Patient lift equipment: analyzing costs/benefits.

Editor's Note: Recently a young woman hired by Medquest Communications to do mailings for some lift equipment advertisers, upon leafing through their brochures and photographs, said, "Wow! I wish my mother's nursing home had this sort of stuff." There could be any number of reasons why it didn't. In the following article, Nursing Homes Editorial Board member and ergonomicist Robert O. Andres discusses some of the thinking that must go into any purchasing decisions for this equipment.

Often, when considering purchase of any lift technology, nursing home management is likely to have two initial responses: (a) "It's expensive!" and (b) "It's impersonal!" Often the decision that flows from this is "It's history!" (or, at least, "wait 'til next year").

Admittedly, there are few hard-and-fast data to guide (or to use in justifying) such a purchase, which I discussed at some length in the January issue of Nursing Homes/Long Term Care Management ("Resident Transfer: Scientific Testing Begins," p. 60). Nevertheless, facility management must make these decisions in the here and now, regardless of data availability. Fortunately, there are guidelines that may help in performing a cost/benefit analysis.

First, on the cost side, it is important to remember that equipment costs are not the whole story, or even a major part of the story. The real costs lie in increased staff time needed in preparing the equipment for a resident lift. This may explain the not uncommon sight of expensive lift equipment sitting unused in a remote corner of the facility, while staff merrily (or not so merrily) continues with manual lifting techniques. For staff - particularly overstretched staff - it is simpler to just go ahead and lift the resident manually. A rule of thumb is that a manual lifting technique that takes 30 seconds to perform will take three minutes and maybe longer using a lifting device. The result is too often a major waste of capital equipment expenditures.

Thus, before purchasing any lift equipment, analyze how many residents in your facility are likely to need it, just how much assistance residents are likely to need and where the heaviest-use residents are located. Location is important because it is more efficient, for starters, to locate as many as possible of the heavy-need residents in a single area or unit of the facility. This, as you will see, can tie in with your eventual staffing needs.

It is ludicrous, of course, to propose increasing your staff six times to make up for the time differential between manual and mechanical lifting. Creative staffing, though, can work. Consider, for example, having a dedicated lift technician whose sole job it is to understand the equipment and to prepare residents for whatever mechanical lifting assistance they will need; remember, preparation is where the extra time is consumed. Once the technician is finished, the nursing assistants can complete the transfer. Obviously, if the heavy-use residents are clustered in a series of rooms, the technician can move from one room to the next with the nursing assistants following, in a sort of leapfrogging approach.

Having such a skilled technician available also addresses the problem of depending on nursing assistants who are semitrained or even untrained in equipment utilization, due to constant turnover. This state of unreadiness results not only in unused equipment but in stressed and demoralized staff who, research has shown, are more inclined to file back injury claims.

In short, you don't necessarily have to beef up staff significantly, but you should consider reorganizing and reassigning them.

Once you have addressed possible staffing costs, what about the type and quantity of lift devices you'll want to purchase? As you know, lift technology today has produced a variety of choices, ranging from gait belts and slide boards to overhead and sling (or basket) lifts. Do you need to get one (or several) of each? Most nursing facilities would quail at the prospect, and understandably so; money is not exactly in superabundance in long-term care. By the same token, you don't want to go the "one-size-fits-all" route. Using an overhead or basket lift for a resident who has potential for increased independence defeats the purpose of modern nursing home care, which emphasizes maximizing independence. A reasonable alternative might be to purchase two lifts: one "low-end" device for those residents who are able to assist with the transfer process, and one "high-end" device for those who are unable, for instance, to even move to the edge of the bed unaided.

The key to determining which and how many devices to purchase is the resident mix prevailing in the facility - i.e., partially independent vs. wholly dependent. And it may help to have a process whereby residents move from one area of the facility to another, depending on their lifting needs.

What about the complaint that lift devices are impersonal-that residents using them are hoisted about like so many bales of hay? This isn't necessarily so. Again, it all goes back to staffing. I have seen situations in which a nursing assistant sits with the resident, explains what is happening and, in general, provides comfort while the lift technician prepares him or her for a lift. The "bale of hay" phenomenon is usually seen when staff simply lack the time or sufficient numbers to perform the task properly; they're in a hurry, so it's "hoist away." Again, an appropriately organized staff is the answer.

All of this presupposes that you would want to analyze your resident mix and needs and reorganize your staff, in addition to investing in the equipment. Why would you want to - what are the benefits? The fact is, there are three quite potent benefits to consider, all of which end up saving money:

1) A major reason there has been so much focus on back injuries in the nursing home - a focus particularly encouraged by the Federal government - is that back injuries occurring as frequently as they do in these facilities are a major cost item. The cost of these injuries includes not only the direct costs of medical care and worker's compensation, but also the indirect costs arising from days lost on the job, general absenteeism and efforts to temporarily or permanently replace staff. Revolving-door staffing is extremely costly.

2) Preventing residents from falling during a lift, whether because the nursing assistant's back suddenly gives out or because the resident struggles combatively, will not only save the resident from pain and suffering but will save a great deal in medical treatment costs for broken bones and other disablements. It may even save a great deal in medicolegal costs, as witness the recent $95.1 million judgment against Beverly Enterprises for a resident who had fallen out of bed and fractured her hip and shoulder. The expenses of lift equipment and staff reorganization begin to pale by comparison.

3) There is the hassle-free factor that can be very gratifying when Occupational Safety and Health Administration (OSHA) inspectors come to call and find that you've carefully planned, organized and documented a safe and effective resident lift program. Simply avoiding the remedial efforts and inspector revisits may seem, in and of itself, to pay for the equipment and then some.

In short, there is no real reason to go without lift assist technology simply on the basis of equipment costs, or even to purchase it and let it go unused. Careful analysis of your facility's residents' needs and staff organization can go a long way toward helping you make cost-effective decisions.

Robert O. Andres, PhD, CPE, is president of Ergonomic Engineering, Pelham, MA. For further information, [phone].