Self-turning beds address many problems.

Over the past decade, manufacturers have been developing and perfecting an automatically turning bed that is portable, easily used on standard bed frames, and far less costly than units requiring a specialized frame as well as sleep surface. For nursing homes, that is good news. According to manufacturers, these new beds are nearly maintenance-free, and can cost, when prorated over their lifetime, less than $5 a day.

For the most part, these turning beds consist of an air-support mattress with a constantly inflated bottom cell or cells and/or a top layer of cells arranged either longitudinally or latitudinally. These top cells are automatically inflated and deflated on alternate sides of the bed to "turn" a patient by raising him as much as 30 to 40 degrees on, first, one side and then the other. The motion can be continuous or as infrequent as every couple of hours. A motor, blower, and controller unit hang on the foot of a standard hospital bed or are placed elsewhere in the room.

For nursing homes, these units can offer economic efficiencies on a number of fronts. First there is reduction of decubitus ulcers, the greatest cause of which is lack of body movement. Automatic turning beds help prevent bed sores by selectively reducing capillary pressure through the gradual and continual turning of patients. With the cost of treating a decubitus ulcer case ranging as high as $60,000 a year, the preventive aspects of lateral rotation and low air-loss pressure relief can mean significant cost savings.

The other major area of medical cost control to which turning beds contribute is reduction of pulmonary complications and infections. The human body requires frequent movement in order to maintain proper fluid dynamics in the lungs and other organs and in vascular and lymphatic systems.

The beds can also improve length and quality of sleep by "mimicking" sleep behavior. During sleep our body tells us to change position on average every 11 to 12 minutes. Automatic turning beds and mattresses, with their ability to turn the patient frequently, provide immobile patients with needed movement far more effectively and less intrusively than the current clinical practice of manually turning the patient every couple of hours.

Aside from a reduced risk of pneumonia, nosocomial infections, and pressure ulcers with appropriate use of turning beds, there are other potential clinical benefits: urinary output is increased, pulmonary blood flow is redistributed, and the gastrointestinal tract is stimulated.

Potential administrative benefits include the elimination of staff time spent on turning patients and reduction of lost work time and workers' comp claims due to staffers' back and other injuries. Further, if a patient has a stage 3 or 4 decubitus ulcer, the nursing home is eligible for Medicare reimbursement for the rental cost of an automatic turning bed.

Designers of automatic turning beds have had to overcome a number of hurdles in creating units that meet a nursing home's needs. First, they had to design a machine which would be highly reliable, breakdown-free, and nearly maintenance-free during its rated life. Secondly, the bed had to be of a size to fit comfortably into patient rooms and, ideally, be compatible with existing bed frames. Third, there was the problem of noise and heat generated by the equipment used for turning. Excessively noisy units could be irritating to patients, while those that generate heat which is then transmitted to the sleep surface create skin problems of their own.

Units also have to be simple to set up and operate, with straightforward, uncomplicated controls. And finally, they have to be priced so that nursing homes can afford to purchase, rent, or lease them.

Manufacturers suggest that the automatic turning beds and mattresses finding their way in to the market in 1994 seem to be meeting these criteria. As nursing homes, hospitals and home care providers make more frequent use of these units, their variety and efficiency will continue to grow, if product history is any guide.