How to prescribe a shower chair? A comprehensive guide for healthcare providers

According to a 2018 study, approximately 80% of falls in the home occur in the bathroom. Knowing how to prescribe a shower chair correctly is a crucial step for healthcare providers in preventing these incidents and ensuring patient safety during bathing. This guide offers a comprehensive look at the process, from assessment to documentation.

Quick Summary

Prescribing a shower chair requires a thorough medical necessity assessment, followed by careful selection of the appropriate equipment based on the patient’s condition, mobility, and home environment, with precise documentation for insurers.

Key Points

• Medical Necessity is Key: A shower chair prescription must be medically justified and documented, typically for patients who cannot stand safely or transfer independently during bathing.

• Patient-Centered Assessment: Evaluate the patient's specific needs, including balance, strength, mobility, and weight, as well as their bathroom's layout to determine the best equipment type.

• Match Equipment to Need: Different shower chairs (stools, standard, transfer benches, rolling) serve different purposes. Selecting the wrong one can be ineffective or unsafe.

• Thorough Documentation: The prescription and medical records must clearly state the patient's diagnosis and why the chair is necessary, especially for insurance purposes.

• Patient and Caregiver Education: Instruction on proper use, safety precautions, and maintenance is essential for preventing accidents and ensuring the chair is used correctly.

Understanding the Need: The Clinician's Role

As a healthcare provider, your role in prescribing a shower chair goes beyond a simple recommendation. It involves a detailed assessment of the patient's physical limitations, safety risks, and overall functional independence. A properly prescribed shower chair can significantly reduce the risk of falls, conserve a patient's energy, and promote greater independence in performing daily hygiene tasks. Failing to identify the specific needs can lead to inappropriate equipment, potentially increasing the risk of accidents rather than preventing them.

Assessing Medical Necessity

For a shower chair to be considered medically necessary, a patient must meet specific clinical criteria. While rules vary by state and insurer, common indications include:

• Inability to Stand Safely: The patient cannot stand independently for the duration of a shower or is at a high risk of falling due to poor balance, weakness, or fatigue.
• Difficulty Transferring: The patient requires significant assistance to transfer into or out of a tub or shower, or cannot do so safely without risking a fall.
• Specific Medical Conditions: Conditions such as arthritis, multiple sclerosis, paralysis, Parkinson's disease, or post-surgical recovery that impact balance, strength, or endurance.
• Injuries or Infections: An injury or infection of the perianal area that necessitates sitting during bathing to maintain proper hygiene.
• Cognitive Impairment: Some cognitive conditions that increase the risk of falls due to impaired judgment or spatial awareness.

Step-by-Step Prescription and Documentation Process

Following a systematic approach ensures all requirements are met for the patient and their insurance provider.

1. Perform a Comprehensive Patient Assessment: Evaluate the patient's specific physical needs, including their strength, balance, mobility, and any cognitive impairments. Conduct a physical examination and take a detailed history.
2. Document Medical Necessity: In the patient's medical record, clearly and thoroughly document the clinical reasons for the shower chair. Include details about the patient's condition, why alternative methods are not suitable, and how the equipment will mitigate risk.
3. Determine the Appropriate Equipment: Consider the patient's weight, mobility level, and the bathroom's layout. Does the patient need a rolling chair? A transfer bench? Is a bariatric model required? Specify this in the prescription.
4. Write the Prescription (Standard Written Order): The prescription must be written and signed by the licensed prescribing provider. It should include:
   • Patient's full name and address
   • Date of the order
   • Diagnosis justifying the need
   • Specific name or description of the equipment (e.g., “adjustable height shower chair with back and arms”)
   • Directions for use (e.g., “use daily for bathing”)
   • Prescriber's signature and address
5. Utilize Correct HCPCS Codes: In some cases, specific codes are necessary for billing. A standard bath/shower chair may use a code like E0240, but this varies based on location and specific equipment. Always verify codes with the insurer or DME supplier.
6. Coordinate with a DME Supplier: Work with a Durable Medical Equipment supplier to ensure the patient receives the correct device. The supplier will handle insurance claims and delivery.

