Bed Rail Safety in Nursing Homes
Bed rails are meant to protect residents, but when used improperly, they can cause serious injury or death. From entrapment to falls, the dangers are real and often overlooked. In this episode, nursing home abuse lawyer Rob Schenk speaks with guest Shelly Wills about bed rail safety, regulations, and how families can ensure their loved ones are truly protected.
Wills:
Really working with the family to identify how we can better care for them. So they’re resting better, they’re staying in bed better. So working with the family and it being real collaborative, involving them in the care planning process is helpful in the decision making and it, and they understand better what we’re doing in the nursing home too.
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we are talking about bedrail safety. What bed, what constitutes a bedrail and why are they on their face, typically more dangerous and do more harm than good, but we’re not having that conversation alone.
We have the fantastic Shelly Wills on the podcast today to guide us through. That issue.
Folks, we, as I mentioned, we’re talking all about bed rail safety. We’re not doing that alone. We have Shelly Wills on the podcast. So Shelly is a registered nurse and legal nurse consultant with over 31 years of healthcare experience, including 28 years.
As a nurse specializing in the nursing home industry. She has served as a CNA instructor, care plan coordinator, and director of nursing, always advocating for residents and families. Now as a legal nurse consultant, Shelly uses her expertise to help attorneys navigate complex medical cases with clear, unbiased insights into nursing home care, and we are so happy to have her on the show.
Shelly, welcome.
Wills:
Thank you. Thanks for having me.
What constitutes a bed rail? (i.e. quarter rail, full rail, etc)
Schenk:
Let’s start with a softball question, and I’m just gonna ask when we talk about bed rails, what is a bed rail? What constitutes a bed rail?
Wills:
So a bed rail is. We also call ’em a side rail, and it would be a railing that is attached to the frame of the bed, and it could be the full length of the bed on either or both sides of the bed, or we could see side rails or bed rails that are only half the length of the bed or the quarter of the length of the bed, or even a shorter rail. That would be more like a assistive device or a like a grab rail to help position residents.
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What are the main safety concerns with bed rails in nursing homes?
Schenk:
So when we’re talking about like the dangers of bed rails, is it all those rails that you just mentioned, or is it just a certain type of bed rail?
Wills:
I think the higher risk would be for the more extensive bed rail. The more railing you put around the bed, the higher the risk for injury.
How can bed rails increase the risk of injury or entrapment?
Schenk:
Okay, so then what, then what is the, what are the primary risks associated with the long bed rail? What are we worried about?
Wills:
Okay, there was a time in nursing home history where bed rails were very commonplace in a facility and.
Through the course of time, we realized that people, it didn’t necessarily keep them safer, and there was studies done and they identified that people did a couple of things. One of the things is they get entrapped in the rail itself, so an arm or a leg, or. Their head get stuck between the rails somehow.
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The entanglement or entrapment thing is a big safety concern. The other thing that happens is they can get the, their head stuck or a limb stuck between the bed rail and the mattress, or the frame of the bed. And those could be minor injuries from bruises to skin, tears on up to maybe say strangulation.
And probably the most common injury that I’ve seen with side rails. Would be the fact that people climb over the top of them. So a bed rail could be 12 to 15 inches higher than the level of the mattress, and by the time a resident climbs over that and then can’t reach the floor safely, they’re at a huge risk to fall and they’re falling from a higher place. And then we increase the risk for serious injury there.
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What are the best alternatives to bed rails for fall prevention?
Schenk:
Okay that if we are, if our resident is at risk for falling out of bed. But at this, but at the same time is potentially at risk. If there is a bed rail, what are we supposed to do? What is the, what are the steps of deciding whether or not they should get a bed rail?
That’s a great question.
Wills:
One of the thing, first thing that would happen is on admission, they we’re gonna take a really close look at that person’s risk factors. Being a new admission makes ’em at higher risk, their cognitive ability, their strength, their their ability to move safely, transfer themselves safely, all of those.
Things would be taken into consideration and we would probably normally have physical therapy, evaluate them as well and get a overall picture of what they need, what their risk is, and then try to find the least restrictive way to keep them safe. And usually side rails is not the first thing. So we would do things like put them in a room close to the nurses station, say, so we’d increase their sur surveillance, keep an eye on ’em closer.
