Electric Bed

An electric bed should be selected after assessment of bed transfers, bed mobility, posture, pain, breathing, skin integrity, cognition, mattress needs, carer tasks, room dimensions and entrapment risk. The person and carers should trial the exact bed and mattress combination.

Overview

An electric adjustable bed uses powered controls to change one or more bed positions.

Functions may include:

• Head or backrest elevation
• Knee break
• Leg elevation
• Whole-bed height adjustment
• Trendelenburg position
• Reverse Trendelenburg position
• Pillow tilt
• Lumbar adjustment
• Massage
• Under-bed lighting

The South Australian Equipment Program defines an electric adjustable bed as a bed with some or all of the following powered features:

• High-low adjustment
• Head raise
• Knee bend
• Leg raise
• Trendelenburg positioning

Purpose

An electric bed may:

• Assist getting into and out of bed
• Assist moving between lying and sitting
• Reduce effort during bed mobility
• Position the person for comfort
• Support the upper body during breathing difficulty
• Support management of reflux when medically appropriate
• Elevate the legs
• Improve working height for carers
• Support personal care in bed
• Reduce manual handling during repositioning
• Support pressure-management strategies when combined with an appropriate mattress and care plan

Main Bed-Base Types

Lifestyle Adjustable Bed Base

A lifestyle adjustable base generally provides:

• Head elevation
• Leg or foot elevation
• Wireless or wired handset
• Preset positions
• Optional massage
• Optional under-bed lighting

It may not provide whole-bed height adjustment.

May Suit

• A person who transfers safely from a fixed bed height
• A person mainly requiring comfort positioning
• Pain or reflux management
• Leg elevation
• A person who does not require carer working-height adjustment
• A couple wanting a split configuration

Benefits

• Domestic appearance
• Broad range of standard bed sizes
• Independent head and leg positioning
• May fit an existing bedroom style
• Often available as split queen or split king
• May support comfort without a clinical-looking bed

Limitations

• Fixed overall height
• May not optimise transfer height
• May not suit hoist access
• May have limited compatibility with bed poles or rails
• Usually has fewer clinical accessories
• May not lower sufficiently for falls-risk management
• Mattress choice remains critical

Hi-Lo Adjustable Bed

A hi-lo bed provides powered whole-bed height adjustment as well as profiling functions.

Common functions include:

• Head elevation
• Knee break
• Leg elevation
• Height adjustment
• Trendelenburg or reverse Trendelenburg on selected models

May Suit

• Difficulty transferring from bed
• Carer-assisted transfers
• Personal care completed in bed
• Hoist transfers
• Need for different transfer and care heights
• Reduced ability to sit up independently
• Progressive conditions
• Frequent repositioning needs

Benefits

• Bed can be lowered or raised for transfers
• Bed can be raised to reduce carer bending
• Supports personal care and dressing
• May support hoist access
• May reduce manual-handling demands
• Can support a range of positioning needs

Limitations

• Higher cost
• Heavier
• More floor space
• May require more room around the bed
• More moving parts
• Greater entrapment assessment requirements
• Can create a false sense that transfer risk has been removed

Floorline or Ultra-Low Bed

A floorline bed lowers closer to the floor than a standard hi-lo bed.

May Suit

• A person at high risk of rolling or falling from bed
• A person where reducing fall height forms part of the care plan
• Situations where bed rails are unsuitable
• A person requiring low sleep height and higher transfer or carer height

Benefits

• Reduces the height of a potential bed fall
• Can still rise for transfers or care
• May reduce reliance on restrictive rails

Limitations

• Does not prevent falls
• Floor-level hazards remain
• Carers may trip over the low bed
• The person may crawl or attempt unsafe floor transfers
• Mats beside the bed can create transfer and trip hazards
• Requires adequate clearance during height adjustment

Static Partner Bed

A static partner base may be placed next to an adjustable bed to maintain a shared-bed arrangement.

Consider

• Mattress heights must align
• A gap between beds can create entrapment risk
• Independent movement may create level differences
• Bedding may restrict bed movement
• Transfers from the adjustable side must remain safe

Split Adjustable Bed

A split queen or split king uses two separate adjustable bases.

