Registration of ipres. Technical facilities for the disabled. How is an individual rehabilitation program for a disabled person is drawn up?

In any country, people with disabilities are a special group of citizens who need benefits and benefits. They also need rehab, or TSW. They are required to ensure a comfortable life for people with disabilities. They are provided by the state. You just need to know how and where you can get them.

Disabled people need a lot of funds to recover properly. They are selected based on the type of deviation. If there is a hearing impairment, then special devices are required. In other cases, other means are needed. They must be provided by the state.

Types of collateral

ТСР for disabled people is available as well as necessary events and services. Disbursement of funds implies:

• provision of technical means;
• performance of services of repair and replacement of the product;
• provision of travel for the child to the territory of the organization;
• payment for the child's accommodation;
• travel.

Period of use

There are periods for the use of TCP for people with disabilities. This is approved by law:

• canes - at least 2 years;
• handrails - from 7 years old;
• wheelchairs - over 4 years;
• dentures, depending on the type, - more than 1 year;
• orthopedic shoes - from 3 months.

For all other devices, certain deadlines are also provided. During this period, the products will be safe for rehabilitation. If the term of use has passed, it is necessary to change the product.

List of funds

According to the law, technical means include devices that allow you to compensate or eliminate a person's life limitations. The list of TSW for people with disabilities consists of funds for:

• self-service;
• leaving;
• orientation;
• learning;
• movement.

People with disabilities need prosthetic products. They also need special clothing, shoes, hearing aids. People with disabilities need exercise equipment, sports equipment, and inventory.

The law prescribes a list of TSWs for people with disabilities. The federal list also contains specific technical means:

• supports and handrails;
• wheelchairs;
• prostheses;
• orthopedic shoes;
• anti-decubitus mattresses;
• means for dressing;
• special clothing;
• reading devices;
• guide dogs;
• thermometers;
• sound signaling devices;
• Hearing Aids.

Depending on the type of deviation, other means are assigned to a person. The federal list of TSW for disabled people is approved by the state. Funds are provided free of charge, so they are not allowed to be sold, gifted or transferred to others.

There are regions of the country where only structures for movement are understood as supports. Because of this, difficulties arise in the rehabilitation of a disabled person. If the rights to provide TSW for people with disabilities are violated, the stakeholders must defend their interests. Indeed, depending on the limitation, special means are required.

Where to contact?

The issuance of TSW to persons with disabilities is carried out after passing the procedure. You must submit an application to the Social Insurance Fund of the Russian Federation at the place of residence. Sometimes you need to submit a document to the executive body that deals with these issues.

It is important to take into account that foreigners and stateless persons who have a residence permit can also apply to the FSS of the Russian Federation. They are required to provide funds for rehabilitation if a disability has been recognized.

Required documents

The receipt of a TSW by disabled persons is possible after submitting an application, as well as several additional documents:

• birth certificate or passport;
• representative's passport;
• rehabilitation program;
• pension certificate.

Only when there is the entire list of documents, the application will be accepted. They are provided in originals.

Application processing

The period for consideration of the application cannot be more than 15 days from the date of its submission. If a positive decision is made, then the following will be received by mail:

• notification confirming registration;
• direction to create a technical product;
• a coupon for a free pass.

The forms of all documents were adopted by the Ministry of Health and Social Development of the country. They serve as confirmation of the issuance of the necessary rehabilitation means.

Payment of compensation

Not only TSW for disabled people can be provided, but also compensation for the purchase of the necessary product. Parents have the right to independently choose the necessary technical means for the child. For this, a wheelchair, prosthetic and orthopedic products, printed publications with the desired font can be purchased. Parents have the right to pay for the repair themselves.

If the product was purchased or repaired at a personal expense, then compensation is provided. It is paid only when the technical means is actually required under the rehabilitation program. When disabled people are opposed to providing the required product, they should be paid funds in the amount of the cost of the product.

How is the amount of the payment determined?

The amount of compensation is not taken arbitrarily, but is calculated according to certain rules:

• the size is equal to the price of the goods;
• should not be higher than the cost of the product.

Payment of funds is documented. Those persons who need it are entitled to compensation.

A special classification is used to approve the amount of compensation for TSW for disabled people. An example is the purchase of a hearing aid that has additional features. Payouts are set based on the price of the device. It takes into account additional functions. The amount of payments is established by:

• the price of the technical means;
• documents confirming the cost of purchasing funds.

Payment documents

In order to receive compensation for the purchase of the desired product, it is necessary to collect important documents. These include:

• statement;
• confirmation of expenses;
• birth certificate of a child;
• representative's passport;
• individual rehabilitation program;

The compensation period is 1 month from the date of the decision. It is accepted by the FSS of the Russian Federation within 30 days.

What if compensation has not been paid?

The right to receive technical equipment and monetary compensation is regulated by the state. If these rights are violated, then liability is provided for. If the money for the purchase of the funds was not paid, then a complaint must be made. It is submitted to the Department of Social Welfare. Moreover, this can be done in paper and electronic form. If option 1 is selected, then it is necessary to obtain a mark of delivery.

The state guarantees not only the provision of vehicles for disabled people, but also repairs. Moreover, this service is performed free of charge. Only for the repair it is required that the opinion of the disabled person about the need to carry out the work converges with the opinion of the experts.

Expertise

To verify the need for repairs, an expert examination is required. During this procedure, it will be revealed whether replacement parts, elements of products are needed. For the examination to be performed, it is necessary:

• submit an application to the body of the FSS of the Russian Federation;
• provide a technical device that requires repair or replacement.

If the remedy cannot be provided, then a decision is made to carry out the examination at home. The impossibility of delivery of the product is associated with the complexity of transportation, the state of health of the disabled person.

The examination is carried out within 15 days from the date of receipt of the application. ТСР users are informed about the time and place of the event. They can participate. As a result, an application is drawn up, one copy of which is provided to the disabled person. The reasons for the breakdown of the tool are spelled out there.If the restoration cannot be performed, then the need to replace the product is indicated.

Repair and replacement

If the need for repairs is determined, then the FSS must provide:

• statement;
• examination document.

The replacement of funds is carried out by decision of the FSS on the basis of an application. This procedure is only possible when the period of use has expired or repairs cannot be performed.

Travel

People with disabilities are given the right to free travel, since it is compensated by the FSS body. To do this, a person with disabilities or his representative is given a coupon and directions for all types of transport. This document is provided for no more than 4 trips to the location of the organization to which the referral is provided. There are also 4 free return trips.

Benefits are provided for such types of transport as:

• railway;
• water;
• automobile;
• air.

Travel compensation

When traveling for personal funds, compensation is paid. It is provided only if these types of transport were used. To receive compensation, you need documents such as:

• travel passes;
• confirmation of the need for a trip.

Compensation is paid for no more than 4 round trips.

Payment for accommodation

If the technical device is only being manufactured, then compensation is provided for the residence of the child and the person in charge. The costs are paid for the entire trip. The amount of compensation is equal to the amount of funds that are provided in case of business trips.

Reimbursement of expenses is carried out for the actual number of days of residence. In this case, certain conditions must be met:

• living in an area remote from the organization;
• the product was made in 1 trip.

The provision for the rehabilitation of disabled people is guaranteed by the state. Ensuring their normal recovery occurs through compensation for various costs.

A person with a disability has to overcome many difficulties in everyday life, which are associated with work, constant treatment, and everyday activities. And in order to better adapt such citizens to a full life, after assigning a group to each disabled person, an IPRA is drawn up. However, many do not know what it is, so you need to figure it out in more detail.

The decoding of this abbreviation is as follows - an individual program of rehabilitation and habilitation of a disabled person. Rehabilitation means helping you recover from surgery or illness. And the concept of habilitation is a set of measures that help a disabled person to develop new functions to replace the lost ones and to adapt to the current situation.

The main objectives of the IPRA:

• adaptation of a disabled person to life in society;
• compliance with health rehabilitation measures;
• assistance in obtaining social independence.

The program is generally aimed at restoring health and raising the standard of living of a person with disabilities.

Sections of the program

When compiling the IPRA, the medical and social examination (MSE) checks how much the basic functions of the body are impaired. These include:

• orientation in space and independent movement;
• the ability to serve yourself;
• ability to work and study;
• communication skills;
• control of their behavior.

Then experts assess the degree of loss of each of the parameters. And after that, on the basis of the examination, they develop a program that will help compensate for the impaired functions. The recommended activities are aimed not only at recovering from an illness, but also at solving psychological problems.

There are some differences in the IPRA for adults and children with disabilities. For example, a child's rehabilitation plan includes mandatory family patronage, and parents or guardians are regularly consulted with a psychologist.

Rehabilitation types

The program itself consists of several types of rehabilitation - medical, social, professional and psychological. Thus, recovery measures cover different aspects of a person's life.

Medical

It includes comprehensive measures to eliminate the consequences of the disease and prevent the patient's well-being. This section contains the following subsections:

1. Treatment.
2. Reconstructive surgery.
3. Necessary prosthetics.
4. Selection of technical means for the restoration of functions.
5. Sanatorium treatment for the patient.

Social

In a consultative form, it helps a person to adapt to social life. The social section of the program includes legal assistance to people with all disabilities, as well as:

1. Acquaintance with information about the prescribed rehabilitation.
2. Family patronage.
3. Physical therapy training.
4. Social and household consultations.

Professional

It is aimed at obtaining an education for a disabled person, which will help him learn to apply his professional skills and get a job. Consists of the following subsections:

1. Recommendations about available professions and working conditions.
2. Career guidance.
3. Help in finding a job.
4. Provision of technical means to ensure new working conditions.

Psychological

Its other name is pedagogical and it is being developed for children and adolescents under 18 years of age. It is aimed at obtaining an affordable education for the child, it involves carrying out correctional work to restore the socio-cultural skills of communication and learning.

Section items:

1. Providing preschool education and upbringing.
2. Passing a general course at school.
3. Corrective methods of work of a psychologist and teacher.
4. Providing technical aids to aid in learning.

Remediation measures

Their goal is to increase the general tone of the body, strengthen immunity, return to normal life without outside help. All this will help to completely or partially remove the restrictions caused by the disease.

Spa treatment

Certain categories of disabled people need a systematic, often occupational disease. But only those patients who have not refused a set of social services can receive a free referral to a sanatorium.

At the end of the course of sanatorium therapy at the IPRA, a note is made about the procedures performed and the timing of the next course with the obligatory stamp of the institution.

Provision of technical means

People with disabilities often need special aids and hygiene items. This is necessary to compensate for movement restrictions and to solve everyday problems. Before undergoing the examination, the attending physician must tell the patient what funds he will need for rehabilitation:

• walking sticks if you have vision disabilities;
• guide dog for the completely blind;
• shower equipment, comfortable handrails;
• special telephones and modern hearing aids for the hearing impaired;
• pressure meters, glucometers, thermometers with voice function;
• wheelchairs, crutches, walkers;
• diapers and absorbent linen for bedridden disabled people;
• orthopedic mattresses for bedsores, pillows.

Prosthetics

Patients with disorders of the musculoskeletal system and the nervous system require prosthetics for complete recovery. According to IPRA, a person is entitled to all types of prostheses, except for dentures. Also, for certain diseases, patients need corsets, splints, hinged structures for the limbs, special insoles.

All this should be provided for in the program so that the disabled person can receive the required funds for free.

Registration

Not all citizens with disabilities know where to get IPRA. And for this you will have to go through the ITU commission, the results of which will be the basis for drawing up a rehabilitation plan.

Referral to ITU

Registration of the document begins with obtaining a referral to the medical examination, which is issued by the attending physician. However, before that, he must send the patient for additional examinations in order to appoint a medical and social examination based on these analyzes and examinations.

Package of documents

Mandatory documentation for submission to the ITU includes:

• the passport;
• certificates with the results of medical examinations;
• outpatient card;
• direction;
• 2 copies of the application.

The application form must contain the patient's full name, his SNILS, passport data, and the actual address of residence. It is also imperative to write the name of the ITU bureau where the commission will be held, date and signature of the applicant, seal and signature of the attending physician.

Statement

The text of the application itself must consist of a request for examination and its purposes. And for more effective drawing up of a rehabilitation map, you also need to indicate:

• all types of restorative measures that the patient needs with their brief description;
• means to improve the patient's quality of life;
• additional wishes marked "Please pay attention".

Expertise

Citizens undergo certification for obtaining disabled status together with IPRA at the local ITU bureau. If a person is physically unable to visit the hospital on their own, then experts can come to their homes. But first, the patient's representative must submit an application along with a package of documents.

Expectation

After submitting the application, the preparation of the rehabilitation program takes place within one month. It is important to know that it needs to be updated once a year, regardless of the validity period of the disability certificate.

Getting the program

Before certifying their consent with a signature, a disabled person must carefully read all the recommendations and timing of medical measures. And in case of discrepancies between the opinion of the patient and the commission, it is necessary to indicate in writing the reasons for disagreement.

People with serious illnesses need to know how to obtain this document if they have an indefinite disability. The procedure for receiving does not differ from the standard one, but the program, as well as the established group, will be unlimited, unlike other categories of disabled people.

Terms of issuance of IPRA

The period during which the document will be valid for all disabled people is different depending on the assigned group:

• 2 years for 1 group;
• 1 year for groups 2 and 3.

For children with disabilities, a plan is drawn up for a period of 2 to 5 years or until they reach the age of majority. And the number of prescribed rehabilitation measures is always calculated for the period until the next confirmation of the diagnosis.

