Accessible Vehicle Transportation Disbursements

Transcription

1 Accessible Vehicle Transportation Disbursements By Kate and William Dussault The goal of this article is to assist the Trustee in understanding the issues and concerns related to accessible vehicle disbursements from a Special Needs Trust and provide potential solutions to what can often be a very difficult disbursement issue. One of the most common requests to a Special Needs Trustee is for the purchase of a vehicle and/or transportation services for the disabled beneficiary. Unfortunately, this issue can be very complex. The Trustee must consider the following: What is the most appropriate vehicle for the trust beneficiary? What safety concerns must be evaluated? How will the vehicle title issues be handled? What is the exposure for vicarious liability to the Trustee depending on the titling of the vehicle? What is the liability of the Trustee for purchase of an unsafe or inappropriate vehicle? How will ongoing maintenance costs be managed and implemented? What level of automobile insurance should be considered and how does the Trustee insure the proper insurance is maintained? How often will the vehicle be replaced and how will vehicle disposal issues be handled? What happens to a vehicle at the trust beneficiary s death? The following case studies and discussions are from real cases we have consulted on over the past several years. Each case is an example of how often vehicle disbursement issues can become very problematic for the Trustee. Case Study 1- Safety and Appropriate Vehicle Selection: Sally is a single mother of Kyle, a 7 year old child who experiences cerebral palsy. He has several medical concerns, and utilizes a wheelchair for mobility. Sally is a petite woman. Kyle is approximately 50 pounds and is almost as tall as Sally. He continues to grow. He suffers from seizures. Often when he is picked up he will have a seizure and becomes very rigid making him difficult to carry and manage. Sally and Kyle were parties to a personal injury action and received a settlement for Kyle s birthing injuries. The funds were placed into a Special Needs Trust for Kyle s benefit. A Life Care Plan developed as a part of the litigation recommended the purchase of an accessible vehicle for Kyle. The plan did not specify the type of vehicle or appropriate resources to obtain the vehicle. The Trustee had no expertise in accessible kated@mobilitysupportsystems.com or (206) Page 1

2 transportation options nor did Sally. The Trustee communicated to Sally that they would approve $48,000 to purchase an accessible vehicle based upon the life care plan specified dollar amount. Sally went to her local Honda dealer and purchased a van. She was then referred by the Honda dealer to a local mobility provider to install a lift. The lift was installed as a bolt on. The installed lift did not work properly and created problems with the overall function of the vehicle. The lift was removed. The local mobility dealer then sold Sally a portable aluminum ramp weighing approximately 40 pounds. Sally must now lift the ramp in and out of the vehicle. The ramp slope is too steep and does not comply with ADA standards creating a safety risk to both Kyle and Sally. To place Kyle in the vehicle she must utilize the ramps which are heavy for her, awkward and unsafe. Sally became frustrated at the inconvenience and no longer used the ramp. She then lifted Kyle out of his wheelchair, carried him through the side passenger door of the van, placed him into the standard vehicle seat behind the driver s seat and strapped him in. She then lifts the wheelchair into the van. The wheelchair is unsecured. The safety issues are obvious. It is just a matter of time before Sally and/or Kyle are injured using the van as it is now configured. When she explains to the Trustee that the van she purchased is not working for her the Trustee is reluctant to sell the van. The van is less than 6 months old and the depreciated value of the vehicle is less than the amount owed on the purchase. The trustee determines it is not a prudent financial decision to sell the van at this time as it would result in a significant financial loss to the trust. Unfortunately, Sally and Kyle s situation is not uncommon. In many situations the disabled individual and/or family member often find the vehicle option they have selected to meet their transportation needs is unsafe, inappropriate and expensive. This case illustrates a variety of concerns the Trustee must consider when obtaining and reviewing accessible vehicle recommendations: The disabled individual s abilities, limitations, health issues, and time frame in which the mobility device and vehicle will match the person with a disability s needs. The overall family circumstance The primary caretaker s situation and safety Safe and appropriate accessible transportation options Safety education and acceptance of personal choice Evaluation of costs and funding options Identification of appropriate resources for obtaining and funding accessible transportation options Community access for individuals who experience disabilities is a key component to their quality of life and independence. However, as illustrated above, the challenge for many individuals who experience disability and/or their family members is obtaining safe, appropriate and affordable private accessible transportation options. The Trustee will often and should play an essential role in obtaining wheelchairs and/or accessible vehicles for the disabled consumer kated@mobilitysupportsystems.com or (206) Page 2

