Transfers

The problem

Most accidents when moving someone from bed to chair do not come from a lack of strength, but from a lack of preparation: an unlocked chair, a slippery floor, socks with no grip. Preparing well is half the job.

What is happening underneath

First there is a decision: is this a transfer or a lift? If the person can bear at least some of their weight on one leg and cooperate, it is a transfer and can be done by guiding them. If they bear none of their weight, it is a lift, and that is done with a hoist or by two trained people, never by sheer force (see the Hoist chapter).

Step by step

1. Clear the path: no loose rugs, cords, or obstacles between the bed and the chair.
2. Place the chair on the person's stronger side, against the bed and at an angle of about 30 to 45 degrees. Lock the brakes and test them by pushing the chair.
3. Remove or lift the footrests and, if it is in the way, the armrest on the side they will move across.
4. If it is an adjustable bed, set it to the same height as the chair seat or slightly higher.
5. Put closed shoes with a non-slip sole on them. Never barefoot, in smooth socks, or in loose slippers.
6. Have the transfer belt within reach before you begin (card C2).

The problem

The reflex of grabbing the person by the arms, the armpits, or the clothing hurts you both. The transfer belt gives a firm point to hold them without pulling on their body.

What is happening underneath

The belt goes around the waist and gives you something to take with both hands, spreading the force, without hanging from their shoulder or their arm. It is not for lifting someone who bears no weight; it is for guiding and steadying someone who does cooperate.

Step by step

1. Place it snugly around the waist, over the clothing, never against bare skin.
2. It should be firm but not tight: your fingers should fit underneath. Tuck the excess in so it does not hang.
3. Hold it with both hands from below, palms facing up, at the sides of the waist.
4. Use it to guide the movement, not to pull straight up suddenly.

The problem

Standing is the moment of greatest risk: the person lurches forward, gets dizzy, or hangs on the caregiver. Done well, they almost stand on their own and you only guide them.

What is happening underneath

To stand, the center of weight has to come over the feet. That is why first they move to the edge, lean forward (nose over toes), and push with their hands. The caregiver does not lift them: they accompany them.

Step by step

1. Bring the person to the edge of the seat or the bed, with their feet flat and a little back, under the knees.
2. Ask if they are dizzy. Wait a few seconds before continuing; their blood pressure may drop as they rise.
3. Stand in front, with your feet outside theirs and one knee ready to block theirs so they do not slip.
4. Take the transfer belt with both hands. Ask them to lean forward, nose over toes, and push with their hands from the seat or the armrests.
5. On the count of three, you guide them up. Do not lift them: the push is theirs.
6. Once standing, wait for them to find their balance before continuing.

The problem

Moving from the bed to the chair combines two risks: standing and turning. Done in a rush or by twisting the body, it is where most falls happen.

What is happening underneath

You do not turn the person by twisting their back: you have them pivot by taking small steps on the stronger leg, until the back of their knees touches the seat. Only then do they sit.

Step by step

1. Prepare everything (card C1): chair on the stronger side, locked, at 30 to 45 degrees; belt on; shoes with grip.
2. Stand the person up following card C3.
3. Standing and steady, ask them to take small steps turning toward the chair, or guide them to pivot by moving the heels little by little. Never twist their back: the whole body turns.
4. When they feel the seat behind their knees, ask them to reach for the far armrest with their hand.
5. Have them lean forward and lower slowly, using the armrests. You control the descent with the belt (card C6).

The problem

Going back to bed seems easier, but the bed gives way and has no armrests, so it is easy for the person to fall backward or to one side.

What is happening underneath

It is the same standing turn, in reverse: stand up from the chair, pivot on the strong leg until the edge of the bed is felt behind the knees, and sit down slowly. Since the bed does not brake on its own, you have to secure it and control the descent.

Step by step

1. Prepare: if the bed has wheels, lock them. Bring the chair on the stronger side, snug against the bed.
2. Stand the person up from the chair (card C3).
3. Guide them to pivot with small steps until the back of their knees touches the edge of the bed.
4. Ask them to place their hands on the bed at the sides and lean forward a little as they lower.
5. Control the descent with the belt until they are seated, and only then help them lift their legs and lie down (see the Bed chapter).

The problem

Sitting badly, dropping down, jars the spine, can tip the chair backward, and hurts whoever tries to stop the fall.

What is happening underneath

Sitting is the opposite of standing: the weight comes back slowly, down and back, controlled by the person's arms and by your legs, not by your back. Dropping down is what causes injury.

Step by step

1. Make sure the back of the knees touches the seat before starting to lower.
2. Ask them to reach for both armrests (or the bed at the sides) with their hands.
3. Have them lean forward a little and lower slowly, braking with their arms.
4. You accompany the descent with the belt, knees bent and back straight, without bearing their weight with your waist.
5. Once seated, check that they are well back and comfortable (in the chair, see the posture in card A2).