6 Things to Consider When Choosing the Best Power Wheelchair for the Elderly

Considering getting a power wheelchair for yourself or your elderly loved one? You’ve probably browsed the Internet and found yourself overwhelmed with too many choices and options available.

Were here to help! This comprehensive guide will run you through essential questions to ask and things to consider, such as design, activity needs, and even insurance coverage before you purchase a power wheelchair.

How Do I Know if I Need a Power Wheelchair?

A powered wheelchair, also called a motorized or electric-assisted wheelchair, is a form of a power mobility device to help individuals keep their independence in mobility.

Here are some questions to ask to know if a powered wheelchair is suitable for the user:

  • Is the older adult unable to propel a manual wheelchair using his or her hands or feet?
  • Is propelling a wheelchair or walking not advisable for the elderly adult?
  • Does the senior have musculoskeletal complications like arthritis or are prone to having injuries to body parts due to stress after repetitive movement (such as carpal tunnel syndrome)?
  • Does the elderly have low endurance and the functional ability to propel a manual wheelchair independently?
  • Does the elderly adult show a progressive functional loss, making powered mobility an excellent energy-saving option and the right choice in the long run?
  • Will a power wheelchair improve the older person’s independence and participation at home, work, or the community?
  • Does the senior have enough cognitive and perceptual ability to operate the device safely?
  • Does the elderly or the caregiver show responsibility for the care and maintenance of the equipment?
  • Is the senior’s home accessible for the use of a power wheelchair?

If you answered yes to most, if not all, of these questions for yourself or a senior, then it is likely that getting a powered wheelchair is recommended for you or your loved one. But it is still crucial to ask your general practitioner or an expert such as an occupational therapist (OT) or physical therapist (PT) before purchasing.

These professionals evaluate the user’s medical needs, goals, routines, and the environment. These are then matched with the most appropriate wheelchair type, control mechanism, features, and accessories. A good fit is determined to enable the user’s optimal participation in day-to-day activities.

Infographic for Things to Consider When Choosing the Best Mobility Scooter for the Elderly

6 Important Considerations When Choosing a Power Wheelchair

Powered wheelchairs come in several designs and allow for varying degrees of programming and customization.

1 Design

Older, traditional power wheelchairs look like standard wheelchairs that look bulkier due to the motor, control systems, and batteries. Newer designs have a power-base where the wheels are separate from the seating components. These platform-model power wheelchairs look like seats atop a power base.

These types are sturdy, making them a good option for full-time wheelchair users, both for indoor and outdoor use. These designs also offer ease in customization to accommodate the changing needs of the user. There are three types of power-base designs:

Rear-wheel drive

These have four wheels, with two drive wheels at the back and two caster wheels in front. This type offers better traction since all the power comes from the back. This allows the wheelchair to propel better over rough surfaces while providing great stability and easy maneuverability.

They also have good shock absorption, which provides users a smooth driving experience. On the other hand, having smaller wheels in front make it hard for this type to go over obstacles and curbs. At the same time, rear-wheel drives require a much larger turning radius than the two types.

Front-wheel drive

Like the rear-wheel drive, these types have four wheels. However, the two drive wheels are situated at the front while two smaller caster wheels are at the back. This arrangement gives these types an advantage in climbing heights compared to rear-wheel drives. These wheelchairs can climb up easily in curbs and bumps that are up to 2 inches high.

Also, having the drive wheels situated in front makes this type useful for different kinds of terrain. However, one downside of this arrangement is that it makes it a little tricky to learn to drive at the start. Front-wheel drives also have a larger turning radius than mid-wheel drives. Despite that, having the drive wheels in front makes it easy for this wheelchair to navigate tight spaces.

 Mid Wheel Drive

These are also known as “center drives.” Mid-wheel drives have six wheels, with two drive wheels at the middle and two pairs of caster wheels on either end. This design places the user’s center of gravity is directly over the drive wheels making it the most stable and the most comfortable type to maneuver. It also requires the least turning radius of the three types, making it suitable for small houses and apartments.

The downside to having 6 wheels is that the user feels more bumps due to more wheels in contact with the surface. Also, it works best on flat surfaces and doesn’t maneuver well over soft and rough terrains. It isn’t easily transportable, and a vehicle lift or an accessible van may be needed to transport the device from one location to another.

