18 August 2010

The Risks that Carers Run

A number of unrelated events have come together in the last couple of days to get me thinking about the risks that carers run when trying to move the person they care for.

Anybody who works in a job where they are lifting heavy weights receives manual handling training; the risks associated with the lifting are carefully assessed, and equipment is specified to minimise the possibility of injury to the lifter. Even so, musculoskeletal damage is common. Chatting to a friend who supplies stairclimbers (devices to carry a wheelchair user up and down stairs), I heard about the experience of a particular NHS Ambulance Trust who introduced powered stairclimbers and saw the rate of absenteeism due to musculoskeletal injury decline from 48% of the total to 6%, in an 18 month period. And this is amongst people who have had all the training designed to prevent them hurting themselves when lifting.

Another conversation with a long-term correspondent based in the US, who sells a cleverly designed lifting vest which makes manual transfers safer and more dignified for both parties, revolved around the costs of manufacturing in the States and labyrinthine systems of distribution in the UK, both of which tend to push the price of his product to a level where he feared it would be out of reach of potential customers. He said "For the life of me I could not understand why people would not pay to prevent back injuries to themselves and injuries to their loved ones."

To which the answer is probably they would, if they could afford it, or perhaps they would, if they understood both the risks and the alternatives. Which brings me back round to where I started. Organisations that employ people who are at risk of injuring themselves in the course of their work have a real financial incentive and legal requirement to measure and minimise the risks. But when it comes to family carers, who are estimated to save the NHS and social services some £87 billion a year on services that would otherwise have to be provided to the people they care for, who assesses and minimises their risks? Very occasionally, I hear about a manual handling training event aimed at non-professionals, but they are rare and not well-publicised.

Am I right to suspect that nobody wants to "find out" about carers running the risk of injuring themselves because they would then need to do something about it, and that would cost money? Even though keeping those carers fit and healthy is actually cheaper than replacing them when they are unable to carry on.

The final part of my injury/cost jigsaw was the story of former miners taking their former solicitors to court for not getting them full compensation for their inability to do various jobs around the house following damage to their hands caused by vibrating machinery. If a carer could point to some statutory body and demand recognition of damage to their health caused by caring, the risk assessors, equipment providers and manual handling trainers would be on the case in the next five minutes.
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23 comments:

  1. Hi agree that this is a problem and is going to get worse with families being able to purchase the care they need without the necessary expertise to choose the caregiver wisely. The legal stand point to date is that this kind of paid help will be considered domestic service which means it falls outside the H&S remit.

    The Carer, that is a relative or friend as apposed to a care worker who is paid, can access help via care for the carers who have manual handling trainers avalable. However most clients and their relatives really are not interested in this they can barely often be pursuaded to accept a moving and handling device. It would look bad in the home, they are happy to lift etc etc.
    Having been a Moving and Handling Trainer/Advisor both privately and for the NHS I do dispair at the attitude amongst the general public in this important subject.

    Fran Moore-Khan FRSPH BA hons RGN Dip Moving and Handling Nebosh Cert Health and Safety.
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  2. I couldn't agree more. I began working in nursing homes caring for the elderly & infirm at the at of 17yrs, long before hoists ect. were used. We all then lifted manually and my word it was heavy. I was working like this for approx 10yrs before the home I worked at purchased hoists and slings, we then all attended moving and handling sessions, we were also expected to produce the updated certificate for the home to keep on record.

    Sadly, I was medically retired from the Caring Industry back in 1999 because of inflamation of my neck, a problem that wouldn't go away. Although I did go on to retrain for hospital administration and worked in that field for some years, I am now unable to work due to mobility problems.

    Now the point is, some doctors say that my condition Ankylosing Spondylitis (a type of arthristis) was instigated by the early years as a carer working without lifting aides, while others say that it was probably brought on by my having 4 children at a very young age and close together. As I did present with hip problems soon after my last child was born. I personally believe that it's a combination of both.

    I would like to end by warning carers, whether professional or family that lifting incorrectly and without the aides available is very dangerous to your muscular skeletal health. I know it's quicker sometimes to just grit your teeth and move a patient in one movement, but it can cause harm to both you and them.

    Please seek out all advice available to you, because once a problem begins it just worsens over time....
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  3. I do agree - being a carer can be bad for your physical and mental health, and for your wealth and livelihood, as I know.

    My stroke survivor wife has recently become unstable on doing transfers to and from the bath chair. So Social Services have referred her for OT assessment - don't know when! Meanwhile she can only have a bath if I do the transfers to protect the social care assistants! There seems to be an assumption that the carer can cope regardless!

