Spinal Cord Injuries: The Economic Aftermath of Quadriplegia

This case study evaluates the economic impact of medical care, rehabilitation and life support services and equipment necessary for a C-7 spinal cord injury survivor, age 20, who additionally suffers from a shoulder injury and a neurogenic bowel and bladder.

This economic analysis has been customized to accommodate changing health and care needs as this young prototypical quadriplegic ages, and considers differing needs during advancing stages in life: ages 20 to 35, 35 to 55 and 55 and beyond. Understandably, the aging process is extraordinarily vicious on survivors of spinal cord injuries and takes its greatest toll during the last chapters of life.

The probable future costs for spinal cord injury related surgical interventions and hospitalizations, have not been cost-factored in this analysis and lost income from earnings and investments are not included.

This is an example of a customized lifecare plan to address special needs, which will differ from person to person.

I. HEALTH AND HUMAN SERVICES COSTS FROM AGE 20 TO 35

A. MEDICAL-HEALTH CONSULTATIONS AND INTERVENTIONS

Access, on an as needed basis (PRN), to a combination of suitable and appropriate medical-health specialists (e.g., neurology, physiatry, orthopedics, urology, dermatology, gastroenterology, psychiatry, etc.), four to six times/year (5 X's per year median), $145.00 to $175.00/consultation ($160.00/consult median). Annual median cost of $ 800.00

B. ASSESSMENT AND EVALUATIVE SERVICES

Access on a PRN basis to a combination of suitable and appropriate services (e.g., radiology, MRI, CT, EMG, genito-urinary, pain assessments, sleep evaluations, etc.), $1,900.00 to $2,400.00 ($2,150.00/year median). Annual median cost of $2,150.00

C. ALLIED MEDICAL-HEALTH CONSULTATIONS

Access on a PRN basis to a combination of suitable and appropriate sources (e.g., podiatry, dietary-nutritional, kinesiology, pharmacology, clinical psychology, physical therapy, occupational therapy, vocational-avocational counseling, etc.), $125.00 to $145.00/consult ($135.00/consultation median), six to twelve times/year (9 X's per year median). Annual median cost $1,215.00

D. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

Access on a PRN basis to a combination of services (e.g., naturopathy, therapeutic massage, acupuncture/acupressure, neuro/bio-feedback, hypnotherapy, aquatherapy, ultra sound, hyperbaric oxygen therapy, etc.), a median of twelve times/year, $85.00 to $115.00/intervention ($100.00/intervention median). Annual median cost $ 1,200.00

E. THERAPY AND SUPPORT SERVICES

Access on a PRN basis to a combination of therapies (e.g., physical therapy, occupational therapy, psychological therapy, pain management, physical conditioning, vocational and avocational therapy, etc.), a median of twelve times/year, $125.00 to $145.00/intervention ($135.00/intervention median). Annual median cost of $1,620.00

F. REHABILITATION ADVOCACY AND MENTORING SERVICES

Monthly interventions from an advocate-mentor specialist for assistance in facilitating access to community integration, specialty sports and recreational programs, $150.00 to $250.00/consultation ($200.00 median). Annual median cost of $2,400.00

G. COMPANION-ATTENDANT CARE SERVICES

Healthcare services from a licensed, bonded, home health agency, four to eight hours/day (6 hours/day median; 2,190 hours/year), $16.00 to $20.00/hour ($18.00/hour median). Annual median cost of $39,420.00

H. HOMEMAKER-CHOREPERSON SERVICES

Access to a median of six hours/week (312 hours/year), from a licensed, bonded service, $12.00 to $15.00/hour ($13.50/hour median). Annual median cost of $4,212.00

I. RESIDENCE/PROPERTY MAINTENANCE AND REPAIR

Handyman services to maintain and repair the residence and immediately adjacent property, a median of one-hundred hours/year (1.9 hours/week median), $13.00 to $17.00/hour ($15.00/hour median). Annual median cost of $1,500.00

J. INPATIENT HABILITATION-REHABILITATION SERVICES

Periodic inpatient re-assessment and re-evaluation services in a specialty spinal cord injury center (e.g., Craig Hospital, Shepherd Spinal Center, Jackson Memorial Hospital, Spain Rehabilitation Center, etc.), to determine current and projected functional capacities, to explore the efficacy of emerging therapies and evolving technologies, every three to five years (4 years median), for a period of four to six days (5 days median), $2,200.00 to $2,600.00/day ($2,400.00/day median; $12,000.00/event median); per diem travel costs for patient and companion ($850.00 to $1,250.00/event; $1,050.00/event median); $13,050.00/event median. Annual median amortized cost $3,262.50

