HOYER LIFTS AND RESIDENT SAFETY
By Roger J Leslie
Nursing home staff use mobile mechanical hydraulic lifts to transfer disabled residents from their bed to a wheelchair and back, or to reposition the resident, or to aid in toileting or bathing. When elderly or vulnerable adults fall from a lift, the injuries are often life threatening. Injuries include fractures of the skull, pelvis, leg, shoulder, arms, and hips as well as brain injuries.
Mechanical lifts are named after one of the first companies to manufacture them -- Hoyer. The original patent identified the lift as an “automotive engine hoist,” but the design was adapted by the addition of a sling to lift patients. The lifting mechanism may be operated manually or with a battery powered motor. Nursing homes and hospitals employ Hoyer lifts to reduce on the job injuries to their staff members and their associated costs of workers’ compensation claims. When used properly by trained staff, Hoyer lifts that are in good working order benefit residents as well.1
A Hoyer lift can safely lift a maximum of 400 to 700 pounds and aid the transfer of residents on the lift’s set of four wheels. Physicians generally order two person assists when using a Hoyer lift. One person is required to operate the machine and the other assists and guards the patient against injury. In instances of negligent operation, the machine may tip over with the resident in it or a loop on the sling may dislodge from the machine causing the resident to fall to the floor. The second person is there to prevent serious injury to the resident. Residents sometimes become agitated and a second person should be there to help stabilize them in the sling. The battery may lose power during a transfer. A second person can go get another battery while the first person stays with the resident.
Operators of Hoyer lifts must follow an established protocol. The Federal Drug Administration (FDA), the National Institute for Occupational Safety and Health (NIOSH), and Hoyer lift manufacturers provide written protocols for operation of Hoyer lifts. Failure of nursing staff to do any of the following is medical malpractice and neglect under the Vulnerable Adults Statute because the offending staff member shows a “serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult’s health, welfare, and safety . . .”2
1. Check resident’s condition.
2. Be sure the sling is of the proper size based on the resident’s measurements.
3. Be sure the sling is appropriate for the patient’s condition and provides head support, back support.
4. Prepare the area where the lift will be operated.
5. Clear a path for the lift – there is enough space for the lift to pivot and move to the receiving area (wheelchair, bathroom etc).
6. Examine sling for damage (holes, fraying, tears). Do not use a sling with any sign of wear.
7. Place resident in sling and confirm the sling properly fits the resident.
8. Ensure straps use matching loops, loops are secure, straps not twisted, resident’s head and back are supported.
9. Lift the resident 2 inches off the bed and Check that the straps are in the hooks and that the guards on the hooks confine the straps against disengagement.
10. Check that patient will not slide out of sling or tip backward or forward.
11. Raise resident to the height necessary to clear the bed.
12. Use hands-on pressure to guide resident as the operator slowly moves the lift.1
Failure of nursing home staff to follow the steps listed above are common causes cited by investigators from DSHS for severe injuries and sometimes death suffered by residents who fall from Hoyer lifts. Often the fall is caused by a strap on the sling becoming detached from the hooks on the lift. Straps can release because the nurse or nursing assistant did not lift the resident clear of the bed. As the resident is moved off the bed, they are dragged creating slack in the straps, which causes a loop in the strap to become unhooked dropping the resident to the floor. A strap or sling may fail because it is worn or damaged. The nurse or nursing assistant must not use a sling that shows any signs of damage or wear.
Nursing home staff should never move a patient who is agitated or uncooperative unless additional staff members are available to help. In some cases, the order will be for a three person assist for morbidly obese residents or for residents with dementia.
The area around the bed must be clear of obstructions. Even small objects can cause a lift to tip over and injure the resident or the operator of the lift.
The base legs of the Hoyer lift can be spread apart to increase the stability of the machine. The legs are sometimes moved closer together to allow them to fit under the bed. The legs should be in the more stable spread position whenever possible to avoid tipping.
Understaffing of a nursing home may lead to negligence in the use of Hoyer lifts. Hoyer lifts usually require a two person assist. Look for physicians’ orders for a two person assist for a resident. The common reason for violation of the physician’s order is that a second staff member was not available because they were at lunch or busy elsewhere. A one-person transfer accident where a second staff member was not available is evidence of understaffing.
Sometimes a staff member will attempt to move a resident without using the Hoyer lift at all. Failure to use a Hoyer Lift where ordered is often caused by understaffing. The nurse or nursing assistant are so over-worked that they are rushed and don’t take the time to find a Hoyer lift. Similarly, a failure of the facility to have enough working Hoyer lifts may lead the staff to take short cuts that endanger the residents. .
Hoyer lifts play an important role in avoiding pressure ulcers by repositioning the resident regularly. A resident who is left in his wheelchair too long is at risk of developing ischial pressure ulcers. A resident who is not turned in bed often enough is at risk for a sacral pressure ulcer. Hoyer lifts are sometimes used to help turn obese residents. The important duty to reposition a resident is impacted adversely by inadequate staffing to operate the Hoyer lift safely.
Nursing homes sometimes either fail to maintain their Hoyer lifts or keep them beyond the lift’s useful life. A lift with a bad wheel can tip. Failure of the hydraulic lift or an electric motor can be problematic. An attorney representing an injured resident or their family should request the maintenance records for the Hoyer lifts in the facility. She may find that there is no maintenance record, which raises the question of whether regular maintenance was done at all. A letter should be sent to the facility giving notice of pending litigation and requesting that the Hoyer lift be preserved for inspection.
The injuries to a resident from a fall from a Hoyer lift can be severe, particularly when the resident is elderly. Older people are at higher risk of brain injuries because of the loss of brain mass due to aging. A fall to their head causes the brain to move and collide with the skull and often results in intracranial bleeding including subdural or subarachnoid hemorrhage. Elderly patients who need the help of a Hoyer lift are often not able to reflexively guard against injury when they fall.
Hoyer lift accidents often result in broken bones, such as hip, pelvis, arm, and leg fractures. The one-year risk of death after a fracture in individuals greater than 50 years old (hip, wrist, humerus, clinical spine, ribs or pelvis) was 3 times greater when compared to the general population.3 Significant for nursing home cases, advanced age and additional health issues more common in geriatric residents. The risk of 30-day mortality following a fracture increased 7.19 times in residents with fluid retention in their abdomen (ascites) caused by cancer, cirrhosis of the liver, or congestive heart failure.4
When a resident is taken to the emergency room with a fracture, the nursing home staff may deny knowing what happened to the resident. Fortunately, most falls from Hoyer lifts are witnessed by other residents in the nursing home. The defendant may describe the fracture as an unavoidable “fragility fracture,” which is a fracture that can occur during ordinary movement in a resident with brittle bones or osteoporosis. In most falls from a Hoyer lift, the patient will suffer fractures that show signs of an impact. The fractures may be compound or comminuted, which are characteristics of high impacts. Plaintiff should counter such a defense by contacting the emergency room physician for her evaluation of the probable cause of the fracture.
The defense may allege that the resident was uncooperative or agitated or combative at the time of the incident. Remind the defense counsel that the nursing home staff has a duty not to place an agitated resident into a Hoyer lift sling. In this regard, always request the facility’s policies and procedures for transferring residents by Hoyer lifts and for caring for residents who are difficult to control. Remember, the facility’s policies and procedures are required to be made public under Washington law.5
Roger Leslie is an eagle member of WSAJ and Co-Chair of the Nursing Home Litigation Section of WSAJ. His practice focuses on nursing home negligence and medical malpractice cases. He practices from the Law Office of Roger J Leslie.
1 Patient Lift Safety Guide, FDA, https://www.fda.gov/media/88149/download, 8/22/18..
2 RCW 74.34.020(16).
3 Klop, C. et al., “The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location and ethnicity” Osteoporos Int. (2017) January ; 28(1): 161–168.
4 Dodd, A.C., et al., “Predictors of 30-day mortality following hip/pelvis fractures”, Orthopaedics & Traumatology: Surgery & Research 102:707–710 (2016).
5 WAC 388-97-1780 and RCW 74.42.430.
Trial News, WSAJ, v. 55, No. 4 January 2020