Palliative and End-of-Life Comfort at Home: How to Turn in Bed Without Exhausting Everyone

Comfort-Focused Turning at End of Life

At end of life, turning in bed is about comfort and dignity, not “keeping mobile” or staying strong. Movements that used to be simple can now cause pain spikes, breathlessness, nausea or sheer exhaustion, even if they are very small.

Palliative situations often involve extreme fatigue, fragile skin, medical equipment (catheters, oxygen, syringe drivers), and complex pain where even light touch can hurt. The aim is the least movement needed for comfort, done in the gentlest way possible.

Many families describe the same pattern: the person dreads being turned because it always feels like a big, painful roll, and the helper is scared of hurting them and worn out from doing all the work. The methods below are designed to share the load, use gravity, and turn each move into a quiet slide rather than a heave.

Why Turning Is Different at End of Life

Palliative and end-of-life turning is different from general back pain or simple stiffness in several ways:

• Very limited energy – even a small effort can leave the person wiped out, nauseated or more breathless.
• Complex, unpredictable pain – from cancer, bone metastases, pressure areas or nerve pain, not just a sore muscle.
• Fragile skin and tissue – weight loss, medication and long bed rest make skin tears and pressure injuries more likely.
• Breathlessness and anxiety – lying flat or being rolled quickly can trigger panic or air hunger.
• Lines and equipment – catheters, oxygen tubing, syringe drivers and dressings must be protected during every turn.

Because of this, end-of-life turning focuses on tiny segments, supporting the whole body, and often accepting a “half-turn” if that is comfortable enough.

Turning in Bed for Comfort

Why Turning Feels So Hard

For many people at end of life, the hardest part of turning is simply getting started. The shoulders and hips feel glued to the mattress, and any attempt to roll feels like dragging a heavy, painful body across sandpaper.

There may be several pain sources at once: ribs that hurt with each breath, a sacrum at risk of pressure injury, bony hips, or metastases in the spine or pelvis. Even a small twist can feel unsafe. Deep fatigue means the person often cannot “help” much, even if they want to.

Helpers are often frightened of causing harm, especially if the person is very thin, very heavy, or has fragile bones. They hesitate, then push harder at the last moment, which can cause a sharp jolt.

What Usually Goes Wrong in a Turn

• Trying for a big roll – aiming for full side-lying when a gentle tilt would be enough.
• Helper doing all the work with their arms – leading to big pulls on the shoulder or hip and strain for the helper.
• Top and bottom halves moving separately – shoulders move, pelvis lags, causing a painful twist at the waist.
• Hitting a “sticking point” on the mattress – the body moves a little, then the hips catch and need a hard yank.
• Lines and tubes getting caught – catheters or oxygen tubing are not positioned first, so they tug at the worst moment.

The most difficult moment is often when the shoulders have started to move but the pelvis and lower ribs are still stuck in the mattress. Without a low-friction layer, the helper may have to haul the hips across the sheet, causing a pain spike and sometimes skin shear.

Step-by-Step: A Gentle Small Turn with One Helper

This method is for one helper turning a person a little towards their side for comfort. It assumes the person can give small amounts of help, like bending a knee or holding a pillow, but it can be adapted if they cannot.

1. Prepare the Space and Equipment

Before you touch the person, set things up so you don’t have to stop halfway.

• Check where lines, tubes and drains are. Make sure there is enough slack on the side you are turning towards.
• Have 2–3 pillows ready: one for between the knees, one for behind the back, and one for the arms if needed.
• If using a Snoozle Slide Sheet, place it under the shoulders, back and hips. Keep it fully on the mattress, not under the head only and not hanging off the bed.

2. Explain and Agree a Stop Signal

Knowing what will happen can reduce fear and muscle tension.

• Tell the person: “We’ll do a small tilt towards your left, just enough to ease the pressure. We’ll stop as soon as it feels okay enough.”
• Agree on a simple signal to stop immediately, such as saying “stop” or raising a hand if they can.

3. Start the Turn from the Legs and Pelvis

Starting at the pelvis helps the body move as one piece and avoids twisting.

• Ask the person, if they can, to bend the knee on the side they are turning towards.
• If they cannot, gently bend that knee for them, supporting under the knee and ankle.
• Place a pillow between the knees to protect bony knees and help the pelvis roll as a unit.
• With a Snoozle under the hips, you will usually feel the pelvis begin to slide with less effort, instead of sticking then jolting.

4. Use a Small Rock to Move the Trunk as a Unit

A gentle rocking motion helps “unstick” the body from the mattress without a big shove.

• Stand facing the person’s trunk, feet apart for balance.
• Place one forearm gently across their upper trunk (not on the neck) and the other hand on the pelvis area. Keep your hands broad and soft.
• Ask them to take a slow breath out. As they breathe out, gently rock their body a few centimetres towards you, then back, once or twice.
• On the next out-breath, use the same rock but let the body roll a little further towards you, aiming for a slight tilt, not a full side-lying position.

5. Let the Snoozle Soften the “Sticking Point”

This is where a slide sheet can make the biggest difference.

• With Snoozle under the back and hips, that usual stuck moment when the pelvis has to cross the sheet becomes smoother.
• Instead of hauling the hip across the mattress, the pelvis can glide with your gentle rock.
• Most helpers find they can keep their elbows close to their body and use their body weight to guide the turn, rather than pulling hard with their arms.

6. Support the New Position and Stop Early

Once you reach “good enough”, hold it there and don’t chase a perfect pose.

• As soon as you reach a slight tilt, slide a pillow or folded blanket snugly against their back to hold them there.
• You can also place a small pillow under the upper arm or hand for comfort.
• Check their face, breathing and any lines or tubes. If they look more relaxed and say the position is okay or better, stop there. You do not need a textbook side-lying position.
• If they feel worse, use the same gentle rocking to glide them a little back towards their previous position.

Moving from Lying Towards Sitting on the Edge of the Bed

Why Lying-to-Sitting Is So Demanding

Moving from lying to sitting is often much harder at end of life than with simple back pain. It can cause:

• Sudden drops in blood pressure – leading to dizziness, faintness or “grey-out”.
• Severe breathlessness – especially in advanced heart or lung disease.
• Exhaustion after one attempt – you may only have one realistic chance to try in a given part of the day.

For some people, sitting on the edge of the bed is no longer a daily goal. The decision to attempt it should be based on comfort and wishes, not on an idea that they “should” sit up. Sometimes a slight head-up tilt with pillows or a profiling bed is enough.

Common Problems When Sitting Up

• Trying to sit up in one big movement – a “crunch” or being pulled up by the arms, causing pain and dizziness.
• No halfway pause – rolling straight from flat to sitting without a side-lying rest overwhelms the heart and lungs.
• Legs left behind – the upper body lifts while legs stay on the bed, twisting the lower back and pelvis.
• Using bedcovers as handles – pulling on blankets or sheets is unsafe and ineffective.

The hardest moment is usually when the upper body starts to lift and the legs are just beginning to swing down. The pelvis is half on the bed, half turning, and the person may feel like they are falling. Without a low-friction layer, the pelvis can catch on the mattress and the helper has to tug harder at the shoulders.

Step-by-Step: From Lying to Sitting (If It Is Still a Goal)

Only use this if the person wants to sit up and their nurse or doctor has said it is safe.

1. Decide if Today Is a “Sitting Day”

• Ask how they are feeling. If they are very breathless at rest, extremely drowsy, or just had strong medication, it may be better to adjust pillows instead.
• Check any advice from the palliative team about blood pressure, fractures or movement restrictions.

2. Prepare the Bed and Area

• If you have an adjustable bed, raise the head a little so you are not starting from fully flat.
• Clear clutter from the bedside. Have a sturdy chair or you as a stable support on the side they will sit.
• If using Snoozle, place it under the shoulders, back and hips, fully on the mattress, not hanging over the edge.

3. First Roll Gently into Side-Lying

• Use the earlier turning method to roll them gently onto their side, facing the side where they will sit up.
• Place a pillow between their knees and keep one hand on their shoulder or upper trunk, one on the pelvis for reassurance.
• Pause here for 20–30 seconds, watching breathing and asking if they feel okay. This pause helps avoid sudden drops in blood pressure.