K. MEMBERSHIPS AND SUBSCRIPTIONS

Memberships in organizations promoting the plight of the spinal cord injured and subscription to periodicals concerning new equipment, supplies and therapeutic approaches, $250.00 to $350.00/year ($300.00/year median). Annual median cost $300.00

ANNUAL MEDIAN AMORTIZED COST FOR HEALTH & HUMAN SERVICES AGE 20 TO 35: $58,079.50

II. DURABLE GOODS AND EXPENDABLE COMMODITIES FROM AGE 20 TO 35

A. ARCHITECTURAL REQUIREMENTS

Modification, renovation and remodeling of a 1600 square foot, single-family residence into a barrier-free, wheelchair accessible living and property environment. Widening of hallways and doorways, installation of ramps, railings, grab bars, roll-in shower, power actuated door systems, slings and transfer systems. Space provision for therapy, physical conditioning and storage of durable goods and supplies. Plumbing and electrical control and switch modifications. Construction of covered passageway between residence and transportation. A construction cost range of $150,000.00 to $200,000.00 ($175,000.00 median), with a seven to twelve year useful life (9.5 years median). Annual median cost of $18,421.05

B. ROLL-IN SHOWER MODULE

Modular roll-in shower system with plumbing fixtures and accessories, $2,695.00 to $2,950.00 ($2,822.50 median), with a 9.5 year median useful life. Annual median cost of $ 297.11

C. POWER ACTUATED DOOR SYSTEM

Front and rear electrically actuated door entrances/exits, $1,150.00 to $1,350.00 ($1,250.00 median each; $2,500.00/two), with a 9.5 year median useful life. Annual median amortized cost of $ 263.16

D. ENVIRONMENTAL CONTROL SYSTEM

Voice-actuated or switch controlled wireless ECS for safe access to numerous electrical appliances and devices within the residence, $1,995.00 to $2,350.00 ($2,172.50 median), with a ten year useful life. Annual median amortized cost of $ 217.25

E. IN-HOME PHYSICAL EXERCISE AND CONDITIONING APPARATUS

A wheelchair accessible home gym exercise and conditioning system, $4,995.00 to $5,675.00 ($5,335.00 median), with a ten year useful life. Annual median amortized cost of $ 533.50

F. SPECIALTY BED SYSTEM WITH PRESSURE RELIEF MATTRESS AND ACCESSORIES

A variably adjustable bed system with pressure relief mattress and transfer devices, $3,999.00 to $4,445.00 ($4,222.00 median), with a ten year useful life. Annual median amortized cost of $ 422.20

G. STANDING FRAME

A standing frame with accessories, $1,350.00 to $1,595.00 ($1,472.50 median), with a ten year useful life. Annual median amortized cost of $ 147.25

H. MANUAL WHEELCHAIR AND ACCESSORIES

A mechanical wheelchair with seating system and accessories, $2,895.00 to $3,350.00 ($3,122.50 median), with a four year useful life. Annual median amortized cost of $ 780.63

I. MANUAL WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $175.00. Annual median cost of $175.00

J. RECREATION-SPORTS SPECIALTY CHAIR

A specially designed and accessorized recreation-sports chair for use in sports activities (e.g., rugby, tennis, basketball) and as a backup chair when the manual wheelchair is in repair, $3,975.00 to $4,450.00 ($4,212.50 median), with a two to four year useful life (3 years median). Annual median cost of $1,404.17

K. RECREATION-SPORTS WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $250.00. Annual median cost of $250.00

L. MANUAL TRANSPORT DEVICES

An all-terrain conveyance (e.g., Natural Access Beach Chair, Iron Horse, Downhill Racer, etc.), for use in sand, snow or rough terrain; a recumbent handcycle, etc., $6,450.00 to $7,395.00 ($6,922.50 median), with a three to five year useful life (4 years median). Annual median amortized cost of $1,730.63

