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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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My LO asked that her bed be made on the floor because she had fallen out of bed so often. She felt safer.
Here is a link on this subject 
fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/HospitalBeds/ucm123676.htm
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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 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 can only sympathise with your frustration.

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?
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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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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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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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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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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 think that the posts here show that there is no single solution that is good for everyone. However, this is what regulations do. They make ONE rule that everyone has to follow or risk getting sued. There are so many things that can make rails safer, but it's easier to just ban them.
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I believe in many states, if the doctor writes an order for bedrails they can be used.
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I thought that a doctor could issue a medical restraint order and that would allow them to put up rails or use some other restraint. Once in the ER, they put on what I would describe as a baby strapjacket on grandma to prevent her from getting off the gurney and hurting herself. Her arms weren't strapped, it was more like a vest that was tied to the gurney.
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I agree with you. My Mom had a back injuring. It was recommended that I get an 18in side rail for her to pull herself up with. When she went to an AL she wasn't allowed to use it even though I explained why she needed it. They recommended a halo. Really, she couldn't use one of her arms to reach that far up. Try your state health department. They oversee nursing facilities.
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I agree. When I heard this 'rule' it flabbergasted me.

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.
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They can't strap her in, and she might get hung up in the rails trying  to climb over it. It's dangerous either way.
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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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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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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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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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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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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 suppose we could just encase the entire bed in a bubble...🙄
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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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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 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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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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Have the moderators been fiddling with things again? I got both links to work by adding www. at the beginning.
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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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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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