Obese client, too much for my back.

[Cucumberpitta]

I've just started work for a company as a carer delivering personal care in clients' homes.

One of the clients has no mobility in her legs and is morbidly obese. She is gantry- hoisted from her recliner chair to her bed to receive a bed bath.

Firstly, she is extremely heavy and even with slide sheets I struggle to assist her onto her sides, and in any case it is very difficult to clean her sufficiently due to the fact she is very overweight.

When lowering her back into her recliner chair using the hoist, she requests that we push her as far back into the seat as we can so that she is upright and doesn't start to 'slide' or 'slouch' in the chair. Unfortunately the foot rest of the recliner is extended to stop her from sliding down, so I literally have to bend over it at 90 degrees and push with all my strength as she is lowering.

I have only been to her twice and each time I feel my lower back suffering afterwards.

My managers are chasing the OT to reassess and have said they will make sure my shifts only include her alternately to give my back a break.

Two other carers have stated similar concerns.

The client refuses a male carer and a residential home.

Has anyone got any advice for me? I don't want to rock the boat too much as I'm new. I really feel for this client too and not sure what the solution is.

What does her care plan actually say regarding lifting and care? Because I know plenty of agencies and care homes that don't refer to the care plans at all when they decide on staffing levels. Ask to see the care plan.

But I would move agencies if I was you.

I did wonder if you were talking about my MIL with your description. She always moans about being slumped in her chair.

There should be a Lifting Plan specific to this patient.

See "Getting to grips with hoisting" at:
www.hse.gov.uk/healthservices/moving-handling.htm

No hoisting by yourself! Even when I was in care pre-nursing over 10 years ago, this was a hard and fast rule. If someone is requiring turning to wash, there should be 2 of you.

If she is using a free standing gantry hoist, at no point should she be pushed back as she is being lowered, as that can cause the hoist to tip. You should have been given training on how to use the gantry safely and that inform would be a key part of it. If you look up the instructions online you'll find the info there. Print it off, show it to your manager and say you cannot continue to carry out the task as it's unsafe.
Is she able to assist in being rolled or are you doing all the work? If so, it's not a single handed task.

Bariatric clients can be managed safely by a single carer. Gantry hoists can also be used safely by one carer (mobile hoists cannot). But to do this, the client has to be at to participate in some way.

Have you looked at the manual handling plan that was created by the OT? Are you following it to the letter? If so and you're still struggling then you need to demand a second carer until the OT reassessment has been done.

Good luck

(And rather than pushing her back, can't the chair be pulled forward so she's in the right position as she's lowered?)

@Steelesauce

No hoisting by yourself! Even when I was in care pre-nursing over 10 years ago, this was a hard and fast rule. If someone is requiring turning to wash, there should be 2 of you.

You can hoist with one with a gantry if an assessment has showed that it's safe.

My grandad was cared for at home with no mobility in his legs (and not obese, but still a hefty weight!).

To echo all those above saying 2 people for hoisting, you should insist on this. Not purely for your own safety, but also because the time will come when the hoist goes wrong, gets stuck etc.

This is nuts op. I'm an OT and always recommend 2 carers for a hoist. I have had a morbidly obese client who I have recommended three carers for. I always ask myself "would I be happy and feel safe to handle this patient with no help?"

Funding shouldn't come in to it.
Please say no. No one will care if you ruin your back completely. I would see manual handling as an urgent referral. Usually the person has to be nursed in bed for a few days until we can assess/get equipment ordered.

Sometimes we put in short term two carers until we have assessed.

@Cucumberpitta

I've been told that another carer is going to meet me there at my next shift to show me how she does it without hurting her back. I know of two other carers that have said their backs get sore though.

Is this in response to you saying you have back trouble or have you not had a chance to tell them yet?

I would simply say no. There is an accident risk here, surely.

@CorrBlimeyGG

Have you had any training around respect and dignity? It's completely unprofessional to post about this lady, this is a real person you're posting about. Even if we don't know her name you're sharing sensitive information.

Please think about how you would feel if you were that lady, or she was a member of your family. Have some respect for your clients.

OP hasn’t given any information that could lead to identifying her client. She needs advice , and is rightly concerned for her health. At no time has she spoken in derogatory terms about her client. OP , you must not risk your health over this. Your company has a duty of care towards you. Have you attended a moving and handling course ? These situations make me furious . I’m a District nurse, and we would never put our nurses in this position . I can’t imagine why any OT would condone this, as if you do hurt your back, surely they would be for the high jump ?