Comparing Common Types of Shower Chairs

Type	Features	Best For	Considerations
Standard Shower Chair	Four legs, backrest, sometimes armrests, adjustable height.	Patients with mild balance issues who can step into a shower.	Ensure sufficient space in the shower stall.
Shower Stool	Backless, no armrests, compact design.	Individuals with good balance needing minimal support; small showers.	Requires better core strength and balance than a chair with a back.
Transfer Bench	Long bench spanning the tub edge, one end inside, one outside.	Patients who struggle to lift legs over the tub wall; high fall risk.	Requires clear space on both sides of the tub.
Rolling Shower Chair	Caster wheels, locking brakes, often doubles as a commode.	Patients with severe mobility issues requiring caregiver assistance.	Requires a larger, fully accessible bathroom or a roll-in shower.
Bariatric Chair	Wider, reinforced frame, higher weight capacity.	Obese patients requiring extra support and stability.	Check weight capacity and dimensions carefully.

Educating Patients and Caregivers

Your role doesn't end with the prescription. Educating the patient and their caregivers on proper and safe use is vital for preventing accidents. Provide instructions on:

• How to properly sit down and stand up from the chair.
• Locking the wheels or ensuring all feet are securely on the floor.
• Positioning the chair correctly to prevent slipping.
• Maintenance and cleaning to prevent rust, mold, or mildew.
• Adding other safety equipment like grab bars and non-slip mats.

A Note on Insurance and DME Coverage

While many shower chairs are considered "convenience items" and not covered by Medicare, exceptions and specific coverages exist. Medicare Part B may cover items classified as durable medical equipment (DME), and some rolling shower commodes may qualify if deemed medically necessary for toileting. Medicaid policies vary by state but often provide broader coverage for such items when prescribed. Always review the specific policy details and work with the supplier to ensure proper billing.

For additional information on medical necessity criteria and related policies, you can consult specific guidelines, such as those provided by individual insurers or state health departments. Aetna's clinical policy bulletins offer an example of the kind of detailed medical necessity criteria that may apply.

Conclusion

Prescribing a shower chair is a critical intervention for promoting safety and independence in at-risk patients. By following a structured process of careful assessment, detailed documentation, and patient education, healthcare providers can ensure the right equipment is selected and utilized effectively. This diligence helps to mitigate fall risks and supports healthy, independent living for seniors and other individuals with mobility challenges.

Frequently Asked Questions

Who can write a prescription for a shower chair?

A licensed healthcare provider, such as a physician (MD/DO), nurse practitioner (NP), or physician assistant (PA), can write a prescription for a shower chair based on a medical necessity assessment.

Is a shower chair considered Durable Medical Equipment (DME) by most insurers?

No, many insurers, including Original Medicare, categorize standard shower chairs as 'convenience items' and not DME. However, some types, like rolling shower commodes, may be covered if deemed medically necessary for specific conditions, and Medicaid policies often differ.

What documentation is required to get a shower chair covered by insurance?

In addition to a signed prescription, the patient’s medical record should include detailed documentation justifying the medical necessity. This includes the patient's diagnosis, functional limitations, and why a shower chair is required for safety and independence during bathing.

How do I choose between a shower stool and a shower chair for a patient?

A shower stool is suitable for patients with better balance and core strength who need minimal support. A standard shower chair with a backrest and arms provides more stability and is better for patients with significant balance issues or weakness.

What is the role of a DME supplier in this process?

The DME supplier provides the equipment, assists with insurance claims, and may handle delivery and setup. They work with the prescribing clinician and patient to ensure the correct device is provided based on the prescription and medical need.

Can a shower chair prescription help prevent falls in the bathroom?

Yes, prescribing a shower chair can be a highly effective fall prevention strategy. By providing a stable seated position, it reduces the risk of slips and falls that can occur while standing on a wet, slippery surface.

What should be included in a prescription for a shower chair?

A prescription should include the date, the patient's name and diagnosis, a specific description of the shower chair needed, and the prescribing clinician's signature and contact information.