Choosing a Mobile Hoist

Medical Card Holders

Equipment for people with disabilities, sometimes referred to as aids and appliances, is usually supplied free of charge to medical card holders. The card holder must first be assessed by the relevant therapist who can recommend and prescribe the most suitable equipment.

Long Term Illness Card Holders

People who have one of the conditions listed as qualifying under the Department of Health’s Long Term Illness Scheme may be eligible to receive items of equipment, essential for the primary condition, free of charge. Assessment by the relevant professional is required.

Hospital Treatment

People in hospital may have aids and appliances provided free of charge when they are prescribed as part of in-hospital treatment in a public hospital.

Health Insurance Schemes

There are three main companies offering private health insurance in Ireland. These are:

• Voluntary Health Insurance (VHI)
• BUPA
• VIVAS Health

All three companies provide members with cover for a limited number of aids and appliances under their out-patient schemes. A list of approved appliances is available on request. A claim for the reimbursement (part or full) will be subject to a member’s out-patient excess. Medical certification is usually necessary. Contact your health insurance company’s Customer Services to check if a particular appliance is covered by your policy.

Some employers have their own special health insurance schemes which provide cover for their employees. The employee’s family is also often covered. Check with the employer to see what, if any, equipment is covered under the scheme.

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.

The purchaser has the option of:

• personally funding the cost of the equipment,
• applying to charities/benevolent funds etc for funding,
• buying second-hand,
• checking with your health insurance company, if a member, to see if, or what, reimbursement is available.

Private Purchase – Applying for a VAT Refund

VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Form VAT 61a is available from Revenue or can be downloaded from their website (see Useful Addresses).

Assessment

Depending on the type of equipment required, a qualified therapist will assess the individual and make a recommendation to the body responsible for the provision of the equipment or to the person or agency who has requested the assessment. Generally the following applies, but the assessment process and provision may vary in different parts of the country.

• Occupational therapists will assess for aids to daily living – these include wheelchairs, mobility aids, specialised chairs, bath, shower and toilet aids, stairlifts, hoists etc
• Physiotherapists will assess for movement, strength and balance training equipment, walking aids and exercise devices
• Speech and language therapists will assess for communication, speech therapy, and training aids
• Other relevant therapists and specialists may also be involved in carrying out assessments, depending on the equipment or appliance required.

All the different therapists described above are based in hospitals, community care areas, and with various voluntary agencies. For more information, contact the Community Care section of your Health Services Executive area or the relevant hospital department as appropriate.

Private Occupational Therapists

Occupational therapists in private practice can carry out assessments in the home or workplace, and if home modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful Addresses).

Private Physiotherapists

Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful Addresses), or through the Golden Pages.

If you decide to buy equipment privately it is strongly recommended to seek the advice of an appropriate therapist on the suitability of that equipment to your condition or situation. It is also recommended that you try out the equipment, if possible, before purchase.

You can also arrange to visit a supplier’s showroom (if they have one). Contact details of suppliers can be found under ‘Disabled Persons Products & Services’ in the Golden Pages and some may have a website with details of their products and services which you can view online. Another source of information on suppliers of assistive technology, aids and appliances is the Access Directory. This directory is produced commercially each year and copies are widely available (see Useful Addresses).

Sometimes suppliers organise exhibitions of different types of equipment in various locations around the country allowing people to see and try equipment. These exhibitions are often advertised in the local paper or on local radio. You can also request to be put on a supplier’s mailing list so you will be notified if there is an event being held in your area.

Some companies will give equipment for a try-out period before purchase. Enquiries should also be made about maintenance (if it will be required), maintenance contracts (if relevant) and whether a user manual is provided with the equipment (essential).

When purchasing from any supplier, it is important to remember that it is their business to sell. There may be several suppliers of that particular piece of equipment or different manufacturers of the same type of equipment, so always shop around.

The main alternatives to mobile hoists are overhead hoists. For more information on overhead hoists see the Assist Ireland Information Sheet ‘Choosing an Overhead Hoist’.

Sometimes there are simpler solutions to overcome moving and handling difficulties. Other options which might eliminate lifting tasks or enable the person to move independently/with limited assistance include changing the daily routine, re-arranging furniture, training in a technique or using small items of handling equipment in a safe way. Small handling equipment could include:

• low friction rollers or sheets - to enable people to turn or slide up and down in bed more easily,

• wooden transfer boards - for sliding from one surface to another,

• lifting poles to pull up on in order to partially sit or change position in bed,

• a handling belt: for example when used in conjunction with a turntable; the person wears the handling belt and stands on the turntable to swivel transfer him/herself in a semi-stand position. The carer can help guide him/her around more easily by holding onto the belt,

• specifically designed wheeled equipment such as wheelchairs and sanitary chairs to move a person from one room to another.

