Weighing the heavier person

It is important for the heavier person - and for those managing their care needs - to know their weight: this is essential to ensure the correct and safe choice of equipment.

• Domestic weighing scales are readily available from high street stores, but they will have a limited weight capacity
• Larger capacity scales are available with a standing platform, a chair or a ramped platform to take a person in their wheelchair
• Some hoists have the option of a weighing scale attachment
• Beds are also available with integral weigh scales
• Many suppliers offer a weighing service, which may have a cost implication.

Moving and Handling equipment

Mobility and Walking
N.B It is not advisable for a carer to assist a heavier person to walk because of the risk of injury to both the person and the carer - if the person being assisted falls down for example.

Walking aids can provide support - walking sticks, crutches and frames are available for the heavier person from a range of suppliers.

Walking frames
Walking frames are designed to provide additional support during walking. Not all frames will accommodate the larger person.

Before considering the purchase of any walking aid seek professional advice from a physiotherapist, occupational therapist or moving and handling specialist to ensure that the equipment is suited to your individual needs, environment etc.

Walking frames should not be used to assist from sitting to standing or vice versa, as this can place the person at risk of falling if the frame should tip, and they are not designed for this use.

Frames can be useful if positioned nearby so the person standing can hold on to them for support once standing. Frames can also be useful to provide steadying support whilst a carer assists with dressing.

Wheeled walking frames
Wheeled walking frames are pushed forwards rather than lifted and can be less cumbersome to manoeuvre in certain environments. However, some floor surfaces and environments may not be suitable.

Some have a tray or basket attachment making it easier when moving items from one area to another.

Getting up and down stairs

Ideally all facilities would be provided on the same level, e.g. bathroom and toilet, bedroom, living room and kitchen, but this is not always possible.

A second stair rail can help to move the individual up and downstairs as this provides additional support. It is important that the rail is securely fixed.

It is possible to install a stair lift in some properties for the heavier person.

Professional advice from a structural engineer must be sought before adaptations to a property are made and an assessment of the person’s size, weight, shape etc should be completed to ensure the person will be able to sit comfortably within the stair space whilst using the stair lift. If this is not possible, and access to the upstairs of the home is still required, a through floor lift may be considered as a solution.

Involvement of an occupational therapist may be needed to ensure correct and appropriate advice and guidance is given.

Wheelchairs

Manual wheelchairs

The use of a manual wheelchair has limitations for both the heavier person and their carer(s). Wider wheelchairs are difficult for a single carer to 

manoeuvre over any distance or restricted environments and are often of a heavy design. Advice should be sought when considering purchase of a wheelchair to ensure the correct design is identified.

Wheelchairs should be fitted with a cushion that corresponds in size to the wheelchair seat and which is suitable for the person’s weight and any pressure care issues they may have. The cushion should be ordered at the time of the wheelchair.

Powered wheelchairs and scooters

A range of powered wheelchairs and scooters are available to aid independent living. Their size and level of manoeuvrability can make it difficult to use them in the average home; however, they can provide independent outdoor mobility. Not all scooters are capable of climbing kerbs and so the environments in which you might want to use this type of product need to be considered.

Both powered wheelchairs and scooters can be driven forwards and in reverse, and although reverse may not be used that often, it is needed for tight manoeuvring in smaller spaces. If the driver has difficulty turning to see behind them, wing mirrors might help.

Certain models have detachable armrests that make it possible to transfer into the seat from the side or using a hoist.

The controls for wheelchairs are either positioned on the armrest or at the back to enable a carer to take control.

Some scooters have a swivel seat to help when getting on and off: often the armrests can be flipped back to improve access. Armrests, when in a down position, provide a hand-hold support when sitting or standing up, but may restrict the width within the seat and ease of movement and/or repositioning.

Scooter controls are mounted on a tiller that is turned left and right to steer. It is important to check the space between the seat and the tiller to ensure that controls can be easily reached.

Both powered wheelchairs and scooters need to be stored in a secure place, and with larger vehicles a garage or shed is often required.

Batteries must be charged up regularly using a charger that plugs into the mains, so as to avoid the user becoming stranded when out due to a flat battery. The position of the charging point on the vehicle will affect how easily the operator can manage this independently.

