Guide: Helping the Elderly out of Bed

How to Help an Elderly Person Out of Bed

When you’re a caregiver, the most physically challenging part of the job is what I like to call “hands-on caregiving”. This is the part of caregiving that requires physically assisting the recipient with their mobility or activities of daily living like bathing and such.

“Bed mobility”, as we call it in the business, is a major area of hands-on caregiving. It comes into play when caregivers give “bed baths” or when changing clothes. 

Helping an elderly person into, out of, or simply re-positioning them in the bed can be daunting. Especially if that senior citizen is overweight or has significant weakness or debility, like someone who has had a stroke. Having equipment like bed rails or steps to help the elderly into bed can be useful when they are available, but this blog post will assume neither are on hand.

In addition to the care recipient’s specific condition, there is the actual bed that can make the job difficult. It can be too large, too high (read how to know the proper bed height for seniors), too low, or even too soft. Any one of these “environmental” factors can make getting a person into or out of bed harder (or easier for that matter).

But, in spite of all of the above, this guide will cover the area of “bed mobility” that we as caregivers and care recipients have direct control over. In particular, 1) how the elder care recipient is positioned and 2) how we chose to help them move. And this is the beauty of this approach. All humans move in the same way and so getting them into the “right” positions is simply a natural act and is not new to them. This is real help for the elderly when getting out of bed.

Before we get into the meat of it, there are some things to keep in mind as you’re working on getting an elderly person into or out of bed:

1. Keep in mind that older persons have been getting into and out of bed for a longer time than most of their caregivers have been alive. They aren’t newborns. They “know” how to do it. But there may be other factors such as pain, anxiety, weakness, and “learned helplessness” that may be at play. They may just need to be given permission or shown an easier way.
2. The caregiver frequently has to “coach” the care recipient through the movements until they are comfortable with the technique and process.
3. Keep in mind, the more of the effort that the care recipient learns to do, the less the caregiver needs to do. It’s in everybody’s interest that, when safely possible, the care recipient is able to get into and out of bed by themselves.
4. Caregiver’s need to look for the “easiest way” to help someone accomplish the task.

How to Help the Elderly Out of Bed: The Sequence

Step 1. Start with the care recipient lying down on their back (some may already be lying on their side, but, we’ll start at the beginning).

Step 2. As much as possible, have them bend their knees and place their feet flat on the bed. This is what we call “hooklying” (I really don’t understand why or how it got this name). Some would leave the legs straight and simply cross one over the other when rolling. But, hooklying is actually superior to this because it prepares us for the next position in the sequence, and it allows the caregiver to assist easier.

Step 3. Have the person roll toward the edge of the bed that they will exit from. They “log roll”. This means that “nose, navel, and knees” all move at the same time and at the same speed.
To initiate the roll, have the CR initiate the motion by reaching across their body with their “far” arm, while at the same time “flopping” their bent legs in the same direction.
When done correctly, they will end up in side lying in a fetal position. They are safely supported and each of you can rest at this time if needed and plan the next step in the sequence. (Their knees should be slightly off the edge of, but their feet firmly on the bed at this stage.)

Step 4. Your care recipient should be lying on their side with their lower arm tucked under them. Now, have them place their top (what was the “far” hand previously) hand on the bed in front of their belly. They will use their top hand and lower elbow to push up from the bed after the next position in the sequence.

Step 5. Have them bring their feet forward off the bed and let them dangle toward the floor while at the same time, pushing up with both upper limbs. This portion can be done easier if a bed rail is available. This movement should bring them into a sitting position on the edge of the bed.

Step 6. Steady them with one/both of your hands. Help them scoot to the edge so that their feet rest on the ground as long as the bed is not too high for them and there is low chance of them sliding off the edge.

How to Help the Elderly Get Into Bed

Helping an older person get into bed is very close to the reverse of helping them out, but it has a few more considerations than helping get them out. But, just keep in mind that all you need to do is help them move through a series of positions in the proper sequence and it will be easier than you might expect.

