Choosing Equipment to Get Up and Down Stairs

Medical Card Holders

Equipment for people with disabilities, sometimes referred to as aids and appliances, is usually supplied free of charge to medical card holders. The card holder must first be assessed by the relevant therapist who can recommend and prescribe the most suitable equipment.

Long Term Illness Card Holders

People who have one of the conditions listed as qualifying under the Department of Health’s Long Term Illness Scheme may be eligible to receive items of equipment, essential for the primary condition, free of charge. Assessment by the relevant professional is required.

Hospital Treatment

People in hospital may have aids and appliances provided free of charge when they are prescribed as part of in-hospital treatment in a public hospital.

Health Insurance Schemes

There are three main companies offering private health insurance in Ireland. These are:

• Voluntary Health Insurance (VHI)
• BUPA
• VIVAS Health

All three companies provide members with cover for a limited number of aids and appliances under their out-patient schemes. A list of approved appliances is available on request. A claim for the reimbursement (part or full) will be subject to a member’s out-patient excess. Medical certification is usually necessary. Contact your health insurance company’s Customer Services to check if a particular appliance is covered by your policy.

Some employers have their own special health insurance schemes which provide cover for their employees. The employee’s family is also often covered. Check with the employer to see what, if any, equipment is covered under the scheme.

Housing Adaptation Grant for People with a Disability

From 1st November 2007, the Housing Adaptation Grant for People with a Disability may be applied for to assist in the carrying out of works that are reasonably necessary for the purposes of making a house more suitable for the accommodation of a person with a disability (who is a member of the household). This scheme replaces what was previously known as the Disabled Person's Housing Grant.

The types of works allowable under the new scheme can be varied and include the provision of access ramps, stairlifts, downstairs toilet facilities, accessible showers, adaptations to facilitate wheelchair access and extensions. In general, people who require grant aid for minor works eg ramps, grab rails, accessible showers and stairlifts, and who satisfy the means test provisions, should apply for assistance under the new Mobility Aids Grant Scheme, also administered by your local authority.

All applications for grant aid under the Housing Adaptation Grant Scheme are assessed on the basis of household means. In November 2007, the maximum grant available under this scheme is €30,000.

How to apply
The Housing Adaptation Grant Scheme for People with a Disability is administered by your local authority. All applications must include two written itemised quotations from contractors indicating the cost of the adapation. The local authority will decide whether it is necessary to refer the application to an Occupational Therapist. This decision is based on the report of the authority's Inspector, the applicant's General Practitioner, and the long term needs of the applicant. For full details of the Housing Adaptation Grant Scheme for People with a Disability, contact the Housing Department of your local authority.

Mobility Aids Housing Grant Scheme

From 1st November 2007, the new Mobility Aids Housing Grant Scheme is available. The scheme is designed to fast track grant aid to cover basic adaptations to address mobility problems primarily associated with ageing. The work allowed under the scheme can be varied and can include grab rails, access ramps, level access showers, and stairlifts. All applications for grant aid under the Mobility Aids Housing Grant Scheme are assessed on the basis of household means. The maximum grant is €6,000. This may cover 100% of the cost of the works and is available to those with gross annual household incomes of up to €30,000.

In cases where grant aid is required for larger work and where the cost of the work is expected to be in excess of €6,000, applicants should apply for grant aid under the Housing Adaptation Grant for People with a Disability (see above).

How to apply
The Mobility Aids Housing Grant Scheme is administered by your local authority. All applications must include one itemised quotation from a contractor indicating the cost of the adaptation. The local authority will decide whether it is necessary to refer the application to an Occupational Therapist. This decision is based on the report of the authority's Inspector, the applicant's General Practitioner, and the long term needs of the applicant. For full details of the Mobility Aids Housing Grant Scheme, contact the Housing Department of your local authority.

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.

The purchaser has the option of:

• personally funding the cost of the equipment
• applying to charities/benevolent funds etc for funding
• buying second-hand
• checking with your health insurance company, if a member, to see if, or what, reimbursement is available.

If you decide to buy equipment privately it is strongly recommended to seek the advice of an occupational therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

Private Purchase – Applying for a VAT Refund

VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Form VAT 61a is available from Revenue or can be downloaded from their website (see Useful Addresses).