It is worth considering Government guidance on driving a scooter as some can be used in the road and some cannot, and this may influence the purchase. 

Whilst scooters are not difficult to drive, as with any moving machine it may be worth trialling one before committing to purchasing one as they can be an expensive investment. 

Alternatively, there are many local ‘shop mobility’ schemes operating in local shopping centres where a scooter can be hired for a few hours, and a reputable mobility scooter may allow a trial before purchase. This will ensure the scooter is specific to individual needs and that the person can competently and safely operate it.

Personal care

Bathing, showering and strip washing

The bathroom environment in the average home can be small, making it particularly difficult for larger people to access and use standard features such as the bath or toilet. This situation is made more difficult and restricting if additional equipment and/or carer(s) are required to assist. Potentially, more space can be created by:

• removing the wall separating the toilet and bathroom (if the two are adjacent to one another)
• changing an inward swinging door to an outward swinging / sliding door to improve access and be less restricting within the bathroom
• removing the bath and exchanging it for a level access shower, or conversion of the bathroom into a wet room.

Ensure you contact an occupational therapist or structural engineer to discuss options before proceeding with any work to your home.

Assistive equipment is available to enable as much independent personal care as possible, from long handled brushes to shower chairs and grab handles.

A heavy duty perching stool can be used to rest on whilst washing at the wash basin. Armrests on the stool provide some sideways security and a handhold to push on when standing up.

Whilst showering provides a more satisfactory alternative to bathing, the needs of other household members should also be considered.

Half height doors across the front of a shower cubicle or to section off a shower area will be less restricting than a completely enclosed shower, and can help reduce water spillage out of the area and keep the carer dry.

Alternatively, a full length, weighted shower curtain may be favourable. This can be tied back out of the way when not in use, to give the effect of more space.

Generally, the choice will depend on:

• space
• if the person can independently shower
• if the person has carers to assist - shower doors will protect the carer from getting wet.

Professional advice from a structural engineer must be sought before adaptations to the property are made. Considerations include:

• the weight limit of shower tray
• the weight distribution of the shower chair
• porcelain or acrylic shower trays
• level access height and design of shower controls
• position of grab rails.

Where mobile shower chairs are to be used, check the thresholds and floor surfaces to ensure movement of the shower chair will not be impeded and that it can be turned within the bathroom and manoeuvred within the shower. Brakes are essential to keep the chair stationary during transfers and when in use.

If an adaptation is not appropriate, or the person prefers to strip wash (perhaps this is more comfortable) this is often completed at a wash basin or with a bowl of warm water on a table in a larger space such as the bedroom. There are a variety of tables that are suitable for this type of activity.

Considerations to the type and size of table required include:

• the number of items needed to complete washing - e.g. bowl, soap, deodorant, brush or comb, towel
• if it will be used for other activities afterwards, such as reading in bed or eating meals from it.

People who spend the majority of time in bed, due to limited mobility or as a result of declining health, may be enabled to transfer onto a mobile shower chair or shower table using a hoist, with support from carers. If this is not possible, a bed bath may be the only option; an electric profiling bed, similar to a hospital bed, should be considered if the person is being washed in bed. This is to ensure safe manual handling can be completed by the carers, and access to both sides of the bed can be facilitated, if necessary, by moving the bed to allow this.

These may be provided via Local Authorities or District Nurses, depending on the need.

It is worth enquiring as to the eligibility for provision of an electric profiling bed as if a person is immobile enough to warrant a bed bath, it is likely they would meet the criteria for one to be provided.

Toileting

Whilst the safe working load of the toilet is important to consider, just as important is the way in which this is to be mounted - a wall mounted toilet will generally have a lower weight limit. Seek professional advice to identify the safe working limit if considering this type of option.

A standard sized toilet seat is often inadequate and causes pinching. Toilets are available for the larger person that provide a wider, deeper seat and higher weight limit. For certain designs the size of the aperture remains similar to a standard toilet (so it can safely be used by children).

A standard toilet can be adapted in a variety of ways to make it more comfortable and to provide better support, although space around the toilet can limit any adaptation.

