How to Use a Transfer Belt Safely

What a transfer belt is

A transfer belt is a strong, washable fabric belt, usually 5 to 10 cm wide and about 100 to 150 cm long, with a secure buckle. Some have handles sewn along the belt for a better grip. It is fastened around the person's waist, over clothing, so that a carer can hold it to guide the person's movement and steady them if they lose balance.

It is a safety and guiding aid, not a lifting device. A carer should never use a belt to lift a person's full weight. For people who cannot bear weight, a mechanical hoist or slide sheet and trained help are needed. The belt is for people who can bear at least some weight on their legs and follow simple instructions.

When a belt helps, and when it does not

A belt helps when your parent:

• can stand with some help but is unsteady, so you need to guide and catch;
• is learning to walk again after surgery, a fracture or a stroke;
• needs help moving from bed to chair, chair to commode or chair to wheelchair; or
• is at risk of falling, and a second person needs a secure grip.

Avoid a belt, or ask a professional first, when the person:

• has recent abdominal, chest or spinal surgery, a hernia, a stoma, a feeding tube or a pacemaker site near the waist;
• has severe osteoporosis or a recent rib or spine fracture;
• has a pressure sore, wound or skin tear near the belt area;
• is pregnant;
• has severe breathing difficulty, since a belt can restrict the chest; or
• cannot bear any weight or follow instructions.

In these cases a physiotherapist or nurse should advise on safer methods. See helping an elderly parent stand up from a chair for other techniques.

Choosing a belt

• Material. Sturdy cotton or nylon webbing that is washable. Avoid thin or stretchy fabric.
• Buckle. A strong metal or heavy plastic buckle that holds under load but releases easily. Quick-release buckles help carers.
• Size. Long enough to go round the waist with a hand's width of space; adjustable. Check the maximum waist size.
• Handles. Several handles, or a continuous gripping surface, so you can hold from the side or behind.
• Cleaning. Washable at a high temperature.
• Non-slip. A textured surface that does not slide on clothing.

Buy from a reputable supplier and check the stitching and buckle. Replace belts that fray or have damaged buckles.

Putting it on

1. Explain what you are doing, in simple words. Ask permission and keep the person at ease. 2. Seat the person upright on a firm chair or the edge of the bed, with feet flat. 3. Place the belt around the waist, over thin clothing, not directly on the skin, and not over a stoma, wound, tube or a bulky pocket. 4. Position it at the narrowest part of the waist, above the hips and below the ribs. If it is too high it presses on the ribs; too low it slides over the hips. 5. Fasten the buckle at the front or the side, and tighten so that it is snug but allows you to slip two fingers between the belt and the body. It must not ride up or slide down. 6. Tuck the loose end away so that it is not a hazard.

Check that the person is comfortable and can breathe easily.

Your body position: protect your back

How you stand matters as much as the belt. Follow the rules of safe handling.

• Wide stance. Feet shoulder-width apart, one foot slightly ahead.
• Bend your knees, not your back, and keep your back straight.
• Keep close. The closer you are to the person, the less strain on your back.
• Hold the belt with both hands, using an underhand grip, with your palms facing up and your fingers curled around the belt, at the person's side or slightly behind. Keep the arms bent.
• Use your legs and body weight, not your arms.
• Do not twist. Move your feet to turn.
• Count together, such as "one, two, three, stand," so that you move at the same time.

If you have back problems or are not strong enough, do not take on the transfer alone. Ask for a second person or professional help.

Standing up from a chair

1. Place the chair firmly against a wall or on a non-slip surface, and brake a wheelchair. 2. Ask your parent to move forward to the edge of the seat, feet flat and slightly back under the knees. 3. Stand in front or to the side, on the weaker side, with a wide stance, knees bent, and hold the belt on both sides. 4. Ask them to lean forward, "nose over toes", and push up with their hands on the chair arms, not on you. 5. On "three," guide them upwards as they push, helping with a small lift in the direction of movement, not hauling. 6. Once up, pause. Let them stand and steady for a few seconds before you move.

If they cannot come to standing with this help, stop and ask a professional. Do not strain.

Walking with a belt

1. Stand slightly behind and to the weaker side, holding the belt at the back with one hand and keeping the other hand near the person's shoulder or the walking aid. 2. Do not hold the walking aid yourself; the person must hold it. 3. Walk at their pace, matching their steps. 4. Be ready to steady, not to catch the entire weight. If they start to fall, use the belt to guide them gently towards the floor, protecting their head, rather than trying to hold them upright. See what to do after a fall. 5. Give calm, simple instructions such as "short steps" or "look ahead".

For walking aids and how to use them, see how to use a walking frame correctly.

Moving from bed to chair or wheelchair

1. Prepare the space. Place the chair or wheelchair at a slight angle to the bed, on the person's stronger side, with brakes on and footrests lifted out of the way. 2. Help the person sit up at the edge of the bed with feet flat, and let them rest a moment to avoid dizziness. 3. Put on the belt while they are sitting. 4. Stand in front, knees bent, and hold the belt on both sides. 5. On "three," guide them up to standing, as above. 6. Pivot, turning by moving the feet in small steps, until the backs of their legs touch the chair. 7. Lower them slowly, with your knees bent, as they reach back for the arms. 8. Check position, seat belt and feet.

For more on bed-to-chair techniques, see moving from bed to chair. For chair-to-toilet transfers, a commode chair or a raised seat helps.

What can go wrong, and how to prevent it

• The belt rides up under the arms or slides down over the hips. Fit it at the waist and tighten.
• The person pulls on your neck. Ask them to hold the chair arms or the walking aid, not you.
• The person is too heavy or unpredictable. Do not lift. Call for help or use a professional.
• Dizziness on standing. Wait for a few seconds and check blood pressure if it happens often; see dizziness when standing.
• Skin damage. Check the skin under the belt after use, especially for people with fragile skin.
• Rushing. Slow, steady movements are safer.
• Forgetting the brakes. Always lock wheelchair and bed brakes.

Training and practice

The best way to learn is from a physiotherapist or nurse, who can watch you and your parent and correct technique. Ask for a session at home, in the real room with the real furniture. Practise with the helper standing in for your parent, so you feel what the movement is like. Teach other family members and any paid attendant so that everyone uses the same method. Our care advisors can arrange training for family carers.

Caring for the belt

Wash the belt regularly, following the label, and dry it fully. Inspect it before each use for fraying, loose stitching and buckle damage. Keep it in a clean, dry place and not under heavy objects. Replace it if it is damaged. Keep a separate belt for each person if there is any skin infection.

When to ask a professional

Seek advice if your parent cannot bear weight, has pain on standing or walking, becomes breathless or dizzy, has recent surgery, falls frequently or has a condition such as Parkinson's disease or stroke that changes how they move. A physiotherapist can assess whether a belt is appropriate and show safer alternatives such as slide boards, hoists or different furniture.