1. Position and lock the wheelchair next to the bed. Swing open both footrests.

2. Help the client turn onto his or her side, facing the wheelchair.

3. Put an arm under the client’s neck with your hand supporting the shoulder blade; put your other hand under the knees.

4. Swing the client’s legs over the edge of the bed, helping them to sit up. If your client has a hard time staying seated upright, you can place a pillow behind them to prop them up.

5. Assist the client in scooting to the edge of the bed.

6. Make sure their feet are stable, either wearing slip proof socks or shoes.

7. Ask the client to place their hands on your shoulders, place your own hands around their torso or on their gait belt ensuring a firm grip.

8. On the count of three, lean backward while your client leans forward, lifting them to a standing position, bending your knees and keeping your back straight. If your client’s legs are weak, support them by bracing them against your legs to prevent them from buckling.

9. Have your client pivot towards the chair while you keep your arms around them. If needed, direct them to move their feet one at a time to turn. Move your feet with them, do not twist only at the waist.

10. Once their back is to the wheelchair, check to see if the back of their knees are against the seat of the wheelchair. If they are not, have them take a step back. This will help ensure they are seated far enough back to avoid repositioning in the future.

11. Have the client sit down while you continue to support them. Once down, check placement in chair.

12. Move foot rests forward and help client place their feet on them.

13. Unlock the wheelchair and take them to their desired location.

HOT TIP! Always ask your client if they have any sensitivities or pain so you can work to avoid touching those areas during transfer.

1. Get the surface the client is moving to and the surface the patient is moving from as close as you can while still leaving enough room for the two of you to move freely.

2. If possible, situate the chair in the appropriate position for the client to move towards his or her strong side.

3. Have the client move from a higher surface to a lower surface if you have control over surface heights. (ie. If client is transferring from the edge of his or her bed to his or her wheelchair, raise the bed so that it’s somewhat higher than the wheelchair.)

4. Angle the chair 45O-90o to the surface you’re moving towards.

5. Lock the brakes on wheelchair.

6. Remove the arm rests on the chair, bedside commode, and/ or bed.

7. Lift the leg closest to the transfer surface and place the sliding board under the leg (mid thigh between the buttocks and the knee, angled toward the opposite hip).

8. The board must be firmly under the thigh and firmly on the surface that the client is transferring towards.

9. Block the client’s knees with your own knees.

10. Instruct the client to place one hand on the edge of the board (don’t let them put any part of their hands under the sliding board) and the other hand on the surface he or she is transferring to.

11. Instruct the client to lean forward and slightly away from the surface they are transferring towards.

12. The client should then transfer his or her upper body weight in the direction opposite of the surface they are transferring. The client should use both arms to lift or slide the buttocks along the board.

13. Assist the client when they need help shifting weight and supporting the trunk while he or she is moving.

14. A pillowcase can be placed on the sliding board if the patient is sliding on bare skin to prevent skin shearing or tears and to make the transfers easier.

1. Get the wheelchair and the car seat as close as you can while still leaving enough room for the two of you to move.

2. You should stand inside the open door where the door meets the car.

3. Make sure that the wheelchair and car are not on an incline, because working against gravity will make this transfer much more difficult. If possible, angle the car and wheelchair so that gravity may be used to assist with the transfer.

4. Angle the chair 45O-90o to the car.

5. Lock the brakes on wheelchair.

6. Make sure the car seat is all the way back.

7. From this point, a stand pivot transfer or sliding board transfer may be used when transferring from a wheelchair into a car seat.

1. Raise the client’s bed as high as possible.

2. Roll your client to their side and put the folded sling behind the client’s back and roll client onto their back.

3. Pull the leg loops forward and under the thigh. Position the sling so all loops are accessible

4. Roll the base of the lift under the bed as far as possible. Legs of the base should be open and locked.

5. Lower the cradle of the lift above the client and attach loops to their respective sides.

6. Once all loops are attached, slowly raise the client from the bed using the lever handle.

7. Raise the client until buttocks are just above the mattress. Grasp client’s legs and turn them so their legs dangle off the bed.

8. Grasp steering handles and move lift away from the bed. Move your client into position over the seat of the wheelchair. Make sure wheelchair brakes are on.

