As providers of the most trusted Phoenix senior care the area has to offer, we know working with bed-bound seniors and chair-bound seniors requires much care and attention, and one of the most critical components is repositioning. The primary purpose of repositioning is to improve circulation to the skin and other organs, relieving pressure and preventing skin breakdown. Repositioning also helps in providing comfort to your loved one and ensures movement of the joints and muscles. Although many bed-bound patients often resist turning and will tell you they just want to be left alone, turning will improve comfort over the course of the day and night, and will also give you opportunity to inspect the skin.
Your Loved One’s Individual Repositioning Schedule
Although the current accepted “guideline for care” is to reposition your loved one every two hours, there is much more involved in finding the right solution for your individual loved one. The frequency of turns/repositioning should be individualized to your loved one based on such factors as:
- Tissue tolerance
- General medical condition
- Level of activity and mobility
- Overall treatment objectives
- Skin condition
To test your loved one’s “tissue tolerance” you must observe and document the time it takes the skin to redden over bony prominences (hips, ankles, shoulders). You must gradually increase the amount of time the person is left in the same position until redness is detected. Once the threshold has been established, you must set the turn frequency to 30 minutes less than the time interval, with no more than 2-hour intervals maximum. Repositioning a chair-bound loved one should occur even more frequently.
In addition to determining tissue tolerance and the frequency of repositioning, you will need to move your loved one using proper techniques. Keep these points in mind when repositioning:
- Make sure the pressure is relieved or redistributed.
- Avoid positioning over bony prominences that redden easily.
- Do not drag or pull your loved one while repositioning, which can damage the skin.
- Alternate between the back, right side and left side on the schedule determined for your loved one, but at least every two hours.
Necessary Equipment for Your Bed/Chair-Bound Loved One
Depending upon your loved one’s condition and activity orders, the use of equipment can make all the difference for a person who is bed/chair-bound. You should talk to your loved one’s physician and health care team about necessary equipment to aid your loved one in repositioning and preventing skin breakdown and other complications.
Some equipment to consider:
- A hospital bed with bedrails
- A trapeze, if your loved one has upper body strength to help reposition
- A Hoyer lift
- Drawsheets and bedpads
- Slide sheets
- Wedges and pillows
- Low air-loss mattress
- Wheelchair cushion
- Heel and elbow protectors
- Contracture rolls
Always Use a Drawsheet!
Using a drawsheet under your loved one makes it much easier to position the person, and also reduces the possibility of your loved one developing a skin injury/breakdown. If you don’t have one, you can make one by folding a twin-sided top sheet in half. To place the sheet correctly under your loved one, follow these steps:
- If your loved one has a hospital bed, raise the bed to a level that reduces the strain on your back, and make the bed flat.
- Roll your loved one to one side and place the half rolled up sheet on top of the fitted bottom sheet so that the top and bottom of the drawsheet go across the bed (perpendicular to the bed). Position the drawsheet so that it will be between the person’s head and knees.
- Roll your loved one onto the sheet and unroll the sheet out flat under the person.
- Tuck in the drawsheet tightly on both sides. Smooth out any wrinkles to reduce possible skin irritation.
Basic Repositioning Rules for a Bed/Chair-Bound Person
- Never lift more than you can manage.
- Get help when needed.
- Explain to your loved one the steps involved, and how the person can help.
- Raise the bed to safe working height and ensure that brakes are applied.
- Never lift your loved one.
- Never pull the person by the arms.
- Never attempt to pull your loved one without a drawsheet; the risk of giving your loved one a skin injury or injuring yourself is very high without one!
Moving Your Loved One Up in Bed
There are several methods for moving a person up in bed. If your loved one has some upper body strength or is able to use his/her bent legs to push up in bed, this can be helpful. Aids such as trapeze bars, side rails and “slide sheets” can be useful tools when you are moving your loved one without additional help. The goal to moving your loved one up in bed is to not lift, but pull the person up in bed using a drawsheet. Do not slide your loved one up in bed without a drawsheet, as you can create friction or shear skin injury. These are instructions for using a drawsheet and two-person assist for moving a person up in bed:
- Lay your loved one on his or her back; place the pillow at the head of the bed and against the headboard.
