Skilled nursing facility removed all bed rails. Said there is a new government law. Anyone know about this?

Glad to see this pop up again. If the person can benefit from a bedrail and the benefits outweigh the risks a "state waiver" form (only about a half page long) can usually allow it to happen. You may have to push the issue with the SNF (as it is easier for them to just ban them in their facility) but if a simple assistive device improves a person's quality of life it certainly should be allowed. How can bedrails be fairly standard in a hospital yet are considered unsafe in a SNF? More info in my answer of nine months ago but if anyone has questions I would be glad to help. Good luck.

My wife was in rehab early this year and the bed had no rails on the fall mats. And she fell a few times. I was told no rails because of the danger involved. Although, the hospital she was transferred from still used the rails. So I question the use of the term Law requires it. They would find her sitting on the mat, unable to get up. It would take two people to get her up. With help she could transition to a wheel chair and did so for about a week, I think. Slowly she would transition to a walker. Eventually, and she surprised me, she would sit up and had grabbed the walker and got herself into the bathroom with only a little guidance from me. Then she surprised everyone and ventured to her room door and shocked the chief nurse and her RN, who was standing at the door with the medical cart.
Wife still needed help cleaning herself after she finished her business , I had no problem with helping her wipe and wash.

Sorry for the extra posts. I corrected a spelling error.

If the resident can't use them properly to get up and reposition they are considered a restraint, which is illegal.

I hope someone can respond to this for me. My mother has a bed assist not a bed rail. The facility she is in is not insisting on an overpriced product that would also require that I buy her a bed with a metal frame versus the bed with a wood frame that she has now. I want to make sure I am clear, what she is using does not even cover a quarter of the bed, it is not a bed rail. Anyone have any experience or recommendations regarding some time of bed assist/bed cane? I think this is an overreaction by the facility to this regulation and their interpretation is very narrow. Keep in mind also I asked if it was acceptable when she moved into this assisted living facility in May. It is now June 28th and it is now an issue. No she has not fallen, never has been caught in it etc.

And yes, I knew you were talking SNL's.

cjbailey: Look here----Question:
Is there a state or federal regulation prohibiting
bed rails and/or fall mats in an assisted living residence?

Answer

There are no state regs in assisted living prohibiting bed rails however in my experience I would not consider them best practice to use them. The reason that they are not safe lies with the risk they present to the resident falling out of bed, being tangled in their sheets/bed rails and the possibility of strangulation. Many facilities may have a policy against bed rails. So in that case the state could write a deficiency for the facility not following their own policy (if the state were to find bed rails in use).

The alternative would be to have the resident use a bed cane and obtain an order from the primary care physician for occupational therapy. The resident can then learn how to use the bed cane safely and efficiently with the goal to maintain as much independence for that resident as possible. The state would be pleased to see that action taken, aside from the fact that it is making the resident's home safer for them.

Fall mats are okay, but whatever assistive devices are in use in the community MUST be care planned for that specific resident and you must have documented training on those devices for your staff.

I wondered about that when Mom was in a NH. I think they outlawed those rails because they were more dangerous - demented people trying to climb over them, catching arms and legs or falling from the climb. They put mats on the floor around Mom's bed, and she was either in the bed in an inflatable
"cradle" to keep her from rolling out, or a cradlelike wheel chair, or wheel chair with a light velcro belt with an alarm. In Mom's mental state, she would definitely have tried to climb over the rails and hurt herself.

Bbtwinks- you are correct. Full bed rails would be considered a "restraint" but shorter ones may be ok depending on the state and the facility. For homecare use I suggest people be very careful of the flimsy/unsafe ones available on the internet.

A lot of elders are fall risks. Thoroughly research your question about bed rails. You could start with the elder's doc.

Those bedrails are put on there for safety

I think that two full bed rails are considered to be a restraint. Ask the facility to provide a half rail to aid dad's mobility. This should be possible unless dad has been assessed to require assistance when getting out of bed. Ask for an explanation of dad's assessments and care plans. Full bed rails have been considered a restraint for many years...

Whenever someone says 'it's the law' ask for chapter & verse ie what is EXACT WORDING - there are many interpretations [that's why lawyers are rich] for many regulations - get it in writing with an actual signature not a vague form letter -

Read it as close to what you wish/want then show the NH how you 'see' it - they'd have to go to court to get another ruling [slow as molasses in Jan] to prove you are wrong - worth a try

It depends on the state, and most states have recently changed such regulations. I had to fight this repeatedly for my mother this summer in two different rehabs, and didn't win.

The government also need to act like it knows

How are these patients who have balance issues going to grab onto something stationary? These nursing homes need to act like they know

Anything that can be considered a "restraint" is never allowed- the only issue is "safety" as viewed by the facility or the government inspectors. A nursing home may say they do not allow bedrails as that is a cya for them. In some states a short "state waiver" form needs to be filled out that the risks have been analyzed and the benefits outweigh them. We insisted my father have bedrails on his bed for his safety- and I believe he was the only person in the SNF with them.

The government tracked the number of deaths over about 30 years attributed to "bedrails" which makes people get on the political bandwagon to ban them. However - how could anyone measure the number of injuries/deaths that were avoided due to their use during that same time period? Much of the bad press is deservedly due to the flimsy/unsafe "bedrails" sold on the internet. There are guidelines for true hospital beds related to the "seven zones of entrapment" but there are no real safety rules for homecare use. I have done a lot of research on this- there are good designs (and terrible ones) and I would be glad to discuss if people want greater detail.

