Nursing Home Does Not Use Restraints - Should we be worried?

Yes, all licensed facilities are moving away from restraints. People have died in them unfortunately. Facilities can actually lose licensure for using them. There are many ways to get around them; have you discussed options with both hospice and the facility? To tell the truth, one place I know of has foam pads below the beds for frequent fall people. This is such a tough dilemma. Just occasionally, on very fragile patients, net beds are used. They have basically a zipped larger than mosquito net hole canopy with sides. They were what was most used in my nursing facility before my retirement. They were called either "vale" bed or "veil" bed, and I am uncertain whether they are still used or not. I retired about the time that restraints became an absolute no-no. Please update us if a solution is found that you can share with us.

Restraints were not permitted by nursing home regulations when my mother was a resident in one. Bed alarms were used. My family was there a lot, my dad never missed a day, others of us were often there, and we never saw a resident fall. The key was good and vigilant care. I can’t say it never happened, but you’ll quickly learn of the quality of care in a place.

Its against the law to use restraints. Has been for a long time. There are concaved mattresses. Mats they put on the floor. Alarms are used but have heard that these may stop to.

Usually the bed is lowered as low as it can possibly go and a mattress or other padding is placed on the floor to cushion.
Alarms are not considered a restraint but they are often not reliable as they go off very easily. What is used more is an alarm that is attached to the chair and the resident and when they try to get out of the chair the alarm will sound. Less likely to go off with just normal movement.
The use of restraints in Facilities have not been used in many years. (thank goodness)
Even the use of hand protectors to prevent scratching at wounds can be considered a restraint.
I would not be concerned about the lack of restraints, I would be concerned if they used them

Like others have said, they aren't allowed to use restraints. Staff are supposed to call you every time LO falls even if not injured. They are also then supposed to tell you of the plan to prevent it from happening again.

I know that hearing about a fall after-the-fact doesnt ease worries about falls and injuries, but it does give you a way to monitor safety.

Ask about their falls and injury reports to get an idea of their safety record. You certainly don't want to see a high number of falls and injuries, but you also dont want to see absolute zero. If it's 0, most likely they are doctoring their stats, because unfortunately, falls arent 100% preventable without restraints.

My dad has fallen out of bed at most rehabs he's been in. Luckily, he never got hurt. He tends to fall more in placement than he does at home. THe plan to fix things for him is usually to put the bed down as low as it can go and put mats on the floor when in bed.

I've seen situations where the bed is set lower to the ground and a mat is put beside the bed to cushion a fall. In a rehab hospital, I saw a net enclosing the bed. There was a slit on the side, so it wouldn't have kept me from getting out of the bed. Ask them what the plan is to prevent falls. Restraints are illegal.

They should just making nursing home beds Japanese style where you sleep on a mattress on the floor.

No more falls.

I know bed rails look safer but these are now considered restraints as everyone has said.

The biggest problem was
climbing OVER the rails & then falling.

Floor-lowered beds are used instead. Often placed against one wall with a 'crash mat' on other side.

I'd look at that. Hospice hopefully can provide this bed type.

What type of facility?
if assisted most states won’t allow
if memory care they do

There are beds that go to within inches of the floor. Pads and alarms that can trigger unusual movements.
I don't like restrints or full rails because going over them is 😥.
If there is an iv, feeding tube , catheter then weigh risk / benefits

Im not sure about the negatives of full rails but I do know my dad and granddad fell in every family without them. Bruised from head to toe.

If it is a well-rated nursing home, they should know how to take care of a resident like your Dad. You can discuss it with them before you make your decision.

Hi Marie,

I work in a nursing home in PT rehab and hope my post will be helpful.

About full length bedrails, they are not used in nursing homes due to evidence of increased deaths and entrapments associated with their use. This is a very real danger. About alarms, evidence has been that they do not effectively reduce falls. Hard to believe, but true.

