HOISTS

hi it the law to use hoists in transferring people. It comes under health and safety. No lift is a safe lift so hoists are provided to ensure injury is not caused to client or carer. Its also classed as abuse not to use the correct equipment if its provided. I know we like to take the easy way at times but its the carers that get the fine if an injury takes place. You have to think of your back it has to last a life time.

I'd have to disagree. Hoisting is not de-humanising when done correctly at all. I think there is far more dignity in being moved safely and comfortable than being man handled and dragged about by out of puff carers. Hoisting may well be frightening at first but if it is performed correctly and confidently, whilst continuing to treat the person with due respect there is no reason it should not be totally successfull. It isn't the hoist thats the problem, its how people use it. And Joyce is correct, it is health and safety law. Although there is no blanket law saying you may not lift people, as in a life threatening situation it would be acceptable. There are however health and safety risk filters on what the maximum weight can be lifted - and its basically no more than your average toddler!

I agree entirely with Catriona. I am a service user who has been hoisted at least twice daily for five years. I do not find it in the least degrading, but a very sensible and practical way of being moved without strain for myself or carers. For those who have a problem with hoisting, perhaps more training is required, In addition, those who seem to object to service users going to the toilet whilst in this position, are they more concerned about what they 'think' is good for the patient/resident rather than what the service user finds to be most beneficial.
I come across quite a few people who think 'they know best'. They are often just as responsible for taking away our independence. This is why I'm a Dignity Champion. Service Users should always decide on their own care - we are the experts by experience.

Hi, thanks for this .......I can`t actually find " a law " stating
that hoists must be used , but I do think there is something in one or other
of the Health and Safety Acts which says their use is recommended ......and
sadly none of this in any way takes the client`s wishes into account which
in the case of the very frail elderly is against being swung about in a
canvas sling . In my particular case my godmother is 93 ,almost blind,
almost deaf, and immobile and the hoist frightens her to a point where her
heart goes into panic mode and her blood pressure drops and she becomes
comatose unless immediately laid flat ........There is no question of her
being an alert service user who has the ability to " decide their own care "
although she too is an expert by experience .
Her wishes sadly cannot be considered as relevant in this case . And
no matter how carefully trained the staff or how well the hoist is used, my
godmother screams all the time she is in it , this causes us an immense
amount of distress to see her so distressed .........and that certainly is
an abusive situation .
The alternative to the hoist is to leave my godmother in bed for
what remains of her life , she is on a profile mattress and this may be the
most gentle and peaceful solution , it is surely against the Human Rights
Act to inflict such terror on an old person on a three times a day basis .
Thanks for your input .

life is hard . soften it with a cat \\\=^..^=///
----- Original Message -----
From: "joyce campbell" <[log in to view email address]>
To: <[log in to view email address]>
Sent: Tuesday, January 19, 2010 6:09 PM
Subject: [Dignity Champions Discussion Forum] - Re: HOISTS

What the Health & Safety at Work act 1974 says is that we must do whatever is reasonably practical to ensure health & safety. It says we must avoid hazardous tasks where possible, where not possible we must assess the risk and mechanise lifting where possible. This would mean using a hoist to lift people.

Sadly if someone is hoisted badly than yes, it will cause them fear and distress, but it doesn't have to happen like that.

The alternative to hoisting is often the Drag Lift. A terribly dangerous, abusive and undignified technique which injures and kills - fact.

Its interesting to hear what Sandra has said about going to the toliet whilst in a hoist, as my first instint would be that this is veru undignified. Having said that - I think all care should centre around the individual receiving it, so if its the most appropriate thingb for them, and certainly if they can tell me thats what they'd prefer then I'd support it. as long as it was truly being done it that persons best ingterests, not as a short cut to save carers time or effort.

Hi, and that is the very dilemma we are in , the need to safeguard the staff which means lifting immobile frail elderly people, which in turn means that you cannot centre the care around the individual being lifted , and it is in my godmother`s best interests and it certainly doesn`t save the carers time or effort as she fights every inch of the way not to be put in the sling ready for hoisting ......so the distress and fear continues though I did lift her myself yesterday as she had been left almost horizontal in her chair by the district nurses and I managed to use the sling to lift her up in her chair . It didn`t hurt me and it was so quick she hardly noticed it had been done !!!

Although I sympathise with you and your dilemma, and I would probably lift my own relative in the same situation : you may not have felt any pain on lifting her, but we know damage is done and that damage is accumulative over time. If carers have to do such things several times a day, day after day, they will be injured.

On a positive note, I'd suggest you ask your god mothers care team to look into more apropriate seating, as if she has the right chair, possible a small aid such as a 'one way glide sheet' to stop her slipping down in the chair, and if she's positioned well when she is first helped into the chair she certainly wouldn't end up almost horizontal!

I'd also be asking them to look into how they are putting the hoist sling on, as they may well be other techniques which are less distressing for her. I can get a sling posistioned under someone without having to lay a finger on them.

Also in the short term, as part of a postive plan to reduce your godmothers distress it may be worth considering a small amount of calming medication.

Using a hoist is not a very comfortable experience, as I have experience this on a manual handling course, but we as carers need to carry on providing care. If we have to carry services uses we could easily put our backs out and will not be able to continue working.
If you use a hoist to move someone you can make it an easier experience by talking to the service user.

I've been hoisted many times perfectly comfortably

If care staff are negative about hoisting clients/patients then the feedback
will be negative. If staff hoisting are positive and reassure the
clients/patients then people will be more relaxed making it an easier
experience.

here here! Emma

Its not the hoist, its how we use it

Sometimes we are too quick to blame other things and too slow to question and look to improve our own practice

Thanks Hayley and Emma , this is exactly the answer , its getting down to the level of the resident , getting them to know what is about to happen , who is going to do the lifting , and everything to help calm the situation ......
Yesterday I found my godmother in bed .....the early afternoon hand over of the shifts was taking place and there wasn`t a single member of staff available to ask why this was . Later I found out that apparently " she simply refused to get up ." This cannot be . This is a member of staff who has not got the time or the patience to go through the routine of getting her prepared for the getting up process . Almost certainly she went without breakfast as a result , and I found her in the early afternoon with her overbed table out of reach with a glass of water on it and the door to her room open and her in bed in full view of anyone who was passing along the corridor ........how about that for Dignity in Care ???? !!!
My godmother is perfectly mentally OK in her own isolated world of near blindness and near deafness , and she has gentle favourite carers . We have tried to get the GP to prescribe some anti-anxiety medication but this request was followed up by a full visit by a psychogeriatrician who pronounced her completely sane and in command of her senses .......so no calming medication was allowed .
I have tried to get the often absent manager of the home to reschedule the shifts so the good slightly older carers are paired with the younger less experienced , and he says he will try .....also to allow the good carers to actually show new and young carers how to care for each more disabled resident ...again the manager says he will think about doing this . ( More than my job`s worth , I am afraid !!!)
At present the home has an outbreak of the norovirus , which was brought in by a rehab unit resident from hospital . I have had it , most of the staff have had it , those in the rehab unit have had it , and the home is currently closed to visitors . My godmother has not had it , but I take down my own anti-bacterial sprays and wipes and clean her room each day I go to visit , and fingers cleanly crossed , she still has avoided it . However I am haunted by the sight of a resident banging frantically against the window of the upstairs sitting room as I left , desperate to understand why her world had been turned upside down as no one was allowed downstairs .
Why they had to be kept upstairs when their normal day was spent downstairs between the hall and the sitting rooms , I have no idea but it completely disturbed and disorientated them all .......they have had it , the staff have had it and yet still this isolation goes on .
I dread each day and what it may bring , but am now off down to the home again .

thats neglect, does your god mother have a care manager?

Hi, thanks for this ....yes this is neglect OK . And when I got to
the home on Friday afternoon, I found my godmother up in her chair which
was good but crammed in and round the chair and sling was a bed sheet ,
which means two things, first that they had a battle with the sling to get
her up and managed to get the sheet tangled up in the sling , and second
that she had not been changed or moved since they got her up .
So I have written a full email of detail for the CareCo who was on
duty both mornings , the one when apparently my godmother " refused " to get
up , and the next when she is up but still in her bed sheet , and asked that
a copy go to the manager of the home and I will keep a copy in a file .
We have a meeting with the Moving and Lifting advisor on Wednesday
morning at the home to try to get some sort of advice or better ideas for my
godmother and the hoist and I intend to take a picture of my godmother`s
black eye for this advisor to see , it doesn`t identify my godmother but its
could be a useful teaching aid , for how NOT to do this hoisting !!! So
you see there is quite a history of failing to move her correctly and gently
.
I also think having the norovirus in the home over this period meant
that the CareCos were very short of staff and maybe some staff were doing
more shifts than they should and with less supervision than ever .

life is hard . soften it with a cat \\\=^..^=///
----- Original Message -----
From: "Catriona McIntosh" <[log in to view email address]>
To: <[log in to view email address]>
Sent: Saturday, January 30, 2010 10:57 AM
Subject: [Dignity Champions Discussion Forum] - Re: HOISTS

hi. i am a moving and handling facillitator and i know that if carers take risks by lifting clients and, dont use the correct equipment the carer can be fined up to 20,000 pounds. At times i have thought of cutting corners but once i found out what the fine was it soon changed my mind. If the sling is uncomfortable a suitable one has to be used to promote comfort. We had a lady that was 106 years old, har daughter was upset when we hoisted her. There was no way round it we had to follow guidelines. The manager made it plain if we didnt use the equipment we would be sacked. Choice goes out the window when it comes to hoists.