Appealing the decision of the commission

There are situations when, after receiving the document, the patient does not agree with the conclusions of the commission. That is, all the complications of the disease were not taken into account, the list of required funds for recovery was incomplete, and the like. Then the patient has the right to appeal the decision of the ITU in the higher organization.

Alteration

Program adjustments are possible under the following circumstances:

• the condition of the disabled person has improved or worsened, which requires amendments to the rehabilitation measures;
• we need recommendations for the employer indicating labor restrictions;
• the patient is transferred to a permanent hospital.

To make specific changes in the IPRA, you must contact your doctor again. He will issue a referral for a repeated medical examination, based on the results of which a new individual plan will be drawn up.

By law, the implementation of recommendations for rehabilitation for a disabled person is voluntary. However, if health care providers ask you to refuse to receive IPRA, then it is considered illegal. Without such a document, a person with a disability will not be able to claim the prescribed funds and medicines for free, which would violate his rights.

Social rehabilitation programs

Individual rehabilitation program for the disabled

The implementation of all areas of social rehabilitation takes place within the framework of an individual rehabilitation program (IPR), which makes it possible to take into account the psychophysiological characteristics of a disabled person and the associated rehabilitation potential.

In accordance with Art. 11 of the Federal Law "On Social Protection of Disabled Persons in the Russian Federation", an individual rehabilitation program for a disabled person is developed on the basis of a decision of the State Service of Medical and Social Expertise a set of rehabilitation measures optimal for a disabled person, including the types, forms, volumes, terms and procedure for the implementation of medical, professional and other rehabilitation measures aimed at restoring the ability of a disabled person to perform certain types of activities.

An individual rehabilitation program for a disabled person is mandatory for implementation by the relevant state authorities, local authorities, as well as organizations, regardless of organizational and legal norms and forms of ownership.

An individual rehabilitation program for a disabled person contains both rehabilitation measures provided to a disabled person free of charge in accordance with the federal basic program for the rehabilitation of disabled people, and rehabilitation measures, in which either the disabled person himself or other persons or organizations take part in the payment, regardless of organizational and legal norms and forms of ownership.

The volume of rehabilitation measures provided for by the individual rehabilitation program for a disabled person may not be less than that established by the federal basic program for the rehabilitation of disabled people.

An individual rehabilitation program is of a recommendatory nature for a disabled person, he or she has the right to refuse one or another type, form and volume of rehabilitation measures, as well as from the implementation of the program as a whole. A disabled person has the right to independently decide the issue of providing himself with a specific technical means or type of rehabilitation, including cars, wheelchairs, prosthetic and orthopedic products, printed publications with a special font, sound amplifying equipment, alarms, video materials with subtitles or sign language interpretation, and other similar means.

If the technical or other means or service provided for by the individual rehabilitation program cannot be provided to the disabled person, or if the disabled person has purchased the appropriate means or paid for the service at his own expense, then he is paid compensation in the amount of the cost of the technical or other means, services that must be provided to the disabled person.

Refusal of a disabled person (or a person representing his interests) from an individual rehabilitation program as a whole or from the implementation of its individual parts frees the relevant state authorities, local self-government bodies, as well as organizations, regardless of organizational and legal norms and forms of ownership, from responsibility for its implementation and does not give a disabled person the right to receive compensation in the amount of the cost of rehabilitation measures provided free of charge.

The main principles for the formation of the IPR are:

Individuality;

Continuity;

Sequence;

Continuity;

Complexity.

Individuality rehabilitation means the need to increase the specific conditions for the emergence, development and outcome of disability in a given individual.

Continuity presupposes organizational and methodological support for the continuity of a single process of implementation of various rehabilitation measures. Otherwise, there is a sharp decrease in their effectiveness.

At the same time, it is necessary to observe a certain sequence in carrying out rehabilitation, dictated by the peculiarities of the course of the illness of a disabled person, the possibilities of his social and environmental environment, organizational aspects of the rehabilitation process.

Continuity stages of rehabilitation is to take into account the ultimate goal of the next stage when carrying out the activities of the previous one. Basically, the following stages of rehabilitation are distinguished: expert diagnostics and prosthetics, the formation and implementation of an individual rehabilitation program, dynamic control over individual rehabilitation results.

The complexity of the rehabilitation process means the need to take into account at all its stages numerous aspects of rehabilitation: medical, psychophysiological, professional, sanitary and hygienic, social and environmental, legal, educational and production, etc.

The structure of an individual rehabilitation program for a disabled person is determined by the Model Regulations on an individual rehabilitation program for a disabled person and has the following sections:

Registration number of the card, number of the certificate of examination, name of the institution of medical and social examination;

Passport data of a disabled person (full name, gender, date of birth, address of permanent or temporary residence, citizenship);

Data on the level of general education (secondary school, primary, lower secondary, secondary, no general education);

Data on the level of vocational education (vocational training, primary, secondary, higher, postgraduate, additional);

Data on the profession - the type of labor activity, occupation of a person who owns a complex of special knowledge, skills and abilities obtained through education and training. The main profession is considered to be the work performed with the highest qualifications or work performed for a longer time;

Data on the specialty - the type of professional activity, improved through special training;

Data on qualifications - the level of preparedness, skill, the degree of fitness for work in a certain specialty or position, determined by the category, class, rank and other qualification categories;

Data on the work performed at the time of the examination (profession, specialty, qualifications, as well as other types of work - self-employment, public works, work in caring for the sick) and the address of the place of work:

Data on the social and everyday status of the disabled person (single, family, orphan, how many family members), as well as the role of the disabled person in the family - breadwinner, dependent;

Data on socio-economic status (employed, unemployed, unemployed, retired);

Data on social and environmental status (immigrant, forced migrant, homeless, conditionally serving a sentence);

Social and environmental conditions of a disabled person (own or rented house, apartment, room; their area, floor; availability of utilities, remoteness of housing from the place of work and availability of transport);

Sources of income (salary, pension, scholarship and their value);

Clinical and expert data, including the disability group, the dynamics of disability over the last 5 years, each duration of disability, ICD-coded clinical diagnosis and severity of functional disorders, clinical prognosis;

assessment of rehabilitation potential, including:

The state of physical development (constitutional and anatomical features, age and sex differences, the level of physical development and physical fitness - standing and sitting height, weight, chest circumference and various muscle groups, muscle strength, endurance, speed of actions and motor reactions, agility, vitality lung capacity, spatial orientation, motor coordination, etc.);

Psychophysiological endurance - an integral assessment of physical and physiological endurance, taking into account the properties of the disabled person's nervous system (strength, balance, mobility, lability and dynamism), assessing the state of sensory and perceptual systems, the state of cognitive functions (attention, memory, thinking), the level of speech development and specific cortical functions (writing, counting, reading), the resistance of these functions to stress.

When assessing psychophysiological endurance, it is also important to take into account the stability of the level of sensorimotor coordination and other aspects that distinguish them for the performing side of the activity, and in addition, the speed and strength of skills formation;

Emotional stability (the dynamic properties of a person's emotions and feelings, that is, the ease of occurrence and extinction of emotional reactions, their intensity, inertia, modality of emerging emotions (anger, joy, fear, etc.), how much emotional processes have a destructive effect on the activity of a disabled person, how his emotions are controllable).

Data on the level of development of professionally important knowledge, skills, abilities (assessment of theoretical training and practical experience for performing a specific job);

Assessment of socio-psychological and socio-economic status, including:

Socio-psychological reactivity (competence) - the ability of an individual to effectively interact with the people around him in the system of interpersonal relations. It includes the level of sociability or sociability, that is, the ability for spontaneous communicative activity, as well as the possession of communication skills, stable types of reactions in socio-psychological interaction;

Areas of social activity, including the participation of an individual in various types of activities in the macro-society (educational, labor activity, leisure activities, various types of creativity, activities for their own health improvement, participation in the work of public organizations, opportunities to exercise their civil rights, etc.);

Family and household relationships - the role functions of a disabled person in the family, the nature of the family's relationship to the disabled person, the psychological climate in the family;

The level and structure of the outlook is a characteristic of the breadth of knowledge that a disabled person uses when solving professional, domestic, personal, social and other issues in their daily activities.

Data on the structure of the needs of a disabled person, that is, an indication of those desires, drives, objects necessary for the existence and development of a disabled person and acting as a source of his activity. The system and structure of needs and the corresponding structure of motivation are interconnected with the structure of those activities in which the personality is included;

The circle of interests of a disabled person, that is, the manifestation of a cognitive need that ensures the focus of the individual on the awareness of the goals of the activity. The developed structure of stable, long-term interests, including various areas of activity, types of activities, subjects of activity, systems of relations, etc., is a prerequisite for the conscious activity of the disabled person himself to resume, as much as possible, his usual way of life and reintegration into society. The presence of a poor, undeveloped system of interests is an unfavorable factor;

The level of aspirations (the degree of difficulty of the goals that he sets for himself). Prognostic in the context of rehabilitation diagnostics is the establishment of the level to which a particular disabled person claims in his life at a certain stage. The presence of claims that are grossly unstable or grossly inadequate to the somatic state and professional or socio-psychological status of a disabled person at the time of examination, regardless of the nature of inadequacy, is an unfavorable factor in relation to rehabilitation;

Data on the rehabilitation potential, that is, the complex of biological, psychophysiological characteristics of a person, as well as social and environmental factors, allowing to one degree or another to realize his potential abilities, with their assessment: the rehabilitation potential is high, satisfactory, low;

Data on the rehabilitation prognosis, that is, the estimated probability of realization of the rehabilitation potential, with its assessment: favorable, relatively favorable, unclear, unfavorable;

Data on the severity of disabilities and the possibility of their recovery (compensation);

Rehabilitation expert opinion, including clinical and functional diagnosis, psychological diagnosis, assessment of professional and labor, social and social and environmental status, assessment of rehabilitation prognosis, assessment of disabilities, severity and cause of disability.

IPR consists of three programs:

- medical rehabilitation programs;

- vocational rehabilitation programs;

- social rehabilitation programs.

The social rehabilitation program at the IPR includes:

Informing and consulting on issues of social and household rehabilitation of disabled people;

Self-service training for a disabled person, including informing about technical means of rehabilitation, teaching techniques and methodological techniques for self-service, teaching the rules of personal hygiene (combing, washing, brushing teeth), using clothes, dressing, undressing, eating, etc. disabling pathology and the severity of limitation of life activity. Adaptive education for disabled people includes "teaching life with a disability", including diet therapy, daily regimen, informing about the peculiarities of the course of the disease, etc .;

Adaptive education for the disabled family should provide information, counseling and training for the disabled family on various issues: the nature of the course of the disabled person's illness, the emerging disabilities, associated socio-psychological, physiological and economic problems; types and problems of social and household assistance to a disabled person, types of technical means of rehabilitation and the peculiarities of their operation; types of rehabilitation institutions, their locations and the range of services they provide, etc.

Teaching a disabled person to use technical means of rehabilitation should ensure that the ergonomic requirements meet the physical and psychophysiological needs of the disabled person;

Organization of a disabled person's life in everyday life, including an architectural and planning solution to the problem of adapting a living space to the needs of a disabled person, equipping with technical means of rehabilitation, redeveloping living quarters;

Providing a disabled person with technical means of rehabilitation, including the selection of technical means in accordance with medical and social indications, delivery of technical means, its service;

Personal safety training, which includes the acquisition of knowledge and skills in such activities as the use of gas, electricity, toilet, bathroom, transport, medicines, etc.;

Social skills training, which includes the development of knowledge and skills that allow a disabled person to prepare food, clean the room, wash clothes, repair clothes, work in a personal plot, use transport, visit shops, consumer services;

Social communication training, which includes ensuring the ability of a disabled person to visit friends, cinemas, etc.;

Teaching social independence, which should be aimed at the possibility of independent living, the ability to manage money, enjoy civil rights, and participate in social activities;

Providing assistance in solving personal problems, which includes providing people with disabilities with birth control, gaining knowledge in the field of sex education, raising children, etc.,

Legal advice, which should provide legal assistance to a disabled person in the field of social protection and rehabilitation;

Training in the skills of recreation, leisure, physical education and sports, which includes the acquisition of knowledge and skills about various types of sports and leisure activities, training in the use of special technical means for this, informing about the relevant institutions that carry out this type of rehabilitation.

When forming a social rehabilitation program, it is necessary to determine:

Contractor (name of institution);

The form of rehabilitation (outpatient, inpatient, boarding house, day care, club);

Terms of implementation (start and end dates of the rehabilitation event);

The predicted result (the ability to compensate for life restrictions, the achievement of self-service, independent living, integration into society).

In case of non-fulfillment of the Social Rehabilitation Program, there must be a record indicating the reason, the signature of the person in charge and the seal.

The disabled person signs the developed program of social rehabilitation.

After the development of the Medical, Vocational and Social Rehabilitation Programs, the signature of the Head of the ITU Bureau follows.

The determination of the performers of all types of rehabilitation should be carried out taking into account the existing and introduction of new organizational forms and methods of rehabilitation in the territory of residence of the disabled person.

To address the issues of providing a disabled person with the necessary types of rehabilitation assistance that cannot be provided to him at the place of residence, it is necessary to organize the referral of the disabled person to the relevant institutions and organizations in other regions (rehabilitation centers, clinics, research institutes, etc.).

Labor and social development authorities should coordinate the development and implementation of an individual rehabilitation program for a disabled person.

The conclusion on the implementation of the individual rehabilitation program is the final section of the rehabilitation program and contains a conclusion on the progress of the program, the effectiveness of the measures.