The tasks

• Activities - is the hoist needed for one particular task (eg getting in and out of the bath) or is it needed for several (eg in and out of bed, on and off a chair)? Remember to consider associated tasks, eg positioning slings, moving the hoist occupied and unoccupied.
• Use - is the hoist for independent use? Independent use is only possible with an overhead hoist. Will it need to reach the floor and/or lift high? Is it for one transfer in a set position or is flexibility required so that lifts can take place anywhere in the room?
• Frequency - is the hoist for emergency use only (eg lifting from the floor after a fall) or is it for frequent use (eg all transfers)?

The home environment

• Space - is there enough space to manoeuvre the hoist and the person into the correct position? This is particularly relevant when the planned location for use includes bathrooms or toilets.
• Furniture - will a hoist base go around or under items such as beds, chairs, baths etc? Will the lifting height of the hoist be sufficient to lift the person clear of all surfaces? If the user has a pressure relief mattress on top of the existing mattress some hoists may not provide sufficient lifting height to clear the mattress.
• Floor surfaces - are these suitable to move a mobile hoist across? Thick pile carpets and door thresholds can impede manoeuvres.

If these factors cause repeated, insoluble difficulties, consider an overhead track hoist, which runs on a straight or curved ceiling-fixed track.

• Storage - is there enough space to store the hoist? Some hoists will dismantle or fold up for storage or transportation.
• Charging - is there a convenient socket in the storage area for charging an electric hoist or is a removable battery needed so that it is taken to be charged elsewhere?

Other environments

• Where - is the hoist purely for home use, or will it be used for getting in and out of the car or for taking on holiday?

The hoist user

• Type of disability - is the particular disability likely to remain stable for the foreseeable future, or is it likely to improve or deteriorate?
• Size - check that the hoist capacity and the size of the sling is suitable for the size and weight of the person.
• Confidence - is the person confused or anxious? Will he/she feel more secure in a close fitting sling with less swing?

The carer

• Physical strength - consider the size and strength of the carer. It requires quite a lot of effort to turn and move a mobile hoist. Remember that hoists are designed as transferring not transporting aids - if the person needs to be carried over a distance, it is advisable to use an overhead track hoist or specifically designed wheeled equipment (eg wheelchairs or sanitary chairs).
• Ability to adapt - if the carer has moved the person in the same way for many years, it may take time and training to learn to use new equipment or new techniques.

STANDARD MOBILE HOISTS

Standard mobile hoists have a mobile base and a sling lifting mechanism. They are used by a carer to lift and transfer a person from one surface to another. They cannot be used by the person independently. The person is lifted in the sling. The many different slings available to suit different needs are described in more detail under Factors to consider when choosing a sling.

Standard mobile hoists have four main parts:

• Base or chassis with legs - wheeled, usually two with brakes.
• Mast - the vertical support. This incorporates the lifting mechanism which is either mechanical (using a hydraulic pump or a winding handle) or battery powered. Choice will depend on individual need and preference. A detachable mast is useful for storage and for transporting the hoist in a car.
• Boom - this extends from the mast to provide the reach across and has the spreader bar attached. Some booms have a peak or angle which helps with lifting from the floor and angles the boom away from the head allowing the person to swivel through 360° when suspended.
• Spreader bar (also called a sling bar)- this provides the width to span the user's shoulders and the attachment points or hooks for the slings

Standard mobile hoists can broadly be divided into two categories by size:

• Small - the base is relatively small and narrow with a maximum lifting capacity of 100-160 kg (16-25 stone). These are generally more practical for domestic use.
• Large - the base is relatively longer, wider and higher with a maximum lifting capacity of 160-300 kg (26-47 stone). These are more suitable in residential homes and hospitals where space is not such a problem and a greater range of lifting height and weight capacity is required.

TOILETING/STANDING HOISTS

Manually operated or electrically powered toileting or standing hoists are available. They have a mobile base (often with a footrest) and a specifically designed sling arrangement. The person is hoisted into a supported standing position.

Most have a narrow sling which is positioned under the user's arms and sits halfway down the back - making it easy to access to trousers, skirts and underwear which need to be adjusted before and after toileting. It is easier to use a standing hoist rather than a standard or overhead hoist for toileting, as long as the person has the necessary abilities. The safe use of this hoist must be reviewed regularly by the relevant therapist. The users must be able to:

• take some of their weight through their legs as the sling lifts them from a seated into a supported standing position;
• brace their knees against a knee block to hold them securely whilst they are moved in the hoist;
• have reasonable muscle tone around their shoulder girdle.

The person is lowered onto a toilet or a commode after the hoist has been carefully positioned and clothes have been adjusted.

If the person needs to be moved over a fairly long distance some standing hoists have an optional seat accessory. The person is lowered onto the seat before he/she is moved.

Some hoists have a dual function system with an interchangeable toileting boom and a standard sling boom.

