Before looking at any piece of equipment in detail, it is essential that you gather some basic information about your rehabilitation plans. This involves not only speaking to your doctor or surgeon, but also to your physiotherapist, occupational therapist, case manager and/or social worker. If you have not been provided with support therapists, you should ask your doctor to make a referral as these specialists are trained in reviewing equipment requirements, understanding your specific needs and advising on suitability and funding options.
You should ask your therapists what equipment you will require upon discharge or return to home. This does not only include the bed itself, and or mattress and pillows, but other equipment to be used on or near the bed. Some of this equipment will need to be attached to the bed, slide under the bed, or rest between the frame and the mattress. This will be crucial when selecting the bed and mattress – as all of your equipment needs to work together. Other equipment can also potentially limit the space you have for a bed and you will need to be aware of this when selecting a frame and fittings.
Understanding your expected care requirements is also important before contemplating the bed itself. This may seem irrelevant until you contemplate:
All of these questions will impact whether you need a height adjustable bed that will prevent your caregiver from suffering back problems of their own.
If you are mobilizing yourself you may require high side bars, but these will be impractical if you need a caregiver in the short term and the bars cannot be removed.
Length of rehabilitation
How long are you expected to take to recover? What are the phases of this rehabilitation? These questions will help determine whether you should purchase or hire equipment. You will need to decide whether it is worthwhile investing in top of the range support for a long term condition, or whether you can make do with less expensive products, or hire alternatives until your condition stabilizes.
While this topic will be considered later in this guide, it will be important to have an idea of what funding for equipment is likely to be available to you.
The differences in costs can be significant, and understanding your total budget will assist in determining what equipment is a priority.
Are you likely to be immobile for an extended period? Are pressure sores a concern, or other circulation issues? Are there specific requirements to avoid these, or support your rehabilitation? Are there specific instructions for spinal care, bowel and/or bladder support, mobility and comfort that need to be considered when selecting a bed and accessories?
Choosing a bed
If you are going to spend an extended period in bed you may want to consider a bed that provides for adjustable posture. This will make it more comfortable for you to sit in the bed, and may make sleeping more comfortable. Adjustable posture can also be helpful for avoiding pressure sores as you are able to adjust to different positions without placing further pressure on your spine or other injured area.
You should ensure you discuss these options with your therapist to ensure you are making an informed decision about the best supports for your particular condition.
These devices can be used on a standard bed and are fitted to the frame to provide sections that can incline at the top or bottom of the bed. The mechanism itself is electrical and controlled by a separate handset.
Mattress inclinators allow you to save on the expense of an entirely new bed, but you will need to check whether they are compatible with your mattress, and whether the platform, frame and power mechanism are compatible with any other therapeutic devices you might require (such as bed poles, side bars and etc. More on these below).
The amount of noise made in moving the platforms can vary considerably. Make sure you have heard the unit incline and recline with the mattress on and with a person in the bed. If the noise is irritating the first time – imagine when your spouse changes position for the twentieth time! Of course noise is not always the prime consideration, and carergivers for the elderly can sometimes prefer to hear when their patient is adjusting the bed, so as to ensure they are able to provide assistance if necessary.
You will want to check whether the incline of a sitting user prevents the bedside table or therapeutic aids from being reached. As the incline will raise you forward, this will need to be taken into account when positioning furniture and aids.
Adjustable beds have a sectioned base that allows the bed to incline to a sitting position, to raise the legs, or both. It is important to discuss your bed selection with your occupational therapist as there may be some postures which are not advisable for your condition.
While manual style adjustment is a cheaper option, these can be difficult to manage for both yourself and your caregiver. An electric mechanism, preferably with a handset control is easier and ensures that changes can be made to posture at all times.
In cases where you need to move regularly and will not have a full time caregiver, this can be very important. It will be important to understand:
There are both domestic and hospital style frames available. Many patients prefer a domestic style, which looks like a regular bed, but there are good reasons to consider the hospital style frame:
Finally, quality of manufacture will be crucial if you need to adjust the frame regularly or will be spending a significant amount of time in the bed (especially in one position). Beds that no longer adjust easily, are noisy, jam or are not smooth in their movements can be the result.
Some beds have the option of separate adjustment for couples, allowing for different inclines on either side of the bed. Essentially this comprises two single beds slotted in together to adjust separately.
If the long term intention is that you will share your bed with your partner, but need bed rails or other supportive equipment in the interim, then a bed with separate adjustment could be a viable option. These beds often come apart and can be used separately as two singles. Then when the equipment is no longer required on both sides, the beds can be slotted back together.
Adjustable height beds
Adjustable height beds are helpful if you find it difficult to stand when getting out of the bed. Raising the height of the bed to allow the use to place their legs on the floor and then turn at waist height can assist. However this height may not be conducive to carergivers providing assistance, or may not be the best height for getting back into the bed. Adjustable height beds allow the bed to be raised and lowered to meet the varying requirements.
Adjustable height beds are also helpful when other furniture is to be used in bed – for example a free standing table from which to eat, drink or read.
Adjustable height beds can be powered manually or electrically. As with adjustable beds, manual adjustment may be cumbersome or physically demanding, and movement may not be as smooth as with electric adjustment.
