In short, safer transfers usually come from preparation rather than strength. Set the space up first, say what is about to happen, let the person do as much of the movement as they can, keep the load close and bend your knees rather than your back. First, though, ask for an in-person assessment by an occupational therapist or physiotherapist, because only they can say what is safe for this particular person.
This post is for family members, friends and carers supporting an adult after a stroke, brain injury or another neurological condition, and for the person themselves. It covers planned transfers: bed to chair, chair to wheelchair, on and off the toilet, and in and out of the car. The social care routes described here are the ones that apply in England; Wales, Scotland and Northern Ireland have their own systems.
Please read this part carefully. This is general information, not medical, clinical or moving and handling advice, and it is not a handling plan for any individual. Written guidance cannot replace hands-on training. Nobody can see your home or the person's balance through a screen, so treat everything below as background for a conversation with a qualified professional, not as instructions to follow today. Get an in-person assessment by a physiotherapist or occupational therapist before you change how you move someone. Hoists must only be used by people trained on that specific hoist and sling. Never attempt a transfer you are not confident with.
To be clear about who we are: Axon Neuro provides reablement support at home from rehabilitation support workers, and home assessments from an HCPC-registered occupational therapist. Our support workers are not therapists. We do not carry out moving and handling assessments or write handling plans, and nothing here replaces an in-person assessment by the physiotherapist or occupational therapist working with the person on their transfers.
Why does moving and handling need to be assessed in person?
Because the safe method depends on details only a trained pair of eyes can judge: how much weight the person takes through their legs, how their balance changes when they tire, and how much space there really is between bed and chair. Two people with the same diagnosis often need different approaches.
The Chartered Society of Physiotherapy's guidance on manual handling in physiotherapy (4th edition, 2014) is written for physiotherapy professionals rather than for families, and it says that potentially hazardous work must be assessed and the risks reduced so far as is reasonably practicable, and that staff should receive regular updates on manual handling from a competent person. Family carers helping a relative at home are generally outside those workplace rules, but the same principle holds: someone competent should look at the task before you do it. NHS guidance on how to move, lift and handle someone else says the most common injuries carers get are back injuries, that lifting someone incorrectly can also injure them or damage fragile skin, and that your council may run free training courses on safe handling and may provide free equipment such as hoists, stand aids, transfer boards or slide sheets.
In England, you can ask your council's adult social services team for a needs assessment, a duty set out in the Care Act 2014. The NHS says a needs assessment is free and anyone can ask for one, and that someone from the council, such as a social worker or an occupational therapist, will ask how you are managing everyday tasks. Occupational therapists in the UK are represented by the Royal College of Occupational Therapists. Wales, Scotland and Northern Ireland have separate systems, and in Northern Ireland assessments come through your Health and Social Care Trust rather than a council. Last verified 23 July 2026.
How do I prepare the space and the person first?
Many transfers are harder than they need to be because of the set-up rather than anything about the person. Clear the route before anyone talks about moving.
- Move rugs, footstools, pet bowls and trailing cables out of the way.
- Put the chair or wheelchair on the person's stronger side, close and slightly angled.
- Put the wheelchair brakes on, and swing the footplates clear or take them off.
- Check shoes are on and fastened. Bare feet and loose slippers slide.
- Raise or lower the bed if it adjusts, so hips sit a little higher than knees.
- Sort out the catheter bag, drip stand or oxygen tubing first. Ask the district nurse or the team who fitted them to show you how to move lines and tubes safely before you handle them yourself, because getting this wrong can cause injury.
Then prepare the person, and prepare with them rather than around them. Talk to them, not over them or about them, and leave the decisions about their own body with them. Say what will happen in short, plain sentences, one instruction at a time. After a stroke or brain injury, processing is often slower, and fatigue slows it further, so leave a gap and wait. Using the same words each time helps some people. If they say stop, stop.
What does a safer sit-to-stand transfer look like?
Only use a method a physiotherapist or occupational therapist has assessed and taught for this person. A sit-to-stand is only safe for someone who can already take weight through their legs, and whether that is true today is a clinical judgement, not something you can read off a page. The outline below is here so you know what to ask about, not so you can try it. If nobody has assessed this person's transfers yet, stop here and arrange that first.
The person does the standing. You guide and steady. Your job is to make their movement possible, not to lift.
- Bring them to the edge of the seat in small shuffles, one hip at a time.
- Place their feet flat on the floor, hip width apart, stronger foot slightly back under the knee.
- Ask them to lean forward from the hips so their weight comes over their feet. "Nose over toes" is an easy cue.
- Ask them to push down through the seat or chair arms rather than pulling on you.
- Count together out loud so you move on the same beat: "ready, steady, stand".
- Stay close, feet apart for a stable base, and bend your knees, not your back.
- Pause once they are up, so blood pressure and balance can settle.
- Turn with small steps, together. Never twist at the waist.
If they feel dizzy, faint, sick or suddenly weak at any point, sit them back down straight away and stop. Mention it to the GP or therapist, as it can point to something that needs looking at, such as blood pressure or medication.
What should I never do during a transfer?
Some habits look helpful and are not. They cause shoulder injuries, skin damage and falls.
- Never pull on the affected arm. A shoulder after a stroke can be unstable and easily damaged.
- Never lift under the armpits, and never use the old "drag lift".
- Never let someone hold around your neck.
- Never lift someone from the floor by hand.
- Do not twist or stretch across a bed. Move your feet instead.
- Do not carry on just because you have started. Sitting back down is always allowed.
What equipment makes transfers safer at home?
The right equipment often does more for safety than technique alone. Every item below needs to be assessed, chosen and fitted for this person by an occupational therapist or physiotherapist, and you need to be shown how to use it before you use it. Buying online on a guess is how people get hurt: the wrong sling, or a grab rail on a wall that cannot take the load, is worse than nothing.
- Transfer board: bridges the gap between bed and wheelchair for someone who cannot stand.
- Turntable or transfer disc: lets someone who can stand pivot without twisting their knees.
- Bed lever or bed rail: something firm to pull up on when moving to sitting. These are not a DIY item. MHRA guidance on bed rails warns that rails, beds and mattresses that do not match can leave gaps a person becomes trapped in, which has caused serious injury and deaths, so the whole set-up needs assessing together.
- Grab rail: fitted in the right place, on a wall that can take the load.
- Slide sheets: reduce the effort of moving someone up the bed or turning them.
- Handling belt: a padded belt with grips, so you hold the belt and not the person's arm.
- Hoist: for anyone who cannot take weight safely. Only ever used by people trained on that specific hoist and that specific sling, following a written plan, and often only by two people. Slings are not interchangeable between hoists or between people.
Our post on adapting the home and everyday equipment covers the wider changes that make daily life easier.
What should I do if someone falls?
Do not lift them, however tempting it is. NHS guidance on falls says to call 999 if the person may have injured their head, back, neck or hip, or if they cannot get up, and that you should keep them comfortable and warm and carefully help them up only if they can help themselves. Otherwise stay calm and take a couple of minutes to check for pain or injury.
If they hit their head, get medical advice the same day even if they seem fine. NHS guidance on head injury and concussion says to call 999 for signs such as being knocked out, a fit, new weakness or numbness, problems with speech, balance or vision, or fluid or bleeding from the ears, and to get urgent advice from NHS 111 if the person takes blood-thinning medicine or has a condition that thins the blood.
If they are not hurt and can move themselves, let them get up in stages at their own pace, resting on something solid and fixed such as a sturdy low step or the floor itself rather than furniture that can slide or tip. If you are not sure, or they cannot do it themselves, do not move them: keep them warm, keep talking to them, and call for help. Tell the GP afterwards, even if the person seems fine, and ask for a falls assessment, because a fall is often a sign that something else needs reviewing.
Frequently asked questions
Can I learn moving and handling from a video?
No. Videos help you recognise good practice, but they cannot judge your home, your back or the person's balance, and following one without an assessment can injure you both. Ask the council or hospital team about a practical, hands-on course. The NHS says councils may run these free of charge, though what is available varies by area.
Who can assess transfers in our home?
Usually an occupational therapist or physiotherapist, through a council needs assessment, a hospital discharge team, a community neuro-rehabilitation team or a private provider. Ask for the plan in writing so everyone follows the same method.
Is it ever safe to use a hoist on my own?
Only if you are trained on that hoist and sling and the written plan allows single-handed use. Many hoist transfers need two people. If in doubt, do not.
What if my own back already hurts?
Say so, early, and see your GP about it. Carrying on through pain can make your own injury worse and can leave you unable to help at all. In England you can also ask the council for a carer's assessment in your own right under the Care Act 2014, alongside the assessment for the person you care for. Our post on carer wellbeing covers this in more detail.
How do we manage getting into a car?
Ask the therapist to look at this specifically, because cars vary and a method that works in one car can be unsafe in another. Broadly, it means parking on flat ground with room to open the door fully, pushing the seat back and reclining it slightly, sitting down first with the feet outside, then bringing the legs round together. A turntable on the seat suits some people and not others. Never let anyone stand on a door sill or pull on the door to steady themselves.
Some people are able to take on more of the movement themselves over time, and for others the picture stays the same or changes in other directions. It varies a great deal and nobody can predict it from a blog post. Agree any change to the method with the therapist rather than trying it on a good day.
If you would like to understand how reablement support can work alongside a therapist's handling plan once one is in place, you are welcome to get in touch. We cannot assess transfers or advise on handling technique, and we would point you to the council or the therapy team for that. No pressure, just a conversation.