CHARITIES: Addressing basic needs - Minor aids and mobility solutions
by Nikki Thompson, Founder & Executive Director
In this article, the second of our educational series for charities, we will explore some of the common minor aids and mobility solutions an occupational therapist may recommend for your beneficiaries.
The most common mobility aid we are requested to assess for is a mobility scooter, so we have focused the mobility solution section predominantly on these. For minor aids, we have introduced some of the more innovative solutions on the market addressing some of the most common and basic challenges that beneficiaries may experience in their daily lives.
Mobility solutions
When a beneficiary contacts a charity to request a grant for mobility equipment, sometimes they are clear on the solution they are looking for and sometimes it is the charity who may suggest an OT assessment to help identify the most appropriate solution to the challenges they are experiencing. A mobility aid of any description can significantly enhance a beneficiary's quality of life. It can allow them to move around their own homes with greater ease and confidence, to visit friends and family more freely, and to re-engage with their community (shops, day centres, clubs) previously inaccessible to them.
It is the role of the occupational therapist to identify what is the most appropriate solution (there are many options such as scooters, walkers, electric or self / attendant propelled wheelchairs) and what specification is required to meet the beneficiary's needs.
The assessment is where the occupational therapist will gather the information they need to make a clinically reasoned, evidenced, and justified recommendation for a mobility solution, if appropriate. In the case of scooter provision they will first need to assure themselves that this is the right solution for the beneficiary considering the criteria for whether a person should be driving a powered chair or scooter (they have trouble walking because of an injury, physical disability, or medical condition).
Once assured a scooter is appropriate, the OT will consider various factors in their assessment. I have outlined a few of these below.
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Usage considerations. The OT will be ascertaining the purpose of the scooter provision. This is central to determining the most appropriate type and category of scooter. For example, if a beneficiary wishes to use the scooter to get their shopping (and the shops are 5 miles away making it 10-mile round trip) this will lead the OT to consider a scooter with long battery life and storage. If they wish to use the scooter to take their dog for a walk this will lead the OT to consider the terrain suitability of the scooter they recommend.
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Transport considerations. The occupational therapist will establish if the beneficiary is needing to transport the scooter to an alternative location for use. Many beneficiaries specifically wish for their scooter to go in the boot of a car for use in locations other than home. This means that the OT needs to look at scooters that can fold or be stored in a car boot. The OT will need to consider who is going to be transporting the scooter (the beneficiary, their husband/wife or grown-up children for example) and their level of physical and functional capacities to breakdown and rebuild a scooter, as well as the size of the vehicle it needs to fit in. As an alternative the OT may consider specifying a lifting hoist to allow the scooter to be transported without the need for dis-assembly.
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Battery considerations. As touched on above, this is very important as the OT may recommend a certain type of scooter based on the distance the beneficiary needs to travel or they may recommend an additional battery pack so the beneficiary can change the battery during the journey therefore increasing the distance they are able to travel on one trip. The distance a mobility scooter can travel depends on several factors including terrain, inclines, weight of the beneficiary and size of the battery. Standard battery life for a class 2 scooter can be between 8-16 miles whereas a class 3 can give a range of between 12-24 miles. Typically Lithium batteries are becoming an increasingly popular recommendation for class 2 take-apart scooters due to them being so lightweight (they are half the weight of the legacy lead acid batteries). The lightweight Lithium packs allow a beneficiary or their carer with reduced strength to remove the battery and charge it away from the scooter if needed.
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Beneficiary’s weight considerations. This will have a significant impact on the type of scooter recommended or even if one is recommended at all. All scooters will have weight limits to ensure the beneficiary and other users safety, but also optimum battery performance and life. It is recommended that the beneficiary's weight is between 10-20kg below the maximum user wright recommended for the model to allow for any weight changes and also carrying objects such as shopping.
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Storage, access & charging considerations. Scooter batteries will need to be charged inbetween uses and the scooter will need to be stored safely, securely and away from direct exposure to the elements. For the most part (but not always), the scooter will be stored and charged in the same location and identifying if this is possible and the best location is a surprisingly challenging element of the assessment. Where possible, the OT will try to avoid the scooter being stored inside the beneficiary's property in case it restricts access or exit in the event of an emergency. Sometimes there is a shed or garage where there is power, or it can be installed. There are also great scooter storage solutions that can be purchased separately and installed. Consideration will need to be given to the journey from the beneficiary's door to the storage location so as not to introduce risk of falls, for example by requiring them to mobilise over a broken-up path or in an exposed space with no rails. The OT will also take into consideration any local restrictions on the storage or charging of scooters such as in communal areas.
I'm now going to discuss some of the more technical information about scooters that the occupational therapist will need to be mindful of when making their recommendations.
Mobility scooters and powered chairs come in 2 categories, class 2 and class 3.
Class 2
- They can only be driven on the pavement (they can go on the road for short periods only if there is no pavement) and are limited to a maximum speed of 4 mph.
- A beneficiary does not need to register a class 2 scooter.
- Class 2 scooters are designed to be used on paths and indoors and to drive on moderate slopes.
Class 3
- They can be driven on the road or pavements and have a maximum 4mph limit for pavements and 8mph for roads.
- A beneficiary must be 14 or over to drive a class 3 scooter
- Vehicles are registered with DVLA to an owner as you would with a car or motor bike using the V5C form.
- You do not have to pay vehicle tax for a class 3 scooter or wheelchair.
- Class 3 scooters are designed to be used on roads and generally outdoors only. They can ride on steeper slopes and rougher terrain.
