Procedure: Helping a Patient to Stand

Before ambulating a patient, Home Health Aides/Personal Care Aides should assist them to a standing position. Allow the patient to stand in place for 1-2 minutes to ensure that they are steady on their feet and to allow their body to adjust to the change in position. Many patients may become dizzy or feel faint when moving from a sitting to a standing position. If dizziness or faintness persists, Home Health Aides/Personal Care Aides should assist the patient back into a sitting position and inform their supervisor. The use of a gait belt is helpful to assist a patient during transfers. It helps to prevent falls and injury. The belt should be applied over the patient’s clothing and around their waist. Never apply a gait belt to bare skin as it could cause skin breakdown.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. Ensure the bed locks are on and the bed is in its lowest position.
4. Ensure the patient has on socks and non-skid shoes.
5. Assist the patient to a sitting position as outlined in Procedure Helping the Patient to Sit at the Side of the Bed.
6. Face the patient. Place your feet about 12 inches apart, using the strength of your thigh muscles to provide the base of your support. Bend your knees slightly. Keep your hips and back aligned.
7. Instruct the patient to place their feet firmly on the floor and to push down on the bed with their arms and to lean forward. If they have one weak leg/foot, instruct them to place their strongest foot under them and to use that foot to provide the base of their support to assist them during the stand.
8. If using a gait belt, ensure that the gait belt is secure and over the patient’s clothing. Grasp the gait belt securely in both hands, with one hand on either side of the patient’s waist as you stand in front of them.
9. If not using a gait belt, stand in front of the patient, place your arms and hands around the patient and place your hand under their shoulder blades. Hold the patient close to your center of gravity. This provides balance and stability. Reassure them as needed. Brace the patient’s knees by placing the inside of your knees against the outside of their knees. If the patient has one weak leg, brace that knee by placing your inner thigh against the inside of their knee. Your other leg should be in front of the patient’s knee, braced against it.
10. Gently rock the patient backward and forward to provide a propelling motion, and begin to count.
11. On the count of three, assist the patient to a standing position. As you assist the patient into a stand, shift your weight onto your rear foot for stability and support.
12. Support the patient until they are stable.
13. Stay in front of the patient to ensure they are not experiencing dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made the patient to indicate this. If the patient remains dizzy or continues to report feeling weak, return them to a sitting and then lying down position. Immediately inform a supervisor.
14. If the patient begins to fall during assisting to a standing position, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the floor or to the bed if you can. Report the near fall or any actual falls immediately to a supervisor. If the patient has fallen, do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
15. Remove gloves if wearing and wash your hands.
16. Document the procedure and any observations or changes in condition.

Procedure: Helping the Patient to Ambulate (Walk)

Many patients will benefit from ambulation (walking), even for short distances. It helps to promote strength, endurance, musculoskeletal strength, and to improve circulation. It can also provide distraction and a sense of empowerment for a patient. Never push a patient to walk further than they feel able. Always follow the Care Plan for guidelines and instructions in ambulating a patient.

1. Explain the procedure to the patient. Ensure the patient understands the benefits for their health of ambulation. Provide reassurance and safety for the patient throughout ambulation.
2. Instruct and assist the patient to apply appropriate shoes. Shoes should be laced if they have laces and should have rubber backing with treads for safety. Socks should be worn with shoes.
3. If using a gait belt, walk slightly behind and to the side of the patient, while holding onto the gait belt with both hands. If the patient is weaker on one side, Home Health Aides/Personal Care Aides should stand on the weaker side to provide extra support.
4. If not using a gait belt, walk slightly behind and to the side of the patient, while supporting the patient’s back with the arm closest to the patient. Use your other arm to provide necessary support at the patient’s waist or to hold their arm at their elbow.
5. Walk slowly, taking small steps, and provide reassurance as needed. Instruct the patient to look forward, and not down, during walking. Assess the patient’s strength, balance, and any signs of fatigue while you are walking.
6. If the patient has a visual impairment, provide directions and inform the patient of any obstacles in their way, steps that need to be stepped up or down on, and when corners will be turned.
7. Ensure the patient uses ambulation devices (e.g. cane, walker) safely and appropriately.
8. Walk for short distances and take the patient’s response to the walking into consideration. If the patient appears fatigued, encourage and take breaks. Allow the patient to sit and rest if needed.
9. If the patient begins to fall during ambulation, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. If the patient falls, do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report the near fall or any actual falls immediately to a supervisor. Report any injuries or concerns.Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and they should seek direction from their supervisor about completing the incident report.
10. Observe, record, and report any changes in condition or behavior. Document the distance the patient walked and assistance needed during ambulation.

