Everyday Aids and Appliances

Stairlifts

Janet Stowe

Most houses have the bedrooms, bathroom, and toileton the first floor or higher. A stairlift enables a personwho has problems climbing stairs to reach upper partsof the house with less difficulty.

What is a stairlift?A stairlift is a device that transports a person up and

down stairs, either sitting on a seat or standing on aplatform; most have a seat. The electrically drivenmotor is usually under the seat on a platform. Theplatform rides up and down on a track that is fitted onthe stairs. The stairlift is usually operated by a rocker(for example, a light switch) or toggle (as in computergames) switch by either the user or the carer. Otherswitch mechanisms are also available for those unableto operate the standard issue.There are 26 different stairlifts currently available in

the United Kingdom, most of which go up and down astraight staircase and cost about £1500. A few go roundcorners and this entails more complicated engineering,which is reflected in the cost-upwards of £3000.Occasionally where there is a half turn in the landingand a further two or three steps an adaptation can bemade to use a straight stairlift. The life expectancy of astairlift can be over 20 years. It is an expensive piece ofequipment that also takes up quite a lot of space at thetop and bottom of the stairs and on the staircase itself.There are several ways in which people with difficul-

ties in climbing stairs tackle this problem. Some go upand down on their behinds-a safe procedure if not alittle uncomfortable-others may go up and down onall fours, descending backwards. As long as the patient(and carer) is happy to manage in this way there isusually no need or reason to install a stairlift. Thereare, however, cheaper alternatives to installing astairlift: stair rails on each side of the staircase andstrategically placed grab handles are often sufficient toenable disabled people to use stairs more easily. Thesemay be at the top and bottom of the stairs and, whererelevant, on a bend in the staircase. They can beprovided by the social services department.

If a wheelchair is to be used a through floor lift maybe more suitable as fire regulations need to be con-sidered. There has to be a way of ensuring that thedisabled person is not stranded upstairs. A throughfloor lift transports a patient in a wheelchair on a seat inthe lift, or standing from one floor to another through atrap in the ceiling. The lift usually runs on two tracksfitted to the wall, and the lift is kept in the upper floorwhen not in use, leaving just the tracks in view.

Rheumatology andRehabilitation ResearchUnit, School of Medicine,Leeds LS2 9NZJanet Stowe, DIP COT, headresearch occupational therapist

Series edited by: ProfessorGraham Mulley.

BrMedJf 1990;301:865-7

Why install a stairlift?Usually all the family sleep on the same floor without

one member of the family alone downstairs. It oftenhelps those caring for a disabled person (especiallythose suffering from multiple sclerosis or stroke) to benearby and within earshot when help is needed duringthe night. To convert a living room into a bedroomwith the possible addition of a commode is in mosthouseholds inconvenient and unacceptable. Patientsusing stairlifts are usually delighted to be able to use

Stairlifis sit on a guiding rail, which is superficially mounted on to thestaircase itself. They are as compact as possible, folding up to takeabout 25cm of the stair width. The seat and footplate each fold,sometimes together, other times independently. The arms may fold upand, ifso, will usually have a safety mechanism to prevent the stairliftfrom moving when the arm is upright. Sometimes the seat swivels (witha handle release mechanism) so that access on and off the seat can bemade easier at the top and bottom of the stairs, where space may belimited. In case ofa power failure or breakdown there is a hand windfacility to lower the stairlift down the staircase

the house normally and not be seen as the cause ofdisruption and loss of living space. They may also bethrilled at the new found ability to go up and downstairs with comparative ease. Stairlifts rarely breakdown and if they do so there is usually an establishedsystem to repair it speedily as it is recognised that anon-working stairlift means a stranded user.

Who needs a stairlift?Many thousands of people who would otherwise be

unable to use stairs use stairlifts. Those with a widerange of disabilities and difficulties such with arthritis,stroke, and coronary disease may benefit. Sometimesthose with progressive disease, such as multiplesclerosis, are supplied with stairlifts, especially in theearly stages. Otherwise through floor lifts are suppliedin anticipation of transporting a wheelchair fromground floor to first floor. Handicapped children growand become heavy for parents to carry up and downstairs. Depending on the disability either a stairlift orlift can be supplied.

How to get a stairlift for your patientDoctors should consider aids and equipment when-

ever they have patients who have difficulty climbingthe stairs. Stairlifts can be provided by the local

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authority social services department, which has a legalresponsibility to provide them when necessary. Whenthere are cash shortages it is not uncommon forprovision of stairlifts to be withheld or simply notallowed. This may mean that discharge from hospital isdelayed. Without stairlifts managing disabled peopleat home may place extra strain on carers. As there areso many variations across the country in the method ofproviding stairlifts the time factor varies considerablyfrom area to area between the assessment for a stairliftand the actual provision and installation. It may varyfrom two weeks to two years. This of course may leadto much anger and frustration by the patient and carers,who are already in a stressful situation and beingstretched to their limit. Often many different staff areconcerned, each responsible for a different aspectof provision and each giving different advice andinformation, leaving the patient and carers mostconfused. Nation wide we need key workers to whompeople could relate and who could take overall respon-sibility for providing such equipment and answer allquestions and queries, thus relieving the patients andcarers of the stresses of conflicting information andadvice.The local social services department usually has an

occupational therapist, who will visit the home andcarry out an initial assessment of the patient's needs.This assessment is often carried out with a socialservices engineer. Together they can accurately assessthe patient, the carers, and the home so that the mostsuitable stairlift is provided. The department ofenvironmental health is usually involved in the acquisi-tion of a stairlift (unless it is being bought privately) asthe environmental health officer assesses patients forgrants towards the cost of providing a stairlift. Some-times the grant can be 75% with a top up of 15% by thesocial services and in cases of severe hardship a further10% by social services. In other cases the family willhave to find the difference. AlL areas of Britain differ intheir financing of stairlifts. It would be sensible if alllocal authorities operated a uniform funding system.When a stairlift is no longer needed, depending on thepractice of the local authority, it is sometimes removedfrom the home, stored, and reused elsewhere. Othertimes it may be the property of the user and the familyto dispose of themselves. Stairlifts may be boughtprivately but even in these cases it is advisable first to

seek the advice of the local social services occupationaltherapist; who will give an informed and unbiasedopinion. The stairlift has to be serviced regularly toensure its safety. The responsibility for this variesdepending on local arrangements.

Assessing a patient for a stairlift is a specialised skill:not only does the patient's physical disability, shape,and size need to be assessed to determine the dimen-sions of the seat and the height of the footrest but alsothe prognosis of the disease, the patient's psychologicalstate, and his or her ability to follow instructions mustbe established. In addition, the stairlift should bematched to the house in many aspects including accessat the top and bottom of stairs and needs of otherpeople living in the house. If the patient, carers, andhome are correctly assessed the installation of a stairliftshould make life easier and happier for all. Thereshould be no problems to either patient or carer unlessof course the medical conditions of either personshould alter. In this case, the occupational therapistshould be contacted again for reassessment. It may bethat guidance on lifting and manoeuvring is all that isrequired.

If a patient has problems ofmobility in the home anda stairlift would possibly be a helpful solution there areseveral ways of contacting the relevant staff, dependingon the facilities of the district. Ideally, the occupationaltherapist at the patient's local social services office willbe the person to contact, The therapist can be contacteddirectly by the general practitioner. If there is no suchfacility at the social services office, then try theoccupational therapy department in the local generalhospital, the main social services office, or the depart-ment of environmental health. In areas where there isa disabled living centre (of which there are 30 aroundthe country) it is advisable to visit a centre where thepatient and carers can try out a variety of stairliftsto discover preferences in design. The occupational

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therapist will be able to tell you where the nearestcentre is.

I thank Ruth Whittaker, of Leeds Social Services, for herhelp and Glynis Cooper and Barbara Dibb for their secretarialhelp.

Appendix

FURTHER READING

Stowe J. How to give your home a lift. Care Weekly 1988 Oct 7:28.

Goodwill CJ, Chamberlain MA, eds. Rehabilitation of the physically disabled adult.London: Croom Helm, 1988.Stowe J. Guide to the selection of the stairlifts. Available from Rheumatology andRehabilitation Research Unit, 36 Clarendon Road, Leeds LS2 9NZ. (£3.00.)British Standards Institute. Specification for powzered stairlifts. Leeds: BritishStandards Institute, 1979. (BS 5776.)

USEFUL ADDRESSES

Disabled Living Foundation, 380-384 Harrow Road, London W9 2HU (071 2896bil)Royal Association for Disability and Rehabilitation, 25 Mortimer Street, LondonWI (071 637 5400)College of Occupational Therapy, 6-8 Marshalsea Road, Southwark, LondonSEI IHL (071 357 6480)

USSR Letter

Creating an association of Soviet doctors

Michael Ryan

Centre of Russian and EastEuropean Studies,University College ofSwansea, SwanseaSA2 8PPMichael Ryan, PHD, lecturerin politics and Russian studies

BrMedJf 1990;301:867-8

Rage and phrenzy will pull down more in half an hour, thanprudence, deliberation and foresight can build up in ahundred years.Those words of Edmund Burke, affirming theprinciples of order and continuity, may apply not onlyto major political institutions but also to thoseorganisations which he called the "little platoons" ofsociety. By the twentieth century these had come toinclude a range of professional associations, and inRussia, following the October revolution, these soonfell victim in the Bolsheviks' campaign to annihilatepotential sources of opposition to the untrammelledexercise of state power. Today, however, a newgeneration of independent groups is being createdthanks to the determination of individuals who acttogether as members of grassroots movements. Thissurely constitutes one of the most promising develop-ments in a country emerging from the ruins of itstotalitarian past.How do Soviet doctors perceive their existing pro-

fessional organisation known as the Union of MedicalWorkers? Set up by the Bolsheviks some 70 years ago,it embraces all categories of health care personnel, andthroughout its history, like other unions, primarilyserved to convey the state's priorities to its membership.Under Gorbachev the concept of democratisation,along with that of glasnost, has been espoused as ameans of furthering the radical transformation of thecountry's socioeconomic system. In theory, therefore,democratisation of the Union of Medical Workerswould be the preferred strategy of a health serviceleadership which urgently needs to include rank andfile doctors in the herculean task of improving thequality of medical care for the Soviet population.A degree of support for that interpretation may be

discovered in the record of the All-Union Congress ofDoctors, which met at the Kremlin during October1988. The first of its sort since 1925, the congress hadbeen organised under an official aegis and shows thatdemocratisation was being taken seriously in thissector of the economy. The first morning's session wasattended by Gorbachev, along with other politicalleaders.

In the opening address by Yevgeni Chazov, the thenUSSR Minister of Health, no mention was made ofthe already current proposal to form an independentAssociation of Soviet Doctors. The first delegate whoraised the issue was a youngish looking woman doctorfrom Leningrad's emergency aid service. In a briefgeneralised definition ofsuch an association's functionsL N Devotchenko said that it "would resolve allmatters concerning the social and legal defence ofdoctors, contribute to raising the prestige of doctors

and look after other matters which create pressingproblems for us."'

Presumably she thought that these functions couldbe undertaken effectively only by a new, completelyautonomous body. Certainly the president of theunion's central committee (Lidiya Novak) got a roastingfrom another delegate who, expressing a widely sharedview, complained that her speech contained "nothingconstructive for improving the conditions of workand daily life of medical workers."' Later a Moscowcardiologist, Aleksandr Sviridov, wrote off the unionas "having long ago discredited itself with thebureaucratism which flourished within it."

Preliminary movesTaken as a whole, Sviridov's speech might be

thought to convey the impression of a man whocombines an incisively analytic mind with exceptionalmoral courage. ' Among other things he went on recordas saying that the administrative command style ofmanagement persisted in the work of the healthministry and that no mechanism existed to guaranteedemocratisation in the restructuring of health care. Hewent on to propose a refinement of the idea of adoctors' association-namely, an association of prac-tising doctors. The objective, in essence, was to createa sense of collective self determination and self con-fidence among doctors in the front line.

Despite the new political climate which favoured theformation of independent organisations of all sorts itseemed for some time as if an All-Union Association ofDoctors would not come into being. Writing inMeditsinskaya gazeta some four months later Sviridovidentified as a major inhibiting influence the sense ofalienation among doctors which had been induced bythe bureaucratisation of medicine in the Soviet Union.2His pessimistic characterisation of the position was asfollows:Things have reached a point where a doctor essentially hasceased to be answerable for his work. He carries out theinstructions of superordinate organisations without thinkingand they bear the responsibility for his work. The mostdeplorable thing is that such a situation is convenient formany of us.

For Sviridov apparently the association would be atleast as concerned to raise standards ofcompetence andcommitment as to defend clinicians vis a vis theadministration and to improve terms and conditions ofwork. (Incidentally, he describes as a "common matter"the non-payment of doctors and nurses for additionalduties.) Most importantly the association could takeover responsibility (from the health ministry) for

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