DME Tips

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Reuse Tips for Durable Medical Equipment
and Assistive Technology

Weekly reuse tips are brought to you by Oklahoma ABLE Tech, the Pass It On Center, and the Association of Assistive Technology Act Programs (ATAP). Each week
Oklahoma ABLE Tech will highlight tips designed to aid Manual Wheelchairstate and local communities with durable medical equipment (DME) and assistive technology (AT) reutilization.

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2014 Reuse Tips (PDF Version)


Weekly Reuse Tips

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Promote Customer Preparedness for Emergencies and Disasters

Create awareness of the need for individual preparedness for emergencies and disasters.

  • Post some of the key information for the local area.
  • Create brochures based on resources designed for reuse by state and national agencies or other reuse programs.
  • Host awareness and preparedness sessions for customers.

Be Prepared to Assist the Community in Disaster Recovery

Is the program prepared to assist the community in recovery from an emergency or disaster situation by providing used AT to existing or new customers?

  • Have staff members and workers individually prepare plans for managing personal situation (and family) health and safety for the first 72 hours after an incident.
  • Establish relationships with local emergency management agencies.
  • Have designated staff participate in emergency management training and FEMA certification for responders.
  • Secure Memoranda of Agreement to work with other agencies and entities in a specified manner, including, but not limited to vendors, therapists, storage facilities, and van and truck rentals.
  • Document AT reuse needs that can be anticipated in emergency situations.
  • With agreements to access additional reusable AT from other programs, vendors or emergency caches.
  • Identify the staff and skill sets that can be made available after a disaster.
  • Participate in community drills.
  • Establish policies and procedures for taking AT requests, and plan a means of delivery.
  • Establish procedures for collecting and recording data regarding the emergency provision of AT for later reporting and planning.
  • Determining methods of communicating to other organizations and to customers about availability of devices or services.

Define a Role for the Program in Emergency Response

The reuse program can become an integral part of the state's emergency response framework:

  • By practicing in the writing of the state plan for people with disabilities.
  • By cooperating with Voluntary Organizations Active in Disaster (VOAD) in the state.
  • By getting training and becoming involved at the state level and networking with supporting agencies

In the event of a disaster, acquisition of needed AT Can be aided by identifying specific needs and notifying the Pass it On Center.

Devise and Implement a Continuity of Operations Plan

The program can be helpful in emergencies only if it continues to function. That requires a current and documented continuity of operations plan that identifies the measures to be taken to remain in operation during and following an emergency or disaster. The plan should address all of the issues that could prevent normal (or extraordinary) operations to assist to the community.

The reuse program can become an integral part of the state's emergency response framework:

Build Relationships with Suppliers and Manufacturers

Collaborate with suppliers and manufacturers of the types of technology used in the program.

  • Appropriate types of medical personnel to asses AT needs
  • Where to find AT professionals (evaluators and/or rehabilitation engineers)
  • Other sources of used AT (including local providers and state or national exchange programs)
  • Where to find qualified individuals to repair devices
  • Where to find additional manufacturer information about the device (e.g., web link for user manuals)

Provide Additional Information Resources to Customers

Be prepared to provide customers with information about other suppliers of assistive technology and related services that may include:

  • Appropriate types of medical personnel to assess AT needs
  • Where to find AT professionals (evaluators and/or rehabilitation engineers)
  • Other sources of AT (including local providers and state or national exchange programs)
  • Where to find qualified individuals to repair devices
  • Where to find additional manufacturer information about the device (e.g., web link for user manuals)

Implement Strategies to Enhance Comprehensiveness

The program can serve clients of all ages and types of disabilities by providing reusable assistive technology of all types:

  • By collaborating with organizations that focus on specific disabilities (e.g. United Cerebral Palsy, the ALS Society)
  • By collaborating with community institutions that reach specific age groups (e.g. schools and senior citizens centers)
  • By collaborating with as many organizations as possible to identify potential users and to reclaim AT for reuse (e.g. Centers for Independence Living, rehabilitation centers, hospitals, veterans groups)

The secondary school reuse programs implemented in Vermont and Massachusetts represent an innovative strategy for expanding reuse into a younger age group.

Develop Strategies to Enhance Capacity for Statewide Geographical Coverage

Developing the capacity to serve all parts of the state can be challenged by size, geography, and limited resources. Some strategies for overcoming these challenges are:

  • A network of strategically-located centers, possibly with partnering agencies.
  • A web-based exchange site.
  • Collaboration with other organization(s). In Georgia, a library became a node in the reuse network. It had space to collect equipment.

Evaluate Worker Performance

Performance evaluation is a tool for personnel development if conducted through a program of consistently implemented, regularly scheduled, and documented sessions. It gives the worker regular feedback on progress, and it builds documentation if steps must be taken to discipline or terminate.

In addition to employees, volunteers can benefits from less formal feedback on performance. This may help someone develop useful job skills for the marketplace. An option for contractors might be review of performance against pre-defined expectations or standards.

Train and Develop Workers

Offering some job-related training for employees and volunteers builds a stronger reuse program and aids the community. Training opportunities may take several forms:

  • Formal training (on or off-site)
  • On-the-job training worker by another worker
  • Tuition reimbursement for education and/or training on the worker's personal time
  • Visits to another reuse program
  • Attendance at a reuse conference (or use of some conference videos from PIOC)

Use a Structured Orientation Plan for All Workers

Use a structured orientation plan for new employees, contractors, and volunteers to ensure that they have a proper understanding of the mission and activities of the program. Develop a presentation and an orientation packet that includes:

  • Essential information about the organization's mission and activities
  • Basics about communicating with people with disabilities (People First Language)
  • Information about benefits
  • Information about required training and the availability of formal training, on-the-job training or tuition reimbursement
  • Required employment documents for signatures

Develop Policies and Procedures for Recruiting and Hiring Employees and Contractors

Reuse programs all operate with limited staffing, so every individual is important. The recruitment and hiring of employees and contractors should be conducted according to written policies and procedures that facilitate the identification of candidates who meet specificed requirements. A few phone calls can ensure better hiring and avoid potential problems.

  • Check professional and personal references. Yes, legal issues make employers very cautious, and some will only confirm dates of employment. But, if you call former supervisors, much can be learned from what they say or don't say about the applicant.
  • Verify the educational background claimed.
  • Verify that the applicant holds the specific licenses or credentials required for the position, and that those licenses or credentials are active in the state of employment.
  • (If required by the program) conduct criminal background checks.
  • Give preference in hiring to volunteers who apply (if they meet the specified requirements).

Develop Job Descriptions and Use Them for Development and Accountability

Job descriptions are not simply onerous bureaucracy. Used properly, they are useful tools in recruiting, personnel development, performance evaluation, and accountability for program activities. Create job descriptions for employees and volunteers. They clarify responsibility and accountability. While contractors are not employees and their work cannot legally be supervised in the same manner as employees, it is still possible to manage expectations by developing standards or expectations of performance (e.g., ethical conduct, compliance with all laws, timely completion of contract deliverables, and timely reporting and billing.

Use Return-on-Investment Analysis to Leverage Support

Return-on-Investment (ROI) is a business formula that calculates how much was returned for the amount of money invested. This can be determined for reuse by determining the value of goods and services provided for the total cost of the reuse program. This is a powerful tool in communicating with potential grantors, donors, or government agencies. Calculate the number and keep it ready to share with anyone it might influence. Share it in the newsletter. Hang a simple framed statement in the facility. Print a small label that can be placed on the back of a business card, for example. "This year we recaptured $2.87 for every dollar spent on AT reuse." Every person who gets the business card gets the message.

Comply with Legal Record-Keeping Requirements

Records are subject to many laws. The nature of the record-keeping is determined by the types of information collected and stored. The program should:

  • Have written and implemented policies and procedures for the mainteance and retention of records for the periods of time required by law (tax records, health records).
  • Maintain records in compliance with its legal organizational structure as required by federal and state law (including tax-exempt status, if applicable).
  • Maintain customer records in compliance with Generally Accepted Accounting Principles (GAAP) and federal and state tax laws.
  • Encourage nonprofit partners to keep a few copies of the most recent IRS Form 990 available to supply upon request. (Customers are entitled to this.)

