Transportation feature: Safe, not sorry

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Planning, sound judgement and attention to detail are keys to ensuring safe resident transportation — on every trip.

"Taken for a ride" and "taken for granted" are two phrases that have no place in the transportation of long-term care residents. Steve Winner knows that all too well.
As the vice president and Chief of Culture at Silverado Senior Living, Winner has come to realize that transporting residents is all about planning. Without proper forethought, transporting residents safely is just a roll of the dice. One unexpected detour, loose wheelchair lock or bad parking job, and a frail individual's well-being could suddenly be put in jeopardy.
"You just have to use good judgment, and consider the people you're transporting," Winner says.
Sometimes that means extra food, drink, clothing or medical supplies packed into the van or bus. Sometimes extra workers need to be on hand. Sometimes trip itineraries or routes need to be flexible.
But there is no "sometimes" when it comes to a facility's vehicles, drivers and policies. Catastrophes can occur — even when the best of intentions are in place.
Take, for example, the bus fire that killed 23 long-term care residents as providers were trying to evacuate them before Hurricane Rita hit Texas in 2005. Proper safety checks could have prevented the tragedy.
While evacuation equipment routes and emergency processes have come under intense scrutiny since then, there is just as great a need for operators to focus more on safety for everyday resident transportation, experts say.
"Whenever you're taking people out, you're going into an uncontrolled environment," notes Judy Cangealose, a senior vice president and relationship manager for Aon Healthcare.

Daily concerns
Silverado's Winner has a special challenge: His facilities serve people with dementia. That means using volunteers or others to accompany riders is vital.
"We always have to be concerned about residents having things they need in terms of medications," he says. "Here in Southern California, what could be a half-hour van ride could become two hours because of traffic issues. Anytime there's a freeway involved, we have a cooler with drinks and snacks."
That also means packing additional briefs if incontinent residents are aboard, he adds.
Standard wheelchair locks and safety belts (with shoulder harnesses) are part of everyday routine. A wheelchair lift should have a rail that moves with the platform, he explains, "so a person has something to hang onto or grip so they don't feel as if they're in mid-air." Level, safe loading and unloading areas also are critical, he notes.
"The long-term care industry has been putting more resources into transportation just because our consumers kind of demand it," Winner says.
"Families have more expectations of people going on outings and doing fun things. It's just more common than in the past."
Nancy Martucci, a registered nurse at Good Shepherd Rehabilitation, Allentown, PA, is another provider who advises caution.
"Whenever you leave your facility, you need to remain totally aware of safety first," she says. "You need to think ahead and not feel rushed. Nothing's worth rushing through."
Basic details for others, such as checking brakes (on vehicles and wheelchairs), seatbelts and sidewalk cracks are important when frail seniors are involved.

Liability issues
Aon's Cangealose says the two most common claim issues she sees involve wheelchair residents not being properly strapped in wheelchair lifts.
"Folks operating lifts are not trained properly, or there's a defect with a lift. It's the same with strapping wheelchair users in. Either the worker's not trained, or the straps simply wore out," she explains.
High turnover in many positions, including those workers who may oversee transportation, ultimately could put riders at risk.
"(Transportation) vendors come in to train, and that should happen continuously," Cangealose says. "In general, vendors are willing to do some training and will come back periodically. The problem is, facilities generally don't ask for it."
A vigilant driver, and vigilance about a driver's past record, are important, says Jay Schaffer, a senior vice president for Marsh Risk Consulting based in Houston.
"What we like to see with fleet safety is to make sure the provider has checked the driver background. You want it as pristine as possible. Some facilities have them take a drug test. I see that as a reasonable precaution," he says.
Facilities also want to make sure there are adequately trained back-up drivers. All drivers should have CPR and "basic life support" training, he adds.
Cell phones or two-way radios are musts, as well as up-to-date vehicle maintenance. Inspecting and testing wheelchair lifts weekly is strongly recommended.

Checking the list
He says healthcare could take some cues from the airline industry when it comes to safety procedures.
"I'd like to see the driver use a brief checklist, verifying each resident is properly secured. That ensures they'll walk through the process for each resident. And we also have documentation that's been done."
Although it's usually unavoidable, transporting long-term care residents is "a risk I would prefer to avoid," Schaffer says.
"It can certainly lead to a situation that would be very difficult to defend," he says. "It's not difficult to establish negligence on the part of the provider and transporter when a resident falls or sustains an injury in a van. It's actually quite a challenge from a defense's perspective. Transportation is a critical issue. It may not be on the top of the 'hit parade,' but it is important."
That's why each facility should have a specially designated transportation manager, especially if the transportation is outsourced, Aon's Cangealose says.
"Somebody has to really ask contractors the questions: Do you have insurance? What kind? What do you do if your cell phone doesn't work? Is the vehicle clean?" she says. "If it doesn't look like it's been washed or cleaned out in a week, it's probably indicative of how good they are with the maintenance."
Ultimately, the provider is going to be liable for transportation oversight. Cangealose says many providers might not realize that, for the most part, providers' liability insurance excludes incidents pertaining to transportation – "it goes back to their vehicle policy."
"And simply because you're outsourcing it doesn't mean there's no liability," she emphasizes. "We've seen with elder services that if there's a line that can be drawn back to the facility, it will be."

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