Assessment

Depending on the type of equipment required, a qualified therapist will assess the individual and make a recommendation to the body responsible for the provision of the equipment or to the person or agency who has requested the assessment. Generally the following applies, but the assessment process and provision may vary in different parts of the country.

• Occupational therapists will assess for aids to daily living – these include wheelchairs, mobility aids, specialised chairs, bath, shower and toilet aids, stairlifts, hoists etc
• Physiotherapists will assess for movement, strength and balance training equipment, walking aids and exercise devices
• Speech and language therapists will assess for communication, speech therapy, and training aids
• Other relevant therapists and specialists may also be involved in carrying out assessments, depending on the equipment or appliance required

All the different therapists described above are based in hospitals, community care areas, and with various voluntary agencies. For more information, contact the Community Care section of your Health Services Executive area, the relevant hospital department as appropriate, or your local authority.

Private Occupational Therapists

Occupational therapists in private practice can carry out assessments in the home or workplace, and if modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful Addresses).

Private Physiotherapists

Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful Addresses), or through the Golden Pages.

If you decide to buy equipment privately it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

You can also arrange to visit a supplier’s showroom (if they have one). Contact details of suppliers can be found under ‘Disabled Persons Products & Services’ in the Golden Pages and some may have a website with details of their products and services which you can view online. Another source of information on suppliers of assistive technology, aids and appliances is the Access Directory. This directory is produced commercially each year and copies are widely available (see Useful Publications).

Sometimes suppliers organise exhibitions of different types of equipment in various locations around the country allowing people to see and try equipment. These exhibitions are often advertised in the local paper or on local radio. You can also request to be put on a supplier’s mailing list so you will be notified if there is an event being held in your area.

Some companies will give equipment for a try-out period before purchase. Enquiries should also be made about maintenance (if it will be required), maintenance contracts (if relevant) and whether a user manual is provided with the equipment (essential).

When purchasing from any supplier, it is important to remember that it is their business to sell. There may be several suppliers of that particular piece of equipment or different manufacturers of the same type of equipment, so always shop around.

SECOND-HAND STAIRLIFTS

It is possible to save some money by buying a second-hand lift. It is advisable to purchase from a lift manufacturer, or an authorised company dealing in re-conditioned lifts who will have checked that the lift meets current safety standards, and will provide a guarantee.

The tracking for straight stairlifts can usually be resited. Most makes, if required, can be installed on the opposite side of the stairs to the original siting - although different makes and models require differing amounts of work.

The track of a second hand curved stairlift cannot be re-sited in another house. However, with some makes, a new track can be made to fit your house and the second hand seat unit and motor can be used in conjunction with it. Be wary of curved tracking that is offered second hand as this is not considered good practice.

Most models of stairlift have the motor incorporated within the seat unit. Some of the older types require a large amount of room under the stairs eg a cupboard in which to house the mechanism. If you purchase such a lift then you must ensure that you have adequate room.

If you are considering buying a lift privately, eg via the local paper or adverts board, it is advisable to get the original stairlift manufacturer, or company dealing in re-conditioned stairlifts to assess the stairlift for its suitability for your use in the new location, service it and, if all is satisfactory, actually carry out the installation. You should not attempt to wire up and install it yourself. Always check that the manufacturer is still in business and/or parts are still available should anything go wrong.

Make sure that the track will be long enough to fit your stairs; a track that covers 14 stairs in one house might only cover 13 in another. The length is the important factor - as an approximate guide, the length required is the length of the face of the stairs from the top nosing to the hall floor plus 14 inches.

Once the stairlift has been installed, it is advisable to set up a service/maintenance contract with a company who you will be able to call on 24 hours a day if mechanical difficulties arise. Annual maintenance is recommended.

SEATED STAIRLIFTS

These tend to be the most common type used in a domestic setting. The majority of users are able to walk, but find it difficult to negotiate the stairs. The person must be able to sit safely on the seat during transit and transfer on and off at the top and bottom of the stairs. A swivel seat and lift-up armrests will make transfers onto and off the seat easier. The swivel seat can be manually or electrically operated.

It is preferable that the user can transfer independently; however, in some situations it may be possible for the carer to carry out an assisted transfer in conjunction with a piece of small handling equipment. The ability of the carer to transfer the user at the top of the stairs should be very carefully considered and avoided if at all possible.

Walking sticks may be carried on the stairlift but, if the person uses a larger walking aid, it probably cannot be carried on the stairlift and therefore two aids will be required - one at the bottom and one at the top of the stairs.

STANDING STAIRLIFTS

These can be used by people who are able both to walk and to stand while travelling up and down stairs. These may be chosen in preference to seated models if the staircase is exceptionally narrow, or if the person has a stiff leg and is unable to bend his knee when seated. These stairlifts usually have one or two guard rails that the user can hold onto during transit.

PERCHING STAIRLIFTS

Perching stairlifts are very similar to standing stairlifts except that they provide a small amount of additional support underneath the buttocks. Therefore, the user is transported in a perching position, ie between sitting and standing. These stairlifts usually have one or two guard rails that the user can hold onto during transit.

STAIRLIFTS WITH A WHEELCHAIR PLATFORM

These may enable the person to retain his independence and eliminate the need to transfer out of his wheelchair and onto a stairlift. Instead the user is able to wheel or be pushed straight onto the platform.

Although most of the platforms fold up against the wall when they are not in use, this type of stairlift takes up a lot of room on the stairs and many domestic stairs may not be wide enough to accommodate it.

TRAVELLING POSITION

• Will the user want to stand, sit on a seat or use his/her wheelchair?
• Will the standard seat provided be the correct size for the user?
• Will the user need a special seat for a child or a harness for a more severely disabled child? A seat unit or moulded seating system will have to be removed before the seat can be folded.
• Which direction will the user need to face? Most seats face sideways, but if the user has a stiff knee he/she may need to face forwards to give them more room.

DIMENSIONS AND HOUSE DESIGN CONSIDERATIONS

If your staircase has a sub-landing at the top, with a few steps to the left or right, most companies can fit a manual or motorised folding platform which bridges the gap between the top of the stairlift and the landing, although the number of stairs and the amount of available headroom will need to be taken into consideration. This allows the user to get off the stairlift and walk straight onto the landing, avoiding the need to have a curved or two straight stairlifts installed. Some people may find the platforms unnerving as they are quite high up over the staircase.

• If a standing stairlift is preferred, is there sufficient headroom?
• If the track for the stairlift cannot continue beyond the bottom or top step of the staircase, usually because it will obstruct a door, some companies can provide a fold-up, hinged rail to overcome this problem. This rail may be manually or electrically operated.
• Can other members of the household easily use the stairway when the lift is folded against the wall?

CONTROLS

Will the user be able to operate the standard controls, usually push button controls sited on the end of the armrest, or is an alternative method required, for example joystick or toggle controls?

Will the controls need to be sited in another position?

Wander leads allow the user to operate the controls from the most comfortable position or a carer to operate the lift independently.

Remote controls, for a carer to operate, are also available from some companies.

Lifts are available with an audible signal to alert blind and partially sighted users that the lift is at the top or the bottom of the track.

POWER SOURCE

Straight stairlifts are available with a battery backup option in case of power failures. Most standard straight stairlifts are powered from the mains. Most curved stairlifts run from rechargeable batteries, which are continually topped up from charging points at the top and the bottom of the stairs. This needs accurate resiting at the charging point because of a warning bleep if it is in the wrong place.

OUTSIDE USE

Because stairlifts only need 24v of power to run, most can be installed outside, with the controls at the top and bottom housed in a lockable stainless steel box, and a removable control key on the stairlift itself.

VERTICAL LIFTS WITHOUT A SHAFT

Vertical lifts without a shaft are commonly used in home environments as they require less structural alterations than lifts with a shaft.

Although versions are available that carry a seated or standing passenger, most are used by wheelchair users. The lift car is either partially or fully enclosed and usually travels up and down a wall-fixed track/s. Partially enclosed cars enable the user to see outside and may be more suitable for users who do not like enclosed spaces. The doors on totally or partially enclosed carriages are electronically interlocked as a safety precaution so that they can not be opened when the lift is moving and the lift will not move if the door is open.

In order to travel between floors a trap door or aperture is constructed in the ceiling/floor which automatically opens and closes. When the lift is on the ground floor the gap in the ceiling is covered by an infill that matches the ceiling of the room, whilst in the upper room the infill blends in with the carpet in that room.

