ERICA SELL: Walkers, Wheelchairs & Lifts, Oh My! Smart Solutions for Care at Home

What if shopping for medical equipment felt empowering instead of depressing? Caregiving is hard enough. Getting the right equipment should not be. In this episode, Hosts Susie Singer Carter and Don Priess talk with Erica Sell, founder of Harmony Home Medical in San Diego, about how the right equipment can help families keep loved ones at home longer, safer, and with more independence.

Erica breaks down what Medicare typically covers (and what it does not), how reimbursement can work, and why the system often forces families to wait until a crisis. They also explore practical home solutions like high-low adjustable beds that still feel like home, safer bathing options, lift chairs, mobility devices, ramps, and monitoring tools that protect privacy.

Plus, a moving story about how one piece of equipment gave a man his community back.

If someone you love experienced neglect in a nursing home…Then you know how desperately the system needs to change.  History has shown us that It takes people power to change anything worthwhile. That’s why we we’re launching something that’s never been done before. On September 27, communities across the country are coming together for the first-ever National Long-Term Care Reform Day.This is a peaceful national walk for dignity, accountability, and change in long-term care.We’r

Transcript

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Opening And Mission Of The Show

Speaker 2 1:07

When the world has got shut down and Alzheimer's sucks.

Don Priess 1:13

It's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is, we continue to fight with the most powerful tool in our arsenal. Love. This is Love Conquers Alls, a real and really positive podcast that takes a deep dive into everything Alzheimer's, the good, the bad, and everything in between. And now, here are your hosts, Susie Singer Carter and me, Don Priest.

Susie SInger Carter 1:47

Hello, everybody. This is Susie Singer-Carter.

Don Priess 1:50

And I'm Don Priest, and this is Love Conquers Alls. Hello, Susan.

Susie SInger Carter 1:55

Hi, Donald. And how are you? How art thou?

Don Priess 1:59

How art thou uh pretty good? Um, with something you let's talk about me.

Susie SInger Carter 2:05

Yeah, that's it.

Don Priess 2:06

Now go.

Susie SInger Carter 2:08

No. No. I'm just gonna I'm gonna put out a little caveat. I have a runny nose.

Don Priess 2:13

So if I sound like, you know, I would just it's yeah, if things start going, you know, just deal with it.

Susie SInger Carter 2:20

Yeah, no, don't just look away. Look away. I do have two.

Don Priess 2:23

Susie, despite what everyone thinks, is actually human. And uh she hasn't. Good God.

Susie SInger Carter 2:29

No, you know what I have. Should I explain what I have?

Don Priess 2:31

Because probably people never because it's really it it actually is interesting and uh yes.

Susie’s Exercise-Induced Rhinitis Aside

Susie SInger Carter 2:36

So I don't have any allergies to anything except exercising, which I love to do. So I've been exercising my whole life, and uh when I take, you know, I dance, and if I take uh a class that is really, really high energy, like in my heart rate gets up, I have what's called uh exercise induced rhinitis. And which means when you you heat up your body so high, and then you if you don't and it's really hard to manage it because they say like you need to like s you know cool down, but even if I cool down the right way, I still begin to start sneezing and runny nose like so violently, it's the worst. And I thought it was from Dave's and it's like I first got it when I was at a the gym and I would do step v step classes that were just ridiculously hard and so much energy, and then I thought that their rug was dirty, like because every time I'd go to lay down and stretch and I'd start sneezing violently, and I don't have allergies. Finally went to the uh uh ear, nose and mouth or throat doctor, and he said, Oh, you have exercise induced rhythmitis, and I said, Shut up, that's ridiculous. But apparently uh marathon runners get it, basketball players get it, and people that do like fast twitch kind of exercise get it. And it's violent because there's nothing, it's not like you can take an antihistamine and it's gonna go away because it's not really an allergy. It's triggering the histamines. This is your lesson for today. It's triggering histamines. But um, yeah, so that's what's going on. And it's so embarrassing because sometimes you can't even stop sneezing and the and it's like a drain, it's awful. It's like not glamorous at all.

Don Priess 4:24

No. And it really affects me more than anyone. It really bothers me. It bothers me, and that and that's more important that I'm not bothered. So deal with it.

Susie SInger Carter 4:32

Well, during COVID, towards the end of COVID, when we were allowed to go out, and I would be sneezing like crazy after a class, and I would have everyone just like going to the other side of the room. I do not have COVID, I have exercise induced rhinitis. So, which we wrote into a script, into our comedy script, I love Lucifer, because we just thought it was ridiculous. Anyway, it's ridiculous. That's that's what that's what's happening with me today. And then good news is uh our movement, Roar, which is uh uh uh a branch that came out of our documentary, No Country for Old People, is officially launched this week because I officially finished the website because um

Launching ROAR And Eldercare Advocacy

Susie SInger Carter 5:19

nonprofits are are just another word for sweat equity, and that's what's going on. So I I did the website, it's was uh eight days of hell because it's just really hard. Websites are so hard to do, but it functions, it might need some tweaks, but you can go there, you can learn more about how to be a roarrier, which we would love you to be, and you know, for reform, oversight, advocacy advocacy, and respect for long-term care, and um you can donate, which is great. It's um tax deductible because we are an official 501c3, and um we're up and running, so check us out. We're at roar for ltc.org. And um yeah, come join us. We need as much help as we can get because we definitely the elder community is in dire straits, right? Yes.

Introducing Guest Erica Sell

Don Priess 6:17

Yes, and that's uh that leads us to you know our guests today because uh because there's just definitely there are some solutions to yeah, to long-term care and and often not in uh institutions, if you will, but more at home if possible.

Susie SInger Carter 6:37

Yeah.

Don Priess 6:37

And uh so she's helped facil helping facilitate that in a very unique way.

Susie SInger Carter 6:42

And uh say to me, what is it?

Don Priess 6:44

I will, you know, why don't instead of just telling you, why don't I introduce her and then she can tell us herself?

Susie SInger Carter 6:50

Do it, Don. Go for it.

Don Priess 6:52

I'll do it. I'll do it right now. Erica Sell is the founder of Harmony Home Medical, a San Diego-based medical equipment company, helping people find real solutions that improve comfort, independence, and everyday quality of life. Erica started Harmony because she wanted the decision-making power back where it belongs in the hands of the end user, not the insurance companies. Knowing how difficult it is for families to actually see, compare, and try equipment before making a purchase, she created beautifully fully stocked showrooms that make shopping for medical equipment feel like shopping for anything else. More selection, more education, and more empowerment. Harmony has become San Diego's most complete medical equipment showroom, committed to next level service that helps people live better at home. We're so happy to have her here with us today. So let's say hello to Erica Sell. Hello, Erica.

Erica Sell 7:45

Hi Erica. Hi Susie. Thanks for having me on the show.

Susie SInger Carter 7:49

Of course, welcome. And and what a what a fortune uh fortunate name that you have, Erica Sell. Right? And then and then you have the keyword in in your description, which is shopping, and that you know, that's like a that's like me, I'm like a cat to uh to involve when you say the word shopping. I'm like, what it's there, I don't need it, but I'll go. What is it? Let's go shopping. Right. So yeah.

Erica Sell 8:13

So many, so many of us women are, and also so many of us women are the decision makers in the household when it comes around to healthcare decisions and and care at home.

Reimagining Medical Equipment Shopping

Erica Sell 8:23

And so I saw that. I felt that when I was a young person working in this industry. Like, where's the appeal? Where is the selection? Where is the education and the color? Um, so yeah, that's that's I kind of wanted to bring the shopping we liked a little bit into the DME durable medical equipment arena, um, because it's just better.

Susie SInger Carter 8:45

It's so much better. I love it. You know, I we're developing this project based on a book called Inflamed. I won't go into it, but one of the characters, and it's about assisted living during a fire, something that happened, but it we'll talk about it another time. But one of the characters, one of the people that's based on a true story, one of the women had her walker, which was like j it was, you know, zhuzed up. It was like her pride and joy, it was like her Porsche, you know, and she loved it. And I think it's why why not? Why not have things that make you feel good and they're not just they're you know, they're more than just functionable.

Erica Sell 9:24

Yeah, absolutely. And having choice and nicer ones and color. There's a manufacturer line called Nova in our industry with a CEO woman named Su Chen. She's amazing, and she brought the turquoises and greens and um purples and maufs, you know, to walker and rollators. So people had that color choice.

Susie SInger Carter 9:46

I want rainbow when I need one, right?

Don Priess 9:50

I was recently we were looking for some stuff for my mom who was at that time was an assisted living, and uh she needed a uh a new walker. And we went to a few of the different stores, and it was literally like walking into kind of a an old warehouse almost. It was just stuff you know lined up against a wall or in some shelves. And it was very depressing. It actually made me feel bad about being there and trying to find something that was going to improve her life.

Susie SInger Carter 10:17

So I want to get into everything, I want to get into everything Erica does, but I just want to just follow up with that. It's like say, yeah, that's why, and most people don't want to have a commit to a walker when it was it they really need one to protect themselves from falling because they because there's such a stigma about it, and it and it makes them and it's and they are unattractive, they look you know utilitarian.

Erica Sell 10:44

Yeah, they've they've made improvements on it for sure. But the psychological barrier to using some of our products is definitely there. It's less when people are in community like assisted living because everyone has it, and it then it kind of becomes like who has the coolest one, the the latest and greatest, the latest feature and colors. Um, but there's there's definitely that, and because of the stores that you know do the gray bent metal and line it against the wall, and they have terrible fluorescent lighting, and you kind of feel like you're walking into a dusty storage closet, it was never anything anybody wanted to approach or to have. Um, and so we attempt to change that with you know, beautiful stores, nice lighting.

Medicare Basics: What’s Covered And Gaps

Erica Sell 11:27

It's warm, it's colorful, there's options. We're excited about it. Like the stuff we sell is amazing, it changes lives. Um, so it's a completely different experience, and that right there can get somebody over the cliff of um that the not wanting it, you know, and of pushing back on it, just making the experience out the gate better.

Susie SInger Carter 11:48

Well, let's back up your story a little bit because I I get asked the question all the time like, why did you not take your mom out of the nursing home when you saw things were not well? And you know, at the at that point it was too late because my mom's acuity was so high. And it would have been it would have been absolutely undoable. Could not do it, couldn't under the kinds of programs that we have. It just wasn't doable. What let's talk about the programs that we do have and that you can help with with your products.

Erica Sell 12:21

Yeah, well, we can start with medical equipment and what's covered and what's not covered, because there's coverage for things, there's a lot of gaps in what's covered. Um, so being aware of what may be needed and what you can do to um to bridge those gaps and products that can bridge that gap is great. Um so Medicare is usually the payer um or a Medicare HMO, something like that, but they all go along the same guidelines as Medicare. And Medicare will cover a basic cane, basic walker, or one of the walker with seat and handbrakes, but um but super basic with an allowable for about $110. Um, and then a standard wheelchair, a power chair if you cannot walk or roll 50 feet or less in home, and a hospital bed if you cannot change position in bed. So you can't perform turning and rolling on your own. And there's there's sometimes room for scooters, um, and there's sometimes room for ultra-lightweight wheelchairs when someone has a condition that is more like MS or um not even Parkinson's so often, but sometimes. Sometimes you can qualify in Parkinson's where they may have an active life and be actively pushing, but a diagnosis that allows them um does not allow them to walk. And but but for seniors in general, they have so much um muscular decline that even the lightweight chair isn't going to enable them to push themselves all over the house and around. So they generally wouldn't qualify for it, they'd qualify for a more standard wheelchair or a transport chair, one that someone else pushes. Um so those are the basic coverages, and the allowables for all of them are for the most basic of them. So, you know, the 40-pound wheelchair versus the 25-pound wheelchair, the semi-electric bed versus the full electric bed. But if you work with the right vendor, you can ask them to do an ABN, which stands for advanced beneficiary notice, and that means that you can pay the difference between the allowable that Medicare pays and the nicer product that you want. And they need to have that product available. The other thing you could do is if you if you worked with a company like Harmony is where we don't bill insurance directly, but all of our equipment that is coded or code eligible is coded on our receipts, you can submit that with a doctor's prescription to Medicare and they'll reimburse you with a self-claim form, the allowable for that product category.

Susie SInger Carter 15:01

Oh, that's good to know.

Erica Sell 15:02

Yeah, so that's a couple ways that you can recoup at least what Medicare's going to pay and use that benefit to lower your cost on the nicer item. And then sometimes the basic item meets the person's need. Um I see that most often in Rollators or walkers and transport chairs. Those are rollator is the walker with a seat and handbrake versus just the walker that doesn't have the seats. So, you know, the the Medicare one, it's it's not glamorous and sometimes it's lacking for size variations, so someone's really tall. Um but you know, could get somebody by or they could do that price difference and buy one of the nicer ones that are out there. Um but those two can can can meet people's needs. Where I see a lot of gap is in the beds and the the bathroom, we can get to that. Um but in the bedding, the bathroom, and then in the actual wheelchair. So because so many people don't qualify for that fancy K5 ultra lightweight sports chair, the 40 pound basic chair just doesn't cut it for most people. So they can uh like buy off the shelf um a 25 pound ultra-lightweight non-custom chair for less than a thousand, and they could try to submit Medicare's um portion to get about two hundred dollars back. That's about all Medicare pay for the chair.

Workarounds: ABNs, Self-Claims, Rentals, Used Gear

Don Priess 16:29

Yeah, it's really a challenge because when my mom suddenly needed just basically be in a wheelchair all the time, she has Parkinson's, um, you know, the the the selection was so little, and the fact that she's all day we wanted one that would kind of recline a little bit so she could change her and my god they were so expensive. And you know, and to get ones that we could also transport so we could get her in and out of the car, then not have to have a second wheelchair. I mean, it and and it gets so pricey so quick it's really hard.

Erica Sell 16:59

It does, and there's rules around so like most people do end up needing more than one thing, right? So if you're gonna get a walker, do not get a transport chair or a wheelchair first, because you can't go back in the qualifications. So it kind of needs to go up the pyramid of need with a a cane and then a walker and then a wheelchair and then powered mobility. If you went in and somehow, you know, doctor qualified you for powered mobility, and then you said, Well, I want a walker when I go into my dining hall, you can't go backwards like that. It has to go up the pyramid of need.

Susie SInger Carter 17:31

Yeah, it's so ridiculous. It's like, why make it so hard on everybody? I know this isn't your expertise, but it just bought I just needed to say that. It's just frustrating because when you have a child and you need a car seat and you need a uh you know a stroller. Stroller, yeah. You know, and then something to put them in with the colour.

Don Priess 17:49

Get them in order.

Susie SInger Carter 17:50

Yeah, like why and and it's like, why wouldn't you want the most comfortable? Why wouldn't you want the best? Why would you want to settle for something that's not great? Like like Medicare, get your act together, you have tons of money, like pay for the good stuff, right?

Erica Sell 18:05

It's it's insane. They cut they've cut rates 42% since I entered the business in 2008. And the So instead of going up, it's going down. It's gone down. It's ridiculous.

Don Priess 18:15

As the price as the prices of equipment go up.

Erica Sell 18:17

Yes. So it's no wonder why, you know, dealers like me, I did insurance for the first nine years of my business and I don't anymore because I can't run a good business on insurance. But there's um there's a companies out there that do it, but they're national chains and they tend to be very poor serviced. Um, but we try to find ways to to help people get those credits back, the reimbursements back. And then I hope that COVID there wasn't a lot of silver lining, but some of a was the one of them was it did show the outcomes at home can be so much better. And that bedside in-home care, um, like back in the day when you had the doctor come to the house, is a much less expensive form of health care. And they started to cover all this telehealth products and telehealth uh visits and they loosened up on their criteria around medical equipment, like they used to deny if you didn't cross

Aging In Place For Dementia And Bed Solutions

Erica Sell 19:12

your T correctly on your prescription. Um and they kind of loosened up around beds and some things, not having to always document that pillows were tried first, like silly stuff that they would do to deny things. So they um they had some loosening in that and and maybe as it's shown that costs go down when people stay in the setting of their choice, they'll be they'll continue to try to cover more. Medicaid is Medicaid has launched a new program over the last two years that we're participating in for home access. And we're actually putting stair lifts and vertical platform lifts, so powered wheelchair lifts. Those are expensive, big pieces of equipment. We're actually putting those in people's homes through Medicaid. Um Community Health Group in San Diego is like the best one about it, and it makes so much sense because that will extend how long that person can live in their home for years and keep them out of uh skilled nursing which which is so much more expensive.

