Caregiving: Beds, Pads, and Beyond

Most of us are choosy when it comes to mattresses, sheets, and pillows, and for good reason: We tend to spend more time in bed than any other single place. For people who are chronically ill or disabled, a quality bed isn't just a luxury item -- it's a necessity. The right bed can bring much-needed comfort. Most important, for people who are bedridden, or who sit or lie in the same position for hours without moving, carefully chosen mattresses and mattress pads can help prevent bedsores. These painful wounds can be dangerous, even fatal, if not treated promptly.

If you're caring for an aging or ill relative, you'll need a crash-course in beds. Since no two people are alike, there's no single bed that's perfect for home care, says Karen Zulkowski, an associate professor of nursing at Montana State University who recently chaired a government initiative to evaluate mattresses and mattress pads for preventing bedsores.

Bedsores aren't likely to be a problem if your relative is still reasonably active and spends much of her time out of bed, but she can still suffer from restless nights if her bed isn't comfortable. Ask questions about where she sleeps: Does she have the right level of support? Is she warm enough? Too often, Zulkowski says, caregivers and medical professionals alike overlook these important questions.

"Soft" is not enough

If your relative has limited mobility or is bedridden, you'll have to look at her bedding in a new light. For starters, you'll have to think about pressure, the force of the bed against her body. If she doesn't have bedsores, a 4-inch foam pad laid over the mattress can cushion her body and help prevent sores from developing. (Some people find these too hot for sleeping, however, and some may even be allergic to them.) Pads filled with gel, air, or water are also available, although it's not clear if they work any better than foam pads. Whatever type of pad she has, she should sink slightly when she lies down, and the pad should mold snugly around her body. Make sure the mattress is thick and supportive enough to keep her from "bottoming out" and reaching the firm mattress below. To quote a report published in the Nursing Clinics of North America, "just being soft is not enough."

Moisture is another concern, especially if your relative has trouble with incontinence, tends to perspire heavily, or has a wound that drains. Damp skin is not only uncomfortable, it's fragile and especially prone to sores. If your relative is incontinent, make sure to gently cleanse the skin, and use a moisture barrier cream to help protect it. Be sure to change her diapers frequently and change the bedding and clothes if they get wet. In addition, don't let her get overheated and sweaty, and don't tuck her in so tightly that her skin can't breathe.

Some mattresses are specifically designed to control moisture while relieving pressure. Low-air-loss mattresses are made up of pillows connected to a pump that provides a regular flow of air. Likewise, air-fluidizing beds containing warm beads are attached to a pump that keeps air flowing through the mattress. In both cases, the flow of air might help keep the mattress dry, but you still have to make sure that your relative isn't lying around in damp sheets.

Air pumps and electrical cords may seem like strange accessories for a bed, but you'll definitely need to consider such high-tech options if your relative will be confined to a bed for months, or if she already has pressure sores. A simple foam pad won't give her the cushioning she needs to heal. In addition to low-air mattresses or air-fluidizing beds, you might consider a "dynamic" mattress pad filled with air or gel that can be inflated or deflated for a custom fit.

A difficult choice

Bedsores, also known as pressure sores, are a particular threat for people who are confined to a bed or wheelchair, and they're more common in people who are malnourished, have poor circulation, and who have mobility problems due to lack of muscle strength, paralysis, or a broken bone. If your relative already has pressure sores, choosing the right bed, mattress, or specialized mattress pad can be a difficult task. Zulkowski recommends asking a wound-care nurse or other specialist in bedsores for advice.

If the bed has any mechanical or electric parts, you should make sure that you have 24-hour repair service or technical support in your area. If it runs on electricity, find out ahead of time how much it costs to keep it running day and night. Also choose a bed that has an alarm system to alert you if there's a power loss.

You may also have to consider cost. A specialized bed or mattress may cost hundreds or even thousands of dollars, and Medicare generally won't pay for an upgrade until severe sores have already formed. Sadly, "unless you're paying out of pocket or have comprehensive private insurance, you might have to wait until [the skin] starts breaking down before you can get one," Zulkowski says. Hospice programs often will pay for a specialized bed or mattress, however, and if your relative needs immediate relief, consider asking your extended family to pitch in for the equipment.

Whatever type of bed, mattress, or mattress pad you choose, keep in mind that it takes more than bedding to prevent sores. "You can have the best bed in the world, but family members still have to do their part," Zulkowski says. Regardless of the bed, people at risk for bedsores still have to be turned every two hours, and someone needs to check for signs of sores at least twice a day.

A good bed is important, but diligent caregiving will always be the true comfort.

References

Interview with Karen Zulkowski, an associate professor of nursing at Montana State University.

Mackey D. Support surfaces: Beds, mattresses, overlays -- oh my! Nursing Clinics of North America. 40: 251-265.

Cleveland Clinic. Support surface considerations for pressure ulcers. http://www.clevelandclinic.org/health/health-info/docs/

British Medical Journal. Best treatments. Pressure sores: Which treatments work? http://www.besttreatments.co.uk/btuk/conditions/1000525664.html

Slachta, Patricia, PhD, RN, CS, CWOCN, Home Alone With a Pressure Ulcer. Wounds1.com. Jn. 20.

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