Single or double handed staff for hoisting?
Declan Barry, moving and handling trainer, has extensive experience providing training to people working in the care industry. He is concerned about the reasons behind the continuing persistence of the idea of double handed care.
Single or Double Handed Staff for Hoisting?
As a Tutor I follow these discussions about safe handling practices with interest, as I am often forced into training that hoisting should only be carried out by two people.
I say “forced”, as this is to abide by the Moving and Handling Policy of the organisation I am working for. These policies without exception require staff to only hoist with two people or not at all.
On enquiring as to the rationale behind this blanket statement, the usual answer that it is safer with two seems in many cases to come from insurers rather than senior carers.
This insistence in turn leads to increased costs, which could be utilised in more productive ways.
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Bypassing the principles of risk assessment?
By using this blanket statement, are we guilty of almost bypassing the first step of a Risk Assessment (Identify the Hazards)?
This may lead to what may be unsafe practice and also an overkill in evaluating risk.
What is needed more in the care setting is robust mobility assessments; good communication to carers; and recognising that those carers are the people most likely to see any change in a service user.
In a similar vein, it is not uncommon for domiciliary carers to be given the double handed hoisting rule, and then to be sent out on their own, or for their second not to turn up…
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We will have to become less risk averse
In all these situations, experienced personnel carrying out Risk Assessments, good communication and competency testing on a regular basis, would identify accurately the needs of the service user – and this may indicate single handed movement as being appropriate.
And finally, with the growing population of care service users and the shortage of carers, both professional and family, we will simply have to try and become less Risk Adverse as an industry.
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What do you think?
Especially if you are involved in the care industry in any capacity, we would love to find out what you think about single or double handed care.
Have you been directed to ensure two people for every transfer?
What happens when only one carer is available?
Do you feel that overly-cautious insurance companies have too much influence on practices in the care industry?
Just add your comments at the bottom of the page!
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Further reading and resources
We have more information about risk assessment and hoist selection here
Five principles of safe manual handling
15 Replies to “Single or double handed staff for hoisting?”
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Thanks so much for raising this. Policies need to address the needs of the person receiving care – as a priority – not just the needs of the carers. After all, the service does not exist to support the care assistants.
The result of this… I have come across a woman in her 80s moving her husband unaided… but a twenty-something year old care workers won’t help. I have a neighbour who is getting pressure sores from being stuck in one chair 24/7 because social services send one carer at a time and they won’t help either.
The problem is the insurer only cares about potential injury to the assistant (which might trigger litigation) but not the distress caused to the recipient of care (most unlikely to have legal consequences). This same issue comes up repeatedly in other areas of social care – I’ve seen it in care homes, which are run for maximum profit at minimum litigation, not in the interests of residents. It also means disabled people out and about are increasingly denied the common sense help they need.
This blanket policy is leaving my son without care. The manual handling review of 2 years ago, states 1/2 Carers to use the hoist.
My son is less than 70kg, is calm and helpful with the sling loops and his room and bathroom are of ample size to move.
I supply steel capped wellies for the wet room as this protects Carers feet from wheeling over them. The idea that suddenly after no changes at all, a requirement for 2 Carers. Live in Care cannot function like this, it was suggested that a second Carer could visit twice a day but this is not practical and not possible to predict when it will be required.
So is that the END OF LIVE IN CARE in UK?
Can’t believe that with an orthopaedic referral for my hip and aged 65, I am left to hoist my daughter on my own but all carer agencies insist on 2:1. This is as a result of OT assessment but I don’t seem to warrant the same level of protection.
I certainly think each case needs consideration on an individual basis, and a risk assessment done – but who should be doing the risk assessment? If its down to the local authority to risk assess, and they decided it was safe for 1:1, the cynic in me would be thinking their motivation was cost cutting…
If it were the insurance company they may decide its a 3:1 activity just to ensure they never get a claim!
As a parent of an adult, I employ PA’s using direct payments. I feel pushed into a corner really, as the residential college risk assessment stated its a 2:1 activity, if I allow our PAs to do this on a 1:1 basis and they injure themselves or my son, as the employer I would be held responsible.
