Assisted Living Options for Wheelchair Users

Until the early 90s, the few federal laws governing civil rights for people with disabilities were largely unenforced by state and federal governments. But then, in 1990, the federal government passed The Americans with Disabilities Act, overhauling the country’s building practices and its attitude toward citizens with disabilities. There is now a broad variety of lifestyle options for wheelchair users, and some of their most comfortable living situations can be found in assisted living communities.

Even now, however, state laws that regulate residential care facilities can sometimes prove problematic for wheelchair users. According to regulations in most states, assisted living facilities cannot accept residents who are completely bedridden and unable to transfer themselves to and from a bed or chair. In some cases, the vague or outdated language used in the drafting of these state regulations is exploited by facilities that, for whatever reason, do not wish to accept residents who use wheelchairs.

Fortunately, thanks to modern legal precedents, the practice of application denial based on wheelchair use is no longer a barrier to assisted living residence. The legality of such policies can be successfully challenged as this is considered a clear violation of the Americans with Disabilities Act, among many other laws. According to AARP Foundation, The Fair Housing Justice Center (FHJC) reached a settlement in 2021 with four assisted living facilities in a lawsuit challenging discrimination against people with disabilities, especially those using  wheelchairs, to admit them on the same basis as other applicants, and offer equal access to housing and services.

People with disabilities are now able to find suitable residential care options as easily as anyone else, and the benefits that assisted living offers wheelchair users can be life-changing.

Below, you can learn more about assisted living and how it can benefit wheelchair users. You’ll also find information on assisted living accessibility regulations and financial assistance for assisted living.

Assisted living facilities are planned communities which make use of both private and social spaces. They provide services to create a low-maintenance lifestyle for seniors who may need minor assistance getting into and out of a wheelchair or with personal grooming tasks. The level of care offered in assisted living facilities can range from support for activities of daily living, like bathing and dressing, rehabilitation services, down to the provision of community events, communal meals and housekeeping services.

Assisted living facilities are intended to accommodate residents with low to intermediate levels of care needs. To maintain the comfort, independence and active lifestyles of residents, all support services in assisted living are elective and provide varying levels of aid. Residents who have greater needs, such as for regular assistance bathing or medical device use, also have the option to hire home care aides to visit them in the community.

According to the 2021 Genworth Cost of Care survey, the nationwide average cost of rent in an assisted living facility is $4,500 per month. However, the services and amenities provided can carry significant added costs, especially for residents with greater physical or mental challenges to face. For example, some assisted living facilities may require some residents to pay additional fees for transportation on shopping trips and other non-medical excursions.

In some types of residential care, such as independent living or in-home care, support and amenities for wheelchair users may be somewhat limited compared to those you’ll find in assisted living. Below are some common aspects of assisted living that promote a safe and satisfying atmosphere for people who use wheelchairs and other mobility aids.

• Personal care services: By providing a comprehensive system of personal care support and basic help with mobility to all residents, assisted living facilities can reduce the stress of living with a disability, especially for people who live alone.
• Safe and accessible spaces: Facility building codes alleviate the need for home modifications for people who have recently begun using a wheelchair in the home or who may soon do so, ultimately saving the time, headaches and high costs associated with modifying a home.
• Built-in accessibility aids: Accessibility aids within assisted living homes are largely the responsibility of staff, with costs and maintenance of these mechanisms usually included in the cost of rent. Commonly offered aids include personal emergency response systems, wall-mounted call systems, stud-mounted grab bars and more.
• Social space accessibility: Building codes optimize shared public spaces for wheelchair use within the community, creating an easily accessible and nearby sphere of public interaction without the need for travel or frequent transference to and from a wheelchair.
• Transportation: Transportation vehicles at assisted living facilities are also optimized for wheelchair access, and residents are never short of someone to do the driving. Some communities may include free transportation for wheelchair users under certain circumstances.
• Physical therapy: On-site physical therapy sessions are a common feature of assisted living, helping low-mobility residents improve on their limitations and find relief from pain through guided exercise and professional assessments.

Determining if assisted living is right for you depends on many factors, including how dependent you are on a wheelchair for mobility, and also your age and any comorbid conditions which may necessitate greater aid. While wheelchair accessibility is legally required of all residential care settings, for reasons of safety and ethical responsibility, assisted living facilities must place certain restrictions on the mobility levels they can accommodate.

People who are permanently bedridden, or who must have the aid of more than one person to help them transfer from a bed to their chair (or vice versa) may not be accepted into assisted living. People with these needs may find more comfort and relief in a nursing home.

The ideal assisted living resident may be a wheelchair user who can be helped to stand and walk around, who can transfer themselves to and from their chair or who can be lifted with the assistance of only one direct care aide.

Eligible assisted living residents can receive assistance with tasks like:

• Bathing and dressing
• Toileting
• Dental care
• Standing and walking
• Laundry 
• Running errands
• Taking medicines

People who can live independently and are likely to remain healthy for the foreseeable future may incur high costs for unneeded care if they opt to move into assisted living. Furthermore, individuals who are permanently bedridden or require significant, ongoing medical care are also not good assisted living candidates. These more dependent individuals may require skilled nursing care or 24-hour supervision, neither of which are offered by assisted living communities.

