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Original poster

Obese client, too much for my back.

132 replies

Cucumberpitta · 30/11/2021 13:35

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.

OP posts:
dumdedumpop · 30/11/2021 21:14

@Cucumberpitta but of the chair is further forward (all the time, not pulled forward during the transfer) then she would closer to the back once she's lowered down?

Sunshineandrainbow · 30/11/2021 21:18

Might be worth asking the OT to consider a Wendy lett slide sheet system that stays on the bed so no rolling to get slide sheet under.
I hope you visit In pairs. Sorry if I missed that bit.

dumdedumpop · 30/11/2021 21:19

@Cucumberpitta you said before that you don't have a copy of the OT manual handling plan, just the support plan which you think is a copy of the OT plan. If it is, it should go through step by step exactly how you manage each part of the task, including how to get her back in the chair. Do you have that level of detail?

I absolutely agree she needs an urgent OT manual handling and seating assessment, but I'm also really curious as to how closely the agency are following the original plan.

Earlybird00 · 30/11/2021 21:33

I thought with a gantry hoist you can use with one person but sounds like there are moving and handling issues on bed and positioning back in chair. Hope you get a reassessment soon

Original poster
Cucumberpitta · 30/11/2021 21:38

[quote dumdedumpop]@Cucumberpitta you said before that you don't have a copy of the OT manual handling plan, just the support plan which you think is a copy of the OT plan. If it is, it should go through step by step exactly how you manage each part of the task, including how to get her back in the chair. Do you have that level of detail?

I absolutely agree she needs an urgent OT manual handling and seating assessment, but I'm also really curious as to how closely the agency are following the original plan. [/quote]
No there is not that level of detail. Just instructs which loops to put on the hoist etc and to ve very mindful of pain in her legs and to "make sure she is comfortable". I don't know when she was last assessed by an OT for sure, don't want to go into detail as to why but I know for a fact it was no longer than 4 months ago.

OP posts:
Original poster
Cucumberpitta · 30/11/2021 21:39

[quote dumdedumpop]@Cucumberpitta but of the chair is further forward (all the time, not pulled forward during the transfer) then she would closer to the back once she's lowered down?[/quote]
Sorry I don't understand. The chair is always fully reclined.

OP posts:
Original poster
Cucumberpitta · 30/11/2021 21:41

@Sunshineandrainbow

Might be worth asking the OT to consider a Wendy lett slide sheet system that stays on the bed so no rolling to get slide sheet under. I hope you visit In pairs. Sorry if I missed that bit.
We don't roll her to put a sheet under. Sorry I'm not very good with the proper names of things. There is a Wendy lett type slide sheet on the bed. I use that to assist to roll her over for personal care.
OP posts:
HarrisMcCoo · 30/11/2021 21:48

Two carers should be used if using a hoist, tbh... never heard of only one carer in this scenario.

dumdedumpop · 30/11/2021 21:49

@Cucumberpitta I'll try and explain a bit more clearly what I mean about her chair, sorry!

If she's being lowered down from a ceiling track hoist, then her bottom is always going to land in the same place on the chair. But you're saying she wants you to push her backwards so she's further back in the chair as she "lands". So, rather than pushing her back, if you pull the whole chair forward, her bottom would "land" further back where she wants to be.

Bagadverts · 30/11/2021 21:49

Just to say you and the others here sound very caring and that you want the best for your clients as well as being safe as carers. I fear in the future I may need care like thud and I hope people like you are around. Flowers

dumdedumpop · 30/11/2021 21:50

(Pull the chair forward before she's lowered into it)

Original poster
Cucumberpitta · 30/11/2021 21:56

@dumdedumpop

(Pull the chair forward before she's lowered into it)
Oh yes. I see what you mean! One carer couldn't do it as she is lowering because our hands are guiding her so she's central but yes we could move the chair forward first that may work!
OP posts:
Original poster
Cucumberpitta · 30/11/2021 22:00

@Bagadverts

Just to say you and the others here sound very caring and that you want the best for your clients as well as being safe as carers. I fear in the future I may need care like thud and I hope people like you are around. Flowers
I haven't been doing it for very long but all of my colleagues do genuinely care for the clients. It's quite alarming to see what life can be like when you are vulnerable, very sobering. Lack of funding also very alarming!
OP posts:
Original poster
Cucumberpitta · 30/11/2021 22:01

And I care for them too, but what I mean when I say I haven't been doing it for very long is that it's easy to care before the novelty wears off....but my more experienced colleagues genuinely care and I hope to be as great as they are in the future

OP posts:
Toddlerteaplease · 30/11/2021 22:05

I'm a nurse and really shocked that you are in this position. A patient should never be hoisted or rolled with just one person.