 2 Terrain

Indoor

These are usually easy to fold and fits in the trunk of a car. They are used in the home or places with smooth flooring.

Outdoor

Since these types are for outdoor use, they have larger wheels and a suspension system for a comfortable drive. They may also be used indoors but may be too bulky to fit hallways and doorways.

Indoor/Outdoor

Some types can be utilized for both indoor and outdoor use.

 3 Activity Needs

Travel and Transport

These types are portable and compact, making them good options for those who are on the go. Their size also allows easy maneuverability allowing easy navigation in small spaces.

Folding

Folding types are rear-wheel drive power chairs that have sling seats. This allows for easy storage and transport.

Standing

This type allows the user to stand while being fully supported. It offers pressure relief and benefits physiological processes such as circulation, breathing, and digestion. It also allows face-to-face interactions, providing the user with a natural experience during social interactions.

Lightweight

Some power wheelchairs are lightweight. These types are usually made of light materials like aluminum. They are portable, easy to lift and maneuver. Some lightweight wheelchairs are designed to be disassembled for automobile transport.

Heavy-duty

These types are designed to carry larger and heavier individuals. They could carry up to 650 pounds.

Recline and Tilt

These types are for those who need assistance in repositioning themselves, need pressure management, or get fatigued with prolonged sitting. Wheelchairs with this feature are most suited for those who spend much of their time in a wheelchair.

  • Reclining types allow seat-to-back angle changes to more than 90 degrees. A reclining wheelchair’s backrest can be adjusted backward and can extend close to a fully flat surface. This allows users to adjust their position without having to leave their wheelchairs.
  • Tilting types have fixed seat-to-back angles but the seating system can be tilted up to 45 degrees. This allows the chair to change its orientation in space, but not the position. This feature enables a reduction in pressure in the buttocks and prevents friction and shear.
  • Recline and tilt. Some wheelchairs have a combination of both functions.

4 Drive control

Power wheelchairs are usually driven using one of these two options:

Proportional

A joystick is most commonly used for this type of control. Here, the direction and speed of the wheelchair are linked to the magnitude and angle of the displacement of the joystick. Proximity sensing devices that detect head movement can also be utilized where head movement serves as a joystick. Here, the user’s head displacement determines the speed and direction of the wheelchair.

Discrete control

For this type of control, microswitches are utilized, where each switch activation triggers a preset or programmed direction and speed. While these micro-switch systems require less skilled movement compared to proportional control, they are also less precise.

It might also take a while to learn to navigate using this control compared to the more intuitive proportional control. This control utilizes body parts such as the hand, arm, chin, mouth, lips, tongue, and even breath (sip-and-puff) to activate a microswitch to move the power wheelchair.

5 Batteries

Power wheelchairs utilize 24 volts deep cycle batteries, which discharge power over long periods. There are three types of batteries:

Lead-acid

These types are cheap but require special handling, especially for airline transportations.

Gel

Compared to lead-acid, this battery does not have liquid and is more expensive than lead-acid types. They are, however, more preferred for air transportations and have longer life cycles.

Absorbent glass mat (AGM)

This type is the most expensive of the three since they last longer and are also safe for airline travel.

Choosing the Best Power Wheelchair for the Elderly

6 Classification for Insurance (Medicare)

 Power wheelchairs are also classified into groups or levels depending on the features they offer, such as stability, speed, terrain capabilities, seat functions, etc. Medicare and other private insurances utilize these classifications for wheelchair coverage. Medicare covers up to Group 3 categories; however, some private insurances cover up to Group 4.  

 Tip: If you are planning to get a high-end wheelchair and want to have it covered by insurance, it is necessary to:

  • look for a DME vendor who is enrolled in Medicare, and can provide a higher level wheelchair
  • secure documentation from a “licensed mobility practitioner” such as a physician with an appropriate specialization, a physical therapist, or an occupational therapist
  • ensure that the DME has a certified Assistive Technology Practitioner (ATP) onboard

While it is the expert’s role to do an assessment of your loved one’s condition, being mindful of their condition will help you plan and make proper decisions regarding the purchase, whether or not you are eligible for coverage. Included in this section are the features that each group offers and the essential things to consider with regard to your loved one’s condition:

Group/Level 1

  • The most basic model of wheelchair
  • Offers a small turning radius, making it suitable for use in the home
  • has the lowest battery life of all the groups, making it suitable for use in short to moderate distances
  • Does not offer powered seat functions like tilt and recline and alternative drive control system
  • Offers basic seating; no add-ons for extra stability
  • portable and can be assembled and disassembled

Things to consider:

  • Not for clients who require aid in postural stability or pressure relief
  • Only a standard joystick control is available. Thus, the user must have the capacity to maneuver the device

 Group/Level 2

  • Has a strong battery life and can drive longer distances at increased speeds (~4mph)
  • has stronger power bases than devices in group 1 and are more durable
  • Usually available in front or mid-wheel drive options, which offer better navigation, maneuverability, and stability.
  • Can manage uneven terrain and some obstacles
  • No alternative control system features; however, joysticks can have limited programming capabilities
  • Usually offers captain style seating designs
  • Seating design does not offer positioning (tilt and recline) and skin protection features

Things to consider:

  • This equipment is not considered complex rehab technology (CRT) and does not require evaluation/justification from a physical or occupational therapist. A written order or justification from a physician and purchasing from a durable medical equipment (DME) supplier and both enrolled with Medicare would suffice.
  • Not suitable for clients who require more significant support, pressure relief and have no capacity controlling a standard joystick

Group/Level 3

  • its batteries last all day and offer higher speeds (~6mph), allowing trips with longer distances, such as navigating in the community
  • has a good suspension system, allowing for smoother drives both in indoor and outdoor use. Smooth rides also cause less fatigue and cause fewer vibrations, which may trigger spasticity
  • Offers a better climbing capability than groups 1 and 2
  • Offers power seating functions such as powered tilt and recline, elevating leg rests, and adjustable seat height
  • Allows use of alternative control system
  • Available in front-, mid-, and rear- drive options

Things to consider:

  • Based on Medicare guidelines, to qualify for group 3 power wheelchairs, clients must have a: neurological diagnosis, myopathy, or a congenital skull deformity. Common diagnoses include: Stroke with hemiplegia, Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), Multiple Sclerosis (MS), progressed Parkinson’s Disease (PD), Amyotrophic Lateral Sclerosis (ALS), Cerebral Palsy (CP), Osteogenesis Imperfecta, and Muscular Dystrophies
  • Despite having strict Medicare guideline, practitioners (GP, PT, and OT) can still try to provide proper justification and documentation if it meets the users’ needs or if it is medically necessary. This may result in approval by Medicare or other private insurance companies
  • Requires an assessment from a PT/OT and a certified ATP in addition to documentation or written order from a GP

Group/Level 4

  • Improved suspension systems that offer safer rides across all terrains
  • Most suited for users with active lifestyles
  • All power functions are available, such as power tilt, recline, seat height elevation (up to 14”), leg rest elevation
  • In addition to the features of group 3 devices, a standing feature is available
  • Offers functional benefits such as improved participation in daily tasks such as toileting, self-care, meal preparation, etc.
  • Offers medical benefits in physiological function such as bladder control, breathing, range of motion, spasticity, pain, and pressure management.
  • Offers psychological benefits of meeting people face-to-face

Things to Consider:

  • Medicare does not cover these types. However, clients may choose to pay the difference not covered by the insurance out of their own pockets if they feel that the device best meets their needs.

Conclusion

There are many things to consider when it comes to purchasing powered wheelchair devices. While it may be overwhelming, adequate preparation and planning will save you from unneeded expense or the hassle of having a wrong purchase.

Not only does getting the most appropriate device support greater independence, but it also gives peace of mind – where you are sure of your own or your loved one’s comfort, ease, and safety.

 

About Rachel Ann

Rachel Ann Tee-Melegrito is a licensed Occupational Therapist in the Philippines and in the United States. She has a Masters in Education with a major in Child Development and Education. She currently teaches at one of the top 4 universities in the Philippines. An INFJ-T, Rachel is introverted yet idealistic, a perfectionist yet also a sensitive, empathetic person. She is a creative individual who loves learning, reading, designing, and writing. She lives in the Philippines with Kenn, her husband, Cali, their daughter, and Pepper, their Mini Schnauzer.