Don Priess 20:15

So much more expensive. I mean, it's it's almost on a small level. My going back to my mom, they they found that she was starting to get redness in an area, and they said, Oh, it's this could become a bed sore. We don't want that to happen. We said, Well, can we get the the the mat the bed that kind of keeps her they said no, not until it becomes a bed sore.

Erica Sell 20:34

Thank you for bringing that up. That is one of the worst. That is, I didn't say air mattress after beds. It's true after beds comes air mattress, and you can qualify if you have a stage three wound on your core or multiple stage twos, and you have to wait to get those. That is that's almost criminal to put somebody through that before applying the certain things.

Susie SInger Carter 20:56

It is criminal. It's not almost criminal, Erica. It is.

Don Priess 20:59

She ended up with a stage.

Susie SInger Carter 21:01

Because that's what happens. If you're if you're immobile and they're not moving you, you want to mitigate as much risk as you can, and to and to deny that a kind of mattress that you know keeps moving and brings air in and all that stuff. What why would you not do that?

Erica Sell 21:18

Like all the reasons why I started the company and why we made it not through the lens of insurance, but just through the lens of what do you need, what makes life better, and then we figure out ways to make it feasible for people. And we have rent to own, we have just regular rental, so you can rent to fill gaps between when insurance is covering and not, um, or just rent to make it less expensive. And then because we rent equipment, we have a great used fleet. So we have a lot of used equipment and we sell. And that's running for so you can get something 50% off of regular. Um, and then there are some grants and programs out there for certain populations, but but for the majority of people, they're not in those programs like the Veterans Program. Um Alzheimer's or sorry, ALS Association does a great job of equipment recycling too. Um Alzheimer's Associations, they tend to have great programs for some respite care, but they don't do um equipment loan closets as much.

Susie SInger Carter 22:17

Which is interesting. Can I just tie it into Alzheimer's because we are love conquerors Alzheimer's and you know there keeping somebody at home who has Alzheimer's as long as you can is so much more preferable because you know the the amount the the in the what am I trying the escalation of their disease when they move into a facility is exponential because they you know being disoriented, agitated, not knowing where they are, it is so disorienting for someone with Alzheimer's that you you want them to age in place you know more almost more than anybody because it's so mentally you know it's just hard to uh adjust to. And it takes a very long time for them to adjust. I know. Because I went through it with my mom. And I talk to people every day about it. And it's just doesn't make sense. Like, yeah, Alzheimer's Association you would think would understand that because anything that you can keep, you know, especially in later stages when you do start losing your ability

Bathroom Access Without Remodeling

Susie SInger Carter 23:24

to feed yourself or your ability to, you know, when you're incontinent, that happens quicker, usually with people with dementia and Alzheimer's.

Erica Sell 23:31

Yeah, it can become really hard to perform care. So some of the ways that we set up homes, some of the the equipment that's beyond the coverages that help people, um, one of them is our adjustable high-low hospital beds. They are not um, they don't look like your regular hospital bed. So as far as setting off a behavior or making somebody feel like they're in an institutional setting, they completely skip that. Like they completely integrate with the homesthetic and they go high, high so the caregiver doesn't have to bend over so far to hurt their back to perform care in the bed. And they'd slope forward and back, so the Trendelenberg position, so they can kind of stay in their bed but make it almost like a chair, um or or sleep with their head elevated without being bent at the hip, or raise their feet way over their heart so their swelling can go down. So it performs all these functions like a bed that you see in a hospital, but it looks like your everyday bed. And that one's been really where do I get it? No kidding. I know good place. Yes, that one is a caregiver family member favorite because it makes everything still feel like home in this beautiful package. Um, and we have them also not in the you know beautiful package, a little more medical looking, and it makes the price point about 1,500 less, 1,000, 1500 less. Um, but either way, the the beds that elevate the patient higher so the family member or caregiver isn't hurting their back to do the changes and position changes that happen more and more as we could get a little further down the road with Alzheimer's in any diagnosis. So that's one. Um and then the other one is some shower equipment called shower buddy was the originator of her. There's another one called New Products, but there are tracks that you put over your tub or shower that remove the need to do remodeling. Remodeling is the best outcome. Like everyone wants a roll in shower, but not everybody wants to spend twenty thousand dollars plus to remodel a bathroom for accessibility.

Speaker 4 25:41

Right.

Erica Sell 25:41

Um, and on on that note, too, if you are going to remodel your bathroom, anybody, you know, from from our age on, do it accessible because accessible can be beautiful and is beautiful. They do it in Europe all the time. The the wet rooms and zero transition has been popular for like the last two decades. Um it's in a lot of new homes. Yeah. And it integrates beautifully, it's more functional for everyone. It's universal design. So that but these are the kitties too. For the kitties too. Yeah. Yeah. I've got grab bars over my kids' bathroom because they pull on the towel hanger and they pull on the toilet paper hanger, and they're all um two-in-one grab bars.

Susie SInger Carter 26:19

Well, ours use the toilet the toilet paper holder to get up on the toilet, and I'm like, oh my god, it's gonna come off the wall. I just know that because they use it.

Erica Sell 26:28

Two in one two and one toilet paper grab bar, it won't go anywhere.

unknown 26:31

Yeah, I kind of get that.

Don Priess 26:33

So is any and all of the this when you're paying it out of your own pocket, is is it tax deductible?

