Question about Hoyer Lift and Patient With Severe Muscle Atrophy

Nurses General Nursing

Published

  • Specializes in Geriatrics, Cath Lab, Cardiology,Neuro.

Hi Everyone,

I took on a HHA Case where the pt is in his 50's with a condition called Fredrick's Ataxia (I think I spelled it wrong) and he has a bad case of muscle atrophy and he is rigid all over. He's a small guy but due to his condition it seems like I am moving a 350 lb guy! I dont know if due to Medicare regs they can only pay for one aide, but he has a Hoyer lift and he has a Mon-Fri aide that does this alone, and I was supposed to be his weekend aide. Well half way thru getting his pants on in bed, my body was ready to give out, and he cannot participate in helping to roll one way or the other when it comes to putting the sling on under him for the lift. I was sweating profusely, he and I were frustrated, and my back which is shot to hell from years of wear and tear and a old injury, was sore. I had to call the agency and they in return called the EMT's to help, which ticks me off because it takes away from their real emergencies. Anyways I flat out told the agency I am NOT COMFORTABLE with this case and I told them thru my training and experience a case like this is a two person case and the use of the hoyer should be a two person thing. They understood my concern. I feel bad about this guy cuz he really needs my help, but my body even today still hurts. I have no idea how the other aide could do this SAFELY on her part and the pt's part.

My questions are:

1) Even with Medicare being as dumb as they are, is it right to have 2 aides there just for transferring but not for other things? (bed bath, wash face, mouth care, light housekeeping and feeding)

2) Is there a law (I live in Mass.) about 2 people being present when using a hoyer lift? (this guy has the old school lift and some parts are either broken, or about to break)

Thank you for letting me vent and your feedback is greatly appreciated!

hi -

not sure on legal standards with each state, but in the facility i work at, it is "facility" protocol to have 2 staff present with all hoyer transfers. now, with that said, i also know that we do have individuals that are a "hoyer" transfer, and that one aide is allowed to do basic cares as in washing their face, peri care, and similar cares.

i also know that each person is unique, in that, what works for one person may not work for all. that is why care plans exist, to provide appropriate care to all. hope this helps alittle to clarify your concerns. be well and know that you were right to call and report that assistance was needed. :yeah:

loriangel14, RN

6,931 Posts

Specializes in Acute Care, Rehab, Palliative.

I used to work in the community and cared for clients with Hoyer lifts and did it alone. I did have one man that had MS and dressing him in bed was a wrestling match. Tough work.We were trained to do the lifts solo so they did not staff two people to do the transfer. Working in a hospital we have a policy of two staff for any mechanical transfer.

rnmi2004

534 Posts

Specializes in private duty/home health, med/surg.

I had a similar situation when I did home health. My patient was rigidly atrophic and it was just me and the Hoyer. She was dead weight, but wasn't very big, and they Hoyer was in very good shape.

When I was trained on it, I was reminded that the purpose of the Hoyer wasn't to speed up transfers, but to help get them done as safe as possible to both the patient and myself. And it was slow going, but manageable on my own.

I'm thinking it's time for a new Hoyer if it's causing you that much trouble. I don't know what the rules are in each state for something as specific as how many staff are supposed to be present for mechanical transfers, but I do know that it's tough to get Medicare to pay for even one staff member. I really doubt they would pay for two. It's worth looking into. At the very least, the Hoyer needs to be replaced. Could you ask the weekday aide what kind of issues they may be having with transfers?

Specializes in Home Health, PDN, LTC, subacute.

I do Hoyer lifts solo on my patient with muscular dystrophy. It is allowed by the agency. Depending on insurance, he should be able to get a new lift ASAP if the MD writes an order. (we got one a few months ago). Faulty equipt is dangerous and your agency should know about it.

That being said, Hoyer lift patients at my LTC were 2 person assist.

I think if you are uncomfortable and unable to take care of this patient, you are doing the right thing in refusing the case.

berube

214 Posts

has physical therapy done an eval on this patient for safety?? medicare really doesnt care how many aides in on a case, it is the agency, medicare will reimburse for one, so if they send out more than one, the agency "eats" that. but your safety comes first,,,,

nkara, CNA

288 Posts

Specializes in Med/Surg/Pedi/Tele.

With home care cases a Hoyer lift is one person. With the hospital or ltc facilities it is a 2 person. If your not comfortable with this assignment the agency should place you with another case. I don't think they should endanger your safety or the patients.

WoofyMutt80

158 Posts

Specializes in Geriatrics, Cath Lab, Cardiology,Neuro.

Thank you so much for your feedback and the agency is trying to re-evaluate this pt to see what can be done. He is a small guy but due to his condition it is like moving 350 lbs! Even the EMT's said they havent seen a hoyer lift like that since they were in the Reserves! (That tells you something right there!) I am going to be placed with a client who needs companionship on the weekends. Also there is this medical staffing agency that has placed me as a Medical Assistant at a very good hospital full time, and if the practice manager likes me, she will bring me on board permanantely.

WoofyMutt80

158 Posts

Specializes in Geriatrics, Cath Lab, Cardiology,Neuro.

UPDATE: the other client I WAS PROMISED to get for a companionship case was given to another aide and I haven't heard ANYTHING from this agency since I had issues with this patient and the issues with mobility.

Morning-glory

258 Posts

Specializes in Psych, M/S, Ortho, Float..

Just my 2 cents here, but weren't those old hoyers pulled off the market? Those things are unstable and unsafe.

I have to say that ceilling lifts are the best thing since sliced bread. I like the Sara lifts too.

fuzzywuzzy, CNA

1,816 Posts

Specializes in LTC.

The old hoyers that you have to crank up so the person in it is bouncing around and someone else has to hold their legs to keep them from sliding out of it?

We still use those on some people. They give you muscles, that's for sure.

CanuckStudent

102 Posts

Not sure if I can help, but I'll try and add what I know (very little!).

-Hoyer lifts (actually ALL lifts) require 2 people where I work (Health and Safety regulations). We have strict TLR (Transfer, Lift, Repositioning) training. However, I work for a Canadian health region. The rules may be different where you live.

-Does this man have a hospital bed that you can raise so you are at least not bending over? Can he use the rails to help pull himself over? Does he have slider sheets?

-Can another aide stop by to help you get him up/put him to bed?

-Can you see if there is a newer lift that can be 'borrowed' for this client from a local agency or see if there is a way to obtain one for him from Medicare?

I would talk to your immediate supervisor first for options. Please, do speak up. Not only is this unsafe for the client(in my opinion), you are risking your back and chance of other injury. It is NOT worth it! Please, it is not worth years of pain and injury for this job. The job wont last for ever, but there is a very good chance that your back pain will. You are doing the right thing by questioning this.

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