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.

@Heartofglass12345

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

No it doesn't tilt backwards it just reclines.

@Sparklehead

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.

It is awful! This is only going to become worse with an ageing population :(

@CorpusCallosum

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 💚

Yes you've got it, she was assessed for hospital discharge and that was around 5 months ago I believe.

Wow thank you so much for that information, I will ask my manager to ask the OT about all of this equipment..she has said she is pushing to be at the OT assessment so hopefully she can talk to them directly.

@Katieandthekids

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

To be fair management do listen and are very supportive. They have really been chasing the OT. They also go out and do care themselves when staff go off sick etc and are spread so so thin. From some answers on this thread obviously single person care with a ceiling track hoist is appropriate in some cases, but obviously the initial care plan from OT was just not appropriate.

I'm sorry you are being put through this. 'Single handed care' is being pushed for a lot of clients recently due to the shortage of carers. This includes those with a ceiling hoist. However single handed care clients have to have a full assessment to ensure they are suitable. They are normal lightweight, of sound mind and able to roll, push themselves up the bed etc independently. It doesn't sound like your client would fit into this category.

Have you seen the manual handling care plan provided by the OT (not the care company)? If not ask to see it as try should give you a full description of how you re meant to move this patient.

Bed rails are not designed for patients to pull on to assist to roll over. If this is happening that should help your case.

I presume this patient uses a slide sheet to reposition up the bed? Does this work for the client or are you having to assist? Again a slide sheet normally require 2 people so when you take them up, or doe the bed they are equal if that makes sense? The client should not be using the bed rails / head board to enable this, as again they are not designed for this purpose.

It's possible that this client needs a new type of bed / chair/ hoist / sling. Again the OT should be reassessing if there are any concerns, which they are.

To be honest my gut feeling is your care company isn't following the OT's advice. I hound it hard to believe that such an obsession, Immobile client would ever qualify for single handed care.

If you feel it is unsafe to move the client you have every right to refuse. Sometimes clients get 'stuck' in bed / chair etc for a variety's reasons when carers / family aren't able to move them. This leads to 2 options of either an ambulance call out or an emergency response team of OT / physio, sometimes referred to as a 'rapid'. Maybe this may have to happen to get listened to.

I hope you get it sorted. Backs are precious, please look after yours. And thank you for all you do.

Hi @Hairyfairy01 I have only just seen your comment I'm sorry.

No I haven't seen the plan provided by the OT.
The bed has a grasp rail near the top of the bed but no safety rails. This is another issue I have raised with management because she is at risk of falling out of the bed when rolled as she is so close to the edge.

She cannot lie flat as this causes here problems with breathing so the bed is in an upright-ish position making it harder to roll her, but she often slides down the bed when I pull the sheet to roll her and then really struggles to breathe.

I have been repeatedly ignored by management in the past week when I raise issues and have now written a long explanation of why I now am refusing to go back to her.

I have had no response from them but can see they've taken her off my shifts for this week.

I am seriously considering leaving now.

All care companies are crying out for good staff at the moment
Look for one where care is mostly client funded, min one hour calls etc... your back will thank you!