Practical Guides #6: Raising chairs, settees and beds.

This blog post contains:

• Why OT’s raise chairs and beds
• How to decide what equipment to use
• How high to raise a chair or bed
• How to fit chair or bed raisers
• Extra equipment you may need to order
• Types of chairs/beds that you can’t raise
• visual configurations of multipurpose raisers

N.B. This is intended a rough guide only and should only be used in conjunction with a qualified OT. If you are not an OT or competent therapy assistant do not use unless supervised by a qualified person.

All patients should be assessed with the equipment before issuing.

If you’re not an OT or aspiring OT and you’re reading this I would always advise getting professional assistance when purchasing equipment. I’ve known people pay privately for unsuitable aids and expensive mistakes can be made. People can use equipment incorrectly and put themselves at risk.

This guide is intended for OT students and is not a replacement for seeking professional advice.

Hello readers, My little blog is celebrating it’s 3 year anniversary today! This made me realise that I have not posted much of late. There’s been a lot to learn on this rotation. It’s only now, 3 months on, I feel that I can consolidate what I have learned.

One of the things that stumped me when I first arrived on this community rotation was raising chairs and beds. I was unsure of what equipment I needed to order. How many sets of raisers I needed. If I needed to order any additional equipment like blocks, clip-on’s and wing nuts. And, most important of all, how do I actually fit these contraptions onto the furniture.

I’d been saved from raising furniture in my previous rotations as our amazing therapy assistants used to do it for us. I felt I needed to learn to do it myself as one day I may have a student or a new member of staff and they may be looking to me to show them.

Why do we raise furniture?

We raise chairs, sofas and beds for 2 reasons:

Making a piece of furniture higher puts the hips above the knees and makes it easier to stand from sitting. Again that’s why we raise toilet seats (see toileting equipment). Although it must be noted in some instances if you raise the bed it can make it harder for the person to swing their leg into bed as they have to be able to lift their leg higher.

Hip precautions are precautionary measures that a person must take following a total hip replacement or hemiarthroplasty. When people are following ‘hip precautions’ chairs and beds (and toilet seats, commodes and perching stools) must be at a certain height to avoid hip dislocation. This height is usually a person’s popliteal height plus 2 inches.

Popliteal height is the distance from the inside of the patients knee to the floor when seated, see the diagram above. Hips must be above knees to avoid the hips being less than a 90 degree angle. For more information on hip precautions and OT, I found this guide very helpful. https://www.stockport.nhs.uk/documents/PIL/47554_TG75.pdf

How do I decide what equipment to use?

In our service, we mainly use one of two types of raisers. MPR’s and adjustable linked raisers. There are others but I’m keeping it simple and nine times out of ten it is these ones that we use.

Multipurpose raisers (MPR’s)

If your chair or bed has castors or block feet, then MPR’s are your best bet.

Adjustable linked chair or bed raisers

You’ll often hear people call the adjustable linked chair raiser “Langham’s”.

adjustable linked chair raisers (or “Langham’s”)

Adjustable Linked bed raisers. Note the blocks in the middle which give furniture additional height if needed

If your chair or bed has thin, long legs, such as the ones on hospital high backed chairs or Queen Anne style legs then the adjustable chair or bed raisers will be your go-to. These have taller, narrower wells than the MPR’s so these types of legs are less likely to move around in the wells. On the bed raisers, make sure the dark grey bits that stick out are underneath the bed so people don’t trip on them.

Queen Anne style chair

Not every chair or sofa legs will fit a raiser, for example; big square wooden legs on sofas that do not fit into the well of the MPR. I have been told, however, the legs can be removed by unscrewing them and then MPR’s can be used. I’ve never done this myself so can’t really go into much detail on this. Check to see whether the service user has an alternative chair can be used or whether a high backed chair can be loaned from equipment stores.

These types of leg usually can’t be raised

Often these can’t be raised as they are too big to fit into the wells of the MPR

Here are two flow charts to help you decide what is the right raiser to choose. Reproduced with kind permission from the lovely people at Langham.

As sofas are a communal piece of furniture, the Langham guide to raising furniture to raising furniture advises to only raise a sofa if there are no other alternatives,. For example; if you adjust the height of the sofa for a 5 ft 11 man, it doesn’t make the sofa the right height for his 5 ft 2 wife. Also it’s easier to stand from a chair as there are two arms to push up from, on a sofa you’ll only have one arm to push up from (unless you’ve got very long arms). However in reality there are always other factors that influence your clinical judgement, like if that person lives on their own or they are insistent they will not sit anywhere else in the house.

Also it’s better for your back to raise chairs rather than sofas as there is less load to lift. Usually, we are only permitted to raise one piece of seating furniture, if people want chair and sofa raised they will have to pay for one privately to be raised.

How high do I raise the furniture?

The maximum you can raise a piece of furniture is 6 inches high. The Langham guide says the chair or sofas should be raised to popliteal height. So you need to measure the height of the bed or sofa when compressed (when you’re sat on it) and the patient’s popliteal height. The difference between the furniture height and the popliteal height is how much you need to raise it. So say, my patient’s popliteal height is 16 inches and the chair was 14 inches high when compressed, then I need to raise the chair by 2 inches. Sometimes people may struggle standing at popliteal height so a general guide is adding up to 2 inches to the height. If they can get off a chair in hospital comfortably, it may be an idea to measure the height of that chair as a quick guide.

Remember those following hip precautions it will always be raising the chair or bed to popliteal height plus 2 inches.

Patient’s must be able to get their feet flat on the floor when they are sat in the chair or on the edge of the bed otherwise it’s hard for them to stand. Also if someone is sitting in a chair all the time and their feet don’t touch the floor they can start to get pins and needles in their feet.

The MPR units by themselves raise the furniture 3 inches high and are raised higher by adding Clip-on’s. Each clip on raises the furniture by three quarters of an inch. If you order a pack, you’ll get 12 clip-on’s. A maximum of 4 can be added to the base of each well which takes the raise to 6 inches.

clip-ons

For the adjustable linked bed and chair raisers, the height is raised by adding blocks which come with the raisers. If you don’t put any blocks in the chair raisers they raise the chair 50mm (2”) high, and 75mm (3”) high if you add one block to the base of the well, and 100mm (4”)high with 2 blocks added to the base of the well. The maximum amount of blocks you can add to the bottom of the well is 2. Although you can stick one down the side to stop the leg moving about in the well.

Bed raisers raise beds 63mm (2 1/2”) high with no blocks, 88mm (3 1/2”) high with 1 block, and 113mm (4 1/2”) with 2 blocks added to the base of the well.

What other bits and bobs do I need to order?

So each leg or castor that touches the ground is load bearing so must be placed in a well of a raising unit. So, as a rule of thumb, for every leg or castor that you have you will need to put it in a well of a raiser. Apart from if there are two castors are right next to each other as they can be placed in the same well.

MPR’s

MPR’s come in attached pairs (units) secured by a wing nut, bolt and washer (for the remainder of the article, I’ll just call them wing nuts for ease) in the middle. So for a 4 castor chair, you need to order 2 pairs of MPR’s.

Spreader bars

You’ll also need to work out whether you need a spreader bar for what you are raising. Spreader bars are used to link units together and give stability to the raiser units. Spreader bars can also be used to extend the length of the MPR units if you’re raising a bed. The spreader bars come in 2 lengths standard (19”) and extra long (42”). If you’re ordering the extra long spreader bar, you’ll need to order some wing nuts with it as it doesn’t come with any. Wing nuts secure the MPR’s with the spreader bar and hold the bits together. Spreader bars are only used for chairs, 2 seater settees and beds.

extra long spreader bar

standard spreader bar with wing nut

The Langham Guide will tell you what combination of MPR’s, spreader bars and clip ons to order for armchairs, 2 and 3 seater sofas, double and single beds. I’ve drawn some normal configurations for you to help you visualise, see at the bottom of the post.

Don’t forget to order a box of clip-on’s if you need to raise the furniture more than 3”.

Linked bed and chair raisers

These come in packs of 2 pairs.

Make sure you order the right width of bed raiser . The standard size raiser is designed to fit beds with a width of 914mm (36”) to 1460mm (57 1/2”). So from standard single bed up to double bed size. The short bed raising units fits small single size beds with a width of 610mm (24”) to 890mm (35”).

Blocks

Blocks already come with the adjustable linked chair and bed raisers, so you don’t need to order any more, although it’s always handy to have some in your home visit bag. .

How do I fit it?

Raising settees and beds should always be done as a “double” visit (i.e. two people do it). Get ready to get dusty as you crawl underneath beds and sofas. It’s hard work! Make sure you observe the weight limits for the equipment; this includes patient + furniture.

• If a bed has drawers, these need to be emptied before you attempt a raise
• Loosely screw your configuration together. Spreader bars go East to West, not North to South. Here are some common configurations. Put your clip -ons on the base of the wells if needed.
• 
• One of you lifts the furniture and the other positions the raisers so that when the bed/chair is put down the legs or castors will fit in the well. You will need to guide them into position. This may take a number of attempts as you go round putting all the wells in place.
• Tighten the wing nuts up once the furnture’s legs or castors are in the wells.
• Castors/legs should rest at the front of the well so go round the furniture and give each well a kick at the front so the castor comes to the front of the well. Make sure no part of the unit protrudes from the bed as could be a trip hazard.
• Once the furniture has been raised, it shouldn’t be moved.

What you can’t raise with these raisers

• risers and recliners
• sofa beds
• corner settees
• Ottoman beds (where the mattress lifts up and you can store stuff in the base)
• chaise longues

Post Script

After writing this post, I went on a free training session at our hospital on raising chairs and beds delivered by the people from Langham and it was really good. You can contact them on enquiries@gordonellis.co.uk if your workplace would like one too. If you are not sure whether a chair or bed leg could be raised, you can email them a picture or ring them up for help.

Click on this link to see more details on the Langham chair and bed raising training session: Training Schedule(1)

On the training session they were promoting a new raiser that they are trying to get people to use called the ‘Sure grip’. I’ve not used it yet, but will do if I get the opportunity.

Sure Grip

Sure Grip

This raiser can be used on beds, chairs and sofas. They are independent units (so they are not linked together like the other equipment I’ve talked about) but you can get spreader bars for them if needed to make the chair more stable, especially if someone flops into their chair. They have a great function where you can twist the unit to raise the height and it has markings on it so you can see how high you are raising it. Brilliant. It takes legs or castors and has slip resistant bottom, which is handy so it doesn’t slip on laminate flooring. They come in packs of 4 and have adaptors for block leg furniture. You can also use them in conjuction with MPR’s, especially useful for those beds that have that odd leg in the middle of the bed base.

So that’s this month’s guide, hope you find it useful. I certainly have! As mentioned before I’m still getting my head around it but writing this post really helped me reflect and consolidate my learning. There are other different types of raising units but thought I would keep it simple and stick to the main ones. I would really recommed giving the Langham guide mentioned a read and going on the training.

See you soon,

Helen