Stuck In Bed. Help! They Can’t Get Up.
Part 1, Basics about the bed and bathing
When your loved one can’t get our of bed, what do you do? You’re here, providing care for a sick loved one but no one told you how to care for the very ill, who can’t care for themselves. You can fly by the seat of your pants, you can ask Hospice for help, or you can learn the techniques every nurse learns to give routine care in a way that is easiest for you and more comfortable for the ill person.
If you care for a loved one at home, especially if they are on Hospice care, they will eventually become bed bound, unable to get out of bed on their own. Perhaps they’re too weak or in too much pain to get out of bed. Caring for a bed bound person is tricky, but you can do it. Let me share some basic tips to save your back and keep your loved one comfortable.
The Hospital Bed
First, you need a hospital bed. A normal bed is too low to get the kind of leverage you need. Being able to raise the whole bed, plus raise the head and foot of the bed will also be important. Keeping the head of the bed at a 30 degree angle is good for those with breathing problems or trouble clearing secretions. If your loved one is on Hospice, they will supply a bed. If not, beds are readily available for rent from medical equipment stores.
Hospice will also send someone to bathe your loved one once a week, but I think I’d want to be clean more than once a week. Or if the patient has an accident, I’m not going to wait until the nurse shows up to clean up.
When you care for the patient in bed, raise the entire bed up to about the height of your waist. This will ease the strain on your back and allow you to give care without hurting yourself. You won’t be much help to anyone if you’re injured. When turning, bathing, and assisting with hygiene activities, be sure to bend your knees. Keep your elbows tucked in, close to your waist. Tilt your pelvis forward so you are using your legs to do any lifting.
Lower the side rails on the side you are working. Keeping the other side rails up. Never leave a patient unattended, with the side rails down. Just as you would never leave a baby on a changing table alone. You may think the person is unable to move, but they may surprise you and fall out of bed.
Turning a patient in bed so they stay in the middle of the bed requires two people. If you’re like me, sometimes you have no help. It’s harder, but possible–if the patient is not twice your size. I can turn my mom. I would not be able to turn my dad if without help. (more on turning later)
Wash your hands, wash your hands, wash your hands. This is the best way to keep you from getting sick or passing an illness on to your loved one. I also use disposable gloves. Hospice will supply them or you can buy them by the box at a drug store or online.
Try to keep a routine as much as possible. It comforts the loved one and keeps you organized. This is my routine:
AM– Toileting/Face and Hand washing/Breakfast
After offering the toilet, commode or changing the diaper/pads as needed, help with face and hand washing. A warm wet washcloth, no soap, works for this. Use one corner of the cloth to wipe the one eye first, another corner to wipe the other eye. Wash the rest of the face with smooth, gentle strokes. Then wash the hands. If the person’s mouth is dry, offer water or use a stick sponge to moisten the mouth. (Dip the sponge in a glass of drinking water and swab the mouth.). Lower the bed height when you are finished caring for the patient. The bed should be in the lowest position if you are not at the bedside.
Raise the head of the bed for breakfast, if they are eating. At this point, I let my mom eat whatever sounds good to her. Right now her favorite thing to eat is pudding and that’s fine. Sometimes she likes oatmeal or scrambled eggs. Then she’ll go through a hungry phase and eat everything. Last night she ate chicken enchiladas. She can eat some foods by herself, she tires quickly and needs help finishing a meal or using a spoon. Some days she needs you to spoon all the food into her mouth. Fluctuations are normal.
Bathing–The Bed Bath
After breakfast, offer the toilet or commode, if applicable. Otherwise, get right into the bath, changing their diaper or pad as part of the bathing process. Be sure to check every inch of the person’s skin as your bathe them, looking for any skin irritations or breakdown. Treat skin breakdowns as instructed by your Hospice nurse or doctor. It’s easier to show, than just tell. Here is a video on how to bathe a patient in bed. There are many YouTube videos used for training nurses/nursing aides. I chose this one as it is geared to a layperson. I found it interesting that no videos geared to laypeople giving home bed baths were produced in the U.S. All U.S. videos are for nurses (and used terms like “draw sheets” that aren’t used in homes). This one is Canadian. There was also one from Singapore and the U.K. I’m not sure what that says about us as a culture–a blog for another day.
Your caree (it’s not a word but I’m using it. You know what I mean). Will be tired after this. Give them whatever medications they need, especially if they are in pain, and allow them to sleep. If moving increases pain, you want to administer pain meds before bathing. We still get my mom up in her recliner chair and she naps there after her morning routine.
It will feel awkward at first but with practice you will become skilled and the motions will be more fluid. Remember to always support arms and legs at the joint, wrist, elbow, ankle, knee. It is easier for you and more comfortable for the patient. Try it on yourself. Try to support your left arm in the air with your right. Hold your arm at the wrist. Now try holding it mid-arm between your wrist and elbow. Notice the difference?
Practice these techniques. Next time we will go on to evening care, how to get your loved one settled for sleep.
Next: Afternoon and PM Care
Have a good caregiving day.