Carol is 82 and bears no weight at all with her legs. Does she HAVE TO use the hoyer lift? She refuses lift and NH refuses any other way.

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Carol is 82 and bears no weight at all with her legs. Does she HAVE TO use the hoyer lift? She refuses lift and NH refuses any other way.

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She agreed to TRY the lift. She tried it, says it's hurts and she wants to go back to being transferred by 2 CNAs. Nursing home now refuses to do transfers any way other than the lift. She hasn't had a bath in 2 weeks because neither side will budge. What is the law in this situation?

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People have said on this forum that some facilities have a no transfer rule. If she can't use her legs then she is dead weight. Even for 2 people, it is hard and a liability to the facility if a CNA gets hurt. She is just going to have to let the CNAs do to get her bathed. They can do sponge baths.

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Nursing homes have a responsibility to maintain a safe environment for their employees. Having a hoyer lift is a way to assure this. Maybe as Carol to try the lift again? As her what hurts when they transfer her. It can’t hurt anymore than 2 people pulling her up under her arms or shoulders to transfer her. They are trying to prevent an injury to both parties. What if Carol suffered a fall when the CNA’s transfer her? Please ask Carol to give it another try & if she can understand, explain why. Good luck.

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What are the facility's policies and procedures regarding transfers? As previously stated, some nursing home facilities have a "No Lift or Transfer" policy which means that if the person cannot bear weight on their legs, then they HAVE TO be transferred with a Hoyer lift. If a resident can bear weight on their legs but cannot walk or pivot safely, then many facilities require that a "Sit-to-Stand" or "Easy-Stand" mechanical device be used for transfers. This to prevent job-related injuries to the nursing staff and to prevent the resident from sustaining injuries if the nursing staff cannot properly support the resident or if the resident and the nursing staff fall to the floor during the transfer.

Please encourage Carol to try the Hoyer lift again and have a nurse manager supervise this transfer so that she/he can make sure that the Hoyer lift is being used properly and that the sling fits Carol as comfortably as possible.

Having worked 20+ years in nursing homes where there were few Hoyer lifts and no "Sit-to-Stand" or "Easy-Stand" mechanical devices, I can tell you plenty of stories of transfers that "went wrong". And many of those "wrong transfers" resulted in injury. As a result of these injuries, I am in constant pain and I cannot lift more than 50 lbs. (a common requirement for most jobs). Do you or Carol want someone to get hurt while transferring Carol? Because that is what might happen if the nursing staff has to transfer Carol without mechanical devices.

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There are different slings that can be used. If one isn’t comfortable, maybe the facility could try another that wouldn’t be so uncomfortable for her. I have a mesh one that’s supposed to be for shower use. It looks like it would be more comfortable.

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It is much safer using a lift. We had a nurse taking care of my sister at home. The nurse dropped my sister and broke her leg. I don't blame the nurse because my parents had a lift and my mother didn't want the nurse use it. It was my mother's fault.
There were no problems after we all started using the lift.

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My Aunt was also dropped by people in the shower and she passed away within the week.

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Mom has been immobile for more than a year, and although I thought she would balk at the lift, she is quite calm about it

occassionally she says it hurts her back, which is painful anyway from compressed vertebrae

previously, mom had at least three "assisted falls" when staff was bathing her when she could still assist with transfers

naturally, observe and make sure her feet are not being bumped or her neck is caught in the sling and then encourage her - a shower would be a treat for her

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My money would be on the law's supporting the NH. They can't be obliged to carry out manual handling they have assessed as unsafe for their staff and their resident.

For now, Carol can be bathed in bed - not a bath, but fine for hygiene purposes if it's done properly.

But speaking of done properly, in a perfect world I should have liked to observe the trial transfer with the lift. What hurt, exactly, did she say? What bit of her, and what was causing the hurt?

Old bones and unfamiliar movements could mean that the 'hurt' was nothing worse than mild discomfort that a person could be encouraged to skip over or even just get used to for the greater pleasure of a nice bath.

But. Those strong straps' edges burn if they're accidentally pulled across skin. If the sling isn't carefully positioned, the person can be skewed sideways on being raised, which could be really unpleasant for an arthritic back and hips. Neurotic amateurs (who me?) may have hours to spend aligning every conceivable moving part and double checking every inch of skin, but CNAs on a tight schedule - and especially CNAs talking to each other instead of looking what they're doing - don't. Speed and efficiency are the name of the game.

Now. You obviously cannot march in there and demand to verify the skills and performance of any CNA who might have contact with Carol.

I wonder if you might suggest that Carol is encouraged to give it another try, on the strict condition that a PT or senior staff member is present to see where "Carol's" - cough-cough - difficulty is.

Being placed in a sling, whooped up into the air, dangled and plonked down again is a bit more excitement than an elderly person necessarily likes, and yes it does take a bit of getting used to. But it *shouldn't* hurt. And if it did, there's something wrong. I should work on the NH to investigate more closely.

