The Changing Structure of Re/hab Technology
In the beginning there was Postura, Posture 90, Mulholland and Gunnell. There were pockets of people around the country building their own seating systems and wheelchairs. There were loosely knit networks exploring issues common to people delivering seating and wheeled mobility services. If you remember P8NU26A770 - you are probably from this generation.
There were highly skilled and motivated people doing the good works of rehabilitation pretty much out there on their own. RESNA, then known as the Rehabilitation Engineering Society of North America, tried to provide shelter and support for these people, but service delivery was not RESNA's strong suit in the early 1980s.
Pioneering the Practice
A number of paths converged as we entered the last decade of the 20th century. Manufacturers developed a wider range of seemingly out-of-the-box rehabilitation products to meet more complex consumer needs and desires. The bottom dropped out of funding for home medical equipment (HME), products and services in general.
DME providers began to see rehabilitation as a way to make up their losses in other areas. More products were available, more people wanted to do rehabilitation, and most had no idea of what was involved.
A group of manufacturers and providers used this schism between those wanting to do rehabilitation and those capable and qualified to do rehabilitation as a catalyst to launch a search for a home for people specialized in rehabilitation products and services. This group interviewed RESNA, the Health Industries Distributors Association (HIDA) and others to find the best match. After much deliberation, the group selected the National Association of Medical Equipment Services (NAMES).
The objectives of the NAMES Re/hab Section were to:
- provide a forum where persons having a common interest in rehabilitation equipment and assistive technologies may meet, confer, advance and promote the practice of providing products and related services to people with disabilities;
- establish a well-defined identity and focal point for the rehabilitation equipment and assistive technology industry;
- secure legislative/regulatory advocacy for the rehabilitation industry to ensure that adequate and prompt funding is available; and
- support and promote development of a credentialing process for individuals providing rehabilitation equipment and related services.
Creating Identity
The first step toward creating an identity for rehabilitation was to develop a name for the people involved in providing the equipment and services. Rehabilitation technology supplier (RTS) was chosen.
An RTS provides enabling technology in the areas of wheeled mobility, seating and alternative positioning, ambulation assistance, environmental controls and activities of daily living. A standard of practice for rehabilitation companies was also developed and a plan for creating a credentialing organization for RTSs was instituted.
The new credentialing organization was called the National Registry of Rehabilitation Technology Suppliers (NRRTS). Its mission as described by its founders was to provide a mechanism so medical professionals, consumers and third-party payers are able to identify suppliers who are qualified to provide high-quality rehabilitation technology and related services to people with disabilities.
NRRTS' corporate charter states: ". . . (NRRTS) is a non-profit corporation organized for the purpose of promoting the welfare of people with physical disabilities through the establishment of high standards for professionalism, service, training, education, trade practices and facilities for individuals and organizations engaged in the provision of rehabilitation technology equipment and services."
It became evident to the newly formed NRRTS board of directors that there were many paths that individuals had taken to become an RTS. The experience and skill base of these RTSs was similar, but their educational background and knowledge base was more diverse.
Membership in NRRTS was based on years of employment in the field, recommendations from referral sources, a commitment to continuing education and adherence to a code of ethics. The next logical step in the process was a certification examination to assure a standard benchmark for the knowledge base among people providing rehabilitation products and services.
RESNA, today called the Rehabilitation Engineering and Assistive Technology Society of North America, had developed a quality assurance program that included a skills and knowledge base for people providing assistive technology (AT), products and services. Rehabilitation technology is a subset of AT. There was a strong synergy between NRRTS' and RESNA's goals.
NRRTS, through the generous support of manufacturers and providers, offered RESNA with funds to develop a certification exam for assistive technology suppliers(ATS). A NRRTS member whose passes the RESNA ATS exam is awarded then title of CRTS, which stands for certified rehabilitation technology supplier. Through this process the credentialing loop is closed - experience, skill base and knowledge base are personified in the CRTS credential.
