Specifying Lifts for Care Homes

This article will serve as a helpful guide on the process of specifying lifts for nursing and care homes, inclusive of all the considerations that need to be taken into account when carrying out this process.

1 Care homes - a growing industry

Care homes - a growing industry

The UK has an ageing population, with around 11.8 million aged 65 and over in the UK (Mid-2016 Population Estimates UK Office for National Statistics, 2017); resulting in the industry continuing to grow rapidly.

The fundamental standards of care as set out by the Care Quality Commission (CQC, 29 May, 2017), the independent regulator of health and social care in England state that care must be person-centred (tailored to the individual service user), service users (residents in care homes) must be treated with dignity and respect and safety is paramount at all times (risks must be evaluated during any care or treatment pathway).

When it comes to the premises and equipment within care homes, the guidelines state that ‘The places where you receive care and treatment and the equipment used in it must be clean, suitable and looked after properly.’

Due to the increased number of people now in residential and nursing care across the UK, there has been an influx in the requirement of lifts for the care sector.

The purpose of lifts in residential homes

If a building is more than one storey/level and the people within the building have, or may have in the future, mobility issues then a vertical life must be supplied.

Lifts play an integral role in helping to maintain the safety of residents at all times. For those who require a lower threshold of care (within residential care homes for example), user-friendly and accessible lifts can help to increase their level of mobility and therefore allow them to maintain their independence for longer.

For those who require a higher level of care and handling such as 1:1 or in some cases 2:1 assistance from carers, the use of a care home lift enables carers to safely move residents between floors and around all areas of the care home, ensuring person-centred care can be delivered at all times.

Lifts also help to ensure the safety of carers and limit the risk of accidents or injury for both residents and carers when it comes to manual handling. Making certain that this requirement is correct, will help ensure the well-being of employees/carers within a facility as it will help to enable the safe movement of everyone, around the building.

What types of lifts may be suitable for a care home?

For guidance on lifts, Part M of the building regulations, Volume 2 (Buildings other than dwellings) needs to be consulted, as this correlates directly to the accessibility and use of buildings. Part M, states that the preferred solution to enable disabled access is a passenger lift. It also recognises that due to site constraints it is sometimes the case that a passenger lift cannot be accommodated, meaning platform lifts can be specified in existing care homes; largely due to the building constraints and layout of existing facilities.

Passenger lifts

Passenger lifts accommodate a high number of people (between 3-33 persons), or mobility equipment, travel over multiple floors (up to 40 metres) and operate at a speed of >0.15 metres per second.

The most common passenger lift sizes for care homes are a 13-person stretcher passenger lift, followed by an 8-person model.

The benefit of a 13-person stretcher lift is that it not only takes multiple wheelchair users but can also accommodate a hospital/care bed. A general standard in larger care homes is that two passenger lifts are provided in case of breakdown and during servicing. These are typically a 13 person stretcher lift and a standard 8 person lift suitable for accommodating a wheelchair.

Platform lifts

Platform lifts can travel up to 12 metres at a steady speed (slower than passenger lifts) of <0.15 metres per second. These lifts are for occasional rather than continuous use.

Popular platform lifts sold into care homes are the Midilift SL and the Piccolo.

The Midilift SL accommodates a wheelchair user and attendant or up to 4 people, meaning that it is a cost-effective option for care home operators. However, it does come with constant pressure buttons so people with arthritic hands can fatigue. The Piccolo can fit up to 5 people and has the benefit of one-touch controls and sliding doors which can allow for easier access for residents; although this option may not always fit inside smaller buildings.

As lifts are used frequently within most care homes (both residential and nursing) a passenger lift should always be installed wherever possible

What are the key considerations when deciding what types of lifts are required?

Lift positioning and specification considerations

The frequency of use of the lift must be carefully considered along with the occupancy of the home. For safety reasons, all lifts must have a clear ‘waiting’ space in front of them and should be located adjacent to central facilities. If lifts are used for regular access to daily dining facilities or to access community areas, then this will influence the type of lift/s required.

Residential care homes with a higher number of residents, or nursing homes where the mobility of residents tends to be more limited may require a greater number of lifts. Nursing homes may also require slightly larger lifts to accommodate extra equipment or carers to assist residents (sometimes 2:1 care is required for lifting and handling of residents) to ensure extra safety.

