After her father stumbles on the back steps, a woman picks up a rolling walker at the drugstore on the way home. She sets the handles where they look about right, shows him the brakes she figured out in the parking lot, and that is the whole fitting.
That is how a lot of walking aids enter American homes. When a physical therapy researcher at the University of Central Arkansas examined 158 people aged 65 and older who used rolling walkers in senior-living communities, almost 80% had gotten the walker without a medical professional’s guidance: 61% on their own, and another 19% through a professional who gave no instruction or demonstration. More than half, 55%, were using it at the wrong height. None had had it rechecked by a medical professional since.
A cane or walker is a medical device that many people choose, size and learn to use by themselves. Medicare’s coverage rules assume the opposite: before the program will consider paying for a wheelchair or scooter, it asks whether a properly fitted cane or walker could solve the problem. Here is what fitting involves, what the injury numbers do and do not show, and what Medicare will and will not pay for.
Who uses walking aids, and how they get them
Mobility devices are common. In the 2011 round of the National Health and Aging Trends Study, a national survey of Medicare beneficiaries, 24% of adults 65 and older reported using one, from canes and walkers to wheelchairs and scooters, and 9.3% had used more than one in the past month. Use rose with age and was more common among women, people with less formal education, and people with several chronic conditions or obesity.
The underlying need is broad, too. According to the CDC’s National Center for Health Statistics, 18.9% of US adults had at least some difficulty walking or climbing steps in 2025. How mobility compares with other types of disability is covered in our article on what makes daily life hard.
The problem is how the devices arrive. Besides the walker study above, the same researcher and colleagues examined 93 cane users aged 65 and older in assisted living and retirement centers, reported in 2010. They found five recurring problems:
- no medical advice in choosing or using the cane;
- the wrong height, or poor maintenance;
- the cane held in the wrong hand;
- trouble keeping a proper walking rhythm with it;
- poor posture while walking.
Only a forward-leaning posture looked possibly linked to falls. In the walker study, 40% of users leaned forward while standing and half while walking.
Mandi Sehgal, Jeremy Jacobs and Wendy S. Biggs, writing a 2021 clinical review for the American Academy of Family Physicians (AAFP), noted that patients often acquire these devices with no professional advice on which one to choose or how to use it. It recommends that clinicians evaluate fit and use, a C-level recommendation in the review’s rating system, based on observational studies and patient surveys rather than trials. The National Library of Medicine’s MedlinePlus service adds that canes, crutches and walkers need fitting, since a device that fits badly can be uncomfortable and unsafe.
Do canes and walkers cause falls?
The most quoted injury figure comes from CDC researchers. Analyzing national emergency department data from 2001 through 2006, Judy A. Stevens and colleagues estimated 47,312 fall injuries a year among adults 65 and older that involved a walker or cane. Walkers accounted for 87.3% and canes for 12.3%, so walkers were linked to seven times as many injuries. Women’s injury rates were higher than men’s. Fractures and bruises or scrapes were the most common injuries, and about a third of patients were hospitalized.
Read that number carefully. It counts injuries associated with a device, meaning the device was involved, not that it caused the fall. And it cannot say how many people use each device or how frail they are, so the sevenfold gap is a count, not a measure of which device is riskier. The data are also two decades old. There is no simple update, because after 2010 the national injury surveillance system stopped using separate product codes for walkers, wheelchairs, canes and crutches.
A team led by Virginia Tech researchers worked around that gap by having volunteers hand-code 30,776 emergency department narratives about older adults injured at home from 2016 to 2020. Published in Innovation in Aging in 2024, the study estimated 10,974 visits over those five years in which an assistive device, from walkers and canes to shower chairs and grab bars, clearly malfunctioned. About three-quarters involved design problems such as slipping, tipping or awkward handling, and the rest involved parts that broke or came apart. Walkers were involved in about two-thirds of these cases, and 42% of the injured were admitted to the hospital. Because the method, years and setting all differ, these figures cannot be set beside the older estimate as a trend.
The most direct look at whether the devices themselves raise fall risk is reassuring. Using the 2011 to 2012 national aging survey, Nancy M. Gell of the University of Vermont and colleagues adjusted for demographics, health and physical function and found that neither any particular type of device nor using several was linked to more falls. The University of Vermont-led team’s conclusion: “Mobility device use is not associated with greater incidence of falls.” They did find that people who used only a cane were more likely than nonusers to limit their activity out of worry about falling.
