Focus On…Baths & Lifts

The miracle of lifting technology

Retired administrator Joe Jolliff continues to advocate for “no-lift” policies in nursing homes

Because of those injuries, Jolliff decided that enough was enough. Not only did he want to prevent harm first and foremost, he wanted to reduce the costs that injuries incur. Seeking to find out what the facility was doing wrong, he asked a representative from the Ohio Bureau of Workers’ Compensation (OBWC) to observe the facility’s moving, transferring, and repositioning procedures. “Joe,” the rep said, “you’re just like other nursing home administrators. You expect staff to keep people from falling. You expect them to lift people who might weigh anywhere from 200 to 300 lbs, and you don’t appreciate your staff.” This criticism got Jolliff’s dander up, and after the OBWC representative left he told the director of nursing, “This woman has a screw loose.” But, Jolliff reflects, “If she hadn’t made me so mad, I might never have done the research that led to remarkable results and the miracles we’ve experienced.”

Back in the mid-1990s, very little research on no-lift technology was available in the United States, so Jolliff searched the Internet and studied the results of interventions that were instituted in Sweden and Germany. For Jolliff, this information provided some relief; he now understood why staff were sustaining injuries, and he knew that he had to take WCNH in a new direction-away from manual lifting. “After I decided to initiate a ‘no-lift’ policy, I attended a seminar and saw my first sit-to-stand lift,” says Jolliff. He arranged to have the lift brought to WCNH so that staff could have a chance to operate it and experience its benefits firsthand. “Staff were reluctant to try it,” he says. “They said that they were ‘too busy.'” Although the manufacturer left the apparatus in place for a week, staff still didn’t try to work with it and it was returned. “At that point, I had to go back to the old system and form a committee,” he notes.

Jolliff posted a sign-up sheet for potential committee members, but he didn’t think there would be much response. To his surprise, 30 people wanted to participate. The selected committee was composed of nurses and nursing assistants representing each shift. They were given the research material that Jolliff had collected, and he urged them to gather more information. “At that time, there weren’t any forms or procedures to use as a prototype for our policy,” says Jolliff. Nevertheless, the committee took a look at the equipment available and made its final selections. “I stayed out of the decision-making process because, after all, these are the people who will be using the equipment.”

By 1997, staff-selected sit-to-stand lifts and total lifts (portable sling-type lift devices equipped with universal/hammock slings or band/leg slings) were in place. “Along with this equipment,” says Jolliff, “we started stretching exercises for our nursing assistants before the start of each shift.”

Every few months, Jolliff would meet with staff to find out where they were still having difficulties in moving, transferring, or repositioning residents. “In 1997, staff also told me that walking some residents was very difficult, so mobile lifts that would help a resident ambulate were added to our program,” he says.

In 1998, an OBWC grant program provided $40,000 in funding if the facility added $10,000 to that amount. “I didn’t want to miss out on that,” Jolliff says, laughing. The bureau recommended using fast beds-i.e., beds that go from high to low position in 20 seconds or less-and that’s where WCNH wanted to invest the grant money. However, there weren’t any such beds on the market, according to Jolliff. Of course, this tenacious administrator wouldn’t let that inconvenience stop him. He contacted a bed manufacturer and worked with the manufacturer for more than a year to develop a 20-second fast bed for his facility. The fast beds were in place at WCNH by April 2000. Research has proven that any electric bed is better than a hand-cranked bed for staff and resident safety. “Although it doesn’t sound like a long time,” says Jolliff, “an electric bed that takes a full minute or more to raise or lower, that is a long time for a nursing assistant to wait to begin care.” When a fast bed is used, the bed is already at a working height by the time the resident is told what he or she has to do. “Fast beds reduced our turnover more than all the other equipment combined,” says Jolliff.

