Mealtime Partners, Inc.

In many cases, it is a spouse who becomes the primary care provider when someone becomes disabled. In this role, they provide a wide range of care including providing hydration and nutrition. They must provide enough to drink, and feed the individual all of their meals and snacks. Frequently, they are able to work out a method for making a drink available (for more information about hands-free drinking systems, click here). Conversely, alternates for independent eating are rarely considered. Historically, therapists have avoided prescribing dining equipment because, prior to about 20 years ago, dining equipment did not meet the needs of the vast majority of people who needed their assistance. Now dining equipment is available, capable, and can allow individuals with a wide variety of disabilities to eat independently.

How a spouse sees their role as a caregiver is not often discussed. Likewise, how the person being cared for feels about how they are being cared for is not talked about. There is a gracious kindness that exists between most couples about how they feel about providing and receiving care. The person who provides care has obviously taken on a large roll providing a diverse range of care; on the other hand, the care recipient, who has lost their independence, must be provided assistance in areas such as bath-rooming, bathing, dressing, mobility, in some cases communication, eating and drinking. The dynamic that typically exists is empathy on the part of the caregiver, who is aware of how hard it must be for their partner, and, on the part of the care recipient, a deep appreciation for the care they are receiving. Each understand that the other person is facing significant challenges and tries to make life as easy as possible for them.

The following provides a little insight into how people consider the feelings of a partner. This was provided by an occupational therapist who regularly discussed how they felt about mealtimes with his patients and their spouses, in anticipation of his prescribing assistive technology for dining. Not wanting to push anyone into receiving equipment that was expensive, if they did not absolutely need it, he asked them if they enjoyed their mealtimes together and if mealtimes were a time that they spent enjoying being together. The answer was consistently yes from both parties.

However, if they are offered the opportunity to try a dining device, most couples were interested in seeing and trying one. And, after they received a dining system, their discussions about mealtimes completely changed. Commonly, the person who was being fed expressed joy at being able to control what they ate and the pace at which they ate. They also were relieved at not being a burden to their spouse at mealtimes. The care provider consistently expressed relief at not having to feed their partner because when they were hand-feeding their partner, they often found that their own food was cold by the time they got to eat. They also felt guilty about wanting their partner to hurry eating, because they knew it was wrong, yet they found mealtimes very time consuming and burdensome!

When asked why they hadn’t expressed their discontent with their mealtimes together when they were being hand-fed, the answers were quite similar from family to family. The caregivers felt guilty about complaining about providing food because their partner was going through a very tough time due to their disability; how could they complain since they were still able bodied. However, they found feeding someone all of the time a grueling task. The care recipient greatly appreciated all of the care they received and felt guilt about complaining about anything; they felt lucky to have someone so caring, meeting their needs. In general, the care recipient would like the volume of food served for each bite to be different from what they were offered. Bites were typically too big, particularly for meats and other “chewy” foods. They would prefer the pace at which each bite was being offered (too fast or slow) to be modified - typically slowed down. They would like to have longer chewing and breathing time between each bite, etc. Generally, they said that they did not like being fed, yet appreciated the person feeding them.

The care recipient typically tries to be as obliging as possible to make life easier for their care provider. One person explained that they asked for milk to drink with their meal. They really would have liked sweetened ice tea, but knew that making the tea was one more chore that their spouse would need to do. Milk came straight out of the carton and thus made mealtime just a little easier.

This discussion is based on care being provided by family members. Even though in many cases it holds true for paid care providers, there are other situations where mealtimes are definitely not an enjoyable time.

Assistive technology can make eating and drinking an enjoyable experience and provide independence for those who lack the ability to feed themselves or pick up a drink. Click on the following links to see more about the Mealtime Partner Dining System, or our Drinking Products.

Assistive Dining at its Very Best
The Mealtime Partner Dining System is a powered feeding device that provides the means to eat independently for those who are unable to feed themselves in the traditional way. Because of its flexible design it can easily be configured to meet the needs of almost any user and will allow a relaxed, enjoyable meal that is under the control of the person eating. They are free to take a bite of food when they want, and to pause between bites for as long as they choose. Thus they are empowered to eat exactly how they want without their meal being controlled by anyone else. To provide exceptional user access, the Mealtime Partner has three different mounting systems. As well as it being placed directly on a table for use, it can be mounted off of the table to meet the needs of a diverse range of users. The Support Arm allows the spoon to be positioned to deliver food very close to the user’s lips. A small forward movement of the head can access the food on the spoon. The Support Arm is suitable for individuals who have very limited head and/or trunk control because it can be fine tuned to the necessary position to provide access for them. The Mounting Shafts provide comfortable positioning of the Mealtime Partner for those who sit close to a table but are unable to put their knees under the table because they are restricted by their wheelchair or for any other reason. The Shafts allow the device to pivot away from the table to allow easy access for users. Shafts come in five different heights.	The Mealtime Partner Assistive Dining Device Mounted on the Support Arm The Mealtime Partner Mounted on a 8-Inch Shaft
For those users who are able to sit at a table with their knees under it to eat, the Mealtime Partner can be mounted on legs. The legs position the device at the appropriate height for each user. Legs are supplied in three different heights. All of the functions and features that were incorporated into the original design of the Mealtime Partner were based on clinical research that developed the detailed requirements for a device that would be able to meet the needs of most of the individuals with disabilities that would result in a need for hands-free eating. No other powered feeding equipment ever developed can come close to matching the Mealtime Partner Dining System for the diverse range of user disabilities the device can accommodate or match it's food handling capabilities.	The Mealtime Partner Mounted on 6-Inch Legs
For additional information, please call us at 800-996-8607, or email our staff for assistance by clicking here.
The Mealtime Partner Assistive Dining Device is available directly from Mealtime Partners, Inc.

