Have you ever cared for anyone who needed help toileting? There’s a game-changing bedside commode for the mobility challenged, and using it helps caregivers, too.

Q: What is your mission?

We have a social entrepreneurial mission: Improve the family caregiving experience by engaging health systems and manufacturing companies to invest in a healthcare self-transferring device. We want them to create a profitable solution to “commercialize” the PPAL™, a patented innovative bedside commode that enables wheelchair users to manage their own toileting needs. If you’ve ever needed to use a bedside commode, or care for someone who needed one, you know the challenges. Click here to watch a 2-minute video of the device in operation.

Q: What prompted the founding of the organization?

My five siblings and I found limited assistive toileting options as we struggled to support our Mother’s decision to age at home. Proud and independent, she had successfully managed throughout her adult life to overcome the effects of the childhood polio she contracted in the late 1920’s. However, she once again began to lose her ability to walk as she approached 60 years of age. By the time she was in her mid-60’s, she was unable to even stand. As adult children, we found that her toileting needs presented unique challenges, even within a very loving and supportive family. Click here to read more about that story.

Q: How did you set goals for the organization?

We realized that, although I had many years of healthcare experience, no one in our family knew anything about manufacturing, marketing, selling or servicing a healthcare self-transferring device. We quickly understood that we would need to attract a Home Medical Equipment (HME) manufacturing partner and that to do that, we needed to accomplish two immediate goals: (1) assess the strength of the intellectual property involved and (2) build a working prototype of the device we had in mind. Our financing came from self-funding as I diverted most of my full-time salary (“bootstrapping”) to cover legal and product development costs.

Q: How do you measure the impact of programs?

The healthcare system has traditionally been dominated by acute care (medical treatments, operations and procedures). Upon discharge, hospitals passed along both clinical and financial responsibility to the next setting, referred to as “post acute care.” If a patient fell, or began to fail, at home or in a nursing home, he/she returned as a re-admission and the hospital was able to once again bill for the additional acute care episode. Under this payment approach, wheelchair users who needed toileting assistance were often institutionalized because family members were unable to deal with the “yuck” factor involved in toileting care. Because the cost of this decision was absorbed by Medicare, Medicaid or private insurance, there was little incentive to upset the status quo.

Thankfully, a new payment approach favorable to relieving the post-acute care stress born by patient and families is being phased in by Medicare, Medicaid and private insurers. Referred to as Value-Based Payment (VBP), hospitals are beginning to be penalized if post-acute care results in a re-admission or an Emergency Department visit. As importantly, hospitals retain the savings generated if someone is discharged to home rather than to a more expensive nursing home, further aligning the financial incentives of hospitals, patients and caregivers.

This makes The PPAL™ a viable hospital investment. By providing a more acceptable toileting option for wheelchair users and their caregivers, wheelchair users can be discharged to home rather than an institutional setting. This new “value proposition” means hospitals have a financial incentive to provide a PPAL™ to wheelchair users, realizing savings from the number of wheelchair users (1) discharged to home rather than to more expensive nursing homes, (2) decreases in the costs of caring for pressure sores and infections arising from dependency on adult diapers and/or urinary catheters; and (3) fewer patient falls due to the caregiver’s inability to safely transfer a wheelchair user via assisted pivoting or ceiling lift. Hospitals will have the option to charge a modest monthly rental fee to the wheelchair user, making the unit affordable to the consumer and offsetting the cost of the original investment. They can contract service and delivery to the equipment suppliers located in the local neighborhoods.

If hospitals purchase in bulk, home medical equipment manufacturers are more likely to realize a profit, and therefore, more likely to assume the risk of manufacturing and selling the PPAL™.

For us, Value-Based Payments are a “win-win” for patients and family caregivers.

Q: What have been the greatest challenges?

The biggest challenge has been to have faith in our belief that we could improve the ability of families to care for their loved ones at home. This meant consistently reminding otherwise caring clinicians, hospital administrators and home medical equipment professionals that patients’ ability to self-manage transferring, toileting, bathing, dressing, and eating after a medical intervention is just as important as the medical intervention itself.

Q: What fundraising strategies have you used?

In addition to my bootstrapping, family and friends have been the source of funding. They have responded to three capital raises: support the initial application for international patents (2008), cover the costs of the annual annuities that need to be paid to continue the patent protections (2010), and most recently build, demonstrate and video tape the latest prototype across diverse populations including senior citizens, wheelchair users and homecare workers (2015).

Thanks to their support, the PPAL™ is patented in the U.S., Mexico, Australia, and Canada; and is patent pending in Europe.

And again, thanks to their support, the video has proven to be key in our quick acceptance by Edison Nation Medical for their “commercialization” review. In return for a willingness to split royalty fees 50/50, Edison Nation Medical shares unproven product ideas with health system and company contacts across the country. We are now at Stage 4 of their 8-Stage process.

Q: What fundraising strategy has worked the best?

Without doubt, the video. And as a result of the video, the decision to go with Edison Nation Medical.

Q: Whatʼs the most critical lesson youʼve learned about nonprofit management?

Embracing change is a huge organizational challenge for profit or non-profits alike. Staff naturally like a predictable workplace, and need inspiration to see beyond “now” to “what can be.” In particular, non-profit leaders should be open to innovations that create the potential to re-align financial incentives, even if they meet internal resistance from their staffs.

Q: What changes do you anticipate in the nonprofit landscape over the next five to 10 years?

Limiting my answer to healthcare, I hope that more attention is paid to the post-acute PHYSICAL CARE needs of patients and their families. There is a great potential to achieve this goal through partnerships between health systems and medical equipment companies. This is no small task. Wheelchair use is associated with stroke, osteoarthritis, multiple sclerosis, absence or loss of lower extremity, paraplegia, orthopedic impairment of lower extremity, heart disease, cerebral palsy, rheumatoid arthritis, and diabetes. With our current demographics, there are 3M wheelchair users in the U.S (and another 10M who depend on walkers or canes for mobility who might also benefit from its self-lift features). This number will only grow as the baby boomer generation ages, potentially overwhelming our healthcare system if it fails to innovate.

Q: How can others help support your organizationʼs mission?

Please like us at www.facebook.com/ThePPAL and follow us on Twitter at @The_PPAL

If you know anyone now needing toileting assistance, or someone who is at risk, ask your clinician why there aren’t more solutions that support self-managed care.

In a very self-serving way, we also urge you to ask your doctor, nurse, physical/occupational therapist, home health agency, social service organization or hospital to contact team@edisonnationmedical.org and ask to be brought into their product review process.

Any questions can be directed to pgraham@quainc.com.


Recommended reading and links:

Product Overview

Toileting Care Fact Sheet

Trade Publication Articles Authored by Peg Graham: