How to assist an older adult to transfer from a bed to a wheelchair? A step-by-step guide

According to the CDC, over 1 in 5 adults aged 65 and older have difficulty walking or climbing stairs, making transfers a frequent necessity. A proper and safe technique is essential when learning how to assist an older adult to transfer from a bed to a wheelchair to prevent injuries for both the caregiver and the individual receiving care. This guide provides a detailed, step-by-step method to ensure a smooth and secure transfer.

Quick Summary

This guide outlines the critical steps and safety precautions for transferring an older adult from a bed to a wheelchair. It details how to prepare the environment and the person, proper body mechanics for the caregiver, the pivot technique, and when to use assistive devices like gait belts or mechanical lifts. The summary also emphasizes clear communication and comfort for a successful transfer.

Key Points

• Prioritize safety: Assess the person's abilities, clear the area of hazards, and use a gait belt for a secure grip.

• Prepare the environment: Position the wheelchair on the person's stronger side, lock the brakes, and remove footrests.

• Use proper body mechanics: Bend at your knees and use your legs to lift, not your back, to prevent injury.

• Communicate clearly: Explain each step of the process to the person to ensure cooperation and reduce anxiety.

• Know when to use assistive devices: For individuals with limited or no mobility, use a transfer board or mechanical lift to ensure safety.

• Protect the person's feet: Ensure the person wears non-slip footwear to prevent slipping during the transfer.

• Follow professional advice: Consult a physical therapist for tailored training and guidance on transfer techniques.

Safety First: Essential Preparations

Before attempting any transfer, safety must be the top priority. Assessing the individual's strength, mobility, and comprehension is crucial. This initial evaluation dictates the level of assistance required and which tools to use. Always ensure the pathway is clear of obstacles like loose rugs, furniture, or wires. Proper communication is key; explain each step to the person being transferred to gain their cooperation and reduce anxiety.

Environmental and Equipment Preparation:

• Clear the space: Remove any tripping hazards from the transfer path.
• Position the wheelchair: Place the wheelchair as close to the bed as possible, on the person's stronger side if applicable. A slight 30-45 degree angle is often recommended.
• Lock the brakes: Engaging the wheelchair brakes is non-negotiable to prevent any unexpected movement.
• Move footrests: Swing the footrests away or remove them entirely to prevent them from becoming an obstacle.
• Adjust bed height: If possible, lower the bed so the person's feet can rest flat on the floor, allowing them to use their legs for support.
• Use proper footwear: Ensure the person is wearing non-skid socks or shoes for firm footing.
• Secure a gait belt: If using a gait belt, apply it snugly around the person's waist, above their hips.

Performing the Transfer: A Step-by-Step Guide

Once all preparations are complete, you can begin the transfer process. This method, often called a "pivot transfer," is suitable for individuals who can bear some weight on their legs.

1. Assist to a sitting position on the bed's edge: Roll the person to the side, facing the wheelchair. Place one arm under their shoulders and the other behind their knees. Swing their legs off the bed, using the momentum to help them sit up. Allow them a few moments to adjust to a seated position to avoid dizziness.
2. Position at the edge: Help the person scoot forward so their feet are flat on the floor and they are at the edge of the bed. The person should lean forward slightly, with their nose over their toes.
3. Use a gait belt (if applicable): Grip the gait belt securely at the person's sides or back. If no gait belt is used, place your hands on their lower back or sides, avoiding their arms.
4. Stand-up motion: Bend your knees and keep your back straight. On a count of three, use your leg muscles to lift and shift the person into a standing position. The person should assist by pushing up with their hands from the bed surface.
5. Pivot toward the wheelchair: As they stand, pivot your feet, not your back, moving toward the wheelchair. Guide them gently but firmly. The back of their legs should be touching the wheelchair seat before sitting down.
6. Lower into the wheelchair: Once positioned, bend your knees and shift your weight to smoothly lower the person into the chair, guiding with the gait belt or your hands.
7. Final adjustments: Once seated, reposition their hips toward the back of the chair, lower the footrests, and ensure they are comfortable and secure.