The honest picture has two sides. A 2005 review in the Archives of Physical Medicine and Rehabilitation by Hamid Bateni and Brian E. Maki found that canes and walkers can improve balance and mobility, but that many users have trouble with them, that the devices can interfere with balance in some situations, and that their strength and energy demands can be excessive. It also noted that device use is associated with a higher risk of falling, a raw link that Gell’s analysis did not find once health and function were accounted for. People who need walking aids are already at higher risk of falling, which is why injury counts cannot separate the device from the person. All of these studies are observational, so whether a well-fitted aid lowers an individual’s fall risk remains unsettled. The AAFP review rates the benefit claim B, based on expert opinion and observational studies, and warns that devices may cause falls when used incorrectly.
Wheelchairs carry their own risks. Ohio researchers estimated that more than 100,000 wheelchair-related injuries were treated in US emergency departments in 2003, double the 1991 number, with tips and falls behind 65% to 80% of them.
Matching the device to the problem
The AAFP review offers a simple first cut. When only one arm is needed for balance or to take some weight off a leg, a cane is preferred. When both arms are needed, a walker or crutches fit better, though crutches are rarely used by older adults because they demand considerable upper-body strength. Canes are the least stable of all the devices.
Walkers come in three main kinds, according to the review:
- Standard walkers have four rubber-tipped legs and no wheels. They are the most stable, but you lift the whole frame with every step.
- Two-wheeled walkers are easier to move and suit people with arthritis, pain or injury in the legs, or poor balance.
- Four-wheeled rollators suit higher-functioning people who do not need to put weight on the device and who need to stop and rest. They should not be used for weight-bearing, and they can slide out from under you if the hand brakes are not set.
Wheelchairs can improve mobility and quality of life, the review says, but they need proper sizing and training, and seat pressure can break down the skin over bony areas.
For arthritis, the guideline position has shifted. The American College of Rheumatology’s 2026 osteoarthritis update, posted in September, treats canes and other mobility aids as an ungraded good practice statement for people with knee or hip osteoarthritis whose walking is limited, telling clinicians to recommend them where they fit. The 2019 version had listed cane use as a strong recommendation. The rest of that guideline is unpacked in our arthritis article.
Getting the fit and the technique right
Height comes first. The AAFP review says the top of the cane handle should sit at the level of the wrist when the arm hangs at your side, giving an elbow bend of about 20 to 30 degrees when you hold it. The academy’s patient handout applies the same wrist-level rule to walkers.
Technique matters as much as height. The AAFP review and handout describe it this way:
- Which hand. The cane goes in the hand opposite the weak or painful leg and moves forward together with that leg.
- Stairs. Going up, the stronger leg leads, then the weaker leg and the cane follow. Going down, the cane and weaker leg go first.
- Inside the walker. Keep your feet between the back legs, stand upright rather than leaning over the frame, and turn slowly without lifting it.
- Crutches. The underarm pad is not for resting body weight. Leaning on it can compress the nerve and artery in the armpit, the AAFP review warns.
- Grip. A curved cane handle can be hard to hold and may contribute to carpal tunnel syndrome.
Equipment wears out, too. In the rolling-walker study, about 17% of walkers had maintenance problems.
The AAFP handout suggests asking whether physical therapy could help if you still feel unsteady. A physical therapist can help choose the device and teach its correct use, sometimes at home, through a referral. Grab bars, lighting and stair rails, the house side of the equation, are the subject of our home modification guide, and building balance and strength is a separate topic in the library.
Questions to ask before buying or using a walking aid
- What problem is this device meant to solve: one painful leg, poor balance, or needing to stop and rest?
- Do I need one hand free, or support for both arms?
- Who will set the height, and will someone watch me walk with it before I take it home?
- Which hand holds it, and how do I manage stairs, curbs and turns?
- If it is a rollator, can I set the brakes every time, and will I be tempted to lean on it?
- Will Medicare or my plan pay if a clinician orders it, and does this supplier accept Medicare assignment?
- When should the fit, tips, wheels and brakes be checked again?
