Pride Causes Deadly Falls

There is a lot of stigma and fear around using a lift. I see P/CALS who try to hang on (literally) to unsafe transfer belts that can easily cause severe damage even if there is no fall. Transfer/pivot disks and rolling shower/toilet chairs, require effort to use as transfer aids and will not be enough for PALS who need a ceiling or floor lift, who cannot help themselves stand.

A good lift is a tool, and a good lift takes less than five minutes. Using the lift the first time is hard. The second time isn't as bad, and so on. It becomes second nature. And it saves the caregiver's health (back) as well as the PALS'.

Hydraulic [non-powered] lifts are still being sold, but unless your PALS is very, very light, you will want a powered lift that rolls across the floor, carrying the PALS in a sling, then lifts or lowers her, using electricity, depending on the need, into bed, the toilet, a wheelchair or another kind of chair. Your MDA chapter/ALS charity may have an indefinite loaner. Sites such as SpinLife also sell lifts; as with many cash purchases of ~$1-2K, you may save by paying cash since reimbursement for a power lift may take a lot of time and not be all that.

Some lifts fold for storage and travel (Liko Light, Hoyer Advance, BestLift 350 and Invacare I-Lift); the Molift Smart folds and fits into a rolling case. There are also vertical systems "ceiling lifts" like Voyager where you install permanent or freestanding rail systems and a portable motor, attached to a sling, lifts the PALS.

When considering a lift, sling or railing system, always consider the future worst case scenario, e.g. the person has no head control (head has to be propped by hand or a collar or a wheelchair/bed) and no torso control to stay upright.

There are two basic kinds of transfer systems: a floor lift (aka "Hoyer," the original brand, like "Kleenex") and a ceiling lift.

Floor Lift
If your rooms are narrow or just generally small, do NOT buy a lift without looking at a schematic that includes the turning radius or leg length of your potential lift.

Some lifts can lift people off the floor. If you can't lift your PALS, and especially if they are prone to falls because they try too much, you do the match. Some PALS can be raised to perch on a half-height furniture cube or table, and then go from there to a standing position.

If the bed that will be used in transfers doesn't go up very high, make sure the floor lift legs fit underneath!

Bed
If you don't have a bed yet and can afford a more pricey one, get one that includes "reverse Trendelenburg" positioning. If you only have the head/foot/bed up type, for most PALS, the most comfortable position will have head/feet both raised, which should also be the case before you transfer the PALS with the Hoyer.

After the transfer, immediately, to avoid slipping down, you increase the angle for sleep because the drop zone should be shallower to hit the right spot. Never transfer into an upright wheelchair (tilt + recline first) or flat bed!

Ceiling Lift
In the ceiling lift category, there are two options.

The simplest, because it does not involve drilling, is a freestanding ceiling lift that does resemble a swing set, two of the brands being Molift (Etac) and EasyTrack (Arjo). RehabMart sells these and they have clinicians there who can answer questions. Each "gantry" frame also requires purchase of a lift that glides on the track. Often these are sold as a kit/bundle.

These are for people who only need a lift in a certain well-defined area, usually the bedroom, for obvious reasons. It does beg the question of toileting, traveling, etc. Core strength loss could, as with stairlifts, make it unusable.

The second ceiling lift option, more familiar to most, is an installed track along the ceiling, where a lift runs. The PALS still has to be transferred to and from the lift.

Etac and Arjo are pretty reputable. But I will admit the portable ceiling lift has never made a lot of sense for me because it takes up more semi-permanent room (they're not cake to move) than a floor lift and does less, while being more costly. Installed track may or may not be the best option depending on the home setting.

I encourage anyone planning for either kind of lift to CAD out the room in question and then drop in their wheelchair with actual turning radius, etc.

Slings
Every journey with a lift begins with placing a patient in a sling. The most common sling used is a divided-leg (“U sling”), often made of polyester mesh, that can be used for bathing, toileting and transfers alike. Many PALS need the “head support” (really, back support) option. Avoid “toileting slings” that completely cover the lower torso except for a toilet-use hole — a recipe for a messy situation.

No one should sleep or sit in a sling. It traps heat, dirt, oils, and moisture, and degrades the skin, especially since the PALS can't shift constantly as we normally do against a static surface.

But if it helps, you can place a slide/transfer sheet with handles under the fitted sheet, then pop the corners of the sheet in the morning, to use the slide sheet to help with repositioning and the morning transfer.

The same is true of the wheelchair -- the sling should be removed once the transfer is done.

Most slings work with any brand of lift though sizing may vary; however, a sling designed for a stander lift (one that supports the patient upright) will of course not work with a lift designed for seated transfers only.

Also, as disease progresses, avoid slings in which the arms cannot be held in by the sling, since the patient will be unable to hold them independently. As muscle atrophies, especially in the lower half of the body, a PALS may need a smaller size sling than at first, irrespective of weight.