Some standing hoists are quite large; their suitability for use in a domestic situation should be assessed before purchase.

MOBILE SEAT HOISTS

Seat hoists tend to be designed for one type of transfer, eg bathing. The seat provides less support than a sling and the person needs reasonable sitting balance. If someone is unable to sit there are some models with a stretcher for the person to lie on - but these are big and bulky - usually unsuitable for home use.

The hoist is moved and operated by the carer(s), and so allows no degree of independence. Manual and powered versions are available.

THE HOIST CHASSIS

BRAKES, WHEELS AND CASTORS

LIFTING MECHANISM

The majority of hoists are better powered, a few are manually operated.

LIFTING CAPABILITIES

BATTERIES AND CONTROLS

USING SLINGS ON A STANDARD MOBILE HOIST

STORING AND TRANSPORTING A HOIST

SINGLE vS DUAL PURPOSE HOISTS

Some of these hoists are exclusively for toileting purposes; others are part of a dual system hoist with an interchangeable toileting boom and a standard sling boom. The following points need to be considered:

• It can be time-consuming changing the booms.
• The booms are quite heavy and not always easy to slot in place as they need to be lifted above waist level; this can be especially difficult for carers who are short in stature or are not physically fit.
• There are often several components to each type of hoist - consider where they will be stored and whether they are likely to be constantly mislaid or mixed up, making the hoist unusable.
• Compare the cost and the feasibility of storing a dual system hoist against that of two single purpose hoists.

TYPES OF SLING SUPPORT

Most models have the option of a standard padded sheepskin standing sling.

SEAT ACCESSORY FOR TRANSPORT

This is a low slot-in seat that can be added if the person is being transferred any distance on the hoist. However, the following need to be considered:

• Hoists should not be used as a method of transport over long distances. A ceiling mounted hoist or specially designed wheeled equipment, such as a wheelchair or sanichair which have much larger wheels in comparison to the castors of a hoist, should be used as they are much easier for the carer to push and manoeuvre.
• Consider the dignity and comfort of the person. Which is more dignified, a wheelchair or a seat attached to a hoist?

COMMODE PAN ACCESSORY

A removable commode pan can be used in conjunction with the seat for short transfers, moving the person from the bed or chair onto the seat with the commode pan underneath.

SEATS

These are most commonly used for bath transfers. The person remains on the seat and is lowered down into the bath.

Most have a seat with a commode aperture that can be used like a sanichair. Either, the person is wheeled over the toilet instead of transferring onto it, or it is used with a commode pan.

STRETCHERS

Some models have the option of a stretcher, which enables the person to be moved and transferred into a bath in a semi-recumbent position. However, because of their size, they are usually unsuitable for use in a domestic setting.

DIRECTION OF TRAVEL

The person can either:

• face forwards during travel,
• face side ways during travel. This makes possible transfers from the bed onto the seat and then straight into a bath without turning or swivelling.

OPTIONAL EXTRAS

The following may be available on some makes of seat hoist:

• Commode pan - enables hoist to be used as a commode
• Legrest - enables a person to extend his/her legs while being transferred. The angle of the legs can be varied using different length straps.
• Weighing scales - enables a person to be weighed while seated on the chair without transferring onto a set of scales.
• Spreader bar for slings - some hoists have an interchangeable spreader bar which converts the hoist so that it can be used with slings instead of a seat, or from a coat-hanger hook-style spreader bar to a Y-shaped spreader bar with keyhole attachment points.

Consider the following:

• Sizes - slings always come in a range of sizes, but, beware; corresponding sizes will vary from one company to another, in the way that shoe sizes often vary. It is very important that the person always uses the correct size of sling, even if this means changing it if he/she gains or loses weight,
• Colour coding of slings - although many manufacturers colour code their slings for size, at the moment there is no consistency between the companies which can prove very confusing,
• Loops (in the past, chains) on the slings - these are for positioning the person correctly in the sling, not for trying to make a sling that is too big or too small fit him/her. It may take several attempts to successfully position the person so that he/she is comfortable. Once this has been achieved, it is worth marking the loops that have been used to avoid wasting time in the future.
• Amount of fabric - the more fabric there is in a sling, the more support it will offer and the larger the area over which to spread the weight of the individual. Hence, hammock slings, which have more fabric, distribute pressure over a larger area and are usually the most comfortable. This is particularly important for people who are susceptible to pain.
• Points of suspension - the spread between the points of suspension for the sling will affect how the person is supported. The greater the spread between the suspension points the more
  open the sling will be. Although this may make the user feel more comfortable, he/she may feel less supported;
• Sling fabrics and linings -a range of different sling fabrics and linings is available. Padded and lined leg pieces tend to be more comfortable and easier to put on. Mesh slings are easier to use in the bath.
• Compatibility of slings - some slings are incompatible with some hoists. There is also the risk of wrongly attaching the slings. Some manufacturers stipulate only their own slings can be used on their hoists. This is because of liability in the case of an accident. However, some companies will give permission for their slings to be used on compatible hoists manufactured by other companies. Always get the permission in writing from both the hoist and sling company.
• Specials - the majority of manufacturers will adapt and produce special slings to accommodate the specific needs of the person and companies like Silvalea Textiles Ltd UK (supplied by JS Dobbs in Ireland) produce made-to-measure slings for most makes of hoist. However, a sling can take up to eight weeks to make and can be more expensive than a ready-made sling. In addition, there is no guarantee that it will solve the problem, as there is no way of trying it before it is made. Always ensure that there is no off-the-shelf sling that is suitable before ordering a special. Try out different styles and sizes.

