When the person you care for is unable to easily move from the bed to the chair, or on to another surface, you may be asked to provide assistance. This can be a high-risk activity. In 2003, it was reported that the health care sector in British Columbia accounts for more worker injuries than any other sector including forestry, construction and transportation.
Patient-handling activities (e.g., repositioning a person or assisting them to transfer) account for almost 50% of the muscle and joint injuries in acute and long-term care settings. The good news is there are things that you can do to ensure your safety as well as that of the person you are assisting.
When the people you care for start to have difficulty, it may be hard for them to admit that they need assistance. This may put them at risk for falling as they may have to make several attempts to stand. They also may not realize how often they call on you to give them a “boost.” If you are helping with this type of activity, you could be at risk for injury and need to work with the person you care for to find a solution that works well for everyone.
Encourage the person to go for an assessment either by their family doctor or a therapist. They may be able to determine if there is an underlying cause that can be treated or remedied with a piece of home healthcare equipment.
The assessment
The first thing the therapist is likely to do is complete an assessment. As a start, the terms “lift” and “transfer” need to be defined to ensure everyone has the same understanding at the beginning of the discussion. A transfer is defined as “the procedure used to assist a client, who can bear weight at least through one leg or both arms, to move from one surface to another.” A lift is “the procedure used to lift or carry the entire weight of a person or object.”
It is important that you, the person who needs assistance and the therapist discuss the following:
- How often assistance is needed?
- What type of assistance is needed (how much effort or strength is needed to help)?
- Does the type of assistance change throughout the day?
- Where is the assistance needed most? (To get out of a chair, get off the toilet or get out of bed?)
- Is there a history of falls? (Where, when and how often?)
Once there is a clear picture of the types of assistance required, the therapist is in a much better position to provide recommendations.
Preserving independence with standing
Depending on the abilities of the person you are assisting, changing the height of surfaces (the bed, chair or toilet), in addition to installing grab bars, may help with the transfer. It is generally easier to get up from a raised surface. Raising the height of surfaces is an easy thing to do in many cases:
- Toilet seat – consider installing a raised toilet seat with arms. The arms provide a stable support for the person to use as they are rising.
- Bed – bed blocks under the legs of the bed can raise the height of a low bed. Make sure you use one bed block for each leg of the bed. A transfer pole at the side of the bed can also assist with rising. Transfer polls may be useful in other locations throughout the home.
- Chair – bed blocks may also work for some chairs and couches. Another approach is to consider purchasing a lift chair. This type of chair uses a motor to lift the chair and tilt it forward, making the transfer much easier. An uplift seat may also provide assistance. This portable device works on many different chairs. As the person shifts their weight forward over their feet, it provides a boost into standing.
Lifts
When people can no longer stand or transfer on their own, the temptation is just to pick them up and move them to their chair. Even if the person is light this is not recommended, and may result in an injury. Many hospitals and facilities have “no lift” policies for just this reason.
A number of different devices are available for purchase or rental to help move a person from one surface to another with less exertion on your part:
- Sit-to-stand lift – this device helps the person into a semi-standing position. The device can then be wheeled around to a chair or other surface and the person lowered down. Space is needed to store this device when it is not in use.
- Floor lift – when using this type of lift, a sling is first placed around the person and attached to the lift. The arm of the lift rises, either through an electric motor or mechanically through a pumping motion, and lifts the person. The lift can then be moved around to a chair or other surface and the person lowered down. The sling then needs to be removed. Space is also needed to store this device when it is not in use.
- Ceiling lift – with this type of lift, a track is installed in the ceiling and a lift runs along the track. The track is installed into the structure of the room, not just bolted to the ceiling, so it will carry the required load. Speak to your therapist or sales representative to determine the specific weight capacity. To use this lift, a sling is again placed around the person and then attached to the lift. An electric motor lifts the person, who can then be guided through the air to the next surface, lowered and the sling removed. Although there are not usually additional storage requirements for this lift, it is important that the track is conveniently located. It may be possible to have track installed in a number of locations in the home, and use one lift that can be moved from track to track.
Final thoughts
Not being able to transfer independently does not necessarily mean it is time for a person to move into long-term care. Simple strategies such as installing grab bars in key locations and changing the height of some surfaces may help to improve a person’s independence and safety with transfers. If a person is unable to bear weight, other devices such as a sit-to-stand lift or ceiling lift may help to improve safety. When looking at any of these issues, a consultation with a knowledgeable healthcare professional and arranging for an assessment is always the best way to begin.