9. Lower client into wheelchair and remove loops from lift.

10. Leave the sling beneath the client for easy transfer back to bed when needed.

HOT TIP! If your client is nervous about using a Hoyer lift, suggest a family member hold onto the sling during transfer for extra stability.

1. Gather all your supplies ahead of time. You will need gloves, a basin, a soft lightweight towel or blanket, clean washcloths, soap/deodorant/waterless shampoo, a bath towel, and fresh clothing.

2. Always provide as much privacy as possible. Close doors if able, and ask non-essential persons to leave the room.

3. Explain to your client the process of what will take place, some may be shy or hesitant about having someone else bathe them.

4. Fill your basin with warm water. The water should be comfortably warm to your elbow.

5. Put on a clean pair of gloves.

6. Cover the client with the soft towel or sheet and assist in undressing them underneath it. Keep the sheet always covering as much of them as possible for privacy and warmth.

7. Start at your client’s head and work your way down.

8. Dampen the washcloth and offer the client a chance to feel its temperature.

9. Start at their face, gently wash the face, neck, and ears. Rinse off the soap and dry the washed areas. Place a towel under one arm. Wash the client’s hand, arm, and underarm. Rinse off the soap and dry the arm well, especially under the arm. Wash, rinse, and dry the other hand and arm.

10. Fold down the blanket to wash the chest and torso, cover them when finished.

11. Remove the blanket from one of the legs and put a towel under that leg. Wash, rinse, and dry the foot and leg. Repeat this procedure on the other leg.

12. Empty the dirty water into the sink. Fill the basin with clean warm water. Ask or help the client to roll on his/her side so you can wash the back.

13. Place the towel on the bed along the person’s back. Fold down the blanket. Wash the client’s neck, back, buttocks (rear end), and thighs (upper legs). Rinse the washcloth in the basin and remove the soap from the washed areas. Dry the back, buttocks, and thighs.

14. The perineum is the last area to be washed. Wear disposable gloves when washing this area. This area is also called the pubic area or genital area. It is the area between the thighs and includes the genitals and anus. This part of the body should be washed every day.

15. Change your gloves, and assist client with dressing.

16. Dispose of water and other materials that were used.

HOT TIP! If your client is not feeling up to a full bath, offer a partial bath that focuses on the face, underarms, and peri care.

1. Ensure your client’s privacy by shutting doors and asking non-essential persons to leave.

2. Wash your hands thoroughly and don disposable gloves.

3. Explain the steps you are going to take with your client, avoid using terms like diaper, instead use brief or undergarment.

4. If the client’s bed is adjustable, lower the head and foot of the bed so the person is flat on the bed. Raise the entire bed to a comfortable height (usually slightly lower than your hips) so that the position is comfortable for you and you are not straining your back.

5. With your client resting on their back, unfasten the adhesive tabs of the adult disposable brief. Roll the front of the brief inward, keeping any mess contained.

6. Using pre-moistened wipes, clean the soiled area front and back, as thoroughly as possible. Remember for women to wipe front to back. Avoid pressing or rubbing the skin too hard. You might need to roll the patient onto their back or on their side to thoroughly clean areas you cannot reach. Place used wipes plastic disposable bag.

7. With one hand on the person’s hip and the other on their shoulder, roll them away from you onto their side. You can ask them to hold onto the railing of their bed if able, or use a pillow to help keep them on their side. Clean any areas you could not reach previously.

8. Keep a close eye on the skin and look for any pressure sores or skin irritation.

9. Apply a thin layer of barrier cream to the client’s perineum to moisturize and protect the skin. If you apply to thick of a layer you may damage the persons skin when trying to remove it during the next change.

10. If you tucked the disposable brief far enough under their hip, you should now be able to pull the adult diaper toward you and out from under them.

11. Place the soiled adult brief into a plastic bag for disposal (but do not seal the bag yet).

12. After allowing the client’s skin to thoroughly dry, roll up one side of the new adult disposable tab brief and tuck it under their side. Flatten and position the rest of the diaper on the bed.

13. Roll the person back toward you onto the disposable adult brief and then pull out the rolled-up side of the brief. Remove any wrinkles and fasten the adult brief as directed by the manufacturer.

14. Remove your disposable gloves and place them in the plastic disposable trash bag before tying it closed.

15. Wash and dry your hands.

16. If the patient’s bed is adjustable, return it to the desired height and raise the head of the bed to the desired level. Cover the person with a clean sheet or blanket if desired.

