Why is it unsafe for only 1 person to use a mobile hoist

Hoists provide a way to transfer somebody with limited mobility without putting unnecessary strain on the carer or the person being moved. This is a broad overview of the different types of hoist available.

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Ceiling hoists
Portable overhead (gantry) hoists
Mobile hoists

It is always advisable to seek independent advice before buying any hoists or manual handling equipment to ensure you make an informed and sensible choice. It is strongly advised that you contact your local social services and seek advice from a professional such as an Occupational Therapist, as they should be able to undertake a full assessment, and provide and maintain the appropriate equipment, as well as providing the carer with all the training required.

One common complaint raised against hoists is that they take too long to use. Carers often say they instead prefer just to lift the person themselves. This can often be because the person using the hoist is unfamiliar with the equipment or because it is unsuitable for the task. This can normally be easily addressed by the provision of the right equipment and thorough training and support in its use. Ultimately the aim of using any manual handling equipment should be to reduce the risk of an injury to the lowest level possible. We have a helpful series of questions to ask before choosing handling equipment here

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Ceiling track hoists

They are generally less arduous for a carer to operate than a mobile hoist, and are the more suitable for longer distance transfers.

In selecting a system, thought also needs to be given to structural considerations: ceiling joists may need to be reinforced, and doorways altered, to accommodate the track.

Many ceiling track systems are powered by mains electricity for the transfer, with either a manual or powered raising and lowering mechanism.There will either be a battery back-up for emergencies, or a manual wind-down facility, to enable the client to be lowered to a flat surface. Alternatively, the system may be powered by rechargeable batteries – which is useful in that it is independent of the power supply, and also removes the need for a cable running along the track to provide power to the hoist from the mains. The disadvantage is that the batteries need to be kept well charged up, by returning them to their charging point at the end of the track – and it is quite easy to forget to do this.

Both the ceiling hoists shown here have been designed to be easily attached and detached from the track, so that they can be moved from room to room as required.

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Portable overhead hoists (Gantry hoists)

This is particularly suitable for situations where a hoist is required in a particular place for a short amount of time: when a disabled person is travelling, for example, or perhaps for use by health professionals working in the community.

The whole system folds into its own wheeled carrying case, which can be stowed in the boot of a car.

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Mobile hoists

In selecting a mobile hoist, thought needs to be given to the environment where it will be used: whether there is enough room to manoeuvre it into the right position; if the legs of the hoist will fit under or around any furniture, such as bed, bath or chair; whether the floor surface is smooth enough to allow it to operate easily: thick carpet or threshold strips are difficult to move over.

It is also important to check that they have sufficient operating range to lift the person clear of any surface, and perhaps also to pick them up from floor level in an emergency.

They also need to be stored when not in use, preferably in an area where they are out of the way, and with a charging point for their battery.

There are smaller mobile hoists with narrower bases which are easier to move in more confined areas. These have a maximum load of perhaps 20 stone (100 kg) or a bit more, and are useful in the domestic environment. Larger hoists which are capable of lifting up to 40 stone (250 kg) give more flexible hoisting in hospital and nursing home situations with a range of patients and more space to work with.

We have an article here about choosing the right hoist for a garden spa or hot tub

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Is double handed care always necessary?

Some interesting research came my way, on the subject of safe moving and handling. Undertaken by the University of Salford, the remit of the report was to challenge the widely received wisdom that two people are required in a situation where someone needs manual handling, i.e. double handed care.

Safe manual handling is one of those topics that comes up a lot on Independent Living; we get emails from family carers who are struggling to move their loved ones from bed to chair or loo unaided, quite frequently contrasting this with care workers refusing to help with transfers unless there are two of them – and not always even then, as in this account:

“What I find difficult to comprehend is the attitude of professional district nurses who refuse to use my mother’s Ergolet stand aid in order to change her sacrum dressings. .. I informed them that training was available for them and I could give them the phone number only to be told that they didn’t want it as they would then be expected to use the equipment! They would visit, find that either I or a carer was not present to use the stand aid and go away again… Even if they arrived in pairs!… The irony is that the carers use this aid safely and efficiently, single handed. I use it, as does my mother’s hairdresser, all of whom are less qualified and significantly less financially rewarded. The latest reason for not using it was that although trained in its use, they didn’t use it sufficiently often to be up to date. If I dropped mother on the floor, that was ok but it wasn’t a risk that they were willing to take!”

Update September 2018

Although this article was written a few years ago, the myth about requiring two people for every transfer still persists.

We have an interesting contribution from Declan Barry, moving and handling trainer, who shares his experience of why this might be. Do please add your own thoughts after reading!
 

Poor quality training in moving and handling

From the other side of the fence, people coming into employment in the care industry are sometimes dismayed at the sketchy nature of the moving and handling training they are provided with, as in this case:

“I have been working as a Social Care worker for one month, in a large, well-known organisation, and frankly I’m appalled at the ‘Moving & Handling’ training, or rather lack of it. An hour or so at best, of formal practical training with a ‘qualified’ trainer. It’s all very well saying, “this is the hoist, this is how it works”, and an arbitrary demo using a co-worker as a ‘dummy service user’. What I really needed to know was… how do we hoist someone into a bath, onto a commode, onto a toilet, onto a shower trolley? What happens if a service user slips through a sling? etc etc.”

Compulsory training, but no quality standards specified

Manual handling training is compulsory for care workers, but the content and quality of the training is left to the professional judgement of the organisation involved, leading to some very dubious courses, which may provide incorrect or misleading information, or just not enough time and practical sessions to enable the trainees to feel confident in their abilities.

Given all the noise around “Health and Safety”, we should perhaps not be surprised that many care providers simply introduce a blanket “no lifting” rule, effectively depriving thousands of people of support; rather than undertaking a proper risk assessment.

Origin of the double handed care myth?

So to this new research, which identifies a possible source for the “two people for every lift” misconception, in the National Minimum Standards Regulations for Domiciliary Care 2003, which state:

“12.8 Two people fully trained in current safe handling techniques and the equipment to be used are always involved in the provision of care when the need is identified from the manual handling risk assessment.”

Note the final third of that statement, when the need is identified from the manual handling risk assessment.

What managers should take from this is that a moving and handling risk assessment is necessary, not that two carers should be involved in every lift.
 

Transfer aids often designed for safe single-handed use

Another factor which is very often not taken into account, is the many developments in transfer aids in recent years: frequently, when I receive information about a new hoist or stand aid, somewhere in the description will be words to the effect that it has been designed for safe use by a single carer. As is so often the case, practice doesn’t always keep up with technology, and what might have been prudent with previous generations of products is just carried over without question.

Today we have perhaps reached some sort of tipping point, where finances are so tightly squeezed, and demands on care providers so great, that attention really has to be given to any sort of waste: and insisting on double handed care in all circumstances, whether necessary or not, means that costs of care are higher than they need to be; many people may miss out on necessary support altogether; coordinating care visits is harder; and those on the receiving end have twice as many people invading their space as is really necessary.
 

Research shows benefits of assessing whether or not two carers are needed

The research from the University of Salford makes a strong financial case for challenging the notion of double handed care for every lift.

I would love to know what you think on this subject, whether you are a professional involved in moving and handling; an equipment supplier; a family carer; or client receiving care services. You can post your comments at the bottom of this page.

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Further reading and resources

You can access information on a wide range of hoists and transfer aids in our Moving and Handling People area

November 2019: Matthew Box and Linda Agnew, independent occupational therapists, have reviewed double-handed care packages in Thurrock, with positive results.

FAQs on manual handling assessments

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