Cover Feature

Bed Basics & Beyond

How providers can take their understanding of this cornerstone DME to the next.

• By Joseph Duffy
• Sep 01, 2010

Beds and sleep surfaces are big business for providers, but in the eyes of mobility patients and their caregivers, they are key to living comfortably. With many of these patients bed bound for more than 50 percent of the day, a bed that does not suit patients’ particular needs can lead to medical complications, sleepless nights, depression, resentment against caregivers and in the worst instances, death.

Providers need to have a good, basic understanding of beds and support surfaces in order to provide patients with the right products that will enhance their quality of life.

Understanding patients’ sleep surface needs

When first accosted by a patient or a caregiver, the provider must help decide what type of bed or support surface best fits the patient’s needs.

To help in the selection of support surfaces, providers must understand Medicare guidelines first and foremost, says Jim Acker, VP, Sales and Marketing of Blue Chip Medical Products, Inc.

In a nutshell, Medicare categorizes support surfaces into three groups.

To qualify for Group 1 support surfaces, which are mattress overlays or mattresses considered medically necessary, a patient must be completely immobile or have limited mobility, any stage pressure ulcer on the trunk or pelvis and one of the following: impaired nutritional status, fecal or urinary incontinence or altered sensory perception.

To qualify for Group 2, which are alternating pressure and low air loss mattresses and overlays, a patient must have multiple Stage II pressure ulcers on the trunk or pelvis, been on a comprehensive ulcer treatment program for at least the past month and the patient’s ulcers must have worsened or remained the same over that time period. Or, the patient has large or multiple Stage III or Stage IV pressure ulcers on the trunk or pelvis. Or the patient has had a recent myocutaneous fl ap or skin graft for a pressure ulcer on the trunk or pelvis and has been on a Group 2 or 3 support surface immediately prior to a recent discharge from a hospital or nursing facility.

Group 3 covers air-fl uidizing beds, and its criteria are more rigorous than Group 1 and Group 2.

Once you know where Medicare fit into the scene, the task is to pick the right product.

For Group 1 patients, Acker says he likes the relief-care foam mattresses. “The patients get all the benefits of the gel and air with a more aggressive heel section and they do not add any height to the bed so sheets are not an issue,” he says.

Acker warns that patients need to be mindful of what type of foam they are getting. He says to look out for foam mattresses with just an egg crate-type topper glued to the top. He says this will not do much for a patient at risk or who currently has wounds.

Group 2 includes the air systems, such as Supreme air, Apollo 3 port, rapid air, power pro Power Turn and GRZ.

Beyond that, says Acker, providers need to look at the clients’ underlying diagnosis. Do they have Multiple Sclerosis or ALS? If so, make sure the mattress system will meet all their needs in three to five years as the disease progresses. They will not qualify for a new system for five years. Also, most patients will have referrals from their physicians as to what type of surface they should be using.

“Every patient is different and even though there is a minimum requirement from Medicare, the patient’s underlying diagnosis matters greatly,” Acker says. “Cancer patients usually prefer low air loss due to the softer nature of the mattress; spinal cord injury patients do better on an alternating pressure mattress due to the extra support the mattress offers; and bariatric patients do better on low air loss due to its moisture control capabilities.

Understanding bed needs

Like support surfaces, there are many types of beds for providers to choose from, including adjustable, electric (both semi-electric and full-electric), bariatric, manual, pediatric and multi-height.

Adjustable beds are typically designed with comfort and durability in mind. Other features to look for include quiet motors, ergonomic designs, a durable frame and massage options.

For bariatric beds, look for features that apply both to the client and caregiver, such as accessibility, user-friendly set up, weight capacities and quiet operation.

As with sleep surfaces, bed basics start with understanding Medicare, which will partially cover hospital beds if certain criteria are met. The following is criteria typical of most states:

• Medicare covers a hospital bed when patients cannot use a normal bed because they need to:
• Change body positions in ways not possible with a normal bed, or
• Be in body positions not possible with a normal bed in order to relieve pain, or
• Have the head of the bed higher than 30 degrees most of the time due to illnesses such as congestive heart failure, chronic pulmonary disease and others, or
• Use traction equipment that must be attached to a hospital bed.

These criteria are the basic coverage criteria for hospital beds. There are several different kinds of beds and each has additional requirements, so make sure you do your homework. Also, a Certificate of Medical Necessity must be completed, signed, and dated by the treating doctor. Patients pay 20 percent of Medicare-approved amounts.

It’s important to note that Medicare does not cover a total electric hospital bed, a bed board, an over bed table or a trapeze bar with a bed attachment when used on a normal bed.

David Hartley, CEO of Home Health Depot, which, among other products, carries semi-electric, full-electric, bariatric and pediatric specialty beds.

Hartley says the three criteria he collects to help patients find the proper bed are: height and weight, so he knows what weight-capacity products to consider; whether there are any active pressure sores; and finally, if there are, the stage(s) the sores are in. The weight question is important, as patients over 350 pounds can qualify for a heavy-duty bed.

Hartley also offers other important points a provider should know about the patient before suggesting a bed type: respiratory conditions, hours spent in bed, current sleeping condition, incontinence issues, edema, history of falls from bed, wheelchair transfer issues, history of or active pressure sores and caregiver status.

