Lifting the spirits
Staff at Levindale Hebrew Geriatric Center in Baltimore strive to make sure residents are lifted properly from their bed to avoid injury or stress.
Getting into a bed or a bathtub may be one of the biggest daily struggles a nursing home resident can have. Luckily, nurses and other facility employees typically make it a priority to ease the process as much as possible, often with the help of lifts.
While opinions may vary as to the best types and brands of lifts, most caregiving experts agree it is imperative to make the resident feel as comfortable as possible — in a not-so-comfortable situation — to help the lifting or transferring procedure go as safely as possible.
There are slings, floor and ceiling lifts, mechanical and manual lifts, and then alternatives to avoid lifts as a whole. But, as long as the resident is safe and gets a say in what is going on, there should be smooth lifting up ahead.
“Although I am no longer a director of nursing, this was a tough situation when I was,” says Sylvia Bennett, RN, BSN, lead nurse planner at the National Association Directors of Nursing /Long-Term Care. “Personal preference was certainly important — and keeping our residents and staff safe.”
Security and comfort
Resident safety is the most important thing when operating a lift. So much so, in fact, that Pat Vanderheiden, vice president at supplier Vancare, advises facility staff members get in the lifts themselves to try them out before purchasing, because each one is designed and functions differently.
It is crucial to have a variety of lifts to better accommodate each resident's particular needs.
“Lifting up and over is rather scary when you think about it,” MasterCare Marketing Manager Rachelle L. Congdon says. “Being hoisted naked up in the air — that doesn't sound fun to me at all.”
To avoid this, MasterCare designs and sells products that are low-level entry, Congdon explains, referencing a not uncommon approach among the vendor community. Ideally, lifts without obstructions to entry and exit could be used at all times, such as a sit-and-pivot lift, Congdon says. This way, the resident does not have to step into or over anything, risking injury, she adds.
Another type of lift favored by many for safety is the transfer lift. Typically, this type of device is integrated within a tub or spa and is chair height. Not only does this make it much easier for residents to get in and out of the tub, Congdon says, but she has found it eases the minds of those who do not like bath time.
“We advocate facilities purchase bathing systems that provide integrated transfer systems, as opposed to using standard patient or stand-aid lifts,” David Anderson, national sales manager at Apollo Bath, explains. “Simple, easy-to-maintain transfer systems that resemble something familiar, such as a wheelchair, makes for effective transfers.”
Alicia Fereno, director of nursing, at RoseGarden Nursing and Rehabilitation Center in Toms River, NJ, says staff have to fill out a resident transfer form to comply with their Safe Movement Act before operating a lift or transfer.
Ten other U.S. states have enacted similar “safe patient handling” laws for nursing homes, according to the American Nurses Association. Although the policies vary from state to state, they all have minimum requirements for the lifting process, such as the number of employees who must be present during operation, or providing safeguards for the residents.
Aside from safety, most caregivers and lift designers say listening to a resident's personal preference before choosing a lift method is critical.
RoseGarden's Fereno says that after speaking with a resident, all staff members collaborate on choosing the most efficient and effective way to meet the needs of the particular resident while getting the job done. They also make sure to incorporate family members in decision-making.
Each resident is an individual, and needs to be treated as one, Congdon emphasizes.
“The community is home for many residents, and not too many adults are told what they can and can't do in their own homes,” Congdon points out. “There are options on the market for no- or low-lift transfers … but open and honest communication with the resident and their family is best.”
Not only is it important to figure out how the resident wants to be lifted or transferred, but also when, reminds Invacare marketing Communications Manager Jeff Steiss. Maintaining the resident's prior routine is ideal; if a resident has always bathed before bedtime at home, then providers should arrange to make that possible in the facility as well.
Taking into consideration both staff members and resident characteristics can relieve some bathing stress. For example, residents who commonly become agitated during evening hours, or those with “Sundowner's Syndrome,” might benefit from a relaxing bath later in the day. It also might help them sleep better, Anderson explains. However, bathing after a meal can be problematic for some residents because they may have voiding or waste accidents, he adds.
Staffing requirements should be tailored for each resident, advises Jessica Schultz, product manager at Direct Supply. Some residents will be fine with one caregiver for the entire bathing and transferring process, but others might need up to three caregivers for the same procedure.
Along those lines, consistent assignment of bathing aides is a critical “bonus” for residents, notes Lee Penner, President of Penner Patient Care Inc.
“If a resident is fully aware of his surroundings and would like to request maybe three baths a week instead of two, that's definitely a viable point for them,” he adds.
There are limits to granting resident wishes, however, Penner and others agree. Residents might say they prefer the looks of a bathing unit, for example, but it's up to management and nursing staff to make sure it's functionally suitable for what's needed.
Bathing and lifting are two of the main assistive needs for residents of a skilled nursing facility, Schultz says, and because it is unfamiliar, they are usually scared the first few times. It is a caregiver's job to be knowledgeable about the process to help ease the minds of residents. Adequate training is essential, experts stress.
Before using any lift, bath or transfer product, caregivers should read and understand the device-user manuals, watch videos and practice using them on other staff members, Steiss recommends.
Patiently going over the process several times, and not rushing it, with both the resident and family members always seems to help too, Bennett says.
While residents often do not like bathing time and resist it completely, “Bathing Without A Battle” is an award-winning video that can make the process easier, Fereno says. She says she recommends it to all facilities because it is 45 minutes long and an effective in-service for certified nursing assistants.
Frequent reviews and routine maintenance checks of the equipment are crucial to its performance, experts add. That includes inspecting lifts and slings before each use to make sure they're safe for the resident to get in, Vanderheiden explains.
After the initial training session is completed, facilities should follow up on a quarterly or monthly basis, according to Steiss. Refreshing caregivers on how to use the specific lifts will make them confident when handling residents.
Bathing time and using lifts is not an easy process in any circumstance; however, maintaining a positive attitude and making the resident the priority can help alleviate associated stress.
“Remember,” Congdon notes, “that at the heart of this process, is a person with thoughts and feelings, likes and dislikes.”