> From: [log in to view email address]
> To: [log in to view email address]
> Subject: [Dignity Champions Discussion Forum] - Re: HOISTS
> Date: Wed, 20 Jan 2010 10:55:00 +0000
>
> Hi, thanks for this .......I can`t actually find " a law " stating
> that hoists must be used , but I do think there is something in one or other
> of the Health and Safety Acts which says their use is recommended ......and
> sadly none of this in any way takes the client`s wishes into account which
> in the case of the very frail elderly is against being swung about in a
> canvas sling . In my particular case my godmother is 93 ,almost blind,
> almost deaf, and immobile and the hoist frightens her to a point where her
> heart goes into panic mode and her blood pressure drops and she becomes
> comatose unless immediately laid flat ........There is no question of her
> being an alert service user who has the ability to " decide their own care "
> although she too is an expert by experience .
> Her wishes sadly cannot be considered as relevant in this case . And
> no matter how carefully trained the staff or how well the hoist is used, my
> godmother screams all the time she is in it , this causes us an immense
> amount of distress to see her so distressed .........and that certainly is
> an abusive situation .
> The alternative to the hoist is to leave my godmother in bed for
> what remains of her life , she is on a profile mattress and this may be the
> most gentle and peaceful solution , it is surely against the Human Rights
> Act to inflict such terror on an old person on a three times a day basis .
> Thanks for your input .
>
>
> life is hard . soften it with a cat \\\=null=///
> ----- Original Message -----
> From: "joyce campbell" <[log in to view email address]>
> To: <[log in to view email address]>
> Sent: Tuesday, January 19, 2010 6:09 PM
> Subject: [Dignity Champions Discussion Forum] - Re: HOISTS
>
>
> > hi it the law to use hoists in transferring people. It comes under health
> > and safety. No lift is a safe lift so hoists are provided to ensure injury
> > is not caused to client or carer. Its also classed as abuse not to use the
> > correct equipment if its provided. I know we like to take the easy way at
> > times but its the carers that get the fine if an injury takes place. You
> > have to think of your back it has to last a life time.
> >
> >
> >
> >
> >
>
>
>
>
>
>

_________________________________________________________________
Your E-mail and More On-the-Go. Get Windows Live Hotmail Free.
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Never mind her care manager, i would refer it as a POVA referral, that is
absolutely disgraceful. Inform CQC too.

What if you weren't there, looking after her best interests. I think you
need to take this further to look out for other residents in the home. They
clearly are not doing things correctly. How many other people are being
neglected or hurt due to lack of training ans inexperience.

I'm sorry but i don't think you can sit back any longer, the co ord will
report to the manager who is already aware of your concerns!

Elizabeth, you could speak to the Health & Safety Executive (usually within your local council) about the poor moving and handling as they may be breaking health & safety law if they are putting anyone at risk, or if carers aren't suitable trained etc

You might also think about talking to the Care Quality Commision about your concerns - http://www.cqc.org.uk/

The Care Coordinator as I was thinking or was more a social worker responsible for purchasing and managing your godmothers care...

Usually a person should not be left sat on the hoist sling, this would only be done if someone had to sit in a moulded chair or such, and then it should be a sling made of specialist materially which causes no friction or pressure - so theres another issue for you

It suddenly occurred to me that we are all possibly talking about different
types of hoists. Whether I have been hoisted in my own home or in a care
home setting or in a London hotel, the hoists have always been ceiling
tracking hoists and I operate the controls whilst the carer helps to put
on/take off the sling. If I was unable to operate the controls, I may
possibly need 2 carers. Either way, a risk assessment should be carried out
to ensure that the person being hoisted remains as independent as possible.

My experience, over many years, is that sitting in the sling is just like
sitting in the cane chairs which were suspended from the ceiling in the 60's
- it relieves the pressure of sitting in a wheelchair all day and is very
comfortable.

If the person being hoisted is experiencing anything less than a comfortable
experience then this is a disgrace. Modern equipment and well trained staff
should be standard for everyone.

