Families and Nursing Homes Often Conflict About Bed Rails and Safety
Every time Norma Washington visited her mother in the nursing home she would find the bed rails down. "The reason my mother was there in the first place was she took a fall at home and injured her back," says Washington. "I don't want her falling out of bed and hurting herself again. Every time I visited I would put the bed rails back up before I left, and every time I came back they would be down again. I finally had it out with the nurse."
What Mrs. Washington learned when she confronted the nurse at her mother's nursing home was that it is against the rules to put side rails up on a nursing home patient's bed unless there is no other way to insure the patient's safety.
Why is that? It would seem that preventing a patient from falling out of bed would be a desirable thing. Sometimes rails do prevent falls and injury, but sometimes they can provoke falls or actually cause injury. The FDA recently reported that between 1985 and 2008, 772 patients were caught, trapped, entangled, or strangled in beds with rails. 460 people died, 136 had a nonfatal injury, and 176 were not injured because staff intervened. Most patients were frail, elderly or confused.
In addition to the number of patients who are trapped and injured or killed by bedrails, an unknown number are injured every year because they try to climb over the rails or the foot of the bed when they want to get up.
Quality of life and the ability to remain independent is reduced for nursing home residents who are "trapped" in a bed with rails. In the eyes of both the patient and health regulators, a resident who would otherwise be able to independently get out of bed to move around, go to the bathroom, even go down the hall for a snack or an activity is being unnecessarily restrained by bed rails.
If there is a risk that a patient will fall out of bed, nursing homes will first try alternatives to bed rails. A bed that can be lowered to within inches of the floor and raised when caregivers need to work over the bed is often the first choice. Soft mats next to the bed are an option if they won't contribute to a trip. Motion detectors and bed alarms alert staff when a patient is moving toward the edge of the bed. More frequent bathroom trips, adequate pain relief, and alleviating boredom all work to reduce a patient's need for bed rails.
Bed rails are not always "restraints." When a patient uses bed rails for support to move around in the bed, to turn over, or for support to stand they enhance safety. Best for this kind of use is the half-rail, which leaves the foot end of the bed open. For this kind of use a nursing home should have no problem permitting the use of a bed rail.
When less restrictive means of insuring a resident's safety have failed, then a nursing home can legally use bed rails or other means of restraint if they can document that the benefits outweigh the risks. The patient's physician must order that rails be used, and the nursing home must closely monitor the patient and regularly re-evaluate the need for bed rails. If the patient's need for the rails changes, then use of rails must be discontinued.
It is important to remember that even when family members request that bed rails be used, the nursing home cannot use such a request as medical justification for using them. Regulatory agencies will hold the nursing home accountable for giving every resident the most independence possible. Use of "restraints" that are not medically necessary, including bed rails, is not permitted.
Your nursing home should be happy to explain their plan for reducing the risk of your family member falling out of bed if bed rails are not part of the care plan and you have concerns.