Evolving the Practice
In 1998, through the efforts of the NAMES Rehab Council, a more comprehensive definition of rehab was developed. Throughout the definition, the words Re/habilitation and Re/hab were written to denote both the rehabilitation (changing state) and habilitation (maintaining status) resulting from the use of technology services.
The technology, equipment and services defined are designed to help people move from one physical state to another as independently as possible. They may also be applied to help the individual maintain a particular level of function or physical well being.
The Rehab Council's definition was the first to include quality of life issues as part of the rehabilitation technology process. "Quality of life" was defined as the ability to perform activities in a manner, or within the range, considered normal for a human being. Quality of life is improved by anything that maximizes the individual's ability to control any or all aspects of their life and perform any task independently.
This is the definition of Re/hab adopted by the NAMES Re/hab Section: "Re/habilitation technology services are defined as the application of enabling technology systems designed to meet the needs of a specific person experiencing any permanent or long-term loss or abnormality of physical or anatomical structure or function.
"These services, prescribed by a physician, primarily address wheeled mobility, seating and alternative positioning, ambulation support and equipment, environmental controls and other equipment and services that assist the person in performing their activities of daily living. Re/habilitation technology services facilitate and/or enhance access and independence thereby improving the person's quality of life.
"Re/habilitation technology services are supplied by a rehabilitation technology supplier (RTS) working for a re/habilitation technology company (RTC) The process of providing Re/habilitation Technology services includes, at a minimum, the RTS working closely with other allied health professionals to: complete a comprehensive evaluation of the consumer's needs and requirements; specify and select appropriate technology and products; assemble, fit, adjust and deliver the selected technology to the consumer; and provide all necessary short and long-term follow-up, training re-evaluation, re-adjustments and service."
Moving to the Future
Together these three organizations, NAMES Re/hab Section, NRRTS and RESNA, formed a solid base for the re/hab industry and profession. It was the stable three-legged stool upon which re/hab was conformably positioned.
Recently the make-up of this base of support has changed. NAMES has merged with two other organizations to form the American Association for Homecare (AAH). The NAMES Re/hab Section has been changed to the AAH Rehab Advisory Council. It remains to be seen what impact these changes will have on the long-term stability of the Re/hab industry and profession.
During the past few years, e-commerce sites have emerged selling re/hab technology equipment directly to end-users - often without even the most rudimentary evaluation of the consumer's needs. Though catalogue sales of these type of products has been around for years, the proliferation of questionable "1-800" marketing schemes directed toward seniors and other consumers has become a major problem.
How are these e-commerce and "1-800" marketers getting the re/hab technology products that they sell? What standards of practice and code of ethics governs these companies' behavior?
It is clear that the need to differentiate quality re/hab technology products and service delivery from these kinds of practices and from HME and home care in general is critical. The founders of the NAMES Rehab Section wrote that the goals of the new organization included establishing a well defined identity and focal point for the rehabilitation equipment and assistive technology industry.
It is also clear that the survival of re/hab and the highly specialized services provided to people with disabilities depends on re-educating all the players in the regulatory and legislative arena about the unique characteristics and requirements of the RTS and the RTC.
Providing quality re/hab technology products and services cannot survive without all the stakeholders recognizing the added value that the RTS and the RTC bring to the process. Clearly, having Re/hab tied to commodity sales of other DME, disposals and the like do not promote this understanding.
The re/hab industry and profession is currently balanced very precariously on a two-legged stool. It remains to be seen how, and by whom, the third leg of the supporting structure will be built and maintained. It must be built, however, with the recognition that hundreds of RTCs, thousands of RTSs and hundreds of thousands of consumers will be directly affected by the outcome.
Additional information about the organizations mentioned can be obtained at www.aahomecare.org , www.nrrts.org , www.resna.org .
This article originally appeared in the June 2000 issue of HME Business.