HOT TIP! You can warm up disposable wipes in the microwave. This will feel much nicer against the skin than a cold wipe!

1. Drape a towel over the clients’s chest. Have them sitting in at least a 30 degree angle.

2. Don a fresh pair of disposable gloves.

3. Using a toothbrush, clean the client’s mouth including teeth, gums, and tongue. Be careful to use only a small amount of toothpaste to prevent excess from being swallowed.

4. Look for any signs of gum disease or infection like lesions and abscesses.

5. Have them take a small amount of water into the mouth and swish to remove remaining toothpaste. Have them spit in a handheld basin

6. Assist your client back into a comfortable position. Dispose of gloves and wash your hands.

1. Put on a clean pair of disposable gloves.

2. Ask your client to remove the dentures from their mouths. If they are unable, have them open their mouth. Gently move the denture up and down to break the seal, starting with the upper then moving to the lower.

3. Take the dentures to the sink, line the basin with a washcloth, and fill the basin partway with warm water, but do not place the dentures in the sink.

4. Using a toothbrush, clean the surface of the dentures as if you were brushing your own teeth. Work with one denture at a time, and use a small amount of toothpaste or denture cleaner. Be sure to clean the areas where the denture comes in contact with the gums or roof of the mouth.

5. Rinse the denture thoroughly and place it into a clean denture cup filled with cool water to prevent contaminating it. Repeat this process with the other denture.

6. Assist the client with proper oral care using sponge swabs and mouthwash.

7. Apply denture adhesive to the denture as directed on the packaging.

8. Assist client in reinserting the dentures.

HOT TIP! Encourage independence, have your client assist in the process as much as possible.

1. Lay out clothing options for your client to pick from.

2. Put on a pair for disposable gloves if you think you may come in contact with body fluids or an open wound.

3. Have the client sit on the edge of the bed in front of you.

4. Assist with putting on socks first.

5. Assist with pants next. Gather the pant leg as much as possible so your client does not have to try to push their leg through the length of the pant. Pull up to their thighs.

6. Assist with putting their shirt on. Start with the weak arm, gathering the sleeve as you did with their pants.

7. Support their arm and guide it through the sleeve, laying it on their lap when finished.

8. Hold the other sleeve for them while they put their strong arm through on their own.

9. If they are able to do up their own buttons allow them to, if not assist.

10. Put on shoes next; be gentle, checking with your client to ensure you are not using too much pressure as you place them on the feet.

11. Have your client stand, place their walker in front of them if needed for support.

12. Pull their pants up, allowing them to button if possible.

1. Have your client sit on the bed.

2. Put on a pair of disposable gloves if you think you will come in contact with body fluids or an open wound.

3. Assist with removing shoes.

4. Assist with removing your client’s shirt. Start with the strong arm, holding the sleeve so they can remove it on their own.

5. Bring their shirt around their back and roll it down their weak arm, removing it from the sleeve. Place the weak arm back on your client’s lap.

6. Ask your client to stand, pulling their pants to their ankles.

7. Ask your client to sit again, removing the pants and socks.

HOT TIP! Suggest your client buy clothes with frontal closures and elastic waist bands to make dressing easier.

1. Know your client’s food preferences as well as any nutritional requirements.

2. Place the meal in easy reach of your client.

3. Ensure they have the proper utensils.

4. Offer to cut their food into smaller pieces if necessary.

5. Sit with them and offer encouragement and help as needed. Try to foster independence as much as possible.

6. If the food is refused, offer a suitable alternative.

7. If your client has been losing weight or is on a meal plan, track the percentage of food finished.

HOT TIP! If your client has memory impairment, a familiar/routine meal plan can encourage regular food intake.

1. Make sure your client has a repositioning sheet or “chuck” under them. This will make the turn much easier.

2. Move your client to the center of the bed so they are not at risk of rolling out of the bed.

3. The client’s bottom arm should be stretched towards you. Place the person’s top arm across the chest.

4. Cross their upper ankle over the bottom ankle.

5. Grab the corners of the chuck closest to you and lift upwards. This will roll the client to their side.

6. Place support pillows as necessary, making sure the client’s ankles, knees and elbows are not resting on top of each other. Head and neck need to be in line with the spine, not outstretched.