What Medicare covers, and why the rules are strict
Under Original Medicare, Part B treats canes, crutches, walkers, manual wheelchairs, power wheelchairs and scooters as durable medical equipment, according to the program’s February 2025 coverage booklet. White canes for people who are blind are not covered. Once you have met the Part B deductible, $283 in 2026, Medicare generally covers 80% of its approved amount and you owe the other 20%.
Where you buy matters. Medicare pays only suppliers enrolled in the program. Participating suppliers must accept assignment, which limits what they charge you to the coinsurance and deductible. Other suppliers can charge more and may ask for full payment up front.
Medicare generally buys canes and walkers outright as inexpensive items. Most other equipment is rented. For wheelchairs, Medicare pays rent for 13 months of continuous use, after which ownership passes to you, though it buys complex rehabilitative power wheelchairs outright. Equipment you own can be replaced if it is lost, stolen, damaged beyond repair or past its expected life, generally five years from when you started using it.
The home rule
Coverage is built around the home. Federal regulation covers durable medical equipment used in the patient’s home or in an institution that serves as a home, which excludes hospitals and skilled nursing facilities. A national coverage determination dating to 2005 covers mobility equipment when a mobility limitation significantly gets in the way of mobility-related daily activities in the home: toileting, feeding, dressing, grooming and bathing.
That determination lays out a step-by-step algorithm, and one step is the point of this article. Before moving on to wheelchairs, the evaluator asks whether a cane or walker could sufficiently resolve the problem, and the cane or walker must be appropriately fitted for that test, with an assessment of whether the person can use it safely. Only then come questions about the home’s layout, a manual wheelchair, a scooter and a power chair.
Power wheelchairs and scooters
Here the most common misunderstanding lives. Medicare’s booklet states that it will not cover a power wheelchair or scooter that you need and use only outside the home. A scooter needed only for getting around town is not covered.
For power devices that do qualify, the paperwork is specific:
- A face-to-face visit with the treating practitioner within the six months before the written order. Federal regulation allows that visit to be by telehealth.
- A written order that reaches the supplier before delivery.
- An on-site evaluation of the home, before or at delivery, to confirm the device can be used there.
- For more complex power chairs, a specialty evaluation by a licensed or certified professional such as a physical or occupational therapist, who may have no financial relationship with the supplier, under the Medicare contractors’ power mobility policy revised in October 2025.
- Prior authorization for some power wheelchairs, usually requested by the supplier.
Coverage has also grown. Since 2023, Medicare has covered power seat elevation on complex rehabilitative power wheelchairs, after a specialty evaluation, for people who need it for transfers or to reach things for daily activities.
The strictness has a history. A 2011 report from the Department of Health and Human Services’ Office of Inspector General found that 61% of power wheelchairs Medicare paid for in the first half of 2007 were medically unnecessary or lacked documentation, $95 million of $189 million. Those who got unnecessary chairs, the report said, generally needed something less expensive, such as a manual wheelchair, cane or walker. That describes 2007 claims, not today’s, but it explains why the program asks so many questions.
These are Original Medicare’s rules. If you have a Medicare Advantage plan or other insurance, ask the plan how it handles each step. Medicare’s separate rules for home health therapy, including what counts as homebound, are laid out in our overview of rehabilitation.
When a walking aid needs a second look
Some signs mean the device, the fit or the plan needs checking by a clinician, often a physical or occupational therapist:
- A fall or near-fall while using it, or a device that wobbles, sits at the wrong height, has worn tips or wheels, or has brakes that slip.
- New hand or wrist pain or numbness from gripping a cane, or numbness or tingling under the arm with crutches.
- Sore, red or broken skin over the tailbone, hips or other bony spots in a wheelchair user, a sign of pressure from the seat.
- Doing less because of fear of falling, the pattern Gell’s team saw in cane-only users.
- New trouble with toileting, dressing, bathing or getting around inside the home. That is the same line Medicare draws, and it is the point at which an evaluation for different equipment makes sense.
A fall that leaves someone unable to get up, unable to put weight on a leg, or with a blow to the head needs emergency care. Call 911.
The takeaway
The device is the easy part. Whether a cane or walker steadies you depends on choosing the right type, setting the right height and learning the right technique, the three steps most people skip. Those are questions a clinician who watches you walk, often a physical therapist, can answer, and the same fitted-device test is what Medicare applies before it pays for anything bigger.
Sources
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