Helping an adult up from a seated position is one of the most difficult tasks you as a caregiver will face. Difficulties with transferring are usually due to a combination of poor seating design and an individual’s health, memory, and behavioral challenges.
In this section, we’ll show you several things you can do to help someone transfer more easily and, at the same time, keep you safe from physical injury.
If the person is seriously disabled, has had a total hip replacement, or needs more than minimal help – it’s essential to get hands-on training from a physical or occupational therapist – for their safety and yours.
Easy Transfer Chair
For most people with adequate strength and function, it’s much easier to get up from the chair illustrated here than from a sofa or an easy chair, because the body movements needed to do so are much easier on the joints and muscles. Even individuals with Parkinson’s, who are rigid or frequently lean forward, can get in and out of a good chair.
If the person is having difficulty getting out of the chair, take a good look at the seating – you may want to get out a measuring tape so you can see where some of the problems may lie. If you are looking for an easy transfer chair you should look out for extended side arms, at least 18 Inch seat height and 19 – 22 inch seat depth and a supportive cushion. It is best to find seating with bright colors & bold contrasts and an opening underneath in case something gets dropped or lost.
4 Step Transfer
There are several ways you can help the person to transfer, depending on how much help and assistance they need.
If the person does not need assistance you should follow these steps-
People with dementia often need coaching in order to rise from a chair. The person still needs adequate strength and language comprehension for this type of transfer.
- First approach the person gently. Getting low can be helpful. You may need to spend a couple of minutes building rapport. Then invite the person to a favorite activity or destination. Sometimes just saying, “Let’s go for coffee” (or some other activity) is all that’s needed.
- Next, remind the person to position his hands on the ends of the arm rest, while pointing or tapping. Then gently tell him to scoot, pointing to or tapping the seat. Give him time to respond and repeat instructions if needed.
- Now, tell him to move both feet slightly back behind his knees, pointing or tapping the floor as a visual reminder. You may need to gently help position his feet. Then he should move his trunk forward until his nose is above the toes. If he tends to lean too far forward, you’ll need to make sure he’s stable and won’t topple over when attempting to stand up.
- Some people transfer more easily by rocking back and forth while counting to 3, giving momentum for rising. Gently place one hand on his shoulder and the other hand at his waist (or even hold onto his pants) and, on the count of 3, gently assist him to rise. Once he’s standing, offer your arm or have his walker nearby. Now, you’re ready to go!
If the person needs minimal assistance you should follow these steps-
If the person needs more than minimal assistance, ask your doctor for a PT or OT prescription. It’s important to know how much remaining strength the person has and the best individualized transfer technique for that person. You’ll receive hands-on training on how to help the person without hurting yourself. Your safety is just as important as the safety of person for whom you care.
The person still needs to have adequate physical ability to rise safely and language comprehension so he or she can understand your instructions. Although it may be hard to imagine, people with dementia sometimes forget how to get out of a chair and reminders often help.
Make sure that they have an easy transfer chair – one that’s not too deep or low, or the following Transfer Steps may not work. And lifting a person out of a chair can seriously injure you back, so if the person needs more than minimal assistance, you may want to consider an automatic lift up chair (like this one).
- The first you thing you want to do is approach the person gently. As people with dementia often pick up on body language and tone of voice more than on what is actually being said, speak with a relaxed tone – and smile. Getting low – if you can do so – can be helpful. If he or she is resistant to getting up, spend a couple of minutes talking and building rapport. Then invite the person to a favorite activity or destination. Sometimes just saying, “Come on, let’s go for coffee” (or some other activity the person really enjoys) is all that’s needed.
- Next, you need to give gentle reminders if the person has forgotten how to get up from a chair. They may have forgotten one or several steps and need your help with reminders. Here are some general guidelines. If needed, remind the person to position his or her hands on the front of the armrests. For example, say, “Victor – put your hands here,” while pointing or tapping the front of the armrests. Then gently tell the person to scoot forward to the front of the chair’s seat. Speak in simple short sentences. For example, “Victor – move closer to the front of the seat” or “Move your bottom here” and point or tap the front of the seat if a visual reminder helps. Be sure to give the person plenty of time to respond. People with dementia can become irritated if they feel they’re being rushed. Repeat the instructions if needed.
- Then gently tell the person to move both feet slightly under the seat, if they’re able to do so. This puts their feet slightly behind their knees. Again, point or tap the floor if a visual reminder is helpful. At times, in the later stages, you may need to gently help position the person’s feet slighting under the seat. Then the person should move his or her trunk forward until the person’s nose is above the toes. You may need to give the person a gentle reminder if necessary. If the person tends to lean too far forward, you’ll need to make sure he or she is stable and won’t topple over when attempting to stand up.
- Sometimes when attempting to help the person transfer from a chair, it helps to count to three and, on the count of 3, help the person rise. Use one hand on the person’s shoulder or upper back and the other hand at the person’s waist (or hold onto the person’s pants at the waist). Some people, especially those with Parkinson’s, can transfer more easily by rocking back and forth when counting – this gives the person momentum for rising. Once the person is standing, offer your arm for balance or have the person’s walker ready to go.
If the person needs more than minimal assistance, ask your doctor for a PT or OT prescription. It’s important to know how much remaining strength the person has and the best-individualized transfer technique for that person. You’ll receive hands-on training on how to help the person without hurting yourself. Your safety is just as important as the safety of the person for whom you care.
Adapting Chairs and Sofas
If the current chair or sofa is too low, you may be able to adapt the seating so it’s easier to get up from, depending on the person’s remaining strength and balance.
To raise the seat height of a sofa or chair, try adding an extra seat cushion – consider a firmer cushion for extra support. Make sure to use a no-slip liner so the cushion doesn’t slip off when the person gets up. This solution works best on seating with relatively high side arms, since the addition of an extra cushion can make the side arms too low for use in pushing off to stand up.
Or, for a sofa, you may want to try placing risers under the legs. Most risers are made out of a high strength plastic, and are available in a variety of heights, from 2 to 5 inches, allowing for a “custom fit.”
If you’re considering risers for a chair, you need to be cautious. As most risers are not attached to the foot of the chair, they could slip out and cause the chair to tip over. A new chair that is more suited to the person’s current needs may be your safest bet.
Motorized, lift-up chairs can be extremely helpful when the person has severely limited movement. When a lift-up chair is used, the person is brought to a semi-standing position by an electrically-operated motor located underneath the chair that lifts the entire chair up and forward. However, to come to full standing, the person must be able to push down on the armrests and straighten the torso or the person will need caregiver assistance.
Lift-up chairs should only be used with supervision. The controls that recline or lift the chair to a standing position are generally too complex for most persons with dementia to operate. A fall could occur when a person attempts to climb out of the chair that is in the reclining position.
Rocking in a chair can be a pleasing activity, improve well being, and can help discharge nervous or pent-up energy for various individuals – for example, those individuals who pace.
Glider chairs are not exactly the same as rocking chairs – their flat stable base allows for a gentle rocking motion and they do not tip over. All glider chairs are not the same, however. Some less expensive chairs glide further back, making it very hard to get into and out of them.
If the person is incontinent – along with toilet reminders every 2 hours, consider using fabric pads that blend in with the upholstery’s seating. Available in colors, they have a vinyl waterproof backing and are machine washable. This type of pad reduces the embarrassment and shame that often occurs when regular incontinence pads are used.