Bed-Making When Occupied 

Purpose: 

To change bed linens as needed while the resident is in bed, protecting their privacy and maintaining their comfort during the procedure. 

Procedure: 

1. Preparation: 

• Gather necessary clean linens and a plastic bag for soiled linens. 

• Ensure all supplies are within reach before beginning the procedure. 

2. Initial Steps: 

• Loosen the sheets around the entire bed. 

• Raise the side rail opposite from where you are working. 

• Gently turn the resident towards the raised side rail, placing a pillow between their head and the side rail for comfort and safety. 

3. Removing and Replacing Linens: 

• Roll the soiled draw sheet towards the resident, tucking it behind their back. 

• Roll the soiled bottom sheet towards the resident, tucking it tightly against their back. 

• Unfold the clean bottom sheet and place its center in the center of the mattress. 

• Tuck in the clean sheet along the side of the bed where you are working. 

4. Shifting Resident: 

• Raise the side rail on the side where you have been working. 

• Gently turn the resident towards the side rail with a pillow between their head and the side rail. 

• Move to the opposite side of the bed and lower the side rail. 

• Roll the resident away from the soiled linens and onto the clean side of the bed. 

5. Completing Linen Change: 

• Remove the soiled linens and place them in a plastic bag to prevent contamination. 

• Pull the clean linens towards you and tuck them in, ensuring they are smooth and secure. 

• Finish making the bed by placing top sheets and bedspreads over the resident, ensuring they are comfortable and covered. 

6. Final Steps: 

• Ensure the resident is comfortably positioned. 

• Lower the bed to its lowest position and ensure the call light is within the resident’s reach. 

Safety and Hygiene: 

• If there is no side rail, ensure another staff member is present to assist on the opposite side of the bed. 

• Do not place dirty linens on the floor. 

• Do not bring dirty linens from room to room. 

• Place soiled linens in a plastic bag and transfer them to the designated dirty linen hamper or area. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the bed-making procedure, including the resident’s response, in their medical record. 

• Note any observations related to the resident’s skin condition or comfort. 

• Regularly review and update techniques for bed-making while occupied according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper bed-making procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.