40 Steps to Making a Bed... And Other Lessons in Caregiving

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One recent morning, a clinical manager who helps train aides at the home care agency where I work, shared with me a lighthearted comment that she'd overheard from one of her newest trainees. "Who knew making a bed was so complex?" the aide had said. That got me thinking — and counting.

I stopped in on a training session for our home health aides later that day to count the steps we teach in making a bed for a patient who is bed-bound — there are 40 separate steps. Making up the bed begins with offering a bedpan and includes a sponge bath and a change of clothes, so both the patient and the bedsheets start out fresh and clean with every change. When you stop to think about seemingly common, everyday tasks like this, it's surprising sometimes to realize how just how involved they can be.

Each of the steps, many of which can be done by a trained aide in seconds or minutes, is necessary to ensure safety, infection control, privacy and overall dignity for a client who is in a very vulnerable position. Many of our clients are unable to take care of themselves without assistance, and like anyone who depends on others to manage personal care, they need focused attention from a caregiver who understands exactly what needs to be done.

A task so simple, mundane — and essential — as making a bed for someone who cannot do it themselves strikes me as a great lens through which to view caring for others.

As our population ages and those with chronic conditions choose to remain at home, more and more Americans are being called to care for loved ones at home. By 2050, the number of Americans who need long-term care is expected to nearly double, according to a recent National Health Statistics Report (NHSR) from the Centers for Disease Control and Prevention. So if you are caring for someone who is recovering from illness or injury, or suffering from a chronic, debilitating condition, you are hardly alone.

If you're caring for someone at home, here are six important things to keep in mind — all of which can be found in the quotidian ritual of making a bed. (Your process may not require all 40 steps — some of which involve offering the patient a bedpan, sponge bathing and replacing protective covers under the bedsheets — but it surely takes more steps than we tend to think about as we hurriedly make our own beds in the morning.)

1. Be Prepared
As with so many aspects of caregiving, making a bed begins with being prepared. Gather all necessary instruments and elements in one place and within easy reach. Make sure you have clean clothes, fresh bed sheets, protective covers, gloves (including several changes), clean washcloths and towels and any lotion or powder you plan to use. Remember, you have a vulnerable person whom you cannot just leave in the middle of things to retrieve something you forgot.

I recommend keeping a checklist, particularly if you are new to caregiving, in a new environment or caring for a new person. If you do have to step away, make sure the patient or loved one is in a safe position on the bed, with either the wall or bedrails for protection.

2. Communicate
It's not by happenstance that my agency begins its 114 hours of home health aide training with a full day of classes on communication. Communication is critical to caregiving. It alleviates misunderstanding, fosters trust and encourages engagement — all vital to the relationship between caregiver and client, or loved one.

When it comes to the 40-step bedmaking ritual, talk the loved one or patient through it, explaining what you are doing, what you'll do next, and why. "I'm putting on gloves now so I don't spread any germs." Or, "I'm going to remove the top sheet, but I'll leave you as covered as possible." Home health aides are also trained to communicate with family members who are in the room and may be wondering: Why is she wearing gloves? Or, Why is this taking so long?

During training sessions, we make sure to communicate to trainees the importance of following what might seem like a lot of steps in making a bed. We want them to understand the rationale behind each step, so they can maximize safety and comfort, and be accountable for their work.

3. Safety First
A good two dozen steps in the bed-making routine are to ensure safety and infection control. Aides use and change gloves frequently, to protect the vulnerable patient. For any caregiver, wash hands and change gloves after coming in contact with something potentially unclean, such as a bedpan or unchanged sheet.

Keep in mind that anything that comes into contact with the patient is potentially contaminating. When changing a sheet for example, this means that the side that has not come into contact with the patient is considered the unclean side. When removing it, be sure to fold or roll the underside away from the patient.

Similarly, for a sponge bath, wash the far side of the patient first, so you don't have to reach across the already sponged side of the face or body. And always begin a sponge bath with the eyes, which are especially vulnerable to contamination.

When you move from one side of the bed to the other, always make sure the patient or loved one is protected, whether by your body, the wall or a bed rail. Further along, when you tuck in the top sheet, keep it loose enough to avoid compressing the patient's limbs.

4. Respect Dignity
In the throes of the most delicate or stressful patient care, we can lose sight of what I view as one of a caregiver's most essential responsibilities: to preserve dignity. This is so vital to a loved one who is facing a precipitous loss of independence and privacy. To maintain privacy, don't uncover the patient or loved one all at once. Keep him or her covered with a sheet except for the area you're working on, whether bathing, offering a bed pan, changing clothes or changing the bed.

A friend of mine recently told me about visiting her aunt in a skilled nursing facility and being horrified to find her in bed with no shirt and with a sheet up to her waist. The nurse rushed into the room, explaining that she was in the process of changing my friend's aunt when she was called away for a moment. Not only did the nurse jeopardize the patient's safety and comfort by rushing away, she undermined her dignity by not thinking to cover her.

5. Encourage Participation
A little goes a long way. Ask the patient or loved one, if able, to hold the top cuff of the new sheet as you tuck it in at the foot of the bed. This helps keep a bed-bound patient alert and active. Encourage participation, too (again, if able), during a sponge bath; it provides a little exercise.

6. Remain Flexible — And In the Moment
After those 40 steps are done, the bed is made and your loved one is clean and changed, you may have to do it all again the next day. Or later that afternoon. This is one of the most difficult, and fundamental, lessons of being a caregiver.

You learn to measure progress differently. Try to live in the moment, taking a measure of comfort that your loved one is safe and comfortable right now. Take satisfaction in a job well done, even if that job is "only" making the bed. It's a job that is absolutely essential to your loved one living safely and comfortably at home. And it's a job that would not have been done without you.

Marki Flannery has been with Partners in Carefor more than 30 years, since its inception in 1983. She was appointed vice president in 1990 and president in 1996. Under her guidance, Partners in Care has become the largest licensed home care services agency in the greater New York City area. A frequent presenter at statewide and national conferences, Ms. Flannery has served in a leadership capacity for various industry organizations, including president of the New York City Chapter of the New York State Association of Health Care Providers from 1991 to 1993. She has also published articles in industry journals, such asCaring Magazine and National Association for Healthcare Quality. She is a blogger for The Huffington Postwhere this blog originally appeared.