-------Original Message-------

From: joyce campbell
Date: 30/01/2010 17:00:44
To: [log in to view email address]
Subject: [Dignity Champions Discussion Forum] - Re: HOISTS

hi. i am a moving and handling facillitator and i know that if carers take
risks by lifting clients and, dont use the correct equipment the carer can
be fined up to 20,000 pounds. At times i have thought of cutting corners but
once i found out what the fine was it soon changed my mind. If the sling is
uncomfortable a suitable one has to be used to promote comfort. We had a
lady that was 106 years old, har daughter was upset when we hoisted her.
There was no way round it we had to follow guidelines. The manager made it
plain if we didnt use the equipment we would be sacked. Choice goes out the
window when it comes to hoists.

> From: [log in to view email address]
> To: [log in to view email address]
> Subject: [Dignity Champions Discussion Forum] - Re: HOISTS
> Date: Wed, 20 Jan 2010 10:55:00 +0000
>
> Hi, thanks for this .......I can`t actually find " a law " stating
> that hoists must be used , but I do think there is something in one or

other

> of the Health and Safety Acts which says their use is recommended .....

and

> sadly none of this in any way takes the client`s wishes into account which
> in the case of the very frail elderly is against being swung about in a
> canvas sling . In my particular case my godmother is 93 ,almost blind,
> almost deaf, and immobile and the hoist frightens her to a point where her
> heart goes into panic mode and her blood pressure drops and she becomes
> comatose unless immediately laid flat ........There is no question of her
> being an alert service user who has the ability to " decide their own care

"

> although she too is an expert by experience .
> Her wishes sadly cannot be considered as relevant in this case . And
> no matter how carefully trained the staff or how well the hoist is used,

my

> godmother screams all the time she is in it , this causes us an immense
> amount of distress to see her so distressed .........and that certainly is
> an abusive situation .
> The alternative to the hoist is to leave my godmother in bed for
> what remains of her life , she is on a profile mattress and this may be

the

> most gentle and peaceful solution , it is surely against the Human Rights
> Act to inflict such terror on an old person on a three times a day basis .
> Thanks for your input .
>
>
> life is hard . soften it with a cat \\\=null=///
> ----- Original Message -----
> From: "joyce campbell" <[log in to view email address]>
> To: <[log in to view email address]>
> Sent: Tuesday, January 19, 2010 6:09 PM
> Subject: [Dignity Champions Discussion Forum] - Re: HOISTS
>
>
> > hi it the law to use hoists in transferring people. It comes under

health

> > and safety. No lift is a safe lift so hoists are provided to ensure

injury

> > is not caused to client or carer. Its also classed as abuse not to use

the

> > correct equipment if its provided. I know we like to take the easy way

at

> > times but its the carers that get the fine if an injury takes place. You
> > have to think of your back it has to last a life time.
> >
> >
> >
> >
> >
>
>
>
>
>
>

_________________________________________________________________
Your E-mail and More On-the-Go. Get Windows Live Hotmail Free.
https://signup.live.com/signup.aspx?id=60969

Hi again , thanks for all this input , I am most grateful as I am determined to see how best I can help both the home and my godmother ... first please what is a POVA ? And CQC is I guess the old fashioned inspection unit ? I am going to wait until I have seen and heard the Moving and Lifting advisor who is coming to the home on Friday at 9 am and with her the Mobility shop man ...I assume this is to ensure that the equipment is being used correctly in the simple physical sense .......and I shall then ask for the manager to look at the staff who clearly have difficulties , patience and compassion difficulties , to be retrained . Sometimes I think the use of this big piece of equipment is as frightening for them as well !!! Failing this , then I shall have to get the Care Commission involved always assuming they will get involved .
And thanks for a good point Sandra .....this is a forklift truck type hoist with two arms and my godmother sits in the sling in her chair all day and the staff wheel the hoist in and attach it in three places either side to material hooks and then crank it up until the resident is free of the chair and then they swing her over to the commode or the bed or wherever she is to go ........she has no control over it , the only thing she understands is that it comes out of the blue , she doesn`t see it coming , nor does she hear it coming , it just appears and hands attach the sling to the hoist and that is when she decides she doesn`t want this . .....some staff are excellent and understand the terror of a 93 yr old almost blind almost deaf immobile person who finds herself being manhandled and swung about .........and they do take the time to coax and persuade and talk her through it .
It is always obvious to me which sort of carers have been on duty when I get to the home each day . Good days and my godmother is smiley and communicative , bad days and she shuts her eyes and will not respond in any way !!!!
And she has been in this home since 2002 so any social worker connected with her at the time has I imagine far too many other things to do, if she still is a social worker . The home has a manager and several care coordinators , and I rely on these doing their jobs . See what Friday brings , and hope its something positive !!!! thanks to you all again .

