4.4.4 Transferring Clients without Assistive Devices

Transfers without the need for a lift device must be set up with proper preparation for success.  In addition to the general guidelines previously stated , it is important to make sure the area is ready for the client before the activity is started. A safety assessment of the living space that looks for ways to assist the client in succeeding without devices is the first step. This assessment will save time, energy, and, potentially, injury for both the client and the staff.

To complete an assessment of the space, work through the following questions:

• In the living area, is there a lift chair to make sitting and rising easier on the client and staff?
• Is the bed at a good height for the client, to make it easier to get in and out of bed?
• If needed, is there a raised toilet, grab bars around the toilet, or safety bars in areas they need them?

Additional information on assessing risks in an environment is provided in the next chapter.

Transfer to a seat from a bed or wheelchair

Here is the process for assisting clients to transfer to a seat from a bed or wheelchair, without assistive devices:

1. Place the client’s chair at a 45- to 90-degree angle so they are transferring to their strongest side, and you can support the weakest side.
2. Lock wheels if in a wheelchair and remove anything between the client and the seat they are going to, such as foot rests, rugs, etc.
3. It is suggested that all transfers of this type include the use of a transfer belt; however if one is not available, complete these steps (or proceed to step 4 if you have a transfer belt):
   • assess the client’s ability to bear weight on one or both feet,
   • have the client move to the edge of the seat,
   • place your feet on the outside of the client’s feet,
   • bend your knees to block the client’s knees for stability,
   • advise the client you will rock them forward on the count of three (explain that you will go on three: 1, 2, go).
   • rock the client to a standing position on three, and
   • pivot them to the seat.
   • have the client move their hips back into the back of the seat for comfort.
4. If using a transfer/gait belt:
   • assist them with your hand in the back of the belt and allow them to weight bear, but steady them using your hand looped into the underside of the transfer belt.
   • have the client take small steady steps.
   • guide the client onto the seat.

When assisting a client without the aid of devices, a slower pace will be the best practice to allow the person to be confident in their movements. Regardless of whether you use an assistive device, do not leave the client without a call bell. 

Reverse the process when the client is returning to the chair.

Manual transfer to surface from a wheelchair with one person assist

This video demonstrates the correct way to move a client using a manual one-person transfer without a belt. Notice the maintenance of the center of gravity, and the forward hold of the client.  Also, remember not to have the client hold around your neck; resting their arms on your shoulders as you take small side steps for positioning is appropriate, but holding or pulling on your neck is not. That is a potential injury situation.

Click here for a video transcript in .docx format: Video Transcript

Transfer to bed

Transferring to bed and back involves turning the client onto their side, lowering their legs while on their side to assist their body weight to help them sit up and stabilize.

Click here for a video transcript in .docx format: Video Transcript

Transfer to chair

Using a transfer belt will make these transfers easier. Stand close to the client. Holding onto the belt, have them scoot forward in their seat, lock their knees inside of yours and have them lean forward. Count to three to signal the time of movement, and make sure they are comfortable.

Click here for a video transcript in .docx format: Video Transcript

Transfer to car

These tips are helpful for persons who are fearful or who have dementia. Try these with a partner.  As we find out more about dementia we are able to find better solutions to solve some of the everyday concerns and make life better for those living with the disease and their carers.

This video demonstrates moving a client into a vehicle.

Click here for a video transcript in .docx format: Video Transcript

Transfers for specific situations

While we have now covered many of the most common transfer situations that you will encounter, it is impossible to cover everything. Here is a short list of resources for other types of specialized transfers, which you can watch if any of them are applicable to you:

• Care Partner Support Tips: Getting In and Out of the Car. This video is a helpful look at how to help someone in and out of the front seat of an average-sized sedan.
• Patient Transfer Techniques. These transfers from Shriners Hospital in California show options for transfers of children. These transfers work well using the equipment shown and are used with persons of small stature only.
• TRANSFERRING PATIENTS-Title2. This video shows several transfer scenarios without mechanical equipment.
• Patient Lifting Techniques. This video shows several movements for clients with reduced mobility. The client is moved from the stretcher to the bed, then up in bed, then to the side sitting position, then up using a standing pivot transfer to chair, chair to bed, floor to bed.