Hospice Patients Alliance: Consumer Advocacy

Helping Your Loved One In & Out of Bed

Transfers from Bed to Chair: in many cases there will most likely be times when the patient will wish to get up out of bed. It may not be advisable for him to get up in some cases. If there is a realistic danger that your loved one will fall, he should not get up alone, and must be assisted by enough people to assure his or her safety.

There are times when some hospice patients will repeatedly request to get up out of bed, and then once in a chair, will soon thereafter request to get back in bed...repeatedly requesting to get in and out of bed over and over. In this case, the patient may be suffering from what is called "terminal agitation" or "terminal restlessness." This problem can become exhausting to you, and the hospice RN case manager and physician must be notified. There are several medications commonly used to relieve this terminal agitation or restlessness.

When a patient is suffering from various symptoms or pain, moving can make things worse. If your physician has ordered pain medications to be given on an as-needed basis, it is good to administer pain medications at least one-half to one hour before attempting to move him. Listen closely to your hospice RN case manager for tips on managing pain before transfers.

You may find that your loved one will suffer from dizziness after laying down for prolonged periods. If you have two persons helping out, one person can lower the patient's legs over the edge of the bed while the other simultaneously helps him to sit up on the edge of the bed, supporting him at the shoulders. This technique for sitting up is simple to accomplish (if you are strong enough to support the patient) once you've watched professional nurses demonstrate. After waiting for him to recover from any dizziness, the transfer to a chair can be attempted (if your RN case manager agrees).

Depending on the patient's strength, the distance to the chair should be adjusted. If the patient is able to support his weight and stand, a little walk to the chair is good exercise, as long as someone is assisting him, supporting him by the arm to steady him if necessary. If however, he is weaker, the chair should be placed next to the bed without any space in between; you may wish to use a transfer or gait belt which is applied around the patient's waist, secured and which can be held to support the patient's weight during the transfer. Watching this done is helpful to learn safe technique.

When your loved one is feeling quite weak, it is important to prevent falls to the floor and any injury that might result. Watch how the hospice nurses assist your loved one. You will notice that the nurse assisting him will place her feet and knees directly in front of your loved one's feet and knees, blocking them in place, preventing his legs from sliding out from under him. Proper lifting technique will help you avoid injuring yourself as well. Using the legs to lift, positioning your loved one as close as possible to the chair, using a gait/transfer belt to help him up, all of these techniques are helpful.

Assisting Your Loved One Back to Bed: If your loved one has already fallen to the floor, do NOT move him or her until you have determined if there has been an injury. If you think there is a real chance that an injury has occurred, you must get help from an RN or the EMS. If there has been no injury, it is still important for you not to strain while helping him back to the chair or bed. Get help when lifting him back up. If you have any doubt about your own ability to assist him back up, getting assistance from other family members, neighbors or friends is appropriate. If there is nobody around who can assist you, you may call the hospice for assistance. In some cases, the hospice will advise you to call the EMS/ambulance for assistance. Straining yourself in the process will only make things more difficult for all involved.

If the patient has fallen to the floor, it is important to notice if there has been any injury. If there has been an injury, it is important to have an RN assess the patient before moving him or her...or call your EMS ambulance to assess the patient. If the patient does not appear to be injured, a useful method of lifting is for two helpers to join in lifting simultaneously, grasping each other's wrists under the patient's hips with one arm and grasping each other's wrists behind the patient's back & under his arms ( sometime's called a fireman's carrying technique). Another method is to take a strong blanket and spread that out on the floor next to your loved one, and position him on the blanket...then using two to four helpers, lift the patient by lifting the blanket up like a stretcher.

It is important to have enough people assisting depending on the weight of your loved one. Ask your RN case manager for guidelines on moving the patient and to demonstrate methods for assisting your loved one in and out of bed or up from the floor.

Assisting to Bathroom: If you need to assist him to the bathroom, the transfer or gait belt can be used as well as using a walker or cane, if the patient is strong enough to use them. Your loved one's ability to walk may become unreliable, and you will need to carefully evaluate his ability as you begin. If there is any indication he's unable to safely transfer, then the attempt to get up should be stopped immediately. Your hospice RN case manager will be able to give you guidance.

If the patient is unable to walk so far, then a portable commode may be placed next to the bed for his use, or a wheel chair can be used. Privacy must be maintained. There is nothing more humiliating to your loved one than sitting on the bedside commode while visitors are present. It is appropriate to ask others to step into another room during use of the bedside commode or bathing. If the patient's bed is not in a private bedroom, a sheet may be hung across the room for visual privacy as well.

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