Temporary Needs, The “Pyramid” Rules, And Rentals

Erica Sell 26:39

Yeah. Um, so whole modifications are, and then medical equipment is too, but I believe you have to go over a certain dollar amount, um, and then then it becomes tax deductible. Uh, but I don't know the ins and outs of that. It it is a health care expense. So if healthcare expenses are, then it should qualify.

Susie SInger Carter 26:59

It should be, yeah. And when does it like you for instance when you're talking about you know in what order that you need to buy things, right? So that you don't because you can't go backwards, does that renew yearly? No.

unknown 27:12

No.

Don Priess 27:13

Okay, so it's a lifetime from the beginning.

Erica Sell 27:16

Yeah, yeah. You can get new equipment once every five years. Um, and if you had a power chair and you wanted to go back to a wheelchair, you could present a change in condition that they improved and you could fight for it. It's just not typical. Um but but you could, but when you do that, I mean you have to have a true change in condition that the doctor's gonna document. Most of the time when people go to that level, they're it's not going that way. It's usually that there's needing to stay in their current mobility status, and so they can't justify going back to a cane walker or w wheelchair after going powered.

Don Priess 27:53

But but if someone had an injury or something and then they had surgery and they're gonna be in a certain state for a certain amount of time, then they're going to get better. It seems like that would be a natural progression that you would be able to do. But I guess that would have to come from the doctor saying they are now at this state.

Erica Sell 28:08

Well, they'll only apply uh approve for they won't approve powered mobility for temporary needs. So they would do a wheelchair and then back to a walker. They probably in that case um give you a walker and a wheelchair at the same time. They they bill first for that walker and wait a couple days and bill for that wheelchair. We'll see that in like knee and hip replacements. That can happen. Um, but you won't get um a scooter or a power chair, even if you needed it during that time, if it were temporary.

Susie SInger Carter 28:39

And no massage chairs gone, so get off of it. No massage chairs. Don't even think about it. No, don't even think about it.

Don Priess 28:45

It just doesn't make sense. I mean, if you had a major surgery and you were in a particular state where you couldn't do something, you're at the fact that they're saying, nope, sorry, you're don't qualify because it's not permanent. Yeah, it just struck.

Erica Sell 28:58

Kind of like uh prosthetics and therapy, you know, you want those things, and if you're gonna hat receive coverage for those things, which generally costs more than the medical equipment, um then you can't get the medical equipment that would support you if you didn't get those things.

Don Priess 29:13

If that makes sense, like that apply for rental too, if you were just renting, you know, meaning I need this temporarily, so I'm just renting it. Does it how does that work?

Erica Sell 29:21

Yeah, all most of the stuff on the Medicare is rental basis, so you get those 13 months once every five years. Um so they would rent that wheelchair for you for 13 months until you own it. Um the thing that sometimes people get caught up with that is that they might have an injury, rent a wheelchair from one vendor for say six months, um, and they don't need anymore, and they turn it back in, and then two years later need a wheelchair for a real for a long term, and have moved or be a different town or go to a different vendor, and the vendor goes to bill and says, Oh, I only have six months I can collect on this product, you're gonna need to pay the other half. Because the vendor's not gonna get money from the other vendor.

Susie SInger Carter 30:04

Until it starts the next year, is that just for the year billing cycle, yeah.

Erica Sell 30:09

Gotcha, okay. Um for for that five-year billing cycle, not the year.

Don Priess 30:13

Oh wow, yeah.

Erica Sell 30:15

Yeah.

Susie SInger Carter 30:15

Oh, five year yeah.

Erica Sell 30:17

Good. Thirteen months of payments and five years for mobility products. So so sometimes you really need to pay attention to that. And in and in most cases

Building A Refurbished DME Ecosystem

Erica Sell 30:27

it it makes more sense to just keep the item and let it bill all the way through and make it become yours if you're anywhere over that six-month mark of need.

Don Priess 30:37

Just store it away so you don't lose it. Now, do you for the for the used stuff like do you would do you buy other people's used equipment or is it just something that you've done on rental stuff?

Erica Sell 30:47

We we usually buy back our own equipment. So we carry the nicest stuff, you know, but best value items. Um, not always the most expensive, but definitely not the least expensive. And a lot of the stuff that's in the the world is some of that Medicare issued uh less expensive stuff that breaks easily. And um, so we we don't buy back general public usually, we buy back products from our clients that no longer need it.

unknown 31:11

Gotcha.

Erica Sell 31:12

So and our warehouses are full. Like there is a whole world and other business opportunity out there to do a refurbished only business like the Goodwill of DME. Um, I'm I'm interested in trying to look at that at the end of this year. I think that it will be more needed than ever because people who um had coverage through ACA, and you know, we all lost our additional Affordable Care Act um money on insurance, there's gonna be a lot of people who just don't get insurance now. And they're gonna be needing equipment and things and be on a budget for it. So there's gonna be more need for that than ever.

Don Priess 31:50

And these are the people who need it most who aren't who can't don't no way they're taking money out of their pocket because they don't have it.

Susie SInger Carter 31:56

So what about the chair lifts?

Don Priess 31:59

Those, you know, yeah.

Susie SInger Carter 32:02

No, no, the kind no, the kind that are, you know, like a ri just a regular chair that lifts up. Yeah. So they have to do that.

Don Priess 32:09

Like a recliner that goes, yeah.

Erica Sell 32:10

Yeah. Yeah. So if like back to the optimal outcome or optimal equipment for the for the home for setting up for care.

