Canadian Association of Occupational Therapists

Factors to consider when choosing electric beds

By Nicole O'Dowd
This article originally appeared in the March/April 2002 issue of Occupational Therapy Now magazine published by the Canadian Association of Occupational Therapists.

More people with disabilities are able to remain in their homes; this has led to an increase in the use of fully adjustable electric (hospital) beds. These beds have three different adjustments: bed height and angle of the head and foot. Electric beds assist not only people with disabilities, but also caregivers providing care in the person's home. Up until the 1990s, occupational therapists recommended fully adjustable, manually operated beds, those most frequently used in hospitals and at home. Unfortunately, these beds were inconvenient for the users who could not transfer or adjust the bed independently. As well, caregivers were more susceptible to injuries due to the strength needed to use the hand cranks.

Since the beginning of the 1990s, the work done by the Association pour la santé et la sécurité du travail, secteur affaires sociales brought about some changes regarding home care bed recommendations for people with disabilities (Proteau & De Serres, 2000; Villeneuve, 1990). In particular, Le Conseil consultatif sur les aides technologiques (1994) published criteria for electric bed allocation which remain valid today and on which we still base our interventions. Since October 1998, only fully adjustable electric beds have been recommended by the Quebec government program for domestic and daily living aids.

The recommendation of an electric bed is based on the person's level of independence, the type of care received in bed, the person's medical condition and the bed's technical specifications. In all cases, it is important to take into consideration the limitations associated with the person's medical diagnosis and their long-term prognosis, particularly in cases of degenerative diseases.

Choosing a bed to increase independence in life's occupations
A fully adjustable electric bed would be recommended to assist a person to:

• Transfer from one surface to another using the optimal bed height to save energy;
• Adopt a comfortable position and change positions more frequently. When lying, shifting one's position helps to minimize pressure points and reduce the development of bed sores (adjustment of head or foot angle);
• Move from a lying to a sitting position without assistance; and
• Use the functions of the bed to engage in meaningful occupations such as dressing, eating or reaching for certain objects.

Choosing a bed to assist the caregiver
A fully adjustable electric bed allows the caregiver to:

• Adjust the height of the bed to his or her optimal working level. Using a more comfortable and safe position when providing care reduces the strain caused by bending forward and the effort needed in providing care, while, at the same time, making certain tasks easier; and 
• Reduce the frequency of interventions by increasing the person's independence to change positions, as well as reduce the risk of injuries.

Choosing a bed due to certain medical conditions
A fully adjustable electric bed may be recommended if the medical condition of the client requires it; some examples include circulatory problems in the lower limbs, obesity, gastric reflux and respiratory problems. However, it's important to first identify the person's limitations in using a standard bed as the purchase of an electric bed may not be necessary when bed positioning devices such as wedges are sufficient.

Technical specifications to consider
When considering an electric bed, the occupational therapist, the person considering the bed and/or the caregiver should consider the following specifications:

Minimum and maximum heights
A person with limited mobility uses the variable height of the bed for transfers or when receiving care in bed. The occupational therapist should find a bed with height adjustments that best responds to the user's needs. For example, in the case of a person who can transfer in a standing position, select a bed featuring a very low height adjustment option. If the person uses a mechanical lift to perform bed transfers with or without assistance, the occupational therapist must verify that the lift can be raised high enough to clear the surface of the mattress when the bed is at its lowest position.

The standard width
Thirty-six inches (36") is adequate for most people who require a fully adjustable electric bed. Some suppliers offer a choice of widths (39", 48", 54", 60") to accommodate the special needs of people with mobility problems in bed. For example, some people with obesity or spasticity are unable to centre themselves on the bed by sliding or lifting, but they can turn themselves over by rolling. For these people, a wider bed may be more appropriate. As a double bed may be an obstacle for some caregivers when performing their duties, a 48" wide bed may be a useful compromise. An electric double bed of 54" or 60" may be suitable for people sharing their bed with a partner. Some couples prefer to double up two single beds, one electric and one standard, depending on the available bedroom space. Finally, before purchasing an electric bed, it is very important to determine whether or not a specialized mattress is required, since the majority of these mattresses are only available in 36" widths.

The bed length
Consider this in relation to the height of the user. Electric beds are usually available in lengths varying from 76" to 84", depending on the manufacturer. The length of a bed is a measurement of the length of the mattress support excluding the bed's headboard and footboard. The length of a bed must exceed the height of the person by several inches without surpassing 84".

The angle adjustment of the head of the bed
This can vary from one model to another. People who need to do activities in bed, such as having a meal, require a more vertical position. However, to reduce the risk of developing sores on the buttocks and around the coccyx it is not recommended that people remain in a semi-reclined or semi-seated position for extended periods of time.

The mattress support
This is made up of springs or a solid platform. The models containing springs are only appropriate for use with spring mattresses. Specialized mattresses that prevent bedsores require a solid platform. If the client already owns a hospital bed with a spring mattress support, it would be possible to install rigid panels if a future need for a specialized mattress was identified.

The remote control
Most electric beds come with a wired-in remote control. This particular style of remote control can easily be located in and around the bed. Some companies offer the option of a wireless remote control. The main factors to consider when choosing a remote control are the size and shape of the buttons as well as the amount of pressure required to activate them.

Other equipment
People requiring electric beds often make use of other equipment such as wheelchairs, bed tables, mechanical lifts, grab bars, trapeze bars, bed rails or bed positioning devices. The occupational therapist should ensure that this equipment is compatible with the recommended bed so that it doesn't interfere with the safety and independence of the person and/or caregiver.

Conclusion
The use of an electric bed at home can increase a person's independence and facilitate his or her care in bed. Occupational therapists who are recommending electric beds must consider the bed characteristics in terms of the occupational needs, capacities and disabilities of the person, along with technical specifications. If possible, a trial period would be an ideal arrangement to ensure a recommendation that would best satisfy the person's needs.

About the author

Nicole O'Dowd graduated from l'Université de Montréal in Occupational Therapy in 1970. She currently works at the Centre de réadaptation InterVal, and has been interested in assistive devices for the last 20 years. She has been a member of l'Équipe de consultation sur les aides techniques since its foundation in 1989. Tel. (819) 693-0041, ext. 27 or e-mail : nodowd@ssss.gouv.qc.ca.

References

Conseil consultatif sur les aides technologiques. (1994). Aides aux activités de la vie quotidienne, (Avis 23). Quebec, QC: Gouvernement du Québec.

Proteau, R. A. & De Serres, L. (2000). Des lits électriques à domicile. Objectif prévention, 23, 8-24.

Villeneuve, J. (1990). Des lits manuels ou 1440 tours de manivelle par jour. Objectif prévention, 13 (2), 13-19.

Acknowledgments
The author wishes to thank the members of the Équipe de consultation sur les aides techniques (ÉCAT) for their comments and invaluable collaboration in the development of this article.