How to Use a Lift for Toileting
One of the most frustrating problems presented by ALS is using the toilet. For men, finding someone strong enough to lift them is a problem. For females, this is a hassle faced several times a day. The most frequently recommended solution is a lift system such as a Hoyer lift or ceiling track lift. Either type eliminates the need to lift the patient and that is a big help, but information on this equipment focuses on lifting and transfer ease. Nobody mentions getting your pants down! No one tells you that in order to use a sling lift for toileting, you have to give up wearing slacks and underwear! Well, I refuse to sit around bare-assed under a drafty skirt or lap blanket waiting for a call of nature! With a bit of experimenting, I've found a way to dress normally and still use my lift.
The brand of lift you get doesn't make as much difference as the type of sling you use with it. Despite what lift manufactures want you to believe, most slings will work just fine on most brands of lifts.
The first thing you need is the right kind of sling, one called a "hygiene" or "toileting" sling, NOT a "transfer" or "commode" sling. Commode slings simply have a hole under your bottom. Hygiene/toileting slings are open underneath your bottom and all the way up to your waist in the back. The key feature I wanted in a sling was that it be easy to put on and take off while I was in my wheelchair. I did not want to have to sit on it all day. Besides being a red flag for the fashion police if I wanted to go out, it could also contribute to pressure sores. These pictures show the difference between a usable toileting sling which can easily put on and removed while seated in a wheelchair, and a commode sling which cannot.
When I purchased my sling the options were limited. I could not get one that had support for upper back and head, nor could I get one in anything but size large. I ended up with an Invacare R121 which still works ok since I can still hold my head up unless I am tipped back. Today there are some models with the back and head support available in small, medium, and large.
The second feature I wanted was a multipurpose sling, one that could be used to get me out of bed as well as from chair to toilet. Without a head rest, my current sling can't do that but the newer Invacare R101 can.
Dress for Success
The third feature I wanted was to be able to get my slacks down and back up without a big hassle. Some manufacturers of toileting/hygiene slings say your caregiver may be able to get your slacks down and back up again while you are in the sling but none guarantee it. We found that with some heavy tugging we could get them down, but getting them back up was a major effort and soon abandoned. That led me to try adaptive clothing.
At first I tried slacks that have zippers at both sides. When unzipped, the backside of the slacks drops down like a trap door and can be pulled forward out of the way before you are lowered down onto the toilet. Lifting the flap back up before sitting requires a couple seconds of standing with only one armed support. Getting the zippers re-zipped once back in the chair required dexterity and hand strength and frustrated my helpers. Side zip pants would still be the best choice if you ever have to stand up in public however.
A much better solution for me are slacks with an open back. As weird as they sound, they look like ordinary slacks when you are sitting in them. Of course you can't wear underwear with them. I just put a hand towel on the wheelchair seat instead. They can be put on while you are lying in bed or sitting in your chair or on the toilet. Just have your helper put your feet in, pull them up to your thighs, lift your knees and pull them up and tuck them under, and snap the waist band in back.
When you transfer to the toilet -- by standing or in a lift -- you don't have to do anything with them. Just transfer to the toilet and go! No removing, pulling, unzipping, unsnapping, un-velcro-ing needed. There is plenty of open space underneath -- I have never gotten my slacks wet or soiled. Back to your chair, remove the sling, do a quick fanny check of your sides to make certain there isn't a revealing gap, and you are on your way. A pit stop with the help of a caregiver who is familiar with the process takes less than 10 minutes --even with me on a ventilator now!
For more information and directions for adapting slacks, go to Adaptive Clothing.
How to Use a Toileting Sling
A sling takes practice to get on properly. You really can't slide down through it as you are lifted, but your position can be adjusted to get you sitting fairly upright. If you think of it as being like the seat on a kids swing where your weight is on your upper thighs rather than your butt, the mechanics of positioning it make more sense. My husband was ready to throw the sling out when it didn't work the first time. I had to insist that we take the time to try different loops on the straps, cross the leg staps, and get the leg straps further up under my thighs. Hope you have a little more patience!
- Place the sling behind the patients back with the lower edge of the sling at the level of the waist band. If a wheelchair seat belt is used, unbuckle it.
- If you wear side-zip slacks, unzip them.
- Bring the leg straps forward and under the leg, lifting each knee to get the straps up high under the thigh. This is the key to a safe, comfortable transfer! If you slide down through the sling, it is probably because the leg straps need to be moved further up under your thighs.
- Fasten sling safety belt. (Actually, we ditched the belt. Because the sling I have is only available in Large, it can't be pulled tight enough to keep me from sliding down through it anyway. With the back rest and leg straps correctly positioned, I don't slide down and can't tip out. I am no daredevil -- I wouldn't use it if I didn't feel safe!)
- Bring the lift bar over the patient and lower it. Hook the loops of the straps over the hooks on the bar. Each strap has a series of three loops. By choosing higher or lower loop you can adjust whether you sit upright or lean back. I find it more comfortable (and dignified!) to cross the leg straps in front of me to keep my knees together.
Both pictures show the same sling. Adjusting strap length makes all the difference in how upright you sit! You can sit up even straighter than shown in picture 2, but a sling with a head rest is the best option.
- If the patient is to be moved sideways to the toilet, remove the armrest on that side.
- Recheck to make sure none of the loops have slipped off the hooks and begin lifting. After making sure the patient is not slipping down through the sling (indicating that the straps need to be moved up higher under the thighs), move the patient over the toilet.
- If you wear side-zip slacks, grab the back waist band of the slacks and pull it down and forward while lowering the patient onto the toilet. For women there is no need to pull down the front of the slacks.
- When the patient is finished, recheck to make sure none of the loops have slipped off the hooks and begin lifting. When the patient is a few inches above the toilet, wiping can be done easily.
- Lower the patient back into the wheelchair. If you use side-zip slacks, grab the back waist band of the slacks and hold it back up in place while lowering the patient back into the wheelchair. Remove the sling, zip slacks, etc.
Purchasing a Toileting/Hygiene Sling
Although there are several manufacturers of the right type of sling, you may find they will not sell you the one you want unless you have their same brand of lift. This is no doubt explained as a liability issue, but the truth is that nearly all slings will fit nearly all lifts. The most common incompatibility is that the sling has four or six straps and the bar (sometimes called the carriage) of the lift only has two hooks. As long as the straps of the sling have loops so you can select the length you need, you should be able to be positioned upright or at a comfortable angle even with just two hooks.
The easiest way to buy is to select a brand of sling sold by general medical supply web sites. There you can purchase over the Internet without having to speak to anyone. Just put one in your shopping cart and pay for it.
If you really want a sling sold only by a lift company, be prepared to lie! Read their web site and decide which model of their lifts you are going to claim to have. If they ask for the serial number, try "Oh, I don't have it yet! I just know it will be the model 700M. My brother-in-law is supposed to be going to get it but I don't how soon that will be." (Everyone can relate to the undependable brother-in-law story.) If they want to send a sales rep out to "make certain it is the sling that will best suit your needs”, hang up.
Links to Slings
Prices on the same sling vary widely among suppliers. Once you find the brand and model you like, do a web search for the best price on it. The best prices I found recently were at:
Hoyer® Padded U-Sling with Head Support $155
Also available in mesh fabric so it can be used for bathing as well.
Invacare Reliant Divided-Leg Sling with Head rest R101 $125.00
BHM Combi $210
Mesh fabric so it can be used for bathing as well, $260
Liko Hygiene Vest with High Back, model 55
Portable lift with Hygiene/Toileting sling.
(Wish I'd seen this before installing my ceiling lift!)
This sling won't work with other brands of lifts.
Somewhat higher back support, but they do not
offer a head support hygiene/toileting sling.
Links to Clothing
They have sweat pants and dressier gabardine slacks
as well as some women's coordinated top and pants sets. They also have side zip slacks.
Buck and Buck.com/
Ladies Open Back Pants
Men's Side-snap Pants
Men's Velcro Fly Pants