The development of the IPR and control over its implementation in accordance with the legislative and regulatory legal acts is entrusted to the institutions of the state system of medical and social expertise.

According to clause 1 of the Approximate Regulation, the IPR includes rehabilitation measures aimed at restoring the disabled person's abilities to everyday, social, professional activities in accordance with the structure of his needs, the range of interests, the level of claims, taking into account the predicted level of his somatic state, psychophysiological endurance, social status and real possibilities of social and environmental infrastructure.

Thus, the range of issues considered in the production of medical and social expertise is expanding, and this sets specific tasks for its organization at a new qualitative level, requiring appropriate personnel, material and technical support, new methodological approaches, as well as forms of interaction with other interested services.

The staffing of ITU institutions with the necessary specialists should be carried out in accordance with the Model Regulations on the Institutions of the State Service of Medical and Social Expertise, which in the staffing standard of the ITU Bureau, in particular, provides not only doctors of various specialties, but also specialists in rehabilitation, social work, and a psychologist.

In connection with new approaches to the definition of disability, as well as the need to develop an IPR for persons recognized as disabled, all ITU bureau specialists must have the necessary amount of knowledge:

Legislative and regulatory documents on healthcare, social protection of the population, education, employment, labor protection, social and medical insurance;

Requirements for the organization of special jobs for the employment of people with disabilities;

Types and functional purpose of technical means of rehabilitation;

Principles and methodological foundations for the formation of IPR, assessing the effectiveness of their implementation.

In the system of measures that ensure a new quality of medical and social expertise and the fulfillment of the functions of the ITU Bureau for the formation of IPR, an important role belongs to the very organization of examination of sick and disabled people and the technology of this work.

The basic requirements for the formation and implementation of the IPR are set out in Art. 11 of the Federal Law "On the Social Protection of Disabled Persons in the Russian Federation", and the procedure and conditions for the development of the IPR - in the Model Regulations on the Individual Rehabilitation Program for the Disabled.

To ensure the specified requirements, the established procedure; and the conditions for the formation of the IPR, the technology of the ITU Bureau provides for:

Participation of all ITU Bureau specialists in the examination of patients and invalids at all stages of medical and social expertise, including expert and rehabilitation diagnostics, assessment of rehabilitation potential, rehabilitation prognosis and the actual formation of medical, professional, and social rehabilitation programs. A special feature is the form of participation of a psychologist in this process, who should carry out work with people with disabilities on psychological diagnostics in a separate, specially equipped room.

Each of the specialists has a specific role in the formation of the IPR at all its stages. For example, a rehabilitation specialist, together with doctors of various specialties, depending on the profile of the ITU Bureau, conducts a medical and social examination at the stages of clinical and expert, social diagnostics, assessment of rehabilitation prognosis, rehabilitation potential, limitation of vital functions, as well as the formation of all IPR programs; prepares the IPR; the social work specialist takes part, along with the rehabilitation specialist and three doctors of various specialties, in the formation of the program of social rehabilitation measures.

In addition, he carries out a survey of the social and living situation of a disabled person, as well as detailed information for a disabled person about the procedure for implementing the IPR after its approval. The disabled person should be given comprehensive explanations about the consequences of refusal to implement the IPR;

Thorough explanatory work with a disabled person about the goals, objectives, projected results and socio-legal consequences of rehabilitation measures, about the rights of a disabled person to rehabilitation and the consequences in case of refusal from IPR as a whole or its individual types and forms;

Participation of the disabled person himself (or a person representing his interests) in determining the procedure for implementing the IPR;

Availability in the ITU Bureau of information on institutions and organizations that can be executors of specific rehabilitation activities and services. To ensure the ITU Bureau, it is advisable to establish (for example, by a decision of the executive authority of the constituent entity of the Russian Federation) that the territorial bodies of health, education, social protection of the population, labor and employment determine and systematically clarify the list of subordinate rehabilitation institutions and the specific types of rehabilitation they carry out. The revised lists should be brought to the attention of all institutions of the state service of medical and social examination of a given territory;

Interaction of institutions of the state service of medical and social expertise with interested services in the field of rehabilitation, which should be carried out both at the stage of formation of the IPR and its implementation. For example, close contacts and consistent actions should be practiced at the stage of formation of the IPR with health care institutions. In order to ensure the formation of the IPR in a timely manner, it is advisable that proposals for the program of medical rehabilitation measures are submitted by medical and preventive institutions with a referral for examination indicating the types, forms, volumes, terms of medical rehabilitation and performers. In the absence of a psychologist at the ITU bureau or under other circumstances, a disabled person may be sent for professional testing to the employment service.

If necessary, a program of additional examination is planned, a record of which is made in the certificate of examination. The ITU Bureau can involve in the development of the IPR specialists from health care institutions, employment services and other bodies and institutions that carry out activities in the field of rehabilitation. In these cases, the disabled person is handed a written request (requests) to the relevant institutions, enterprises, with a request to conduct the necessary examination (clarify information regarding the professional and labor, educational environment, etc.) and report the results by the established deadline.

In case of non-receipt of the requested data, the head of the ITU Bureau takes measures to clarify the reasons for the failure to fulfill the order.

The formed IPR must be signed by the head of the ITU Bureau, his signature must be certified by a seal, the IPR is handed over to the disabled person, and a copy of it is sent within three days to the municipal department of social protection of the population (MUSZN) at the place where the disabled person receives the pension.

In the event that a disabled person is retired not in the social security authorities (in the internal affairs, security, defense, etc.), then the IPR is sent to the SZN at the place of permanent residence (registration) of the disabled person, and if it contains activities for free for for a disabled person with sanatorium-resort treatment, providing a car (motorized wheelchair), an extract from the IPR of that part is sent to the appropriate body that provides pension for the disabled person.

When registering an IPR, it should be borne in mind that, in accordance with the legislation, it includes both rehabilitation measures provided to a disabled person free of charge (in accordance with the basic programs), and rehabilitation measures, in which the disabled person or other persons and organizations take part in the payment, regardless of organizational and legal forms and forms of ownership. Therefore, if the disabled person agrees to independently (with outside help) pay for one or another means of rehabilitation (service) shown to him, but not provided for by the basic programs, a note about this must be made in the IPR ("the disabled person pays") before the disabled person's signature.

Control over the implementation of the IPR is carried out by the ITU Bureau during the next survey, as well as during surveys appointed in some cases in the order of dynamic observation.

To ensure control over the implementation of rehabilitation measures by a disabled person, the ITU Bureau uses computer technologies that allow dynamic monitoring of the rehabilitation process of each individual disabled person and in general the serviced contingent of disabled people on the basis of special information systems.

The IPR is mandatory for the relevant state authorities, local self-government bodies, as well as organizations, enterprises and institutions, regardless of the organizational and legal forms of ownership (bodies and institutions of the state service for the rehabilitation of disabled people), which are determined by the executors of specific rehabilitation measures.

The main set of measures for medical, professional and social rehabilitation of disabled people is carried out at the local (district, city) level. Institutions of various departments implement the IPR within the framework of their professional activities and provide the necessary information on the implementation of the IPR to the appropriate local body for social protection of the population.

In cases where it is not possible to implement the IPR at the local level, the disabled person is sent to territorial or federal institutions of a rehabilitation profile, on the basis of which it is possible to carry out comprehensive rehabilitation measures and implement the IPR in full.

The implementation of the IPR is carried out by rehabilitation institutions of any form of ownership with a license for the right to engage in this type of activity.

The activities of rehabilitation institutions should provide a comprehensive solution to the problems of integrating the disabled person into society, which can be achieved through joint forms of work (interagency meetings, discussions, exchange of information, etc.). The process of interaction in the implementation of the IPR is carried out through a joint analysis by the rehabilitation service specialists of the progress of their implementation and the search for optimal solutions.

The interaction of rehabilitation services of various departmental affiliation is carried out at the stages of the formation of the IPR; execution of the IPR; organization of control over the implementation of the IPR, as well as joint activities of public organizations.

The bodies of health care, social protection of the population, education, employment of the constituent entities of the Russian Federation, systematically bring to the attention of the subordinate institutions, which are determined by the executors of specific types of rehabilitation, and the ITU institutions, the list of the types of rehabilitation measures carried out by them, the services and technical means provided.

The choice of rehabilitation institutions for the implementation of IPR is carried out taking into account:

Ensuring the approximation of rehabilitation services to the consumer;

High quality guarantees of rehabilitation services

Ensuring the complexity of rehabilitation services; uniformity of forms and methods of rehabilitation based on a systematic approach in their implementation.

For the implementation of rehabilitation, a full-service institution or (in the absence of one) several institutions can be used.

Institutions used as a base for rehabilitation and IPR keep a special record of work with people with disabilities (rehabilitation measures carried out, services rendered, technical means of rehabilitation provided, their cost) and submit a report on the work carried out to a higher management body.

A disabled person (his legal representative) applies to the appropriate rehabilitation institution specified in the IPR independently, representing the IPR in his hands.

In institutions that implement the IPR for disabled people, a specialist is allocated who is responsible for organizing the implementation of IPR activities (hereinafter - the organizer of the IPR implementation).

Organizer of the implementation of the IPR:

Leads the initial reception of a disabled person when applying to this rehabilitation institution;

Carries out control over the implementation of rehabilitation measures by the relevant specialists;

Provides contacts with a disabled person (his legal representative) in case of late attendance (termination) for rehabilitation,

Organizes a collegial discussion of the effectiveness of rehabilitation measures at the stages of the implementation of the IPR and the need for its adjustment;

If a decision is made about the need to make changes to the IPR (termination of its implementation), within three days, it informs the ITU Bureau and the relevant body for social protection of the population, indicating the reasons that served as the basis for making this decision.

The ITU Bureau, taking into account the proposals received, makes the appropriate changes, additions to the IPR and gives detailed explanations to the disabled person (his legal representative).

The control over the implementation of the IPR is carried out by the ITU Bureau, which approved the IPR, and the district (city) bodies of social protection of the population at the place of permanent (actual) residence of the disabled person.

In the body of social protection of the population, a structural unit (specialist) is allocated, dealing with the problems of rehabilitation of the disabled.

Control over the implementation of IPR by rehabilitation institutions, regardless of departmental subordination and ownership, is carried out by local (district, city) bodies of social protection of the population, as well as institutions (bureaus) of the state service of medical and social expertise during the next examination, as well as examination in the order of dynamic observation. These institutions concentrate information on people with disabilities undergoing rehabilitation.

The issues of adjusting the IPR are considered in case of receipt of relevant information and proposals from institutions that carry out rehabilitation measures.

The heads of the ITU Bureau keep records of IPRs for disabled people, their implementation, reasons for non-compliance, efficiency, systematically analyze these data, inform the relevant social protection body, and, if necessary, the institutions implementing the IPR, as well as the main ITU Bureau.

District (city) bodies of social protection of the population perform both the functions of managing rehabilitation and the functions of executing the IPR for disabled people.

The individual rehabilitation program used in inpatient social service institutions has peculiar features. It reflects medical, social and vocational and labor rehabilitation. In each of these forms of rehabilitation, methods of influence are highlighted. So, in particular, within the framework of medical rehabilitation, drug treatment and non-drug therapy, dispensary observation are provided. Social rehabilitation offers ways such as skills training, environmental therapy, and adaptation to new living conditions. Vocational and labor rehabilitation has even greater opportunities in terms of methods of influence.

It includes employment, vocational guidance, vocational training and employment. For each method, within a certain form of rehabilitation, an appropriate remedy is selected. Various options are possible here. Their choice depends on the organizer of rehabilitation activities, who must take into account all the features of the disabled person, his potential and prognosis. So, for example, drug therapy, depending on the clinical condition of the patient, can be presented in each case either by pathogenetic, or general strengthening, or symptomatic therapy, or complex therapy, that is, by a combination of all types.

The terms of the rehabilitation impact, its duration are also completely individual (constantly, occasionally, according to indications, etc.), taking into account the initial data about the disabled person and the specifics of the methods and means of rehabilitation.

Consequently, the essence of an individual rehabilitation program is that for each specific patient it contains only the sections of the main rehabilitation program corresponding to his condition.

An important section of the individual rehabilitation program is fixing the effectiveness of the rehabilitation impact. It is presented in the corresponding columns of each type and method of rehabilitation. So, to judge the effectiveness of medical rehabilitation, options are given such as prevention of exacerbations of the disease, compensation of the functional capabilities of the body, elimination of signs of exacerbation of the disease, streamlining of behavior, activation of activity.

Efficiency options not provided for in this list are also possible, which can be introduced by a doctor; the options corresponding to the real situation from the proposed list should be underlined. The effectiveness of non-drug exposure can be expressed in the form of correction, motor skills, an increase in the volume of movements, etc. The consequence of organizational measures may be facilitation of the regime, removal from dispensary registration, etc.

The effectiveness of social rehabilitation can be judged by such indicators as acquiring self-service skills, expanding the range of interests, restoring communication skills, instilling communication skills, activating leisure activities, and participating in the life of a boarding school.

The effectiveness of vocational and labor rehabilitation in an individual program can be expressed by the following indicators: restoration (formation) of work attitudes, mastering labor skills, mastering an elementary profession, choosing a profession.

The indicator of the highest efficiency of complex rehabilitation impact is the discharge of patients from the boarding house and their integration into society.

An individual rehabilitation program, filled out annually for each patient, will allow tracing the dynamics of his condition, isolating the most effective methods and means, and varying the rehabilitation impact.

An individual program allows for timely correction, taking into account changes in the psychosomatic status of a disabled person, conditions and opportunities for the implementation of rehabilitation measures.