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There shouldn't be any plonking down.lol..its a very smooth movement if the staff is skilled.The machine has a hydrolic breaking system and can be controlled so it's a slow steady descent.

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She sounds like total dead weight and nursing homes are becoming "no lift" because of injuries to staff. she can still get a bed bath. Bed bound patients are very common--so unless she is refusing bed baths I can't imagine her not getting bathed. Since human bodies are quite heavy a hoyer lift is the only way to get them up if they are unable. I can't imagine getting a dead-weight person up without a hoyer lift. Even with two people helping--say a person weights 200 pounds, that is 100 pounds per person. She is hurting? How about the staff and their probability of injury. Most people can't lift that much. I can't blame the nursing home using a hoyer lift. Hoyer lifts are NOT "more painful" -- pulling a person up manually would require more possibility of injury to the patient as well because your are pulling on the arms

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Absolutely! I have seen more patients accidentally dropped or bruised and knocked when manually lifting a person. I have to talk her through every step when transferring her with a hoyer lift...every step...every time as if it's the first time.If she says oooh too much it hurts..I ask her it hurts?or squeezea and it's not comfortable?she says it squeezes ...it's literally only about 2 minutes from when she is in the lift to where she is being transferred.reassuring her through talking and distraction helps.I have had back injuries and missed work because of people insisting on no hoyer lift .Never will I listen to that again.I am happy to give the family member a demonstration of how it feels if they worry so much.

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Have they tried a slider board? Would they allow transfers via that method? Ask.

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Hoya lifts are typically terrifying for any patient- especially if there’s any dementia involved. I refused to buy a lift for my mom even though some of the agency caregivers wanted it. We used a PT “lift/gait belt” and also a transfer board which are far simpler to use and so much more comfortable and safer for the patient as many caregivers don’t know how to use a Hoya lift properly. We had mom’s MD write a note saying that the lift was not appropriate to use for my mom and that there were several very accceptable alternatives other than the Hoya. Good luck as those lift devices can physically hurt patients. Your mom is right!

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It doesn't HURT when done properly.It squeezes their legs a little but I use a hoyer lift and when learning how to use it I had to be the gineapig a few times.It sometimes squeezes the legs which some find annoying but not painful.some people just don't want to have any unfamiliar feelings.she could just be afraid and worry about falling.As long as the sling is the proper size for her body she needs to relax and go for the ride.

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That’s very true. My husband freaks about about hanging from the lift bar. I think maybe Carol may be frightened and it translates as “pain”.

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Have to mention another option- if a person has reasonable arm strength they may be able to use the Transfer Bar Option of a "Friendly Bed". It allows safe/independent bed transfers for many with no leg strength. As a person is using their muscles to a greater degree to "help themselves" they also have a chance to get stronger.

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The OP's 'Carol' is bearing no weight at all on her legs. So, although I agree about using a range of muscles being a good idea in principle, I can't see any definition of 'reasonable' arm strength being sufficient here.

Bear in mind that even much younger women would often not have sufficient upper body strength to support their own weight, let alone manoeuvre it.

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The Memory Care to which we moved my father to recently told me, after we were in, that they do not have a lift and should he be unable to be transferred to the toilet by two aids, he would have to go to the hospital or to a different facility. I do not believe they have tried a belt or a board. Part of the problem is his inability to focus on directions when he panics if he thinks his legs won't hold up. You can't always talk him through it. Only weighs 165 pounds but it is dead weight. They did use a lift on him in the nursing home (transitional care) but he hung there like a side of beef for quite awhile, which upset all of us. He did not say it hurt but he was afraid he would slide out of it.

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Yikes - Was he left unattended in the sling at the NH?

some smaller facilities don't have lifts - they cost a bit or the family has to pay for them
others have weight limits of say 150 lbs so that they can manage transfers

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My mom was placed in the worst nursing home in the area in her late 80's ... she could stand a bit and pivot into bed when I was there and helped her but the staff insisted on using a hoyer. She only weighed 92 lbs. I walked in more than once to find them yanking her up and plopping her down in that thing and seeing her with a terrified look on her face. Towards the end the joints at the back of her knees were all raw, sore and bleeding and of course would never heal even after she was bed ridden. If the nursing home staff had an ounce of kindness and compassion in their hearts and not been so rough with her she would have tolerated the hoyer better. I still have nightmares of the horrors of that place...just hope the majority of other homes are not like that!

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It's much safer to use a lift and it doesn't hurt. My guess, as others', is that Carol is calling the sensation 'pain' when it's really anxiety over falling or unease with an unfamiliar feeling, probably exacerbated by dementia.

You can try to find a different SNF that will do a two person transfer, but if mom isn't a tiny person (and I'm guessing she isn't), they may rightly refuse, too. It's an incredible and unnecessary risk to their staff who may potentially suffer permanent injury lifting a heavy resident.

