Better lift programs raise bottom line

Policies, leader support make difference

Safe lift programs save money, and they save more if they are comprehensive and have leadership support. That finding from a new study of workers' compensation and lift-related injuries in long-term care provides a strong, new underpinning for the financial benefits of safe patient handling.

"Now we finally have the data: There's a good return on investment. It will pay for itself," says Melissa A. McDiarmid, MD, MPH, DABT, director of the Occupational Health Program at the University of Maryland School of Medicine in Baltimore, which collaborated on the study with the National Council on Compensation Insurance (NCCI) in Boca Raton, FL.

Previous studies have demonstrated cost-savings from safe patient handling programs in hospitals and nursing homes. For example, a 2004 case study showed that an investment of $158,556 in lift equipment and training resulted in a savings of $55,000 a year in workers' compensation costs, providing a return on investment after just three years.1

This study adds a new dimension: The quality of the overall program makes a difference in cost savings.2 "When you have a stronger program, it does seem to reduce your frequency and total cost in claims due to lifting," says Tanya Restrepo, an economist with NCCI and lead author of the study.

Lifts are now commonplace in nursing homes, so the study authors couldn't simply compare facilities with a lift program and those without one. Instead, they created a safe lift index based on 11 variables related to the facility's policies and procedures, the preferences of the director of nursing, barriers to safe lifting and lift policy enforcement. The study included only facilities that had a lift program in place for three or more years — or about half (48%) of the facilities surveyed.

Nursing homes with a higher safe lift index score had fewer workers' compensation claims and lower total cost of claims, the study found. "Having lifts is a necessary requirement but not the only requirement to reducing frequency," says Restrepo.

Or, to put it another way, "it's not enough to have the lifts," says Pat Gucer, PhD, assistant professor in the Occupational Health Project at the University of Maryland School of Medicine, who developed the safe lift index. "You need the policies and procedures in place to maximize the use of those lifts."

Lifts catch on at nursing homes

The NCCI study found a promising trend in long-term care, which has high rates of injury due to overexertion. Nursing homes have been purchasing lift equipment.

"When we first started collecting the data and thinking about the study we thought we might look at facilities that have a program versus facilities that don't have a program, but most of the facilities that answered our surveys had powered mechanical lifts in place," says Restrepo. "A large percentage also used them routinely."

In 2005, one in four (26%) long-term care facilities had two or fewer lifts per 100 residents. By 2007, that had dropped to 10%. The median ratio of lift equipment also rose, from 3.8 lifts per 100 residents in 2005 to 5.7 lifts per 100 residents in 2007.

Most of the facilities actually exceeded the ratio of lift equipment that is recommended by the National Institute for Occupational Safety and Health (NIOSH) — one full-body lift for every eight to ten non-weight-bearing residents and one sit-stand lift for every eight to ten partially weight-bearing residents.3 In fact, the average ratio was one for every three non-weight-bearing (0.351) or partially weight-bearing (0.329) residents.

Nursing homes may have begun by using lifts out of necessity to move bariatric patients, then discovered the benefits for other residents who needed assistance, says McDiarmid.

Beyond the increased availability of lift equipment, the most effective programs in the study had a combination of important elements, including robust policies that required the use of lifts and mandated appropriate training of the certified nursing assistants (CNAs). They provided for rigorous enforcement of the lift policy. The preferences of the director of nursing and perception of barriers to using the lifts also played an important role, as reflected in the safe lift index, says Restrepo.

"The institution's commitment to effectively implementing a safe lift program appears to be the key to success," the study concluded.

NCCI is continuing to analyze the data to quantify how changes in the variables affect workers' compensation claims. If enforcement of a safe lifting policy becomes more stringent, for example, the analysis will determine how much that affects the magnitude of claims, says Restrepo.

References

1. Collins JW, Wolf L, Bell J, et al. An evaluation of a 'best practices' musculoskeletal injury prevention program in nursing homes. Injury Prevention 2004; 10:206-211.

2. Restrepo T, Schmid F, Shuford H, et al. Safe lifting programs at long-term care facilities and their impact on workers compensation costs. NCCI Research Brief, 2011. Available at http://bit.ly/m6AOCP

3. Collins JW, Nelson A and Sublet V. Safe lifting and movement of nursing home residents. DHHS (NIOSH) Publication No. 2006-117. Cincinnati, OH, 2006. Available at http://1.usa.gov/lpi4sW