My mother is currently in memory care at an assisted living facility. After numerous falls, nondisplaced hip fracture and surgery to repair it she is pretty much wheelchair bound. Since then she has rolled out of bed several times. I asked about rails for her bed and was told they're considered restraints and are not allowed in assisted living. As I've stated, my mother is in memory care. After researchng this online I find this is a state rule. Patients have been known to get themselves tangled up and some have died as a result. According to the state of Florida it is better for them to fall out of bed onto mats placed on either side of the bed where they can break their necks, a hip or a limb. Where I come from, it is rails UP to prevent falling out of bed to prevent injury. My mother has now rolled out of bed about 4 times now. I've lost count. Something is backward here. Do they mean to tell me that instead of checking on residents at frequent intervals, it is better to risk further injury by just letting them fall out of bed on 4"-5" mattresses on the floor? My mother now complains of pain in the hip she has already injured. No one is listening to me about how freaking backward this thinking is. I've raised the remote idea that rails are a safety issue. People getting tangled up in the rails is a CARE issue. Patients in memory care are there because of...what? There's a memory problem associated with dementia/Alzheimer's. Sadly, they live their lives in a state of confusion and there is no coming back from its debilitating progression. As I'm sure everyone here knows it is heart wrenching to see your loved one just deteriorate mentally and physically in front of your eyes and you are powerless to stop it. Even the medical field is stumped for a cure. It is a terrible and awful disease worse than cancer. At least with cancer you have a chance of survival and full recovery. Alzheimer's is an evil sadistic devil from which there is no escape except death. This stupid backward rule about rails must be changed. I'm sure there are rails designed as a solid piece, like a barrier, instead of bars that would be acceptable. It is inexcusable to let a frail and feeble elder fall out of bed onto the floor where they can still sustain injury, which could be life threatening. One of the biggest risks to the elderly in breaking a bone is called a "fat emboli" that occurs during a break that can travel through the body and lead to death. Is this what the state wants? Can they defend this outrageousness in a court of law? Who can I contact at the state? This ridiculous law MUST be changed to allow those in need to be safe. Rolling out of bed is NOT safe I don't care what they say.
Here is a link on this subject
fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123676.htm
Please do persevere. I wonder (I don't know) if you might be able to unearth some obscure process which you can follow to apply for special permission for this unobtrusive "restraint" to be put in place for your mother?
Also. When she came home for end-of-life care, my mother was supplied with a proper hospital bed complete with side rails -
just goes to show the grass is always greener. I stuck notices all over her room reminding myself to check the rails were UP, and lost count of the number of cold sweats I went through fearing I'd forgotten. I digress...
- would you be able to arrange anything like that, maybe?
Elders can become intertwined in those bed rails, breaking legs, and even getting their heads caught to a point of death. And then there are those patients who would climb over the rails only to seriously injure themselves.
When my Mom was living in long-term-care due to a serious head trauma she had at home which caused her serious memory loss, Mom couldn't remember that due to the head trauma she could no longer walk or stand.... but her brain kept telling her she could.
My Mom was a climber, and would routinely climb out of bed only to fall. The Staff kept trying different things to keep her from hurting herself. Yes, one would think bed rails would correct the situation, and even if it was legal, my Mom would probably climb over the rails causing a much higher fall.
Hospital beds can be lowered, and fall mats placed around the bed. Pillows can be stuffed into the mattress to make the bed more difficult to climb out of. That finally worked with my Mom.
Or do we want to sedate the patient to a point where they are sleeping 90% of the time?
I feel your pain. My DH was in rehab and unable to sit upright in bed by himself (no climbing was going to occur), but rolled out of bed twice. Upon further research, I found that state law DID not allow bed rails that are FIXED to the bed. However, they allowed the type that push under the mattress and serve as a handrail to help a person rise from the bed. They are only about 1/4-1/3 the length of the bed. Anyway, they are enough to keep your LO from falling COMPLETELY out of bed and hitting their head.
