Bed rails are being used less often in aged care because there is tighter regulation of their use and a greater awareness of their risks. But the alternative practice – of placing residents in low beds with sensor mats beside them – has its own problems, says an expert in the field.
According to Professor Joseph Ibrahim, a specialist in geriatric medicine and aged care safety at Monash University, older residents can’t get up out of the low beds and can become “incontinent, immobilised, and frightened” in them.
This investigation began when a reader commented that aged care is now so regulated, staff are not using bed rails and are instead using sensor mats to detect falls from beds.
This seemed unreasonable, so HelloCare decided to take a look at the issue.
What we found was there are real dangers associated with using bedrails.
“Some like them [bed rails], and others don’t,” said Prof Ibrahim.
Bed rails can cause serious physical and psychological harm, and even death, though they are necessary in some circumstances.
Prof. Ibrahim said in the early 2000s, there was a lot of concern about strangulation of older people from bed rails, as well as aged care residents being injured from trying to climb over them.
More recently, discussions of physical restraint, which bed rails are considered to be, has tightened regulation of their use.
A Health Department spokesperson told HelloCare, “From 1 July 2019, new regulations significantly strengthen the requirements that apply to the use of physical and chemical restraints in aged care homes.”
“Restraint must only be used as a last resort.”
According to the Aged Care Royal Commission report, “Restrictive Practices in Residential Aged Care in Australia”, using physical restraint “may be necessary to mitigate risks to a resident or others in an emergency”.
But the report says there is evidence to show that physical restraint (of all kinds) can cause death, “fear, shame, anxiety, loss of dignity, agitation, depression, lower cognitive performance, bruising, direct skin injuries, pressure injuries, contractures, respiratory complications, urinary and faecal incontinence and constipation, undernutrition, reduced mobility and increased dependence in activities of daily living, impaired muscle strength and balance, reduced cardiovascular endurance, and serious injury”.
The recent changes to Quality of Care laws mean, before bed rails can be used, aged care residents have to be assessed, alternatives have to be considered, and the resident has to give their consent.
Getting rid of bed rails through tighter regulation has been seen in the industry as a “great success”, Prof. Ibrahim said.
But the solution to the bed rail issue – which is putting residents in “low, low” beds with sensor mats beside the beds – has created a whole new set of problems, Prof. Ibrahim said.
Older people, whether they be at home, in hospital, or in residential aged care, can not get out of low beds because they lack the muscle strength, according to Prof. Ibrhaim.
As a result, in low beds older people can become “incontinent, immobilised, and frightened”.
So, what’s the solution?
Prof. Ibrahim said the industry needs to find a “middle ground” between using standard beds with bed rails and low beds with sensor mats.
“There’s no easy answer, and there hasn’t been the debate with people who know enough about the topic,” he said.
“People are doing the best they can with the knowledge they have,” he said.
Prof. Ibrhaim said it would be helpful for aged care staff to have more information about what options are available for residents in a range of different circumstances, so they can make better informed decisions.