Procedure: Transfer to a Wheelchair, Chair, or Commode

When transferring a patient to a wheelchair, chair, or commode, Home Health Aides/Personal Care Aides should position the chair the patient is transferring to on the patient’s strongest side. When transferring a patient back to the bed, wheelchair, or another chair, they should reverse the procedure, following the same safety rules. Home Health Aides/Personal Care Aides should always use proper body mechanics to ensure the safety of themselves and their patient.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. Ensure the bed locks are on and the bed is in its lowest position.
4. Angle the wheelchair, chair, or commode next to the bed. Angle it so that it is slightly turned toward the bed. If using a wheelchair, ensure the chair brakes are on and remove the footrests.
5. Assist the patient to a sitting position as outlined in Procedure Helping the Patient to Sit at the Side of the Bed.
6. Place non skid slippers or shoes on the patient’s feet.
7. Place a gait belt on the patient, if using.
8. Stand in front of, and facing, the patient. Place your feet about 12 inches apart. Use your thigh muscles to provide a strong base of support. Keep your back aligned with your hips. Slightly bend your knees.
9. Remember to avoid twisting your body as you move. Brace your knees against the patient’s knees and block their feet with yours. Alternatively, you can place one knee and foot against the patient’s weakest leg. Your other foot should be slightly behind you. You may also straddle both your legs around the patient’s weakest leg.
10. Place your hands on the patient’s waist, or if using a gait belt, grasp the gait belt with both hands.If able, instruct the patient to push down on the bed with their hands at their sides. Instruct them that you will assist them to a stand on the count of 3. Alternatively, instruct the patient to place their hands on your hips or shoulders. Do not allow them to hold onto your face or neck.
11. With a gentle rocking back and forth motion, and on the count of three, assist the patient to a stand. If using a gait belt, follow the same procedure.
12. Assist the patient to pivot slightly toward the chair/wheelchair.
13. Instruct the patient to take small steps backward until they feel the chair/wheelchair/commode behind their knees.
14. When the patient’s knees are touching the chair/wheelchair/commode, ask them to put their hands on the armrests, and gently lower them into a sitting position.
15. Stay in front of the patient and check to ensure they are not experiencing dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made by the patient to indicate this.
16. If putting a patient into a wheelchair or chair with wheels, ensure the locks are on and leg rests are positioned so that the patient’s feet are resting comfortably on the footplates.
17. If the patient begins to fall during a transfer, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. Home Health Aides/Personal Care Aides should report the near fall or any actual falls immediately to their supervisor. Do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
18. Position and cover the patient for comfort, warmth, and privacy.
19. Remove gloves if wearing and wash your hands.
20. Document the procedure and any observations or changes in condition.

Procedure: Positioning Patient in Chair or Wheelchair

Positioning a patient comfortably and safely in a chair or wheelchair is an important task of the Home Health Aide/Personal Care Aide. Just as in bed, patients need to be re-positioned every two hours when they are in a chair or wheelchair. Patients can also slide down while in a wheelchair or chair, and may require assistance to maintain a proper sitting position. Patients should sit on pressure distribution devices, such as wheelchair cushions. This helps to prevent pressure ulcer formation. If the patient is able, Home Health Aides/Personal Care Aides should instruct them to shift their weight from side to side every two hours to relieve pressure on their buttocks. Use a draw sheet/bed pad under a patient sitting in a wheelchair or chair. This will help a HHA/PCA with safely repositioning and lifting the patient.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. If the chair reclines: Obtain assistance from another person. Lock the wheels. Recline the chair. This allows gravity to help you move the patient up in the chair. Using a draw sheet, fold and grasp one end. Ensure you use proper body mechanics. Just as in Procedure Turning the Patient in Bed, on the count of three, each person will lift the person up toward the head of the chair.
4. If the patient is able to assist you with standing: Lock the wheelchair or chair locks. Move footrests or stools out of the way. Apply a gait belt, if using. Instruct the patient to hold onto the armrests and to push down on your instruction. Stand in front of the patient and brace their legs and knees with your own. Ensure you use proper body mechanics. On the count of three, ask the person to push down against the armrests as you assist them to a stand.
5. Once the patient is standing: Straighten wrinkles in chair pads or draw sheets, fluff pillows, and check their skin for any reddened areas.
6. When positioning the patient back into the wheelchair or chair: Reverse the procedure used to assist them to a stand. Ensure patient’s hips are as far back in the chair as possible. Position feet so they are in proper alignment with their body. Make sure feet are on footrests if using a wheelchair and that they are not caught behind the footrests or chair legs.
7. Check for positioning of male genitals. The patient should not be sitting on their scrotum.
8. Place a pillow behind the patient’s back if they wish.
9. Position arms on arm rests or comfortably on the patient’s lap. You may also use pillows for positioning the arms.
10. If the patient requests, recline their legs and feet by reclining the chair, if it reclines, or by positioning a stool or foot rest in front of them. Elevate legs and feet with pillows, ensuring the heels are floating off the pillow. This prevents pressure ulcer formation.
11. Remove gloves if wearing and wash your hands.
12. Document the procedure and any observations or changes in condition.
13. Just as in bed, reposition the patient every two hours when sitting in a wheelchair or chair.
14. Wheelchair pillows and pressure redistribution devices should be used with patients who will spend long periods of time in wheelchairs or chairs. These will help prevent pressure ulcers.

