Slings and lifts in nursing homes are used to move residents when necessary, however they can fail causing injury and even death. In today’s episode, attorneys Rob Schenk and Will Smith discuss how slings and lifts are used in nursing homes and their failure rates with guest Teresa Boynton, a clinical consultant at Hill-Rom.
Schenk: Hello out there and welcome to the Nursing Home Abuse Podcast. My name is Rob Schenk.
Smith: And I’m Will Smith.
Schenk: And you have come upon episode 94 of this podcast. Today, we’re going to be talking about the use of slings and lifts in a nursing home or skilled nursing facility setting – what’s usually involved in that, how they’re operated, the different types of lifts, because this is something that’s very important. A lot of our cases, at least a fair percentage of them, involve the handling of residents getting out of bed into a wheelchair or even standing up, and a lot of times, that requires more than just personnel. It requires…
Schenk: Equipment. And so a lot of times, there can be malfunctioning equipment. There can be equipment that’s human error – there’s a misuse of the equipment, and it can involve injuries, and sometimes those injuries can be catastrophic. So today on the episode, we’re going to be talking about the use of lifts, the use of slings, how they can be made safer. And we are not alone in that task, in that charge. We’re going to have a guest on, and this is the second time she’s appeared on the podcast. And Will, can you tell us about who it is?
Smith: Sure. Today we’re going to have second-time guest Teresa Boynton. She is a Hill-Rom clinical consultant on safe patient handling and mobility – if you hear us talking about it, we abbreviate it as SPHM – a position she’s held for the past three years. She assists healthcare facilities across the US with implementing and sustaining SPHM programs, which include a focus on preventing and resident falls.
Before this, she worked at Banner Health for over 26 years. She led the Banner Health Safe Patient Handling and Falls Prevention team and she developed and worked with a Banner team on validating and implementing the bedside mobility assessment tool for nurses, which is just amazing that she was the lead on that team. And that’s the BMAT, which is used in nursing homes and hospitals all across the nations. She’s authored two articles on BMAT. She’s certified by the Association of Safe Patient Handling Officials and she’s presented at numerous conferences, including last year’s National Fall Prevention Conference on “Mobility as a Fall Prevention Intervention,” and then the year before that at the Greenhouse Long Term Care Conference on “Meaningful Life and Mobility: Safe Lifting Practices.” This is a very important issue and she is a very knowledgeable guest, so we are very happy to have Ms. Boynton on the show today.
Schenk: Teresa, welcome to the show.
Teresa: Thank you.
Schenk: All right.
Smith: And Teresa, we’re happy to have you on here because, and I think we’ve talked about this last time, I was a CNA for a long time in nursing homes, and back before – this was 20 years ago when I started – back before when it became wider practice with Hoyer lifts and different mechanical assistants that they use now, they would just use the stronger CNAs to try to lift people, and that’s a horrible idea for both the CNA and the resident. So my first question is what needs do slings and lifts actually fulfill in nursing homes?
Teresa: Again, a great question. They really do provide a much-needed environment, both for the resident and for the caregivers. Using a variety of lifts and slings help the resident to move, to transfer as much as they should be, so you avoid keeping them bed or chair-bound. It definitely allows for a much more dignified way of handling and caring for the patient, given there are fewer caregivers, or you don’t have to just grab the strongest CNAs and have them grabbing, lifting, pushing and pulling the resident. It allows for safer and more frequent toileting. You can keep the resident independent with their elimination needs longer, avoid having to use adult diapers any earlier than absolutely necessary.
And it really is safer for both residents and their caregivers, and especially as you’ve pointed out, it’s a key element in protecting caregivers by preventing caregivers’ muscular skeletal injuries. We’re not asking our CNAs, our aides to do the heavy lifting, pushing and pulling at awkward positions. I am really passionate about this topic because I’ve worked with way too many CNAs, patient care techs that suffered from career-ending, life-altering, back-shoulder injuries. So it’s just about providing a safer environment, again, not only for the resident, but for their caregivers.
Smith: Yeah, I think that a lot of people have this misconception that nursing homes are just a bunch of little, old people. And they’re not. They’re reflective of society as a whole. They’re humans. And some humans can be larger than others. I’ve taken care of men who may not have been very mobile but were 6-foot-3 and 200-something pounds. That’s a large person to take care of.
Teresa: I just want to add that if you think about a small, elderly, frail person can easily weigh 110-125 pounds, and in no other industry would we expect an employee, a worker, to have to lift even that amount of weight. So you’re absolutely right. They’re not all frail, elderly people, but even the frail elderly weigh a significant amount.
