropriate.

• Not to be sold.

AuthorizersLifters and homecare beds/accessories

• Occupational Therapists, Physiotherapists andRegistered Nurses

• Competency expectations– Knowledge and skills in the use of pressure redistribution for the

management of chronic wounds.

– Need to know when to order the regular pressure reduction mattress that comes with the homecare bed or when a pressure reduction overlay is more appropriate.

– Ability to assess the client’s environment.

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Alberta Health - Pharmaceutical and Suppelementary Benefits Primary Module B, Part 3 - Patient Lifters and Slings, Homecare Beds and Accessories

© 2019 Government of Alberta March 2019

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AADL Program Vendors

Lifters

• Multiple recycle vendors for lifters – see (L) Vendor List

• Client chooses vendor, authorizer indicates vendor on authorization form.

Homecare Beds and Accessories

• Single vendor for homecare beds - awarded contract through tender process – current award to Eco Medical Equipment.

• Client deals directly with Eco Medical Equipment Vendor for returning bed, dealing with repairs, paying cost share.

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Eligibility Criteria for Homecare Beds (BL) and Patient Lifters (L)

• Must meet general AADL eligibility and benefit specific eligibility

• Intended for clients who want to remain in their home yet do not require the higher level of support provided at level SL3/4.

• Type of residence affects eligibility for (L)& (BL) benefits

• Funded in private homes, apartments, lodges and group homes.

• Higher Levels of Assisted Living/Long term care not covered.

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Eligibility Criteria - Lifters

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Homecare Beds & Accessories

Ceiling Track Lifters

• Must have Ceiling Track in place or funding in place

• On 1250 Authorization form indicate:

• Client has a quote for whole track package and funding is in placefor track and installation.

Portable Floor Lifters

• Folding feature requires justification

• Only one type of lifter funded per client



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Benefit Specific Eligibility (BL)

Homecare beds and Accessories

• Client must be palliative and/or remain in bed 80% of the day for the homecare bed and/or accessories.

• Criteria must be written on the authorization.

• Homecare beds are not provided to clients with power wheelchairs.

• Maximum of one of each type of accessory per client: overbed table, trapeze bar and floor stand for trapeze.

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Benefit Specific Eligibility (BL)

Homecare beds and Accessories

• Pressure relief mattress (L210) used withhomecare beds and are the default mattressprovided.

• Order a Standard Underlay (L206) if client has apressure ulcer and the plan is to obtain an overlaywhich has higher pressure relief properties.

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Authorization Process

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Need: (L) APL - Lifters



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Authorization Process (Steps)Lifters, Pressure Redistribution Overlays & Homecare Beds

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Assessment

QFR

Trial

Authorization

Form submitted

Clinical assessment of need and eligibility. Assessment date is when you have completed the assessment including eligibility confirmation and home assessment.• QFR?• Do you submit authorization form if QFR needed?

Trials are necessary for all equipment except the homecare beds. Need to discuss the room/space required to house the bed within the home. Provide handout for homecare beds.

Authorization forms are required. Check rationale requirements. Add QFR # if appropriate.

If you are authorizing an AADL recyclable benefit, AADL orders the item from the vendor you list on the form. You can still forward a copy of the form.

Authorization Completion

• Complete 1250 Authorization form. Use separate 1250for non-recycle benefits.– Always use separate form for homecare bed/accessories

– Must use separate form for each vendor.

– Do not combine recycle with non-recycle e.g., slings (not recycled) should be on a separate 1250 from the lifter (formally recycled)

• Include all additional rationale/information required aslisted on APL to avoid delays.– HD equipment, folding feature, overhead lifter

– See APLs e.g. Lifters and Slings

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Approved Product Lists

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Approved Product ListsPatient Lifter Slings

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Authorization – informing client

• Review 1250 Authorization formwith client

• Provide handouts, information sheets if appropriate

• Ensure client is aware of cost upgrades and vendor expectations

– Vendors require payment before providing equipment

– Client timely payment preventsdelays

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Alberta Aids to Daily Living

Homecare beds and accessories

AADL provides eligible Albertans with homecare beds, mattresses, rails, over-the-bed tables, and trapeze bars through Eco Medical Equipment.

Beds and accessories are provided as a package or individual items. A bed package includes a homecare bed (power), a pressure reduction mattress, and bed rails.

This equipment is not provided to persons in acute care facilities or continuing care centres.

Equipment may be new or recycled.

Eligibility requirements

The recipient must be an Alberta resident with a valid Alberta Health Care Insurance Plan card and:

requires equipment due to a long-term disability, chronic illness or terminal illness,

spends 80% of their time in bed and/or are end-stage palliative, and

has been assessed by an AADL Authorizer.

Steps to obtain a bed

1. The individual is assessed by an AADL Authorizer and eligibility for equipment is determined.

2. Correct equipment is identified.

3. Client signs declaration form.

4. Client pays cost-share portion, if appropriate.

5. Equipment is delivered.

Client responsibility

The client (their family, trustee/guardian) is responsible to ensure reasonable care and maintenance of AADL-supplied equipment. The client is responsible for replacing equipmentthat is lost, stolen or damaged due to misuse.

Ownership

The AADL program retains full ownership of the equipment. The equipment is not for resale and must be returned to the vendor, Eco Medical Equipment, in the following circumstances:

1. The equipment is no longer required, for whatever reason.

2. The equipment needs to be replaced by AADL.

3. The person using the equipment moves out of Alberta.

4. If, for any reason, the person becomes ineligible for the benefit.

Authorization Completion

• All additional rationale/information provided.