The relationship between fall risk and functional decline in nursing home residents is evaluated on the impact of preventive health measures in elderly populations.
We would maybe put ’em in a bed that goes very low down to the floor. So if they did get out, it’s just a very short few inches. To the floor surface, we would maybe put pads on the floor. So if they did come off the bed that it’s a soft landing. Lots of facilities use some type of an alarm system, so when they move off the bed or when they step onto the floor, it alarms and it’s.
Staff comes and helps. So any one or all or some combination of those types of things. Another thing they use often is a mattress that’s got a raised edge. So there’s a boundary for the edge of the bed. Some places and some residents, you have to be very creative to find ways to keep them safe without necessarily going to a full bed rail on their bed.
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How can caregivers ensure bed rails are used safely?
Schenk:
So I guess the default is no bed rail and we’re doing everything we possibly can before we institute a bed rail.
Wills:
That’s basically the starting point is we would start with no side rail and there’s another factor to consider, and that’s the fact that this would be considered a restraint in some cases, so that plays in as well in the decision.
Schenk:
Is there a particular. Profile or portrait of the resident that would be suitable for a side rail? Who are we talking about would qualify?
Wills:
They would probably the deciding factor is gonna be is it something that’s needed specifically for a medical reason? So we could talk about a resident who is in.
For practical guidance on protecting residents, read about precautions nursing homes can take to prevent falls.
A situation where they can’t move in bed without a little bit of help. So say they’ve just had some type of a surgery or a weakness and they could move from side to side, roll from left to if they had something to hang onto. And we could maybe put a side rail, get a doctor’s order, do all the assessments, get side rails on the side of the bed on, for part of the bed, say like a quarter of the bed, a quarter rail so they can hang onto and help position themselves.
Not necessarily to keep them in the bed, but to help them be able to move. The other time that I’ve seen side rails used for a medical reason is for someone that has seizures and in those cases where they cannot be safely kept in bed due to the fact that they have a seizure activity, they would possibly be a candidate for a side rail.
Tragic consequences of improper equipment use are discussed in this case involving a fatal bedrail dispute.
Schenk:
I feel like from what you’ve described, it almost starts from cognition. Like the person has to be completely self-aware and then we’re just talking about what their ability is in terms of their physical ability to, to their physical bed mobility at that point. But they, it starts with are they able to be aware.
Wills:
And for, if you think about someone, a lot of people come from a hospital setting where they’ve had a change of condition, they’ve been in a different environment. Often they’ve had side rails there at the hospital that’s more common than in the nursing home. And they come to the nursing home and we just expect that they’re going to recognize the side rail and know they need to get help.
Learn what legal options you may have if your loved one was injured by bed rails in a nursing home.
So they’re gonna ring the call light and we’ll come and help ’em to the restroom. That’s. Really not what happens. And a lot of cases, and I’m thinking of people that I’ve taken care of and even my own family, they will just really go ahead and help themselves even though they’re cognitively aware and assume they can get outta that bed safely.
So it’s. Not necessarily as helpful as we think it’s going to be to put a side rail on a bed.
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Schenk:
So let me ask a dumb question. Let me get your opinion on this. I, I don’t understand why this isn’t a design issue. What, why can’t we design a mattress bed rail combo that keeps somebody from falling outta bed, but also keeps them from asphyxiating?
I feel like that would be an easy solution.
Wills:
I think I, it seems like it would be pretty low tech. You, we ought to be able to do it. There are some things that we do that we can do, which would be like a wedge cushion that fits in there and some things that fill the gap and that helped, mitigate that risk.
But I’m, I wanna go back to again, there’s other regulations, specifically the idea of restraining people that, that there’s gonna be a factor there. So it’s not just a hundred percent on safety. There’s a degree of the fact that they have the right to free movement. To, and it, and maybe even a dignity issue when we’re saying to my 80-year-old dad who’s doing life and if he has a stroke and tomorrow he is in the nursing home, that you’re stuck in this bed with these rails up, whether you like it or not.
And so that’s, that, that’s a factor in it. It isn’t just that we can’t keep him safe, is that there’s other factors too.
In Episode 42: How Nursing Homes Can Be Liable for Injuries from Falls, we explore liability and prevention.
Are there specific regulations for bed rail use in nursing homes?
Schenk:
That makes sense. I guess I don’t, I guess I don’t think about it that way. That’s what probably makes the issue extremely difficult. It’s the convergence of those things, the safety, the deal.
Absolutely. And the restraint concept. Yes. Okay. So what do the federal regulations tell us about bed rail usage? What are the steps? And they might mirror what you’ve already described, but what is the, what are the rights say?
Wills:
So there is no regulations specific to the use of side rails.
There’s not one that just says, here’s what you do for side rails. There are regulations that are more general, that the side rail use fits under, and I’ve touched on those already. The safety component, we have a, the regulations say we have to provide a safe environment for them. And so all of the things, so you look at the, that factor and then we have to, provide a restraint free environment. They have the right to move freely. And so then we look at that and take that into consideration. And that regulation talks about the least restrictive amount of restraint possible. So there’s nothing that, it’s not a simple, yes you can, no you can’t. Yes or no.
Equation to side rails. It’s a. It’s very resident specific and it’s dynamic. They may change their level of cognition, their strength, their whatever happens and changes. We continually assess them and make sure we’re handling their safety properly with those side rails on or not on.
Discover the hidden risks in Episode 56: The Dangers of Bedrails in Nursing Homes.
What should families know before requesting bed rails for a loved one?
Schenk:
Do you ever have to have the conversation with a family member Hey, why can’t my mother keeps falling outta bed. Why can’t you put bed rails up? Have you ever had to have that conversation, explain these things? How do you explain it in the, in a way that’s, that makes sense to them?
Wills:
First of all. There’s, it’s a teaching moment. We have to talk about what the regulations say, just like we are here today. And then the other thing that, that I think is probably maybe more important is, I haven’t really gotten into this, but we need to look at the reasons people wanna get outta bed.
Are they needing to go to the bathroom more often? Are they cold? Are they in pain? Why are they not asleep? And so really working with the family to identify how we can better care for them. So they’re resting better, they’re staying in bed better. And typically people don’t roll outta bed necessarily.
Strategies for caring for nursing home residents at risk of fall are discussed in Episode 86.
They’re trying to get outta that bed. There’s a reason for that. And so working with the family and being real collaborative and involving them in the care planning process is helpful in the decision making. They understand better what we’re doing in the nursing home too.
For insights on lawsuits and fall-related harm, listen to Nursing Home Bed Rail Injury.
Schenk:
Okay. I guess then it, there should be like a checklist of here are all the things that we should do as an alternative to those side rails. And you just you go through them all before the side rail talk even begins.
Wills:
Yes. That’s basically the way it is handled. Yes.
Schenk:
Okay. That, that’s a great point that you said a little bit earlier about how, like we need to find out why they’re getting up. And I think to kind of segue, sometimes it’s that transition from hospital to nursing home where they, the family sees the resident has beds and then not at the nursing home.
And they want that, they want to have that squared away.
Wills:
Yes. So they assume that what we’re doing in the hospital is what we’re going to do automatically when they get to the facility, and that’s not necessarily the case. So it’s helpful if we can identify and do teaching what the family, so they understand that the rules and regulations that govern that hospital are not what we work under in a nursing home.
And that there’s just a different level of care that we’re providing. From the hospital to the nursing home and we’re not gonna look exactly the same.
Episode 141 highlights real-world approaches to reducing injury from nursing home falls.
Schenk:
Very well said. Shelly, thank you so much for coming on the show today and sharing your knowledge with us.
Wills:
It was my pleasure.
Schenk:
Thanks for having me folks. I hope that you found this episode educational. If you have any ideas for topics that you would like for me to discuss, please let me know. If you have any ideas for guests that you’d like for me to talk to, please let me know that as well. New episodes of the Nursing Home Abuse Podcast come out every single Monday, and again, please make sure that you do something to get this mug.
That would make my wife happy so I can get these boxes outta the house. And with that folks, we’ll see you next time.
Shelly Wills’ Contact Information: