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.

Please don't get this thread removed.

I'm an OT and I would never advise hoisting is done single handed.

Gantry/ceiling track systems work well for certain people who are able to engage in the transfer, and maybe have fewer needs but obese and unable to roll, bridge and move on the chair is unsafe.

@Fantails that's not what she's saying. One carer can hoist (gantry or ceiling Track) if it's been assessed as safe. So it's not about cutting corners or putting people at risk to save money, it's about sensible use of resources.
That doesn't mean what the OP is describing is safe, but it's just not true to say all hoist transfers need two carers.

Has anyone explained the situation to the woman? If she knew two carers were really needed, is this something she herself could make a fuss about/push for? (Lest she end up in a home or such).

@BigRedBoat

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'.

Sorry, I think you probably have a point. I'm seeing it through my own lens as a carer who deals with pretty much dead weights on a daily basis. We have very few clients who are capable of even assisting with rolling onto their sides, although off the top of my head I could think of a couple who I could probably deliver personal care and hoisting single handed. I'm glad I don't have to though!

[quote dumdedumpop]@Fantails that's not what she's saying. One carer can hoist (gantry or ceiling Track) if it's been assessed as safe. So it's not about cutting corners or putting people at risk to save money, it's about sensible use of resources.
That doesn't mean what the OP is describing is safe, but it's just not true to say all hoist transfers need two carers. [/quote]
Agreed. Apologies, I was quick to snap. I can only blame it on a very long day

OP, you won't be doing the client any favours by continuing to care for her in a situation where you feel unsafe. It only prolongs the situation and delays her getting more appropriate support.

As some previous posters have said, there is an increasing push towards single carer setups, but that needs to involve sufficient training to allow you to feel confident handling those situations without risk to yourself. If you don't feel that way after repeated visits, the situation is wrong.

You are not a guinea pig for the company or local authority to experiment with to find a solution for their staff shortages or funding issues.

In the care sector, it's an employee's market. The company is profiting from your labour, so choose one that looks after you.

@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.

The client is not identifiable and she hasn't be in any way rude. She has been most sympathetic to the client's situation.

Thanks @Fantails. I'm a community OT and have so much admiration for what carers do. I really hope I contribute to them feeling safer and supported in their role. Risk assessment is such a huge part of what we do so can keep clients and cares safe.

If the client needs to be hoisted, she should be having 2 carers. It is up to your employers to provide 2, and up to them to sort it out with Social Services/OT/Social Worker.

Refuse to go until it has been sorted out.

I worked in the care sector for 20-odd years, understand exactly what you're saying.

Yes and other OTs have put it better than me!

I/we look at client need, what are we working with - environment, person, task...

What equipment can we use... how will this work....

Things have moved on a bit now. But someone up thread was suggesting slide sheets and anti slip mats to keep her in the chair.

Slide sheets are pretty impossible to use in a chair. But if you did then it would be 2 people - one either side.

Antislip mats aren't any good as they increase risk of shear - the body is taken by gravity forward but the bum bones (ischeal tuberosities) are going downwards.

Don't go there again and fill in an incident form. I fucked up my back in my early 20s lifting heavy patients and as a result lost my nursing career and had to retrain as a podiatrist. Manual handling is absolutely critical. I'm 60 now and disabled because of this. No hoists in those days.

I don’t know the care sector but can you ask for an occupational health assessment about your back strain. That could indicate that whether or not this patient can be managed by one carer, due to back beginning to show strain it cannot be you.

I was at school with someone whose mum was a nurse, and she f*cked her back in her 30s with a larger patient and a hoist. She never recovered and suffered financially and physically for the rest of her life. Family life suffered hugely. You must never do this alone again, whatever it takes. I'm sorry for both you and your colleagues as well as the patient.

Sorry to disappear I was putting children to bed!

It is a ceiling track hoist (I thought this was also referred to as a gantry, sorry - I'm very new to all this!). The client is very good with her hands and has a very sharp mind. She has trouble breathing when lying flat so sleeps in her recliner chair and only hoists to bed to have personal care. She spends most of her time in the chair so I am concerned that if i have been of an evening and she isn't in the right position, slumped/sliding down in the chair then she is stuck that way until the next carer comes in the morning.

