Single-Handed Care (SHC) is not simply about reducing the number of carers; it’s about ensuring care is safe, proportionate, and person-centred. To do that, clinicians need a clear and structured way to assess whether one carer, supported by the right equipment and environment, can safely complete a task.
This article explores a practical, evidence-based approach for assessing SHC suitability using TILE, PEO, a Risk Matrix, and Outcome Measures frameworks.
Step 1: Start with the TILE Framework
The TILE model (Task, Individual, Load, Environment) is mostly used in the UK, whereas the PEO model is used more in Australia. It can however still be used to provide a systematic starting point for SHC assessments:
| Element | Key Considerations | Example |
|---|---|---|
| Task | What specific actions are required (e.g., rolling, applying a sling, standing transfer)? | Hoisting from bed to commode. Sling application to be done in bed. Client needs to be rolled on their side to get the sling underneath them. |
| Individual | What are the capabilities and limitations of the carer doing the manual handling task. | Are they confident and trained to apply a sling and operate a hoist and to assist as a single-handed carer. |
| Load | How much assistance or stabilization does the person require? What are the client’s physical, cognitive, and emotional abilities? | Partial weight bearing vs no weight bearing. Can they assist using a rope ladder or push through elbows? |
| Environment | What environmental factors impact safety and access? | Space, floor type, bed height, plug access for equipment. Is there space for a floor hoist or leg posts of a gantry or do they need a ceiling hoist. |
In SHC, TILE helps identify what risks can be engineered out and what still needs human handling.
Step 2: Apply the PEO Model
The Person–Environment–Occupation (PEO) model adds a clinical reasoning layer, ideal for OTs:
- Person: What can the client safely contribute to the transfer? (E.g., can they press the handset or use a rope ladder?). What are their strengths and limitations? Are there behaviours or cognitive limitations that can make the transfer more difficult for a single carer to do?
- Environment: Can the space, equipment, or surfaces be adapted to reduce handling strain? (E.g., use a profiling bed, gantry, or slide sheet system.)
- Occupation: What type of the transfer will be done (e.g., bed to chair to floor to bed transfer). This is similar to the Task component in TILE.
Law M, Cooper B, Strong S, et al. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Can J Occupat Ther 1996;63(1):9–23.
Step 3: Use a Risk Assessment with a Risk Matrix
Every SHC plan must be underpinned by a documented risk assessment. Use a risk matrix to evaluate likelihood and severity of injury for both the client and the carer. Use the TILE or PEO in combination with the Risk Assessment Matrix. For example, evaluate risks related to the client, carer, environment, and risks within the task itself.
Example:
| Risk | Probability | Consequence | Risk Rating | Control Strategy |
|---|---|---|---|---|
| Carer overexertion when positioning sling | Possible (2) | Moderate (4) | Medium (5) | Use in-situ sling or slide sheet with handles |
| Client instability during roll | Very Likely (4) | Severe (5) | High (8) | Use tilt bed, two-way glide system |
| Equipment failure (battery/hoist) | Rare (2) | Major (6) | Medium (7) | Regular maintenance, pre-use checks |
Goal: Reduce all risks to “as low as reasonably practicable” through equipment, environment, or training, not automatically through extra carers.
Step 4: Identify Each Handler’s Role
Before reducing staff numbers, map out what each handler does. Then ask two key SHC questions:
- Can Handler 2’s tasks be absorbed safely by Handler 1 with correct setup and technique?
- If not, can those tasks be mechanised (through equipment or automation)?
This approach ensures care reduction is risk-led, not resource-led.
| Handler | Role | Can It Be Eliminated / Mechanised / Absorbed? |
|---|---|---|
| Handler 1 | Adjusts bed, applies sling, operates hoist | Primary carer – essential. But can the client perhaps operate handset of the bed to adjust it themselves? |
| Handler 2 | Steadies client to prevent client making contact with hoist mast/actuator, supports leg, applies sling under body | Can be replaced by mechanical aid (e.g., gantry, slide sheet, in-situ sling, rope ladder). Can the technique Handler 1 uses to move the hoist be improved to reduce risk of client’s legs swinging into the hoist (e.g., position at angle instead of head-on and bring chair close to bed to reduce having to move hoist as much)? |
Step 5: Mechanise Wherever Possible
Consider what equipment can replace the physical actions of a second handler:
- Ceiling or portable gantry hoist – eliminates pushing/pulling/manoeuvring of hoist in room and risk of contact with hoist mast/actuator.
- Profiling or turning bed – reduces rolling strain.
- In-situ sling – removes repetitive sling application.
- Slide sheets / low-friction fabrics / wedges – enable one-person repositioning.
- Rope ladder or overhead self-help pole – allows partial client participation.
The aim: replace physical labour with engineered control.
Step 6: Measure and Review Outcomes
To ensure SHC is effective and sustainable, use measurable outcomes that track safety and performance over time.
Recommended outcome measures:
- Borg Perceived Exertion Scale – rate the physical effort experienced by the carer.
- The REBA (Rapid Entire Body Assessment) tool objectively measures body posture risk during handling tasks.
- Client Comfort Scale / Verbal Feedback – measure perceived safety, dignity, and comfort.
- Task Duration – track if transfers remain efficient after implementation.
- Incident or Near-Miss Reports – ongoing risk review.
-
Functional Independence Measure (FIM) – to monitor participation or independence gains.
Check out our articles to know more more about FIM Score
Click here: FIM Score Explained
Click here: Enable's Mobility Stages (FIM)
The goal isn’t just to prove SHC can work; it’s to demonstrate that it does work safely and sustainably.
Step 7: Document and Reassess
- Record initial risk level, control measures, and staff training provided.
- Include equipment setup photos or diagrams for consistency.
- Reassess regularly, especially if the client’s health, cognition, or environment changes.
Documented SHC trials are a powerful way to demonstrate compliance with WHS and duty-of-care requirements.
Final Thoughts
Assessing a client’s suitability for single-handed care is about clinical reasoning, not cost reduction.
By combining TILE, PEO, structured risk matrices, and outcome measures, therapists can deliver care that is:
- Safe for both client and carer,
- Supported by evidence and regulation, and
- Grounded in independence, dignity, and efficiency.
In short, single-handed care isn’t about doing more with less. It’s about being person-centred, risk-based and achieving the same or greater safety & dignity through a holistic risk assessment, appropriate equipment & thorough training.