I hope you get the outcome you need, please let me know how things go.

Regards
Emma

Dear Elizabeth

Your post says it all, the issue is around a lack of knowledge, good practice, compassion and effective communication.

No one should ever be moved without it being communicated to the first! She should not be left sat on the sling, its uncomfortable, undignied and unneccessary.

POVA stans for Protection of Vulnerable Adults, although the term often used now is SOVA - Sfaegaurding of Vulnerable Adults. There will be an Adult protection Team within the council social services who deal with adult protection issues - you could try speaking to them.

CQC is the Care Quality Commision who do home inspections as you've said. I'd definately report your concerns to them.

Your doing a good thing here, not just for your godmother but other vulnerable elderly people to. I know its frustrating and disheartening when you can't put things right easily or quickly, but keep going!

Good Luck, and lets us know how it goes.

Elizabeth,

Your completely right, we must stand up for the other elderly people who do
not have people to look out for there best interests.

Emma

Hi to you all and thanks for keeping on reading ........the meeeting on Friday at 9 was WONDERFUL , you have to give praise where its due ....the girl who is the Moving and handling advisor was brisk and business like and got to the bottom of the problem immediately , and went up to my godmother`s room when the staff were ready to get her up .
With two staff , one a trained hoist user , my godmother was swung onto the edge of her bed and talking to her all the time , very gently they got her nightclothes off , offered her a bowl of hot water and flannels and soap and whilst she did her face and hands they were doing her back and front and then drying her and getting her clothes on ......finally , finally , the word hoist was mentioned and by then she was OK about it and they said , come on let`s get it over and done with , and they did !!!
The moving and handling advisor was discreetly in the room behind my godmother so there was no invasion of her privacy , and made notes . I and the manager were outside waiting ........The moving and handling advisor afterwards said she was pleased with the way the staff worked and could see no improvement for these two .
However she accepted that there were staff who simply hadn`t understood the social and caring side of using the hoist and she is going to fit in a Hoisting workshop at the home sometime next month . When I went back to the home at 2.30 my usual visiting time my godmother was like a new woman , she knew who I was , she remarked on the headline in the paper , she took in information about her old cousin , and it was a pleasure visiting her . She wasn`t sitting there with her blanket over her head waiting for the next assault .
The penny dropped today , and I now know that all four CareCos have this hoist training and do the inhouse induction training for all new staff who have no experience of hoists . So why couldn`t they have taken the very poor quality staff and retrained them , thus avoiding all this pain and fear daily for my godmother . ????!!!!!

Hi again , sorry to give you all extra eye strain , but I meant to add that whilst I was talking to the manager outside my godmother`s room , he said that the home hadn`t been inspected since Dec 2008 yes that`s right 2008 !!! now that is disgraceful and does allow bad practices to set in and become entrenched , so I may just contact cqc.org.uk and ask for an unannounced visit and a formal inspection . It can`t hurt and it could be very beneficial .

I am so pleased that eventually you were able to see a "good hoisting". In this day and age, with so much modern equipment and so much emphasis on training, there is absolutely no excuse for the way in which your Godmother has been treated.
Inspection of Care Homes used to be carried out by CSCI (The Commission for Social Care Inspection), but last year the CQC (Care Quality Commission) was formed and it has taken over as the Regulator, combining CSCI, The Health Commission and The Mental Health Act Commission.
CQC will be able to give you the details of your local inspector.
Please let us all know how you get on - we are all behind you.

Bl**dy well done you!

Very pleased your getting positive action finally :O)

Just proves that if you persevere you get there in the end! Great result.

As I understand it is early days yet for the CQC who expect to have homes registered by Oct. - 24,000 homes. I offer no comment as to how appropriate such an inspection regime is but being practical about things I understand that the likely inspection rate will be once every three years.
If you really want to make a difference and improve Health & Social Care delivery I again suggest that you join your local LINk - here you can directly influence Commissioners, the PCT, the NHS and the Council and others and your LINk has statutory powers including Enter & View. However we should be aware that you cannot inspect in quality - what we need is a change of attitude, what will you do to bring it about? Visit http://www.lx.nhs.uk/ for more information.