HOT TIP! You should be repositioning your client at least every two hours if bed bound.

1. Positioning: Ensure your client is sitting as far back in their seat as possible. Keep their feet on the foot rests while moving, do not let them drag their feet on the ground.

2. Safety: Wheelchairs are not walkers. Wheelchairs are not balanced for downward pressure on their handles. Using them this way can lead to falls.

3. Pathways: Uneven pathways and gravel can lead to tip-over accidents and injuries. Use paved walkways and drives whenever possible. Keep hallways, doorways, and other areas in the home clear from clutter that could get stuck under wheels.

4. Brakes: Always know where the brakes are located on your client’s chair. Remember to engage them whenever performing a transfer.

5. Fit: If your client complains about feeling uncomfortable in their chair or you notice pressure sores emerging, inform the family so they can speak with a professional regarding fit.

6. Hygiene: Keep arms, seat, and wheels of the chair clean and hygienic as you would with any other medical equipment.

HOT TIP! Seat cushions, cup holders, and foot rests are all ways you can make your client’s chair more comfortable for frequent use.

1. Fit: Walkers need to be adjusted to the right height. With the client’s shoulders relaxed and hands on the grips, their elbows should bend slightly at a comfortable angle (about 15 degrees). With their arms hanging relaxed at their sides, the top of the walker should line up with the crease on the inside of their wrist.

2. Posture: Remind your client of good posture, their back should be as straight as possible. They should not hunch over.

3. Positioning: The walker should be an arm’s length in front of your client. Ensure they are stepping into the frame of the walker, not simply pushing it in front of them.

4. Safety: Walkers are not wheelchairs. If your client’s walker has a seat, do not push them in the walker while seated.

5. Brakes: If your client has a walker with wheels, know where the breaks are located. Remember to engage them whenever a client is using the walker to transfer to a seated or standing position.

HOT TIP! There are several different styles of walker. If your client seems unhappy with theirs, suggest they speak with their doctor or PT/OT about other options!

1. Fit: Make sure your client’s cane is the right height for them. Their elbow should be bent at a 15 degree angle while holding their cane.

2. Positioning: Your client should hold their cane in the opposite hand of the hand that needs support about 2 inches in front of them. They should gaze straight ahead of them, not at the ground or cane.

3. Safety: Make sure your client has the cane planted firmly before they lean their weight onto it. If your client is unable to balance correctly, a four-prong cane may be a better fit for them.

1. Fit: The gait belt should be snug, but you should be able to slide two fingers underneath easily.

2. Positioning: The gait belt should be positioned at your client’s waist and slightly off center for comfort.

3. Usage: You can use a gait belt to reposition a client, steady them as they walk, for better grip during a transfer and more.

4. When: A gait belt may be helpful if your client still has partial mobility but is too unsteady on their feet to support themselves independently.

HOT TIP! Your client can wear their gait belt while seated in their wheelchair or ambulating about the home. This will avoid the constant application and removal.

A client with dementia or memory impairment may become agitated for a variety of reasons. Crowding, discomfort, or frustration can lead to the client lashing out. The following are some tips to avoid or navigate these situations.

• Redirect: Attempt to change the subject or introduce a meaningful activity as a distraction.
• Reapproach: Give your client some space in a safe environment and keep an eye on them from a distance. After a few minutes, reapproach with a smile on your face ready to listen and assist. Do not try to reason, argue, or confront.
• Reassure: Many times, agitation stems from a place of insecurity; not knowing where they are, who they are with, or what is happening. Reassure your client that they are safe, reminding them of the day, time, or activity they are doing as many times as necessary.
• Review: Take a look at your surroundings. Is the room a comfortable temperature? Is it crowded or noisy? Try to keep your client’s immediate surroundings clam, and comfortable. Remember that your client may need the room warmer than your prefer or may want the blinds closed despite it being sunny outside. This is all acceptable and should be based off your client’s preferences.

Dementia can cause your client to lose their ability to recognize familiar places. It is common for a person with dementia to wander, or become lost or confused about their location. Wandering can be dangerous and it is important for caregivers to keep an eye out for wandering behaviors and address them swiftly if they emerge.