One consideration is the height of the bed. I know that I previously classified this as an “environmental” factor that you may or may not have control over, but it is important, because getting “into” bed can be more of a challenge than getting out. Especially when a person may be older, in pain, or physically weakened.

In a perfect world, for a person to get into bed easily, the height should be just above the top level of their knee. At this height, when a person sits on the bed, their feet will rest on the floor and not dangle. Plus, at this height, they can easily sit on the edge of the bed, but be far enough into the bed that they feel secure and will eventually end up in a good position in the bed. 

In case where the bed is higher than the top of the knees, having them stand on a riser will usually help get them where they need to be. What I have found works best is an “aerobic step” rather than a common step stool. You may remember the aerobic step from the “step aerobic” fitness craze in the 80s and 90s (yes they are still out there being used). I like the aerobic step because they are sturdy, have a large footprint that allows for both feet to rest on top without the care recipient feeling unsteady. Plus, most aerobic steps will come with adjustable heights to accommodate different heights that may be needed. 

The second consideration is where your senior places their bottom on the bed. If it’s placed too low (which is most common) then once they are lying in bed, they have to be repositioned and pulled up to the head of the bed so that they are in the “right spot”.

In order to avoid this extra work, it’s important that they sit in the proper position and place on the bed before they try to get into bed.To make sure you hit the correct spot, it’s important to draw an imaginary line across the middle of the bed separating the head and foot of the bed. Then have your elder sit, placing their bottom on the head board side of that imaginary line. When they complete this maneuver, they will be right where they are supposed to be.

The next consideration actually takes place when they are in the side lying position on the bed and we will address it when we come to that part of the sequencing. If you skip this step, your care recipient will end up lying diagonally across the bed which then makes extra work trying to get them into the right position.

Help an Elderly Person Into Bed: The Sequence

Step 1. Have the person position themselves properly with the backs of both legs touching the bed prior to sitting. Making sure that when they sit, they will hit the target on the head of the bed side of the imaginary line across the bed. Then sit down on the bed as far back as they can.

Step 2. Once sitting on the edge of the bed, using the arm closest to the foot of the bed, reach across the front of the body and start to lean toward the head of the bed controlling the speed with the hand (mentioned above) onto the elbow of the arm closest to the head of the bed.
I like to tell people to “rest your ear on the pillow” as they descend toward the bed.

Step 3. Once they are lying on their ear and shoulder, have (help) them lift both legs onto the bed with knees bent. This should put them pretty much into the fetal position again and is fairly comfortable for most people.
At this point that last consideration comes into play. It’s important to get this right so that when a person “rolls” into position from here, they are not cattywampus in the bed. What you’re going to do is head to the foot of the bed and look at the alignment of the shoulders, hips and feet. They should be in a straight line, parallel with the edge of the bed, head to foot. If they are not ( and probably won’t be), have the care recipient scoot their hips back and then help them move their feet back until they are all in a straight line.

Step 4. From here, have (help) them log roll to their backs, nose, navel, and knees. Avoid having them twist their shoulders first as this can take them out of the proper position. They should end up in the “hook lying” position from where they started and now you can have them straighten their legs.  

If you follow along with this guide, there is little need for “lifting someone out of bed”. Using this technique the need for a lot of physical exertion is kept at a minimum and so the potential for injury or straining a muscle is low.

What will even help more is using this technique consistently from day to day and from caregiver to caregiver. The intent is to help the care recipient understand how to do it themselves and how they can participate with the activity rather than either the caregiver or recipient struggling to get into or out of bed.

As I mentioned earlier in this guide, the more work the care recipient does, the less work there is for the caregiver to do. It’s win/win all around.

The video above was shortened from the original slide show presentation. I have included the complete slideshow below. Feel free to let me know how I can improve or clarify in anyway.