Bathing and lifting are among the most challenging and dangerous tasks for skilled nursing staff and residents. It follows, then, that safety should remain the top priority for these tasks. Unfortunately, it can easily slip through the fingers of budget-focused providers and time-strapped caregivers if they fail to give the bathing and lift equipment the attention it needs.
Experts agree that point-of-use equipment inspections and routine maintenance are essential for avoiding resident and staff injuries, not to mention for getting the most value and use out of the purchase. But some facilities are falling short on both fronts.
“Preventive maintenance is one of the biggest issues and perhaps the greatest weakness we see in the field,” says Mike Zuern, healthcare equipment specialist for Direct Supply Inc., Milwaukee. “Proper, timely and documented inspection, maintenance and cleaning of the equipment appears to be a significant challenge for many facilities.”
Still, operators may be surprised to learn that some of the bathing and lift equipment they have in service is either so outdated or worn that it’s unsafe or even just inefficient to operate. On a positive note, they may also find that, upon closer inspection, some damage and visible wear on equipment may be quickly and easily fixed, without the need for another major purchase.
“Either way, the only real way you can know what you’re dealing with is by doing regular inspections and educating [staff] on what to look for in terms of wear and tear,” notes Liz Weingast, corporate director for clinical excellence at Jewish Home Lifecare in New York City.
Beware wear and tear
When it comes to lift equipment, almost any sign of visible wear can spell big trouble. Before each use, slings, lift arms and other equipment components should be carefully inspected, with staff being fully trained on what constitutes harmless cosmetic wear versus dangerous breakdown that requires a major overhaul or replacement.
Slings bear the brunt of the lifting burden and require keen attention.
“Stains are normal. Safety is the concern,” says Ross Walhof, vice president of sales, Medcare Products Inc., Burnsville, MN.
Fabric and stitching breakdown, on the other hand, always signal danger and indicate that the sling should be promptly pulled from service.
“Any fraying of a strap or sling is unacceptable,” stresses Pat Vanderheiden, vice president of Vancare Inc., Aurora, NE. Although some fabric staining can be expected and does not automatically necessitate a replacement, fading is a good indicator that a sling has reached its expiration date.
“If the colors are faded, it is a sign that the fabric is getting weak, either because of age or bleaching,” he says. “A quick reference usually is if the color has gone, the safety factor of the sling has gone with it.”
Some manufacturers offer sling repair, but this option is not the same as a replacement, he notes.
Although good nylon slings are designed for durability and can be safely laundered in commercial-grade equipment, too many variables—such as resident weight and degree of use—make it impossible to give slings a reliable expiration date. When in doubt, it’s always prudent to err on the side of caution, says Alan Bingham, senior product manager, AliMed Inc., Dedham, MA. A good rule of thumb? “Purchase two sets of new slings each year,” being sure to clearly mark them with the date they were placed into service, he says.
Jewish Home Lifecare pulls slings from service after two years (and earlier, if needed).
“We’d rather replace things earlier rather than later. There’s no benefit in keeping something in service longer if it increases the risk of injury,” Weingast explains.
Hard components of a lift also must be routinely scrutinized. Cracks–even hairline ones – that appear on a lift arm or elsewhere warrant a prompt pull from service and a call to the facility’s local service technician for thorough evaluation.
“Give serious consideration to involving the vendor when a crack is identified,” urges Ray Miller, Direct Supply’s director of risk and safety solutions.
Corrosion, surface bubbling, worn metal, unexplained powders, and fraying cords also are cause for concern and usually signal poor preventive maintenance, adds Vanderheiden.
Although it’s not uncommon to find 20-year-old lifts still in operation, quality-conscious providers know that routine preventive maintenance and scheduled parts replacement is the only way to keep older equipment operating safely and effectively. Providers should request maintenance and inspection schedules from their vendors. They also should provide ongoing education to ensure that staff are properly inspecting lifts before each transfer and documenting their findings.
“When you follow these outlined procedures and inspections, it extends the life of the product and virtually eliminates all unexpected failures,” according to Vanderheiden of Vancare.
Jewish Home Lifecare trains new-hires on safe lift use, which includes detailed inspection, and then conducts annual competency testing. The provider contracts with a biomedical company to perform comprehensive quarterly preventive maintenance (from plugs to wheels and all mechanical components) on every lift in the organization.
Beyond preventive maintenance, Bingham recommends the lift manufacturer do a thorough overhaul every five years.
As any long-term care operator knows, bathing equipment is a major capital expense and one that warrants ongoing attention to drive long-term value, safety and comfort. While baths can realistically last 15 to 20 years, that lifespan will be significantly shortened if equipment is neglected or misused.