• Are all your client’s needs met? They may wander because they are hungry or need to use the restroom. Keep your client on a set routine to ensure that needs are being met on a scheduled basis.
• Are they getting enough exercise or entertainment? Boredom or lack of physical activity can lead to pent up energy throughout the day. Keep your client busy, engaging them in activities such as gardening, assisting with easy tasks around the home, and puzzles or games.
• Place deadbolts either higher or lower on the doors, out of the line of sight.
• Install a warning bell or a monitoring device near doors that signal when a door is opened.
• Label or place symbols on all doors that explain the purpose of each room.
• Ensure every room and hallways have nightlights installed.
• Store items that may trigger a person’s instinct to leave, such as coats, hats, pocketbooks, keys and wallets.
• Do not leave your client alone.

People living with Alzheimer’s and other dementia may have problems sleeping or experience increased confusion, anxiety, agitation, pacing and disorientation beginning at dusk and continuing throughout the night. Assist your client with avoiding triggers while also redirecting when needed.

• Make notes on what happens before sundowning events and try to identify triggers.
• Reduce stimulation in the evenings. Suggest that your client avoid television, loud music, bright lights, and chores. Distractions like this can lead to agitation.
• Keep the home well lit; better lighting can help with lessening confusion.
• Try to identify soothing activities to do with your client, like looking through a family photo album or listening to calming, quiet music.
• If your client is having problems sleeping through the night, limit napping during the day. This can help reset their internal clock.
• Offer to go on a walk with your client to ease their restlessness.
• If behavioral interventions and environmental changes do not work, suggest your client have a conversation with their doctor.

When a person with Alzheimer’s or other dementia hallucinates, he or she may see, hear, smell, taste or feel something that isn’t there. Some hallucinations may be frightening, while others may involve ordinary visions of people, situations, or objects from the past. This usually begins in later stages of the disease. Do not be alarmed if your client begins seeing old relatives or having conversations seemingly no one.

• Suggest the client visit a neurologist to rule out other causes of hallucinations.
• Offer reassurance by responding in a calm and supportive manner.
• Gentle pats on the arm or other touch, can redirect the client’s attention from the hallucination to you.
• Acknowledge what the client is seeing, and see if you can find the cause of the hallucination by asking simple questions such as, “When did you first notice the dog in the room? What was he doing?”
• Suggest moving to another room or going to a walk as a distraction if your client is becoming distressed.
• If the person asks you about a hallucination or delusion, be honest. If they ask if you see it, respond honestly, letting them know while you cannot see it you understand that they are able to.
• Check your environment. Look for household items that could be causing confusing effects for your client like lights that cast shadows, reflections, and furniture.

A person with dementia or memory impairment may say or do something repeatedly. They may ask the same question over and over again or complete the same task five times a day. They may be seeking comfort in the familiarity of the task, or they may not remember they have completed it at all.

• Try to deduce why they are repeating. Is there a specific trigger that you recognize, like time of day or in certain environments?
• Redirect the repetitive motion into something productive. If your client consistently walks to the sink and turns it on, ask them for help with rinsing some dishes.
• Stay patient. Repetitive questions can become wearing. Do not argue or remind them that they have already asked this question numerous times. Stay calm and remember, your client does not realize they’ve asked the time of day already.
• Visual reminders can help! Keep a large calendar on the wall with the date clearly marked. Easy to read digital clocks in every room can be helpful as well if your client becomes concerned about the date or time.
• Accept the behavior. If it isn’t harming anyone, leave it be.

These are actions which seem tactless, rude or even offensive. They occur when people don’t follow the usual social rules about what or where to say or do something. Your client may make inappropriate comments about a person’s appearance or body; they may act flirtatious or remove their clothing unexpectedly; they may even publicly fondle themselves. It is important to remember that they do not realize what they are doing is wrong.

• Do not hesitate to be firm. Let your client know that you are uncomfortable with the behavior and want them to stop.
• Address them by their name or Mr./Mrs. Avoid using pet names like ‘Sweetie’ or ‘Honey’.
• Dress professionally, avoid lowered necklines or tight clothing.
• Adjust the client’s clothes. It may be worth looking into clothing that isn’t as easy to remove.
• Suggest a visit with the client’s doctor. Sudden onset of unusual behaviors can be a sign of an underlying, physical illness.