When developing and implementing IPR in stationary social service institutions, it is necessary to be guided by the following considerations:

When involving patients in labor, be based on the interests of the patients, and not the institution;

Consider medical indications and contraindications to work;

Dose labor, taking into account the somatopsychic state of the patient (time, frequency, intensity, timing);

Assign labor as treatment;

Assess the effectiveness of labor impact;

Objectively reflect all information about the patient in the relevant documentation.

IPR in the rehabilitation cycle has the advantage that it takes into account all the potential capabilities of a disabled person, which makes it possible to achieve the greatest success with adequate measures.

Questions for self-control

1. Give the definition of an individual rehabilitation program for a disabled person (IPR).

2. What are the principles of forming the IPR?

3. What is the structure of the IPR?

4. What are the components of the IPR.

5. What is included in the concept of "rehabilitation potential"?

6. Who and how forms the IPR?

8. What is the role of the social work specialist in the IPR?

9. What are the features of the IPR in inpatient social service institutions?

1. Andreeva O.S. Principles of the formation and implementation of an individual program for the rehabilitation of disabled people // Professional rehabilitation and employment of disabled people. Interdepartmental conference reports. Moscow: Labor and Employment Committee of the Moscow Government: TSIETIN: Social Partner Fund, 1999. pp. 29-36.

2. Guseva N.K. Fundamentals of social protection of sick and disabled people in the Russian Federation. N. Novgorod: NGMA,

3. Dementyeva NF About individual rehabilitation programs for disabled people and the elderly in boarding houses // Medical labor examination and rehabilitation of disabled people: Republican interdepartmental collection; Kiev: Health, 1984. Issue. 16.P. 98-105.

4. V. N. Katyukhin, Dementyeva N. F... Boarding houses. St. Petersburg Institute for Advanced Training of Medical Experts. Specialist. Olympic Committee of St. Petersburg, 1996.

5. Approximate provision on an individual rehabilitation program for a disabled person. Approved by the decree of the Ministry of Labor of Russia dated December 14, 1996, No. 14 // Coll. laws and regulations. documents on vocational rehabilitation and employment of disabled people. M .: TSIETIN, 2000. S. 113-128.

6. Federal Law "On Social Protection of Disabled Persons in the Russian Federation" // Collected Legislation of the Russian Federation. 1995. No. 48. Art. 4563.

2. Social rehabilitation of older persons in stationary social service institutions

Social rehabilitation of older citizens in boarding schools is given a special perspective. It has its own peculiarity and difference from the prevailing concept of social rehabilitation. This peculiarity is explained by a number of circumstances.

1. Characteristics of older persons in boarding houses:

The prevalence of elderly citizens (56.9%). together with long-livers they make up 63.2%;

Severe health condition (on average, each resident was diagnosed with more than 7 diseases);

Limited ability to self-service; the incapable and partially self-serving make up 62.3% of the residents;

Limited ability to move; persons incapable of movement and exercising physical activity within the ward make up 44.6% of the contingent of boarding houses;

Changes in the psyche in old age are manifested in memory impairments for new events with the preservation of reproduction of old ones, in attention disorders (distraction, instability), in slowing down the pace of mental processes, in disorders of the emotional sphere, in a decrease in the ability to chronological and spatial orientation, in motor disorders ( pace, fluency, accuracy, coordination);

Personality changes characteristic of old age; revealed polar, contrasting features: increased suggestibility, coexisting with rigidity, pronounced sensitivity with increasing callousness, emotional "dryness". Age-related personality traits also include touchiness, egocentrism, etc.

These characteristics, reflecting these characteristics of elderly citizens, call into question the legitimacy of discussing their social rehabilitation. Nevertheless, the issue not only deserves attention for consideration, but also to determine the prospects for the development and improvement of a number of areas of rehabilitation activities in boarding schools.

Characteristics of the environment, living conditions in boarding houses.

Even in highly organized institutions, the peculiarities of the environment cannot be avoided:

Limited employment opportunities;

Monotonous lifestyle;

Limited living space;

Lack of household comfort;

Psychological incompatibility of residents;

Dependence on others;

Formal attitude of the staff.

Both groups of circumstances reflect the peculiarities of social rehabilitation of elderly people in boarding schools.

One of the leading problems in creating a rehabilitation environment in boarding houses is the organization of social and psychological adaptation of the elderly and old people as a specific stage of social rehabilitation.

Entering a boarding house, changing the usual life activity is a critical moment in the life of an elderly person. Unforeseen situations, unusual surroundings, unclear social status - these life circumstances force an elderly person not only to adapt to external movement, but also to react to changes taking place in them. Older people are faced with the question of assessing themselves, their capabilities in a changed situation. The process of personality restructuring is very painful and difficult.

It is known that in old age, weakening of memory, attention, a decrease in the ability to navigate in normal conditions, an alarming background of mood and lability of emotional processes are revealed. One of the main properties of aging people is psychological vulnerability and an increasing inability to cope with a variety of stresses. Therefore, older people are particularly sensitive to manifestations of attention, moral and psychological support.

Moving to a boarding house leads to a sharp change in the usual ways of adaptation, which, along with social adaptation, increases the risk of cardiovascular diseases and even death in older people.

Since the main stressor, which is the very fact of admission to a boarding home, cannot be eliminated, the expected help and support from the boarding home staff is of paramount importance. In these conditions, directed work on the socio-psychological adaptation of older people to the conditions of a boarding house is of particular importance.

The initial period of residence of older people in a boarding house consists of three main stages: admission and stay in the admission-quarantine department, resettlement to a permanent place of residence, the period of the first six months of residence

Each of these stages is characterized by its own characteristics and differs in goals and objectives in the implementation of socio-psychological adaptation.

These circumstances determine the functions of a social worker in organizing the adaptation of older people in a boarding house. The activity of a social worker, its content depends on the stage of "passing" the socio-psychological adaptation of elderly people in a boarding house.

Admission is related to health conditions;

Admission is associated with a conflict situation in the family;

Information about these institutions plays an important role for the subsequent socio-psychological adaptation of older people in boarding schools.

By the time they entered the boarding house, most of the elderly had basic information about this institution, obtained from various sources (from relatives and close friends, doctors and workers of social protection agencies). The information was formal, and in some cases - distorted (the idea of ​​a boarding house was identified with the routine of the hospital, with daily rounds of doctors, constant daily supervision of nurses). The understanding of consumer services and work organization was incomplete. Insufficient information caused and maintained increased anxiety and uncertainty in the future in older people, which in turn adversely affected their subsequent adaptation to new conditions.

Despite the fact that the decision to enter the orphanage was made independently and deliberately, more than half of the elderly who entered the admission-quarantine department of the orphanage, until the last moment, experienced hesitation and doubts about the correctness of the step taken. These fluctuations are associated with two things: fear of change and ignorance of specific living conditions.

The role of the social worker during the stay of the elderly in the admission-quarantine department of the boarding house is to explain the functions of this institution, to familiarize the applicants with the daily routine, the location of household services and medical offices, the opening hours of the administration, etc .; to conduct a conversation, familiarize with the living conditions in a boarding house for older people who have decided to enter these institutions, which in many ways can reduce the state of uncertainty and anxiety.

The presence of a stand reflecting the main sections of work, an album with photographs of residents, their employment, leisure activities, etc., can contribute to a more complete informing of older people about the boarding house from the very first days of their stay in this institution. way of life in order to realize the possibility of obtaining information about public life in the admission and quarantine department, radios (preferably with headphones), a TV, a large wall clock with large numbers, wall calendars, and newspapers are required. The implementation of these measures makes the role of a social worker in a boarding house and especially at the first stage of an elderly person's stay there even more urgent.

After a two-week stay in the admission-quarantine department, older persons are resettled at their main place of residence in a boarding house. This stage is characterized by additional emotional stress for the elderly person. He is faced with the problem of forced adaptation to new conditions with a long perspective. The search for a new life stereotype, forced communication with strangers, not always pleasant people, strict regulation of the daily routine - all these circumstances lead to the emergence of a crisis of the first month of adaptation. The first 3-4 weeks of stay in a boarding house, connected with the transfer to a permanent place of residence, are the most difficult for the elderly. During this period, 70% of them easily develop colds, exacerbations of the existing chronic pathology. The emotional state is characterized by the appearance of a feeling of hopelessness of what is happening.

For the successful socio-psychological adaptation of an elderly person, it is important that he successfully "settles in", that is, placement in a department. When transferring an elderly person to a department and settling him into a room with neighbors, difficulties of living together often arise. They can be related to the concept of "crowding". Its psychological essence lies in the formation of an idea of ​​"one's own" and "someone else's" territory. The invasion of another's "own" territory can cause acute stress, manifested by sharp negative emotional experiences.

Undesirable consequences can be caused by the settlement in one room of two people with pronounced leadership traits. It is known that in the case of forced close communication, one of the subjects, as a rule, takes on the role of a follower.For a person with a tendency to lead, the option of permanently being in the role of a follower is an excessive psychological burden, which can end in an emotional breakdown.

During this period, the attitude of the staff, which is associated with the outside world, begins to acquire special significance. The role of the social worker is to ensure that the older person adapts to the new environment. This requires information about the characterological characteristics of the elderly person, inclinations and interests, attitudes and habits. Elucidation of these circumstances is also clear for the creation of microsocial groups, which also pursue the goal of improving the socio-psychological adaptation of elderly people.

In addition to studying personality traits and other circumstances, a social worker can and should teach an elderly person how to communicate, the ability to understand a person who is more weak than himself, understanding the situation of living together, etc.

In these circumstances, a social worker, having certain knowledge and practical experience, acts both as a social psychologist and as a social educator, while the social worker makes contacts with the doctor and medical personnel, using data from the medical history, about the past life of the elderly person, gets to know and with the state of his health, his ability to move and the degree of safety for self-service.

From the admission-quarantine department, older persons should get into a calm, well-organized environment of adaptive influence, which is formed by the joint efforts of a doctor, a floor nurse, a labor instructor, a cultural worker, and a librarian. Each of these specialists must understand their tasks of adapting older people to the conditions of a boarding house.

An elderly person who is transferred to a permanent place of residence from the admission-quarantine department should be attracted the increased attention of all employees, which will help him find his place in the community of living and weaken the negative impact associated with a sharp change in life stereotype and the resulting emotional overstrain.

The role of a social worker as a specialist with the basics of knowledge in gerontopsychology, deontology and social pedagogy is also increasing in connection with the need to train the staff of boarding schools in a differentiated approach to the elderly.

After 6 months of staying in a boarding house, the elderly face the problem of the final decision: to live in the house-interpat permanently or return to their usual environment. At this time, there is a critical assessment of both the conditions of the boarding house, and their abilities to adapt to them.

A survey of older people after 6 months of living in a boarding house showed that their expectations related to admission to these institutions were not met in 40.4%. The situation in the boarding house was perceived as more difficult compared to their preliminary ideas. Only 7.7% of the elderly rated life in a boarding house higher than their expectations.

The main reasons for dissatisfaction are associated with the poor organization of life in the boarding house, inattentive, formal attitude of the staff, and an unfavorable psychological climate.

The positive leisure and recreational setting available in the admission and quarantine department is not fully implemented. This is explained by the fact that the main form of organized leisure is passive listening to radio broadcasts (90.7%). The impossibility of spending full-fledged leisure time causes dissatisfaction among the elderly. Communication of elderly people in the boarding house is passive, situational, the circle of communication of older people is limited to the staff and persons living in the boarding house.

It is known that one of the causes of emotional stress may be too close forced communication between people. The traumatic effect in this case is determined by the fact that narrowing the circle and deepening communication quickly depletes the information value of each of the group members, which ultimately leads to tension and the desire for isolation.

At this stage, the so-called environmental therapy becomes important, which includes the creation of a favorable psychological microclimate, the preservation of the appropriate activity of the elderly, and the prevention of painful reactions. These goals are achieved by organizing comfortable living conditions, employment, meaningful leisure. Rationally organized environmental therapy helps to maintain mental tone, establish and strengthen interpersonal relationships, fill life with positive emotions and meaningful content. The importance of environmental therapy becomes clear if we bear in mind the environment of the boarding house, which is characterized by the limitation of social ties of the elderly and contacts with the outside world.

The named stage, as well as the subsequent period of life in the boarding house for the elderly, represents a wide field of activity for a social worker and sets several tasks for solution together with a psychologist:

Determination of individual methods of action to resolve conflict situations;

Development of individual psychocorrectional approaches;

Help in the formation of a new life stereotype;

Maintaining active coping strategies;

Formation of adequate attitudes towards the environment;

Removal of negative emotional experiences;

Formation and involvement of older people in various microsocial groups;

Group psychocorrectional work.

To solve the set tasks, it is necessary to conduct an experimental psychological examination of older people in order to study the characteristics of the value-motivational sphere, self-awareness, emotional response to a situation, the use of included observation of the behavior and communication of older people. There is a need for help and support for manifestations of social activity in various activities of older people in a boarding house.

Individual psychotherapeutic work should be aimed at forming a new life stereotype, changing evaluative characteristics, relieving emotional stress. The number of classes is determined individually.

Group psychocorrectional work should be carried out using discussion groups, communication groups, skills training, relaxation groups.

Discussion groups, as a rule, do not require special selection of listeners. Its purpose is to become aware of the current situation, to discuss the questions "what helps us to live?", "What prevents us from living?"

Communication groups require preliminary selection, it is desirable to form them from persons who are not in interpersonal conflicts. The goal of the group is awareness of oneself, conscious of one's own and other feelings, and the development of interpersonal trust.