Be Proactive in Managing Risk and Liability

Assess risk and liability and implement strategies to mitigate them. Risk is the possibility of loss or injury. Liability is responsibility or legal obligation. Being proactive to mitigate risk is a strategy for minimizing potential liability.

  • Assess exposure to risk and/or liability by reviewing compliance with laws, the features and use of the physical environment, and how activites are performed.
  • Writing and following policies and procedures helps to mitigate risk and/or liability.
  • Identify and obtain appropriate types of insurance to address risk and/or liability.

Use a Mission Statement to Focus on Planning and Activities

Devise a mission statement that defines the purpose of the organization, and drives program planning and activities. It should be brief, focused, and easily understood. The annual goals and objectives are formulated for consistency with the stated mission, resources are allocated in this manner, and customers and their support systems are treated in a manner consistent with the stated mission. Post the mission statement prominently in the facility, on the website, and in printed literature.

Follow Up with Customers to Improve Outcomes

Document the scheduled follow-up with every new customer via telephone, e-mail, or in person. Use the routine customer follow-up by a trained individual to learn more about what could be done to better serve the customers expanding or improving services.

Provide Technical Assistance for Customers

Users often have questions about the equipment after they get home. Initial training helps, but it's also important to have a trained individual respond to a new user's request for technical assistance promptly.

Confirm the Donor's Right to Donate or Sell AT

Does the program have written policies and procedures to confirm that the donor has the right to sell or doante the equipment? Think it isn't needed? The AT could be the property of the original payer, a rental, or it could be stolen. Procedures may help prevent this. Consider adding a statement to the donation receipt requiring the donor to affirm the right to donate or sell the item.

Allow a Trial Period on the Device

Give customers a trial period (of specified duration) with the device, both at the facility and the environment(s) in which it will be used.

Provide Customer Training on the Assigned Device

The customer and his direct support provider(s) may need basic training on features, operation, maintenance, safety and troubleshooting for the device at the time the device is given. Don't have a lot of time for this level of customer involvement? Try videotaping these explanations for the most frequently reassigned items. Tell customers where to find this information online for later use, or create written instructions for basic operation and maintenance that can be printed on demand. This could be a scanned user manual.

Involve the Customer in Device Choice

Choice is a significant factor in the acceptance and use of an AT device. The customer and direct support provider(s) should be informed of all appropriate device options and allowed to participate in the choice of device.

Match the Customer with an Appropriate Device

Customers deserve an appropriate solution, not just a solution. Finding the appropriate device may be a challenge, and networking may help. Demonstration loans may help. In some circumstances, matching requires specially trained professionals who follow documented procedures to match customers to the technology solution. The professional may vary, depending on the situation and type of technology. If these professionals are not affordable, consider strategies to obtain their services.

  • Approach the local chapters of professional organizations to identify volunteers.
  • Partner with local hospitals or healthcare organizations.
  • If academic programs exist locally to train the needed professional, approach the director about creating internships or field experiences in the reuse program.

Devise Consistent, Legally-Compliant Procedures for Customer Intake

Use written policies and procedures that are applied consistently for application of equipment and determination of eligibility.

  • Written standards for determination of eligibility.
  • Writen referral procedures, when referrals are required.
  • Written application for services that includes demographics and financial information.
  • Staff training in compliance with privacy laws.
  • Monitoring and enforcement of compliance with privacy laws.
  • Staff training in customer service.
  • A computer databse for maintaining customer records.
  • If appropriate, information about sources of funding for the customer.

Practice Safe, Legal End-of-Life Recycling

Does the refurbishing program have a written procedure that is legally compliant and applied consistently for disposal of end-of-life and non-usable equipment/AT? Some ideas from programs:

  • Identify the devices that can be broken down for reusable spare parts.
  • Find a certified recycler for unusable equipment.
  • Save time by triaging donated equipment before it is brought into the facility. Keep a container for the recycler at the receiving door. Ask if the recycler will provide the bin.

