By C.A. Wolski
Once the product of improvisation and given no special status in the market, bariatrics beds, like most products for the morbidly obese, have evolved in both quality and status over the last decade and a half.
For today’s bariatrics patient, the therapeutic support systems are designed to meet their particular needs, offering improved features and comfort that aid in both recovery—for those in a short-term rehabilitation situation—and prevention of further complications.
The beds are beneficial to the caregiver, allowing them to minimize risk of injury while confidently attending to the unique needs of this ever more commonplace population.
AN INCREASING NEED
The need for bariatrics beds and other bariatrics products is a reflection of today’s world. According to Kevin Huffman, DO, president of American Bariatrics Consultants, St Cloud, Fla, about one out of three Americans is obese. The obesity rate is, literally, a growing problem, with a fourfold increase in the last 20 years. And this epidemic is reaching pandemic proportions as obesity becomes a problem throughout the world. “It’s a relatively new field,” says Huffman. “We’re responding to an overwhelming epidemic.”
The definition of obesity has changed over the years; according to Huffman, a patient is categorized as obese if their body mass index (BMI) is 30 and morbidly obese once it tops 40. Typically, a morbidly obese patient is someone who weighs 100 pounds more than their ideal weight.
Though there are numerous items intended for the bariatrics patient, the bed is probably the key item since, as Huffman observes, “These patients are not very mobile, and they are spending a lot of time in bed.”
There is another reason why the bed is so key in the rehab setting, says Michael Dionne, PT, of Choice Physical Therapy, Gainesville, Ga. “Rehab really starts at the bedside,” he says.
BEDSIDE CARE
In the early days of bariatrics care, therapists tended to improvise, bolting two normal-sized beds together to make one that could accommodate an obese patient. The next iteration saw simply larger versions of regular beds. Today that has changed. “We’ve gone from making things bigger to making things better,” says Huffman.
Today’s bariatrics beds have denser mattresses and can be rated for patients exceeding 1,000 pounds. One of the problems many bariatrics patients face is the development of pressure ulcers. Primarily, this is due to the fact that these patients have difficulty changing positions and have other comorbidities—such as diabetes—which make their skin susceptible to breakdown. One of the newer systems Huffman recommends in his consulting work provides alternating pressure, keeping the patient from settling in one position and preserving skin integrity. Prevention of pressure ulcers is key in maintaining the health of the patient because “once the wound’s there, it takes forever to heal,” says Huffman.
For Huffman, a key feature for a bariatrics bed is articulation. It has to be able to either move the patient into a sitting position or lower the legs of the patient. This feature is important to address comorbidities such as sleep apnea—which is alleviated when the patient is sitting up—and edema—which requires the legs to be lowered. Aiding in articulation is the use of heavy-duty motors that can support the weight of heavier patients.
In addition, the beds allow for tilting from side to side, which is important in cleaning patients. One of the beds Dionne uses rotates 60 degrees, which aids in cleaning patients and maintaining skin integrity. The overlays also assist in maintaining skin integrity. The overlays used on a bariatrics bed tend to offer low friction and shear, and are water resistant.
A pressure-relieving mattress overlay is beneficial in maintaining skin integrity.
The beds, unlike their earlier iterations, are also more suited to the normal-sized environment. The bariatrics beds that Dionne and Huffman use in their practices can contract and expand to fit through standard doorways. There are even beds that telescope in length. This makes the bed easier to use and makes expense capital upgrades to hospital buildings unnecessary.
For those patients who are ambulatory or who need to be moved from their beds, there are two ways to do so, from either the side or feet first. The foot exit is best for patients who have functional dependency and medical instability. The side exit is best for the patient who has functional dependency and medical stability. The side exit gives an advantage to the therapist. “It allows me to control the line of gravity [when moving the patient],” says Dionne.
The rotational ability of the bed also assists in ambulation. The bed can be lowered to the floor, and the patient can then easily exit the bed with the assistance of the therapist.
The benefits of bariatrics-specific beds are obvious to Dionne. “These beds have improved outcomes, get the patient moving, and decrease length of stay,” he says.
Even though the bariatrics patient is becoming more commonplace, there is still reluctance from some quarters about whether investing in bariatrics equipment is worth it.
