Helping an elderly person move from bed is a common task that carries a significant risk of injury for both the person being assisted and the caregiver. Improper lifting techniques are a primary cause of musculoskeletal injuries, particularly to the caregiver’s back, with nearly 80% of professional caregiver injuries resulting from moving or lifting patients. Safe transfers require careful planning and execution to ensure the physical safety and dignity of the elderly person while protecting the caregiver from strain. The process relies on using leverage, momentum, and proper body mechanics rather than brute strength to minimize physical strain during the transfer.
Assessing Mobility and Pre-Transfer Safety
Every transfer must begin with a rapid, accurate assessment of the elderly person’s current physical and cognitive status. The caregiver needs to confirm the person’s ability to bear weight on their legs and their capacity to follow one-step instructions throughout the transfer process. A person’s mobility can fluctuate, so the caregiver must check for pain, dizziness, or confusion before every attempt.
The environment requires preparation before any physical movement begins to ensure a clear and secure path. The bed brakes must be engaged, and the bed height should be adjusted so the elderly person’s feet can rest flat on the floor when sitting on the edge. All obstacles, such as rugs or clutter, must be cleared from the transfer route.
Non-slip footwear should be worn, and a gait belt must be secured snugly around the person’s waist, providing the caregiver with a safe, firm grip point. The destination surface, such as a wheelchair, should be placed close to the bed, preferably at a slight angle. Its wheels must be locked to prevent it from sliding away during the transfer.
Manual Techniques for Safe Bed Transfers
The most common manual technique for an elderly person who can provide some assistance is the pivot transfer, moving the person from a seated position on the bed to a standing pivot, and then to the destination. The first step is transitioning the person from lying down to sitting upright on the edge of the bed with their feet on the floor, a position called “dangling.” Dangling helps re-establish blood pressure stability and prevent orthostatic hypotension, which causes dizziness upon standing.
Once the person is sitting, the caregiver positions themselves directly in front, establishing a wide, stable base of support with their feet shoulder-width apart. The caregiver should bend at the knees and hips, keeping the back straight and maintaining the natural curve of the spine. They must use the large leg muscles for lifting rather than the smaller back muscles. The caregiver should grip the transfer belt from underneath and, if necessary, block the elderly person’s knees with their own to prevent buckling.
To initiate the movement, the caregiver must communicate clearly, agreeing on a count—such as “one, two, three, stand”—to coordinate the effort. On the count, the elderly person is encouraged to lean forward, using their arms to push off the bed surface while the caregiver uses their leg strength to help guide the lift. The movement should be a controlled squat-to-stand motion, bringing the person only to a partial stand or a squat position, keeping their weight close to the caregiver’s body.
Instead of twisting the torso, the caregiver must pivot their entire body and feet toward the destination surface while maintaining the upright posture. Twisting the spine while bearing weight significantly increases the risk of muscle strain or back injury. Once the person’s back is aligned with the destination, the caregiver bends their knees again, controlling the descent and lowering the person slowly into the chair. This sequence maximizes the elderly person’s participation while minimizing the physical load and torsional strain on the caregiver’s body.
When to Use Mechanical Aids and Specialized Tools
Manual transfers are unsafe and contraindicated when the elderly person is non-weight-bearing, fully dependent, or when a significant disparity exists between the caregiver’s and the person’s weight. In these scenarios, a full mechanical lift, often referred to as a Hoyer lift, becomes mandatory to prevent injury to both parties. These devices use a sling to cradle the person’s entire body, enabling a completely dependent lift and transfer without the need for manual strength.
For individuals who can sit but cannot bear weight on their legs, specialized tools facilitate safe movement. A transfer board, or sliding board, is used for lateral seated transfers, allowing the person to slide across a gap between two surfaces, such as a bed and a wheelchair. This technique requires the elderly person to have sufficient upper body strength to shift their weight and the ability to follow instructions.
Additionally, slide sheets, which are low-friction fabric tubes, can be placed underneath a person to reduce the force required to move them up or down in bed. These tools help prevent skin shearing and friction injuries to the elderly person while significantly reducing the physical strain on the caregiver.
If a person requires a full lift, using the correct size and type of sling is imperative. An improperly sized sling can cause skin tears or allow the person to slip out, turning a safety measure into a hazard.