M. MANUAL TRANSPORT MAINTENANCE AND REPAIR

A median annual cost of $300.00. Annual median cost of $300.00

N. SHOWER-COMMODE CHAIR

A specialty chair for commode and roll-in shower use, $2,875.00 to $3,250.00 ($3,062.50 median), with a six year useful life. Annual median amortized cost of $ 510.42

O. ORTHO-BIOTIC CHAIR

Height adjustable chair for ease in wheelchair transfers with swivel and recline functions, $795.00 to $950.00 ($872.50 median), with a ten year useful life. Annual median amortized cost of $ 87.25

P. SPECIALTY FURNITURE

Wheelchair accessible desk with Lazy Susan access features; height adjustable and accessible table; over-the-bed table; computer desk with wheelchair accessible features, $3,275.00 to $3,499.50 ($3,387.25 median), with a ten year useful life. Annual median amortized cost of $ 338.73

Q. SPECIALTY CLOTHING AND FOOTWEAR

Clothing designed for ease of dressing and undressing (velcro closures, no buttons, zippers or snaps); footwear designed for unassisted access; wheelchair rain poncho and gloves, etc., $400.00 to $500.00/year ($450.00/year median). Annual median cost of 450.00

R. ASSISTIVE AND ADAPTIVE DEVICES

Reachers, extenders, ADL aids for hygiene, eating and personal care, $500.00 to $600.00 ($550.00 median), with a four year useful life. Annual median amortized cost of $ 137.50

S. TRANSPORTATION REQUIREMENTS

Modified ramp or lift van, four-door pickup or P.T. Cruiser with hand controls, tie-downs and other suitable and appropriate accessories; $41,500.00 to $47,250.00 ($44,375.00 median), with a seven year or 84,000 mile useful life; end-use equity of $4,400.00 ($39,975.00); subtraction for the median cost of a mid-size automobile ($16,500.00), $23,475.00 differential. Annual median amortized cost of $3,353.57

T. OPERATIONAL COST/MILE DIFFERENTIAL

The cost/mile differential of a van or truck ($0.49/mile) and a mid-size automobile ($0.29), assuming 12,000 miles/year driving. Annual cost differential $2,400.00

U. HOME HEALTH MONITORING EQUIPMENT

The cost of an otic thermometer, pulse meter, digital blood pressure gauge, bladder scan and genitourinary inspection mirror, etc., $2,995.00 to $3,245.00 ($3,120.00 median), with an eight year useful life. Annual median amortized cost of $ 390.00

V. PHARMACEUTICALS, NUTRACEUTICALS, PATIENT MEDICINES AND SUPPLIES

Prescriptive and non-prescriptive medications; salves, powders, ointments, emollients; food supplements; bowel-bladder incontinence devices; suppositories and enemas; disposable undergarments, bed pads and gloves, $375.00 to $450.00/month $412.50/month median). Annual median amortized cost $ 4,950.00

ANNUAL COST FOR DURABLE GOODS & EXPENDABLES AGE 20 TO 35: $37,559.42

ANNUAL COST FOR GOODS AND SERVICES AGE 20 TO 35: $95,638.92

III. HEALTH AND HUMAN SERVICES COSTS FROM AGE 35 TO 55

A. MEDICAL-HEALTH CONSULTATIONS AND INTERVENTIONS

Access, on an as needed basis (PRN), to a combination of suitable and appropriate medical-health specialists (e.g., neurology, physiatry, orthopedics, urology, dermatology, gastroenterology, psychiatry, etc.), three to five times/year (4 X's per year median), $145.00 to $175.00 PER consultation ($160.00/consult median). Annual median cost of $ 640.00

B. ASSESSMENT AND EVALUATIVE SERVICES

Access on a PRN basis to a combination of suitable and appropriate services (e.g., radiology, MRI, CT, EMG, genito-urinary, pain assessments, sleep evaluations, etc.), $1,650.00 to $1,950.00 ($1,800.00/year median). Annual median cost of $1,800.00

C. ALLIED MEDICAL-HEALTH CONSULTATIONS

Access on a PRN basis to a combination of suitable and appropriate sources (e.g., podiatry, dietary-nutritional, kinesiology, pharmacology, clinical psychology, physical therapy, occupational therapy, vocational-avocational counseling, etc.), $125.00 to $145.00/consult ($135.00/consultation median), twelve times/year median. Annual median cost $ 1,620.00

D. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

Access on a PRN basis to a combination of services (e.g., naturopathy, therapeutic massage, acupuncture/acupressure, neuro/bio-feedback, hypnotherapy, aquatherapy, ultra sound, hyperbaric oxygen therapy, etc.), a median of twelve times/year, $85.00 to $115.00/intervention ($100.00/intervention median). Annual median cost $ 1,200.00

E. THERAPY AND SUPPORT SERVICES

Access on a PRN basis to a combination of therapies (e.g., physical therapy, occupational therapy, psychological therapy, pain management, physical conditioning, vocational and avocational therapy, etc.), a median of twelve times/year, $125.00 to $145.00/intervention ($135.00/intervention median). Annual median cost of $1,620.00

F. REHABILITATION ADVOCACY AND MENTORING SERVICES

Monthly interventions from an advocate-mentor specialist for assistance in facilitating access to community integration, specialty sports and recreational programs, $150.00 to $250.00/consultation ($200.00 median). Annual median cost of $1,200.00

G. COMPANION-ATTENDANT CARE SERVICES

Healthcare services from a licensed, bonded, home health agency, a median of eight hours/day (2,920 hours/year) $16.00 to $20.00/hour ($18.00/hour median). Annual median cost of $52,560.00

H. HOMEMAKER-CHOREPERSON SERVICES

Access to a median of six hours/week (312 hours/year), from a licensed, bonded service, $12.00 to $15.00/hour ($13.50/hour median).

Annual median cost of $4,212.00

I. RESIDENCE/PROPERTY MAINTENANCE AND REPAIR

Handyman services to maintain and repair the residence and immediately adjacent property, a median of one-hundred hours/year (1.9 hours/week median), $13.00 to $17.00/hour ($15.00/hour median). Annual median cost of $1,500.00

J. INPATIENT HABILITATION-REHABILITATION SERVICES

Periodic inpatient re-assessment and re-evaluation services in a specialty spinal cord injury center (e.g., Craig Hospital, Shepherd Spinal Center, Jackson Memorial Hospital, Spain Rehabilitation Center, etc.), to determine current and projected functional capacities, to explore the efficacy of emerging therapies and evolving technologies, every three to five years (5 years median), for a period of four to six days (5 days median), $2,200.00 to $2,600.00/day ($2,400.00/day median; $12,000.00/event median); per diem travel costs for patient and companion ($850.00 to $1,250.00/event; $1,050.00/event median); $13,050.00/event median. Annual median amortized cost $2,610.00

K. MEMBERSHIPS AND SUBSCRIPTIONS

Memberships in organizations promoting the plight of the spinal cord injured and subscription to periodicals concerning new equipment, supplies and therapeutic approaches, $250.00 to $350.00/year ($300.00/year median). Annual median cost $300.00

ANNUAL MEDIAN AMORTIZED COST FOR HEALTH & HUMAN SERVICES AGE 35 TO 55: $69,262.00

IV. DURABLE GOODS AND EXPENDABLE COMMODITIES AGE 35 TO 55

A. ARCHITECTURAL REQUIREMENTS

Modification, renovation and remodeling of a 1600 square foot, single-family residence into a barrier-free, wheelchair accessible living and property environment. Widening of hallways and doorways, installation of ramps, railings, grab bars, roll-in shower, power actuated door systems, slings and transfer systems. Space provision for therapy, physical conditioning and storage of durable goods and supplies. Plumbing and electrical control and switch modifications. Construction of covered passageway between residence and transportation. A construction cost range of $150,000.00 to $200,000.00 ($175,000.00 median), with a seven to twelve year useful life (9.5 years median). Annual median cost of $18,421.05

B. ROLL-IN SHOWER MODULE

Modular roll-in shower system with plumbing fixtures and accessories, $2,695.00 to $2,950.00 ($2,822.50 median), with a 9.5 year median useful life. Annual median cost of $ 297.11

C. POWER ACTUATED DOOR SYSTEM

Front and rear electrically actuated door entrances/exits, $1,150.00 to $1,350.00 ($1,250.00 median each; $2,500.00/two), with a 9.5 year median useful life. Annual median amortized cost of $ 263.16