Assisted living is unsuitable for those who: 

• Cannot perform most or all of their personal care tasks
• Rely on medical equipment that they cannot operate or maintain 
• Cannot follow directions or move to safety in emergency situations
• Have active tuberculosis
• Are chronically bedbound

Accessibility regulations for residential care facilities are largely dictated by federal laws passed to protect the rights and independence of people with disabilities. State Health and Human Services departments often institute additional accessibility requirements of their own but, at the very least, the federal government requires states to adhere to the following laws affecting wheelchair users in assisted living.

Residential care is often the safest choice for older adults with mobility challenges who can no longer live alone; however, it does present a major budgetary obligation. Ensuring that financial resources can stand up to long-term care expenses can cause a great deal of stress for seniors and their families. Fortunately, there are ways to mitigate that burden. Financial support for residential care can come from multiple sources, such as Medicaid, Medicare, Social Security and Veterans’ Affairs.

Medicaid is a federally mandated program administered by state governments, under which low-income or otherwise categorically needy people can receive partial reimbursement for healthcare services. For recipients who have high-level healthcare needs but wish to remain in their homes or in assisted living, Medicaid waivers may be available to maintain coverage in these settings. Waivers also commonly cover the expense of a new wheelchair, if it is medically necessary.

While waiver programs vary from state to state, if Medicaid recipients in assisted living cannot function without the use of a wheelchair, waiver services will usually cover the cost of a wheelchair purchase. Likewise, if it is assessed that a wheelchair user cannot operate a manual wheelchair on his or her own but can safely operate an electric wheelchair, the cost of a scooter will be covered instead.

All of this is assuming, of course, that the coverage recipient has been assessed by a physician and found to need this equipment in order to perform basic activities of daily living inside the home.

While mobility aids like wheelchairs, walkers and scooters are less restrictively covered under Medicare Part B than they may be under a Medicaid waiver, Medicaid can cover Medicare Part A premium payments. Additionally, Medicaid covers other auxiliary mobility products and services.

Mobility-specific Medicaid coverage can also include reimbursement for:

• Personal care services (bathing, eating, transferring to and from chair etc.)
• Prosthetics
• Chiropractic services
• Physical therapy

Medicare is a tax-funded program that offers health insurance for American citizens who are 65 or older, or who have certain disabilities that would qualify them for early coverage. For people who have worked and paid taxes for at least 10 years, Medicare is available at a low cost. Medicare Part A is premium-free for those who are disabled Social Security recipients or who have had Medicare-covered government employment. However, many recipients pay a premium, a co-pay and a deductible as with other forms of health insurance.

Wheelchair users can benefit from multiple parts of Medicare:

• Medicare Part A, otherwise known as hospital insurance, covers services like home health care and hospital stays.
• Medicare Part B may be the most important source of coverage for wheelchair users, as it is considered general medical insurance and accounts for costs associated with medical equipment such as scooters, wheelchairs and prosthetics.
• Medicare Part C is like a combination of Parts A, B and D, though unlike those government-offered plans, Part C is offered through private insurance companies.
• Medicare Part D helps cover the cost of prescription drugs.

Once confirmation is obtained from a physician that a wheelchair is required in order for a Medicare recipient to function in the home, Medicare Part B plans will cover all but 20% of the total Medicare-approved costs for a needed device as long as deductibles are paid up front. For those who have supplemental Medicare insurance, the remaining 20% of costs may be covered as well. Premiums for Part B are higher for people in higher income brackets, but for low-income recipients, premiums are low and may be covered by Medicaid.

The Medicare Part B Wheelchair and Scooter Benefit applies to people who:

• Have written notice from a physician stating their need for a wheelchair
• Individuals who have limited mobility and meet all of the following five conditions:
  • They have a medical condition that causes significant difficulty to move around inside the home.
  • They cannot perform activities of daily living with only a cane or walker.
  • They can safely operate a wheelchair or scooter, or always have an aide available.
  • They have a doctor and medical equipment supplier who are Medicare-enrolled.
  • A doctor or supplier visited their home and verified all surfaces and doorways are compatible with the device.

Social Security is a tax-funded benefits program for previously employed people who are unable to work due to a disability or who are still working and are very low-income. Recipients who have been working and paying Social Security taxes for a number of years can typically qualify for benefits as long as the Administration considers them disabled. Additionally, low-income people with disabilities can qualify for Supplemental Security benefits.

However, determining if you qualify can be a highly complicated process. Even if you use a wheelchair most or all the time, the Social Security Administration may not consider you technically ‘disabled’. The SSA grants coverage based on how severe and debilitating an applicant’s disability is and uses three main questions to determine whether one may qualify:

• Are you working? If you have been working during the year in which you apply and you have made $1,470 per month (effective January 2023), the Social Security Administration may not consider you disabled due to your proven ability to function regardless of your disability.
• Is your condition ‘severe’? If your condition does not significantly limit your ability to perform basic maneuvers required for work, like standing, lifting, walking and remembering, the SSA may not  consider you disabled.
• Is your condition found on the SSA list of disabilities? Even if your condition does not currently limit your ability to work, if it is found on the list of disabling conditions, there is still a chance that you could qualify. The SSA keeps separate lists of disabling conditions for adults and children. Some conditions, such as ALS (Lou Gehrig’s disease) and renal disease qualify applicants automatically.