A raised toilet seat can give a higher sitting position but seat size is similar to a standard toilet. The seat must be firmly secured and it is generally safer to choose a design which replaces the existing toilet seat and uses the bolt-holes at the back of the pedestal to secure it.

When cleaning oneself it is easier if there is a substantial cut-away at the front of the seat.

An extra wide combination toilet seat and frame provides a raised seat on a frame and can be adjusted in height to suit the stature of the heavier person. Some styles have a squarer seat giving a larger area to sit on. Frames can be bolted to the floor to prevent tipping.

Grab rails on the wall can provide a handhold to assist standing. If wall-fixing alone is not adequate, some drop-down rails can have an extra support leg, distributing some of the load through the floor. These need to be mounted on the wall behind the toilet and it is essential to ensure the wall is sufficiently strong to support the rails before fixing them.

Another option is a floor to ceiling rail that is secured with screws at both ends. A separate horizontal rail can also be attached to the side wall.

When considering a purchase or installation check that there is room either side of the toilet and that plumbing can accommodate the frame.

Toilet chairs are also available that include a backrest to increase comfort and stability. Check that the chair backrest doesn’t obscure the toilet flush.

Some toilet chairs are mobile so they can be positioned over the toilet (space permitting) and as with the mobile shower chairs the person can transfer or be transferred into the chair in another room (e.g. bedroom, using a hoist if necessary).

Over-toilet chairs usually have a fitting to accommodate a commode pan. If there are occasions when the heavier person has restricted movement, the commode option can be used. Combining a shower and a toilet chair can reduce the amount of equipment in the home and the number of transfers a person has to make when completing personal care tasks.

There are a limited range of toilets available that provide a self-cleaning function, which combines the function of a toilet with a bidet and drying air. This can enable the person to be completely independent with toileting, even if they have limited hand function, without the addition of separate toileting equipment or carers. This is provided they are able to mobilise to the toilet, either independently or with assistance.

It is worth noting though that the general weight limit of these products are approximately 30 stone, however some manufacturers add seat upgrade options that increase the maximum load of the toilet to 57 stone.

Commodes
If access to the toilet is not possible, or the person is unable to move any distance, a commode will be required. A range of static commodes are available with features such as:

• a lightweight metal frame
• a wide seat with different widths and depths of seat
• removable armrests
• a removable backrest (to make positioning on the commode easier if transfers are via a hoist)
• height adjustment.

Check how the commode pan is positioned – some slide in from the back and this might present problems if the commode is placed with its back to a wall.

A mobile commode (sometimes called a glideabout commode) gives the opportunity to bring the commode to the person when the need arises, but then taken away and stored elsewhere.

This can be more discreet and less invasive for a person, and can assist in ensuring their dignity.

Portable urinals
Urinals are useful for people who are very immobile and also for emergencies when there’s not enough time to transfer to a commode or toilet.

A lot of urinals available now are disposable or specifically designed to be used when travelling, to assist those with limited mobility and to reduce the effort, stress and strain of transferring from a car to a public toilet for example.

There are versions available for both men and women, but these are easier for men to use than women. A perching or sitting position is best although some designs can be used with the person lying down.

For women, it may be difficult to position the urinal and therefore some are designed to fit the female anatomy - those with a wider necked receptacle may be more useful.

Incontinence
Some people may suffer stress incontinence and will require extra padding. These can be purchased from chemists, supermarkets or online and generally take the form of slip-in pads or pull-up pads that feel like the person is wearing underwear. A variety of absorbencies are available. Please seek professional advice as a referral to the continence service may be appropriate, to identify the correct type and absorbency of pads needed, as well as if the person is eligible for pads to be provided.

Clothing and footwear

Clothing

The design of clothing can influence how quickly it can be removed for toileting or personnel care. Loose fitting clothing may be easier to manage and more comfortable for some larger people.

Clothing should be considered for ease of wear and laundering. Front fastenings are better for independent dressing. Small fastenings will be difficult for large or oedematous fingers to manipulate. Velcro can be used to replace buttons, but be sure that the garment is generous in size or the Velcro will part under strain.

Avoiding clothing styles that could cause:

• restriction to blood flow
• fluid retention
• irritation such as tight straps, waistbands, collars, cuffs and sock/stocking tops.