D. SLINGS-LIFTS-TRANSFER DEVICES

Mobile or ceiling mounted sling, lift or transfer devices for independent ambulation and mobility within the residence, $8,920.00 to $9,995.00 ($9,457.50 median) with a 9.5 year useful life. Annual median amortized cost of $ 995.53

E. ENVIRONMENTAL CONTROL SYSTEM (ECS)

Voice-actuated or switch controlled wireless ECS for safe access to numerous electrical appliances and devices within the residence, $1,995.00 to $2,350.00 ($2,172.50 median), with a ten year useful life. Annual median amortized cost of $ 217.25

F. IN-HOME PHYSICAL EXERCISE AND CONDITIONING APPARATUS

A wheelchair accessible home gym exercise and conditioning system, $4,995.00 to $5,675.00 ($5,335.00 median), with a ten year useful life. Annual median amortized cost of $ 533.50

G. SPECIALTY BED SYSTEM WITH PRESSURE RELIEF MATTRESS AND ACCESSORIES

A variably adjustable bed system with pressure relief mattress and transfer devices, $3,999.00 to $4,445.00 ($4,222.00 median), with a ten year useful life. Annual median amortized cost of $ 422.20

H. STANDING FRAME

A standing frame with accessories, $1,350.00 to $1,595.00 ($1,472.50 median), with a ten year useful life. Annual median amortized cost of $ 147.25

I. MANUAL WHEELCHAIR AND ACCESSORIES

A mechanical wheelchair with seating system and accessories, $2,895.00 to $3,350.00 ($3,122.50 median), with a four year useful life. Annual median amortized cost of $ 780.63

J. MANUAL WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $175.00. Annual median cost of 175.00

K. MOTORIZED WHEELCHAIR AND ACCESSORIES

A battery-powered wheelchair with seating system and accessories, $8,995.00 to $9,845.00 ($9,420.00 median), with a seven year useful life. Annual median amortized cost of $1,345.71

L. MOTORIZED WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $350.00. Annual median cost of $350.00

M. RECREATION-SPORTS SPECIALTY CHAIR

A specially designed and accessorized recreation-sports chair for use in sports activities (e.g., rugby, tennis, basketball) and as a backup chair when the manual wheelchair is in repair, $3,975.00 to $4,450.00 ($4,212.50 median), with a two to four year useful life (3 years median). Annual median cost of 1,404.17

N. RECREATION-SPORTS WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $250.00. Annual median cost of $250.00

O. MANUAL TRANSPORT DEVICES

An all-terrain conveyance (e.g., Natural Access Beach Chair, Iron Horse, Downhill Racer, etc.), for use in sand, snow or rough terrain; a recumbent handcycle, etc., $6,450.00 to $7,395.00 ($6,922.50 median), with a three to five year useful life (4 years median). Annual median amortized cost of $1,730.63

P. MANUAL TRANSPORT MAINTENANCE AND REPAIR

A median annual cost of $300.00. Annual median cost of $300.00

Q. SHOWER-COMMODE CHAIR

A specialty chair for commode and roll-in shower use, $2,875.00 to $3,250.00 ($3,062.50 median), with a six year useful life. Annual median amortized cost of $510.42

R. ORTHO-BIOTIC CHAIR

Height adjustable chair for ease in wheelchair transfers with swivel and recline functions, $795.00 to $950.00 ($872.50 median), with a ten year useful life. Annual median amortized cost of $87.25

S. SPECIALTY FURNITURE

Wheelchair accessible desk with Lazy Susan access features; height adjustable and accessible table; over-the-bed table; computer desk with wheelchair accessible features, $3,275.00 to $3,499.50 ($3,387.25 median), with a ten year useful life. Annual median amortized cost of $338.73

T. SPECIALTY CLOTHING AND FOOTWEAR

Clothing designed for ease of dressing and undressing (velcro closures, no buttons, zippers or snaps); footwear designed for unassisted access; wheelchair rain poncho and gloves, etc., $400.00 to $500.00/year ($450.00/year median). Annual median cost of $450.00

U. ASSISTIVE AND ADAPTIVE DEVICES

Reachers, extenders, ADL aids for hygiene, eating and personal care, $500.00 to $600.00 ($550.00 median), with a four year useful life. Annual median amortized cost of $137.50

