Personal Care - Positioning, Ambulation and Exercise & Transfers

Positioning your client in bed

Positioning (alignment in bed, wheelchair, etc) is important so that your client does not develop bed sores. The standard is to reposition the client every 2 hours. Caregivers should only be assisting a client with positioning when the client is:

• able to identify either verbally, non-verbally or through others, when the position needs to be changed

• if the client is unable to identify when their position needs to be changed, the caregiver may assist with positioning if there is no skilled skin care required in conjunction with the positioning

Ambulation

Properly assisting a senior with ambulation (walking) requires careful attention to safety, the senior's capabilities, and the use of correct assistive techniques and devices. The goal is to maximize their mobility while preventing falls and injury to both the senior and the caregiver.

Key Principles

• Assess the Environment: Ensure pathways are clear of clutter, throw rugs, and electrical cords. Good lighting is essential.

• Assess the Senior: Note their strength, balance, cognitive state, and any recommendations from physical therapists (PTs).

• Use Proper Footwear: The senior should wear sturdy, non-skid shoes that fit well (no slippers or socks alone).

• Communicate Clearly: Inform the senior of your intentions and use simple instructions. Move at their comfortable pace.

• Body Mechanics for the Caregiver: Use safe lifting and supporting techniques: bend your knees, keep your back straight, and lift with your legs. 

Step 1: Preparation

• Gather Equipment: Ensure any prescribed mobility aids (cane, walker, gait belt) are available and in good working order.

• Plan the Route: Decide on a safe, clear route for the walk.

• Positioning: Help the senior into a seated position first, allowing them to rest for a moment to prevent dizziness (orthostatic hypotension).

• Apply Gait Belt (Highly Recommended): A gait belt is a safety device used by caregivers.

  • Wrap the belt snugly around the senior’s waist, over their clothes.

  • Secure it so you can get a firm grip, typically in the back or on the sides. Do not use the belt for lifting; use it to steady them and prevent falls.

See below for the proper technique to using a Gait Belt

Step 2: Helping the client to stand

• Stand in front of the senior with your feet apart for a stable base.

• Place your hands on the gait belt.

• On the count of three, encourage the senior to push up using the arms of the chair (not your shoulders) while you provide stability with the gait belt.

• Ensure their feet are flat and stable before starting to move.

Step 3: Helping the client to walk

• Walk slightly behind and to the side of the senior, ideally on their weaker side if one exists.

• Keep one hand firmly on the gait belt at their back.

• Stay close enough to react quickly if they stumble or lose balance.

• Encourage the senior to look forward, not down at their feet.

• Maintain a natural pace that is comfortable for them.

• If using a Walker or Cane:

  • Walker: The senior should place the walker a comfortable distance in front of them, step toward it with one foot, then bring the other foot forward. Ensure they don't lean heavily on the walker.

  • Cane: The cane is typically held in the hand on the strong side of the body. The cane moves forward with the weak leg.

To help your client navigate stairs safely, please view this video:

Step 4: Helping the senior to sit back down

• Guide the senior back toward the chair until the back of their legs touches the chair.

• Instruct them to reach back for the armrests.

• Provide support with the gait belt as they slowly bend their knees and lower themselves into the chair. 

Exercise and Transfers

Our goal as caregivers is to encourage clients to be physically engaged so that they can stay as physically independent as possible. Being able to help the client transfer and helping them to exercise safely are two crucial skills to be able to accomplish this:

Transferring

Exercising

Caregivers should be encouraging their clients to exercise. However, caregivers should not be performing passive range of motion exercises (i.e., when someone moves the client's limb / joint through the full range of motion for them - rather than the client using their own muscles to do it).

A caregiver can help with passive assistance if it's limited to encouraging normal bodily movement, as tolerated by the client and encouragement with a prescribed exercise plan.

Home exercises for seniors for fall prevention

Exercises to help clients move from sit to stand