Every year, 234,000 people are hospitalized for fall-related injuries that occur in the bathroom. In Pennsylvania, most accidents resulted in serious head injuries due to hard hits against bathtub rims or sinks. Poorly situated grab bars and other fixtures lead to many dangerous accidents that could have been avoided. What's worse is most of these accidents occur much more frequently among older and older age groups. The 85-year-old seniors suffer the most from these accidents - and understandably so - due to the natural degeneration in the strength of aging muscles' ability to perform ordinary tasks. When straining to get up, sit down, climb into a bathtub, or walk on a wet floor, bathrooms can easily become a hazard to aging seniors if modifications aren't made to them.
Medicare and Medicaid agree to cover assistive technology, in general, based on how the product is defined, how much it costs, and whether the patient has a prescription pertaining to the device in question - and even then, the device would have to meet pre-defined Medicare and Medicaid conditions to be considered as durable medical equipment (DME).
The minimum requirements to be considered for a grant or reimbursement:
Medicare and Medicaid will only cover a walk-in tub if it falls under the category of Durable Medical Equipment (DME), which is why walk-in tubs are rarely covered by both institutions.
The difference between Medicare and Medicaid is that Medicare programs are open to applicants whose age is 65 and up while Medicaid is open to all applicants from low-income homes.
As long as a walk-in tub is considered to be medically necessary, applicants with Medicare Part B plans should be eligible for coverage. Medical necessity hinges upon your doctor or practitioner prescribing a walk-in tub for you, only then would your application be considered to cover the purchase of a tub.
In most cases, Medicare will cover the cost of such a tub as reimbursement rather than a payment in advance.
There is a higher chance for seniors to receive coverage from Medicaid rather than Medicare due to the various sets of rules that govern Medicaid programs from state to state. Programs such as Community Transitions that deal in helping seniors transition from living in a facility to living at home involve making in-home modifications that suit their mobility needs. When eligible, a senior may receive coverage of the cost of a walk-in tub or its installation upon approval.
| Name of Organization | Phone | City | State |
|---|---|---|---|
| The Allegheny County Department of Human Services Area Agency on Aging Pittsburgh, PA | 800-581-9145 | Pittsburgh | PA |
| Southwestern Pennsylvania Area Agency on Aging Charleroi, PA | 724-489-8080 | Charleroi | PA |
Pennsylvania also has Home and Community Based Services (HCBS) that specialize in helping those with a disability by making modifications to their home. If you have a prescription for a walk-in tub and you're diagnosed with a condition that limits your mobility, you can request an approval from the local HCBS listed below.
| Name of Organization | Phone | City | State |
|---|---|---|---|
| The Delaware County Office of Services for the Aging (COSA) | 610-490-1300 (800-416-4504) | Eddystone | PA |
| Pennsylvania Department of Aging | 717-783-1550 | Harrisburg | PA |
| The Montgomery County Office of Aging and Adult Services (AAS) | 610-278-3000 | Norristown | PA |
There are three home modifications grants in Pennsylvania that could be allocated towards the purchase of a walk-in tub and/or its installation, and these are the Home Improvements and Structural Alterations (HISA) grant, the Special Home Adaptation (SHA) grant, and the Specially Adapted Housing (SAH) grant.
The SHA and SAH grants require that a senior veteran has suffered an injury or disability connected to their service in order to be eligible, the HISA grant does not, but applicants with injuries or disabilities related to their service will receive a higher grant.
Veterans Directed Home and Community Based Services (VD-HCBS) of Pennsylvania allow all applicants from any age group with a service history a chance at attaining a sum that could be used to purchase or install a walk-in tub or low-threshold shower in their homes.
| Name of Organization | Phone | City | State |
|---|---|---|---|
| U.S. Department of Veterans Affairs: Pittsburgh Regional Benefit Office | 800-827-1000 | Pittsburgh | PA |
| Philadelphia Regional Benefit Office | 800-827-1000 | Philadelphia | PA |
