Nursing home bed rail injury

Episode 158
Categories: Neglect & Abuse, Regulations

Bed rails in nursing homes may cause serious injury or death. In fact, Federal regulations prohibit the use of bed rails in most instances. In this episode, we discuss whether you have a claim from a nursing home bed rail injury.

Hello out there. Welcome back to the podcast. My name is Rob. I will be your host this week. We have a very informative episode about an injury-type of topic that I think is – I don’t think there’s a lot of information out in the public. There’s a lot of misinformation. The injury’s kind of counterintuitive – and that is injuries, serious injuries from the use of bed rails in nursing homes.

So the topic of the day is bed rails. Bed rails – literally the railing that goes along the side of your loved one’s bed that they have, that hospital type of bed at the nursing home. They’re rails that can either be lifted up or installed on the sides. They come in all shapes and sizes. They can run full length of the bed. They can be a quarter, half, whatever the case may be. But there’s – like I said – a counterintuitive idea about bed rails. Most people, and even myself before I got into this line of work, I just assumed, “Hey, bed rails are a good thing. Everybody needs them because you don’t want to roll out of bed while you’re sleeping.” I remember as a kid I had bunk beds with my brother in a room and I remember for a time that we had bed railings on the top bunk for that purpose. But in fact, bed rails can be dangerous and so much in fact that the default pretty much is due to the safety concerns, the default rule is we don’t use these unless the condition requires it.

Is a nursing home bed rail injury common?

So the question of the day is why – what makes bed rails so dangerous? Well they’re, according to some recent statistics, over the course of a 20-year period, there were over 800, close to 1,000 incidents of either a patient in a hospital or a nursing home resident becoming literally caught or entrapped between the mattress of the bed and the actual rail, which causes asphyxiation and choking. So of those 800 to 1,000 incidents, almost 500 people died, 138 had nonfatal injuries, so still injured but not fatally. And many, the injury did not result because the staff of the hospital or the nursing home intervened in time.

Why are bed rails in nursing homes dangerous?

So what’s the cause of a nursing home bed rail injury? The issue is if the resident has no cognitive impairments, is mobile, then that asphyxiation danger isn’t quite as high. Obviously it’s not a problem. You or I can go to sleep at night and if we become entrapped, we have the physical ability and the cognitive ability to get out of that situation. But when you’re dealing with an individual who might have cognitive impairments or more importantly might have some type of paralysis or be immobile, there are some times when somebody is immobile but might have involuntary movements, and that’s how their body moves into that position where they become trapped and they’re unable to breathe because of cognitive impairments or other chronic illnesses. They can’t cry out for help and become trapped and become unfortunately seriously injured or killed. So that’s the mechanical – that’s the mechanics of actually what is happening is you have an individual that can barely move, chronic illnesses prevent them from crying out and that’s unfortunately what happens and it happens so often that we’ve passed laws regarding the use of bed rails in nursing homes.

What would be the reason? And again, the main reason that comes to mind is, well, what’s worse? The danger of falling out of bed and hurting yourself or becoming asphyxiated by the bedrail? And that’s pretty much the principal give and take. But there are many benefits to bed rails. The principal benefit of bed rails, like I said, is it’s most of the time going to prevent the resident from rolling out of bed, and that can happen to the best of us. That can happen to people who are as young as 10, 15, doesn’t matter. We’ve probably had an incident where we’re sleeping and we roll over and we don’t realize that we’re on one side of the bed and we fall out. So that’s the principal component of having a bed rail.

Are there benefits to using bed rails in nursing homes? 

But bed rails have other benefits as well. It acts as essentially a turning or repositioning device, so the resident that does have some mobility or some strength can use that to roll over, to kind of sit up, these types of things logistically to get up in the bed, turn around or roll over, what have you, which can be important if the resident isn’t strong enough to do that kind of on their own. They need that assistance device, which that’s what the rail does. It helps with transferring, so for residents that need a little bit of extra assistance to get out of the bed or get into the bed, the rail is there. From a social or mental or emotional standpoint, it provides a little bit of comfort and security in terms of like, well this relative of yours is unlikely to fall out of bed, maybe they’ll sleep easier. So there are some benefits aside from the risk of falling for the use of bed rails. But as I mentioned, the risk, depending on the situation of the resident, can outweigh those benefits.