    I'm worried what will happen with the indications of expenditure cutbacks of 25% to 40% - I don't think its fair to have such savage cutbacks to protect tax payers.

    Bepositive
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  4. Having worked in the NHS for 5 years until being unfairly dismissed last year (but that is another story!), we were expected to do Manual Handling training sessions & I was on the admin side.Now, it seems that nobody is bothered with what damages carers to themselves at home.I have a long standing back problem,which predated my NHS career, but I am responsible for my mum & so,I do agree with the role of a carer being bad for physical & mental health as well as on your pocket.I am looking for a new job as well as combatting with other long term health problems.

    Francis
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  5. I have been a 24 X 7 carer for my paraplegic husband for three years. No-one has ever taught me how I should help my husband transfer etc. They sent him home with a transfer board and a commode. Today was very interesting, my husband had to attend the Xray department at hospital, 5 nurses with a hoist, assisted him onto the bed. I manage by myself at home, Do the powers that be, really understand what caring at home consists of. I do not think so.
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  6. I have been caring for my wife who is almost paralised through MS for 20 years. I suffer constant back pain, even on a good day.
    I use a ceiling track hoist for morning bed to shower chair transfers. But due to chair design, supplied by the NHS, I have to do the shower chair to wheelchair and wheelchair to bed by hand.
    Getting a sling in a carved foam chair is immpossible.
    I'm now 52 and have recently stepped down from a management job and I'm now part-time, with he same employer I have had for 30 years. They are really understanding.
    I do worry what will happen when my back finally has had enough.
    I do physio and stretching for about 30 minutes a day to try to keep my ageing back reasonably supple. But it only takes an awkward moment and it can takes months for the pain to ease off.
    There is no easy answer, except for state provided 24 hour specialist care, but you may as well try and catch the wind.
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  7. Interesting and rather depressing to see a professional’s view of home carers.

    We are coming from two different positions, as exemplified by a recent visit from an OT.

    She is concerned with her professional position and the Health and Safety Regulations. She cannot allow anything to go on that she views as unsafe.

    I am only concerned about caring for my father independently. And my ideas about safety may not match up her to hers.

    Fortunately, she does want the best for us, I believe, and so far we are being allowed to continue as we are.

    I certainly don’t want to be governed by H&S rules. The time when I wanted manual handling training has gone as I have had to work out the best ways of moving my father by myself. They are not strictly conventional but they work for us. (I would not want any compensation if I hurt myself in this role.)
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  8. OK, Manual Handling, 2nd attempt, as my computer just crashed and lost all I had written.
    Background, my Best Beloved wife, has Multiple Sclerosis, and has been in a wheelchair, both indoor and out for over 14 years. At our last home, we lived on the first floor and had a stair lift. I had to lift Best Beloved on and off everything, Bed, Commode, Toilet, Wheelchair, stair-lift, (top and bottom of stairs) Armchair etc. you get the picture, lots of lifting. We had a body-lifting belt, next to useless. For anyone who hasn’t used one, it is a belt about 150mm deep, which goes around the waist, with fabric handles either side to lift with. If you don’t get it tight enough, it slides up under the boobs. If you get it too tight, most uncomfortable for the wearer, especially when lifted very far. (A strap under the crotch would possibly help but awkward to fit to someone sitting down). We soon gave that up and resorted to the Bear Hug, quick, easy and yet a big strain on the lifters back.
    I developed back strain problems, the OT was summoned to advise, and recommended a hoist top and bottom of stairs and an Oxford hoist. The Oxford and sling duly arrived, only to find it would not fit through the passageway from bedroom to livingroom. Suggestions to OT to take it away were countered with ‘It will save your back’. After struggling to get it from one room to another, I soon gave up and it spent 3 months idle in the bedroom, before I took it back.

    We went to see my sister and whilst there, during a walk, my beloved needed the loo. As we were passing a Disabled persons day centre, I took her in there to beg the use of the toilet. Boss lady says, ‘Can she transfer?’ to me. I said ‘No, I lift her’
    ‘Sorry’ she says ‘Health and safety, she can’t use the toilet’. As we were outside at the back of this establishment, I requested the use of the bushes!!! Eventually, almost too late, we were shown to the toilet and allowed to use it, by bear hug.

    2 Years later, we have moved, for the last year I have still been doing the lifting, the back is worse. For the last year, as the bathroom in our new residence is too small for the wheelchair, my beloved has been going to a local centre, once a week, for a bath.
    There is a hoist, but Health and safety means that the assistant there who does the bathing has to have an assistant to use the hoist for my beloved, and I am not qualified, as I don’t have an NVQ in hoist use. So rather than have a larger audience for her bath, Yes, you guessed, I lift by Bear Hug.
    Some joy though, a disabled facilities grant is progressing, so soon we should have a wet room that Best Beloved can get into, a Closo-mat she can use and Yippee, a ceiling mounted hoist as well.