3 and/or their family member(s). As a result it is critical that the Trustee be able to recognize unsafe private accessible transportation situations and insist on obtaining a proper evaluation. The evaluation must consider all safety concerns and properly educate the trust beneficiary and/or family member(s) on safety and appropriate options available. This material will provide basic information which will assist the Trustee in providing appropriate recommendations/referrals to their clients. General Safety Issues: Safety considerations for all accessible transportation options must include: (1) a review of the personal safety of the individual who experiences a disability, their family and primary care providers (if utilized), (2) ensuring the basic accessible transportation safety guidelines are met and the recommended vehicle and/or products are appropriate to meet the client s specific needs, (3) coordination and review of the wheelchair selection and transport safety and (4) appraisal and selection of appropriate wheelchair restraint systems within the vehicle. 1. Personal Safety: Each client s situation will be unique and will require a comprehensive evaluation to ensure safety and provide appropriate recommendations. In some cases the disabled consumer and/or family member may have unrealistic expectations and/or desires for a particular vehicle selection. Thus, it is also imperative to properly educate the client on safety concerns and appropriate vehicle options. 2. Accessible Transportation Standards and Safety: Not all accessible transportation options will be safe or appropriate for meeting the client s individual circumstances. Thus, part of meeting the safety needs will be dependent upon fitting the client with appropriate accessible transportation or mobility transportation option(s). It is also important to understand the underlying safety of the mobility transportation products. Some accessible transportation options should not be considered at all due to the lack of safety controls and standards. The first step in understanding mobility transportation safety is to define existing safety standards and regulations. While there are some existing safety standards and regulations that apply to vehicles that are modified, the current standards are not equivalent to safety standards applicable to non-modified vehicles. This area is still developing for modified vehicles. The primary organizations that have developed the current modified vehicle guidelines and safety standards are as follows: National Mobility Equipment Dealers Association (NMEDA): This organization is the primary resource for adaptive vehicle modifications. MEDA is a nonprofit trade association of mobility equipment dealers, driver rehabilitation specialists, and other professionals dedicated to broadening the opportunities for people with disabilities to drive or be transported in vehicles modified with kated@mobilitysupportsystems.com or (206) Page 3

4 mobility equipment. All members work together to improve transportation options of people with disabilities. The board and membership consists primarily of mobility manufacturers and dealers and currently has no disabled consumer representation. It is not an independent third party organization or information source. However, it has developed the industry s only national accreditation program for the mobility industry governing personal transportation. This is the Quality Assurance Program (QAP). The goal of the program is to ensure that participating dealers abide by specified guidelines and safety standards. National Highway Traffic Safety Administration (NHTSA): This government agency is primarily responsible for all vehicle transportation safety issues and concerns. Under the National Traffic and Motor Vehicle Safety Act (enacted in 1966) the U.S. Secretary of Transportation was required to promulgate Federal Motor Vehicle Safety Standards (FMVSS). Today the NHTSA is responsible for oversight of the FMVSS. These standards are defined as a minimum standard for motor vehicle performance or motor vehicle equipment performance, which is practicable, which meets the need for motor vehicle safety, and which provides objective criteria. These standards apply to all vehicles. As a part of these standards, primary manufacturer s (i.e. Dodge, Honda) must meet rigid crash testing requirements and are rated on crashworthiness. Crash testing measures the vehicles ability to handle front, side and rear impact collisions, fuel spillage and fire safety, and roll over scenarios. These primary safety standards are important and become even more important when evaluating how a modified vehicle will perform in a crash. Anytime a vehicle is structurally modified (i.e. raised roof and/or lowered floor, the insertion of a ramp, etc.) it must be re-crash tested after the modifications have been completed to ensure its safety and define the crashworthiness. This requires a second rigorous crash testing process. The testing process is a good assessment of the vehicle s structural design. Manufacturers of accessible vehicles should comply with FMVSS. Unfortunately, some manufacturers and/or local mobility dealers/companies will modify a vehicle and do not comply with these standards. This is because re-crash testing to meet FMVSS is expensive and is currently not mandatory for modified vehicles. Thus, it is important for the Trustee to ensure all recommendations to adaptive transportation options comply with existing mobility vehicle guidelines and safety standards. Once the selected mobility transportation option has been determined to comply with the standard industry safety guidelines the next step is to evaluate the appropriateness of the mobility option to the client s specific situation. Outlined below is a detailed discussion of private adaptive transportation options. 3. Wheelchair Review: Safety testing and standards for occupied wheelchairs used as seats in vehicle transportation are currently in the infancy stages. Unfortunately, many wheelchairs are not properly safety rated for transportation use within a vehicle. Since the kated@mobilitysupportsystems.com or (206) Page 4