Driving on the road
There are restrictions for which scooters and wheelchairs can be driven on the road. The Government rules are that only a class 3 mobility scooter or powered chair can drive on the road and the maximum speed is 8 miles per hour. Also, there are specific features that a class 3 vehicle must have in order to drive on the road including an audible horn, front and rear lights and reflectors, rear view mirror and a maximum speed of 8mph. Surprisingly they can even drive on a dual carriage way if they have an amber flashing light!
Rules and regulations
A beneficiary does not need a licence to drive a mobility scooter or powered wheelchair, but the vehicle may have to be registered and there are restrictions on where they can be driven based on their classification, as explained in the section above.
There is no legal requirement for insurance to drive a mobility scooter or powered chair, but the government website and many providers do recommend considering insurance for class 3 vehicles. This is the slightly faster category and the one that can drive on the roads. The benefits of insurance include:
- Accidental damage cover.
- Theft and vandalism cover.
- Cover for any legal costs.
- Third-party liability protection.
Scooter insurance is relatively inexpensive and there are many brokers who provide it.
There are no eyesight requirements to drive a mobility scooter or powered chair, but again the government website does recommend a beneficiary can read a car registration number from a distance of 12.3 meters (40 feet). It is expected that the beneficiary regularly checks this and it is their responsibility to cease driving the vehicle if their eyesight doesn't reach the threshold.
Changes are coming in 2024
Whilst charities generally validate scooter provision with an occupational therapist to ensure the provision is clinically appropriate, currently there is little validation or regulation around individual's privately selling or purchasing them. In 2022 there was a tragic case of an elderly lady who sadly died after being hit by a scooter in a supermarket car park. The Coroner called for the Transport Secretary Mark Harper to bring in assessments for all scooters similar to those we have for cars and through a ‘Prevention of Future Deaths Report’ highlighted the risk posed by the lack of overall regulation around scooter provision.
From 2024 it is looking like there will be a voluntary scheme (it was originally thought to be compulsory but has since been changed to voluntary) led by Driving Mobility called Powered Wheelchair and Mobility Scooter Retailer Training Scheme (PWMS) and supported by the Department of Transport. The scheme aims to elevate standards and skills of providers to ensure that scooters are only sold once they are satisfied users are safe and appropriate to drive them. As a clinical practice we wholeheartedly support such as scheme and will be looking for ways to support Drive Mobility and the DfT to ensure this approach is embodied in practice.
Minor aids
When a beneficiary and their occupational therapist have identified day to day activities that they are struggling with, the first approach of the OT will be to look at alternative strategies or techniques of doing the activity that will make it easier. A good example of this is where a beneficiary may have arthritis or weakness in one side (possibly due to a stroke) and they are struggling to lift heavy pans full of hot water in the kitchen, the OT may advise them to put their rice/vegetables/pasta into a sieve and place the sieve into the boiling water so when it is cooked then only have to lift the sieve our rather than transport the whole (and heavy) pan.
Where changes to technique are not possible or have not worked, the OT can also look at recommending small aids or items of equipment that might help. There are of course the standard items, such as a raised toilet seat/bed or chair raisers to help a beneficiary get on and off items of furniture, however there are some more innovative simple solutions on the market that an occupational therapist may recommend, some of which I highlight below.
Challenge: For those in wheelchairs, it can be hard to make hot drinks independently as they are often not able to have an aerial view of the cup to see when it is full. This can pose an increased risk of burns and scalds and can lead to elderly beneficiaries limiting their liquid intake and not being able to enjoy a cup of tea or coffee.
Possible basic aid solution: There is a great device called a Liquid Level Indicator that sits over the side of a cup and vibrates or makes a noise when the liquid reaches a certain point. The beneficiary then knows to stop pouring. The item can also be used for those with reduced vision. They are generally under £20 and are a relatively cheap but effective way to solve a significant issue for many of our ageing population giving them the confidence and independence back in making their own hot drinks.
Challenge: A family are worried about their parent (a beneficiary) who lives alone eating enough throughout the day. They do not live locally, and the parent is socially isolated. On a recent visit the family have noticed the beneficiary is loosing weight despite their reassurances that they are eating well.
Possible basic aid solution: There are some excellent movement sensors available to track movement in all sorts of areas including in and out of bed (for concerns over wandering at night) or temperature alerts (for if the house becomes too cold). One of their uses can be to help create a picture of if a loved one is eating regularly. The sensor simply sits on the fridge door and tracks how often it is opened and closed. A popular solution in the phase we can find beneficiaries in, who are perhaps experiencing the onset or deterioration of a cognitive decline and where there is a strong desire to remain at home.
Challenge: One of the most common challenges we all face as we get older is reaching down to get things from the floor or lower body (shoes, socks etc). This will affect us all regardless of any other diagnosis or medical conditions and when we add these into the mix it can mean that basic tasks such as picking up something we have dropped or putting socks on can become impossible.
Possible basic aid solution: There are a few simple solutions in this category:
- our favourite is the Helping Hand – a long handled grabber (like the ones you see litter pickers using). These are a great addition to any home particularly for the elderly where reaching things can become difficult.
- Next, we would have the long-handled shoehorn, another basic solution that makes getting shoes on so much easier.
- Finally, a sock aid, again a long reaching device to help with this important activity.
Each of these cost under £10 and provide a much-needed boost to a beneficiaries independence and confidence with daily living activities.
Hopefully this article has offers a deeper understanding of how occupational therapists can work with charities to support their beneficiaries. We have explored in detail the considerations an OT will need to make when being asked to assess for a scooter and also highlighted just a few of the vast array of small items of equipment that are on the market to help maximise independence with daily living tasks.
We are proud to support charities both large and small and would be delighted to discuss in more detail if you provide grants for health and well-being to your beneficiaries. Call Aaron on 0330 024 9910 or email enquiries@theotpractice.com.
