I think that very large people require lifting and turning aids, many of which are built right into most bariatric air beds like "turn assist" and "max inflate" It really helps if the patient is able to participate by using a trapeze. I've used a tool called a chairlift, I think, before which is useful for transferring a patient to and from chair to bed. This was a long time ago and again, the patient had to be able to participate.