Essential Lifts, Chairs, And Safer Transfers

Erica Sell 32:17

So the the bed that does the more functions, the bathing equipment, when it gets to a certain point, that track on the shower can allow someone to transfer from their bed to this rolling chair and then bring it into the bathroom and click it and slide it across into the tub. So no need to transfer over the edge or trans or step over the shower ledge. The cool, yeah, they're really amazing. The bedroom setup once they need a transfer device. You could use something called a sit to stand that most people don't know about that's way easier than a hoyer, and that lets the person, as long as they're able to sit on the edge of the bed, then let's them go to a standing position with a lift. So a sling goes behind their back, stands them up, and they stay kind of in a seated position. So when you go to put them in a wheelchair or their lift chair, it's easy to get them back in the chair in a seated, proper seating position. Where with the Hoyer lift, you're kind of hammocked, and when you go to get to your chair, you kind of you end up s at the front of that chair sliding forward. Good caregivers and people who know how to use it well can can pull their bottom back at the last minute and get their bottom back to the back of that seat. But it's hard. It's hard. So for those caring for their loved ones who aren't experts in at uh CNAs and caregivers and stuff, that they would benefit from using a sit-to-stand lift. And then the lift chair, that's again um one of those products that just integrates into your home setting where it doesn't feel like medical equipment at all, and allows the person to change in infinite positions throughout the day. So you've got pressure sore prevention, you've got a swelling uh reduction in our lower extremities, and then help standing up when you need to go stand up. And the way they've made these chairs now, I bought two of them last year for myself. There's they're so nice. I moved furniture around just so I could get some because they do inversion, they have these tilt motors, they heat, massage, stand you up. They're wonderful. So that's a great.

Susie SInger Carter 34:13

We have a massage chair that actually rocks you if you want.

Don Priess 34:15

It's but but stuff like that, then none like for example, that that's that reclined, that's not covered by Medicare.

Erica Sell 34:25

It's not covered. So they say there's a coverage for a lift mechanism. I've actually only seen it approved like three times. Uh, but the lift mechanism, uh, Medicare has it allowable for $200 and something dollars. So if you qualify for it, you buy a lift chair. No, nowhere can you get a lift chair approved on Medicare, but you would buy a lift chair and submit for the lift mechanism, and you might get $200 back from Medicare.

Susie SInger Carter 34:49

Good to know. Good to know. That's $200. So that's good.

Erica Sell 34:53

Yeah. So there's some criteria around that. We won't get into details, but you could possibly get that back. Um, and then the other thing that's uh not covered at all, but it's worth noting about the ideal home setup is to have some of these new monitoring devices, and you've probably had people on talking about it, some of the ones that are um non-invasive, so it it protects your privacy, it uses it's not LiDAR, but it's an MMR, it's like little sound waves, and it's super super accurate accurate. Um we have one called Pontone Sense, and it it can tell you if you had a fall, it tells you the person's heart rate and respiration remotely. And so those kind of things, especially with dementia and Alzheimer's, to always keep track of the individual in a way that doesn't invade their privacy, but you know they're safe, can be a great thing to have in the home too.

Don Priess 35:53

Yeah, especially with Alzheimer's where you have you know the flight risk and all those things. You can see, oh, we're not in their room out there. They should be right now, yeah. I think that's that's super, super important. Yeah. Yeah. So you have um do you have multiple locations or just one location right now?

Erica Sell 36:10

We do, yeah. We have one in central San Diego and one in Vista, which is North County, San Diego, about 40 minutes apart from each other.

Don Priess 36:17

And are there plans for expansion at out of San Diego area as far as maybe franchising

Discreet Home Monitoring And Safety Tech

Don Priess 36:22

or doing this? Because it sounds like this is something that every city should have available.

Erica Sell 36:27

Yeah. I know. Um we are looking at possibly going to Palm Springs this year. And good location.

Don Priess 36:35

Good choice.

Erica Sell 36:35

Yeah. And then we would um look at a franchise after that. I'm I'm very busy trying to improve some technology around the our our business and in this industry using new technology like RFID, it's um radio frequency trackers for inventory tracking and smooth and easy um rental and pickup process for people. Our goal is to make it as easy and seamless as possible for people because when they come into our ecosystem, they're stressed out. They've they've usually not been given a whole lot of help from a facility or healthcare provider. It's unfortunate a lot of the facilities and doctors and healthcare providers they don't spend a lot of time learning about resources beyond a Medicare resource. Um and so they are they are left with so many gaps and they're sent home and they're they do not know for the most part.

Susie SInger Carter 37:29

None of them know. I mean, we interviewed so many frontline providers and doctors and even gerontologists don't really know the difference between Medicare and Medicaid and or Medicao. They just don't know.

Erica Sell 37:40

Yeah, they don't and they don't know it's covered. They'll they'll say that happens a lot too. The doctor will write a prescription for a lift chair and they go, I wrote the prescription, bring it in, they'll cover it. And the person comes in like my doctor said, and it's like, oh

Expansion Plans And Service Philosophy

Erica Sell 37:52

I'm so sorry. I know they don't know about they do not know.

Susie SInger Carter 37:58

No, and everybody has a different definition, but if someone is not in San Diego, can they re can they shop online with you?

Erica Sell 38:06

We have yeah, we have online shopping and um and support and education. We have a great YouTube channel, and when it's a product that we can support easily, like we've sold lift chairs and beds, and we do have white glove in other states for it. When it's something complex, um, like some uh power assistant devices, those are devices you put on a manual chair to turn it into power, custom custom chairs, uh complex conditions. I get on the computer and Google with that person on the phone and try to find them a local provider. There's times when that's wonderful. It's so important to have hands and support, and I I believe in that, and so I believe it's shop locally, you know. And so if there's a case where it sounds like they could use the support, I help them find somewhere if it's available in their area.

