Injured at mercy of red tape

Many people with spinal cord injuries, like Andrea Reaves, rely on Medicare or Medicaid to provide medical necessities that keep them alive, from equipment as large as a wheelchair to something seemingly as small as cushions.

Pressure sores form when someone has been in the same position in bed or a chair for too long. Under constant pressure, tissues deprived of oxygen and fuel ulcerate quickly and die. Such ulcers can be life-threatening to people with spinal cord injuries, who have little or no sensation in much of their bodies.

Reaves struggles against anxiety, especially about the thought that insurance cuts could threaten her Medicare benefits. Losing them would force her out of her home and into an institution, where she fears she would die.

Terra Patrom, executive director of the Arkansas Spinal Cord Commission, shares that concern.

“That’s the thing that a lot of people don’t understand is that the medically necessary items in which a lot of these long-term cuts are incorporated, they have long-term effects,” Patrom said.

Bob Moos, a public affairs specialist for Medicare’s Region 6, said that no cuts have been made for six years, and new cushions are allowed every five years because they qualify as “durable medical equipment,” a qualification added in 2012. Region 6 is based in Dallas and includes Arkansas.

Medicaid, a state-run program, opted to implement the five-year period earlier. For anyone 21 and older, wheelchair seat cushions can be replaced every five years. People younger than 21 can get a cushion every two years, said Marci Manley, the Department of Human Services’ deputy chief of communications. Medicaid operates under the department.

Patrom said the cushions often don’t last five years because they are used every day.

“You wear the same pair of shoes every day, and they wear out,” she said. “It just happens. So, when our clients are sitting on their cushion every day — they’re either a gel or air normally — sometimes the cushions go bad.”

Dr. Twala Maresh, a senior clinical instructor at the University of Central Arkansas who specializes in spinal cord rehabilitation, said learning strategies to avoid pressure sores is one of the topics she has her students of physical therapy teach patients.

At Maresh’s clinic, about six clients come in each semester to allow students to practice skills. The students get to practice, and the patients get free therapy.

At a recent session of the clinic, students gathered around a man with a spinal cord injury to work on his pressure relief skills.

He had just recovered from a pressure sore, and demonstrated that he could lean on one elbow in his chair for relief.

— Ginny Monk