Being bed-bound doesn't mean she can't be bathed.

You try the lift in front of her. May help, but if dementia is a big factor, probably not.

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Here are a couple of information sheets about "How to Use a Hoyer Lift".
https://www.phc-online.com/How_to_use_Hoyer-Lift_a/146.htm

http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/4%20Care%20for%20the%20Caregiver/How_to_Use_a_Hoyer_Lift.pdf

You can also find YouTube videos that show people using the Hoyer. Unfortunately some of the people in the videos use improper or incorrect techniques when transferring the "patient". Maybe this information will help you and Carol determine the BEST way to transfer her.

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If she can pull / push her weight completely on her own arms, she should be allowed to angle herself into her wheel chair.

It is possible there are just pressure points for her that are only applicable to her and so goes to getting a caring senior professional to determine a specific procedure for her and specific spots for the straps etc.

Specific process would be unpopular with staff and exactly why it might be necessary. Not everybody is the same, and she may not feel comfortable speaking up in SOME situations, so she speaks up when she CAN, when her loved ones are listening or before the problem arises.

Glad she's speaking up and that you are helping!!!

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I concur that the Hoyer lift does not hurt if used properly. My brother has used one for several years. The family paid for it and it's been GREAT. My brother is a good soldier and does not experience anxiety about these things. He's been disabled from birth -- has never been able to walk.

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I agree. It’s been my experience that to use a transfer board, a person must have some strength and mobility. My husband’s is very “iffy”. For instance, we could never use a board to slide him into my car or anywhere else for that matter, I was trained by the CNA at my husband’s rehab to use the Hoyer. The only chance we have to move him is our Hoyer Lift. Done carefully and done right, there should not be a problem.

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There are different types of slings that can be used with the Hoyer.
There is a mesh sling with a commode hole, I used this one to get my Husband into the shower wheelchair to shower him.
After getting him into the shower I would remove the sling and shower him. After the shower I would dry him off and slip the solid split leg sling around him and transfer him to bed so I could put the briefs (tab type not a pull up type) on and then he would either stay in bed or if it was a good day I would transfer him back to the Broda Chair for breakfast.
In addition to the mesh sling and the solid sling with the split leg there is also a solid sling with no split. It might be easier on her to try another type of sling.
Also I always made sure there were no wrinkles in the sling and that the loops were all at the correct position. The color of the loops will position a person differently. Placed one way the person is sitting up more move to a different loop and is is a slight recline, move another loop and the position changes again. You might want to see how the loops are positioned to see if that makes a difference.

I think there are now rules that prohibit 2 person transfer when a person needs that type of care the use of equipment is then necessary. for the safety of the patient as well as the staff.

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Let me first address the issue of not bathing. That is going to cause potential skin infections. The skin is the largest organ on the body and as such, must be kept clean. You mean to say that there is no one at the NH who can bathe her? They should try getting a bed bath, which will do the task.

Hoyer lift request is reasonable. Another alternatives is setting up what is called a trapeze lift. If the person can push themselves up with the trapeze that will help in transfers.

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I agree with Countrymouse. If a person cannot bear weight at all on their legs, then they cannot do a "pivot transfer" to a chair, wheelchair, or bath chair. Also, at her 82 age, she no longer has reasonable arm strength. Even a very fit 50-year-old who is basically a paraplegic from the waist down would have trouble transferring to any kind of chair without a two-person assist or a Hoyer lift.

Many care facilities have state regulations regarding how patients are permitted to be moved, such as requiring the use of a lift if a patient cannot bear weight on their legs, for the safety of their staff, the patient - and also to avoid legal ramifications in case of injury.

About that bath - there is no reason why she cannot be given bed bath, and be permitted to wash herself from the groin up - doing as much as she is able. I used to be a CNA - we gave bed baths to our patients ALL of the time and they stayed clean this way.

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I am a very recent double (leg) amputee, and I can assure you that I do all transfers very well without bearing weight on legs. Many, if not most, are able to do transfers unassisted. I am a not-so-fit 64 year old. I don't know where you got that information, but you are dead wrong.

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Dragonflower- regarding your comment on the paraplegic person- bed transfers can safely/independently be done with no leg strength (or even no legs) if a person has reasonable arm strength with certain equipment (see earlier comment). I just wanted to clarify that lack of leg strength does not mean a hoyer (or two person lift) are the only options.

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My mom could not bare any weight on her legs after neglected by sister , in her first room they used portable lift. She was overjoyed when her private room had the lift in the ceiling. Some aides mad a game first floor sportswear second floor lingere I can’t spell . It was so much easier for her and the Stna she was also able to get a shower she would just be lifted into shower chair all clean dry sling great I would make sure the aides are skilled to use ... she too was nervous because being dropped so many rimes before. Hope this helps someone anyone. God bless

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Carol is 82 and bears no weight at all with her legs. Does she HAVE TO use the hoyer lift? She refuses lift and NH refuses any other way.

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