Smith: Absolutely. You can’t predict what a human body’s going to do.
Schenk: That’s what I was going to say. It’s not like a box of cans. It’s a human person. It has different weight points and it can be very difficult. And I appreciate the fact that you say that because you’re right. Day-in and day-out, an employee that has to lift 110-year-old Ms. Johnson out of bed, they’re going to develop problems. So that’s one of the benefits of these lifts is it’s not just for the resident but it’s for the long-term health of the actual employees administering the aid.
Smith: So Teresa, if we could talk about how a sling is used and how it’s related to a lift?
Teresa: Sure. A sling is a piece, typically fabric, sometimes it can be a more rigid material, but it’s a piece that’s applied directly to the resident. Think of a hammock or think of a baby sling sheet, that type of thing. It typically has different ways of being attached, but it has to be attached to the lift. So the sling by itself can’t really do anything with it, nor the lift by itself. The two pieces are working in conjunction. Usually the sling is attached to a hanger bar or a spreader bar, so it comes down from the lift. It goes up and down and the sling is attached onto the hanger bar or spreader bar.
Slings can be used to lift up residents in a seated position, suspend them, move them for instance from bed to chair. There are slings that are used to hold up just a leg, for instance, doing a wound care bandage change. It can be used to keep a resident flat to do what is called a lateral transfer. It also can be used in ambulating a patient. Typically that would be called a sling or a type of nest or a pants that holds the resident up so they cannot fall. But the sling is attached in some manner – looped, clipped, a key type of the clip – to the hanger bar or to something on the lift.
Smith: Yeah, as I was saying earlier, we didn’t have a lot of equipment when I first started, because not only was it a couple of decades ago, but it was also in some very rural areas of Georgia that by themselves were a couple of decades behind the rest of Georgia, the rest of America. But the first time I went somewhere that had the Hoyer lift, I was like, “Man, this is amazing,” because you really can pick up – let’s say you have a 300-pound resident. Instead of me and maybe one other person hurting our backs or hurting ourselves and risking dropping the resident, you’ve got this machine that comes right in there, you put the sling underneath them, you wrap it up to the lift and it picks them up with ease, without any problems. They’re amazing.
Smith: But they’re still equipment. Our audience doesn’t realize this but in the middle of filming this podcast, we actually had a malfunction because technology is not foolproof.
Schenk: Yeah, I’m still stressing out about it. I’m having to lean back to just catch my breath.
Smith: But how safe is the equipment? And are there dangers in the failure? Because a Hoyer lift might throw its back out like I can, but there is some danger, right?
Teresa: Well absolutely, and I’d like to say that Hoyer is a brand and it’s been around for a long time, but there are a variety of other vendors, manufacturers of equipment. And I’d like to say that they’re all safe, but unfortunately I recognize that not all lifts are created equal, nor are all slings created equal. I became aware of that when I started really looking at the FDA Medical Devices Report from the Manufacturer and User Facility and Device Experience Database – I know that’s a lot of words. But it’s a database that’s mandatory reporting for manufacturers and asks that caregivers at resident nursing homes also report their incidents.
And in reviewing these, found out that there really are some issues. Some lifts tip over much more easily, leading to some pretty significant injuries, possibly even death. Slings do not stay attached to the hanger bars or to the lifts for a variety of reasons. It may be that they’re worn. It may be that they weren’t applied properly in the first place, again, leading to some very significant injuries and death.
Sometimes some slings come off, or again were not properly attached, but one of the areas that really concern me personally was there were a large number of residents who fell out or slid out of these slings that was properly attached, and from my own experience in the field working with a variety of lifts and slings, I recognized that if you had a sling, for instance, that really hasn’t been designed or safety tested to fit on a longer hanger bar, or so a hanger bar that’s wider than another hanger bar, that may stretch this one tightly, and if the resident is sitting in it, it kind of pitches them or has them sit very upright, very forward, and then it becomes very easy for them to just shift their weight slightly forward and they can slip, fall out, fly out of the sling, and again, with very devastating consequences.
So the resident can sustain both bones, knocked out teeth, head injuries. And again, there have been a number of deaths, and I just think that this is just absolutely unacceptable, but we need to really be looking at the slings and the lifts that are being used in our nursing homes and in our long-term care facilities have to be safe, they have to be well-chosen. Staff have to be well-trained on how to use them.
