58. CCA Study Notes: Safe Client Transfers and Lifting Procedures

The Big Picture

A client transfer and a client lift are different. During a transfer, the client helps by putting some or all body weight on their feet. During a lift, the client does not help by bearing weight.

Safe movement depends on the client’s abilities, the care plan, the equipment being used, and the amount of help required. Some clients transfer with little help. Others need two people, special equipment, or a mechanical lift.

Safety also includes dignity, privacy, independence, individual care, preferences, and comfort. The CCA needs to prepare carefully, communicate with the client and helper, follow equipment directions, and report and record according to employer policy.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Transfer, Weight-Bearing, and Lift

A transfer means moving a client from one place to another while the client helps through partial or full weight-bearing.

To weight-bear means placing body weight on the feet while trying to stand.

A lift moves a client from one place to another without the client bearing weight or helping with the move.

These differences matter because the client’s ability to weight-bear affects the type of assistance and equipment needed.

Manual Lifts and No-Lift Policies

A manual lift means physically picking up a client who does not weight-bear without using a mechanical lift.

Most long-term care agencies follow a no-lift policy because manual lifting creates a serious risk of back injury. Under this type of policy, workers do not manually lift clients and instead use a mechanical lifting device.

Home care situations differ. A support worker might take part in a manual lift with help from a family member. Before entering the home for this type of work, the support worker must know the agency’s lifting policies.

Before a manual lift:

• Remove jewellery that might injure you or the client.
• Make sure your shoelaces are tied.
• Complete back-stretching exercises to reduce injury risk.
• Follow agency policy.
• Get assistance if you feel unsafe.

A manual lift might be used in some home situations because:

• A child’s small size makes a mechanical lift unnecessary.
• The home does not have enough space to move a mechanical lift safely.
• The client or family lacks the money to rent or purchase a mechanical lift.

Safety: If you feel unsafe lifting a client in the home, do not attempt the lift. Get assistance.

A client’s abilities also change. A client who previously could weight-bear and transfer with minimal help might later need a two-person assist. The support worker should notify the case manager. The home care team then assesses the client further, and the case manager seeks resources for a suitable lift.

Mechanical Lifts

A mechanical lift raises and moves a client in a special body sling ⓘ.

Different lifts work differently. Knowing how to operate one type does not mean you know how to operate another.

Before using a mechanical lift:

1. Make sure you received training for that lift.
2. Make sure the lift works.
3. Compare the client’s weight with the lift’s weight limit.
4. Do not use the lift if the client exceeds its capacity.
5. Follow the manufacturer’s instructions.
6. Ask your supervisor for instruction when you have not used that type of lift before.
7. Get help from a co-worker or trained family member. At least two people are usually needed to operate a mechanical lift.

Employers usually provide special training. Some employers also require yearly refresher training.

Sit-to-Stand Mechanical Lifts

A sit-to-stand mechanical lift moves a client from one seated position to another.

It is used for:

• Bed-to-chair transfers
• Toileting
• Perineal care
• Changing incontinence briefs

The sit-to-stand lift differs from a sling-type mechanical lift. The client must meet specific conditions for safe use.

The client needs:

• Enough awareness to understand and cooperate with instructions
• Some muscle tone in at least one leg
• Some upper-body muscle tone

The lift is not always suitable for a client who has severe pain when bending the knees and hips.

Levels of Transfer and Lifting Assistance

Long-term care facilities identify how much assistance each resident requires and which equipment the resident needs.

This information is usually included in the care plan ⓘ. The way the information is displayed must respect confidentiality ⓘ and privacy.

Possible assistance levels include:

• Independent with no assistance
• Standby, or observe and supervise
• Transfer board required
• One-person transfer
• Two-person transfer
• One-person lift
• Two or more people to lift
• Ceiling lift
• Mechanical lift, also called a MediLift, Argo, or ground-based lift
• Standing lift, also called a sit-to-stand lift

A transfer board is a smooth board placed between two surfaces. It helps a client slide between the surfaces. For example, some clients with paraplegia have enough upper-body strength to transfer themselves with a transfer board.

A transfer belt is a strong strap secured around the client’s waist or hips. It provides support when the client stands, sits, or walks. Remove the belt when the activity ends.

Core Safety Principles During Transfers

Several safety steps appear throughout transfer procedures.

Before moving the client:

• Identify the client according to employer policy.
• Check the care plan for the client’s abilities and limitations.
• Explain the procedure.
• Gather needed equipment before starting.
• Perform hand hygiene.
• Provide privacy.
• Check the surrounding area and equipment.
• Communicate with your helper throughout the procedure when another worker assists.

Planning ahead reduces unnecessary movement and keeps needed equipment close.