Once the number of lifts and types of lifts required for the building has been determined, then the next step is to consider the special requirements of residents. As well as mobility issues, residents may have a cognitive or sensory impairment, a learning disability or a mental health condition that causes them particular distress, or they may even present with dementia. This is where the lift specification plays an important part in ensuring a comfortable ride.

When specifying lifts for care homes, it is paramount to consider the following:

Controls - As a general rule, access doors or lift controls must be easy and intuitive to use. Lift controls should be in a logical position adjacent to the lift where their function and operation is obvious.
Lift signage and lighting - should make lift entrances easy to locate and use. Access doors to stairs and lifts should be well lit and clearly distinguishable from their background by using a different colour or tone.
Lift finishes - For both floors and walls mirrored interiors, shiny or swirly surfaces are not recommended finishes for any lift in a care home.
Floor - Provide a continuous floor finish and colour from the corridor into the stairs or lift.
Walls - Use a contrasting colour or tone so that the handrail stands out clearly from the background.
Mirrors - Consideration should be given to the use of mirrors within lifts as these may cause confusion to residents with dementia* and visual impairment. They can not be included in the specification, or if they are provided, alternative approaches such as the use of manifestations can provide an effective but decorative solution, although will likely require approval from building control

Similarly, care must be taken with lift announcements to ensure they do not startle or confuse a person with dementia.

Announcements and communication devices - Always ensure that the lift has a verbal system, which clearly advises passengers of their location, door movements and arrival at their destination. All lifts require an emergency communication device to enable trapped passengers to notify someone they are trapped in the lift. If the residents are likely to be deaf then we would recommend the use of an induction loop.

As well as the standard emergency call panel, normally positioned on the wall of the lift, care home operators should ensure that there is also an emergency button positioned near the ground floor of the lift, in the event of an unsupervised fall/incident.

Lift specification for dementia - This link details specific guidance on lift specification for care homes and hospitals with dementia in mind. Another useful reference is the design audit tool, produced by the Dementia Services Development Centre (DSDC), which provides a framework for making decisions about design and spaces for people with dementia. The tool can be applied to a range of existing and new buildings within a range of settings such as care homes and awards care homes a gold, silver or bronze standard depending on how the lift (along with other building elements) conform to essential and recommended points.

Following safety guidelines & regulations

It’s important to be aware of all relevant standards and guidelines when deciding which lift is best suited for care home requirements. These are the key ones to be aware of:

Lift Standards & Regulations - these vary dependent on lift type and specification.
The ‘Fundamentals of Standard Care’ as laid out by the independent regulator of health and social care in England, the Care Quality Commission (CQC), when setting up any new care home or making significant changes to any existing facility.

Finally, once any lift is installed, it becomes the responsibility of the care home owner to ensure that the lift equipment is regularly serviced and examined at suitable intervals by a competent person. As the legislation surrounding existing lifts is complex, compliance with these regulations tends to be completed with the assistance of a lift service provider.

Breakdowns & emergencies

Spending time considering which style of lift is the most suitable for the residents in care is certainly worth doing, particularly in the event of an emergency. Whether a Simultaneous Evacuation strategy, a Horizontal/progressive evacuation strategy or a Delayed Evacuation strategy is best for a care home, it needs to be confirmed that there are adequate numbers of staff available to implement the emergency plan.

It’s essential for every care home to have a backup in the event of a breakdown or for use when a lift is out of action due to a routine inspection/maintenance.

As part of any lift service plan, there are options for 24-hour emergency call-outs, normal working hours emergency breakdown cover, repairs and supplementary testing, it is, therefore, important to consider what type of lift servicing plan is required by the care home.

It’s also paramount that alternative methods to lifts can be used to exit the building in the event of an emergency. Most lifts (unless specifically equipped to do so) cannot be used more evacuation or in the event of a fire, so stairs and fire escapes are a must as part of any building management evacuation plan.

Summary

As the ageing population continues to grow, it’s inevitable that so too will the need for residential and nursing homes as well as the requirement for adequate lift facilities.

For any lift in a care home, the following is recommended to be considered:

The type and number of lifts the building requires, subject to building regulations and the requirements of the nursing home, e.g. to transport beds and accommodate undertaker requirements
That the lift specification takes into account the residents need both audibly and visually
How the ongoing lift, maintenance and repair will be managed post installation