Another “hands on” challenge for caregivers is toileting. Having a person who is weak, painful, scared, or any combination of those (or other) limitations, is going to make getting to a toilet or commode difficult.
As with any of the guides provided on this blog, the purpose of them is to help make the role and tasks of the caregiver easier. We strive for efficiency and to minimize the effort it takes to help someone move better. When we do that, it’s a lot less stressful for the caregiver and the loved one needing care. In many cases, caregivers and their care recipients make a lot of the daily duties more difficult than they need to be because they haven’t been taught or told a better way.
If you’ve struggled to help someone get to and from a bedside commode, this guide is especially for you. It will go over the mechanics or series of positions that actually eliminates the need for a person to “stand up” to get to a commode and it also reduces or eliminates the amount of foot steps needed to accomplish the transfer if one does choose to stand up. This will be a help to those have to transfer a person that can’t stand up on their own.
But before we get into the meat and bones of this guide, I want to say up front that I realize that there’s a lot more involved with getting someone to and from a commode than simply helping them move. There is the clothing and clean up issue that goes along with toileting. This particular guide only addresses the moving to and from as each person, depending on their gender, health status and ability is different when it comes to clothing and clean up. But, we’re all the same when it comes to how humans move.
How to Get From Wheelchair to Commode Easier
As with any activity we do as humans, whether throwing a baseball or putting on a pair of pants, each task is broken down into a series of movements in which we put our bodies (and it’s parts) into specific sequential positions. And these positions, when done in the correct order, allow us to complete the overall task.
If you think about it, the technique/movements/positions required for getting to a bedside commode (or putting on a pair of pants) would be no different for a young spry person than they would for a person who is a little more seasoned. Its only that the younger person would probably do it a little faster.
Our position is if we break the activity down into its basic movements, then the process should be easier (or the easiest that it will be). And keep in mind, “easier” doesn’t mean “effortless”. The loved one is still weak, painful, frightened, and the caregiver is still nervous, overwhelmed, and possibly has a bad back themselves.
I want you to think of this process as a “recipe”. If you add all the ingredients, in the right order, then the dish you’re making will probably come out ok. Plus, the more you practice, the easier it gets. That goes for everyone involved.
How to Transfer to a Commode if You Can’t Stand Up
This is a valid question and the method that we will look at in a moment is for anyone who can “bear weight” through one or both legs although they may not be able to stand up safely or for very long.
The good thing about this wheelchair to commode transfer is that it’s a perfect way for people to get to the commode if they can’t stand up. There’s really no need to try to use a walker because all the person is going to do is “pivot” from on surface to the other.
What do I mean by “bear weight”? If a person can use one or both feet to help steady themselves when trying to stand, that’s “bearing weight”. They may not have enough strength or confidence, or even range of motion in their knees or hips to straighten up all the way. But, if they aren’t just “dead weight” and they can push into the floor when being transferred, then they can use this method.
Hopefully with more and more weight bearing, they will be able to eventually stand up and get to the commode independently without the need of someone helping them.
How to Transfer From Bed to a Bedside Commode
Although this is a guide about how to transfer from a wheelchair, that doesn’t mean you have to be in a wheelchair for it to work. Some people have to transfer from the bed to a bedside commode and still others are in recliners.
The technique and strategy will work wherever a person may be seated. If you’re in the bed and sitting on the edge, this technique will work as long as you’re able to reach the ground. If you’re seated in a recliner or on a sofa, it’s the same maneuver. In general, this is a “modified pivot” transfer which simply means moving from one seated surface to another seated surface.
Many people when transferring to the commode, like it to be right in front of it. This is because they grasp the arms of the commode with both hands because it gives them more security and control. Unfortunately, doing it this way actually is more strenuous and requires the patient to spin 180 degrees to sit down. This is at least 6-8 steps they may have to take making their way to the commode.
The following method will make it easier.
Wheelchair to Bedside Commode Transfer: The Sequence
Step 1. Wheel the loved one up to the commode at a near 90 degree angle. When you’re at 90 degrees, you’ve already cut the distance you need to travel in half.
Step 2. Have them scoot forward toward the front of the wheelchair. This will get them even closer to the destination of the commode.
Step 3. Ask or help them to “turn their back toward the commode” (they should not be facing it). This motion brings them even closer to the commode.
If you notice from the photos the subjects rear end is getting closer and closer to it’s destination.
Step 4. Now this is a very important part of the transfer and can be seen in the photo from step 3. Have them point their feet away from the commode as far as possible. By doing this one motion, you virtually eliminate the need to take any steps at all. This is important for people who have difficulty walking or have a lot of pain when weight bearing.
Step 5. Have them reach with their “near hand” across to the “far side” of the commode. This movement can also be seen in the photo from step 3.
Step 6. Have them lean forward and using their legs, “push forward” lifting their hips from the wheelchair.
Step 7. Once they are airborne ask them to “swing” their hips to the commode, pivoting on their toes. You know that you’re on the right track if they do not have to stand up all the way or take any steps.
Step 7. Once they are airborne ask them to “swing” their hips to the commode, pivoting on their toes. You know that you’re on the right track if they do not have to stand up all the way or take any steps.
Step 8. Have them place their rear end on the commode seat and adjust for comfort.
And that’s it. As you can see, each movement is a natural progression that builds on the previous step. Putting them in sequence like this lets you see each movement that needs to be made to get to and from a commode. With enough practice a person can do it fluidly. Even if they still need someone to assist, it’ll be a lot easier.
Getting off the commode and back to the wheelchair, bed, or recliner is simply performing the same steps going in the opposite direction.
Step 1. They should already be at a 90 degree angle to their chair. And is demonstrated in step 8 above.
Step 2. Scoot forward toward the front of the commode.
Step 3. Turn their back toward their destination. As seen in the above in step 2 of the return trip.
Step 4. Point their feet away from their destination. Also seen in step 2.
Step 5. Reach across to the far side of where they will be returning to sit.
Step 6. Lean forward, push forward and lift their hips from the commode. As seen above.
Step 7. Once airborne, swings hips back to the chair/bed, pivoting on their toes.
Step 8. Place their hips on the destination surface gently and adjust for comfort. And we’re back where we started.
Practice Makes Perfect
You may not be comfortable trying something new, especially if your care recipient has multiple limitations. But, what I frequently encourage the caregivers of my actual patients to is “put yourself in their shoes”. In this case, you the caregiver should practice these movements and positions yourself so that you have an understanding of how they feel and why they work. It will also give you a chance to “model” the technique in front of the care recipient. Let them see you doing it so they understand what’s expected and how it looks seeing someone else doing it.