When to Consider Other Transfer Methods

Not all individuals have the strength for a pivot transfer. Understanding alternatives and when to use them is essential for safety.

Transfer Method Comparison Table	Feature	Stand-Pivot Transfer	Transfer Board	Mechanical Lift (Hoyer Lift)
Patient Mobility	Requires some weight-bearing ability, trunk, and leg strength.	Requires good upper body strength, trunk control, and balance.	For individuals with limited or no mobility, or who are unpredictable.
Caregiver Strength	Requires moderate physical strength and proper body mechanics.	Requires less lifting strength, but skill in positioning the board.	Requires minimal lifting, but specific training for operation.
Equipment	Often uses a gait belt.	Requires a smooth, rigid transfer board.	Utilizes a hoist with a sling.
Setup Complexity	Relatively simple setup with proper training.	More complex setup, may require removing wheelchair armrests.	The most complex setup, with specific equipment and sling requirements.
Best Used For	Most common method for moderately mobile adults.	Individuals who cannot bear weight on their legs but can use their arms.	Individuals who are fully dependent on a caregiver for transfers.

Conclusion

Mastering how to assist an older adult to transfer from a bed to a wheelchair is a critical skill for any caregiver. The key is prioritizing safety through meticulous preparation, clear communication, and using the correct transfer method for the individual's abilities. Whether it is a stand-pivot, transfer board, or mechanical lift, proper technique protects both the caregiver and the person being moved from harm. Always consult with a healthcare professional, such as a physical therapist, for personalized training and to ensure the safest practices are followed. Regular practice and attention to detail will ensure that transfers are smooth, dignified, and injury-free.

Further Reading

For more in-depth information on patient handling, proper body mechanics, and assistive device training, consult the resources from the National Institute of Health (NIH) or MedlinePlus on patient care transfer techniques.

Frequently Asked Questions

What is the best way to help an older adult stand up from the bed?

The stand-pivot transfer is a common method. Start by helping the person sit on the edge of the bed with feet flat. Use a gait belt for a secure grip, and on the count of three, use your leg muscles to help them stand. Ensure they lean forward slightly as they rise, with their 'nose over toes'.

How can I transfer someone from bed to a wheelchair if they can't stand?

If the person cannot bear weight, a transfer board or mechanical lift is necessary. A transfer board, used for those with good upper body strength, bridges the gap between the bed and chair. For individuals with no mobility, a mechanical lift (Hoyer lift) and sling provide a safe and controlled transfer.

Is a gait belt necessary for every transfer?

A gait belt is highly recommended for most transfers involving a standing pivot, as it provides a firm, safe handhold for the caregiver and promotes stability for the person being transferred. It is safer than grabbing their arms or clothing, which could cause injury.

What should I do if the person starts to fall during the transfer?

If the person begins to fall, your priority is to lower them safely to the nearest flat surface, whether it's the bed, wheelchair, or the floor. Do not try to hold or catch their full weight, as this can cause injury to both of you. Stay close and bend your knees to control the descent.

Where should the wheelchair be positioned for the transfer?

The wheelchair should be placed on the side of the bed that aligns with the person's stronger side, if applicable. Position it at a slight 30-45 degree angle to minimize the distance and pivot required for the transfer.

How do I use a transfer board safely?

To use a transfer board, position it under the person's buttocks and extend it across to the wheelchair seat, ensuring it is secure. Guide the person to scoot across the board while they use their arms for support. Never place your fingers under the board where they could be pinched.

How do I ensure the person is positioned correctly in the wheelchair?

After the transfer is complete, reposition the person's hips to be as far back in the seat as possible. Adjust any cushions or padding as needed. Then, lower the footrests and ensure their feet are securely placed on them for comfort and stability.