Adaptive Equipment for Transfers (Gait Belts and Lifts) and Fall Prevention
Ability to assist in the use of specific adaptive equipment, such as a mechanical lifting device, if the worker will be working with clients who use the device.
Safe Lifting Tips:
Think with the end in mind: communicate to the senior how you will assist
Clear the area: move furniture and prepare the wheelchair or chair (are the brakes on or off? Any rugs or clothing in the way?)
Bend at knees, widen stance: maintain a wide stance with your feet apart to balance your weight on your knees, not you waist by squatting.
Keep the client close to you: place a secure hold on the client and use a gait belt when necessary.
Stand and pivot: by keeping the wheelchair or chair close to the bed, a pivot works best.
Practice: be sure you go through the motions before you make the transfer.
Gait belts: these belts are the most commonly used tool for making safe transfers. The gait belt has a big loop buckle and is placed around the senior’s waist to help steady them during a transfer.
Bending at the knees allows your buttock muscles and thighs to do the work for you. Always bend forward from the hips, not the waist.
Lifting Devices
A physical therapist or occupational therapist should diagnose necessary transfer equipment and provide training for the senior caregiver. If a senior’s condition changes while you are caring for them and they begin to need more assistance with transfers, be aware that the following devices and techniques may be used.
Back belts
Gait belts
Roller boards
Slide boards
Draw sheets
Trapeze
Mechanical lifts
Proper training in using of each of the devices is required, by a care manager or therapist.
Watch this video on moving from a bed to a chair:
Talk your senior client through the process: remember, fear of falling for a senior can make them extra anxious about a transfer. Be sure to make the senior feel at ease and confident in your ability to transfer them. Be sure you are feeling well and understand how to use the transfer equipment. If you have any doubts, don’t do the transfer alone. Call your care manager. Better safe than sorry.
Safely Transfer From Bed to Chair
Helping a client move from a bed to a chair may be simple or difficult, depending the size of the client and type of chair and bed and the client’s mental condition.
Consider these factors and think about how to plan for them when you are assisting the client to transfer.
How much does the client weigh?
How well can the client move their eggs ar?
Is the client “connected” to medical devices such as a catheter bag or leg brace?
Can the client support their own weight without a walker or cane (stand by themselves)?
Decide upon a 1-person or 2-person transfer. If you feel you could not help the client to stand and prevent them from falling by yourself, then choose the 2-person transfer.
1-Person Transfer (Hands on Client’s shoulders, not under armpits)
Steps:
Make sure the client is dressed appropriately with socks, slippers or shoes that will allow them to stand without slipping.
Assist the client to first sit up in bed and let them sit for a moment to feel comfortable and secure before making the transfer (communicate each step of the way with the client to allow them to be prepared).
Lower the bed to the lowest position, if this is an option for the type of bed you are in. Many beds in homes can be very high. Think about the height of the bed and how that will impact the transfer.
Move the chair into a position close to the bed. If the chair has wheels, be sure they are locked. Does the client have a “good side” of their body that is stronger? If so, structure your transfer accordingly so that they will be shifting their weight onto their good side. If you are not sure, ask, as even healthy people usually have a “good side” of their body that also connects to being right or left-handed.
Assist the client to swing their legs over the side of the bed. Support their knees by placing your knees directly in front of them being careful not to lock your knees.
Using proper body mechanics, support the client’s shoulders with your hands and rock them forward to a standing position, tightening your abdominal and buttock muscles at the same time (this can happen naturally). It is a good idea to count to 3 with the client and on “3” make the transfer.
Ask the client to hold onto your shoulders or waist but never around your neck, then bend your knees slightly and pivot your feet to turn your body along with the client’s body.
Lower the client slowly into the chair seat, being careful to keep your back and shoulders strong (do not round your back). Assist the client to position themselves comfortably.
Note: All of us have nerves under our armpits and while it seems to make a lot of sense to grab someone under their armpits when transferring them, this can be very uncomfortable for the client and can pinch a nerve and cause them to lose balance. It is important to support the client by holding onto their shoulders.
2 -Person transfer for Client’s unable to stand on their own:
Step 1: Ask client to fold their arms in a locked position across their stomach.
Step 2: Position the chair at the level of the client’s hips next to the bed (side of chair is next to the side of the bed). One person stands behind the chair and reaches for the client’s shoulders while the other person stands in front of the chair and reaches under the client’s thighs and calves.
Step 3: Count to 3 and lift the client into the chair using safe body mechanics.
Using a Drawsheet
Draw sheets are a safe way to assist a client to move up in bed or to transfer them from bed to stretcher or to the side of the bed for a transfer to chair.
Draw sheets can be made from a regular flat bed sheet: fold the sheet in half from top to bottom and place the folded sheet on the bed with the fold toward the head of the bed.
Position draw sheet under client from neck to calves.
Carefully slide a drawsheet under a client by rolling them to one side or lifting their legs and arms to slide the sheet under them.
Two people may stand on each side of the bed and roll the edges of the draw sheet up as close as possible to the client’s body in order to use them as handles to then pull the person’s body up in bed or reposition their body for a transfer.
Using a Gait Belt
Watch Video on how transfer using a gait belt:
The gait belt allows Caregivers to assist clients who have difficulty walking or who are recovering from bed rest to feel more secure.
Gait belts allow caregivers to more securely guide and support a client and are long canvas straps with an adjustable loop closure.
Place the gait belt around the client’s waist and tighten the loop buckle to be comfortable yet secure.
Hold onto the gait belt while the client is transferring from a bed to chair ( for client’s able to support themselves this serves as a safety net if they should lose their balance or strength).
Use the gait belt to help keep a client steady when they are walking.
Always communicate with your client to know when they are ready to walk or move in order to be ready to support them with the gait belt.
Follow the same system each time you transfer your client and they will learn the routine. By knowing what to expect, your client will become more comfortable with the process. Be consistent!
Fall Prevention
Growing older naturally will impact some of our capabilities and eventually the “Oldest Old” will sometimes be more likely to fall not because they trip over something with their feet and legs, but because their equilibrium or balancing no longer works at 100%.
Remember: Equilibrium Problems Cause Balance Issues, Which Lead to Falls
65% of seniors older than age 60 will experience dizziness or loss of balance, sometimes on a daily basis.
Some level of imbalance will be present with all older adults. As part of the aging process, we may lose functionality of:
Muscle strength
Joint flexibility
Near and far-sighted vision
Vestibular system in the inner ear which monitors motion and provides orientation clues
Why? Something called “Functional Degradation” begins to happen in the body.
This means falls will happen because the body can no longer react quickly, called “Sensory Degradation”. Even if the senior wants to slow down and react quickly when their foot hits a slippery surface, they may simply not be able to react quickly enough because of the body’s degradation, or loss, of this ability to quickly communicate to the muscles.
Think of your body as a computer. By the time you are over age 60, you are operating on an older computer system that cannot process information as quickly as it could when it was new.
Understanding the body’s loss of the ability to respond as quickly as a teenager, helps you to understand that the best way to prevent falls will simply be to make sure the senior does not place themselves in a danger zone.
Tools to Prevent Falls
Use these guidelines to assist in making sure seniors you care for avoid being in a situation where they are likely to fall.
Encourage Seniors to do the following:
Wear sensible shoes: sturdy shoes with non-skid soles
Physical exercise for strength and balance: tai chi, yoga, waling, water workouts
Avoid steep stairs: use the railing when walking up and down the stairs
Use medical alert system: most falls happen in the home are in close proximity to the home and medical alert bracelet or necklace allows for quick response
Use caution when walking: walk on smooth, level surfaces with good visibility (tripping while walking causes falls most often for seniors)
Keep house tidy: don’t leave books, clothes and other items on the floor
Rugs: tape down the edges of throw rugs that are necessary and remove ones that may not be required
Grab bars: install grab bars in the bathtub, shower, and next to the toilet
Watch Video on 6 Steps to prevent falls:
Managing Falls
Risk of falls will always be present when you are assisting a senior with care needs. Follow these guidelines:
Assisted Falls - these are falls where the client begins to fall but the impact of the fall is lessened either because the caregiver is able to hold the client, or the client breaks the impact of the fall by holding onto something. In these cases, if there is no obvious injury, the caregiver should make the client comfortable and ask if they have any type of injury or pain. The caregiver should then contact the emergency contact person listed on the Care Plan (or follow their company guidelines for who to call for an emergency), and explain what has taken place and ask if they would like anything further done. This discussion will determine what further action, if any, should be taken.
Witnessed Falls - these are falls the caregiver observes when the fall is not broken in any way and the client directly falls to the floor or ground. These type of falls can result in serious injuries including internal bleeding, fractures and dislocations. In this type of incident, the caregiver should reassure the client that help will be on the way and determine if and where the client has pain. The client should not be moved and 911 and your Care Manager should be contacted and advised of the fall and the location of the client. The Care Manager will manage next steps and an incident report.
Unwitnessed Falls - these are falls where it is discovered that a client has fallen but the fall has not been observed by the caregiver or anyone else in the area. In these cases, 911 should be called and the client comforted until their arrival. The emergency medical technicians will determine the next course of action. These type of falls require the Care Manager to be contacted.
Remember that internal damage may happen when someone falls, in addition to bruises and broken bones.
Fall Danger Zones
Be aware that it can be easier to fall in situations that require better footing, simply because the older adults “computer system” works more slowly.
Hold onto railings when walking up and down stairs, avoid walking on icy sidewalks and streets (coach seniors to stay home when there can be slippery snow and ice weather conditions as a fall can lead to even more health challenges).
The centers for Disease Control and Prevention reports 1 million Americans are injured and 17,000 die annually as the result of a slip or fall injury.
💡 Tip Sheet
Bend knees and use wide stance for safe lifting, communicate transfer game-plan, receive transfer device training, gait belts and drawsheets work well