There are three basic ways to bring technology to bear on the problem, and each method has seen significant advances develop in recent years. Their purposes are to:
1. Eliminate the need for high-risk transfers altogether. We have seen, for example, the development of furniture that can be transformed to serve different purposes at different times. A particular example of this would be beds that can be converted into chairs and back again. These are used primarily in acute care, but I would hope that this technology could be integrated into beds that are appropriate in the long-term care environment. Fairly recently introduced into the long-term care environment are devices that provide automated rotational, or turn-assist, therapy for bedridden residents, repositioning them as needed. Technologies such as these should be closely investigated for their ability to prevent residents and staff from having to undergo transfers. 2. Redesign mechanical lifts. Probably the chief innovation we have seen in this area is the adoption, particularly in Europe and Canada, of the ceiling-mounted lift. This device addresses two problems: the need to find a lift when and where you need one, and the need to push floor-mounted lifts from one place to another, sometimes over and around dangerous obstacles. Strategically positioned, the ceiling-mounted lift is designed to be available when and where you need it.
Even the positioning of such lifts is no longer a problem with the development of track-mounted lifts with attachable/detachable motors. Particularly when using so-called H-track grids, these lifts can serve virtually any area in the facility you wish by simply attaching the motor to the appropriate lift. The basic cost of installing a ceiling-mounted lift is comparable to that of the traditional lift-about $2,000 to 5,000 a room. However, with the detachable motor approach, that cost could conceivably be reduced to less than $2,000 a room. These advantages have become apparent enough for Canada, for example, to mandate the installation of such lifts in nursing facility renovation and new construction.
Traditional floor-mounted lifts have also seen significant improvement, particularly in the slings they use. Today's slings are more comfortable, have a greater variety of uses-for example, bathing slings-and have safer, more sophisticated attachments. The downside remains that the slings still have to be positioned underneath the resident whenever a transfer is needed. It would be helpful if slings could be developed that the resident could "wear" for extended periods of time without pressure-relief concerns.
3. Minimize risk by using new assist technology. An example here would be the new gait belts with handles that permit the safe assist of a resident who retains some weight-bearing capacity. Another example would be the friction-reducing transfer sheets that allow safe and relatively easy lateral transfers from bed to chair, and so forth. These sheets, using extra-long handles, can also be used to reposition a resident in bed-for example, if the resident has managed to slide uncomfortably toward the foot of the bed, which is a high-risk situation for the caregiver attempting to reposition the resident. The sheet can be used to slide the resident back into proper position with minimal strain.
All of these developments are based on very simple concepts. But they need to be discussed, addressed and used by enlightened facilities to achieve our goal of transfers that are as safe as possible for residents and staff. NH
Guy Fragala, PhD, PE, CSP, is director, Department of Environmental Health and Safety, University of Massachusetts Medical School. For further information, phone Dr. Fragala at (508) 856-6741 or fax (508) 856-3623.