The skill training group requires the selection of elderly people with relatively intact sensory functions. Various training bases are possible. For example, training in the ability to conduct a conversation. The goal is to reduce anxiety associated with interpersonal communication, the possibility of practicing communication skills. It is also possible to organize groups of behavior rehearsals, group drawing, drawing with a partner, etc.

The relaxation group does not require a special selection of elderly people. The goal is to relieve stress. The classic version of level 1 autogenous training. When carrying out it with old people, it is necessary to take into account violations of skin sensitivity, as a result of which the initial stage associated with the feeling of one's body becomes longer, requiring special exercises to form adequate sensations.

When working with the elderly, it is necessary to use all the group lessons conducted in the boarding school to form a positive emotional mood.

A special place should be given to an individual program of social and psychological adaptation of an elderly person living in a boarding house.

It includes the following sections: type of employment, type of activity, duration, responsible for carrying out, duration, efficiency. The types of employment include: employment, public employment, leisure, socializing, self-service. An important section is efficiency, which reflects options for preservation, implementation of labor skills, preservation of social activity and interpersonal relationships, preservation of cognitive interests, everyday independence, etc.

The socio-psychological adaptation of older people as an integral part of their social rehabilitation in boarding homes can be considered as a complex process, as a result of which a person deformed by aging, multiple somatic pathology and a stressful situation adapts and actively functions in the new conditions of existence. The duration and effectiveness of this process is determined by the ratio of the personality traits of older people and the uniqueness of the social environment.

When discussing the problem of social rehabilitation of older persons staying in boarding schools, one circumstance must be kept in mind - the organization of their employment. At the same time, it is important to take into account that in human life there are two important factors that determine the social orientation - these are movement and activity. Both of them are interconnected directly or indirectly and constitute the basic essence of human existence. This is especially evident in old age, when, due to somatic ailments, psychological restructuring, the implementation of movement and activity is limited.

The purpose of organizing employment for older people is to restore, revitalize, stimulate fading activity and movement, which will contribute to the saturation of life with meaningful content and the extension of life itself.

Physical inactivity, a sedentary lifestyle, conscious withdrawal from activities associated with mobility, intellectual and emotional stress, negatively affects both the somatic and psychological status of an elderly person.

It has now been established that mentally and intellectually active people, physically mobile, age much more slowly. There is, as it were, a reciprocal process: activity prevents aging, and aging slows down in the presence of an active lifestyle.

In this regard, when organizing the lifestyle, employment of older people in boarding houses, it is advisable to shift the focus, recommend movement therapy, employment, the use of physical therapy methods, consider this an alternative to "rest", prolonged sitting on sofas, armchairs. Only movement taking into account the somatic state will allow you to prevent, alleviate, and maybe get rid of senile ailments, to feel the joy of being.

Occupational therapy occupies a special place in the socially rehabilitating effect on older people in boarding houses - a specially organized type of employment with the use of scientifically based recommendations, taking into account the somatic health of this category of citizens, their interests and desires.

The work activity of older people is an indicator of an active lifestyle. Despite the limited opportunities due to the state of health, the work stereotype that has developed throughout life persists for a long time. Often, the elderly and disabled people, who were forced to be in special, deprivation conditions, feel the need to perform some kind of work.

The feasibility of the participation of older people in the labor force is based on a number of provisions:

Labor activity has a positive effect on the psychological state of an elderly person, awareness of their social significance, self-assessment of their physical capabilities, communication in the process of collective labor, etc.);

Labor activity associated with movement has a positive effect on cardiovascular activity, the respiratory system, the functions of the musculoskeletal system and other physiological processes;

Labor activity is the implementation of an active lifestyle in old age.

It is important that work activity is beneficial for the health of the elderly, has a rehabilitative nature of the impact.

Opportunities for working, realizing an active lifestyle for the elderly in boarding houses are sufficient: in 80.1% of institutions, medical and labor workshops (JITM) have been created, in 85.7% of institutions - subsidiary plots.

In LTM, the predominant profile is sewing; haberdashery and cardboard are also widely represented. To a lesser extent, there are LTM shoe and joinery profiles.

Of the elderly people capable of self-service, 85.5% actually take part in the labor force. They carry out work on the maintenance of a boarding house, work in the LTM, in full-time positions, and are employed in a subsidiary farm.

Of the activities for organizing leisure, the most often used are those that address passive perception: watching movies, attending lectures, concerts. Although these events do not encourage older people to be active, they have an active emotional impact: they brighten up their leisure time, provide a topic for communication, to a certain extent unite and introduce them to art.

In boarding houses, measures are taken to involve older people in socially useful, active activities: duty at the entrance, at the telephone, on residential floors, work in cultural and household commissions, participation in amateur performances.

With the aim of activating older people, their wider involvement in labor and socially useful activities, sanitary and educational work is being carried out, promoting the importance and necessity of maintaining an active lifestyle.

When approaching the solution of issues of employment of elderly and senile citizens in boarding houses, an important provision is the need for differentiation of the contingent, which is based on the ability to be socially active. In accordance with this criterion, five groups have been identified.

The first group, which includes 8.8% of the elderly living in boarding houses, is represented by those who have retained their labor and professional skills and the need to carry out labor activities. For this category of persons, types of work are selected that are close to their professional interests and inclinations. Of these, workers are formed for regular positions, groups of assistants to the librarian, cultural worker, responsible duties are assigned to them (foremen, supervisors, etc.).

When organizing the labor activity of this category of elderly people, it is advisable to form small groups united by a common interest and mutual emotional attachments. Over time, interpersonal relationships acquire stability, contribute to the emotional stabilization of the elderly and, consequently, adaptation in the conditions of a boarding house. Often, these stages are formed spontaneously, without the intervention of staff and, being based on emotional attachments, function for a long time.

The second group (23.5%) is formed of elderly people for whom labor activity is psychologically less significant and in this regard, their involvement in systematic work seems to be difficult. Along with sanitary and educational work to explain the usefulness of labor activity, occasional assignments are practiced (cleaning the premises, helping the medical staff, on duty, etc.).

The predominant form of social activity in this group is communication and leisure activities. Their interpersonal relationships often develop spontaneously and are based on factors such as living together, providing other

What information is contained in an individual rehabilitation program

The Individualized Rehabilitation Program (IPR) is developed by the Medical Commission at the ITU Bureau. Actually, this is the result of the work of this very commission. If a person is recognized as disabled, then this card must be drawn up.

What information does the document contain:

1. Personal data of a disabled person - his full name, date of birth, age and gender. In the card, a tick marks the presence of Russian citizenship and a detailed address (if a person does not have a specific place of residence, this is also noted), a contact phone number;
2. Part of the IPR section is devoted to complete information about the institution that sent the person to the commission;
3. The IPR indicates the profession and work experience of the disabled person, his qualifications at the time of the examination, whether or not he is registered at the employment center;
4. Then there is information about the group assigned as a result of the examination, the reasons for the disability and the date of its establishment, the card was developed for the first time or not, the degree of restriction to different spheres of life;
5. Most of the map is devoted to a detailed description of rehabilitation measures, including vocational education, the need for reconstructive surgery and prosthetics, sanatorium treatment;

Important! In the card, a disabled person puts his consent to assistance in finding a suitable job for him.

1. The medical board in the individual rehabilitation program places a conclusion on the persistence of functional impairment as a result of illness or injury and recommends measures for social and medical rehabilitation. The table containing the recommendations indicates who should implement these specific points. Particularly important is the section devoted to technical means of rehabilitation and prosthetic and orthopedic products.

The card must be developed by the commission within 30 days from the date of the establishment of disability. To develop it, you need to submit an application to the ITU. It is better to write it in duplicate and on the second to require a mark of acceptance. So you will get at least some guarantee that the procedure will not take long.

What is the benefit of an individual rehabilitation program for a disabled person?

This card is a necessary document literally in all instances. If a disabled child enters a higher educational institution on a quota, you need to present an IPR; if a person is registered at an employment center, too. The card will be asked at the social insurance fund for registration of a voucher to a sanatorium and an application for free rehabilitation means. In a word, there is simply nowhere without her.

Important! Information about the necessary means of rehabilitation is entered into the card in accordance with the federal list. If you really need, for example, a specialized bed, you may not be able to enter it, since it is not included in the list, but if you insist, the bed will be brought in, and in the column "Contractor" they will put down "independently." Why is this needed? If you apply to charities or, for example, a trade union, you will be able to substantiate your request for help, confirming it by the presence of the necessary TCP in the card.

Most likely, the ITU Commission will offer you a standard application form, in which you cannot enter any additional, but very important wishes for you. In this case, at the end of the application, write down the recommendation requirement in the appendix and make an appendix sheet in which you write down all your needs. Requirements for making recommendations in the map should be confirmed by the conclusions of specialists. The card is developed for a year, but you can demand its new issue earlier, for this you will have to go through the entire commission again. We described recommendations for passing the ITU commission in the article "".

Advice! Some ITUs go for serious violations, inviting people with disabilities (mainly representatives of minors with disabilities) to abandon the development of IPR. Don't agree in any way!

What to do if you are not satisfied with the prepared individual rehabilitation program?

You must sign for each section of the card upon receipt. This confirms that you agree with its content. Do not hurry. Carefully read the contents of the section and, in case of disagreement, just write: I disagree and indicate the reason. You can then appeal the decision of the local committee to the regional office. If they recognize your requirements as legal, you will be given a new card. If you don’t find understanding there too, contact the federal ITU and the court.

For more information on how to appeal the ITU decision, read this.

For the performers specified in the IPR, its content is a guide to mandatory actions, but the disabled person himself can refuse the ITU recommendations. All services are of a declarative nature, so if you do not apply for them, you will not receive them.

Please note that the executors of rehabilitation measures are not specific organizations, but their type - that is, a social insurance fund (and not a specific branch), social protection agencies, and so on. If a specific organization at the place of residence refuses to fulfill the assignments of the IPR, demand from them a written refusal and go to court.

What to do if you are not satisfied with the rehabilitation means provided free of charge under the IPR?

The provision of disabled people with technical means of rehabilitation and prosthetic and orthopedic products in most regions is carried out by the social insurance fund. In some - by the social protection authorities. The procurement of TSR and POI is carried out through a system of government contracts and tenders. Very often the quality of products supplied free of charge does not suit disabled people. This is understandable: when the search for the cheapest products is carried out, nothing good can be expected. There are two alternatives:

The first is to reasonably demand exactly the product that suits you, to write complaints to all instances from the higher authorities to the prosecutor's office. Practice shows that in most cases the disabled person wins and the FSS concludes an individual contract for him.

Fight and seek, find and not give up

The procedure for the implementation of the IPR recommendations cannot yet be called fully worked out. There are many nuances and discrepancies that exhaust the nerves and strength. Don't give up and keep everything under control. Read the list of possible rehabilitation services in advance, consult and get an opinion from your doctor about the products you need. Believe me, many people who have missed this moment leave the ITU with blank cards, and then grab their heads. It is in your interests to include everything that is possible in the individual program, and then you yourself will decide what is worth getting from the recommended.

Technical means for the rehabilitation of disabled people
(information letter for social work professionals and rehabilitation specialists)

