What to do when patient is too heavy for staff to transfer?

Thank you for the answers. It turns out it wasn’t so much that The girls can’t move him, but they wanted him to be under hospice care for state certification reasons. We did bring in hospice to visit him a few times a week and they are fine with that. How things work out

Seems his care is gotten to the point of needing more help than assisted living can provide. So, he does need skilled nursing care - they have those lifts which are easy to use in the facility - and will turn him frequently. They will help him toilet, do his hygiene, and feed him.

Hospice care focuses on comfort and not on curative care. He probably would not be forced to get out of bed. He should still be turned every 2 hours and helped to toilet and feed.

My mother is facing the same issue in her memory care facility. All staff that attempted to toilet or shower my mother required more than a 2 person assist primarily because my mother was resistant and would not assist in the transfer process more times than not. In order to keep her safe and not hurt the staff, the staff is currently doing bed baths and brief changes in the bed. To my knowledge they have been able to do this using 2 person assists from the wheel chair to the bed. The facility recommended OT/PT eval to see if strategies could be developed to maintain 2 person-assist status, but my mother's cognitive ability to process commands to stand etc. has not been helpful to this process. We will meet as a team to discuss the final recommendation but in the mean time I am touring nursing facilities. and submitting referrals. The transfer problem was not eliminated with hospice services; the issue remained the same - too heavy to lift by 2 persons with minimal assist from the Resident. I wish you well on this journey with your loved one.

My husband is an 87-year-old Parkinson's sufferer who is 6'2" and weighs 225. He always had trouble with transfers but after a hospitalization, he cannot attend to daily functions. He hated the idea of ALF. We now have a male health aide who is 6'2" and can handle all my husband's current needs, including exercising to regain his ability to walk. Keep looking.

A quick suggestion: in looking for nursing homes, Medicare rates them on their website as well as hospices. No place or organization is perfect but it’s good to increase your odds of finding a good facility.

SKelly,
It seems you have determined that it is time for a skilled nursing facility.

Schedule a tour of at least 3 and meet with an admissions director. Nursing homes can be vastly different. Some much better, or much worse than others. Find one that will best suit his needs and where you feel he will be most comfortable and cared for.

Ask about the food and the social activities. And take a look at the staff. Do they all look worn down and stressed? Many care workers are overworked due to being short staffed. Take a look at the rooms, patient rooms and common areas. Are they pleasant?

An upscale facility may even have a ceiling mounted track in lieu of a portable hoyer lift, making it easier and more convenient to move patients around.

Hospice is just like any other service provider. There are good ones (my experience) and the ones that apparently made contact with some of our other posters. IMO they are a great help. I say that as a long time caregiver of someone I love very much who has been on and off hospice for years.

I feel the same way about ALFs, SNFs, etc. Some are more helpful, better ran than others.

Why not try the hospice suggestion first and if that proves not to be successful, you can move to a SNF. I would get a hospice that would go with your dad to SNF for continuity of care should you later decide to move him.
You don’t have to use the hospice the ALF recommends although that one might be fine. Drill down with your questions so you aren’t assuming something will happen because someone else said it happened to them. you can change or cancel hospice at anytime. It’s on the contract. It’s not like paying a community fee at an ALF. Medicare pays for it.

You don’t have to remove dad from any meds. Hospice will provide the meds he needs to keep him comfortable if he needs those and for any meds needed to treat the condition for which he is on hospice. For instance, my DH aunt gets her Rx skin care and her antidepressants from hospice. She is on hospice for dementia . Her health insurance part d pays for her thyroid and her three BP meds. It’s your choice about the meds. Not the hospice company. I decided to take aunt off of the “memory” meds. She seemed more herself afterwards. Hospice had been and would have continued to pay for those. The hospice may recommend him stopping the meds. Mine never has but I know some do. Do it when you are comfortable with the decision. I liked that little insurance that aunt might not wind up with a stroke and dementia or all the issues an untreated thyroid can cause. Unless it’s life support they don’t just drop dead when the meds are removed. It’s not keeping them alive. Rather keeping them status quo.
Keep his regular insurance just in case he needs something you want him to have. I don’t use it often for aunt but it has been helpful.
My aunts hospice CNA gets her out of bed three times a week to shower. She is bed bound. She is not 180 lbs I hurry to add but the hospice cna is the only one who gets her up for a shower. She gives her a complete bed bath all other days.
My hospice CNA is there 5 days a week, sometimes feeds her breakfast and lets me know what’s going on. She has hospice CNAs on the weekend also. They aren’t as helpful as the weekday CNA but aunt has them. Not many have this service so don’t discount your company if they don’t offer that. Ask for what you need. Let them tell you what they can do or not. I do know many of the staff at the hospice and if I need something, I just call them. I like having the hospice be primary on the care because they are more familiar as we had their home health group for years before hospice.
She also has a longtime geriatrician that we do Telemed appointments with on occasion. You don’t have to subtract care. You are adding care.

