Care Home Referral Criteria & Guidelines April 2013

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Community Services Division
Wheelchair Services

Eligibility Criteria: Provision Of Wheelchairs For Patients Being Discharged To Care Homes
Guidelines For Referring To The Wheelchair Service
Aim of the Wheelchair Service
The service provides wheelchairs to people who have permanently impaired mobility to enable
them to become independently mobile within their home.
Provision of Equipment in Care Homes
Clients may be provided with self propelling manual wheelchairs to enable them to become
independently mobile. Subject to an assessment consideration may be given to clients requiring a
manual wheelchair for use outdoors where a carer is available to take the client out on a frequent
and regular basis (at least four days each week).
Wheelchairs to be pushed by a carer indoors are not provided. It is the responsibility of the home to
provide wheelchairs for transit, general portering and nursing use within the home. For safety and
comfort residents who are not independent wheelchair users should not spend long periods of time
sitting in a wheelchair but should sit in a supportive armchair instead.
Clients should be referred to the service by an occupational therapist, physiotherapist or their GP.
Referrals
Following referral the client will be assessed by a therapist from the wheelchair service who will
prescribe a wheelchair if appropriate. Equipment is provided for specific individuals, is issued on a
loan basis to that named client and must be used only by them.
When a referral is made to the Wheelchair Service, we will assess once the patient is discharged,
and not while they are still in hospital. This is for several reasons:

Anticipated situations and outcomes often change on discharge eg family members are less
involved than they originally hoped to be or care routines and environments are different
from those in hospital. This will have an impact on the client’s mobility requirements.

Please be aware also that when someone moves into a residential or nursing home, they
usually change their GP to the practice that covers that particular home. This does
sometimes mean that they are no longer under any of the PCTs that our services cover so
referrals should then be made to other wheelchair services.
Assessment for and provision of equipment for clients in care homes is undertaken within the
wheelchair service’s standard response times. Equipment may take 6 months to be available
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following an assessment. Equipment will not be provided for discharge to a residential/nursing
home.
What can hospital therapists/discharge coordinators do?
You can phone us to discuss individual clients, even before a referral is received. A therapist is
usually available every morning (Mon-Fri) to help with any queries.
You can also advise family members of the wheelchair service procedure and timescales in order to
help avoid unrealistic expectations of what we can offer and how quickly we can organise
assessments and equipment. Assessments are based on the wheelchair service’s eligibility criteria
and the range of equipment used. The type of equipment that is used in the hospital setting is not
necessarily the same as that used by the wheelchair service. It must be made clear to family
members that if the client is using a particular piece of equipment in hospital as part of their
rehabilitation then this is not necessarily what the wheelchair service will consider issuing.
Please see also attached guidelines for provision of tilt in space wheelchairs. These are not
normally provided to clients in nursing homes unless the family is actively involved in taking the
client out regularly (see above).
The Wheelchair Service also reserves the right to withdraw equipment if it is not being used within
these guidelines or if the client’s circumstances change.
Contact details
Roehampton Wheelchair Service
020 8487 6084/6085
(clients with Sutton, Merton, Kingston, Richmond, Spelthorne & Wandsworth GPs)
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Community Services Wandsworth Division
Wheelchair Services
Provision of Manual Tilt-in-Space Wheelchairs
Definition of equipment
A tilt-in-space wheelchair has the ability to adjust the angle of the seat whilst maintaining the seat to
back angle.
Guidelines for provision
A standard wheelchair with a fixed semi-reclining back and wedge cushion should be considered as
the first option where a user needs to sit in a tilted position.
The user must meet all of the following criteria:
 There is a need for wheeled mobility in addition to postural support
 The user has a need to mobilise both indoors and outdoors
 The user is unable to walk
 The user will spend more than 4 hours per day in the wheelchair
 The user has significant postural difficulties e.g. poor sitting balance which cannot be met in
any other wheelchair or in a supportive armchair
 The user needs to change the angle of tilt during the day
 The user will gain significant improvements in their posture and mobility from the provision of
a tilt-in-space wheelchair
 At the time of issue the user is residing in his permanent home environment
Environmental constraints will be considered when prescribing this type of wheelchair. There must
be sufficient space for such a wheelchair to be used.
If all of the above criteria are not met consider:
o A posturally supportive armchair
o A standard wheelchair with a fixed semi-reclining back and wedge cushion
Note
Hospitals or Rehabilitation Units are expected to supply their own tilt in space wheelchairs to be
used during rehabilitation.
Assessment for a tilt-in-space wheelchair will not be carried out while progress is being made and
posture and/or mobility is still improving.
The voucher scheme may be an option when tilt-in-space is desired by the user but not clinically
essential for mobility and postural needs.
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