Applying the sling

When putting on slings in bed, if possible raise the height of the bed to a position that is comfortable for the carer to work at.

When putting on slings in a wheelchair, commode or armchair, remember the following:

• Leave the leg/foot rests on the chair as this makes it easier to get the slings under the thighs.
• To get the slings under the thighs, the carer should squat in front of the chair and put the person's foot on his/her thigh so that there is enough room under it to manoeuvre the sling, in this way the person's leg is supported and the carer's back is in a good position.

The carer should NOT stand up and bend over to lift one or both of the legs of the person to position the sling underneath.

When trying out new slings, remember that it may take a few attempts to find the most comfortable position, and that the first sling that is tried may not be the correct size and/or shape.

DIVIDED LEG SLINGS

A divided leg sling is a U-shaped piece of fabric available with or without head support. This sling can be used:

• with a leg band under each leg and then crossed in the middle. This provides the person with a reasonable amount of dignity.

• with a leg band under each leg and not crossed. This allows the legs to be kept apart for toileting and washing. There is a risk of abducting the hips and this position is not recommended for general transfers.

• with both leg bands under both legs. Sometimes this is more comfortable for the person in the sling. There is a greater risk he/she will slip out and this position should be used only after a careful assessment.

TOILETING/ACCESS/INDEPENDENCE SLINGS

Access or toileting slings fit between the legs and around the user's chest.

These slings leave a large area clear around the hips so that clothing can be adjusted for toileting. This style does not offer as much support as other slings and is therefore only suitable for a few hoist users.

HAMMOCK SLINGS

This is usually a rectangular piece of fabric, with or without a commode aperture.

The person is rolled onto the sling in a lying position. If the sling is to be sat on for long periods of time, the fabric from which it is made should be considered. Polyester netting may be suitable.

BAND SLINGS

• slings consist of two separate bands of material - one under the thighs and the other behind the back. Many accidents have occurred when band slings have been used. These are unsafe and should not be used. They have now been replaced by more adaptable and supportive slings. The comparable sling is the independent or toileting sling.

SLINGS FOR USE WITH A TILTING SPREADER BAR

These spreader bars are wishbone shaped. The slings have no choice of loops, as positioning is achieved by using the moveable spreader bar which will enable positions from lying to sitting to be
achieved.

Advantages

• It is easy for users to reposition themselves within the sling.
  

Disadvantages

• This type of hoist will not accommodate a hammock-type sling.
• Sling design means they cannot be used with other manufacturers' hoists.
• If this type of hoist is being used to lift someone from the floor, the carer may need to use a sling which is one size larger than that generally used, since the spreader bar does not reach low enough for the sling to be attached easily.
  

Comfort

• It is generally accepted to be a very comfortable hoist and sling, due to the ease of positioning.

AMPUTEE SLINGS

Although many companies sell specially designed amputee slings, a one-piece or hammock sling used on a conventional spreader bar may serve just as well. However, the sling may need to be supplied with extra long straps at the front edge if the person is to achieve an upright sitting position.

STANDING/WALKING HARNESS/DRESSING SLINGS

It is possible to use these slings with some of the larger portable hoists and many of the overhead track hoists to assist with walking, standing or dressing. They support the trunk area of the body. The
fastening mechanism allows a degree of adjustment and on some makes of harness the straps are self-adjusting. This style of sling may offer a solution to standing up from a chair, especially one with a deep seat.
Some walking harnesses have the addition of leg straps to distribute body weight better.

Lift Pants

Shaped sling that runs between the user's legs to provide support in an upright, standing position. Primarily used for confidence building when walking.

DISPOSABLE SLINGS

These are made of a very strong, disposable material and are used in environments where the sharing of slings would increase the risk of infection. A disposable sling is used for a single person for the duration of his/her stay, then thrown away.

STRETCHER SLINGS

These are used to transport a person in a supine position. Some stretcher slings are made of fabric, others are solid. If they are to be used in an X-ray situation, check that they are X-ray translucent. The solid stretchers are usually composed of several components that make transferring the person easier.