Restraining nursing home residents is not allowed unless deemed medically necessary and then only with doctor's orders. Many facilities are going "restraint free" so what you are encountering is not unusual. That said, there are other ways to increase safety if someone were to attempt getting up (some of which may require doctor's orders):
-- low bed near floor
-- padded mats at bedside
-- scoop mattresses with built up sides
-- moving the resident's room closer to the nurse's station
-- out-of-bed schedule that gives the patient position changes and allows for social interaction
-- activities to address restlessness and boredom
-- medical management and nursing interventions that will address restless associated with pain and discomfort

You should have this conversation with any facility you are considering and do independent checking of their safety record. Every facility has a yearly survey and rating from the Centers for Medicare and Medicare Services (CMS) that is available online. Each facility is required to display and make available their yearly survey. You can ask to see it.

Unfortunately, there is never a completely fool-proof method of preventing falls, especially as one's physical and cognitive impairments decrease their safety.

It's not an easy decision to make, but many families find that caring for a loved one with an advanced degenerative medical condition is more than they are equipped to handle. Best of luck in your search for placement of your father!

I have limited experience with nursing homes but the ones we interviewed when placing MIL, they indicated that in her state it was illegal to restrain the patient. They were allowed to have a bed or chair alarm but no rails. So there may be no solution to your problem.

when my dad first went into NH they had rails, but due to the change in laws (I think someone got a leg or arm stuck and it broke) they now are not allowed to use them as they are considered restraints......what they did for my father was to put the bed as far down close to the floor and then they put thick mats down on both sides of the bed on the floor, that way if he fell out of bed (which he did only one or two times) they won't get hurt.  Ask the nursing home you are considering if they lower the beds and put mats down.  Also if they know he might try to be an "escape artist" out of the chair they will keep him close to the nursing station to keep an eye on him, and the bed can be lowered when he is in it.  Wishing you luck on this issue.

I volunteered through a Hospice at a locked memory care unit. They had special beds that literally went all of the way to the floor. Most standard hospital beds can be lowered and should be. Also, sensored mats on either side of the bed to alert staff should they fall out. Never have side rails up. People have done more than break bones getting caught...patients have accidently hung themselves. Restraints are against the law in most states now. I would advise against nets above them. A determined patient could pull that done and get it wrapped around themselves. In my first year nursing, we had an alcoholic patient in locked leather restraints. My colleague was dealing with a screaming patient in the next room. Our 'restrained' patient walked into that room, dragging a broken IV bottle (yes, glass in the old days) and handing her the leather restraints! "here, I think you need these".
Also, determine if the facility is using chemical restraints as in heavy sedatives. Not a good solution ever.

You should be worried that with no bed rails he will fall be hurt and die.

If he is already on Hospice Care, if at all possible, you should continue with the Live In until he dies.
No matter how great a Nursing Home seems to you, your Dad will probably be miserable, depressed, scared and sad.
My Grandmother lasted 1 month.

If it were my Dad, I would continue letting him stay where he is, where he will be the safest.

After hip surgery, upon returning home from a rehab center, mom kept falling out of bed. She never had before, I can only assume it was the anesthesia she was shaking off. Or the pain meds. Anyway..

She BEGGED me to buy her guardrails and I kind of fought her on them-they seemed more dangerous, but I hit Amazon and the next am there they were (am I the only person who feels slightly creeped out that you can order something and get it before you even have time to regret your purchase?)

ANYHOW-the rails came, I went right up and installed them. That night she slid down in between the rails and the bed and was stuck.

Rails came down less than 24 hours after they were installed.

We took her bedskirt off (not an issue in NH's) and lowered her bed as far as possible and had her PT work with her specifically on safely getting up. IF she 'fell' it was more of a gentle slide to the ground. We didn't use pads, there was no room.

If she were on a mattress on the floor---not one of us 'kids' could deal with her care...we're 57-66 yo and sore knees and backs won't allow that.

My Dad has Parkinson’s and is fairly weak. He is allowed to have the short “half” rails (that run from the top of the bed to between his shoulder and elbow). It is allowed because he needs them in order to turn when he’s in bed.

