Personal care for a larger person: equipment, two carers and dignity

1. 1

   Ask the council for a needs assessment

   Free to ask for

   Ring adult social care at your relative’s local council, or apply online. The NHS is clear that a needs assessment is free. Say plainly what has become hard, such as getting out of bed, getting to the toilet or getting in the shower, and that you are worried about equipment and handling.
2. 2

   An occupational therapist visits at home

   Usually at least an hour

   The NHS describes an occupational therapist visiting at home, asking questions and walking round with your relative to see what they struggle with. Mention everything that is difficult, including the small things, and mention anything that has already broken or felt unsafe.
3. 3

   Equipment is matched to your relative and the rooms

   Part of the same visit

   Equipment is chosen against your relative’s weight and their shape, including the width of the hips and the space they need to sit and turn. The rooms matter too: doorways, the space either side of the bed, and whether a hoist can move across the floor.
4. 4

   A moving and handling plan is written

   Before the first transfer

   The plan names the equipment, the sling and how it attaches, the technique for each move and the number of people needed. Ask for a copy. Anybody who helps your relative, paid or family, should work from it.

On the NHS social care pages, the council's own professional or an occupational therapist visits you at home to see what you need, and the NHS page on home adaptations describes what happens during the visit. The council's side of the process, and the means test that follows if the council is asked to pay for care, is explained in the care needs assessment and local authority funding.

If your relative is in hospital, the assessment and the equipment should be in place before they come home. Ask the ward who is doing the moving and handling assessment and whether the community equipment service has the order, because a bed may need to come downstairs, which the options when stairs get hard covers, and a hoist has to be delivered and fitted. What to arrange before discharge day is the checklist for that week.

The safe working load is marked on lifting equipment by law. The Lifting Operations and Lifting Equipment Regulations 1998 require machinery and accessories for lifting to be clearly marked with it, which covers a hoist and its sling. The Health and Safety Executive's guide Getting to grips with hoisting people asks for a check that the person's weight does not exceed the safe working load of both the hoist and the sling, because they are rated separately and the lower figure is the one that counts. An NHS trust's specialised equipment guidance applies the same rule to beds, chairs, hoists and slings alike.

Two practical things follow. The first is that the check only works against a current weight, so if your relative's weight changes, or they have been unwell, ask for the equipment to be looked at again. The second is that equipment which lifts people must be thoroughly examined by a competent person at least every 6 months. If it came from the council, that is arranged for you; it is worth knowing the date.

Transfers, hoists and two carers covers the five ways a transfer is done and the hoisting mistakes to avoid, which apply to anybody who is hoisted. For a wheelchair, the NHS page on walking aids and wheelchairs explains how a GP, physiotherapist, occupational therapist or hospital staff refer your relative to the local wheelchair service. The right equipment to aid the elderly goes through the smaller items.

The Health and Safety Executive's guidance on managing moving and handling risks in health and social care is the source for both of the first two cards. The number of carers is written into the moving and handling plan before the first visit. It is not a matter of what the family would prefer, or of what one carer feels able to try on the day. If the plan says two, a visit with one carer should not include that move. If you think the plan is wrong in either direction, ask the team who wrote it to look again. The therapist can look at whether different equipment or a change to the room would alter what a move needs, in either direction.

Under the client contract you agree to give carers full and accurate information in advance about mobility and handling requirements, and to tell them promptly when things change. So share the handling plan with any carer before their first visit. If a carer is unwell and offers a substitute, the contract lets you object on reasonable grounds, and a substitute who has not used your relative's hoist is a reasonable concern to raise.

NICE's briefing on intertrigo describes it as a common inflammatory skin condition caused by moisture, heat and friction from skin-to-skin contact. That is why the drying matters as much as the washing. If a fold is sore, weeping or smells, ask the pharmacist or GP rather than trying products one after another.

The NHS lists swollen, sweaty or broken skin and difficulty moving among the things that make pressure ulcers more likely, and says a person cared for at home can ask a GP for a pressure ulcer risk assessment so a plan can be made. Pressure sores explains what to look for, when to call the district nurse, and how mattresses and cushions are arranged.

For continence, the NHS says a GP can refer your relative to the local continence service, and in some areas you can refer yourself. Managing incontinence covers pads, products and the day-to-day routine.

When you talk to carers, you are listening for two things. The first is experience: how they have helped somebody with a high body weight before, what equipment they used, and how they worked with a second carer. The second is manner. A good answer is calm and practical, and does not dwell on your relative's size. If a carer talks about your relative with any hint of judgement before they have even met, choose somebody else.

Ask your relative what they want before anybody arrives. They may want a woman or a man for washing and the toilet, and asking for a male or female carer for intimate care explains how to set that on the search and what to confirm. If you have been doing the washing yourself and it is time to hand it over, handing intimate care to a professional covers how to do that gently.

Not every visit in the week has to have two carers. If the hoist is only used to get up in the morning and into bed at night, a lunch visit for a meal and company may only need one. Two carers for an hour each morning and evening, with one carer for an hour at lunch, comes to £630 to £875 a week. Whether that works depends on what the plan says about each move, so check with the therapist before you book it that way. If the council has assessed your relative as needing care and is paying for some or all of it, the figures above are not what you will pay; local authority funding explains how the council's share is worked out, and what an hour of care costs sets hourly care against the other arrangements.

What to ask each carer before you bookSection titled What%20to%20ask%20each%20carer%20before%20you%20book

PrimeCarers checks every carer's identity and right to work, confirms an accepted criminal-record check (Enhanced DBS issued within the last 18 months, DBS Update Service, Scottish PVG or Access NI), and interviews every carer online. We do not check qualifications, training or references, so moving and handling experience is something you ask about and the carer describes on their own profile. Every visit booked through PrimeCarers is insured, by the carer's own policy or by cover PrimeCarers arranges where they do not hold one.

• What moving and handling training have you had, and when was it last refreshed?
• Have you used this type of hoist and sling, and bariatric equipment in general?
• Have you worked as one of two carers before, and who led the transfers?
• Would you read the handling plan and walk through each move with us before the first visit?

When you are ready, search for carers near you and compare their rates, then ask each one about their experience with bariatric moving and handling before you book two for the same visit. Settling in with a personal carer covers the first weeks. Ending an hourly arrangement takes 48 hours' notice under the client contract.