V. TRANSPORTATION REQUIREMENTS

Modified ramp or lift van, four-door pickup or P.T. Cruiser with hand controls, tie-downs and other suitable and appropriate accessories; $41,500.00 to $47,250.00 ($44,375.00 median), with a seven year or 84,000 mile useful life; end-use equity of $4,400.00 ($39,975.00); subtraction for the median cost of a mid-size automobile ($16,500.00), $23,475.00 differential. Annual median amortized cost of $3,353.57

W. OPERATIONAL COST/MILE DIFFERENTIAL

The cost/mile differential of a van or truck ($0.49/mile) and a mid-size automobile ($0.29), assuming 12,000 miles/year driving. Annual cost differential $2,400.00

X. HOME HEALTH MONITORING EQUIPMENT

The cost of an otic thermometer, pulse meter, digital blood pressure gauge, bladder scan and genitourinary inspection mirror, etc., $2,995.00 to $3,245.00 ($3,120.00 median), with an eight year useful life. Annual median amortized cost of $ 390.00

Y. PHARMACEUTICALS-NUTRACEUTICALS-PATIENT MEDICINES-SUPPLIES

Prescriptive and non-prescriptive medications; salves, powders, ointments, emollients; food supplements; bowel-bladder incontinence devices; suppositories and enemas; disposable undergarments, bed pads and gloves, $375.00 to $450.00/month $412.50/month median). Annual median amortized cost of $4,950.00

ANNUAL COST FOR DURABLE GOODS & EXPENDABLES AGE 35 TO 55: $40,200.66

ANNUAL COST FOR GOODS AND SERVICES AGE 35 TO 55: $109,462.66

V. HEALTH AND HUMAN SERVICES AGE 55 TO DEATH

A. MEDICAL-HEALTH CONSULTATIONS AND INTERVENTIONS

Access, on an as needed basis (PRN), to a combination of suitable and appropriate medical-health specialists (e.g., neurology, physiatry, orthopedics, urology, dermatology, gastroenterology, psychiatry, etc.), two to four times/year (3 X's per year median), $145.00 to $175.00 per consultation ($160.00/consult median). Annual median cost of $ 480.00

B. ASSESSMENT AND EVALUATIVE SERVICES

Access on a PRN basis to a combination of suitable and appropriate services (e.g., radiology, MRI, CT, EMG, genito-urinary, pain assessments, sleep evaluations, etc.), $1,500.00 to $1,750.00 ($1,625.00/year median). Annual median cost of $1,625.00

C. ALLIED MEDICAL-HEALTH CONSULTATIONS

Access on a PRN basis to a combination of suitable and appropriate sources (e.g., podiatry, dietary-nutritional, kinesiology, pharmacology, clinical psychology, physical therapy, occupational therapy, etc.), $125.00 to $145.00/consult ($135.00/consultation median), a median of six times per year median. Annual median cost $ 810.00

D. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

Access on a PRN basis to a combination of services (e.g., naturopathy, therapeutic massage, acupuncture/acupressure, neuro/bio-feedback, hypnotherapy, aquatherapy, ultra sound, hyperbaric oxygen therapy, etc.), a median of six times/year, $85.00 to $115.00 per intervention ($100.00 per intervention median). Annual median cost $ 600.00

E. THERAPY AND SUPPORT SERVICES

Access on a PRN basis to a combination of therapies (e.g., physical therapy, occupational therapy, psychological therapy, pain management, physical conditioning, vocational and avocational therapy, etc.), a median of six times/year, $125.00 to $145.00/intervention ($135.00/intervention median). Annual median cost of $ 810.00

F. REHABILITATION ADVOCACY AND MENTORING SERVICES

Quarterly interventions from an advocate-mentor specialist for assistance in facilitating access to community integration, specialty sports and recreational programs, $150.00 to $250.00/consultation ($200.00 median). Annual median cost of $ 800.00

G. COMPANION-ATTENDANT CARE SERVICES

Healthcare services from a licensed, bonded, home health agency, a median of twelve hours/day (4,380 hours/year) $16.00 to $20.00/hour ($18.00/hour median). Annual median cost of $78,840.00

H. HOMEMAKER-CHOREPERSON SERVICES

Access to a median of eight hours/week (416 hours/year), from a licensed, bonded service, $12.00 to $15.00/hour ($13.50/hour median). Annual median cost of $5,616.00