That is about the only legitimate way to get permission for them anymore.

Sadly, because of lawsuits, the use of restraints like full bed rails are not used. If a patient has mats, lowered bed, and concave mattress, there is still risk. They could land awkwardly or end up with a greater risk of aspiration pneumonia. Even without the Covid situation, staffing can be difficult, particularly third shift in the middle of the night. Until there are lawsuits because restraints weren't used, here we are. Neither situation is without risk. My mother sustained two falls due to this. Luckily in both cases, she didn't break anything. Often, if a patient who is particularly known for being an escapist artist are placed in a room near the nurse's station where they can be observed more continuously. You could ask about that. If your loved one is on hospice, it can be a sticky situation if they do fall and an x-ray is taken. When this happened with mom (who was on an independent hospice inside a nursing home) there was some pushback about the x-ray from hospice who felt it shouldn't have been done. Wow! Why wouldn't you? These decisions as your loved ones near life's end are impossibly difficult and I found myself choosing between the lesser of two evils. Just know that you will make the best decision for the moment you are in and that you musn't be too hard on yourself. Your father could fall at home, and will fall out of bed in facility without restraints. There is risk in either place. At home, you could try what they would do in facility (pads, lowering the bed, etc) and he would get one on one care. In facility, they will provide him attention, but it certainly won't be one on one 24/7 and they are at the mercy of who they share a room with. When my parents each spent the last few months in facility, I visited as often as possible to fill in the gaps in care. There were gaps. They passed away before Covid, but with Covid happening now, I would wonder how well they would fair without my ability to visit and advocate. This is a consideration for you. Take care.

Almost all residential facilities have gone away from restraints since there are a lot of issues with restraints: need for a lot of eyes on supervision, need to offer fluids and potty every 2 hours, and it doesn't always work keep folks from falling. Instead, facilities put people on "falls precaution" with beds at lowest height, thick mats placed on floor next to beds, checking on folks more often,,,

We have been having problems with my Mom getting up at night and falling. Her memory care facility , which also does not use restraints, cranked her bed down to the lowest level and since she can’t stand without assistance she usually just rolls onto the floor. They have mats put down to cushion her. So far so good. I was told they can also put her mattress on the floor if it continues to be a problem.

Also, the rooms have motion sensors so if the staff detects unusual movement in her room at night an aid is sent to check it out.

Nursing home are able now to put the bed lower to the ground, and have a mat on the floor to set off the alarm. Talk to the boss person as you have to give them the ok to do this. If they can’t help go to someone higher. Your father has a right to be safe. God bless.

I am not up on the laws but I have heard that restraints are NOT allowed in many facilities. Why? I don't know - makes no sense to me with the needs of these patients. I am for restraints in certain cases but I am not sure.

Restraints are against the law in many if not all states. What differs is "What is a restraint?"

In some states a restraint is anything that could prevent a patient out of or off of whatever they are on/in ie chair, bed . If fact in some states or large cities
geri-chairs are considered a restraint if they are even used, in others only if it is reclined, and still others any use is o.k.

Imho, restraints are not used because of potential injury. Prayers sent.

I think restrainting is illegal many states. Ik it is heart breaking and it can be very upsetting situation. You're in my prayers.

My BIL is a hospice Chaplin and regularly, before COVID, visited nursing homes. He told us that falls are a fact of life in facilities for the aged. Old people will fall, you can do all you can to protect them but they will fall.

Restraints for a long term facility are not only inhumane but can lead to injury, more falls and death. Full bed rails do not prevent falls

lower bed as close to ground as possible. find a mattress or something to help cushion the fall.

Or find a night stand or something and place it as close to bed as possible.

and go to home depot or lowes and find pipe insulators. or pool noodles and cut and place on bed rails. use duct tape to hold insulators in place (not dad)if you feel it is necessary.

pipe insulation is pretty cheap and so are pool noodles. pool noodles has colors, so it may be prettier to look at.