'Hi-lo' beds gaining popularity

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Long-term care providers in the market for new resident beds now have access to cutting-edge options that many may have, ironically, only dreamed of in the past.

The latest bed technology aims to increase comfort and safety for residents, maximize efficiency, and reduce the risk of caregiver injuries.


Driven in part by industry concerns over resident falls and entrapment, as well as healthy vendor competition, manufacturers are looking to take even their most advanced products to higher levels and make beds of the future available today.


"Beds not only have to be comfortable and functional for residents, they also should meet safety requirements for residents and caregivers," said Scott Goeb, product manager, Sunrise Medical, Stevens Point, WI.


Going the distance


Perhaps the greatest industry trend is offering beds with a broad vertical travel range. Sleep-surface decks now can range from less than 7 inches off the floor to more than 33 inches, depending on the manufacturer.


So-called "hi-lo" beds offer dual benefits. A bed that can be kept close to the ground during rest is ideal for fall-prone residents, and serves as a more suitable alternative to placing mattresses directly on the floor – a somewhat common, albeit ill-advised approach some facilities have used to prevent falls. Conversely, a bed that can be raised to a comfortable working height helps ease caregiver strain during transfers, feeding and other activities.


"Almost all the major players in the long-term care [bed industry] have added a low bed to their offering. The big industry game among these manufacturers right now is to develop a bed with the greatest travel range," noted Victoria Cote, marketing coordinator for Carroll Healthcare Inc., London, Ontario.


The gravitation toward hi-lo beds means manufacturers are also turning out more electrified models. Keith Cramer, vice president of engineering for Atlanta-based Basic American, estimates that more than half of all beds purchased today are electric, compared to just 10% to 15% approximately 15 years ago.


"There's a good reason for that. With a manual bed, every time residents want their beds adjusted, they have to call a nurse," he said, noting that if a wing has 15 to 20 rooms with two beds each, a facility would conceivably need one full-time employee available just to adjust beds.


Manually moving a bed from the low position would also be physically taxing for caregivers, added David Jones, vice president of marketing and business development, M.C. Healthcare Products Inc., Beamsville, Ontario. "To my knowledge, there is no manufacturer that makes a manual low bed because cranking a bed – with the weight of a [resident] – would be no easy task."


Side rails are also falling by the wayside because of guidelines set forth by the Hospital Bed Safety Workgroup, as well as the long-term care industry's adoption of practices that promote resident independence.


Seeking alternatives


The workgroup, composed of representatives from the medical bed industry, Food and Drug Administration, and national healthcare and patient advocacy groups, released the guidelines in April 2003 to assess the risks of side rails and encourage facilities to explore other alternatives.


"Entrapment is a big issue in long-term care. This initiative represents the most comprehensive work that has been done regarding bed rails and entrapment," said Evvie Munley, senior health policy analyst, American Association of Homes and Services for the Aging, Washington.


The workgroup reported that between 1985 and 1999, there were 371 incidents of patients caught, trapped, entangled or strangled in beds with rails reported to the FDA. Of those cases -- most of which involved frail, elderly or confused patients -- 228 died.


As a result, many manufacturers are replacing side rails with assist bars to enable resident repositioning without restraining. Some models also feature enhanced locking mechanisms to prevent movement when a resident enters or exits a bed, as well as lock-out controls to prevent residents from ra