Transferring a Client to a Chair or Wheelchair

This transfer supports dignity, independence, individualized care, preferences, privacy, and safety.

Pre-Procedure

1. Identify the client according to employer policy.
2. Check the care plan for abilities and limitations.
3. Explain the procedure.
4. Make sure the client is fully dressed or wearing a robe and nonskid footwear ⓘ.
5. Review the care plan for transfer directions.
6. Gather:
   • Wheelchair or armchair
   • One or two sheets
   • Transfer belt, when required
   • Transfer board, when used by the agency
   • Seat cushion, when used by the client
7. Perform hand hygiene.
8. Provide privacy.
9. Decide which side of the bed to use and move furniture to create enough space.
10. Communicate directions with your helper throughout the transfer.

Prepare the Chair and Client

11. Align the back of the chair with the head of the bed. This shortens the distance the client needs to move.
12. Place the client’s gel-seat pad or cushion on the chair when the care plan directs it. The cushion reduces pressure on the bony areas of the buttocks, lowers the risk of pressure ulcers, and improves comfort during longer periods of sitting.
13. Lock the wheelchair wheels.
14. Raise the footrests or move them out of the way.
15. Lower the bed to its lowest position or the height stated in the care plan.
16. Lock the bed wheels.
17. Lower the nearby bed rail when it is raised.
18. Fan-fold the top linens toward the foot of the bed.
19. Help the client sit with the legs over the side of the bed.
20. Make sure the client’s feet touch the floor.
21. Apply the transfer belt when it will be used.

Method 1: Using a Transfer Belt

22. Stand in front of the client with your feet apart.
23. Flex your hips and knees.
24. Align your knees with the client’s knees.
25. Ask the client to hold the mattress or place their fists on the bed beside their thighs.
26. Make sure the client’s feet stay flat on the floor.
27. Ask the client to lean forward.
28. Grasp the transfer belt on both sides.
29. Brace your knees against the client’s knees.
30. Block the client’s feet with your feet.
31. Tell the client to push down on the mattress and stand on the count of three.
32. Bring the client to standing as you straighten your hips and legs.
33. Keep your knees slightly flexed.

The transfer belt stabilizes the client without requiring you to grasp clothing or easily damaged skin.

Method 2: Without a Transfer Belt

34. Stand in front of the client with your feet apart. Flex your hips and knees, align your knees with the client’s knees, and have the client hold the mattress or place their fists on the bed beside their thighs.
35. Place your hands under the client’s arms and around the shoulder blades.
36. Ask the client to lean forward.
37. If one knee is weak, place your feet on either side of that foot.
38. If both knees are weak, position your feet outside the client’s feet.
39. If the client’s feet slide forward, brace the knees with your knees and block the feet with your feet.
40. Tell the client to push down on the mattress and stand on the count of three.
41. Bring the client to standing while straightening your hips and legs.
42. Keep your knees slightly flexed.

These positions support proper body mechanics, meaning careful and efficient body movement.

Turn and Lower the Client

43. Support the standing client around the shoulder blades.
44. Continue to block the client’s feet and knees with your feet and knees.
45. Do not allow the client to hold your neck. Holding your neck puts you at risk of serious neck or nerve injury.
46. Pivot and turn the client toward the chair.
47. Help the client grasp the far armrest.
48. Continue turning until the client grasps the other armrest.
49. Lower the client while bending your hips and knees.
50. Keep your back straight with the lumbar area curved.
51. The client assists by leaning forward and bending the elbows and knees.
52. Move the client’s buttocks toward the back of the chair.
53. Position the client in good alignment.
54. Place the client’s feet on the wheelchair footrests.
55. Cover the lap and legs with a sheet or blanket.
56. Keep the covering away from the floor and wheels.
57. Remove the transfer belt when it was used.
58. Position the chair according to the client’s preference.
59. Lock the wheelchair wheels.

Post-Procedure

60. Provide safety and comfort.
61. Put the call bell ⓘ within reach.
62. Remove privacy measures.
63. Perform hand hygiene.
64. Reverse the procedure when returning the client to bed.
65. Report and record actions and observations according to employer policy.

Reporting and recording keep the health care team informed and serve legal purposes.

Transferring From a Wheelchair to a Shower, Commode, or Bath Chair

Pre-Procedure

1. Identify the client according to employer policy.
2. Check the care plan for abilities and limitations.
3. Explain the procedure.
4. Gather:
   • Shower, commode, or bath chair
   • Sheet
   • Towel
   • Transfer belt, when used
5. Perform hand hygiene.
6. Provide privacy.
7. Make sure the shower chair is secure and locked.
8. Do not transfer the client when the shower chair is not secure.
9. Check the grab bars.
10. Do not transfer the client when the grab bars are loose.
11. Report loose grab bars to your supervisor.