Susie SInger Carter 38:55

But set but your website has resources and all kinds of you know, like your checklist of what you need to really be a successful uh age in place caregiver.

Erica Sell 39:06

Yep, absolutely. We have way more resources and way more knowledge than uh an online platform like an Amazon or a Medmart. Um so you know, we're we're experts, and everyone on my floor is an expert in this field. So people from anywhere can call, and if they do want to buy online, we can help make that that process smoother and get them the right thing the first time if they pick up the phone. Because that's that's the other thing. A lot of people who buy online, I get it a lot in the store. They want to sell me the stuff back that they made the wrong purchase of. And uh and it's because they they they think they're they're researching, they're doing their best to select it, but it is a very vast field with a lot of options, and so if you don't know this field, it's very likely that you could pick the wrong product.

Don Priess 39:49

Yeah, even if something as simple as well, we were looking for a wheelchair for my mom, the width. I didn't, you know, to figure out the proper width that would be best for her. Best for her, and yeah, and then does it does it fit the house too?

Erica Sell 40:03

And what is the overall width of a wheelchair? Yeah, that's it.

Online Support, Sizing Right, And Local Expertise

Erica Sell 40:07

Exactly.

Susie SInger Carter 40:08

You have to think about that. I mean, everything we don't think about it could because and we talk about this before, like even with medication, it's not a one-size fits-all, you know, and we tend to lump in you know this gener this this this particular you know population as a one size fits all in everything, and it's so not, it's the opposite, right?

Erica Sell 40:28

It is totally the opposite. It's differences uh and even the simplest of stuff. You want to be sized for it. If you're working with a company, it doesn't ask your height and weight or height and weight of the end user in the first three or four questions, you know, go go the other direction. Run, run.

Susie SInger Carter 40:45

I mean, I just started doing Pilates, and I mean, even like you go into Pilates, like it's a science of like how you know what the bar should be up, depending on your height, and uh, you know, because you could hurt yourself if you if it's not you know calibrated exactly right.

Erica Sell 41:01

Yeah, and that's true. So we install grab bars and do all of our installations uh for home accessibility, and there's ADA codes, and people often think they want to do that, like they say, you know, what's ADA? Put ADA in my house, but that's a standard for the general population. We want to get mom or dad or yourself in there and stand you on the wall and have that bar be it where your arm is like a 120-degree bend. And we set it to like what works best for the end user. So it it matters in almost every product category that we do.

Don Priess 41:35

That's incredible. It has to be. Yeah, I mean, one person might not have as much strength in their right arm as their left, or they, you know, so where should it be? And all those, every there's so many tiny variables that make a world of difference.

Susie SInger Carter 41:46

Yeah. Here's just a little funny and an anecdote, and I'm gonna probably be wrong. So somebody correct me, but I think it says Bella Rosalini, or an actress of that ilk, who I remember this interview saying that when they remodeled their home, this was like t 15 years ago, it was all for aging in place. So it was already like that and done so that she would never have to leave the house. Yes. As for as long as you know she could stay there. So like i everything that you're talking about was already there. And they you know, so and and and made it chic.

Erica Sell 42:23

Yeah. Oh, it can totally look great. Absolutely. So when you're doing that, like removing transitions, you know, the the shower thresholds or tubs, entryways, uh, transitions between carpeting and flooring, and making sure those are small and have color distinctions. Our eyes take a little more light and to see, and so the color distinction helps. Um, so many little pointers to make your space functional. But those are some of the biggest ones, like lighting and removal of thresholds and barriers, um, and then wider like turning radiuses for chairs, you know, wide hallways, space next to your furniture, that kind of stuff is pretty pretty basic and can get the job done.

Don Priess 43:07

Is there anything for for people who have homes with backyards? You know, is there anything in that specifically for the backyard? Because you don't want people just inside all the time. You want to make it easy for them to be to go outside. Is there anything specific to backs, or it's just, you know, well, we just make it possible to get into your backyard.

Erica Sell 43:23

So if you have the wheeled device, then the threshold ramps or big ramps or lifts, depending on what your backyard setup is or your home entry exit is, we can modify it so you can get your wheeled device out there or that you can walk safely on your own out there. Um, and so we make sure you can access it that way. And then if you need assistance with your mobility to move around it, well, then you need a wheelchair or maybe a power chair with a little gut gumption, a little torque that can do bumps and terrain. Like an SUV?

Susie SInger Carter 43:57

Like a SUV.

Erica Sell 43:59

We have the SUVs of power chairs, yeah. Yeah, yeah.

Susie SInger Carter 44:02

And then there's what about swimming pools?

Don Priess 44:03

What about therapy?

Erica Sell 44:06

Yeah, yep, and then there's pool lifts. So it can install pool lifts, get you in a pool, get you in a spa. Um, we

Universal Design Tips And Home Layout

Erica Sell 44:12

did one of those recently. So we did a lift for a swim spa. She had put in her swim spa for her therapy and to keep herself strong, and she needed a lift to get into it. So, yep, yep, all those things are possible. And you know, we we talked about the the limitations in coverage, just in case there are any veterans listening out there. The VA does have amazing coverage. TRI-Care, which would be the insurance they would normally be activating and going through, sometimes is the same as Medicare, and they might like run into walls. And I don't know if people talk to veterans who who work with in TRICARE about going to the VA. But if you go to the VA, they have programs for um portable power chairs, complex power chairs, custom wheelchairs, stair lifts, vertical platform lifts, it all it just comes out of the VA, it doesn't come out of TriCare, it's like two separate programs. And um We've done amazing work with them.