I had to get approval from my Dad's memory care in order for me to put on a portable short rail at the top side of his bed. It had to be a certain size and it was within their regulations. Dad had used this same bed rail when he was in the facility's Independent Living. It was a great help for Dad getting up out of bed.

It can become tricky, because my Dad was becoming more of a fall risk. With the bed rail he would try to get up and fall.... without the bed rail he would also try to get up and fall. There were less falls with the rail so he was able to keep it on his bed.

Staff just couldn't get Dad to use his pendant alarm if he needed help to the bathroom. He just didn't want to bother anyone.

BTW - it is not always a matter of not enough help when someone falls. People always make that assumption. The use of bed alarms is important as patients can get more confused at night and do not use the call lights. No staff person can be everywhere for everyone all the time. Frequent falls can be a result of impulsive behavior If someone you know is having that problem in a facility ask if they are using bed and chair alarms which are perfectly acceptable and help prevent many risk behaviors.

I work in a SNF in Arizona and we have the patient or MPOA sign to have the 2 rails at the head of the bed up so the patient can move themselves around in bed. We do not use the rails at the end of the bed as they seem to be the ones that cause most injuries and are considered a restraint. The rails at the head of the bed are for mobility. I have never heard of an across the board law prohibiting total use of bedrails however they we do need to have patient consent.

CMS (center for medicare services) is going after bed rails and facilities are running scared. BUT if the patient or POA submits a written request to keep the upper rail as an assistive device, they can keep it.

There can not be 2 full length bed rails on a bed in a facility.
There can not be more than 3 short bed rails on a bed in a facility.
If the bed rails go the full length of the bed that is considered a restraint.
They can use 1 long one or short ones and wedges.
It is not a matter of suffocating it is "restraining" someone within the bed.
I think the type you are talking about should be permitted.
I think it might be worth it to ask to see how the code is written and how they are interpreting the code.
(Anytime someone says there is a code and it somehow effects you you have every right to see that code and how it is written.)
And I am sure that you can get a Doctor's order that would over ride the interpretation they have.

There have been nasty accidents, including fatal accidents, involving bedrails. This is true, and deplorable.

In terms of casualties-per-person using (and benefiting from) a bedrail, though, accidents have been vanishingly rare (thank goodness); and when you go on to read the details of a particular incident the cause of the accident is not usually the bed rail per se. The cause is usually somebody, or several people, doing something monumentally stupid and dangerous; such as continuing to use a bed rail that is faulty and requires maintenance; or using a bed rail that doesn't properly fit the bed it's attached to, so that there is a head-sized gap between the bottom edge and the mattress.

Since you can't cure stupid, some authorities have chosen to cure bed rails instead. I find it frustrating. Competent, responsible professionals in the care services industry must find it absolutely maddening.

Ask for a meeting. There are exceptions to policy. Not having side rails is a significant change that impacts his quality of life as he can no longer be mobile. He is no longer safe if he attempts to get up on his own without rails. Key words: quality of life , significant change and safety- regulatory agencies love those words. A call to the nursing home ombudsman if they do not listen.
Good luck and keep us posted...

Is he a fall risk? The rail may have been removed so that he has to wait for assistance rather than attempt to get up on his own.

I'm sorry for 3rd post here - I said help him make his point -and that's only if an argument would be OK for him. If that would tire him, you should make the point yourself, to all you can - be polite but explain, and ask others who know him to support your view that he is able to do this and it matters to him. If you are persistent, I think you'll find some who support this, for keeping someone healthy and strong and independent as possible is the goal. Good luck!

Another thing, those are not actually a "bed rail" - those are lifted up and down and could catch people's parts in them. What you are describing is a "Transfer Handle" for a bed - available in many varieties on Amazon.

I really suggest that if you think this matters to your dad, that you make some time to help him make the point to the nursing home. I've worked in direct care support for years, and helping a person continue to do whatever it is they can, is a major part of motivation that helps them keep going as strong as they can - and with dignity, not always lying there waiting for busy help to come.

Hi, I requested a special 12 inch vertical assist for getting up for my brother in a nursing home, and he got one - though he lives on the end of the facility which is residential care, not the nursing home end. The difference I've seen is that the residential ones can often walk without a wheelchair, but with a walker - if that's the case for your father, I think you should fight for this - it makes a huge difference. When you speak up, you can tell them that if he finds himself no longer able to get up safely when he needs to do so, he will deteriorate, physically, mentally. When you fight, you contact his doctor, nursing home executives - you can write a letter - actually, when you make your point to enough people, and ask what they can do, you can often find those who will agree. It is also possible for you as his family, to buy one of those vertical self help assists at any medical supply store or online, and you can provide it - when something really is safer and better for the patient, I have found it is possible to convince some people. Too many laws were written for one size patient, or one age or circumstance, and when the opposite is true, busy staffs all listening to general rules from distant superiors, or interpreting rules in general - apply the wrong rules to help a patient, and when that happens and the pt deteriorates slowly, they don't pay any attention. To me, I always felt much better when I spoke my mind, to any and all, and asked for help to get something relevant done. When you mention that in his case, his health and safety will deteriorate below what it is, you get some people to pay attention.

My sister works at a memory care center, where they have done the same and of course have done away with restraints. They are also admitting more folks there who have more serious behavioral problems. There are always problems getting enough STNA's (Ohio) to work at these facilities on top of that, and what few there are stay impossibly busy with too many patients. I would think there will be more falls. I can't imagine any of this will actually be good for the residents. For the 15 days my own mother was there back in 2014, she managed to fall twice trying to find the bathroom at night. Again, not enough help and it doesn't look like they can keep enough good dedicated workers because they're overwhelmed as it is.