Photo above courtesy of Guldmann™ Inc.

Photo above courtesy of SureHands®.

Among keeping the safety of both the patient and caregiver in mind, there are a lot of factors to consider when determining the best way to do a lift and/or transfer and when choosing the proper equipment. Certain processes should also be set in place for a successful lift/transfer, whether it is in the home or clinical setting. From ceiling, floor (mobile), and wall-based lifts, we'll help you avoid common purchasing mistakes and provide some insight into any new trends in the industry.

Definitions:

• Ceiling-based: runs on tracks installed in the ceiling. Can be portable.
• Floor-based (mobile): rolls on coasters/wheels.
• Wall-based lift/hoist: attaches to a wall with brackets.

FROM THE BEGINNING

Determining if patients will be doing the lift independently and what their goals are should be at the top of the list. "How much sitting down do they have to do, and how much hand function do they have?" asks BevVan Phillips, OTR/L, CAPS, SRIS. "I also see what their respiratory status is and if there is a medical condition. You don't want to create additional problems with equipment," she notes.

Phillips has been an occupational therapist for nearly 30 years and is in private practice. She also owns a company—Home Access Solutions ((homeaccesssolutions.com/home.asp), which is based in Omaha, Neb—that provides residential accessibility planning and design to individuals and builders, offers specialty equipment for independence, and accommodates real estate services through Prudential Ambassador Real Estate.

Additionally, Phillips is a dealer for SureHands® (www.surehands.com), Pine Island, NY. "Before I became a dealer, SureHands was what I specified the most with my clients," she says. Phillips works with many people who have progressive conditions such as amyotrophic lateral sclerosis/Lou Gehrig's disease or multiple sclerosis. SureHands is a system she uses that adapts to her patients as their needs/postural requirements change. "They can buy one motor, and I can adjust sling types and keep up with them as they progress," she says.

A specific product Phillips frequently mentions is the Superpole™ System from Healthcraft™ (www.healthcraftproducts.com), for which she is a dealer as well. The Superpole is a modular support system designed for those requiring assistance with standing, transferring, or moving in bed. Central to the system is a floor-to-ceiling grab bar, which provides a secure structure that can be installed between a floor and a ceiling.

OTHER QUESTIONS

Are the patients' needs temporary, long-term, or permanent? What if their needs change or evolve over time? What is the longevity of the condition or impairment? Do you rent/lease or buy? These are all good questions to ask, advises Patricia Mechan, PT, MPH, CCS. Mechan is also the consulting education and clinical services manager for Guldmann™ Inc (www.guldmann.com), Tampa, Fla.

She had worked at a rehabilitation hospital in the Boston area as the physical therapy manager. This facility utilized the Guldmann ceiling and floor lift technology, and Mechan could see how staff had benefitted. "It helped us mobilize individuals who were highly dependent; patients with spinal cord and brain injury, stroke, amputees, orthopedic [issues], and multitrauma," she says.

Guldmann develops, manufactures, and markets technical aids for the physically challenged in addition to working tools for caregivers. "The products they (Guldmann) develop are solely focused on lift and accessibility technology for individuals with limited mobility," Mechan says.

Mechan also takes into consideration the kinds of care tasks and functions for which the technology will be needed. "The lift technology is quite varied in what it can assist in," she explains. "It can help with repositioning in bed to boost a person up to the head of the bed and with rolling side-to-side. It can help support limbs that are heavy when active assistive exercise is indicated, when limbs must be held up in the air and [aid] caregivers who do dressings and wrap limbs," she says. "Obviously, the technology helps with transfers—up from one surface to another—but the flexibility of today's lift technology allows the therapist to safely ambulate, work on gait and balance, and really focus their tactile input and hand placement in a therapeutic way."

"Think about how adaptable the item would be for when patients' skill levels change," Mechan says. The current equipment might render itself obsolete a few years down the road, especially if the person's condition declines. Another purchase [of an entire system] could be quite expensive, so perhaps just an adaptation or new accessory is all that is needed if one thinks ahead.

With the Guldmann ceiling lift technology there's a lot of flexibility with the type of environment it can get placed in: imaging areas of the hospital, inpatient CAT scan rooms, or outside in the emergency bay underhang where there might be a need to get people out of ambulances and cars. There is also a wide variety of accessories/attachments.

Mechan recalls an experience involving another therapist and treatment team from the Boston area working with a patient who had neurological issues and problems getting out of bed. They were struggling with rolling the individual and having him come to a sitting position, and had to use a lot of brawn, pushing fully. Two or three people were unable to do it because the patient was quite large.

They tried the gait/standing harness and got the individual up to a stand and not only walking, but trotting and then running. Everyone was amazed in that they all had struggled so much with what they thought was a much lower level of activity for this person.