Asphyxiation is a common nursing home bed rail injury 

And so, again, one of the other downsides aside from the risk of asphyxiation is kind of the other end of the comfort and security component of it where the resident may be feel comforted by the fact that there is a rail there and that is the idea that the rail there is a restraint. So we’ve had a couple of episodes – off the top of my head, I think we’ve had a couple of episodes, concerning the use of restraints in nursing homes. And a restraint in a nursing home can be any mechanical device or actually chemical device, like a medication, that is designed to restrict the movement or the mobility of the resident. So think of anything from putting something in front of the door so the resident can’t get out to placing maybe a tray on a wheelchair that prevents the resident from standing up. Any type of device, even if it’s not intended to restrain the resident, can be considered a restraint and we have federal regulations, state regulations that state you cannot, in most situations, restrain a resident. And that’s what I’m saying is the flipside of having a rail there – some people might think it’s a comfort but most of the time, it’s going to act, particular with a resident who has mobility issues, as a restraint on their ability to get out and move around. So that’s another kind of reason why the use of bed rails are frowned upon, because from a basic standpoint, it’s a restraint, even if it’s a quarter-rail or a half-rain. If it makes it more difficult for that person to get up and get out, then you are infringing on that resident’s rights.

What are the alternatives to bed rails? 

So what are the alternatives to using a bed rail? Well the alternatives I guess are going to depend on what the primary purpose of the bed rail is. So if the bed rail is being used to prevent the resident from falling out of bed, that’s the rationale, then there are several alternatives to bed rails.

  • LOWERED BED: The first one is essentially having a bed that can be raised and lowered and then in fact lowering that bed to its lowest position such that if the resident falls out, they’re not falling from three or four feet – they might be falling from 18 inches, two feet, which can be the difference between a scratch or a subdural hematoma that causes the resident to pass. So placing a bed, having an adjustable bed, placing it in its lowest position is one of the primary workarounds or alternatives to having a bed rail.
  • FALL MATS: Another is fall mats and we actually had an episode dealing with fall mats and the mechanics of how the body hits ground after a fall and how floor mats can take the brunt of the force such that if the resident does fall out of that bed and hits their head, that mat’s going to absorb that fall so that any resulting injury would be mitigated or lessened. So again, another alternative, so lowest position, floor mats.
  • STAFFING: And this is one that’s almost always overlooked because of staffing issues but it’s to have appropriate monitoring and rounding so you can keep an eye on the resident. So a lot of times we’ll see cases where the resident falls out of bed and typically it’s because of some type of trigger. So for instance, the resident needs to use the restroom. The resident is getting out of bed because in their mind they’re getting ready to go to work – some type of environmental or mental trigger that’s causing that resident to get out of bed. So the nursing staff should make regular rounds and monitor that resident and assess that resident for those triggers and try to be there for that resident. So if it’s a toileting issue, then you make sure that Mr. Smith visits the restroom at 11 p.m. because that’s the time of bed he tries to do it himself. Monitoring and observing the resident to prevent that risk of fall is, like I said, an often overlooked alternative to side rails themselves if the purpose of the side rails is to prevent falls.
  • TRANSFER AIDS: Now if the purpose of the side rails is for bracing oneself and for transferring, then there are other aids and there are other devices that can do that at the time of transferring, so you can use like the gait belts and things like that, lifts. So in most instances, the use of that bedrail, you won’t need it. It’s not something that would be necessary. You have a lot of rather inexpensive alternatives. We’re not talking about having to spend millions of dollars to prevent somebody from falling out of bed. It’s as simple as mats and putting the bed in the lowest position and then just watching that person, assessing that person, person-centered care will prevent that person from falling out of the bed.
  • QUARTER RAILS: And where the nursing home is in the category of where they need to use the side rail, then the standard of care is to make sure that only the amount of bed rail that’s absolutely necessary – so not having the full bed rail if it’s not necessary, just doing it in a half or a quarter, making sure that there is that’s it’s maybe one side of the bed, the foot of the bed versus the head of the bed, and then making sure that the mattress size is workable such that there’s not a gap between the mattress and the actual bed rail, which is the cause of the entrapment and the asphyxiation. So even where you have to have the bed rail, you’re doing everything you can to mitigate the safety issues involved with it.

