Some client conditions result in a decreased ability to perform activities of daily living including one’s ability to be mobile. Some clients may require assistance to move around in bed, or to transfer from bed to wheelchair or bed to stretcher. Others may need assistance to ambulate. Changing client positions in bed and mobilization are also  vital to prevent contractures from immobility, maintain muscle strength, prevent pressure injury, and to help body systems function properly for optimal health and healing (Perry et al., 2018). The level of assistance each client will require depends on the client’s previous health status, age, type of illness, and length of stay (Perry et al., 2018).

Levels of Assistance

Commonly in acute and long-term care settings, clients are assessed and assigned with a “level of assistance” designation. The level of assistance required is based on the client’s ability to transfer, stand, and cooperate in care activities. Terms to describe different levels of assistance are one way for health care providers to communicate with each other how much and what kind of assistance is required.

The terms may differ from one institution to the next and as such it is the healthcare provider’s responsibility is to know the correct terms in the institutions they are working in (South Island Alliance, n.d.). The level of assistance needed is somewhat subjective can change over time. Thus, the need for constant reassessment and communication by and among the healthcare team (South Island Alliance, n.d.).

The level of assistance should be documented where healthcare providers can easily access the information. This might include the client’s care plan, above the head of the bed, and/or in the client’s chart. Table 8.2 describes general levels of assistance and the terminology sometimes used in hospital and community settings to describe them.

Table 8.2 General Levels of Assistance

Data sources: South Island Alliance, n.d.; Winnipeg Regional Health Authority (WRHA), 2008; Worksafe BC, 2006

Special considerations:

• The weight, height, and general physical, mental, or emotional condition of the client all influence the potential for injury to the client and healthcare worker.
• If the client is uncooperative or unable to follow commands, there is an increased risk for injury. In these cases, a mechanical lift or assistive device should be used to prevent injury to the healthcare provider and/or client.
• Any client-handling injuries must be reported using the reporting system of the facility. In British Columbia,  the British Columbia Client Safety and Learning System (BCPSLS) is used. The BCPSLS is a web-based tool used to report and learn about safety events, near misses, and hazards in healthcare settings (BCPSLS Central, 2015). Be sure to follow the agency’s policies and procedures for reporting such injuries.