For disabled veterans and service members, there are multiple avenues of relief from the often high costs associated with having a disability. The U.S. Department of Veterans Affairs offers aid with mobility devices, assisted living costs and transitional expenses.

The Department of Veterans Affairs has traditionally covered the cost of mobility aids and prosthetics for qualifying individuals. However, the VA also provides funding and regulation for multiple types of residential care facilities across the country, including assisted living facilities, and can offer veterans aid in locating and planning their care. Additionally, the VA operates two Armed Forces Retirement Homes — one in D.C. and one in Gulfport, Mississippi — which provide assisted living and skilled care services.

To find out more about disability benefits, residential care or in-home care, call the VA Health Care Benefits number at (877) 222-8387, or contact your local VA Regional Benefits Office.

This benefit comes in the form of a cash addition to the military pension of veterans who are 65 or older or who are otherwise fully disabled. Eligible veterans must have been enlisted for at least 90 days and on active duty for at least one day during their service. Applicants for the Aid and Attendance benefit must have income and assets up to a set limit, and they must require the aid and attendance of another person to function at home or be otherwise housebound.

A physician must attest to an applicant’s need for this benefit, and if applying veterans request the benefit to help them pay for a stay in an assisted living facility, the facility’s administrators must also attest to the veteran’s need for the level of care offered at the facility. This benefit can provide up to $2,000 per month depending on various factors and can be used to cover costs for assisted living, mobility equipment or anything else the recipient desires.

To apply for the Aid and Attendance benefit, write to the Pension Management Center (PMC) that serves your state. For further details, visit Benefits.VA.gov.

Veterans may receive VA-subsidized personal care services while they are living at home or in an assisted living community. The HCBS program is intended for veterans who may be eligible for a nursing home level of care, offering coverage with the aim of helping veterans avoid nursing home placement for as long as possible. The main benefit of the program to assisted living residents is that it can reduce the costs charged by an assisted living facility for services rendered beyond the basic cost of room and board.

The services provided under this program require veterans and their families to dictate how best to meet their own care needs, which means the veterans or their caregivers must take responsibility for creating a care plan and then selecting and hiring service providers.

Payments and finances for care services are largely handled by a Finance Management Service (FMS), which allocates payments to service providers upon pre-approval by care recipients.

When searching for information on this program, it helps to understand that it is referred to by many names. Among them are:

• Veterans-Directed Home and Community-Based Services (VD-HCBS)
• Cash and Counseling for Veterans
• Veterans Community Living Program (CLP-VDHCBS)
• Veterans Independence Plus Program
• Veteran-Directed Home Services (VDHS)

This program may not currently be available in all states, but there is an effort underway to expand it nationwide. VD-HCBS programs are administered through VA medical centers in conjunction with the Area Agencies on Aging. For more information or to begin the sign-up process, find your local Area Agency on Aging office location.

Finding the right care setting for your budget and particular needs can be a daunting task, but you don’t have to do it alone. A team of senior care advocates is available at the Caring.com call center to help seniors and wheelchair users all over the country find local care options. To find an appropriate residence in your area, speak with a Caring.com Family Advisor toll free at (800) 973-1540.

• https://www.ada.gov/ada_intro.htm
• https://www.nytimes.com/2018/04/30/health/wheelchairs-assisted-living.html
• https://www.genworth.com/aging-and-you/finances/cost-of-care.html
• https://www.kff.org/other/state-indicator/medicaid-eligibility-through-the-medically-needy-pathway/
• https://www.medicaid.gov/medicaid/benefits/list-of-benefits/index.html
• https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html
• https://www.medicareadvocacy.org/medicare-info/medicare-coverage-for-people-with-disabilities/
• https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
• https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
• https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
• https://www.medicare.gov/Pubs/pdf/11046-Medicare-Wheelchair-Scooter.pdf
• https://www.cms.gov/research-statistics-data-and-systems/research/mcbs/downloads/2008_appendix_b.pdf
• https://www.medicare.gov/supplierdirectory/search.html
• https://www.ssa.gov/benefits/ssi/
• https://www.ssa.gov/planners/disability/qualify.html#anchor3
• https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm
• https://www.va.gov/geriatrics/guide/longtermcare/Nursing_Home_and_Residential_Services.asp
• https://www.va.gov/geriatrics/guide/longtermcare/Assisted_Living.asp
• https://www.afrh.gov/
• https://www.va.gov/disability/eligibility/
• https://www.va.gov/directory/guide/division.asp?dnum=3
• https://www.benefits.va.gov/PENSION/resources-contact.asp
• https://www.benefits.va.gov/pension/aid_attendance_housebound.asp