Bed safety concerns

Safety is of paramount importance when helping mobility patients choose the right bed. You must be prepared to field questions from patients and caregivers. An in-depth article on bed safety, co-authored by DuWayne Kramer, Jr., president of Burke/Leisure-Lift, a manufacturer of bariatric hospital beds for over 30 years, can be found at burkebariatric.com.

According to Kramer, side rail entrapment, which includes the interaction of the rails and mattress, is the No. 1 cause of deaths in beds, with 14 fatalities reported in the first half of 2010.

“The U.S. FDA- and OSHA-recognized consensus standard for hospital beds is the IEC 60601-2-38,” says Kramer. “It is the world’s first standard for medical beds. The manufacturer must meet specific measurements, such as between the rails, rails OSHA has jurisdiction with medical beds in public facilities. “The IEC 60601-2-38 is FDA’s and OSHA’s testing standard for electric hospital beds,” says Kramer. “Currently homecare beds do not need to be tested to the 2-38. Unfortunately, manufacturers or distributors can set any testing criteria they want to establish equivalency to place their bed on the market. Because they do not test to the and mattress, top of mattress to top of side rail. Unfortunately dealers and institutions in many cases are not using manufacture-approved mattresses or even mattresses that meet the mattress height, width and length specified by the bed manufacturer. The bed and mattress must be treated as one unified product design. Dealers are required to fit the mattress to the bed properly so they meet the 2-38 requirements or at least the FDA entrapment guidelines that were taken from the 2-38 or the new 2-52, which takes effect in two years.”

Kramer further underscores this issue by pointing out that CNN did an article called, “Killer Beds,” which talked about DME dealers not sizing the mattress properly to their beds.

“It is a point of emphasis at the FDA with the Hospital Bed Safety Working Group,” says Kramer. “Dealers can buy a ‘go, no-go’ kit to test the measurements. For a dealer to not follow well-established requirements is inviting triple damages and multi-million dollar lawsuits.”

The FDA oversees the medical bed market in the U.S. and OSHA has jurisdiction with medical beds in public facilities.

“The IEC 60601-2-38 is FDA’s and OSHA’s testing standard for electric hospital beds,” says Kramer. “Currently homecare beds do not need to be tested to the 2-38. Unfortunately, manufacturers or distributors can set any testing criteria they want to establish equivalency to place their bed on the market. Because they do not test to the 2-38 there are large recalls for beds breaking and fires. In two years all new medical beds will be required to be tested to the new IEC60601-2-52 medical bed standard.”

Quality bed manufacturers have their beds certified to the U.S. bed standard 2-38 by an OSHA Nationally Recognized Testing Laboratory (NRTL), says Kramer. Examples of NRTLs include UL, ETL, TUV, and CSA. For the medical bed to be certified the bed must have a label on the bed listing the NRTL and the U.S. Recognized Consensus Standard, the IEC60601-2-38 or in the future the IEC 60601-2-52.These are the only two standards specifically designed for medical beds, says Kramer.

“Be aware that there are bed manufactures and distributors claiming certification to other meaningless general standards,” says Kramer. “Some claim certification to the IEC 60601-1 because their motors have been tested and they take the motor certification off the motor and place it on the bed. This is illegal. A medical bed must be certified to the particular bed standard and not to a component standard.”

In summary, regarding bed safety issues for providers, patients and caregivers, the side rail and mattress requirements are most important.

“For example the 2-38 requires 8.66 inches or more from the top of the mattress to the top of the side rail,” says Kramer. “People are dying because the bed has an air mattress that is much taller or a fl otation pad is placed on top of the mattress. This is especially important in bariatrics. Consider a 500-pound or 600-pound person with a 60-inch or 72-inch girth. A three- to five-inch side rail height is not even a speed bump. This causes three types of problems. First the person rolls out of bed. The fall causes serious injury or death. Second, the person roles on top of the rail, his or her weight causes the bed to tip over on top of the person and he or she dies. Three, the person roles on top of the side rail, and his or her weight causes the side rail to break or collapse, causing the person to fall, possibly on top of the broken rail.”

So how can a patient or provider make sure a bed is as safe as possible? Kramer offers these tips:

• Find out if the bed it certified to the 2-38.
• Make sure to keep the bed and mattress as one unified product design that meets the U.S requirements.
• Make sure you place the appropriate type of bed for the location. Never place a home care bed in a public facility, such as an assistive living or nursing home. It is a violation of federal regulations.
• Check the bed for maintenance and safety issues.
• Ask if the bed is appropriate for the user. Just because a bed claims to support a 600-pound person does not make it medically appropriate for every 600 lb. person. A bariatric person that is 5-feet tall and 600 pounds will require a much wider bed so they can be rolled over for nursing care and hygiene.
• Use the proper mattress. Most bariatric patients are predisposed to decubitus ulcers. These obese patients have very delicate skin that is under pressure and tears easily.
• Maceration from sweating is a major problem because of poor circulation. Alternating pressure, low air loss mattresses are often recommended.
• Consider the caregiver. A trapeze to help boost the patient back up in bed may help the caregiver to transport the patient.

Is the location appropriate for the bed? People have died from fires because the bed was attached to an extension cord that the manufacturer’s warnings specifically stated not to use.

Perform proper in-service and setup. Inadequate training can lead to injuries to users. People have died because the bed was not set up properly, collapsed or caught fire.

This article originally appeared in the September 2010 issue of HME Business.