What are the Federal regulations regarding nursing home bed rails?

So what are the federal regulations as I mentioned at the top of the show? What are the federal regulations with regard to the use of bed rails? So again, every nursing home in the country is regulated by the federal government if they take Medicare/Medicaid, which is 99.9 percent of them. And so because they take Medicare or Medicaid, they can be overseen by the federal government rather than the state government, although state government does oversee nursing homes in their individual states. But the regulation that I’m referring to here is the federal regulation. And so the federal regulation is that every nursing home facility must attempt to use appropriate alternatives prior to installing a side or bed rail. Why? Because a nursing home bed rail injury can be very severe. If a bed or side rail is used, the facility must ensure correct installation, use and maintenance of bed rails, including but not limited to following elements: access the resident for risk of entrapment in bed rails prior to installation, review the risk and benefits of bed rails with the resident or resident representative and obtain informed consent prior to the installation, ensure that the bed’s dimensions are appropriate for the resident’s size and weight, and follow the manufacturer’s recommendation and specifications for installing and maintaining bed rails. So that’s literally the federal regulations, like every nursing home has to go through these steps if they are going to use side or bed rails.

And again, we often have clients come in and go, “We demanded that they used bed rails before our loved one fell,” and again, it’s the counterintuitive nature of this that it’s kind of an unknown risk. So years ago, our federal government decided after these studies that we needed regulations for this to prevent these asphyxiation injuries, and that’s where you get this federal regulation.

Can you sue a nursing home for a bed rail injury? 

So I guess the $64,000 question is, can you have a claim for a nursing home bed rail injury? And the answer is yes. Typically a case against a nursing home, a negligence case against a nursing home for this type of injury, is going to require at minimum a showing of negligence, meaning that the nursing home did or did not do something they were supposed to do. And as we see in many cases, we call that the breach of the standard of care. And so the standard of care can be the federal regulations here. It can be state regulations. It can be best practices. It can be the policies and procedures of the actual nursing home.

But at the end of the day, most of the time it’s going to come down if your loved one was injured or killed due to a bed rail, the issue would be did the nursing home conduct an appropriate assessment of your loved one such that it was determined that the use of bed rails was necessary. Then it’s going to be did the nursing home take reasonable precautions in the use of those bed rails or side rails? And if the answer is no, they did not, then you’ve met the negligence component of that case. So that’s going to be the factual issue for these types of cases. Was an assessment done? Did the nursing home do a head-to-toe assessment taking into account cognitive capacity, mobility, chronic illnesses, the risk of becoming entrapped? And based on that assessment, which under federal regulations is required to be done by nursing staff as well as by physicians and nurse aides that actually provide the direct care, person-centered assessment, creating a person-centered care plan that ultimately determine that bed rails are necessary. That’s the main key.

And then like I said, the second component of that is typically a nursing home is going to be negligent with regard to the use of the bed rail. We’ve seen cases where the client has come in or the loved one of the resident that has been injured comes in and they’ll show us pictures where there’s a 6-inch gap between the mattress and that bed rail, so I mean that’s a blatant breach to the standard of care in that sense from every component – federal, state regulations and the general practice, standard of care best practice of the area.

These cases don’t happen too often, although they are – I would say they’re common but they’re not the most common injury that we see by and large. But if you have a loved one that was injured by a bed rail, then chances are there probably was some type of negligence involved and you are recommended to seek out the counsel of an attorney to talk about that case. These can be pretty gruesome cases and they’re very sad cases, because as I mentioned, there are alternatives to using side rails. Other things could have been done to mitigate whatever the danger was for using the bedrail.

I think that is going to conclude this particular episode of the Nursing Home Abuse Podcast. We hope you found that informative and if you like the content of the podcast, please like and subscribe wherever you get your podcasts from. If you’re watching this on YouTube, please leave a comment. Let us know if you want to see anything or have us talk about any particular subject matter. The Nursing Home Abuse Podcast comes out every other week on Monday. That’s when you can get new episodes fresh and hot off the kitchen. And I believe with that, we will see you next time.