Helping a Person with Dementia Transfer

Helping a person get in and out of a bed or chair is one of the most difficult tasks a caregiver faces. The best transfer technique depends upon the care receiver’s abilities, your abilities, and the living environment. Here are some important questions to consider before helping a person with dementia transfer.

Questions to Ask Before Dementia Transfer:

Care Receiver

• Can the person help if you use simple instructions? It’s better for the person, for it helps maintain muscle strength. Sometimes the person still has the physical ability but, due to the dementia, needs simple instructions and guidance.
• Does the person have the ability to bear weight in at least one leg and stand?
• Does the person have good upper body strength and ability to sit upright?
• Is the person cooperative all the time or at specific times of the day? If the person refuses to budge, place your cursor here.
• How much does the person weigh? A heavy person may need two persons or a lift to get out of bed.
• Does the person have pain? If so, is there a position that’s the best?
• Is the person’s skin thin and frail? If so, this will also effect how you place your hands to help and the type of transfer that you do. You’ll need to move gently and slowly, as older adults bruise easily and their skin tears easily.
• Does the older person have special circumstances that may affect transfer tasks, such as abdominal wounds, knee or hip replacement, or one-sided weakness from a stroke? If so, you need to seek advice from your doctor.
• Is the person dead weight and not able to help with transferring? If so, you need a lift.

Do you know most insurance policies cover a home visit consultation if the person qualifies? For example, physical therapists and occupational therapists can offer specific transfer techniques, strengthening exercises, and the right equipment tailored to your care receiver. And you can get hands-on training for your unique situation. Ask your doctor for a referral, as a prescription is usually necessary.

Caregiver

• What is your strength? Are you putting yourself at risk? You can easily injure your back when trying to lift the person. And falls can happen to both you and your care receiver during transferring.
• Are you helping the person use their remaining strength so you don’t have to lift him or her?
• Do you need special transfer devices or another caregiver to help? Most back injuries happen slowly over time, and you could be putting yourself at risk without knowing it.

Living Environment

• Is there adequate room to transfer your care recipient safely? Do you need to remove clutter, carpets, or furniture?
• Do you have the right equipment and know how to use it? Medicare and other insurances often will pay for helpful transfer devices and hospital beds if your care receiver meets special qualifications. Check with your health care provider.

Tips on Good Body Ergonomics

• Tighten your stomach muscles during transferring to protect your back.
• Bend your knees and hips. (If you’re doing this right, your buttocks stick out). This way, your upper legs and stomach muscles do the work – NOT your back.
• Keep your back straight (don’t round your back).
• Keep your feet about 9 to 12 inches apart, with one foot slightly ahead of the other. This will help you transfer the person by shifting your weight instead of lifting dead weight.
• Assist the person at the hips if a moderate amount of assistance is needed – don’t pull on or under the person’s arms. This is very painful for the person being transferred and can actually cause injury.
• Keep the person close to you as you move.
• Move your feet to turn your entire body. If you turn without moving your feet, you’re twisting your back, which increases injury risk. Pick up your feet and turn (pivot) your whole body in the direction of the move.

1. Ask the person for his or her help, using simple step-by-step instructions, even if you think the person will not understand you. Allow plenty of time to respond. You should only be assisting, not doing for the individual. Sometimes, all a care receiver in the beginning and middle stages actually needs is a hand on the lower back and one on the shoulder to gently guide them forward.
2. Use transfer devices whenever possible to slide, push, and pull instead of physically lifting. You’ll have better success at not injuring yourself.
3. Get equipment ready. Have the walker nearby or position the wheelchair close to the bed or chair and lock the wheels. If possible, remove the armrest and swing away or remove the leg rests in preparation for the transfer. Check the area for clutter on which you or the care receiver might trip on.
4. Use your body properly. Take in account your body type as well as the body type of your care receivers. Where you place your hands and your approach will differ depending on your body type and your care receiver’s. But the golden rule is – get yourself in a position that allows you to maintain a “neutral” spine. Anytime that you lose the natural lumbar curve, you’re putting your back at risk for injury. It’s the small micro traumas that develop into an injury versus just one single isolated event.
5. Position the care receiver’s body properly. For example, for standing transfers, make sure the person’s feet are positioned slightly under his or her knees. For seated transfers, make sure your care receiver’s head/shoulders are bending away from the surface he or she is transferring. In other words, lead with the “okole” (Hawaiian for buttocks).
6. Know your care receiver’s assets and deficits. You want to maximize the person’s assets so the person is doing the most he/she can do – and you as the caregiver do the least. Keep in mind that it’s therapeutic for your care receiver to help as much as possible because it helps the person maintain muscle strength and mobility. For example: If your care receiver has a stronger left or right side, make sure to lead with that side. If your care receiver tends to push or grab, lead with the person’s non-pushing /grabbing side or control the “pushing/grabbing arm(s)” by how you position your hands.
7. Communicate, giving simple step-by-step instructions, especially when you’re ready to transfer. That’s why counting to three is helpful – you and your care receiver then move at the same time. But allow for greater time if your care receiver has Parkinson’s disease because initiating movement will be more difficult.
8. Use momentum, like rocking and counting to three, to transfer.
9. Give the person a moment to adjust to each new position. People with dementia react slower then we do, and rushing a person can be disastrous.
10. Get professional advice. Many insurance companies cover a physical therapy consultation for you to get specific strengthening exercises for your care receiver and hands-on training for your unique situation. Of the numerous ways to help a person transfer, the safest may be unique to your care recipient’s situation. Keep in mind that with individuals with dementia, what works today may not be work a month from now, so it’s important to get ongoing advice from a health professional.

What NOT to Do During Dementia Transfer

• Don’t Bend or Round Out Your Back. This puts tremendous strain on the joints and will lead to a back injury over time. Micro traumas to your back occur when good body mechanics are not used. Keeping your back straight and bending with your knees allows you to lift with the stronger leg muscles, not the weaker back muscles.
• Don’t Do All the Work. The key is to have your care receiver do as much possible to maintain his or her independence and to protect your back as a caregiver. Many care receivers, even in the late stages, can offer limited assistance if you give them simple instructions and enough time to respond.
• Don’t Lift Under the Care Receiver’s Arms. This can cause damage to the arms, and it doesn’t allow you adequate control of the person’s body. In addition, it’s painful for the care receiver if you grab them here, for this is where a network of nerves and blood vessels run (brachial plexus). If your care receiver has an unstable shoulder, you could injure him or her. If you need to give assistance, assist from the hips.
• Don’t Twist Your Body without Moving Your Feet in the Same Direction. This is how many injuries occur.
• Don’t Lift. To reduce your risk of injury, it’s always better NOT to physically lift a person. Use special techniques so you can have the person use his or her remaining abilities to help and, when needed, use special equipment.