Benefits

• Each person can choose a different position
• One person can use profiling without moving the other
• May preserve shared sleeping arrangements

Limitations

• Centre gap
• Different mattress heights
• Difficult cross-bed transfers
• Bedding may interfere with independent movement
• More controls and electrical components
• Higher cost

How to Choose the Bed Base

Choose a Lifestyle Adjustable Base When

• Fixed bed height is already suitable
• Comfort and positioning are the main goals
• Independent head and leg elevation are required
• Clinical accessories are not required
• Carer working height is not a concern
• A domestic appearance is important
• Transfer performance remains safe during trial

Choose a Hi-Lo Bed When

• Transfer height needs adjustment
• The bed must be raised for carers
• The person needs assistance moving from lying to sitting
• Hoist access is needed
• Personal care occurs in bed
• Function is expected to change
• The bed must support multiple clinical positions

Choose a Floorline Bed When

• Bed-fall risk remains high
• Reducing potential fall height is part of the risk plan
• Rails are contraindicated or restrictive
• The person still needs hi-lo functions

Bed-Base Feature Comparison

Examples of Available Features

Complete Comfort describes adjustable beds that can raise the head and legs independently, with selected models also offering height adjustment, massage and under-bed lighting.

Moveability Australia lists a range from basic head-and-foot adjustable bases to hi-lo and floorline beds.

Examples include:

• MLily iActive Adjustable Bed: independent head and foot elevation, preset positions and optional massage
• MLily iActive HILO: height adjustment from about 350 mm to 700 mm, head and foot elevation and battery backup
• MLily iActive LOLO: ultra-low height adjustment, head and foot elevation, pillow tilt and lumbar support
• iCare IC333: hi-lo adjustment, head lift, knee break and Trendelenburg functions
• iCare IC222: homecare bed designed for transfers, positioning and carer support

Product features and dimensions should be confirmed for the exact model and size.

How an Electric Bed May Assist Transfers

Lying to Sitting

Head elevation may:

• Reduce the effort needed to lift the trunk
• Support a staged move from lying to sitting
• Assist a person with reduced abdominal or upper-limb strength
• Reduce pain during trunk movement
• Allow carers to assist from a more upright position

A possible sequence is:

1. Bend the knees or use the knee-break function if prescribed.
2. Raise the head section gradually.
3. Roll or move toward the bed edge.
4. Lower the legs from the bed.
5. Use the prescribed bed aid or carer assistance.
6. Sit upright and establish balance before standing.

Sit-to-Stand From Bed

Whole-bed height adjustment may:

• Raise the bed to reduce hip and knee flexion
• Support foot placement
• Reduce the effort needed to stand
• Match the person’s transfer height
• Reduce pulling on carers or furniture

The bed should not be raised so high that:

• Feet lose contact with the floor
• The person slides forward
• Standing balance is compromised
• The person is pushed into standing before ready

Standing to Sitting

The bed can be adjusted to:

• Match the person’s leg length
• Allow the backs of the legs to contact the mattress
• Reduce the distance of descent
• Support a controlled sitting transfer

Carer-Assisted Transfers

A hi-lo bed may help carers by:

• Raising the bed for personal care
• Reducing bending during dressing or repositioning
• Matching the height of a wheelchair or commode
• Supporting hoist sling application
• Improving access from both sides

The South Australian bed assessment form includes both the person’s required transfer height and carers’ required working height.

Bed Transfer Assessment

Assess:

• Method of transfer
• Side of bed used
• Standing or non-standing transfer
• Bed stick or rail use
• Slide-board transfer
• Hoist transfer
• Wheelchair height
• Walking-aid position
• Foot placement
• Sitting balance
• Orthostatic symptoms
• Falls history
• Night-time transfers
• Carer assistance
• Space at bedside

Pain and Positioning

An electric bed may improve comfort by allowing gradual position changes.

It may assist with:

• Back pain
• Hip pain
• Knee pain
• Shoulder pain
• Arthritis
• Post-operative discomfort
• Difficulty lying flat
• Pain during bed mobility

Potential benefits include:

• Adjusting hip and knee angles
• Supporting the knees
• Reducing sustained flat positioning
• Allowing small changes throughout the day or night
• Supporting an easier lying-to-sitting movement

Important Considerations

• Positioning does not treat the cause of pain
• Some positions may worsen pain
• Excessive knee elevation may increase hip flexion
• Head elevation may increase sliding and shear
• A mattress that is too firm or soft may worsen symptoms
• Medical or physiotherapy input may be required

Trial the intended sleeping and resting positions.

Breathing and Upper-Body Elevation

Raising the head section may help some people who feel breathless when lying flat.