VERTICAL LIFTS WITH A SHAFT

Lifts for use in any nursing, residential or public building must be enclosed within a shaft and usually require extensive structural alterations. Shafts are usually made of sheet metal or glass, and therefore require minimal building disruption during installation.

They can carry more than one person at a time, either someone standing, someone in a wheelchair or both. They can be accessed via a ramp or recessed into a shallow pit for level access.

FOR WHEELCHAIR PASSENGERS

Level access or ramped access lift cars will be necessary. Independent users should make sure that they can open the lift door and lower the ramp easily. Some have an automatic push button, others have a lever handle to lower the ramp.

FOR SEATED PASSENGERS

There is a choice of fixed seats, fold-down seats, perching seats and seats which slide forward to assist access in and out of the lift.

Some companies will fix the seat at the most appropriate height for the user.

DIMENSIONS AND HOUSE DESIGN CONSIDERATIONS

It is important that there is enough space for the user to approach and enter the lift easily. Most lifts are accessed from the front of the car but some companies are able to offer side door entry.

CONTROLS

Most lifts have push button controls sited within the car. Some companies offer alternative control mechanisms and some can position the controls to suit the user.

Illuminated controls are available and may be particularly helpful for visually impaired users.

SAFETY FEATURES

Look for the following safety features when choosing a lift:

• Emergency lowering via a wind-down handle or a battery operated back-up system.
• An in-car alarm or telephone to call for help.
• An over-speed governor.
• An automatic door locking mechanism when the door shuts.
• Smoke and fire detection monitors within the car which will automatically take the car away from the fire and seal the ceiling aperture.
• A lockable car door, especially if there are young children in the household.
• Sensors underneath the car to detect any objects which could possibly block its path, eg toys.

ADDITIONAL FEATURES

Most companies are also able to offer: grab rails to assist entry and exit; a telephone, lights and a carpet inside the car.

FIXED SHORT RISE LIFTS

Short rise lifts can be used indoors or outdoors where a change in level occurs, eg at a front step or in a split level hallway. They are particularly useful in confined spaces where installation of a ramp is not possible. They make it possible for wheelchair users to be independent as they are able to propel directly onto the platform and move between levels without assistance. Some short rise lifts are able to carry both the wheelchair user and carer. Fixed short rise lifts may require structural alterations before installation. Level access for pedestrians can still be provided when the lift is in its lowest position. Mobile/portable short rise lifts do not require structural alterations. They are useful for transferring a wheelchair user, eg into a vehicle or onto a stage.

To enable the wheelchair user to have level access, the mechanism of many models has to be sunk below ground level in a pit so that the platform is flush with the ground at its lowest position. Where this is not possible, ramped access to the platform will be necessary. Some platforms lift vertically so that they would have to be placed next to, or instead of, steps; others have a bridging mechanism so that when not in use the steps can be used in the normal way and, when in use, the platform lifts up and over the steps.

Check whether the lift has back-up emergency battery in case of mains failure. Side support rails are advisable.

MOBILE/PORTABLE SHORT RISE LIFTS

These lifts do not require structural alterations. They may be useful for overcoming a small change in level which does not need to be accessed very often, eg into the garden, garage.

The lifts may be operated electrically or manually (via a foot pump) and are accessed via a ramp. The ramp then folds up whilst the lift is in use. Some enable a carer to travel with the wheelchair user. Once in position, electrically operated versions may be used independently; hydraulic versions require a carer to operate the pump.

Check how easy it is to move the lift. Those with wheels may be easier to transport.

MOBILE STAIRCLIMBERS

These are operated by a carer and are designed to climb up and down a flight of stairs, as they are not attached to the staircase they can be transported and used on different staircases. They are available either as a seated device into which the user is transferred or as an attachment which fits onto a standard manual wheelchair or powered wheelchair. Some have caterpillar tracks that grip the stairs and others have a wheel cluster which rotates to transport the user up or down. They are powered by rechargeable battery.

It is essential that the carer is familiar and has been trained with the equipment before trying to operate it. It is important to consider the staircase, as stairlifts will only cover a certain depth of tread, and cannot cover curved staircases without spacious landings.

STAIRCLIMBING WHEELCHAIRS

There are some powered wheelchairs with stair climbing features. Again, the environment in which they will be used needs to be considered.