Some clothing tips for men include: 

• opt for trousers with a long length fly zip helps when positioning a urinal
• Edgware braces are a ‘home-made’ idea to stop trousers falling down and enable trousers to be lowered without removing garments worn over the braces or undoing the braces. Contact a clothing advice service for further advice.
• trouser clips are designed to clip onto a user’s trousers and upper body garments to prevent the user’s trouser from falling down when they are dropped to sit on the toilet.

For women:

• fuller skirts and dresses are easier to adjust when using the toilet. It’s generally easier to pull up the bottom layer than pull it down
• wrap over designs can help by being easier to put on and because the overlap can be pulled open
• wide-legged French knickers are less likely to restrict, and if loose enough, can be pulled to one side to use a urinal
• bra straps can be made more comfortable by fixing a padded guard to the shoulder strap, and the back can be lengthened by using an extender that hooks onto the existing back fastening. Alternatively, front fastening bra hooks may be easier to use.

For both men and women it can be difficult to find under-garments that are comfortable to wear, although high street stores and online shopping sites are beginning to acknowledge this and are providing ranges for larger sized people in more fashionable, modern and appealing styles than in the past. It is worth looking online or in high street stores to gain an idea of what is available and suitable for individual need.

Footwear

For some people, swollen feet and joints can be particularly painful. The arches of the foot may have fallen and support within the footwear may be needed.

People with poor circulation and reduced sensation may have difficulty keeping their feet warm. Thicker soles give more heat insulation. Fleece-lined slippers can be worn when at rest.

Footwear that opens to the toe is easier to wear. Extra width and depth can accommodate swollen feet. Supportive insoles can make weight bearing more comfortable. Soft leather and cushioning can protect the skin against pressure ulcers.

A long handled shoe horn can help to put shoes on. Reaching down to do fastenings may be difficult. Velcro is easy and can also be adjusted if swelling varies throughout the day. If swelling is excessive or varies throughout the day, adjustable Velcro strap extensions can be added which create even more room in a shoe for very swollen feet.

If off-the-shelf footwear is not suitable, footwear can be made-to-measure. This is sometimes available through a local hospital or via a G.P. referral or alternatively, items can be purchased privately.

Small handling aids

Transfer boards
There are transfer boards with a greater safe working load (SWL) for heavier people.

Transfer boards are predominantly designed for independent use and are used to bridge the gap between two surfaces (e.g. bed and wheelchair) to enable a person who is unable to stand to transfer.

There are risks associated with assisting in the use of transfer boards for the heavier person and they are not suitable for all people; their use should only be implemented following a professional assessment.

The user must have sufficient strength in their arms to assist themselves during the transfer.

Slide sheets (flat, tunnel, roller)
These are products used as repositioning aids by the user or carer(s). Use of the slide sheet (or equivalent) may require additional carer(s): they should only be used after appropriate assessment and training in their use.

This type of product is available from a range of suppliers in different sizes.

Chairs

Chairs

A chair should provide comfort and support for activities such as reading and watching TV. To provide support and comfort the following should be considered:

• chair dimensions
• design
• straight or tilted back
• adjustability
• safe working load
• height of the seat
• whether an inclined backrest is necessary
• how much time is spent in the chair
• purpose of the chair (sleeping or recreation)
• position within the room
• other equipment the chair is to be used with e.g. hoist, cantilever table
• the requirement of a pressure relieving cushion
• armrests should provide a firm surface to push up from and should extend at least to the front of the seat. Detachable/drop down armrests can help positioning of slings should the person require hoisting.

Riser recliner chairs
People who have difficulty standing from the sitting position can be assisted if they use an electrically powered riser recliner chair. There are different designs available; the seat unit or the entire chair rises and tilts to help bring the person up to a standing position and they must have sufficient strength in their legs to rise up from sitting. 

• People who have difficulty transferring may spend the majority of their time (day and night) in their chair and consequently a powered riser recliner may best meet their needs and allow easier repositioning
• Some people may choose to sleep in their chair if they find lying flat difficult and uncomfortable; a powered riser recliner chair may help provide a semi-reclined position with legs raised
• Some powered chairs allow the person to adjust the leg and backrest independently, giving the person more choice of position. These are often referred to as ‘dual motor’ chairs as they have two motors instead of one to provide more choice of movement options
• Sitting with legs raised for periods of time can help reduce swelling of the lower limbs.