Assistive Technology: Medical Necessity or Convenience?

As new assistive technology is invented to meet specific user needs, once it has been developed, the question always arises “will health insurance cover this technology?” To answer this question the medical necessity of the technology (for each user) must be established. Yet this is not as straightforward as it might seem. Medicare, Medicaid and private health insurance companies challenge the medical necessity of many items asserting that these products are convenience items rather than meeting a medical need, and that because they are identified as convenience items, gives insurance reviewers justification for denying funding for the item. However, being a convenience item does not exclude the item from being a medical necessity!

It should also be noted that historically, as equipment becomes more and more common, it also becomes more accepted that those who need it, should have it, even if it is a convenience item as well as a medical necessity. A very good example of this evolutionary process is the wheelchair. The wheelchair is clearly a convenience item. It is much more convenient for the user to become mobile using wheels than for the caregiver to have to carry the person who lacks mobility. For the vast majority of wheelchair users, it provides minimal therapeutic or healing value, if any at all. The user may require help in getting into (and out of) the wheelchair, may require assistance getting properly positioned, and may occasionally need to be repositioned in the wheelchair. That is, even though they use a wheelchair, they may still require frequent help from a caregiver. However, despite all of the shortcomings listed above, a wheelchair is now commonly accepted as a medical necessity for those who lack independent mobility.

The first U.S. patent was issued for a wheelchair in 1869, and the first electric wheelchair was patented during World War I. More significantly, in 1937 the first folding wheelchair was patented, making the wheelchair itself much more mobile. The first electric folding wheelchair was patented soon thereafter, in 1940. However, even in the 1940’s, wheelchairs were not readily available. In an article in New Mobility magazine (November 2002, volume 13, number 110), it was reported that in a VA Hospital in 1944, two cane-backed wheelchairs were available for 60 spinal cord injury (SCI) patients who had been injured in World War II. These men spent all day, every day, in bed except for the two hours each week when they were allowed to use one of the wheelchairs.

2018 sales of wheelchairs of all kinds is estimated to be $2,515 million, and 3.6 million Americans residing outside of institutes use wheelchairs. The number of wheelchairs used in institutions including hospitals and nursing homes is not known, but must be considerable.

It is rare for an individual to actually buy a wheelchair for himself or herself. Instead both manual and powered wheelchairs are funded through health insurance. Over the past several decades wheelchairs have become accepted as medically necessary for those who have mobility limitations. Now, Medicare provides clinical guidance for choosing the appropriate type and complexity of mobility assistance equipment (MAE) to restore the beneficiary’s ability to participate in mobility-related activities of daily living such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home. It is now commonly accepted that if someone cannot stand and/or walk that they will receive a wheelchair. It is not a considered solution to have a caregiver carry the individual even if you could actually find a caregiver strong enough to do so. Over a period of less than a hundred years the United States has moved from wheelchairs being a rare commodity to being a common-place piece of durable medical equipment that is regularly funded when the need exists. Thus, the wheelchair is accepted as a medical necessity for those who lack independent mobility, and, there is no dispute from health insurance organizations (private or public) that it is medically necessary. The only issue is that the type of mobility assist device must adequately meet the individual’s medical need (i.e., manual or powered, simple or complex in configuration, etc.).

In the twenty-first century, with the development of advanced technologies, more and more equipment is available to help those with disabilities. Some are of enormous help to them in their daily lives but cannot be classified as medical in nature (e.g., computers and cell phones). Other equipment falls in a “gray zone” and can be classified as a medical necessity for some people but not for others. For example, electronic aids for daily living or environmental control units can be essential for some people to be able to call for help in a medical emergency, but for others just a more convenient way of controlling their environment. For these items to be covered by medical insurance, medical necessity must be established.

Then there are the items like the Mealtime Partner Dining System. Even though powered feeding devices have been available for the past four decades, because the older models did not meet the needs of the vast majority of people who could not feed themselves, they did not become established as a medical necessity for independent eating. However, with the development of the Mealtime Partner Assistive Dining System, the majority of people who cannot self-feed in the traditional manner can now feed themselves with this assistive technology. Powered dining devices have no application for anyone who does not have a severe disability and is unable to feed them self. Clearly, if someone cannot feed themselves, equipment that can enable them to do so, must be considered a medical necessity.

Referring back to the discussion of wheelchairs, MAE is provided so that individuals can participate in mobility related activities such as toileting, bathing and eating. However, without assistive technology to facilitate independent eating, many people, despite their being able to get to the dining area of a home in their wheelchairs, will be unable to eat! The wheelchair does not let them participate in eating without someone to feed them. It only moves them to the customary location of their food. If they cannot self-feed, to participate in eating they must have dining equipment.

Yet some medical insurance reviewers do not see eating as a medical necessity but just a convenience. They also overlook (or deny) the fact that feeding yourself, rather than being fed by another person, reduces the risk of choking and aspiration (which, on a statistical basis, provides a direct medical benefit). (For more information refer to: Factors that increase the risk of aspiration.) They see communication as medically necessary because augmentative communication devices are funded by medical insurance (including Medicare); they see hearing as a medical necessity as hearing aids are funded by Medicaid; they see mobility as a medical necessity as they readily fund wheelchairs; but eating is viewed by many of them as not medically necessary even though if we do not eat, we die of starvation. However reviewers tend to think that, "Eating independently is just a convenience." Or, "it is just a convenience for the caregiver."

If applying for coverage of a feeding device to a health insurance company, remember to present all of the medical reasons that the equipment is needed. Be tenacious; do not simply give up if your request is denied. Correct all of the reasons your claim was denied and reapply. If you are denied again request a fair hearing! If Mealtime Partners can be of help please call at 800-006-8607.