When actually I believe with ceiling hoists 1:1 is perfectly fine…
I was told by an insurance assessor from the Zurich company that it should be two. I fall rarely I replied and as I assured him that my technique of using a curved sliding board with a looped sliding sheet is perfect. I added that it’s not taught in the community. He said it’s not used. It transpired that insurance is avoiding the claims of sore backs acquired by unfit assistants. Flexible and supple staff are rare…
Maybe we should be making Pilates mandatory for people working in care…
My husband is attended by double Carers four times every day. They attend to his personal hygiene. He is wheelchair bound so we have 2 ceiling hoists- bathroom and bedroom and a mobile one for wheelchair transfers in the lounge.
He is a very heavy chap. I can manage to hoist him on my own but rarely do so now as it is difficult for one person to position him comfortably in chair or bed.
Probably risk assessment is the answer.
My mother, much lighter, also required hoisting. Even dad at 90+ years thought this ridiculous and opted to be the designated second Carer.
Thank you for sharing this, Lin – I think a perfect example of how risk assessment on a case-by-case basis is the only way to go. Of course there will be situations where two carers are needed, but also many where it is safe for a single person to undertake the transfer.
It is and should always be down to risk assessment, not what insurance companies demand, not organisations’ blanket policies and not as a result of risk aversion. Even with a mobile hoist there are occasionally scenarios when it is safe and quite acceptable for one person to hoist. Good carer training and the provision of the right equipment is of course also very important.
Thanks to Declan and Frances for this interesting read. It’s also important to consider that blanket policies that dictate double-handed care may in fact be illegal – it’s known as ‘fettering discretion’…
An authority should not take over-rigid decisions; if it does so it might be fettering it’s discretion; this is unlawful because an authority cannot ‘slavishly follow a policy without regard to individual cases’. The concept of fettering discretion is used to prevent authorities from adopting blanket policies which they are not prepared to modify, even in exceptional circumstances. (M.Mandelstram 1997)
Which, when boiled down, means not delivering patient-centred care.
We have a bit more info and opinion on it at: http://www.felgains.com/blog/single-handed-care-the-solution-to-pull-us-back-from-the-brink/ (external link will open in a new browser window)
Thanks again, both, for highlighting this important subject.
if it is a portable hydraulic hoist then it does take 2 people to hoist but with an electric one this is not the case. Parents hoist without a second person available all the time.
My 19 year old son weighs 100kgs. We have ceiling hoists and I would be perfectly happy for 1 PA to hoist using this. The residential college he attended stipulated hoisting using ceiling hoist requires 2:1. On the back of this, I demanded increased funding via direct payments so we too could double up on staff for hoisting. As an employer of these PA’s I wanted to ensure my son is safe, his staff are safe, and avoid injury or a potential claim against me.
That said, I can hoist using ceiling track hoists easily on my own, and its no problem at all. Drying and dressing him is way more difficult on a 1:1 basis for both him and the PA’s.
BUT at times we also have to use a manual hoist – when out and about, hotels etc. I would always say this requires 2:1 as someone needs to be steering the hoist feet, and another person needs to ensure his legs don’t hit the upright, or his face get hit by the boom.
Also most hotel rooms are carpeted – it can be really difficult to move the mobile hoist with my son in it across carpet even with 2 of us.
So in my opinion 2:1 isn’t needed for ceiling track hoists, but yes, 2:1 is needed when using a mobile hoist.
Hi Pauline Many thanks for your letter as it highlights the very core of the problem with regard to having a complete risk assessment in place to get the correct answer. Using your ceiling tracking you identified one carer but with a mobile hoist this changed to two. I am most certainly not suggesting one or two or more people are required to hoist, however the appropriate risk assessment is needed to identify the number of care staff and reduce risk to a reasonable level.
Drinking 2 litres of liquid a day – has to be water
Office electrical equipment has to PAT tested every year
Moving and Handling always requires 2 people
There are so many urban myths that have become accepted ‘Fact’ despite not being true at all that it’s hard to fight the tide. Love this article by Declan and the well researched articles on Independent Living in general.
Hi Adam – yes, it’s really hard to fight these things once they take root! I confess I was a bit shocked by how much of an influence insurance companies seem to have, without having the expertise to actually justify their demands!