Hi and thank you all again for being so supportive I am sure I should have gone mad without your constant input .....
I will do LINk in fact I will do anything to make this never happen again , and hope it will spread to other homes as well .
As of today things are gathering pace at the home , and the manager has an ALL STAFF meeting today , and in my godmother`s room is a typed summary stuck onto the wall of her care and how to set about it .......it mentions words like empathise , sensitivity , socialise !!! and there is now a set course of supervision , something I have been screaming about for years, of staff using the hoist with all residents . And those staff I speak to regularly , all agree that you do 99 % of the work , dressing undressing , washing , toileting etc , without even mentioning the word hoist and only at the very end do you bring in this horrid machine .....
My godmother I now know is not the only one to be hoisted so if it can be done well for her then I hope that that better friendly attitude can spread to other very disabled residents throughout the home . And if the girls move to other homes, then it may well spread further . This sudden improvement is not my doing of course, but the dynamic Moving and Handling advisor who was chilli hot on doing things properly .

I disagree Elizabeth, this is your doing because without you looking out for
your godmother the moving and handling advisor would never of entered the
building.

Well done!

Sorry to be the other side of the coin reference the still being in bed having refused the hoist

If a Client refuses to do any thing we have no right to go against their wishes it is called Client choice.

Anything we do against their wishes is seen as abuse on our part and a SOVA issue

Yes we can cajole , beg call it what you will but if the answer is still no we cannot intervene

Hi Nigel , you are good to be on the other side of the coin, both sides of a discussion are always better than one !!!
It is however the carer`s job surely to find the best way forward with a difficult client to get them to agree to be clean and to have a drink and perhaps something to eat , all of which can only be achieved if they allow themselves to be got up out of bed .....in my godmother`s care home situation , if she has woken up in a foul mood , they do the best they can , and then come back later to start again until they can finally persuade her that her porridge is getting cold or her tea or something similar .......it doesn`t always work but 99.9% of the time it does with patience and care and gentleness the carers do find a way through to her better nature !!!

Hi Elizabeth
Yes time is a great factor when you have it on your side , but out in the community time is as the old saying goes, of the essence .
If our call is only 30 minutes and we have to spend 25 of those minutes persuading someone that what we need to do is for their own good , it does not leave us much time to what is necessary without making us late for our next client. Who after all is entitled to their care at the time they expect.

Yes I have worked in a home environment and being able to leave and go back is wonderful , but in the community with a full workload it is not always possible just to pop back to try and persuade someone .

Hi Nigel , the community is of course by far and away the most
difficult care area in which to work . Your instinct is to give the maximum
care you can , but the clock ticks and you have many other dependent people
waiting for you , but I still think that it is dangerous to leave a client
in bed where for health reasons they should be up .......and I would be
inclined to report this situation to my manager and then if that fails to
the Social Services .

life is hard . soften it with a cat \\\=^..^=///
----- Original Message -----
From: "Nigel Dowe" <[log in to view email address]>
To: <[log in to view email address]>
Sent: Saturday, February 20, 2010 2:55 PM
Subject: [Dignity Champions Discussion Forum] - Re: HOISTS

I have to disagree with Nigel, as we have a legal duty to care, and there are times when we have to act in someone's best interests, even if that goes against their stated choice. Of course that should always be done as a balance decision after careful assessment by a multi disciplinary team in partnership with the individual and those who know them best. And then documented in a care plan and regularly reviewed. Legally this must be done in the least restrictive way possible, and morally in the most sensitive.

When we get into the subject of cajoling, begging and bribing I'd be nervous of it progressing to ignoring someones wishes and bullying.

The Mental Capacity Act states we must assume someone has capacity untill it is proven through careful assessment that they don't, and that assessment must be around a specific choice at a specic time, such as ' Does Elizabeth's Godmother have the capacity to understand the implications of refusing to be hoisted, at this moment?'

We do not have the luxury of using 'its their own choice' as an excuse to neglect the vulnerable. It is not abuse to meet peoples basic needs or keep them safe, when they are unable to understand the implications of not doing so. It would however be abusive to fail to do this.

Good point Nigel and your answer raises the issue that perhaps community care is not suitable for some clients however much we want to uphold choice of staying at home. It also raises the point that community care is totally up the creek by limiting time for each client and I would argue that this is not  community CARE when it is so strictly time controlled instead of being needs based. How can we justify community care on this basis? Community care is only sucking up all the resources which can be used to fund homes and more choice-based care.
 Dr. Taleb Durgahee

Palm Court and Keller House Centre of Excellence in Dementia Care
PREFERRED PROVIDER OF DEMENTIA CARE FOR EAST SUSSEX COUNTY COUNCIL
Provides Nurse Education and Overseas Nurse Programme
In Collaboration With Brighton University

17-19 Prideaux Road, Eastbourne, East Sussex, BN21 2ND
Tel: 01323 721911
Fax: 01323 410244

www.palmcourtnursinghome.co.uk

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Obviously Taleb you are all for homes but i have experienced bad homes with
not enough staff on shift, not enough time to spend with the residents etc.
This goes back to a conversation that took place last week about there being
good and bad in everything, homes also!