Manual adjustment often requires the caregiver to adjust bed height as the control is outside of the bed (usually at the foot), which may hinder independence.
These come in two forms – beds that will allow a high level of incline to resemble a chair, and chairs that allow a high level of recline to resemble a bed. You can then move between sitting and laying without needing to transfer from one piece of furniture to another.
Consider the following:
Choosing a mattress
While the functionality of an adjustable bed can seem like the essential key to sleeping comfort, the mattress you place on top of it is not to be overlooked. Not all mattresses are suitable for use with mattress platforms or adjustable beds.
Specific conditions will demand you consider your mattress more carefully, especially if you are expected to be immobile for an extended period. While the softness of a memory foam or latex mattress may assist in avoiding pressure sores, a firmer mattress may be required if you have difficulty turning or moving in the bed. It will be important to test out the mattress not only sitting, but lying, turning and returning to a standing position to ensure it is the best option.
For those with continence problems, ensure you check the availability of waterproof mattress protectors. You will also want to feel these against the mattress to check they do not affect the firmness and comfort of the bed itself – and also that they are not noisy and do not cause friction when turning.
Hinged mattresses are most suitable for adjustable beds and mattress inclinators. Fibre or foam filled mattresses are also possible alternatives. Inner coil, pocket sprung or wire edged mattresses are unsuitable and can cause discomfort as the movement damages the mattress. If you have loss of sensation these can be particularly dangerous as you may not feel if skin is being pinched by the coils.
More than likely the bed you slept on as a child was an innerspring mattress. This type of mattress is the most common type of mattress sold and most of us have slept on a variety of them in our lives. Unlike the mattress in the hospital, which was likely foam of some variety, an innerspring mattress consists of wire coils covered by padding. The more coils the firmer the mattress, due to the reduction in space between the coils to create sagging.
As the padding on top of the coils ages, it thins. If you have slept on the same bed for years, and then taken a vacation, you know what how this feels. Suddenly you realize the bed is hard and you can feel the coils through the padding. Sometimes the solution is as simple as purchasing a new mattress.
For those who prefer an innerspring mattress, there are a number of varieties of coil type that will suit different types of sleeper. For more information on coils, see our article under “Mattress Types Guide”.
Memory foam mattresses
Created from a material designed by NASA scientists to cushion astronauts on take off, memory foam mattresses conform to your shape when you lay down, but then return to their original shape when you move. This allows shoulders and hips to sink into the foam, providing support for the areas in between, but also ensures that the shape of the mattress changes when you move on it.
Memory foam mattresses are available in varying levels of firmness and durability.
Be wary of very cheap alternatives in memory foam – as they may be correspondingly low in quality and age quickly into a hard, flat lump.
Latex mattresses are more elastic and pliable than the memory foam mattress and will feel more springy and resistant. This can be experienced as a faster “bounce back” when moving in the bed, and less likelihood of sinking into softer patches.
These may not be appropriate if you experience latex allergies – however it may still be worthwhile checking them out. As your body will not actually be touching the mattress – and therefore the latex – you may find there is no problem with allergies.
Therapeutic aids and other furniture
Whilst in hospital the occupational therapist may have recommended and/or provided any of a number of devices to assist you in sitting, turning or getting out of the bed.
Typically these can include:
Check what equipment is available once you leave the hospital before you go bed shopping – some attach items to the frame, and some slide under the bed. This will influence your choice of bed frame. Remember that the model used in the hospital may not be available for hire or purchase elsewhere or may be outdated.
Check the equipment requirements before committing to a bed frame. Does it need a particular size frame to attach to? Does have specifications for the headboard? Is there a requirement for space either side of the bed or between the bed and the floor?
Grab rails need to be positioned carefully in a bed with a motorized adjustment – to ensure cords and cables do not get caught, or trip you when you leave the bed.
Ensure you understand how much electrical equipment you are anticipating placing in a confined space – some equipment will generate heat, and take up space in the area between bed and wall, making movement difficult. You will need to be careful not to overload power outlets, so ensure you understand where equipment will need to be located to access an appropriate outlet. Free standing backrests will have specific requirements for headboards.
Also, ensure you try the equipment itself. Some examples of why this is important:
In the case of accident or injury, ensure your lawyer provides advice on your ability to receive compensation for appropriate bed and equipment, including mattress, for rehabilitation. Ensure you raise this early so that the items can be included in the care management plan. If you are going to require suitable bedding for a long time, ensure your lawyer is aware of this – now is not the time to be taking cheap alternatives. You are going to be sleeping on this bed for a long time!
Always speak to your occupational therapist prior to purchasing expensive equipment. In many cases an OT recommendation will be required if your health insurer is going to fund the equipment. The OT may also be able to discuss you requirements with your doctor if the insurer requires a doctor’s recommendation.
Occupational therapists can also advise on best value for money when comparing models – there may be twenty different functions in a motorized adjustable bed – but do you really need that many? If your health insurer will only fund a certain dollar value for appliances and rehabilitation aids, the OT can assist you in prioritizing these, or suggesting alternative avenues for funding. If some equipment is only required for a short time it may make more sense to hire this and save your insurance for the longer term needs.