Procedure: Transfer from Wheelchair to Toilet

When transferring a patient from a wheelchair to toilet, Home Health Aides/Personal Care Aides should position the wheelchair chair next to the toilet, or at an angle facing the toilet. When transferring a patient from the toilet to the wheelchair, reverse the procedure, following the same safety rules. Home Health Aides/Personal Care Aides should always use proper body mechanics to ensure the safety of themselves and their patient. Remember to offer toileting at least every two hours, and more frequently as needed.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves.
3. If you are required to measure the patient’s output, place the measuring tool, or hat in the toilet.
4. Follow the guidelines in Procedure Transfer to a Wheelchair, Chair, or Commode
5. Place the wheelchair at an angle, facing the toilet or commode. Alternatively, you may position the wheelchair so it is parallel (next to) the toilet.
6. Ensure wheelchair locks are on. Raise or remove footrests.
7. Stand in front of, and facing, the patient. Place your feet about 12 inches apart. Put the foot closest to the toilet in front of you, with your other leg slightly behind. Use your thigh muscles to provide a strong base of support. Keep your back aligned with your hips. Slightly bend your knees. Remember to avoid twisting your body as you move.
8. Brace your knees against the patient’s knees and block their feet with yours. Alternatively, you can place one knee and foot against the patient’s weakest leg. Your other foot should be slightly behind you. You may also straddle both your legs around the patient’s weakest leg.
9. Assist the patient to a stand and pivot backward until the patient’s back is toward the toilet or commode. Follow Procedures Helping a Patient to Stand, and Transfer to a Wheelchair, Chair, or Commode.
10. Place your hands on the patient’s waist, or if using a gait belt, grasp the gait belt securely.
11. Instruct the patient to hold onto the grab bars near the toilet for support and balance.
12. Instruct the patient not to sit until they feel the toilet or commode at the back of their knees.
13. Instruct the patient to take small steps until they feel the toilet/commode behind their knees. If the wheelchair is parallel to the toilet, they should take small steps to the side, moving in the direction of the toilet. If the wheelchair is at an angle to the toilet, they should take small steps backwards.
14. If the patient is able, support them while they remove their pants/underwear. If unable, assist with removing pants/underwear. Have the patient hold onto the grab bars in the bathroom for support. Make sure that clothing is not caught at the patient’s feet in a manner so that they could trip.
15. When the patient’s knees are touching the toilet/commode, ask them to put their hands on the armrests of the commode or on the support bars of the toilet. If using a gait belt, hold onto the gait belt securely. Gently assist with or lower them into a sitting position.
16. Stay in front of the patient and check they are not experiencing dizziness, weakness, or shortness of breath. Make sure to record and report any conditions observed or statements made by the patient to indicate this.
17. Allow for privacy. If the patient is weak, or requests, you should stay with them.
18. Assist with cleaning the patient when they are done using the restroom.
19. Assist with transfer back to wheelchair/chair. Reverse the procedures used to assist the patient during transfer to the toilet. Ensure that wheelchair brake locks are on and feet are resting in the foot rests, with the leg rests appropriately positioned.
20. Teach the patient to wash their hands at the sink if able. If too weak to stand, you should provide a warm, soapy washcloth or hand sanitizer for the patient to use.
21. If the patient begins to fall during a transfer, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. Home Health Aides/Personal Care Aides should report the near fall or any actual falls immediately to their supervisor. Do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
22. Remove gloves if wearing and wash your hands.
23. Document the procedure and any observations or changes in condition.

 Procedure: Transfer from Wheelchair to Shower and Assisting with Shower

Assisting a patient who is in a wheelchair to bathe is an important task of the Home Health Aide/Personal Care Aide. A patient may be assisted into the shower from a wheelchair by using a gait belt and being guided first to sit on the edge of the tub and then to move into the shower. Home Health Aides/Personal Care Aides should always stay in the same room as patients who are weak or frail. Encourage the patient to provide as much care for themselves as possible. Provide assistance as needed.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. Ensure all equipment needed is gathered (shower chair, bathing supplies, and bath linens).
4. Fill the tub with water. Check the temperature to ensure it is no more than 105 degrees Fahrenheit.
5. Place the wheelchair at an angle, facing the shower between the grab bars or safety rails.
6. Ensure wheelchair locks are on. Raise or remove footrests.
7. If using a gait belt, ensure it is secure and that the patient has a shirt or towel on, with the gait belt positioned over their clothing. This is to prevent skin irritation and breakdown. Instruct the patient, or assist with moving to the edge of the wheelchair seat.
8. Assist the patient in placing one leg at a time over the edge of the tub.
9. Instruct the patient to grab onto the bars or the side of the tub and assist them into a sitting position on the edge of the tub.
10. Assist the patient into the tub by instructing or lowering the patient into the tub.They will be sitting in the tub. They may take a bath or shower depending on their preference.
11. Place toiletries and bath linens in patient’s reach. Provide for privacy.
12. If the patient is weak, or requests, stay nearby and assist as needed.
13. Ensure all soap is rinsed off the patient and that their skin is thoroughly dried.
14. Assist the patient out of the shower in the reverse way that you helped them into the shower.
15. Assist with dressing as needed.
16. Put away equipment and supplies. Place soiled clothing and linens in the appropriate place. Clean shower/tub.
17. If the patient begins to fall during a transfer, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. Home Health Aides/Personal Care Aides should report the near fall or any actual falls immediately to their supervisor. If the patient falls, do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
18. Remove gloves if wearing and wash your hands.
19. Document the procedure and any observations or changes in condition.

 Procedure: Transfer from Wheelchair to Stool or Chair in Tub

A person may be transferred from a wheelchair into a shower chair or stool in the tub. A shower chair is water and slip resistant. If the shower chair has wheels, ensure the brakes are locked during transfers and while the patient is using it.

1. Explain the procedure to the patient.
2. Wash your hands and don gloves as needed.
3. Ensure all equipment needed is gathered (shower chair, bathing supplies, and linens).
4. Place a non-slip mat in the tub.
5. Fill the tub with warm water (not to exceed 105 degrees Fahrenheit).
6. Position the wheelchair so that it is at a slight angle facing the tub, next to the shower chair.
7. Ensure wheelchair locks are on. Raise or remove footrests.
8. If using a gait belt, ensure it is secure and that the patient has a shirt or towel on, with the gait belt positioned over their clothing. This is to prevent skin irritation and breakdown.
9. Assist or instruct the patient to move to the edge of the wheelchair seat.
10. Instruct the patient, or assist with placing their legs, one at a time, over the edge of tub.
11. Instruct the patient to grab onto the bars or the side of the tub and assist them into a sitting position on the edge of the tub.
12. Ensure wheelchair locks are on. Raise or remove footrests.
13. Assist the patient to remove clothing.
14. Assist the patient to a stand and then to a sit at the edge of the tub, following procedures above.
15. Push the wheelchair out of way.
16. Assist the patient onto chair or stool in tub.
17. Place toiletries and bath linens in patient’s reach. Provide for privacy.
18. If the patient is weak, or requests, stay nearby and assist as needed.
19. Ensure all soap is rinsed off patient, and that skin is thoroughly dried.
20. Assist patient out of the shower in the reverse way that you helped them into the shower.
21. Assist the patient to the edge of the tub. Guide their legs over the edge, one at a time. Assist the patient to a stand and then pivot them into the wheelchair as in procedures above. Assist them to sit in the wheelchair.
22. If the patient begins to fall during a transfer, widen your stance. Bring the patient’s body close to you to provide support. Bend your knees and using the strength of your thighs, lower the patient to the ground. Home Health Aides/Personal Care Aides should report the near fall or any actual falls immediately to their supervisor. If the patient falls, do not attempt to get the patient up alone. The agency may require the patient gets evaluated by a nurse before helping the patient back up. Report any injuries or concerns. Home Health Aides/Personal Care Aides will also likely be required to complete an incident report, and should seek direction from their supervisor about completing the incident report.
23. Assist with dressing as needed.
24. Put away equipment and supplies. Place soiled clothing and linens in the appropriate place.
25. Clean shower/tub.
26. Remove gloves if wearing and wash your hands.
27. Document the procedure and any observations or changes in condition or behavior.