APPROPRIATE SIDE RAILS
There are several different kinds of side rails available on bariatric beds. These include ones that drop down at various angles, others that swing out and back, and others that swing forward. The key to choosing a side rail for a bed is that it is rated to bear the weight of the patient.
Dionne says that there is a keen need for orthopedic beds. The primary problem with bariatric patients and orthopedics—particularly in the case of a spinal surgery—is that there is no way to fixate them postoperatively. “It’s tough because these patients have so much soft tissue,” he says.
Typically, the bed used for spinal patients allows for fixation and full rotation of the patient. “This frame allows for stability…and keeps the patient well-supported,” says Dionne.
This is not possible for the bariatric patient, making their ability to have the surgical procedure—which can be problematic because of their size and the co-morbidities associated with it—even more complicated with both the inability to fixate the patient and the dangers of developing pressure ulcers and blood clots.
When purchasing beds, Dionne recommends that clinicians be very careful to make sure that they are rated to bear the weight of a bariatric patient. Not every bed on the market is necessarily able to support a heavy patient.
To aid in the transfer of patients, there are swings to lift the patient’s body and/or extremities.
MAKING A CASE
In this obese age, Huffman says that it is less a question of “if” as one of “when” a bariatrics patient will be admitted to a rehab hospital. “I’ve seen facilities get caught off guard,” he says. “The facility isn’t planning to admit a bariatrics patient, but it will happen. I think it’s critical that facilities be prepared for this.”
But this does not mean that a hospital or other long-term facility needs to invest large amounts of money to purchase a fleet of bariatrics beds—which can cost in the neighborhood of $25,000. There is the option of renting the bed from a durable medical equipment dealer. In order to decide whether to buy or rent, the facility has to determine the frequency of use and the number of bariatrics patients being admitted.
“If you’re admitting a bariatrics patient every week, you might as well buy it,” says Dionne. “But if you’re admitting a bariatrics patient every 2 months, you should rent it.”
There are several advantages to renting a bed. The beds are portable, so they can follow the patient throughout their stay, necessitating the rental of only a single bed, instead of multiple beds. And since bariatrics beds tend to become more acutely soiled, because of the immobility and difficulty of moving the patient, a rented bed can save staff time; the rental company—by law—is responsible for adequately cleaning and maintaining the bed.
But purchasing makes sense if there is a regular bariatrics population moving through the facility.
There is another economic issue to take into consideration: how the beds protect staff as well as patients.
PROTECTING THE PROTECTORS
Huffman says that one of the biggest fears bariatrics patients have is hurting the clinicians and themselves while they are being moved from the bed. Typical injuries are to the back and neck.
These injuries are minimized with the beds, since they are designed to assist clinicians in moving patients. And this has a positive effect on the patients themselves. “They’re more willing to accept treatment, if they know they won’t be hurt or won’t hurt their therapists,” says Huffman.
But all the improvements this new class of bariatrics bed has yielded for both patient and clinician do not mean that it is a panacea. There is a factor that has to be avoided.
COMPLACENCY EQUALS PROBLEMS
Huffman says that because the new equipment improves outcomes and promises to minimize problems such as pressure ulcers, there is a dangerous level of complacency that can develop. “We want to avoid this [reliance] on the equipment to take care of the patient’s needs.”
And when the therapists become complacent, they may ignore good basic care, such as checking for pressure ulcers.
Huffman also decries the move toward ever larger and higher capacity beds. According to him, there are beds on the market rated for patients in excess of 2,000 pounds—patients few, if any, hospitals will ever see. Evoking the Cold War, Huffman describes this as an “arms race” to get the biggest equipment on the market, which he dismisses as an unnecessary exercise. “At some point, they’re going to have to get realistic,” he says.
But this race has netted some good results—the current class of beds with their ability to retract, rotate, articulate, and be portable—and promises even more in the future. “We’ll eventually develop an antiseptic…mattress cover,” says Huffman, noting that hygiene issues are among the most difficult for the bariatrics patient.
Dionne foresees a self-propelled bed.
No matter the future, there is one thing for certain in the present. “The beds are doing more work for us,” says Dionne.
C.A. Wolski is a contributing writer for Rehab Management.