Smith: Yeah, and I completely agree with that. I have actually seen a couple of people fall through a sling before. We had one woman, I mean God bless her, she may have been 90 pounds, she was very contracted, and it was very difficult to get a sling around her, because she would go through the middle part of it every time. What kind of training is required so that staff know how to use these slings and this equipment?
Teresa: Well there does need to be good training. Staff need to really be competent not only in how to use the lift, how to push the buttons to make it go up and down, how to apply the slings, but then really a lot of care needs to be taken into how do you choose the appropriate type and size length. So for the resident that you mentioned, there are slings that there would be no way she could slide through the hole in the center of the bottom. It’s applied properly, it’s sized properly and that just should not happen. I’m afraid too often that the training is not focused enough on choosing, again, not only the right type of sling and having it available. I’ve been in long-term care and nursing home facilities where they just don’t have enough slings, nor do they have the right type or the right size, so I should be able to know what type of sling is needed for this resident’s particular size, weight, girth, medical conditions such as contractions, such as really fragile skin.
So I should be able to choose from what type of slings is available, and then I should be able to look at, using the manufacturer’s guidelines, what size sling is going to be not only the most comfortable for this resident, but also absolutely safe. Again, there’s no way this resident can slide out or fall out of this sling. So that has to be part of the training and that’s a piece that I don’t think enough emphasis is put on. The sling, sizing it, choosing it, choosing the appropriate type is really important, and I think that administrators of the facilities really should be paying attention to their safe resident handling programs. So they not only have lifts that are safe and stable that don’t tip over that staff are well trained on, that they have instruction guides, they’ve gone through some type of competency check for the lift, and then the same thing for the sling.
And then the other piece of the training that we absolutely need to cover is doing that safety inspection before you ever put a sling on the resident or before you ever attach the sling to the lift. So checking it over – are there are any worn areas that could potentially split? Are there any chairs close to a loop on a sling that again could tear? Is the clip, is the plastic clip in good condition? No cracks in it? Can you really push it on, secure it onto the piece of the lift that it needs to be secured to? So those safety checks every single time before you ever put the sling on the resident or before you ever use the lift to lift the resident in the sling, all of that needs to be covered in the training. It really isn’t just, “Here, this is how it works. Push the button, it goes up and down. And here’s the sling and you just put it on the resident,” and we don’t have enough slings and we don’t really know where to find them. All of those parts of the pieces are needed to have the components or the foundation for not only a program that’s going to help your caregiver, but again, it’s really going to ensure the safety of your residents.
Schenk: Teresa, where is the training manual or the programming coming from? Is it coming from the manufacturer that says this is how it works or these are best practices? Or is this something that – is there an association that produces guidelines that the nursing home can just basically take a implement? Literally, where are those documents coming from that nursing staff can be trained on?
Teresa: So there are a variety of places where they come from. OSHA has their ergonomics for the prevention of muscular-skeletal disorders that talk about lifts and the Safe Resident Handling Programs in rather broad terms. And then it really does kind of vary. I’m fortunate I work for a company that provides very good training material, competency checklists that you go through the checklist, video training, to make sure that you really can see how it works. And then the recommendation is an instruction guide. This is an instruction guide – here’s how you size the sling, here’s how you test if the weight is appropriate for the sling, and other very specific guidelines on how to safely apply and use the sling. So I really think, again, I’m pleased that the company I work for provides very good materials for training, clinical videos.
And then part of the training – so you have some of those resources – it really to me is manufacturer specific. So I would go to the manufacturer, the vendor for the equipment and say, “Show me. What do you provide that’s going to help me make sure that my staff is fully trained, is fully competent, and that we can easily keep staff trained, looking at turnover, looking at retention? Not only how do we train new staff but how do we do those quick updates, quick competency checks so that your caregivers really feel like they are competent and they can safely for themselves and for the residents that they care for come in and use the equipment appropriately?”
So at some facilities, they develop some of their own tools in conjunction with the manufacturer, but I think, again, there are some manufacturers that automatically provide as part of a comprehensive program good training materials.
There are national standards, international standards, but I think for the front line, I want those videos. I want the competency checklist. I want the instruction guides that are brief but very succinct so that when I’m done with that training, I know that I can safely move a resident.
Schenk: And we briefly touched on this, but what is your understanding of the thought processes of the administrator when they’re looking through catalogs or they’re determining what lifts to purchase? Are they looking at MDS reports for the facility? Like how do they know to pick one lift over another?