    (Why did we move to a place with too small a bathroom? Long story. Short answer, no other options available with housing association that suited all our other needs)

    Final note, IF there is a petition in your area for ‘Changing Rooms or Dis-Abilities’ (Disabled toilets with hoist and changing table and more room etc.) Sign it, if not for yourself, think of other people that need them.

    If you have read this far, you have the patience of a Saint. Bless you and Goodbye.
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  9. Hi, I have been caring for my son for the last 7 years, and fighting for needed adaptations to my property to help me continue to care for 5 of them. I also employ PA's to help with his care (via direct payments), one of whom is very skilled and has done moving and handling as part of his study, and also risk assessment,I have tried to access this type of training myself, and for other PA's, but have not been given a budget for this and cannot get it through CBS, even if I could find an available appropriate course.
    One of the concerns I raised to Local authority officers was that, I have no choice but to lift my son as I have no adaptations, hoists etc.and some of the PA's I have employed have lifted as I have, but the trained PA is aware of the risks and has refused to do the lifting that I do,if one of the PA's who is untrained, lifts as I do and injures themselves, then they would be within their rights, I am presuming to sue me, as I am classed as their employer and have not given them correct training.
    I now have back problems,skin conditions and mental health issues, I would say brought about by not having my needs as a carer properly met from the start. I think the point I was trying to make was, unpaid carers should be valued more from start and be treated like an employee by the system, given the tools, training and support to do their job, not just left to cope as most are,carers try their best regardless of the impact on themselves, rather than see loved ones suffer, or stuggle.
    I suppose this is a request also, to the moving and handling trainer who commented earlier, for some advice on moving and handling without equipment and alone, when nursing/care can't help due to their health and safety policies? I am sure, I am not the only carer who has been told "we can't help due to government cuts to the budget".
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  10. Many companies have developed wonderful equipment to help reduce the risks of manual handling associated injuries such as the Rotoflex from Theraposture Ltd. However, trusts and Councils are often looking at cheaper and less effective solutions (because of the lack of funding)and this could put these organisations in a position of potentially much highher costs should an employee get injured.
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  11. Until I packed up work six years ago to become a full time Carer to my wife, who suffers from MS, I was an operational Manager for 13 residential homes for adults with learning disabilities. Although I was never a specialist on Moving and Handling (not lifting!) myself, I was well aware of the best practice we should have in place in this respect.

    Firstly, until new staff had completed a Basic Moving and Handling course, they were not allowed to do Moving and Handling tasks with residents at all. However, even that basic course in itself did not fully qualify someone to undertake Moving and Handling tasks with a service user without additional input. Each service user, who needed it, would be given an assessment by a more qualified Moving and Handling Assessor. As well as the basic training, a new member of staff would also be given a hands on induction into the specific Moving and Handling needs of each service user, which, I might add, were very individual to them.

    My front line experience, before I became a Manager, had mainly been in child care and with adults with learning difficulties, who were not physically disabled, so I had little direct experience of Moving and Handling myself.

    With all this in mind, when my wife’s needs changed to the extent that I needed to help her to make many transfers from her wheelchair, bed, bath seat and stair lift every day and when I started having to turn her in bed five or six times a night, I began asking the OT service for a Moving and Handling Assessment. I’m not sure that many family Carers would be that specific, but I was. Despite asking several times over the course of six months and receiving vague assurances that something would be arranged, the assessment did not materialise. It was only when I injured my back and I got angrier and more insistent, that the MS Nurse arranged for someone known as the Back Care Nurse to make a home visit and do an assessment.

    It was great. We received excellent advice and several pieces of equipment, including a slide sheet, a rotor stand, a moving and handling belt and a commode wheelchair. I was also given a one to one tutorial on how to use the equipment and how to look after my back.

    Brilliant as the service was, actually extracting it from the powers that be had been like drawing teeth. I got the impression that professionals thought I was being a smartass by asking for a Moving and Handling Assessment and that perhaps nobody else had asked for one before, so it wasn’t part of their standard service.

    My message to all the Carers out there is to be a pain in the neck and ask for one too. Even in these times of budget cuts getting Moving and Handling training and assessments right for informal family carers and their loved ones would be a worthwhile and effective investment, which would save untold misery.

    Ian Cormack
    Chairman of the Buckinghamshire Carers Partnership Board
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  12. Robin

    Home care greatly reduces the cost to the community. There should be a website and body to advise on the latest equipment to suit the various needs of carers.