5 Trustee will often purchase wheelchairs for their clients in addition to private accessible transportation options the two items should be reviewed and coordinated at the same time whenever possible. The specifics of an overall proper wheelchair evaluation are beyond the scope of this article. However, it is important to understand the importance of the wheelchair selection as it relates to vehicle transportation. The wheelchair recommendations should consider (a) how the client will utilize the chair in relation to vehicle transportation (occupied or unoccupied), (b) the safety rating and WC19 compliance for an occupied wheelchair used as a seat in vehicle transportation, and (c) the occupied wheelchair fit and placement within the accessible vehicle or storage of an unoccupied wheelchair within the vehicle. Both the modified vehicle and occupied wheelchair used as a seat for vehicle transportation should be crash tested and evaluated for specified safety standards. Safety standards for occupied wheelchairs are defined under the WC19. In April 2000 the US standard, WC19 Wheelchair Used as Seats in Motor Vehicles was approved. Although this voluntary standard was established eight years ago one of the primary barriers to full implementation is the lack of awareness. Any Trustee purchasing wheelchairs and/or accessible transportation options must be aware of these standards and which wheelchair manufacturer s currently provide WC19 compliant wheelchairs. For additional information on WC19 standards please see the Rehabilitation Engineering Research Center on Wheelchair Transportation Safety (RERC WTS) website at: Referring to the wheelchair manufacturer s websites and/or manuals will also provide important information and/or disclaimers regarding the use of occupied wheelchairs in vehicle transportation settings. An additional consideration to review when recommending a wheelchair and/or accessible vehicle option is the overall fit and placement of the occupied wheelchair within the vehicle or the storage of the wheelchair if unoccupied. Storage of other durable medical equipment (DME) items (i.e. suctioning devices), safety items (i.e. vehicle battery charge packs) and general items (i.e. umbrellas, etc.) should also be considered. 4. Wheelchair Tiedown and Occupant Restraint Systems (WTORS): Another important safety consideration is securing the wheelchair within the vehicle. Whether the wheelchair is occupied or unoccupied ensuring a proper wheelchair restraint system is critical. An unsecured wheelchair poses a significant safety hazard for the individual who experiences a disability, other drivers/passengers in the vehicle, and in the event of a collision; other individuals outside of the vehicle. There are three basic wheelchair restraint systems (a) traditional manual four point tie down system, (b) manual retractable four point tie down products and (c) automatic restraint systems. a. The traditional manual four point tie down system consists of four straps with manual ratchet mechanisms. The user must identify four separate structurally kated@mobilitysupportsystems.com or (206) Page 5

6 appropriate points on the wheelchair, secure the straps to the wheelchair and then secure the brackets in the floor of the vehicle. The manual ratchet system is then used to tighten the wheelchair down. The disadvantage of this system is many disabled consumers are unable to utilize this system independently. Additionally, many family members and/or care providers find the systems cumbersome and difficult to use thus often opt not to use the restraint system at all. b. The manual retractable restraint systems are similar to the traditional four point tie downs in that they also utilize straps which are secured to four points on the wheelchair and vehicle floor as outlined above. However, the ratchet system is retractable and is similar in its function to a typical retractable seat belt. Thus, they are slightly easier to utilize. However, some disabled consumers may not be able to use them independently and family members/care givers often will not properly utilize them or use them at all. A sample retractable strap restraint product is the Q-Straint, please see: c. Automatic restraint systems do not use a strap and ratchet approach at all. Rather a specialized electronic box is bolted to the floor of the vehicle. Then a steel bolt is secured onto the bottom of the wheelchair. The wheelchair is then guided over the plate in the floor and a mechanized system latches the wheelchair into the electronic box on the floor. The electronic box looks for the wheelchair and if it is not properly latched an alert alarm will sound. There is an override system for the alert alarm if the wheelchair is not in use within the vehicle. The system uses electronics to operate but also has manual overrides. The biggest advantage of this system is it is easy to use and has added fail safes. However, the direction of entry onto the electronic box (forward vs. rear) is critical so must be carefully evaluated. Caution: Not all wheelchairs are compatible with this product thus the model and type of wheelchair must be specified to ensure this system is an kated@mobilitysupportsystems.com or (206) Page 6

7 appropriate option. An example of this product is the EZ-Lock. Please see: These products should meet FMVSS established for safe transportation as well. However, the key factor to ensure the safety with these products is proper use. Thus, the end users must be properly educated and trained to use these products. In addition to securing the wheelchair within the vehicle a wheelchair occupied passenger should also be safely restrained with the use of the vehicle specialized seat belt lap/shoulder belt systems. These systems are called Occupant Restraint Systems (ORS). This should always be included with the overall recommendation for adapted transportation. Caution: The wheelchair positioning belts should not be considered appropriate restraints for a wheelchair occupied passenger. However these are often important components to consider for individuals who require assistance with upper body support. Overall safety for the individual who experiences a disability (whether as a driver or passenger), their family members and/or caregivers is the paramount consideration for all adaptive transportation recommendations. One additional area of caution when reviewing mobility transportation options is to ensure the individual(s), organization or company providing the recommendations to the disabled consumer are knowledgeable and as objective as possible. Unfortunately, when utilizing non-independent third party adaptive mobility organizations or companies which have a primary focus on selling particular product(s) the recommendations may be based more in selling product than in safety and appropriateness. Thus, the Trustee should consider using specialized rehabilitation professionals to obtain basic safety evaluations and recommendations and/or look for organizations/companies which offer a variety of accessible transportation options. Private Adaptive Transportation Options: Once the basic safety and personal needs are properly evaluated the Trustee should have a fundamental understanding of the various private adaptive transportation options available in the market today. There are two primary adaptive transportation or mobility conversions kated@mobilitysupportsystems.com or (206) Page 7