Susie SInger Carter 45:09

And I asked you this before we started the recording, but I because someone had mentioned IHSS to me, and I know you don't know a lot about it, but can you you could explain it better than me and maybe people can look into it further?

Erica Sell 45:23

Yeah, for California at least, um there's the IHSS which is qualifiable when you qualify for Medi-Cal. And it allows you certain number of hours of having a home aid or a caregiver. And those hours will vary depending on diagnosis and doctor prescription recommendations. But the the family member or um uh spouse or or family member caregiver who may be home doing the care can actually qualify as the IHSS worker as well. That or then they can send in caregivers who work for that department to help support that care. And there's not many there's not many other avenues to get home care covered. So that's one that Medicaid has in California.

Susie SInger Carter 46:13

And Erica, you also, you know, had a caveat that you know sometimes the kinds of the quality of caregiver that they send out may not be the toppest, you know, the top of the food chain. So you want to be careful with that. Don't think that just because that it's covered that it's you know that they've been vetted and and that they're you know quality, you have to really make sure that it's a match. And to me, just listening to you, if it were me and I was already caregiving, I would take that, you know, whatever they could whatever I could get for for myself because when I was caregiving for my mom, I didn't know anything about that.

Erica Sell 46:51

Yeah, absolutely. Every bit helps. Caregiving is so expensive. Um, and then the homemakers program through the VA too, they also have benefits for it. So, but as far as I know, Medicare doesn't have anything coming down anytime soon for caregiving. No.

Susie SInger Carter 47:08

Yeah, get it now, guys, because we don't know what's happening tomorrow.

Outdoor Access, Pool Lifts, And Mobility “SUVs”

Susie SInger Carter 47:12

But is there anything we left out, Miss Cell?

Erica Sell 47:17

Um around medical equipment, I I think just making sure that you work with an expert. Like we're work with a company. If if you don't want to go into a a DME or you don't have access to occupational therapists, are probably the most knowledgeable people in this realm that are on the front lines of healthcare. So they they are um very good at helping to spec out equipment correctly and know what equipment will be needed. Um and and put away a couple shillings to save for some of this stuff because it is surprising to a lot of families how much Medicare doesn't cover when they want to get the lift chair and the the scooter and stuff, and so it's good to try to be prepared for these things financially too.

Susie SInger Carter 48:05

Yeah. Yeah, no more la la la la la.

Erica Sell 48:09

Yeah, no, no, but it it can be all the difference in the world. Um, I'll share one story before we go about like the difference that medical equipment can make for someone. I had a client who was first his wife was my client, she was in a power chair, and she was always telling him, like, you need to get a chair, you need to get a chair. He didn't want to because of that psychological barrier. Um, he just was a strong man, he was a service man, and um he wouldn't accept it. So he lived in this part of town called Kensington. He would go to the coffee shop, everybody knew him, he'd walk everywhere. Well, one year he quit going to the coffee shop, the next year he quit going to his neighbor's house. And in about three years' time, he didn't leave his house, he even quit gardening, and he didn't realize how small his world had gotten. And he finally said yes, and we worked um with the VA, I I was the ATP on the chair setup, um, and finally convinced him to get this chair. We deliver it, we customized it to him. And uh his wife called me the next day and she said, When Jerry went down to um the coffee shop, they remembered his name and he started to cry.

Susie SInger Carter 49:19

Oh my god.

Erica Sell 49:20

And he was so happy to be part of the community again. He was a community man and he didn't realize that how much he missed it. How much he missed it, and how the that that pride had kind of kept him from that, and then he was all over town again. He was everywhere.

Susie SInger Carter 49:36

Wonderful. Yeah, he just yeah, he he needed to get over that hump. Oh beautiful. That's so beautiful because community's everything. And and yeah, that's so important. So keep doing the things. That's so nice. That's a great story to end on. I really appreciate that. Yeah, thank you for sharing it. That's really nice. Yeah, thank you so much. I I really think you're a superstar, and I think what you're doing is so important, and you know, people don't realize like how important it is until you get there, and it's not the time to think about it, it's the time you need to think about all this stuff ahead

Veterans’ Benefits Versus TRICARE Paths

Susie SInger Carter 50:12

of time. And um, you know, that's why you guys are doing this.

Erica Sell 50:16

There's so many resources out there. Like it's it's so many things to consider in this world of aging and Alzheimer's, and it's tough to pull them all together. So it's good to do that.

Susie SInger Carter 50:27

It is tough, and it's but but there's but there is resources out there, and people that actually care and are actually experts and they know what they're talking about, and you know, we have to be careful, you have to vet. And I, you know, one thing I we Don and I try to do is make sure that we really believe in the people that you we have and speak to. So, you know, I I can't guarantee it, but we we do our best to bring the best people, and I I really think you're one of them. So thank you so much so much. Thank you very much.

Erica Sell 50:57

Yeah, that's wonderful. All right, well, thank you for having the show and sharing with people. It's great.

Susie SInger Carter 51:03

Of course. Well, we love to do it, right, Don?

Don Priess 51:06

We do, and you know why? You know why we do, and that's because love is powerful, love is contagious, and love conquers all. So we thank everyone for watching and listening today. If you like what you saw and heard, please like, share, subscribe and subscribe.

Susie SInger Carter 51:19

And if somebody needs something that you heard about today, you know, give them the link to the show. Just tell them to listen to it.

Don Priess 51:25

We'll have the link about Harmony Home Medical. We'll have all your information up in the show notes, and so they can contact you and they should do that right now. The second they hear this, they should be contacting you. So we'll please. Anyway, bye, everybody. We hope to see you next time. Take care, everybody. Bye bye.

Speaker 2 51:40

Love you. Bye.