++Government of South Australia: Department for Families and Communities ++Disability SA Information Sheet ++Bed: Comfort and Mobility We all spend at least third of our lives in bed, however, chronic illness, injury or disability can increase this amount of time considerably. With some thought and effort, a comfortable and supportive environment can be created to provide a more restful experience. ++Choosing a Mattress A standard bed consists of a mattress and a base. The base must be firm enough to provide good support for the mattress. The mattress must be firm enough to provide good support for the user, but also be soft enough to be comfortable when used at length. When choosing a mattress a number of features need to be considered; including the mattress comfort, stability, longevity, pressure management requirements and ease for transfers. Mattresses are available in a range of materials including foam, latex, innerspring, water filled or air filled. When trialling a mattress for purchase it is recommended to lie down in the normal sleeping position for at least 20 minutes. If the bed is for two people then it is important that both users try it together. It is important that the natural curves of the spine are maintained when lying on your back. When lying on your side, the spine should be straight. Pain can occur when the natural alignment of the muscles and joints of the spine are not maintained. A good bed is unlikely to cure pre-existing back problems, but one with good support can prevent problems from developing further. ++Getting in and out of bed Getting in and out of bed may be difficult if the edges of the mattress are too soft. Check that the mattress has firm side supports to ensure that it does not ‘dip down’ when a person is sitting on the edge. If the base is too soft, extra support can be added by placing wooden slats or a wooden board under the mattress. This also allows air to circulate. It is important that the bed is high enough or low enough to make it easy for the person to get in and out of bed. Other things to consider include: - Is the bed at a comfortable height for the person making the bed? - Does the height need to be adjustable for carers or wheelchair transfers? - If using a hoist to transfer, is there adequate clearance space under the bed for the legs of the hoist? - Is pressure care equipment required (as this will raise the height of the bed)? To raise the overall height of the bed, bed blocks can be placed under each leg. If multiple bed heights are required, then an electrically adjustable bed may need to be considered. Consider removing any extra pillows. They can make getting in and out of bed more difficult. ++Bed mobility Some people find it difficult to move around in bed. Consider trialling satin sheets—the slippery surface reduces the friction when moving. Tri-turn sheets feature three panels, the middle made from satin to assist with movement and the two outer panels made from cotton to provide grip. Slide sheets (often referred to as a 'slippery sam') can be used to reduce friction and enable carers to assist with bed mobility. Turn tubes are made from a slippery nylon which has been sewn over to form a tube and can be used to assist with transferring and sitting up in bed. Bed poles help a person roll over in bed, sit up and get in and out. The frame of the pole fits between the mattress and the bed base and is stabilised by the weight of the mattress. Bed poles are available in models which feature a pole/stick on each side of the bed to pull up on (a double bed pole) or a single bed pole with support on only one side of the mattress. The Lawson bed rail features a broad upside down U-shaped top providing two poles to hold onto and a rounded top for increased safety. Clamp on bed rails attach to the frame of a bed and also provide a pole for assisting in climbing in and out of bed. A bed ladder attaches under the foot end of the bed and allows a user to sit up from a lying position by pulling up on each rung of the ladder. Rungs can be grasped with the hand or an alternative grip can be used by sliding the whole forearm through the rung. A self-help or overhead pole (also know as a monkey pole or gooseneck pole) can be positioned at the head end of the bed and features a triangular handle (trapeze) which hangs above the users head and can be used to assist in sitting up or repositioning. A leg lifter can assist a user to lift their legs onto and out of a bed independently but relies on reasonably good arm strength. An electric inflatable leg lifter which attaches to the side of the bed is also available but can be expensive. ++Getting comfortable Head and neck comfort is important for relaxation. There are many different pillows available in different styles, shapes and choice of fillings. To assist in propping someone up in bed consider using a large wedge pillow or an adjustable angle back rest. Electrically operated mattress lifters are also available and feature an adjustable metal frame or inflatable cushion which lifts the head of the bed to the desired angle. The weight and prolonged pressure of bedding can sometimes be uncomfortable for those with injuries or increased sensitivity to feet or lower legs. A bed cradle is a box like frame which lifts the bedcovers up and away from the feet. Heel and leg protectors may assist in protecting fragile and sensitive skin. They are available in a range of materials including foam, gel, lambswool, air, fibre or fluid. Foot Elevators are designed to lift a heel and foot off the bed, reducing pressure and shear forces. Mattress overlays can be used on top of the mattress to provide extra comfort. They are available in a range of materials including air, fibre, feather, latex, foam, gel or a combination. If you are considering purchasing products to assist with preventing or treating pressure sores, it is important to first seek advice from a health professional. ++Recreation to pass the time Over-way tables provide a flat surface on which to carry out recreational activities while sitting up in bed. Some are available with split tops—one section can tilted to the appropriate working angle to assist with activities such as reading and writing. Book holders reduce the amount of muscle work required to hold a book when reading. There are many designs, including those which are free standing and those which need to sit on an over-way table or other flat surface. For those who need to lie flat on their back, prism glasses (which allow vision to be angled ) can assist with reading and viewing TV. Automatic page turners are useful for people who have reduced arm movement and strength—these can be hired or purchased. Good lighting is an important consideration, as is the ability to turn lighting on and off, and adjust its intensity. Remote control switches enable people to do this independently. ++Personal Care Wearing adapted clothing such as open back night gowns or shirts and pyjama pants with side openings can make personal care easier. If the person cannot rise from the bed, pre-moistened disposable wipes can be useful as a rinse free way of washing without water. Hair washing in bed can be made easier using a contoured, plastic hair wash tray, featuring a raised lip that rests under the user’s head and neck while an attendant pours water on their hair. A vinyl inflatable version is also available. A waterless rinse free shampoo treatment is another option. Varieties include a rinse free shampoo lotion which is applied to dry hair, lathered and towel dried, or a shampoo shower cap which is placed over the user’s head and gently massaged. ++Toileting Urinal bottles for men and women are available in spill-proof models and can be used while sitting on the edge of a bed. Bed Pans are also available and may be useful for those who cannot rise from the bed. Other useful items include waterproof mattress protectors or an absorbent bed pad (often referred to as a ‘Kylie’) which is available in both re-usable and disposable models of varying sizes and absorbencies. Waterproof covers are also available for quilts and pillows. For more information on the range of continence products available please refer to Disability SA’s information sheet Continence Products or make an appointment to meet with the Continence Resource Centre Nurse, located at the Independent Living Centre. ++Communication It is important that people who cannot rise from the bed are still able to contact carers or family members around the house. For short-term solutions, consider whether a pager, bell, whistle or walkie talkie might work. Another simple solution is to purchase a portable wireless door chime which features a push button held by the user and a portable chime which can be carried around by the carer. If it is a long-term situation, it may be worth considering installing an intercom system or purchasing a personal alarm/emergency call system which can contact external parties. For more information on these or other equipment ideas please contact the Independent Living Centre. The Independent Living Centre offers free advice on equipment and techniques to help you with everyday tasks. Independent Living Centre 11 Blacks Road Gilles Plains SA 5086 Telephone 1300 885 886 (SA & NT callers only) or (08) 8266 5260 Fax (08) 8266 5263 Email to ilcsa@dfc.sa.gov.au Website at www.disability.sa.gov.au Accessible off street parking is available. Bus routes: from the city T500/T501 or 207/208 to Stop 28 Sudholz Road Timetable information: (08) 8210 1000 ++Copies of this publication are available from the Disability Information Service Telephone 1300786117 Email to disabilityinfo@dfc.sa.gov.au Website at www.sa.gov.au/disability Revised August 2008