8 available to individuals who experience disabilities (1) add on lift systems and products and (2) fully manufactured van conversions which incorporate a lift or ramp system into the overall vehicle construction. It is essential to understand the differences as well as the appropriate application for these products. 1. Add-On Products: These products are sometimes referred to as bolt on products. There is a wide range of these types of products available on the market today. From a historical perspective it was the advent of bolt on lift systems which created the first opportunity for private accessible transportation for persons with disabilities. Thus, many folks are more familiar with these types of products. However, as the demand for safe and appropriate mobility transportation has increased additional options have become available. a. Bolt-On Lift Systems: The most traditional application of a bolt on lift product is the use of a typical full size van with a lift installed for access. For many years this was the most viable and popular option. While a full size van may be appropriate for some clients there are many considerations which must be reviewed including the following: Vehicle Selection: Not all full size vehicles may be appropriately modified and the standard lift systems may not work correctly with the vehicle. In some cases it may be appropriate to add on a lift system to an existing vehicle. However, vehicle selection in this process is critical and safety in these situations may be compromised. The addition of the weight of the bolt-on lift system and the additional weight of the wheelchair used by the disabled consumer can radically affect the braking capacity of the vehicle. The weight of the lift attached to the side of the vehicle can also cause torsion against the vehicle frame particularly when the lift is fully extended and the wheelchair user is on the lift. In today s market there are full size vehicle mobility manufacturers which ensure all structural modifications made (i.e. raised roof/doors, lowered floors, lifts/ramp systems) meet the QAP safety standards as established by NMEDA. However, be advised in the majority of these situations the vehicles are not re-crash tested to meet FMVS Standards. Caution: Bolt on ramp systems which create steep ramp access should be avoided as these create significant safety concerns. Conversion Process: Many local mobility dealers and/or other conversion manufacturing companies will provide a variety of conversion features. This may include not only installation of a lift system but raising the roof and/or lowering the floor on the kated@mobilitysupportsystems.com or (206) Page 8

9 vehicle. As outlined above, any time a vehicle is cut whether to raise the roof or lower the floor the structural integrity of the vehicle has been compromised and the basic functions of the vehicle altered. Additionally, with a lowered floor the location and structural protection around the gas tank is also affected. This can create significant safety concerns. Thus, it is imperative to only work with companies which are Quality Assurance Program (QAP) certified. The company should also provide written documentation that the vehicle has undergone a valid and full recrash testing process to define the crashworthiness of the modified vehicle and confirm that it meets FMVS Standards whenever possible. Client Access and Use: Access to the vehicle via the doorway and selection of the lift is critical to meeting the client s needs and safety. The client s size, weight, and height in the wheelchair must be considered. Additionally, the size and weight of the wheelchair must be considered. Many lift systems have specified weight restrictions. The vehicle modifications can include a raised roof or popped top for more internal head space within the vehicle and/or raised doors for better vehicle ingress and egress. Taller clients may require both modifications. In addition to the vehicle modification selections, the client s and/or family/caregiver s ability to properly operate the vehicle and lift system safely should also be reviewed especially if used in a disabled driver s application. Community Access: Access to the community may be impeded due to the size of the vehicle especially when a raised roof or lowered floor is utilized. Parking may be an issue for raised tops. Maneuverability in environments with high snow levels may be an issue for lowered floors. Some family members may be uncomfortable driving a full size van. Overall Cost: Full size conversion vans are often more costly to obtain and maintain. The initial purchase cost will vary significantly based upon the method of purchase as well as location. There as three purchase methods for full size vans: (a) purchasing a van from the original manufacturer (i.e. Ford) and then adding a bolt on lift system, (b) purchasing from a secondary mobility manufacturer via direct/internet sales model and (c) purchasing from a secondary manufacturer via dealer network kated@mobilitysupportsystems.com or (206) Page 9

10 sales models. The purchase method should be carefully reviewed for both safety and cost effectiveness. Lastly, full size vans are not fuel efficient. With fluctuating gas prices this can be a significant factor for some clients. Appropriate Application: Typically the most appropriate application for this type of vehicle is for larger clients who utilize large wheelchairs and/or large families who wish to transport their disabled family member as well as all other members of the family. Sample Product: b. Add-On Products: Alternative add-on mobility options include products which can be added to a variety of vehicles in addition to just vans. These may include wheelchair/scooter hoist products (including lifts and platforms), specialty trailers and trailer hitches, truck caps and wheelchair/scooter hoist systems, roof hoist and storage products, etc. Careful evaluation of all of these options is often more critical than with fully modified vehicle options. Vehicle Selection: With any of the above products the types, the make and model of the vehicle must be reviewed. Not all vehicles will accommodate the add-on product(s). Additionally, the appropriateness of the vehicle itself must be considered given the overall basic evaluation needs. Conversion Process: The safety and appropriateness of the vehicle and the add-on mobility product as well as how the product is added must be considered. For example: if a trailer and hitch system is utilized will the vehicle safely pull a trailer and what is the appropriate hitch for the vehicle? What impact will the trailer have on the vehicle s braking distance? Will the driver (i.e. an elderly wife for a disabled senior husband) be able to safely back the trailer? Client Access and Use: With many of these products it is very difficult for the end user (whether it is a disabled consumer, family member or care-provider) to safely use these products. Typically, transfers in and out of wheelchairs/scooters are required, lifting or kated@mobilitysupportsystems.com or (206) Page 10

11 specific placement of DME may be necessary, security of the DME storage is an issue, etc. These products may pose safety, access and proper utilization issues. Caution is advised when recommending these types of products. Community Access: This may vary significantly depending upon the products used and must be carefully analyzed. Overall Cost: Typically these are lower cost options. However, if not applied properly it may result in increased cost to the consumer in the long run. Appropriate Application: Much caution is advised when recommending these types of products as it is this author s experience that very few individuals who experience a severe physical disability can safely utilize them. If the disabled consumer is high functioning in all aspects of the functioning evaluation some of these products may be appropriate. When recommending these products the overall safety, individual s personal safety and overall situation must be the primary considerations. Additionally, the security and wear and tear issues of the wheelchair/scooter or other DME must also be evaluated. Sample Products: c. Vehicle Chair Turning Systems: There are a variety of vehicle chair turning systems which allow access into a vehicle. These are primarily utilized in minivan type vehicles but may be appropriate for other vehicle applications. There are pros/cons to these systems. Vehicle Selection: Not all vehicles will be appropriate for these product applications. Thus, it is important to work with qualified professionals and/or companies which may assist with determining the appropriateness of the vehicle. Conversion Process: These systems typically utilize traditional vehicle seats which are placed onto specialized mechanical systems which allow access in and out of the vehicle. These products should also meet FMVSS both in manufacturing as well as in the installation process. Because these products do not require any structural changes to the vehicle it is not necessary to re-crash kated@mobilitysupportsystems.com or (206) Page 11

12 test the vehicle itself but it is important to understand the safety ratings of the seat and adapted seating systems and components. Client Access and Use: Client access will vary as these products can be installed in a wider variety of vehicles. When properly implemented the product can be modified to meet specific needs. The product customization must meet all safety standards and the vendors concern regarding liability. Caution: these systems typically require the disabled consumer to transfer from a wheelchair into the adaptive seating system. Thus, it is critical to evaluate the client s function as well as the family/caregiver s abilities in this area. Safety can be easily compromised if a client is not able to safely transfer. One major disadvantage of many of these systems is the transfer must take place outside of the vehicle. Thus, the client s personal safety and living environment should also be taken into account (i.e. weather, typical parking situation, etc.). One advantage of these products is once the disabled consumer is in the vehicle a traditional vehicle seating system is used. This is a safer option over a wheelchair occupied seating application. One company is in the process of creating a best of both worlds product. A traditional vehicle seating system is used with a portable base. The vehicle seat and base can be moved in and out of the vehicle. This allows the disabled consumer to transfer out of his/her wheelchair in a safer environment (i.e. in the home using in-home transfer devices) and then use the vehicle seating system while transporting in the vehicle. The consumer would then have the option to use the vehicle transportation seat as a temporary travel wheelchair or to bring their standard wheelchair along and transfer back to the chair. Community Access: In the proper situations these products can be beneficial as they can often be installed on a wider variety of vehicles. However, careful evaluation of the product application is required. Overall Cost: These options are typically more cost effective than fully modified vehicles. However the cost of the adaptive product as well as the overall cost of the underlying vehicle must be considered. Additionally, as with any add-on mobility product if not appropriately applied the long term cost may be significant. Appropriate Application: Carefully evaluation of the disabled consumer s personal safety and family situation must be kated@mobilitysupportsystems.com or (206) Page 12