Optimize Use of Space to Store Donated Equipment

Adequate space for storage of donated equipment is often a challenge. Try to:

  • Create separate storage for different types of devices.
  • Optimize the use of space with adequate shelving, bins, or other storage options.
  • Separate sanitized from unsanitized equipment.
  • Provide proper heating, cooling, and ventilation for equipment storage as needed.
  • Acquire materials handling equipment to access high storage in a safe manner.

Implement Procedures for Transportation of Equipment

Transportation is a major challenge for most reuse programs. If the program operates vehicles, safety and liability are major concerns. Policies and procedures for picking up and delivering equipment should confirm that:

  • Drivers have current licenses and safe driving records.
  • Drivers and other workers who pick up donated equipment are trained in safe lifting and handling techniques.
  • Vehicles used to pick up donated devices have proper loading features and/or accessories (lifts, dollies, lift truck, as needed).
  • Workers are trained in appropriate procedures for dealing with donors (e.g., courtesy, giving receipts to acknowledge donations, obtaining liability releases from customers, etc.).

Offer a Limited Warranty on Refurbished Devices

Many programs offer a limited warranty on refurbished devices. The warranty should be given to the customer in writing when the device is delivered and the terms should be very specific. This language is often included on the customer's delivery receipt. The warranty may permit the user to return the device for refund (if a fee was paid) or have the device replaced with an equivalent device within a specified time period.

Comply with Software Licensing Law and Agreements

The program should have written policies and procedures that are consistent with current law and licensing agreements when loading software to refurbished computers.

  • Comply with the software publisher's licensing agreements
  • Track the purchase and assignment of licenses
  • Reload programs only if the original software is provided with the computer

Remove Personal Data from Digital Devices Before Reassigning

If digital devices (computers, cell phones, tablets, PDAs, etc) come through the reuse program, all personal data should be permanently removed to avoid the possibility of identity theft or breach of privacy. This requires measures beyond the routine deleting of files because that leaves the data stored in the device.

Refurbish Donated Equipment in a Manner Consistent with Manufacturer Specifications

Implement a written procedure for refurbishment/repair of equipment/AT that is consistent with manufactured specifications. This may include obtaining manufacturer training for technicians. Guard against the risk inherent in modifying the device from the original specifications (remanufacturing).

Implement Appropriate Procedures for Sanitizing Donated Equipment

Devise written procedures based on sound medical or scientific practice for sanitizing equipment to protect both workers and new users.

Use a Systematic Method for Evaluating the Condition of Donated Devices

Develop  written, device-specific procedures for evaluating the repair and refurbishing needs of donated equipment. Some veteran refurbishing programs have donated both written checklists and videos for evaluating some common devices.

Specify Equipment Needs and Make Donors Aware of the Needs

Develop written policies specifying the categories of devices that will or will not be accepted for donation, and methods to communicate the policies of prospective donors. This information can be posted in the facility, on the website, and included on a brochure. For ease of sharing, Project MEND (San Antonio) uses a business card with the needed devices on the front and information about dropping off donations or requesting services on the back. (A sample image of the card can be found in the Knowledge Base.)

Notify Customers about Recalls, Withdrawals and Safety Alerts

Devise procedures to track device recalls, market withdrawals and safety alerts and to identify and contact individuals who received devices from the program that are affected by such notices. Assistive Technology for Kansans suggests putting this responsibility into someone's job description. The procedure should include:

  • A method to monitor device recalls and alerts
  • The ability to identify devices that are the subject of recalls, market withdrawals or safety alerts by the FDA, and to identify and notify users of reassigned devices
  • An attempt to replace (temporarily or permanently) the device it is recalled or withdrawn

Implement a Good Inventory Management System

An accurate and efficient method to track the inventory of available devices is important. This includes written policies and procedures and software capable of:

  • The unique identification of every donated device (by label or barcode)
  • The ability to determine the availability of devices by type
  • The assignment of an inventory valuation to each device
  • The ability to identify devices subject to recall notices
  • The ability to identify customers who have received devices subject to recall notices

The specially-designed systems from AgoraNet and AT4All are widely used, but other programs use Quick Books or the built-in inventory reporting of 3dcart, an online store system for programs that refurbish and sell devices on the Internet.

