A Community Is Enabled Through the Reuse of Walkers, Wheelchairs and More

A decade ago in Hazard, Kentucky, home of the University of Kentucky Center of Excellence in Rural Health, physical therapists from four health programs met and shared a common complaint. Used wheelchairs, walkers, canes, crutches and other durable medical equipment desperately needed by their patients were routinely thrown away. The items ending up rotting and rusting in landfills.

“We had people who literally couldn’t afford the $10 copay,” recalls Patrick Kitzman, a doctor of physical therapy and a professor at the university since 2000. (A quarter of Hazard's residents live in poverty.)

In 2010, representatives from the programs formed a partnership and applied for, and received, a federal grant with which they created Project CARAT. (The acronym stands for "Coordinating and Assisting the Reuse of Assistive Technology.") 

A project of the Kentucky Appalachian Rural Rehabilitation Network (KARRN), CARAT collects used durable medical equipment items from donors, hospitals and health care providers. The items are sanitized, repaired, sometimes customized, and distributed for free to uninsured, underinsured and other Kentuckians in need. Three-quarters of the people served by CARAT are older than 50. 

Training Therapists and Equipping a Makerspace

Two years after the program's formation, Kitzman enlisted his physical therapy students at the University of Kentucky as its first service-learning cohort.

“When I did in-patient physical therapy, I was always having to MacGyver somebody's wheelchair because it was so beaten up,” he explains. “I figured we might as well teach students how to do it correctly from the beginning. They help clean, fix the equipment and get it out the door.”

The students work out of the university's Center of Excellence in Rural Health, which makes them well placed for securing donations. “They do clinical rotations. When they’re at the hospitals or clinics, they talk about our program,” Kitzman says.

A 2022 AARP Community Challenge grant enabled CARAT to acquire equipment (see box, above) for its "makerspace" room at the center, where the acquired gear is also used by CARAT-TOP, a 10-week intergenerational voluteering program that brings together high school students and older adults in eastern Kentucky's Perry County. 

In 2022, CARAT-TOP’s inaugural year, 17 students from both the traditional and special education tracts at Perry County Central High School learned how to use tools and technology to refuburish durable medical equipment as well as toys.

“The toys are a new avenue for us to work within the community and it's been the one that seems to have struck a chord with so many different groups,” Kitzman says. “A very low-tech toy is a wooden puzzle. By using a drill press, we can drill holes and add pegs so kids who have problems with grasping can now grasp and play with the puzzle.”

Teens in the CARAT-TOP program also learn about budgeting and how to request meetings with local leaders. For their class project, the students chose to adapt a playground so it could be used by children who have disabilities.

“Our students have become leaders and innovative thinkers while working with the CARAT-TOP program,” said school principal Michelle Ritchie. “They have learned to care not only about their school but the community. The experience is going to benefit them for the rest of their lives.”

Serving People of All Ages

Wheelchairs, which typically cost from $500 to $2,000, get beat up with use. Most insurance companies will only pay for a replacement once every five years. But they’re not the most requested item by CARAT’s clients. That honor goes to bath benches (also known as a shower seat or bath-and-shower transfer bench), which Medicare and most insurance companies won’t cover since the seating is not considered to be medically necessary.

“The bathroom is the most dangerous room in your house because it gets wet," says Kitzman. "Getting in and out of your tub is dangerous, especially if someone doesn’t have good balance or movement. A bath bench is not a luxury.”

Children with a range of disabilities and differences are often in need of customized toys. “A standard off-the-shelf toy might not be usable by children who have motor, visual or sensory issues,” says Kitzman, who explains that adding weighted bags to some toys, such as a stuffed animal, can be helpful to a child who has sensory challenges. “It's the same as when we put weights on a cane or a walker for older clients who don't have good sensation in their extremities," Kitzman notes.

Students from several of the university’s departments, including engineering, assist with the toy revamps. “Toys we’re working on have lots of components, like multiple switches,” explains Kitzman. “The students figure out how to turn the sound down for individuals who don’t like loud sounds, or how to make lights brighter for kids with low vision. Students are even creating handsfree connections to toys.”

The toy work, says Kitzman, “let's us make the world a little bit easier for kids."

Results Lead to Funding

CARAT has eight sites across Kentucky. The organization has refurbished and distributed some $3.5 million in equipment since its founding.

Kitzman reports that CARAT’s 2022 AARP Community Challenge grant led to the organization receiving additional public and private grant funding ($156,000 and $125,000, respectively). The latter came in March 2023 from Toyota Motor Manufacturing Kentucky to support the new Appalachian Center for Assistive Technology, or ACAT, located in Hazard at the Center of Excellence in Rural Health. 

The center will serve the disability population in eastern Kentucky through education, demonstrations and loans of assistive technology. The makerspace allows for the rapid adapting of equipment to meet individuals’ needs. The ACAT will also serve as a training site for aspiring disability and accessibility aides and professionals, such as speech-language pathologists, physical therapists and occupational therapists.

_{Reporting by Amy Lennard Goehner | Page published May 2023}

Watch a Video About Project CARAT