Table 2.

Sample Durable Medical Equipment for Optimizing Patient Independence Within the Palliative Care Setting

Device	Description	Notes	PC considerations
Goal: Optimize independent mobility.
Cane	Provides minimal additional balance support and offloading of painful joints.	Multiple types; consider tradeoff between weight and stability of cane.	• Some patients may come to PC already using mobility devices, and some may experience need for a first device while receiving PC. • For any patient, mobility device needs may change over time. • High-tech devices may not always be preferable to low-tech devices. • Beyond support for balance and ambulation, mobility devices can be used strategically to manage dyspnea, fatigue, and pain.
Walker	Provides increased balance support relative to canes.	Multiple types; can be heavy to lift; rollator can address multiple needs—has wheels, foldable seat, hand brakes, basket; can be bridge to wheelchair.
Manual wheelchair	Supports functions ranging from transport to independent community mobility to specialty use for athletics.	Multiple types; can be self-propelled or pushed; can be ultralight or lightweight; can be off-the-shelf or modified; for routine use, customize seating for pressure relief.
Powered mobility	Supports seated mobility for long distances/duration. Includes scooters (typically not modifiable) and power wheelchairs (can be highly customized).	Most insurance covers one powered mobility device every five years; customized wheelchairs can take several months to be produced; when prescribing, consider present needs (e.g., seating for pressure relief) and anticipated needs (e.g., ventilator tray); consider acceptability to patient and available space in a home to maneuver; can require specialized transportation such as modified van; collaborate with wheelchair clinics to write nuanced prescription. Typically not covered by hospice.
Goal: Optimize independent self-care
Universal cuff	Compensates for hand weakness; a sleeve that covers hand, with slot to insert device or tool such as pen or toothbrush.	Facilitates independence with eating, grooming, writing. Consider especially for patients with hand weakness associated with amyotrophic lateral sclerosis, multiple sclerosis, spinal cord injury.	• In the PC setting, patient function may fluctuate. Device use and needs can similarly fluctuate. • Regularly assess patient needs and safety of use of current devices. • Some patients and companions may develop their own creative ways to support ADLs in the home. Learn from each patient about what strategies they devise.
Transfer aid	Enables safe transfers between surfaces; includes sliding boards, transfer belts, sling-based manual and electric Hoyer lifts.	Supports safety for patient and caregiver; training required before use. Can facilitate performance of ADLs in their usual locations (e.g., bathing, toileting). Select transfer device based on patient ability to participate in transfers (e.g., sliding boards require patient trunk stability and arm strength).
Grab bars	Promote safety and independence in toileting and bathing	Must be specially installed. Towel racks cannot be used as grab bars.
Goal: Optimize communication
Alphabet or image selection board	Allows user select letters to spell desired words, or to select images that reflect the patient's needs.	Often requires a communication partner to facilitate.	• Devices can be low tech or high tech. High tech is not always better or the best fit for a given patient. • If a communication partner is needed for use of a device, ensure that the partner is trained along with the patient. • Software or applications available for smartphones or other devices can also be effective communication tools (e.g., voice-activated calling).
Speech generator	Converts the input of letters/words/images into computer-generated speech. Can utilize a range of methods of input (e.g., touch, eye gaze).	Often requires training and practice to optimize use.

This list is not comprehensive of all goals, devices, and strategies. Collaboration with rehabilitation colleagues can facilitate detailed assessment for and procurement of durable medical equipment.