In accordance with Art. 10, 11 of the Federal Law of November 25, 1995 No. 181-FZ "On social protection of disabled people in the Russian Federation" (as amended on August 22, 2004), the state guarantees disabled people at the expense of the federal budget to carry out rehabilitation measures, obtain technical means and services, provided for by the federal list approved by the Government of the Russian Federation.
For the first time, the Federal list of rehabilitation measures, technical means of rehabilitation and services provided to a disabled person was approved by the order of the Government of the Russian Federation dated October 21, 2004 No. 1343-r (hereinafter the Federal List), entered into force on January 1, 2005. the expanded Federal list approved by the order of the Government of the Russian Federation of December 30, 2005 No. 2347-r.
The main mechanism for the implementation of these guarantees is individual rehabilitation programs (IPR) for disabled people, developed by federal state institutions of medical and social expertise (MSE bureau).
The concept of medical and social expertise, as determining in the prescribed manner the needs of the examined person in measures of social protection, including rehabilitation, based on an assessment of disabilities, is given in Article 7 of the named Federal Law. And the main functions of the ITU Bureau are set out in Article 8. These include the development of the IPR for disabled people.
Art. 11 of Law 181-FZ defines an individual rehabilitation program for a disabled person, which is a list of rehabilitation measures that are optimal for a disabled person, including the types, forms, volumes, timing and procedure for the implementation of medical, professional and other measures aimed at restoring or compensating for body functions, restoring or compensation for the ability of a disabled person to perform certain types of activities, i.e. OZhD.
The volume of such recommendations cannot be less than the established federal minimum determined by the federal list, with exemption from payment, but it can also contain rehabilitation measures, in which the disabled person himself or other persons or organizations take part in paying. If the selected rehabilitation measure, which is optimal for a disabled person, is included in the Federal List, the bureau's specialists have no right not to include it in the IPR.
On the one hand, the IPR is mandatory for implementation by the relevant state authorities, local authorities, as well as organizations and institutions, regardless of organizational and legal forms and forms of ownership. On the other hand, the IPR is of a recommendatory nature for a disabled person; he or she has the right to refuse one or another type of event or from the entire program as a whole.
The form of an individual rehabilitation program for a disabled person, issued by federal institutions of medical and social expertise, was approved by the Order of the Ministry of Health and Social Development of the Russian Federation of November 29, 2004. No. 287.
The procedure and conditions for the provision of technical means of rehabilitation (TSR) to persons with disabilities are specially stipulated in the Law. Article 11.1 provides a definition of TCP and their classification. The decision to provide disabled people with TSW is made when establishing medical indications and contraindications, which are based on an assessment of persistent disorders of the body's functions. Financing of expenditure obligations to provide disabled people with technical assistance, including the manufacture and repair of prosthetic and orthopedic products, is carried out at the expense of the federal budget and the Social Insurance Fund of the Russian Federation. The list of TSW and indications for providing them to disabled persons, as well as the procedure for providing them, are determined by the Government of the Russian Federation.
Thus, the state guarantees persons with disabilities to carry out rehabilitation measures, technical means and services provided for by the Federal list approved by the Government of the Russian Federation.
The guaranteed provision of technical means for the rehabilitation of citizens who are not disabled and injured at work is regulated by the Federal Law of January 12, 1995 No. 5-FZ "On Veterans" (as amended on August 22, 2004). Articles 14-19, among other measures of social support, provide for the provision of prostheses (except for dentures) and prosthetic and orthopedic products in the manner established by the Government of the Russian Federation. (it should be noted that the legislation of the Russian Federation on veterans, in addition to the aforementioned federal law, consists of other regulatory legal acts of the constituent entities of the Russian Federation). Veterans who have the right to be provided with prostheses (except for dentures) and prosthetic and orthopedic products at the expense of the federal budget, excluding disabled people, include participants in the Great Patriotic War, war veterans, military personnel who served in military units, institutions, military educational institutions that were not part of the active army in the period from June 22, 1941 to September 3, 1945 at least 6 months, servicemen awarded orders and medals of the USSR for service in the specified period, persons awarded the sign "Resident of besieged Leningrad", persons who worked during the Second World War at the objects of air defense, local air defense, the construction of defensive structures, naval bases, airfields and other military facilities within the rear borders of operating fronts, operational zones of operating fronts, on the front-line sections of railways and highways. If the veteran has reasons to receive the same form of social support on several grounds, i.e. for example, he is both a veteran and a disabled person, then this form is provided on one basis at the choice of the veteran.
The formation of the IRP in determining the need of a disabled person in TSW is currently associated with certain difficulties associated with an insufficiently developed regulatory framework. At present, the procedure for the development and implementation of IPR, medical indications for providing disabled people with technical equipment, the nomenclature of funds related to the Federal List have not been approved.
However, an analysis of the existing normative and methodological documents shows that there is a sufficient information base for the work of specialists from ITU institutions.
What is TCP?
In Federal Law 181-FZ, they are defined as devices containing technical solutions, including special ones, used to compensate or eliminate persistent disabilities.
These include:
- special means for self-service;
- special care products;
- special means for orientation, communication and information exchange;
- special means for training, education and employment;
- prosthetic products;
- special exercise and sports equipment, inventory.
There are other classifications of TSR: by functional purpose (for removing and putting on clothes and shoes, for personal hygiene, for preparing and eating food, etc.), by type of rehabilitation (TS for medical, professional, social rehabilitation).
Tiflotechnical and deaf-technical means can be distinguished separately in various literatures, i.e. funds for the "blind" and "deaf" disabled people. The typhoid means include means for optical correction of vision (hyperocular glasses, hand-held support magnifiers, telescopic glasses, magnifiers with a hyperocular), for orientation in space (canes, a photoelectric probe, ultrasonic locators and alarms), for reading and writing (devices for writing and braille readings, typewriters, special drawing instruments, measuring instruments, computing devices), household appliances (dispensers, sewing devices, braille watches). Means of aids include vibration alarms, amplifying means of communication and information transmission, decoders for televisions, telephones with amplifiers, creeping line).
When determining the need for TSW, the IPR includes specific means, forms of provision of TSW (outpatient, inpatient, at home), volume (i.e. the number of products and components for TSW), terms of provision (within a year, once every 4 years and etc.), and in the case of complex or atypical prosthetics - and the implementing agency. In other cases, the executor is determined by the executive body of the FSS RF.
When determining a specific TCP, you can focus on the following regulatory documents:
1. The list of technical means used exclusively for the prevention or rehabilitation of disabled people, the sale of which is not subject to value-added tax, approved by Decree of the Government of the Russian Federation of December 21, 2000 No. 998 (as amended by RF Government Decree No. 357 of May 10, 2001) (hereinafter - List of TSRs used for rehabilitation);
2. An indicative list of technical and other means of rehabilitation of victims of industrial accidents and occupational diseases and the terms of their operation (reference material sent to the regional branches of the FSS RF by letter of the FSS RF dated 05.02.2002 No. 02-18 / 10-783) (hereinafter - Indicative list);
3. The list of standard representatives of prosthetic and orthopedic products used in the implementation of work and services for the provision of prosthetic and orthopedic care, and subject to approval as licensed standards, approved by order of the Federal Service for Surveillance in Healthcare and Social Development dated October 21, 2004 No. 279 -ПР / 04 (hereinafter - the List of type representatives);
4. The nomenclature of technical and other means of rehabilitation of disabled people of domestic and foreign production, subject to state registration, approved by order of the Federal Service for Supervision of Healthcare and Social Development of March 14, 2005 No. 505-Pr / 05 (hereinafter - the Nomenclature of TSR);
5. Terms of use of technical means of rehabilitation, prostheses and prosthetic and orthopedic products before their replacement, approved by order of the Ministry of Health and Social Development of the Russian Federation of 12.04.2006 No. 283 (hereinafter Terms of Use).
Which TSRs are currently included in the Federal List?
1. Support and tactile canes, crutches, supports, handrails.
Walking sticks are produced in the following modifications: metal, wood, fiberglass; one-piece and foldable; with 1, 3, 4 and 5 legs. Components for them are also produced (tips, anti-skid devices, handles (handles), reflectors).
According to the information of the regional branch of the Federal Security Service of the Russian Federation, the enterprises that passed the competitive selection for the supply of technical equipment in 2006 produce the following canes: a support cane with a height of 800, 850, 900, 950 mm, a four-support cane with a pyramidal base (adjustable in height and is intended mainly for stroke survivors), tactile folding cane (4-section), lightweight.
The rationale for determining the need for this vehicle is the limitation of the ability to move 2, 1 degree; self-service 2, 1 degree; orientation 3, 2 degrees due to disease, the consequences of trauma, a defect with impaired statodynamic or sensory functions 2, 3 degrees.
Medical indications for provision:
1.1. Walking stick with one leg and handle (various modifications) can be:
- diseases, consequences of injuries and deformities of the lower extremities, pelvis and spine with moderate or severe impairment of walking and standing functions;
- Moderate hemiparesis;
- Moderate paresis of one lower limb;
- Diseases of the peripheral vessels of the lower extremities with chronic arterial insufficiency of the 2nd degree, chronic venous insufficiency of the 3rd degree;
- Elephantiasis of one lower limb;
- Endoprosthesis of the knee or hip joint;
1.2. A multi-support cane (three-support - tripod, four-support - quadripod, five-support) can be:
- Moderate paresis of both lower extremities;
- Moderate triparesis (paresis of both lower and one upper limb;
- Moderate tetraparesis;
- Diseases of the peripheral vessels of the lower extremities with chronic arterial insufficiency of grade 3, chronic venous insufficiency of grade 3-4;
- Elephantiasis of both lower extremities;
1.3. One-piece tactile cane or folding (various standard sizes):
- Diseases, congenital anomalies, consequences of trauma to the organ of vision, leading to low vision or blindness (visual impairment of III, IV degree)
Provision standards and terms of operation (in accordance with the Terms of Use): 1 pc. for 2 years; disabled children - sliding canes 1 pc. for 2 years, other models - taking into account the height and other anthropometric data of a disabled child; components - 5 pcs. for 2 years (issued in addition to the product in cases where the recommendation to provide them is indicated in the individual rehabilitation program for a disabled person or if they are part of the product as an integral part).

Crutches are also produced in various modifications: wooden, metal; supported by the forearm, axillary, supported by the elbow; various standard sizes, adults and teenagers; adjustable length. Accessories to them (tips, anti-skid devices, handles (handles), reflectors) are also provided.
According to the information of the regional branch of the Federal Security Service of the Russian Federation, the enterprises that passed the competitive selection for the supply of TSR in 2006 produce the following crutches: axillary crutches that can withstand a load of up to 100 kg; with armrest support (height adjustable); with support on the forearm, withstands a load of up to 110 kg with a handle height of 45 to 68 cm (small), from 53 to 76 cm (medium), from 73 to 96 cm (large).
The rationale for determining the need for this TSW is the limitation of the ability to move 2 degrees, self-service 2, 1 degrees in combination with the limitation of the ability to move 2 degrees due to illness, defect, accompanied by impairment of statodynamic or sensory functions of 2, 3 degrees.
Medical indications for provision can be:
- Persistent deformities or diseases of the bones and joints of the lower extremities with ankylosis, severe contracture, bone defect, pseudarthrosis; persistent pain syndrome;
- Amputation stumps of one or both lower extremities;
- Vicious position of the foot with trophic disorders when it is impossible to use orthopedic shoes;
- Fistulous form of osteomyelitis of one lower limb with impaired support;
- Endoprosthesis of the knee, hip joints;


- Diseases of the peripheral vessels of both lower extremities with chronic arterial insufficiency of the 3rd degree; with chronic venous insufficiency of 3-4 degrees;

- Moderate, pronounced hemiparesis;
- Moderate, pronounced paresis of both lower extremities;
- Severe paresis of one lower limb in combination with paresis of one upper limb (crosswise).
Supply standards (pcs., Pairs) and service life: 1 pair for 2 years; disabled children - 1 pair for 6 months; components - 5 pcs. for 2 years (issued in addition to the product in cases where the recommendation to provide them is indicated in the individual rehabilitation program for a disabled person or if they are part of the product as an integral part).

Supports (walkers, arena, frames, support poles) are available in various modifications (axillary, with emphasis under the chest region, with emphasis under the lumbar region, with armrests, with emphasis on the arms, with fixation of the body; folding, adjustable, walking, on wheels , hinged, with a rest seat); and accessories for them (tips, wheels, anti-skid devices, handles (handles), latches, tables, seats, bags).
According to the information of the regional branch of the Federal Security Service of the Russian Federation, the enterprises that have passed the competitive selection for the supply of technical equipment in 2006 produce the following supports: a) folding with a load-bearing capacity of up to 135 kg, height from the floor to the handrails 81-91 cm (large), 71-81 cm ( small); b) supports "step", withstand load up to 135 kg, c) walking on 4 wheels with a hand brake, adjustable in height, with a bag for shopping, a seat for rest.
The rationale for determining the need for this TSW is the limitation of the ability to move 2 degrees, self-service 2, 1 degrees in combination with a limitation of the ability to move 2 degrees due to illness, defect, accompanied by impaired statodynamic functions of 2, 3 degrees.
Medical indications for provision may be:
- Diseases, consequences of injuries and deformities of the lower extremities, pelvis and spine with severe dysfunctions of walking and standing;
- Severe paresis of both lower extremities;
- Moderate tetraparesis;
- Moderate triparesis;
- Severe hemiparesis;
- Severe vestibular-cerebellar disorders;
- Severe amiostatic disorders.
Provision standards and service life: 1 pc. for 2 years; disabled children, taking into account the height and other anthropometric data of a disabled child; components - 5 pcs. for 2 years (issued in addition to the product in cases where the recommendation to provide them is indicated in the individual rehabilitation program for a disabled person or if they are part of the product as an integral part).

Handrails (continuous, removable, for toilets and baths). The competitive selection of supplier enterprises has not yet been carried out. Security standards in accordance with the Terms of Use 1 time in 7 years.

2. Wheelchairs with manual drive (indoor, walking, active type), with an electric drive, small-sized.
Components and accessories for them are included in a single set with the stroller (wheels, backs, removable sidewalls, headrests, armrests, footrests, belts for fastening shoes, belts for fastening legs, heel pads, handles (handles) for pushing, seats (with an adjustable strut, for arthrodesis, leather for disabled people with high amputation of the lower extremities, with a removable segment for the toilet), pillows (side, for the back, for sitting, solid, anti-decubitus, head rollers, etc.), anti-tipping supports, parking brakes).
When forming the IPR, it is necessary to indicate the anthropometric data of the disabled person (height, weight, hips), as well as the age of the child.
2.1. The need for room wheelchairs (of various modifications) is justified by the limitation of the ability to move 3, 2 degrees, self-service 2, 1 degrees in combination with the limitation of the ability to move 3, 2 degrees.
There are modifications for adults (seat width from 340 mm to 490 mm, load capacity up to 100-150 kg), including models with a reclining backrest, for teenagers, for children (ages 3 to 6 and from 6 to 14), for children with cerebral palsy. The narrowest strollers for adults up to 61 cm wide m. recommended for small apartments.