Heartofglass12345 · 30/11/2021 22:07

I can only echo what others are saying in that you shouldn't be hoisting by yourself. It's dangerous for both of you and I'm surprised an OT is saying it's ok!

What about look for personal assistant work instead? It's usually people who are looking for someone a few hours a week to help them around the house or assist them on community outings, and they pay you using direct payments. You could take on a few different ones during the week to make up the hours

Heartofglass12345 · 30/11/2021 22:09

With regards to the chair, does it tilt backwards at all or just recline?

dumdedumpop · 30/11/2021 22:11

@Toddlerteaplease

I'm a nurse and really shocked that you are in this position. A patient should never be hoisted or rolled with just one person.
As I and quite a few OT's have said on the thread, it is possible to support a client to roll and to be hoisted single-handedly where appropriate. The OP's situation doesn't sound appropriate, but there certainly isn't a blanket rule that stated hoist = two carers. Each case is assessed individually and recommendations put in place based on the assessed need.
Twillow · 30/11/2021 22:15

Far from obese lady I knew, with a freestanding hoist - 2 carers per call.

Sparklehead · 30/11/2021 22:23

I am an OT working in a hospital and make assessments and referrals for care packages for clients such as yours frequently. People who require hoisting and/or all care in bed should always have 2 carers attend to their needs plus all the specialist moving and handling equipment in place. Unfortunately the shortage of caters and funding cuts mean that they might receive the correct level of care for a very short time before social services start to push to reduce the care package. It’s awful but the reality that we’re living in. You must protect your own health in this scenario. Good luck.

Suzi888 · 30/11/2021 22:26

Absolutely no advice (sorry) but thank goodness for people like you and your colleagues Flowers. Hope something is sorted out not just for yourself, but for the person you care for.

dumdedumpop · 30/11/2021 22:33

@Twillow

Far from obese lady I knew, with a freestanding hoist - 2 carers per call.
And @Sparklehead a mobile hoist does always require two carers. A ceiling track or gantry, not necessarily.
CorpusCallosum · 30/11/2021 22:36

Hi OP, another OT soooo many issues going on here, she 100% needs a reassessment.

Sounds like she does need 2 if she's that heavy but there may be other things that can be done instead/as well which depend on individual assessment.

Sounds like the equipment she has came from a hospital discharge? A social care OT will almost certainly be able to improve on it. ETAC make some great products like slide sheets which attach to the gantry/CTH hoist and will roll her for you.

You're worried about her falling off the bed; she likely needs a bariatric profiling bed with side rails (need to be risk assessed but are essential for single handed care). You put the rails up on the side opposite you so she can't fall out when you roll her that way.

She's not comfy sleeping on the bed but presumably it is a profiling bed which can be adjusted so she's more upright to sleep. Then you could reposition her more easily in the morning. An OT should be able to work with her on positioning till it's 'right' - if then take photos (with her permission) and put that in the handling plan for carers to recreate.

She's slipping down in the chair & she's difficult to position; she needs a tilt in space chair, this will let gravity get her bottom back in the chair when hoisting her in. If she then wants to be moved upright a 'one way glide' may help her stay put. If she can't stand there's no point in the rise function of a rise and recline!

It sounds like your management are listening to you but if you really feel at risk call the social care team directly and ask to speak with the Duty OT, there may well be safeguarding issues here so now, or in the future, don't hesitate if something doesn't feel right.

It's absolutely right that local authorities specify single handed care where it's safe to do so. It's more than just budgets; it frees up capcity in the care market as those 2 carers can see 2 people rather than 1 (although single handed calls often do need to be longer so it's not quite double the capacity), and research shows clients generally prefer it - handling is often more comfortable and they get a carer who talks to them rather than their colleague.

Also, thanks for working in care 💚

Katieandthekids · 30/11/2021 22:37

Your employer has a duty of care towards you that they are not fulfilling. This is a two person caring job that is being put on one person. It is not fair on you or the lady needing care. She has a right not to want a make carer thAt is totally understandable

jd88123 · 30/11/2021 22:41

If a hoist is used there should always be two carers. This is part of the initial risk assessment. This is part of manual handling training. If you were to hurt yourself of the patient your company and possibly you would be in a lot of trouble.

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