Progress on the no-lift front: based on an interview with Guy Fragala, Director of Compliance Programs, Environmental Health and Engineering

Nursing Homes, April, 2004 by Guy Fragala

Although a formal ergonomics standard failed to receive congressional approval two years ago (and seems unlikely to reappear anytime soon), the Occupational Safety and Health Administration (OSHA) continues to cite nursing facilities for unsafe staff working conditions, particularly resident lift policies, under its General Duty Clause. Nursing homes are continuing to respond positively with efforts toward achieving the no-manual-lift ideal. As these facilities have learned, this is a complex process that involves additional expenditures and, often, staff reorganization. Fortunately, trends in lift technology and its acceptance are supporting this progress. Some of the trends involve expansion of established lift-assist technologies; others are outgrowths of technologic innovation.

Overhead track lifts, or ceiling lifts, for example, are a recently evolved technology that has conquered Europe and made inroads in Canada, and seems to be gaining acceptance in the United States. Ceiling lifts offer several advantages: They are easy to find when staff need them; they don't take up precious floor space; they can cover every area of a room, depending on the type of track installed; and they can be installed cost-efficiently by using clip-on motors, rather than fixed motors, for attachment to lifts as needed. In fact, entire tracking systems can be made movable using portable support beams. Although ceiling lift installations are indeed an added expense, running $2,000 a room or more, they potentially can pay for themselves with added staff convenience and reduced exposure to injury.

Floor-based lifts continue to evolve in flexibility and sophistication, offering customers more cost-effective choices than ever. At least one company, for instance, offers three pricing levels for its line of lifts, depending on the number of electric-powered features selected. A new type of lift does not use slings; rather, it has a horizontal, flat surface upon which residents can rest their forearms as they are gradually lifted to or lowered from a standing position.

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As far as assistive devices are concerned, the old "strap-plus-buckle" gait belt seems gradually to be giving way to the gait belt with handles. Handles give staff firmer grasping control of the resident, and therefore increased protection from injury during a one- or two-person assist.

In general, it has been gratifying to see how nursing homes have increasingly accepted lift equipment. Recognition is growing that totally dependent residents need something more than manual lift assistance, and even people with at least some weight-bearing capability benefit from use of stand-assist technology--and that in both instances, staff are safer.

The burden remains, however, on these facilities to make rational purchase decisions, and to understand their specific resident population, facility layout, and the particular mix of equipment that will work best. Moreover, they must maintain the equipment properly once they have it. Maintenance and upkeep concerns are important reasons to include maintenance staff, as well as hands-on staff, in the equipment-acquisition process. Once acquired, regular maintenance and ongoing staff training are essential for the equipment's optimal use.

Although I've mentioned that OSHA continues to cite nursing facilities for unsafe lifting practices, it is worth noting that the agency has tended to go easy on fines if it is satisfied that the facility is making a genuine effort to improve. This is one area of regulation in which there seems to be a genuine sense of collaboration between government and providers, with OSHA doing what it can to pass along useful information and advice. I would strongly urge facilities, even without OSHA's prodding, to seriously reevaluate their resident-lift practices and take advantage of the information resources that are now readily available (www.osha.gov). Facilities should then carefully investigate the technologies that promise to make "no-manual-lift" a realistic option for everyone.

Guy Fragala is Director of Compliance Programs with Environmental Health and Engineering, a consulting firm based in Newton, Mass. Retired from his position as Director of the Department of Environmental Health and Safety at the University of Massachusetts Medical Center, he has worked as a consultant with OSHA and with the National Institute for Occupational Safety and Health (NIOSH) on safe patient handling. His book Ergonomics: How to Contain On-the-Job Injuries in Health Care is available from the Joint Commission on Accreditation of Healthcare Organizations. For further information, phone (800) 825-5343 or send e-mail to gfragala@eheinc.com. To comment on this article, send e-mail to tragala0404@nursinghomesmagazine.com. For reprints in quantities of 100 or more, call (866) 377-6454