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Making the Case for a Safe Lifting Program in Nursing Homes

Investing in mechanical lift equipment for the safe lifting and movement of nursing home residents can cost tens of thousands of dollars, depending on the number of residents in your facility. But research conducted by the National Institute for Occupational Safety and Health (NIOSH) and other agencies concludes such an investment pays for itself in short order.

NIOSH, in its guide titled Safe Lifting and Movement of Nursing Home Residents, notes a 100-bed nursing facility can expect to spend $25,000 to $30,000 on portable (not ceiling-mounted) mechanical lifts. For an"effective combination" of floor and ceiling-mounted lifts, a 100-bed facility might expect to spend $50,000 to $60,000. Fortunately, NIOSH explains, there's a strong case for making such an investment.

The NIOSH guide, which was issued earlier this year, references a study the agency conducted that looked at injuries among 1,728 nursing personnel at six nursing homes over a six-year period. As part of the study, the six nursing homes which ranged in size from 60 to 120 beds took part in a "best practices intervention" that included the implementation of: mechanical lifting equipment and re-positioning aids; worker training on the use of the lifts; a medical management program; and a written zero-lift policy.

Researchers compared the injury rates, workers' compensation costs and lost and restricted workday rates for the three years before the best practices intervention and the 3 years after the best practices intervention.

The researchers found that "a safe resident handling and movement program significantly reduced the rate, severity and cost of injuries to caregivers associated with lifting and moving residents." The study was detailed in an article in Injury Prevention magazine titled "An Evaluation of a 'Best Practices' Musculoskeletal Injury Prevention Program in Nursing Homes."

"The initial investment of $158,556 for lifting equipment and worker training was recovered in less than three years based on post-intervention savings of $55,000 annually in workers' compensation costs," the authors concluded.

Other quantifiable improvements in worker safety, according to NIOSH, included a 61 percent reduction in resident-handling workers' compensation injury rates; a 66 percent drop in lost workday rates; and a 38 percent decline in restricted workdays.

Also, the rate of post-intervention assaults during resident transfers was down 72 percent based on workers' compensation claims, 50 percent based on OSHA 200 Logs and 30 percent based on first reports of injury data.

According to the NIOSH guide, other benefits of safe resident lifting programs include increased caregiver job satisfaction and morale; increased comfort and feelings of security among nursing home residents; and a reduction in the number of injuries to residents because mechanical lifts protect residents from being dropped.

Is Training Enough?

It's hard to dispute the assertion that lifting and re-positioning nursing home residents puts caregivers' backs and bodies at risk. According to the Bureau of Labor Statistics, caregivers in 2003 suffered 211,000 occupational injuries. Due to the aging of the U.S. population, the demand for nursing care workers is expected to increase over the next few years and, consequently, so is the number of musculoskeletal injuries suffered by caregivers.

"Factors that contribute to the difficulty of lifting and moving a resident include the size and weight of the resident, combativeness and propensity to fall or lose balance," the NIOSH guide explains. "In addition, performing resident transfers in the confines of small bathrooms and rooms cluttered with medical equipment and furniture works against the caregiver being able to use good body mechanics."

For those who believe training caregivers on body mechanics alone is an effective strategy to prevent injuries associated with handling nursing home residents, NIOSH's James Collins tells "You can't train the problem away."

"If you have no mechanical lifting equipment, you cannot train somebody to bend their knees and keep their back straight and so on and safely lift the types of loads expected to be lifted in nursing home environments," says Collins, who is the associate director for science in NIOSH's Division of Safety Research in Morgantown, W.Va.

The NIOSH guide explains it this way: " … Training caregivers on how to use proper body mechanics to lift residents is not an effective prevention measure, because lifting the weight of adult patients is intrinsically unsafe."

The NIOSH guide also points out that the effectiveness of back belts to mitigate the risk of back injuries "remains unproven and may give workers a false sense of security."

Instead, NIOSH advocates a safe resident lifting program that includes three main components:

  • Mechanical lifting equipment;
  • Worker training on the use of the equipment; and
  • A written resident lifting policy.

The NIOSH guide discusses a number of aspects of safe resident lifting programs that typically raise questions, including ways to motivate staff to use lifting equipment; training; best practices for the effective implementation of a safe resident lifting program; and convincing recalcitrant residents to agree to be lifted by mechanical lifts. The guide is available on NIOSH's Web site.

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