Teresa: So that’s a real good question. So I think different facilities go about it in different ways. I really feel like they should be trialing the equipment. I also think, not that they need to dive into it thoroughly, but I think it wouldn’t hurt to look at the FDA Medical Device Reports. There are other incident report databases out there. I think it would be good to look at those and see are there certain lifts, certain manufacturers that are showing up in those databases more than others? It’s just being aware that if you go to the database, you’ll see certain names that those lifts tend to tip more easily. So I, as an administrator, would want to know that.
If I’m doing an equipment demonstration or an equipment trial or skill fair, I would want to bring in a couple different pieces and look at these. How easy are they to maneuver? How intuitive are they? And then I’d want to know from the manufacturer – show me what are the training pieces that you provide to help me make sure that my staff are competent in using those lifts.
I’m afraid that too often, especially in nursing homes, long-term care, they are just looking at what is the least expensive, but I think if they would look at sometimes choosing the least expensive is not in their best interest, especially if they experience some of these severe injuries, deaths associated with using the equipment. So I think they need to look at safety features. I know that sometimes people think that programs or the lifts can be expensive, but I think if they would look in terms of what is worker’s comp costing you, what are any of these medical malpractice injury suits costing you…
Schenk: Right. I think that in our experience though, in our lawsuits, the administrators are only looking at cost. I don’t think they’re really worried about worker’s comp.
Teresa: I think they should, both for their lifts or their bids for other equipment, look at what are we trying to accomplish. What’s the risk with going with something that needs to be intent – it’s a lift, it’s a sling – but it really is not safe, nor is the safety testing really adequate. I think it would be good for administrators to consider all of those viewpoints and not just say, “We only have X number of dollars, so we’re going to go with the least expensive piece.” And again, it may be adequate, but it may not be really safe.
Smith: So we just talked about how and why administrators should pick different equipment, but as far as determining what residents actually need a lift, is the intent to replace any physical lifting at all? How do you know who needs a lift?
Teresa: So you should have a good evaluation, and there are different ways to evaluate the resident. You need to consider what level of assistance is required. This can remain stable. Some residents will need the same level of assistance or no assistance for an extended period of time. Others, you may see fluctuations in the level of assistance needed throughout the day. They may need more assistance in the morning, less in the afternoon. During the night, if they do a quick toilet break, they may need some assistance there. You also have to look at resident’s ability and willingness to cooperate as well as any medical conditions that may influence the choice of the lift and sling. And so I think having a good evaluation and assessment screening to really help determine, okay, right now given how the resident is able to participate or not, which piece of equipment, which lift should we use?
So for instance, some nursing homes, long-term care, they have ceiling lifts and they use them, again, depending on the level of assistance needed. They have ceiling lifts and some floor-based lifts depending on if I’m trying to move the resident out of a chair in the common area and back to bed, a sit-to-stand lift may be appropriate.
So having some type of quick evaluation, and then I think also screening the residents, and there are a number of quick screening tools to see are they becoming more debilitated. Are they less able to participate? Do they need a greater level of assistance? So we made do well, for instance, the timed up-and-go test at the beginning of the month, and then you see that their time is becoming less, not that you need to do that type of test on a real regular basis, but on some kind of a frequent basis that you can determine the resident’s needing greater assistance because maybe they are becoming weaker, they are becoming more debilitated.
Smith: And are you seeing an increase in the use of lifts?
Teresa: I would say that overall, yes. There are some nursing homes, long-term care facilities that are, for instance, part of their standard bill is they put in ceiling lifts in each resident’s room, and it tracks not only over the bed and the main living area, but it tracks into the bathroom to allow for toileting and to allow for shower.
I do see floor-based lifts at some facilities being used more. Again, I think some systems, some facilities have embraced it much more than others, but yes. Also based on unfortunately the number of incidents that are being reported to the FDA Medical Device Report, it would appear there are more lifts out there because there are – I’m seeing more incidents in this database.
Smith: You know, I will say this and I don’t know what your experience is with this, I saw a lot of resistance on the part of the staff to use lifts simply because I think they’re safer and they’re easier on those of us who end up having to do the lifting, but they do take longer because you’ve got to put the sling underneath somebody, and it may be only a couple of minutes and it may be only a perception issue, but when you’re already short staffed, it can be frustrating.
Teresa: Well I absolutely agree. So if you are going to implement lifts and slings, again, you need to have adequate numbers of the lift, adequate numbers of the slings, staff that become proficient at using the lift will tell you it absolutely makes you more efficient and they know they’re safer. And frankly, having to overcome that resistance against using them, sometimes I always want to look at why a staff is resistant – well if they have a lift that’s 20 years old and it’s very difficult to operate and very heavy to move, I would be resistant also. So maybe looking at why a staff is resistant – are they resistant because they don’t feel like they have had adequate training? Or again, maybe they have to go way down into the basement, get the elevator, bring it up, bring the lift up. That obviously is going to take too long.