It may:

• Support a more upright resting position
• Reduce effort when moving from lying to sitting
• Allow adjustment during episodes of breathlessness
• Support prescribed respiratory positioning

Moveability describes adjustable beds as potentially useful for people with respiratory conditions. The exact position should follow medical or respiratory guidance.

Consider

• Diagnosis
• Oxygen use
• CPAP or BiPAP
• Tubing length
• Position of the machine
• Emergency access
• Whether the person slides down
• Whether leg elevation changes breathing comfort
• Whether side-lying is required

Seek Medical Guidance When

• Breathlessness is new
• Symptoms are worsening
• The person cannot lie flat
• Chest pain occurs
• Oxygen needs change
• Night-time breathing is disrupted

Reflux

Head-of-bed elevation may help some people with reflux or hiatus-hernia symptoms.

Healthdirect advises that raising the head of the bed can reduce reflux symptoms for some people.

Consider

• Raise the upper body rather than using multiple loose pillows
• Avoid creating excessive neck flexion
• Monitor sliding
• Follow medical advice
• Do not rely on bed positioning as the only treatment

Leg Elevation

Leg elevation may support comfort for some people with:

• Lower-limb swelling
• Fatigue
• Pain
• Venous symptoms

Consider

• Medical cause of swelling
• Heart or kidney conditions
• Skin integrity
• Heel pressure
• Knee comfort
• Ability to reposition
• Whether elevation affects breathing

Leg elevation should follow medical advice when significant oedema or cardiac conditions are present.

How to Choose the Mattress

The mattress and base should be assessed as one system.

The mattress must:

• Be approved for use on an adjustable base
• Flex without buckling
• Match the bed dimensions
• Remain stable during profiling
• Support transfers
• Meet pressure-care needs
• Suit temperature and comfort preferences
• Remain within the bed’s safe working load

Mattress Types

Standard Foam Mattress

Benefits

• Lightweight
• Usually flexible
• Low maintenance
• Available in different firmness levels
• May suit low pressure-risk users

Limitations

• Quality varies
• Can compress over time
• May retain heat
• May not meet moderate or high pressure-care needs

Viscoelastic or Memory-Foam Mattress

Benefits

• Contours to body shape
• May reduce peak pressure
• Can support comfort
• Usually flexes with an adjustable base

Limitations

• May retain heat
• Can make turning or transfers harder
• Slow recovery may feel restrictive
• Edge support may be limited
• Softness varies with temperature

High-Resilience or Layered Foam Mattress

Benefits

• Combines support and comfort layers
• May provide better edge support
• Can support pressure redistribution
• Often lighter than hybrid mattresses

Limitations

• Performance varies by design
• Foam fatigue can occur
• Must be matched to risk level and body weight

Hybrid Mattress

A hybrid mattress combines foam with springs or other supportive components.

Benefits

• May provide stronger edge support
• Familiar mattress feel
• Can support easier transfers
• May offer ventilation

Limitations

• Heavier
• Not all spring systems suit adjustable bases
• May resist tight profiling
• More difficult for carers to handle
• Must be approved by the bed manufacturer

Pressure-Care Mattress

A pressure-redistributing mattress may use:

• Specialist foam
• Air cells
• Alternating air
• Hybrid air and foam
• Low-air-loss features

Consider When

• Pressure injury risk is moderate or high
• The person cannot reposition
• There is reduced sensation
• A pressure injury is present
• Sitting and lying duration is prolonged
• Moisture and continence increase risk

See:

• Pressure Injury Prevention and Management
• Cushions

Mattress Selection Comparison

The aim is not simply “firm” or “soft.” The mattress should balance:

• Comfort
• Pressure redistribution
• Bed mobility
• Transfer stability
• Postural support

Mattress Measurements

Check:

• Width
• Length
• Depth
• User height
• User weight
• Bed-base compatibility
• Side-rail compatibility
• Gap around the mattress
• Compression at the edge
• Safe working load
• Maximum mattress height allowed with rails

An incorrect mattress size can create entrapment gaps.

Bed Size

Options may include:

• Long single
• King single
• Double
• Queen
• Split queen
• Split king
• Long double
• Bariatric sizes
• Petite sizes

Choose the Width Based On

• Body size
• Bed mobility
• Carer access
• Hoist use
• Partner needs
• Room size
• Doorway access
• Delivery route
• Ability to reach controls or supports

A wider bed may improve turning space but:

• Requires more room
• Increases carer reach
• May reduce access from both sides
• May make independent bed mobility harder for some people

Choose the Length Based On

• User height
• Foot clearance
• Pillow position
• Mattress movement during profiling

Long single and king single beds are often approximately 203 cm long, while some standard double mattresses may be shorter. Confirm current dimensions.

