Hospital Beds at Home: Manual, Semi-Electric and Electric

What a hospital bed does that an ordinary bed does not

A good care bed offers four things.

• Adjustable backrest. Raising the head end lets a person sit up to eat, take medicines, breathe more easily or watch television. Sitting up in bed with pillows slips and slumps; a mechanical backrest holds the position. See backrests for sitting up in bed.
• Adjustable knee break. Raising the knees stops a person sliding down the bed, which causes friction and shearing of the skin.
• Adjustable height. A bed that lowers helps a person stand up and sit down safely, and one that raises saves a carer's back during washing and dressing. See bed height and getting out of bed.
• Rails and fittings. Attachment points for side rails, drip stands, overbed tables and sometimes a trapeze handle.

A hospital bed is also built to take a medical mattress, and a mattress with a pressure-relieving function; see air mattress for pressure sores.

The three main types

Manual bed. The backrest and knee break are raised by hand cranks at the foot end. Height is fixed or adjusted by crank in some models. Manual beds need no electricity, are the cheapest to buy or rent and have few parts that can fail. But someone has to crank, usually the carer, and cranking is slow and tiring. The patient cannot change position alone. A manual bed suits a person who rarely needs to change position, a short-term need, a home with unreliable power or a carer who is able to crank several times a day.

Semi-electric bed. Motors raise the backrest and knee break at the push of a handset, while the height is changed by a hand crank or is fixed. It is a common compromise. The patient may be able to adjust the back and knees alone, which brings independence and reduces carer effort. Height adjustment by crank is a chore, though, and for a patient who needs frequent height changes a fully electric bed is better.

Fully electric bed. Three motors adjust the backrest, knee break and height. Some also tilt the whole bed head down or feet down. A patient with good hand function can control the bed, and a carer can bring it to working height in seconds. Fully electric beds are heavier, cost more to buy or rent and depend on mains power or a battery backup. See hospital beds and power cuts for planning in cities with load-shedding.

Other types. Low-height or "floor" beds that lower almost to the ground suit people at risk of falling out; see bed choices for dementia. Bariatric beds are wider, stronger beds for heavier people. Profiling beds may have special sections for pressure care.

How to choose: start with the patient

Ask these questions with the doctor or physiotherapist.

1. How long will the bed be needed? A few weeks after surgery, months, or the rest of life? See renting or buying a hospital bed. 2. How much time is spent in bed? A person who is in bed day and night needs more positions and better pressure care than one who rests in the afternoon. 3. Can the patient move or turn alone? If not, you need a bed that helps a carer turn them safely, and a pressure-relieving mattress; see preventing bedsores at home. 4. Can the patient use a handset? Weak or tremulous hands, confusion or poor eyesight may make a handset unsafe or useless. Controls may need to be locked out. 5. What is the patient's weight and height? Check the safe working load and the mattress platform length. 6. Does the patient need to sit up for breathing, eating or swallowing? Then a reliable backrest is essential. 7. Is the patient at risk of falling out or climbing out? Then low beds and sensors may be better than rails; see bed rails guide. 8. Does the patient have dementia, confusion or restlessness? See bed safety for restless sleepers.

Then think about the carer

A bed that the carer cannot use properly is no bed at all.

• Working height. Look for a bed that raises to about waist height of the carer, which spares the back. Beds that cannot rise force bending for washing, dressing and changing linen.
• Cranks and controls. Cranks should be within easy reach, fold away so they do not trip anyone, and turn smoothly. Handsets need large buttons and a lock.
• Wheels and brakes. Castors with locks make cleaning and moving easier. Check that the brakes hold firmly and are easy to apply.
• Access from both sides. Where possible, leave room on both sides for a carer to work. See small room bed layouts.
• Cleaning. A bed frame with smooth, wipe-clean surfaces and few crevices is hygienic. Removable head and foot boards help.
• Training. Ask the supplier to demonstrate every function and let your carer try.

Measurements and fit

• Overall size. Many beds are about 90 cm wide and 200 to 210 cm long, and need extra space for rails and the head and foot boards. Measure the room, the door, the lift and the stairs.
• Delivery route. Many beds arrive in sections that must pass through a narrow Indian door and turn corners. Ask the supplier if the bed can be disassembled; see equipment delivery, installation and aftercare.
• Weight limit. Safe working load typically includes the patient, the mattress and any equipment. Choose a margin above the patient's weight.
• Mattress size. Mattresses made for ordinary beds may not fit the platform or may slip. Use a mattress made for the bed.
• Height range. Check the lowest and highest height of the sleeping surface. For a person who gets out alone, the lowest height should let their feet touch the floor.
• Platform type. Slatted or perforated platforms ventilate the mattress, which matters in humid cities.

Features worth having

• Side rails that are firmly fixed, and have safe spacing; see bed rails guide. Not everyone should use rails.
• Head and foot boards that can be removed to reach the patient in an emergency such as resuscitation.
• Trendelenburg and reverse Trendelenburg tilt, on some beds; useful only when a doctor advises.
• Manual override or battery backup for electric beds.
• A lockable handset, so a confused patient cannot move the bed unsafely.
• Under-bed clearance for equipment, though clearance for a hoist is rarely needed at home.
• Extra points for an overbed table or drip stand; see overbed table guide.

Features to be careful about

• Very light, thin-tube frames, which may flex or loosen.
• Rails with large gaps, where an arm, leg or head could be trapped.
• Beds sold without a safe working load.
• Motors with no overload protection.
• Exposed cables that people may trip over, or that can be chewed by pests.
• Poor welds and sharp edges.
• Spare parts unavailable. Check that the seller can supply handsets, motors and mattresses later; see equipment returns, warranty and servicing.
• Missing documentation. A reputable supplier provides a manual and a safety check. See medical device licences and safe buying and spotting fake or poor quality care products.

Putting it all together

For a bed-bound person who needs frequent repositioning and sitting up, a fully electric bed with a pressure-relieving mattress is usually the most practical, if power is dependable or backed up. For a person who rests in bed during the day but moves about, a semi-electric or even manual bed may be enough. For a person at risk of falls from bed, a low-height bed with a mat on the floor may suit better than rails. Tell the supplier what the patient can and cannot do, and do not be shy about asking to see the bed working before delivery.

After the bed arrives, learn how to arrange the room and position the patient; see setting up a hospital bed at home and positioning a bedridden parent.

When to ask a professional

Ask a doctor, physiotherapist or occupational therapist to advise on bed type, mattress and positioning before you buy. They can assess how your parent moves, the risk of pressure sores and falls, and what position is safe for breathing and swallowing. A nurse can show carers how to use the bed, turn the patient and check the skin. If your parent has dementia, breathlessness, a swallowing problem or very frail skin, professional advice matters even more.