When helping an elderly person move from a chair or wheelchair into bed, the primary concern is preventing injury to both the person receiving care and the caregiver. The physical act of transferring another person involves significant risk, particularly back injury for the caregiver, which is common in caregiving roles. Proper technique ensures the transfer is safe and dignified, allowing the individual to assist with movement to the best of their ability. Adopting a systematic approach reduces strain and minimizes the chance of a fall or musculoskeletal injury.
Pre-Transfer Safety Assessment and Setup
The safety process begins well before any physical movement, focusing first on the environment and the individual’s readiness. Assess the elderly person’s current mobility and alertness, noting whether they can bear weight on one or both legs, as this determines the appropriate transfer method. Ensure the immediate path between the starting point and the bed is clear of clutter, rugs, or any obstacles that could cause a trip. Good lighting is necessary to clearly see the working area and the steps of the transfer.
Preparing the equipment involves locking the brakes on any mobility aids, such as a wheelchair or walker, to prevent unwanted movement during the transfer. The bed height should be adjusted to a level that is comfortable for the caregiver, ideally around the caregiver’s waist, to minimize bending and strain. If using a wheelchair, the armrest nearest the bed should be removed, and footrests should be swung away to ensure a clear space for the person’s feet.
The Assisted Standing Pivot Technique
The assisted standing pivot is the preferred method for individuals who can partially bear their own weight and have the strength to push up into a standing position. The caregiver must first establish a wide, staggered stance with one foot placed slightly ahead of the other to create a strong base of support. The objective is to use the powerful leg muscles for lifting, keeping the back straight and in a neutral alignment to prevent strain.
Before initiating the stand, the person is encouraged to lean forward, aligning their “nose over toes” to shift their center of gravity forward, which assists in leveraging their weight for the stand. The caregiver should grip the person securely around the waist or by using a transfer belt, avoiding pulling on the arms or shoulders, which can cause soft tissue injury. On a count of three, the caregiver shifts their weight from the front foot to the back foot, using the momentum and leg power to assist the person into a standing position.
Once standing, the person takes small, shuffling steps to pivot their body toward the bed. The caregiver pivots their own feet to avoid twisting their torso; twisting the spine while bearing weight is a significant cause of back injury and must be avoided by moving the entire body as one unit. The person should be positioned with their back to the bed so they can feel the edge of the mattress against their legs before slowly lowering themselves. The lowering motion is controlled by the caregiver bending their knees and hips, continuing to engage the leg muscles while maintaining a straight back until the person is safely seated on the bed.
Utilizing Specialized Transfer Aids
When the standing pivot is unsafe or the person requires more than minimal assistance, specialized aids become necessary to ensure a controlled and secure transfer. A gait belt, also known as a transfer belt, is an effective tool used to provide the caregiver with a secure handhold around the person’s torso. This belt should be fastened snugly around the person’s waist, over clothing, and tight enough that the caregiver can fit two fingers comfortably underneath it but not so tight that it restricts breathing.
The caregiver grips the belt’s handles or the belt itself with an underhand hold, which allows them to provide support and control during movement without pulling on the person’s limbs. For individuals who have difficulty moving laterally, a sliding sheet can be placed under the person to reduce friction and shear forces on the skin. Other aids, such as a trapeze bar mounted above the bed, enable a person to use their upper body strength to reposition themselves.
If the elderly person is unable to bear any weight or requires a significant amount of physical assistance, a mechanical lift is the appropriate and safest transfer method. Attempting a manual transfer in these situations substantially increases the risk of injury for both the person and the caregiver. Mechanical lifts use a sling to safely raise, move, and lower the individual, ensuring the person is supported across their entire body and reducing the physical strain for the caregiver. The decision to use a mechanical lift should be made when the person is assessed as non-weight bearing.
Safe Positioning and Comfort After Transfer
Once the elderly person is safely transferred onto the bed, attention must shift to their final positioning for comfort and long-term skin integrity. Prolonged pressure on bony prominences can lead to the development of pressure ulcers, so the individual must be positioned to distribute their weight evenly. Repositioning should occur at least every two hours, as sustained pressure compromises blood flow to the tissue.
A common and recommended position is the 30-degree lateral side-lying position, which relieves direct pressure from the sacrum and hip bones. Pillows or foam wedges should be used to support the back, upper arm, and between the knees to prevent skin-to-skin contact and maintain proper body alignment. Furthermore, the heels should be suspended or floated off the mattress using specialized devices or pillows, as they are a highly vulnerable area for pressure injury.
To minimize downward sliding and shear forces on the skin, the head of the bed should not be elevated more than 30 degrees unless a specific medical condition requires a higher angle. Ensure that necessary items, such as a call bell, remote control, and a glass of water, are within easy reach of the person before leaving the bedside. If bed rails are used, they must be appropriate for the bed and serve as an assist for turning or repositioning rather than acting as a restraint.