Hi All. I've been working with a lady with Alzheimers who still sleeps in a double bed (alone) which is up against the wall and there is limited space. She has 2 carers who help with all transfers. She is still able to follow some direction but takes some time to process the requests. Getting into bed is fine, the issue is the morning. She turns 90 degrees and ends up horizontal in the bed overnight (head towards the wall and the feet by the edge of the bed where she get outs). Carers are struggling to get her to turn on the morning as she takes a long time to wake up. She also removes her pad overnight. Carers are now moving her doing gradual increments, which concerns me because of friction. Slide sheets are difficult to fit due to the overreaching and soiling. I'm concerned about wendy-letts as she is obviously 'active' overnight. And she has fallen from a profiling bed previously and family have said that they do not wish for her to be in one.
I have also consdered Phil-e-slide but again possible that she'd slip out of bed (more slippy than a wendy-lett) and the Etac but concerned that she may move over the 'brake' and again slip.
I feel that i'm at a bit of a loss of any other ideas. Anyone out there have any ideas?
The 2 suggestions i have had so far are phil-e-slide making sure carers are always tucking it in on leaving! and Profling bed, set low to the floor overnight with an etac.
I agree that sleeping arrangements need to be reviewed. I think that fitting and removing any type of slide sheet with single sided care will result in an excessive amount of bending and reaching for carers - has a risk assessment been done regarding this? Carers would probably be within their right to decline to carry out bed transfers, due the risk and this is often where moving & handling regulations can clash with family/client wishes.
Double beds aren't great for moving & handling - their fixed height and the excessive amount of reach/bending/poor posture required, to provide personal care and assist with transfers would normally indicate a different type of bed to lower risk as far as is reasonably practicable.
If falling out of bed is the main concern of the family, then you could assess with the Accora Floorbed, with a cot side and breathable bumper on the wall side to prevent entrapment.
Hi @sharon. We've seen you've had a wide range of advice in our Facebook group Occupational Therapy Community, which is great to see! A few additional comments from when we posted about this on our main Facebook page: "If falling from bed is an issue, the Harvest Woburn ultra low is good. But just have to be aware of entrapment risk between bed and wall."
"Would she tolerate a sleep system to prevent her from turning 90 degrees?"
Hi Sharon, the first thing I would do (which may have already be done) is check if the patient has capacity to make that decision in regards to safety, care needs and maybe even changing the bed.
In terms of moving and handling- what is her cognition like? She's assistance of 2- is that with a frame, return or hoist?
If she is not mobile then you could consider a low bed if she does not have capacity. I would seek advice from your equipment company as there may be special order you could consider that's a low bed that profiles for the carers. Also maybe considering a mattress on the floor next to the bed.
Consider- is this normal for the patient, has they always slept like this? Could medication cause this? Any changes in meds? Do certain meds make her very drowsy? Is patient just trying to get out of bed during the night because she is incontinent?
Also after that capacity ax I would look at sourcing a night sitter for 3 nights or so to document her behaviours at night so that social services then have evidence that perhaps a night sitter is required/alternative placement.
Hope this helps :)
@Charmi Shah - a challenging scenario, with some real problem-solving to do here! Any thoughts, or know someone else who might have a view?
Hi there @sharon, This is a difficult bit of problem-solving! As an OT working with similar challenges in the community, I feel your frustration at not yet reaching a solution here. It seems you have trialed the most logical ideas. Unfortunately, this lady's sleeping arrangements may need to change (although I get why she might like to keep her double bed!) A single (low) profiling/hospital bed may be a solution, such as this one: www.medisave.co.uk/sidhil-bradshaw-low-nursing-care-bed-with-covered-ends.html. Whilst her family are not keen on the profiling option, the low version would massively reduce her falls risk. Perhaps this could be set up with cot sides down (plus a wendy-lett for if this lady still moves some degree overnight?)
I imagine budget might not allow, but there's also rotational chair beds, with hybrid mattresses, such as this one: www.shelden-healthcare.co.uk/apollo-saturn-rotational-chair-bed-with-hybrid-mattress.html.
Not helpful for lying-to-sitting in bed, but I also came across this Phil-e-Slide product, for other transfers... https://phil-e-slide-uk.com/product_view.php?backtoid=6&backtoname=All+Products&catid=5&products_id=6
Given the nature of this lady's progressive condition, plus the daily strain on carers, a profiling bed does seem the sensible long-term solution. I agree with your concern over friction from gradual increment transfers. I imagine her skin may at some point (if not already) be at risk of pressure sores and/or moisture lesions. So a new bed would address the 90 degree mobility issue AND provide speedy/easy-to-complete transfers for current/future personal care needs. Not sure I've come up with anything particularly new here, but hope this helps. Good luck! Jamie Urgent Care Occupational Therapist, Rapid Response
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