Now, they are archaic and found to cause more bad outcomes as well.
At this point I am glad I don’t need to decide this yet but this is a huge safety issue both “to use” them vs not.
Just like within the past 5 years we added pain assessment as “Vital sign 5” & needed to document what you did to address the patient’s pain.
We encouraged the use of narcotics back then- now in less than 5 years its swung the pendulum & pain mgmt is not needed for so many.
I think I would have mixed emotions regarding the bed rails. I would like the option to keep them, especially since they are only 1/3rd the bed length.
Every thing old is new again!
Bedrails are allowed in my state if the patient or POA signs a disclosure. It’s an issue that needs to be dealt with on a case-by-case basis.
My father did fine with bedrails until they tried ativan on him. (At 94, he’d never had anti anxiety meds, but probably needed them decades prior.) He alerted the nurse he was going to visit the bathroom and single hand vaulted over the bedrail (nailing a perfect dismount.) Upon his return, he fought off five male nurses’ help and vaulted back into bed.
They immediately lowered his bed and barracaded him with pillows. (He later said he had to fight the marshmellow army to get out of bed.) They posted a nurse to watch him until the effects of the ativan wore off and said, “no more “a(c)tivan” for him.”
The pillows were a much better option for him.
If they don't allow you bedrails, call the primary physician and ask for bedrails. We did this, and within 24 hrs. My mom had the partial length bed rails. Doctors can write a script for them.
In rehab they used the mats. I was told it was the law. Glad they did because she constantly tried to get up. A bed alarm was used as well as the mats. Many times they would find her sitting on the mat. Her bed was lowered and she had an inflatable mattress. When the bed alarm would go off it would take her nurse several minutes to get there. Because they have other patients to tend to, they cannot be expected to just drop what ever they are doing to run to her aid. They get there as quickly as possible but even that will not prevent injury if they climb over the rails and get tangled up in the covers or get a limb caught.
She could not be trusted with a call button because she would constantly push the button. She still pushes any button she sees. She even pulled the chain in the bathroom for the help signal.
Those pads helped prevent injuries in her case. And I would get a call at home when she was found sitting on the pads. I was always told of her condition when she was recovered.
Now for the good news on this. On day she finally was able to get up and she grabbed the walker, while I was in the room, and stood up and headed for the bathroom. I did assist her, completely. When she finished I ask her if she wanted to go to the door and see the people. Well the DoN was walking by and nearly went into shock when she saw DW standing in the doorway. Rehab accelerated after this.
Perhaps the rail thing should be on a case by case basis. And our Dr. did not know she was in hospital or rehab since this was a non emergency trans port from home.
My dad also had a problem with falling out of bed and when he was in assisted living, we bought some rails that he could not get caught in. They never told us he couldn’t have them. Got them on amazon. Both were the kind you push under the mattress. One was totally covered in fabric and had pockets stitched so you could place a tv remote, glasses, magazines etc. the other was just a low bar . There was no way he could get caught in either one. I moved the one for magazines down to his bed in LTC and they had no problem with it. They too do not allow regular long bedrails as they’re considered restraints as are bed alarms. So they fall!! It is crazy.
Like everything, restraints should be a tool used when the occasion warrants it. In all my working career I restrained less than ten patients. A few of those were dementia patients who were physically violent. One was hitting his wife and the other hit me and knocked me down.
RULES are always too rigid when there is never an exception!
fda.gov/downloads/medicaldevices/productsandmedicalprocedures/generalhospitaldevicesandsupplies/hospitalbeds/ucm125857.pdf
BTW - my husband and I put up 1/3 side rails at the tops of our bed at home after he fell out of bed 3 times within 18 months. When he sustained a huge gash in the back of his head after the third fall, requiring staples to close the wound, I said, "That's it! We are ordering side rails tomorrow." He has not fallen out since.
Of course, since we are still living at home, we are not bound by the laws that govern assisted living or nursing homes. But the day may come when we will be dealing with that stuff.