ALS From Both Sides
Care of an ALS Patient
By Diane Huberty, Retired RN, Certified Neuro Nurse
...and ALS Patient
Choosing a Van
My Computer Desk
Before discussing the lifts available, let's start with the moment many of us finally get serious about getting equipment to lift us up. That moment is when we end up on the floor and no one can get us up by themselves. There are ways to handle this short of calling 911. (Though I found this a delightful solution because I got 4 hunky EMS and Firemen to lift me and dance me to my chair.)
Lifting a person who can help to some extent can be made easier using a gait belt. With the belt around the waist it provides a good place to grab and lift rather than pulling on an arm, clothing, or using a bear hug.
Another way to make the task easier is to place a low footstool in reach, then lift the person to a sitting position and put the footstool behind him or her. Using a gait belt or a bear hug from behind and whatever arm strength the person has to boost himself, move up onto the footstool. Repeat the process moving to a chair or to a higher stool and then a chair.
Place a simple kitchen chair next to someone unable to get up from the floor. The best chair is one with a flat back. A high back is ideal for someone with neck weakness. A chair with a curved back is harder to slide onto and knobby spindles are uncomfortable. After checking for broken arms, legs, or shoulder, hip or neck pain, turn the person on his back. Place the chair on its back along side of him. Lifting with your legs so you don't hurt your back, slide and lift him on to the chair so he is in a sitting position but on his back on the chair. A strong person can then lift the chair upright. If the fallen person is "floppy" you will need and extra person to keep him from falling off the chair.
One of the first places we need lifting help and don't want to ask for it is in the bathroom. Toilet elevation works well as long as standing is safe. Later, when assistance to remain standing, walk, or transfer is needed, it reduces strain for the caregiver.
Power toilet lifts:
Can lift about a foot up for easy standing and maximum independence.
Are expensive for short term use.
Will not work with all bidet systems. (Bidets wash your bottom and delay the need for assistance wiping.)
Seat top risers
Inexpensive, available at drug stores or any place selling patient care items.
Most are easy to install.
May be easy enough to remove for single person use and portability.
The easier they are to remove the less stable they are likely to be.
Those with grab bars must be clamped tightly and securely to the toilet.
Require frequent cleaning.
Range from obvious to downright ugly.
Fit beneath the toilet and raise it 3 to 4 inches.
Can be used under standard height toilets or handicapped height.
Available for round (less than $100) or elongated ($200) toilets.
More sanitary than seat top risers.
Not obvious to visitors. Can be painted to match fixtures.
Requires very basic plumbing skills to install.
The standard patient lift is frequently called a Hoyer lift. "Hoyer" is a brand name and there are many other brands. A manual lift is a bit more work but is less expensive and doesn't have the electronics that could break down. But for frequent use, electric is nice. Don't get a lift that has a big hanger (cradle) for the sling. Two hooks work as well as four. Compare prices for used equipment on Craig's List. It is often minimally used and cheaper than buying new even if you have insurance/Medicare to cover a new one. Because you can buy locally, you can try out the equipment and don't have to pay shipping. Pushing a lift across carpet is not fun, so you may want to replace the carpet with wood or vinyl at some point. Be prepared for the lift to be too large to move into the bathroom. Any turns, narrow doorways, or small floor space in the bathroom can be big problems. You may find that the best way to use the lift is to move over a commode, not the bathroom toilet. That is not ideal and definitely an emotional adjustment, but being in a sitting position for bowel movements is important.
The brand of lift you buy makes little difference but the type of sling you use with the lift is critical to how it will work for you!
The sling should be purchased separately from the lift in order to get the right type. Almost any sling will work on any lift. A hygiene sling, also called a split leg sling or U-Sling is by far the best. These can be put under the patient or removed while in a chair or in bed. Standard "commode slings" are a major effort to get under the patient and can't be adjusted as well to get the person sitting more upright. Look for the simplest, uncluttered design and get one with a headrest. In my experience, sling sizes tend to run large so downsize if the ranges are close. Weight loss in ALS adds to the possibility of oversizing.
First attempts at using the lift and sling are seldom successful! Have extra help and don't use the patient as the test crash dummy! With patience and adjustments, only one caregiver will be needed for a smooth lift. Refer to
Toileting Using a Lift
for information on how to use the lift and sling.
A lift becomes a necessity at some point, but I have found that an overhead or ceiling mount lift over the bed is much more convenient than the Hoyer so you will want to consider that option before buying.
Things to consider when buying this type of lift:
Can it be lowered to the floor to pick up a person who has fallen?
Will it fit under the bed you will be using? Most require 4 to 7 inches of space. Measure before buying.
When the base is spread for stability, will it fit around your recliner or wheelchair? Measure before buying.
Will it fit in your bathroom and bedroom? Requires at least a 5 foot square turning area. Suggestion: Before buying get the specifications list. Find the full length and width (with the base opened out). Cut cardboard to this size and see if you can fit and turn it on the floor in the hallways and rooms you will be working in.
Weighs about 100 pounds. Consider the weight of the person and the ability of the caregiver to push the total weight.
Hard to push and turn on carpeted floors.
Requires storage space.
Does not work as a bath lift for standard tub.
Manual (hydraulic $550 and up. A battery powered ($1,300 and up) is easiest for caregivers.
The bar (carriage) that the sling attaches to may have two, four, or six hooks. Two hooks are all that is needed.
Some portable lifts are available but may not be usable with other brands of slings and the sling may not have head support.
Stand Up Lifts
Have a sling seat behind you and a padded knee block in from to keep your knees from buckling.
Require some weight bearing strength and some upper body strength and stability.
Some require the arm strength to hold on to a bar.
Cannot be lowered to the floor to pick up a person who has fallen.
One brand, the Easy Pivot, lifts you to stand but leans you forward over a cushion so upper body strength isn't needed. It may interfere with breathing however.
There are three types of overhead lifts available:
Ceiling mounted lifts:
Are the most expensive.
Can fit any space, can turn or curve.
Can be installed flush with ceiling, on ceiling, or hung from ceiling.
Are the least noticeable in a room.
May be tracked to go from room to room.
Does not take any floor space.
Requires company installation for safe use.
May require construction work to strengthen or support ceiling joists.
Free Standing Lifts:
Lower cost than ceiling lift.
Over the bathtub frame option.
No attachments to walls or ceiling so no repairs when removed.
Easily and quickly dismantled to move or take along.
Wall Mount Lifts
Mounts to wall along side a toilet, bathtub, or bed.
Most compact and space saving.
Built into wall so it is not portable.
May require reinforcement of wall stud.
Swing bar must be positioned for a specific touch down spot.
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