does the top mattress have to be moved so it is slightly staggered?

I did not have to stagger the top mattress at all. The bedcane fits flush once the board is slid between the mattress and box springs.

Is this compatible with a queen-sized tempurpedic adjustable based bed ?

It works fine for one side of our split king bed. Can’t think of any reason it would be any different for one side of a queen size bed. It’s the weight of the bed that holds it in place. Ours is a very tall mattress and the handle sticks up from it so that a person can use it for an assist I sitting up.

Can this be used with a bed that has an elevating head (i.e. Hospital bed)?

no you can't the mattress holds it in place the tie is for if the patient leans against it. soon as the bed lifts it will fall off maybe a differs kind.

what is the inside measurment of the hand hold, minnesota has rules

The top is about 12 or 13 in across that's what they put their hand on to push themselves up

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