It is very difficult to clean her up because she can only do so much to assist with rolling to her side by pulling on the handle on the side of the bed. She is a large lady so without meaning to be rude, a lot of her flesh remains on the bed if you see what I mean and as she has been sitting in her pads for hours is difficult to clean if she's had a bowel movement. She also has very very sensitive skin. I really feel for her because she suffers with the indignity of it all and she finds it hard having different female carers coming that she doesn't know (staff retention is awful) and she would never accept a male carer.

I also worry for her possibly falling out when she is trying to roll to her side on the bed.

And even without the lifting, I feel she is too heavy for one person to assist to roll her over with the slide sheets, you have to really use all your strength to tug at the sheets.

A situation like this sounds like a challenge even for two caregivers. Those ceiling hoists are doable single handed, but only under certain conditions and with full risk assessment.
As it concerns you, your physical health must be a priority. Let your colleague demonstrate by all means but you'd be within your rights to refuse that call. I hope for the lady's sake that it is looked into very soon, and funding given.

@Thegreencup

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.

I have only seen the support plan written by the care company but I understand its basically a copy of what the OT prescribes.

@Moonstardust

A situation like this sounds like a challenge even for two caregivers. Those ceiling hoists are doable single handed, but only under certain conditions and with full risk assessment. As it concerns you, your physical health must be a priority. Let your colleague demonstrate by all means but you'd be within your rights to refuse that call. I hope for the lady's sake that it is looked into very soon, and funding given.

I will certainly be very interested to see how my colleague does it....but at least two others have told the managers that their backs are sore after the visits.

I'm an OT and my local authority provides seating although it seems that not many do. Sounds like she needs a seating assessment for something like a glide and lock sheet, or more likely a tilt in space chair that will maintain the position of her pelvis to prevent her from sliding down the chair. It sounds like the single handed care is only half the issue as from what you're saying she definitely needs two. Honestly OP, I think you and your lady here are at risk, if nothing is being done to protect her then it's quite possibly a Safeguarding.

@Cucumberpitta

Sorry to disappear I was putting children to bed!

It is a ceiling track hoist (I thought this was also referred to as a gantry, sorry - I'm very new to all this!). The client is very good with her hands and has a very sharp mind. She has trouble breathing when lying flat so sleeps in her recliner chair and only hoists to bed to have personal care. She spends most of her time in the chair so I am concerned that if i have been of an evening and she isn't in the right position, slumped/sliding down in the chair then she is stuck that way until the next carer comes in the morning.

It is very difficult to clean her up because she can only do so much to assist with rolling to her side by pulling on the handle on the side of the bed. She is a large lady so without meaning to be rude, a lot of her flesh remains on the bed if you see what I mean and as she has been sitting in her pads for hours is difficult to clean if she's had a bowel movement. She also has very very sensitive skin. I really feel for her because she suffers with the indignity of it all and she finds it hard having different female carers coming that she doesn't know (staff retention is awful) and she would never accept a male carer.

This is what l was referring too when l asked how she toileted... as my concern would be her pressure area's.

And to answer the response earlier... no l have never done home care. I have always worked in a care home with other colleagues..... and now in a hospital

@Muchmorethan yes it seems awful that there is no solution to her having to wait for possibly hours for personal care after a bowel movement.

@carleyemma91

I'm an OT and my local authority provides seating although it seems that not many do. Sounds like she needs a seating assessment for something like a glide and lock sheet, or more likely a tilt in space chair that will maintain the position of her pelvis to prevent her from sliding down the chair. It sounds like the single handed care is only half the issue as from what you're saying she definitely needs two. Honestly OP, I think you and your lady here are at risk, if nothing is being done to protect her then it's quite possibly a Safeguarding.

Thanks so much I will ask my manager to ask the OT about a seating assessment. She has told us that she is going to push to be at the assessment.

@dumdedumpop

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

We have to use both of our hands to guide her centrally in the chair as she uses the controls to lower herself down. It's all very precise. If she is not totally centred in the chair she is uncomfortable. So it's a case of us pushing her back into the chair and keeping her central at the same time.

@QueenLagertha

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.

Unfortunately she refuses to stay on her bed as she finds it too uncomfortable. She only goes to her bed for personal care.