There are inherent risks of job-related injuries for hospital and nursing home health care workers and now, with the increasing number of caregivers in the home environment, these risk factors have expanded to the domestic arena.

According to government statistics, the most prevalent workers’ compensation claims among health care workers are due to musculoskeletal injuries with the majority of injuries to the lower back, and with the neck, shoulders, arms, wrists, and legs also at risk. These back injuries include low back pain, herniated discs, strained muscles, pulled and/or torn ligaments, and disc degradation (a disorder where discs break apart due to excessive strain).

What makes these findings especially important to providers of lifts used in homes is that the danger of these musculoskeletal injuries is not limited to health care workers. More than one quarter of all Americans, or 54 million people, are now shouldering the task of caring for someone who is older, ill, or infirm—and that number is growing. Providers and recipients of health care increasingly demand treatment protocols and independent living in the home environment for reasons such as:

• Outsourcing of care for quality and economy.
• Innovative treatments that allow self-administration of care.
• The emergence of the informed patient and consequent erosion of the traditional authority structure of health care.

As a result, the problem of musculoskeletal injuries spreads to the home environment. Caregivers who must lift, position, and/or transfer the homebound patient risk overexertion, which causes sprains and strains. Lifting the bed-bound patient creates an additional risk. Caregivers are unable to use their leg muscles because they are leaning over the edge of the bed. They have no choice but to use their back muscles to lift the patient, which exposes them to the three main back-injury risk factors:

• Force: The effort it takes to lift, move, or reposition the patient.
• Repetition: How often the movement must be performed.
• Awkward positions: Lifting or doing other tasks while the body is in a twisted, bent, stooped, or other position that puts a strain on muscles and joints.

“Lifting patients is not a trivial task,” says William Marras, professor of industrial, welding, and systems engineering, and physical medicine and rehabilitation at Ohio State University in Columbus. “This activity presents very significant risks, and anything we can do to sidestep those risks is worthwhile, because one of the problems with back injuries is that you don’t get much early warning. Typically, by the time you feel the pain, it is too late.”

Researchers at Ohio State University estimate that when caregivers lift patients by themselves, their movements appear about 98% similar to those of workers at high risk for developing lower back disorders. The researchers found that caregivers experienced the most stress when they worked alone to reposition the patient on the bed. The second highest level of stress occurred when one person worked alone to lift the patient out of the bed.

Interestingly, the study also showed that when two people shared the task of lifting and moving the patient, they did little to lessen their load. Two people repositioning the patient together still mirrored high-risk movements by about 88%; two people lifting the patient together still maintained a similarity above 78%.

The moral of the story, according to Marras, is that changing the way people lift does not seem to control the risk in these situations. “We are going to have to get lifting devices to help workers transfer patients,” he says. “That way, the workers help, but they are using a machine, not moving the patient directly. Those will be the kinds of measures that will significantly lower the risk of back injury.”

The Real Value of Lifts
While Marras notes that the cost of a patient lift is significant, he says it is necessary to mitigate the high cost of back injuries. “A back injury can cost as much as $50,000, and that’s not even including all the indirect costs.”

In the home environment, these indirect costs can become especially significant. Should a back injury incapacitate a primary caregiver in the home environment to the extent that they are no longer able to perform caregiver tasks, the patient they are caring for may then be forced into an institutional environment, which greatly increases the costs relative to the back injury.

The solution lies in the use of a patient lift in the home environment. This portable lifting device is suitable for those patients who are unable to make independent transfers. Routinely, the patient is moved onto a suspended polyester-nylon fabric or mesh sling with straps that adjust the patient to a seating position. The sling may be solid or may offer divided legs or a commode opening based on patient/caregiver preference and/or toileting needs. A hydraulic or mechanical jack provides the lifting power. Height ranges allow the patient to be picked up from the floor or high surfaces and safely transferred between a bed and a chair, wheelchair, or commode.

But simply providing a lift is not enough to properly care for a mobility-impaired individual. Prior to dispensing a patient lift, the supplier should assess the patient to determine that the right lift and sling are being provided. In addition, given what we know about how a caregiver injury can impact a patient, the supplier should also evaluate the caregiver to determine if he or she is capable of safely operating the lift as well as provide thorough training in the proper and safe use of the equipment. A caregiver must be able to:

1. Move the patient lift to bedside and place a comfortable chair in a convenient location.
2. Raise the bed to working height.
3. Turn the patient to the side and place the sling from head to knees.
4. Instruct the patient to keep his or her arms crossed over the body.
5. Position the patient lift with base spread under the bed.
6. Attach the lift chains to the sling.
7. Adjust the sling to evenly distribute the patient’s weight.
8. Raise the lift to elevate the sling enough to clear the bed.
9. Guide the patient’s legs over the side of the bed while protecting the patient’s head and extremities from injury.
10. Check the position of the chair and guide the lift over so the patient will be positioned appropriately.
11. Release the lift valve slowly, lower the patient into the chair, and release the lift chains.

If the caregiver cannot complete these tasks, providing the lift is not meeting the patient’s needs.

Funding Lifts
Lifts are one of the few product categories where Medicare considers the needs of caregivers. According to Medicare guidelines, a hydraulic patient lift may qualify for reimbursement if transfer between a bed and a chair, wheelchair, or commode requires the assistance of more than one person and, without the use of a lift, the patient would be bed-confined. An electric lift mechanism is considered a convenience item, and is not covered under Medicare. Payment for the required sling is included in the initial reimbursement or rental payments received for the patient lift, but a replacement sling for the original may be submitted to Medicare for reimbursement if the original sling is worn or damaged.

While a patient lift does not require a certificate of medical necessity (CMN), the supplier must obtain an order that has been signed and dated by the physician and that meets the Medicare criteria for a physician order. In addition, the physician’s records should contain information that supports the medical necessity of the use of a patient lift.

Private insurance carriers, as well as workers’ compensation carriers, will frequently approve this item as a purchase. In addition, these same payor sources may offer separate reimbursement for the sling. The supplier should determine the payor source’s reimbursement procedures during the insurance verification process.

A critical issue in providing patient lift devices is understanding how the needs of caregivers relate to meeting the needs of home care patients. Overall, the use of a patient lift in the home setting can greatly reduce the risk of injury to the caregiver by eliminating the need to lift the patient, and help eliminate the high costs these injuries continue to inflict on our already overtaxed health care programs. By caring for the caregiver, we care for the patient and help preserve the value of home care.

Helen M. Farrell is a senior consultant with Jane’s Billing & Consultation Services Inc of Marietta, Ga. Contact JB&C at (678) 445-1221 or visit it Web site at www.jbcservices.com.