- Stage III rheumatoid arthritis with a predominant lesion of the joints of the lower extremities with severe dysfunction;
- Thrombosis of the arteries of both lower extremities with chronic arterial insufficiency of the 3rd degree;
- Diseases of the veins of both lower extremities with chronic venous insufficiency of the 3 (4) degree;
- Elephantiasis of both lower extremities at the stage of lymphodema;



- Tetraplegia, significantly pronounced, pronounced tetraparesis;
- Triplegia, significantly pronounced, pronounced triparesis;
- Significantly expressed, pronounced hyperkinetic disorders;
- Significantly pronounced ataxia;
- Severe vestibular-cerebellar disorders;


- Diseases of the cardiovascular system with stage III circulatory insufficiency, angina pectoris with functional class IV
- Diseases of the respiratory system with respiratory failure of the 3rd degree in combination with circulatory failure of any degree;
- Diseases of the liver with severe dysfunction, portal hypertension, ascites;
- Kidney disease with chronic renal failure grade 3.
Provision standards and service life: 1 pc. for 4 years; disabled children - taking into account the height and other anthropometric data of the disabled child.
2.1. The need for walking wheelchairs is justified by the limitation of the ability to move 3, 2 degrees, self-service 2, 1 degrees in combination with the limitation of the ability to move 3, 2 degrees.
Models are available with manual drive from the wheel rim and with lever drive on the front wheels (optional with a left-hand lever), for adults (with plastic or spoke wheels, with solid or pneumatic tires, with or without parking brakes, folding or non-folding) and for children, incl. with cerebral palsy (equipped with straps to fix the head, trunk and legs of a sick child).

Medical indications include:
- Amputation stumps of one or both lower extremities at any level;
- False joint of the bones of the lower extremities with impaired walking and standing;
- Bone defect of the lower extremities with impaired walking and standing function;
- Stage III deforming arthrosis of the hip or knee joint with severe pain or pronounced flexion or adduction contracture;
- Ankylosis or pronounced contracture of both ankle joints with a vicious position of one or two feet;
- Stage III rheumatoid arthritis with a predominant lesion of the joints of the lower extremities with severe dysfunctions;
- Thrombopliterating diseases of the arteries of the lower extremities with chronic arterial insufficiency of the 3rd degree;
- Diseases of the veins of the lower extremities with chronic venous insufficiency of the 3rd degree;
- Paralysis of both or one lower limb;
- Hemiplegia, significantly pronounced, pronounced hemiparesis;
- Significantly pronounced, pronounced paresis of both or one lower limb;
- Congenital anomalies (malformations) and deformities of both lower extremities, pelvis and spine with severe dysfunctions of walking and standing;
- Stage III circulatory failure;
- Angina pectoris with functional class IV;
- Pulmonary heart failure 3 degrees.
Terms of operation in accordance with the Terms of use - 4 years.
2.3. The need for a small wheelchair (and accessories to it, including warm leather gloves and woolen covers on the stumps of the thighs) arises when the ability to move is 3, 2 degrees with high amputation stumps of both thighs.
The term of use before replacement is 1.5 years.
2.4. On the determination of indications for providing a wheelchair with an electric drive. The rationale for inclusion in the IPR is the presence of a limitation of the ability to move in combination with a limitation of the ability to self-service II, III degrees in the presence of established medical indications:
- Persistent deformities or diseases of the lower and upper extremities, pelvis or spine in combination with diseases of the upper extremities;
- paralysis, significantly pronounced paresis of both lower extremities in combination with persistent diseases, deformities, as well as paralysis and paresis of the upper extremities;
- paralysis, significantly pronounced, pronounced paresis of one lower limb in combination with persistent diseases, deformities, paralysis and paresis of the upper limbs.
Terms of use - 5 years.
2.5. The above letter from the main bureau also applies to indications for the provision of active-type wheelchairs, which have increased maneuverability and are intended for disabled people who lead an active lifestyle, physically developed, who have the skills of independent active movement in wheelchairs with a manual drive.
It should be remembered that for movement on the last two types of wheelchairs, you need a hard surface of streets and sidewalks, a relatively flat terrain.
Before the approval of medical indications for technical means of rehabilitation, it is allowed to use "Medical indications for providing wheelchairs for disabled people", approved by the instruction letter of the Ministry of Security of the RSFSR dated 09.06.1989 No. 1-79-I.

Terms of use are 4 years.

3. Prostheses, including endoprostheses, and orthoses.
Prostheses (including prostheses of the upper and lower extremities, eye, ear, nose, palate, teeth, mammary gland, genitals, combined facial and palate).
Orthoses (including orthopedic devices for upper and lower extremities, reclinators, corsets, obturators, bandages, bras, semi-graces for breast prosthetics, splints, corrective devices for the upper and lower extremities).
The need for prosthetics and orthotics, provision of orthopedic shoes is included in the IPR on the basis of the conclusion of the medical and technical commission of the prosthetic and orthopedic enterprise (MTK POP). The conclusion should indicate the type of prosthesis and the name. The specific type of prosthesis or product is determined taking into account the List of type representatives. This document contains a list of all prostheses and orthoses offered for production, manufacture and sale for all types of lesions. For example. Amputation or dismemberment of the shoulder. A shoulder prosthesis may be recommended or, after the shoulder has been removed, a cosmetic prosthesis, with traction control, with an electric drive, working. In case of scoliosis, a functional corrective corset of individual production or from semi-finished products of maximum readiness. After mastectomy, breast (breast) prosthesis included: bra, cover and exoprosthesis of the breast. Etc. Those. it is a reference point for the bureau's specialists. ТСР presented in the List of Typical Representatives are recommended for licensing as licensed reference samples. For each of them, a certificate of entry into the register of samples of standards of prosthetic and orthopedic products was issued. Thus, in the period before the approval of medical indications for the provision of TCP, the List of Type Representatives may serve as a justification for the ITU institution's choice of TCP.
The terms of use before replacement (provision standards) are determined taking into account the Order of the Ministry of Health and Social Development of Russia dated April 12, 2006 No. 282 "On approval of the terms of use of technical means of rehabilitation, prostheses and prosthetic and orthopedic devices before their replacement", brought to the attention of the ITU bureau by a letter from the main bureau dated 18.05 .10.42 / 1233-2544.
Terms of use of cosmetic prostheses of fingers and hands of the upper extremities - 3 months;
Upper and lower limb prostheses 2 years old (for children - 1 year old);
Lower limb braces - 1 year;
Lower limb prostheses for bathing - 3 years;
Woolen covers for the stump of the lower limb - 3 months;
Cotton covers for the stump of the lower limb - 3 months;
Polymeric covers for the stump of the lower limb - 1 year;
Covers for the stump of the upper limb - 6 months;
Spare cosmetic casings for upper limb prostheses - 4 items per prosthesis for 1 year;
Spare cosmetic casings for lower limb prostheses - 1 item per prosthesis for 1 year;
Support elements - 6 months;
Moisture-absorbing elements - 6 months.
Exoprostheses of the mammary gland - 1 year;
Bodice (bra, grace or half-grace) for fixing the breast exorpotesis - 4 months;
Cover for breast exoprosthesis - 4 months;
Bandages on different parts of the body, loose shoes - 1 year;
Orthopedic bandage on the upper limb to improve dymphovenous outflow, including after breast amputation - 6 months.
It should be remembered that the performer is determined by the regional branch of the FSS of the Russian Federation in accordance with the results of the competitive selection. At the same time, if a disabled person (veteran) independently decides on his or her prosthetics in accordance with the IPR, he may be issued by the authorized body with a letter of guarantee confirming payment to the relevant organization for the cost of manufactured products in amounts not exceeding the cost of products manufactured in organizations selected in established order.
For endoprosthetics: The Social Insurance Fund (FSS) of the Russian Federation pays only for the endoprosthesis itself. Surgical intervention is paid for from the federal budget (in accordance with the order of the Ministry of Health of Russia and the Russian Academy of Medical Sciences dated 19.03.2004 No. 125/13 (see also the order of the Ministry of Health of the Russian Federation dated 29.12.2000 No. 459). Endoprostheses can be joints (the brand is indicated according to the conclusion of leading specialists ), ligaments, vessels, heart valves, cochlear implants.Moreover, in accordance with the terms of use, the timing of replacement of endoprostheses, including joints, ligaments, blood vessels, heart valves, cochlear implants, is determined by medical and preventive institutions (LPI) and confirmed by MSE institutions ...
The need for ocular prosthetics is determined on the basis of the opinion of an ophthalmologist of a health care institution (for primary prosthetics - a regional consultative and diagnostic polyclinic). The executor is also indicated by the executive body of the FSS of the Russian Federation, but you should know that if in 2005 17 manufacturers were selected, then according to the results of an open competition held in 2006, only three organizations were recognized as winners in eye prosthetics: FSUE "Ioshkar-Olinskoye POP", FSUE "Nizhegorodskoe POP" and Kemerovo Clinical Ophthalmological Hospital. The executive bodies of the FSS can conclude government contracts with any of the above-named organization. At the same time, if a disabled person independently decides on the issue of eye prosthetics in the presence of an IPR, by decision of the FSS executive body, a letter of guarantee may be submitted on payment of the cost of eye prostheses to the relevant organization.
The terms of use of dentures, eyes, ear, nose, combined facial, palate, genitals - 2 years (for children - 1 year).
The conclusion about the need for hearing aids is included in the IPR on the basis of the conclusion of the audiologist of the health care institution. When preparing a medical report, the audiologist must determine the required model from the supplied hearing aids, taking into account the form and degree of hearing loss, the presence of FUNG and a conductive component, the development of hearing and speech, the experience of wearing hearing aids and the state of motor function. possible binaural prosthetics, i.e. provision of two hearing aids in accordance with the IPR.

4. Orthopedic footwear.
Orthopedic footwear (complex and uncomplicated), footwear for apparatus, and prostheses, orthopedic pads, insert orthopedic corrective devices (insoles, half insoles).
Security standards and terms of use:
- sophisticated orthopedic footwear and footwear for orthopedic devices - 2 pairs for 1 year, including 1 pair with an insulated lining (for children - 4 pairs for 1 year, including 2 pairs with an insulated lining);
- uncomplicated orthopedic shoes (with or without an insulated lining at the request of a disabled person) - 1 pair for 1 year (for children - 2 pairs for 1 year);
- insert corrective elements for orthopedic shoes (including insoles and half insoles) - 3 months;
Shoes for prostheses - with bilateral amputation - 2 pairs for 1 year; with unilateral amputation - 2 pairs for 1 year (including 1 pair on an insulated lining at the request of a disabled person.

5. Anti-decubitus mattresses and pillows (seats for wheelchairs) refer to special care aids, and therefore the need is determined when the ability to self-service, movement of the III degree is limited.
Medical indications can be various diseases with a pronounced violation of statodynamic functions; dysfunctions of blood circulation, respiration, digestion, urination (renal failure), mental disorders (dementia). The provision rate is 1 time in 2 years.
Terms of use - 3 years.

6. Apparatus for dressing, undressing and grasping objects.

Appliances for dressing and undressing (including for fastening buttons, for putting on and taking off items of clothing, special buttons, a rack for dressing outerwear).
The indicative list provides for the provision by the executive body of the FSS of the Russian Federation with the following products: aids for putting on socks and tights (once every 5 years), a shoe horn and a device for removing shoes (once every 10 years), clothing holders (once every 5 years) ), hooks for dressing and undressing (once every 5 years), Velcro (once every 5 years).
The rationale for need is a limitation of the ability to self-service I, II degrees, due to impaired statodynamic functions (mainly of the upper extremities), blood circulation, respiration, digestion, liver), urinary excretion (renal failure).
Medical indications are:
- diseases, consequences of injuries and deformities of the lower extremities, pelvis and spine with severe dysfunction;
- diseases, consequences of injuries and deformities of the upper limbs, with severe dysfunctions;
- moderate, pronounced tetraparesis, triparesis, hemiparesis;
- severe paresis of both lower extremities;

- pronounced vestibulocerebellar phenomena;
- pronounced amiostatic disorders;
- severe hyperkinetic disorders;
- pronounced paresis of one upper or one lower limb;
- liver disease with impaired liver function, chronic renal failure III;
- kidney disease with renal failure;

Devices for gripping and moving objects are recommended when limiting the ability to self-service I, II degrees associated with impaired statodynamic functions.
Medical indications include:
- moderately pronounced paresis of both upper limbs;
- moderate, pronounced vestibulo-cerebellar disorders;
- pronounced amiostatic disorders;
- moderately pronounced hyperkinetic disorders;
- moderately pronounced paresis of one upper limb with minor paresis of the other upper limb;
- diseases, consequences of injuries and deformities of the upper limbs and shoulder girdle with severe dysfunction of the upper limbs;
An indicative list regulates the provision of the following products by the executive body of the FSS of the Russian Federation:
holder: for dishes (removable, stationary on suction cups) with a non-slip base, tiltable and non-tiltable with a flexible tripod, with attachment to a table, wheelchair, bed, with fasteners on the ceiling); for keys (with attachment to a table, wheelchair, bed, with fasteners on the ceiling); telephone receiver (cuff holder for hand, wrist, palm of the hand); anti-slip coatings (rugs); anti-slip tapes, stickers; magnetic tapes; clamp, including finger; stubcins; bounding frames; stickers, rugs.
Terms of use - 5 years.

7. Special clothing
The competitive selection of supplier enterprises has not yet been carried out. In the List of TCP used in rehabilitation, these means are defined as special-purpose clothing for disabled people, made to order, or other special clothing (including compression clothing, compression and protective gloves, stockings, socks, helmets, vests, fixing belts, bags for legs, trousers and skirts for movement in a wheelchair).
Terms of use and security standards:
- functional and aesthetic clothing for disabled people with paired amputation of the upper limbs - 2 sets of outerwear (winter and summer) for 1 year;
- leather or knitted gloves (for an upper limb prosthesis), a leather glove for a preserved upper limb prosthesis on an insulated lining -1 pair for 1 year;
- leather gloves for deformed upper limbs -1 pair for 2 years;
- orthopedic trousers -1 year;
- leather insulated gloves (for disabled people using small wheelchairs) -1 pair for 1 year);
- woolen covers for the stump of the thigh (for disabled people using small wheelchairs) - 3 pairs for 1 year);
.

