When a loved one falls, it’s natural to want to lift them back up; however, the process can be complicated. For any caregiver, one of the most important skills to master is the ability to safely transfer a loved one from one surface to another. There are many types of transfers, ranging in difficulty based on the ability of the person you’re transferring and the specific situation.
In my practice as an occupational therapy assistant, I have witnessed all types of transfer-related injuries, from minor to serious. It is my job not only to transfer my patients safely, but also to train family members in this important skill.
In this article, I will cover proper transfer techniques, body mechanics to avoid injury, and possible risks if done incorrectly.
There are risks involved when transferring loved ones that can result in injury to you, your loved one, or — in the worst cases — both of you. The most frequent transfer-related injuries I have witnessed in caregivers are low-back strains, nerve damage, broken ribs, disc herniations, and rotator cuff injuries.
The risks to your loved one can be just as serious, if not more so. In many cases, a person will require assistance during a transfer due to existing injuries or illness, such as a fractured bone, a brain injury, or stroke. In other cases, your loved one may simply be deconditioned and in a weakened state. No matter the reason, these conditions can significantly impair a person’s ability to perform a safe transfer and thus can increase the risk of an accident.
How to Lift an Aging Loved One Safely
By paying close attention to the following steps, you can ensure your own safety, in addition to that of your loved one.
1. Be Aware of Your Setup
Position your loved one as close to the transfer surface as possible, and make sure there is enough space and a clear path to move. Make sure the person being transferred has on proper footwear to avoid slipping on a slick surface. Ensure there is adequate lighting. Always position your arms to lift while holding your loved one’s trunk, pants, or belt. Never lift using a person’s arms or from underneath their armpits.
Give clear, concise directions before and during the transfer. For loved ones with dementia or other cognitive impairments, do a simple demonstration of the desired movement beforehand. Also, agree on timing, such as counting to 3 and standing on 3, to ensure a coordinated effort.
3. Use Proper Body Mechanics
Set up with your feet shoulder-width apart, with one foot staggered to aid balance and pivoting. Get as close to your loved one as possible, and try to keep your elbows close to your body. Bend your knees slightly, and tighten your abdominal muscles to stabilize your core.
Always lift with your legs, not your back, and avoid twisting at the waist by pivoting from your back foot or taking small steps to turn.
4. Ask for Assistance
Instruct your loved one to push up from the surface as they stand, if they are able to assist you. This will not only lessen your load, but also give the person an element of control, decreasing anxiety, which can be very common during transfers. It also helps to keep their upper body strong and conditioned for this specific movement.
5. Stabilize Your Loved One
Once your loved one is standing, instruct them to step back until they feel the edge of the surface behind their legs and then reach back with one hand to stabilize on the armrest of the couch, edge of the bed, commode chair, or other balancing surfaces. This provides an added layer of safety before sitting.
6. Be Prepared
Always use a gait belt for those who need more than very minimal assistance in standing, as well as for loved ones who have a more involved history, such as a stroke, brain injury, or recent surgery. Remember to ask for help with lifts requiring more than you can safely handle alone.
As a caregiver, you may lose sight of your own health and well-being due to the intensity and attention it takes to provide care for another. The demands placed on your body, mind, and emotions can lead to caregiver burnout; in other words, you reach a point of physical and mental exhaustion that makes it nearly impossible to continue your caregiver duties.
To be successful in keeping your body free from injury, you must maintain a good range of motion and keep certain muscle groups strong. The main muscles you use for lifting are your quadriceps (thighs), gluteal muscles (buttocks), and your abdominal muscles; however, it is smart to also maintain strong supportive core muscles including your erector spinae (large muscle group in the back).
Below are some essential exercises that caregivers can do to target these muscles and increase their lifting power:
Push-ups (these can be done standing up, against a counter or wall)
Lunges (if you are able, include rotation for added benefit)
As important as exercise is to a caregiver, your mental well-being can be even more essential. In my years working with patients and their families, I have seen my share of burnout, and more times than not, it is a person’s mental health that gives out first. This is why it is so crucial to make sure you stay on top of it. We all know that physical exercise boosts mood and endorphins, and can help to lower stress, but here are some things to consider in order to maintain mental well-being:
Sleep amount and quality
Relaxation techniques such as rhythmic breathing or mediation
Taking time for yourself regularly/sometimes saying no
Finding outside support, like caregiver support groups, other family members, or community resources
Common Mistakes While Lifting Patients or Loved Ones
Nobody is perfect; mistakes are part of the learning experience. That being said, it is my job to reduce the opportunity for mistakes that can lead to injury by providing the best training possible to all the caregivers I work with. Here are some of the most common mistakes I see with transfers, and how to avoid or solve them.
Poor communication: Not addressing fear of falling (if present), not explaining what is expected, or giving complicated instructions can lead to confusion and resistance during the transfer. To avoid this, I always ask my caregivers to use simple, one-line instructions for each transfer (bed to walker, walker to toilet, etc.) and wait a few seconds to allow for processing of information.
Improper body mechanics: In my experience, using improper body mechanics is the No. 1 cause of injury to caregivers during transfers. Just remember the basics: properly set up the transfer, stay close to the person you’re lifting, and keep your elbows at your side. Lift with your legs, not your back, and pivot or take small steps to avoid twisting.
Rushing: Trying to move quickly or skipping steps to save time can result in injury or a fall. Take the time to make sure your loved one is wearing appropriate footwear, modify the transfer space (if necessary), and communicate slowly. While transferring, move slowly and fluidly to avoid injury.
To fully prepare for the regular lifting of a loved one, you’ll want to start with the following:
First, take a look at the environment you’re working in. Consider all the spaces in which transfers may take place, normally bedrooms, bathrooms, and main living area. Move furniture, remove clutter, and make sure there is ample room for you and your loved one to safely make the transfer.
Second, figure out exactly how you plan to communicate the instructions for the transfer. For example, for a simple sit-to-stand transfer from the couch to a walker, you might say, “Scoot to the edge of the couch (pause). Lean forward (pause). I will count to 3, and you will stand up on 3 (pause). Ready?”
The simpler the instructions, the better. It is also beneficial to use the same instructions each time for consistency, so work out the instructions for each lift/transfer and practice them!
Next, review the proper stance and body mechanics for each type of transfer. Is it a sit-to-stand transfer, where you will be standing to the side? Or a full-stand, pivot-style transfer from wheelchair to toilet requiring a front setup? Once you know your part in each, practice them without using a person to make sure your space is adequate and you feel comfortable with the pivot or steps needed to complete them safely.
Third, consider other safety aspects. Perhaps you can do a bed or toilet transfer alone; however, getting your loved one in and out of the shower may be unsafe without more assistance. Figure out who will be able to help on shower days, and arrange for that second pair of hands. Also, you may want to purchase a gait belt. Even if your loved one can stand with minimal assistance, keep in mind that some days may be more difficult than others. A poor night’s sleep, an illness, or general fatigue can affect a person’s ability to transfer. It’s better to have equipment on hand and ready just in case.
Finally, remember the importance of self-care. Take care of your mind and body to avoid burnout and remain strong and stable. Give yourself a break and take time to decompress, exercise regularly, and get enough sleep.
A former member of the Navy, Jenny Atwell has spent six years as an occupational therapy assistant, working in rehab hospitals, skilled nursing facilities, and, most recently, as a home health care specialist. Her primary focus is on geriatric care in a variety of settings.