Giving a Presentation Related to Reuse? Want to Explore a Topic for Staff Training? Use Resources from National Conferences.

A wealth of information and ideas from program leaders and speakers from all over the country is available for reference and use or reuse. Presentations from regional or national conferences are in the Knowledge Base under "National Conferences." Travel funds may be limited, but the presentations from ATIA Conferences and Reuse Conferences are available for viewing. (Please remember to credit the original source in your presentation.)

Provide Adequate Space and Services for Refurbishing Operations

Smart organization and adequate space is essential for programs to conduct the chosen AT reuse activities. Consider:Hospital Bed

  • A separate, secure area for administration and program records.
  • A private area for customer intake.
  • A separate area for device matching.
  • A separate area for device refurbishing.
  • Appropriate areas for unloading and loading equipment.

Create a Safe and Secure Workplace

Create a safe and secure workplace for employees, contractors, and volunteers and a secure place for customers. This depends on planning, policies, procedures, and training. Identify work areas that are not accessible to customers, secure storage for chemicals and tools, and appropriate safety training for each worker. Even if not required by law to do so, conduct regular drills for fire, weather, and other emergency evacuation circumstances.

Ensure that Program Facilities are Accessible

Set an example for accessibility by ensuring that the program's facility is physically accessible for employees, contractors, volunteers, and customers. It should:

  • Comply with building codes and other applicable ordinances.
  • Comply with federal and state laws for physical accessibility.
  • Take advantage of any opportunities to demonstrate how to make facilities more accessible.

Collect and Use Output and Outcome Data

The program measures output by number of devices distributed, number of devices donated, and number of customers served. Survey participants to determine outcomes: how they use the device they received from the program to participate in work, education or daily living, and the level of satisfaction with devices and services.

  • Use the information to plan for unmet needs or greater emphasis in specific categories.
  • Include the data in brochures and newsletters.
  • Post charts in the facility that tracks the data. Include a request for support.
  • Publicize output and outcomes on the website and in a press release to media outlets (newspapers, TV, and radio) that serve the area.

Develop a Marketing Plan

Every program needs a comprehensive marketing plan to acquire and sustain community support. The plan should identify target audiences and use the most cost-effective means for reaching those audiences.

  • To obtain donations of equipment.
  • To inform the community about services and to reach potential customers.
  • To generate additional financial (or volunteer) support to sustain the program.
  • To show the economic and environmental benefits of the program.

Need a form, model plan, example or brochure related to some aspect of reuse or operations? Save time. Practice reuse.

Search for the related topic in the Knowledge Base. Programs all over the country have generously donated all types of documents (nearly 600 so far) for reuse. The examples are attached to "articles." Download the file and use to make a customized version.

Partner to Expand Capacity

Nearly all successful AT reuse programs have partners: nonprofit reuse programs, Centers for Independent Living, and other agencies. They network with healthcare organizations, commercial suppliers, and civic groups. Identify every group that is supportive (or could be persuaded to be supportive) of reuse in the community. Sharing extends the reach of limited resources.

Diversify Sources of Program Income

Multiple small streams of dependable income contribute to sustainability. Be wary of hosting large events that require significant investments of time and money. Here are ideas from programs:

  • Walton Options CIL suggests modest contributions from device recipients.
  • Project MEND has a $20 application fee (waived if not affordable) and a partnership model with levels of support ranging from $20 to $225
  • Paraquad and FODAC offer device repair services at modest fees.
  • FODAC operates a thrift store. Lacking space for that, consider the proceeds from having volunteers host yard or garage sales or a booth at a local flea market on a regular basis.

Devise a Sustainability Plan for the Reuse Program

Pursue strategies to sustain the program for the long term, and continue to improve and expand its services. The strategy should be documented in a written plan that addresses diversification of sources of income, strategies for enhancing community support, retention of employees and volunteers, and succession planning for program leadership. Make it a group effort by involving employees and key supporters in developing the plan. Use the IQ-ATR Online Program Assessment Tool in a group exercise to jump-start discussion of needs and opportunities. Watch videos for sustainability ideas from other program leaders.

Snyder, Oklahoma

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William, son