Procedure

12. Place the wheelchair at a 90-degree angle to the shower chair.
13. Position the client’s unaffected side near the shower chair.
14. Lock the wheelchair wheels.
15. Raise, remove, or move the footrests out of the way.
16. Prepare the water and test the temperature.
17. Apply the transfer belt when used.
18. Help the client stand and turn toward the shower chair.
19. Have the client use the grab bars or shower-chair armrests for support.
20. Support the client while they undress.
21. Hold the transfer belt or support the client around the shoulder blades.
22. Continue to block the client’s feet and knees with your feet and knees.
23. Instruct the client to hold the grab bars or armrests.
24. Lower the client onto the shower chair.
25. Remove the transfer belt when used.

Post-Procedure

26. Help the client dry after the shower.
27. Cover the client with a sheet to reduce chilling and injury risk.
28. Reverse the procedure to move the client back to the wheelchair.
29. Help the client dress in clean clothing while maintaining warmth and privacy.
30. Perform hand hygiene.
31. Report and record actions and observations according to employer policy.

Transferring a Client to and From the Toilet Seat

Pre-Procedure

1. Identify the client according to employer policy.
2. Check the care plan for abilities and limitations.
3. Explain the procedure.
4. Perform hand hygiene.
5. Provide privacy.
6. Make sure the client has an elevated toilet seat so the toilet seat and wheelchair sit at the same level.
7. Check the grab bars.
8. Tell your supervisor when grab bars are loose.
9. Do not transfer the client when the grab bars are not secure.

Procedure

10. Make sure the client wears nonskid footwear.
11. Place the wheelchair beside the toilet when space allows.
12. If space is limited, place the wheelchair at a right angle to the toilet.
13. Position the client’s unaffected side near the toilet when possible.
14. Lock the wheelchair wheels.
15. Raise, remove, or move the footrests out of the way.
16. Apply the transfer belt when used.
17. Help the client unfasten clothing.
18. Help the client stand and turn toward the toilet while using the grab bars.
19. Support the client while clothing is lowered.
20. Hold the transfer belt or support the client around the shoulder blades.
21. Continue to block the client’s feet and knees with your feet and knees.
22. Have the client hold the grab bars.
23. Lower the client’s pants and undergarments.
24. Lower the client onto the toilet.
25. Remove the transfer belt when used.
26. Tell the client you will stay nearby and that they should use the call bell or call for help.
27. Some clients must have someone stay right by their side while toileting because of increased fall risk. Check with your supervisor if you are unsure.
28. Close the bathroom door to provide privacy.
29. Stay nearby.
30. Knock before entering after the client calls.
31. Help with wiping, perineal care, flushing, and handwashing as needed.
32. Wear gloves during this care.
33. Reapply the transfer belt when used.
34. Help the client stand.
35. Support the client while standing.
36. Continue to block the client’s feet and knees with your feet and knees.
37. Help the client pull up and secure clothing.
38. Transfer the client back to the wheelchair.

Post-Procedure

39. Provide safety and comfort.
40. Place the call bell within reach.
41. Perform hand hygiene.
42. Report and record actions and observations according to employer policy.

Using a Mechanical Lift to Move a Client

Mechanical lift procedures differ by equipment. Follow the manufacturer’s instructions and your employer’s directions.

Pre-Procedure

1. Identify the client according to employer policy.
2. Check the care plan for abilities and limitations.
3. Ask another person who is properly trained with that lift to help.
4. Explain the procedure.
5. Gather:
   • Mechanical lift that has been cleaned between clients
   • Armchair or wheelchair
   • Client footwear
   • Cushion or towel
   • Blanket for covering the client afterward
6. Perform hand hygiene.
7. Provide privacy.

Procedure

8. Put footwear on the client.
9. Centre the sling under the client.
10. Turn the client from side to side to position the sling.
11. Follow the manufacturer’s directions for sling placement.
12. Communicate directions with your helper throughout the procedure.
13. Place the chair at the head of the bed.
14. Align the chair with the headboard and place it about 30 cm, or 1 ft., from the bed.
15. Place a folded towel or cushion on the chair when needed for hygiene or privacy.
16. Lock the bed wheels.
17. Lower the bed to its lowest position.
18. Raise the lift enough to position it over the client.
19. Position the lift over the client.
20. Lock the lift wheels.
21. Attach the sling to the swivel bar.
22. Help the client into a sitting position.
23. Raise the head of the bed or use pillows for support.
24. Cross the client’s arms over the chest.
25. The client may hold the straps or chains.
26. Do not let the client hold the swivel bar.
27. Raise the lift until the client and sling are free of the bed.
28. Check that the client is safely positioned before moving away from the bed.
29. Ask your helper to support the client’s legs while moving the lift away from the bed.
30. Position the lift with the client’s back toward the chair.
31. Position the chair for safe lowering.
32. Lower the client according to the manufacturer’s directions.
33. Guide the client into the chair.
34. Lower the swivel bar and unhook the sling.
35. Remove the sling unless instructed otherwise.
36. Use more than one person to remove the sling when required.
37. Place the client’s feet on the wheelchair footrests.
38. Cover the lap and legs with a blanket.
39. Keep the blanket away from the floor and wheels.
40. Position the chair according to the client’s preference.
41. Lock the wheelchair wheels.

