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Monday, July 22, 2013

Hoyer Lifts Versus Engine Hoists


Above is a hoyer lift. The hoyer lift also known as the patient lift was invented in 1955 by R.R Stratton. The design of what became known as the hoyer lift has not changed since it was invented. The idea for the hoyer lift was based on automotive repair shops. Engine hoists were widely used as an inexpensive way of lifting an engine out of a car. In fact in the patent Stratton identified the lift as an "automotive engine hoist". Today, hoyer lifts are used in virtually every hospital and nursing home in the country. Many variations of the hoyer lift exist. The legs of the lift are adjustable, a multitude of slings exist, and many are powered by electricity. In a clinical setting two people are supposed to be present when using a hoyer lift to transfer a patient. In the home setting one person can easily operate a hoyer lift.  Many companies manufacture hoyer lifts and multiple videos can be found at You Tube about how they are operated.  Cost depends upon the bells and whistles. Generally, hoyer lifts sell for as little as $1,200 and well in excess of $4,500.  The cost of the lift does not include the sling. Slings cost at least $150. 

It is one thing to state a hoyer lift is similar in design to an engine hoist another to see it.


The hoyer lift is institutional gray. The wheels are slightly larger and some padding has been added. But the mechanics of the design are virtually identical. In fact the engine hoist is far more powerful, that is it can lift more weight, than the hoyer lift. The engine hoist is fire engine red, a color that appeals to me.  Let me ask a simple question: which lift would you want sitting in your bed room? A brand new engine hoist can lift up to a ton. At a tractor supply store the cost would be $205. Used models abound for about $125. 

I would like an answer to a simple question: why is the cost disparity so stark? The design of a hoyer lift and engine hoist have not changed in decades.  A $200 engine hoist can lift a ton. A hoyer lift that can lift a person up to 500 pounds puts one squarely into the $4,500 and up price range. I am not an economist by any stretch of the imagination but this is wrong. And who is getting screwed? Who is being gauged? The most vulnerable among us, people who simply need help transferring.  

20 comments:

Matthew Smith said...

I've got a friend who is waiting to be assessed for and provided with a hoist. She's paralysed with a neurological disorder and is currently bedridden, because although she could transfer into a wheelchair with her husband's help, that resulted in falls and they've decided it's too risky. That was months ago and she's still stuck in bed with no sign of when the occupational therapist is going to show up. I looked on eBay for a hoist that she could buy, but apart from a delapidated looking second-hand manual one, they all cost hundreds of pounds. I'm guessing the reason is that they're made with institutional buyers in mind, such as insurers, chains of care homes, healthcare trusts and hospitals. Probably the same is true of wheelchairs and cushions.

william Peace said...

Mattew, Your friend's experience is the norm. Waits for assessments are very long. In NYC the wait for a seating assessment is about nine months. There is very little after market sales for hoyer lifts. They are used by institutions until they fall apart. Those used by individuals are likely discarded at the end of their life. No one wants to sell an iffy lift to a another person with a disability. Yes these lifts are designed to be used in institutions. I am not sure the same can be said for wheelchairs or wheelchair cushions unless you are referring to the very bottom of the market.

Chie Alemán said...

My understanding - and I'm not an expert by any stretch - is a lot of the price gouging in medical equipment, supplies, etc., is a result of insurance manipulating the market.

Matthew Smith said...

When I said institutional buyers, I just meant big organisations including insurers and healthcare trusts (like NHS trusts in England). Of course, care homes don't pay for decent wheelchairs.

Jim said...

Not saying this accounts for all the price difference, but just for fun, go ask an insurance company how much they would charge for industrial liability insurance on a product that lifts and transports a person who already has a disability. Then divide that cost across the number of units you will sell. Put another way, if you were a juror in a lawsuit in which someone fell from a poorly designed or built lift, what would be the absolute top dollar amount you would award the plaintiff?

Laurey Jaros said...

I'd take the fire-engine red, sexy convertible, thank you. And spend the balance of the funds on something even more fun ...

william Peace said...

Jim, Sorry but your point does not fly for me. Car engines are very expensive and all the same worries exist with the exception of the FDA.

Lynn said...

The Hoyer lift was a liberating innovation when it was invented in the 40's (by Ted Hoyer, who had become a quad in 1936 at the age of 16, and whose motivation to develop the lift was reportedly his determination to court his future wife and "take her places" - they were married for only two years before he died in 1954. But I digress.) BUT, in addition to the fact you point out, that the traditional Hoyer is wildly overpriced compared to functionally-equivalent non-medical products... it's also not necessarily the best solution for many, many users. There are quite a few newer designs that many users and caregivers find more comfortable and ergonomic to use - particularly the products that utilize more of a bent-pivot, upright style of transfer rather than the often frightening and uncomfortable "dangle in midair" quality of a Hoyer transfer. But reimbursement-wise, these alternatives cannot break into the market. People are stuck with ungainly, uncomfortable, space-devouring Hoyer lifts unless they can pay out-of-pocket for the alternatives. Thus, there is no meaningful competition among products and nothing driving any improvement in what you rightly observe was a kluge based on an already-available industrial product even when it was conceived more than sixty years ago.

william Peace said...

Lyn, As always you make insightful and interesting replies. I am unfamiliar with the different lifts you mention. I was lifted once by a hoyer lift. I hated it. The dangle as you put it scared the shit out of me.

Lynn said...

Thanks, Bill.
Just by way of example, here's the category of "stand-up patient lifts" offered by one vendor. http://www.spinlife.com/critpath/match.cfm?categoryID=229
But if I go into a home and see that a mechanical lift is needed, there's no way I can get any of these paid for; the traditional Hoyer owns the third-party-payor market. (And some of these are made by the Hoyer company, too, so it's not just a matter of one business having a monopoly.)So we order Hoyer lifts, and then people despise them and don't use them, and on we go. It's definitely an area with vast potential for improved technology, if only the whole industry were not set in virtual concrete.

william Peace said...

Lynn, I would love to know how many hoyer lifts sold end up becoming dust collectors. I bet the percentage is very high.

Rachael Pierson said...

As a wheelchair and or hoyer lift user, I was very interested in this blog. There are several types of for your lifts and not all of them are suitable for everybody. There are kind that make it impossible to sleep in an elevated bed. There are kinds that are limited to only 250 pounds not the mentioned 500 pounds. Most of people cannot get past the pride of having a hoyer sling under them. If properly placed it can be of minimal viewing when seated in your wheelchair. And yes when describing a lift to someone who has never seen one I tell them that it is basically an engine hoist.
When you mentioned the free flying swinging with no support I actually giggled because that is one of the fun parts for me. It is like being on a swing set which I have never been on because of my physical limitations.

I was actually dropped on the floor because of an air bubble from using this type
http://www.emedhospitalbeds.com/hoyer-heavy-duty-power-lift/

I have never had any trouble with what people referred to as the older model
http://www.spinlife.com/Hoyer-Classic-Hoyer-Lift-Manual-Patient-Lift/spec.cfm?productID=77749

But I know people that have used both and prefer the first. As for using the standup models that may be an option for someone who is a para or quadriplegic, but that is not a possibility for someone who has zero strength anywhere in their body such as someone like me with a neuromuscular disease.

The price gouging I would attest to the mere fact that it is something most businesses do with certain words attached. An example not of the medical industry would be pet supplies. A dog collar can range from $3 up to $10-$20. But a simple Collar of similar shape and size as a small dog collar is never any more than $8. That is because they know people treat dogs more like children and are willing to pay any price. With people with disabilities they know we cannot just go down to the corner store to grab someone cheaper. They can charge whatever they want knowing that we have a need and must buy it.

Charles Grimmer said...

Medical gouging is common practice. They know they have a captive group of customers to feed off of.

My wife has Transverse Myelitis, paralyzed from the waist down. I needed a lift because she had lost here balance a couple of time while transferring to her chair and had fallen.

A Harbor Freight folding 1 ton shop hoist, a gambrell for hanging deer after hunting along with a commercial grade rubber swing seat does the job! All for $200. It gives me a peace of mind now and my wife as well.

Koos Saayman said...

I am busy developing a mobile lift to assist with transfers without the assistance of any second person - if the user is able to place the sling correctly and hook it up, the transfer from bed to wheelchair etc can be done without any other person present.

It is interesting to note the issues with the Hoyer lift that causes discomfort and I am taking this into account in my design. In my research, I have found all of the lifts on the market to be adaptations of the one concept, which has it's pros and cons.

Reason for my post is really the comment about the cost of these products. In terms of direct costs of manufacturing a lift, the cost is not very high even if expensive materials are used to make it lighter and stronger. When one amortize the cost of the patenting process over the number of lifts anticipated to be sold, this rises a bit but is still not that high. Then you have to market the lift, but I believe displaying it at a few prominent exhibitions and word of mouth from actual users should help here as it is truly unique and a deviation from the norm for the past 60+ years. This will add some cost to the unit price as well, as it is not a high intensity approach.

Then however, the real big costs start to come into play, as manufacturers of lifts will start to infringe on your patent and you have to defend it, making the attorneys rich and yourself even more grey haired. That is however still manageable, as it should be defendable provided your patent filing is solid and covers all the angles.

Then, there is the product liability insurance to cover you as a manufacturer / distributor. Accidents do happen no matter how well the product is designed and built, and this has the potential of wiping you out completely. I have just spent 3 hours on the web researching how what aspects I need to get cover for to protect myself, but the web is full of lawyers advertising their service, even on an outcome basis, to go after anyone that touched a device that caused their prospective client harm. In order to protect myself, I therefore have to get the best cover I can afford, which in turn pushes up the price dramatically.

It is all of these add-ons that make products that will give it's users so much independence so expensive, and as a result unobtainable in some cases.

william Peace said...

Koos, As I read your comment the real issue is legal, specifically liability. Is there a way around this? If a product is outstanding word of mouth can spread like wild fire, I saw this when the first rigid framed wheelchairs hit market. Within a few years E&J was out of business. I would not shed a tear if I saw hoyer lifts made obsolete.

McGuy Stein said...

The boom type lift like the Hoyer will probably always be around, as despite the fact that it does not suit everybody, it certainly caters for the majority of transfer requirements. The reason for the Concorde's alternative design is exactly to cater for the individual that needs assistance with transfers but in the absence of any other options, has to use a boom type lift or ceiling lift and therefore be assisted and have limited mobility, specifically when alone at home.

In terms of the exposure to risk as mentioned before and attack by lawyers when a user might have a mishap with the Concorde, I often wonder if it is worth proceeding with it despite the fact that significant funds have been sunk into getting it this far, but get renewed energy when I speak to OTs and see the need there is for such an aid, and how it can change the lives of so many people. I recall having a discussion with two gentlemen in wheelchairs at a facility in Perth more than a year ago, and the parting phrase by the one gentleman was “If it can do that mate, it is worth a million dollars to me”.

I have started a simple blog to try and stimulate a discussion around what an ideal lift would be - to highlight the good and the bad of these aids in order to see how these can be overcome in an alternative design. I am convinced that some of the factors have already been addressed, but being an able bodied person, I can never fully imagine the issues that are really causing discomfort using the boom type lifts. Please feel free to participate and invite others to do so as well over here http://mcguystein.blogspot.com.au/

william Peace said...

If one can transfer independently this radically changes a persons life.

Rhen Nicey said...

Hi there guys! Hoists are found in abundance across many different types of working areas, they are commonly used on construction sites, in warehouses, workshops, car maintenance garages, dockyards and large ships but there are numerous other places that they are utilised that you would not expect, for example, lifting large tree stumps out, or lowering a chandelier for maintenance and cleaning.

deskwarrior said...

The Hoyer hosts are mostly electric, whereas portable engine hoists are almost all hand-pump hydraulic. It takes long enough to do the work required before an engine can be lifted, that a minute or two of pumping makes little difference (and you want to take your time lifting anyhow, to avert snags). But to someone hanging in the air in a Hoyer hoist, a long slow lift could be frustrating.

Someone else mentioned that there's a difference in liability issues, and I think you were too quick to dismiss that. An auto repair environment is somewhat dangerous by nature, so a simple hydraulic system is fine, whereas an electrical (or manual) hoist operated in bedside environment needs to be carefully designed to minimize the possibility of injury. That's just the reality of it.

And before we get too cynical about insurance and lawyers -- the costs are different not just because of liability insurance, but because there's a higher standard of actual design safety - e.g. fault protection on electrical systems would need to be more substantial. And if the device starts leaking a bit of hydraulic oil, that's not a big deal in a repair shop, but would reflect terribly on a medical device.

And this little extra can cost a lot more. Electronics used in some applications require, by regulation, traceable documented manufacturing processes. You and I can buy a USB hub made somewhere in China for $20 or so, but if you want to put it in an aircraft (and, likely, in an ultrasound cart or other medical system) you need to get it from one of a small number of domestic manufacturers who can meet and document the criteria, and it will cost more than $100. In principle, at least, the extra cost gives you a much higher confidence that it will keep working, and won't start a fire in your aircraft or hospital room.

Brad E said...

Hey William!
I love your take on this. I run enginehoist.net and I can tell you that literally any of the engine hoists on my site would do this job just fine! To charge upwards of $4500 for the exact same thing that would cost $150 is outright robbery!
-Brad