13 considered. These products will require transfers in and out of a wheelchair. The client s ability and/or the abilities of the family/care providers to assist must be considered as well as the environment in which the transfer must take place. At this point in time these products are most appropriate for a higher functioning disabled consumer. Sample Product: 2. Automatic Manufactured Conversions: Fully automatic manufactured adaptive transportation options are the most complex. With these products a traditional vehicle chassis (i.e. Dodge Grand Caravan) is completely de-constructed and then reconstructed via a secondary manufacturing process. The challenge with these products is not only to ensure the proper vehicle selection and equipment but to make sure ongoing service and maintenance of the vehicles is established. Vehicle Selection: Not all vehicles may be appropriately modified and there is typically a very specific process for obtaining these vehicles. There are two competing sales methods for these vehicles. One is via national direct sales companies (typically internet based) and the other via a specified dealer network. There are pros/cons to both methods of sales. Unfortunately the disabled consumer is often caught in the middle in the conflict between these competing sales methods. Typically the direct sale/internet models will provide more cost effective pricing. Some of the direct sales companies also have well developed personalized ongoing service and maintenance programs. Others do not. This is where the conflict typically arises. If a disabled consumer purchases a modified vehicle from a direct sales model that does not have a good service program it is often difficult for them to obtain ongoing maintenance and service from a local mobility dealer which sells product via a dealer network. Thus, it is important to understand and evaluate how and where to obtain the fully modified vehicle in order to meet the disabled consumer needs. Once the method of obtaining the vehicle is determined evaluating the specific vehicles overall safety, pros/cons, kated@mobilitysupportsystems.com or (206) Page 13

14 dimensions, features, options, etc. and matching the appropriate vehicle to the disabled consumer is required. Conversion Process: As outlined above these vehicles undergo a separate and complete secondary manufacturing process. The vehicle is re-engineered to incorporate the adapted components. The original chassis is taken apart. The vehicle chassis shell is then moved through the manufacturing plant where the floor is removed and rebuilt, a ramp or lift system is installed, all new electronics are developed, etc. The electronics will then be coordinated to work with the original equipment manufacturers (OEM) systems. For example: a keyless remote entry system developed for the Dodge Grand Caravan is coordinated to not only open the electric side passenger door but to deploy the ramp on the adapted vehicle. The vehicle is then completely reconstructed with many of the original vehicle components remaining in place and fully operational. The final product looks very similar to the original chassis but now includes fully integrated adaptive equipment. To ensure safety these vehicles must undergo a second process for crash testing and meet the FMVSS. There are several national secondary manufacturers which specialize in these types of conversion products. Research and due diligence on these companies should also be completed prior to making recommendations. Client Access and Use: There are several automatic conversions available on the market today. The majority of these conversions are completed on mini vans and full size vans. Fully understanding the disabled consumers needs and situations plays a critical role in proper selection of these vehicles. There are some variances in the door entry heights and widths, ramp widths, ramp weight restrictions, interior space, features, electronic components, etc. Thus the Trustee must also understand and analyze the specifics of the vehicle products and/or work with qualified individuals to assist in this area. The majority (if not all) of the automatic conversion options are side entry vehicles. Meaning access into and out of the vehicle occurs via a sliding passenger side door vs. the rear of the vehicle. Community Access: Community access with these products is typically easier especially if a mini-van conversion it utilized. The mini-van options are easier to maneuver and park. However, kated@mobilitysupportsystems.com or (206) Page 14

15 caution should be used to carefully evaluate the client s environment as these conversions typically involve lower floors with ramp kneeling systems. In rural communities with roads which are not well maintained or in high snow level environments this may be problematic. Additionally, review of the side-entry into the vehicle should be accessed in relation to community specifics for the client. Overall Cost: Costs for these vehicles vary significantly depending upon the purchase method and the clients location. As mentioned above the direct sale/internet sale models are much more cost effective. The primary reason for this is there is typically not a dealer network involved. Pricing within the dealer network framework will vary from dealer to dealer and via the disabled consumer s location. The manner in which these dealer networks are established are very competitive with the manufacturers often limiting or not allowing out of area sales. This artificially fixes pricing. Unfortunately, this does not always bode well for the disabled consumer. The consumer cannot assume the local mobility dealer has entered this area of business out of good will toward the disabled consumer. The price mark-ups are often steep and profitability in the industry in general is typically high. The competitive sales environment can also create problems when obtaining needed service and maintenance. While the manufacturers of these vehicles are required by law to service the vehicle during the warranty period, many local mobility dealers may refuse or charge higher rates to service the vehicle. Thus, careful review of the cost and how ongoing service will be provided is necessary. Appropriate Application: There are many appropriate applications for these adaptive transportation options. These are generally the safest overall options available. The key is working to ensure a proper fit and appropriate vehicle option for the individual who experiences a disability and/or their family. Sample Product: kated@mobilitysupportsystems.com or (206) Page 15

16 3. Manual Conversions: Manual conversions can involve a complete secondary manufacturing process (as outlined above) or special installation of integrated manual rear-entry ramp systems. With the latter option the original vehicle chassis is not deconstructed and re-constructed so the original integrity of the vehicle chassis remains intact. Vehicle Selection: Not all vehicles can be properly modified to accommodate manual ramp systems. As with the automatic manufactured conversions there are direct/internet and dealer network sales models. There are also a variety of vehicles options available including rear-entry options where the individual who experiences the disability accesses the vehicle from the rear vs. a side door. As with any of the above options; careful review of the specific vehicles overall safety, pros/cons, dimensions, features, options, etc. and matching the appropriate vehicle to the disabled consumer is required. Conversion Process: These products may undergo a full secondary manufacturing process as outlined above or may only have a specialized integrated rear ramp system installed. With either of these processes the vehicle must still meet basic safety standards. Client Access and Use: As with the automatic conversions there are a variety of manual adaptive vehicles available. Fully understanding the disabled consumers needs and situations plays a critical role in proper selection of these vehicles. There are some variances in the door entry heights and widths, ramp widths, interior space, features, and ingress/egress to the vehicle, etc. When evaluating the use of a side entry vs. a rear entry access it is important to evaluate personal safety concerns when in the community (i.e. a rear entry vehicle requires the client to access the vehicle from the rear, when in a busy parking lot ingress/egress into the vehicle in this manner may be a safety concern). Additionally, where the disabled individual is located within the vehicle when a rear entry is utilized must also be considered. A bench seat may be placed between the front driver/passenger seats and where the wheelchair sits in the rear of the vehicle. This may make communication and caregiver access more difficult. The Trustee must understand and analyze the specifics of the vehicle kated@mobilitysupportsystems.com or (206) Page 16

17 products and their applications to meet a specific clients needs and/or work with qualified individuals to assist in this area. Community Access: The most typical application of the manual conversion options are for mini-vans or smaller vehicles. Thus, the vehicles are easier to drive and park. However, as mentioned above ingress/egress from the vehicle must be carefully considered especially when a rear-entry conversion is utilized. Overall Cost: As with automatic conversions pricing can vary significantly if purchased on a direct/internet basis vs. dealer network basis. When utilizing dealer networks pricing will vary from location to location. As with the automatic conversions this pricing model does not always bode well for the disabled consumer. Manual conversions are often more cost effective to both purchase and maintain than automatic conversion because there are fewer electronic components. With the use in mini-vans or smaller vehicles gas mileage is also better thus saving on fuel costs. Appropriate Application: There are a wide variety of applications for manual conversions. The appropriate solution will be based upon the evaluation of the client s needs, situation and desires. Manual rear conversions can be a good solution for overall cost savings and for individuals living in rural areas where obtaining service on the adaptive components may be difficult. Sample Product: 4. Products to Avoid: From an overall safety perspective there are certain accessible vehicle modifications which should be avoided. These include: Vehicles which have been structurally modified and not re-crash tested to meet NMEDA QAP and FMVSS. Exterior bolt on or portable ramp systems which do not meet ADA standards and create safety hazards with inappropriate ramp grades/angles and storage concerns. Add on lift systems which are not appropriately matched to the vehicle. kated@mobilitysupportsystems.com or (206) Page 17

18 Exterior lift/storage units which cause personal safety concerns and/or will cause damage to the wheelchair and/or scooter. Any product, modification or adjustment which does not meet QAP, FMVSSs and other safety standards established in the industry. Sample Products: These types of products should be avoided! Funding/Financing Options: As noted above the cost for adaptive vehicle equipment will vary significantly. Add-on types of vehicle products are typically the most cost effective but it is critical to ensure the proper vehicle selection and overall client fit. Often a recommendation will be provided for an add-on type product in an effort to reduce costs. This may be absolutely appropriate in some cases but if the recommendation is not appropriate it will cost the disabled consumer more in the long term. Fully modified vehicle costs have the largest variation in cost and can range from $29,000 (for slightly used vehicles) to as high as $95,000. This significant cost range is due to the vehicle type, method of sale, and the client s location. Thus, the Trustee should carefully research the methods of purchase and location as it relates to both cost and ongoing service and maintenance needs. Active client advocacy is often critical in negotiation of fair and appropriate pricing for both purchases and service needs. The Trustee must also be cautious that the recommendations provided are not only appropriate to meet today s needs and situation but will be valid for at least a 5 to 7 year period and will not require premature sale of the adaptive equipment and/or vehicle. Premature sales of these types of vehicles and equipments may be extremely costly to the disabled consumer thus should be avoided if at all possible. The Trustee should also be aware of specialized funding sources available to the disabled consumer these include the following: Public Funding Sources: Veterans Administration (VA) program. The VA may offer assistance to qualifying veterans. This assistance typically only includes the modifications to the vehicle but assistance with a fully modified vehicle may also apply. Please see: Department of Vocational Rehabilitation (DVR). DVR programs and assistance varies from State to State. Typically, only the vehicle adaptive equipment kated@mobilitysupportsystems.com or (206) Page 18