Post-Procedure

42. Provide safety and comfort.
43. Place the call bell within reach.
44. Perform hand hygiene.
45. Reverse the procedure to return the client to bed.
46. Report and record actions and observations according to employer policy.

Using a Sit-to-Stand Lift From a Chair to a Commode

The exact sit-to-stand lift used by an employer might require different actions. Follow employer directions and the manufacturer’s instructions.

Pre-Procedure

1. Identify the client according to employer policy.
2. Check the care plan for abilities and limitations.
3. Ask another person who is properly trained with the lift to help.
4. Explain the procedure.
5. Gather:
   • Mechanical sit-to-stand lift that has been cleaned between clients
   • Commode chair
   • Supplies needed for perineal care after toileting
6. Perform hand hygiene.
7. Provide privacy.

Procedure

8. Make sure the client wears supportive footwear. Put footwear on the client when needed.
9. Communicate directions with your helper throughout the procedure.
10. Make sure the client’s chair will not slide.
11. Lock wheelchair wheels when the client sits in a wheelchair.
12. Place the harness around the client’s trunk, under the armpits, and around the lower back.
13. Tighten the inner belts so they fit snugly.
14. Apply leg straps when applicable.
15. Position the lift facing the client with its base open.
16. Lock the lift wheels.
17. Have the client place their feet on the lift footplate.
18. Attach the harness strap without lifting or tugging it.
19. Help or instruct the client to grasp the lift handles.
20. Keep the client’s arms outside the harness.
21. Close the lift’s leg base.
22. Do not move the lift while the leg base remains open.
23. Tell the client that movement is about to begin.
24. Ask the client to lean back into the back harness.
25. Slowly raise the client only a small amount at first.
26. Check that the client is safely positioned before lifting farther or moving.
27. Bring the lift-supported client to the commode.
28. Undo and lower the client’s pants enough for toileting.
29. Position the commode so the client will lower onto it safely.
30. Lower the client into the commode according to the manufacturer’s instructions.
31. Guide the client onto the commode.
32. Once the client sits on the commode, open the lift base legs to create a wider base of support and reduce tipping risk.
33. Provide toileting privacy according to the care plan.
34. After toileting, raise and move the client enough to reach the perineal area.
35. Perform needed perineal care while the client remains supported by the sit-to-stand harness.
36. Assist the client with hand hygiene.
37. Help the client dress again.
38. Make sure clothing is not twisted or bunched.
39. Reverse the procedure to return the client to the chair.

Post-Procedure

40. Provide safety and comfort.
41. Place the call bell within reach.
42. Perform hand hygiene.
43. Report and record actions and observations according to employer policy.

Reporting and Recording

After these transfer and lifting procedures, report and record your actions and observations according to employer policy.

The information supports two stated purposes:

• Meeting legal recording and reporting needs
• Keeping the rest of the health care team informed

Safety, Dignity, and Client Choice

Transfer and lifting procedures repeatedly support:

• Dignity
• Independence
• Individualized care
• Preferences
• Privacy
• Safety

These principles affect practical steps. Examples include providing privacy during toileting, keeping the client covered, positioning a chair according to the client’s preference, and staying close enough to provide required assistance.

Common Mix-Ups

Wrong Idea	Better Idea
A transfer and a lift mean the same thing.	A transfer uses some client weight-bearing. A lift does not.
A manual lift uses lifting equipment.	A manual lift physically moves the client without a mechanical lift.
Training on one lift means you know every lift.	Each type requires proper training and its own instructions.
A transfer belt and transfer board do the same job.	A belt supports standing, sitting, or walking. A board helps the client slide between surfaces.
Every client is suitable for a sit-to-stand lift.	The client needs enough awareness, leg muscle tone, and upper-body muscle tone for safe use.
Privacy means leaving every client alone while toileting.	Some clients need someone directly beside them because of increased fall risk. Follow the care plan and ask the supervisor when unsure.