I. RESIDENCE/PROPERTY MAINTENANCE AND REPAIR

Handyman services to maintain and repair the residence and immediately adjacent property, a median of one-hundred hours/year (1.9 hours/week median), $13.00 to $17.00/hour ($15.00/hour median). Annual median cost of $1,500.00

J. INPATIENT HABILITATION-REHABILITATION SERVICES

Periodic inpatient re-assessment and re-evaluation services in a specialty spinal cord injury center (e.g., Craig Hospital, Shepherd Spinal Center, Jackson Memorial Hospital, Spain Rehabilitation Center, etc.), to determine current and projected functional capacities, to explore the efficacy of emerging therapies and evolving technologies, every five to seven years (6 years median), for a period of four to six days (5 days median), $2,200.00 to $2,600.00/day ($2,400.00/day median; $12,000.00/event median); per diem travel costs for patient and companion ($850.00 to $1,250.00/event; $1,050.00/event median); $13,050.00/event median. Annual median amortized cost $2,175.00

K. MEMBERSHIPS AND SUBSCRIPTIONS

Memberships in organizations promoting the plight of the spinal cord injured and subscription to periodicals concerning new equipment, supplies and therapeutic approaches, $250.00 to $350.00/year ($300.00/year median). Annual median cost $300.00

L. ANNUAL MEDIAN AMORTIZED COST FOR HEALTH & HUMAN SERVICES $93,556.00

VI. DURABLE GOODS AND EXPENDABLE COMMODITIES AGE 55 TO DEATH

A. ARCHITECTURAL REQUIREMENTS

Modification, renovation and remodeling of a 1600 square foot, single-family residence into a barrier-free, wheelchair accessible living and property environment. Widening of hallways and doorways, installation of ramps, railings, grab bars, roll-in shower, power actuated door systems, slings and transfer systems. Space provision for therapy, physical conditioning and storage of durable goods and supplies. Plumbing and electrical control and switch modifications. Construction of covered passageway between residence and transportation. A construction cost range of $150,000.00 to $200,000.00 ($175,000.00 median), with a seven to twelve year useful life (9.5 years median). Annual median cost of $18,421.05

B. ROLL-IN SHOWER MODULE

Modular roll-in shower system with plumbing fixtures and accessories, $2,695.00 to $2,950.00 ($2,822.50 median), with a 9.5 year median useful life. Annual median cost of $ 297.11

C. POWER ACTUATED DOOR SYSTEM

Front and rear electrically actuated door entrances/exits, $1,150.00 to $1,350.00 ($1,250.00 median each; $2,500.00/two), with a 9.5 year median useful life. Annual median amortized cost of $ 263.16

D. SLINGS-LIFTS-TRANSFER DEVICES

Mobile or ceiling mounted sling, lift or transfer devices for independent ambulation and mobility within the residence, $8,920.00 to $9,995.00 ($9,457.50 median) with a 9.5 year useful life. Annual median amortized cost of $ 995.53

E. ENVIRONMENTAL CONTROL SYSTEM (ECS)

Voice-actuated or switch controlled wireless ECS for safe access to numerous electrical appliances and devices within the residence, $1,995.00 to $2,350.00 ($2,172.50 median), with a ten year useful life. Annual median amortized cost of $ 217.25

F. IN-HOME PHYSICAL EXERCISE AND CONDITIONING APPARATUS

A wheelchair accessible home gym exercise and conditioning system, $4,995.00 to $5,675.00 ($5,335.00 median), with a ten year useful life. Annual median amortized cost of $ 533.50

G. SPECIALTY BED SYSTEM WITH PRESSURE RELIEF MATTRESS AND ACCESSORIES

A variably adjustable bed system with pressure relief mattress and transfer devices, $3,999.00 to $4,445.00 ($4,222.00 median), with a ten year useful life. Annual median amortized cost of $ 422.20

H. STANDING FRAME

A standing frame with accessories, $1,350.00 to $1,595.00 ($1,472.50 median), with a ten year useful life. Annual median amortized cost of $ 147.25

I. MANUAL WHEELCHAIR AND ACCESSORIES

A mechanical wheelchair with seating system and accessories, $2,895.00 to $3,350.00 ($3,122.50 median), with a four year useful life. Annual median amortized cost of $ 780.63