8. Special devices for reading "talking books", for optical correction of low vision.
The competitive selection of supplier enterprises has not yet been carried out.
Special devices for reading “talking books”, according to the Tentative List, include a specialized audio recorder for “talking books” of various modifications of domestic production and a specialized audio player for listening to “talking books” of various modifications of domestic production. The rationale for inclusion in the IPR may be the limitation of the ability to learn II degree, communication II, III degree, labor activity II degree with visual impairment of 3 and 4 degrees associated with diseases, the consequences of trauma to the organ of vision, leading to visual impairment or blindness. Terms of use - 7 years.
For information and use in work, it is possible to take into account the letter of the President of the VOS A.Ya. Naumyvakin dated 03/10/2006 No. 1 / 10-21 to the chairmen of the Regional Organizations of the VOS and regional branches of the FSS RF with a proposal to provide disabled people with a universal TKD-K typing apparatus for listening to books on cassettes and CDs with the function of recording on cassettes, including those with a CD player in a four-track format (based on the "Panasonic RX29" radio tape recorder) (Price 5700 rubles). The named device allows you to play talking books recorded on cassettes, re-record from a CD to a cassette (4 tracks), listen to music recordings on cassettes and CDs in stereo mode, as well as record from a microphone and other external source; has a built-in radio receiver.
Specific optical correction devices for low vision, according to the Indicative List, include:
a) loupes 4, 8, 10-fold (limitation of the ability to communicate II degree, learning II degree, labor activity II degree with visual impairment of 3, 4 degrees due to a disease, the consequences of trauma to the organ of vision, leading to low vision or blindness; b) hyperocular glasses (spectacle correction) (limitation of the ability to orientate I, II degrees, communication I, II degrees, self-service I, II degrees, movement I, II degrees, learning I, II degrees, work activity I, II degrees , with impaired visual functions of 2, 3, 4 degrees due to a disease, the consequences of an injury to the organ of vision, leading to low vision or blindness;
c) contact lens (limitation of the ability to learn, work, self-service, movement, communication in case of impaired visual functions of 2, 3, 4 degrees due to refractive errors, keratoconus, corneal dystrophy; d) intraocular lens (limitation of the ability to learn, work, movement in case of impaired visual function of 2, 3, 4 degrees due to aphakia, cataracts; if necessary;
It is also possible to take into account the aforementioned letter from the President of the VOS A.Ya. Naumyvakin, proposing the provision of disabled people, including with a manual video magnifier ERVU-RM (a compact hand-held optical-electronic magnifier specially for disabled people with visual acuity from 0.005. It resembles a computer mouse in shape and size, (connects to a regular TV using the supplied adapter and cable. Provides 21x text magnification on a 20 "TV screen).
Terms of use - 5 years.
9. Provision of disabled people with guide dogs with a set of equipment
regulated by the "Rules for the provision of guide dogs for disabled persons, including the payment of annual compensation for the costs of maintaining and veterinary services for guide dogs", approved by Decree of the Government of the Russian Federation of November 30, 2005 No. 708 (hereinafter the Rules).
There is no clear regulatory framework for medical indications, however, in the decree of the Presidium of the central board of the VOS dated October 31, 1960, No. 28-2, the Instruction on the procedure for the distribution and use of guide dogs for the blind was approved, according to which guide dogs are intended to ensure movement (in cities and rural areas) disabled people of group I, mainly working, having no vision or having such a residual vision, which does not make it possible to independently navigate in space. Together with the dog, a set of special equipment (collar, leash, harness, muzzle, brush and comb) is issued free of charge.
The provision of a disabled person who has a dog guide for free use of an IPR for payment of compensation is not provided for by the Rules. When submitting an application to the Fund, a disabled person presents a passport of a disabled person or an authorized person, as well as a standard passport for a guide dog.

10. Medical thermometers and blood pressure monitors with speech output.
The competitive selection of supplier enterprises has not yet been carried out.
Tonometers with a speech output, according to the above-mentioned Indicative list, are intended for disabled people with limited self-service ability of I, II, III degrees with visual impairment of 3, 4 degrees due to illness, trauma to the organ of vision, leading to blindness; terms of use 7 years;
According to the VOS proposals, the most convenient device that has been tested in medical institutions in Russia and approved for use in Russia is the TT-01 (TT-01P) electronic typhlotonometer with a speech output (TT-01P - with a memory for 14 readings).
The offered medical thermometer is the DX6623B medical electronic thermometer with speech output. Does not contain glass components or mercury, power consumption 50 mW (for voice messages). Weight 23g (with AG 12 batteries). The term of use is 7 years.

11. Light and vibration signaling devices are classified as a means of hearing (for people with hearing and speech impairments).

According to the above Indicative List, these TCPs include a light telephone call signaling device, a vibrator and a stroboscope for connecting to an alarm clock, doorbell and telephone bell.
The indications are a violation of the ability to communicate and orientation, associated with impaired auditory functions of 3, 4 degrees due to the disease, the consequences of trauma to the organ of hearing, leading to hearing loss.
Terms of use - 5 years.
12. Hearing aids, incl. with custom earmolds
relate to aids (for people with hearing and speech impairments), are produced in various modifications (internal, behind-the-ear with automatic volume control, electronic, etc.), domestic and imported.

Terms of use: hearing aids - 4 years; custom earmolds - 1 year.

13. Teletext TV sets for receiving closed captioning programs.
We do not have information on the types or brands of such products. The term of use is 7 years.

14. Telephone devices with text output, i.e. text telephones can be recommended for people with disabilities with limited ability to communicate, orientation II degree with impairment of hearing functions 3, 4 degrees due to illness, the consequences of hearing organ trauma, leading to hearing loss. The term of use is 7 years.

15. Voice-forming apparatuses belong to the aids (for people with hearing and speech impairments).
According to the above-mentioned Indicative List, they are assigned to persons with disabilities with limited learning ability of I, II degrees, work activity I, II degrees, communication of I, II degrees with impaired voice-forming functions of 4 degrees due to a disease, the consequences of laryngeal injuries leading to impaired voice formation; terms of use 5 years.

16. Special means for dysfunctions of excretion (urine and fecal collectors) -
body care items - included as TSR in the IPR of disabled people with limited ability to self-service I, II, III degrees with disorders of visceral functions (pelvic organs) 3, 4 degrees due to diseases or consequences of injuries of the pelvic organs, central nervous system with fecal or urinary incontinence ... They are means of individual selection, and the choice of the model of the product, as well as the size of the stoma, are determined by the location of the stoma. The conclusion about the necessary modification and model of the product can be given by specialists (surgeon, oncologist, etc.) of an inpatient (before and after ostomy operations) or outpatient clinic.
Performer enterprises produce the following items: one-component colostomy bags (for stoma diameters up to 60 mm and over 60 mm) and ileostomy (stoma sizes up to 60 mm); two-component ileostomy colostomy bags (stoma size over 60 mm) and two-component urostomy urine bags (stoma diameter up to 60 mm).
The bureau's specialists make a record in the IPR about the need for a stool or urine collection bag of a specific name, size (diameter) of the stoma.
Auxiliary products include numerous deodorants, protective creams and powders, protective films, wipes with various types of impregnations, O-rings and pastes.
Collateral standards in accordance with the Terms of Use:
- two-piece colostomy bags and urine bags (with a plate and a bag): for plates up to 10 pcs. for 1 month; for ileo- and urostomy bags - up to 30 pcs. for 1 month; for colostomy bags - up to 90 pcs. for 1 month;
- one-component colostomy bags and urine bags: loya of ileo- and urostomy bags - for 30 pcs. for 1 month; for colostomy systems and pediatric colostomy and urine collection systems - up to 90 pcs. for 1 month;
- clips for open bags - up to 2 pcs. for 1 month;
- belt for feces and urine bags - up to 2 pcs. for 1 year;
- a paste for sealing to a stool or urine bag - 1 tube for 1 month;
- absorbent powder - 1 bottle for 1 month;
- protective cream - 1 tube for 1 month;
- protective film - 1 package for 1 month;
- cleaner - 1 bottle for 1 month;
- plastic bag on the belt, complete with bags - up to 6 pcs. for 1 year;
- catheters for stoma, catheters for self-catheterization - up to 120 pcs. for 1 month;
- urine collection device included:
urop condoms up to 30 pcs. for 1 month;
day and night bags for collecting urine - for day leg bags - up to 4 pcs. for 1 month; for night leg bags - up to 2 pcs. for 1 month;
straps for attaching the leg bag to the leg - up to 2 pairs for 1 month.

17. Absorbent linen, diapers.
Refers to body care items, assigned to disabled people with limited self-service ability I, II, III degree.
The total number of products paid for from the federal budget is up to 90 pcs. for 1 month (with polyuria syndrome - according to individual medical indications up to 150 pcs. for 1 month). The IPR indicates the type of product, size and degree of absorbency.
Absorbent underwear includes absorbent napkins (for additional protection of bedding) of various sizes and degrees of absorbency, urological pads and liners (to protect clothes of bedridden and mobile disabled people), panties (mesh panties, elastic (for fixing pads and inserts).
Pampers (diapers) are produced both for adults (with severe urinary and fecal incontinence for bedridden and mobile disabled people) and for children (with urinary and fecal incontinence).
In adults, diapers are indicated by size (S, M, L, XL) and absorbency (medium, high). In the IPR, an indication of the volume of the hips is mandatory. At U = 50-80 cm, a small (S) size of diapers is assigned, but they can be of medium (~ 830 ml) or high (~ 1300 ml) degree of absorbency; At U = 70-120 cm, a medium (M) size of diapers is assigned, but they can be medium (~ 1170 ml) or high (~ 2230 ml) absorbency; At U = 100-150 cm, a large (L) size of diapers is assigned, but they can be medium (~ 1450 ml) or high (~ 2400 ml) absorbency; At U = more than 150 cm, a very large (XL) size of diapers is prescribed, but they can only be of a high (~ 3200 ml) degree of absorbency;
In children, universal diapers are recommended for children of different age groups; the size is indicated by the weight of the child (3-5kg, 5-10 kg, 8-18 kg, 15-30kg).
Night and day can be recommended in different quantities.

Absorbent nappies as additional protection for bedding.
Disabled people are provided with nappies of three sizes and varying degrees of absorbency:
Size 40 x 60 (absorbency 550 or 750 ml), 60 x 60 (absorbency 940 or 1150 ml), 60 x 90 (absorbency 1525 or 1750 ml).
Urological pads and inserts:
- for mild and moderate incontinence in mobile disabled people) urological pads (for women) and urological liners (for men);
- with moderate and severe incontinence in bedridden and mobile disabled people;
The sizes and the degree of absorbency are indicated in accordance with the information letter of the regional department of the FSS of the Russian Federation (they depend on the products supplied by the enterprises that passed the competitive selection in the corresponding year). For fixing any pads and inserts, panties are recommended (mesh panties, elastic).

18. Armchairs-chairs with sanitary fittings,
as a means for the administration of natural needs, it can be prescribed to persons with disabilities with limited ability to self-service II, III degree in violation of statodynamic functions, functions of blood circulation, respiration, digestion (liver), urination (renal failure), mental functions.
Terms of use are 4 years.
Medical indications include:
- diseases, consequences of injuries and deformities of the lower extremities, pelvis and spine with dysfunction;
- hemiplegia;
- paralysis of the lower extremities;
- pronounced, significantly pronounced tetraparesis;
- pronounced, significantly pronounced triparesis;
- pronounced, significantly pronounced lower paraparesis;
- pronounced, significantly pronounced hemiparesis;
- pronounced, significantly pronounced vestibulo-cerebellar disorders;
- pronounced, significantly pronounced amiostatic disorders;
- pronounced, significantly pronounced hyperkinetic disorders;
- diseases of the cardiovascular system with circulatory insufficiency of stage 3 or angina pectoris IV f.cl .;
- diseases of the respiratory system with respiratory failure of the 3rd degree;
- liver disease with impaired function of the 3rd degree with portal hypertension and ascites;
- kidney disease with chronic renal failure of the 3rd degree;
- severe mental disorders (dementia).
The competitive selection of supplier enterprises has not yet been carried out. There are various modifications of this product: without wheels, on 4 wheels, with a toilet lid, with adjustable legs.

Provision of disabled people and veterans of labor force, provided for by the Federal List, is carried out in accordance with the "Rules for providing disabled people with technical means of rehabilitation and certain categories of citizens from among veterans with prostheses (except for dentures), prosthetic and orthopedic products," approved by the Government of the Russian Federation. dated 31.12.2005 No. 877.
The terms of use of technical means of rehabilitation, prostheses and prosthetic and orthopedic devices before their replacement were approved by the order of the Ministry of Health and Social Development of 12.04.2006 No. 282. The Terms of use of technical means of rehabilitation, prostheses and prosthetic and orthopedic products before their replacement, approved by order of the Ministry health and social development from 17.10.2005 № 638.
Repair of technical equipment issued free of charge or purchased at their own expense with subsequent compensation, as well as replacement after the expiration of the term of use or the impossibility of repair, are carried out without an IPR, at the request of a disabled person (clauses 7, 8). Early replacement of ТСР is also possible at the conclusion of the ITU bureau.
The list of technical means of rehabilitation, not subject to delivery after the expiration of the terms of their use, was approved by order of the Ministry of Health and Social Development of 12.04.2006 No. 283.
You should be guided by the information letters of the regional branches of the FSS about the technical means of rehabilitation supplied by the enterprises that passed the competitive selection in the corresponding year.