It's a European Directive from 1992, so the alternatives are a) a hefty fine and b) the risk of serious injury to both you and your client. It may be dehumanising but the alternatives are far worse, as you will know if you have ever suffered a back injury yourself, or dropped a 90 year old lady on a tiled floor.

I've been using a mobile bath hoist similar to this - http://www.gainsboroughbaths.com/product/patient-hoists/glide-m150-mobile-bath-hoist - when I've been looking after my elderly mother. I found it really easy to manoeuvre with padded seating surfaces, the ensures a safe, comfortable and dignified bathing experience.

I've just posted the question about 'what is the legal situation' on the Dignity in Action Facebook page:

https://www.facebook.com/groups/289089744481097/

Many apologies everyone - brain hopeless today !

I've just responded to the first post in this series - the question has I think been answered.

I think my brain (which is getting too old !!!) was 'stuck in BMJ mode' - on BMJ, when you go to the discussion, on the browser I use the most recent addition comes up first (which is the opposite way round to here on DIC).

Hi All

I am surprised that people do not know where to look for People Handling (Including Hoists) information and HSE Guidance. This it appears a failing of your organisation and your training if this is not clear.

http://www.hse.gov.uk/pubns/hsis3.pdf

This information sheet explains the problems associated with hoisting people and sets out guidance to deal with them. It covers fixed, mobile and overhead hoists. The advice is intended for health and social care providers or other organisations who move and handle people and will help them to comply with their legal duties.

Hope this helps

Hi Keith,

I've just had a flick through the guidance you pointed at. It covers how to safely use hoists.

I don't think that guidance addressed something I thought I saw in the original post in this series: '... What is the alternative to this de-humanising way of moving people ?'.

Surely some people, 'find being hoisted undignified/dehumanising'. What happens, if the person says 'yes, I know I can't do this safely unaided, but I just need a bit of human 'helping hands' to enable me to do it safely - I don't want to be 'hoisted and treated like a sack of coal'', but somebody else (for example 'the carer's employer's rules') seem to be saying 'H&S requires you to use a hoist' ?

I don't think the PDF you pointed at, covers that question ?

The issue of patient wishes should be recorded in the Care Plan and use of a hoist or not recorded in the Manual Handling Risk Assessment and this is agreed with all parties. Usually differences can be solved by explaining a situation in a understanding and empathetic way.

An employer and employees safety and legal duties will always override the individuals wishes. If there is a difference between the wishes of the individual and legal duties of the provider this should also be recorded. CQC will put H&S first and penalise providers for not acting Safely.

As to dignity in Hoisting CQC fundamental standards state "You must be treated with dignity and respect at all times while you're receiving care and treatment." This includes lifting. Maybe I live in a sunny land but a well trained staff member committed to client dignity should not have this problem.

Thanks Keith,

I'm not sure of the correctness of 'An employer and employees safety and legal duties will always override the individuals wishes ... CQC will put H&S first and penalise providers for not acting Safely'.

I'll ask my CQC contact whether that is indeed true - it looks 'flawed' to me.

Best wishes, Mike

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Must your grandmother be hoisted? Are we talking personal hygiene to clean her or moving her into a wheelchair? Some people I work with are in the same boat as your grandmother, so we roll them, we don't hoist them.

Please check out www.waymayka.com
They have designed a Dignity cover! A first of its kind!
The Dignity cover has been designed to reduce exposure and to keep a persons modesty in tact when being raised with a hoist.
I myself have had to be hoisted, and i wish this cover had been around when i needed it!

Please also check out this link so you can see the video of this product in use!
https://www.youtube.com/watch?v=mitvIEGW8hQ

Hi everyone,

There is no specific legalities for Mandatory use of Hoists, however, there MUST be an audit trail of training provided and a person centred risk assessment documented in the Care Plan. The use of a hoist Safeguards the person and the staff if carried out correctly.

A more important 'HOWEVER', when it comes to the Moving and Handling of people, are Articles 3, 5 and 8 of the Human Rights Act 1998.

Suzie Lloyd

Hi, I am passionate about dignity and know the effects that can take place when there is lack of providing it especially in the area of moving and positioning, my company have designed innovative products to preserve dignity for individuals who need assistance being moved via the hoist method. Our first product launched is called the Dignity Cover, we believe in making a person feel like an individual meeting there needs for dignity and putting the person first, As many of you know its not very nice for a person being moved in this process, so we have provided a solution and aim to make a difference,Thank you Clare for seeing the Dignity cover's importance and posting above.

