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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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I used to think the same until I educated myself about the problems associated with bed rails, anyone who is determined will attempt to find a way around them and the statistics on severe injuries and death are frightening. Ask about a high/lo bed, they can be lowered to within a foot of the floor. They are also a deterrent for those who want to get up on their own without asking for help because most can't get up from that height.
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ZenZen,
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.
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I’m not new to this rodeo, as in the beginning of my career in nursing (1979) you could get in serious trouble with your supervisors and everyone if those bedrails were not in the “Up” position when the patient was unattended. 
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!
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Zen, keep advocating!

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.
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I feel your pain. I am going through the same thing at Moms NH. I gave up on the bed rail issue. Now all I’m fighting for is reinstatement of her magnetic wheelchair alarm. It was removed suddenly when it was deemed a restraint. It comes apart when the person slides and pulls apart the magnet. Pulls apart the magnet! How is that restraint? Anyway she’s slid from the chair 3 times in the past few weeks. Hasn’t hurt herself. Yet. Other NH in NY still allow them so I’m fighting it with the ombudsman. Anyway to your bed rail issue the NH and I have implemented these 6 precautions: if it’s an electric bed lower it to the ground. If she’s in a normal twin bed ask for a really wide one usually used for larger patients as it’s harder to get out of. While she’s in bed put the mats on each side. Move the wheelchair and anything else she could fall on to the end of the bed. Roll up a blanket or pillow and kind of wedge under the blanket on each side of her bum to keep her into the middle of the bed. (This one is questionably a restraint so we all do kind of on the down low). Mom has a really wide flat call button like a disk for the visually impaired. Shes never actually used it to call for help, so we place it on the bed next to her bum so if she’s on the move and rolls onto it the alert goes to their pagers. She has rolled out once since these precautions were put into place but has not hurt herself. I hope these give you some things to implement while you fight your fight for the rails. Good luck.
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I agree with cwillie after I also educated myself about the hazards of having bed rails. There are excellent reasons why such State laws are in place.

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?
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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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I also found this to be ridiculous. My father went to rehab after he fell and hit his head on the sidewalk. After a hospital stay he was sent to rehab. He always fell out of bed because there were no rails. I asked why the bed did not have rails to keep him in bed but the rehab center said it was the law. How stupid. Because of his tendency to fall, they kept him at the nurses' station in a wheelchair. There he would be slumped over in the chair the whole time he was there. I complained but to no avail. You are right it is a matter of checking patients at regular intervals so that they are safe. My father lives in my home now and he is in a hospital bed with rails. He has neither fallen out of bed nor gotten tangled up in the rails.
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I agree that there needs to be room for compromise, in my case we were allowed to have the rails as long as we signed a waiver acknowledging the risks. Those beds are pretty narrow and mom feels more secure being able to grab the sides when she is being cared for in bed, but she is pretty much immobile so there are no worries about her climbing out. Beds that have partial rails would be a good compromise, or using the bed assist rails as jjariz mentioned.
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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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