J. MANUAL WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $175.00. Annual median cost of 175.00

K. MOTORIZED WHEELCHAIR AND ACCESSORIES

A battery-powered wheelchair with seating system and accessories, $8,995.00 to $9,845.00 ($9,420.00 median), with a seven year useful life. Annual median amortized cost of $1,345.71

L. MOTORIZED WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $350.00. Annual median cost of 350.00

M. RECREATION-SPORTS SPECIALTY CHAIR

A specially designed and accessorized recreation-sports chair for use in sports activities (e.g., rugby, tennis, basketball) and as a backup chair when the manual wheelchair is in repair, $3,975.00 to $4,450.00 ($4,212.50 median), with a two to four year useful life (3 years median). Annual median cost of 1,404.17

N. RECREATION-SPORTS WHEELCHAIR MAINTENANCE AND REPAIR

A median annual maintenance and repair cost of $250.00. Annual median cost of $250.00

O. MANUAL TRANSPORT DEVICES

An all-terrain conveyance (e.g., Natural Access Beach Chair, Iron Horse, Downhill Racer, etc.), for use in sand, snow or rough terrain; a recumbent handcycle, etc., $6,450.00 to $7,395.00 ($6,922.50 median), with a three to five year useful life (4 years median). Annual median amortized cost of $1,730.63

N. MANUAL TRANSPORT MAINTENANCE AND REPAIR

A median annual cost of $300.00. Annual median cost of $300.00

O. SHOWER-COMMODE CHAIR

A specialty chair for commode and roll-in shower use, $2,875.00 to $3,250.00 ($3,062.50 median), with a six year useful life. Annual median amortized cost of $ 510.42

P. ORTHO-BIOTIC CHAIR

Height adjustable chair for ease in wheelchair transfers with swivel and recline functions, $795.00 to $950.00 ($872.50 median), with a ten year useful life. Annual median amortized cost of $ 87.25

Q. SPECIALTY FURNITURE

Wheelchair accessible desk with Lazy Susan access features; height adjustable and accessible table; over-the-bed table; computer desk with wheelchair accessible features, $3,275.00 to $3,499.50 ($3,387.25 median), with a ten year useful life. Annual median amortized cost of $338.73

R. SPECIALTY CLOTHING AND FOOTWEAR

Clothing designed for ease of dressing and undressing (velcro closures, no buttons, zippers or snaps); footwear designed for unassisted access; wheelchair rain poncho and gloves, etc., $400.00 to $500.00/year ($450.00/year median). Annual median cost of $450.00

S. ASSISTIVE AND ADAPTIVE DEVICES

Reachers, extenders, ADL aids for hygiene, eating and personal care, $500.00 to $600.00 ($550.00 median), with a four year useful life. Annual median amortized cost of $ 137.50

T. TRANSPORTATION REQUIREMENTS

Modified ramp or lift van, four-door pickup or P.T. Cruiser with hand controls, tie-downs and other suitable and appropriate accessories; $41,500.00 to $47,250.00 ($44,375.00 median), with a seven year or 84,000 mile useful life; end-use equity of $4,400.00 ($39,975.00); subtraction for the median cost of a mid-size automobile ($16,500.00), $23,475.00 differential. Annual median amortized cost of $3,353.57

U. OPERATIONAL COST/MILE DIFFERENTIAL

The cost/mile differential of a van or truck ($0.49/mile) and a mid-size automobile ($0.29), assuming 12,000 miles/year driving. Annual cost differential $2,400.00

V. HOME HEALTH MONITORING EQUIPMENT

The cost of an otic thermometer, pulse meter, digital blood pressure gauge, bladder scan and genitourinary inspection mirror, etc., $2,995.00 to $3,245.00 ($3,120.00 median), with an eight year useful life. Annual median amortized cost of $ 390.00

W. PHARMACEUTICALS, NUTRACEUTICALS, PATIENT MEDICINES AND SUPPLIES

Prescriptive and non-prescriptive medications; salves, powders, ointments, emollients; food supplements; bowel-bladder incontinence devices; suppositories and enemas; disposable undergarments, bed pads and gloves, $375.00 to $450.00/month $412.50/month median). Annual median amortized cost of $4,950.00

ANNUAL COST FOR DURABLE GOODS & EXPENDABLES AGE 55 AND CONTINUING $ 40,200.66

ANNUAL COST FOR GOODS AND SERVICES AGE 55 AND CONTINUING: $133,756.66.

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