Cracks can and do occur in bathtubs, and should be promptly addressed because they can render the bath unit’s surface unable to be cleaned, says Kirk Penner, vice president of Aurora, NE-based Penner Patient Care.
Holes in fiberglass units can be repaired, even if the damage appears significant—and it doesn’t always require a vendor to fix it, according to another expert on the supply side..
“Accidents happen. A lift, for example, may fall over and break the fiberglass, or someone may accidentally ram a lift into the side of the [bath],” says Diane Walkowiak, vice president of sales and marketing, MasterCare Patient Equipment, Columbus, NE. “In cases like this where it wouldn’t be covered by a warranty, it may be more cost-effective to call a local auto body shop and have one of their guys come out and take a look. They can probably do a good job of patching it and because they’re local, the repair cost will probably be much lower.”
There is even a relatively simple fix if tub jets stop working. Although it’s a “very rare occurrence,” Penner says, a repair typically necessitates only replacement of the air blower.
While baths might last a decade or more, certain components have a limited lifespan. Door seals on walk-in bathtubs, for example, should be routinely checked by maintenance staff—ideally, every month or so. Damaged seals can translate to leaks—and subsequent slips and falls—when the tub is in use. Seals can be quickly and easily replaced by the facility’s maintenance person, according to Pat Krushen, director of sales and marketing, Safety Bath Inc., Saskatchewan, Canada. Safety Bath offers a lifetime warranty on its door seals and will send a new one to customers if damage occurs.
Positioning straps and comfort pads also will break down with regular use and should be replaced roughly every year, or as needed. Fraying or otherwise worn straps used for bathing positioning can potentially cause skin tears and might even present an infection issue because bacteria could make its way into the fabric and prevent proper cleaning, Walkowiak warns. She adds that the low replacement costs of security belts/straps and accompanying comfort pads (under $20 each) mean facilities can keep the equipment looking and functioning like new at minimal expense.
Cushioned headrests, back pads and bottom pads also require attention and more frequent replacement. Bottom pads/seat cushions can be expected to last approximately one year and can be replaced for under $50, according to Walkowiak. Headrests might last approximately five years, but they should still undergo periodic review every six months or so to check for tears and cushion breakdown.
“Again, if any tears are present, these need to be replaced because they can pose a safety risk to residents,” she reiterates.
Rules of replacement
While operators can expect a long life out of well-maintained lifts and bathing units, sources agree that replacements are always in order when resident and staff safety are at risk—and when their outward appearance might leave a bad impression on current and prospective residents.
“Safety must always come first,” Weingast stresses. “If ever there’s a question that residents and staff might be injured, or residents’ dignity and comfort become an issue, then it’s time to pull the equipment from service.”
Although most operators aren’t interested in prematurely upgrading their equipment, there are times it may make sense. Walkowiak believes one instance is with “up and over” equipment that lifts a resident in the air and lowers them into the tub. Many of these units are still in use and were being sold just four or five years ago, she believes.
“This, in my opinion, is a case where it’s wise to upgrade to a new tub, even if the [current unit] is not very old,” she says. “Think about a resident and staff safety and also think about resident dignity. What about the liability associated with a unit that might malfunction in mid-air? The payoff could be far greater if it’s replaced.”
Cost of ownership and parts availability also weigh heavily into the equation. As Penner explains, if a tub is always breaking down and the parts to keep the equipment running become expensive, then it’s a good time to replace it. Penner spas carry a five-year parts warranty, he notes.
Utility and water consumption should be considered, as well. Modern amenities of bathing units, such as utility and water conservation, for example, also can add up to significant savings. Walkowiak reasons that, in some cases, it could make financial sense to replace a $15,000 unit purchased five years ago because a new contoured unit could potentially shave off $250 in labor, maintenance, cleaning supplies and water consumption.
“It’s important to put a pen to paper and do a comparison,” she advises. “Factor in liability insurance, too, which might come down if newer, safer equipment is purchased.”
Facilities looking to distinguish themselves from the competition also might want to consider how new equipment supports their goal of creating a homier, more spa-like atmosphere, Penner adds.
Because most facilities hope to use their lift and bathing equipment for up to two decades (or longer), trade-in programs are rare. Those that do accept trade-ins typically offer little for the used equipment.
“The value of an old lift is typically less than $500,” Walhof says.
SafetyBath is one company that accepts trade-ins, with each unit judged on an individual basis, depending on age and condition of the trade-in.
“It’s difficult to make a hard-and-fast rule due to the wide range of models and, of course, their age and condition. However, our company is very fair and accommodating in this regard,” Krushen says.
When equipment replacement is in order, operators should take their time and arrange side-by-side comparisons, taking into account the opinions of end-users and other stakeholders, such as risk managers and maintenance staff.