4. Bring the Legs Off the Bed First

• Support under their knees and ankles and slowly guide both legs together towards the edge of the bed.
• Let gravity help. As their lower legs begin to hang off the bed, their pelvis will naturally want to roll towards sitting.
• With Snoozle under the hips, this pivot is smoother: the pelvis can glide a little as the legs lower, instead of catching and forcing a twist at the waist.

5. Guide the Trunk Up in a “Log Roll”

• As the legs come down, keep one hand or forearm across their upper trunk and the other at the pelvis.
• If they can, ask them to gently push with their top hand into the mattress as you guide them up.
• On a slow breath out, guide shoulders and pelvis together into sitting, like a log roll, rather than pulling just at the shoulders.
• Try to keep their nose roughly over their belly button to avoid twisting.

6. Stabilise and Reassess

• Once sitting, keep a hand at their back or shoulder until you are sure they feel steady.
• Place pillows or the headboard behind them, and make sure their feet are supported on the floor or a stool.
• Watch for dizziness, greyness, sweating or sudden breathlessness. If these appear, gently reverse the process to bring them back to lying.

Using a Snoozle Slide Sheet Safely at Home

Snoozle is a low-friction slide sheet designed for home use on a normal mattress. It is not a lifting device and must not be used to drag someone between bed and chair or to suspend anyone off the bed.

Its role is to reduce friction so that small, gentle movements are enough. In palliative care, this often means:

• Less drag on fragile skin – which may reduce the risk of skin tears and shear over bony areas.
• Less effort for the helper – so you can guide rather than heave, protecting your own back.
• Smoother pivots – especially at the pelvis when turning or moving towards sitting.

Many families notice an “aha” moment: previously, they would get stuck halfway through a turn when the hips had to cross the mattress and they had to pull hard on the shoulder. With Snoozle under the back and hips, that sticking point often becomes a controlled glide, so the body can roll as one unit with a steady, gentle push instead of a painful yank.

General Comfort Strategies Around Movement

Because palliative needs are different from general back pain, it helps to think not just about how to move, but whether and how much to move.

• Think in micro-movements – a 5–10 degree tilt or a small shift of the pelvis can sometimes relieve pressure as well as a big roll.
• Use the breath – timing small movements with the person’s out-breath often reduces pain and anxiety.
• Coordinate with pain medication – if possible, plan larger moves (like a full turn or sitting up) for 30–60 minutes after pain medication, when it is working best.
• Respect “no” – if a movement is consistently unbearable despite good technique and medication, discuss alternatives with the palliative care team.

Many people try to “get it over with” and rush through a big turn, which can leave everyone shaken and reluctant to try again. Slowing down and accepting smaller, more frequent, gentler adjustments often leads to better comfort and less fear.

When to Stop and Seek Professional Help

Gentle turning is usually safe and important for comfort, but there are times to pause and get advice.

• New or sudden, severe pain during movement that does not settle quickly when you stop.
• New weakness, numbness, or inability to move arms or legs compared with earlier in the day.
• Severe breathlessness, chest pain, or collapse when trying to sit up.
• Lines, tubes or catheters that seem dislodged, leaking, or painful after a turn.
• Skin that looks broken, blistered, very red, purple, or blackened over bony areas.

If you are unsure, stop the movement, return to the last comfortable position if you can, and contact your community nurse, palliative care team, or emergency services according to the plan you have been given.

Bringing It All Together

Moving at end of life is not about pushing through or “keeping going”. It is about using the smallest, smoothest movement to relieve pressure, ease breathing and support dignity.

By understanding where turns usually get stuck, using gravity and the person’s breath, and adding a low-friction layer like Snoozle under the hips and shoulders, you can often turn what used to be a dreaded, exhausting event into a quieter, more manageable part of care.

You do not have to get it perfect. Aim for “a bit better” rather than “ideal”, and adjust as you both learn what works best on that particular day.

Related comfort guides

• Effortless Bed Mobility for MS: Using Momentum and Snoozle to Move Without Pain or Fatigue
• Effortless Bed Mobility for Those Living Alone with Pain and Low Energy: Practical Bedroom Planning and Movement Strategies
• Effortless Bed Mobility with Knee Osteoarthritis: How to Move and Get Up Without Aggravating Pain