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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.

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We got bed and chair alarms for my mother. She would manage to I clip them from her clothes. Tried putting them on the back of her clothes. Problem was, she would rise up, set off the alarm and, by the time the Aide got there, she was out of bed. If the Aide is tending to someone else, they just can't leave that person to check on an alarm going off. They put a bed alarm on her bed at Rehab, she got out of bed during the night and nobody heard the alarm! They moved her closer to the nurses station. Having spent my fair share of time in hospitals and Rehabs with relatives, I can see this is a chronic problem, esp with elderly and dementia patients. I have watched them try to crawl over the rails or scoot down to get out of bed. I have caught more then one person from falling out of beds that no rails were up. Of course, I notified someone. The larger facilities can be horribly understaffed and/or have quite a turnover of employees. I don't know what the answer is.
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Nature73 - bed alarms do alert the staff that a resident has left the bed. Therefore, they don't necessarily keep a patient safer. My mother set her alarm off, when she unexpectedly got up from bed and walked to the bathroom (something that she hadn't done in three or four months. The staff member did see her turn into the bathroom but did not get to her in time to prevent her fall. Bed/wheelchair alarms can help if the patient is very slow moving and the workers are vigilant, but provide a limited form of protection.
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They should at least lower the bed if they choose to use crash mats.
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When my aunt was in long-term skilled Pennsylvania nursing home, bed rails were not allowed. The staff placed long foam noodles (like the kind used in swimming pools for water aerobics) under the fitted sheet on each side of the bed. They helped prevent her from rolling out of bed. Also she had a hi/lo bed which was lowered to about 6-8 inches off the floor at night.
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Nursing Home Neglect Lawsuit Investigation | Bed Sores, Fractures, Infections
topclassactions.com/lawsuit-settlements/lawsuit-news/10518-elder-abuse-nursing-home-neglect-class-action-lawsuit-investigation/

This is a class action lawsuit and if this site describes what you are experiencing, contact them.
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1 - my dad requested & got the rails as he used them as aids to get in & out of bed

2 - when they say that people get injured with the rails have they documented the size of person involved -

My mom is quite large so she could never get trapped in any rail but a tiny person would be in greater danger - if the person's size is not with the information then the information is incomplete so how can it be used to make decisions on - maybe that would be a way to get the law recinded & thrown out - good luck
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One last thought and I will quit.
Has anyone seen or used those big long pillow things advertised as something to hang onto at night and throw your legs over while sleeping? Wifey used to keep pillows in the bed to throw her legs over and slept really well like that.
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I forgot to mention that in rehab the aids carried a pager for the alarms. It was silent and no one heard it but the pagers alerted the staff if the patient moved off of the alarm pad.
Still the aids could not just stop what they might be doing. like cleaning and changing a patient or preforming some procedure on a patient.
Only in the hospital did she have to wait for help, up to an hour in a dirty diaper.
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There are some hospital beds that have bed alarms built in that "sound off" when the patient moves off the sweet spot. Anyone have experience with these?
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My mother was fine in her nursing home without them. 18 months in, she was moved to a different unit, where they put the rails up every night. Well, she got used to them and would sleep near the edge, leaning against them (for comfort and a sense of security, I think). Then one day,  presto! the rails disappeared because they were now a hazard. Well, she's used to sleeping at the edge of the bed now. She has fallen 4 times. It's only the mercy of God she hasn't been hurt.

THEY SHOULD NOT SWITCH THINGS UP LIKE THAT ON PEOPLE WITH DEMENTIA!!!

Their solution was to get her a bed that lowers practically all the way to the floor and after fighting another year and a half with them, they added a mat.
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I have already sent a letter to Congress about this six months ago when I had to hire round the clock sitters since the facility he was in would not allow restraints. I was told they would respond. The document itself if you request a copy from the facility will have a box in the middle with the statement that restraints can be used if a doctor requests it. The surgeon did request it but the rehab facility said their policy is not to use them and since the doctor on " their staff" did not want it they are not required to use one. I am waiting for someone to be badly injured or killed and then the lawsuits will begin. Ask your facility to give you a copy. They would prefer we pay to have a sitter, and by the way the sitter can only notify the nurse that the patient needs help. Where my spouse is at least they "cushion and wrap" so hopefully if he falls no injury.
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ZenZen: Write or call your state or county representative on this issue. And if they don't respond, keep at it until they do. I worked with my county constituent on an issue until they did something about it.
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My Mom is in assisted living. After about 3 years there in the same bed she suddenly started falling out of bed. She claimed it was because she always slept in a King or Queen size bed when my Dad was alive. 13 years ago. The AL allowed me to get an order from her PCP for a partial rail on one side of her bed. I used a pool noodle on the other side under the sheet. This stopped the falling out of bed problem. The rail I got sets a foot from the top of the bed and in no way hinders her from being able to get out of bed and actually provides an assist to standing up. It has a fabric cover and pockets in it for her to put things in. Like the remote for the TV. When my father was alive he was in the VA the last few months and they didn't use side rails but did have mattresses that the edges were slightly elevated so the patient needed to make an effort to get over it to get out of bed. Made the bed uncomfortable to sit on the edge but worked well to stop falling.
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My mother passed last April at age 95. I had her living with us for almost 3 years but it was getting too hard on me, with my health issues, to care for her 24/7 as she needed more care. She was tiny at about 4'11" and under 100 lbs. I put her in a licensed private care facikity that had 6-7 residents. My mother started getting out of bed and could not, or would not, call for help. She was in a regular bed. I was told they could not put up a rail. They started putting her wheelchair beside the bed but she would scoot down to the end. Long story but I moved her to a different, similar facility where they actually had night staff. She was in a hospital bed at that place and they put both rails up and also put a camera on her to monitor her. Maybe they weren't supposed to but the nurses that came knew it and nothing was said. At least I could finally get some sleep at night. However, one time when she was in rehab, they had rails up and she did scoot down to the bottom and got up. When she was in the hospital, the rails were up. I don't know what the answer is because who can sit and watch them 24/7? Still, I prefer the option of putting rails up.
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Remove the frame and use only the mattress with its box.
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You might want to consider purchasing pool noodles - they are a floating device that kids use but are wonderful for using under the sheets at the edge of the bed. They act as rails.
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Assisted living has different regulations than nursing homes in most states, as persons in assisted living are supposed to still have some independence. Nursing homes can allow side rails if (1) a physician orders them and (2) the patient or POA signs a disclosure statement.