Kelly Campbell

As a moving and handling specialist trainer and adviser to CQC no one should ever be hoisted without a dignity blanket, curtains closed and the door even if they live alone in the middle of nowhere. If a person is hoisted in public i.e. a lounge then a dignity blanket and screen are to be used.
The individual should at all times have the controls and the care staff next to them until one carer moves the hoist.
The sling and full assessment should be carried out by an occupational therapist who is professionally competent to do so such as the moving and handling adviser for the local authority.
It is not illegal to manually lift a person (court ruling in 2003 East Sussex County Council summary of case on MenCap website) as there are no weight restrictions in the regulations.
So long as any manoeuvre is carried out with consent in an appropriate manner considering dignity, comfort, tissue viability, infection control and ensuring good posture is achieved both during and after the transfer it does not have to be carried out by a hoist as there are many different methods of moving a prosper from A to B safely.
Any manoeuvre should be suitable for the individual, assessed and consented to and the staff correctly trained with the correct knowledge and equipment suitable for the movement. This is why OT's spend several years at university to be able to carry out this type of assessment for the benefit of the individuals involved. That is both the service user and the staff

sorry should have read - moving a person from A to B in second to last paragraph

Absolutely Anne, this is why we have developed the Dignity Cover to preserve dignity maintain well-being and promote professionalism in a dignified manner. our product is also personalised with a name tag for an individuals use and comes with a neat storage pouch.
I don't mean to be solely promoting my product I just believe its a necessity to use with a hoist as an accessory in the moving and positioning procedure to ultimately provide dignity the best way possible.

sorry Ann*

Thank you Ann.
A balanced view that looks at a multidisciplinary approach and mentions the role of the Occupational Therapist. Their are so many devices available with brainstorming and patience a product acceptable to the client can be found. Clients recognise a compromise and different packages meet different levels of physical and mental function.
I have nursed in the Commmunity for over 20 years and never been afraid to involve other professionals expertise. Private practice/nursing home does not exclude reaching out to Social Services and health if your company does not have in house expertise. It is showing this insight that protects us in law. If you don't ask you don't get. It is also (with clients consent) to see family as part of the MDT,involving them in the meeting empowers them to understand priorities within the care plan. Informed they can reinforce the efficacy of any care decision prescribed. Equipment like medicine should be
S-safe
A-acceptable
F-functional
E-effective
Sarah Holden RGN BSc Community Practice

I have mixed opinions a out hoists while I agree they are a very necessary piece of equipment I also understand how it must feel for service users. My view is that ceiling hoists should always be fitted. In service users own homes as moving mobile hoists on unsuitable flooring can be very hard on our backs and are not always the smoothest hoists to use. I also feel that when it looks inevitable that a service user will require a hoist it should be done sooner rather than later as like previously said in other comments, thus allowing the service user to become familiar with being hoisted before they have to come to terms with yet another deterioration in there ability to care for themselves,, being hoisted can be a traumatising experience for some people especially when one has to be used in cases of service users with dementia and I think all to late hoists are provided to late. While I also appreciate its seems all down to money at the end of the day, I also feel that it's sad that suitable slings aren't always readily available to suit service users requirements and often waiting for the correct sling can take far to long how can a price be put on facilities being provided for people who genuinely need them. But sadly it is.

I agree entirely Sharon.

Suzie Lloyd

Under the Care Act 2014 every person whether they are in an establishment or their own home is entitled to up to £1000 worth of equipment or adaptations to their home for their safety and comfort. This is not means tested and is available throughout the UK. (Don't tell your local authority that you know about this). The Occupational Therapist will do an assessment of needs and this is not means or situation tested.
I have carried out a costing on the disposable or single patient use slings and they do actually work out cheaper at £20 each and they do not have to be tested every 6 months you just thrown them away if dirty or 6 months old. Where as the material slings are LOLER tested, you should have 2 per person (one in use, one in the wash as they should not be tumble dried) and cost in the region of £120 each. Disposable slings come in all shapes and sizes and can be obtained very quickly from the suppliers.
In this area we have a community store where equipment is and can usually be got to a person within 24 hours.
I feel it is down to the family/carers/healthcare professionals to ask for help earlier. If a person has a condition which is degenerative i.e. cancer or dementia, then the sooner the equipment is installed the easier it is for the individual to accept it and get used to using it rather than waiting till the very last minute and having to wait possibly too long for a suitable bed etc.