    GP consortia and PCT's should be actively promoting these aids and supporting services to carers in the community.

    NuTec Medical Ltd with their Innovation award winning Paraskate have identified that many NHS staff actively block new product information from reaching them by email.Consequently this makes life more difficult to maintain up to date information and identify ways of saving on resources.

    We all pay for the NHS but it is falling short in its duty of care.

    Yes we can save money but it requires the structure. Avoiding the procrastinated fudge of numerous committee meetings and lack of incentive to make changes.

    We would welcome advise on how Nutec Medical ltd can reach out to the community. Our email info@nutec-medical.co.uk
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  13. 26 years ago I had an accident and broke my spine and severed my spinal cord which left me paralised. I cannot understance why anybody who cannot walk would want to have a bath when a shower is much easier. I transfer from my bed in a sling in to my shower chair and my carer pushes me into the bathroom. for 20 years I used a board which was tucked under my backside and I slid into my chair. The reverse proceddure and I slid onto my bed. Now I have to have a sling to get into my shower chair. The way my carer does it she protects her back, but what is giving her a problem are her wrists when she puts the straps on to the sling and takes them off. My carer has been with me for 7 years full time but she had to go self employed and leave the agency. This means she has not had a day off in those 7 years as it is impossible to find somebody who would come in for 2 days a week who would be qualified to care for me. I think the problem of having a bath could be solved by taking the bath out and putting in a shower where the patient could wheel up to. A sling could be used as I do and the carer has no heavvy lifting to do This would not suit everybody, but I personally would say baths are a no no. It would make life easier for a carer.
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  14. I would like to comment on this issue from a slightly different perspective. I am a disabled person. I can walk a short distance, but it's very painful. Most of the time I use my wheelchair, especially when going places. I am appalled at the number of able-bodied people that insist on lifting me even though it is obvious they have no idea of the possible consequences.

    On holiday recently I wanted to go on a boat trip. They assured me everything was accessible and that there would be no problem getting me and my wheelchair on board. I arrived at the boat (in my powerchair) to find that there was a 12" gap between the quayside and the boat's deck. The 'deckhands' immediately pounced, saying 'No problem love, we'll just lift you across the gap.' I know they meant well, but they had no idea that the chair weighed 9 stone and I weigh 14 stone! Fortunately I was able to get out of my chair and step across the gap, then they lifted my powerchair on board. They struggled to lift it, even without me sitting in it. Why didn't they just put a metal plate across the gap, like a bridge? They hadn't thought it might be useful. They had risked injury to themselves, and to me, by their well-meant but niaive assumptions.

    A similar situation arose when I attended a Conference in a Hotel. Checking in advance, i was told it was wheelchair accessible. On arrival I found a flight of steps up to the main entrance, and not even a buzzer to press for assistance. A passer-by alerted staff for me, and they came down the steps saying 'It's quite alright, no problem, we usually just carry people up the steps.'

    Similarly with lots of taxi drivers there are problems because they can't be bothered to set up the ramp. They just presume it's OK to tilt my chair backwards and lever it into the cab, just as if I was as light as a baby in a buggy.

    I could give many more examples, including the times when I used to allow people to lift me, and the times when they have actually dropped me because they have underestimated my weight, the weight of the wheelchair, and their own capabilities. Fortunately there haven't been any serious injuries, but this is probably because I am more assertive now and I won't allow people to lift me.

    I am concerned about what will happen to me when I am no longer able to get out of my wheelchair and walk a few steps. Will I just have to miss out on going places and doing interesting things? Should I have a kind of 'Government Health Warning' tattoo on my forehead ... you know the kind of thing that says 'Caution. Heavy Load. Not to be lifted under any circumstances.' Any suggestions?
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  15. I found this article very interesting. As a carer I often find myself in situations where I know that I am at risk, but for the dignity and comfort of my mother and brother I carry on.

    As a manual handling trainer in my work environment, the things I do at home I would never dream of doing at work or even allowing my trainees to do. But trying to get equipment from social services is like trying to get blood out of a stone.
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  16. When I worked in a care home, we always got people off the floor one way or another. Now homes are made to phone 999. This should also be a standard for where someone is cared for by next of kin, and should not be seen as a waste of resources. The guys and girls in green are there to help, and have the techniques etc. to get that person off the floor.