Talk to the ALF about how they manage falls without hospice. You may already know that after two years.
With hospice, they can call the hospice nurse who will come check on dad and order an X-ray if needed to be done at the ALF.
When it’s just the ALF they usually have to send him off to the hospital.
Ditto with SNF w/o hospice and some of the SNFs will send them a long distance due to contracts.
When your dad passes while on hospice the hospice nurse will come.
Without hospice the procedure is different. Ask your ALF about this.
It can be daunting to sign the paperwork for hospice due to the awareness that life is growing short. But hospice is a service, not a sentence.
Oh and the only sitters you will get, regardless of where he lives, will be those you pay for.
Your dad sounds like a sweet and well loved man. Let us know how things go.

Skelly I AM WITH YOU. As an ex RN who faced this sort of thing daily I cannot imagine how "today's hospice" can be the slightest help. They send ONE aid twice a week for a bath, send in medication and equipment, and have one RN visit weekly; trust me, she/he does no heavy lifting. Hospice would be zero help and if they claim it would other than their getting a kickback of some kind, I hope they will explain exactly HOW they will help.

I however do agree with them that your father is now too deibilitated for ALF care. I think he requires nursing home care, and turns, and likely SHOULD have hospice, but not for movement.

I am amazed your father has made it to this age with this amount of weight. It is unusual. I wish you the very best of luck. It is looking like you are moving toward the end and I would DEFINITELY discuss palliative and hospice care now, and get Dad moved where he can more or less be bedridden with turns. He will be too difficult to maneuver soon any other way. I am so sorry.

Your dad needs to be in a nursing home.

180lbs is likely too heavy for ONE person to transfer - if they are deadweight. But there are tools (like a hoyer lift), and straps that can be used by one or two people to lift considerably more weight - even dead weight. But they may not be able to use those in ALF - because in most cases they have to be specially trained for list assist with tools.

My FIL weighed almost 300lbs when he entered SNF. And he was very little help when transferring. So either two people would assist with the lift straps or they would use the hoyer lift if they couldn't do it any other way.

I’m surprised 180 lbs is too heavy, with so many 400+ lb people all over the place nowadays.

We went with a memory care facility that seemed to have no problem using one person to lift our father from bed to chair to toilet. He weighed around 160 and was not very mobile. It cost us $7500 per month, much less and much nicer than local Chicago area nursing homes that quoted $10000-$12000 per month. Nursing homes use hoyer lifts which can be uncomfortable. Our understanding was that hospice rarely exceeds 6 months and they visit maybe once a day.

Each state has a fairly universal scope of practice. SNF might be the only option if a 2 person assist is needed. Some homes limit the total weight they will accept

Hospice sends one aide twice a week to bathe him plus an RN to take his vitals. But as it is likely fruitless to consider routine screening for an advanced dementia patient, they are a reasonable choice insofar as medical professionals they are another set of eyes in preventing or observing bedsores.

If your dad is self pay, I would recommend checking into board and care homes. They allow equipment for safe transfers and they have a better resident to caregiver ratio.

You do want to make sure they allow hospice though, not all do and you do not want to be looking for a place for dad when hospice is truly needed.

"Once they do get him out of the recliner he can use his wheelchair, with their guidance, to go into the bathroom and walk back to his recliner".

He can walk a distance but can't get himself out of bed? Or *won't* due to his dementia?

So he still has some mobility? I can see why the facility isn't sure what to do with him... I agree that SNF may be the most appropriate place for him, for now.

Whatever you do, don't involve hospice. Believe me, they will be USELESS. They will run up a high bill for Medicare though. Your father is old and needs others to get him from his bed to a chair and to help him eat. Hospice doesn't provide this. They don't provide elder-sitters who will stay with him either. What they will provide is enough narcotics and other controlled substances to treat an army when your father probably doesn't need any of them. They also like to to take an old person off their regular meds for conditions like diabetes or high blood pressure. Please don't involve them unless your father is actually actively dying. Really all they're good for is serious narcotics if you need them. I say this because I worked as a CNA for many in-home hospice cases.

