DME Re-use Consumer Survey

We are seeking input from users of durable medical equipment (DME) to guide the plans for a pilot DME re-use program in Greater Boston generously funded by the Shapiro Family Foundation, MRC and Spaulding Rehab. Thank you for taking the time to answer these ten questions about your needs, challenges and interest in using refurbished medical equipment. Your replies will be kept confidential and will be used solely to inform our pilot program. You may also print out this survey and send it completed to Randi Sargent, MRC, 600 Washington St 2nd fl, Boston MA 02111. For more information, call 617-204-3626 or email reuse@massmail.state.ma.us. Please complete your survey by October 4, 2013.

Question Title

* 1. About you or the DME user:

DME User/Child <22

DME User/Adult

DME User/Senior

Parent of DME User

Other family of DME user

Guardian

DME Provider

Other and your region in MA

Question Title

* 2. What is your primary method for obtaining durable medical equipment now?

Medicaid

Medicare

Private insurance

School system

Vets

Out of pocket

Grant or loan

Care provider

Other loaned equipment

Other (please specify)

Question Title

* 3. What types of equipment would improve your/users ability to live with better quality of life?

	Home	Work	Community	School	Don't use
Power wheelchair	Power wheelchair Home	Power wheelchair Work	Power wheelchair Community	Power wheelchair School	Power wheelchair Don't use
Manual wheelchair	Manual wheelchair Home	Manual wheelchair Work	Manual wheelchair Community	Manual wheelchair School	Manual wheelchair Don't use
Positioning chair	Positioning chair Home	Positioning chair Work	Positioning chair Community	Positioning chair School	Positioning chair Don't use
Walker or stander	Walker or stander Home	Walker or stander Work	Walker or stander Community	Walker or stander School	Walker or stander Don't use
Hoyer-type, sling lift	Hoyer-type, sling lift Home	Hoyer-type, sling lift Work	Hoyer-type, sling lift Community	Hoyer-type, sling lift School	Hoyer-type, sling lift Don't use
Bathroom equipment	Bathroom equipment Home	Bathroom equipment Work	Bathroom equipment Community	Bathroom equipment School	Bathroom equipment Don't use
Electric/semi-electric bed	Electric/semi-electric bed Home	Electric/semi-electric bed Work	Electric/semi-electric bed Community	Electric/semi-electric bed School	Electric/semi-electric bed Don't use
Portable ramp	Portable ramp Home	Portable ramp Work	Portable ramp Community	Portable ramp School	Portable ramp Don't use

Other (please specify)

Question Title

* 4. How interested would you/user be in using used equipment if cleaned and refurbished?

	Very Interested	Possibly	Not Interested
Power wheelchair/scooter	Power wheelchair/scooter Very Interested	Power wheelchair/scooter Possibly	Power wheelchair/scooter Not Interested
Manual wheelchair	Manual wheelchair Very Interested	Manual wheelchair Possibly	Manual wheelchair Not Interested
Positioning chair	Positioning chair Very Interested	Positioning chair Possibly	Positioning chair Not Interested
Walker or stander	Walker or stander Very Interested	Walker or stander Possibly	Walker or stander Not Interested
Hoyer-type, sling lift	Hoyer-type, sling lift Very Interested	Hoyer-type, sling lift Possibly	Hoyer-type, sling lift Not Interested
Bathroom equipment	Bathroom equipment Very Interested	Bathroom equipment Possibly	Bathroom equipment Not Interested
Electric/semi-electric bed	Electric/semi-electric bed Very Interested	Electric/semi-electric bed Possibly	Electric/semi-electric bed Not Interested
Portable ramp	Portable ramp Very Interested	Portable ramp Possibly	Portable ramp Not Interested
Medical supplies	Medical supplies Very Interested	Medical supplies Possibly	Medical supplies Not Interested

Other (please specify)

Question Title

* 5. What is the primary reason you would consider using refurbished equipment?

No insurance

Get items that insurance does not cover

Need items for more than one location

Back up when mine is not working/out for repair

Need something ASAP and can't wait!

Need item while waiting for new through insurance

Item used for a visitor

Other (please specify)

Question Title

* 6. How much would you be willing to pay to have refurbished medical equipment delivered to your home?

	$0	< $25	$26-50	$51-100	Other donation
For DME item	For DME item $0	For DME item < $25	For DME item $26-50	For DME item $51-100	For DME item Other donation
For delivery	For delivery $0	For delivery < $25	For delivery $26-50	For delivery $51-100	For delivery Other donation

Other (please specify)

Question Title

* 7. Would you like to receive more information about our DME Re-use Program or participate in a forum?

Yes

Best way to contact you (please provide your name, email or phone)

DME Re-use Consumer Survey

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* 1. About you or the DME user:

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* 2. What is your primary method for obtaining durable medical equipment now?

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* 3. What types of equipment would improve your/users ability to live with better quality of life?

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* 4. How interested would you/user be in using used equipment if cleaned and refurbished?

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* 5. What is the primary reason you would consider using refurbished equipment?

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* 6. How much would you be willing to pay to have refurbished medical equipment delivered to your home?

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* 7. Would you like to receive more information about our DME Re-use Program or participate in a forum?

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* 8. How did you learn about this survey?

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* 9. Can you recommend a community group or organization that should know about our new re-use program?

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* 10. Please share any other comments or thoughts about a DME re-use program here: