Installing patient-lifting equipment can dramatically reduce staff injuries and workers compensation claims for nursing homes and hospitals, researchers and health care officials say.

However, hospital and risk management experts warn that-for such an investment to have a genuine payback-health care facilities must make certain that staff members are trained so they will actually use the patient-lifting equipment and that the equipment is properly maintained.

While most U.S. hospitals reportedly have purchased at least some lifting equipment, the industry in general has opposed state and federal mandates that would mandate its purchase and use.

For example, the Washington State Hospital Assn. encourages use of lifting equipment as a way to reduce injuries and workers' compensation payments, but the problem is "getting staff to follow established policies and use the equipment," the group said in a recent issue brief. "Even when a hospital provides lifting equipment, staff (members) sometimes choose not to use it."

The brief, citing a 2005 member survey, says most Washington hospitals have installed mechanical lifts or use lifting teams, another way to reduce staff injuries, and have provided training on use of the equipment.

The Washington association says it opposed a state mandate requiring lifting equipment and trained lifting teams in hospitals because it "dictates the creation and membership of a patient-lifting committee, how the hospitals have to write a patient care activities program, initial training and an annual update and an annual performance evaluation."

Nonetheless, the Washington lifting equipment mandate was enacted in March. It is the first and, as yet, only such hospital mandate in the nation, but similar bills have been proposed in California, Florida, New Jersey and Rhode Island as well as in Congress, according to the American Nurses Assn.

California lawmakers approved such a bill again this year, but Gov. Arnold Schwarzenegger again vetoed it. The governor's latest veto, in September, stated most hospitals already have lifting equipment.

When Connecticut temporarily required Medicare-reimbursed nursing homes to buy patient lifting equipment in the mid-1990s, "it pretty much bombed," recalls Kymberlee Keefe leader of the Atlanta healthcare practice of Chicago-based Aon Corp. "The machines sat in the corner and built up dust and everybody hung stuff on them."

Meanwhile, Ohio is providing interest-free loans to nursing homes to buy lifting equipment and Texas requires health care facilities to adopt lifting policies. On the federal level, the Occupational Safety and Health Administration has a voluntary system that encourages buying lifting equipment.

While Aon's Ms. Keefe speaks against mandates, she agrees that savings from voluntary lifting programs, if done correctly, can be substantial.

For example, a 2004 study cited by the National Institute of Occupational Safety and Health found that it cost about $160,000 to install lifting equipment and train staff, but nursing homes recouped the costs in less than three years in the form of lower workers compensation payments.

The study, published in the journal Injury Prevention, examined six nursing homes that installed lifting equipment and followed results for six years. The nursing homes spent on average $143,556 each in 1997 to install equipment, such as full-body lifts that give total assistance and stand-up lifts, which give partial assistance. Each also spent about $15,000 on employee training.

Initial training involved 30-minute sessions showing use of the equipment, but the project later added a 45-minute testing session in which staffers had to identify what equipment they would use for a particular resident and demonstrate its use. Maintenance training also was provided.

The study noted that barriers to purchasing lifting equipment involved cost, concerns about patient comfort and the extra time needed to use the equipment. But it found that once patients became accustomed to the equipment, they reported a higher comfort level than with manual lifting.

The study found significant reductions in the number of repeat injuries and lost workdays related to patient lifting in the three years after installation. Meanwhile, workers comp expenses fell by an average of $164,609-more than the initial cost of the equipment plus staff training.

Workers comp savings are significant because musculoskeletal injuries from lifting patients are the No. 1 cause of workers comp claims in health care facilities, says Ann Abke, a loss prevention specialist at Catholic Healthcare West, a 41-hospital system based in San Francisco that has implemented a no-manual-lift policy.

She says some staff members-citing nursing school training-insist on manually lifting patients, but, in fact, standing beside a bed and trying to lift patients out of it is an invitation for a back injury, especially now that patients are heavier and nurses are getting older.

"Now we have patients who weigh 400 to 600 pounds," Ms. Abke says. "When you're dealing with that kind of weight, body mechanics are not enough."