Complaint #3: The Patient Lift
The patient lift is a machine used to transfer a resident from their bed to their wheelchair and back. No resident I’ve met likes using one, and I suspect the reason is the combination of loss of control, the frightening feeling of being suspended, helpless, in midair, and a lack of training which makes the procedure more alarming and uncomfortable than it needs to be.
When I was in grad school, all psychologists-in-training were required to undergo psychotherapy. Similarly, aides could gain perspective from a ride in the lift as part of their orientation or ongoing training. (I’d like to do this and blog about it, so if there’s a home in the New York Metro area willing to let me, please contact me.)
A professional approach by staff members with a focus on increasing confidence in the transfer procedure can reassure anxious residents. Techniques that reduce anxiety include:
- letting residents know what’s about to occur at each step of the process
- engaging in a dialogue with residents so they know the focus is on them
- listening to feedback about how they’re feeling (frightened, uncomfortable, etc) and responding to their concerns
What techniques do you use to make this procedure more pleasant?
My mother simply refuses. It's terribly scary and makes her concerned for her safety. I think the fear of breaking something is heightened in this contraption.
Using lifts saves the backs of many aides. But I know many residents who refuse to allow themselves to be transferred via lifts and aides who go along with those wishes- placing themselves at high risk. In some facilities, it is policy (NO LIFT policies). I've hurt my back lifting a resident, so I know what can happen. I missed 9 weeks of work because of that. Never again. If a resident refuses, they don't get transferred. Staff do have rights when it comes to their personal safety.
I did experience the actual transfer. It wasn't fun, but it did give me the feel for it. When done correctly it does not hurt, nor feel unsafe. It is all about the training of aides to use the actual device as each is different. Sadly too many facilities hold the belief that a "mechanical lift is a mechanical lift"- that they are all the same. Not so.
Anonymous, your mother is in good company. I hope she's able to find other ways of getting in and out of bed that are safe for all involved, and that someone is able to address and calm her fears if she does need to use the lift.
Thanks, Patti, for offering the staff perspective on the lift. They're an essential tool for many aides and residents and I hope this blog post raises awareness about the need for training regarding their use. Extrapolating from your example, it seems like the time and cost of additional training would increase the use of the lifts and decrease the loss of staff time and amount of money spent on disability. Sounds like a good research study to me, and worthy of a blog post. Thanks!
In my experience, the most important thing to remember in using any lift is to GO SLOW. If you try to go fast, bad things happen. Explaining what you are doing as you go along will help you slow down and will make sure you don't miss any important steps.
I wish our facility would do training where everyone had to be the "liftee". I imagine it would make everyone more cognizant of how scary it can be up on one.
Thanks for the tip about going slow, K. Tree. It helps to hear from people who have been there.
This is an excellent blog. I know culture change absolutely has to come to every nursing home. Most nursing homes do not resemble anyone's home at all.
Thanks, Roberta, for your comment. Nursing home culture can improve in many ways, even if homes aren't ready to commit to the formal culture change process.
I think you make an excellent point that aides should be required to be moved in the Patient Lift as part of training. Working in a nursing home can be very stressful and sometimes people may cope by distancing themselves from the patients. It's vital that the people who care for the elderly can see the patient's point of view.
Thanks for your comment, Brian. It's possible to keep the necessary clinical distance while also understanding the experience of the resident. As can be seen from some of the comments above, it's a matter of maintaining a balance between taking care of yourself and taking care of your residents. Finding ways to have a calm transfer in the lift is taking care of everyone.
I definitely agree with your suggestions for making the lift transfer less stressful. In the NH where my mother resides I feel that many aides are too rushed and not sympathetic to the resident. I am in the NH a lot and have observed the interaction with many residents. If possible I'd like to ask about a related concern I have that there appears to be a movement toward using the lift for residents when it may not actually be necessary. Please believe that I do not want anyone to be hurt during a transfer (as the nursing aide, Patti, mentioned),and I understand that there are some situations where a personal transfer is really not possible. But there are many reasons it may be better for residents to be personnally transferred and it may only need indiviualized transfer techniques and instruction to do the transfer safely. Even limited movement and use of the body contributes to general health and maintenance of abilities, whereas use of the lift may cause general weakening and muscle deterioration. In my mother's case the order to use the lift has even condemmed her to living in a diaper since they refuse to transfer her to the toilet. Since my mother is still cognisant enough to know that we use toilets, she asks to go and gets extremely upset when she is refused. She trys to hold it until she can find someone to help her, so then there are urinary tract issues plus constipation issues due to holding and the simple fact that it is easier to have a bowel movement when you are sitting on a toilet. And then they give a laxative and when they have to clean her up she is so upset and humiliated she forgets that they would not take her and apologizes to them for making a mess. Is this what we want to do to people?
Sincere thanks for your caring and sharing.
Worn-out advocate
Dear Worn-Out Advocate,
I'm sorry to hear of the trouble with transferring your mother. It sounds like you're well-versed in the nursing home world and that you've spoken up about this problem. In case you haven't tried this yet, I offer this: In the nursing homes in which I've worked, residents need an evaluation by the rehab department to determine if they can safely use a manual transfer, so that would be the first step. If they must use a lift transfer, it might be possible to talk with the staff about working your Mom's out of bed schedule around her toileting needs. This would involve a conversation with the aides, charge nurse, nursing supervisor, Director of Nursing, and/or social worker, depending on who is receptive and able to make this happen. I've had situations like this before and, in speaking with the resident and the aide, we were able to come up with a solution that worked better for both of them.