Safe patient handling/transfers in homecare

[Iphonenurse13]

Hello nurses, I'm just curious to know how those of you employed in the homecare setting handle safe patient transfers. We have a patient in our agency who is total care and non-weight bearing. She receives a visit from 2 CNA's daily (simultaneously). During this visit, they initially transfer from the bed to the bedside commode for toileting, then back to bed for the bath. After the bath, she is then lifted into the wheelchair to be fed. After feeding, she is then lifted back to bed. The caregiver is insistent on the transfers being done, and refuses to allow a Hoyer lift to be used for the patient. I should also add that this patient is not "lightweight". Burnout and injury among the CNA staff is a real concern. What are your thoughts on this situation, particularly in regards to staff rights regarding back safety, especially in light of the caregiver's refusal of a Hoyer lift?

[chrisrn24]

I'm not too familiar with home care...does she have to buy the lift or is it covered by insurance?

[Iphonenurse13]

I'm not too familiar with home care...does she have to buy the lift or is it covered by insurance?

It is covered by the insurance.

[nursel56]

Every agency I worked for gives us OSHA handouts regarding what type of physical activity will be expected on the job, and details what basic safety measures we have a right to expect even though we are in someone's home. If a two-person transfer isn't safe based on the lady's weight/mobility they should not do it, no matter what the caregiver says.

I wonder why the caregiver is calling the shots there. Is she a family member?

[QualityNurseRN]

I'm surprised the home care company does not require that a hoyer lift be used for patients over a certain weight. Many healthcare organization's workman's comp insurance companies are insisting they start incorporating safe lifting practices into their workflows- overhead lifts in hospitals, turning teams, etc. The CNAs absolutely have a right to insist on having the right equipment to do their job safely. I am not sure where to refer you to - perhaps OSHA? The other thing is, we're not just talking about staff safety here. What if these CNAs were to drop the patient due to a back strain or other injury? They need to insist on having the right equipment.

[Iphonenurse13]

Every agency I worked for gives us OSHA handouts regarding what type of physical activity will be expected on the job, and details what basic safety measures we have a right to expect even though we are in someone's home. If a two-person transfer isn't safe based on the lady's weight/mobility they should not do it, no matter what the caregiver says.

I wonder why the caregiver is calling the shots there. Is she a family member?

Yes, caregiver is next of kin.

[jeannepaul, BSN]

it sounds like this company is not standing up for their employees. I do Home Hospice and when I am doing an admission, I flat out tell the family if the patient cannot bear weight, or help in any way in the transfer, our CNA will NOT even attempt it. It will be a bed bath, for safety of both CNA and patient. We do not supply hoyer lifts and if the family has one, they have to be present and be trained in using it. Never use a hoyer with just one person.

They do no always like it, but I do not give them an option, safety comes first. I also tell the family to always use 2 people to change, or reposition pt. I tell the cna's to have family help with turning of pt if they are physically able.

[jm_emt]

I am wondering if most home care agencies who are often paid by private insurance or Medicare (whether in Hospice or not) would pay for two CNAs to take care of a patient at home. Does anyone have experience in reimbursement for such a patient?

It seems like they might refuse to pay for anything beyond one CNA for home visits.