– HD equipment, folding feature, overhead lifter tracking in place

• No expiry date entered.– Authorizations automatically expire once the equipment is provided

and the vendor has made a claim.

• Submit to AADL.– AADL orders the equipment – may be from recycle pool or

purchased new.

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Equipment Provided – Now what

Patient Lifters

•AADL will fund repairs and ongoing maintenance

•AADL will fund repairs and ongoing maintenance

Client no longer requires equipment

•Contact AADL equipmentvendor to arrange to return equipment.

•May do an internaltransfer if equipment meets another eligible clients needs.

•Contact AADL equipmentvendor to arrange to return equipment.

•May do an internaltransfer if equipment meets another eligible clients needs.

Equipment is refurbished and recycled out to a new AADL client

•AADL continues to fund repairs and maintenance•AADL continues to fund repairs and maintenance

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What if it needs repairs? What if client no longer needs it?

Beds and accessories

•AADL will fund repairs and ongoing maintenance.

•AADL will fund repairs and ongoing maintenance.

Client no longer requires equipment

•Contact AADL vendor to arrange to return bed/accessory

•Internal transfers are rare

•Contact AADL vendor to arrange to return bed/accessory

•Internal transfers are rare

Bed is refurbished and recycled out to a new AADL client

•AADL continues tofund repairs and maintenance. May replace pressurerelief mattress when worn out.

•AADL continues tofund repairs and maintenance. May replace pressurerelief mattress when worn out.

Example 1

Need: Blank authorization forms (2)

(BL)APL for Homecare Beds and Accessories(L) APL – Pressure Redistribution OverlaysClient Residence/Diagnostic Codes Sheet

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Example 1 – Homecare bedsMr. J. has been diagnosed with Lung Cancer and is considered palliative because his cancer is considered inoperable, the doctor has given him an estimated 18 months to live.

He is being seen by home care as his biopsy wound became infected and he needs community wound care follow-up. The RN notices the client is having difficulty getting in and out of bed and he has difficulty breathing at night when he goes to bed. Mr. J’s mobility is impaired, requiring a wheelchair full time.

It may be beneficial to have the head of the bed elevated to increase his comfort and ease of breathing when he is in bed for several hours during the day and at night. Is your client eligible for a homecare bed. Why and why not?

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Example 1 – situation progressedMr. J. has now been transferred to the Palliative home care team. He is on comfort measures only and will likely not live past 6 more months. He lives at home and the plan is to keep him at home.

He is now in bed at least 80% of the time and has developed Stage 2 pressure sores that are not responding to the wound care plan in place. You plan to authorize a homecare bed, overbed table, trapeze and mattress to help him remain in his home with his wife as primary caregiver. They have financial concerns however are cost share exempt.

Consider the type of mattress you would authorize, and what rationale you would use. Two choices – standard underlay and pressure relief overlay or a pressure relief mattress.

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Equipment – Approved Product ListsHomecare Beds and Accessories

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Equipment - Approved Product ListsPressure Redistribution Overlays – Under Manual E



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Example 1Please complete the authorization form(s) (10 minutes)

Mr. J. is Palliative. He lives at home with his wife and the plan is to keep him at home. He is now in bed at least 80% of the time and has developed Stage 2 pressure sores that are not responding to the wound care plan in place.

You plan to authorize a homecare bed, overbed table, trapeze and mattress to help him remain in his home with his wife as primary caregiver. They have financial concerns however are considered cost share.

You have explained there is a cost and they have agreed to pay the vendor – Eco Medical Equipment for the cost share prior to receiving the bed.

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Example 1 - reviewWhat residence code did you use?

What diagnosis code?

Who is the Vendor?

Choices on the Approved Product List(s)- What cat # did you use?

• Standard mattress and pressure relief overlay or

• Pressure relief mattress

• One or two 1250 forms?

Rationale for Pressure relief choice?

• Stage 2 pressure ulcer

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Example 2

Need:Blank Authorization forms

(L) APLVendor Lists for Large Equipment

Residence/Diagnostic Codes sheet

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Example 2

Please complete a 1250 for this lifter using the APL for lifters

• Ms. P has Parkinson’s, weighs 325 lbs. and lives in a lodge in Banff, Alberta. She can no longer transfer herself. Her therapist came in and assessed her mobility and transfers on November 20,2017 and determined she needed a portable ceiling lifter. She has no other transfer equipment.

• The lodge agreed to allow ceiling track to be installed and Helping Hand Company in Banff was chosen as a preferred vendor. The vendor provided the ArjoHuntleigh Voyageur Lifter and slings for trial on November 25, 2017. It was a successful trial and the family agreed to fund the ceiling track and the client is cost share for the equipment. The client signed the authorization form that day.

• Is there an upgrade? (see APL on following slide)

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Example – Review

• What is the diagnosis code?

• What is the vendor code?

• What did you write in Section 3?

• What forms are required?– Two 1250 Authorization forms

• One for ceiling lifter – recycle equip.

• One for slings – non recycle.

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End of sessionQuestions

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Quiz

Please complete the quiz for B-3 and turn it over once you’ve completed it.

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alberta aids to daily living€¦ · notices the client is having difficulty getting in and out of...

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