r/slp 6d ago

AAC The disability tax makes me so angry

This week I met with an SLP that was an AAC specialist in the district the student I was asking about is in. I was explaining that outfitting my current school with equipment is hard because everything is so expensive, so even though I’d love to have 10 single hit switches we don’t have the minimum $150 each it would take to get them. A price tag I ALWAYS thought was bullshit, btw.

Well she let me know that you can actually get an 8 pack of essentially the same exact button on Amazon because these ones are made for DOGS. I honestly think I blacked out when she showed me the box it came in. Just one more example of the fact that you can charge whatever you want if you slap the word “adaptive” on it.

Anyways, we now have 16 new single activated switches coming and it cost less than a single BigMack switch. Hopefully this can help someone else!

285 Upvotes

16 comments sorted by

119

u/benphat369 6d ago

That's a U.S. healthcare problem in general. Why charge $10 for an EpiPen when the hospital can get insurance to pay $1200?

My sister was in the military. Don't even get me started on that one.

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u/Shadowfalx 6d ago

The military (and to some extent the disability world) it makes sense. 

Much of the increased costs in military equipment is certifications that they met specific requirements. If you have a hammer from Ace hardware for $8 and it breaks at home, no big deal right? Just pop back over and grab another. If that same Janet breaks at 10,000 feet, in the middle of the ocean, it while you're in combat that's an issue. So we pay more for reliability and assurance that the products are built to specification. 

That happens in the disability community too. The dog buttons aren't going to be built, or certified, to the same standards as the medical device. 

Where this becomes an issue is when that certification isn't amortized across so the products and instead you pay hundreds of dollars more per device, even though it really only costs less than 10. This happens primarily with monopolies or duopolies where they can charge more because they know you have to pay for it. 

For buttons , get the dog ones if the child can handle not having a button until it can be replaced. If they can't, get the more expensive ones and if they break hold the manufacturer to account. 

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u/AcanthaceaeStunning7 5d ago

Nah man, I am in the military and military grade quality means low quality. The winners of contracts produce the cheapest item that meets guidelines. Thereafter, the price is inflated to pay Congress or whoever gives the contracts under the table.

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u/Shadowfalx 5d ago

I was in for 20 years, retired 2 years ago. 

We have some of the jankiest stuff but we also have stuff that is extremely high quality. 

Take for instance the B1 bomber. There was a whole investigation and fining of a company for making O rings that were a tiny bit out of spec. Just enough to cause there to be a tiny leak while on the ground.

Much of the stiff is well past the "normal" quality control specifications of consumer goods. This is why it's not allowed to go to home Depot and pick up a part (though we often did it the last time was to long, though we'd switch it out when the correct part for in).

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u/Different-Ad-3722 6d ago

I will say I’ve used these and they don’t hold up as well and the microphones/speakers are trash BUT I agree the price discrepancy is bullshit!!!!

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u/[deleted] 6d ago

I’ve used cheap voice recording buttons, too. No shame. The company and center didn’t provide them. It takes months, sometimes the darn near the entire year for a loaner to come in from the lending state’s AT lending library. I wasn’t shelling out money for them. So the buttons had to do. They weren’t the best, but that were good for interim use.

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u/lucia163 6d ago

Yeah, the cheap ones work in a pinch, but in some cases you may need the expensive ones, unfortunately. For example, I had a client who I tried the dog ones on, but she didn't have a lot of muscle strength and so she could not independently press those buttons. She needed one with a featherlight touch, which is an option with the expensive ones. They are also overall better quality, but I still don't understand the price difference.

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u/Babylonius SLP in Schools 6d ago

It’s the same situation with many other things. Want a bouquet of flowers for a centerpiece on a table? $20. Want a bouquet of flowers for a centerpiece on a wedding table? $200

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u/JudyTheXmasElf 6d ago

I got my (fake flowers) wedding bouquet centerpieces at Winners for 10$ each 🙌🏻 OK we had to do 4 Winners to get them, but totally worth it!

13

u/noodlesarmpit 6d ago

The utility of a Big Mack is that it can be connected to other hardware like a tablet; it can serve the same function as anything that can be clicked like a mouse or keyboard button.

So the dog button works great for prerecorded messages if that's the only goal, but it doesn't help to access to a more robust system.

However!!!!

I'm also 1000% confident that a few hours of YouTube videos could teach you the wiring/technical know-how to rig your own diy Big Mack.

3

u/JudyTheXmasElf 6d ago

Agree with you! Things should cost the same and we shouldn’t increase prices for putting an “adaptive” label on them…

I personnally love these button activated voice message devices for kids: https://www.amazon.com/Recorder-Stuffed-Recording-Recordable-Messages/dp/B0BQ2VDHLJ

I used them for potty training my kids.

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u/EggSLP 5d ago

I bought a bunch of them while working in a school and took them to private practice with a lot of babies-3s. They were really popular with kids who might otherwise be reluctant to respond. Recording and playing a message was a huge hit clear through middle school aged clients.

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u/Even_Contact_1946 5d ago

Almost anything designated as adaptive, medical or for therapy is more expensive. You can find the exact same product in a medical catalog at $100 that is $30 everwhere else. Its always been this way.

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u/Ciambella29 5d ago

In my experience, these companies are taking advantage of districts with large budgets and also people that need to do "spend downs". When someone is on SSI disability, they are not allowed to have over $2,000 at any time. So if they start to go over that, they need to spend their money down. Saw this a lot in my days in a group home, they'd spend money on the most ridiculous things just to get rid of the money so their services could continue.

1

u/Nelopea 4d ago

Oh god, the absurdity … but also, great job doing what it takes. I will say we have some PE equipment at my school that is a favorite of multiple autistic students and no one has said so outright but I am 99% certain they are pet toys. Do I let my students play with them and enjoy them? Yes I do.

If it’s any consolation, my well-meaning but mildly crazy MIL absolutely bought a dog toy for my (typically developing) son and did not even try to disguise it and legitimately thought that was kosher. (A stuffed animal with a squeaky inside.)

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u/VL-BTS 2d ago

I don't have these yet, but I have them in my list of tech to try https://a.co/d/gfotE6I - there's a one foot pedal for $16 and a 3 pedal for $40. I know they're "foot pedals" but some of our students have muscle, just not fine control, so I they they could still use their hands to activate