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What are your/your agencies polices about lifting?

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by nursenmom3 nursenmom3 (Member) Member Nurse

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Sorry, I feel like I've taken over the forum with my questions!

My son will have surgery on his feet at some point in the coming months, and for a period of time afterwards will be completely non-weight bearing.  He's got pretty severe arthritis in his hands and wrists as well, and can't bear a lot of weight on them either, definitely not enough for him to transfer himself.  On the other hand, he's not a kid with significant tone issues that make him harder to lift.  He's able to follow directions and cooperate with a transfer.  He weighs 38 lbs right now, but we're working hard on gaining weight, so let's assume he's somewhere under 50 lbs.  He uses a wheelchair and we have a ramp, a first floor bed/bath for him, and a roll in shower and a rolling shower chair/commode, so the transfers he'd need would be from bed to shower chair, from shower chair to wheelchair, from wheelchair to couch, from wheelchair to toilet etc . . .  

What are your agencies' rules or your personal preferences for transfers for a kid like that?  Do you feel comfortable lifting from one to the other?  Would you expect something mechanical to help?  I'm just wondering what to prepare for.  

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Based on what you have posted, you should have no problem finding a nurse, or nurses, who are able to deal with the transfers.  It is when the patient weighs more than 100 lbs and there is no lift available in the home or the family is not there to help with a two person transfer, that you start to have problems finding nurses.  The policy from my agencies in the past has always stated no more than 40 lbs, unassisted.  However, no agency has ever effectively dealt with weight problems when they arise, yet they are quick to remind the nurse that they have to follow policy or they will be out in the cold should they suffer a back injury.

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

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One of my agencies states that if I lift more than 40 pounds without using a mechanical lift, workman's comp will not cover me if I'm injured.

It sounds like your son's mobility is not going to improve a lot as he gets older. If a lift will be necessary down the road, why not get it now? It will save wear & tear on your back. As a nurse, you know that back problems can follow you for life.

And yes, I always use a lift when one is available.

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1 minute ago, Kitiger said:

One of my agencies states that if I lift more than 40 pounds without using a mechanical lift, workman's comp will not cover me if I'm injured.

It sounds like your son's mobility is not going to improve a lot as he gets older. If a lift will be necessary down the road, why not get it now? It will save wear & tear on your back. As a nurse, you know that back problems can follow you for life.

And yes, I always use a lift when one is available.

Actually, the hope is that the surgery will make a big difference in his mobility.  Right now, he can stand to assist with a transfer, walk short distance (in pain, but he chooses to do so pretty regularly).  The hope is that he'll, at a minimum, be able to do those things with less pain, but it's possible that he'll be walking a lot more afterwards.  However, there will be a period of a few months where it gets worse before it gets better, which is why I'm trying to figure out what's needed in that window.  

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

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Can you rent a Hoyer lift?

 

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2 minutes ago, nursenmom3 said:

Actually, the hope is that the surgery will make a big difference in his mobility.  Right now, he can stand to assist with a transfer, walk short distance (in pain, but he chooses to do so pretty regularly).  The hope is that he'll, at a minimum, be able to do those things with less pain, but it's possible that he'll be walking a lot more afterwards.  However, there will be a period of a few months where it gets worse before it gets better, which is why I'm trying to figure out what's needed in that window.  

I just wanted to add that this doesn't mean we can't ask to rent a lift for the period.  

 

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4 minutes ago, Kitiger said:

Can you rent a Hoyer lift?

 

If I need to, my guess is that Medicaid or insurance would cover it, although I haven't asked.  I might also be able to ask for things like a different wheelchair or shower chair with a removable arm so he could use a sliding board. 

A Hoyer is a huge piece of equipment, and space is at a premium for us, so while I'm open to the idea, the question is whether nurses would actually use it.  As a parent, my guess is that I wouldn't use it. When my other kids were his weight they were around 4, and I was still lifting them in and out of the tub, and into their carseats, and onto my shoulders so they could see something, and carrying them upstairs when they were sleepy.   Clearly, I'm not asking a nurse to do any of that, because those are mom things, but I'm not sure whether asking them to lift from a seat to a seat immediately next to it, is reasonable.  

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Kitiger has 40 years experience as a RN and specializes in Pediatrics.

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A Hoyer lift can store over the bed, or over the footboard of the bed. The floor does need to be clear under the bed, which is too bad, because it's handy to store things under the bed. Sometimes vertical space in the closet can make up for some of that.

I know all about tight spaces in small bedrooms.

Talk to your physical therapist; there may be a different way to safely transfer him.

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2 hours ago, Kitiger said:

A Hoyer lift can store over the bed, or over the footboard of the bed. The floor does need to be clear under the bed, which is too bad, because it's handy to store things under the bed. Sometimes vertical space in the closet can make up for some of that.

I know all about tight spaces in small bedrooms.

Talk to your physical therapist; there may be a different way to safely transfer him.

It's not about space when it's not being used, as much as space when it is being used.   For example, right now if he has to go to the bathroom when he's in bed (continuous overnight feeds make this a pretty common occurrence), we just pull up the commode chair to the side of his bed, so it's a 2 minute procedure that doesn't involve disconnecting anything.  With a lift it would be way more complicated.  Doable?  Yeah, we could problem solve it and if he was 100 lbs and keeping it home was on the line we'd do it in a heartbeat, but I can also see setting up the whole thing and having the nurse decide that it's easier to lift him for the split second that it takes than to deal with the lift.  Similarly, we'd need to completely rearrange the living room in order to use a lift there. 

I'll definitely talk to his PT, and if we get any kind of consistent nursing care, I'll talk to them.  I'm just wondering what other PDN have found works for kids in this range.  I have trouble believing that there's not something between just picking them up at 39 lbs and a full Hoyer lift at 40.  

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I just wanted to add that all my experience with lifts has been with hospitalized adults, which is a very different situation.  Easier in some ways because the spaces are designed for it, but also more necessary, because of patient size.  So, maybe I'm overestimating the challenge?  

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What about a ceiling lift with a track? Other than that, what you are asking doesn't seem unreasonable. If he's able to help with the transfers (i.e. being able to stand like you've said) that makes a huge difference. It sounds like you've got a good set up for him (downstairs room, walk in shower and shower chair etc). 

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50 minutes ago, Crystal-Wings said:

What about a ceiling lift with a track? Other than that, what you are asking doesn't seem unreasonable. If he's able to help with the transfers (i.e. being able to stand like you've said) that makes a huge difference. It sounds like you've got a good set up for him (downstairs room, walk in shower and shower chair etc). 

I don't know if we could get Medicaid to pay for a ceiling lift, both because we'd need to argue that he needs it long term, which would be hard because we're simultaneously ask them to pay for the surgery on the grounds that it will help him walk, and because looking at the information about the waiver he's on, it seems like they might consider the tracks to be a "home modification" and we spent right up to the cap for that modifying the downstairs bathroom, and putting in a ramp. 

In addition, in every setting I've ever worked in, the rule has been 2 people to use a lift like that.  I know that home care is different, but it would still take me some time to wrap my mind about feeling safe with someone I don't know well putting my kid in one by themselves.  I imagine that if someone has been with him for a while, and we have a relationship, I might come to feel differently, but right now the thought kind of freaks me out.  He has pretty severe osteoporosis so a fall has the potential to be a very bad thing.  

I posted about this on the General nursing forum and someone suggested something called a Rifton TRAM which actually looks like it could work really well.  So, I'm going to ask his P.T. about that. 

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