19 modifications are funded via DVR programs. Each State will have a specific website for DVR services. Social Security Plan for Achieving Self-Support (PASS). Individuals receiving social security benefits may apply for a PASS plan which permits them to set up a savings program using a portion of their social security benefits. These savings are then used to purchase accessible vehicle adaptations and/or fully modified vehicles. See: Community Programs. Some states have local community programs which may provide some assistance. These are typically non-profit agencies which serve individuals who experience disability and/or churches. Some communities will also provide fund raising efforts for individuals who experience disability to obtain accessible vehicles. Private Funding Sources: Manufacturers disability rebate programs. The majority of auto manufacturers offer a $1000 rebate for the accessible components and some offer $200 for alerting devices on new vehicles. Look to each of the manufacturers websites: (i.e. Some states will also provide sales tax exemptions or reductions for the value of the accessible components added to a vehicle. Look to the county Department of Motor Vehicle Divisions for this information. If the disabled consumer s injury is work related many worker s compensation carriers will provide funding for adaptive vehicle equipment and or fully adapted vehicles. Contact the specific worker s compensation claims adjuster or medical catastrophic claims unit. There are some specialized financing options available via local mobility dealers which can provide financing based upon a 10 year term vs. shorter more expensive terms. Longer term financing will typically reduce the monthly payment. However, caution should be used with these funding options as the disabled consumer may become upside down in the financing structure whereby the amount owed is much higher than the vehicle value. Additionally, these types of finance terms will often require the disabled consumer to hold the vehicle longer than is typically recommended and may increase overall maintenance costs as the vehicle ages. These programs are typically available via the direct/internet or local mobility dealer networks. Traditional leasing models. There are some traditional leasing models which also assist in lowering the monthly cost of the vehicle. However, these programs should be carefully evaluated as there are pros/cons to these funding methods. These may be available via traditional vehicle leasing programs or programs kated@mobilitysupportsystems.com or (206) Page 19

20 specialized for adaptive transportation. Contact the direct/internet and/or local mobility dealers. All inclusive funding models. One company specializing in accessible vehicle programs for Special Needs Trust administrators and Worker s Compensation carriers has developed a unique program. This program offers assistance in personal and vehicle evaluations, provides personal delivery, coordination of local service, vehicle funding via leased options, full maintenance program, bumper to bumper extended warranty, 24/7 road side assistance and a specialized national insurance program. The all inclusive program is offered on a national basis. For more information see: Case Studies 2, 3 and 4-Title Issues and Concerns: Case Study 2: Sam and Loretta have a 10 year old child, Joe, who sustained a severe traumatic brain injury in an automobile accident. Shortly after the accident Sam and Loretta divorce. Loretta has primary custody of Joe. A personal injury action is settled and a Special Needs Trust is established for Joe. One of the first requests Loretta has for the new Trustee is a vehicle. She tells the trustee she will not drive an accessible van because she will not have her child labeled as disabled. The Trustee purchases a $70,000 Escalade. It has no accessible lift or ramp. Loretta lifts Joe in and out of the passenger car seat and puts his wheelchair in the back of the vehicle. The vehicle is titled in the Trust s name to protect it as an asset of the trust. Two months later Loretta is arrested and charged with dealing drugs out of the back of the Escalade purchased by the trust. The vehicle is confiscated by the police and is impounded. The Trustee is notified by Sam who was not aware of the purchase of the vehicle and who is extremely upset and demands the Trustee recover the vehicle, sell it and obtain an appropriate vehicle for Joe. Case Study 3: John is a 13 year old boy who has a severe spinal cord injury due to a swimming pool accident. His recovery is placed into a Special Needs Trust for his benefit. His parents are his primary care providers. A year after the trust is funded the trustee purchase a fully accessible vehicle for John. The trustee is concerned with title and potential liability issues thus titles the vehicle in John s parents name. A year later the parents have significant financial problems and sell the vehicle without providing notice to the trustee. They pay off some of their personal bills and ask the Trustee to purchase a new vehicle for John. When the Trustee refuses to purchase a second vehicle they purchase a less expensive non-accessible vehicle for the John and the family. The vehicle is inappropriate for meeting John s needs and raises several safety concerns. Case Study 4: Susan is a single 45 year old woman who sustains a severe spinal cord and brain injury as a result of a medical malpractice incident. The recovery from her settlement is placed into a Special Needs Trust on her behalf. She is receiving SSDI, SSI, Medicaid and kated@mobilitysupportsystems.com or (206) Page 20