- Stand between the shoulders and hips of your loved one, with your feet shoulder-width apart. Weight will be shifted from back foot to front foot.
- Fan-fold the drawsheet toward your loved one and grab the drawsheet at the person’s upper back and hips.
- Ask your loved one to tilt his/her head toward the chest to protect the neck, and to fold the arms across the chest, bending knees to assist with the movement. Let your loved one know when the move will happen.
- Tighten your gluteal and abdominal muscles, bend slightly at your knees, and keep your back straight and neutral.
- On the count of three, gently slide (not lift) your loved one up the bed, shifting your weight from the back foot to the front, keeping your back straight with your knees slightly bent.
- You may need to do this more than once to get your loved one in the right position.
- Replace the pillow under the person’s head, and position the person in bed.
- If your loved one is going to remain on his/her back, raise the foot of the bed enough to bend the knees. In addition, you can place a pillow under the knees to prop the person up to prevent sliding down in bed. This will help reduce friction and shear skin injury as well.
Turning and Positioning Your Loved One in Bed
Repositioning bed-bound seniors is easier to accomplish with help. If you don’t have help, it can be done but will require more steps to accomplish. Here are the steps to repositioning a person in bed without help from experienced providers of home care Paradise Valley families depend on.
- Move the person to the center of the bed so the person is not at risk of rolling out of the bed.
- Ask your loved one to look towards you. Position the arm nearest you stretched toward you and the arm farthest from you across his/her chest.
- Position a pillow next to the person on the opposite side of the bed.
- Reach over the person and grab the drawsheet on the opposite side, gently pulling the drawsheet toward you.
- Gently pull the person’s hip and shoulder towards you with the drawsheet as you place the pillow under the drawsheet to prevent your loved one from rolling back.
- Go around the other side and get your hands, palms up, under the person’s hips to pull him/her back into position.
- Position the pillow or a foam wedge under the drawsheet at the person’s back. Push the pillow close against the back to help prop the person on his/her side.
- Make sure the arm under your loved one is pulled out from under him/her, resting more on the shoulders for comfort.
- Make sure your loved one‘s ankles, knees, and elbows are not resting on top of each other to prevent skin problems.
- Make sure his/her head and neck are in line with the spine, not stretched forward, back, or to the side.
- Place a pillow under the top arm of your loved one.
- Place another pillow or a specially designed foam leg wedge between the person’s knees. This extra bit of support will add comfort by keeping the spine in alignment and by easing pressure on the bony areas of the knees and ankles.
- Return the bed to a comfortable position with the side rails up. Check with your loved one to make sure he/she is comfortable.
Repositioning Your Seated Loved One
Repositioning chair-bound persons is just part of the care to prevent the development of skin problems, and each person will present different needs. Seated people need to be repositioned more frequently than bed-bound people. Instruct your chair-bound loved one to shift his/her weight every 15 minutes. If your loved one is unable to reposition, you will need to physically move him/her at least every hour. To do this, you will need to use a drawsheet or sling under your loved one’s buttocks and hips to gently pull from side to side. In addition, your loved one who is chair-bound should always use a pressure redistribution cushion, which will distribute the weight of the body without impeding function or increasing the risk of skin damage.
Other factors, such as your loved one’s nutrition, medical condition, skin condition, and tissue tolerance will also determine repositioning needs. Ask your loved one’s health care team what their recommendations are for repositioning. Use of a Hoyer lift, geri-chair and a seated positioning system may be necessary for your loved one who is unable to reposition independently in a chair.
To ensure your loved one is safe from injury – as well as yourself! – call on Nightingale Homecare, providers of the most trusted Phoenix senior care the area has to offer. We can assist with a full range of both skilled and non-medical services for seniors in the home, based on each person’s individual needs. Call us at (602) 504-1555 to learn more.