Changing Bed Linen With Someone Still in the Bed

When to change linen

• When it is soiled or wet, at once, to protect the skin.
• Daily for a person with incontinence, sweating or wounds, and more often if needed.
• At least once a week, for a person who is clean and dry, and more often in hot weather.
• Whenever creased, damp or crumb-filled, since wrinkles and crumbs cause pressure marks.
• After infection or illness, with hotter washing.

A full change need not be done at one time. Often only the draw sheet or underpad is changed, since it takes the soiling, which is quicker. See changing and managing incontinence in bed and washable underpads care.

Prepare before you start

A good start saves time and stress.

1. Gather everything: clean bottom sheet (fitted if possible), draw sheet or underpad, top sheet or blanket, pillowcases, a clean gown or nightclothes, towel, gloves, a laundry bag or bucket, wipes and barrier cream if used. 2. Explain to your parent what you will do, and ask for help as appropriate, such as holding the side rail or the pillow. Even a person with dementia is reassured by a calm voice. 3. Wash your hands and put on gloves if there is soiling; see infection control for home caregivers. 4. Close doors, curtains and windows for privacy and warmth. Make sure the room is comfortable, not draughty, with a fan off or turned away. 5. Raise the bed to waist height if adjustable, and lock the brakes; lower the head of the bed to flat or the lowest comfortable level, as tolerated, since rolling is easier. If the person must stay sitting up for breathing, discuss with the nurse. 6. Remove the overbed table and anything on the bed. 7. Lower the rail on your side if rails are used, and have a helper on the other side if available. If the person can be left on the bed with a rail raised, keep it up on the far side. See bed rails guide. 8. Cover the person with a light sheet or towel as you remove the top bedding, to keep them warm and modest. 9. Position yourself. Stand close to the bed, feet apart, knees slightly bent, back straight. See how to lift and transfer safely.

The method: rolling the person side to side

This method assumes the person can be rolled onto one side. If rolling is painful or forbidden, such as after some surgeries or with some fractures, ask the nurse or physiotherapist before you begin.

Step 1: loosen and roll. - Loosen the bottom sheet and draw sheet all round. - Remove the pillow or move it aside, keeping one under the head. - Have your parent bend the knees if they can, and cross the far arm over the chest. Place the nearer arm out of the way, with the hand free. - Place one hand on the far shoulder and the other on the far hip, and roll the person gently toward you onto their side, or ask a helper on the other side to roll them away from you. A person on their side should be facing the carer, with a pillow behind the back for support, if safe. - Check the skin on the back, tailbone and hips while the person is on their side.

Step 2: roll up the old sheet. - Roll the soiled bottom sheet and draw sheet toward the middle of the bed, tucking them against the person's back, as flat as possible. - Wipe and dry the mattress with a cloth if needed, check the mattress and cover; see mattress protector guide.

Step 3: lay the clean sheet. - Fold the clean bottom sheet in half lengthwise, lay it with the fold along the middle of the bed and tuck the half nearest you under the mattress, tight and smooth at the head, foot and side; make a mitred corner if you wish. - Roll the other half of the clean sheet into a long fold and tuck it close against the old sheet, behind the person's back. - If using a draw sheet or underpad, fold and place it in the same way, across the middle of the bed so that it covers from shoulders to knees.

Step 4: roll back over the lump. - Roll the person gently back over the folded sheets towards the clean side, toward you, or over the lump. A person can usually roll over the bundle easily. - Move to the other side of the bed.

Step 5: remove the old linen. - Pull the old sheet and draw sheet out from under the person and put them straight into the laundry bag, rolled with the soiled side inside. Do not shake them in the room. - Wipe any soiling with a cloth.

Step 6: pull through the clean sheet. - Pull the clean sheet through from under the person, smooth out all wrinkles and tuck it under the mattress on this side, tight at the head, foot and side. - Pull the draw sheet through and tuck it in as well. - Roll the person onto their back, or the position advised.

Step 7: top sheet and pillows. - Replace the top sheet or cover. Slip the old one out while the new one is in place. Make sure it does not press on the toes: leave a loose fold or "toe pleat" at the foot of the bed so toes and heels are not squeezed. - Change the pillowcases by holding the pillow under your chin or with a hand, and changing the cover while supporting the person's head. - Replace the pillows to the position the person finds comfortable; see positioning a bedridden parent.

Step 8: finish. - Check that the person is comfortable and safe, with the call device, water and tissues within reach. - Return the bed to the lowest height with brakes on, and raise the rail only if one is in use and judged safe. - Dispose of gloves, wash your hands and record anything unusual, such as skin redness; see care diary and handover notes.

Keeping skin safe during the change

• Lift, do not drag. Dragging causes friction and tears fragile skin; see turning a bedridden patient.
• Check skin on the back, hips, tailbone and heels whenever the person is on their side; see preventing bedsores at home.
• Smooth wrinkles. A wrinkled sheet under the person leaves marks and sores within hours.
• Wash and dry skin if soiled, using wipes or a cloth, and apply barrier cream if advised; see wipes and perineal hygiene and barrier cream and skin care.
• Use soft, breathable fabrics such as cotton; see bed linen and fabrics for sensitive older skin.
• Avoid plastic sheets directly under the skin. Use breathable underpads.
• Keep fingernails short, yours and theirs.
• Take care with tubes, lines, catheter bags and drains: keep them from pulling, and place bags below the bladder level. Ask a nurse to show you.
• Keep the pressure-relieving mattress working. Do not unplug the pump for long; see air mattresses for pressure sores.

Tips for special situations

• Person with dementia or agitation. Explain gently, do one step at a time, play familiar music and stop if distressed. Ask a second person to hold hands and reassure. Do not force.
• Painful joints, fractures or surgery. Get advice on safe rolling. A slide sheet or a team of two may be needed.
• Heavy person. Use two people, a slide sheet or a draw sheet to move, and avoid heavy lifting; consider asking a trained attendant to help.
• Breathless person. Keep the head raised and work quickly, resting often. Change one half, then rest.
• Catheter or drip. Move the bag first, and keep tubes free.
• Wet or soiled by diarrhoea. Wear gloves and apron, clean the person first, then replace linen. Wash soiled linen separately in hot water; see disposal, laundry and odour control.
• Fitted sheets. A fitted bottom sheet is easier than a flat one. Many hospital beds need special sizes.
• Hot weather. Use light cotton sheets, and keep the person cool; see keeping a bedridden parent cool in Indian summers.
• Power cuts. A torch and a plan to avoid changing in the dark.

Looking after your own back

Bed changes are a common source of back injury for carers.

• Raise the bed to waist height and lock it.
• Keep your back straight, bend your knees, keep the person close.
• Do not twist; move your feet.
• Use a slide sheet and a helper when you can.
• Take rests, and do not rush.
• See how to lift and transfer safely and caregiver burnout signs and prevention.

When to ask a professional

A nurse or physiotherapist can demonstrate the technique at the bedside, and advise on safe positions for your parent's condition. A doctor or nurse should check any skin redness, break, blister or wound. An occupational therapist can recommend slide sheets and aids. Hire a trained attendant if you cannot manage safely; see hiring a home attendant checklist. Seek urgent help if the person becomes breathless, pale, faint or distressed, or if rolling causes severe pain.