Research conducted in 1999 by William S. Marras, PhD, at Ohio State University concluded that there is no safe way to manually handle residents. Statistics indicate that the lifting, bending, and stretching that nurses and nursing assistants do in the process of moving a resident cause damage to the spine and impede blood flow. Staff become exhausted, are weakened, and are prone to injury.

“We invested $116,000 on equipment to outfit the facility,” says Jolliff, “and all the original equipment is still in use 10 years later. With the savings realized from decreased turnover and an injury-free environment, we’ve been able to add additional equipment. Today, every bed at WCNH is electric and 90% of them are fast beds,” he says proudly.

Residents were cautious when lifting devices were installed. No one was forced to use them, but many were willing to try. “Even residents with Alzheimer’s went along with the idea after I demonstrated how safe the devices were by jumping around and acting silly,” comments Jolliff. One male resident wasn’t comfortable with the idea. He had a muscle disorder that made lifting painful and uncomfortable. “To help this resident, we installed our first ceiling lift,” says Jolliff. Previously, it took up to four aides to handle him and, naturally, it caused the resident pain and discomfort. He was shown videos on the device, and he was willing to try it out. For the first time in years he could sit in the bathroom and have privacy. “It made a new man out of him,” says Jolliff. Using the ceiling lift, he could be put on his scooter, secured, and travel all around the facility.

Along with the “people” benefits, WCNH has also reaped rewards. Jolliff states that when floor lifts were installed in 1997, staff turnover dropped from 73% to 50% and remained at that level until fast beds were added in 2000. “At that point, our turnover dropped to 5%. Today, it fluctuates between 5% and 15%,” he says. With no injuries in 10 years from moving, transferring, or repositioning, workers’ compensation claims have virtually disappeared. That original $116,000 investment has created a savings of more than $100,000 per year in just workers’ compensation claims. “If you add in other factors such as staff retention, less sick time, and overtime, the total savings are more than $400,000,” he adds.

Jolliff has seen firsthand what miracles a no-lift policy can create. When staff turnover is reduced, the quality of care skyrockets. “I’ve been told by staff that the equipment makes their jobs easier. Husbands have thanked me for their ‘new wives,’ who go home with more energy because we aren’t asking them to do more than their bodies can do.”

Jolliff may be retired from his work at WCNH, but his legacy remains. His successor, former WCNH Administrator Bryon Eshelman, has acknowledged that he inherited one of the most technologically advanced facilities in the country. He says: “From fast electric beds to sit-to-stand lifts to the ceiling lifts, we are completely manual lift’free…. My first day here Joe demonstrated using me as a guinea pig. I am not your normal resident. I stand 6’2″ and weigh 365 lbs. Joe lifted me up out of bed, moved me completely across the room, and dropped me like a skilled fly fisherman right onto the toilet. I was impressed. I was hooked. Joe Jolliff left me one of the most technologically advanced facilities in the country, and I love it! Joe is the ambassador. I’m the disciple.”

Medcare Disposable Slings have a breaking strength of 1,650 lbs, are 100% breathable, and may be left under a resident. They may also be used for bathing or in a pool and will not fall apart when wet. In addition, they can be spot-cleaned or spray disinfected. Medcare Disposable Slings fit 2-, 4-, and 6-point spreader bars, including keyhole openings, and they are available in bariatric sizes.

The Extended Reach Lavatory Faucets meet the latest plumbing codes, are ADA-compliant, and are easy to install. They are backed by a five-year warranty against materials or manufacturing defects.

The CAMEL packs away neatly into a lightweight, compact bag, making it easy to transport wherever it will be used, indoors or out. The CAMEL can be used by individuals without assistance, reinstating independence for those prone to falls.

Niagara’s reservoir tank fills automatically in five to eight minutes as the resident is being prepared for the bath, which allows for quick immersion to preserve resident dignity and comfort. The Niagara tub also features an anti-scald device that accurately measures the bathwater temperature and automatically shuts off the hot water if it gets too hot.

With an easily removable footplate, the Reliant 440 can also be used for gait training as well as standing therapy.