Certain chairs feature integral pressure relieving cushions, which can often be more comfortable for the user than having a removable cushion. If pressure relief is an issue for the person, it may be worth considering a tilt in space style of chair as this allows for the seating angle to be maintained when the chair is reclined, which can assist in providing additional pressure relief.

Hoists

Hoists are used to lift and transfer people who are unable to take their weight through their legs. There are a number of suppliers with designs from mobile battery powered versions to electrically powered hoists which may be permanently or temporarily installed.

There are different designs of hoist available for different transfers; their use should only be implemented after assessment and training.

Fitting the sling and transferring the heavier person can require considerable assistance by carers.

Considerations when choosing a hoist are:

• ability of the person - how much the person can assist the carers
• weight of the person
• safe working load (SWL) of the hoist and slings. SWL must be considered to allow for changes in the persons weight
• types of transfer required
• number of carers
• required distance of travel.

Mobile hoists
Mobile hoists are used to transfer a person over a short distance e.g. bed to chair. The person is lifted in a sling attached to the hoist.

Overhead/ceiling hoists
Overhead hoists may be the preferred option where there is limited space for carers, free movement and the type of transfer required. Overhead hoists run on tracking that can be fixed to:

• the ceiling
• from wall-to-wall, spanning the room from one side to the other
• free-standing gantry.

Assessment of the strength and capacity of the ceiling or walls will determine whether tracking can be fitted - advice from a structural engineer will be required. If tracking cannot be installed, then the option is to use a free standing gantry frame hoist design. Gantry hoists are simple to install as they require no permanent fixing. The assessment will consider:

• floor surfaces
• loading capacity of ceiling/floor/walls
• the range of lifting height of the hoist (to ensure clearance when lifting off a bed, from the floor)
• space around and underneath furniture (if considering a mobile hoist).

Slings
Slings support the person during the transfer. There is a wide range on the market, including those for people with sensitive skin. Bespoke slings are also available from certain suppliers.

The choice of the right sling for an individual requires expert assessment and knowledge.

Beds

A bed should provide comfort and support for the individual and allow sufficient room for repositioning – this is especially important for the larger person.

Different designs of profiling beds and mattress are available with a range of functions. It is recommended that professional advice is sought prior to purchasing and bed.

To ensure the selection of the best bed, the following should be considered:

• the size and design of the bed
• the position of the bed within the room
• transfers on and off the bed
• changing position in the bed
• providing access around the bed
• the position of fixtures and fitting within the room e.g. power points, windows
• other equipment
• number of carers.

Bed transfers

The ability to adjust the height of a standard bed can be critical for both independent transfers and those involving carer(s) and equipment e.g. hoists.

If mobility is limited, a powered profiling bed can be an essential equipment item for the heavier person.

Equipment that can help with independent bed transfers includes:

• bed blocks or raisers, positioned under the legs of a normal divan bed to raise it up
• a bed lever - a handle that fits between the mattress and the bed base to provide a handhold when pushing-up, to stand from sitting
• an electric leg lifter - a powered device that lifts / lowers the legs up level with the mattress
• a sliding sheet: slippery fabric that can help to reposition the person in the bed.

There are certain beds which have a greater profiling range, which can be used to assist a person from lying through sitting to standing. With the lower limbs down, this makes it possible to transfer from the end of the bed more easily.

Repositioning in bed

The heavier person may need a wider bed to enable them to turn safely. A wider bed will require carers to reach across a wider area.

If the person requires further assistance with bed mobility, beds and mattresses are available to assist turning them. Slide sheets may help carers to achieve this more easily.

The design and type of mattress is critical for providing support and comfort for the person.

Accessing your needs

If further help is required, contact your local social services for a community care assessment. The assessor will consider personal needs – whether they are:

• simple or complex
• many or few
• essential to independence and quality of life.

If the client qualifies for help, their needs will be more fully assessed to identify hazards with moving and handling the heavier person. Help may be provided by providing extra carers and/or equipment that will make managing tasks at home easier.

