How to Set Up a Hospital Bed at Home: Room, Power and Positioning

Step one: choose the room

The best room for a care bed is not always the one the patient used before. Think about:

• Distance to the toilet and bathroom. A room close to a toilet reduces trips and falls, and makes a commode or urinal routine easier; see bedside commode and urinal routines.
• Ground floor. For a person who may need to be moved in an emergency, a ground-floor room is safest. See ground floor vs upper floor living.
• Space for a carer to work. You need room around at least one, ideally both sides of the bed, and at the foot.
• Door width and route. The bed, the patient in it and equipment must be able to pass if the patient needs to be taken to hospital.
• Light and view. Natural light, a window view and a way to see family movement reduce loneliness. Avoid direct glare on the patient's face.
• Temperature and ventilation. A room that is comfortable in summer and winter, with a fan or cooler that does not blow straight on the patient; see keeping a bedridden parent cool in Indian summers.
• Noise and privacy. A quiet room helps sleep, but the patient should not be isolated. A room near the family living area allows the patient to hear and be heard.
• Closeness to the carer. The carer may need to sleep nearby; see night-time caregiving routines.
• Power sockets. Near the head of the bed for the bed, a mattress pump, a night light and a phone charger.

In a joint family home, agree the room with everybody and make the patient's wishes part of the decision; see setting up a care room in a joint family home.

Step two: clear and prepare the room

Before delivery:

• Remove loose rugs, low tables and unneeded furniture.
• Measure and clear the route from the front door.
• Clean the floor, and clean or wipe the walls near the bed.
• Check the ceiling fan, since a raised bed and an upright patient may be nearer to it than you think.
• Move electrical cables and sockets to avoid trailing leads.
• Decide where bedside items, commode, wheelchair and storage will go.
• Prepare the mattress, linen and pillows; see bed linen and fabrics for sensitive older skin.

Step three: position the bed

Head against a wall, or free-standing? Many hospital beds are placed with the head end against a wall to stop them moving. But leaving a small gap lets you reach behind for a power point or to clean. Keep the head end away from curtains and cables.

Side access. Place the bed with at least one long side clear by about 90 cm, ideally both. A carer needs room to stand and turn, to place a chair for transfers and to use a hoist or sliding sheet if needed. If there is a wall on one side, put the stronger side of the patient against open space, or the side from which the patient will get in and out, as advised by the therapist. See bed transfer techniques.

Foot end. Leave space at the foot for the carer and a walking aid. A foot-end clearance of at least 60 cm is useful.

Away from heat and draughts. Keep the bed away from direct sun through the window, heaters, air conditioner outlets and fans.

Window. Place the bed so the patient can see out, if they wish, but not directly under a window that may be left open in the rain.

Near the door but not in the line of traffic. The patient should be able to see who enters, but should not be disturbed by people passing.

Near the toilet. Keep a clear, lit path from bed to toilet, and place a night light.

Floor. Place the bed on a firm, level floor. Marble and tiles are slippery under castors, so use the brakes, and check wheel locks each time. If the floor slopes, place the bed on the level part.

For tight rooms, see fitting a care bed into a small Indian flat.

Step four: power and cables

Electric beds depend on a safe power supply.

• Socket. Use a properly earthed socket near the bed, not an extension lead run along the floor. If you must use an extension, use a good quality, heavy-duty one and secure it away from traffic.
• Cables. Route cables along the wall, behind furniture or in cable clips. A bed that moves up and down can pull or crush a cable. Leave slack and check that it does not catch the wheels.
• Water and fluids. Keep sockets and plugs away from spills, urine, and cleaning water.
• Pests. Check cables for chewing by rats; see pest, damp and mould at home.
• Power cuts. Know how to lower the bed and bring the backrest down manually, and keep the manual release or backup battery in good order; see hospital beds and power cuts.
• Other equipment. An air mattress pump, an oxygen concentrator or a suction machine may also need power. Do not overload one socket. See safe use of oxygen and electrical equipment.
• Handset. Hang the handset on the rail or bed frame so it cannot be dragged on the floor. Lock or remove it if a confused patient might use it.

Step five: mattress, rails and fittings

• Mattress. Fit the mattress designed for the bed, with the correct size. For pressure-prone patients, fit a pressure-relieving mattress and check the pump and settings; see air mattress for pressure sores and choosing an anti-bedsore mattress.
• Cover. A waterproof, breathable cover protects the mattress. Avoid plastic sheets directly on the skin.
• Linen. A smooth, wrinkle-free bottom sheet. Wrinkles cause pressure marks.
• Rails. Decide whether rails are right for this patient; see bed rails guide. If used, check they lock firmly, there are no gaps where limbs or heads could be trapped and that the mattress fits tightly against them.
• Overbed table. Place it so it can be moved aside quickly; see overbed table guide.
• Pillows and wedges. Keep a few for positioning; see positioning a bedridden parent.
• Footboard and headboard. Ensure they are fixed and removable in an emergency.
• Brakes. Apply all castor brakes, and test by pushing the bed.

Step six: bedside setup

Put the patient's essentials within reach of a person lying in the bed and a carer standing beside it:

• Water, a cup with a lid or straw, and a bell or phone.
• Tissues, spectacles, medicines list and a clock.
• A night light and a torch.
• A call method that works; see bedside essentials checklist.
• Waste bin, wipes, gloves and hand sanitiser for the carer.
• A chair for the carer or visitors.
• The commode, urinal or bed pan; see bedside commode and urinal routines.

Step seven: first-day safety check

Before the patient settles, walk through this list.

1. All castor brakes on, and the bed does not move when pushed. 2. The frame is level and there are no loose bolts or parts. 3. Backrest, knee break and height work through their range, up and down, with the patient out of the bed. 4. Handset works, with cables safe and not under the wheels. 5. Mattress fits and sits flat, with no gaps. 6. Rails (if used) are locked and gap-free. 7. The bed is at its lowest height with brakes on when the patient is left alone. 8. Manual release or crank is known and accessible. 9. The route to the door and the toilet is clear. 10. The light and fan are safe, and the room temperature is comfortable. 11. A carer has been shown how to adjust the bed and has tried it. 12. Emergency numbers are written down; see ambulance and emergency numbers in India.

Daily and weekly habits

• Lower the bed and apply brakes after every care task.
• Raise it to carer height only while attending to the patient.
• Check the skin and the position at every turn; see preventing bedsores at home.
• Keep the area under the bed clean and dry.
• Wipe the frame and rails weekly.
• Check bolts, brakes and cables monthly.
• Record any faults and ask the supplier to repair early.

When to ask a professional

A physiotherapist or occupational therapist can visit to place the bed, advise on transfers and equipment, and teach carers safe moving and positioning. A nurse can advise on mattress setting, skin care and positioning to protect the patient from sores, and for those with breathing or swallowing problems. The supplier should demonstrate the bed and provide service support. Call a doctor if the patient has breathing difficulty, skin redness that does not fade, new pain or a fall from the bed.