He needs to be in a facility with a competent CNA staff who knows how to properly and safely use a Hoyer to get him from bed to chair. A nursing home would be the place for him now. That is where you will find Hoyer lifts and CNA staff.

A facility like Assisted Living, Independent Living and even Memory Care in most States can not use equipment to transfer a resident. (Rehab and Skilled Nursing can use equipment) This is for the safety of both staff and resident.
It is possible that they can use equipment IF the resident is on Hospice that might be what they want to do for your dad.

If Hospice comes in the facility will keep your dad until End of Life.
The staff will still have the same problems transferring him that they do now. but because he is on Hospice they will allow him to remain.
He will probably be better remaining with the staff he has now and a familiar room, dining room and other locations he has now.
There is a GOOD possibility that he will not be getting out of his room as much if the staff can not safely transfer him.
Hospice will take over some of the things that the facility now does.
The CNA from Hospice will now be giving your dad a bath or shower the facility staff will not do that.
The Hospice doctor will order medications not the facility doctor.
If there is a medical problem or question the facility staff will contact Hospice not the facility doctor.
If there is an emergency Hospice will be contacted, no transport to the ER.
You will be asked to sign a POLST. It is NOT a requirement though to get Hospice service. (good idea though as IV's, Tube feedings and CPR are not well tolerated at end of life and can cause problems rather than help)
Hospice will provide all the supplies that he needs briefs, wipes, gloves, creams, ointments, under pads.
So as difficult as the decision is I would opt for Hospice rather than transfer dad to a Skilled Nursing facility

No.......the AL agrees to keep dad until death IF he's on hospice. Only bc hospice provides an extra layer of care and supplies to make their job a bit easier. As soon as my father became a 2 person assist, he too was asked to leave his AL and go into Skilled Nursing which I did not want. My mother lived with him in AL, so he'd have to go to the SNF alone! So, what the AL is saying is, they're willing to do 2 person assists with dad for as long as he remains on hospice, like they did with my dad. Hospice brought in NO Hoyer lift, either as the AL did not allow them. The AL staff just did whatever they needed to do to help dad transfer from wheelchair to bed/toilet/chair etc. It's the way it works in most ALs, for some reason.

Hospice nurses and CNAs will come in max 3 days a week for an hour each time. But the CNA will bathe him, so that's another task the AL doesn't have to manage. The hospital bed is also a blessing, and makes tending to dad easier for staff. MUCH easier to transfer him bc the bed raises and lowers, unlike a regular bed.

If I were you, I'd get the hospice evaluation for dad and keep him right where he is. AL in a private room is better, imo, than a SNF on Medicaid with a roommate especially at end of life when comfort is paramount. Now, if you're self paying and dad can get into a great SNF with a private room, and you don't think he'll further decline due to the move, then consider it.

Best of luck.

I think it is time for him to be in a SNF. He will get the care he needs by staff who know how to do these transfers.

My father's situation is similar to how you describe yours with the weight and cognitive issues. My dad will be 96 in October. He has adjusted to life in the facility, he has been there since January 2023. His transfers which I think are twice a day take two people and a lift, he is about 200 pounds.

The important thing is your father receives the care he needs now that his needs have increased.

Hospice won't do anything. The nursing home will have Hoyer lifts.

Hospice will not be there enough to care for Dad. I don't know why it was even suggested. May get an aide but they are just for bathing. Most ALs and MCs will not do a a two person assist. Als and MCs are not skilled Nursing. Your Dad is beyond their ability to care for him. Time for Long-term care.

I thought you were going to say he was 300 or 400 lbs, which is an increasing reality in a lot of care homes. At 180 he should be able to use an alternating pressure mattress or mattress pad which can cut down on the number of times he needs repositioning, and I imagine the AL plans to leave his personal care needs to the hospice staff, who can provide a portable lift. But instead of guessing you really need to talk with his director of care to see what they have in mind.

Your right, hospice will be absolutely NOT help to you with any transferring and the like, as they are not allowed to pick up any of their patients. So the best bet would to now have your dad moved into skilled nursing where they can use a Hoyer lift if needed and be able to assist your dad better.