The healthcare industry plays a major role in waste and greenhouse gasses emissions.  Worldwide, healthcare is responsible for 4.4% of net emissions (Lombardi, 2021). While some of this is generated directly from healthcare facilities, over 70% of healthcare emissions are generated in the supply chain, including the manufacture and disposal of medical devices (Lombardi, 2021). Though much of this waste is created by single use items which cannot safely be reused, a great deal also comes from limited use of items which are reusable.  

In the United States, the push to reuse durable medical equipment (DME) started as a grassroots movement in the 1980s to fill the unmet need for assistive technology (AT). In 2004, the Tech Act was reauthorized and included funds to support reuse activities through state AT Act programs (Kniskern et al., 2008). With this funding, state AT acts collaborated with private entities such as manufacturers to develop guidelines for successful reuse programs. Data collected from fifty four AT programs demonstrated that consumers saved over 5 million dollars between October 2005 and September 2006 through repeated reuse of over 5,600 devices (Kniskern et al., 2008). 

As occupational therapists, "we have an important role in advocating and educating others about the continued use of assistive technology (AT) and durable medical equipment (DME) and ensuring that it makes it into the hands of people who need it rather than into the waste stream” (Oldfrey et al., 2021; Smith et al., 2020). We can connect our clients with reuse and recycle programs, encourage clients with unused devices to donate or sell items, and ensure that clients only receive items they will truly use at home. Through our efforts, we can contribute to a reduction in waste in the environment and a reduction in cost to our clients. 

A DME closet, also referred to as a “loaner closet”, is an organization which lends, gives, or sells gently used DME such as wheelchairs, walkers, canes, crutches, specialized beds, and bathroom safety equipment. These services are often provided through larger charitable organizations, such as Easterseals, but can also be free-standing organizations.

Closets work by receiving used DME from those who longer need it.  When equipment is received, it is checked for safety, cleaned, and added to the loan closet collection.  When someone else needs that piece of equipment, they receive it on loan for a set period of time, give it away, or sell it. This is dependent upon how the organization operates. 

Most urban areas in the United States have a DME closet where patients can borrow  medical equipment free of charge. In rural areas, the closets are much more scarce. There are multiple ways to locate used DME in your area:

1. General internet search: To start browsing what is available in your area, you can search Google using a combination of terms such as used, closet, lending, rental and durable medical equipment with your city name.  You can also search databases such as the one through Georgia Tech (https://pioc.gatech.edu/pioc/) or Seniors Mobility. 

2. Local community centers or churches: Some local community centers also have DME which they lend or donate to those in need. 

3. State assistive technology programs: You can search for your state assistive technology program through the AT3 center website. In the search box, put “device reutilization” and then the state. 

4. Specific national organizations: You can search through national organizations that help provide DME such as local chapters of Easterseals, the ALS Association, the National MS Society, United Cerebral Palsy, and Centers for Independent Living. 

5. Second-hand stores: If there are no DME closets near you, you can find DME at local thrift stores such as Savers, Salvation Army, and Goodwill. 

6. Online marketplaces: You are likely to find cheaper, used DME through online sites such as Craigslist or Facebook Marketplace.  

7. Social media: “Buy Nothing” Facebook groups or local freecycle groups can also be good resources for locating DME for free. 

Please note that if you encourage clients to obtain DME from non-rehab sources, it is very important that the equipment is thoroughly checked to make sure it is clean and strong. In addition, you can use your occupational therapy skills to train the client in using their equipment and to make sure it is properly adjusted for individual use.

Climate change is caused by human occupation and we, as occupational therapists, have tremendous potential to address environmental sustainability in our practice (Smith et al., 2020). While tackling the issue can feel overwhelming, taking small steps to set positive examples of sustainable occupational engagement for our clients is a powerful and necessary step.

Start recommending DME closets to your clients using this form.

References

Kniskern, J., Phillips, C., and Patterson, T. (2008). Technology (AT) reutilization (reuse): What we know today. Assistive Technology Outcomes and Benefits, 5(1), 59-71. 

Lombardi, A. (2021, December 6). Environmental sustainability: Healthcare and medical devices. Green Book. https://www.greenbook.org/mr/market-research-news/environmental-sustainability-healthcare-and-medical-devices/​​ 

Oldfrey, B., Barbareschi, G., Morjaria, P., Giltsoff, T., Massie, J., Miodownik, M., & Holloway, C. (2021). Could assistive technology provision models help pave the way for more environmentally sustainable models of product design, manufacture and service in a post-COVID world? Sustainability, 13(19), 10867. 

Smith, D., Kayley, F., Brown, L., Allen, A., Jamie, B., and Mary, G. (2020). Occupational therapy and environmental sustainability: A scoping review. Annals of International Occupational Therapy, 3(3), 136-143.