Bed Height

Check:

• Lowest bed height
• Highest bed height
• Mattress depth
• Final transfer surface height
• Foot contact
• Wheelchair height
• Hoist access
• Carer working height

The advertised base height may not include the mattress.

Hand Control

Assess:

• Wired or wireless handset
• Button size
• Symbols
• Backlighting
• Number of functions
• Lockout
• Preset positions
• Ability to stop movement
• Ability to return to flat
• Storage location
• Dominant hand
• Vision
• Dexterity
• Cognition

Trial Requirements

The person should demonstrate:

• Raising and lowering the head
• Using the knee break
• Raising and lowering the whole bed
• Returning the bed to the transfer position
• Getting into bed
• Getting out of bed
• Repositioning
• Reaching the control
• Operating the bed at night
• Responding to power failure

Carers should demonstrate:

• Adjusting working height
• Repositioning the person
• Using lockout functions
• Managing accessories
• Emergency lowering
• Keeping cords clear

Room and Installation Assessment

Measure:

• Bed width and length
• Space on both sides
• Space at foot of bed
• Door width
• Hallway width
• Turning space
• Delivery route
• Lift access
• Ceiling height for hoists
• Power-point location
• Clearance for profiling
• Clearance for height adjustment

Power and Cord Safety

The bed should use:

• Manufacturer-approved power supply
• A suitable power point
• Safe cable routing
• Accessible isolation point
• Battery backup when required

Avoid:

• Cords across walking paths
• Cords under loose rugs
• Cords trapped under castors
• Cords caught in moving sections
• Damaged extension leads
• Overloaded power boards
• Liquids near electrical parts
• Unapproved chargers or controls

Battery Backup

Check:

• Whether backup is included
• Which functions operate on backup
• Battery replacement schedule
• Whether the bed can return to a safe transfer position
• Whether carers know the emergency process

Entrapment Risk

Entrapment may occur between:

• Mattress and bed rail
• Mattress and bed frame
• Split rails
• Headboard and mattress
• Wall and bed
• Bed stick and mattress
• Moving bed sections
• Partner beds

Risk increases with:

• Cognitive impairment
• Agitation
• Small body size
• Involuntary movement
• Reduced sensation
• Incorrect mattress
• Unapproved rails
• Loose accessories
• Bed movement

Complete an entrapment assessment before adding:

• Bed rails
• Bed sticks
• Poles
• Bumpers
• Partner-bed infills
• Positioning devices

Bed Rails

Bed rails are not routine falls-prevention devices.

They may:

• Assist repositioning
• Provide a boundary
• Increase entrapment risk
• Increase injury from climbing
• Restrict movement
• Be considered restraint in some circumstances

Assess the person, mattress, rail and bed as one system.

Bed Sticks and Transfer Poles

Check:

• Compatibility with adjustable bed
• Clamp security
• Position during profiling
• Entrapment gaps
• Ability to grip
• Transfer method
• Manufacturer approval

Falls Risk

An electric bed may reduce some transfer risks but create others.

Potential risks include:

• Bed too high
• Feet not contacting the floor
• Person standing before stable
• Bed moving during transfer
• Castors unlocked
• Night-time confusion
• Control used incorrectly
• Sliding from elevated head position
• Floor mats creating trip hazards
• Low bed obstructing carers

Pressure and Shear

Head elevation may cause the person to slide toward the foot of the bed.

This can increase:

• Shear
• Sacral pressure
• Heel pressure
• Repositioning needs

Strategies may include:

• Knee break before head elevation
• Smaller position changes
• Repositioning
• Appropriate mattress
• Heel offloading
• Review of clothing and bedding
• Carer training

Carer Manual Handling

A hi-lo bed can reduce bending, but the final setup must consider:

• Carer height
• Tasks performed
• Side of access
• Number of carers
• Hoist use
• Repositioning method
• Bed width
• Mattress friction
• Space around the bed

Safety Issues

• Do not exceed the safe working load
• Lock castors unless movement is required
• Keep people and objects clear during adjustment
• Keep cords out of moving parts
• Do not allow children to operate the bed
• Do not use unapproved mattresses
• Do not add rails without entrapment assessment
• Do not use the bed to lift a person who cannot transfer safely
• Avoid placing the bed hard against a wall if movement creates crushing risk
• Follow servicing instructions
• Keep emergency contacts accessible

Safe Working Load

Confirm whether the safe working load includes:

• User
• Mattress
• Bedding
• Accessories
• Carer force
• Bed pole
• Medical equipment

Do not confuse maximum user weight with total safe working load.