    I have witnessed a man trying to get his wife off the floor, and he ended up in hospital himself. I think that whoever is caring for someone, be it pa, care staff or next of kin, should be trained, as this is a way of reducing accidents in the home. And it would be better as we should then see a reduction in staff taking time off for bad backs etc.
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  17. It seems to me that there is a wide variation in the support offered by Social Services in different parts of the country. A friend of a friend has carers for her dad for free while she believes that across the county border they would have to self-fund.(Yorks or Derbyshire)

    I would like to express my gratitude to Wirral Social Services for their excellent loan service. We have just had our stand-aid hoist replaced with a brand new one, we have had a bed sensor but now have an electric pressure reducing mattress (and cushion for day)and bed rails with bumpers. I have been told that the adaptive technology dept offers a free service to come and get people up off the floor but have not checked this yet. So far I have been well impressed by the ambulance service for this need.
    But training for carers seems to be a real need nationwide.
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  18. Always good to be kept informed, and good to see the debate you are provoking.

    Although HSE is only involved in the regulation of workplaces, it strikes me that some of our guidance may be of interest and this section of our website , which focuses on muskuloskeletal disorders.

    Your readers can download any of our guidance for free.
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  19. Brian KingsmanAug 23, 2010 07:27 AM
    I am a full time carer for my wife Patricia who has ALZHEIMER'S, she will be 64 in September, I have recently turned 65 and retired from self employment to care for my wife.
     
    We have recently moved downstairs as my wife cannot manage the stairs anymore and I am now planning a wet room so my wife can have a shower.
     
    The situation that carers are in is a disgrace, the problem is and I am talking about caring for someone with Alzheimer's is that unless you have actually cared fully for at least a week, you would have no idea of the care and dedication this entails.
     
    As regards handling and lifting by carers, I did enquire recently and spoke to someone at Age Concern who said there was nothing definitive in place but occasionally there was some training available, which I do not find acceptable.
     
    This week I will be contacting my MP to air my grievances and ask questions on this most unsatisfactory situation.
     
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  20. Liz North East EnglandAug 24, 2010 07:58 AM
    Hello a very interesting debate I am a "Moving and Handling Co-ordinator in the North East from my experience it very much depends where you live as to the extent of services available. I developed a training package many years ago for carers but the problem being that they could not leave the person they were caring for to attend training and like an earlier mention the "training" needs to be specific to the individual. Currently in my area through completing a manual handling risk assessment (referral to Occupational Therapy) the handling equipment is provided free of charge including mobile or portable hoists and slings including instruction and practice in use. I have completed many "specific training sessions" for PA's family and paid carers in their own homes.I believe in this area we provide a very good service but I appreciate it is not the same everywhere. There needs to be more emphasis/ promotion of preventative musculoskeletal health injury people have seen the advertisements for health campaigns eg Stroke there should be one for musculoskeletal health everyone including children need to be aware about safe handling (lifting)as it is something we all do day in day out.
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  21. Basil S. writes: Although I am heavily disabled, I am surely also fortunate, in that I do not need Carers. But I send my congratulatory best wishes to Francis Leckie, the originator of this paper. Only by encouraging folk to discuss and air their feelings and problems can such matters be improved. The degree of difference between Authority regions is patently obvious from many comments, and one should insist on the help you and yours may need.

    Good wishes go out to you all and again, dear Francis, please keep up the good work!
    God Bless and support you!
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  22. James Ritchie, Total Training SolutionsAug 31, 2010 03:38 AM
    I have just read your blog regarding 'The risks that carers run' with interest and whole heartedly agree with your comments regarding training.

    We have perceived similar problems and have been working hard to support carers with Manual Handling Training, this has proved most effective when working with charities to offer our help though their networks, providing short sessions on awareness, technique and equipment. We have also been providing home visits enabling bespoke training and advice for individuals with their complex needs within the environment in which they work.

    Despite this it is evident that most carers do not see the value of this until they have either been on a session or have been troubled with an injury directly.

    It is often perceived as 'interfering Health and Safety' and most do not realise the implications when a primary carer is unable to support due to injury.

    As always funding remains one of the biggest boundaries to carers receiving training. As you you say in your blog, it is a false economy to not support these unspoken heroes.
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  23. 27 years caring, much of it 24/7. One moving and handling course after much demanding. Some equipment helpful but only real concern of service commissioners/providers is for backs of staff - uninterested in carers a no danger of being sued.
    It isn't just lifting that damages health - working nights/unsocial hours is documented to shorten life. We did 24/7 with minimal sleep for almost 20 years, to the extent that one health visitor confiscated our car keys as she felt we were unable to drive safely - but no assistance offered.
    Sorry for rant but the lack of interest from some professionals coupled with same professionals taking away services because it puts their staff at risk, leaving us at same and worse risk, plus no service, makes me angry.
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