Can she help,at all with rolling onto her side if she is in bed. Does she have a bariatric bed, chair, commode and the right size slings and like pp said you cannot push back on a hoist as it coukd tip up. She needs another assessment and risk assessment, if she is sliding on the chair the ot needs to look at getting her a more appropriate chair and you can get anti slip mats to sit on to stop her sliding and chair slide sheets so she has to wiggle her bum back. If you damage your back no one will support you, you could seriously injure yourself. I would refuse to go on your own.

You should not be rolling a client on your own and should not be hoisting a client on your own. You can refuse to go to any client you feel unsafe going to. If your employer doesn't like that then honestly quit, every care agency is crying out for carers you could walk into a new job today.

I'm social worker and have been for 8 years, come across 1000's cases, anyone hoisted always has 2 carers, I have never ever known an OT to ever recommend one. Are you in the UK?

I'm a domiciliary care assistant and in the co I work for any hoisting always requires 2 carers. I love my job but not enough to risk my health. I don't know or care where funding is from, that's for the office to deal with. Hope you get this sorted asap.

Ask to see the Risk Assessment. If something has changed since it was done it needs reviewing.

@CorrBlimeyGG

Have you had any training around respect and dignity? It's completely unprofessional to post about this lady, this is a real person you're posting about. Even if we don't know her name you're sharing sensitive information.

Please think about how you would feel if you were that lady, or she was a member of your family. Have some respect for your clients.

This is bonkers. Of course op can post about an anonymous patient.

How does this lady go to the toilet if she is so unmobile?

@Muchmorethan

How does this lady go to the toilet if she is so unmobile?

I take it you've not done work of this nature....

There is a huge push for single handed care nowadays, there are plenty of situations where 1 carer can manage but there needs to be a few things in place:

1. Proper assessment of the clients needs
2. Appropriate equipment in place
3. A clear care plan/moving and handling plan
4. The carer to be competent and trained in the correct techniques/know how to use the equipment appropriately.

All the people saying a hoist is a blanket 2 carer policy are really out of date, everything should be down to individual risk assessment.

If you cant get it sorted I think it's better to quit

I see so many people with severe back problems because they used to be carers or HCPs

@BigRedBoat

There is a huge push for single handed care nowadays, there are plenty of situations where 1 carer can manage but there needs to be a few things in place:

1. Proper assessment of the clients needs
2. Appropriate equipment in place
3. A clear care plan/moving and handling plan
4. The carer to be competent and trained in the correct techniques/know how to use the equipment appropriately.

All the people saying a hoist is a blanket 2 carer policy are really out of date, everything should be down to individual risk assessment.

Are you someone you issues the funding perchance?! We shouldn't have to 'manage' and OP should not be putting her own or her client's health at risk

@Muchmorethan

How does this lady go to the toilet if she is so unmobile?

Pads. Or hoisted to the toilet/commode. Or both. Same as anyone else who is bedbound

I am an OT, I don't make decisions around funding. It also wouldn't make any difference to my recommendation around single handed care if the person had their care funded by the state or paid for out of their own pocket. Plus there are other reasons to look at single handed care than pure cost - client dignity, the national shortage of care staff.

Perhaps 'manage' was not the best word, I will re-phrase to say 'there are plenty of situations where care tasks can be safely completed by 1 carer, providing appropriate risk assessment has taken place and the correct equipment is in place'.

I am a community OT and it isn't always a case of hoist = 2 carers, Lot of things are taken into account on a Moving and Handling assessment including the client's ability to help. I have known larger clients who are single handed hoist with gantry/ceiling tracks and the right equipment. I have also known clients needs 2, or sometimes even 3 carers due to different factors.

It might also be that the OT assessed when the client was feeling alert and awake, and you are seeing them later in the day when they are tired and not able to assist as much so there is a difference. All risk assessments are down to personal abilities, both of client and therapist, and are done on the basis of what is assessed at that point in time. They can, and frequently do, change.

I would recommend that you and your other colleagues tell your manager that you can't use the equipment safely and that you feel she needs to remain on the bed until an urgent reassessment is carried out.

Does your area have an urgent care team or similar? In our patch there are the routine team (big wait currently) and an urgent team if you are needing urgent input ie big M & H concern or carer breakdown risk which can respond within a day or two. If no urgent care team there then should be a Duty social worker on every day that your manager can contact. Your manager should explain you are not able to provide the care as not safe and ask for an urgent reassessment.

God luck. You only get one back - look after it!