Facilities that have adequate ties, adequate numbers of both lifts and slings and staff have been well-trained, you will find staff that say, “I absolutely would not move this dependent resident who requires assistance without a lift. I’m much more efficient. I can get it done.”
And the other thing I hear from staffing, “And I go home and my back doesn’t hurt, so it’s a win for me.” In some situations, I think administrators have to pay attention to why staff is resistant, but then they also might have to say, “Listen, you have to do this because it is safer for you. We need you here taking care of our residents. We can’t have you out with an injury. And it’s also safer for our residents. We cannot be dragging residents, dropping residents. So this is how we operate. These are our standards, our practices and procedures, and we’ll support you in making sure you are able to do the right thing every time.
Schenk: Yeah, that makes a lot of sense, Teresa. And kind of along those lines, are there any just basic tips that you would give to a family member of a loved one who is a resident of a nursing home that needs a lift? Like are there things you would advise – hey, watch out for this, or make sure that this gets done or something along those lines that would protect the safety of that resident?
Teresa: I would want to choose a facility that had lifts and had a good program in place. And I know that is sometimes hard to find, but I’m thinking about my own mother when I was at, when she was at assisted living, and was able to talk to administrators and say, “I really don’t want…” and my mom at the time, 5-4, 114 pounds, but, “I don’t want to see your staff struggling by putting a gait belt around my mom and pretty much dragging her.” Like, “You need to use this lift with her.” They had a lift. It wasn’t the best, but then the discussion I had was, “There are lifts out there that are much smaller, freeing, much easier to maneuver, it’s much easier to apply the sling. It really would be good if you looked at some of those lifts and that is how I would prefer that my mother and the rest of your residents be handled with greater dignity, and again, not pulling and pushing on them, and not obviously causing your staff such significant discomfort.” And it was just such a difficult thing to watch two young, healthy, athletic CNAs try to move my 114-pound mother with a gait belt.
So I think having that discussion, and I know it’s a difficult time when you’re transitioning a loved one into long-term care, into a nursing home, but I think really looking at the fact that there are nursing homes out there that have installed ceiling lifts, that have adequate numbers of floor-based lifts, and they’re providing safe, dignified care for their residents. So having that discussion, I’m hopeful that administrators would be receptive to that and might say, “Okay, let’s see how we can bring in more lifts and bring in the right types of lifts and slings.”
Schenk: That’s very insightful, very helpful, and Teresa, thank you so much. I think we’ve covered most of the bases with slings and lifts in nursing homes. And again, we really appreciate you coming on and sharing your knowledge with us and with our audience.
Smith: And being a trooper despite the technical difficulties too – we appreciate that.
Teresa: No problem. I appreciate the opportunity. Thank you.
Schenk: Thank you.
Smith: Absolutely. Thank you, Teresa.
Schenk: Yeah, Teresa is great. Like we said, it’s the second time on. She’s fantastic, very knowledgeable.
Smith: Well she’s not just knowledgeable but you can also tell she’s a presenter because she’s engaging, she’s informative. She does a lot of presentations. She knows what she’s talking about. She’s got a lot of credibility. So I always appreciate when somebody is not just extremely smart and knowledgeable about a subject, but also knows how to communicate that subject matter, which she does.
Schenk: Exactly. Well the only other thing left to say is for everybody out there, thank a veteran, because as we all know, as this goes to air, it’ll be November 12th, and that is Veterans Day. And as we remarked, I think a few weeks ago, the correct way to write out Veterans Day is Veterans – plural, not with an apostrophe. It’s not possessive, which I thought was an interesting fact that I learned while I was researching Veterans Day. So thank a Veteran out there, everybody.
If you would like to continue enjoying episodes of the Nursing Home Abuse Podcast, they come out every Monday, and you can consume them in one of two ways. You can either watch the episode on our YouTube channel or at NursingHomeAbusePodcast.com, and if you do, like and subscribe, or you can listen wherever you get your podcasts from – Stitcher, Spotify, iTunes – and you can also like and not subscribe – well I guess you can subscribe to those as well, but also leave a review if you’re so inclined. But we appreciate you out there listening. We appreciate Teresa, and with that, we will see you next time.
Smith: See you next time