Cleaning and Maintenance

Check:

• Handset
• Handset cable
• Power cable
• Transformer
• Motors
• Actuators
• Castors
• Brakes
• Frame
• Slats or platform
• Mattress cover
• Rails
• Bed stick
• Battery backup
• Unusual noise
• Uneven movement

Inspection Checklist

• [ ] Bed functions meet the assessed need
• [ ] Mattress is compatible
• [ ] Mattress size is correct
• [ ] Transfer height is correct
• [ ] Carer working height is adequate
• [ ] Feet contact the floor during transfer
• [ ] Head elevation supports the person
• [ ] Knee break is understood
• [ ] User can operate the handset
• [ ] Carer can operate the bed
• [ ] Bed returns to safe transfer position
• [ ] Castors lock
• [ ] Power cord is safe
• [ ] Battery backup is understood
• [ ] Entrapment assessment is complete
• [ ] Rails or sticks are compatible
• [ ] Hoist access is adequate
• [ ] Room clearance is adequate
• [ ] Pressure-care needs are met

Review Triggers

• Falls or near misses
• Change in transfer ability
• Change in bed mobility
• New pain
• New breathlessness
• New pressure area
• Weight change
• Cognitive change
• Increased carer assistance
• New hoist
• New wheelchair
• Mattress compression
• Bed or handset fault
• Power failure
• New rail or bed stick
• Change in room layout
• Change in partner sleeping arrangement

Client and Carer Instructions

Before Transfer

• Adjust the bed to the trained height.
• Ensure feet can reach the floor.
• Lock the castors.
• Keep the walking aid nearby.
• Clear cords and obstacles.

To Sit Up

1. Use the knee break if prescribed.
2. Raise the head section gradually.
3. Move toward the edge.
4. Lower the legs.
5. Pause in sitting before standing.

Before Sleeping

• Position the bed for comfort.
• Keep the handset within reach.
• Keep personal alarm or phone accessible.
• Ensure tubes and cords are not trapped.
• Follow the pressure-care plan.

Stop Using and Seek Review When

• The bed moves unevenly
• The handset fails
• The cord is damaged
• The mattress shifts or gaps develop
• Transfers become unsafe
• The person slides repeatedly
• New skin redness appears
• Breathing or pain worsens

Related Notes

• Pressure Injury Prevention and Management
• Cushions
• Bed Sticks
• Bed Rails
• Transfer Equipment
• Hoists
• Personal Alarms
• Electric Recline Lift Chair

References

• Complete Comfort. Adjustable Beds: https://www.completecomfort.net.au/beds/
• Moveability Australia. Adjustable Beds: https://moveabilityaus.com.au/collections/adjustable-beds
• Moveability Australia. MLily iActive Adjustable Bed: https://moveabilityaus.com.au/products/mlily-iactive-adjustable-bed
• Moveability Australia. MLily iActive HILO Adjustable Lift Bed: https://moveabilityaus.com.au/products/mlily-iactive-hilo-adjustable-lift-bed
• Moveability Australia. MLily iActive LOLO Adjustable Lift Bed: https://moveabilityaus.com.au/products/mlily-iactive-lolo-adjustable-lift-bed
• Moveability Australia. iCare IC333 Hi-Lo Adjustable Bed: https://moveabilityaus.com.au/products/ic333-hi-lo-adjustable-bed
• Moveability Australia. iCare IC222 Homecare Bed: https://moveabilityaus.com.au/products/icare-ic222-homecare-bed
• South Australian Equipment Program. Bed, Mattress and Bed Equipment Assessment Form: https://equipmentprogram.sa.gov.au/__data/assets/word_doc/0006/38292/Bed%2C-Mattress-and-Bed-Equipment-Assessment-Form.doc
• South Australian Equipment Program. Prescribing Equipment by Equipment Type: https://equipmentprogram.sa.gov.au/lists/dhs-equipment-program-documents/prescribing-equipment-by-equipment-type
• Healthdirect Australia. Gastro-oesophageal reflux disease: https://www.healthdirect.gov.au/gord-reflux
• Relevant manufacturer instructions and organisational procedures