Selecting the right in-home lift-and-transfer device.

When an individual suffers from loss of mobility and lives alone, it can be more than an uphill challenge. Basic tasks like getting out of bed and using the restroom require great effort. Considerations must be given to all areas of the living quarters, house or apartment. When a family member must care for an ailing family member or one who has suffered from loss of mobility, there are also a variety of considerations that must be taken into account.

Assessing the Terrain

The first thing most physical therapists recommend taking into account before determining how and what is not so much who and why, but where. A patient who requires a lifting or transferring device is usually not in the most ideal of circumstances. In a perfect world, we would be able to say, “Fit the device to the patient, not the patient to the device.” However, in the real world, there are real-world considerations. It is a sad fact that many patients who are not ambulatory are relying on Social Security or Disability insurance, being unable to work. In the case where the patient lives with family, long-term medical care must be financially draining. If this is not the case, then there are greater options. However, if finances are a concern, and they usually are, then the living quarters may be limiting.

For example, if the patient lives in an apartment, he or she may be prohibited from installing devices affixed to the ceiling or walls. Space may be too limited to have a power lift in the middle of the living room. If the patient lives in a house, there are not the same prohibitions, but construction is a consideration. Straps or ballet bars cannot be installed directly into stucco; there must be a firm anchor, or they will pull right out of the wall. Doorways that are too narrow may impede wheelchair movement. The bathroom’s construction is also very relevant. A home with a sink next to the toilet is a blessing to a patient suffering loss of mobility, as the edge of the sink can often be used to assist in lifting. If the patient still drives a vehicle, there is also the consideration of transferring to and from the garage or driveway.

In short, the first step is to formulate a plan of attack. Assess the terrain and the limitations, and it is easy to head off any potential problems. Then, once the “where” is out of the way, on to the “what and how.”

Assessing the Patient and Caregiver

This is the easy part. You’ve already assessed your patient, so you know the extent of your patient’s abilities and needs. The most important factor is, of course, how frequently the patient will be alone. If the patient will always have assistance, there are types of lifting devices that may be utilized that are not advisable for patients who must function alone. Assessing the individual who will be a caregiver is also important. The caregiver’s age and physical condition are obvious considerations. However, when one undertakes the responsibility of caring for a loved one, it is a normal human tendency to be overly optimistic. A strong caregiver may tell the PT he or she can lift the 90-pound patient from a bed with no trouble at all. That may be true, but come back and talk to this person in a week after he/she has been lifting this patient from a bed six times a day.

As physical therapists, you are more than qualified to instruct the caregiver in proper lifting techniques. However, many forget one of the most basic lifting devices, which is not for the patient but for the caregiver. This is the lifting belt. A lifting belt is inexpensive; easy to obtain at hardware stores, home improvement stores, and lumber yards; and can spare the caregiver a great deal of future back pain or injury. A local sporting goods store will also carry lifting belts utilized by power lifters and bodybuilders, as well as lifting straps used by weight lifters.

A caregiver who is not in good physical shape or lacking in strength is, obviously, far more limited. Overly optimistic attempts to lift and transfer the patient with physical strength alone will endanger not only the patient but also the caregiver. Age is also a factor, as a geriatric patient’s bones will be far more brittle. Also, the geriatric patient is far more subject to bruising and clotting when grabbed tightly by the forearms or wrists.

The patient’s weight and physique are also paramount considerations. Obviously, a large patient will require a greater amount of effort and different equipment than a light or slender patient. A tall patient with a long reach will have different capabilities than a short or pediatric patient. Finally, there is also the insurance consideration. The patient’s financial means definitely factor in, as a patient with good finances may be able to purchase or rent a device not approved by the insurance provider.

Basic Lifting Devices

The most basic lifting devices are probably the simplest to deploy. The humble walker, which is lightweight and portable, can frequently be utilized as a lifting device. Of course, it is also limited to the partially ambulatory patient, unless it is used strictly as a transfer device—ie, to transfer the patient from a bed to a wheelchair. Since the walker folds up and is easy to transport, it is also convenient to carry in a car to use as a car-to-wheelchair transfer device.

The transfer board remains one of the most popular transfer devices—and with good reason. It is effective, convenient, and inexpensive. The board is simply placed beneath the patient’s legs, allowing the patient to slide from one surface to another. Plastic or modern polymer boards are intended to be as friction-free as possible. Wooden transfer boards are smoothly finished and coated to again be friction-free. However, if the client is elderly, has skin breakdown problems, or any decubiti, sliding across the board can exacerbate these problems. The transfer board is also highly operator-dependent, meaning it requires a caregiver to assist in the process. Since this process is critical to the patient’s health, the caregiver will require instruction from the PT on proper transfer techniques. The PT must be confident that the caregiver will follow instructions to the letter.

Another option is the transfer belt. The belt fastens around the patient’s body and has handles, usually in the form of loops, which the caregiver can grip to lift the patient. The drawback to this system is that it requires a patient who is able to cooperate and assist the caregiver. A more effective variation of this device is the transfer sling, which is a large strap on which the patient sits. One caregiver stands on either side, and both of them lift the client together. The limitation is obvious: It requires two people. 

A more recent introduction on the scene is the lifting harness or vest, which is worn by the patient in a wheelchair. Affixed to it are loops, which the caregiver can grasp to lift the patient. These devices are convenient because they can be worn comfortably by the patient when outdoors and can be used to assist in car-to-wheelchair transfers.

Mechanical Lifting Devices

These devices, basically variations of the winch, consist of a sling suspended from a boom by a cable. The patient is placed on the sling and lifted from the surface by the power of the device, not the caregiver. Manual lifting device are hydraulic and require a user to either pump a lever or turn a crank to lift the patient. The power lift is almost identical to the manual lift, with the obvious exception that it is powered by an electric motor. Mechanical lifting devices make life easy for the caregiver, but they also have drawbacks. The power lift is easier to use; however, it will not function in a power outage. Both lifts are large and require a great deal of space. Additionally, the caregiver must then move the patient by means of wheels attached to the base of the lifting device, which is quite large. The base must be able to fit under a bed, and the lifting device must be able to be moved on the floor, carpeted or not.

Of course, it is necessary to mention that the nature of the patient’s insurance is another fact. The insurance company may be unwilling to pay for a device that could make daily living tasks much easier for your patient. It is possible, at times, to overturn these decisions, but your patient then must wait while this process takes place. In these instances, it is best to make do with the best device available within the patient’s means.

Alexanda Bilca is a contributing writer for Physical Therapy Products.