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.
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My Papa was in a NH bed that had a small section of bars, maybe a foot long, up by his head. One day they were gone. We were told it was a new rule against restraint. Ridiculous, 75% of the bed was still open. He almost fell out of bed 4 times that night. We complained to the DON and she had him assessed and the bars returned. He also used the bars to turn over during the night, as he has Parkinson’s and can no longer turn on his own. I LIVE IN FLORIDA TOO, so it is possible to at least get some type of bars. Good luck with the fight.
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Have the moderators been fiddling with things again? I got both links to work by adding www. at the beginning.
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Hi all, the link posted by 93yroldmom no longer works. Here is a link to a pamphlet from the same website that gives the pros and cons. Cut and paste the link into your browser.
fda.gov/downloads/medicaldevices/productsandmedicalprocedures/generalhospitaldevicesandsupplies/hospitalbeds/ucm125857.pdf
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This is the legal system determining the medical care of a patient. There have been patients injured by bedrails, so due to litigation and awareness, the rails have been determined a hazard and the law prohibits their use. Now we have to wait to see how many patients are injured or die because a bedrail wasn't used, and then wait to see the outcome of a few law suits, before the law will likely change back to allowing bedrails again. Somehow, it will eventually be seen that bedrails prevent more harm than cause more harm. Unfortunately, it will take quite some time during which patients will be endangered.
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With my loved one it was the same. He was in Memory Care and they didn't allow side rails. Then, after a hospitalization, Hospice had me sign him up. With hospice, he got a wheelchair, and they DO allow side rails. They do not allow any life-prolonging measures, however. When he went into a coma-NO hospital unless I discontinued hospice. He died about ten days after going into the coma. I held his hand and gave him gatorade and applesauce. He was ninety years old. Two years on, I feel Terribly Guilty. Oh, and I'd rather they be on Depakote, etc. than Ativan. It DOES make them even more nervous sometimes.
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This is a battle for me as well. My mom's NH has this rule and as no bed alarms to alert the staff that she is attempting to get up on her own. They say the rails are considered restraint and the alarm scares them or their roommate. She had to go to the bathroom and noone came to check on her so she got up on her own, made it to the bathroom, but fell getting up from the toilet and broke her femur (not to mention that she laid on the floor for about an hour before her roommate found her and alerted staff). It seems to me that the bed rails and/or alarms should be used on a case by case basis. If they don't need them, great, but in my mom's case a bed rail or alarm may have saved her from that nasty fall and months of painful recovery time.  The bed alarm can't be a law because when she was in the local hospital her bed was alarmed.
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I suppose we could just encase the entire bed in a bubble...🙄
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It seems like the real solution is to develop bed rails in which a person cannot get entangled. My grandson is studying to become a bio medical engineer. Perhaps he can come up with a solution! Seems to me it could be as simple as solid, padded rails that have a sensor in them when a person touches them so staff can come help. But of course, that would mean staff would have to do their job and do it quickly!
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I too come from the old school of nursing when we’d get into trouble if we neglected to leave the side rails up and the hospital bed lowered as far down as it is able to go. I know things change (usually I’m not impressed with the changes, most are reactive, pointless rules to cover hospital liability more than patient safety). I don’t remember any patient that became tangled in the bed rails. We had climbers and Houdinis that were amazing in how they could escape. But part of the use of bed rails and restraints was CHECKING ON THE PATIENT REGULARLY. Especially the escape artists. I’d stand in the door and watch the patient meticulously undo all the ties and wriggle out. That’s when I’d redo everything and round and round we went all night.

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!
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With a Doctors written order the side rails can be provided. I am pretty sure that the order has to be renewed occasionally but that should not be a problem.
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Wow. I'm glad this issue is being addressed. My mother had sacral chordoma which was pressing on nerves leaving her right leg useless. One night she was in so much pain she was brought to the ER. They switched her pain med to a high dose Fentanyl patch. Then they left her alone in her room with the bed rails down. She got up and thought she was fixing lunches for her kids to take to school (we "kids" are now in our 60's). Having no use of her right leg of course she fell and hit her head. I did not know that this had happened until I called in the morning to check on her. Luckily I was close by and zoomed over there. Well - I read them the riot act. How could they possibly have left her alone completely hopped up without something in place to prevent this? They explained the rule about bed rails and I had never heard anything so ridiculous. They then had to have an aid sit with her 24/7 when I couldn't be there.
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Only1001 your reply had me chuckling this morning. Thanks for that visual image of your dad and his vaulting and dismount!
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.
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Last year my wife was in the hospital for three midnights (required for transfer to rehab) and then transferred to rehab. In the hospital her bed had rails and she would try to get out of bed. Made a mess of the covers. could have hurt herself if she had gotten out. Her legs would not support her.
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.
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