On A Roll/Independence Care System (ICS) Clinical Specialist Rachel Spiers, OTR/L, ATP, knows that when a person with a disability has no mobility equipment available, it is not only disruptive, but affects both their mental and physical health. That’s what has driven Rachel, an occupational therapist, to provide crucial support for low-income New Yorkers with disabilities for nearly 14 years through ICS’ On a Roll program—a comprehensive wheelchair evaluation program and premier provider of specialized mobility assessments conducted by expert occupational and physical therapists.
Rachel spoke with me about On A Roll, helping members during the coronavirus pandemic, and advocating for preserving services for people with disabilities.
How does On A Roll work?
There’s a clinical side, which I’m on, and a repair side. The clinical side features occupational and physical therapists. I’m a RESNA credentialed Assistive Technology Professional (ATP), a credential earned based on my level of experience and the completion of an examination.
We do individualized assessments for wheelchairs but we have a holistic view—we also assess physical presentation, posture, skin integrity, activities of daily life, cognition, vision, pain and what the wheelchair needs to do to meet a person’s needs. If we are seeing someone new to using a mobility device, we can set up more appointments to try different equipment in order to figure out the best match. It’s always a partnership between On A Roll and the person who will be using the wheelchair or other equipment. They know their lived experience and their body, which is important to determining the best solutions for them.
On the repair side, if a chair is under warranty, less than a year or two old, the vendor who provided it manages the repairs, as funded by insurance. Backup chairs and older chairs are managed by On A Roll Repair Services.
How is the approval process?
The happiest and easiest outcome is when all equipment is approved. If not, we receive a request for more information and assist with an appeals process.
It can be challenging to communicate the person’s actual need, to a reviewer who may not be familiar with the functional challenges people with disabilities face, or the products being recommended to address the need. Some reviewers are required to make a determination based on an algorithm contained in a coverage policy.
Often times a payment coverage policy is based on the Medicare policies that considers the needs of adults aging in their home, and not the needs of people with disabilities aging in their home or people living in the community, who are working, going to school, or doing other things outside of their home.
How has On A Roll supported members during COVID-19?
We suspended new evaluations briefly, but repairs never stopped. Certainly service delivery changed. On A Roll used to have weekly workshops where people could stop in for tune-ups and repairs in our offices, but those were suspended.
Repair techs moved to a curbside model. People would bring chairs to us and they were assessed or repaired while social distancing. One vendor has a regional repair and clinic space in the Bronx, and could offer us a space for fittings and deliveries for wheelchairs during COVID-19. People came from all over in order to have access to functioning equipment. A properly fitting chair has an important impact on a person’s health—it’s someone’s independence, mobility and comfort.
When On A Roll reopened, how was it seeing members again?
We see people by appointment only. Some members have not been outside their homes since March. They value our services tremendously. This is the appointment they’re willing to come into the community for. I’ve been with ICS so long. There’s a great deal of trust with members and vendors. That’s the reason I come into work. My work matters. It makes a difference to people. I have built relationships with people over the years that are rewarding.
One of the themes I hear from people is that they feel invisible in the world of traditional medicine and insurance. While there is a long way yet to go, the gift of the Americans with Disabilities Act and the legacy of the disability rights movement has been the improvement of access, of architecture, curb cuts, for example, and more, for people with disabilities. They have become more visible. With On a Roll, people with disabilities are evaluated for the chair they need to live their life. We work with them from evaluation to delivery, and we assist them with denials or appeals.
We’re linked with the Civics League for Disability Rights and routinely encourage people to write letters and talk to the Department of Health and say, ‘These changes you brought in are impacting my life. Why must my needs be sacrificed?’ We know people struggle. They have real concerns. ‘Is my home attendant going to show up? Did I get enough supplies? Is there enough food this week? Was my medication delivered?’ We encourage members to be registered voters, and to make sure politicians know their names and faces and what the issues are. There needs to be collective action. A wheelchair is a tool in the arsenal for supporting a full, active human life in the family and in the community.