"It was very much an automatic motor response," Mechan says. Once the patient was on his feet, the body interpreted the upright position. "Based on the individual's size, they wouldn't have been able to get that person standing without having that harness around him and having the hoist support that individual's weight."

ERRORS IN JUDGMENT

One of the biggest mistakes Phillips sees is that too much emphasis is placed on what funding sources are willing to cover. "If the goal is truly independence, a lot of times traditional medical reimbursement systems do not define it as ‘medically necessary,' " Mechan says.

"Some insurance plans may have some level of benefit for lift assistance but may only [cover] a floor-based lifter," She states. What about a ceiling-based hoist that is up and out of the way so there's no friction from carpeting on the floor, no thresholds to push over, no storage space needed? Mechan adds that sometimes with the ceiling-based hoists, when she's in the home environment, individuals and families will spend tens of thousands of dollars doing remodels to bathrooms and doorways because of the need for the equipment to fit through the spaces, not to mention if the patient needs to get into the tub and there is a tub wall.

"People think they have to do extensive remodels, which can be a lot of renovation money. If it's ceiling-based and runs on a rail, you can still go right over the tub wall and get lowered in," she says. The hoist helps the client with out-of-bed transfers and into the bathroom for activities like tub or toileting as well as just walking. "It depends on where you set the rail up.

"Don't settle for something that only does one of the [multiple] things you need it to do because it's the easiest thing you can get or the least expensive. [Then] you're really not eliminating the risk of injury," she says. "The whole idea behind lift technology is providing the tools for the caregivers or persons who need to assist others when the patient is more dependent."

Phillips' primary focus is often on the caregivers, trying to make their jobs easier and safer, thus resulting in the patient feeling more secure with the transfer. "I think it behooves everybody to pay attention to the caregiver because if something happens to them, the client will have a big problem. If people are overly concerned about what the funding source might cover, they may not think about what's better for the caregiver," she says.

Mechan agrees and says you have to ask who will help the patient use the technology. Will a client use it independently, with family members or health care providers? "What is the setting? Is it the home or an assisted living facility? Is it a nursing home or a hospital?" she asks. One must also consider weight capacity for a patient to be lifted or supported.

THE EVALUATION PROCESS

Phillips says that she will go on-site, and if her patients are already working with a treatment team, she confers with everybody involved. She'll bring her floor-based list and a large bag of slings and body-support accessories, and approach the evaluation in two parts. First, she determines which motor system and where in the home or facility the track is needed. Second, it goes back to goals. "Do we need to get the patient out of bed, onto the toilet, etc?" she says.

Then Phillips tries on the sling she believes would accommodate that person's posture and tone, and how the patient is going to approach the transfer independently. "That way, the patient can actually [experience] what it's going to feel like. There's no guessing going on. We've sized the sling; we've chosen the right style. It should give the patient the support needed to feel safe and be as functional as possible," she says.

Some individuals don't have a lot of head control, so you'll want to think about supporting the head and trunk. The sling or body support that works best is going to be very different based on an individual's muscle tone. "SureHands reps have the ability to fit. It's not one-size-fits-all," she says. More tips:

• Talk to caregivers, whether they are therapists, nurses, or physicians, and get their feedback.
• If no health care professionals are involved, listen to family members and patients, and let them tell you what they think the needs are for tasks and where the most challenges are.
• Evaluate the physical space needed.
• Determine where the system is going to be attached.
• What type of attachment brackets are needed, and in what length?
• Is there a need for storage?
• Where is it going to be plugged in or charged?

ON THE WEB: Want more tips for choosing the right lift equipment or implementing a successful patient lift/transfer program in your facility? Don't miss our special podcast related to this article. Join editor Arati Murti as she speaks with Patricia Mechan, PT, MPH, CCS, consulting education and clinical services manager for Guldmann Inc, for more in-depth insight on how lift products are being used for various patient applications.

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TRENDS

"The trend in the technology is that the weight capacities are getting greater to manage the growing weight trend of the US population," Mechan points out. "The ease of operation as well as the types of functions you can perform with the hoists have gotten better."

She says Guldmann released a new line that has a lot of unique features for ceiling hoists so facilities can pull data to know if staff is using them and gauge compliance with their program if they're trying a no-lift policy, for example. There's a scale integrated right into the hoist with the weight display and the hand control so any privacy issues are maintained and there is no number hanging in the middle of the room for anybody to see. Maintenance reminders are built in to make it easier for the engineering people at the facility.

"We're getting away from thinking that everybody needs to use a floor-based lift," Phillips concludes. "The migration of the technology toward ceiling-based equipment has freed a lot of flexibility up for caregivers and individuals, in every environment from inpatient settings to the home. And there's no need for storage space," Mechan adds.

Nina Silberstein is a contributing writer for Physical Therapy Products. For more information, contact .