Considerations before buying equipment

The expertise of a professional person (physiotherapist, occupational therapist or a Moving and Handling Practitioner) who has specialised knowledge of moving and handling equipment can help when choosing equipment. Heavier people often have other complex needs and a professional assessment will ensure all factors are considered to recommend the right type of product. You can contact your local social services and ask about an assessment on the GOV.UK website.

Private physiotherapist
If you wish to request a private appointment with a physiotherapist then you can obtain a list of local physiotherapists who offer private services from the Chartered Society of Physiotherapists.

Private occupational therapist
If you wish to request a private appointment with an occupational therapist then you can obtain details of local private occupational therapists from the College of Occupational Therapists Specialist Section Independent practice (COTSS-IP) website.

If you do contact a private physiotherapist or occupational therapist, make sure they are registered with the Health and Care Professions Council (HCPC). The HCPC is responsible for the conduct, performance and ethical behaviour of its registrants. Health care professionals who do not meet the standards of practice, conduct and behaviour required by the HCPC are removed ('struck off') from the register. 

To provide you with some helpful hints, consider:

1. Capacity of equipment (Safe Working Load  or SWL). The equipment must be strong enough to support the heavier person’s weight (and reflect possible changes in the person’s weight and size e.g. increase or decrease) and must not exceed the product’s SWL.

2. The ability of the heavier person. A person’s ability may change over time and due to changing health needs, which may include:

• progression of their diagnosis
• muscle weakness
• restricted movement caused by size
• pain from over-stressed joints
• breathlessness
• pressure ulcers.

3. The ability of the carer(s). Any person expected to use equipment must have received training prior to its use. This should be facilitated by a professional trainer or attending a relevant course e.g. those organised by the Disabled Living Foundation (DLF). Make sure you discuss the level of training provided by suppliers; more complex equipment will require more detailed training.

4. The environment. This is a very important aspect to consider when purchasing equipment for your home. Common restrictions in the home layout e.g. bedroom toilet/bathroom and living room include:

• size of rooms
• doorway widths - the average door opening may not be wide enough for larger equipment
• thresholds and changes in floor surface limiting movement of wheeled equipment
• space for free movement of equipment and the carers
• moving heavier equipment up/downstairs
• the load bearing capacity of the floor or ceiling. A structural engineer (council or private) can advise on these issues
• height of ceiling
• storage spaces for equipment e.g. hoist as well as easy access to power points for charging.

Supply and provision

People don’t have to accept the service or equipment offered by social services. Instead, they are entitled to ask for a direct payment that is a cash alternative, equivalent in value to the service/equipment they would have received. This money must then be used to independently organise relevant services or to buy appropriate equipment. Local authorities using Government guidelines, will make a decision on an individual’s capabilities to organise their own services when deciding on whether a direct payment will be appropriate.

Try equipment before you buy

If you decide to purchase equipment privately, try and compare the different ranges first, perhaps in your local Independent Living Centre.

There are a considerable amount of Independent Living Centres located throughout the UK. They provide unbiased, expert advice and information about equipment offering advice how much it costs, where to obtain it and offer the opportunity for you to try a wide range of products. Advice and information about other issues related to daily living is also available.

It is always advisable to contact the centre before visiting to check whether you need to book an appointment, and to also check for up to date opening hours which may be subject to change.

Be cautious of sales people who try to persuade you to buy equipment that may not meet your needs fully or is over-priced. Buying from a company that belongs to a trade association, such as the British Healthcare Trades Association (BHTA) may give you some reassurance. BHTA members have signed up to a code of practice governing standards of customer service.

VAT relief

You don't have to pay VAT on products designed for disabled people if you have a long term illness or disability, or are terminally ill.

Mobility shops may automatically sell you equipment without charging you VAT, but you may have to ask for this to be discounted off the total price.

Individuals with a temporary injury such as a broken arm or hip do not qualify for VAT relief.

Equipment Hire

Many suppliers offer a hire service. Contact the Disabled Living Foundation Helpline on 0300 999 0004 for contact details.

Funding equipment

Charitable trusts may sometimes provide funding for equipment.

Charities will only give awards in accordance with a predetermined criteria, so it is important that you carefully select the trusts you apply to.

Most libraries hold directories of suitable funders in their reference section.